Hemangiopericytoma is an aggressive vascular tumour that rarely affects the central nervous system and is even more rarely spinal in presentation. The clinical features of a patient with a recurrent extraspinal hemangiopericytoma presenting with an epidural spinal cord compression by local invasion are described, including a review of the literature on metastatic hemangiopericytoma to the spine.

A case of a 53-year-old male, with a recurrent extraspinal hemangiopericytoma which metastasized to the thoracic spine five years after detection of the primary tumour is presented. A chart review was conducted where all pertinent history, physical, laboratory, and radiological data were collected. A Pub-Med search using the keyword “hemangiopericytoma” identified all reported cases documenting clinical features, treatment, recurrence and outcome with respect to metastatic hemangiopericytoma to the spine.

Nine patients have been reported to have metastatic hemangiopericytoma to the spine. The median patient age was 47 years and there was a slight male preference. An unusual feature of the hemangiopericytoma is the prolonged period, up to 16 years, between the diagnosis of the primary hemangiopericytoma and the metastases to the spine. All patients were treated with a combination of radiation and surgery.

Hemangiopericytomas show a slow clinical evolution with a strong propensity to relapse long after previous treatment and thus, once identified, prolonged follow-up for recurrence is indicated. A close follow-up of these patients is required because of frequent recurrences and delayed metastases even if the primary lesion was well-controlled. Although overall uncommon, hemangiopericytoma should be kept in mind in the differential diagnosis of vascular epidural spinal cord tumours.

To report an unusual case of large synchronous lumbar disc herniation in adult twins.

Case report and relevant literature review.

The authors report a case of adult female monozygotic twins who synchronously presented with huge lumbar disc herniation. Rather than being a curious coincidence, this case highlights the potential importance of hereditary factors in the causation of lumbar disc degeneration. The relevant literature regarding the role of genetic factors and their relationship to other risk factors in lumbar disc degeneration is reviewed and discussed.

Synchronous lumbar disc herniation in adult twins is a rare event. It, however, sheds light on the role of genetic factors in disc degeneration.

Central neurocytoma is a tumour that typically occurs in young adults in close association with the lateral and third ventricles of the cerebrum.

We report the unusual case of a central neurocytoma that developed in the fourth ventricle of a 59-year-old woman and metastasized to the upper cervical canal. Subtotal excision and adjuvant radiotherapy were used to treat the lesion. Microscopic evaluation, discussion of the pathologic differential diagnosis and theories of the histogenesis of the tumour are presented. Results and

Fourth ventricular neurocytoma is rare and has only been reported twice previously. It appears most likely that this tumour arises from subependymal progenitor cell lines.

Spontaneous intracranial hypotension (SIH) is a well-recognized neurologic disorder that typically presents with orthostatic headaches, low cerebral spinal fluid pressures and distinct abnormalities on magnetic resonance imaging.

We present a case of a rare presentation of SIH.

A 49-year-old man presented with a two week history of orthostatic headaches that rapidly progressed to encephalopathy and coma, requiring intubation. Neuroimaging revealed abnormalities typical of SIH; diffusely enhancing pachymeninges, subdural fluid collections, and descent of the brain. Treatment with an epidural blood patch reversed his coma within minutes. Following a second blood patch, the patient became asymptomatic. No cerebral spinal leak could be identified on magnetic resonance imaging or on a nuclear medicine technetium cerebral spinal fluid flow study. At six month follow-up, he remained symptom free.

The mechanism of coma in SIH is presumed to be compression of the diencephalon from downward displacement of the brain. Although it is very unusual for patients with SIH to present with coma, it is important to recognize since the coma may be reversible with epidural blood patches.

A patient with a constellation of severe neurological symptoms caused by spontaneous intracranial hypotension, which was successfully managed by epidural blood patch, was described.

A 50-year-old woman presented to the neurological service with a two-month history of orthostatic headache. Associated clinical features included sensorineural deafness, ataxia and short-term memory loss. Magnetic resonance imaging showed downward displacement of brain structures, bilateral subdural collections and the postgadolinium images demonstrated diffuse dural enhancement suggestive of the diagnosis of spontaneous intracranial hypotension.

Following a lumbar epidural blood patch, all symptoms improved significantly and her headache resolved.

The principal presentation of spontaneous intracranial hypotension is orthostatic headache. The patient described presented a combination of various neurological symptoms, ataxia, memory loss and deafness, which all responded well to epidural blood patch.

To describe an association of Tourette's syndrome with rapid eye movement sleep behaviour disorder (RBD) in a prepubescent boy.

A four year longitudinal single-case study.

The co-existence of Tourette's syndrome and RBD was confirmed after polysomnographic studies using the standard criteria. The authors propose possible overlap in the pathophysiological mechanisms underlying the two disorders.