Choroid plexus cyst development and growth following ventricular shunting

ManuscriptChoroid plexus cysts are typically incidental, asymptomatic cysts. They have been reported to hemorrhage and grow, causing symptoms of obstruction. However, growth and multiplication has not been reported following ventriculoperitoneal shunting procedures. A 66-year-old woman initially underwent a suboccipital retrosigmoid craniotomy for resection of a large petroclival meningioma. Preoperatively, the patient demonstrated imaging findings consistent with hydrocephalus. After surgery the patient required a ventriculoperitoneal shunt. Two years after the initial shunting procedure, imaging demonstrated significant growth of new bilateral choroid plexus cysts as compared with pre-shunt imaging. Post-shunt imaging also demonstrated evidence of diffuse dural enhancement characteristic of intracranial hypotension. Despite radiographic growth and multiplication of the cysts, the patient was clinically asymptomatic and had a good neurological outcome

Hemorrhagic and nonhemorrhagic Rathke cleft cysts mimicking pituitary apoplexy

Journal ArticleObject. Rathke cleft cysts (RCCs) are infrequently symptomatic, and apoplexy is one of the most unusual presentations. Only a few cases of apoplexy associated with RCCs have been reported, and their clinical, imaging, surgical, and pathological features are poorly understood. In the cases that have been reported, intracystic hemorrhage has been a consistent finding. The authors report 6 cases of RCCs in which the presenting clinical and imaging features indicated pituitary apoplexy, both with and without intracystic hemorrhage. Methods. The authors retrospectively reviewed charts and magnetic resonance (MR) imaging studies obtained in patients who underwent transsphenoidal surgery for RCC. Six patients were identified who presented with symptoms and MR imaging characteristics consistent with pituitary apoplexy but were found intraoperatively to have an RCC. All 6 patients presented with a sudden headache, 2 with visual loss, and 1 with diplopia. Review of the preoperative MR images demonstrated mixed signal intensities in the sellar masses suggestive of a hemorrhagic pituitary tumor. In all patients there was a presumed clinical diagnosis of pituitary tumor apoplexy and an imaging-documented diagnosis of hemorrhagic pituitary tumor. Results. All 6 patients underwent transsphenoidal resection to treat the suspected pituitary apoplexy. Intraoperative and histopathological findings were consistent with the diagnosis of an RCC in all cases. Only 2 cases showed evidence of hemorrhage intraoperatively. In all cases, an intracystic nodule was found within the RCC at surgery, and this intracystic nodule was present on the initial MR imaging when retrospectively reviewed. The imaging characteristics of the intracystic nodules were similar to those of acute hemorrhage seen in cases of pituitary apoplexy. Conclusions. The clinical and imaging features of RCCs appear similar to those of hemorrhagic pituitary tumors, making them often indistinguishable from pituitary apoplexy

Rathke cleft cyst intracystic nodule: a characteristic magnetic resonance imaging finding

Journal ArticleObject. The fluid content of Rathke cleft cysts (RCCs) displays variable appearances on magnetic resonance (MR) images and can appear indistinguishable from other intrasellar or suprasellar cystic lesions. Intracystic nodules associated with individual RCCs have been noted, but to date their significance has not been fully explored. Methods. The authors retrospectively reviewed MR imaging studies obtained in patients harboring intrasellar or suprasellar lesions that were consistent with RCCs to identify the presence and imaging characteristics of intracystic nodules. An intracystic nodule was present in nine (45%) of 20 patients with an RCC. All intracystic nodules were clearly visible and displayed a characteristic low signal intensity on T2-weighted MR images. The nodule was only visualized on T1-weighted images in four cases, in which it exhibited a consistent high signal intensity similar to that of the cyst fluid. The nodules did not enhance following the intravenous administration of a contrast agent. Conclusions. Although it is difficult to differentiate RCCs from other sellar cystic lesions because of the variable signal intensities displayed on MR images, the intensity of the intracystic nodule seems consistent on T1- and T2- weighted images, and the nodule is always clearly visible on T2-weighted images. With a nonenhancing cystic lesion that does not cause significant symptoms in the patient, the identification of an intracystic nodule with a characteristic signal intensity will aid in the diagnosis of RCC and the selection of conservative management

Retained peritoneal shunt tubing causing hematuria

Journal ArticleThis 14-year-old boy with congenital hydrocephalus underwent initial shunt placement shortly after birth. During his first 6 years of life, multiple ventriculoperitoneal (VP) shunt revisions were performed to address seven shunt malfunctions and one shunt infection (Staphylococcus epidermidis). During the last shunt revision, which took place 8 years before the current presentation, it was noted that the distal peritoneal shunt tubing (Peritoneal Catheter, Standard, Barium Impregnated; Medtronic Inc., Minneapolis, MN) had fractured and was coiled in the pelvis. Nevertheless, the tubing was not retrieved at that time

Optic pathway gliomas: a review

Journal ArticleOptic pathway gliomas represent approximately 3-5% of childhood intracranial tumors. They usually occur in children during the first decade of life and are seen in 11-30% of patients with neurofibromatosis Type 1 (NF1). Although these tumors are typically low-grade gliomas, the clinical course and natural history are highly variable, making treatment paradigms difficult. Overall, however, they are often indolent tumors that can be observed over time for progression without initial treatment, especially in patients with NF1. Chemotherapy is the first-line treatment for progressive tumors, and radiation therapy is reserved for patients with progressive disease who are older than 5-7 years. Surgery is reserved for large tumors causing mass effect or hydrocephalus and tumors confined to the orbit or unilateral optic nerve

Delayed presentation of acute ischemic strokes during the COVID-19 crisis

This article is made available for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.Background: The COVID-19 pandemic has disrupted established care paths worldwide. Patient awareness of the pandemic and executive limitations imposed on public life have changed the perception of when to seek care for acute conditions in some cases. We sought to study whether there is a delay in presentation for acute ischemic stroke patients in the first month of the pandemic in the US. Methods: The interval between last-known-well (LKW) time and presentation of 710 consecutive patients presenting with acute ischemic strokes to 12 stroke centers across the US were extracted from a prospectively maintained quality database. We analyzed the timing and severity of the presentation in the baseline period from February to March 2019 and compared results with the timeframe of February and March 2020. Results: There were 320 patients in the 2-month baseline period in 2019, there was a marked decrease in patients from February to March of 2020 (227 patients in February, and 163 patients in March). There was no difference in the severity of the presentation between groups and no difference in age between the baseline and the COVID period. The mean interval from LKW to the presentation was significantly longer in the COVID period (603±1035 min) compared with the baseline period (442±435 min, P<0.02). Conclusion: We present data supporting an association between public awareness and limitations imposed on public life during the COVID-19 pandemic in the US and a delay in presentation for acute ischemic stroke patients to a stroke center

Rathke cleft cyst intracystic nodule: a characteristic magnetic resonance imaging finding.

Journal ArticleOBJECT: The fluid content of Rathke cleft cysts (RCCs) displays variable appearances on magnetic resonance (MR) images and can appear indistinguishable from other intrasellar or suprasellar cystic lesions. Intracystic nodules associated with individual RCCs have been noted, but to date their significance has not been fully explored. METHODS: The authors retrospectively reviewed MR imaging studies obtained in patients harboring intrasellar or suprasellar lesions that were consistent with RCCs to identify the presence and imaging characteristics of intracystic nodules. An intracystic nodule was present in nine (45%) of 20 patients with an RCC. All intracystic nodules were clearly visible and displayed a characteristic low signal intensity on T2-weighted MR images. The nodule was only visualized on T1-weighted images in four cases, in which it exhibited a consistent high signal intensity similar to that of the cyst fluid. The nodules did not enhance following the intravenous administration of a contrast agent. CONCLUSIONS: Although it is difficult to differentiate RCCs from other sellar cystic lesions because of the variable signal intensities displayed on MR images, the intensity of the intracystic nodule seems consistent on T1- and T2-weighted images, and the nodule is always clearly visible on T2-weighted images. With a nonenhancing cystic lesion that does not cause significant symptoms in the patient, the identification of an intracystic nodule with a characteristic signal intensity will aid in the diagnosis of RCC and the selection of conservative management

Fenestration of the oculomotor nerve by a duplicated posterior cerebral artery and aneurysm

Journal ArticleThe authors report a case of a posterior cerebral artery aneurysm arising from an aberrant arterial branch that was found to be splitting the oculomotor nerve. This 63-year-old man presented with headaches, and CT imaging revealed subarachnoid hemorrhage primarily within the basilar cisterns. Formal angiography and CT angiography revealed a saccular aneurysm arising from the posterior cerebral artery. Intraoperatively, the third cranial nerve was found to be fenestrated with the artery and aneurysm