A comparison between obstructive hydrocephalus and non-obstructive hydrocephalus on midsagittal brain MRI

Hydrocephalus refers to distension of the cerebral ventricles, usually as the result of obstruction somewhere along the pathway of the cerebrospinal fluid circulation. Hydrocephalus ex vacuo means ventricular enlargement in the presence of cerebral atrophy or irreversible loss of brain parenchyma. According to morphologic change of ventricular enlargement, the mechanism and results of treatment are quite different. MRI improves diagnostic accuracy in patients with hydrocephalus because of its ability to show small obstructing lesion and anatomical changes. To evaluate differential points, we compared patients with obstructive hydrocephalus and non-obstructive hydrocephalus. T1-weighted sagittal images were retrospectively analyzed in 19 patients with obstructive hydrocephalus, 22 non-obstructive hydrocephalus, and 36 normal subjects. On midsagittal section, we evaluated mamillopontine distance, thickness and shape and position of the corpus callosum, and antero-inferior portion of the 3rd ventricle. The average mamillopontine distance was 11.5mm for normal subjects, 8.2mm for obstructive hydrocephalus group, and 13.6mm for non-obstructive hydrocephalus group(p < 0.01). Dilatation of the anterior inferior portion of the 3rd ventricle was seen only in 11 patients of obstructive hydrocephalus group. Average thickness of the corpus callosum at the level of the foramen of Monro was 7.5mm for normal subjects, 5.1mm for obstructive hydrocephalus group, and 4.4mm for non-obstructive hydrocephalus group(p < 0.01). There was a difference in the shape of corpus callosum between obstructive hydrocephalus and non-obstructive hydrocephalus group. It is concluded that mamillopontine distance, thickness and shape of the corpus callosum, dilatation of the antero-inferior 3rd ventricle could be good differential points between obstructive hydrocephalus and non-obstructive hydrocephalus.

Bilateral spontaneous carotid-cavernous fistula(CCF) presenting as painful ophthalmoplegia: Two cases

Carotidcavernous fistula(CCF) is a syndrome in which arteriovenous sinus shunts exist between the carotid artery and the cavernous sinus. These shunts have very wide spectrums in pathogenesis, angiografic findings, hemodynamics and teatment. Spontaneous dural CCF is dural vascular malformations that usually runs a benign course with variable clinical findings. We experienced two case of bilateral spontaneous CCF presenting as painful ophthalmoplegia. In the first case, a 53-years old hypertensive, diabetic woman had previous history of unilateral painful ophthalmoplegia eight months before admission and as partially recovered. On examination, she had slowly progressive bilateral chemosis, exophthalmos, and sixth nerve palsy. MRI showed abnormal vessels in the cavernous sinus from prominent superior ophthalmic vein. Angiographic findings showed fistulas of both external carotid and left internal carotid arteries draining into the cavernous sinus. We had multiple trials of transarterial and transvenous embolization with gelfom material or platinum coils with partial improvement of chemosis and exophthalmos. In the second case, a 45-years old woman noted slowly progressive headache, ptosis, dilatation of pupil in the left side, and diplopia suggesting paralysis of the left inferior rectus muscle. MRI showed signal voids in the cavernous sinus. Angiographic findings showed fistulars of the right and left internal carotid arteries draining into the cavernous sinus. CCF should be consider as a underlying cause in patient presenting as painful ophthalmoplegia. We report two cases of bilateral spontaneous CCF presenting as painful ophthalmoplegia.

A case of spinal intramedullary malignant astrocytoma with intracranial seeding

BACKGROUND: Astrocytoma in spinal cord is rare, comprising only 1% of all primary central nervous system tumors. Malignant astrocytomas( grades III and IV) account for only 7.5% of intramedullary glioma occuring in all age. Dissemination from malignant astrocytoma in spinal cord to the cerebral subarachnoid space has been rarely reported. CASE DESCRIPTION: A 22-year-old male was brought for evaluation of a back pain and progressive left leg weakness over 40 days. MRI of the thoracolumbar spine showed intramedullary mass lesion(T11-L1). Concurrent cranial CT and CSF cytology showed no abnormal findings. The tumor was removed partially. At that time, pathologic diagnosis was low grade astrocytoma. He was given regional irradiation. Six months after surgery the patient was reevaluated because of seizure. CSF cytology revealed malignant cells. Brain MRI showed leptomeningeal carcinomatosis with hydrocephalus. A second pathology of the tumor revealed malignant astrocytoma. CONCLUSION: We report a arae case of spinal intramedullary malignant astrocytoma with intracranial seeding.

A case of spinal intramedullary malignant astrocytoma with intracranial seeding

BACKGROUND: Astrocytoma in spinal cord is rare, comprising only 1% of all primary central nervous system tumors. Malignant astrocytomas( grades III and IV) account for only 7.5% of intramedullary glioma occuring in all age. Dissemination from malignant astrocytoma in spinal cord to the cerebral subarachnoid space has been rarely reported. CASE DESCRIPTION: A 22-year-old male was brought for evaluation of a back pain and progressive left leg weakness over 40 days. MRI of the thoracolumbar spine showed intramedullary mass lesion(T11-L1). Concurrent cranial CT and CSF cytology showed no abnormal findings. The tumor was removed partially. At that time, pathologic diagnosis was low grade astrocytoma. He was given regional irradiation. Six months after surgery the patient was reevaluated because of seizure. CSF cytology revealed malignant cells. Brain MRI showed leptomeningeal carcinomatosis with hydrocephalus. A second pathology of the tumor revealed malignant astrocytoma. CONCLUSION: We report a arae case of spinal intramedullary malignant astrocytoma with intracranial seeding.