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1.
Rinsho Shinkeigaku ; 63(2): 97-100, 2023 Feb 25.
Article in Japanese | MEDLINE | ID: mdl-36725008

ABSTRACT

The patient is a 73-year-old woman. She presented with dysarthria, and a head MRI revealed multiple acute cerebral infarctions in the bilateral cerebral hemisphere and cerebellar hemisphere. Transesophageal echocardiography after admission revealed a 16 mm large mobile calcification of the mitral annulus (caseous calcification of the mitral annulus; CCMA) on the posterior apex of the mitral valve annulus. Since the CCMA had a high risk of relapse, and a new infarction was detected on the 8th day, resection of the mass and mitral valve replacement surgery were performed. CCMA is a subtype of mitral annular calcification (MAC). When calcification progresses from the MAC state to form a mass, it is called a calcified amorphous tumor; CAT. Reports of embolic cerebral infarction caused by CAT are rare, but this is a rare report of an embolic cerebral infarction from CCMA presenting as CAT.


Subject(s)
Calcinosis , Heart Valve Diseases , Female , Humans , Mitral Valve/pathology , Calcinosis/pathology , Echocardiography, Transesophageal , Cerebral Infarction/pathology
2.
J Neurosurg Case Lessons ; 4(9): CASE22274, 2022 Aug 29.
Article in English | MEDLINE | ID: mdl-36051778

ABSTRACT

BACKGROUND: A vestibular schwannoma (VS) presenting with paroxysmal facial electric shock pain, that is, trigeminal neuralgia (TN), is relatively rare. Furthermore, TN is extremely rare in small VSs. OBSERVATIONS: Herein, the authors report the case of a 52-year-old woman with a complaint of right TN. Magnetic resonance (MR) imaging revealed a right VS of 12-mm diameter that compressed the trigeminal nerve. Although she did not report any hearing impairment, audiometry revealed decreased high-frequency range on the right side. The tumor was excised using the right retrosigmoid approach, and TN was confirmed to be caused by direct compression of the trigeminal nerve by the VS. Sufficient decompression of trigeminal nerve was done. The proximity of the trigeminal nerve root to the vestibular nerve root was the cause of TN. TN disappeared immediately after surgery, and there was no worsening of hearing impairment and facial paralysis. LESSONS: It is important to remember that TN may occur with direct tumor compression, even in small VSs. A preoperative 3-dimensional MR cisternogram/angiogram fusion image clearly showed direct tumor compression of the trigeminal nerve and the absence of responsible vessels, which was useful for surgical planning.

3.
Rinsho Shinkeigaku ; 62(3): 184-189, 2022 Mar 29.
Article in Japanese | MEDLINE | ID: mdl-35228459

ABSTRACT

A 31-year-old man visited our hospital due to experiencing severe headaches, vomiting, and hypesthesia in the left side of his body. He had no past illnesses and had had no severe headaches before. The symptoms started the day after receiving the coronavirus disease 2019 (COVID-19) vaccination with Tozinameran. An MRI revealed cerebral venous sinus thrombosis and high intensity (DWI & FLAIR) of the right thalamus. Anticoagulant therapy was initiated, and his symptoms improved gradually. The follow-up MRI showed recanalization in a large part of the occluded venous sinuses. Most of the coagulation tests were normal, except for slightly high value of D-dimer, and the polymerase chain reaction (PCR) test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was negative. Further cases are needed to judge if there is some sort of relationship between the vaccination and the cerebral venous sinus thrombosis.


Subject(s)
COVID-19 , Sinus Thrombosis, Intracranial , Adult , Humans , Magnetic Resonance Imaging , Male , SARS-CoV-2 , Sinus Thrombosis, Intracranial/diagnostic imaging , Sinus Thrombosis, Intracranial/etiology , Vaccination
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