Background: We present a case of tentorial dural arteriovenous fistula (TDAVF) causing subarachnoid hemorrhage with mass effect of large venous pouches, which was struggling to diagnosis and ...management due to complex vasculature and severe general condition.
Case Description: A 43-year-old man was transferred to our hospital due to sudden consciousness disturbance. A neurological examination revealed tetraparesis and pupil dilatation with no light reflex. Imaging findings showed a large lesion in the brainstem with subarachnoid and intraventricular hemorrhage. Since there were multiple feeding arteries and large and multiple venous pouches on vascular imaging, we diagnosed the patient with TDAVF. Because of a high-flow arteriovenous shunt and the presence of large venous pouches, it appeared to be very difficult to approach the shunting point by direct surgery. Therefore, we first performed transarterial endovascular treatment with 25% n-butyl-2-cyanoacrylate to shrink the venous pouches and to reduce the pressure of the posterior fossa, followed by direct radical interruption of the shunting point using the craniotomy maneuver. Postoperative vascular imaging revealed disappearance of abnormal feeding arteries, draining veins, and venous pouches. The patient was discharged and transferred to a rehabilitation hospital with a modified Rankin Scale Score of 3. Accurate interpretation of the detailed vasculature preoperatively and an appropriate treatment strategy using endovascular and direct surgical technique are required to achieve a satisfactory outcome for difficult-to-treat dural arteriovenous fistulas.
Conclusions: This combined maneuver with endovascular embolism as complementary pretreatment for radical surgery is useful for a case with high-flow shunting and large venous pouches.
We perform a detailed investigation of sources from the Cold Cores Catalogue of Planck Objects (C3PO). Our goal is to probe the reliability of the detections, validate the separation between warm and ...cold dust emission components, provide the first glimpse at the nature, internal morphology and physical characterictics of the Planck-detected sources. We focus on a sub-sample of ten sources from the C3PO list, selected to sample different environments, from high latitude cirrus to nearby (150pc) and remote (2kpc) molecular complexes. We present Planck surface brightness maps and derive the dust temperature, emissivity spectral index, and column densities of the fields. With the help of higher resolution Herschel and AKARI continuum observations and molecular line data, we investigate the morphology of the sources and the properties of the substructures at scales below the Planck beam size. The cold clumps detected by Planck are found to be located on large-scale filamentary (or cometary) structures that extend up to 20pc in the remote sources. The thickness of these filaments ranges between 0.3 and 3pc, for column densities NH2 ~ 0.1 to 1.6 × 1022 cm-2, and with linear mass density covering a broad range, between 15 and 400 M⊙ pc-1. The dust temperatures are low (between 10 and 15K) and the Planck cold clumps correspond to local minima of the line-of-sight averaged dust temperature in these fields. These low temperatures are confirmed when AKARI and Herschel data are added to the spectral energy distributions. Herschel data reveal a wealth of substructure within the Planck cold clumps. In all cases (except two sources harbouring young stellar objects), the substructures are found to be colder, with temperatures as low as 7K. Molecular line observations provide gas column densities which are consistent with those inferred from the dust. The linewidths are all supra-thermal, providing large virial linear mass densities in the range 10 to 300 M⊙ pc-1, comparable within factors of a few, to the gas linear mass densities. The analysis of this small set of cold clumps already probes a broad variety of structures in the C3PO sample, probably associated with different evolutionary stages, from cold and starless clumps, to young protostellar objects still embedded in their cold surrounding cloud. Because of the all-sky coverage and its sensitivity, Planck is able to detect and locate the coldest spots in massive elongated structures that may be the long-searched for progenitors of stellar clusters.
A Survey of Dense Cores in the Orion B Cloud Ikeda, Norio; Kitamura, Yoshimi; Sunada, Kazuyoshi
Astrophysical journal/The Astrophysical journal,
02/2009, Letnik:
691, Številka:
2
Journal Article
Recenzirano
Odprti dostop
We have carried out an H13CO+(J = 1 - 0) core survey in a large area of 1 deg2, covering most of the dense region in the Orion B molecular cloud, using the Nobeyama 45 m radio telescope with the ...25-BEam Array Receiver System. We cataloged 151 dense cores using the clumpfind method. The cores have mean radius, velocity width, and mass of 0.10 ± 0.02 pc, 0.53 ± 0.15 km s-1, and 8.1 ± 6.4 M , respectively, which are very similar to those in the Orion A cloud. We examined the spatial relation between our H13CO+ cores and the 850 is a subset of m cores observed by Johnstone and colleagues in 2001 and 2006, and found that there are two types of spatial relationships: H13CO+ cores with and without the 850 is a subset of m cores. Since the mean density of the 850 is a subset of m cores is higher than that of the H13CO+ cores, we can interpret the H13CO+ cores with 850 is a subset of m cores as being more centrally concentrated and hence more evolved, compared with those without. Considering the relationship between the masses of the H13CO+ and 850 is a subset of m cores, we estimate the 850 is a subset of m core mass function (CMF) using the H13CO+ CMF through the generalization of the confusion model proposed by Ikeda and colleagues in 2007. Our predicted 850 is a subset of m CMF is found to be quite consistent with that directly derived by Johnstone and colleagues. Furthermore, we predict the initial mass function (IMF) by the generalized confusion model assuming a star formation efficiency of 40% for the H13CO+ cores, and found that our predicted IMF is consistent with the Galactic field-averaged IMF within uncertainties. This agreement may indicate that the origin of the IMF goes back to the cloud structures with densities of less than 104 cm-3.
Introduction
Well-differentiated papillary thyroid carcinoma generally (PTC) have a favorable prognosis. This metastasis is rare in the central nervous system. Brain metastasis has a relatively poor ...prognosis. We present a rare case of cerebellar metastasis, one that mimics a solid type cerebellar hemangioblastoma and because of which it was very hard to reach accurate preoperative diagnosis. Accurate diagnosis was challenging because of the similar imaging and histopathological findings for these two tumors.
Case description
A brain lesion was detected by routine medical checkup of the brain with MRI in a 49-year-old woman 2 years after thyroidectomy for well-differentiated PTC. Gadolinium-enhanced MRI showed a homogeneous prominently enhanced lesion with surrounding enhanced dilated vessels in the left cerebellar hemisphere. Digital subtraction angiography showed a strongly stained lesion fed by the peripheral branch of the left posterior inferior cerebellar artery with drainage into the inferior vermian vein, revealing arteriovenous shunting. The most like likely preoperative diagnosis was felt to be that of a solid cerebellar hemangioblastoma. Gross total resection of the tumor was achieved by bilateral suboccipital craniotomy, and intraoperative pathological analysis suggested hemangioblastoma. Histopathological findings showed proliferation of vacuolated sheeted tumor cells with clear and eosinophilic cytoplasm and numerous thin-walled microvessels, consistent with hemangioblastoma. However, the final diagnosis was brain metastasis of the follicular variant of PTC due to a partial thyroid follicle-like pattern including eosinophilic fluid pathologically and positive TTF-1 immunostaining.
Discussion and evaluation
Since presented rare case of cerebellar metastasis of PTC was very similar to solid type cerebellar hemangioblastoma on imaging and histopathological findings, accurate diagnosis was challenging. Moreover, it is extremely rare for a cerebellar metastasis to occur as an initial distant metastasis of PTC, and hemangioblastoma is the most common primary cerebellar neoplasm in adults. This epidemiological data was also one of the reason of difficulty to reach preoperative accurate diagnosis.
Conclusions
To the best of our knowledge, there are no other reports of challenging diagnosis case of these two tumors in the literature. Brain metastasis of a well-differentiated PTC could be a relatively poor prognostic factor, and accurate diagnosis and suitable surgical therapy or radiotherapy are needed.
We report three cases that involved the use of the Wingspan stent (WS) system for the treatment of intracranial atherosclerotic disease and review the literature. The first patient was an 80-year-old ...man who presented with recurrence of a transient ischemic attack and medically refractory restenosis of the left petrous internal carotid artery (ICA). He underwent percutaneous transluminal angioplasty (PTA) and stenting using the WS. There have been no ischemic events and no restenosis after treatment. The second patient was a 73-year-old man who presented with minor stroke due to chronic total occlusion of the left ICA. He underwent PTA and stenting using the WS for dissection of the left ICA. There have been no ischemic events and no restenosis after treatment. The third patient was a 65-year-old woman who presented with minor stroke due to stenosis of the right middle cerebral artery (MCA). She underwent PTA and stenting using the WS for dissection of the right MCA. There have been no ischemic events and no restenosis after treatment. The WS system was useful for the treatment of medically refractory restenosis and dissection of intracranial arteries after PTA. The 1-year risk of recurrence of ischemic stroke in the treatment of symptomatic intracranial arterial stenosis (ICAS) with the WS system was lower than that in the Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) trial. However, the Stenting versus Aggressive Medical Therapy for Intracranial Arterial Stenosis (SAMMPRIS) trial demonstrated that aggressive medical treatment was superior to stenting with the WS system in preventing recurrent ischemic stroke. Further evaluation of clinical outcome is required to confirm the safety and efficacy of the WS system for symptomatic ICAS.
The optimal method for diagnosing cochleovestibular neurovascular compression syndrome(CNVC)remains controversial, and the aim of this study is to develop a standard diagnostic instrument for the ...condition. The clinical features of 53 sides of 50 patients with a combination of vertigo, tinnitus, and/or hearing loss were retrospectively evaluated. The following five clinical features were evaluated and given a score of 1 or 0:1)a long history of recurrent vertigo, tinnitus, or hearing loss;2)neurological findings related to positional vertigo, nystagmus, tinnitus, or hearing loss;3)neuro-otological findings involving tinnitus, audiometry, or vestibular testing;4)auditory brainstem response(ABR)evaluation with the detection of a low 25-75% II wave amplitude on the contralateral side and delayed interpeak latency in the I-III or I-V waves(usually low II wave amplitude combined with double peaks and a wide-based form)during ABR evaluation using 80 and 90dB clicks;and 5)the detection of vascular contact with the eighth cranial nerve on magnetic resonance imaging-constructive interference in steady state or air computed tomography imaging. Finally, the sum of these scores was evaluated. For cases in which more than one of the features of the items 1), 2), or 3) were present, the score was evaluated based on the most representative of the items.
The patients were divided into those with scores of 4-5 and those with scores of 2-3. All the patients with scores of 4-5 exhibited CNVC, while those with scores of 2-3 had other diseases. Therefore, CNVC should be suspected in patients with scores of 4-5, but can be ruled out in those with scores of 2-3.
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