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Hickam's dictum versus ockham's razor
A 56-year-old man presented with evolving symptoms of left-sided weakness and fatigue over six months. Examination revealed spastic hemiparesis. MR brain imaging revealed confluent, oedematous white matter lesions in the right hemisphere without restricted diffusion or enhancement. Initial CSF analysis was unremarkable, including negative JC virus. Blood screen revealed a mild lymphopaenia. CT scanning of the viscera showed pulmonary changes which revealed, via transbronchial biopsy, non-caseating granulomata suggesting pulmonary sarcoidosis. High dose prednisolone was commenced following which the weakness improved. Metho...
Source: Journal of Neurology, Neurosurgery and Psychiatry - November 14, 2016 Category: Neurosurgery Authors: Marchant, R., Bunting, E., Barritt, A., Good, C., Adams, N., Merve, A., Wickremaratchi, M. Tags: Immunology (including allergy), Neuroimaging, Stroke, Radiology, Surgical diagnostic tests, Radiology (diagnostics) ABN Annual Meeting, 17-19 May 2016, The Brighton Centre, Brighton Source Type: research

Differential diagnosis of stroke: Subacute leukoencephalopathy following high-dose methotrexate therapy in a young patient with osteosarcoma
We describe the case of a thirty-year-old man with a subacute leukoencephalopathy following high-dose methotrexate treatment which resembled a stroke in terms of clinical presentation and MR-tomography.
Source: Interdisciplinary Neurosurgery - February 16, 2016 Category: Neurosurgery Source Type: research

Differential diagnosis of stroke: Subacute leukencephalopathy following high-dose methotrexate therapy in a young patient with osteosarcoma
Publication date: Available online 10 November 2015 Source:Interdisciplinary Neurosurgery Author(s): Viktoriya Brajnik, Oliver Kastrup
Source: Interdisciplinary Neurosurgery - January 21, 2016 Category: Neurosurgery Source Type: research

Cervical aspergillosis with dissemination to the central nervous system: Case reports and review of the literature.
CONCLUSION: IA must be considered a possibility whenever an immunocompromised patient presents with a new brain lesion. These lesions require surgical evacuation, a procedure that allows for diagnostic confirmation and enhances prognosis. Appropriate anti-fungal therapy must be started as soon as the diagnosis is confirmed. In addition, the patient's neurological exam must be repeated and images obtained periodically to monitor treatment and detect possible recurrences. PMID: 26600985 [PubMed - as supplied by publisher]
Source: Surgical Neurology International - November 25, 2015 Category: Neurosurgery Tags: Surg Neurol Int Source Type: research

Rapidly Fatal Internal Carotid Artery Mycotic Aneurysm Rupture in a Rheumatoid Patient Taking a TNF-α Inhibitor: Case Report and Literature Review
Conclusions Although fungal mycotic aneurysms of the ICA are rare, their incidence may increase with the expanded use of immunosuppressive medications. Patients with rheumatoid arthritis who take potent immunosuppression regimens may be prime candidates for mycotic aneurysms because they often have two favoring conditions: atherosclerosis and immunosuppression. These ICA aneurysms carry a high mortality rate, so early diagnosis and aggressive therapy, potentially by endovascular trapping/vessel occlusion coupled with long-term antifungal therapy, is essential.[...]Georg Thieme Verlag KG Stuttgart · New YorkArticle in Th...
Source: Journal of Neurological Surgery Part A: Central European Neurosurgery - July 21, 2014 Category: Neurosurgery Authors: Bowers, Christian A.Saad, DanyClegg, Daniel O.Ng, PerryClayton, FredericHaydoura, SouhaSchmidt, Richard H. Tags: Case Report Source Type: research