Concurrent Inverted Papilloma and Squamous Cell Carcinoma with Intradural Extension Presenting with Frontal Lobe Syndrome

Inverted papilloma is an uncommon tumor mostly arising from the lateral wall of the nasal cavity and displays a benign but locally aggressive behavior. Intracranial extension is an extremely rare presentation of inverted papilloma. Extension occurs either as a benign lesion or due to malignant transformation. We report a case of concurrent inverted papilloma and squamous cell carcinoma presenting with epistaxis and recent-onset altered behavior and memory impairment. After literature review of similar cases having inverted papilloma with intracranial extension, we could identify a total of 12 cases, most of which were recurrences of a primary inverted papilloma that were resected before extension into the cranial cavity. Most cases were of extradural extension, and intradural spread resulted in poor prognosis on follow-up. Concurrent inverted papilloma and squamous cell carcinoma extending into the anterior cranial fossa and frontal lobe is a very rare clinical entity and can present as frontal lobe syndrome.

Median arcuate ligament syndrome in a patient with frontal lobe syndrome

A boy aged 19 years presented to emergency room with severe postprandial upper abdominal pain and recent significant weight loss, with history of decompressive craniotomy for post-traumatic frontal lobe haemorrhage. CT scan revealed an acute indentation of coeliac artery with high-grade stenosis and post-stenotic dilatation, diagnostic of median arcuate ligament syndrome (MALS). MALS, a diagnosis of exclusion, is identified using patient’s accurate symptomatic description. Exclusion of other causes of abdominal angina in a patient with frontal lobe syndrome was a challenging job, as they lack critical decision-making ability. Hence, the decision to proceed with the complex laparoscopic procedure was made by the patient’s parents and the surgeon, with the patient’s consent. Laparoscopic release of the median arcuate ligament resulted in relief of the patient symptoms much to the relief of his parents and the surgeon.

Purely Neuro-endoscopic Transventricular Approach for Cystic Craniopharyngiomas

Background and Importance: Craniopharyngiomas are tumors made up of mixed components which can present intraventricular cystic portion. The aim of our work is to evaluate the outcome of the endoscopic marsupialization as a surgical approach. Methods and Materials/Patients: We report 11 cases presenting craniopharyngioma with intraventricular cystic portion inducing hydrocephalus managed at Neurosurgery Unit of Fann Hospital between June 2013 and June 2017. Endoscopic marsupialization was realized for all patients with a rigid neuroendoscope Karl Storz. Results: The mean age of cases was 30.18 years with a ranged 07-69. There was a male predominance with a sex ratio of 1.75. All patients were suffering from an intracranial pressure syndrome. Lowering visual acuity including two (02) blindness cases was found in patients under 15 years. Frontal lobe syndrome was found in all patients of more than 50 years. A cerebral CT scan was realized for 9 patients and an MRI for 4 patients. A cystic marsupialization with biopsy was realized by precoronal approach. Fluid looked like “waste oil” for 9 patients. Ventriculocisternostomy of the 3rd ventricle was realized in 2 cases. Progress was favorable with intracranial pressure signs disappearance in 8 cases. We noticed 3 failures with cyst persistence at control CT Scan. Three patients had a recurrence, requiring revised marsupialization complicated by death in 1 case. Conclusion: Endoscopic marsupialization represents a seductive technique which is an easy and reproducible treatment for intraventricular cystic craniopharyngioma.

Behavioural changes as the first manifestation of a silent frontal lobe stroke

A 67-year-old man was admitted to our hospital after his relatives found him to have severe personality and behavioural changes. His behaviour was inappropriate and uninhibited. The patient reported no symptoms and he showed poor insight into his own behaviour. Neuroimaging showed an orbitofrontal lesion, due to an infarction of the anterior cerebral artery. The patient was diagnosed with frontal lobe syndrome.

Predicting progression in the late onset frontal lobe syndrome

ABSTRACTA late onset frontal lobe syndrome (LOF) refers to a clinical syndrome with apathy, disinhibition, or stereotypical behavior arising in middle or late adulthood. Diagnostics are challenging, and both clinicians and patients need reliable predictors of progression to improve clinical guidance. In this longitudinal multicenter and genetically screened prospective study, 137 LOF patients with frontal behavior (FBI score≥11) and/or stereotypical behavior (SRI≥10) were included. Progression was defined as institutionalization, death, or progression of frontal or temporal atrophy at magnetic resonance imaging (MRI) after two years of follow up. Absence of progression at MRI in addition to stable or improved Mini Mental State Examination and Frontal Assessment Battery scores after two years was indicative for non-progression. The presence of stereotypy and a neuropsychological profile with executive deficits at baseline were found to be predictive for progression, while a history and family history with psychiatric disorders were predictors for non-progression. The combination of these clinical markers had a predictive value of 80.4% (p < 0.05). In patients presenting with late onset behavioral symptoms, an appraisal of the rate of deterioration can be made by detailed mapping of clinical symptoms. Distinction of progressive discourses from non-progressive or treatable conditions is to be gained.