Spontaneous rupture of a presumed colloid cyst of the third ventricle--case report.
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An 83-year-old man presented with gait disturbance, dementia, and urinary incontinence that had progressed over 2 months. Computed tomography (CT) of the brain revealed hydrocephalus due to a well-demarcated, round hyperdense mass in the third ventricle, which was not enhanced by contrast agent. Ten days after the initial evaluation, CT revealed that the cyst in the third ventricle had disappeared. Magnetic resonance imaging revealed spontaneous rupture of the lesion and remnants of cyst wall anchored to the anterior roof of the third ventricle. Thereafter, the symptoms of hydrocephalus subsided. However, 6 months later the patient's condition gradually deteriorated and the ventricles dilated without any evidence of tumor regrowth. Surgical intervention was not performed as the family of the patient withheld consent. The natural history of colloid cysts of the third ventricle remains unclear. Spontaneous rupture of a presumed colloid cyst of the third ventricle should be considered when planning treatment. (+info)
Fourth ventricle computed tomography indexes: standardisation and characteristics in neurocysticercosis.
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OBJECTIVES: to propose standardisation of fourth ventricle dimensions and to study its characteristics in neurocysticercosis. METHOD: a control group (CG) constituted by 114 individuals with normal CT, and 80 patients with neurocysticercosis composed the group with neurocysticercosis (GN). Measures of the inner cranial diameter (Cr), fronto-polar distance between both lateral ventricles (FP), antero-posterior (AP) and latero-lateral (LL) fourth ventricle width based the standardisation of six indexes. RESULTS: AP/Cr, AP/LL and AP/FP were the more discriminative indexes, presenting in CG the mean values of 0.063, 0.267 and 0.582, respectively. The indexes in GN had values statistically higher than in CG. From GN, 51 patients had increased indexes values above 2 standard deviation of the CG mean. AP/Ll was >/= 1 in 95% of patients with ventricular shunting and in 88% with depression. It also occurred in 73% patients with satisfactory follow-up and in everybody who died. CONCLUSION: AP/Cr, AP/LL and AP/FP may represent fourth ventricle dimensions. (+info)
Possible acute hemorrhagic leukoencephalitis manifesting as intracerebral hemorrhage on computed tomography--case report.
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A 15-year-old girl presented with meningeal irritation and bilateral cerebral signs after contracting influenza. A lumbar puncture revealed bloody cerebrospinal fluid and polymorphonuclear predominant pleocytosis with an elevated protein level and normal glucose level. Computed tomography showed a hematoma in the right basal ganglia and lateral ventricles. Symmetrical low density areas were also noted in the bilateral white matter. The preliminary diagnosis was hemorrhagic cerebrovascular disease of unknown cause. However, her neurological condition deteriorated. Magnetic resonance (MR) imaging showed diffuse high intensity signals in the bilateral white matter and small spotty lesions, indicating hemorrhages in various stages. The final diagnosis was acute hemorrhagic leukoencephalitis (AHL). However, high-dose steroid administration and plasmapheresis failed to improve her condition. Hypothermia could not control her intracranial pressure and she died 12 days after admission. The neuroimaging findings indicated the histological characteristics of AHL, but the hematoma formation is rare. AHL is a fulminant form of brain demyelination and can be fatal, so early diagnosis and aggressive treatment are important for successful recovery. Therefore, early investigation by MR imaging is necessary. (+info)
Pseudo-subarachnoid hemorrhage: a potential imaging pitfall associated with diffuse cerebral edema.
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We report CT findings in seven patients with diffuse cerebral edema and increased attenuation in the basilar cisterns resembling subarachnoid hemorrhage. On the basis of autopsy (three cases) and lumbar puncture (four cases) findings, true subarachnoid hemorrhage was reasonably excluded. Pathophysiologic changes that occur with diffuse cerebral edema are explored, with proposed explanations for the appearance of a pseudo-subarachnoid hemorrhage. (+info)
MR ventriculography for the study of CSF flow.
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BACKGROUND AND PURPOSE: Various MR techniques have been used to assess CSF flow and to image the subarachnoid spaces and ventricles. Anecdotal reports describe the use of intrathecal and intraventricular gadolinium-based contrast agents in humans and animals. We sought to determine the clinical usefulness of gadolinium-enhanced MR ventriculography for assessing CSF flow in patients with various neurologic conditions. METHODS: Five patients (three female and two male patients aged 6 months to 65 years) were included in the study. After performing sagittal, coronal, and axial T1-weighted MR imaging of the brain, 0.02-0.04 mmol of gadodiamide was injected into the lateral ventricle. Sagittal, coronal, and axial T1-weighted imaging was repeated soon after the injection. We were specifically looking for the site of obstruction to CSF flow in those patients with hydrocephalus, communication between cysts and ventricles, elucidation of suspicious intraventricular lesions, and patency of third ventriculostomies. RESULTS: MR ventriculography showed good delineation of the ventricular system in all patients. In one patient with carcinomatosis and hydrocephalus, a block to contrast material flow was detected at the right foramen of Luschka. In another patient with hydrocephalus, partial block to the flow of contrast material was demonstrated at the right foramen of Monro. In a patient with hydrocephalus and a posterior fossa cyst, flow of contrast material was blocked between the third ventricle and the cyst, with a thin streak of contrast material in the aqueduct. As an assessment of the patency of a third ventriculostomy, MR ventriculography showed flow of contrast material into the suprasellar cisterns from the third ventricle in one patient and absence of flow in another. CONCLUSION: MR ventriculography is a safe technique for assessing CSF flow, with application in determining the site of obstruction in hydrocephalus, in assessing communication between cysts and the ventricle, and in determining the functioning status of endoscopic third ventriculostomies. (+info)
Cerebellar astrocytoma with repeated episodes of fourth ventricle isolation causing peritoneal shunt tube obstruction--case report.
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A 9-year-old girl underwent total removal of a cerebellar astrocytoma complicated by hydrocephalus after postoperative meningitis, requiring a ventriculoperitoneal shunt. Five months later, headache, vomiting, and gait disturbance appeared and computed tomography detected enlarged fourth ventricle. A fourth ventriculoperitoneal shunt resulted in immediate relief of all symptoms. After 2 months, obstruction of the peritoneal tube required shunt reconstruction. This recurred three times in 8 months. At the last operation, tumor cells were detected in the cerebrospinal fluid and the substance clogging the tube. This suggested that the tumor had recurred and clogging by tumor cells had caused the repeated episodes of isolated fourth ventricle. Radiation therapy prevented further shunt obstruction and achieved remission of all signs and symptoms. (+info)
Ventricle-to-brain ratio and symptoms at the onset of first-break schizophrenia.
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Ventricle-to-brain ratio (VBR) was measured from the computed tomographic (CT) scans of 33 very recent-onset psychotic patients. Illness severity and positive and negative symptoms were also assessed in 21 of these patients with schizophreniform disorder. Forty-five neurology patients served as controls. Analyses revealed no significant differences between the VBR of the psychotic group as a whole, the schizophreniform subgroup, the affective psychotic subgroup, and the controls. Control subjects with a neurological diagnosis of vertigo or syncope had significantly higher VBR than the remainder of the control group and the psychotic group. When the psychotic group was compared to the control group minus those controls with syncope or vertigo, the psychotic group had significantly higher VBR. The schizophreniform subgroup also had significantly higher VBR than the control group minus subjects with vertigo or syncope. In the schizophreniform subgroup, positive symptoms and illness severity were associated with smaller VBR. There was no association between negative symptoms and VBR. (+info)
Dementia associated with lacunar infarction.
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BACKGROUND AND PURPOSE: The purpose of this study was to assess the number of patients with lacunar lesions who develop dementia and to evaluate in patients with and without dementia the relevance of risk factors for cerebrovascular disease, the occurrence of leukoaraiosis, the volume and location of vascular lesions, the size of ventricular and subarachnoid spaces, and stroke recurrence. METHODS: One hundred eight patients in whom computed tomograms revealed lacunar lesions that could account for their clinical neurological pictures were followed up for an average of 4 years after their first lacunar stroke. RESULTS: Twenty-five patients (23.1%) developed dementia. The prognosis regarding occurrence of dementia during the follow-up period, evaluated by the Kaplan-Meier method, was significantly worse in subjects with the greatest evidence of cerebral atrophy (p less than 0.009) and in subjects who underwent new focal cerebrovascular episodes (p less than 0.000001). No differences were seen in the frequency of vascular risk factors or the site or volume of lesions between the demented and nondemented groups. CONCLUSIONS: Patients with lacunar infarcts suffer from dementia 4-12 times more frequently than the normal population. Cerebral atrophy and recurrent stroke, as well as other as-yet unclarified factors, are involved in producing dementia. (+info)