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Unsteady Gait In A  20 Year Old Boy
Neurosurgery

Unsteady Gait In A 20 Year Old Boy

20130824_150811
20 year old student of Kumasi polyechnic  presented with 6 months duration of recurrent severe headache. This was worse defectation durng which it becomes more localised to the occiput. He had a single episode of vomiting during one evening . He noticed unsteadiness in his gait during the period. He complained of double vision in both eyes which improved on reading with one eye closed. He remained continent of stool and urine during the illness.
Examination :. convergent squint, unsteady gait couldnt walk without support. Positive past pointing sign.
Diagnosis: Posterior cranial fossa tumour.
Investigation : Head CT scan reported a cystic lesion with solid component measuring 3.9 * 4.6cm, enhancing strongly with contrast administration. Lesion attached to the fourth ventricle. There is a smaller lesion in the right crebellum measuring 0.8* 0.8cm. Moderate hydrocephalus with Evans Index of 0.32 ( normal =0.3)
Impression : Pleomorphic xanthoastrocytoma . DDx : haemangioblastoma, ? solitary mets to the right cerebellum
 Surgery : Craniotomy and tumour excision . patient positined prone. Incision extending from ocipital protuberance to posterior aspect of foramen magnum and C1 spinous process and lamina.  8 *8 cm  shaped incision made in the dura and the occipital sinus ligated. vermis and cerebellar tonsils exposed. Corticotomy done in the midlineand the cyst drained. Cyst fluid and parts of the wall sent for histopathological analysis. Wound passively drained and closed in layers
Findings : Yellowish fluid about  80 mls drained from cyst . 0.5 * 0.5cm sized haemangioblastoma
Postoperative state: Vision improving, gait improving
Credits : Drs Owusu, Lamina, (neurosurgeons) ,Opata (House Officer) , Department of neurosurgery, KATH, Kumasi
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