Caudate hemorrhage with moyamoya-like vasculopathy from atherosclerotic disease.
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BACKGROUND AND PURPOSE: Caudate hemorrhage usually results from hypertension, rupture of arteriovenous malformation or aneurysm, or rarely, moyamoya disease. Moyamoya-like changes related to severe atherosclerotic occlusive disease, usually causing ischemic stroke, have been reported. CASE DESCRIPTION: A 51-year-old normotensive patient was admitted with headache due to a left caudate hematoma with ventricular extension. There was a history of smoking, leg claudication, elevated cholesterol, and coronary artery disease. Angiography demonstrated complete extracranial carotid occlusion on the left and atherosclerotic stenosis at the bifurcation on the right, with supraophthalmic occlusion distally. At the base of the brain, bilateral moyamoya-like vessels, presumed to be secondary to atherosclerotic occlusion, were evident, but neither aneurysm nor arteriovenous malformation was present. Cerebral blood flow and transcranial Doppler studies indicated severely impaired cerebral perfusion that improved after bilateral extracranial-to-intracranial bypass surgery. CONCLUSIONS: Atherosclerotic occlusive carotid disease with moyamoya-like changes may be a rare cause of caudate hemorrhage. A decrease in moyamoya vessels with bypass surgery may reduce the risk of recurrent hemorrhage. (+info)
evaluation of communication between intracranial arachnoid cysts and cisterns with phase-contrast cine MR imaging.
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BACKGROUND AND PURPOSE: The demonstration of communication between arachnoid cysts (ACs) and the adjacent subarachnoid space is a prerequisite for their proper management. CT cisternography (CTC) is the conventional method for functional evaluation of ACs. The sensitivity of MR imaging to CSF flow has been demonstrated, but reports of the clinical usefulness of MR CSF flow techniques in this application are limited. The purpose of our study was to prospectively evaluate the accuracy of MR CSF flow study as an alternative to CTC in this setting. METHODS: MR CSF flow study with retrospective ECG-gated 2D, fast low-angle shot, phase-contrast (PC), cine gradient-echo sequence was performed in 39 patients with an intracranial AC. Results were compared with intraoperative and CTC findings. RESULTS: PC cine MR imaging results were compatible with operative or CTC findings in 36 (92.3%) of 39 patients. Twenty-four cysts were noncommunicating, and 15 were communicating. Three cysts were evaluated as being noncommunicating on PC cine MR imaging (false-negative) but demonstrated contrast enhancement on CTC. No false-positive diagnoses occurred. All cysts regarded as being communicating on PC cine MR imaging were also found to be communicating on both confirmation methods. CONCLUSION: MR CSF flow imaging with a PC cine sequence can be incorporated in the imaging work-up of ACs. This is a reliable alternative to invasive CTC for the functional evaluation of ACs. (+info)
MR ventriculocisternography by using 3D balanced steady-state free precession imaging: technical note.
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This study investigated the effects of flip angle setting in 3D balanced steady-state free precession (SSFP) imaging on CSF-parenchyma contrast and section aliasing artifacts. Theoretical derivations indicated that the extent of section aliasing artifacts decreased as the flip angle was lowered, at the expense of a sacrifice in CSF-parenchyma contrast. Experimental data agreed closely with theoretical predictions. A flip angle of about 40 degrees is therefore recommended for 3D balanced SSFP MR ventriculocisternography. (+info)
A case of familial third ventricular colloid cyst.
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Colloid cyst of the third ventricle is a rare benign intracranial lesion, and familial cases are rarer still. They may be asymptomatic or present with symptoms of raised intracranial pressure, including sudden death. Surgical excision is curative. We report a 24 year old pregnant woman with familial colloid cyst, who presented with headaches and suffered a cardiorespiratory arrest. Early computed tomography scan of the brain is advised in patients with a family history of third ventricular colloid cyst presenting to the accident and emergency department with headache. (+info)
An unusual case of posttraumatic porencephaly preceded by neither overt cerebral contusion nor hemorrhage is reported. The cerebral cortex just above the porencephalic cyst was found intra-operatively to be partially herniated into a fracture line, while the cortex elsewhere was completely intact. The porencephalic cyst communicated with the lateral ventricle. Apparently, brain herniation and the cyst-ventricle communication can be causative factors in the occurrence and growth of posttraumatic porencephaly. (+info)
Cisternography and ventriculography gadopentate dimeglumine-enhanced MR imaging in pediatric patients: preliminary report.
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BACKGROUND AND PURPOSE: Complex CSF diseases may be underdiagnosed or poorly understood on conventional CT or MR imaging. Although intrathecal CT cisternography with water-soluble iodinated contrast medium has been used, very few studies have dealt with the intrathecal use of gadopentate dimeglumine (Gd-DTPA), though it appears superior to CT. We report our experience with the intrathecal use of Gd-DTPA for MR cisternography and ventriculography in pediatric patients referred for study and treatment of complex CSF-related diseases. MATERIALS AND METHODS: Ten patients (range, 1 month-16 years of age) were selected after we obtained specific informed consent. Intrathecal gadolinium injection was performed via transfontanelle ventriculostomy, ventriculoperitoneal shunt reservoir, or lumbar puncture. Cases included spontaneous CSF leaks (n=1), complex traumatic frontoethmoidal fractures with suspected CSF leak (n=2), multiloculated congenital or acquired hydrocephalus (n=3), intraventricular tumor (n=1), suspected postoperative arachnoiditis (n=1), complex midline defect (n=1), and acquired orbital meningoencephalocele (n=1). RESULTS: No patient showed biologic, behavioral, or neurologic alterations. In complex hydrocephalus or intraventricular cysts, ventriculography Gd-DTPA MR imaging helped to differentiate isolation of a ventricle or noncommunicating cyst in all 4 patients. In suspected posttraumatic CSF leaks, the procedure established with precision the place of the leak in 1 patient and excluded it in the other. In 1 patient who underwent surgery for spinal cord neoplasm, the procedure excluded arachnoiditis. In the other 3 patients with complex CSF-related diseases, the procedure showed distinctive radiologic findings for the understanding and treatment of the disease. Altogether, in 8 patients, imaging findings influenced or changed clinical decisions and surgical planning. CONCLUSIONS: Our preliminary results showed no side effects and potential useful clinical applications in the evaluation of CNS diseases involving the ventricular system or the subarachnoid space in selected pediatric patients. (+info)
Suprasellar arachnoid cyst: a 20- year follow-up after stereotactic internal drainage: case report and review of the literature.
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Approximately 9 to 15% arachnoid cysts occur in the sellar or suprasellar region. The optimal management of symptomatic suprasellar cysts continues to pose a challenge to neurosurgeons. This case report describes a patient with a suprasellar arachnoid cyst who presented at the age of 3 and was followed for 20 years after cystoventriculostomy. A girl was referred to neurosurgery department by a pediatric clinic because computed tomography demonstrated a suprasellar cystic lesion. The neurological examination and all routine blood tests including hormone profiles were normal. The physical examination was unremarkable except premature thelarche. Stereotactic ventriculocystostomy was performed using a catheter providing permanent internal drainage. Postoperative cystoventriculography showed contrast medium in both the cyst and the ventricles. Control computed tomography confirmed that the ventricular cyst catheter was within the cyst. During a follow-up of 20 years, signs of precocious puberty disappeared and the girl showed normal sexual development. Endocrine profiles and visual function remained normal. The stereotactic approach to suprasellar arachnoid cysts is a safe procedure in experienced hands. (+info)
The anterior choroidal artery does not supply the corona radiata and lateral ventricular wall.
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BACKGROUND AND PURPOSE: We sought first to characterize the clinical syndromes of patients found to have angiographic, computed tomographic, or magnetic resonance imaging scan indexes of anterior choroidal artery territory infarction and then to determine the frequency of involvement of the periventricular corona radiata in such patients. METHODS: Sixteen patients were selected based on angiographically, or surgically, documented occlusion of the anterior choroidal artery or based on infarcts whose minimal lesions included the anterior choroidal territory as defined by Kolisko and Beevor. We mapped the lesions using the templates of the Matsui and Hirano atlas and entered them into a computer using a program allowing overlapping diagrams of the cases. RESULTS: The anatomic distributions were fairly uniform, all involving the lower portion of the posterior limb of the internal capsule, the medial pallidum (75% of cases), cerebral peduncle in 44%, thalamus in 37%, and the medial temporal lobe in 38%. None extended outside these areas to include the upper corona radiata. The clinical picture corresponded to the well-established neurological syndrome featuring motor deficits with varying degrees of visual field and sensory impairments. Only two showed hypesthetic ataxic hemiparesis. CONCLUSIONS: Our findings indicate that the syndrome of anterior choroidal artery infarction is fairly uniform; ataxic hemiparesis occurs infrequently; and lesions in the lateral ventricular wall and the corona radiata are not part of the territory supplied by the anterior choroidal artery. (+info)