Occipito-temporal infarction manifesting as isolated visual perceptual abnormalities: A rare case of posterior cerebral artery stroke

2021 ◽  
pp. 112067212110461
Author(s):  
V Muthu Krishnan ◽  
AR Rajalakshmi ◽  
Upasana Pokal ◽  
Koushik Shivakumar
Keyword(s):  
Cerebral Artery ◽  
Posterior Cerebral Artery ◽  
Visual Field Defects ◽  
Temporal Region ◽  
Resonance Imaging ◽  
Rare Presentation ◽  
Visual Phenomena ◽  
Neurological Event ◽  
Magnetic Resonance Imaging Mri ◽  
Prompt Diagnosis

Ischemic stroke in the Posterior Cerebral Artery (PCA) territory is an uncommon entity. Majority present with visual field defects while isolated visual perceptual abnormalities are an exceptional manifestation. About 60 year old hypertensive patient presented with vague symptoms of blurring of vision and palinopsia. Defective color vision was recorded in superior quadrants. Perimetry revealed bilateral congruous left superior quadrantanopia. Magnetic Resonance Imaging (MRI) disclosed right PCA infarct involving occipito-temporal region. This case highlights a rare presentation of PCA stroke with palinopsia and cerebral dyschromatopsia. Perimetric examination coupled with urgent neuroimaging helps the clinician in prompt diagnosis of neurological event causing unexplained visual phenomena.

scholarly journals Early Recognition of Stroke by Confrontation Visual Field Test – Is It Possible?

2020 ◽  
Keyword(s):  
Case Report ◽  
Visual Field ◽  
Cerebral Artery ◽  
Vision Loss ◽  
Posterior Cerebral Artery ◽  
Early Recognition ◽  
Past History ◽  
Neurological Deficits ◽  
Visual Field Defects ◽  
Axial Tomography

Introduction: Visual field loss is often the first sign of lesion of the anterior or posterior visual pathways. Screening for visual field defects should be a part of all routine eye examinations, mainly when neurological lesions are suspected. A confrontation visual field (CVF) test provide a rapid and practical method of visual field assessment, allowing the recognition of major neurological deficits. Materials and Research Methods: To report a case of posterior cerebral artery (PCA) stroke early suspected by CVF test. Case-Report: A 77 year-old male presented to our emergency department with vision blurring complaints and a strange sensation of a vision loss on one side on the left eye (OS), for the previous 15 days. He explained that symptoms initiated after an episode of dizziness followed by lipothymia. He denied diplopia or headaches. Past history revealed hypertension and diabetes as cardiovascular risk factors. The best corrected visual acuity was 20/25 on right eye (OD) and 20/60 on OS and pupillary reflexes were normal. CVF test was performed and showed a decrease on left hemicampus of OS. The biomicroscopy was normal and the fundus examination showed optic nerve edema bilaterally, also documented by Optical Coherence Tomography. Considering the findings and the history, neuroimaging and a neurological observation were requested. Computerized axial tomography revealed a hypodense lesion in right occipital posterior region, with hematic density. He was hospitalized for proper treatment with the diagnosis of posterior cerebral artery ischemic stroke, with further hemorrhagic transformation. Discussion: In acute stroke, visual disorders may form all or part of the initial presentation. Homonymous visual field deficits are well-known almost universal characteristics of PCA ischemia, however, due to the absent of cognitive impairment or speech problems associated to many cases, the diagnosis can be challenging at early stages. Our case-report highlights the importance of using CVF test to an immediate inspection of the peripheral visual field, in order to detect acute major defects, including homonymous deficits, to understand if a further prompt neurological examination is mandatory.

scholarly journals An aggressive locoregional orbital rhabdomyosarcoma and Li Fraumeni syndrome

2021 ◽  
Vol 19 (1) ◽  
pp. 81-85
Author(s):  
Berrin Erok ◽  
◽  
Kenan Kıbıcı ◽  
Keyword(s):  
P53 Gene ◽  
Early Age ◽  
Past Medical History ◽  
Resonance Imaging ◽  
Rare Presentation ◽  
Orbital Mass ◽  
Li Fraumeni Syndrome ◽  
Li Fraumeni ◽  
Magnetic Resonance Imaging Mri ◽  
The Right

Introduction. Rhabdomyosarcoma (RMS) is the most common pediatric soft tissue sarcoma with 10 % of the cases occuring in the orbit. Patients often present with a rapidly developing proptosis and globe displacement. Aim. We aimed to present a very rare presentation of orbital RMS, with a giant exophytic orbital mass, a very rare presentation occuring in more advanced cases. Description of the case. A 3-year old girl presented to our hospital with a rapidly enlarging tissue like ulcerative mass. Her past medical history was remarkable with the diagnosis of embryonal rhabdomyosarcoma (RMS) and treatment with chemoradiotherapy at the age of 15 months. On magnetic resonance imaging (MRI), there was a giant heterogenously enhancing mass filling the right orbit and extending to the intracranial region. Li Fraumeni syndrome (LFS) was considered due to her sister death from neuroblastoma at an early age. Cytogenetic analysis revealed mutations of p53 gene, which supported our consideration. Conclusion. RMS is a highly malignant tumor which usually occurs sporadiacally. However, some rare syndromes are associated with increased incidence of RMS, such as LFS.

Cognard Type V Intracranial Dural Arteriovenous Shunt

Neurosurgery ◽  
2013 ◽  
Vol 74 (1) ◽  
pp. E135-E142 ◽  
Author(s):  
Shinya Haryu ◽  
Toshiki Endo ◽  
Kenichi Sato ◽  
Takashi Inoue ◽  
Akira Takahashi ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
Venous Drainage ◽  
Arteriovenous Shunt ◽  
Resonance Imaging ◽  
Signal Flow ◽  
Dural Arteriovenous Shunt ◽  
Magnetic Resonance Imaging Mri ◽  
Type V ◽  
Mri Characteristics ◽  
Prompt Diagnosis

Abstract BACKGROUND AND IMPORTANCE: Prompt diagnosis of intracranial dural arteriovenous shunt (DAVS) with spinal venous drainage, classified as Cognard type V, is difficult. We investigated the angiographic and magnetic resonance imaging (MRI) characteristics of Cognard type V DAVS to determine the reason for the difficulty in early diagnosis. CLINICAL PRESENTATION: We systematically reviewed 54 published and 3 new cases of Cognard type V DAVS. The pattern of venous drainage was classified on the basis of relative dominance of the anterior and posterior spinal veins with the use of angiograms. T2-weighted sagittal MRIs were used to detect signal flow voids of enlarged spinal veins. Types of venous drainage were determined in 49 of the 57 cases. Twenty-eight and 8 cases showed a dominance of anterior and posterior spinal venous drainage, respectively. In 13 cases, venous drainage was equally distributed through the anterior and posterior spinal veins. Of 41 cases with an abnormally dilated anterior spinal vein, MRIs were available for 25 cases. Signal flow voids of enlarged anterior spinal veins were detected in 9 cases (36.0%), whereas dilatation of the posterior spinal veins was apparent in 9 of 16 cases (56.3%). Overall, MRI detected enlargement of either anterior or posterior spinal veins in 15 of 41 cases (36.6%). CONCLUSION: In Cognard type V DAVS, anterior venous drainage is dominant. Because the anterior spinal veins are located subpially, flow voids are less prominent on sagittal T2-weighted MRI. This may lead to difficulties in diagnosing. Evaluation with MR angiography may compensate for these limitations.

Pregnancy luteoma: a rare presentation and expectant management

2018 ◽  
Vol 7 (2) ◽  
Author(s):  
Sinem Ayse Duru Coteli ◽  
Gokcen Orgul ◽  
Mehmet Coskun Salman
Keyword(s):  
Surgical Intervention ◽  
Hormone Secretion ◽  
Expectant Management ◽  
Clinical Findings ◽  
Resonance Imaging ◽  
Successful Management ◽  
Rare Presentation ◽  
Pathological Evaluation ◽  
Magnetic Resonance Imaging Mri

AbstractPregnancy luteoma (PL) is a rare cause of non-neoplastic masses in pregnancy. PLs are usually asymptomatic. However, general symptoms like pelvic pain, lumbalgia, constipation or virilization due to active hormone secretion can be detected as the clinical findings of these benign cysts. The definitive diagnosis of PL is most commonly possible with a pathological evaluation after surgical intervention. Therefore, we present a successful management of PL with close follow-up until delivery. Beside the suspicion of malignancy by ultrasonography and magnetic resonance imaging (MRI), the cytological evaluation of ascites revealed benign cells which was helpful to decide expectant management.

scholarly journals Multiple myeloma revealed by a sphenoid plasmocytoma: case report and literature review

2016 ◽  
Vol 3 (2) ◽  
pp. 57-59
Author(s):  
Selma Kadiri
Keyword(s):  
Multiple Myeloma ◽  
Positive Staining ◽  
Resonance Imaging ◽  
Rare Presentation ◽  
Sphenoidal Sinus ◽  
Biological Studies ◽  
Plasma Cell Neoplasms ◽  
Gamma Peak ◽  
History Of ◽  
Magnetic Resonance Imaging Mri

Plasma cell neoplasms can manifest as a solitary or multiple plasmocytomas and may be associated with or progressing to multiple myeloma (MM). Cranial and intracranial plasmocytomas revealing multiple myeloma are very rare and only few cases are reported in the literature. We report the case of a sphenoid plasmocytoma that revealed a multiple myeloma in a 56 year-old woman with 3 months history of temporal headache and diplopia. Magnetic resonance imaging (MRI) and computed tomography (CT) showed a sphenoid mass. An endoscopic sphenoidal biopsy was performed and the histopathological exams showed a plasmocytoma with a positive staining for CD138. Further biological studies confirmed the diagnosis of multiple myeloma with a monoclonal gamma peak of immunoglobulin (Ig) A. The patient started systemic chemotherapy and received decompressive radiation therapy on the sphenoidal sinus. She remained in remission for 8 months and died from renal dysfunction. Although the sphenoid plasmocytoma is a very rare presentation of multiple myeloma it should be considered for effective patient management and prognosis improvement

scholarly journals Melioidosis with endocarditis and massive cerebral infarct

2015 ◽  
Vol 10 (1) ◽  
pp. 55 ◽  
Author(s):  
Mansoor C. Abdulla ◽  
Jemshad Alungal
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Burkholderia Pseudomallei ◽  
Liver Lesion ◽  
Cystic Lesions ◽  
Middle Cerebral Artery Territory ◽  
Resonance Imaging ◽  
Ct Guided ◽  
Magnetic Resonance Imaging Mri ◽  
Upper Abdominal

Endocarditis due to melioidosis is rare. A 60-year-old male was admitted with upper abdominal pain and vomiting for one month. Contrast enhancing computed tomography (CT) of the abdomen showed multiple hepatic, splenic and pancreatic nonenhancing cystic lesions. Culture of CT guided aspirate from the liver lesion showed growth of <em>Burkholderia pseudomallei</em>. He was started on ceftazidime and cotrimoxazole. Four days after admission patient developed decreased speech and response. Magnetic resonance imaging (MRI) and MR angioram brain showed massive infarct in the middle cerebral artery territory and occlusion of the middle cerebral artery. Echocardiogram showed vegetation in the aortic valve. He was diagnosed to have disseminated melioidosis with endocarditis resulting in massive infarct in the middle cerebral artery territory.

scholarly journals Unruptured Saccular Aneurysm Arising from the Fenestrated A1 Segment of the Anterior Cerebral Artery: Report of 2 Cases

2018 ◽  
Vol 10 (2) ◽  
pp. 140-149 ◽  
Author(s):  
Naoya Iwabuchi ◽  
Atsushi Saito ◽  
Kentaro Fujimoto ◽  
Taigen Nakamura ◽  
Tatsuya Sasaki
Keyword(s):  
Cerebral Artery ◽  
Cerebral Angiography ◽  
Anterior Cerebral Artery ◽  
The Other ◽  
Saccular Aneurysm ◽  
Resonance Imaging ◽  
Surgical Clipping ◽  
Magnetic Resonance Imaging Mri ◽  
Aneurysmal Neck ◽  
Difficult Cases

Some cases of aneurysms originating from the fenestrated A1 segment of the anterior cerebral artery (ACA) have been reported, but the pitfalls of the surgical procedure have not been well determined. We herein report 2 cases of a saccular aneurysm arising from the fenestrated A1 segment. Case 1 was a 72-year-old man incidentally diagnosed with an unruptured left ACA aneurysm on magnetic resonance imaging (MRI). Cerebral angiography revealed a saccular aneurysm arising from the proximal end of the left A1 segment. He underwent surgical clipping via the left pterional approach. The aneurysm originated from the proximal bifurcation of the fenestrated left A1 segment. A fenestrated ring clip was applied to obliterate the aneurysmal neck and one small fenestrated trunk, preserving the other fenestrated trunk and perforators around the fenestration. Case 2 was a 73-year-old man incidentally diagnosed with an unruptured ACA aneurysm on MRI. Cerebral angiography revealed a saccular aneurysm arising from the proximal end of the fenestrated left A1 segment. He underwent surgical clipping via the interhemispheric approach. The aneurysm originated from the proximal bifurcation of the fenestrated left A1 segment. A fenestrated ring clip was applied to obliterate the aneurysmal neck and one hypoplastic fenestrated trunk, preserving the other fenestrated trunk and perforators around the aneurysm. Detailed intraoperative evaluations of the anatomical structure and hemodynamics around the fenestration are important. The intentional obliteration of a fenestrated trunk and application of fenestrated clips need to be considered in difficult cases in order to expose the aneurysmal neck.

Through the Choroidal Fissure

2010 ◽  
Vol 66 (suppl_2) ◽  
pp. ons221-ons229 ◽  
Author(s):  
Anhua Wu ◽  
Steve W. Chang ◽  
Pushpa Deshmukh ◽  
Robert F. Spetzler ◽  
Mark C. Preul
Keyword(s):  
Temporal Lobe ◽  
Cerebral Artery ◽  
Posterior Cerebral Artery ◽  
Temporal Region ◽  
Mesial Temporal Lobe ◽  
Optimal Approach

Abstract BACKGROUND We compared the transsylvian transchoroidal (TSTC) approach with the lateral transtemporal (LTT) approach. Both approaches proceed through the choroidal fissure but through different incisions and along different trajectories. METHODS Four fixed, silicon-injected heads (8 sides) were used. Nine strategic anatomic points within the dissections were compared between the TSTC and LTT approaches in 7 other silicon-injected heads (14 sides). Neuronavigation was used to gather coordinates from selected points of both approaches to calculate surgical angles and distances to common targets. RESULTS The surgical angle of the TSTC approach for the inferior choroidal point was wider compared with the LTT approach (P &lt; .05). The surgical angles for the P2a-P2p point were similar for both approaches. In the TSTC approach, the P2-P3 point angle was smaller than in the LTT approach (P &lt; .05). The TSTC approach provided (except for the P2-P3 point) significantly shorter distances to all defined anatomic targets compared with the LTT approach. When the posterior cerebral artery was the target in the TSTC approach, the hippocampus was retracted 3 to 8 mm compared with 8 to 13 mm in the LTT approach. CONCLUSION We quantitatively described anatomic features of the TSTC approach and compared them with the LTT approach. For approaching the mesial temporal region, the TSTC approach offers an adequate surgical angle and shorter or similar distances proximal to P2-P3 and requires less temporal lobe and hippocampal retraction than the LTT approach. Such information can help surgeons select the optimal approach to the mesial temporal lobe and its surrounding structures. The TSTC approach should be considered for lesions located in the medial temporal region.

scholarly journals A Rare Case of Large Skull Base Meningioma Mimicking Otitis Media with Effusion

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Musaed Alzahrani ◽  
Louis Gaboury ◽  
Issam Saliba
Keyword(s):  
Skull Base ◽  
Middle Ear ◽  
Otitis Media With Effusion ◽  
Tumor Board ◽  
Resonance Imaging ◽  
Middle Ear Effusion ◽  
Rare Presentation ◽  
Skull Base Meningioma ◽  
Magnetic Resonance Imaging Mri ◽  
Ear Effusion

A 48-year-old woman presented with unilateral hearing loss and tinnitus for three years associated with middle ear effusion. Previous treatments, including antibiotics, corticoids, and transtympanic tube, were ineffective. Otomicroscopy showed a greyish retrotympanic mass associated with middle ear effusion. High resolution CT scan of the mastoid was in favor of chronic oto-mastoiditis without any evidence of tegmen dehiscence. Surgical exploration revealed a polypoid greyish mass filling the tympanic cavity. Histological examination postoperatively revealed a meningothelial meningioma. Postoperative magnetic resonance imaging (MRI) was obtained and showed a large skull base meningioma, extending from the clivus anteriorly to the porus acusticus posteriorly with middle ear invasion. After discussion with the multidisciplinary tumor board, it was managed by stereotactic radiotherapy due to the high surgical associated neurovascular risks. In conclusion, middle ear meningioma, although still a rare presentation, should be suspected in the presence of atypical chronic OME.

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