Spinal hydatid disease is a rare form of hydatid disease caused by the larval form of Echinococcus granulosus (E. granulosus). Dogs are primarily the definitive hosts of E. granulosus with man and sheep serving as intermediate hosts. Spinal HD contributes to approximately 45 % of all skeletal hydatid disease cases. Spinal HD is perhaps the worst form of parasitic infestations associated with morbidity requiring surgical correction. Braithwaite and Lees have classified spinal hydatids into five types (1) intramedullary (2) intradural extramedullary (3) extradural intraspinal disease (4) vertebral hydatid (5) paravertebral hydatid. When hydatid disease from spinal canal extends into retroperitoneal space through the neural foramen, it gives dumbell formation (similar to nerve sheath tumors). Symptoms of hydatid are mainly due to compressive effects of the cyst, low back pain accompanying motor weakness, sensory disturbances, bowel and bladder disturbances and cauda equina syndrome. Extensive vertebral hydatidosis can cause fractures of vertebrae. Serology tests are used in diagnosing suspected cases of hydatid disease. MRI with soft tissue detail is more preferable than other modalities in diagnosing spinal hydatid. Successful treatment of spinal hydatid disease necessitates adequate neuroimaging evaluation, careful surgical removal without spillage of cystic components and adding adjuvant chemotherapy in few cases is the mainstay of treatment. Sometimes when it is difficult to retrieve all the cysts in toto, debulking is advised.
Background: Giant colloid cysts (size > 3 cm) are very rare with only few reported cases in the literature. Case presentation: We report a case of 44 year female who presented with features of raised intracranial pressure, memory and gait disturbances. CT and MR imaging showed a large colloid cyst at foramen of Monro leading to obstructive hydrocephalus. The patient underwent right interhemispheric transcallosal-transforaminal approach and complete excision of the cyst. Conclusions: For a large size of colloid cyst complete surgical excision is recommended. However deep midline location, proximity to the vital structures and giant size of the lesions make surrounding vital structures vulnerable for injury.
Cavernous sinus thrombosis (CAST) is a rare and potentially fatal complication following tooth extraction. In present case of a 55 year old male known case of diabetes mellitus underwent tooth extraction. After 5 days, he noticed swelling around the cheek, high grade fever, and frontal headaches. Diagnosis of alveolar abscess after inspection was made, for which incision and drainage was done. Next morning, he noticed that the cheek swelling progressed to left eye and there was CT brain was performed which showed hyperdense areas in cavernous sinus on left side and left sylvian fissure with hemorrhagic venous infarct in left temporal and frontal lobes. More caudal sections revealed mucosal thickness in left maxillary and ethmoidal sinuses, edema over cheek, preseptal orbital swelling, retro-orbital fat stranding and axial proptosis. A diagnosis of rhino-orbital infection from dental source with cavernous sinus extension causing left temporo-frontal hemorrhagic venous infarction was made Emergency surgery for decompression was performed but the patient did not responded to the treatment and succumbed to the infection. This case is a reminder that in patients with uncontrolled diabetes, undergoing dental procedures should be carefully dealt with appropriate antibiotic cover. Early signs like unilateral facial edema, orbital chemosis, edema, and proptosis should raise high index suspicion of cavernous
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