Concluded Case

Cystic dialatation of Rt frontal & Lt temporal horns of lateral vent

New case 10 yr old girl presented with deterioration of higher functions in the form drowsiness with reduced food intake for one week.No fever.No seizures. She had undergone surgery for Medulloblastoma 5 yrs ago and was on VP shunt.3 yrs ago she developed shunt infection with brain abcess, treated and removed the shunt. Since surgery she is moving with help only ,ataxic.. On exam tendency to sleep,on shaking answering simple questions.Gaze evoked nystagmus in all directions. Moving all limbs .Spasticity noted both lower limbsDtrs bilaterally hyperactive with extensor plantars.On standing she is ataxic . Diagnosis and management?. Case is under Neurosurgeon

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Concluded answer

Thanks for all answers Ventriculomegaly with asymmetrical cystic dialatation of frontal horn of Rt lateral ventricle and temporal horn of left lateral ventricle.Presence of differential density noted in the frontal horn of Rt lateral ventricle suggestive of Trapped ventricle, possibly die to adhesions. * Extensive hypodensity of white matter involving the periventricular region and extending up to subcortical U fibers,no evidence of effacement of sulci - indicating old gliotic area.. * Gliotic changes noted in both cerebellar hemispheres and vermis in midline. Cysto-perotonial shint done. CSF- Normal . Child is discharged , better.

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Thanks for all answers Ventriculomegaly with asymmetrical cystic dialatation of frontal horn of Rt lateral ventricle and temporal horn of left lateral ventricle.Presence of differential density noted in the frontal horn of Rt lateral ventricle suggestive of Trapped ventricle, possibly die to adhesions. * Extensive hypodensity of white matter involving the periventricular region and extending up to subcortical U fibers,no evidence of effacement of sulci - indicating old gliotic area.. * Gliotic changes noted in both cerebellar hemispheres and vermis in midline. Cysto-perotonial shint done. CSF- Normal . Child is discharged , better.

Are they abcesses? If so what was done for cystic lesions. Your clip&your interest in cases in curofy is great.
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Spread of medulloblatoma is known Malignant Corebiopsy HP Chemo radio therapy after oncologist opinion

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Seems infective lesion with perilesional edema Ventriculitis ? With multiple small abscess As of now urgent drainage of same required Although prognosis remain poor

Now reduce icp medically in icu. Shunt may help&if gc improves radiotherapy can be tried

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Looks like original surgery was successful. Now 5years elapsed

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Multiple abscesses ? Fungal due to chemo&immuno supresson. Tapping them may reduce icp

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Is the patient on chemo madam

Not on chemo ,only single antiepileptic drug
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Multiple mets can occur intracranial&intraspinal

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