Publications by authors named "Zaitun Zakaria"

23 Publications

  • Page 1 of 1

Commentary: Radiofrequency Ablation for Movement Disorders: Risk Factors for Intracerebral Hemorrhage, a Retrospective Analysis.

Oper Neurosurg (Hagerstown) 2021 Jun 10. Epub 2021 Jun 10.

Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu, Malaysia.

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http://dx.doi.org/10.1093/ons/opab190DOI Listing
June 2021

Cerebral venous sinus thrombosis 2 weeks after the first dose of mRNA SARS-CoV-2 vaccine.

Acta Neurochir (Wien) 2021 08 8;163(8):2359-2362. Epub 2021 Jun 8.

Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, 16150, Kota Bharu, Kelantan, Malaysia.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), also known as coronavirus disease 2019 (COVID-19) is a highly transmissible virus and has become pandemic. Part of the prevention of disease spread by the Malaysian government is by getting COVID-19 vaccine. Using the mRNA technology, the Pfizer/BioNTech vaccine is one of the vaccines been approved by the Drug Control Authority in Malaysia. Herein, we report an immediate complication of cerebral VST after the first dose of the Pfizer/BioNTech vaccine.
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http://dx.doi.org/10.1007/s00701-021-04860-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8186353PMC
August 2021

Quantum and Electromagnetic Fields in Our Universe and Brain: A New Perspective to Comprehend Brain Function.

Brain Sci 2021 Apr 28;11(5). Epub 2021 Apr 28.

Department of Physics, Faculty of Science, University of Malaya, Kuala Lumpur 50603, Malaysia.

The concept of wholeness or oneness refers to not only humans, but also all of creation. Similarly, consciousness may not wholly exist inside the human brain. One consciousness could permeate the whole universe as limitless energy; thus, human consciousness can be regarded as limited or partial in character. According to the limited consciousness concept, humans perceive projected waves or wave-vortices as a waveless item. Therefore, human limited consciousness collapses the wave function or energy of particles; accordingly, we are only able to perceive them as particles. With this "limited concept", the wave-vortex or wave movement comes into review, which also seems to have a limited concept, i.e., the limited projected wave concept. Notably, this wave-vortex seems to embrace photonic light, as well as electricity and anything in between them, which gives a sense of dimension to our brain. These elements of limited projected wave-vortex and limitless energy (consciousness) may coexist inside our brain as electric (directional pilot wave) and quantum (diffused oneness of waves) brainwaves, respectively, with both of them giving rise to one brain field. Abnormality in either the electrical or the quantum field or their fusion may lead to abnormal brain function.
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http://dx.doi.org/10.3390/brainsci11050558DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8146693PMC
April 2021

Commentary: Tractography-Guided Anterior Capsulotomy for Major Depression and Obsessive-Compulsive Disorder: Targeting the Emotion Network.

Oper Neurosurg (Hagerstown) 2021 03;20(4):E281-E283

Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, 16150, Kota Bharu, Kelantan, Malaysia.

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http://dx.doi.org/10.1093/ons/opaa473DOI Listing
March 2021

Commentary: Demonstration of Microsurgical Technique and Nuances for the Resection of a Midbrain Tectal Glioma via the Transcollicular Approach: 3-Dimensional Operative Video.

Oper Neurosurg (Hagerstown) 2021 03;20(4):E308-E311

Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, 16150 Kota Bharu, Kelantan, Malaysia.

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http://dx.doi.org/10.1093/ons/opaa465DOI Listing
March 2021

COVID-19 Pandemic and Its Impact on Neurosurgery Practice in Malaysia: Academic Insights, Clinical Experience and Protocols from March till August 2020.

Malays J Med Sci 2020 Oct 27;27(5):141-195. Epub 2020 Oct 27.

Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.

The newly discovered coronavirus disease 2019 (COVID-19) is an infectious disease introduced to humans for the first time. Following the pandemic of COVID-19, there is a major shift of practices among surgical departments in response to an unprecedented surge in reducing the transmission of disease. With pooling and outsourcing of more health care workers to emergency rooms, public health care services and medical services, further in-hospital resources are prioritised to those in need. It is imperative to balance the requirements of caring for COVID-19 patients with imminent risk of delay to others who need care. As Malaysia now approaches the recovery phase following the pandemic, the crisis impacted significantly on neurosurgical services throughout the country. Various emergency measures taken at the height of the crisis may remain as the new normal in the provision of neurosurgical services and practices in Malaysia. The crisis has certainly put a strain on the effective delivery of services and as we approach the recovery era, what may have been a strain may prove to be a silver lining in neurosurgical services in Malaysia. The following details are various measures put in place as the new operational protocols for neurosurgical services in Malaysia.
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http://dx.doi.org/10.21315/mjms2020.27.5.14DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7605837PMC
October 2020

The Neurological Exam of a Comatose Patient: An Essential Practical Guide.

Malays J Med Sci 2020 Oct 27;27(5):108-123. Epub 2020 Oct 27.

Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.

A thorough examination of a comatose patient is essential given the spectrum of clinical diagnoses. The most immediate threat to patients is airway, breathing and circulation. All attending physician should employ a structured and focused approach in dealing with a comatose patient. It is important to recognise the urgent steps needed at the time to prevent further deterioration, followed by the final diagnosis of patient's neurologic status. Here we provide the essential practical guide to the neurological exam of a comatose patient that would assist to determine the aetiology, location and nature of the neurological lesion.
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http://dx.doi.org/10.21315/mjms2020.27.5.11DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7605838PMC
October 2020

Disconnecting surgery at alveus and cornu ammonis of hippocampus, amygdala superficialis, and amygdala medial nuclei for epilepsy associated with attention deficit hyperactivity disorder.

Childs Nerv Syst 2021 05 19;37(5):1797-1802. Epub 2020 Sep 19.

Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kota Bharu, Kelantan, Malaysia.

The neural basis for epilepsy and attention deficit hyperactivity disorder (ADHD) is currently incompletely known. We reported a young girl with both epilepsy and ADHD, who had a calcified lesion in the right basolateral amygdalo-hippocampal region extending to the ventral striatum. The child underwent disconnecting surgery and biopsy of the lesion. Fascinatingly, the child's behavior changed immediately after the surgery from inattentive and impulsive to nearly normal behavior experiencing no more breakthrough seizures since after 3 years of surgery. The Schaltenbrand Wahren Brain Atlas revealed alveus, cornu ammonis, amygdala superficialis, and medium as the disconnected region in this surgery.
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http://dx.doi.org/10.1007/s00381-020-04893-zDOI Listing
May 2021

Commentary: Temporoinsular Glioma Resection Under Awake Mapping: 2-Dimensional Operative Video.

Oper Neurosurg (Hagerstown) 2020 07;19(1):E55-E57

Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.

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http://dx.doi.org/10.1093/ons/opz390DOI Listing
July 2020

System-based approaches as prognostic tools for glioblastoma.

BMC Cancer 2019 Nov 12;19(1):1092. Epub 2019 Nov 12.

Centre for Systems Medicine, Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland.

Background: The evasion of apoptosis is a hallmark of cancer. Understanding this process holistically and overcoming apoptosis resistance is a goal of many research teams in order to develop better treatment options for cancer patients. Efforts are also ongoing to personalize the treatment of patients. Strategies to confirm the therapeutic efficacy of current treatments or indeed to identify potential novel additional options would be extremely beneficial to both clinicians and patients. In the past few years, system medicine approaches have been developed that model the biochemical pathways of apoptosis. These systems tools incorporate and analyse the complex biological networks involved. For their successful integration into clinical practice, it is mandatory to integrate systems approaches with routine clinical and histopathological practice to deliver personalized care for patients.

Results: We review here the development of system medicine approaches that model apoptosis for the treatment of cancer with a specific emphasis on the aggressive brain cancer, glioblastoma.

Conclusions: We discuss the current understanding in the field and present new approaches that highlight the potential of system medicine approaches to influence how glioblastoma is diagnosed and treated in the future.
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http://dx.doi.org/10.1186/s12885-019-6280-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6852738PMC
November 2019

Neurosurgical management in children with bleeding diathesis: auditing neurological outcome.

J Neurosurg Pediatr 2018 01 10;21(1):38-43. Epub 2017 Nov 10.

OBJECTIVE The aim of this study was to assess the outcome of neurosurgical treatment in children with bleeding diathesis and also to evaluate the current management plan applied in the authors' service. METHODS The authors retrospectively analyzed all cases in which neurosurgical procedures were performed in pediatric patients presenting with intracranial hematoma due to an underlying bleeding tendency over a 5-year period at their institution. They evaluated the patients' neurological symptoms from the initial referral, hematological abnormalities, surgical treatment, neurological outcome, and scores on the Pediatric Glasgow Outcome Scale-Extended (GOS-E Peds) obtained 1 year after the last operation. RESULTS Five patients with a bleeding diathesis who underwent surgery for intracranial hematoma were identified; the diagnosis was hemophilia A in 3 cases, idiopathic thrombocytopenic purpura in 1 case, and severe aplastic anemia in 1 case. Intracerebral hematoma (ICH) (n = 4) and acute subdural hematoma (n = 1) were confirmed on radiological investigations. In 2 of the 4 patients with ICH, the diagnosis of bleeding diathesis was made for the first time on presentation. Four patients (all male) were younger than 2 years; the patient with severe aplastic anemia and spontaneous ICH was 15 years old and female. The duration of symptoms varied from 24 hours to 5 days. Neurological examination at 1 year's follow-up showed complete recovery (GOS-E Peds score of 1) in 3 cases and mild weakness (GOS-E Peds score of 2) in 2 cases. CONCLUSIONS Neurosurgical management of patients with bleeding diathesis should be carried out in a tertiary-care setting with multidisciplinary team management, including members with expertise in neuroimaging and hematology, in addition to neurosurgery. Early diagnosis and prompt treatment of a bleeding diathesis is crucial for full neurological recovery.
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http://dx.doi.org/10.3171/2017.6.PEDS16574DOI Listing
January 2018

Dermatofibrosarcoma protuberans of the scalp: therapeutic challenges.

ANZ J Surg 2019 03 16;89(3):261-264. Epub 2017 May 16.

Department of Neurosciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia.

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http://dx.doi.org/10.1111/ans.14040DOI Listing
March 2019

Possible toxicity following embolization of congenital giant vertex hemangioma: case report.

J Neurosurg Pediatr 2017 Mar 9;19(3):296-299. Epub 2016 Dec 9.

Departments of 1 Plastic and Craniofacial Surgery.

The authors describe the case of a 3-year-old boy with a giant congenital vertex hemangioma who underwent presurgical embolization with Onyx (ethylene-vinyl alcohol copolymer dissolved in dimethyl sulfoxide) and Glubran ( N-butyl-2-cyanoacrylate). This vascular tumor had no intracranial vascular communication as assessed by pre-embolization MRI and catheter angiography. All embolizations were performed by direct percutaneous injection. One week following the last embolization procedure the child presented with a 24-hour history of ataxia and extrapyramidal tremor. He was diagnosed with a possible immune-mediated reaction to Onyx or Glubran, which was treated with an urgent surgical excision of the hemangioma followed by intravenous administration of immunoglobulin and steroids. To the authors' knowledge, this is the first case of possible immune-mediated toxicity secondary to either Onyx or Glubran administration. This case highlights the need for awareness of potential toxic reactions to these embolic agents in the treatment of hemangiomas in the pediatric patient.
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http://dx.doi.org/10.3171/2016.5.PEDS13345DOI Listing
March 2017

Routine cerebrospinal fluid analysis during 'de novo' ventriculoperitoneal shunt insertion: Single Institution Experience.

Br J Neurosurg 2016 Aug 19;30(4):427-8. Epub 2016 Jan 19.

a Department of Neurosurgery , Beaumont Hospital , Dublin , Ireland.

Background Cerebrospinal fluid (CSF) sampling is performed during ventriculoperitoneal (VP) shunting procedure surgery for early detection of infection. We have performed a retrospective study to determine whether routine intraoperative CSF sampling at new VP shunt insertion has predicted shunt infection or changed subsequent surveillance or management. Method From January 2011 to December 2013, 99 patients underwent first time VP shunt insertion at our hospital. The data collected from Beaumont Hospital Information System and operating theatre logbook. The reviewed data were patient demographics, the clinical condition requiring VP shunt procedure, shunt type, date of VP shunt insertion, date of VP shunt infection or malfunction and laboratory data. Results A first time VP shunt insertion procedure was performed in 99 patients. During the VP shunt insertion procedure, 64 patients had CSF sampling for microbiological analysis. The CSF culture was negative in all samples. All patients were followed up for 12 months. During the follow-up period, a total of 15 patients underwent VP shunt revision. Three of the shunt revisions were secondary to infection. The three infected shunt cases had sterile CSF cultures at the time of insertion. Conclusion There appears to be no correlation between CSF sampling during first time VP shunt insertion and the later development VP shunt infection. This questions the need for routine CSF sampling at the time of insertion. This would be confirmed as a part of future randomised trials.
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http://dx.doi.org/10.3109/02688697.2015.1119235DOI Listing
August 2016

Rapid Clinical Course of Multiple Metastatic Cerebral Angiosarcoma.

Turk Neurosurg 2015 ;25(4):643-8

Beaumont Hospital, Department of Neurosurgery, Dublin, Ireland.

Central nervous system (CNS) angiosarcoma, both primary and secondary, is an exceptionally rare malignant tumor. The behaviour of angiosarcoma is one of rapid progression with early metastatic spread but as with all sarcomas, the primary site may not clinically evident by the time metastases develop. Identification of the primary site of origin is masked by the carpet-like growth pattern that may occur in the left atrium, the most frequently encountered primary site for angiosarcoma. This rare tumor presents many diagnostic challenges. We describe the clinical and neuropathologic features of two patients with angiosarcoma of the brain and review the previously published cases described to date.
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http://dx.doi.org/10.5137/1019-5149.JTN.9042-13.1DOI Listing
February 2016

Inhibition of multidrug resistance protein 1 (MRP1) improves chemotherapy drug response in primary and recurrent glioblastoma multiforme.

Front Neurosci 2015 16;9:218. Epub 2015 Jun 16.

Department of Physiology and Medical Physics, Centre for Systems Medicine, Royal College of Surgeons in Ireland Dublin, Ireland.

Glioblastoma multiforme (GBM) is a highly aggressive brain cancer with extremely poor prognostic outcome despite intensive treatment. All chemotherapeutic agents currently used have no greater than 30-40% response rate, many fall into the range of 10-20%, with delivery across the blood brain barrier (BBB) or chemoresistance contributing to the extremely poor outcomes despite treatment. Increased expression of the multidrug resistance protein 1(MRP1) in high grade glioma, and it's role in BBB active transport, highlights this member of the ABC transporter family as a target for improving drug responses in GBM. In this study we show that small molecule inhibitors and gene silencing of MRP1 had a significant effect on GBM cell response to temozolomide (150 μM), vincristine (100 nM), and etoposide (2 μM). Pre-treatment with Reversan (inhibitor of MRP1 and P-glycoprotein) led to a significantly improved response to cell death in the presence of all three chemotherapeutics, in both primary and recurrent GBM cells. The presence of MK571 (inhibitor of MRP1 and multidrug resistance protein 4 (MRP4) led to an enhanced effect of vincristine and etoposide in reducing cell viability over a 72 h period. Specific MRP1 inhibition led to a significant increase in vincristine and etoposide-induced cell death in all three cell lines assessed. Treatment with MK571, or specific MRP1 knockdown, did not have any effect on temozolomide drug response in these cells. These findings have significant implications in providing researchers an opportunity to improve currently used chemotherapeutics for the initial treatment of primary GBM, and improved treatment for recurrent GBM patients.
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http://dx.doi.org/10.3389/fnins.2015.00218DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4468867PMC
July 2015

ETV as a last resort.

Childs Nerv Syst 2014 May 30;30(5):859-66. Epub 2013 Nov 30.

Pediatric Neurosurgery, Children's University Hospital, Temple Street, Dublin 1, Ireland,

Introduction: The field of neuroendoscopy is rapidly expanding with increasing indications for endoscopic third ventriculostomy (ETV).

Discussion: As a treatment for hydrocephalus, ETV has the advantage of providing a more physiological cerebrospinal fluid diversion without shunt hardware which reduces the risk of recurrent infection and malfunction. The success rate of ETV has been increasing with decreasing morbidity and mortality.

Conclusion: Originally, ETV was indicated for cases of obstructive hydrocephalus, however the indications are expanding. To highlight this, we present a small series of cases were ETV is not traditionally indicated and was a treatment of last choice.
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http://dx.doi.org/10.1007/s00381-013-2330-2DOI Listing
May 2014

Intraoperative Cerebrospinal Fluid Sample from First Ventriculoperitoneal Shunt Operation: Is it Indicated?

Malays J Med Sci 2013 Jul;20(4):102-3

Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3773362PMC
July 2013

Stupp-treated glioblastoma accompanied by EBV-positive primary CNS lymphoma.

Br J Neurosurg 2014 Apr 19;28(2):287-9. Epub 2013 Aug 19.

Department of Neurosurgery, Beaumont Hospital , Dublin , Ireland.

We describe a patient who within 2 months of undergoing radio-chemotherapy for glioblastoma developed an Epstein-Barr virus-positive primary diffuse large B-cell CNS lymphoma. To our knowledge, this is the first such case reported in the literature showing that new tumefactions following aggressive treatment for glioblastomata might represent secondary malignancies.
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http://dx.doi.org/10.3109/02688697.2013.829554DOI Listing
April 2014

Extradural haematoma--to evacuate or not? Revisiting treatment guidelines.

Clin Neurol Neurosurg 2013 Aug 4;115(8):1201-5. Epub 2013 Jun 4.

Department of Neurosurgery, Cork University Hospital, Wilton, Cork, Ireland.

Background: We describe three cases of extradural haematomas (EDHs) and their management, focusing on operative and non-operative treatment. We also review the available literature from the past three decades as well as the guidelines for the management of EDH. An algorithm is formulated based on different factors, including the clinical course of the patients and their CT findings.

Methods: The first patient presented to us after sustaining a fall with a GCS of 15/15 and a large parieto-occipital EDH with a volume of 90 cm3. He was treated non-operatively. Follow-up CT showed good resolution of the haematoma. The second patient presented with a GCS of 7/15, a posterior fossa EDH with a volume of 30 cm3, and obstructive hydrocephalus. Emergency ventriculostomy was performed, which was converted to a VP shunt. The third case was a patient presenting with a large hemispheric EDH, which was 130 cm3 in volume. The GCS at presentation was 14/15 but dropped to 6/15, following which he underwent craniotomy and evacuation of the EDH.

Results: The Glasgow Outcome Scale (GOS) at three months was five for the first two cases and three for the third case with a dense right hemiplegia.

Conclusion: EDH, both supratentorial and in the posterior fossa, can be managed non-operatively. A large volume EDH (>30 cm3) can be managed non-operatively provided the GCS at presentation and follow up remains the same with symptomatic improvement. Prompt treatment of a large volume EDH may still result in a poor outcome.
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http://dx.doi.org/10.1016/j.clineuro.2013.05.012DOI Listing
August 2013

Acute surgical management in idiopathic intracranial hypertension.

BMJ Case Rep 2012 Dec 13;2012. Epub 2012 Dec 13.

Department of Neurosurgery, Beaumont Hospital, Dublin, Ireland.

Idiopathic intracranial hypertension is a headache syndrome with progressive symptoms of raised intracranial pressure. Most commonly, it is a slow process where surveillance and medical management are the main treatment modalities. We describe herein an acute presentation with bilateral sixth nerve palsies, papilloedema and visual deterioration, where acute surgical intervention was a vision-saving operation.
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http://dx.doi.org/10.1136/bcr-2012-007949DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4545110PMC
December 2012

Unilateral facial palsy in an infant: an unusual presentation of familial multiple cerebral cavernous malformation.

BMJ Case Rep 2012 Nov 30;2012. Epub 2012 Nov 30.

Department of Neurosurgery, Beaumont Hospital, Dublin, Ireland.

Cerebral cavernous malformation (CCM) in infants tends to have genetic predisposition. These cavernomas have a progressive course of events and associated neurological symptoms with increase in age. They most commonly present with seizure and syndrome of increased intracranial pressure comprising of headache, vomiting and focal neurological signs. We describe a case of a 7-month-old infant who presented with an acute onset of right facial paralysis with a background of familial CCM. The CT and MRI scan revealed fresh haemorrhage in the right cerebellar and pontine cavernomas with surrounding oedema and no evidence of obstructive hydrocephalus. These two cavernomas re-bled in a week duration causing episodes of incessant crying and irritability. After discussing the pros and cons of treatment, owing to stable clinical status, the patient is currently been managed conservatively.
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http://dx.doi.org/10.1136/bcr-2012-007508DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4543825PMC
November 2012

The occult nature of intramedullary spinal cord metastases from renal cell carcinoma.

BMJ Case Rep 2012 Nov 21;2012. Epub 2012 Nov 21.

Department of Neurosurgery, Beaumont Hospital, Dublin, Ireland.

Renal cell carcinomas (RCC) are characterised by a tendency to metastasise widely, often while remaining occult. Intramedullary spinal cord metastases (ISCM) from RCC may be the presenting feature of the disease or present at any time in the disease course. This case report discusses an ISCM from RCC which became manifested at the time of resection of the primary tumour. We review the literature published on ISCM from RCC from 1990 to date comparing disease characteristics and presentations.
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http://dx.doi.org/10.1136/bcr-2012-007476DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4544952PMC
November 2012
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