A rare case of carotid body tumor associated with near complete cerebral sinus thrombosis and idiopathic intracranial hypertension. Management strategy and review of the literature.

BACKGROUND: Carotid body tumors (CBTs) are rare hypervascular lesions with critical location which makes them very challenging to treat. In rare occasions, compression of the jugular vein from the tumor mass could predispose to progressive thrombosis of intracranial venous sinuses. The latter consequently leads to intracranial hypertension (pseudotumor cerebri) with the accompanying danger to the vision. Herewith, we present our management strategy for this rare presentation of CBTs. CASE DESCRIPTION: A 38-year-old woman, with no medical history, was admitted in the emergency unit with acute onset of headache, dizziness, and vomiting. On the diagnostic imaging studies (CT venography and MRI) a near total occlusion of all cerebral venous sinuses and a large CBT (Shambin Type II) were diagnosed. Initially, the patient was treated with anticoagulants for the thrombosis and with lumbo-peritoneal (LP) shunt for the management of pseudotumor cerebri. At a second stage, after resolution of the cerebral sinus thrombosis, the CBT was completely resected under electrophysiological monitoring, without preoperative embolization. At 1-year follow-up, the patient is neurologically intact with functioning LP shunt, patent cerebral venous sinuses, without tumor recurrence. CONCLUSION: We present a rare case of CBT with intracranial complications, which was managed successfully by staged treatment. Careful study of the preoperative radiological and laboratory data, thorough preoperative planning of the tridimensional lesion anatomy, as well as meticulous microsurgical technique under intraoperative electrophysiological monitoring was essential for the successful outcome of the case.

Unconscious Semantic Priming Influences Performance of Visuomotor Tasks Differently but the Effects are Similar in Young and Older Adults.

We examined the effects of semantic priming of attention on two sequentially presented visuomotor tasks, traffic judgments and saccadic adaptation. Priming was accomplished with the scrambled sentence task: participants formed meaningful sentences from a list of words where a word denoting wide attention focus was involved. The results showed that semantic priming influenced positively saccade adaptation (its' benefit increased) while it attenuated visuomotor performance in the traffic task (RT of hand movements increased). We found the effects of priming on both tasks' performance to be comparable in young and older participants. It was suggested that semantic priming effect on visuomotor tasks depended on the cognitive resources which were needful as for the priming as for the primed task.

Recognition of unprovoked (idiopathic) pulmonary embolism-Prospective observational study.

BACKGROUND: The assessment of the clinical symptoms is the weakest link of the pulmonary embolism (PE) diagnostic algorithm. Despite the presence of highly sensitive and specific imaging methods, verifying PE remains difficult due to nonspecific clinical symptoms and frequently its subclinical course. OBJECTIVE: The aim of this study is to improve the recognition of PE by investigating the clinical presentation and short-term prognosis of unprovoked PE in comparison to provoked PE. The study was directed to patients who suffer from PE as a primary disease. METHODS: This prospective observational study included 331 patients with PE, approved by computer tomographic pulmoangiography. They were categorized as having unprovoked or provoked PE, according to their epidemiological data. The clinical characteristics and one-month mortality rate were compared between both groups. RESULTS: About 67% of the patients had provoking factors and ∼33% had unprovoked PE. The patients in the unprovoked PE-group were younger compared to provoked PE-group (56.67 ±â€¯17.95 vs 63.76 ±â€¯14.58, p < .0001) and the males predominated vs females (62.04% vs 37.96%, p = .012). The patients with unprovoked PE had more previous thromboembolic events compared to provoked PE-group (30.56% vs 19.45%, p = .022) and a larger thrombotic burden (p = .001). Dyspnea (85.18% vs 85.13%), chest pain (47.22% vs 46.85%), cough (43.92% vs 45.94%), hemoptysis (16.67% vs 14.41%), hemodynamic instability (9.26% vs 8.56%), deep venous thrombosis (49.51% vs 44.5%) had similar frequencies in both groups. No significant differences in the means of systolic pressure of arteria pulmonalis, D-dimer, arterial blood gases, Revised Geneva probability score were found. One-month mortality was lower in unprovoked PE-group than in provoked (1.85% vs 8.52%, p = .042). CONCLUSIONS: Unprovoked PE occurs at a younger age, more frequently in males. It is characterized by the following significant variables: higher Wells score, lower PESI score, lower CRP, higher thrombotic burden and lower one-month mortality rate, compared to provoked PE.

Adaptation of Reactive Saccades is Influenced by Unconscious Priming of the Attention Focus.

The authors investigated whether the size of the attention focus can influence saccadic adaptation, and whether this influence changes in older age. Using the scrambled sentence task, young and older participants were either primed for a wide attention focus, or primed of a narrow attention focus, or were not primed for any specific attention focus. Subsequently, all participants underwent a double-step saccadic adaptation paradigm aimed at changing the direction of reflexive saccades. The authors found that compared to the nonprimed control group, priming for a wide attention focus enhanced saccadic adaptation in both age groups by a similar amount; the benefit persisted throughout the adaptation phase, but was absent during the deadaptation phase. In contrast, the authors found no effects of priming with a narrow attention focus on saccadic adaptation. From this the authors conclude that a wide attention focus is beneficial for workaround strategies but not for adaptive recalibration, and that those benefits are similar in young and older persons.