Temporal Lobe Encephalocele with Epilepsy in A Young Female: An Atypical Presentation of Idiopathic Intracranial Hypertension.

Idiopathic intracranial hypertension (IIH) is typically described in a middle-aged female and present with symptoms of headache, transient visual obscuration, photophobia, diplopia, rarely with pulsatile tinnitus. Seizure as a sole manifestation is very rare. Here we present a case of a young non-obese female with epilepsy, and imaging revealed temporal lobe encephalocele with typical imaging features of IIH. She underwent further workup, which confirmed the diagnosis of idiopathic intracranial hypertension.

Complex basilar artery fenestration aneurysm successfully treated with single flow diverter using novel "crossing flow diverter technique" - A rare case report and review of literature.

Basilar artery fenestration aneurysms are very rare and endovascular management of large and complex aneurysms is extremely challenging. Most of these type of cases are managed with stent assisted coiling, dual flow diverters (FD) and single FD with additional coiling of aneurysm and occlusion of one of the vertebral artery. Here, we report a case of large complex basilar artery fenestration aneurysm successfully treated with single FD using novel technique called "crossing flow diverter technique" without any additional coiling of aneurysm or occlusion of vertebral artery. Using this technique cost of procedure and procedural complexity inherent with other above mentioned techniques can be significantly reduced.

Calvarial Melanotic Neuroectodermal Tumor of Infancy with Rhabdomyosarcomatous differentiation-A Rare Case.

BACKGROUND: Malignant neuroectodermal tumor of infancy is a rare neural crest cell-derived neoplasm of infants. Histologically, melanotic neuroectodermal tumor of infancy usually consists of 2 types of cells: neuroblast-like and melanocyte-like cells. Here we present a rare case of melanotic neuroectodermal tumor of infancy containing a third type of cell population, that is, rhabdomyoblasts in addition to the above two. CASE DESCRIPTION: We report a case of a 10-month-old female child who was brought to us with complaints of swelling over the right forehead for the last 9 months, which started increasing in size rapidly 3 months before presenting to us. Noncontrast computed tomography scan showed a large well-defined extra-axial lesion in the right frontotemporal region. The child underwent an open biopsy under general anesthesia. Histopathological sections showed a malignant small round cell tumor consisting of hyperchromatic cells lying in sheets and lobules separated by fibrous septae. The patient underwent 7 cycles of neoadjuvant chemotherapy over a period of 2 months. The patient underwent right frontotemporal craniotomy and gross total excision of the lesion as a definitive surgery. Postoperatively, the patient was stable, and there was no new deficit. Histopathology revealed neuroblast-like and melanocyte-like cells with rhabdomyosarcomatous differentiation. The patient received chemotherapy in the postoperative period. The patient had recurrence of the tumor and died 8 months after the surgery. CONCLUSIONS: Calvarial malignant neuroectodermal tumor of infancy with rhabdomyosarcomatous differentiation is a rare entity with no cases being reported before. Neoadjuvant chemotherapy with surgical excision can be a promising modality of treatment.

Filar arteriovenous fistula associated with anomalous common posterior intercostal arterial trunk - A case report and review of literature.

An anomalous common trunk giving rise to bilateral intercostal arteries at multiple levels is exceedingly rare and its association with spinal filar AVF and low-lying cord has not been reported so far. Here, we report this uncommon anatomical variation in a 60-year-old male who presented with paraplegia and on imaging found to have low-lying spinal cord with filar AVF and venous congestive myelopathy and discuss its embryological basis and associated malformations. Although rare, interventional radiologists should be aware of this entity, as these trunks may be a major source of bleeding in patients with hemoptysis, and also may be involved in vital spinal cord supply.

Endovascular management of a ruptured aneurysm associated with distal PICA fenestration.

Fenestrations are rare but well-known arterial anatomic variations in which a segment of artery divides into two parallel channels that reunite distally. Although fenestrations as such are asymptomatic, they have gained clinical significance because of their association with aneurysms and other intracranial vascular pathologies. Here we present a 35-year-old woman with history of sudden severe occipital headache and vomiting. Imaging revealed a ruptured aneurysm in the distal posterior inferior cerebellar artery arising from one of the limbs of the fenestration. The aneurysm was successfully managed by coiling, and the patient made complete recovery without neurological sequelae.

Endovascular Management of a Rare Case of Pediatric Vertebral Artery Mycotic Aneurysm: A Case Report.

Pediatric posterior-circulation aneurysms are uncommon, difficult-to-treat lesions associated with significant morbidity and mortality. Infections and trauma are important risk factors in children. Here, we present a 10-year-old boy with a lower respiratory tract infection, rapidly progressive right-neck swelling, and weakness of the right upper limb. Imaging revealed a partially thrombosed right vertebral-artery pseudoaneurysm with multiple cavitory lung lesions. Subsequent laboratory work-up showed underlying primary immunodeficiency disorder (chronic granulomatous disease). The aneurysm was successfully managed by parent-artery occlusion. The child made a complete recovery without neurological sequelae.

Comparison of computed tomographic angiography and noncontrast magnetic resonance angiography in preoperative evaluation of living renal donors.

INTRODUCTION: The computed tomographic angiography (CTA) renal donor protocol is an established method of preoperative renal vascular pedicle evaluation in prospective renal donors. However, CTA is associated with significant radiation exposure and intravenous contrast administration. The newer noncontrast-enhanced magnetic resonance angiography (NCE-MRA) techniques, especially arterial spin labeling (ASL) with steady-state free precession (SSFP) hold promise as an effective alternative. We prospectively compared CTA with NCE MRA for accuracy in the evaluation of renal arterial anatomy in prospective renal donors. METHODS: A total of 43 subjects underwent CTA followed by NCE MRA in a prospective comparative study. The number of renal arteries and early branching of renal arteries were noted in both kidneys in all subjects. Intermodality agreement was calculated using "K" (Kappa) statistics and 95% confidence interval for both modalities. RESULTS: A total of 63 single, 21 double, and 2 triple arteries were detected in 43 subjects on CTA. CTA showed an early branch in 17 kidneys. NCE MRAshowed 64 single arteries, 20 double arteries, and 2 triple arteries. A total of 14 kidneys showed an early branch. Unweighted Kappa statistic of agreement between CTA and NCE MRA for number of renal arteries and for frequency of early branching was 0.9707 and 0.8822, respectively. CONCLUSIONS: The newer NCE MRA techniques such as ASL with SSFP among others are potential alternatives for CTA, in the evaluation of prospective renal donors.

Misery of neurosurgeon: Gauzoma causing foreign body granuloma-role of radiologist.

Materials used in neurosurgery to achieve hemostasis may be of resorbable or nonresorbable substance and may cause foreign body granuloma if left at the operative site. Foreign body granuloma depending on clinical history may be indistinguishable from an abscess, resolving infarction, and hematoma. Here we present two cases, who had decompressive craniectomy following road traffic accident. Follow-up computerized tomography (CT) scan revealed hyperdense lobulated lesion with peripheral rim enhancement. On magnetic resonance imaging (MRI), lesions were predominantly hypointense on T1-weighted images, and hyperintense on T2-weighted images and showed a lack of restricted diffusion. In view of recent craniectomy and imaging findings diagnosis of foreign body granuloma was made. Both patients underwent surgery, intraoperatively gauze pieces were retrieved from lesions which confirmed preoperative diagnosis. The combination of CT and MRI can diagnose foreign body granuloma, especially in trauma settings. Thus, we can help the surgeon by providing the probable diagnosis for proper management.

MR imaging of cavernous sinus lesions: Pictorial review.

The main purpose of this pictorial review is to highlight the important MR imaging findings of various conditions involving the cavernous sinus in addition to brief description of normal anatomy. The pathological conditions that can involve the cavernous sinus can be categorized into infective, inflammatory, granulomatous, vascular and neoplastic causes. Imaging, especially with MRI, plays an important role not only in detection but also in definition of disease extent and in characterization of the pathology. Currently, high-resolution MR images clearly show various components of cavernous sinus which help in making a proper diagnosis and thus appropriate further management.

Traumatic pseudoaneurysm of bulbourethral artery managed by coil embolization.

Urethral injury is a common form of urogenital trauma in males. Urethral injuries can be diagnosed with ease in emergency due to the presence of blood clot at external urethral meatus or inability to catheterize the urethra. Stricture formation is usual sequelae of such injuries. Uncontrolled urethral hemorrhage is a relatively rare complication which can present either as immediate or delayed. Such injuries can be managed conservatively in majority; however, if uncontrolled may require interventional management. Such patients usually have underlying pseudoaneurysm formation or arteriovenous fistula. Here, we are reporting a case of bulbar urethral injury which presented with delayed uncontrolled urethral hemorrhage. On angiography, pseudoaneurysm arising from left bulbourethral artery with active urethral extravasation was noted and was managed with coil embolization.

Acute hemorrhagic encephalitis: An unusual presentation of dengue viral infection.

Dengue is a common viral infection worldwide with presentation varying from clinically silent infection to dengue fever, dengue hemorrhagic fever, and severe fulminant dengue shock syndrome. Neurological manifestation usually results from multisystem dysfunction secondary to vascular leak. Presentation as hemorrhagic encephalitis is very rare. Here we present the case of a 13-year-old female admitted with generalized tonic clonic seizures. Plain computed tomography (CT) scan of head revealed hypodensities in bilateral deep gray matter nuclei and right posterior parietal lobe without any hemorrhage. Cerebrospinal fluid (CSF) and serology were positive for IgM and IgG antibodies to dengue viral antigen. Contrast-enhanced magnetic resonance imaging (MRI) revealed multifocal T2 and fluid attenuated inversion recovery (FLAIR) hyperintensities in bilateral cerebral parenchyma including basal ganglia. No hemorrhage was seen. She was managed with steroids. As her clinical condition deteriorated, after being stable for 2 days, repeat MRI was done which revealed development of hemorrhage within the lesions, and diagnosis of acute hemorrhagic encephalitis of dengue viral etiology was made.

99mTc-Methylene diphosphonate SPECT/CT as the one-stop imaging modality for the diagnosis of osteoid osteoma.

PURPOSE: The aim of this study was to evaluate the utility of Tc-methylene diphosphonate (Tc-MDP) single-photon emission tomography (SPECT)/computed tomography (CT) for the diagnosis of osteoid osteoma and compare the same with three-phase planar bone scintigraphy (BS) and CT alone. MATERIALS AND METHODS: Data of 31 patients (age: 20.6±13.2 years; male: 80.6%) who had undergone Tc-MDP BS with SPECT/CT for clinically and/or radiographically suspected osteoid osteoma were retrospectively evaluated. Planar BS images were analyzed by an experienced nuclear medicine physician. CT images were evaluated by an experienced radiologist. SPECT/CT images were evaluated by the nuclear medicine physician and radiologist in consensus. On the basis of the diagnostic confidence the interpreters used a scoring scale of 1-3, in which 1 is negative for osteoid osteoma, 2 is equivocal, and 3 is positive for osteoid osteoma. For the calculation of sensitivity, specificity, and predictive values for planar BS, CT, and SPECT/CT an interpretive score of 2 or higher was taken as positive for osteoid osteoma. Receiver operating characteristic curve analysis was performed and the area under the curve was calculated and compared. Histopathology and microbiology/clinical imaging follow-up was used as the reference standard. RESULTS: There were nine equivocal lesions on planar BS and five equivocal lesions on CT, but none on SPECT/CT. The sensitivity, specificity, and accuracy of SPECT/CT were all 100%; those of CT were 77.8, 92.3, and 83.8% and those of planar BS were 100, 38.4, and 74.1%, respectively. On comparison, the area under the curve of SPECT/CT was significantly larger than that of planar BS (1.00 vs. 0.761; P=0.005) and CT (1.00 vs. 0.872; P=0.044). However, no significant difference was seen between planar BS and CT (0.761 vs. 0.872; P=0.236). CONCLUSION: Tc-MDP SPECT/CT shows excellent diagnostic accuracy for osteoid osteoma and can be used as a one-stop imaging modality for the same. It is superior to planar BS and CT alone for the diagnosis of suspected osteoid osteoma.

Ciliary body metastasis in a patient with non-small cell lung carcinoma--incidental detection with 18F-FDG PET/CT.

Ciliary body metastasis in a case of lung cancer is very rare. Intraocular metastasis by any cancer most commonly involves choroid followed by iris and ciliary body. We present a case of a 71-year-old male with non-small cell lung cancer who was found to have an 18F-FDG avid right lung mass. Incidentally a focus of abnormal increased 18F-FDG uptake was noted in the region of ciliary body in the right eyeball. The findings were confirmed to be a metastatic lesion in ciliary body on Ultrasonography and MRI. Our case depicts this extremely rare occurrence corroborated by various modalities.

Posttraumatic cortical defect of femur.

Posttraumatic cortical defect of bone is a rare entity which occurs in a maturing skeleton following green stick or torus fracture. Most of the cases are asymptomatic and they are detected incidentally on radiograph. These lesions usually require no treatment. However, the appearance of these lesions can mimic various pathological conditions affecting bone. Knowledge about this entity is important as it avoids unnecessary investigations. We present this case as the occurrence of this entity in femur is very rare and the child was symptomatic.

Myoepithelioma of the soft palate: a case report.

Myoepitheliomas are rare benign tumors of myoepithelial cell origin, most commonly seen in parotid gland. These tumors are also reported in oral cavity, soft palate being the most common site of involvement. Imaging findings are nonspecific, and histopathology is necessary to differentiate from other tumors. Our case showed mildly enhancing well-circumscribed mass in soft palate with histological findings consistent with myoepithelioma. The aim of this case report is to increase the awareness about this rare benign tumor regarding its morphological, histopathological, and radiological features along with its possible differential diagnosis.