Intracranial hemorrhage as the initial presentation of disseminated intravascular coagulation in association with malignancy.

A 76-year-old man presented with a sudden disturbance of consciousness and right hemiplegia. An initial computed tomographic examination revealed multiple hematomas. The laboratory studies were highly suggestive of disseminated intravascular coagulation, although the underlying diseases were unknown at the time of admission. Despite various attempts at management, including replacement therapy, bleeding was not controlled and the patient died on day 5. An autopsy revealed the presence of prostate and rectal cancers. This case illustrates the fact that a fatal intracranial hemorrhage can be the first manifestation of disseminated intravascular coagulation in association with malignancy.

Long-term follow up of antegrade recanalization of vertebral artery dissecting aneurysm after internal trapping: case report.

A 34-year-old female presented with subarachnoid hemorrhage caused by the rupture of a right vertebral artery (VA) dissecting aneurysm. The affected site, including the aneurysm and parent artery, was successfully occluded with detachable coils. Follow-up angiography performed 28 days after the endovascular treatment revealed recanalization of the parent artery. We decided to treat the patient conservatively without further intervention because the aneurysm had been completely occluded. Magnetic resonance imaging showed a normal VA configuration with a minor irregularity of the affected wall at 6 years after onset. Rebleeding tends to occur during the acute stage because spontaneous healing of the dissecting vascular wall typically occurs within one month after onset. Our case suggests that additional intervention is unnecessary during the chronic stage once the aneurysm has been occluded and no further signs of the development of VA dissection are found.

Progression of pre-existing Chiari type I malformation secondary to cerebellar hemorrhage: case report.

A previously healthy 32-year-old man was surgically treated under a diagnosis of right subcortical hematoma. Magnetic resonance imaging incidentally demonstrated tonsillar herniation. Thirty-two months later, he was readmitted with complaints of occipital, neck, and shoulder pain as well as cerebellar ataxia. Subsequent magnetic resonance imaging demonstrated cerebellar hemorrhage and progression in the downward herniation of the tonsils. Conservative treatment resulted in spontaneous disappearance of the cerebellar hematoma, and the clinical signs and radiological findings improved. Patients with Chiari type I malformation require neuroimaging follow up because the downward herniation of the tonsils can progress in association with subsequent pathophysiological disorders.

Supra- and infratentorial subdural empyema secondary to septicemia in a patient with liver abscess--case report.

An 81-year-old man presented with subdural empyema in the left parietotemporal convexity 2 months after treatment under diagnoses of liver abscess and septicemia. Systemic investigation found no evidence of otorhinological or other focal infection except for liver abscess. Emergency drainage of pus was performed via a single burr hole and additional intravenous antibiotics were administered. Six weeks later, magnetic resonance imaging revealed subdural empyema in the right cerebellopontine angle in addition to recurrence of pus in the left parietotemporal subdural space. Ischemic changes were also shown in the right cerebellar hemisphere and brainstem. Although subdural empyema secondary to septicemia is rare, the possibility of this type of intracranial infection must be kept in mind, especially in compromised patients with septicemia.

Parenchymal anaplastic ependymoma with intratumoral hemorrhage: a case report.

We report an unusual case of a 56-year-old woman with a supratentorial anaplastic ependymoma localized in the parenchyma without continuity with the ventricular system and brain surface. The patient presented with vertigo, and a calcified mass was detected in the left temporal parenchyma. Five years later, she had seizure of the right extremities. Computed tomographic scanning and magnetic resonance imaging revealed an enhanced mass with an intratumoral hemorrhage adjacent to the calcified mass. Subtotal removal of the tumor was performed. The histological analysis revealed that the tumor was an anaplastic ependymoma. After focal radiation therapy (50 Gy), the outcome was favorable, although the residual lesion was still seen on the images. Ependymomas usually arise from the cells lining the ventricular system and the central canal of the spinal cord. We discuss the summary of published cases of supratentorial ectopic ependymoma since the first case in 1995.

Three dimensional digital subtraction angiography imaging of a ruptured aneurysm on the anterior communicating artery.

BACKGROUND: Although angiography is still gold standard for the diagnosis of cerebral aneurysms, false-negative angiograms in cases of subarachoid hemorrhage due to a rupture of an anterior communicating artery aneurysm have been previously reported. We now report a case of an anterior communicating aneurysm demonstrated by 3-dimensional digital angiography (3D-DSA) after a negative standard angiogram. CASE DESCRIPTION: A 41-year-old female was admitted in a comatose state. Computed tomography (CT) revealed intraventricular hemorrhage and a clot in the frontal interhemispheric fissure, suggestive of rupture of an anterior communicating artery aneurysm. Two days later, angiography was performed. Although standard 3-vessel angiogram with multiple views, using cross-compression on each carotid artery, was negative, 3D-DSA revealed an anterior communicating aneurysm. The aneurysm was successfully clipped based on the findings obtained from the 3D-DSA. The outcome was favorable, with mild memory disturbance. CONCLUSION: The standard angiogram sometimes fails to demonstrate aneurysms, especially those on the anterior communicating artery. In this case, 3D-DSA was useful for the diagnosis of the anterior communicating aneurysm which was not seen on standard angiogram.