Large empty sella with an intrasellar herniation of an elongated third ventricle. Case report.
A 73-year-old female presented with a large empty sella with herniation of an elongated third ventricle concomitant with herniation of the surrounding subarachnoid space into the sella, manifesting as visual impairment and amenorrhea without galactorrhea. Magnetic resonance imaging and computed tomography cisternography clearly showed the large empty sella, without evidence of either hydrocephalus or benign intracranial hypertension, which is extremely rare. (+info)
Midline cerebellar cystic schwannoma : a case report.
An extremely unusual case of a cystic schwannoma in the region of the inferior vermis and posterior to the fourth ventricle in a fifteen year old boy is reported. The cystic tumour caused partial obstruction to the outflow of cerebrospinal fluid from fourth ventricle and resulted in development of supratentorial hydrocephalus. On investigations, the schwannoma simulated a Dandy-Walker cyst. The boy presented with symptoms of increased intracranial pressure. On surgery, the lesion was not arising from any cranial nerve, nor was it attached to brain parenchyma, blood vessel or to the dura. The possible histogenesis of the cystic schwannoma in a rare location is discussed. (+info)
Initial loss of consciousness and risk of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage.
BACKGROUND AND PURPOSE: Delayed cerebral ischemia (DCI) is a major cause of death and disability in patients with aneurysmal subarachnoid hemorrhage. We studied the prognostic value for DCI of 2 factors: the duration of unconsciousness after the hemorrhage and the presence of risk factors for atherosclerosis. METHODS: In 125 consecutive patients admitted within 4 days after hemorrhage, we assessed the presence and duration of unconsciousness after the hemorrhage, the neurological condition on admission, the amount of subarachnoid blood, the size of the ventricles, and a history of smoking, hypertension, stroke, or myocardial infarction. The relationship between these variables and the development of DCI was analyzed by means of the Cox proportional hazards model. RESULTS: The univariate hazard ratio (HR) for the development of DCI in patients who had lost consciousness for >1 hour was 6.0 (95% CI 3.0 to 12.0) compared with patients who had no loss or a <1-hour loss of consciousness. The presence of any risk factor for atherosclerosis yielded an HR of 1.4 (95% CI 0.6 to 3.5). The HR for unconsciousness remained essentially the same after adjustment for other risk factors for DCI. The HR for a poor World Federation of Neurological Surgeons score (grade IV or V) on admission was 2.9 (95% CI 1.5 to 5. 5); that for a large amount of subarachnoid blood on CT was 3.4 (95% CI 1.6 to 7.3). CONCLUSIONS: The duration of unconsciousness after subarachnoid hemorrhage is a strong predictor for the occurrence of DCI. This observation may contribute to a better understanding of the pathogenesis of DCI and increased attention for patients at risk. (+info)
Prediction of effectiveness of shunting in patients with normal pressure hydrocephalus by cerebral blood flow measurement and computed tomography cisternography.
Measurement of cerebral blood flow (CBF) and computed tomography (CT) cisternography were performed in 37 patients with a tentative diagnosis of normal pressure hydrocephalus (NPH) to predict their surgical outcome. The mean CBF of the whole brain was measured quantitatively by single photon emission computed tomography with technetium-99m-hexamethylpropylene amine oxime before surgery. The results of CT cisternography were classified into four patterns: type I, no ventricular stasis at 24 hours; type II, no ventricular stasis with delayed clearance of cerebral blush; type III, persistent ventricular stasis with prominent cerebral blush; type IV, persistent ventricular stasis with diminished cerebral blush and/or asymmetrical filling of the sylvian fissures. The mean CBF was significantly lower than that of age-matched controls (p < 0.005). Patients with a favorable outcome had a significantly higher mean CBF than patients with an unfavorable outcome (p < 0.005). Patients with the type I pattern did not respond to shunting. Some patients with type II and III patterns responded to shunting but improvement was unsatisfactory. Patients with type IV pattern responded well to shunting, and those with a mean CBF of 35 ml/100 g/min or over achieved a favorable outcome. The combination of CBF measurement and CT cisternography can improve the prediction of surgical outcome in patients with suspected NPH. (+info)
Treatment of intraventricular hemorrhage with urokinase : effects on 30-Day survival.
BACKGROUND AND PURPOSE: Intraventricular hemorrhage (IVH) remains associated with high morbidity and mortality. Therapy with external ventricular drainage alone has not modified outcome in these patients. METHODS: Twelve pilot IVH patients who required external ventricular drainage were prospectively treated with intraventricular urokinase followed by the randomized, double-blinded allocation of 8 patients to either treatment or placebo. Observed 30-day mortality was compared with predicted 30-day mortality obtained by use of a previously validated method. RESULTS: Twenty patients were enrolled; admission Glasgow Coma Scale score in 11 patients was +info)
The adult radiographic shuntogram.
We describe the adult radiographic shuntogram, a simple method to evaluate the function and patency of a ventriculoperitoneal or ventriculoatrial shunt. The procedure involves placing contrast material into the valve of a shunt system and following the flow for appropriate clearing of contrast agent from the shunt tubing. Twenty-three studies were obtained in 15 patients in whom shunt malfunction was suspected. The method can be used to establish valve malfunction, ventricular or distal catheter obstruction, and peritoneal encystment. (+info)
Radiological abnormalities in temporal lobe epilepsy with clinicopathological correlations.
In 73 patients with drug-resistant temporal lobe epilepsy submitted to an unilateral anterior temporal lobectomy the radiographs were studied to see if there were any correlation with the pathology subsequently found and with the outcome of the operation. A small middle cranial fossa, focal calcification, and temporal horn displacement are often better indices of the underlying pathology than temporal horn dilatation alone. In a small number of cases, however, radiological changes were seen on the side opposite to an unilateral EEG focus, thus suggesting bilateral disease. (+info)
Effect of intracranial pressure of meglumine iothalamate ventriculography.
Intraventricular pressure was studied in 12 patients undergoing ventriculography with a water soluble positive contrast medium. Isovolumetric instillation of meglumine iothalamate into the lateral ventricles and the anterior part of the third ventricle caused only a small increase in ventricular fluid pressure (1.3 +/- 0.3 mmHg), but the pressure increased markedly (46.3 +/- 3.7 mmHg; P less than 0.001) when the contrast medium entered the posterior end of the third ventricle, aqueduct of Sylvius,, and fourth ventricle. This sharp increase in intracranial pressure could not be attributed solely to the postural changes or to alterations in arterial blood pressure. Possible mechanisms are discussed. (+info)