{"title":"Recurrence of Central Nervous System Methotrexate-related Lymphoproliferative Disorder after Methotrexate Discontinuation: A Case Report.","authors":"Yoshihiro Okada, Yusuke Tomita, Hisakazu Nishimori, Hiroki Ueno, Kanji Matsuura, Keigo Makino, Naoya Kidani, Kenichiro Muraoka, Nobuyuki Hirotsune, Shigeki Nishino","doi":"10.2176/jns-nmc.2024-0296","DOIUrl":"10.2176/jns-nmc.2024-0296","url":null,"abstract":"<p><p>Methotrexate-related lymphoproliferative disorder is a rare but serious complication of methotrexate treatment. Recurrent methotrexate-related lymphoproliferative disorder in the central nervous system is uncommon. An 86-year-old woman, who had been on methotrexate for 3 years to treat rheumatoid arthritis, was admitted with left hemiplegia and sensory disturbance. Brain magnetic resonance imaging revealed a right basal ganglia lesion that was hyperintense on diffusion-weighted imaging and showed patchy enhancement. Methotrexate-related lymphoproliferative disorder was suspected, and methotrexate was discontinued, which led to improvement in her symptoms and partial remission. Twenty-eight months after methotrexate cessation, the patient presented with reduced activity and left hemiparesis. Brain magnetic resonance imaging showed homogeneously enhancing lesions in the right frontal lobe, basal ganglia, and brainstem. A craniotomy for biopsy of the right frontal lobe lesion confirmed the diagnosis of methotrexate-related lymphoproliferative disorder. Whole-brain radiation (40 Gy in 20 fractions) was administered without chemotherapy due to her advanced age and poor performance status. Her symptoms improved, and she was transferred to a rehabilitation hospital. Methotrexate-related lymphoproliferative disorder of the central nervous system can recur spontaneously, even without resumption of methotrexate, making long-term follow-up necessary after methotrexate cessation.</p>","PeriodicalId":101331,"journal":{"name":"NMC case report journal","volume":"12 ","pages":"255-260"},"PeriodicalIF":0.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12209498/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144546720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A Combined Transtemporal and High-parietal Approach for Large Intraventricular Trigone Meningioma: A Case Series and Review of the Literature.","authors":"Kosuke Nakajo, Hiroki Morisako, Tsutomu Ichinose, Takeo Goto","doi":"10.2176/jns-nmc.2025-0031","DOIUrl":"10.2176/jns-nmc.2025-0031","url":null,"abstract":"<p><p>The trigone of the lateral ventricle is deep and surrounded by eloquent gyri and subcortical fibers. Resection of intraventricular trigone tumors has therefore been challenging, and the optimal surgical approach to the trigone of the lateral ventricle remains controversial. Three patients with large intraventricular trigone meningioma (≥4 cm in diameter) underwent surgical excision using a combined transtemporal and high-parietal approach at Osaka City University Hospital between July 2016 and January 2021. Clinical and imaging studies, as well as surgical complications, were retrospectively reviewed based on medical records from our institution. We also reviewed 153 patients with intraventricular trigone meningioma from 11 reports in the literature and assessed pre- and postoperative symptoms. Gross total resection of the tumor was achieved in all cases. None of the patients showed deterioration of neurological symptoms at 3 months after tumor resection, although one patient experienced transient language dysfunction several weeks after surgery. No cases showed recurrence or required additional therapy. According to our literature review, postoperative visual field defects are more likely to persist than postoperative language dysfunction at 3 months postoperatively. In conclusion, combining the transtemporal and high-parietal approaches appears to be useful for treating large intraventricular trigone meningioma. Postoperative language dysfunction after resection of intraventricular trigone meningioma may tend to resolve more rapidly than postoperative visual field defect.</p>","PeriodicalId":101331,"journal":{"name":"NMC case report journal","volume":"12 ","pages":"267-273"},"PeriodicalIF":0.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208790/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144546716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Lumbar Disc Herniation during Pregnancy: A Case Report and Literature Review.","authors":"Yoshiyuki Takaishi, Hiroto Kajimoto, Hirotomo Tanaka, Masahiro Sugihara, Takeshi Kondoh, Mayu Ooi","doi":"10.2176/jns-nmc.2025-0038","DOIUrl":"10.2176/jns-nmc.2025-0038","url":null,"abstract":"<p><p>Low back pain during pregnancy is common. However, lumbar disc herniation in pregnancy is rare, and when severe, it can cause lower extremity pain that resists conservative treatment or lead to cauda equina syndrome. In this report, we describe a case of severe lower back pain that did not improve with conservative treatment, necessitating surgery at 12 weeks of gestation. Additionally, we reviewed the literature. A 35-year-old woman, 7 weeks pregnant, presented to our outpatient clinic with right lower extremity pain. Magnetic resonance imaging revealed a herniated disc at the right L4/5. Acetaminophen, a pregnancy-safe analgesic was prescribed. Despite initiating treatment, the pain persisted, and the patient was hospitalized for bed rest. After one month of conservative treatment with no relief, a repeat magnetic resonance imaging showed an enlarged herniated disc. After consulting with the patient and her family, surgery was performed at Kobe University Hospital, which offers comprehensive neurosurgery, obstetrics and gynecology, and anesthesiology services. At 12 weeks of gestation, the patient underwent a microscopic discectomy in the prone position under general anesthesia. Fluoroscopy for surgical level confirmation was minimized. The surgery lasted approximately 1 hour, and the right lower extremity pain was alleviated. Five months later, the patient delivered a healthy child. We report a case of surgery for a herniated disc during pregnancy, along with a review of the literature.</p>","PeriodicalId":101331,"journal":{"name":"NMC case report journal","volume":"12 ","pages":"261-265"},"PeriodicalIF":0.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208792/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144546718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Papilledema in NF2-related Schwannomatosis without Ventriculomegaly and Overt Intracranial Hypertension: A Case Series and Literature Review.","authors":"Eiji Ito, Kiyoshi Saito, Masazumi Fujii, Shigenori Takebayashi, Lushun Chalise, Ryuta Saito, Tadashi Watanabe","doi":"10.2176/jns-nmc.2025-0034","DOIUrl":"10.2176/jns-nmc.2025-0034","url":null,"abstract":"<p><p>Neurofibromatosis 2-related schwannomatosis is a rare genetic disorder marked by the development of multiple central nervous system tumors and, occasionally, non-hydrocephalic intracranial hypertension. This report details two cases of papilledema in patients with neurofibromatosis 2-related schwannomatosis, characterized by normal ventricular morphology on Magnetic resonance imaging and refractory to conservative treatment. Both patients-a 23-year-old and a 31-year-old female-demonstrated complete resolution of papilledema and restoration of visual function following ventriculoperitoneal shunt placement. These cases underscore the critical role of early ventriculoperitoneal surgical intervention in mitigating vision loss and emphasize the necessity for rigorous clinical surveillance in this unique patient population.</p>","PeriodicalId":101331,"journal":{"name":"NMC case report journal","volume":"12 ","pages":"241-247"},"PeriodicalIF":0.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208794/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144546719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Visual Evoked Potential Monitoring in Long-term Anesthesia Maintenance and Challenging Environments for Cerebral Arteriovenous Malformation Treatment: A Technical Case Report.","authors":"Shoto Yamada, Ayumu Yamaoka, Kanae Hashimoto, Katsuya Komatsu, Sangnyon Kim, Yukinori Akiyama, Mika Taniuchi, Yuki Sakurai, Sho Matsunaga, Takeshi Mikami, Tomoki Hirahata, Tomohiro Chaki, Nobuhiro Mikuni","doi":"10.2176/jns-nmc.2024-0341","DOIUrl":"10.2176/jns-nmc.2024-0341","url":null,"abstract":"<p><p>The monitoring of intraoperative optic nerve protection using visual evoked potential has been increasingly used in neurosurgical procedures. Although visual evoked potential is a valuable tool, its application is often hindered by anesthetic limitations and challenges related to measurement and recording environments. This case study indicates the successful use of visual evoked potential monitoring during long-term anesthesia maintenance and in artifact-prone environments for the treatment of a ruptured cerebral arteriovenous malformation. We report the case of a woman in her 30s who underwent surgical treatment for a ruptured cerebral arteriovenous malformation in the right occipital lobe, adjacent to the optic radiation. Visual evoked potential monitoring was essential during both transarterial embolization and subsequent microsurgical resection. During transarterial embolization, the implementation of improved measurement environments, localized light stimulation, and optimized recording conditions facilitated stable visual evoked potential monitoring despite the high levels of environmental noise in the angiography suite. Post-embolization, deep sedation was required to mitigate the risk of postoperative bleeding, causing an 18-hr duration of anesthesia before microsurgical resection. Despite the prolonged anesthesia, visual evoked potential monitoring was successfully maintained by carefully managing anesthesia depth. This case shows that visual evoked potential monitoring can be reliable and reproducible during extended periods of anesthesia and in challenging, artifact-rich environments. These findings underscore the feasibility of using visual evoked potential in complex neurosurgical cases, even under less-than-ideal conditions.</p>","PeriodicalId":101331,"journal":{"name":"NMC case report journal","volume":"12 ","pages":"233-239"},"PeriodicalIF":0.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208791/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144546721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
NMC case report journalPub Date : 2025-06-04eCollection Date: 2025-01-01DOI: 10.2176/jns-nmc.2024-0233
Yousuke Tomita, Yoshiaki Adachi, Nobuo Tamesa, Isao Date
{"title":"Unveiling the Possibility of Subclinically Present Congenital Hydrocephalus Triggered by Thalamic Hemorrhage in Late-onset Years: A Case Report.","authors":"Yousuke Tomita, Yoshiaki Adachi, Nobuo Tamesa, Isao Date","doi":"10.2176/jns-nmc.2024-0233","DOIUrl":"10.2176/jns-nmc.2024-0233","url":null,"abstract":"<p><p>Congenital hydrocephalus manifesting in old age is exceptionally rare. We present a case of hydrocephalus in an older woman, where congenital hydrocephalus was suggested following a thalamic hemorrhage. A woman in her 90s gradually developed gait and cognitive impairments. Eight months before her admission, she suffered a thalamic hemorrhage, after which she became bedridden and was transferred to our hospital following impaired consciousness from asphyxiation. Upon admission, her Japan Coma Scale score was 200. A head computed tomography scan revealed significant ventricular enlargement. A tap test was conducted to diagnose normal pressure hydrocephalus, resulting in a slight improvement in her Japan Coma Scale score to 20. Consequently, a ventriculoperitoneal shunt was performed. Two weeks after the ventriculoperitoneal shunt, her consciousness improved to a Japan Coma Scale score of 2, and she resumed oral intake. Two months after the surgery, head magnetic resonance imaging revealed tetraventriculomegaly, an open aqueduct, a wide foramen of Magendie, and a large cisterna magna. These findings raised the suspicion of previously undetected congenital hydrocephalus, exacerbated by panventriculomegaly with a wide foramen of Magendie and a large cisterna magna, revealed after the thalamic hemorrhage. At the final evaluation, she required only minimal assistance with oral intake, showing significant improvement not only compared with her condition before the ventriculoperitoneal shunt procedure but also to her state before the thalamic hemorrhage.</p>","PeriodicalId":101331,"journal":{"name":"NMC case report journal","volume":"12 ","pages":"209-213"},"PeriodicalIF":0.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12187197/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A Case of a Non-giant Intracranial Aneurysm with Spontaneous Occlusion Directly Observed during Clipping Surgery.","authors":"Yasutaka Horiuchi, Ryuta Yasuda, Takeshi Okada, Masanori Tsuji, Seiji Hatazaki, Naoki Toma, Hidenori Suzuki","doi":"10.2176/jns-nmc.2024-0283","DOIUrl":"10.2176/jns-nmc.2024-0283","url":null,"abstract":"<p><p>A man in his 60s was referred to our hospital due to a large basilar artery aneurysm incidentally detected 12 years before. Cerebral angiography revealed the basilar artery aneurysm and another 2 aneurysms at the left middle cerebral artery. Coil embolization was performed for the basilar artery aneurysm, and the middle cerebral artery aneurysms were to be monitored because of their small size. The middle cerebral artery aneurysms had enlarged on magnetic resonance imaging over 8 years, and therefore we recommended surgery. Clipping was performed 4 years after the recommendation and intraoperative findings revealed that there were 3 aneurysms at the left middle cerebral artery, one of which closest to the M2 superior trunk harbored an entirely sclerosed dome wherein no blood inflow was observed. Rather than simple growth of the 2 middle cerebral artery aneurysms initially found 12 years before, it appeared that one of the 2 middle cerebral artery aneurysms had spontaneously occluded, and another had been newly formed and enlarged. Spontaneous occlusion of small, unruptured saccular, intracranial aneurysms is rare, and just 10 cases have been reported in the literature. To the best of our knowledge, this is the first report in which the spontaneous occlusion of such an aneurysm was directly observed during microscopic surgery.</p>","PeriodicalId":101331,"journal":{"name":"NMC case report journal","volume":"12 ","pages":"227-232"},"PeriodicalIF":0.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12187196/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Syringomyelia Associated with Magendie's Foramen Obstruction Due to Probably Congenital Gliomesenchymal Anomaly.","authors":"Shunsuke Kumagai, Ryosuke Ogura, Kohei Shibuya, Jotaro On, Shoji Saito, Masakazu Sano, Akiyoshi Kakita, Makoto Oishi","doi":"10.2176/jns-nmc.2025-0041","DOIUrl":"10.2176/jns-nmc.2025-0041","url":null,"abstract":"<p><p>We report a case of syringomyelia in a 55-year-old man with a unique obstruction of Magendie's foramen. Spinal magnetic resonance imaging revealed a large syrinx extending from C1 to C3, with intermittent syringomyelia extending down to Th11. While the obstruction was not clearly evident on T2-weighted imaging, three-dimensional constructive interference in steady-state imaging demonstrated a thickened membranous tissue blocking the cerebrospinal fluid outlet, leading to syrinx formation. Surgical intervention, involving the resection of the thickened membrane to open the foramen of Magendie, resulted in considerable improvement in the syringomyelia and neurological symptoms. Histopathological examination revealed gliomesenchymal tissue, suggesting an embryonic origin of the obstruction. This case highlights the importance of detailed imaging, particularly three-dimensional constructive interference in steady-state sequence, in diagnosing foramen of Magendie obstruction and the potential for successful surgical treatment in selected cases. Histopathological examination is crucial for differentiating gliomesenchymal tissue from adhesive arachnoiditis.</p>","PeriodicalId":101331,"journal":{"name":"NMC case report journal","volume":"12 ","pages":"221-226"},"PeriodicalIF":0.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12187467/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Repeated Recurrence of Spontaneous Cervical Epidural Hematoma Associated with Habitual Strength Training.","authors":"Yuki Watabe, Kyoka Nishita, Kaoru Tomikawa, Koshi Seki, Shisei Yoshida, Masayasu Okada, Makoto Oishi","doi":"10.2176/jns-nmc.2025-0025","DOIUrl":"10.2176/jns-nmc.2025-0025","url":null,"abstract":"<p><p>Spontaneous spinal epidural hematoma is a clinical entity as a hematoma occurring in the spinal epidural space with unknown etiology. It is known to sometimes show spontaneous regression, and recurrence is rare and repeating even rarer. We had an experience of repeated recurrent spontaneous spinal epidural hematoma, eventually leading to surgery. A 25-year-old man, a habitual exerciser of strength training, had a sudden onset of cervical back pain during sleep the same night after training. Radiological examinations revealed a cervical epidural hematoma but no vascular anomalies, and the patient's symptoms and the hematoma resolved rapidly and spontaneously in a day. Within 2.5 years, he had another three more similar hemorrhagic episodes with rapid and spontaneous resolution. On the 5th episode, the patient underwent surgical treatment with removal of the epidural tissue and packing of the epidural space. The pathological diagnosis was only the normal connective tissue and veins. He has had no recurrence in the 1.5 years after surgery with the same strength training as before. The appropriate timing and method of treatment for recurrent spontaneous spinal epidural hematoma with rapid resolution is still under debate, but surgery should be considered if there are multiple recurrences. It is important to collapse the epidural space with packing to prevent further recurrence.</p>","PeriodicalId":101331,"journal":{"name":"NMC case report journal","volume":"12 ","pages":"215-219"},"PeriodicalIF":0.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12187198/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Primary Malignant Melanoma of the Sphenoid Sinus as a Crucial Differential Diagnosis of Skull Base Tumors: A Case Report.","authors":"Takahiro Ueno, Shuhei Morita, Seiichiro Eguchi, Kenta Masui, Takakazu Kawamata","doi":"10.2176/jns-nmc.2024-0277","DOIUrl":"10.2176/jns-nmc.2024-0277","url":null,"abstract":"<p><p>A 79-year-old man presented with progressive ptosis, diplopia, and headaches, which led to the diagnosis of a rare primary malignant melanoma of the sphenoid sinus. Imaging revealed extensive bone destruction and aggressive tumor behavior. The rarity of primary malignant melanoma in the sphenoid sinus complicates early detection. Despite undergoing surgical decompression, immunotherapy, and radiation therapy, the tumor rapidly recurred, necessitating supportive care. This case highlights the need for neurosurgeons to include primary malignant melanoma in the differential diagnosis of skull base tumors, particularly in the sphenoid sinus, due to its potential for aggressive local invasion and significant impact on critical neurovascular structures. Early recognition and intervention are crucial for managing this rare and aggressive malignancy effectively.</p>","PeriodicalId":101331,"journal":{"name":"NMC case report journal","volume":"12 ","pages":"189-195"},"PeriodicalIF":0.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12148556/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}