Acute Hydrocephalus in an Adult Patient Secondary to Unruptured Arteriovenous Malformation

Acute hydrocephalus as a result of unruptured arteriovenous malformation (AVM) is a rare phenomenon in the adult population. Patients with AVMs typically present with hemorrhage, seizures, or focal neurologic deficits. Hydrocephalus may result from obstructing the native cerebrospinal fluid drainage by the malformation’s architecture. We report a previously healthy 32 year-old male who initially presented to an optometrist with blurry vision, visual obscurations, and papilledema. A large right frontal cerebral AVM with hydrocephalus and papilledema was confirmed by MRI. Unfortunately localized lesions may result in hydrocephalus as a rare presentation in unruptured AVMs.

Dorsal skull meningeal lymphatic vessels drain blood-solutes after intracerebral hemorrhage

Drainage of intraparenchymal hematoma is crucial for the treatment of intracerebral hemorrhage (ICH). We investigated here the possible function of the meningeal lymphatic vessels (mLVs) in ICH resolution. Meningeal lymphatics have been reported to be involved in cerebrospinal fluid drainage, but their role in the drainage and clearance of brain parenchyma has not been characterized in details. Using two preclinical models of ICH, mimicking focal cortical ischemic hemorrhage and subcortical extended hemorrhage, we characterized the dynamics of blood drainage through the dorsal mLVs by two-photon real time imaging in awake mice. After ICH induction, we observe the flow of blood-derived components within the mLVs, suggesting that meningeal lymphatics can play a role in facilitating the drainage of the hemorrhage. We also found that local formation of new mLVs is directly correlated with ICH-related neuroinflammation levels. These findings suggest that meningeal lymphatics could provide a valuable therapeutic target for ICH resolution.SummaryIn vivo awake imaging reveals the direct drainage of extravasated blood-solutes from brain parenchyma into dorsal meningeal lymphatic vessels, following focal or diffuse intracranial hemorrhage

PARAPLEGIA AFTER A FROZEN ELEPHANT TRUNK PROCEDURE Successful reversal by immediate spinal liquor drainage

We report a patient who presented with paraplegia after ascending aorta and arch replacement using the frozen elephant trunk technique. Immediate postoperatively cerebrospinal fluid drainage allowed successful reversal of spinal chord injury. Early awakening of patients following a frozen elephant technique is mandatory because it allows recognition and treatment of this complication by prompt cerebrospinal liquor drainage.