1/45. Auditory agnosia restricted to environmental sounds following cortical deafness and generalized auditory agnosia.We encountered a case of auditory agnosia restricted to environmental sounds, which was associated with the development of bilateral subcortical lesions after suffering a bilateral putaminal hemorrhage. The patient had a history of a putaminal hemorrhage on her left side without any major disability. Three years later, she suffered a putaminal hemorrhage on the other side. The clinical picture started with cortical deafness, then changed to generalized auditory agnosia for verbal and environmental sounds, and finally developed into auditory agnosia confined to the perception of environmental sounds. Her errors in a test of sound recognition were discriminative rather than associative in nature. Neuro-radiological examinations revealed bilateral subcortical lesions involving the fibers from the medial geniculate body to the temporal lobes after bilateral putaminal hemorrhage. This case suggested that the subcortical lesion involving bilateral acoustic radiation could cause either cortical deafness, auditory agnosia of all sounds, or auditory agnosia restricted to environmental sounds.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/45. Hemorrhage in cerebral metastasis from angiosarcoma of the heart: case report.The purpose of this article is to describe the clinical and pathological features of metastatic angiosarcoma in the central nervous system. Only a few cases of cerebral metastasis from angiosarcoma of the heart have been recorded in the literature; particularly related to intracerebral hemorrhage. A case of secondary cerebral angiosarcoma of the heart in a 33 years old man is presented. The initial symptoms were headache, vomiting, lethargy and aphasia. There was a mass in the left temporal lobe with hemorrhage and edema on the computerized tomography (CT). After 24 hours the neurological status worsened and another CT scan showed rebleeding on the tumor area. He underwent an emergency craniotomy but died two days after. Considering the longer survival of sarcoma patients with new modalities of treatment, the incidence of brain metastasis may increase, demanding a better preventive and more aggressive approach. Besides, due to the hemorrhagic nature of such lesions, we suggest the immediate surgery to prevent a fast and lethal evolution because rebleeding.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/45. Unilateral fixed dilation of the pupil as a false-localizing sign with intracranial hemorrhage: case report and literature review.OBJECTIVE AND IMPORTANCE: Although other focal signs may prove "false localizing," it is a neurosurgical axiom that unilateral fixed dilation of the pupil occurs ipsilateral to a supratentorial mass. CLINICAL PRESENTATION: A 25-year-old man collapsed with a dense right hemiplegia and a glasgow coma scale score of 6 (eye opening, 1; motor, 4; verbal, 1) after rupture of a left middle cerebral artery aneurysm associated with an intrasylvian hematoma. Initially, both pupils had remained equal-sized and reactive: however, within hours, the right (contralateral) pupil became fixed and dilated (i.e., false localizing). For some time, the left (ipsilateral) pupil remained small and reactive; at emergency craniotomy, this also became fixed and equally dilated. INTERVENTION: After evacuation of the clot and wrapping of the aneurysm, both pupils rapidly became equal-sized and reactive. Twenty-four hours later, concurrent with massive left hemispheric swelling and a midline shift, the left (ipsilateral) pupil became unilaterally fixed and dilated (i.e., false localizing). Eventually, the right (contralateral) pupil also became fixed and dilated, concurrent with cardiovascular collapse. death occurred within 10 hours. CONCLUSION: Unilateral fixed dilation of the pupil in patients with hemispheric mass lesions may be false localizing. Furthermore, disparate "herniating mechanisms" can arise despite mass effect emanating from the same side. Because such mechanisms cannot be witnessed, their nature remains speculative. An extensive review is contained in this article.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/45. Congophilic angiopathy complicated by surgery and massive hemorrhage. A light and electron microscopic study.Three autopsied cases of congophilic angiopathy have been studied by means of polarized light microscopy and in 2 of these, biopsy material is available for electron microscopic study. All 3 patients had a surgical procedure and a subsequent massive hemorrhagic episode. Two of these patients had clinical evidence of dementing syndrome, for which shunts were performed. Ultrastructural studies have confirmed the amyloid nature of the congophilic material in the 2 biopsied cases. The deposition of amyloid in these cases is believed to be a primary event and is related to a generalized body disorder. The distinction of congophilic angiopathy from Alzheimer's disease is discussed.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/45. Symptomatic de novo arteriovenous malformation appearing 17 years after the resection of two other arteriovenous malformations in childhood: case report.OBJECTIVE AND IMPORTANCE: This report describes the first case of symptomatic de novo arteriovenous malformation (AVM) appearing ectopically after total resection of other AVMs. We discuss the growth phenomenon and the nature of AVMs. CLINICAL PRESENTATION: A 27-year-old woman with sudden headache and right-sided numbness was admitted to our hospital. Computed tomographic scans revealed a hemorrhage of the corpus callosum and the bilateral lateral ventricles. A cerebral angiogram demonstrated an AVM that was fed by the bilateral pericallosal arteries and drained into the inferior sagittal sinus. Seventeen years earlier, at the age of 10 years, the patient had undergone resection of two other AVMs. At that time, the newly presented AVM was not detected. This AVM had grown markedly and caused hemorrhage after 17 years. INTERVENTION: The AVM, which was located in the bilateral cingulate gyrus and the corpus callosum, was totally removed through a right frontal craniotomy. The patient was discharged without neurological deficits. CONCLUSION: Our findings suggest that patients who undergo complete resection of AVMs may sustain other de novo AVMs some years later. The growth of an AVM seems to be related to the patient's age at onset and the duration of the posttreatment period. We emphasize the importance of long-term follow-up in patients with cerebral AVMs treated during childhood.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/45. Dynamics of dotlike hemosiderin spots associated with intracerebral hemorrhage.The authors observed dotlike, low-intensity spots in T2*-weighted magnetic resonance imaging (MRI), subsequently diagnosed histologically as previous microbleeds associated with lipofibrohyalinosis, amyloid angiopathy, and small vessel disease. The nature of dotlike hemosiderin spots (dotHSs), however, is still unknown. This case report seeks to demonstrate the dynamics of dotHSs associated with an intracerebral hematoma (ICH). T2*-weighted MRI of a 72-year-old man with a history of hypertension demonstrated 4 dotHSs 24 months after a left putaminal hemorrhage. Follow-up T2*-weighted MRI 40 months after the acute event demonstrated the asymptomatic formation of 3 more dotHSs, even with good control of blood pressure. Fifty months after the stroke, T2*-weighted MRI showed that 2 of the new dotHSs had become fainter, whereas the hemosiderin associated with the ICH scar remained detectable. To the authors' knowledge, this is the first description of dotHS dynamics associated with ICH.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/45. Insights into the pathogenesis of cerebral lesions in incontinentia pigmenti.We report the case of a neonate with incontinentia pigmenti and seizures on day 4 of life who underwent magnetic resonance imaging and angiography scanning at 8, 13, and 21 days of age. The serial magnetic resonance images demonstrated the evolution of acute microvascular hemorrhagic infarcts in the periventricular white matter in the first week of life. The associated magnetic resonance angiogram findings consisted of decreased branching and poor filling of intracerebral vessels. This report adds important insights into the nature and timing of cerebral lesions in incontinentia pigmenti.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/45. Ruptured infectious aneurysm of the distal middle cerebral artery manifesting as intracerebral hemorrhage and acute subdural hematoma--case report.A 21-year-old woman with severe mitral valve regurgitation due to infectious endocarditis was transferred to our institute in a deep coma with intracerebral hemorrhage and acute subdural hematoma. She had no history of head injury. brain computed tomography revealed left frontoparietal intracerebral hematoma and adjacent acute subdural hematoma that were evacuated on the day of admission, but the distal middle cerebral artery (MCA) aneurysm remained undetected. Follow-up cerebral angiography demonstrated the distal MCA aneurysm, which had enlarged by 25% at 2 weeks following the first operation. The aneurysm originated from a branch of the angular artery and was successfully resected on Day 22. Histological examination of the aneurysm section showed no infectious nature, but the final diagnosis was infectious intracranial aneurysm based on the presence of infectious endocarditis.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/45. A case of pleomorphic xanthoastrocytoma presenting with massive tumoral hemorrhage.Pleomorphic xanthoastrocytoma has been generally conceived to be in a benign nature, showing a relatively favorable prognosis. Apoplectic attack attributable by massive hemorrhage in this distinct form of the supratentorial glioma is an exceedingly rare event. A 61-year-old female presented with a sudden onset of generalized tonic--clonic convulsion. CT and MRI disclosed the presence of a tumor composing of massive intra-tumoral hemorrhage filling the cyst associated with mural nodule in the left frontotemporal lobe. At surgery, the subpial mass involving hematoma was well marginated and slightly adherent to the dura mater. It could be removed totally and proved to be a pleomorphic xanthoastrocytoma. The unusual hemorrhagic presentation of this typically benign entity is extremely rare and is thought to be intra-tumoral bleeding in this case, since subarachnoid hemorrhage was absent.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
10/45. Infected neonatal cephalohematomas caused by anaerobic bacteria.OBJECTIVE: To present the microbiological and clinical features of six children with infected cephalohematomas (IC) caused by anaerobic bacteria. DESIGN: Presentation of a case series. RESULTS: Polymicrobial infection was present in all instances, where the number of isolates varied from two to four. Two patients had anaerobes only and the other four had mixed flora of strict anaerobes and facultatives. There were 16 bacterial isolates (12 anaerobic, 4 aerobic). The anaerobic isolates were peptostreptococcus spp. (5 isolates), prevotella spp. (4), bacteroides fragilis group (2), and propionibacterium acnes (1). The aerobic isolates were E. coli (2), staphylococcus aureus (1) and group B streptococci (1). Blood cultures were positive for three patients. The most common predisposing conditions were vacuum extraction and amnionitis (4 instances of each), instrumental delivery (3), electronic fetal monitoring (2), prolonged delivery (1), and premature rupture of membranes (1). All patients underwent drainage, and four also had surgical incision and drainage of the IC. osteomyelitis developed in one instance and scalp abscess developed in two patients, both of whom had electronic fetal monitoring. All patients eventually recovered from infection after receiving parenteral and subsequent oral antibiotic therapy for a total of 14-38 days. CONCLUSION: This study highlights the polymicrobial nature and potential importance of anaerobic bacteria in IC in newborns.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
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