A Case of Adult Brain Stem Tuberculoma:MR Imaging: Case Report

A 39 years old healthy male patient with intracranial brain stem tuberculoma manifested hydrocephalic symptoms due to obstruction of aqueduct of sylvius is presented. Surgical excision was undertaken for obtaining histologic diagnosis and resolving hydrocephalus, which made postoperative neurologic deficits. CT and Magnetic resonance(MR) imaging of intracranial tubercuroma were studied for approaching nonsurgical diagnosis of tuberculoma. MR imaging of tuberculoma shows low intensity on T2-weighted imaging with Magnevistring enhancement. The MR imaging feature of the tuberculoma were found to be distinct from those abscess, metastasis and glioma. Antituberculous chemotherapy is thought to be better than surgical approach in managing brain stem tuberculoma if radiologic diagnosis was obtained.

Giant Serpentine Aneurysm of the Posterior Cerebral Artery: Case Report

Aneurysms of the posterior cerebral artery are rare, furthermore giant serpentine aneurysms-partially thrombosed aneurysms containing a tortuous vascular channel-of the posterior cerebral artery are extremely rare. The author et al. were able to remove 3.9cm x 2.9cm x 3.0cm sized giant serpentine aneurysm of the distal PCA totally, without any significant postoperative neurological sequela except transient ipsilateral third cranial nerve paresis and transient hemihypesthesia. Various kinds of surgical treatment were proposed by several authors in managing unclippable giant aneurysms:excision including partial excision;clipping of feeding artery and excision;trapping and excision;revascularization and excision;anastomosis only. We took subtemporal approach under the surgical microscope and trapping & excision was performed in several steps:proximal clipping of the PCA distal to the Pcom-PCA junction;reducing volume of the mass through piecemeal resection of the aneurismal wall;distal clipping of the PCA;total excision and final trapping just proximal and distal to the origin of the aneurysm. We are discussing the characteristics of the giant serpentine aneurysm, precognition of rich collateral circulation of the PCA distal to trapping and surgical management of the giant serpentine aneurysm.

Three Cases o Pituitary Apoplexy

Three cases of pituitary apoplexy in patients with pituitary tumors are described. This uncommon condition is characterized by the sudden onset of headache, nausea, vomiting, visual impairement, diplopia, disturbance of consciousness and autonomic or hormonal dysfunction. The diagnosis is strengthened by a radiologically abnormal pituitary fossa & clinical symptoms and confirmed by the operative findings of hemorrhage necrotic tissue. Recently, CT enables the early diagnosis of pituitary apoplexy. Since CT can detect blood, it can document acute or chronic hemorrhage in pituitary adenoma. In addition, CT can discriminate between densities other than blood and can therefore be used to diagnosis those cases of pituitary apoplexy in which infarction & necrosis predominate. Finding of acute bleeding within tumor in enlarged sellar on plain CT establishes the diagnosis of pituitary apoplexy. Following three cases of pituitary apoplexy had special findings which was fluid level with faint rim enhancement of high density of dependent portion. Conculsively We agree that CT can help the early diagnosis and prompt surgical intervention of pituitary apoplexy.

Von Hippel-Lindau's Disease: Case Report

Although cases of von Hippel-Lindau syndrome are not rare, the fact that hemangioblastomans can occur at sites in the nervous system other than the cerebellum is not appreciated. We are reporting a case of VHL complex in 23-year-old male. In this case, there were multiple cerebellar hemangioblastomas, retinal angiomas, multiple spinal hemangioblastomas, syringomyelia, and papillary cystadenoma of epididymis. There was no evidence of polycythe mia or abnormality of other organs. Large cystic cerebellar hemangioblastomas were removed surgically and papillary cystadenoma of epididymis were excised, too. Total laminectomy of T2, T3 and T4 revealed abnormal meningeal varicosities, enlarged spinal cord, inra-axial hemangioblastomas, and syringomyelia.