Vertebrobasilar artery dissection complicating cervico-dorsal intramedullary Ependymoma: a case report

Vertebral artery dissection [VAD] is an important cause of posterior circulation stroke in young adults. It could be either spontaneous or traumatic; initial symptoms are often non-specific, and diagnostic arteriography is not performed until neurological deficits are obvious. We describe a rare case of a patient who presented with cervico-dorsal intramedullary ependymoma, and developed brain stem infarction caused by vertebrobasilar artery dissection during her postoperative period, which was diagnosed by Magnetic Resonance Imaging [MRI] and Magnetic Resonance Angiography [MRA]. Although vertebrobasilar artery dissection is rare, it should be considered in the differential diagnosis of brain stem infarction, and urgent MRI / MRA should be done as it is a reliable diagnostic tool and less invasive compared to cerebral angiogram

Inflammatory demyelinating pseudotumor

Inflammatory demyelinating pseudotumor [IDP] is a rare inflammatory lesion of unknown etiology, which presents as a space-occupying lesion but responds dramatically to steroid therapy. The objective of this report is to document 2 cases of IDP seen in Kuwait. Two female patients, aged 35 and 27 years presented with the clinical and radiological features of a space-occupying lesion. Radiological investigations showed partial ring-enhancing lesions with insignificant mass effect, which were multiple in patient one, and single in patient 2. Biopsies in each patient showed features of a demyelinating disorder. Both patients remarkably improved clinically on steroid therapy. The report highlights the need for an early and correct diagnosis of IDP for therapeutic purposes