ABSTRACT
A 51-year-old woman with left proptosis, diplopia, headache, and nausea was found to have bilateral intraorbital abscesses, left superior ophthalmic vein thrombosis, bilateral cavernous sinus thromboses, and a left temporal lobe intracerebral abscess. Because the paranasal sinuses were unaffected, a dental origin was suspected and confirmed. The causative organism was Streptococcus milleri. Aggressive surgical intervention included bilateral orbital abscess drainage and dental extraction, and medical therapy included intravenous metronidazole, ceftriaxone, heparin, and methylprednisolone. A left sixth cranial nerve paresis was the only long-term sequela.
Subject(s)
Abscess/microbiology , Cavernous Sinus Thrombosis/microbiology , Eye Infections, Bacterial/microbiology , Orbital Diseases/microbiology , Streptococcal Infections/microbiology , Streptococcus milleri Group/isolation & purification , Abscess/diagnosis , Abscess/therapy , Anti-Bacterial Agents/therapeutic use , Cavernous Sinus Thrombosis/diagnosis , Cavernous Sinus Thrombosis/therapy , Combined Modality Therapy , Drainage/methods , Drug Therapy, Combination , Eye Infections, Bacterial/diagnosis , Eye Infections, Bacterial/therapy , Female , Functional Laterality , Humans , Magnetic Resonance Imaging , Middle Aged , Orbital Diseases/diagnosis , Orbital Diseases/therapy , Streptococcal Infections/diagnosis , Streptococcal Infections/therapy , Tooth Extraction , Treatment OutcomeSubject(s)
Cerebrovascular Disorders/diagnosis , Intracranial Arteriovenous Malformations/diagnosis , Jugular Veins/diagnostic imaging , Jugular Veins/pathology , Magnetic Resonance Angiography/instrumentation , Tomography, X-Ray Computed , Diagnosis, Differential , Humans , Imaging, Three-DimensionalSubject(s)
Frontal Sinus/anatomy & histology , Image Processing, Computer-Assisted , Imaging, Three-Dimensional , Tomography, X-Ray Computed , Turbinates/anatomy & histology , Ethmoid Bone/anatomy & histology , Frontal Bone/anatomy & histology , Humans , Palate/anatomy & histology , Reference ValuesABSTRACT
We report a case of cerebral fat embolism (CFE) that was imaged with T2- and T2*-weighted, fluid-attenuated inversion recovery, and contrast-enhanced T1-weighted images. Multiple white matter lesions demonstrated contrast enhancement, with little evidence of hemorrhage. The patient regained complete neurologic function. CFE can cause capillary inflammation and breakdown of the blood-brain barrier, without associated hemorrhage or permanent neurologic deficit. In this case, both contrast-enhanced T1-weighted and gradient-echo T2*-weighted images were important in diagnosing CFE and in determining the severity of the patient's condition.
Subject(s)
Embolism, Fat/diagnosis , Image Enhancement/methods , Intracranial Embolism/diagnosis , Magnetic Resonance Imaging/methods , Adult , Artifacts , Blood-Brain Barrier/physiology , Brain Edema/diagnosis , Contrast Media/administration & dosage , Diagnosis, Differential , Femoral Fractures/surgery , Humans , Male , Postoperative Complications/diagnosisABSTRACT
Neuroradiologists generally do not fully appreciate the importance of the territory of the ascending pharyngeal artery. The ascending pharyngeal artery is a small but important artery that supplies multiple cranial nerves and anastomotic channels to the anterior and posterior cerebral circulations. Several disease processes in the head and neck involve the ascending pharyngeal artery. To evaluate and treat such diseases, it is necessary for neuroradiologists not only to know selective angiography and embolization techniques, but also the territory of the ascending pharyngeal artery, anastomoses, and vascular supply to the vasa nervorum of lower cranial nerves. Herein, the normal angiographic anatomy of the ascending pharyngeal artery, its relationship with neighboring territories, its importance in clinical situations, and research models are reviewed.
