Cerebral manifestations in liver disease and transplantation.

Patients with liver disease frequently develop cerebral complications. The brain may be affected directly by the pathological process or agent responsible for the liver disease, as a consequence of the metabolic and haemodynamic derangement caused by hepatic dysfunction, or as a complication of the treatment of liver disease. Computed tomography (CT) and magnetic resonance imaging (MRI) can be helpful in the diagnosis and management of these complications, and advanced techniques such as diffusion weighted imaging (DWI) and magnetic resonance spectroscopy (MRS) are providing new insights into the underlying pathophysiological processes. We present a radiological overview of the cerebral manifestations of liver disease, categorized as acute presentations, chronic presentations, and conditions occurring in the context of liver transplantation.

Aneurysmal sub-arachnoid haemorrhage in patients with Noonan syndrome: a report of two cases and review of neurovascular presentations in this syndrome.

To date, intracranial aneurysms have been reported in two patients with Noonan syndrome. We report two unrelated patients with Noonan syndrome who presented with sub-arachnoid haemorrhage secondary to intracranial aneurysms. These cases are discussed and other cerebrovascular abnormalities that have been described in association with Noonan syndrome are reviewed. Ultrastructural and genetic factors contributing to these associations are considered.

Third ventricular plasma-cell lesion with delayed intraventricular transudation of contrast medium.

We report a patient presenting with hydrocephalus secondary to a posterior third ventricular plasma-cell lesion which exhibited delayed transudation of contrast medium into the adjacent aqueduct and fourth ventricle.

De novo development of presumed cavernomas following resolution of E. Coli subdural empyemas.

Cavernomas fall within the group of angiographically occult lesions and may be found in up to 4 % of the population [1]. They may occur at any age, and with the advent of MRI incidental cavernomas are increasingly identified. The pathogenesis is uncertain. Familial cases are well recognised with a reported prevalence of 10-15 % [2-3]. The incidence of new lesions has been reported at 0.4 lesions per patient per year in cases with familial cavernomas [4]. Presumed cavernomas have been documented following radiation for malignancy [5-6], and stereotactic cerebral biopsy [7]. There have been no previously documented cases of de novo genesis of cavernomas following bacterial meningitis and subdural empyemas.

Delayed reconfiguration of a Guglielmi detachable coil mass associated with late occlusion of an adjacent aneurysm and parent vessel.

We present a case of asymptomatic, progressive, late occlusion of the left superior cerebellar artery (SCA) and an aneurysm arising from the junction of the SCA and basilar artery after embolization of an adjacent aneurysm arising between the left posterior cerebral artery and the left SCA. The delayed occlusion was associated with reconfiguration of the Guglielmi detachable coils at the neck of the treated aneurysm.

Intrapituitary fluid levels following haemorrhage: MRI appearances in 13 cases.

Demonstration of fluid levels on MRI is well recognised in cerebral haematomas, tumours and cysts. The occurrence of fluid levels within haemorrhagic pituitary tumours has not previously been described in detail. Evidence of haemorrhage was identified in 27 of 125 pituitary tumours. Fluid levels occurred in 13 of these haemorrhagic tumours. No association with histological type was identified. Recognised risk factors for haemorrhage were identified in half of the cases.

Endovascular Management of a Traumatic Basilar Tip Aneurysm following Endoscopic Ventriculostomy in a Child.

SUMMARY: We report the case of four year nine month old girl that presented a basilar tip iatrogenic arterial aneurysm following ventriculostomy. Despite being a false aneurysm the lesion was successfully coiled two years later.

Endovascular management of complete vertebral artery dissection presenting with subarachnoid haemorrhage.

SUMMARY: Spontaneous vertebral artery (VA) dissection may involve the intradural segment of the VA and result in subarachnoid haemorrhage (SAH). These lesions are frequently associated with recurrent SAH, and have a high mortality. Prior to the development of endovascular techniques the majority of these lesions were treated surgically. In cases where the dissection involved the posterior inferior cerebellar artery (PICA) origin surgery was associated with significant complications including recurrent SAH from retrograde VA flow into the dissected segment above the surgical clip. We describe two cases of complete VA dissection in which the entire intradural VA was sacrificed to prevent recurrent SAH. The first case tolerated planned left PICA occlusion without developing a significant neurological deficit. The second case had infarcted the right PICA territory at presentation.