Blister Aneurysms

Blister aneurysms are rare carotid lesions characterized by a thornlike appearance in combination with prominent fragility. Comprising less than 2% of all intracranial aneurysms, they are considered to be either dissecting or false aneurysms. Etiogenesis remains poorly understood, though atherosclerosis seems to be playing a prominent role. Although many approaches have been tried throughout the years, treatment of blister lesions remains debatable. Both surgical and endovascular modalities can be used, with every technique having though its own limitations and pitfalls. In this context, when confronted with such a lesion, physicians should consider all available alternatives in order to maximize the chances of a good outcome

Malignant neuroleptic syndrome following deep brain stimulation surgery: a case report

<p>Abstract</p> <p>Background</p> <p>The neuroleptic malignant syndrome is an uncommon but dangerous complication characterized by hyperthermia, autonomic dysfunction, altered mental state, hemodynamic dysregulation, elevated serum creatine kinase, and rigor. It is most often caused by an adverse reaction to anti-psychotic drugs or abrupt discontinuation of neuroleptic or anti-parkinsonian agents. To the best of our knowledge, it has never been reported following the common practice of discontinuation of anti-parkinsonian drugs during the pre-operative preparation for deep brain stimulation surgery for Parkinson's disease.</p> <p>Case presentation</p> <p>We present the first case of neuroleptic malignant syndrome associated with discontinuation of anti-parkinsonian medication prior to deep brain stimulation surgery in a 54-year-old Caucasian man.</p> <p>Conclusion</p> <p>The characteristic neuroleptic malignant syndrome symptoms can be attributed to other, more common causes associated with deep brain stimulation treatment for Parkinson's disease, thus requiring a high index of clinical suspicion to timely establish the correct diagnosis. As more centers become eligible to perform deep brain stimulation, neurologists and neurosurgeons alike should be aware of this potentially fatal complication. Timely activation of the deep brain stimulation system may be important in accelerating the patient's recovery.</p

Extracranial Vertebral Artery Aneurysm Presenting as a Chronic Cervical Mass Lesion

Background. Aneurysms of the extracranial vertebral artery are rare and can provide a diagnostic and therapeutic challenge. Methods. We reviewed the clinical history of a patient presenting with cervical radiculopathy, who harboured an extracranial vertebral artery aneurysm eroding the cervical spine. Results. CT Angiography and MR Angiography set the diagnosis, by revealing a left C5-C6 vertebral artery aneurysm with cervical root impingement. Bony reconstruction depicted enlargement of the C6 transverse foramen and a marked enlargement of the C6-C7 intravertebral foramen. The lesion was treated by intravascular proximal vertebral artery occlusion. Conclusions. Extracranial vertebral artery aneurysms require a high index of clinical suspicion. This is the first report of a vertebral artery pseudoaneurysm presenting with bony erosion, which supports a less minacious portrayal of vertebral artery aneurysms

Pitfalls in the diagnosis of a tumefactive demyelinating lesion: A case report

<p>Abstract</p> <p>Introduction</p> <p>In rare instances, demyelinating disorders manifest as tumefactive lesions that simulate brain tumors. We report a patient with a space-occupying lesion in the parietal lobe, which presented a serious diagnostic dilemma, between a rare tumefactive demyelinating disease, such as Balo concentric sclerosis and a glioma. This case report highlights important diagnostic clues in the differential diagnosis of Balo concentric sclerosis.</p> <p>Case presentation</p> <p>A 20-year-old Caucasian woman with acute onset of left-sided weakness and numbness was admitted to hospital with neurologic signs of left-sided hemiparesis and hypoesthesia. Brain magnetic resonance imaging showed a mass lesion of abnormal signal intensity with concentric enhancing rings in the right parietal lobe, without perifocal edema. The characteristic concentric pattern detected on the magnetic resonance images was highly suggestive of Balo disease, and corticosteroids were administered. Evoked potentials, cerebrospinal fluid analysis, and magnetic spectroscopy findings were not specific, and glioma was also included in the differential diagnosis. A stereotactic biopsy was not diagnostic.</p> <p>After one month the patient showed moderate clinical improvement, and during 12 months follow-up, no further relapses occurred. In the follow-up magnetic resonance imaging, the concentric pattern had completely disappeared, and only a low-signal, gliotic lesion remained.</p> <p>Conclusion</p> <p>We hope this case presentation will advance our understanding of clinical and radiologic appearance of Balo concentric sclerosis, which is a rare demyelinating disease. Although this is a specific entity, it has a broader clinical impact across medicine, because it must be differentiated from other space-occupying lesions in the central nervous system.</p

The ancient Hellenic and Hippocratic origins of head and brain terminology

Corpus Hippocraticum, a collection of Hippocratic writings, is considered to be the first written monument of rationale medicine. This article focuses on a series of ancient Hellenic words which are cited in Hippocratic passages and have been adopted in current head and brain terminology either invariably, i.e., keeping their original meaning, or as component parts of newly formed terms. This study aims to demonstrate first that the deeper roots of current neuroanatomical terminology spread in Hippocratic writings and second, that ancient Hellenic remains a living language that would probably ever continue to play a catalytic role in the formation of neuroanatomical glossary by providing accurate, emblematic, and functional terms. Clin. Anat. 25:548558, 2012. (C) 2012 Wiley Periodicals, Inc

Ictal Intracranial Recording from a `Burned-Out Hippocampus&apos;

Objective: To present a case involving a discrepancy in the presurgical data of a patient suffering from pharmacoresistant mesial temporal lobe epilepsy. Clinical Presentation and Intervention: A 47-year-old, female patient with complex partial seizures since her twenties came to be evaluated in the Epilepsy Surgery Unit. The ictal electroencephalogram suggested a left temporal epileptogenic zone and the magnetic resonance image showed an abnormality in the right mesial temporal lobe. Intracranial monitoring revealed a pacemaker zone in the right hippocampus that discharged fast spreading to the left mesial temporal lobe, a phenomenon known as ‘burned-out hippocampus’. Conclusion: The intracranial recording, even though it is an invasive procedure, was necessary for the presurgical evaluation of our patient. This case demonstrates the risks of using surface electroencephalography to determine localization of epileptogenic zones. Copyright (C) 2012 S. Karger AG, Base

Remission of drug-resistant epileptic psychosis following left selective amygdalohippocampectomy

We describe two female patients with drug-resistant mesial temporal lobe epilepsy and chronic drug-resistant psychosis. In both patients, MRI scans revealed left mesial temporal sclerosis. After clinical assessment, ictal video/EEG monitoring, and a neuropsychological evaluation including Wada testing, the patients underwent selective left amygdalohippocampectomy. Since the operation, the two patients have remained free of seizures for 17 and 15 months. During the same period, both patients have sustained a full remission of the psychosis. (C) 2008 Elsevier Inc. All rights reserved