Ruptured Fusiform Anterior Cerebral Artery Aneurysm in an Infant : Case Report and a Literature Review.

Ruptured intracranial aneurysms in infants are rare and infantile fusiform anterior cerebral artery (ACA) aneurysms are much rarer. In this report, we described the case of a 7-month-old infant with a ruptured fusiform ACA aneurysm who presented with seizure and underwent endovascular treatment. The patient was initially in a coma and the neurologic condition did not improve after treatment. The clinical characteristics of the case and literature review were discussed.

The early detection of recurrence of malignant peripheral nerve sheath tumor by frequent magnetic resonance imaging.

Surgery has a key role in the treatment of malignant peripheral nerve sheath tumors (MPNSTs), but the resectability of paraspinal MPNSTs is only 20%. Therefore, spinal MPNSTs show frequent recurrence and poor prognosis. Local recurrence is much more common than metastasis for MPNSTs, and surgery still has a key role in the treatment of local recurrence. Therefore, it is important that recurrence must be detected before resectability is lost. However, no evidence-based follow-up protocol has been established for MPNST. The authors performed gross total resection in a 34-year-old woman presented with thoracic MPNST. Adjuvant radiotherapy and chemotherapy were not administered since these adjuvant therapies generally do not improve survival in MPNST and may cause additional neurovascular damage. Instead, the authors monitored the primary site every 3 months using magnetic resonance imaging to detect local recurrence at the earliest opportunity. The tumor recurred locally on two occasions without overt symptoms at 21 and 24 months postoperatively. These recurrences were treated successfully by gross total removal.

Cerebral aneurysm in the long fenestration at the middle portion of m1 segment.

We report a unique case of bilateral mirror image M1 aneurysms, one of which was an unruptured aneurysm arising from the proximal end of right middle cerebral artery fenestration with long loop and the other ruptured aneurysm from the contralateral side. We clipped ruptured aneurysm first and unruptured one in three months after the first operation. The difficulties of identifying this unusual vascular anomaly and possible problems during the surgery of an aneurysm at the site of fenestration are discussed with a review of the literature.

Imaging of the walls of saccular cerebral aneurysms with double inversion recovery black-blood sequence.

In this study, we evaluated the wall of saccular cerebral aneurysms (SCAs) using two-dimensional double inversion recovery black-blood sequence (BBDI). We examined 14 patients with an unruptured SCA (USCA). The BBDI was peripheral-pulse gated, and was acquired during the mid-diastolic period. We evaluated whether the aneurysmal wall could be visualized with BBDI, and the wall thickness in the neck and dome portion of the aneurysm was measured in cases with acceptable imaging quality. BBDI demonstrated the USCA walls in ten patients. In four patients, the USCA walls were poorly delineated from the adjacent brain parenchyma or cerebrospinal fluid. The mean aneurysm size was 8.0 mm. The mean thickness of the aneurysmal wall in the neck portion was 0.60 +/- 0.13 mm in 10 cases. The mean thickness at the dome portion was 0.46 +/- 0.05 mm in five cases. In this study, BBDI revealed some portion of the USCA wall, despite the limited spatial and contrast resolution for delineation of the entire USCA wall. In our opinion, this technique may be used as an additional imaging tool for the evaluation of the aneurysmal wall.

Cerebellar pilocytic astrocytoma presenting with intratumor bleeding, subarachnoid hemorrhage, and subdural hematoma.

INTRODUCTION: Massive intracranial hemorrhage is a very rare initial presentation of cerebellar pilocytic astrocytomas. There are no reports in the medical literature on a cerebellar pilocytic astrocytoma presenting with intratumor bleeding (ITB), subarachnoid hemorrhage (SAH), and subdural hematoma (SDH). CASE REPORT: A 15-month-old boy presented with lethargy and nausea to our hospital. Magnetic resonance imaging showed a mass with ITB at the left cerebellar hemisphere in addition to SDH in the posterior fossa and SAH at the interpeduncular cistern. The patient underwent emergency surgery. On incising the dura, we found SDH, the tumor was visible at the cerebellar cortex, and near total removal followed. Microscopic examination of tissue sections revealed a pilocytic astrocytoma. DISCUSSION: The authors' case is the first report with a presentation including ITB, SAH, and SDH. The presumed mechanism of the SAH and SDH was leaking of the ITB into subarachnoid and subdural spaces.

Leo stent-assisted coil embolization of a giant middle cerebral artery aneurysm.

We report a case of a 70-year-old man harboring a wide-necked thrombosed giant aneurysm of the left middle cerebral artery (MCA) on the M1 segment. The patient presented with generalized tonic-clonic seizures. A computerized tomography scan showed a calcified aneurysmal wall with perianeurysmal swelling. The aneurysm was successfully embolized using closed-cell nitinol stent-assisted coiling (Leo, BALT Co., Montmorency, France).

Thunderclap headache as initial manifestation of Vogt-Koyanagi-Harada disease.

A 59-year-old Asian woman suffered from a TCH followed by sudden, binocular blurred vision, mimicking pituitary apoplexy. The diagnostic workup (including fluorescein angiography, MRI of the brain, and CSF analysis) showed severe optic disc swelling and dye leakage of multiple faint hyperfluorescent spots at retinal pigment epithelium level, diffuse pachymeningeal hypertrophy, and monocytic pleocytosis, respectively. VKH disease should be considered in the differential diagnosis of patients presenting with a TCH followed by sudden, bilateral decreased visual acuity.

Non-Hodgkin's lymphoma of the sphenoid sinus presenting as isolated oculomotor nerve palsy.

BACKGROUND: Solitary involvement of the sphenoid sinus has rarely been reported in non-Hodgkin's lymphoma. Isolated oculomotor nerve palsy is uncommon as an initial presentation of malignant tumors of the sphenoid sinus. CASE PRESENTATION: A 53-year-old woman presented with a three-month history of headache and diplopia. Neurological examination revealed complete left oculomotor nerve palsy. Magnetic Resonance Imaging (MRI) demonstrated a homogenous soft-tissue lesion occupying the left sphenoid sinus and invading the left cavernous sinus. The patient underwent transsphenoidal biopsy and the lesion was histologically diagnosed as non-Hodgkin's lymphoma, diffuse large B-cell type. Tumor cells were positive for CD20 and negative for CD3. Following six cycles of chemotherapy, the left oculomotor nerve palsy that had been previously observed was completely resolved. There was no enhancing lesion noted on follow-up MRI. CONCLUSION: It is important to recognize that non-Hodgkin's lymphoma of the sphenoid sinus can present with isolated oculomotor nerve palsy, although it is extremely rare. The cranial nerve deficits can resolve dramatically after chemotherapy.

Lateral ventricular diverticulum extending into supracerebellar cistern from unilateral obstruction of the foramen of monro in a neonate.

A ventricular diverticulum is usually found in patients with long-standing severe obstructive hydrocephalus that may extend into the supracerebellar cistern. The route involved in the supracerebellar extension of the ventricular diverticulum is believed to originate through the tela choroidea of the temporal choroid plexus or of the antral choroid plexus. The authors report a 4-week-old girl with hydrocephalus as a result of unilateral obstruction of the foramen of Monro, which dilated the right ventricle and displaced the midline to the left side, collapsing the contralateral lateral ventricle. The dilated lateral ventricular diverticulum herniated to the supracerebellar cistern in the posterior fossa that compressed the cerebellum inferiorly. She was treated successfully by a ventriculoperitoneal shunt, resulting in a marked reduction of the ventricle and diverticulum on the follow-up computed tomography and magnetic resonance imaging. We reviewed the literature for the supracerebellar extension route of ventricular diverticulum and suggest that the medial choroidal fissure in the antrum and the velum interpositum may be important anatomical structures for the extension of the lateral ventricular diverticulum into the supracerebellar cistern.

Helmetlike skull deformity with a large arachnoid cyst.

BACKGROUND: It is not difficult to find localized skull ballooning or macrocrania in patients with intracranial arachnoid cysts. However, there have been no previous reports regarding large localized skull protuberant deformities resembling a war helmet. The authors report with a review of literature a case of an adult with helmetlike skull deformity resulting from a large supratentorial arachnoid cyst. CASE DESCRIPTION: A 35-year-old man presented with a large head deformity since his early childhood that had been the result of gradual progression from infantile macrocrania. He also had mental retardation, sixth cranial nerve palsy with recent aggravation of headache, reduced activity, poor voiding control, and walking disturbance. Magnetic resonance imaging of the head showed hydrocephalus with a large supratentorial arachnoid cyst located in the bilateral parietooccipital area compressing the hemisphere anteriorly, and the tentorium and cerebellum inferiorly. Magnetic resonance venogram demonstrated low-lying short transverse and lateral sinuses, and the superior sagittal sinus and falx were displaced to the right side. Radioisotopic cisternogram showed nonfilling of the isotope in the bilateral parietooccipital area. Cerebrospinal fluid pressure measured by lumbar puncture was 17 cm H(2)O. We tentatively diagnosed the condition as normopressure hydrocephalus with a large supratentorial arachnoid cyst. His headache, reduced activity, poor voiding control, and walking disturbance improved after a cystoperitoneal shunt. CONCLUSIONS: This might suggest that large arachnoid cysts found in childhood should be treated for prevention of skull deformity and late aggravation of increased intracranial pressure.

Successful reduction for a pediatric chronic atlantoaxial rotatory fixation (Grisel syndrome) with long-term halter traction: case report.

STUDY DESIGN: Clinical case report of atlantoaxial rotatory fixation (AARF) in a girl presenting with torticollis and neck pain. OBJECTIVE: To report this rare case that was successfully treated with long-term traction and a brace. SUMMARY OF BACKGROUND DATA: AARF is a rare kind of subluxation that is a pathologic fixation of the atlas on the axis. It is most common in pediatric patients and is usually reduced easily with conservative treatments only in the acute stage. However, previously reported chronic AARFs have usually been treated with operative reductions. Although high success rates have been achieved with operative reduction in chronic cases of AARF, even successful operative reduction may result in significant neck motion limitation. METHODS: A 9-year-old girl had torticollis of more than 3 months duration develop as a result of an upper respiratory infection. Dynamic computerized tomography showed consistent fixation of the atlantoaxial joint consistent with type 1 AARF according to the classification of Li and Pang. The patient was treated with halter traction of 5-lb weight for 6 weeks, and with a brace for 4 months and collar for 2 months. RESULTS: We successfully treated this patient with chronic AARF only with cervical traction. She had full recovery of neck motion and normal atlantoaxial angle on follow-up computerized tomography after 6 months. CONCLUSION: From this case, we suggest that long-term traction could be another treatment method for chronic AARF, especially in children.