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infiltration in large peripheral nerves or plexus is suspected and when histological biopsy is not possible or is negative.[8] FDG PET/CT can be used as a single modality to evaluate neurolymphomatosis – to demonstrate multiplicity, activity of the disease, staging and response assessment.
Hina J. Shah, Vikram R. Lele, Abhishek R. Keraliya1, Parag S. Aland Department of Nuclear Medicine and PET/CT, Jaslok Hospital and Research Centre, 1Department of CT and MRI, ESIC hospital, Mumbai, Maharashtra, India E-mail: [email protected]
References 1. 2. 3. 4. 5. 6. 7.
8.
Lhermitte J, Trelles LO. Neurolymphomatose peripherique humaine. Press Med 1934;42:289-92. Grisariu S, Avni B, Batchelor TT, van den Bent MJ, Bokstein F, Schiff D, et al. Neurolymphomatosis: An International Primary CNS Lymphoma Collaborative Group report. Blood 2010;115:5005-11. Kelly JJ, Karcher DS. Lymphoma and peripheral neuropathy: A clinical review. Muscle Nerve 2005;31:301-13. Baehring JM, Damek D, Martin EC, Betensky RA, Hochberg FH. Neurolymphomatosis. Neuro Oncol 2003;5:104-15. Vallat JM, De Mascarel HA, Bordessoule D, Jauberteau MO, Tabaraud F, Gelot A, et al. Non-Hodgkin malignant lymphomas and peripheral neuropathies – 13 cases. Brain 1995;118:1233-45. Dalmau J, Rosenfeld MR. Paraneoplastic neurologic syndromes. Harrison’s Principle of Internal Medicine. 17th ed., Ch. 97. 2008. p. 623-8. Durán C, Infante JR, Serrano J, Rayo JI, García L, Domínguez ML, et al. Neurolymphomatosis: Diagnosis of extension and assessment of response to treatment with PET-CT. Rev Esp Med Nucl 2009;28:295-8. Rosso SM, de Bruin HG, Wu KL, van den Bent MJ. Diagnosis of neurolymphomatosis with FDG PET. Neurology 2006;67:722-3.
metastatic lesions are very rare. Metastasis from rectal carcinoma is very rare, hence this letter to the editor. A 34-year-old male patient presented with double vision initially on looking to right of 2 months duration and then on looking to left for 2 weeks and restricted eye movements laterally on right side first and then on left side for 2 weeks. Examination revealed bilateral lateral rectus palsy. He had history of surgery for carcinoma (poorly differentiated signet cell type) rectus, anterior 2 years before this presentation. Post-operatively, anterior resection he had received chemotherapy and radiotherapy. Contrast brain magnetic resonance imaging showed enhancing clival lesion [Figure 1] and computed tomography (CT) of the para-nasal sinuses showed bony destruction of clivus [Figure 2]. Patient underwent endoscopic transsphenoidal gross total excision of the lesion. Histopathological confirmed signet cell adenocarcinoma [Figure 3]. The post-operative course was uneventful. Immediate post-operative control CT scans documented gross total resection of lesion. Clinically the patient’s diplopia improved within a week.
Access this article online Quick Response Code:
Website: www.neurologyindia.com PMID: *** DOI: 10.4103/0028-3886.128341
Figure 1: Magnetic resonance imaging showing clival metastsis with bony destruction
Received: 11-12-2013 Review completed: 22-12-2013 Accepted: 26-01-2014
A rare case of carcinoma rectum metastasing to clivus Sir, Primary clival lesions are not very common, of which
Neurology India | Jan-Feb 2014 | Vol 62 | Issue 1
Figure 2: Computed tomography showing clival metastsis with bony destruction
85
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Anterior third ventricular epidermoid presenting with diabetes insipidus
Figure 3: Histopathology slide showing signet ring cell adenoocarcinoma
Brain metastasis is increasingly diagnosed with the advanced imaging, however the exact incidence is not known. Metastasis to clivus is mostly reported to case reports or case series.[1] The common primary sites were prostate (in men) followed by lung, other sites were thyroid and liver. The common route of spread is hematogenous.[2] The clinical presentation of clival metastasis is similar as other clival lesion. The lesion can be removed through extended endoscopic transsphenoidal approach like other clival lesions.
Bhaskar Kendre, Chandrashekhar Deopujari, Vikram Karmarkar, Vishwaraj Ratha Department of Neurosurgery, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra, India E-mail: [email protected]
References 1. 2.
Pallini R, Sabatino G, Doglietto F, Lauretti L, Fernandez E, Maira G. Clivus metastases: Report of seven patients and literature review. Acta Neurochir (Wien) 2009;151:291-6. Gavrilovic IT, Posner JB. Brain metastases: Epidemiology and pathophysiology. J Neurooncol 2005;75:5-14.
Access this article online Quick Response Code:
Website: www.neurologyindia.com PMID: *** DOI: 10.4103/0028-3886.128343
Received: 12-12-2013 Review completed: 19-12-2013 Accepted: 26-01-2014
86
Sir, Epidermoids are rare and account for 0.2-1.0% of all intracranial tumors. [1] The common location for epidermoids are cerebellopontine angle and parasellar region followed by middle cranial fossa.[2] Intraventricular epidermoids are less frequent and third ventricular epidermoids are rarest accounting for 0.7% of all intracranial epidermoids. [2] Though parasellar/suprasellar epidermoids frequently extend into third ventricle, only few cases of truly intra-third ventricular epidermoids have been reported. [3,4] Intraventricular epidermoids usually present with features of raised intracranial pressure. Though parasellar/suprasellar epidermoids may present with anterior pituitary hormonal dysfunction, diabetes insipidus (DI) as a presenting feature of an intraventricular epidermoid has not been previously described. We hereby describe one such rare case of an anterior third ventricular epidermoid presenting with DI. A 40-year-old male presented with polydipsia and polyuria for past 2 years and headache for past 6 months. Neurological examination was unremarkable except for mild bilateral papilledema and decreased visual acuity (vision-6/9 both eyes). Urine specific gravity ranged from 1000 to 1004. Serum sodium was between 150 and 160 meq/ml. Anterior pituitary hormonal profile was normal. Radiological evaluation revealed anterior third ventricular lesion that was hypodense on computed tomography scan [Figure 1a], heterogeneously hypointense on T1W [Figure 1b] and heterogeneously hyperintense on T2W [Figure 1c] images and showed peripheral rim enhancement [Figure 1d and e]. These radiological features raised the suspicion of cystic craniopharyngioma. However, the diagnosis became clear with diffusion weighted sequences showing restricted diffusion [Figure 1f and g] thereby suggesting a diagnosis of epidermoid cyst which was confirmed intraoperatively. Patient underwent removal of anterior third ventricular epidermoid through bifrontal basal interhemispheric trans-lamina terminalis approach. Intraoperatively, characteristic pearly flakes could be seen inside third ventricle [Figure 1h]. Complete removal of epidermoid was achieved except for a small portion of its wall adherent to floor of third ventricle.
Neurology India | Jan-Feb 2014 | Vol 62 | Issue 1
Copyright of Neurology India is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
infiltration in large peripheral nerves or plexus is suspected and when histological biopsy is not possible or is negative.[8] FDG PET/CT can be used as a single modality to evaluate neurolymphomatosis – to demonstrate multiplicity, activity of the disease, staging and response assessment.
Hina J. Shah, Vikram R. Lele, Abhishek R. Keraliya1, Parag S. Aland Department of Nuclear Medicine and PET/CT, Jaslok Hospital and Research Centre, 1Department of CT and MRI, ESIC hospital, Mumbai, Maharashtra, India E-mail: [email protected]
References 1. 2. 3. 4. 5. 6. 7.
8.
Lhermitte J, Trelles LO. Neurolymphomatose peripherique humaine. Press Med 1934;42:289-92. Grisariu S, Avni B, Batchelor TT, van den Bent MJ, Bokstein F, Schiff D, et al. Neurolymphomatosis: An International Primary CNS Lymphoma Collaborative Group report. Blood 2010;115:5005-11. Kelly JJ, Karcher DS. Lymphoma and peripheral neuropathy: A clinical review. Muscle Nerve 2005;31:301-13. Baehring JM, Damek D, Martin EC, Betensky RA, Hochberg FH. Neurolymphomatosis. Neuro Oncol 2003;5:104-15. Vallat JM, De Mascarel HA, Bordessoule D, Jauberteau MO, Tabaraud F, Gelot A, et al. Non-Hodgkin malignant lymphomas and peripheral neuropathies – 13 cases. Brain 1995;118:1233-45. Dalmau J, Rosenfeld MR. Paraneoplastic neurologic syndromes. Harrison’s Principle of Internal Medicine. 17th ed., Ch. 97. 2008. p. 623-8. Durán C, Infante JR, Serrano J, Rayo JI, García L, Domínguez ML, et al. Neurolymphomatosis: Diagnosis of extension and assessment of response to treatment with PET-CT. Rev Esp Med Nucl 2009;28:295-8. Rosso SM, de Bruin HG, Wu KL, van den Bent MJ. Diagnosis of neurolymphomatosis with FDG PET. Neurology 2006;67:722-3.
metastatic lesions are very rare. Metastasis from rectal carcinoma is very rare, hence this letter to the editor. A 34-year-old male patient presented with double vision initially on looking to right of 2 months duration and then on looking to left for 2 weeks and restricted eye movements laterally on right side first and then on left side for 2 weeks. Examination revealed bilateral lateral rectus palsy. He had history of surgery for carcinoma (poorly differentiated signet cell type) rectus, anterior 2 years before this presentation. Post-operatively, anterior resection he had received chemotherapy and radiotherapy. Contrast brain magnetic resonance imaging showed enhancing clival lesion [Figure 1] and computed tomography (CT) of the para-nasal sinuses showed bony destruction of clivus [Figure 2]. Patient underwent endoscopic transsphenoidal gross total excision of the lesion. Histopathological confirmed signet cell adenocarcinoma [Figure 3]. The post-operative course was uneventful. Immediate post-operative control CT scans documented gross total resection of lesion. Clinically the patient’s diplopia improved within a week.
Access this article online Quick Response Code:
Website: www.neurologyindia.com PMID: *** DOI: 10.4103/0028-3886.128341
Figure 1: Magnetic resonance imaging showing clival metastsis with bony destruction
Received: 11-12-2013 Review completed: 22-12-2013 Accepted: 26-01-2014
A rare case of carcinoma rectum metastasing to clivus Sir, Primary clival lesions are not very common, of which
Neurology India | Jan-Feb 2014 | Vol 62 | Issue 1
Figure 2: Computed tomography showing clival metastsis with bony destruction
85
[Downloaded free from http://www.neurologyindia.com on Thursday, March 13, 2014, IP: 202.177.173.189] || Click here to download free Android application for this journal Letters to Editor
Anterior third ventricular epidermoid presenting with diabetes insipidus
Figure 3: Histopathology slide showing signet ring cell adenoocarcinoma
Brain metastasis is increasingly diagnosed with the advanced imaging, however the exact incidence is not known. Metastasis to clivus is mostly reported to case reports or case series.[1] The common primary sites were prostate (in men) followed by lung, other sites were thyroid and liver. The common route of spread is hematogenous.[2] The clinical presentation of clival metastasis is similar as other clival lesion. The lesion can be removed through extended endoscopic transsphenoidal approach like other clival lesions.
Bhaskar Kendre, Chandrashekhar Deopujari, Vikram Karmarkar, Vishwaraj Ratha Department of Neurosurgery, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra, India E-mail: [email protected]
References 1. 2.
Pallini R, Sabatino G, Doglietto F, Lauretti L, Fernandez E, Maira G. Clivus metastases: Report of seven patients and literature review. Acta Neurochir (Wien) 2009;151:291-6. Gavrilovic IT, Posner JB. Brain metastases: Epidemiology and pathophysiology. J Neurooncol 2005;75:5-14.
Access this article online Quick Response Code:
Website: www.neurologyindia.com PMID: *** DOI: 10.4103/0028-3886.128343
Received: 12-12-2013 Review completed: 19-12-2013 Accepted: 26-01-2014
86
Sir, Epidermoids are rare and account for 0.2-1.0% of all intracranial tumors. [1] The common location for epidermoids are cerebellopontine angle and parasellar region followed by middle cranial fossa.[2] Intraventricular epidermoids are less frequent and third ventricular epidermoids are rarest accounting for 0.7% of all intracranial epidermoids. [2] Though parasellar/suprasellar epidermoids frequently extend into third ventricle, only few cases of truly intra-third ventricular epidermoids have been reported. [3,4] Intraventricular epidermoids usually present with features of raised intracranial pressure. Though parasellar/suprasellar epidermoids may present with anterior pituitary hormonal dysfunction, diabetes insipidus (DI) as a presenting feature of an intraventricular epidermoid has not been previously described. We hereby describe one such rare case of an anterior third ventricular epidermoid presenting with DI. A 40-year-old male presented with polydipsia and polyuria for past 2 years and headache for past 6 months. Neurological examination was unremarkable except for mild bilateral papilledema and decreased visual acuity (vision-6/9 both eyes). Urine specific gravity ranged from 1000 to 1004. Serum sodium was between 150 and 160 meq/ml. Anterior pituitary hormonal profile was normal. Radiological evaluation revealed anterior third ventricular lesion that was hypodense on computed tomography scan [Figure 1a], heterogeneously hypointense on T1W [Figure 1b] and heterogeneously hyperintense on T2W [Figure 1c] images and showed peripheral rim enhancement [Figure 1d and e]. These radiological features raised the suspicion of cystic craniopharyngioma. However, the diagnosis became clear with diffusion weighted sequences showing restricted diffusion [Figure 1f and g] thereby suggesting a diagnosis of epidermoid cyst which was confirmed intraoperatively. Patient underwent removal of anterior third ventricular epidermoid through bifrontal basal interhemispheric trans-lamina terminalis approach. Intraoperatively, characteristic pearly flakes could be seen inside third ventricle [Figure 1h]. Complete removal of epidermoid was achieved except for a small portion of its wall adherent to floor of third ventricle.
Neurology India | Jan-Feb 2014 | Vol 62 | Issue 1
Copyright of Neurology India is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
