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A rare case of epidermoid of the third ventricle was experienced. The patient was a fifteen years old boy, who had been hospitalized four years earlier due to acute hydrocephalus. The ventriculography at that time revealed a large cystic tumor containing heterogeneous mass filling the entire third ventricle, which seemed to be a dermoid or epidermoid. Ventricular drainage and ventriculo-peritoneal shunt were performed and he was discharged one month later without any complaint. On February 10th 1983, he was re-admitted with severe headache, nausea and showing markedly increased intracranial pressure and right hemianopsia. Computerized tomography scans demonstrated a large round low density mass in the entire third ventricle extending into the prepontine cistern. Radical operation was performed by the anterior transcallosal approach. After dissecting the interhemispheric fissure, a longitudinal incision about 15 mm long was made in the anterior part of the corpus callosum and the tumor was removed. Mild diabetes insipidus and subdural effusion appeared postoperatively. The patient was discharged on April 7th with right hemianopsia and returned to school. The anterior transcallosal approach seemed to be a good operative procedure in such large third ventricle tumor cases since it allowed excellent exposure of the third ventricle and minimized postoperative neurological deficits.
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PMID:[Epidermoid of the third ventricle--report of a case]. 398 97

A forty four year-old woman had had an amenorrhea-galactorrhea syndrome for 3 months when a Korsakoff's syndrome with headache suddenly appeared. Neuroradiological investigations revealed a hematoma involving the anterior part of the IIIrd ventricle. After a short period of neurogenic hypernatremia the lesion disappeared with the development of a spontaneous ventriculocisternostomy. Simultaneously, the Korsakoff's syndrome decreased until it went off almost completely, but a diabetes insipidus appeared and the hyperprolactinemia remained unchanged. Four years later, those are the only symptoms which are still present. This case, particular by its aetiology and evolution, illustrates well the possibility of functional Korsakoff's syndromes.
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PMID:[Acute transient Korsakoff's syndrome caused by hematoma of the floor of the 3rd ventricle]. 401 45

The authors described a case of primary intracranial endodermal sinus tumor (EST), and presented a review of 24 reported cases. From the middle of December 1981, this 15-year-old boy experienced progressive diplopia. At the other hospital, partial removal of the intrasellar tumor was performed by a left frontotemporal craniotomy approximately 2 months after the onset of symptoms. The histological diagnosis was suspected to be a pituitary adenoma, and thereafter, 60Co irradiation was carried out for about a month. On June 5th. 1982, the patient was admitted to the Kochi Medical School Hospital, because of increasing headache with diplopia, hoarseness, dysphagia and limitation of tongue movement. On admission, he had a small stature for his age with moderate diabetes insipidus. Neurological examination showed left abducens, glossopharyngeal and vagal nerve palsies in addition to bitemporal hemianopsia. CT scans revealed a heterogenously enhanced high density mass lesion behind the dorsum sellae with an extension from the upper clivus to the sphenoid sinus. Cerebral angiograms showed posterior displacement of the basilar artery. In the endocrinological examination, panhypopituitarism was recognized with a high level of serum alfa-fetoprotein (AFP). While, serum carcinoembryonic antigen (CEA) and human chorionic gonadotropin (HCG) were in normal range. On July 1st. 1982, a left suboccipital craniectomy was performed. The tumor existed mainly in the extradural space along the clivus, and only a small intradural portion of the tumor was excited.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Primary intracranial endodermal sinus tumor with a skull base extension--a case report]. 620 69

The authors report a case of histiocytosis X which presented with neurological manifestations in a 20 year old man: episodes of headache with vomiting, followed, three months later, by the development of paralysis of the right 6th and 7th cranial nerves associated with nystagmus. The CT scan revealed a tumour-like lesion on the floor of the IVth ventricle with a long axis of 18 mm. The chest x-ray revealed diffuse nodular opacities in the pleural and apical regions with features suggestive of histiocytosis X. The diagnosis was confirmed by surgical biopsy of the typical pulmonary nodules which were rich in histiocytes with X bodies on electron microscopy. The neurological signs disappeared after one month of treatment with Prednisone (1 mg/kg/day) and Vincaleukoblastine (10 mg/week). By the 3rd month, the pulmonary lesions were reduced and the intra-ventricular formation had regressed by 40%. In the authors' series of 29 cases of confirmed histiocytosis X in adults, the present case is the only one with a clinical neurological presentation, apart from 3 cases of diabetes insipidus. A review of the literature confirms the rarity of this type of presentation. The suggestion of the diagnosis by the chest x-ray appearance enabled a dangerous neuro-surgical operation to be avoided.
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PMID:[Cerebral and pulmonary histiocytosis X. Neurologic manifestations disclosing a pseudotumoral formation on the floor of the 4th ventricle]. 633 82

A retrospective analysis of 40 cases with histiocytosis X was undertaken to find out the course of primarily localized disease, and the prognosis of children with initially disseminated disease. Bone lesions recurred in nine of 23 children with localized histiocytosis X. In eleven cases other organ manifestations occurred as well; in four cases without bone relapse. After an observation period of 1-14 3/12 years, nine of 22 children in remission suffer from long-term sequelae like diabetes insipidus, convulsion, extrahypothalamic CNS-disease, orthopedic disability, growth retardation, dystrophia adiposogenitalis , and chronic headache. Four of 17 children with disseminated histiocytosis X died. Our results and others from the literature indicate various risk factors to be prognostically significant. 1) age less than 2 years 2) involvement of spleen and/or lung 3) elevated Lahey-score 4) dysfunction of the hematopoietic system, liver, and/or lung 5) histologic feature resembling malignant type 6) no response to therapy 7) severely affected general health. These factors can be evaluated initially. Considering our own experiences and some risk factors we suggest the definition of four risk groups: 1.) localized histiocytosis X of bone, lymph nodes or skin; 2.) disseminated histiocytosis X with benign histologic type and Lahey-score of one or two; 3.) Lahey-score of 3-8; 4.) disseminated histiocytosis X with dysfunction of certain organ systems and/or malignant histology.
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PMID:[Histiocytosis X--a retrospective analysis of 40 cases with localized or disseminated disease]. 661 Jan 8

A case of cavernous angioma at the lateral wall of the third ventricle which was totally removed with interhemispheric trans-lamina terminalis approach is reported. A 40-year-old male had a slowly progressive onset of partial diabetes insipidus and headache with no neurological deficit . CT scan revealed a high density area at anterior third ventricle. The tumor was diagnosed ectopic pinealoma because of CT findings and clinical symptoms. Irradiation and chemotherapy ( RAFP therapy) was performed to this lesion. After two months, his clinical symptoms disappeared. CT scan showed decrease of the density of the region at this point. He was discharged with no symptom. After a half year, he suddenly complained of right homonymous hemianopsia with headache. CT scan showed that the high density area became larger to left posterior than that of half year before. Left carotid angiogram showed no mass lesion and no abnormal vessel. Operation was performed with interhemispheric trans-lamina terminalis approach using bifrontal craniotomy. Operative findings revealed that the tumor situated at the lateral wall of the third ventricle, had rough surface with reddish colour, and old and fresh blood clots inside the tumor. The tumor was carefully dissected without brain damage and was totally removed. The histological findings was compatible with cavernous angioma. Post-operative CT scan showed no high density area. He was discharged with no neurological deficit without right homonymous hemianopsia. Cavernous angioma of anterior third ventricle is very rare.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[A total removal case of cavernous angioma at the lateral wall of the third ventricle with interhemispheric trans-lamina terminalis approach]. 673 98

Primary germ cell tumors confined to the optic nerves and chiasm without suprasellar extension are uncommon. These tumors appear similar to chiasmatic gliomas on both computed tomography and magnetic resonance imaging, potentially resulting in treatment errors if the diagnosis is based on radiologic criteria alone. Unlike chiasmatic gliomas, suprasellar germinomas characteristically present with a clinical triad of endocrine abnormalities, diabetes insipidus, and visual complaints. We report the case of a 9-year-old boy who presented with a 5-month history of fatigue, 16-pound weight gain, polydipsia, polyuria, visual complaints, and intermittent headache. Imaging studies demonstrated findings consistent with a glioma of the chiasm with infiltration into the optic tracts. At surgery, the chiasm and optic tracts were diffusely enlarged with no other suprasellar abnormalities. Biopsy specimens were characteristic of germ cell tumor. Based on this result, the patient received a treatment regimen different from that used at our institution for chiasmatic gliomas. We feel it is imperative to biopsy chiasmatic lesions that radiologically appear to be gliomas if symptoms do not adhere to the classical clinical presentation.
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PMID:Primary diffuse chiasmatic germinomas: differentiation from optic chiasm gliomas. 749 60

A 29-year-old woman presenting with persistent headache and oligomenorrhoea was found to have a pituitary adenoma which was treated surgically. Postoperatively she developed diabetes insipidus which resolved on treatment with desmopressin acetate. She represented 11 days post surgery with nausea and vomiting and inappropriate antidiuresis was diagnosed in an infectious diseases unit. On re-admission to our unit cranial diabetes insipidus was confirmed by water deprivation. This case demonstrates the need for careful monitoring of patients after pituitary and suprasellar surgery or head injury.
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PMID:The triple-phase response--problems of water balance after pituitary surgery. 756 42

Pituitary apoplexy into nonadenomatous tissue is extremely rare. The authors describe a 20-year-old woman with symptomatic pituitary hemorrhage into an apparently intrasellar malignant teratoma, which caused headache, visual impairment, involvement of III, IV, VI, and 1st division of the V cranial nerves, and hypopituitarism. Diabetes insipidus had developed previously. Magnetic resonance scans had a high-intensity signal in the pituitary on T1- and T2-weighted images, and lack of the signal of the posterior pituitary. Transsphenoidal approach, radiotherapy, and chemotherapy management did not preclude a fatal outcome.
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PMID:Pituitary apoplexy into nonadenomatous tissue: case report and review. 763 46

Erdheim-Chester disease is related to a tissue infiltration of foamy histiocytes. Results of immunoperoxydase stains for S-100 and T6 protein, the Langerhans cells antigen, is negative. It is a multisystemic disease, and it particularly involves bones and orbit. The visual prognosis is threatened, and the disease may lead to a fatal issue. Treatments have poor effects on the disease. Patients sometimes have good symptomatic response to corticotherapy. This case was revealed by headaches and diabetes insipidus. The orbital infiltration was asymptomatic.
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PMID:[Orbital Erdheim-Chester disease]. 775 61


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