Cystic retrochiasmatic craniopharyngioma may reach enormous size by expanding into the posterior fossa along the retroclival area, which is very unusual finding. An 11-year-old girl presented with walking disturbance and irritability. On the neurological examination, she had positive Babinski sign, hyperactive deep tendon reflex, and left lateral gaze nystagmus. She also had right hearing disturbance. Initial magnetic resonance(MR) images revealed a huge, thin capsuled cystic mass which extended into the cerebellopontine angle down to the medulla oblongata. Secondary adjuvant chemotherapy, radiotherapy, and reoperation were necessary after first tumor removal by a suboccipital approach, due to the progression of disease. Finally, neurological condition was much improved without remnant tumor although some sequelae were remained. We report this interesting case because of its rarity, complex clinical presentation, and challenge in its management.
Cerebellopontine Angle ; Chemotherapy, Adjuvant ; Child ; Craniopharyngioma* ; Female ; Hearing ; Humans ; Medulla Oblongata* ; Neurologic Examination ; Radiotherapy ; Reflex, Babinski ; Reflex, Stretch ; Reoperation ; Walking

A 42-year-old male was admitted to our clinic on May 4, 1980, because of slight neck stiffness, quadriparesis and urinary difficulty. On admission, neurological examination revealed alert mental state, slight neck stiffness, quadriparesis and loss of pain and temperature sense below the level of C3 sensory dermatome. All deep tendon reflexes were hyperactive and Babinski's sign was positive. Roentgenographic examination of the cervical spine showed widened interpedicular distance at C5 to C7 in A-P view. Myelogram disclosed widening of the dye column at C4 to T1 vertebral level, suggesting intramedullary tumor. Laminectomy was performed from the C5 to T2. The cord appeared to be widened and swollen at the C6-7 segment level. 1ml of yellowish pus was aspirated from the distended spinal cord at the C6 level. Mid-line posterior myelotomy was performed and hard cavity wall was visible. Upon incision of cavity wall, about 5ml of yellowish purulent pus exuded, allowing the cord to become "flaccid". The abscess cavity was irrigated with saline and penicillin solutions and a small rubber drain catheter was placed in the abscess cavity. The organism from the abscess was identified as Staphylococcus aureus. Postoperative course was uneventful. Antibiotic therapy was continued for four weeks after operation. The patient's condition was much improved and he could walk with assistance on discharge time.
Abscess* ; Adult ; Catheters ; Humans ; Laminectomy ; Male ; Neck ; Neurologic Examination ; Penicillins ; Quadriplegia ; Reflex, Babinski ; Reflex, Stretch ; Rubber ; Spinal Cord ; Spine ; Staphylococcus aureus ; Suppuration ; Thermosensing

Herpes zoster can be associated with a number of neurologic complications but meningoencephalitis with herpes zoster is rarely seen. We report a case of herpes zoster ophthalmicus followed by the meningoencephalitis, which developed during treatment with acyclovir infusion. A 73-year-old male patient developed a fever and mental confusion on the third day of the treatment. Neurological examination revealed neck stiffess, increased deep tendon reflex and positive Babinski sign. The cerebrospinal fluid examination revealed increased opening pressure, increased protein and a lymphocytic pleocytosis. The glucose level was decreased, which is a very unusual feature in viral meningoencephalitis.
Acyclovir ; Aged ; Cerebrospinal Fluid ; Encephalitis, Varicella Zoster ; Fever ; Glucose ; Herpes Zoster Ophthalmicus ; Herpes Zoster* ; Humans ; Leukocytosis ; Male ; Meningoencephalitis ; Neck ; Neurologic Examination ; Reflex, Babinski ; Reflex, Stretch

We describe a rare case of cerebral venous thrombosis and liver infarction with HELLP syndrome in a 25-year-old woman with eclampsia. She had complained of epigastric pain and had visited a local hospital for treatment. Also, signs of fetal distress were presented. After an emergency cesarean section, generalized tonic-clonic seizure occurred twice at a 10-minute interval. The patients was transferred to our emergency room, and the neurologic examination at that time, revealed a deep drowsy mentality and positive Babinski's sign; the deep tendon reflex was two positive. The laboratory findings revealed thrombocytopenia, an elevated liver function test, abnormal coagulation profiles. A bilateral ischemic change with left basal ganglia hemorrhage was seen on brain CT, and multiple foci of ill defined low-density lesions, mainly in the subcapsular portion of the liver and perivascular space, were visible on the abdominal CT. There was a faint showing of the deep venous system on the angiogram of both carotid arteries and a cerebral venous thrombosis was confirmed by using 4-vessel angiography. During the following 2 days, the cerebral hemorrhage and the low-density lesion were resolved through applications of heparin, and the patient returned to a nearly alert mental status. Finally she died of a hemorrhagic shock as a complication of disseminated intravascular coagulation.
Adult ; Angiography ; Basal Ganglia Hemorrhage ; Brain ; Carotid Arteries ; Cerebral Hemorrhage ; Cesarean Section ; Disseminated Intravascular Coagulation ; Eclampsia ; Emergencies ; Emergency Service, Hospital ; Female ; Fetal Distress ; HELLP Syndrome* ; Heparin ; Humans ; Infarction* ; Intracranial Thrombosis ; Liver Function Tests ; Liver* ; Neurologic Examination ; Pregnancy ; Reflex, Babinski ; Reflex, Stretch ; Seizures ; Shock, Hemorrhagic ; Thrombocytopenia ; Tomography, X-Ray Computed ; Venous Thrombosis*

A 4-year-old boy presented with a cervical enterogenous cyst manifesting as right arm pain. Neurological examination revealed weakness of his right upper extremities and increased deep tendon reflexes. This isolated, cervical intraspinal enterogenous cyst was treated successfully by posterior laminectomy, intradural exploration, and subtotal resection. He made a good recovery without additional neurological deficits. A brief overview is given of this rare cyst, together with their clinical, pathological, radiological features and associated findings.
Arm ; Child, Preschool ; Humans ; Laminectomy ; Male ; Neurologic Examination ; Reflex, Stretch ; Spine* ; Upper Extremity

When recovery of specific reflexes after acute spinal cord injury are delayed or absent, we should consider an acute local complication or other factors that influence reflex function. We observed three spinal cord injury cases with a long-standing delayed plantar reflex and no evolution of Babinski sign despite enough recovery time had passed for the flexor spasm and all deep tendon reflexes of the lower extremities. In these cases we confirmed common peroneal nerve neuropathy at the fibular head by the nerve conduction study and electromyography. Long-standing delayed plantar reflex without evolution of Babinski sign, beyond expected recovery period, would be considered as a sign of local complication such as common peroneal nerve injury.
Electromyography ; Head ; Lower Extremity ; Neural Conduction ; Peroneal Nerve ; Reflex* ; Reflex, Babinski ; Reflex, Stretch ; Spasm ; Spinal Cord Injuries* ; Spinal Cord*

Neuromyelitis optica (Devic's syndrome) is characterized by acute bilateral visual loss (optic neuritis), acute trans-verse myelitis, near simultaneous development of these optic and spinal symptoms, no other symptoms and involve-ment of the central nervous system. Sporadic reports of patients with neuromyelitis optica in association with tubercu-losis confined to the lungs have appeared over the last years. A 67-year-old man presented with visual disturbance and sudden onset of lower limb weakness. On neurological examination, bilateral visual loss, flaccid paraparesis, hypesthe-sia below T2 dermatome, and extensor plantar responses were noted. Chest X-ray revealed bilateral nodular densities in the upper lung fields and a fluorochrome stain for tuberculosis was positive. Magnetic resonance imaging showed spinal cord swelling and high signal intensity (T2WI) in thoracic spinal cord. We report a case of neuromyelitis optica with pulmonary tuberculosis. It is suggested that this condition might caused by an immune reaction to tuberculosis rather than the use of antituberculosis medication.
Aged ; Central Nervous System ; Humans ; Lower Extremity ; Lung ; Magnetic Resonance Imaging ; Myelitis ; Neurologic Examination ; Neuromyelitis Optica* ; Paraparesis ; Reflex, Babinski ; Spinal Cord ; Thorax ; Tuberculosis ; Tuberculosis, Pulmonary*

We report the case of a 58-year-old man who developed multiple cerebral infarctions after ingesting accidently a 5% hydrogen-peroxide detergent solution. A 3~5% hydrogen peroxide solution is commercially available as an oxidant and detergent. Neurologic examination of this patient revealed grade III weakeness in both upper and lower limbs and bilateral positive Babinski signs. CT and MRI revealed bilateral multiple brain infarctions in the anterior and the middle vascular territories. The likely mechanism of pathogenesis must be paradoxical cerebral air embolism. Decompression through Nasogastric tube and hyperbaric oxygenation therapy were used to treating this patient. In spite of our intensive care, the patient expired 21days after ICU admission.
Brain Infarction ; Cerebral Infarction ; Decompression ; Detergents ; Eating* ; Embolism, Air* ; Humans ; Hydrogen Peroxide* ; Hydrogen* ; Hyperbaric Oxygenation ; Critical Care ; Lower Extremity ; Magnetic Resonance Imaging ; Middle Aged ; Neurologic Examination ; Reflex, Babinski

A rare case of intramedullary neurilemmoma of the spinal cord has been reported. A 23-year-old woman was admitted to our hospital, on 4th July, 1982, because of weakness of legs and difficulty of urination. Neurological examination revealed motor weakness of the both lower extremities with muscle atrophy. Sensory examination showed hypesthesia below the level of L3 dermatome of the right side and of L4 dermatome of the left. All deep tendon reflexes of the lower extremities were abolishes and Lasehue's sign was not appeared. Manometric Queckenstedt's test showed a complete block, with CSF protein of 460 mg/dl. Pantopaque myelogram demonstrated a complete block at the midportion of L1 spine. Total removal of the intramedullary tumor which was located in the dorsal column of the thoracolumbar segment was performed. The tumor was 4.0x1.5x1.0 cm in size and it proved to be an Antoni-A type neurilemmoma histologically. Only 20 similar cases have been published so far and summarized on Table 1, including our case. The relevant literature was reviewed.
Female ; Humans ; Hypesthesia ; Iophendylate ; Leg ; Lower Extremity ; Muscular Atrophy ; Neurilemmoma* ; Neurologic Examination ; Reflex, Stretch ; Spinal Cord ; Spine ; Urination ; Young Adult

The authors reported a case of a dumbbell-shaped meningioma which originated from the falx. A six-year-old girl was admitted to our clinic with generalized convulsion, headache, vomiting, visual disturbance and motor wakness of the left extremity. Neurological examinations revealed the left hemiparesis with hyperactive deep tendon reflex and marked papilledema. The skull films showed prominent diastasis of the coronal and sagittal sutures and abnormal calcification in the frontal region. The right carotid angiogram showed a huge irrgular tumor vascularity in the midfrontal region. On Nov. 5, 1977 a right frontal craniotomy was carried. A large dumbbell-shaped tumor was removed which arised from the falx cerebri. Each tumor measured 5x5x6 cm, 6x6x7 cm respectively and weighed 110 gm totally. The histopathological examination comfirmed the diagnosis of fibroblastic meningioma. Postoperative course was uneventful and the patient was discharged on the 14 th hospital day. The patient was seen 6 months after operation without any symptom.
Craniotomy ; Diagnosis ; Extremities ; Female* ; Fibroblasts ; Headache ; Humans ; Meningioma* ; Neurologic Examination ; Papilledema ; Paresis ; Reflex, Stretch ; Seizures ; Skull ; Sutures ; Vomiting