Moyamoya disease with mesial temporal sclerosis

2013 ◽  
Vol 11 (6) ◽  
pp. 713-716 ◽  
Author(s):  
Subash Lohani ◽  
Joseph R. Madsen ◽  
Ann M. Bergin ◽  
Edward R. Smith
Keyword(s):  
Clinical Problem ◽  
Temporal Lobectomy ◽  
Neurological Deficits ◽  
Mesial Temporal Sclerosis ◽  
Moyamoya Syndrome ◽  
Simultaneous Operations ◽  
History Of ◽  
Mesial Temporal Lobe ◽  
The Right ◽  
Revascularization Surgery

The combination of moyamoya syndrome and symptomatic mesial temporal sclerosis (MTS) has not previously been reported. The authors present the case of a 5-year-old boy with symptomatic MTS who developed progressive moyamoya syndrome. This combination of progressive moyamoya and a structural seizure focus presented a unique clinical problem, with the natural history of MTS predicting a high likelihood of needing resection in the future, which could be challenging following any type of moyamoya-related revascularization surgery. In anticipation of this problem, the patient underwent resection of the right inferior and mesial temporal lobe followed by right pial synangiosis as a 1-day combined operation. Postoperatively he recovered well without any neurological deficits and had an uneventful hospital stay. This case of moyamoya is unique in its association with MTS, and for the simultaneous operations for pial synangiosis and temporal lobectomy, highlighting the importance of surgical planning in patients with dual pathological processes.

scholarly journals Anterior temporal lobectomy versus selective amygdalohippocampectomy in patients with mesial temporal lobe epilepsy

2015 ◽  
Vol 74 (1) ◽  
pp. 35-43 ◽  
Author(s):  
Fábio A. Nascimento ◽  
Luana Antunes Maranha Gatto ◽  
Carlos Silvado ◽  
Maria Joana Mäder-Joaquim ◽  
Marlus Sidney Moro ◽  
...  
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Mesial Temporal Lobe Epilepsy ◽  
Temporal Lobectomy ◽  
Mesial Temporal Sclerosis ◽  
Anterior Temporal Lobectomy ◽  
Selective Amygdalohippocampectomy ◽  
Significant Difference ◽  
Mesial Temporal Lobe ◽  
Neuropsychological Outcomes

ABSTRACT Objective To contribute our experience with surgical treatment of patients with mesial temporal lobe epilepsy (mTLE) undergoing anterior temporal lobectomy (ATL) or selective amygdalohippocampectomy (SelAH). Method This is a retrospective observational study. The sample included patients with medically refractory mTLE due to unilateral mesial temporal sclerosis who underwent either ATL or SelAH, at Hospital de Clinicas – UFPR, from 2005 to 2012. We report seizure outcomes, using Engel classification, cognitive outcomes, using measurements of verbal and visuospatial memories, as well as operative complications. Result Sixty-seven patients (33 ATL, 34 SelAH) were studied; median follow-up was 64 months. There was no statistically significant difference in seizure or neuropsychological outcomes, although verbal memory was more negatively affected in ATL operations on patients’ dominant hemispheres. Higher number of major complications was observed in the ATL group (p = 0.004). Conclusion Seizure and neuropsychological outcomes did not differ. ATL appeared to be associated with higher risk of complications.

scholarly journals Bilateral Subdural Haematoma and CPAP Use: A Possible Association

2020 ◽  
Author(s):  
Beatrice Khater ◽  
Vicky Kassouf ◽  
Georges Haddad ◽  
Roula Hourany
Keyword(s):  
Subdural Haematoma ◽  
Brain Mri ◽  
Sleep Apnoea ◽  
Neurological Deficits ◽  
Angiotensin Ii Receptor Blocker ◽  
Angiotensin Ii Receptor ◽  
Acute Subdural Haematoma ◽  
Obstructive Sleep ◽  
History Of ◽  
The Right

Obstructive sleep apnoea (OSA) is a common condition usually treated with continuous positive airway pressure (CPAP). No reports have linked it to an acute subdural haematoma. A 54-year-old white man who had hypertension well controlled with an angiotensin II receptor blocker, presented with a 2-week history of occipital headache with no other focal neurological symptoms. The headache began 12 days after he had started using CPAP for OSA. A brain MRI performed 2 weeks later showed bilateral subdural haematomas which were chronic on the left and sub-acute/acute on the right. Since the patient was clinically stable with no focal neurological deficits, he received prednisone for 3 weeks and was followed up with consecutive CT scans demonstrating gradual regression of the haematomas. This is the first report showing that subdural haematomas could be linked to CPAP use.

Distinguishing Spastic and Dystonic Features in a Patient With a History of Brainstem Encephalitis: A Clinical Case Study

2021 ◽  
pp. 1-11
Author(s):  
Heather M. Clark
Keyword(s):  
Clinical Problem ◽  
Management Plan ◽  
Speech Disorders ◽  
Neurological Deficits ◽  
Brainstem Encephalitis ◽  
Motor Speech ◽  
Modest Improvement ◽  
Clinical Problem Solving ◽  
History Of

Purpose One role of a speech-language pathologist (SLP) is to differentially diagnose motor speech disorders to aid physicians, typically neurologists, in establishing a medical diagnosis. The present case study describes the clinical problem solving undertaken by the SLP to characterize the nature of neurological deficits to develop an appropriate management plan. Method The patient is a 29-year-old man with a history of brainstem encephalitis who presented for evaluation of dysarthria, dysphagia, and gait difficulties. The neurological exam characterized a spastic dysarthria. The SLP conducted a motor speech examination expressly for the purpose of differential diagnosis. Results The patient exhibited features of spastic dysarthria including strained phonation and hypernasality, equivocally slow rate associated with intermittent interword pauses rather than lengthened segments, and articulatory imprecision in the absence of weakness or slowness of the articulators. Defining features of spastic dysarthria absent from his speech were monopitch and monoloudness, as well as slow alternate motion rates. A diagnosis of hyperkinetic dysarthria associated with dystonia was informed by (a) hypernasality disproportionate to other deviant speech features, with preserved reflexive velar movements and nonspeech movements; (b) adventitious lip pursing; (c) modest improvement in speech with sensory tricks; (d) mild and intermittent phonatory strain; and (e) normal nonspeech oral motor function. Conclusions This case demonstrates the role speech-language pathology can play in the neurological assessment and management process. The recognition by the SLP of hyperkinetic dysarthria led to additional diagnostic tests and to a broader range of options for medical management.

scholarly journals “Unusual brain stone”: heavily calcified primary neoplasm with some features suggestive of angiocentric glioma

2015 ◽  
Vol 123 (5) ◽  
pp. 1256-1260 ◽  
Author(s):  
Jahangir Sajjad ◽  
Chandrasekaran Kaliaperumal ◽  
Niamh Bermingham ◽  
Charles Marks ◽  
Catherine Keohane
Keyword(s):  
Ct Scan ◽  
Neurological Deficits ◽  
Parietal Region ◽  
History Of ◽  
Angiocentric Glioma ◽  
Primary Neoplasm ◽  
History Of Epilepsy ◽  
The Right ◽  
Visual Blurring ◽  
Excised Tissue

This 40-year-old man presented with a 5-month history of progressive right-sided headache associated with visual blurring. He also had a history of epilepsy but had been seizure free with medication for the past 10 years. An initial CT scan of his brain performed 16 years previously had revealed a small area of calcification in the right parietal region. In the current presentation, he had a left-sided homonymous hemianopia but no other neurological deficits. A CT scan of his brain showed a much larger calcified, partly cystic lesion in the right parietal region. Because he was symptomatic, the lesion was excised and the cyst was drained. Histological examination of the excised tissue showed an unusual primary tumor that was difficult to classify but had some features of angiocentric glioma. The heavy calcification, mixed-density cell population, and regions with features of angiocentric glioma were most unusual. The patient remained asymptomatic 5 years after surgery, and follow-up scans did not show recurrence.

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.

MOYAMOYA SYNDROME: RARE CASE IN 34 YEAR OLD MALE PATIENT IN INDIAN POPULATION – A CASE REPORT

2021 ◽  
pp. 8-9
Author(s):  
Dinesh Agarwal ◽  
Debashish Baidya
Keyword(s):  
Indian Population ◽  
Past History ◽  
Research Centre ◽  
Moyamoya Syndrome ◽  
Sudden Loss ◽  
Left Hand ◽  
Mri Brain ◽  
History Of ◽  
Collateral Vessels ◽  
Revascularization Surgery

Moyamoya is a rare idiopathic progressive vaso-occlusive disease involving cerebral vessels like distal internalcarotid arteries on both sides, To compensate for the occlusion there is development of collateral vessels. Unilateral presentation of the condition is known as Moyamoya syndrome. Authors are presenting a case of a 34-year-old male who presented to the emergency department of Marwari Hospital and Research Centre with sudden loss of consciousness. Patient had past history of difculty in holding objects with left hand & difculty in walking for 3 years. The patient had undergone MRI BRAIN, diagnosed as Moyamoya disease and treated with revascularization surgery.

scholarly journals Pediculectomy and fenestration for spinal cord decompression of the lumbar spine of a bush dog (Speothos venaticus) - case report

2020 ◽  
Vol 72 (4) ◽  
pp. 1397-1402
Author(s):  
P.V.T. Marinho ◽  
A.S. Macedo ◽  
C.R.A. Ferrigno ◽  
I.S. Dal-Bó ◽  
A.C.B.C.F. Pinto ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Neurological Deficits ◽  
Disc Space ◽  
Lumbar Intervertebral Disc ◽  
History Of ◽  
Bush Dog ◽  
The Right ◽  
Spinal Cord Decompression ◽  
Speothos Venaticus ◽  
Disc Extrusion

ABSTRACT A captive adult male bush dog (Speothos venaticus) was referred to our Veterinary Medical Teaching Hospital from a local zoo due to a two-week history of progressive hind limb gait impairment and ataxia, non-responsive to clinical management. Computed tomography revealed decreased disc space at L3 - L4 level, with probable disc extrusion narrowing the right side of the spinal canal, compressing the spinal cord. We opted to surgically remove the disc material using both fenestration and right lateral pediculectomy (mini-hemilaminectomy) techniques. Twelve days after surgery there was mild residual proprioceptive ataxia. Gait was fully regained with remission of the neurological deficits around the 30th postoperative day. This is - to the best of our knowledge - the first successful report of a lumbar intervertebral disc extrusion in a bush dog (Speothos venaticus) surgically treated by pediculectomy and disc fenestration.

Mood Changes After Right-Hemisphere Lesions

1989 ◽  
Vol 155 (1) ◽  
pp. 79-85 ◽  
Author(s):  
Sergio E. Starkstein ◽  
Robert G. Robinson ◽  
Marc A. Honig ◽  
Rajesh M. Parikh ◽  
John Joselyn ◽  
...  
Keyword(s):  
Major Depression ◽  
Daily Living ◽  
Right Hemisphere ◽  
Demographic Variables ◽  
Neurological Deficits ◽  
Mood Changes ◽  
Frontal Operculum ◽  
History Of ◽  
The Right

Ninety-three patients with acute stroke lesions restricted to the right hemisphere were examined for the presence of mood changes. While 46 patients showed no mood changes, 19 were unduly cheerful, 17 had developed major depression, and 11 had developed minor depression. Although there were no significant between-groups differences in other demographic variables, neurological deficits, activities of daily living, cognitive impairment, or quality of social support, patients with major depression had a significantly higher frequency of familial history of psychiatric disorder and lesions of the parietal cortex than patients with either no mood change or major depression following left-hemisphere lesions. On the other hand, undue cheerfulness was significantly associated with lesions of the right frontal operculum. These findings suggest that major depression following right-hemisphere lesions may have a different aetiology and mechanism than major depression following left frontal or basal ganglia lesions.

SPECT in a Patient with Postictal PLEDs: Is Hyperperfusion Evidence of Electrical Seizure?

2002 ◽  
Vol 33 (4) ◽  
pp. 171-173 ◽  
Author(s):  
Murat Fani Bozkurt ◽  
Serap Saygi ◽  
Belkis Erbas
Keyword(s):  
Partial Seizure ◽  
Brain Mri ◽  
Epileptic Seizures ◽  
Brain Perfusion ◽  
Complex Partial Seizure ◽  
Temporal Lobectomy ◽  
Mesial Temporal Sclerosis ◽  
Complex Partial Seizures ◽  
Epileptiform Discharges ◽  
The Right

The pathophysiological relation between periodic lateralized epileptiform discharges (PLEDs) and epileptic seizures is not known and the exact causative mechanism of PLEDs still remains unclear. In this report, the authors present a case in which the EEG displayed PLEDs after a complex partial seizure. This patient, with a long history of complex partial seizures, had previously undergone right standard anterior temporal lobectomy with hippocampectomy, with a diagnosis of mesial temporal sclerosis. She had one complex partial seizure 72 days after operation and was admitted to hospital. Her brain MRI revealed changes due to temporal lobectomy and small residual posterior hippocampic anomalies. PLEDs over the right temporal lobe were seen in postictal EEGs and persisted for 4 days despite the patient's normal mental status and normal neurologic examination. Brain perfusion scintigraphy with Tc-99m-HMPAO during PLEDs was performed on the second day after the seizure, and right temporal hyperperfusion was detected. EEGs and scintigraphic imaging were repeated after cessation of PLEDs. The repeated brain scan displayed right temporal hypoperfusion. PLEDs during the postictal period may actually be an ictal pattern, and if hyperperfusion in the brain SPECT studies during PLEDs is seen, further aggressive antiepileptic drug therapy may be necessary in some cases.

scholarly journals Isolated café-au-lait macules: Think of neurofibromatosis type V

2021 ◽  
Vol 12 (4) ◽  
pp. 470-470
Author(s):  
Samia Mrabat ◽  
Hanane Baybay ◽  
Zakia Douhi
Keyword(s):  
Systemic Disease ◽  
Neurofibromatosis Type ◽  
Neurological Deficits ◽  
Systemic Involvement ◽  
General Physical Examination ◽  
Dermatological Examination ◽  
History Of ◽  
General Physical ◽  
The Right ◽  
Type V

Sir, Segmental neurofibromatosis (SNF) is a rare form of neurofibromatosis (NF) with a reported prevalence of 0.0014%–0.002%. It is included in Riccardi’s classification as type V NF [1]. It is characterized by café-au-lait macules and/or neurofibromas distributed in only one dermatome, less commonly in two or more dermatomes [2]. Roth et al. reclassified SNF into four subtypes: true SNF, localized SNF with deep involvement, hereditary SNF, and bilateral SNF. A limited number of cases of SNF have been reported with systemic involvement, such as visceral neurofibromas, skeletal abnormalities, and renal agenesis [1]. Laser therapy may be performed if an aesthetic demand arises. Herein, we report a case of SNF in a young boy with no systemic disease. An eleven-year-old male was sent by his pediatrician for skin spots that appeared at the age of four. The young patient came from a non-consanguineous marriage and had no family history of skin disease. A general physical examination revealed normal parameters, such as weight, size, intelligence, speech, auditory function, and visual acuity. A dermatological examination found unilateral café-au-lait macules with a ranging size of 1 to 5 mm in the right half of the trunk with no crossing of the midline (Figs. 1a and 1b). We thoroughly examined the boy and found no other features of neurofibromatosis, including neurofibromas, neurological deficits, or bone abnormalities. We assured the patient and his parents that this was a benign disease, so the risk of developing any disease-related complications was low. Annual monitoring was started. No therapy was proposed because the patient expressed no aesthetic demands.

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