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Biomedical subjects

Naim-Ur-Rahman

Publications and source records attributed to Naim-Ur-Rahman.

At least 19 recordsLinked to original sources
PubMed1999

Atypical forms of spinal tuberculosis: case report and review of the literature.

OBJECTIVE: The object of this report is to highlight some of the less known atypical features of spinal tuberculosis (TB) in the hope of facilitating early diagnosis. Pure neural arch and sacral TB is rare and the co-existence of these two as widely separated skip lesions in the same patient is even rarer. CLINICAL PRESENTATION: An unusual case of tuberculous process affecting the sacrum as well as the neural arches of upper cervical vertebrae is presented. Neither the clinical features nor the imaging techniques, including radiography, bone scintigraphy, computed tomography, and magnetic resonance imaging, were helpful in establishing the diagnosis. The destructive lesion of the sacrum with a rectally palpable presacral mass was thought to be a chordoma or chondrosarcoma until the patient developed upper cervical cord compression with an extradural myelographic block. Development of this second destructive lesion involving the posterior spinal elements (the neural arch) led to a diagnosis of malignant spinal metastasis. The true diagnosis was only revealed by the histology of the solid tumor-like extradural mass in the upper cervical region and demonstration of acid-fast bacilli (AFB) in the lesion. Anti-TB chemotherapy resulted in complete resolution of sacral and cervical lesions as well as the neurologic deficits. CONCLUSION: Differential diagnosis of the obscure spinal lesion should include tuberculosis, specifically the atypical forms; especially because complete cure is possible with early treatment and neurologic morbidity is high in neglected cases.

Adult↗
PubMed1998

Primary midline cranial vault lymphoma simulating a parasagittal meningioma: the role of angiography in preoperative diagnosis.

Primary non-Hodgkin's lymphoma (NHL) of the skull with extra- and intracranial extension without systemic or skeletal manifestation in a non-immunocompromised patient is extremely rare. Up to date, only nine such cases have been reported in the literature and in none was the lesion located in the midline. The authors report a unique case of a primary NHL involving the midline of the cranium. The lesion presented as a slowly growing scalp swelling mimicking a parasagittal meningioma. The angiographic findings of mild vascularity in the periphery of the tumor and downward displacement of a patent superior sagittal sinus indicated that the lesion was unlikely to be a meningioma. Neurosurgeons must maintain a broad differential diagnosis in any patient with a scalp mass eroding through the skull and associated neurological symptoms or signs. An intraoperative frozen section is recommended since the identification of a lymphoma is likely to influence the neurosurgeon's decision about the extent of the surgical excision.

Adult↗
PubMed1998

Intramedullary ossified cavernous angioma of the spinal cord: case report.

A case of a heavily ossified cavernous angioma of the spinal cord along with its histological features and surgical implications is reported. The unusually dense calcification and even bone formation along with the unique eggshell-like cyst formation posed problems in diagnosis and surgical excision. This calcified vascular lesion was treated by subtotal excision.

Adult↗
PubMed1997

Neural arch tuberculosis: radiological features and their correlation with surgical findings.

Radiological features of 17 cases of neural arch tuberculosis (NAT), treated surgically by the authors, are reviewed and correlated with the operative and histopathological findings. The diagnostic accuracy of different imaging modalities in the evaluation of this rare, atypical form of spinal tuberculosis was found to be very low. Thus, the initial diagnosis was in error in 15 out of 17 of our cases. Recognition of the radiological diagnostic features of NAT is important, not only because they may mimic primary or metastatic spinal neoplasms, but also because of the surgical implications. Computed tomography (CT) and magnetic resonance imaging (MRI) features correlated most closely with the surgical findings, whereas plain spinal radiographs and myelograms were found to be non-specific and non-diagnostic.

Adolescent↗
PubMed1996

Modified coronal computerized tomographic cuts for transsphenoidal surgery. Technical note.

Computerized tomographic (CT) cuts passing through the anterior nasal spine and the most prominent part of the sellar floor (spino-sellar or SS cuts) were found to be useful in minimizing the chances of anatomical disorientation during the transsphenoidal microsurgical approach as well as in preoperative planning and selection of the length and choice of the instruments to be used. Routine preoperative SS cuts of CT scan are advised.

Adenoma↗
PubMed1996

Cranial and intracranial aspergillosis of sino-nasal origin. Report of nine cases.

This paper is an attempt at defining the most efficacious surgical and antifungal therapy for invasive cranial and intracranial aspergillosis, and is based on experience with nine non-immunocompromised patients treated and followed-up by the authors between 1983 and 1994; as well as on the summary of previously reported cases and advances in therapy of this condition. Depending on the degree of aspergillar involvement of the cranial base and intracranial structures, a classification, with implications for treatment and prognosis, is also proposed. Two patients had extracranial skull base erosion; whereas relentlessly progressive granulomas, mimicking malignancy, invaded the skull base and intracranial contents in seven cases. Of these seven patients with cranial and intracranial invasion, two died of acute intracranial haemorrhage due to fungal invasion of cerebral blood vessels. In two patients, complete surgical eradication of the disease proved impossible due to cavernous sinus involvement, while residual aspergillomas are still present in orbit and paranasal sinuses (PNS) in a further two patients in spite of multiple surgical procedures and prolonged antifungal chemotherapy (AFC). What appears to be a cure has been effected in one patient only. Multiple therapeutic strategies were used. Biopsy plus systemic AFC was ineffective, surgical drainage and debridement plus systemic AFC resulted in long-term survivals but no cure. Radical surgery in conjunction with systemic and local (intracavitary) AFC should be considered to improve an otherwise poor prognosis.

Adult↗
PubMed1996

Growing skull fractures: surgical management of difficult and atypical cases.

The authors treated and followed-up 11 patients with growing skull fractures during the last 10 years. Two atypical forms of these fractures, characterized by difficulties in surgical repair or failure of conventional procedure, were identified. Five patients required unconventional procedures to effect a cure. Thus, three required shunt surgery (ventriculoperitoneal, n = 2 and cystoperitoneal, n = 1) and two recurrent cases had a modified surgical procedure. This unique and useful method of repairing this defect is described as well.

Acrylic Resins↗
PubMed1996

Intestinal obstruction caused by extraperitoneal cerebrospinal fluid collection.

External compression caused by a massive extraperitoneal cerebrospinal fluid collection lead to intestinal obstruction in a 3-year-old child who had previously had a ventriculoperitoneal shunt for treatment of hydrocephalus. Radiological findings and ways of preventing this situation are discussed. A useful diagnostic radiological sign, the "coiling sign', indicating shunt misplacement at the peritoneal level, is also described.

Cerebrospinal Fluid Pressure↗
PubMed1996

Developmental tumour of the visual pathways. Report of an unusual case.

An unusual case of congenital hydrocephalus and visual loss due to developmental tumour of optic pathways is described. Diffuse, uniform and symmetrical replacement and enlargement of optic nerves, chiasma and optic tracts resulted in remarkable computerized tomographic (CT) scan images not yet described in the literature. Embryo-pathogenesis of this anatomical configuration of the neoplasm outlining the enlarged visual pathways in their entirety is discussed. The relevant literature is reviewed.

Blindness↗
PubMed1994

Post-operative central sleep apnoea complicating cervical laminectomy: case report.

Breathing disorders following decompressive laminectomy for cervical stenosis are rare. We report a case of postoperative central apnoea following cervical laminectomy, and discuss the aetiology, management and potential relationship between upper cervical surgery and sleep apnoea. Preoperative evaluation of respiratory function, intraoperative monitoring and caution with sedative and anaesthetic drug use is important and the need for postoperative apnoea monitoring in cases with critical upper cervical compression with compromised breathing is emphasized.

Adult↗
PubMed1994

Growing skull fractures: classification and management.

Seven patients with growing skull fractures treated between 1983 and 1993 are described. These growing fractures constituted 1.6% of all the cases of skull fractures seen during the period (a total of 449 cases). Based on aetiopathogenesis, computed tomography (CT) appearances, operative findings and management strategies required, three main types of growing skull fractures were recognized. In type I (n = 3) a leptomeningeal cyst, in type II (n = 3) damaged and gliotic brain, and in type III (n = 2) a porencephalic cyst extended through the skull defect into the subgaleal space. A combination of type I and type III co-existed in one patient. Initial head injury and neurological deficit were judged to be mild to moderate in all the seven cases. Continued growth of skull fractures correlated closely to the increasing neurological deficit in five cases. In two patients natural arrest of fracture growth at 5 and 7 months after trauma was accompanied by arrest in progress of neurological deficit. Available surgical options are discussed and general guidelines for the management are given.

Brain↗
PubMed1994

Experience with brain abscess in the central province of Saudi Arabia.

The characteristics of brain abscess in the Central Province of Saudi Arabia are outlined in this report which is a review of 22 consecutive cases that were treated at King Khalid University Hospital between 1985-1991. The incidence of brain abscess in Saudi Arabia is calculated to be 3.6 cases/500,000 population/year which is twice as high as the incidence reported from the West. There were 17 males and 5 females with an age range of 8 months-80 years (mean 29.9 years). The parietal lobe was involved in 27%, while the abscess was in the posterior fossa in 14% and multiple in another 14% of cases. The primary source of sepsis was unknown in 50%, post-traumatic in 18% and from a dental and mastoid origin in 14% of cases only. Duration of symptoms ranged between 4-30 days (mean 12 days). Fever was present in 55% of cases and epilepsy in 23%. Sixteen (73%) cases had burr hole aspiration, while 3 (14%) had craniotomy and excision, and 3 (14%) cases were managed with antimicrobial treatment only. Staphylococci were the pathogens in 27%, while streptococci were cultured in 23% cases and the culture was negative in 23%. Three (14%) cases all of which died had fungal abscesses caused by Fonsecaea pedrosoi. The mortality was 18%, good recovery in 68% and fair recovery in 14%. Follow-up was from 3 months to 5.5 years (mean 1.8 years).

Adolescent↗
PubMed1993

Systemic metastasis of medulloblastoma through ventriculoperitoneal shunt: report of a case and critical analysis of the literature.

An unusual case of medulloblastoma metastasizing through a ventriculoperitoneal shunt to the scrotum in a child with a hydrocele is presented. A review of the literature disclosed 160 cases of medulloblastoma with systemic metastases, 30 (18.7%) of them having undergone systemic shunts. Analysis of the distribution patterns of the metastases in relation to the shunt type revealed that shunts had probably provided the route of systemic spread in no more than 11 cases (6.9%). Only one of these cases had no intracranial tumor at autopsy, suggesting that the outcome was probably worsened by the systemic metastases through the shunt. In contrast, five patients had intraaxial tumor recurrence that largely determined the outcome. In the remaining five cases, information concerning the tumor within the central nervous system was not available, and it remains speculative whether these patients could have survived longer without the shunts. It is concluded that the chance of medulloblastoma metastasizing through cerebrospinal fluid shunt is quite small and has an even smaller chance of adversely affecting the final outcome of the medulloblastoma patient. Consequently, in our opinion there should be no contraindication to precraniotomy shunting if required in such patients.

Cerebellar Neoplasms↗
PubMed1992

Ventriculitis and hydrocephalus caused by Candida albicans successfully treated by antimycotic therapy and cerebrospinal fluid shunting.

A unique case of Candida albicans ventriculitis and hydrocephalus in the absence of any evidence of systemic candidiasis or immunosuppression is reported. Initial treatment with CSF shunting and intravenous antimycotic therapy appeared to have eradicated the infection. Recurrence occurred 5 months after discharge and this was treated by intravenous and intrathecal antimycotic therapy in addition to removal of the shunt system, external ventricular drainage and then replacement of the shunt. A concomitant pyogenic brain abscess responded to burrhole aspiration and antibiotics. The role of mannan antigen monitoring is discussed.

Adolescent↗
PubMed1991

Cerebello-pontine angle paraganglioma simulating an acoustic neurinoma.

An unusual case of paraganglioma arising from the internal auditory meatus and growing into the cerebello-pontine angle is reported. Clinical features, pre-operative radiological appearances and intra-operative findings were indistinguishable from those of an acoustic neurinoma. However, the paraganglionic nature of the tumour was confirmed by the electron microscopic evidence of neurosecretory features.

Adult↗