Intracranial tuberculoma in non-immunosuppressive state.

The rise in the incidence of tuberculosis is generally related to human immunodeficiency virus infection. However, intracranial tuberculoma, a complication of tuberculosis considered to be a critical disease, can develop even in the absence of immunosuppressive state. Here, we describe 2 cases of intracranial tuberculoma occurring in patients with no evidence of immunosuppressive state or past history of tuberculosis. In Case 1, lesions were observed in the right lateral ventricle, with histological examination revealing granulomatous lesions. In Case 2, scattered lesions were observed in the cranium and the lung fields. In both cases, the QuantiFERON Test (QFT) was positive, and improvements were observed in the symptoms following administration of antituberculous drugs. Intracranial tuberculoma cannot be considered rare, and needs to be included in the differential diagnosis of intracranial lesions. Diagnosis can be tricky since this disease can develop in a patient in a non-immunosuppressive state or without a past history of tuberculosis. The QFT is an effective test to enable the diagnosis of tuberculomas in atypical patients.

Hemodynamic stability under general anesthesia in carotid artery stenting.

PURPOSE: The purpose of our study was to investigate the frequency of hemodynamic instability in patients undergoing carotid artery stenting (CAS) under general anesthesia using sevoflurane and nitrous oxide in oxygen. METHODS: A total of 97 consecutive CAS procedures were performed in 84 patients under sevoflurane anesthesia. The following hemodynamic variables were assessed: degree of systolic blood pressure change (deltaSBP) during CAS, hypotension, and bradycardia during and after CAS. RESULTS: During CAS, hypotension occurred in 43% of the patients, and bradycardia occurred in 14%. There was individual variation in the deltaSBP during CAS. Systolic blood pressure (SBP) change >50 mmHg was not seen in this series. After CAS, hypotension occurred in 24%, and bradycardia occurred in 10%. Cerebral infarction occurred in three cases. The stroke rate was 3.1% in this series. CONCLUSION: General anesthesia using sevoflurane and nitrous oxide in oxygen depressed barorecepter reflex sensitivity, induced hemodynamic stability under CAS, and may decrease the rate of occurrence of complications.

Improved cerebral perfusion after simultaneous stenting for tandem stenoses of the internal carotid artery--two case reports.

Two patients with extracranial internal carotid artery (ICA) stenosis and tandem stenosis of the ipsilateral intracranial ICA were treated simultaneously by angioplasty with stenting. A 68-year-old man who presented with neovascular glaucoma had 90% stenosis of the right cervical ICA and 80% stenosis of the ipsilateral petrous ICA. A 74-year-old man who suffered from transient ischemic attack had 75% stenosis of the left cervical ICA and 90% stenosis of the ipsilateral cavernous ICA. Hemodynamic compromise was confirmed in both patients. Tandem stenting of both extracranial and intracranial ICA stenoses was performed simultaneously in both patients without complications. Poststenting angiography demonstrated excellent dilation of both lesions and normalization of cerebral perfusion. Simultaneous tandem stenting for extracranial ICA stenosis with intracranial tandem stenosis is less invasive than open surgery in high-risk patients with hemodynamic compromise, especially if the major lesion responsible for cerebral hypoperfusion is difficult to determine.

Traumatic middle meningeal artery pseudoaneurysm and subsequent fistula formation with the cavernous sinus: case report.

BACKGROUND: A combination of pseudoaneurysm and arteriovenous fistula of the middle meningeal artery is rare. We describe a case of traumatic pseudoaneurysm of the middle meningeal artery, which subsequently formed a fistula with the cavernous sinus. CASE DESCRIPTION: A 23-year-old man suffered from blunt head trauma and skull fractures. Sixteen days later, he suddenly experienced headache and a bruit was auscultated over the left ear. Three-dimensional computed tomographic angiography revealed dilatation of the left middle meningeal artery. The dilation proved to be a pseudoaneurysm on cerebral angiograms and it was also found to have formed a fistula with the cavernous sinus. Both lesions were successfully obliterated by endovascular embolization using microcoils. CONCLUSION: Head injury may lead to asymptomatic pseudoaneurysm or dural arteriovenous fistula. Neurosurgeons should always bear in mind the possibility of such vascular injuries after blunt head trauma to prevent any hemorrhagic complications.

Rapid expansion of benign scalp neurofibroma caused by massive intratumoral hemorrhage--case report.

A 62-year-old man with neurofibromatosis type 1 presented with rapid growth of a scalp mass. Head computed tomography demonstrated a large extracranial tumor of soft tissue density with massive intratumoral hematoma. Cerebral angiography demonstrated remarkable hypervascularity of the tumor. Preoperative embolization and total removal of the tumor was performed. The tumor contained a large amount of intratumoral hematoma (500 ml). The histological diagnosis was neurofibroma without malignant transformation. Benign scalp neurofibroma showing massive intratumoral hemorrhage is rare. Rapid growth or intratumoral hemorrhage in neurofibroma may be an indicator of malignant transformation.