We present two recent cases of toddlers who developed malignant cerebellar edema subsequent to accidental ingestion of prescription opioids. Both children presented acute neurological decline, hydrocephalus, and tonsillar herniation requiring emergent ventricular drain placement, suboccipital craniectomy, and partial cerebellectomy. Together with several other reports, these cases suggest the e...

Objective Glial fibrillary acidic protein antibody (GFAP) is a newly recognized biomarker for an immunotherapy responsive autoimmune meningo-encephalomyelitis with wide variety of clinical presentations. We report the second GFAP positive case in young man who died despite appropriate and aggressive immunomodulatory treatment. Background 29 year old previously healthy male childhood immune diso...

A retrospective case-control study based on craniometrical evaluation was performed to evaluate the incidence of basilar invagination (BI). Patients with symptomatic tonsillar herniation treated surgically had craniometrical parameters evaluated based on CT scan reconstructions before surgery. BI was diagnosed when the tip of the odontoid trespassed the Chamberlain's line in three different thr...

Little is known regarding typical neuropsychological outcomes of intracranial empyema, a rare complication of sinusitis marked by accumulation of purulent material adjacent to the brain. A 15-year-old, right-handed male presented with a 3-day history of congestion, lethargy, fever, headache, dizziness, unequal pupil dilation, and right-sided facial droop. Computed tomography revealed right-side...

Abstract Approximately 125 years ago, a group of pathologies now known as Chiari malformations was described for the first time. However, some mechanisms its formation still remain unknown. A bibliographic survey performed through search in PubMed. In 1938, it already theorized that an increase spinal cord tension could be cause malformation type 1 (CM1) tonsillar herniation. 1953, condition an...

OBJECTIVE AND IMPORTANCE 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...

Results The first patient was a 18-year-old pregnant woman. The sonographic evaluation at 26 weeks showed the presence of polyhydramnios, lemon and banana signs, and defective fusion of the spine at lumbosacral level. Magnetic resonance imaging (MRI) also revealed ectasia of the lateral and third ventricles, and herniation of the cerebellar tonsils into the spinal canal (Arnold-Chiari type II)....

OBJECTIVE To compare the effectiveness of the telovelar approach with tonsillar manipulation for approaching the recesses of the fourth ventricle. METHODS A telovelar approach was performed in 8 injected cadaveric heads. Areas of exposure were measured for the superolateral and lateral recesses. Horizontal angles were evaluated by targeting the cerebral aqueduct and medial margin of the later...