Board Certified Neurosurgeon Brain & Spine Care 860-889-9035
Mark Hornyak, MDBoard Certified Neurosurgeon

Cases

Educational Case Library

Case of the Week

Repair of skull base defect

28 year old woman presents with complaint of right-sided hearing loss and sense of fullness within her right ear Exam with conductive hearing loss in right ear

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DegenerativeSpine

Spondylolisthesis and Lumbar Stenosis

66 yo woman presents with leg greater than back pain Greater than 1 year duration Pain radiates down back of legs Numbness and tingling in calves No weakness, but reports falling Worsens with walking, better with rest Has had injections – limited benefit Has tried PT Ibuprofen helps Smokes ½ ppd; cutting down

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SpineTumor

Metastatic tumor to T12

53 year old man presents with mid-lower back pain radiating to the left side of the lower chest and flank Severe after minor fall 2 weeks prior Mild back pain for about 4 months No significant prior medical history

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SpineTumor

Spinal meningioma (C2)

71 yo woman presents with 10 months of progressive weakness of arms and legs. Started with difficulty walking and has progressed to the point that she needs significant assistance to walk. She also reports difficulty with voiding. Examination reveals severe left-sided weakness most pronounced in left hand and hip muscles. She is hyper-reflexic.

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Brain

Chronic subdural hematoma (SDH)

This is a 70 year old male presents to ER after seizure. He has no history of seizure. The seizure occurred at dinner table. He had generalized shaking with loss of consciousness, witnessed by wife. The patient is without memory of the event. He complains of headache. He has no history of trauma. The patient has history of cardiac stents placed 3 years prior and takes aspirin, 81mg daily, and clopidogrel (Plavix) 75 mg daily.

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SpineTumor

Kyphoplasty and RF ablation

66 year-old woman presents with severe back pain. She has known history of breast cancer with spread to multiple bones. Back pain started 8 weeks prior without specific traumatic event. No neurologic complaint

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DegenerativeSpine

Cervical stenosis with myelopathy

65 year-old man presents to ER after multiple falls. Describes progressive hand weakness and loss of dexterity along with difficulty walking resulting in multiple falls recently

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Brain

Repair of skull base defect

28 year old woman presents with complaint of right-sided hearing loss and sense of fullness within her right ear Exam with conductive hearing loss in right ear

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BrainTumor

Brain Metastasis

69 year old man with known history of renal cell carcinoma presents with cognitive decline and neck mass. Memory issues were attributed to chemotherapy. Also was having new headaches. Neck mass was due to an infection. Neurologic examination was relatively unremarkable.

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BrainTumor

Craniotomy for Meningioma

52 year old woman presenting to ER with new onset seizure. Patient & husband report being in good health until while seated in passenger seat of car, she had brief loss of consciousness with stiffening of right arm and body. Episode lasted about 2 minutes. EMS was called.

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DegenerativeSpine

Lumbar Disc Herniation

48 year-old woman presenting with back and right leg pain Pain worsening despite conservative management Back and leg both 9/10 Leg pain goes to bottom of foot Has numbness of her foot on exam and some weakness of her ankle.

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BrainTumor

Craniotomy for Tumor Resection

64 year-old man presenting with headache and visual changes Headache for about 2 weeks getting stronger Seeing flashing lights and losing sight in the left side of his vision

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Brain

Chiari Malformation

20 year-old man presenting with headache Pressure in back of head When lifting weights, coughing, laughing Over 1 year, and getting worse Neurologic exam is unremarkable

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DegenerativeSpine

Acute cervical disc herniation

61 year old man undergoes unrelated surgical procedure. Upon waking from surgery reports new pain, numbness, tingling in his forearms and hands and weakness of his legs. No prior history of arm problems No neck pain Neuro exam with sensory loss in medial hands and radial forearm into axilla Proximal leg weakness Urgent MRI c-spine obtained

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Spine

C1-2 fusion

C1-2 instability with rheumatic pannus 75 year-old woman with history of rheumatoid arthritis presents to office with several years of progressive neck pain. Also reports 3 months of numbness in her hands; denies weakness but reports apraxia

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Spine

Arachnoid cyst of thoracic spine

65 yo woman presents to office with complaint of mid-back pain, progressive over several weeks Numbness in her toes for about 2 weeks She also complains of difficulty walking; feels off balance, but not dizzy On exam she has mild increased deep tendon reflexes.

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Spine

Cervical Fusion

85 year old man presents with shock-like sensations shooting into his arms and hands Increasing numbness in hands One month of hand and arm weakness, getting worse rapidly Off balance walking Can’t use his hands for fine motor tasks like shaving, buttoning clothes etc.

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Information on this site should not be relied upon to make a medical diagnosis or determine treatment for a medical condition. Case examples are educational and de-identified. They do not represent expected outcomes for any individual patient. The information on this website is not intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice.