ABSTRACT
BACKGROUND: Moyamoya disease (MMD) is linked to the formation of intracranial aneurysms. The authors recently observed an effective use of magnetic resonance vessel wall imaging (MR-VWI) to detect de novo unruptured MMD-associated microaneurysms. OBSERVATIONS: The authors describe a 57-year-old female who was diagnosed with MMD 6 years ago after suffering a left putaminal hemorrhage. MR-VWI revealed point-like enhancement in the right posterior paraventricular region during the annual follow-up. On the T2-weighted image, this lesion was surrounded by high intensity. Angiography revealed a microaneurysm in the periventricular anastomosis. Right combined revascularization surgery was performed to prevent future hemorrhagic events. Another de novo circumferential enhanced lesion on MR-VWI appeared in the left posterior periventricular region 3 months after surgery. Angiography revealed that the enhanced lesion was a de novo microaneurysm on the periventricular anastomosis. The left combined revascularization surgery went well. The bilateral microaneurysms vanished on follow-up angiography. LESSONS: Unruptured MMD-associated microaneurysms on the periventricular anastomosis can be detected using MR-VWI. Revascularization surgery can eliminate microaneurysms by reducing hemodynamic stress on the periventricular anastomosis.
ABSTRACT
BACKGROUND: A paradoxical reaction (PR) is a phenomenon in which the primary tuberculous lesion worsens or another de novo tuberculous lesion appears while on anti-tuberculosis therapy. Here, we report a rare case of cerebellar tuberculoma caused by a PR during therapy for lumbar tuberculous spondylitis (Pott's disease). CASE DESCRIPTION: A 47-year-old male with human immunodeficiency virus seronegative was diagnosed with lumber tuberculous spondylitis (Pott's disease) and prescribed anti-tuberculous agents. His lower back pain and inflammatory condition recovered after initiation of anti-tuberculous therapy. Two months later, he complained of headache, nausea, and staggering. Magnetic resonance images revealed a ring-enhanced lesion located at the cerebellar hemisphere extending to the vermis, which caused perifocal edema and bilateral ventriculomegaly. These findings were consistent with his symptoms of hydrocephalus. He did not have preceding clinical findings of meningitis, and a PR was suggested to cause de novo aggregation of cerebellar tuberculoma. A lesionectomy was performed, and the surgical specimen was pathologically diagnosed as a tuberculoma. He recovered well from neurological disorders after the resection. CONCLUSION: De novo formation of intracranial tuberculoma alone caused by a PR without preceding meningitis is very rare. Lesionectomy is needed for intracranial tuberculoma, which manifests as a mass effect, as well as antituberculous therapy.
ABSTRACT
BACKGROUND: There are few case reports of primary leiomyosarcoma originating from the dura mater. We herein report a case of primary dural leiomyosarcoma that presented with repeated intracranial hemorrhage. CASE DESCRIPTION: A 62-year-old man presented with a 4-year history of a temporo-occipital bump. He showed a disturbance with reading words. The sudden onset of occipitalgia occurred 13 days after the onset. Computed tomography revealed a left temporal subcortical hematoma and thin subacute subdural hematoma associated with a temporal osteolytic mass lesion extending into the subcutaneous layer. The hematoma and tumorous mass lesion were removed. The subcutaneous tumor mass penetrating the skull bone originated from the dura mater and extended into the transverse sinus. No invasion into the cortical surface was observed. The lesion adjacent to the transverse sinus was not resected, and the remnant lesion was irradiated with local radiation therapy of 60 Gy. A left subdural hematoma and intrasylvian subarachnoid hemorrhage occurred 3 months after the first surgery, and a second removal was performed. Temporal subcortical hemorrhage repeatedly occurred 2 months after the second surgery, and the patient died. CONCLUSIONS: In the present case, primary dural leiomyosarcoma may have invaded the dural sinus and repeated intracranial hemorrhage occurred due to a venous circulatory disturbance. The aggressive clinical course observed is rare. A clearer understanding of the route of invasion and a careful evaluation after primary treatment are needed in order to avoid hemorrhagic complications.
