Intracranial Space-occupying Lesions Research Articles

Clinical Presentation of Toddlers With New Intracranial Space-Occupying Lesions: A Case Series.

Intracranial space occupying lesions (ICSOLs) like tumors and abscesses can be life-threatening conditions. It can be especially difficult to diagnose these conditions in toddlers. We aimed to describe symptoms and signs present in a sample of toddlers with ICSOLs. We performed a retrospective chart review of 15 toddlers with intracranial tumors, abscesses, or infected cysts. We collected data on the presence of various signs and symptoms on presentation to the emergency department. Eight toddlers (53%) presented with vomiting. A change in behavior was the second most common symptom (6, 40%). Seven children (47%) had motor weakness, and 5 (33%) had ataxia. Eleven of the 12 children with tumors (92%) had documented abnormal neurologic signs on initial physical examination. Vomiting, a change in behavior, and an abnormal neurologic examination were common signs and symptoms in our sample of toddlers with ICSOLs. An accurate history and appropriate neurologic examination can help physicians make this challenging diagnosis in this age group.

A retrospective clinical analysis of pediatric paragonimiasis in a Chinese children\u2019s hospital from 2011 to 2019

Diagnosis of pediatric paragonimiasis is difficult because of its non-specific clinical manifestations. We retrospectively reviewed the records of pediatric paragonimiasis in Children’s Hospital of Fudan University from January 2011 to May 2019. The confirmed diagnosis of paragonimiasis was based on positive anti-parasite serological tests from the local Center for Disease Control (CDC). A total of 11 patients (mean age: 7.7 ± 3.1, male–female ratio: 7:4) diagnosed as paragonimiasis were included. 81.8% were from endemic areas such as Sichuan and Yunnan, and 36% had a clear history of raw crab or crayfish consumption. The characteristic clinical features of pediatric paragonimiasis were eosinophilia (100%), pleural effusion (81.8%), hepatomegaly (54.5%), ascites (54.5%), and subcutaneous nodules (45.5%). Misdiagnosed with other diseases including tuberculosis (18.2%), pneumonia (9.1%), intracranial space-occupying lesions (9.1%) and brain abcess (9.1%) led to rehospitalization and prolonged hospitalization. For treatment, a 3-day course of 150 mg/kg praziquantel (PZQ) didn’t show ideal treatment effectivity and 63.6% needed more than one course of PZQ, while triclabendazole in a total dose of 10 mg/kg had a better efficacy to stubborn manifestations. This study indicated that pediatric paragonimiasis was often misdiagnosed, and the treatment with a 3-day course of 150 mg/kg PZQ had a high rate of failure.

The Value of Cross-Sectional Imaging in Evaluation of Stroke Patients

Background: Due to poor availability of functional cross-sectional imaging in the developing countries, cerebrovascular accident (CVA) and its management has continued to be a major health problem. The need for cross-sectional imaging such as computed tomography (CT) of the brain for the exclusion of stroke mimics and for therapeutic decision cannot be overemphasized. Materials and Methods: This was a prospective case study conducted at the Federal Teaching Hospital, Gombe, from June 2016 to December 2016. One hundred and thirty patients who presented with clinical features and provisional diagnosis of CVA (also known as stroke) and were referred to the radiology department for brain CT were consecutively selected. A total of 111 had CT scan features of acute stroke, 6 had brain atrophy, 8 had intracranial space-occupying lesions, and 5 were normal brain scan. Data were analyzed using SPSS version 16.0 package. P≤ 0.05 and a confidence interval of 95% were adapted for the statistical analysis. All comparisons of variables were done applying kappa statistical analysis. Results: There were 81 (62%) males and 49 (38%) females aged 18–80 years (mean ± standard deviation of 57.49 ± 13.47 years). About 15% (19) of the patients had a diagnosis other than stroke (stroke mimics). One hundred and eleven (85%) had a stroke, of which 94 (84.7%) were ischemic stroke, while the remaining 17 (15.3%) were hemorrhagic stroke. This study also found a discordance between clinical and CT diagnosis of stroke and stroke subtypes; κ = 0.289. Conclusion: The clinical diagnosis of stroke and stroke subtypes may not be reliable without neuroimaging, and the need for CT scan for proper evaluation of stroke patients is well justified.

MANAGEMENT OF INTRACRANIAL ARACHNOID AND PORENCEPHALICCYSTS (CONSERVATIVE VERSUS SURGICAL)

Background: Arachnoid cysts (ACs) are benign developmental cysts that occur along the craniospinal axis. Arachnoid cysts comprise 1% of all intracranial space-occupying lesions. Objective: To evaluate the cases of intracranial arachnoid cysts clinically and radiologically and the possibility of surgery. Patients and Methods: The study was done prospectively on 22 patients presented with intracranial arachnoidcysts (15 of them were medically managed, and 7 of them were surgically managed) in the Neurosurgery Department, Al-Azhar and Alexandria Universities on patients suffering from extra-axial intracranial arachnoid cysts. The study was performed through the period from March 2019 to February 2020, and the follow up period was 6 months. All cases, either surgical or conservative cases, had been evaluated regarding (clinical improvement of symptoms, radiological reduction in size of the cyst, rate of complications, wound healing and need for subsequent lines of management. Results: Patients with satisfactory clinical outcome was observed in most of the total managed cases (72.7%). There was a statistical significant difference in clinical outcome between the medical management group and the surgical management group as almost medically managed patients (86.7%) improved clinically. Improved radiological outcome was observed in 42.9% of surgically managed patients. Postoperative complications were observed in the majority of surgically managed patients. Most common complication was hydrocephalus in 42.9% of patients. Conclusion: Management of intracranial arachnoid cysts remained controversial, and most of the patients managed conservatively, but we believe that proper clinical and radiological evaluation of symptomatic arachnoid cysts leads to better outcome.

Intracranial hydatid cysts: a report on 16 cases

AimTo describe the epidemiological and clinical criteria of those patients with rare intracranial cysts.BackgroundCentral nervous system (CNS) hydatid cysts are a rare presentation of hydatid cyst, although may be the cause of intracranial space-occupying lesions in 4% in endemic countries. It affects mostly children. The diagnosis of CNS hydatid is still problematic despite the advancements in imaging techniques (computed tomography or MRI). Extirpation of the intact cyst is the treatment of choice, resulting in most cases to a complete recovery.Patients and methodsA retrospective descriptive study was conducted on the CNS hydatid cases operated in our departments between 2011 and 2016. A total of 16 cases were included. For each case, we reviewed the presenting clinical manifestations and the imaging findings. The Glasgow Outcome Scale was followed for all cases throughout the follow-up period.ResultsOf 16 cases, 12 were children (<12 years). The most presenting findings were increased intracranial pressure. A single cyst was detected for 14 cases, whereas multiple cysts were identified in two cases. Extirpation of the cyst without rupture was achieved in 12 patients. Only two cases developed recurrent hydatid after 3 years. No intraoperative mortality was detected, whereas postoperative mortality occurred in one case owing to anaphylaxis following intraoperative rupture of the cyst.ConclusionSurgical excision of the whole hydatid cyst without rupture is the treatment of choice to avoid the life-threatening complications of CNS hydatid rupture.

Etiology, localization of the lesion, and prognosis for patients firstly diagnosed in ophthalmology department with oculomotor nerve palsy.

Oculomotor nerve palsy is a kind of disease with many causes, showing eye movement disorders, abnormal eyelid position, and/or damage of the pupil. The etiology of oculomotor nerve palsy in different departments is different. The study discussed the etiology, localization of the lesion, and prognosis for oculomotor nerve palsy firstly diagnosed in department of ophthalmology. Clinical data of 137 hospitalized patients with oculomotor nerve palsy at the Department of Ophthalmology, the First Medical Center of PLA General Hospital from 2009 to 2018 were retrospectively collected. The etiology and its distribution characteristics in different age groups, the location of the lesion, and the prognosis of patients were analyzed. In 137 patients, the top 3 causes for oculomotor nerve palsy were head trauma (38.69%), cavernous sinus lesions (12.40%), and orbital inflammation (9.49%). Other causes included intracranial aneurysm, the intracranial space-occupying lesion, cerebral vessel diseases, infection, orbital tumors, diabetes, the operation of nasal cavity. Traumatic oculomotor nerve palsy was more common in young adults aged 20-49 years and in the patients with cerebral vascular disease in elderly people aged 60-69 years, while diabetic oculomotor nerve palsy is common in middle-aged and elderly people aged 50-69 years. The age distribution of other etiological types was relatively balanced. Seventy-five cases of orbital apex lesions were due to trauma, inflammation, infection, and tumor; 40 cases of cavernous sinus lesions were due to inflammation, tumor, and thrombosis; 6 cases of subarachnoid lesions were due to aneurysms, tumors, and trauma; 5 cases were oculomotor nucleus lesions were due to infarction; 11 cases could not be allocated because of unknown etiology. After treatment, the corrected visual acuity of oculomotor nerve palsy side was not significantly improved. The patients with oculomotor nerve palsy caused by intracranial aneurysm, cerebrovascular disease, and diabetes mellitus had the highest proportion of partial or complete recovery from ptosis and ocular dyskinesia. Oculomotor nerve palsy is a common cause of ophthalmoplegia and diplopia. Head trauma, cavernous sinus lesions, and orbital inflammation are the most common causes for oculomotor nerve palsy first diagnosed in ophthalmology department. Traumatic oculomotor nerve palsy is common in adolescents. Oculomotor nerve palsy caused by diabetes and cerebrovascular disease are common in the middle-aged and elderly people. Most of the lesions locate in the orbital apex and cavernous sinus. The prognosis of corrected visual acuity is poor. The prognosis of ptosis and ocular dyskinesia caused by intracranial aneurysm, cerebrovascular disease, and diabetes is good. Figuring out the cause timely and accurately is the basis and key to treat oculomotor nerve palsy.

Clinical indication-based diagnostic reference levels for paediatric head computed tomography examinations in Kano Metropolis, northwestern Nigeria

IntroductionPaediatric patients are recognised to be at higher risk of developing radiation-induced cancer than adults because of rapidly growing organs and tissues which are vulnerable to cellular damage. The aim of the study was to determine indication based Diagnostic Reference Levels (DRLCI) for paediatric head computed tomography (CT) examinations within Kano metropolis, Nigeria. MethodsCT dose index (CTDIvol), dose length product (DLP) and other scan parameters were recorded for 113 paediatric undergoing CT head examinations. Different clinical indications were recorded and categorised in addition to patient age. Third quartile values (75th percentile) of the median dose were considered as DRLCI. Analysis of Variance (ANOVA) was used to test for differences between DRLCI, for different age groups, and variations among institutions. The Statistical Package for Social Sciences version 23.0 was used for analysis. Statistical significance was set at p < 0.05. ResultsDRLCI for Hydrocephalus for <5 years and 5–10 years was 28.10 mGy and 28.11 mGy with DLP of 1623.20 mGy cm and 1623.21 mGy cm, respectively. The 11–15 year group recorded 29.10 mGy and 1625.20 mGy cm. Indications of haemorrhage/trauma and post-seizure imaging all had same values for <5 years and 5–10 years (28.10 mGy and 1623.20 mGy cm) while the 11 to 15-year group recorded 39.60 mGy and 1626 mGy cm. Intracranial Space Occupying lesion had the same DRLCI value for < 5years and 5–10 years (29.0 mGy and 1600 mGy cm, respectively) the 11 to 15-year group recorded values of 46.20 mGy and 1663.4 mGy cm. There was no statistically significant difference between DRLCI for <5 years and 5 to 10-year age groups (p = 0.199), while different centres showed some statistically significant relationships (p = 0.02). ConclusionThe study noted dose differences between age groups less than 10 years and above ten years, there were some statistically significant relationship with DRLCI. Dose optimisation techniques for paediatric examinations together with selection of the right protocol for paediatric head CT are necessary. Implications for practiceThe study has provided DRLCI for paediatric head CT examinations. These values can be used for future comparisons and as a potential dose optimisation tool. Such data can also guide radiographers when selecting appropriate parameters for indication-based CT examination to help achieve a low dose with acceptable image quality.

Clinical aspects of pregnancy-related lymphocytic hypophysitis

Objective: To analyze clinical features, diagnosis, treatment and prognosis of pregnancy-related lymphocytic hypophysitis (LyH). Methods: The clinical data of 16 cases diagnosed as pregnancy-related LyH at Chinese PLA General Hospital between October 2010 and November 2019 were reviewed. Results: Sixteen patients were included (aged 20-40 years). All patients' symptoms occurred from the last 2 months of pregnancy to 12 months postpartum, with 6 cases in the third trimester and 10 cases during postpartum, and all the patients were diagnosed after delivery. Six patients had lymphocytic adenohypophysitis (LAH), 4 patients had lymphocytic infundibuloneurohypophysitis (LINH), 4 patients had lymphocytic panhypophysitis (LPH), and 2 had lymphocytic hypothalamitis. Eight patients presented with symptoms of intracranial space-occupying lesions, 14 patients had symptoms of anteriorpituitary hormone deficiencies, 9 patients had central diabetes insipidus (CDI), and 2 had hyperprolactinemia. Pituitary MRI showed that the pituitary presented with diffuse enlargement, pituitary stalk thickening, disappearing of high-intensity signals in posterior pituitary and space-occupying lesions in the infundibulum of hypothalamus. Nine patients were treated with immunosuppressive agent, 3 patients alleviated the space-occupying effects after surgery, and 4 patients recovered spontaneously. Fourteen patients were followed up with a period of 3-98 months. Four patients had a relapse, 2 patients had a complete remission, and 12 patients needed long-term hormone replacement therapy. Conclusions: Clinical manifestations of pregnancy-related LyH are diverse. LyH should be suspected in pregnant or postpartum women with a sellar mass to avoid missed diagnosis or misdiagnosis. Immunosuppressant therapy is effective. Overall, LyH patients have a favorable prognosis.

BIOM-35. MULTI ANALYTE ASSAY FOR NON-INVASIVE DIAGNOSIS OF BRAIN TUMORS

Abstract The diagnosis of Central Nervous System (CNS) malignancies such as Gliomas in individuals presenting with Intracranial Space Occupying Lesions (ICSOL) is based on histopathological examination (HPE) of tumor tissue obtained by an invasive brain biopsy. However, brain biopsies are resource intensive and are associated with procedural risks such as haemorrhage, morbidity and mortality. The present study evaluated a non-invasive approach for diagnosis of CNS-M in symptomatic individuals based on evaluation of circulating tumor analytes in peripheral blood. The non-invasive multi-platform approach for diagnosis of CNS-M included Immunocytochemistry (ICC) profiling and Fluorescence in situ Hybridization (FISH) of Circulating Tumor Cells (CTCs) and Digital Droplet PCR (ddPCR) of cell-free tumor DNA (ctDNA) and exosomal mRNA. Performance characteristics of each platform were evaluated using blood and tissue samples from 445 individuals including 227 known cases of CNS-M, 47 known cases of benign CNS conditions (CNS-B), 141 known cases of other cancers with brain metastases (OTH-M) and 30 asymptomatic individuals (ASYM). In a set of 37 samples from individuals with radiological ICSOL, suspected of malignancy (CNS-S) complete diagnostic work-up was performed with ICC, FISH and ddPCR. Glial CTCs were detected in 88.8% of 227 CNS-M and undetectable in 89.4% of 47 CNS-B or 100% of 141 OTH-M, indicating high sensitivity and specificity, respectively. The multi-analyte approach discerned CNS-M from CNS-B as well as OTH-M with 91.7% accuracy and accurately inferred lineage in 84.6% of cases. This non-invasive multi-analyte approach can diagnose CNS-M with an accuracy not inferior to standard HPE, can substitute invasive biopsies in most cases and is particularly helpful in cases where a biopsy is not viable.

Comparison of Dexmedetomidine Infusion versus Scalp Block with 0.5% Ropivacaine to Attenuate Hemodynamic Response to Skull Pin Insertion in Craniotomy: A Prospective, Randomized Controlled Trial

Abstract Background The insertion of the skull pin head holder to stabilize the head during neurosurgery causes significant periosteal stimulation, resulting in hemodynamic responses, which may lead to brain edema, intracranial hypertension, and hemorrhage in patients with intracranial space-occupying lesions and intracranial aneurysms. We compared the efficacy of dexmedetomidine infusion and 0.5% ropivacaine scalp block in attenuating the hemodynamic response to the skull pin application. Methods A total of 65 American Society of Anesthesiologists (ASA) class I and II patients aged between 18 and 65 years with a preoperative Glasgow Coma Scale score of 15 undergoing elective craniotomy were randomized to receive either a bolus of 1mcg/kg of dexmedetomidine followed by an infusion of 1 mcg/kg/hour (group D) or a scalp block with 0.5% ropivacaine (group S) in a single-blinded comparator study. Patients were monitored for the following hemodynamic changes following skull pin insertion: heart rate (HR), mean arterial pressure (MAP), the requirement of additional analgesia/anesthesia, and adverse events. Results HR and MAP were comparable between the groups at baseline, before induction, and before pin insertion. HR and MAP at 1, 2, and 3 minutes after skull pin insertion were significantly higher in group D as compared with group S (p &lt; 0.05) and were comparable between the groups at 5 minutes. The groups were comparable with respect to the requirement of additional analgesia, anesthesia, and incidence of adverse events. Conclusion Scalp block with 0.5% ropivacaine is effective and superior to dexmedetomidine in attenuating the hemodynamic response to skull pin insertion in ASA I and II neurosurgical patients undergoing craniotomy. However, the hemodynamic effects achieved with dexmedetomidine were within the permissible limits.

Examination of the Practicability of Brain Atlas Technique in Patients with Intracranial Space-Occupying Lesions

Marianna Nagy*1, Csaba Aranyi2, Gábor Opposits2, Levente Lánczi1, Tamás Papp1, Mária Kern1, Tamás Spisák3, Ervin Berényi1 and Miklós Emri2 Author Affiliations 1Department of Medical Imaging, Division of Radiology and Imaging Science, Hungary 2Department of Medical Imaging, Division of Nuclear Medicine and Translational Imaging, Hungary 3Department of Neurology, Essen, Germany Received: August 13, 2020 | Published: August 21, 2020 Corresponding author: Marianna Nagy, Division of Radiology and Imaging Science, Department of Medical Imaging, Faculty of Medicine, 4032 Debrecen, Nagyerdei krt 98, Hungary DOI: 10.26717/BJSTR.2020.29.004842

Approach to an Intracranial Mass in Patients With HIV.

Space-occupying lesions represent a diagnostic challenge among people with the human immunodeficiency virus, acquired immunodeficiency syndrome (HIV/AIDS). To determine the best diagnostic approach to the wide array of possible etiologies and provide a thorough interpretation of neuroimaging in order to narrow a hierarchical differential diagnosis among these patients. Given that there is no pathognomonic neuroimaging pattern in this clinical setting, we searched results from brain biopsies to best determine the etiology of commonly found lesions. Multimodal brain MRI and MRI spectroscopy (MRS) often provide the most valuable information in the study of focal masses among people with HIV/AIDS. Brain biopsy appears safe and provides high diagnostic yields in these patients. Among patients with HIV/AIDS who present with space-occupying intracranial lesions, brain MRI and MRS are useful tests. However, in cases of diagnostic uncertainty, brain biopsy is a safe procedure and should be performed. The role of metabolic studies like 201Th-SPECT or PET is useful in the detection of primary central nervous system lymphoma.

Cerebral Phaeohyphomycosis: A Rare Case from South India

Background and Importance: Cerebral phaeohyphomycosis is a rare but frequently fatal clinical entity caused by dematiaceous fungi like Cladophialophora bantiana. Fungal brain abscess often presents with subtle clinical symptoms and signs, and present diagnostic dilemma due to its imaging appearance that may be indistinguishable from other intracranial space-occupying lesions. Still, certain imaging patterns on Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) help to narrow down the differential diagnosis and initiate prompt treatment of these infections. Case Presentation: A 48-year-old immunocompetent man presented with right-sided hemiparesis and hemisensory loss and a provisional diagnosis of stroke was made. The radiological evaluation suggested the possibility of a cerebral abscess. Accordingly, surgical excision of the lesion was performed and the histopathological examination of the specimen revealed the etiology as phaeohyphomycosis. The patient was further treated with antifungals and discharged when general conditions improved. Conclusion: Fungal Central Nervous System (CNS) infections present diagnostic challenges and should be considered while interpreting ring-enhancing CNS lesions in immunocompetent patients. Surgical resection and antifungal treatment should be considered in all patients with cerebral phaeohyphomycosis.

Intracranial Mass Lesion Due to Fungal Infection: A Case Series and Review of Literature

Background: Fungal infections of the central nervous system (CNS) usually present as subacute meningitis or intracranial space-occupying lesion with mass effect on surrounding structures and consequent focal neurological deficits. Intracranial fungal granulomas are often misdiagnosed clinically and radiologically as neoplastic lesions. Biopsy of the lesion is the only reliable technique to establish the correct diagnosis as well as to detect the causative fungal species. Voriconazole is a broad-spectrum triazole antifungal agent. It can be given orally and intravenously and has lesser adverse effects. Methods and Materials: In this article, we report a series of 6 cases of biopsy-proven fungal granuloma with varied clinical and radiological presentations who were given treatment with voriconazole for 6 months and demonstrated favorable response. Results: Out of 6 patients (4 males and 2 females), 1 was immunocompromised (DM with uncontrolled hyperglycemia). Headache was the most commonly observed symptom. Paranasal sinus and anterior cranial fossa were the most commonly affected site. Four patients received voriconazole therapy for 12 months and 1 received the same for 6 months before showing clinical resolution of disease. There was 1 death in the study group from non-related medical complications. Conclusion: Our series focuses on the correct diagnosis of fungal granuloma which can be achieved by biopsy and clinical evidence of the efficacy of voriconazole against intracranial fungal granuloma.

Tuberculosis: a great masquerader

Central nervous system tuberculosis caused by Mycobacterium tuberculosis is the most severe form of tuberculosis, accounting for 1% of all TB cases. Intracranial tuberculosis can present as Tuberculous meningitis, Tuberculous encephalopathy, Tuberculous vasculitis, CNS tuberculomas and Tuberculous brain abscess. Here authors present a case of a 10-year-old girl who presented with insidious onset of early morning vomiting, excessive sleepiness with classical neuroimaging findings of intracranial tuberculosis. Authors emphasise that intracranial tuberculoma should be considered in the differential diagnosis of any intracranial space-occupying lesion with or without pulmonary involvement.

Abstract B17: An mRNA signature that accurately discerns gliomas from healthy individuals

Abstract Diagnosis of suspected cases of gliomas such as intracranial space-occupying lesions (ICSOLs) is based on histopathologic analysis of tumor tissue obtained by invasive biopsies, which are, however, associated with risk of serious complication, high rates of mortality, procedural expenses, sequelae, and other risks. Liquid biopsy (LB)-based noninvasive approaches for diagnosis of gliomas based on circulating tumor biomarkers in peripheral blood have hence gained considerable interest. We describe the discovery of a unique 20 exosomal mRNA signature that can discern gliomas from healthy individuals. We obtained 15 mL of peripheral blood by venous draw from 222 individuals, among whom 47 had confirmed diagnosis of gliomas and 175 were asymptomatic. Exosomes were enriched from peripheral blood and were used for isolation of mRNAs. Exosomal mRNAs were used for expression analysis of 20,802 gene transcripts, including 18,574 coding genes and 2,228 noncoding genes based on University of California Santa Cruz (UCSC) hg19 annotation. Differentially expressed mRNAs were analyzed using a machine learning algorithm to identify transcripts that were unique to or uniquely absent in known cases of gliomas and in healthy individuals. The machine learning algorithm identified a 20-mRNA signature that discerned gliomas from healthy individuals with high sensitivity (87%) and specificity (95%) with an overall accuracy of 94%. The differentially expressed transcripts included MST4, RARRES3, TARP, IL32, PPP3CC, RSL1D1, RSL24D1, EIF4B, ARHGEF3, DENND2D, EVL, SEC11A, RPL22L1, HIST1H1C, IRF8, SOS2, GLTSCR2, GIMAP7, HIST1H4D, and CDK11. These differentially expressed transcripts are potentially involved in various functions such as tumor suppression, protein phosphorylation-dephosphorylation, signal transduction (ligand binding), and cell cycle regulation. Our data indicate that exosomal mRNA profiling is a viable approach for discerning suspected cases of gliomas from healthy individuals. The noninvasive nature of this approach coupled with high sensitivity and specificity favor potential clinical application. Citation Format: Sachin Apurwa, Pooja Fulmali, Dadasaheb Akolkar, Darshana Patil, Sushant Pawar, Sneha Puranik, Vipul Todarwal, Akshay Ainwale, Pradip Devhare, Vineet Datta, Cynthe Sims, Ajay Srinivasan, Rajan Datar. An mRNA signature that accurately discerns gliomas from healthy individuals [abstract]. In: Proceedings of the AACR Special Conference on Advances in Liquid Biopsies; Jan 13-16, 2020; Miami, FL. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(11_Suppl):Abstract nr B17.

A cross sectional study of prevalance, clinical profile and CT scan features of intracranial space occupying lesions

Introduction: Intracranial space occupying lesion (ICSOL) are infective and non-infective conditions, which can infect and occupy space in brain parenchyma. These ICSOL produce characteristic symptom and signs. If these symptom and signs are identified at an early stage of disease, more than half of these ICSOL are amenable to treatment Objective: Our study was done to identify the incidence of ICSOL in our city, along with the various co factors such as the gender, age socioeconomic condition and other risk factors. We also determined the prognosis of various ICSOL and Materials and Methods: Patients admitted in RKDF Medical College and Hospital, Bhopal in the department of Medicine, Neurology and Neurosurgery department with history and clinical features suggestive of intracranial space occupying lesion. Results: The study sample size included 30 patients, Of the 30 patients studied, 17 were male and 13 were female patients. Infective ICSOL was found to be more common in young age, while non infective was more common in old age. Common infective(16) causes, were Neurocysticercosis, Tuberculoma, Toxoplasmosis and Brain abscess. Non infective ICSOL accounted for 14 cases. Common non infective ICSOl were Glioma meningioma had the second highest incidence. Conclusion: The prevalence of ICSOL was found to be around 0.01%. Infective SOL was found to be more common in males during second and third decade. While Non infective SOL was found to be more common in females during sixth and seventh decade. ICSOL were associated with features of raised ICT, seizure or focal neurological deficit.. Radiologically, they were characterized by multiple or single well circumscribed ring-enhancing lesion. Aims and Objectives: 1: To find out the prevalence of intracranial space occupying lesion (ICSOL) and different causes of intracranial space occupying lesion in RKDF Medical college hospital and research center Bhopal during one year period between 01/03/2018 - 28/02/2019. 2: To find

Periotic congenital cholesteatoma – A rare case report

Congenital cholesteatoma is a rare entity and cholesteatoma surrounding the entire otic capsule and involving petrous apex is even rarer. The condition may remain hidden for a long duration destroying the temporal bone and might present as an intracranial space-occupying lesion, loss of hearing, facial nerve palsy without significant otoscopic findings. We report a case of thirty-three years old female who presented with facial palsy and hearing loss for 7 months without any history of ear discharge. Possibility of congenital cholesteatoma was sorted based on clinical and radiological features. Transotic approach was done for clearing the disease. Congenital cholesteatoma should be considered as a differential diagnosis in any patient with unexplained otological signs and symptoms. Radical excision is the mainstay of treatment. Keywords: Congenital cholesteatoma, Facial nerve palsy, Hearing loss, Petrous bone.

Analysis and relevance of electroencephalograpic changes in intracranial Space Occupying Lesions (ICSOL)

Analysis and relevance of electroencephalograpic changes in intracranial Space Occupying Lesions (ICSOL)

The Functional Outcome of Spontaneous Hypertensive Supratentorial Intracerebral Haemorrhage after Surgery

This study was to determine the different parameters that affect the outcome and the functional recovery after surgical evacuation of spontaneous hypertensive supratentorial intracerebral haemorrhage. This cross-sectional analytic study was conducted in the Department of Neuro- surgery, Shaheed Suhrawardy Medical College Hospital, Dhaka, Bangladesh during a period of 4 years from January 2016 to December 2019 and total 96 patients were included in this study. Patients with post-traumatic hematomas, intracranial space-occupying lesions with bleeds, haemorrhagic transformation of an ischemic stroke, vascular malformations, aneurysms, and infratentorial haemorrhages were excluded from the study. Decompressive craniotomy and evacuation of clot was performed in most of the cases. The outcome of the patients was categorized according to the Glasgow Outcome Scale. Outcome was classified as “favourable” if the Glasgow Outcome Scale (GOS) score was 5 or 4, and classified as “unfavorable” if GOS score was 3 or less. The mean age of the patients was 57.99±12.74 years with male and female ratio was 1.66. The mean blood volume was 28±19.99 cc and all patients were hypertensive. There was significant difference (p &lt;0.001) in outcome in relation of age and volume of blood. Age &gt; 70 years, GCS &lt; 8 on admission, clot volume above 40 cc, and intraventricular extension remain the most consistent predictors of mortality and poor outcome following surgical evacuation of spontaneous supratentorial intracerebral hematoma. The present study could only assess mortality and the functional outcome. Since a proportion of survivors had an unfavorable outcome, quality of life measures is important and need to be addressed in future studies.