Cerebral pachyleptomeningitis associated with MPO-ANCA induced by PTU therapy.
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A 34-year-old woman with hyperthyroidism, who had been previously treated with propylthiouracil (PTU) is reported. She was admitted because of clumsiness in her left hand and abnormal behavior. A neurological examination demonstrated impairment of higher cortical function, and weakness and hyperreflexia of the left leg. An MRI scan with gadolinium enhancement showed pachyleptomeningeal thickening in the right frontoparietal lobe. Blood tests revealed a high MPO-ANCA titer of 122 EU (normal:<10 EU). After steroid administration, the neurological symptoms and the MRI findings improved markedly. This is the first report of PTU-induced cerebral pachyleptomeningitis associated with a high serum MPO-ANCA titer. (+info)
Arachnoid granulations of the posterior temporal bone wall: imaging appearance and differential diagnosis.
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Arachnoid granulations are rarely seen on high-resolution CT (HRCT) at the posterior temporal bone wall, where they appear as erosions, without bone spicules and often with a lobulated surface. Differential diagnosis includes endolymphatic sac tumor, paraganglioma, chordoma, and chondromatous and metastatic tumors. MR imaging can confirm the diagnosis because arachnoid granulations behave like CSF without gadolinium enhancement. This report aims to illustrate the appearance and differentiation of temporal bone arachnoid granulations on HRCT and MR imaging. (+info)
A polycystic variant of a primary intracranial leptomeningeal astrocytoma: case report and literature review.
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BACKGROUND: Primary leptomeningeal astrocytomas are rare intracranial tumors. These tumors are believed to originate from cellular nests which migrate by means of aberration, ultimately settling in the leptomeningeal structure. They may occur in both solitary and diffuse forms. The literature reports only fifteen cases of solitary primary intracranial leptomeningeal astrocytomas. CASE PRESENTATION: The authors report the case of a seventy-eight year-old woman with a polycystic variant of a solitary primary intracranial leptomeningeal astrocytoma. The first neurological signs were seizures and aphasia. CT and MRI scans demonstrated a fronto-parietal polycystic tumor adherent to the sub arachnoid space. A left fronto-temporo-parietal craniotomy revealed a tight coalescence between the tumor and the arachnoid layer which appeared to wrap the mass entirely. Removal of the deeper solid part of the tumor resulted difficult due to the presence of both a high vascularity and a tight adherence between the tumor and the ventricular wall. CONCLUSION: A new case of a solitary primitive intracranial leptomeningeal astrocytoma of a rare polycystic variant is reported. Clinical, surgical, pathologic and therapeutic aspects of this tumor are discussed. (+info)
Atypical growth pattern of a meningioma in an adult.
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A 49-year-old woman presented with a rare atypical growth pattern of meningioma without evidence of dural attachment manifesting as chronic headache associated with transient paresthesia and left motor disorders. On admission, neurological examination showed no abnormalities. Magnetic resonance (MR) imaging revealed a right temporo-parieto-occipital lesion, which appeared to involve the subdural space and filling the cortical sulci. The lesion caused peritumoral white matter edema. The tumor appeared hypointense on T(1)-weighted and hyperintense on T(2)-weighted MR images, with homogeneous enhancement after contrast administration. A biopsy of the lesion was performed. Histological examination indicated that the lesion was a meningioma. Intraparenchymal meningiomas should be considered in the differential diagnosis of intraaxial lesions in patients of any age. (+info)
Meningioma in the posterior fossa without dural attachment.
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A 14-year-old boy presented with a very rare meningioma in the posterior cranial fossa without dural attachment. Magnetic resonance imaging revealed a 3-cm, well-circumscribed, heterogeneously enhanced, round mass without dural tail sign in the right side of the posterior fossa. Right vertebral angiography revealed very faint tumor staining supplied by the right posterior inferior cerebellar artery. Total removal of the tumor was performed. Intraoperatively, the mass exhibited no attachment to the dura mater, cerebellar parenchyma, or choroid plexus, but was firmly attached to the arachnoid tissue near the foramen of Luschka. Histological and immunohistochemical studies established the diagnosis of meningothelial meningioma (World Health Organization grade I). (+info)
Modeling NF2 with human arachnoidal and meningioma cell culture systems: NF2 silencing reflects the benign character of tumor growth.
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Meningiomas, common tumors arising from arachnoidal cells of the meninges, may occur sporadically, or in association with the inherited disorder, neurofibromatosis 2 (NF2). Most sporadic meningiomas result from NF2 inactivation, resulting in loss of tumor suppressor merlin, implicated in regulating membrane-cytoskeletal organization. To investigate merlin function in an authentic target cell type for NF2 tumor formation, we established primary cultures from genetically-matched meningioma and normal arachnoidal tissues. Our studies revealed novel and distinct cell biological and biochemical properties unique to merlin-deficient meningioma cells compared to merlin-expressing arachnoidal and meningioma cells, and other NF2-deficient cell types. Merlin-deficient meningioma cells displayed cytoskeletal and cell contact defects, altered cell morphology and growth properties, most notably cell senescence, implicating the activation of senescence pathways in limiting benign meningioma growth. Merlin suppression by RNAi in arachnoidal cells replicated merlin-deficient meningioma features, thus establishing these cell systems as disease-relevant models for studying NF2 tumorigenesis. (+info)
Bilateral abducens nerve palsy following ruptured anterior communicating artery aneurysm: report of 2 cases.
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Isolated abducens nerve palsies associated with intracranial aneurysms have rarely been reported. Their association with anterior communicating artery (ACoA) is even rarer. Intracisternal clot formation and elevated intracranial pressure has been proposed to be the responsible mechanisms. Herewith, we report two cases of bilateral abducens palsies following ruptured ACoA aneurysms and speculated the possible mechanisms. Opening of Liliequist's membrane provides clinical improvement due to CSF release. (+info)
Nontraumatic skull base defects with spontaneous CSF rhinorrhea and arachnoid herniation: imaging findings and correlation with endoscopic sinus surgery in 27 patients.
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BACKGROUND AND PURPOSE: Defects at the skull base leading to spontaneous CSF rhinorrhea are rare lesions. The purpose of our study was to correlate CT and MR findings regarding the location and content of CSF leaks in 27 patients with endoscopic sinus surgery observations. MATERIALS AND METHODS: Imaging studies in 27 patients with intermittent CSF rhinorrhea (CT in every patient including 10 examinations with intrathecal contrast, plain CT in 2 patients, and MR in 15 patients) were analyzed and were retrospectively blinded to intraoperative findings. RESULTS: CT depicted a small endoscopy-confirmed osseous defect in 3 different locations: 1) within the ethmoid in 15 instances (53.6% of defects) most commonly at the level of the anterior ethmoid artery (8/15); 2) adjacent to the inferolateral recess of the sphenoid sinus in 7 patients including one patient with bilateral lesions (8/28 defects, 28.6%); 3) within the midline sphenoid sinus in 5 of 28 instances (17.9%). Lateral sphenoid defects (3.5 +/- 0.80 mm) were larger than those in ethmoid (2.7 +/- 0.77 mm, P < or = 0.029) or midsphenoid location (2.4 +/- 0.65 mm, P < or = 0.026). With endoscopy proven arachnoid herniation in 24 instances as reference, MR was correct in 14 of 15 instances (93.3%), CT cisternography in 5 of 8 instances (62.5%). Plain CT in 1 patient was negative. CONCLUSION: In patients with a history of spontaneous CSF rhinorrhea, CT was required to detect osseous defects at specific sites of predilection. MR enabled differentiating the contents of herniated tissue and allowed identification of arachnoid tissue as a previously hardly recognized imaging finding. (+info)