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A herniated disc occurs when an intervertebral disc displaces and compresses a spinal nerve root. Nerve stretch tests or provocative tests have a great diagnostic value and are quite specific for the pathology of lumbar disc herniation. The nerve stretching tests that are most often used to prove or rule out compression on the spinal nerve are the following: Lazarević's test, Cram's, Bragard's, crossed-contralateral Lazarević's test, inverted Lazarević's or Fajerstein's test, Bekhterev's, Neri's, Govers' and Kernig's tests, Lhermite's sign, Dendy's test, Milgram's and Nafciger's test, bowstring sign, Trandelenburg sign, Hoover's simulation test, Menel's test, Genslen's test and Patric-faber's test. This article describes the techniques of performing all the mentioned tests, as well as their clinical significance.

Introduction. Angiomyolipomas represent neoplasms of mesenchymal origin, made up of abnormal thick-walled blood vessels, smooth spindle muscle cells, and mature adipose cells. The most common site of origin are kidneys, and other localizations are extremely rare. We represent a case of a spermatic cord angiomyolipoma misdiagnosed as incarcerated inguinoscrotal hernia, and to our prudence this is second described case of an angiomyolipoma localized in the spermatic cord. Case outline. We present a case of a 63-year-old man presented with high fever and difficulty in walking due to pain and swelling in the right groin. According to the clinical examination and laboratory tests, presumptive diagnosis was incarcerated inguinoscrotal hernia, so the patient was immediately operated on. The exploration of the inguinal canal showed a timorous mass, 9 × 9 cm in size, with the origin from the spermatic cord, so radical inguinal orchiectomy was performed with the removal of the tumor mass. Histopathological and immunohistochemistry examination suggested angiomyolipoma of the spermatic cord. The postoperative course was uneventful. Conclusion. Although rare, an angiomyolipoma of the spermatic cord must be included in the differential diagnosis of scrotal masses. Also, we advocate additional diagnostic procedures (ultrasound or computed tomography) for every inguinoscrotal mass before undertaking surgery, since a variety of different causes can be found. After definitive angiomyolipoma diagnosis is obtained, further investigation is needed, especially brain computed tomography due to possible tuberous sclerosis coexistence.

Introduction. The spine is involved in less than 1% of all tuberculosis (TB) cases, and it is a very dangerous type of skeletal TB as it can be associated with neurologic deficit and even paraplegia due to compression of adjacent neural structures and significant spinal deformity. The spine TB is one of the most common causes for an angular kyphotic deformity of spine. Patients with kyphosis angle ≥ 60° at dorsolumbar spine are at great risk to develop late onset neurological deficit and paraplegia due to chronic compression and stretching of the spinal cord over bonny ridges. In a small number of cases, other conditions may lead to neurological deficit in patients with long standing angular kyphosis which also alters the treatment strategy that otherwise involves prolonged and mutilant surgery. Case outline. We present a case of a 61-year-old male patient with concomitant 90° dorsolumbar spine kyphosis due to spinal TB and ligamentum flavum hypertrophy which led to spinal canal stenosis with myelopathy, and consequent paraplegia. The patient underwent dorsal decompression with hypertrophic yellow ligament removal after which he recovered to the level of walking. Conclusion. Many authors propose guidelines for treatment of spinal TB, taking into account the stage of the disease, the age of the patient, the angle of kyphosis, and other factors. We find that personalized medical approach is the best approach for each patient.

Introduction. Osseous metaplasia is a heterotopic formation of bone and its appearance in benign gastrointestinal polyps is exceedingly rare. The mechanism responsible for this type of metaplasia is not fully understood, however it seems to be an innocent rare phenomenon. Case outline. We present a case of a 31-year-old male with mesenchimal osseal metaplasia in a large inflamatory polyp measuring 57 × 23 × 20 mm in diameter, located in the anal canal region. Conclusion. According to our knowledge, this is the largest gastrointestinal polyp with osseous metaplasia described so far. Although a rare phenomenon, there are certain characteristics of this disease, so we conducted a literature review and summarized these characteristics.

Introduction. Arachnoid cysts are common among the general population. Best treatment option is still the subject of much debate. Surgical options include open-craniotomy or endoscopic cyst fenestration, cysto-peritoneal shunt insertion, or marsupialization via craniotomy. The aim of this article was to present a patient with an extremely large arachnoid cyst which occupied almost the entire left hemisphere. Case outline. The patient with a large symptomatic arachnoid cyst was treated by craniotomy and open fenestration. The patient suffered multiple postoperative complications, such as imidiate intracerebral hemorrhage due to hypertension, obstructive hydrocephalus, and a fresh ulcer in the bulbus duodeni. All the complications were successfully treated. Conclusion. Since the best treatment option is still the subject of much debate, we think that personalized medical approach is the best one, taking into account patient symptoms, localization and size of the cyst, patient’s general condition, and surgeon’s familiarity with the procedure.

Introduction. Intracranial extension is rarely seen with craniofacial dermoid cysts, with few cases reported in the literature. Case Outline. We report a case of a 30-year-old woman who was initially seen with a subcutaneous mass of the frontotemporal region. The patient underwent a right craniotomy by a frontal approach. Histopathologic analysis confirmed the diagnosis of a dermoid cyst. Conclusion. Craniofacial dermoid cysts may be associated with an intracranial extension.

Introduction. According to the literature, a fusiform aneurysm located in the cerebellopontine angle (CPA) is an extremely rare condition. Case Outline. We report a case of a 59-year-old patient with initial dizziness and left-sided sensorineural hearing loss that had gradually developed over six months. Vertebrobasilar fusiform aneurysm, with intraluminal thrombus, which was displaced to the right cerebellopontine angle, creating mass effect, was diagnosed using brain magnetic resonance imaging and magnetic resonance angiography. Conclusion. Atherosclerosis may be the essential factor in the pathogenesis of a fusiform aneurysm of the basilar artery, especially in elderly patients. The best treatment option is yet to be determined, but in spite of numerous previous large studies, personalized approach is probably the best.

Vascular dementia (VaD) is the second most frequent dementia after Alzheimer’s disease, and is diagnosed during lifetime in 20% of demented patients. Five­year survival rate in VaD is 39%, while it is estimated to be 75% in healthy persons of the same age. It is therefore important to make correct diagnosis of VaD early in the course of the disease. Risk factors for VaD are identical to stroke risk factors, and there are significant possibilities for the prevention of vascular cognitive decline. Cognitive decline develops acutely or step­by­step within three months after stroke, but more gradual progression of intellectual decline is also possible. Neurological examination can reveal pyramidal and extrapyramidal signs, pseudobulbar palsy, gait disturbance and urinary incontinence. Neuropsychological profile comprises the loss of cognitive set shifting, decline in word fluency, verbal learning difficulties, perseverations, difficulties in complex figure copying, and in patients with cortically located lesions also problems with speech and praxia. The basis of the diagnosis is, besides history, neurological examination and neuropsychological assessment, computed tomography and/ or magnetic resonance brain imaging. Vascular risk factors control is the most important measure in VaD prevention. Modern guidelines for the treatment of cognitive decline in VaD emphasize that donepezil can be useful in the improvement of cognitive status at the level of Class IIa recommendation at the level of evidence A, while memantine may be useful in patients with mixed VaD and Alzheimer’s disease dementia. [Projekat Ministarstva nauke Republike Srbije, br. 175022 i br. 175033]