International Journal of Neurology and Neurosurgery

 No Abstract

We report a case of 3 year old male child presented with regressed milestone in form of motor, language and cognition after the age of one year. The initial detail work up including neuroimagings and genetic studies for leukodystrophy, mitochondrial disorders, congenital muscular dystrophy, congenital myopathy, Wilson disease and metabolic disorders were normal. However serial neuroimagings were helpful to reach the diagnosis of mitochondrial disease (leighs disease). 

Keywords: Leigh’s disease; 3Tesla MRI; Mitochondrial disease; MR spectroscopy; Basal ganglia. 

Rosai-Dorfman disease (RDD) also called Sinus histiocytosis with massive lymphadenopathy is a rare benign histiocytic proliferative disorder predominantly affecting lymph nodes. Extra nodal sites include central nervous system, head and neck region, eyes, upper respiratory tract and skin. Involvement of the central nervous system (CNS), especially in the absence of nodal disease is rare. We are reporting 2 cases of RDD in the meninges. Both cases are presented with intractable headache and seizures. Clinically and radiologically, both were diagnosed as meningioma. Histopathologically both turned out as Rosai-Dorfman disease. IHC studies confirmed the diagnosis. 

Keywords: Central nervous system; Emperipolesis; Histiocytic proliferation; Rosai-Dorfman disease. 

Peripheral diabeticneuropathy (PDN) is one of the major complications arising in patients with diabetes.A triad of metabolic abnormalities is known that render the peripheral nerve in diabetes mellitus susceptible to chronic compression: conversion of glucose to sorbitol increases the intraneural water content, slowing of axoplasmic transport of proteins hinders structural repair, glycosylation of endoneurial collagen reduces perineurial gliding. Due to connective tissue fibrosis, impaired microcirculation, and impaired endoneurial oxygenation, diabetic peripheral nerves are more at risk for entrapment neuropathies both focally and diffusely.Surgical release and decompression was shown to be effective in many entrapment neuropathies but not in diabetes, hence there is a dearth need to evaluate the current evidence on surgical decompression’s effectiveness in diabetic peripheral neuropathy (DPN).The objective of this review is to provide and evidence-informed update on the effects, efficacy and effectiveness of surgical treatments in patients with painful diabetic peripheral neuropathy (PDPN). MEDLINE was searched for articles and 23 studies were obtained and a descriptive review found that surgical decompression of superimposed nerve compressions in the patient with symptomatic neuropathy reliably relieves pain, restores sensation, and thereby prevents ulceration and amputation. Surgical decompression is thus an established critical, practical and a successful treatment option for patients with PDPN.

Keywords: Diabetic peripheral neuropathy; Decompressive surgery; Operative management.  

Objective: To discover the clinical risk factors that may affect the outcome, over a 6-year period of CTB at King Abdul Aziz University Hospital (KAUH), Jeddah, Design: Retrospective study From January 2005 to December 2010. Results: A total of 78 cases were reviewed. 34 (43.59%) males and 44 (56.41%) females. Factors that may lead to poor prognosis were: old age (p<.047), headache (p<.025), history of weakness (p<.005), classic TB symptoms (p<.001), history of contact with a TB patient (p<.006), HIV (p<.001), elevated ESR (p<.001) and altered mental status (p<.001). Conclusion: CTB presentation is usually with headache. Clinical risk factors are: headache, weakness, ESR and others. Patients with those risk factors should receive full medical treatment.

Keywords: Tuberculoma, Meningitis, Tuberculosis, Saudi Arabia,  Jeddah 

Context: Many approaches were used to remove tumors of the pineal region. None of these approaches could gain general acceptance. Consequently, the choice of the approach is always problematic. Aims: To illustrate and evaluate the usefulness of using the interhemispheric occipital transtentorial approach in treating pineal tumors. Settings and Design: A retrospective study of ten cases of pineal region tumor Materials and Methods: Ten patients suffering from pineal region tumors were operated upon through the interhemispheric occipital transtentorial approach.Results: Three tumors (30%) were easy to dissect from the surrounding and thus were totally removed. Other three tumors (30%) were found adherent to the brain stem and thus sheets of the tumor were left behind i.e. subtotal removal. Four tumors (40%) were very vascular and infiltrating the surrounding and were only debulked. In all the ten patients, the approach was never the limiting factor for tumor removal. When complete surgical excision was not achieved it was due to either a poor plane of cleavage between the tumor and the brain stem, difficulty to dissect the tumor from the deep venous system of the brain or due to invasion of the surrounding vital structures. Conclusion: The interhemispheric occipital transtentorial approach is a suitable approach when treating pineal body tumors.

Keywords: Interhemispheric occipital transtentorial approach; Occipital transtentorial approach; Pineal region tumors; Surgery to pineal region.