Radiology

Ewing's sarcoma is a primary bone cancer that mainly affects the long bones. This malignancy is particularly common in pediatric patients. Primary cranial involvement accounts for 1% of cases, with occipital involvement considered extremely rare. In this case study, primary occipital Ewing's sarcoma with a posterior fossa mass and subsequent relapse resulting in spinal seeding is reported. A 3-year-old patient presented with a 1-year history of left-sided headaches, localized over the occipital bone with progressive torticollis. Computed tomography (CT) imaging showed a mass in the left posterior fossa compressing the brainstem. The patient then underwent surgical excision followed by adjuvant chemoradiation therapy. Two years later, the patient presented with severe lower back pain and urinary incontinence. Whole-spine magnetic resonance imaging (MRI) showed cerebrospinal fluid (CSF) seeding from the L5 to the S4 vertebrae. Primary cranial Ewing's sarcoma is considered ...

The association between acute rise of blood pressure and encephalopathy with early recognition, and therapy reversibility has been reported. We reported a case of a young lady in postnatal period, presented with acute rise of blood pressure, encephalopathy, quadriparesis, and apraxia. Magnetic resonance imaging of the brain showed hyperintense lesions in occipital, parietal and right temporal areas. Cerebral angio showed multiple segmental vasoconstriction and narrowing of intracerebral vessels. Immediate control of blood pressure enhanced recovery but it is incomplete.

Polyostotic sclerosing histiocytosis, also known as Erdheim-Chester disease (ECD), is a rare form of non-Langerhans histiocytosis. ECD has wide clinical spectrums which mainly affect skeletal, neurological, dermatological, retroperitoneal, cardiac, and pulmonary manifestations. Here we describe a case of ECD in a 45-year-old female who presented initially with bilateral knee pain and homonymous superior quadrantanopia progressed to ophthalmoplegia and complete visual loss of the left eye over a period of one year. Plain X-ray of both knees showed bilateral patchy sclerosis of the distal femur and upper parts of the tibiae. Initial brain magnetic resonance imaging (MRI) showed bilateral enhancing masses in the temporal lobes anterior to the temporal horns, thickening of the pituitary stalk, partially empty sella, and involvement of the left cavernous sinus one year later. Our case is a peculiar case of ECD initially presented with unilateral homonymous superior quadrantanopia due to ...

PURPOSE In this case report, we document new recommendations for the treatment of pediatric glioblastoma based on a genetic understanding of the disease. PATIENTS AND METHODS A Saudi girl aged 18 months presented with a history of right sided weakness and partial seizures. MRI revealed the presence of large complex left frontal tumor. Craniotomy and gross total resection were performed. post-operatively The patient showed excellent recovery with no neurological deficits. Pathology reports confirmed glioblastoma (GBM). Due to the expected poor survival, the patient’s family declined standard therapy, including chemotherapy and/or radiation therapy. RESULTS Molecular analysis showed positive fusion mutations for ETV6-NTRK3 making the patient an ideal candidate for larotrectinib, an oral tyrosine kinase (TRK) inhibitor. Unfortunately, follow-up MRI showed local tumor recurrence at 3-months post-surgery. The family agreed to the initiation of oral larotrectinib as a less invasive therap...

Cowden syndrome is a rare autosomal-dominant disease characterized by multisystem hamartomas usually affecting the skin, thyroid gland, breast, and gastrointestinal tract; these hamartomastend to undergo malignant transformation in various tissues. We describe a 32-year-old woman who presented with a progressive headache, neck pain, nausea, vomiting, transient loss of vision, dizziness, and unsteady gait during the previous2 months; she had one episode of a seizure and a previous history of an ovarian cyst manifesting as abnormal menses. Brain magnetic resonance imaging (MRI) revealed a left cerebellar mass with features suggestive of dysplastic gangliocytoma with obstructive hydrocephalus in addition to multiple meningiomas. Imaging features raised the suspicion of Cowden syndrome (CS). Thus, the patient underwent suboccipital craniotomy for resection of the left cerebellar mass; pathological and immunohistochemical examination confirmed the diagnosis of CS. Most cases found in the...

ABSTRACT Pulmonary embolism (PE) is a common condition in the Emergency Department and its incidence increases exponentially with age [1]. PE remains largely underdiagnosed and inappropriately treated, resulting in suboptimal outcomes. This is partly due to the fact that clinical symptoms and signs are nonspecific [2]. © 2012 International Society on Thrombosis and Haemostasis.