Search

Dermal sinus is more commonly associated with intradural dermoid than an epidermoid cyst. Conus epidermoid cyst with dermal sinus is a rare entity. We are presenting a rare case of infected conus epidermoid cyst along with the dermal sinus in an 18-month-old girl presented with flaccid paraparesis with sphincter dysfunction and timely intervention leads to complete recovery. We had searched PubMed for previously reported similar cases and did a case-based review of the literature. This 18-month-old girl with discharging lumbosacral sinus with fever since 3 days presented with flaccid paraparesis with sphincter dysfunction. Preoperative magnetic resonance imaging (MRI) showed a large enhancing lesion from L1-S1 along with the dermal sinus tract. Complete excision of the cyst along with the sinus tract, followed by long-term antibiotic therapy. The excision of the infected cyst was done through myelotomy under neuromonitoring, while some part of the capsule densely adherent to the neural tissue was left behind. The patient gradually improved following surgery and motor power of the lower limbs were $$ \raisebox{1ex}{$3$}\!\left/ \!\raisebox{-1ex}{$5$}\right. $$ while going home. Histopathology revealed epidermoid cyst with secondary inflammatory tissue. Follow-up MRI of the spine showed excision of the dermal sinus tract and cyst with postoperative changes. At 1-year follow-up, the patient was asymptomatic without any focal deficits. Early surgical intervention followed by long-term antibiotic therapy is a must for good functional recovery in patients of an infected dermal sinus tract with associated cyst. While excising cyst through myelotomy, some part of the capsule densely adherent to neural tissue may be left behind. Regular follow-up in the first year of surgery is essential to look for the recurrence of the lesion.

The clinical presentation of spinal or extraspinal neurofibroma is radiculopathy or myelopathy, pain, and motor weakness. Extraspinal neurofibroma presenting with acute-onset monoparesis and Horner's syndrome is very rare. We report the case of a 55-year-old female who presented with acute-onset monoparesis of the left upper limb along with left-side drooping of the eyelid. Imaging revealed C6-D2 extraspinal solitary mass lesion lateral to spinous process with bleed without intraspinal component. The patient underwent an anterior cervical approach and excision of the tumor. Final biopsy report was a neurofibroma. At 3-year follow-up, she recovered from motor weakness, and Horner's syndrome subsided. Extraspinal neurofibroma can present with acute bleed, and surgical outcome is superior in early intervention.

Spinal clear cell meningiomas (CCMs) are rare and dural-based lesion usually affecting the younger population. We report the rare case of giant nondural-based spinal CCM mimicking schwannoma and review the literature. A literature search was performed at PubMed and Embase until January 1, 2020. A total of 19 cases of nondural-based spinal CCM was reported. The following relevant data were extracted: authors, publication year, patient and tumor characteristics, treatment, and outcome. The mean age of the presentation was 20.58 years. Twelve (63.16%) were female and seven patients (36.84%) were male. The most common location was lumbosacral region 15 (79%). Fifteen (79%) tumors had cranio-caudal dimension ≤2 vertebral level, and only four (21%) tumors had dimension ≥2 vertebral level. Gross total resection (GTR) was performed in 18 (95%) patients and subtotal resection (STR) in 1 patient. Recurrences were reported in five (26.14%) patients. Four of them showed recurrences within 6 months; earliest at 2.3 months in the patient had undergone STR. Our patient is 19-year-old male diagnosed with a lumbosacral intradural lesion. Craniocaudal dimension is ≥2 vertebral level shows the foraminal extension and vertebral scalloping. GTR is performed. Intraoperatively, the tumor has foraminal extension and shows attachment with right S1S2 nerve root. No dural attachment is found. Six-month follow-up magnetic resonance image shows no evidence of disease. Nondural-based spinal CCMs are extremely rare and should be kept as a differential diagnosis in young patients with giant intradural tumor, and whose radiological features suggesting of schwannoma. It affects young patients and usually involves more than one vertebral level. The chances of recurrences and metastasis are always high even after GTR; hence, close follow-up of the entire neuraxis is warranted.

Background: The role of craving in alcohol dependence and its relationship with relapse has been studied widely in the past decade. The present study was undertaken to assess the role of craving in short-term relapse of patients seeking treatment for alcohol dependence and changes in craving score at the end of detoxification and at follow-up. Materials and Methods: A total of 34 male individuals with alcohol dependence (excluding comorbid drug dependence, organic or psychiatric disorder), after detoxification and discharge, consented. No anticraving medicine, aversive or psychotherapy, was advised. They were diagnosed on the International Statistical Classification of Diseases-10 using Diagnostic Interview for Genetic Studies. Severity of Alcohol Dependence Questionnaire (SADQ) and Clinical Institute Withdrawal Assessment Scale–Alcohol-Revised (CIWA-AR) were administered at the time of admission. Penn Alcohol Craving Scale (PACS) was applied at the time of discharge and follow-up to measure craving for alcohol. Results: Out of a total of thirty patients analyzed after dropout, 21 relapsed at the end of 1 month. On comparing PACS scores between relapsed and nonrelapsed patients, the difference was significant at both time points, i.e., at discharge and follow-up (t = 4.15, P < 0.0001 and t = 4.01, P < 0.001, respectively). In the total sample, SADQ and CIWA-AR scores were positively correlated (r = 0.47, P = 0.009). PACS at discharge was compared with PACS at follow-up, of which the correlation was high (r = 0.832, P < 0.0001). Conclusion: Craving seems to be a main factor related to relapse. Its measurement with PACS can be a useful tool to predict subsequent drinking and to identify individual risk for relapse during treatment.

Moyamoya disease (MMD) is a rare arteriopathy associated with cerebral ischemia, due to stenosis or occlusion of the internal carotid artery and its branches and primarily presenting with stroke. However, neuropsychiatric symptoms such as acute psychosis, manic symptoms, attention deficits, and behavioral problems are reported in relation to MMD. We describe here a case of an adult female, who presented with headache, easy irritability, and suspiciousness against family members, inability to identify familiar objects and faces, and inability to perform activities easily done earlier. This case appears informative as the presence and excessive importance given to behavioral symptoms lead to substantial delay in her diagnosis.

Concurrent occurrence of brain tumors in the same location is very unusual and has been noted in patients with neurofibromatosis. Two lesions, occurring in close contact but of different histology, are called contiguous tumors. Schwannoma and meningioma are the two common histologies reported to present as contiguous tumor. We present two patients with contiguous tumors in the cerebellopontine angle. The magnetic resonance imaging characteristics in both cases demonstrate important findings that should be identified to raise the possibility of contiguous tumors. We discuss the surgical implications in identifying the facial nerve in this complex tumor morphology and steps we took to preserve function. Variable displacement of the facial nerve in the presence of multiple tumors needs to be kept in mind during surgical management and can be significantly aided by intraoperative monitoring.

We are reporting two patients of fatal and rapidly progressive amoebic encephalitis in immunocompetent host from poor socioeconomic status. Both these patient had acute neurological worsening preoperatively and did not respond to subsequent surgical decompression. Biopsy report confirmed acanthamoebic cerebral infection.

Recommendation systems now days are the heart of success stories for business and optimization of resources. The accurate prediction of business decision accurately depends on heuristic algorithms used for analytics. Classical algorithms used for the data mining find their utility to perform with the new challenges considering key factors for improvement. This paper presents the performance of the specific algorithms of the data mining class in view to observe their suitability for recommender systems.

Mobius syndrome is defined in most studies as congenital facial weakness associated with abnormal ocular abduction. Facial nerve and Abducens nerve are most frequently involved, but other cranial nerves may be involved as well. In one third or more of patients, Mobius syndrome can also be associated with musculoskeletal abnormalities like talipes equino varus, brachydactyly, syndactyly, smallness of limbs etc. Mobius syndrome is a very rare condition. In 2007, Mobius syndrome foundation estimated that 2000 individuals worldwide have this condition. Mobius syndrome associated with cardiovascular anomalies are rarely described. Till date four such cases has been reported to the best of our knowledge. Hereby we are reporting a case of mobius syndrome associated with ventricular septal defect and aortic regurgitation.

Today it is very necessary to protecting Sensitive information from external world. To protecting sensitive information now a day's barcode technique is used. In the real world many industries are using the technique to protect sensitive information form external parties. This paper contains the algorithm which helps to protect the sensitive information. This proposed algorithm is useful to hiding information and to store big amount of data with high percentage of error correction of information. In this paper i will introduce you about the smart credential cum unique identification and reorganization system which help us to identify product uniquely without any interrupt.

The awareness of choosing the right option for career is increasing among the students. The students fail to know their strengths and choose career randomly which leads to frustration and demoralization. The automated systems used by the counsellors are to evaluate the personality traits of the individual. The accuracy of prediction depends on the set of relevant skill parameters and analytics on these., The research in view to design the accurate prediction and recommendation systems shows use of mining and statistical algorithms. In this work we propose the improved accuracy approach for prediction where C4.5 algorithm for rules generation and applying statistical correlation on the results.

Image compression is inevitable now a days as multimedia based data is increasing at faster rate. Vector Quantization plays vital role in Codebook generation. Codebook is the soul of Vector Quantization. There are several methods to generate Codebook but the recent one is Thepade's Cosine Error Vector Rotation (TCEVR), which is proven better than others (KEVR, KEVRW, LBG). Paper proposes novel Column based error Vector Rotation for TCEVR. The proposed column based improvisation in TCEVR is tested with a test bed of 18 images for image compression. Experimentation result show that the proposed TCEVR Codebook generation in VQ for Image compression is showing improvisation over earlier proposed Row based TCEVR. As observed from lower average Euclidean distance between the original and regenerated images for various Codebook sizes.