Chronic Subdural Hematoma Infected by Propionibacterium Acnes: A Case Report

We present a very rare case of a patient with an infected subdural hematoma due to Propionibacterium acnes. A 63-year-old male complained of dizziness and was admitted to our hospital. He had a history of left chronic subdural hematoma due to a traffic accident, which had been conservatively treated. Physical, neurological and laboratory examinations revealed no definite abnormality. Plain CT scan demonstrated a hypodense crescentic fluid collection over the surface of the left cerebral hemisphere. The patient was diagnosed with chronic subdural hematoma and underwent burr hole surgery three times and selective embolization of the middle meningeal artery, but the lesion easily recurred. Repeated culture examinations of white sedimentation detected P. acnes. Therefore, he underwent craniotomy surgery followed by intravenous administration of antibiotics. The infected subdural hematoma was covered with a thick, yellowish outer membrane, and the large volume of pus and hematoma was removed. However, the lesion recurred again and a low-density area developed in the left frontal lobe. Craniotomy surgery was performed a second time, and two Penrose drainages were put in both the epidural and subdural spaces. Subsequently, the lesions completely resolved and he was discharged without any neurological deficits. Infected subdural hematoma may be refractory to burr hole surgery or craniotomy alone, in which case aggressive treatment with craniotomy and continuous drainage should be indicated before the brain parenchyma suffers irreversible damage

Removal of superior vermian arteriovenous malformation through the occipital transtentorial approach

Background: Arteriovenous malformations (AVMs) of the superior vermis are extremely rare. Although they have a higher rate of hemorrhagic presentations than supratentorial AVMs, the surgical approaches for AVMs at this location remain controversial. Case description: We report the case of a 73-year-old man with a hemorrhagic superior vermian AVM that was treated with surgical resection through the occipital transtentorial approach (OTA). This approach, with a direct perpendicular view of the whole lesion, enabled us to control the feeding arteries safely and to finally accomplish a total resection. Conclusions: The OTA is an elegant approach for the resection of superior vermian AVMs. Detailed assessment of angiographic features is mandatory in selecting an effective and safe surgical approach for posterior fossa AVMs depending on their location. Keywords: Arteriovenous malformation, Occipital transtentorial, Posterior fossa, Superior vermian, Surgical approac

Reversal of Cognitive Dysfunction by Total Removal of a Large Lateral Ventricle Meningioma: A Case Report with Neuropsychological Assessments

Although cognitive impairment is one of the major symptoms of ventricular tumors, few studies have reported the details of cognitive impairment before and after their surgical removal. The expected effects on cognitive function should also be considered when choosing a surgical approach. We report the case of a large lateral ventricle meningioma in which cognitive impairment was detected on detailed neuropsychological examinations. The tumor was totally removed through the right superior temporal gyrus. Postoperative neuropsychological assessment revealed the reversal of cognitive impairment. As cognitive impairment is complex and easily overlooked, it is important to precisely assess neuropsychological function in patients with large brain tumors

Detection of Hyperdense Arterial Sign in Acute Ischemic Stroke with Dual-Energy Computed Tomography: Optimal Combination with X-ray Energy and Slice Thickness

Background: The hyperdense artery sign (HAS) in acute ischemic stroke (AIS) is considered an important marker of a thrombus on computed tomography (CT). An advantage of scanning with dual-energy CT (DECT) is its ability to reconstruct CT images with various energies using the virtual monochromatic imaging (VMI) technique. The aim of this study was to investigate the optimal combination of X-ray energy and slice thickness to detect HASs on DECT. Methods: A total of 32 patients with confirmed occlusion of the horizontal (M1) portion of the middle cerebral artery were included in this study. Modified contrast-to-noise ratio (modified CNR) analysis was used as a method for evaluating HASs in AIS. A region of interest (ROI) was set as an HAS, the M1 portion, and an approximately 2 cm diameter ROI was set as the background including the HAS and measured. CT images with X-ray energies from 40 to 190 keV, with increments of 10 keV, were reconstructed based on VMI with 1, 2, and 3 mm slice thicknesses. Results: The top five combinations of X-ray energy and slice thickness in descending order of the mean HAS-modified CNR were as follows: Rank 1, 60 keV-1 mm; Rank 2, 70 keV-1 mm; Rank 3, 60 keV-2 mm; Rank 4, 80 keV-2 mm; Rank 5, 60 keV-3 mm. Conclusions: Our study showed that the optimal combination to detect an HAS was 60 keV and a 1 mm slice thickness on DECT