Onset of Dandy-Walker Syndrome in Adult following Head Trauma: A .

Although head trauma is suggested to precipitate hydrocephalus in adult-onset Dandy Walker syndrome (DWS), the clear mechanism is not verified. A 56-year-old female recovered completely after evacuation of acute epidural hematoma until development of dementia 7 days after operation. At day 20, she underwent ventriculo-peritoneal shunting to treat progressive hydrocephalus and has been free from neurologic symptoms for 2 years. The serial CT examinations indicate that after head trauma without subarachnoid hemorrhage, hydrocephalus can develop in a case of previously silent DWS. Rapid changes of intracranial pressure in trauma may affect cerebrospinal fluid outflow through a DWS-related valve mechanism at the foramina of Luschka, which results in hydrocephalus

Kissing Aneurysm of the Distal Anterior Cerebral Artery: Preoperative CT Angiography and Surgical Management: A

We describe a patient with mirror-image aneurysms in the bilateral distal anterior cerebral artery (ACA). The larger aneurysm was clearly disclosed with digital subtraction angiography (DSA), but the smaller one could not be definitely identified. The bilateral aneurysms were confirmed with computed tomographic (CT) angiography, which showed the right ACA aneurysm to be hidden behind the left ACA aneurysm, likely buried in the cingulate gyrus. During surgery, the left ACA aneurysm was clipped first. The right ACA aneurysm was exposed by a small subpial resection of the cingulate gyrus, and the right ACA aneurysm, which strongly adhered to the surrounding tissue, was safely dissected. Multiple aneurysms associated with a distal ACA aneurysm are not rare. We conclude that further examination with CT angiography is important when kissing aneurysms are suggested by DSA

Stenting with Coil Embolization for Dissecting Restenosis of the Internal Carotid Artery after Balloon Angioplasty

We report here the successful use of endovascular stenting combined with coil embolization for dissective restenosis of the internal carotid artery after balloon angioplasty. The patient was a 76-year-old man was with a history of frequent transient right hemiparesis. Angiogram showed severe stenosis in the cervical portion of both internal carotid arteries. The left lesion was treated initially by percutaneous transluminal angioplasty, which resulted in satisfactory dilatation. However, three months later, angiogram revealed restenosis and subintimal dissection at the original region. Stent implantation was performed to reconstruct the true arterial lumen, then packed the false lumen with Guglielmi detachable coils through the stent mesh. Despite anticoagulation therapy, right leg monoparesis developed two days after coiling but disappeared after a week. Nine months later, complete obliteration of the false lumen and patency of the internal carotid artery were confirmed on angiogram. This combined technique may be useful to better manage dissecting restenosis in the cervical portion of the left internal carotid artery after balloon angioplasty

Three-Dimensional Anisotropy Contrast MRI and Functional MRI of the Human Brain: Clinical Application to Assess Pyramidal Tract in Patients with Brain Tumor and Infarction

We describe and evaluate the findings of three-dimensional anisotropy contrast MR axonography (3DAC MRX) and functional MRI (fMRI) in brain tumor and infarction. We obtained diffusion-weighted images (DWI) in 28 patients including 23 brain tumors and 15 acute infarctions located in or near pyramidal tract. Three anisotropic DWIs were transformed into graduations color-coded as red, green or blue, and then composed to form a combined color 3DAC MRX. We also performed functional MRI in 7 of the 28 patients and compared with cortical mapping of 3DAC MRX. 3DAC MRX with 23 brain tumors showed that the ipsilateral pyramidal tract was either discontinuous due to impaired anisotropy (n=8) or compressed due to mass effect (n=15). In 10 patients of acute infarction with motor impairment, pyramidal tract involvement was visually more conspicuous on 3DAC MRX compared to standard DWI. On functional MRI, hand motor activation was observed between blue vertical directional colors of pre- and post central gyrus. In conclusion, 3DAC MRX is a new noninvasive approach for visualization of the white matter neuronal tract and provides the information concerning pyramidal tract involvement

Comparison of 1.5T and 3T 1H MR Spectroscopy for Human Brain Tumors

OBJECTIVE: We wanted to estimate the practical improvements of 3T proton MR spectroscopy ((1)H MRS) as compared with 1.5T (1)H MRS for the evaluation of human brain tumors. MATERIALS AND METHODS: Single voxel (1)H MRS was performed at both 1.5T and 3T in 13 patients suffering with brain tumors. Using the same data acquisition parameters at both field strengths, the (1)H MRS spectra were obtained with a short echo time (TE) (35 msec) and an intermediate TE (144 msec) with the voxel size ranging from 2.0 cm(3) to 8.7 cm(3). The signal to noise ratios (SNRs) of the metabolites (myoinositol [MI], choline compounds [Cho], creatine /phosphocreatine [Cr], N-acetyl-aspartate [NAA], lipid and lactate [LL]) and the metabolite ratios of MI/Cr, Cho/Cr, Cho/NAA and LL/Cr were compared at both TEs between the two field strengths in each brain tumor. The degrees of spectral resolution between the Cho and Cr peaks were qualitatively compared between the two field strengths in each brain tumor. RESULTS: The SNRs of the metabolites at 3T demonstrated 49-73% increase at a short TE (p 0.05) compared with those of 1.5T. The SNR of inverted lactate at an intermediate TE decreased down to 49% with poorer inversion at 3T (p < 0.05). There was no significant difference in the metabolite ratios between the two field strengths. The degrees of the spectral resolution at 3T were slightly superior to those of 1.5T at a short TE. CONCLUSION: As compared with 1.5T, 3T 1H MRS demonstrated 49-73% SNR increase in the cerebral metabolites and slightly superior spectral resolution only at a short TE, but little at an intermediate TE, in the brain tumors. There was no significant difference in the metabolite ratios between the two field strengths

Testicular tuberculosis presenting with metastatic intracranial tuberculomas only: a case report

<p>Abstract</p> <p>Introduction</p> <p>Intracranial tuberculomas are a rare complication of tuberculosis occurring through hematogenous spread from an extracranial source, most often of pulmonary origin. Testicular tuberculosis with only intracranial spread is an even rarer finding and to the best of our knowledge, has not been reported in the literature. Clinical suspicion or recognition and prompt diagnosis are important because early treatment can prevent patient deterioration and lead to clinical improvement.</p> <p>Case presentation</p> <p>We present the case of a 51-year-old African man with testicular tuberculosis and multiple intracranial tuberculomas who was initially managed for testicular cancer with intracranial metastasis. He had undergone left radical orchidectomy, but subsequently developed hemiparesis and lost consciousness. Following histopathological confirmation of the postoperative sample as chronic granulomatous infection due to tuberculosis, he sustained significant clinical improvement with antituberculous therapy, recovered fully and was discharged at two weeks post-treatment.</p> <p>Conclusion</p> <p>The clinical presentation of intracranial tuberculomas from an extracranial source is protean, and delayed diagnosis could have devastating consequences. The need to have a high index of suspicion is important, since neuroimaging features may not be pathognomonic.</p