Dysembryoplastic Neuroepithelial Tumor (DNET) causing Refractory Focal Seizures


Dysembryoplastic neuroepithelial tumor (DNET) is relatively uncommon benign tumor, responsible for causing partial seizures in children, many of those cases may be medically refractory. The most common location is temporal lobe, as in this case (about 65% of cases). About 20% cases involve frontal lobe. The remainder of cases involve caudate nucleus, cerebellum and pons.Continue reading “Dysembryoplastic Neuroepithelial Tumor (DNET) causing Refractory Focal Seizures”

CAVERNOMA Causing Chronic Focal Epilepsy


FLAIR MRI images shows a left frontal hypointense lesion with multiple flow voids, surrounded by hyperintense areas, suggestive of a cavernoma with surrounding gliosis. The patient had a history of right focal motor seizures (with or without secondary generalization) of 5 years duration, which was well controlled with medications (oxcarbazepine, sodium valproate and clobazam). Therefore,Continue reading “CAVERNOMA Causing Chronic Focal Epilepsy”

Rapid Expansion of Hypertensive INTRACEREBRAL HEMATOMA


54-year old lady presented with left-sided hemiparesis and drowsiness of 6 hours duration. Her BP at admission was 220/160 mmHg. She was started on anti-hypertensive medications. After 11 hours, her clinical condition worsened and she became comatose. Anisocoria was also noted. BP was 160/100 mmHg. CT scan of brain was repeated, which showed massive increaseContinue reading “Rapid Expansion of Hypertensive INTRACEREBRAL HEMATOMA”

INCIDENTAL CERVICAL SYRINX


Syrinx refers to a fluid (cerebrospinal fluid) filled cavity in the spinal cord. A small syrinx either may not cause any symptoms or cause only minor symptoms, and therefore, they remain undiagnosed for long. They get detected when MRI spine is done for evaluation of neck pain, or other symptoms. In the MRI of cervicalContinue reading “INCIDENTAL CERVICAL SYRINX”

POST-TRAUMATIC RIGHT FRONTAL CONTUSION


This is the CT scan of a 24-year old person man who met with a road-traffic accident. He was riding a two-wheeler, without wearing helmet. CT scan shows right frontal contusion, with mass effect. There is fracture of overlying frontal bone. Treatment is conservative in the initial stage with anti-cerebral edema measures and anti-epileptic drugs.Continue reading “POST-TRAUMATIC RIGHT FRONTAL CONTUSION”

Acute Hydrocephalus Developing After Pontine Hemorrhage


Pontine haemorrhages are uncommon and account for about 10% of all cases of intracerebral hemorrhage (ICH). Hypertension is the most common underlying cause, accounting for about 90% of all cases. Pontine hemorrhages are associated with high morbidity and mortality. About 40% people with pontine bleeds do not survive. Low GCS at admission and hemorrhage volumeContinue reading “Acute Hydrocephalus Developing After Pontine Hemorrhage”

Subdural Hematoma Developing after VP Shunt Surgery for Normal Pressure Hydrocephalus


Normal pressure hydrocephalus (NPH) consists of Hakim-Adams triad: Gait disturbances, memory decline and urinary incontinence. Ventriculo-peritoneal shunt (VP shunt) is routinely recommended to treat this condition. Acute or subacute subdural hematoma (SDH) can occur in 2-17% of patients following VP shunt. Increased susceptibility to SDH can be attributed to the shunt decreasing intracranial pressure byContinue reading “Subdural Hematoma Developing after VP Shunt Surgery for Normal Pressure Hydrocephalus”

Hemifacial Spasm caused by a Dolicho-ectatic Basilar Artery


An otherwise healthy man presented with left hemifacial spasm of 3 years duration. It started with left blepharospasm (involuntary contractions of eyelid muscles) causing narrowing of palpebral aperture. Gradually, the symptoms progressed to involve the left side of face. Involuntary contractions occurred in muscles of facial expression and lip muscles also. MRI with MR AngiogramContinue reading “Hemifacial Spasm caused by a Dolicho-ectatic Basilar Artery”

Large CP Angle tumor Presenting with Long-standing Deafness


40-year old gentleman presented with left-sided hearing loss, which slowly deteriorated over time. At the time of presentation, he was completely deaf. Other symptoms included mild dizziness and imbalance. On examination, he had left-sided sensori-neural hearing loss. Tandem gait was impaired. He had consulted several ENT doctors over the past 4 years, and he wasContinue reading “Large CP Angle tumor Presenting with Long-standing Deafness”