A 7-year-oId girl with a previous diagnosis of Parry-Romberg syndrome presented with acute headache and. Parry-Romberg syndrome is a subtype of localized scleroderma of the head that, although rare, ...may be associated with giant intracranial aneurysms. The etiology of these aneurysms is still poorly understood; however, it is believed that it may be related to endothelial inflammatory injury or vasa vasorum microangiopathy and vascular wall ischemia., Dissecting pseudoaneurysm of intracranial arteries is rare and may result in acute headache and neurological deficits., The characterization of mural enhancement in vessel wall magnetic resonance imaging (MRI) in this case corroborated the hypothesis of a vasculitis-related etiology.
A 62-year-old female with a previous history of 2 ischemic strokes presented with sudden headache and left hemiparesis. Imaging revealed a partially-thrombosed right cavernous carotid artery ...aneurysm. Vessel wall imaging showed an extensive vascular wall enhancement of the parent vessel, which might be related to vasa vasorum or inflammation. The role of vascular inflammation within the defective areas of the aneurysm are well known. However, less explored are the inflammatory changes of the parent vessel, which can be detected by magnetic resonance (MR) angiography and indicate a pathologic artery more subject to aneurysmal formation and thrombotic events.
Sprenger et al present a case of demyelinating sentinel lesion preceding a primary central nervous system lymphoma. A 29-year-old man presented with tonic-clonic seizures. Initial MRI showed a lesion ...centered on the white matter of the left frontal lobe, with restricted diffusion and contrast enhancement on its margins and low rCBV and hypometabolismon PET-CT, suggestive of a tumefactive demyelination lesion. Patient underwent surgical biopsy, with no signs of malignancy. Two months later, control MRI showed a new lesion on the brainstem, with solid enhancement and hypermetabolism on PET-CT, compatible with lymphoma. Demyelinating sentinel lesions preceding CNS lymphomas are a rare entity and its pathophysiology is not fully understood.
Abstract
BACKGROUND
Identification of the nerve of origin in vestibular schwannoma (VS) is an important prognostic factor for hearing preservation surgery. Thus far, vestibular functional tests and ...magnetic resonance imaging have not yielded reliable results to preoperatively evaluate this information. The development of the video head impulse test (vHIT) has allowed a precise evaluation of each semicircular canal, and its localizing value has been tested for some peripheral vestibular diseases, but not for VS.
OBJECTIVE
To correlate patterns of semicircular canal alteration on vHIT to intraoperative identification of the nerve of origin of VSs.
METHODS
A total 31 patients with sporadic VSs were preoperatively evaluated with vHIT (gain of vestibule-ocular reflex, overt and covert saccades on each semicircular canal) and then the nerve of origin was surgically identified during surgical resection via retrosigmoid approach. vHIT results were classified as normal, isolated superior vestibular nerve (SVN) pattern, isolated inferior vestibular nerve (IVN) pattern, predominant SVN pattern, and predominant IVN pattern. Hannover classification, cystic component, and distance between the tumor and the end of the internal auditory canal were also considered for analysis.
RESULTS
Three patients had a normal vHIT, 12 had an isolated SVN pattern, 5 had an isolated IVN pattern, 7 had a predominant SVN pattern, and 4 had a predominant IVN pattern. vHIT was able to correctly identify the nerve of origin in 89.7% of cases (100% of altered exams).
CONCLUSION
The pattern of semicircular canal dysfunction on vHIT has a localizing value to identify the nerve of origin in VSs.
PDF
