Nishant S. Yagnick, Manjul Tripathi and Sandeep Mohindra
Sandeep Mohindra and Kanchan Kumar Mukherjee
✓ The authors report a case of primary brainstem tethering, a component of a spinal dysraphic state, occurring in a 13-year-old girl. This patient also had associated hydrocephalus, a low-lying tethered cord, and a syrinx in her conus medullaris. The significance of imaging surveys of the craniospinal region and head in a case involving a low-lying tethered cord is highlighted. The insertion of a ventriculoperitoneal shunt, leading to traction on the tethered brainstem, proved nearly fatal for this patient. In cases involving a multiple-level tethered cord, the sequence of detethering should be decided on with caution. It seems prudent to detether the vital neural structure first, so as to minimize the traction force on that structure. All four previously reported cases of secondary tethered brainstem and cerebellar vermis in the literature are reviewed and compared with the present case of primary brainstem tethering. The literature describing brainstem dysfunction caused by ventricular drainage is also reviewed.
Report of two cases
Sandeep Mohindra, Rahul Gupta, Suresh Narain Mathuriya and Bishan Dass Radotra
✓The authors report on two patients with intramedullary tumors complicated by abscess formation. Both patients experienced abrupt onset of neurological deterioration and poor surgical outcome. An intratumoral abscess developed in one, whereas the other had a tumor-associated syrinx in which an intramedullary abscess developed. Such a conversion of a syrinx into an abscess has not been reported earlier. It is septicemia that underlies all such catastrophic complications; therefore, rapid neurological deterioration should always be looked on with caution and investigated with contrast-enhanced magnetic resonance imaging. Despite poor neurological outcome in such patients, urgent surgical intervention is mandatory.