Case of microarteriovenous malformation-induced trigeminal neuralgia treated with radiosurgery.
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Radiosurgery to the right fifth cranial nerve was performed with the Gamma Knife on a 39- year-old patient who presented with classic symptoms of trigeminal neuralgia (TN), but was found on imaging studies to harbour a small intrinsic vascular malformation within the nerve. Based on size and drainage, the arteriovenous malformation (AVM) was Spetzler-Martin Grade III and no previous history of bleeding was reported. The patient had failed a trial of carbamazepine, and no surgical procedures had been performed. A decrease in symptoms was reported by the 6-month follow-up. A review of the literature on microAVM-induced TN is provided as well as a discussion of management. (+info)
Epidermal nevus syndrome with internal carotid artery occlusion and intracranial and orbital lipomas.
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We report a case of epidermal nevus syndrome involving the brain in which there is chronic occlusion of the left distal internal carotid artery resulting in ipsilateral atrophy. Orbital and cerebellopontine angle cistern lipomas and a wide cortical developmental malformation are associated with the condition. We present MR imaging findings of a patient and discuss features in the context of other neurocutaneous diseases. (+info)
Lipoma in the cerebellopontine angle--case report.
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The authors report a case of a cerebellopontine (CP) angle lipoma with a very unusual histological appearance. The 38-year-old male patient suffered vertigo, left tinnitus, and left hearing disturbance. Computed tomography and magnetic resonance imaging showed a nonenhanced low-density area and a high-intensity region in the left CP angle, respectively. The tumor, which was only partially removed because of its tight adhesion to the VIIIth nerve and brainstem, consisted of mature lipocytes and contained a piece of cartilage, which is highly unusual. (+info)
Intracranial and intraspinal dissemination from pineal yolk sac tumor treated by PVB therapy--case report.
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A 15-year-old male was admitted because of diplopia and persistent headache. Postcontrast computed tomography (CT) revealed a homogeneously enhanced large mass, 3 x 4 cm in size, in the pineal region and moderate obstructive hydrocephalus. A right ventriculoperitoneal shunt was installed. At that time, the serum alpha-fetoprotein (AFP) level increased to 23,036 ng/ml, but the level of serum beta-subunit of human chorionic gonadotropin was less than 0.2 ng/ml. These data indicated the tumor to be a pure yolk sac tumor. Following cisplatin-vinblastine-bleomycin (PVB) therapy and whole-brain irradiation (50 Gy), the tumor disappeared on CT, although the AFP level did not return to normal. Eight months after the completion of initial therapy, he had lumbago. Spinal magnetic resonance imaging revealed a metastatic mass at the L5-S2 levels, which was subtotally removed and histologically diagnosed as yolk sac tumor. Postoperative local irradiation (30 Gy) was performed. Seven months after the operation, spinal dissemination at the Th7 level occurred and, 1 month later, intracranial dissemination in the left cerebellopontine angle was detected. He died 25 months after the first admission. PVB therapy did not prevent spinal dissemination in this case. (+info)
Bilateral wallerian degeneration of the middle cerebellar peduncles due to unilateral pontine infarction.
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We report the case of a patient with bilateral and symmetrical T2 hyperintensities of the middle cerebellar peduncles. She had a history of left pontine infarction 8 months before. This was attributed to bilateral Wallerian degeneration. MR Spectroscopy showed decreased N-acetyl aspartate/Creatine (NAA/Cr) ratio in the cerebellar peduncles as well as in the whole cerebellum. We hypothesize that this could reflect neuronal degeneration following a stroke. (+info)
Arteriovenous malformation in the cerebellopontine angle presenting as hemifacial spasm--case report.
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A 64-year-old female was admitted with a 6-year history of right hemifacial spasm. Neurological examination and precontrast computed tomographic (CT) scanning showed no abnormality. Vertebral angiography disclosed, however, a small arteriovenous malformation (AVM) in the right cerebellopontine angle. A postcontrast CT scan demonstrated a high-density area in the right cerebellomedullary junction which appeared as a flow-void signal on magnetic resonance images. A right retromastoid craniectomy was performed to separate an enlarged and tortuous loop of the right anterior inferior cerebellar artery from the right facial nerve using a Teflon-felt sheet. The AVM was not excised. Postoperatively, she was completely free of hemifacial spasm. (+info)
Hemifacial spasm caused by CP angle AVM associated with ruptured aneurysm in the feeding artery--case report.
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A 66-year-old male presented with clinical features of hemifacial spasm. Cerebral angiograms disclosed an arteriovenous malformation (AVM) in the cerebellopontine angle. The hemifacial spasm was caused by a dilated feeding artery of the AVM compressing the facial nerve at the root exit zone. Surgery was not initially performed because of his age and absence of AVM rupture. However, the AVM was associated with a small aneurysm in the feeding artery, which rapidly grew during 20 days after discharge and ruptured causing subarachnoid hemorrhage. The aneurysm was clipped and the feeding artery of the AVM partially obliterated. Careful angiographic examination for associated aneurysms and consequent surgical obliteration to prevent hemorrhage are suggested in cases of AVM. (+info)
Hemifacial spasm due to cerebellopontine angle epidermoid tumor--case report.
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The authors report a case of cerebellopontine angle epidermoid presenting as typical hemifacial spasm. A 33-year-old male had experienced intermittent right hemifacial spasm for 2 years. Cranial nerve examination was otherwise normal, including auditory and trigeminal nerve functions. Metrizamide computed tomographic cisternography and magnetic resonance imaging demonstrated a characteristic epidermoid tumor. The tumor was totally removed. Postoperatively, no facial spasm or other facial nerve dysfunction was noted. (+info)