Faculty Bibliography

A 49-year-old man with a history of basal cell carcinoma and psoriasis presented for routine skin exam and psoriasis management. He had multiple erythematous, scaly patches and plaques, originally diagnosed as psoriasis. Noticeably, one erythematous patch had a focal erosion. Dermoscopy revealed arborizing vessels, an erosion, pink structureless areas, and short, fine telangiectasias (SFTs), suggestive of superficial basal cell carcinoma (sBCC). Dermoscopy of all other lesions was consistent with psoriasis, exhibiting dotted vessels on a faint erythematous background. In conclusion, sBCCs may be overlooked in patients with multiple psoriatic plaques. In this case, the lesions were all initially presumed to be psoriasis. After detecting an erosion, the clinician was prompted to inspect further with dermoscopy and biopsy. Suspicion of sBCC was confirmed after visualization of dermoscopic structures consistent with sBCC. We highlight this case to encourage the use of dermoscopy in these patients for prompt diagnosis of BCCs.

Individuals with migraine often have recurrent, painful symptoms, and symptomatic treatments have detrimental side effects and do not prevent further attacks. Studies indicate that riboflavin can be used to decrease headache frequency and lessen the need for symptomatic treatment. Mitochondrial dysfunction may play a role in migraine pathogenesis by interfering with oxygen metabolism. Daily doses of riboflavin, vitamin B2, may improve mitochondrial function by increasing the reserve of brain mitochondrial energy, and there are minimal side effects with daily treatment. However, there is a need for further randomized, double-blind controlled studies to determine the effective dose. Although riboflavin may not fully eliminate migraine nor take effect for several months, riboflavin is a promising prophylactic agent with minimal adverse effects that may significantly reduce the frequency of migraine

OBJECTIVES/HYPOTHESIS:: Medulloblastoma is the most common pediatric malignant tumor of the central nervous system in children. Treatment includes surgical excision, external beam radiation, and multiagent chemotherapy. Otologic sequelae are common and may result from radiation and/or chemotherapy. Profound sensorineural hearing loss (SNHL) is a known complication of neuro-oncologic treatment and may render these patients eligible for cochlear implantation (CI). Issues of CI in this population, including diagnosis, treatment of preoperative middle ear disease, operative and postoperative course, performance data, and long-term tumor surveillance are highlighted and reviewed. STUDY DESIGN:: Retrospective chart review. METHODS:: Three patients treated for pediatric medulloblastoma with surgical resection, postoperative hyperfractioned craniospinal radiotherapy, and multiagent adjuvant chemotherapy who underwent cochlear implantation were identified. Details of neuro-oncologic treatment and associated otologic complications are presented and analyzed. Primary outcome assessment includes treatment of middle ear pathology, perioperative cochlear implant course, and postimplantation performance data. RESULTS:: Each patient required surgical treatment of chronic ear disease 4 to 16 years after chemoradiation. All progressed to profound SNHL and were implanted 8 to 17 years post-neuro-oncologic treatment. There were no intraoperative complications, and full insertion of the cochlear implant electrode array was achieved in each patient. One patient developed postoperative wound dehiscence requiring operative closure. Postimplantation performance data support significant benefit in all patients. CONCLUSIONS:: Patients treated for pediatric medulloblastoma develop otologic sequelae, including profound SNHL, and may require cochlear implantation. Successful management of middle ear and mastoid pathology involves consideration of potential future cochlear implantation. Postoperative performance data supports cochlear implantation in this population. Laryngoscope, 2009

Anterior cingulate epilepsy is a diagnostic and therapeutic challenge, with a broad range of nonspecific symptoms. Seizures can arise from any region of the anterior cingulate cortex (ACC) and manifest distinctive features based on the area of onset and pattern of spread. These features may provide insight as to the origin of the seizures, but because the ACC integrates information from several networks involving emotional and executive functions and has a diverse cytoarchitecture, functional-structural correlates are complex. Further, the location of the ACC within the interhemispheric fissure limits the capacity of scalp electrodes to record seizure activity from this region. This case review illustrates one part of the spectrum of cingulate epilepsy and discusses clinical features of the disorder