Pterional craniotomy with total resection

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Pterional craniotomy with total resection PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/27658512 of a World Health Organization grade I craniopharyngioma. He was discharged on POD 9 under dexamethasone (3 mg three times daily) with subsequent dose tapering. On POD 18, the patient experienced fever and was drowsier than usual. A computed tomography scan showed a right frontal subdural collection; an empyema could not be excluded (Fig. 2a). However, an MRI showed no sign of empyema but instead leptomeningeal enhancement and lesions compatible with acute ischemic changes in the right corona radiata and centrum semiovale (Fig. 2b). CSF analysis showed lymphocytic meningitis with 188 M/l leucocytes, 92 lympho-monocytes, 26 M/l erythrocytes, 1.25 g/l protein, 1.6 mmol/l glucose, and 4.2 mmol/l lactate. No bacteria were detected on direct examination of the fluid. He was started on IV meropenem, vancomycin, and acyclovir 15 mg/kg three times daily (POD 19). The next day, revision surgery was performed with cranial flap removal. Operative status was normal and showed no sign of empyema. Surgical samples showed no bacteria on direct examination and cultures remained negative. Broadrange PCR for bacteria on surgical samples was negative and vancomycin and meropenem were stopped on POD 22 and 27, respectively. HSV-2 DNA PCR came back positive on the CSF. IV acyclovir was continued for a total duration of 21 days and he improved rapidly. Neurological status at discharge was comparable to baseline.CaseFig. 1 Coronal FLAIR MRI sequence illustrates a Chloroquinoxaline sulfonamide diffuse leptomeningeal enhancement (arrows) after surgery of an epidermoid cyst of the right cerebellopontine angleA young girl suffered from HSV-1 encephalitis at the age of 11 months. By that time, she had predominant involvement of her right temporal lobe in the form of a multiple area of focal encephalomalacia (Fig. 3a) and exhibited clinicallyJaques et al. Virology Journal (2016) 13:Page 3 ofFig. 2 Post-surgical CT visualization of a right frontal heterogeneous collection (2a, left). MRI showed no empyema but ischemic lesions of the right deep frontal white matter (2b, right)minimal left-sided weakness. Over the years, her epilepsy had worsened and became progressively intractable. At 12 years of age, epileptic surgery was considered. She underwent a right temporal lobectomy and amygdalohippocampectomy and was discharged at POD 7 without steroids. At POD 11, she presented to the emergencydepartment for headache associated with fever. A worsening level of consciousness at POD 14 prompted a cerebral MRI that demonstrated PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/27832717 abnormal signal intensity with vasogenic edema distant from the resected area and compatible with an inflammatory process (Fig. 3b). CSF analysis revealed mild pleocytosis with 91 M/l leucocytes,Fig. 3 Sequels of HSVE at the level of the temporal lobe and right hippocampus (3a, upper left, arrows and asterisk). Post-surgical MRI shows areas of suspected encephalitis with high signal on T2 in the right frontal, parietal and temporal lobes at 3 weeks (3b, upper right), associated with hemorrhagic transformation and mass effect one month later (3c, lower left). Follow-up MRI at 45 days showed large sequelae of the temporal lobe (3d, lower right)Jaques et al. Virology Journal (2016) 13:Page 4 of96 lympho-monocytes, 837 M/l erythrocytes, 2.05 g/l protein, 1.9 mmol/l glucose and 2.7 mmol/l lactate. Empiric IV ceftriaxone and vancomycin were first initiated for presumed superficial wound infection and contiguous bacterial cerebritis. Conside.

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