Cerebral venous etiology of intracranial hypertension and differentiation from idiopathic intracranial hypertension.

This study presents the characteristics that distinguish between idiopathic intracranial hypertension (ICH) and ICH caused by intracranial vascular damage. Twenty-one patients with ICH were included in this study. The analysis of the symptomatology correlated with the values of intracranial pressure, and the imaging findings revealed significant differences between these two types of ICH. ICH caused by intracranial venous vascular damage is named vascular ICH. Vascular ICH has a known etiology, such as cerebral vascular illness, and a relatively rapid increase in intracranial pressure of approximately 21 cmH2O and imaging findings show characteristic images of thrombosis or stenosis of the intracranial venous system, while all brain images (computed tomography, magnetic resonance imaging, angio-magnetic resonance imaging) are normal in idiopathic ICH. The treatment of vascular ICH is etiologic, pathogenic, and symptomatic, but that of idiopathic ICH is only symptomatic.

Lethal recurrent hemorrhages of a brainstem cavernoma.

Hemorrhages of brainstem cavernomas may cause severe neurological deficits. Surgical strategies are frequently described, and advanced neuromonitoring with intraoperative imaging can help neurosurgeons to achieve good results. However, patients are often confronted with significant therapeutic risks by the primary doctor before talking to an experienced brainstem neurosurgeon. On the other hand, lethal progression with repeated hemorrhages is rarely described, although many would agree on this possibility by experience or assumption. Our reported case represents the natural development of a patient with repeated hemorrhages of a brainstem cavernoma and consequently increasing neurological deterioration, which led to a fatal ending. After two recurrent hemorrhages, the patient and his family declined twice the offered surgical procedures to evacuate the hematoma of the pons. The patient died after three noticed hemorrhages of the same brainstem cavernoma and their consecutive consequences. This case report represents one possible clinical scenario for consultation for brainstem cavernoma procedures.

Intradural dermoid tumor of the posterior fossa in a child with diastematobulbia.

Dermoid tumors (DTs) are rare lesions and represent 0.3% of all intracranial tumors. More than 50% of these tumors are diagnosed in childhood or early adolescence. Authors report an intradural DT of the posterior fossa in a child aged 4 years, possibly originating in the brainstem in which the diastematobulbia was detected postoperatively. Magnetic resonance imaging investigations are mandatory to diagnose these cases. The only curative treatment in DT is the total removal of the lesion. The reported case presents good recovery in the follow-up period of 3 years. The surgical intervention is particularly related to the DT type. Diastematobulbia associated with DT and the origin of the DT in the brainstem is discussed based on the literature.