Parasellar extra-axial cavemomas are rare lesions.The authors report a case of extra-axial cavemoma in a 50-year-old male patient,who presented with occipital headache and double vision.The magnetic resonance imaging ...Parasellar extra-axial cavemomas are rare lesions.The authors report a case of extra-axial cavemoma in a 50-year-old male patient,who presented with occipital headache and double vision.The magnetic resonance imaging showed an enhancing extra-axial dural-based mass in the left parasellar region invading cavernous sinus,hyper-intense on T2-weighted images,iso-intense on Tl-weighted images and high relative cerebral blood velocity on magnetic resonance perfusion.The patient underwent a left pterional craniotomy and parasellar space occupying lesion was excised.Histopathology was suggestive of cavernous hemangioma.展开更多
Bilateral thalamic infarcts have a low frequency among different subtypes of strokes.Since it does not involve a particular vascular territory,it therefore usually involves the occlusion of the artery of Percheron(AOP...Bilateral thalamic infarcts have a low frequency among different subtypes of strokes.Since it does not involve a particular vascular territory,it therefore usually involves the occlusion of the artery of Percheron(AOP).Here we report a 79-year-old right-handed Parkinsonian female patient,who was found unresponsive in bed.On examination,the patient was drowsy with a Glasgow Coma Score(GCS)of 10/15(E2M5V3).She had absent doll’s eye response with anisocoric pupils and intermittent vertical gaze palsy.Although the patient had no apparent motor deficits,she was in a state of persistent somnolence with memory impairment and lack of initiative.Diffusion-weighted magnetic resonance imaging(MRI)of the brain showed focal areas of restricted diffusion in the medial part of the thalami bilaterally and the rostral part of mid-brain(right>left)(bilateral paramedian thalamic with mid-brain pattern),suggestive of a hyper-acute infarct in the territory of AOP.The patient was anticoagulated with 40 mg subcutaneous low molecular weight heparin and was started on double anti-platelets along with supportive measures.The level of consciousness is improved at a slow rate to a GCS of 12/15(E4M5V3).The patient had marked abulia with periods of drowsiness interspersed with periods of restlessness and uttering of abnormal sounds,but she was able to execute simple commands.In conclusion,occlusion of the AOP is a rare cause of coma in elderly patients.Diffusion-weighted MRI is the imaging modality of choice for early diagnosis.Early diagnosis of AOP occlusion may lead to favorable outcomes.展开更多
Spontaneous intracranial hypotension treatment can be complicated by concomitant cerebral venous thrombosis and subdural hematoma.A 48 years old male,presenting orthostatic headache and neck pain for 1 month displayed...Spontaneous intracranial hypotension treatment can be complicated by concomitant cerebral venous thrombosis and subdural hematoma.A 48 years old male,presenting orthostatic headache and neck pain for 1 month displayed sagittal sinus thrombosis and bilateral subdural effusions,as well as extradural fluid collection at T3-T8 level,upon magnetic resonance imaging.Cerebrospinal fluid opening pressure was 50 mmH2O,and a leak was confirmed at C2-C3 level by computed tomography(CT)myelogram.The presence of subdural hematoma precluded anticoagulation treatments.An autologous epidural blood patch at C2-C3 level under CT guidance improved the patient’s condition,remaining free of residual symptoms or recurrence at six-month follow-up.展开更多
Intracranial hypertension is a common cause of morbidity in herpes simplex encephalitis(HSE).HSE is the most common form of acute viral encephalitis.Hereby we report a case of HSE in which decompressive craniectomy wa...Intracranial hypertension is a common cause of morbidity in herpes simplex encephalitis(HSE).HSE is the most common form of acute viral encephalitis.Hereby we report a case of HSE in which decompressive craniectomy was performed to treat refractory intracranial hypertension.A 32-year-old male presented with headache,vomiting,fever,and focal seizures involving the right upper limb.Cerebrospinal fluid-meningoencephalitic profile was positive for herpes simplex.Magnetic resonance image of the brain showed swollen and edematous right temporal lobe with increased signal in gray matter and subcortical white matter with loss of gray,white differentiation in T2-weighted sequences.Decompressive craniectomy was performed in view of refractory intracranial hypertension.Decompressive surgery for HSE with refractory hypertension can positively affect patient survival,with good outcomes in terms of cognitive functions.展开更多
文摘Parasellar extra-axial cavemomas are rare lesions.The authors report a case of extra-axial cavemoma in a 50-year-old male patient,who presented with occipital headache and double vision.The magnetic resonance imaging showed an enhancing extra-axial dural-based mass in the left parasellar region invading cavernous sinus,hyper-intense on T2-weighted images,iso-intense on Tl-weighted images and high relative cerebral blood velocity on magnetic resonance perfusion.The patient underwent a left pterional craniotomy and parasellar space occupying lesion was excised.Histopathology was suggestive of cavernous hemangioma.
文摘Bilateral thalamic infarcts have a low frequency among different subtypes of strokes.Since it does not involve a particular vascular territory,it therefore usually involves the occlusion of the artery of Percheron(AOP).Here we report a 79-year-old right-handed Parkinsonian female patient,who was found unresponsive in bed.On examination,the patient was drowsy with a Glasgow Coma Score(GCS)of 10/15(E2M5V3).She had absent doll’s eye response with anisocoric pupils and intermittent vertical gaze palsy.Although the patient had no apparent motor deficits,she was in a state of persistent somnolence with memory impairment and lack of initiative.Diffusion-weighted magnetic resonance imaging(MRI)of the brain showed focal areas of restricted diffusion in the medial part of the thalami bilaterally and the rostral part of mid-brain(right>left)(bilateral paramedian thalamic with mid-brain pattern),suggestive of a hyper-acute infarct in the territory of AOP.The patient was anticoagulated with 40 mg subcutaneous low molecular weight heparin and was started on double anti-platelets along with supportive measures.The level of consciousness is improved at a slow rate to a GCS of 12/15(E4M5V3).The patient had marked abulia with periods of drowsiness interspersed with periods of restlessness and uttering of abnormal sounds,but she was able to execute simple commands.In conclusion,occlusion of the AOP is a rare cause of coma in elderly patients.Diffusion-weighted MRI is the imaging modality of choice for early diagnosis.Early diagnosis of AOP occlusion may lead to favorable outcomes.
文摘Spontaneous intracranial hypotension treatment can be complicated by concomitant cerebral venous thrombosis and subdural hematoma.A 48 years old male,presenting orthostatic headache and neck pain for 1 month displayed sagittal sinus thrombosis and bilateral subdural effusions,as well as extradural fluid collection at T3-T8 level,upon magnetic resonance imaging.Cerebrospinal fluid opening pressure was 50 mmH2O,and a leak was confirmed at C2-C3 level by computed tomography(CT)myelogram.The presence of subdural hematoma precluded anticoagulation treatments.An autologous epidural blood patch at C2-C3 level under CT guidance improved the patient’s condition,remaining free of residual symptoms or recurrence at six-month follow-up.
文摘Intracranial hypertension is a common cause of morbidity in herpes simplex encephalitis(HSE).HSE is the most common form of acute viral encephalitis.Hereby we report a case of HSE in which decompressive craniectomy was performed to treat refractory intracranial hypertension.A 32-year-old male presented with headache,vomiting,fever,and focal seizures involving the right upper limb.Cerebrospinal fluid-meningoencephalitic profile was positive for herpes simplex.Magnetic resonance image of the brain showed swollen and edematous right temporal lobe with increased signal in gray matter and subcortical white matter with loss of gray,white differentiation in T2-weighted sequences.Decompressive craniectomy was performed in view of refractory intracranial hypertension.Decompressive surgery for HSE with refractory hypertension can positively affect patient survival,with good outcomes in terms of cognitive functions.
