Tumours Of The Cerebellopontine angle

Tumours Of The Cerebellopontine angle

Left Cerebellar Abscess

52 year old Indian gentleman, with no known medical illness, admitted with history of severe headache for the past 1 month, and persistent vomiting for 1/7. He was admitted with full GCS with positive left cerebellar sign. Otherwise vital signs was stable. NO history of ENT discharge. Clinically afebrile. RBS 5.3mmol/l. TWBC 11.0. CT scan plain, subsequently proceeded with contrast study revealed ring enhancing lesion at left cerebellar region with displacement of 4th ventricle and obstructive hydrocephalus.
Right frontal burrhole and ETV was performed and omaya placement after ETV. Post ETV CT scan showed smaller ventricles.MRI was planned the next day, however his GCS deteriorated to E1V2M5. He was intubated and ventilated. A repeat CT scan done showed similar findings with worsening of hydrocephalus. Emergency posterior fossa craniectomy was performed. Intra-operatively noted with encapsulated cerebellar abscess with thick capsule wall and frank pus content. A complete excision of the abscess was performed. Omaya was removed and EVD placement was performed. Subsequently EVD was removed after a repeat CT scan showed resolved hydrocephalus with visualization of 4th ventricle and minimal edema over left cerebellar. He was extubated and GCS improved to full.

Syringomyelia

Syringomyelia

The Pathophysiology And Management Of Hemorrhagic Stroke

The Pathophysiology And Management Of Hemorrhagic Stroke

Brain Metastasis of Testicular Yolk Sac Tumour

28 Years old Male
Diagnosed Left testicular tumour with lungs metastasis 1 year ago
Underwent left orchidectomy and HPE diagnosis of Yolk sac Tumour
He had completed radiotherapy and chemotherapy
Presented with 1/12 history of progresive left sided body weakness and numbness
Associated with worsening headache
Admitted with 1 episode of generalised tonic clonic seizure
O/E Pink, alert
GCS full
PEARL
BP 120/71
PR 77
Higher mental function intact
No cranial nerves deficit noted
Left hemiparesis 3/5 with sensory impairment

CT scan brain (plain + contrast) done showing homogenous enchanced tomour over right post central gyrus with marked surrounding edema




MRI was performed and he was planned for surgery






He underwent right parietal craniotomy and tumour excision. The tumour was just below a thin grey matter of post central gyrus (detected using intra-operative ultrasound). Post-central gyrus corticotomy done.
The tumour was pink-greyish in colour, soft to firm in consistency, well-circumscribed with surrounding gliotic brain tissue, highly vascular- completely excised

Post-operatively he was extubated and maintained on dexamethasone.
Clinically he still having left hemiparesis power of 3/5

CT scan (plain) post-operative day 1 showing pneumocranium with edema, no post-operative bleeding.

Carotid endarterectomy

Arnold Chiari Malformation