Background Nocardia cyriacigeorgica was first described in 2001. It is an emerging pathogen that mainly affects immunocompromised patients. A brain abscess caused by N. cyriacigeorgica has been reported only in immunocompromised hosts. We present a rare case of brain abscess caused by N. cyriacigeorgica in an adult male receiving low dose steroids. Case presentation A 75-year-old male weekend gardener without an immunocompromising condition presented with neurological complaints that were initially attributed to an ischemic stroke. Due to the unusual presentation and rapid progression, his condition was thought to be caused by a cerebral space-occupying lesion. He underwent an emergent right-sided parietal craniotomy and the histopathological report of the specimen was an abscess caused by N. cyriacigeorgica. The patient received appropriate antibiotic treatment and completely recovered without sequelae. Conclusions Nocardia species are a rare cause of brain abscess in immunocompetent patients. Their clinical presentation can mimic other more common cerebral diseases, such as brain tumors (primary and secondary) and stroke. The possibility of an abscess caused by N. cyriacigeorgica should also be considered in the differential diagnosis in an immunocompetent patient.

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OBJECTIVE Ventriculoperitoneal shunt placement is the most common treatment for hydrocephalus. However, most patients will require multiple shunt revisions over time. In cases of peritoneal shunt failure, the pleura and heart are alternative distal sites. Sinus shunts have been described but are not commonly used. The potential vascular complications, as well as inexperience with these shunts, make these tools less attractive. The goal of this study was to share the authors’ experience with ventriculosinus shunts (VSSs) in selected patients. METHODS Between December 2018 and February 2022, a total of 7 patients (1 adult, 6 children) underwent 11 surgeries for the placement of a VSS at the authors’ institution. Data regarding complications and shunt function were retrospectively collected and assessed, and a review of the literature was conducted. RESULTS The mean (± standard deviation) age at surgery was 11.9 ± 12.8 years (range 1.3–38.2 years). All patients had had previous shunt systems that failed and systemic conditions that made other distal sites less desirable. In all cases, a low-pressure differential valve was installed. Over a mean follow-up of 18 ± 9.8 months (range 9–39 months), 4 of the 7 patients underwent additional shunt revisions, 2 of whom had shunts placed at other sites. One patient had symptomatic partial sinus thrombosis, managed conservatively. During follow-up, 5 patients showed improvement in their symptoms of high intracranial pressure using the VSS. There were no severe complications of air embolism, bleeding, or infection. CONCLUSIONS VSSs may have a role to play in selected patients in whom more commonly used distal shunt locations have failed. Significant complications with these shunts are rare. Additional experience is needed to better understand the ideal catheter and placement locations.

Background: Intracranial epidermoid cysts are rare benign lesions. Cases of malignant transformation (MT) into squamous cell carcinoma (SCC) have rarely been reported. We present a case of concurrent occurrence of SCC diagnosed during primary resection of epidermoid cyst (EC) and a relevant literature review. Case Description: A 61-year-old patient was diagnosed with a right cerebellopontine angle (CPA) lesion after suffering from vertigo, diplopia, and right trigeminal (V2) hypoesthesia. Brain magnetic resonance imaging (MRI) showed a lesion consistent with an EC, demonstrating restricted diffusion with rim-enhancing area on the medial side of the cyst. During resection, two different tissue pathologies were observed, one consistent with an epidermoid (which was completely removed) and an additional firm tissue adherent to the brainstem, preventing gross total resection. Pathological evaluation confirmed two separate histologies – epidermoid and SCC. The patient never recurred to complete the recommended radiotherapy. Eleven months following surgical resection, a follow-up MRI showed local massive recurrence of the enhancing lesion. He was, further, treated with radiotherapy and is currently being followed up. Conclusion: MT of an intracranial EC to SCC is rare and associated with poor prognosis. SCC may be found incidentally at time of primary resection or arise from a remnant of previously operated EC. Thus, aggressive complete resection should be intended, and separate pathological specimens should be sent from any abnormal region of the tumor.