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
Friday
[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.
Thursday
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
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