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Pseudallescheria/Scedosporium boydii complex (P. boydii) is a ubiquitous fungus that shows tropism for central nervous system (CNS), blood vessels, and polymorphonuclear leucocytes ending up with a wide spectrum of diseases. There are rare cases reported with CNS involvement, mainly as brain abscess (69 %) and meningitis (9 %) [1]. Disseminated infection is mostly seen in immunocompromised patients. We herein report the first patient from Turkey with disseminated P. boydii infection involving the CNS, lungs and pancreas.

Background Ictal urinary urge is a rare autonomic symptom usually lateralizing to the non-dominant hemisphere and localizing to the temporal lobe. Case report A 12-year-old boy was referred with desire to void and contraction of the left arm. The history of the case revealed tickling and an unpleasant rising feeling in the stomach and sense of fear lasting for 1 year. He had been evaluated and treated several times with the diagnosis of gastroesophageal reflux and cystitis. His cranial MRI displayed an intraaxial mass formation on the right temporal lobe. Pathological findings were consistent with a low-grade glial mass. Conclusion Ictal urinary urge has a considerable value both for localization and lateralization of seizures.

Shaken baby syndrome (SBS) is a serious type of physical abuse characterized by sub - dural hematoma and retinal hemorrhage. This syndrome is frequently seen in children younger than 2 years of age. Most of the time it results in death or severe neurological damage. In these cases, external visible injuries are generally absent; often there no history of shaking or trauma. Clinical symptoms and findings are nonspecific. Therefore, most of the cases are missed when SBS is not considered in the differential diagnosis. In this article, we reported two SBS cases admitted to our hospital with a history of head trauma and convulsions, resulting in death in one case.

Introduction Veillonella parvula is a small, nonfermentative anaerobic gram-negative coccus. Meningitidis due to V. parvula seen extremely rare. Here we want to report the fourth case with meningoencephalitis due to V. parvula and emphasize the significance of brain biopsy in encephalitis cases with unknown ethiology. Case report A 64-year-old male admitted to the emergency room with a frontal and bitemporal headache. On physical examination, the patient was concious and oriented, his reaction time was prolonged. There was no focal neurological deficit, fever and meningeal signs. The magnetic resonance imaging scan showed hyperintensity on the T2-FLAIR weighted sequences and diffusion restriction at the same place, concordant with encephalitis. On the third day of admission, oromandibular focal motor seizures were observed. We could not define any microbiological agent by analysis of cerebrospinal fluid. Stereotactic brain biopsy performed and the bacterial culture of the biopsy material grew V. parvula . Discussion We reported the fourth V. parvula encephalitis case in the literature. The aim of this case report is to emphasize that brain biopsy should be considered in patients with encephalitis of unknown etiology.

Atypical teratoid/rhabdoid tumor (AT/RT) is a rare aggressive infantile neoplasm of uncertain origin. This study was performed to assess the clinicopathologic and immunohistochemical features of four AT/RT cases. Two cases were male and two were female, and their ages ranged from 8 to 103 months. Tumors were located in the cerebellum (two cases), frontoparietal lobe (one case), and third ventricle (one case). Histopathologically, the tumors were composed of rhabdoid cells and undifferentiated small cells mixed with epithelial or mesenchymal components. However, one of the tumors was composed predominantly of a mesenchymal component mimicking a sarcoma. Immunohistochemically, vimentin (4/4), epithelial membrane antigen (4/4), cytokeratin (3/4), smooth muscle actin (4/4), glial fibrillary acidic protein (4/4), S-100 (4/4), and synaptophysin (1/4) were positive in varying proportions, while desmin and INI-1 were negative in all the cases. All of the patients died within a mean of 14 months due to tumor progression despite the chemotherapy. Only one of our patients lived for 40 months after the diagnosis. In conclusion, AT/RTs are aggressive tumors. They can occur in a variety of locations, such as the third ventricle. Morphologically, a large spectrum can be seen, like predominantly sarcoma in appearance, but immunohistochemistry is helpful in the correct diagnosis.

The aim of this study was to assess the prognostic value of MIB-1 and p53 in the pediatric medulloblastoma group. Forty-two pediatric medulloblastoma cases diagnosed in a single institution during the past 10 years were evaluated. Follow-up data were available for 35 patients. The immunoreactivity of MIB-1 ranged from 10% to 95%; p53 immunoreactivity was found in five cases. Of the 35 patients with follow-up, 34 patients received a combination of chemotherapy and radiotherapy, while one received chemotherapy alone. The follow-up period ranged from 5 to 64 months. Of the 35 patients, 21 were alive without any evidence of recurrent disease, three were alive with evidence of recurrent disease and 11 died of disease during follow-up. The mean survival for these 11 patients was 21.9 ± 10.4 months. Of the 35 cases, 16 had MIB-1 value of 25% or lower and 19 had a value of 26% or more. Of the 16 cases with low MIB-1 value, six died of disease; of the 19 cases with high MIB-1 value, five died of disease. The statistical difference between MIB-1 and prognosis was not significant. Three of the 35 (8.5%) cases were found to be positive with p53 protein; no correlation was observed between p53 immunoreactivity and prognosis. It appears that the MIB-1 value and p53 immunoreactivity have no relation with prognosis in pediatric medulloblastomas. However, it is convenient to support these findings with large series.

PubMed ID: 18230687, Objectives: This study aimed to compare the antibacterial activity of moxifloxacin and ampicillin + gentamicin in the treatment of Listeria monocytogenes meningitis in a rabbit meningitis model. Methods: Meningitis was induced by direct inoculation of a clinical strain isolated from an immunocompromised patient (107 cfu/mL) into the cisterna magna of New Zealand rabbits. After 16 h of incubation, rabbits were separated into four groups: moxifloxacin (M), ampicillin + gentamicin (A), ampicillin + gentamicin 2 (A2) and control (C). Group M received 20 mg/kg moxifloxacin at the end of the incubation time and 5 h later by intravenous (iv) route. Group A received ampicillin (30 mg/kg/h) and gentamicin (2.5 mg/kg/h) by iv route with continuous infusion for 8 h in 36 mL of 0.9% NaCl, group A2 received the same dosage of gentamicin and ampicillin in two different 36 mL 0.9% NaCl solutions and group C did not receive any treatment. Cerebrospinal fluid (CSF) samples (0.1-0.25 mL) were obtained 16 and 24 h after induction of meningitis. Results: At the end of the 16 h of incubation, CSF bacterial counts were similar in all groups (P > 0.05). At the final stage of the study (24 h after induction of meningitis), bacterial counts in all treatment groups were significantly lower than the control group (P < 0.05). When the three treatment groups were compared, bacterial counts were found to be similar (P > 0.05). Conclusions: These data suggest that antibacterial activity of moxifloxacin is similar to ampicillin + gentamicin in the treatment of experimental L. monocytogenes meningitis of rabbits. © The Author 2008. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved., Ege Üniversitesi, The study was funded by Ege University.

For the successful microneurosurgical treatment of CP angle located pathologies, an understanding of the relationship and variations between neural and vascular structures and a certain diagnosis are the most valuable factors for surgeons. CP angle lesions have now become a visible area by advances in magnetic resonance imaging (MRI) technology. An evaluation of this area and the decision for a neurosurgical decompression procedure are easier than before. Twenty unfixed adult human cadaver specimens, that have no sign of central nervous system pathology, were obtained and dissected bilaterally at routine autopsy. The facial-vestibulocochlear (VII - VIIIth) nerve complex and the anterior inferior cerebellar artery (AICA) were identified in all specimens. Thirteen of the 40 (32.5 %) AICA were situated ventrally and fourteen (35 %) were located dorsally to the VII - VIIIth nerve complex. Thirteen (32.5 %) passed between the VIIth and the VIIIth nerve fibers. Five of the 40 (12.5 %) AICA had a loop near the nerve complex and then passed the nerves ventrally or dorsally. In an MRI study 74 adult persons (148 sides) were investigated by using three-dimensional Fourier transformation constructive interference in the steady state technique (3D FT-CISS) on a 1.5 Tesla MRI system (Siemens Magnetom, Erlangen, Germany). The results were as follows; 48 AICA (32.4 % of all 148 AICA) were situated ventrally to the VII-VIIIth nerve complex, 45 AICA (30.4 %) were situated dorsally to the VII-VIIIth nerve complex, and the AICA passed between the VIIth and VIIIth nerves in 51 samples (34.5 %). In four of the 148 CP angles (2.7 %), the AICA was not identified. There was an AICA loop coursing to the internal acoustic meatus in 15 patients (10.1 %). In this study, we examined the relations between VIIth and VIIIth nerve complex and the AICA in cadaver and MRI materials for an understanding of the value and reliability of the radiological data. This study also shows the anatomical variation between these structures.

Alagille syndrome is associated with various ocular abnormalities, including pseudopapilledema or optic disk edema due to increased intracranial pressure. Several mechanisms have been proposed to explain the mechanism of intracranial hypertension in Alagille syndrome. Craniosynostosis is an unusual but significant cause of increased intracranial hypertension in Alagille syndrome. It has recently been demonstrated in animal models that Jagged1 gene in which mutations are responsible for Alagille syndrome may also take part in cranial suture formation. We report a child with Alagille syndrome and craniosynostosis who presented with pruritus, elevated liver enzymes, and suspected increased intracranial pressure.

Melanotic progonoma or melanotic neuroectodermal tumor is a rare tumor in infancy. This lesion has to be considered in the differential diagnosis of benign or malignant lesions of calvarium. The authors present a case of a 4-month-old infant with left retroauricular mass. The patient had a subcutaneous mass that is fixed to the underlying skull. CT and MRI scans showed left occipitotemporal expansile mass. The tumor was removed by surgery. A tumor, brownish-black in color, was diagnosed as melanotic progonoma. The patient remained symptom-free for the last 2 years after complete surgery. Extracranial subcutaneous masses involving the skull are uncommon in infants. Benign or malignant lesions may occur as lumps on calvarium. Physical examination and some laboratory findings are helpful in the assessment of patient. Benign or malignant lesions can be differentiated by craniography, CT, or MRI scans, but exact diagnosis of melanotic progonoma is made by histopathology and immunostaining, as was in the presented case. Cranial vault progonomas have a better outcome by complete surgery. The tumors usually do not recur in long-term period.