International Journal of Neurology and Neurosurgery

Tumor related intracerebral hemorrhage (ICH) is relatively uncommon and lung cancer is fourth amongst all tumor related ICH in term of frequency. Hemorrhagic brain metastasis due to lung cancer are multiple. We report a case of solitary hemorrhagic metastasis due to lung cancer. A 48 year old lady was admitted with features of raised ICP for 20 days and altered sensorium for 1 day. NCCT head showed an ill definedhyperdense lesion in the right temporal region with adjacent parenchymal edema and mass effect. CEMRI (contrast enhanced magnetic resonance imaging) brain showed a vascular lesion in right temporal lobe. MR venography of brain was normal and MR brain angiography suggested a vascular lesion. Working diagnosis was a vascular lesion. Intraoperatively reddish brown, firm, moderately vascular tumor was seen in right temporal region with areas of hemorrhage. Total excision was done and temporal dura was seen and was coagulated. Post operative period was uneventful. Microscopic and IHC (immuno histochemistry) examination was suggestive of metastatic adenocarcinoma. PET CT showed left lung lesion with no residual disease in brain. The patient received chemotherapy for lung lesion and radiotherapy for brain and it was asymptomatic 6 months after surgery. Keywords: Tumor, brain metastasis, intracerebral hemorrhage, lung cancer.

Cerebellar Degenration Associated with NNTTR/DNE Antibodies is a Rare Condition that is Seen in Case of Malignancy. However many recent studies have suggested ZIC-4 Antibodies Association with Paraneoplastic Cerebellar Degenration Particularly seen with Small Cell Carcinoma of Lung. However ZIC-4 Antibodt Associated Cases are underestimated beacuse of Prevalence of anti Hu Related Cases. Keywords: Paraneoplastic Cerebellar degeneration, Zic 4 antibody, anti Hu antibody.

Context: COVID-19 predisposes to rhino-orbito-cerebral mycosis (ROCM) which can further form fungal space occupying lesions (SOLs) in the brain. Aim: To study the clinico-radiological profile, type of fungus, response to treatment, outcomes and prognostic factors in patients with COVID-19 associated mucormycosis (CAM) who suffered fungal space occupying lesions (SOLs) in the brain. Results: Twelve subjects with CAM and intracranial SOLs were studied. Brain scans were performed in all patients at rhino-orbital stage, even before appearance of brain symptoms. The localized pus collections manifested as either parenchymal abscesses (N=10) or subdural empyema (N=2). In addition to involving the brain adjacent to the rhino-orbital disease, abscesses were also seen to form in areas distant to the primary site of infection. Abscesses developed in two regions, in the midline at the base of the skull, around the cavernous internal carotid arteries or the basilar arteries and in the lateral frontal, parietal and occipital lobes. Mucormycosis was identified in all patients and dual infection with aspergillus was encountered in 25%. Treatment involved combination of anti-fungal agents and early excision surgery and the mortality was 33%. Conclusion: Fungal abscesses form in the brain at sites contiguous to the rhino-orbital disease and also at distance sites via hematogenous route. These pus collections can be diagnosed early by screening the brain while undertaking the scan of orbits and paranasal sinuses. Mortality is high if pus spreads around the cavernous portion of the internal carotid or the basilar artery. Dual infection with mucorales and aspergillus can be seen. Early aggressive treatment can improve outcome and reduce mortality. Keywords: rhino-orbito-cerebral mycosis (ROCM), pus collection, parenchymal abscess, subdural empyema, contiguous spread, hematogenous spread.