scholarly journals A Case of Recurrent Hemorrhages due to a Chronic Expanding Encapsulated Intracranial Hematoma

2015 ◽  
Vol 7 (3) ◽  
pp. 173-180 ◽  
Author(s):  
Akiko Marutani ◽  
Kiyoshi Nagata ◽  
Jun Deguchi ◽  
Yuji Nikaido ◽  
Syuji Kazuki
Keyword(s):  
Basal Ganglia ◽  
Case Reports ◽  
Neurological Deficits ◽  
Intracranial Hematoma ◽  
Local Doctor ◽  
Hematoma Growth ◽  
Single Mass ◽  
Wait And See ◽  
Magnetic Resonance Imaging Mri ◽  
The Right

Few case reports of encapsulated intracranial hematoma (EIH) exist, and the mechanisms underlying the onset and enlargement of EIH remain unclear. Here, we report on a 39-year-old woman with an EIH that repeatedly hemorrhaged and swelled and was ultimately surgically removed. In June 2012, the patient visited her local doctor, complaining of headaches. A magnetic resonance imaging (MRI) scan identified a small hemorrhage of approximately 7 mm in her right basal ganglia, and a wait-and-see approach was adopted. Six months later, her headaches recurred. She was admitted to our department after MRI showed tumor lesions accompanying the intermittent hemorrhaging in the right basal ganglia. After admission, hemorrhaging was again observed, with symptoms progressing to left-sided hemiplegia and fluctuating consciousness; thus, a craniotomy was performed. No obvious abnormal blood vessels were observed on the preoperative cerebral angiography. We accessed the lesion using a transcortical approach via a right frontotemporal craniotomy and removed the subacute hematoma by extracting the encapsulated tumor as a single mass. Subsequent pathological examinations showed that the hematoma exhibited abnormal internal vascularization and was covered with a capsule formed from growing capillaries and accumulating collagen fibers, suggesting that it was an EIH. No lingering neurological symptoms were noted upon postoperative follow-up. This type of hematoma expands slowly and is asymptomatic, with reported cases consisting of patients that already have neurological deficits due to progressive hematoma growth. Our report is one of a few to provide a clinical picture of the initial stages that occur prior to hematoma encapsulation.

Interhemispheric Contralateral Transfalcine Approach for Subparacentral Arteriovenous Malformation: 3-Dimensional Operative Video

2021 ◽  
Author(s):  
Matías Baldoncini ◽  
Alvaro Campero ◽  
Sabino Luzzi ◽  
Juan F Villalonga
Keyword(s):  
Right Hemisphere ◽  
Vascular Lesion ◽  
Neurological Deficits ◽  
3 Dimensional ◽  
Postoperative Mri ◽  
Drainage Vein ◽  
History Of ◽  
Magnetic Resonance Imaging Mri ◽  
Superior Longitudinal Sinus ◽  
The Right

Abstract Neurovascular procedures along the interhemispheric fissure harbor unique features differentiating them from those arteriovenous malformations (AVMs) located at the lateral surface of the brain.1-4  The aim of this 3-dimensional operative video is to present a microsurgical resection of an AVM in a subparacentral location, operated through an interhemispheric contralateral transfalcine approach.1,3,5  This is a case of a 29-yr-old female, with headaches and history of seizures. The patient presented an interhemispheric bleeding 6 mo before the surgery. The magnetic resonance imaging (MRI) showed a vascular lesion located on the medial surface of the right hemisphere at the confluence between the cingulate sulcus and its ascending sulcus. In the cerebral angiography, a right medial AVM was observed, receiving afference from the right anterior cerebral artery and draining to the superior longitudinal sinus. The patient signed an informed consent for the procedure and agreed with the use of her images and surgical video for research and academic purposes.  The patient was in a supine position, and a left interhemispheric contralateral transfalcine approach was performed,1-3 a circumferential dissection of the nidus, and, finally, the AVM was resected in one piece.  The patient evolved without neurological deficits after the surgery. The postoperative MRI and angiography showed a complete resection of the AVM.  In the case presented, to avoid exposing the drainage vein first and to use the gravity of the exposure, the contralateral transfalcine interhemispheric approach was used,1,2 which finally accomplished the proposed objectives.

scholarly journals Delayed Stroke following Blunt Neck Trauma: A Case Illustration with Recommendations for Diagnosis and Treatment

2017 ◽  
Vol 2017 ◽  
pp. 1-4
Author(s):  
Best Anyama ◽  
Daniela Treitl ◽  
Jeffery Wessell ◽  
Rachele Solomon ◽  
Andrew A. Rosenthal
Keyword(s):  
Neck Injury ◽  
Neurological Deficits ◽  
Blunt Cerebrovascular Injury ◽  
Rare Injury ◽  
Basketball Game ◽  
Ct Angiogram ◽  
Blunt Neck Trauma ◽  
Magnetic Resonance Imaging Mri ◽  
The Right ◽  
The Brain

Blunt cerebrovascular injury (BCVI) to the carotid artery is a relatively rare injury that is difficult to identify even with imaging. Any symptoms or neurological deficits following blunt neck injury mandate evaluation and consideration of BCVI. In an effort to highlight this issue, we report the case of a 31-year-old male patient who presented with left-sided weakness consistent with transient ischemic attack (TIA) and concussion. The patient’s symptoms occurred within 24 hours of a blunt neck injury sustained by a knee strike during a basketball game. An initial computerized tomography (CT) scan of the brain was normal; a CT angiogram (CTA) of the neck and carotids did not reveal obstruction, dissection, stenosis, or abnormalities of the carotid or vertebral vessels and the patient was subsequently discharged. A magnetic resonance imaging (MRI) of the brain obtained four days after the initial injury demonstrated an acute infarct in the right middle cerebral artery (MCA) territory. Thus, despite initial negative imaging, neurological deficits must be aggressively pursued in order to prevent stroke in BCVI cases.

Abnormal MRI in a patient with ‘headache with neurological deficits and CSF lymphocytosis (HaNDL)’

Cephalalgia ◽  
2009 ◽  
Vol 30 (5) ◽  
pp. 615-619 ◽  
Author(s):  
A Yilmaz ◽  
H Kaleagasi ◽  
O Dogu ◽  
E Kara ◽  
A Ozge
Keyword(s):  
Cerebrospinal Fluid ◽  
Grey Matter ◽  
Brain Regions ◽  
Neurological Deficits ◽  
Hemiplegic Migraine ◽  
Headache Episode ◽  
Magnetic Resonance Imaging Mri ◽  
The Right ◽  
Similar Imaging

A 27-year-old woman was admitted to the Emergency Department with right upper-extremity numbness and mild weakness followed by a bifrontal throbbing headache for 30 min, which was similar to a headache lasting for 12 h that had occurred 3 days ago. Laboratory tests were unremarkable except for cerebrospinal fluid (CSF) lymphocytic pleocytosis. On the following day, a headache episode with left hemiparesis and hemihypoaesthesia, left hemifield visio-spatial inattention, anosagnosia and confusion recurred. The headache was diagnosed as headache and neurological deficits with cerebrospinal fluid lymphocytosis (HaNDL) syndrome according to the criteria of the second edition of the International Classification of Headache Disorders. Simultaneously performed magnetic resonance imaging (MRI) revealed swelling of the grey matter, CSF enhancement in the sulci of the right temporal and occipital regions and hypoperfusion of the same brain regions. During the following 10 days two more similar episodes recurred and during the ensuing 12 months the patient remained headache free. Neuroimaging findings of the HaNDL syndrome are always thought as virtually normal. MRI abnormalities in our patient have not been reported in HaNDL syndrome previously, although they have been reported in hemiplegic migraine patients before. The findings in our case suggest that hemiplegic migraine and HaNDL syndrome may share a common pathophysiological pathway resulting in similar imaging findings and neurological symptoms.

FC07-05 - Resting brain perfusion in alcohol-induced psychotic disorder: A comparison in patients with alcohol dependence, schizophrenia and healthy controls

2011 ◽  
Vol 26 (S2) ◽  
pp. 1850-1850
Author(s):  
G.P. Jordaan ◽  
J.M. Warwick ◽  
R. Hewlett ◽  
R. Emsley
Keyword(s):  
Basal Ganglia ◽  
Alcohol Dependence ◽  
Healthy Volunteers ◽  
Brain Imaging ◽  
Psychotic Disorder ◽  
Alcohol Withdrawal ◽  
Case Reports ◽  
Brain Perfusion ◽  
Temporal Lobes ◽  
The Right

IntroductionAlcohol-induced psychotic disorder (AIPD), is an uncommon complication of alcohol abuse. AIPD needs to be distinguished from alcohol withdrawal delirium and schizophrenia and the underlying pathophysiology is poorly understood. Few brain-imaging studies in AIPD have been reported to date. Case reports of brain-imaging in AIPD suggest possible dysfunction in the thalamus, basal ganglia, frontal lobes and cerebellum. The aim of this study was to compare resting brain perfusion (rCBF) in patients with AIPD, uncomplicated alcohol dependence, schizophrenia and healthy volunteers.MethodsSingle photon emission computed tomography (SPECT) was utilized to compare rCBF in patients with AIPD (n = 19), schizophrenia (n = 16), uncomplicated alcohol dependence (n = 20) and healthy volunteers (n = 19).ResultsIncreased rCBF was demonstrated in the right calcarine area in patients with AIPD compared to healthy volunteers, with a trend towards increased rCBF to the frontal and temporal lobes and the right pallidum. Decreased left sided rCBF to the putamen, parietal, mid-frontal and mid-temporal lobes and heterogenous flow to the cerebellum were demonstrated in patients with AIPD when compared to patients with uncomplicated alcohol dependence. The left posterior cingulate and right cerebellum showed higher and lower rCBF respectively in patients with AIPD compared to patients with schizophrenia.ConclusionThe findings implicate the right occipital lobe and possibly the cerebellum in the pathogenesis of AIPD. Some findings have similarities with rCBF reports in alcohol-withdrawal. Reduced rCBF to the frontal lobes, thalamus and basal ganglia in AIPD as suggested in previous case reports could not be confirmed.

scholarly journals Hemi Chorea and Hemi Balllismus: A Rare Presentation of Prolonged Uncontrolled Hyperglycemia

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A384-A384
Author(s):  
Jocelyne Georges Karam ◽  
Chinenye Uchenna Eze-Raphael ◽  
Chrystel Calliste
Keyword(s):  
Basal Ganglia ◽  
Case Reports ◽  
Common Factor ◽  
Hand Movement ◽  
Vital Signs ◽  
Symptomatic Improvement ◽  
Rare Presentation ◽  
Lenticular Nucleus ◽  
The Right ◽  
Persistent Hyperglycemia

Abstract Background: Hemi chorea and hemiballismus interestingly, are rare presentations of severe chronic persistent hyperglycemia which resolves with correction of hyperglycemia in most cases. Clinical Case: Here we report a case of a 67 YO woman with a PMH of prolonged uncontrolled DM evidenced by average baseline HbA1c of 14.6% (n<5.7%) presenting with dance-like movements of the left arm and mouth deviation. Initially the patient presented as a stroke code. Vital signs were unremarkable. On Physical exam, there was mild L face weakness and obvious abnormal hand movement. Other neurological exams were unremarkable for stroke. MRI showed the typical decreased T2/flair signal within the right frontal lobe, white matter, right caudate head, and bilateral lenticular nucleus with mild increased T1 signal of the right caudate and lenticular nucleus compatible with hyperglycemic nonketotic hemichorea hemiballismus. Her significant admission lab values of random blood glucose of 306mg/dl (n 74-200mg/dl), HbA1c of 18.7% (n<5.7%), urine sugar >1000 (n neg mg/dl), absence of ketonuria and acidosis also support the diagnosis. With improvement in her blood sugar control, there was a significant decrease in her abnormal hand movements. However, sugar control was not enough as there was the need for additional medications to improve the chorea such as risperidone and tetrabenazine. Eventually over the course of many months of tight glucose control, there was significant symptomatic improvement. While the exact etiology is unclear, the hyperintensity usually seen on head CT scan and the pathognomonic T1 hyperintensity of the basal ganglia on MRI is postulated to be related to metabolic abnormalities caused by hyper viscosity of the blood in the end arteries supplying the basal ganglia. Many case reports associated movement disorders to chronic persistent hyperglycemia but there are many other cases that described hemiballismus in acute cases of hyperglycemia or persisting despite adequate glycemic correction. Most of the patients described had an underlying markedly elevated HbA1c as a common factor which suggests that a prolonged period of uncontrolled hyperglycemia may be necessary to produce hemiballismus. When thinking of complications of diabetes, we often think of CAD, ESRD, CVD, DKA and HHS. We aim to create an awareness of this rare association and to recognize hemiballismus as one of the varying presentations of severe hyperglycemia in order to ensure early diagnosis and treatment of this condition. Conclusion: Hemichorea and hemiballismus are increasingly becoming popular as one of the many complications of severe chronic or acute hyperglycemia. This warrants recognition in literature.

scholarly journals Ring enhanced aneurysm due to vasa vasorum of aneurysm wall mimicking a metastatic brain tumor

2021 ◽  
Vol 12 ◽  
pp. 64
Author(s):  
Yu Shimizu ◽  
Katsuyoshi Miyashita ◽  
Nozomu Oikawa ◽  
Masaaki Kobayashi ◽  
Yasuo Tohma
Keyword(s):  
Differential Diagnosis ◽  
Brain Tumor ◽  
Metastatic Brain Tumor ◽  
Vasa Vasorum ◽  
Neurological Deficits ◽  
Peripheral Edema ◽  
Thrombosed Aneurysm ◽  
Aneurysm Wall ◽  
Magnetic Resonance Imaging Mri ◽  
The Right

Background: A spherical intracranial mass can be occasionally misdiagnosed due to the lack of typical radiographic features. Completely thrombosed intracranial aneurysms (CTIA) are uncommon, but a possible differential diagnosis must be considered to guarantee the best surgical approach for these lesions. Case Description: Here, we report an extremely rare case of a right frontal mass mimicking a brain tumor, in which the surgery unveiled a CTIA of the right middle cerebral artery (MCA). A 56-year-old woman presented with right hemiparesis and mild headache. Magnetic resonance imaging (MRI) revealed a right frontal mass with peripheral edema. The lesion enhanced on initial and follow-up MRI of the brain. Subsequent vascular studies and metastatic workup were negative. A temporal craniotomy with neuronavigation (Brain Lab AG, Germany) was performed and an intraoperative diagnosis of a thrombosed aneurysm along the branch of the MCA was established. The aneurysm was successfully trapped and resected. The patient did not exhibit any postoperative neurological deficits. Conclusion: This is the rare report of a ring enhanced completely thrombosed aneurysm due to vasa vasorum which is misdiagnosed as metastatic brain tumor. In case of an intracranial ring enhanced mass with signs of intralesional hemorrhage and peripheral edema, CTIA should be considered as a possible differential diagnosis.

scholarly journals Progressive multifocal leukoencephalopathy during ixazomib-based chemotherapy

2018 ◽  
Vol 25 (1) ◽  
pp. 99 ◽  
Author(s):  
C.P. Sawicki ◽  
S.A. Climans ◽  
C.C. Hsia ◽  
J.A. Fraser
Keyword(s):  
Multiple Myeloma ◽  
Progressive Multifocal Leukoencephalopathy ◽  
Demyelinating Disease ◽  
Opportunistic Infections ◽  
Case Reports ◽  
Neurological Deficits ◽  
Resonance Imaging ◽  
Latent Form ◽  
The Central Nervous System ◽  
Magnetic Resonance Imaging Mri

Progressive multifocal leukoencephalopathy (pml) is a rare demyelinating disease of the central nervous system that most often affects immunocompromised individuals. It is caused by the reactivation of the John Cunningham virus (jcv), which is found in latent form in the majority of adults. We describe a 59-year-old man with multiple myeloma who developed severe neurological deficits during treatment with ixazomib-based chemotherapy. A diagnosis of pml was established with gadolinium-enhanced magnetic resonance imaging (mri) and by detection of jcv in the cerebrospinal fluid. Despite cessation of chemotherapy and treatment with mirtazapine, he had an inexorable neurological decline and died two months after presenting to hospital. Multiple myeloma and its treatments can predispose patients to opportunistic infections including pml. Although there have been case reports of pml in patients with multiple myeloma treated with bortezomib (a different proteosome inhibitor), this is, to our knowledge, the first documented case of pml in a patient treated with a regimen that includes ixazomib.

scholarly journals Case Report of a Rare Cause of Reactive Arthritis: Leptospirosis

2021 ◽  
Vol 11 (3) ◽  
Author(s):  
Sudipan Dey ◽  
Arun Kumar Sipani ◽  
Rajdeep Das
Keyword(s):  
Case Report ◽  
Hip Joint ◽  
Reactive Arthritis ◽  
Past History ◽  
Case Reports ◽  
Female Child ◽  
The Body ◽  
Pathogenic Leptospira ◽  
Magnetic Resonance Imaging Mri ◽  
The Right

Introduction: Leptospirosis is a zoonosis caused by infection with pathogenic Leptospira species. Leptospirosis has protean manifestations and rare, unusual presentations should be kept in mind in relevant epidemiological scenario. Reactive arthritis refers to acute non-purulent arthritis complicating an infection elsewhere in the body. It is attributed to an immune activation following certain infections; it is, therefore considered as aseptic arthritis. Very few case reports are available attributing leptospirosis as an established cause of reactive arthritis. We present a case of reactive arthritis of the hip joint due to leptospirosis. Case Report: Here, we present a case of a 12-years- old female child who was admitted to our hospital with complaints of fever, headache, and pain in the right hip joint since past 5 days from admission. Subsequent elaboration revealed a past history of fever, headache, and myalgia for around 5-7 days around a week before the present complaints. There was rat infestation near her house and her father was working as sewage cleaner. Routine investigations, Ultrasonography (USG), Magnetic Resonance Imaging (MRI) of both hips and subsequently, diagnostic hip aspiration was performed. USG revealed synovitis, MRI revealed hip joint arthritis of infective or inflammatory origin. Diagnostic hip aspiration was negative for any microorganism. On 10th day of admission, patient started developing icterus with yellowish discolouration of urine. Patient was evaluated for the cause of jaundice. Screening for Leptospira was positive. Synovial biopsy of hip was performed, which showed inflammation with no specific pathology and no growth of any microorganism. In addition, Leptospira IgM MAC ELISA was done which was positive. Patient was thus confirmed to be having leptospirosis and reactive arthritis as a consequence of it. Conclusion: The presentation of reactive arthritis secondary to leptospirosis is rare. Leptospirosis can be an etiological fa

scholarly journals Rapidly Destructive Inflammatory Arthritis of the Hip

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Jenny Shu ◽  
Ian Ross ◽  
Bret Wehrli ◽  
Richard W. McCalden ◽  
Lillian Barra
Keyword(s):  
Case Reports ◽  
Joint Destruction ◽  
Radiographic Finding ◽  
Initial Presentation ◽  
Caucasian Woman ◽  
Diagnostic Laboratory ◽  
Plain Films ◽  
Original Case ◽  
Magnetic Resonance Imaging Mri ◽  
The Right

Rapidly destructive coxarthrosis (RDC) is a rare syndrome that involves aggressive hip joint destruction within 6–12 months of symptom onset with no single diagnostic laboratory, pathological, or radiographic finding. We report an original case of RDC as an initial presentation of seronegative rheumatoid arthritis (RA) in a 57-year-old Caucasian woman presenting with 6 months of progressive right groin pain and no preceding trauma or chronic steroid use. Over 5 months, she was unable to ambulate and plain films showed complete resorption of the right femoral head and erosion of the acetabulum. There were inflammatory features seen on computed tomography (CT) and magnetic resonance imaging (MRI). She required a right total hip arthroplasty, but arthritis in other joints showed improvement with triple disease modifying antirheumatic drugs (DMARD) therapy and almost complete remission with the addition of adalimumab. We contrast our case of RDC as an initial presentation of RA to 8 RDC case reports of patients with established RA. Furthermore, this case highlights the importance of obtaining serial imaging to evaluate a patient with persistent hip symptoms and rapid functional deterioration.

scholarly journals Unusual Presentation and Imaging Findings of a Rare Supratentorial Neurenteric Cyst

2019 ◽  
Vol 47 (1) ◽  
pp. 121-123
Author(s):  
Eduardo Portela de Oliveira ◽  
John Woulfe ◽  
Carlos Torres ◽  
Nader Zakhari
Keyword(s):  
Vision Loss ◽  
Peripheral Vision ◽  
Brain Magnetic Resonance Imaging ◽  
Lesion Size ◽  
Neurological Deficits ◽  
Neurenteric Cyst ◽  
Magnetic Resonance Imaging Mri ◽  
The Right ◽  
Head Computed Tomography

This is a case of a 30-year-old right-handed male patient who presented to the hospital in 2014 after hitting his head on the mat during a wrestling match followed by headache and temporary peripheral vision limitation. The patient’s past medical history was unremarkable. On physical examination, Glasgow Coma Scale was 15 with no focal neurological deficits. Unenhanced head computed tomography (CT) and enhanced brain magnetic resonance imaging (MRI) were performed (Figure 1). The patient was managed conservatively, and follow-up CT and MRI in 2015 (Figure 2) demonstrated significant decrease in size of the previously seen right frontoparietal lesion with also changes in its radiological features. The patient remained asymptomatic for about 3 years when in 2018 he presented to the Emergency Department with increasing headaches and peripheral vision loss. MRI demonstrated an increase in the right frontal lesion size (Figure 3). He underwent surgical resection of the lesion.

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