International Journal of Neurology and Neurosurgery

 Spinal degeneration has been conventionally attributed to disc space reduction related to disc degeneration. The author has recently speculated that the process of degeneration is an outcome of muscle weakness that results in facetal telescoping and overriding. All the events observed in cases with spinal degeneration are secondary to this event and are probably protective in nature. Facetal distraction using interfacetal or intraarticular spacers can result in reversal of the facetal over-riding and all other secondary spinal events in cases with spondylotic spinal degeneration. 

Keywords: Interfacetal Spacers; Facet Distraction; Facetal Over-Riding; Goelfacetal Spacers.

 Background: Intradiploic dermoid cysts represent 0.04– 0.7% of cranial tumours. Very few cases of dermoid cysts occurring in the lateral front temporal region with a sinus tract up to dura are described in literature. We hereby report a case with intradiploic dermoid cyst with intracranial (but extra parenchymal) extension with complaint of a discharging sinus since birth. Case Report: A 2 year old male presented with history of serous discharge from the sinus located in right lateral frontal region at the level of coronal suture noticed since the age of two months. On CT and MRI imaging of brain, patient was found to have intradiploic expansile lytic lesion in the region corresponding to the sinus and was extending intracranially. Differential diagnosis as per imaging studies were Dermoid cyst, Epidermoid cyst and Eosinophilic granuloma. Gross total excision of the cyst along with involved sinus tract done and histopathology of the cyst confirmed it to be Dermoid cyst. Conclusion: Intradiploic dermoid cysts are relatively rare especially with discharging sinus and intracranial extension. We hereby add one such rare case to the literature. Surgical excision with careful excision of tract forms the adequate treatment of choice.

Keywords: Dermoid; Sinus.

 Introduction: Extrapontine myelinolysis associated with metabolic abnormalities especially hypernatremia is extremely rare. Osmotic demyelination syndrome resulting from postpartum hypernatremia is recently described entity with hypernatremic encephalopathy, quadriparesis and rhabdomyolysis with myelinolysis on imaging. This communication aims to highlight a case and discuss the pathogensis and management. Case Report: A 20 year-old lady presented with fever and disorientation of 5 days and generalized seizures of 1-day. She had undergone a lower segment caesarean section following an uneventful antenatal period, 3 weeks prior to this and was discharged home on 7th postoperative day where she was keeping well for next 1 week. On examination she was febrile, vitals stable, drowsy, flexing limbs and opening eyes to pain, with no verbal response. Limbs were flaccid; deep tendon and bilateral plantar reflexes were unresponsive. Biochemical evaluation revealed a sodium level of 182meq/l, creatinine phosphokinase (CPK) -2207 U/L, urea-135mg/dl, and creatinine-4.3mg/dl. Neuroimaging showed T2/FLAIR hyperintensities in bilateral putamen, isthmus of hippocampus, middle cerebellar peduncles, posterior internal capsule, and subcortical white matter suggestive of extrapontine myelinoysis. Inspite of correction of metabolic abnormalities, she progressively worsened and succumbed to her illness in 7 days. Conclusion: Clinicians must be aware of this entity of postpartum hypernatremia secondary to water restriction and diabetes insipidus and treat at the earliest, as mortality remains high (>60%). 

Keywords: Hypernatremia; Myelinolysis; Postpartum; Osmotic; Diabetes Insipidus.

 Primary Non-Hodgkin’s Lymphoma of cranial vault is a rare entity. We came across an interesting case of a 30 year old immunocompetent male who presented to us with a scalp swelling in the left parietal region. Computed tomography (CT) and MRI (Magnetic resonance imaging) of head showed contrast-enhancing lesion in left parietal region. CT scan of patient’s abdomen, chest and pelvis did not reveal any lymphadenopathy or organomegaly. After excision, the histopathology and immunohistochemistry of the lesion confirmed the diagnosis of Diffuse Large B cell Lymphoma. Patient was further treated with chemotherapy and radiotherapy with complete resolution of the lesion. The rarity of the condition with a good response to treatment combining surgery, chemotherapy and radiotherapy prompted us to report this case. 

Keywords: Primary Diffuse Large B-Cell Lymphoma; Cranial Vault; Chemotherapy; Immuno Histochemistry.