Occult leptomeningeal large cell medulloblastoma in an adult.

Large cell medulloblastoma is an uncommon malignancy of childhood that often pursues an aggressive clinical course. We report the first case of this entity in an adult that proved to be an unsuspected primary leptomeningeal tumor.

CLINICAL PRESENTATION:
A 30-year-old man complained of worsening neck pain over the course of 3 months. Neck pain increased a few days prior to admission and a cervical spine CT revealed tonsillar herniation.

Cervical spine MRI performed the day prior to admission confirmed the diagnosis of Chiari I malformation and C3-4 disk herniation without spinal cord compression. On the day of admission, the patient became unresponsive and resuscitative measures were unsuccessful. Postmortem examination of the brain was notable for necrotic cerebellar tonsils, but demonstrated no evidence of an intraparenchymal mass lesion.

Microscopic examination of the cerebellum revealed discohesive neoplastic cells, which showed characteristic dot-like immunoreactivity for synaptophysin, diagnostic of large cell medulloblastoma within the subarachnoid space.

CONCLUSIONS:
Our experience with this unique case illustrates the challenges of diagnosing a primary leptomeningeal neoplasm. This case also underscores the importance of maintaining a high degree of suspicion for leptomeningeal neoplasms in patients who present with imaging studies suspicious for Chiari I malformation.


Occult leptomeningeal large cell medulloblastoma in an adult.
Clin Neuropathol. 2009 May-Jun; 28(3): 188-92Rushing EJ, Smith AB, Smirniotopoulos JG, Douglas AF, Zeng W, Azumi N

[Treatment of cervical spondylotic myelopathy and radiculopathy by anterior subtotal vertebrectomy and decompression combined graft and internal fixation]

Zhongguo Gu Shang. 2009 May; 22(5): 394-5Chen Z, Lin L, Cao GH, Wu JM

[Potentialities of traction therapy for diskogenic compressive radicular syndromes]

Vopr Kurortol Fizioter Lech Fiz Kult. 2009 Mar-Apr; 13-5Ziniakov NN, Ziniakov NTThis study included 78 patients with lumbar subligamentary herniation. Based on their clinical and functional examination, several variants of diskogenic radiculopathies were distinguished. Special emphasis was laid on the evaluation of efficiency of underwater vertical traction in these patients. The proposed method was shown to produce better effect than underwater horizontal traction when used for the treatment of both axonopathies and axonomyelinopathies. The efficiency of underwater vertical traction applied to the treatment of axonopathies appears to be higher than in patients with axonomyelinopathies.

Peridural injection of Mailuoning compound liquor for treatment of prolapse of lumbar intervertebral disc in 100 cases.

J Tradit Chin Med. 2009 Mar; 29(1): 6-8Zhi MX, Zhang GB, Hou JC, Yang YH, Wan ZZOBJECTIVE: To observe the therapeutic effects of peridural injection of Mailuoning Compound Liquor for prolapse of lumbar intervertebral disc (PLID). METHODS: Peridural injection of Mailuoning Compound Liquor (MCL) was given to 100 cases of PLID, once a week, 4 sessions constituting a therapeutic course. By adopting the scoring method, observations were carried out on the total therapeutic effect and changes in the 13 items of the symptoms and signs. RESULTS: After treatment, the JOA scores in this series of patients were markedly enhanced as compared with the scores before treatment, showing significant differences in the paired t test (P

[Clinical observation on Xiaoyusan plaster and Daoyin in the treatment of disease of cervical vertebrae]

Zhongguo Gu Shang. 2009 May; 22(5): 357-9Teng WROBJECTIVE: To investigate the effects of Xiaoyusan plaster and Daoyin in the treatment of cervical vertebrae disease, to search new methods in the treatment of cervical vertebrae disease. METHODS: From May 2007 to April 2008, 63 patients with disease of cervical vertebrae were treated. By odd or even numbers in random digits table, the patients were randomly divided into two groups included treatment group and control group. Thirty-three patients in the treatment group were treated with Xiaoyusan plaster and Daoyin included 21 males and 12 females with an average age of (30.60+/-7.89) years ranging from 20 to 49. Thirty patients in the control group were treated with Votalin Sustained Release Tablets included 16 males and 14 females with an average age of (32.43+/-8.00) years ranging from 20 to 49. The pain, pressing pain, activity of cervical vertebrae were observed before and after treatment in two groups. RESULTS: Compared the scores before and after treatment in treatment group: pain (t=8.953, P

Cervical spinal disc replacement.

J Bone Joint Surg Br. 2009 Jun; 91(6): 713-9Denaro V, Papalia R, Denaro L, Di Martino A, Maffulli NCervical spinal disc replacement is used in the management of degenerative cervical disc disease in an attempt to preserve cervical spinal movement and to prevent adjacent disc overload and subsequent degeneration. A large number of patients have undergone cervical spinal disc replacement, but the effectiveness of these implants is still uncertain. In most instances, degenerative change at adjacent levels represents the physiological progression of the natural history of the arthritic disc, and is unrelated to the surgeon. Complications of cervical disc replacement include loss of movement from periprosthetic ankylosis and ossification, neurological deficit, loosening and failure of the device, and worsening of any cervical kyphosis. Strict selection criteria and adherence to scientific evidence are necessary. Only prospective, randomised clinical trials with long-term follow-up will establish any real advantage of cervical spinal disc replacement over fusion.

Comparison of growth factor and cytokine expression in patients with degenerated disc disease and herniated nucleus pulposus.

Clin Biochem. 2009 Jun 26; Lee S, Moon CS, Sul D, Lee J, Bae M, Hong Y, Lee M, Choi S, Derby R, Kim B, Kim J, Yoon JS, Wolfer L, Kim J, Wang J, Hwang SW, Lee SHObjectives: This study was conducted to investigate the expression of cytokines and growth factors in disc specimens obtained from patients with herniated nucleus pulposus (HNP) and degenerated disc disease (DDD) Design and methods: MRI and Western blot analyses were performed to evaluate the levels of disc degeneration and the expression levels of cytokines and growth factors. Results: The levels of: TNF-alpha and IL-8 were significantly greater in the DDD group than in the HNP group, but no statistical differences were observed in the expression of IL-1alpha, IL-6 and IL-12 between the HNP and DDD groups. In addition, the expression of TGF alpha, VEGF and NGF was significantly higher in the DDD group than in the HNP group. Conclusion: The greater levels of cytokine and growth factor expression in the DDD group than in the HNP explain why discogenic patients usually have more severe back pain than patients with herniated discs.