1/19. Vascular changes in tuberculous meningoencephalitis.Our report refers two cases of tuberculous encephalomeningitis which differ in the course and pathological changes. In case 1 blood vessels showed features of peri, endo-, or panvasculites. In some vessels endothelium proliferation leading to the stenosis or obliteration of the vascular lumen was observed. necrosis was an effect of vessels occlusion. In case 2 many fewer vessel were involved in onflammation process. Vascular changes were also less extensive and were observed more rarely. Tuberculous infection often caused less tissue lesions than vascular changes. Different pathological changes probably depend on the type and virulence of Myobacterium tuberculosis and on the host immune response to the infection.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/19. Infantile hiv encephalopathy associated with cerebral and cerebellar telangiectases.We describe a paediatric case of hiv encephalopathy associated with cerebral and cerebellar telangiectases. Although immunohistochemistry failed to show hiv in the walls of dilated blood vessels, or in their vicinity, brain capillary telangiectases might be an additional complication indirectly related to paediatric hiv infection.- - - - - - - - - - ranking = 0.25keywords = vessel (Clic here for more details about this article) |
3/19. Distal superior cerebellar artery aneurysm presenting with cerebellar infarction: report of two cases.SUMMARY: We report two cases of aneurysm of the distal branches of the superior cerebellar artery presenting with cerebellar infarction. In both cases, the diagnosis required close correlation of the findings from different imaging techniques, as catheter angiography failed to opacify the lesions. In one patient endovascular parent vessel occlusion was performed, whereas in the second patient the aneurysm thrombosed spontaneously. We describe the clinical and radiologic presentation of these aneurysms and discuss their pathogenesis, diagnosis, and treatment.- - - - - - - - - - ranking = 0.25keywords = vessel (Clic here for more details about this article) |
4/19. Distal anterior inferior cerebellar artery syndrome after acoustic neuroma surgery.OBJECTIVE: To define a clinicopathologic syndrome associated with persistent cerebellar dysfunction after acoustic neuroma (AN) excision. STUDY DESIGN: Case series derived from radiographic and clinical chart review. SETTING: Tertiary referral center. patients: In 12 patients with AN, persistent cerebellar dysfunction developed after AN removal. Each case demonstrated abnormality in the ipsilateral cerebellar peduncle on postoperative magnetic resonance imaging. MAIN OUTCOME MEASURES: Cerebellar function and ambulatory status over the first postoperative year. RESULTS: On magnetic resonance imaging scans, the extent of cerebellar peduncle infarcts was variable. It ranged from focal brain injury (<1 cm) involving only one third of the peduncle to diffuse defects (>2 cm) spanning the full thickness of the peduncle. Peduncular infarcts were associated with large tumor size (average 3.8 cm, range 2.0-5.5 cm diameter). The long-term functional outcomes (>1 yr) varied. Dysmetria was unchanged or improved in over half of the patients (6 of 11 patients). gait recovered to normal or to preoperative levels in 5 patients. In the 6 patients with persistent impaired mobility, 2 had mild gait disturbance, 3 required regular use of a cane, and 1 has been dependent on a walker. One patient had sustained mild motor weakness. Three of 11 patients remained dependent on others for activities of daily living. CONCLUSIONS: Peduncle injury most likely stems from interruption of distal branches of the anterior inferior cerebellar artery (AICA). These small vessels are intimately related to the capsule of the tumor and may supply both the neoplasm and the brain parenchyma. It has long been recognized that interruption of the proximal segment of the AICA results in severe injury to the pons, with devastating neurologic sequelae. A limited AICA syndrome caused by loss of its distal ramifications seems a more plausible explanation for peduncular infarction than either venous insufficiency or direct surgical trauma.- - - - - - - - - - ranking = 0.25keywords = vessel (Clic here for more details about this article) |
5/19. vertigo secondary to isolated pica insufficiency: successful treatment with balloon angioplasty.BACKGROUND: The posterior inferior cerebellar arteries (pica) arise from the intracranial segments of the vertebral artery (VA). We report a case where a nondominant isolated vertebral artery, which terminated in pica, was stenotic. This resulted in brainstem-lower cerebellar ischemia, corrected with balloon angioplasty. CASE DESCRIPTION: A 62-year-old male presented primarily with transient vertigo, syncope, and dizziness and was diagnosed with transient ischemic attack. Angiography of the left vertebral artery (VA) demonstrated a small-caliber vessel terminating in pica with a 90% stenosis at the C6 level. angioplasty of the left VA was performed with excellent resolution of the stenosis. CONCLUSIONS: This case illustrates cerebellar insufficiency in a unique case where the pica was isolated, supplied by a small- caliber VA. Correction of the stenosis improved the patient's symptomatology and prevented an inferior brainstem-cerebellar infarction.- - - - - - - - - - ranking = 0.25keywords = vessel (Clic here for more details about this article) |
6/19. Giant cerebellar tuberculoma mimicking a malignant tumour.We present a patient with a giant cerebellar tuberculoma which MRI led us to believe was a vascular, malignant tumour. Angiography revealed the mass to be relatively avascular, but also showed marked narrowing of the posterior circulation vessels, suggesting arteritis. biopsy of the lesion was reported as consistent with tuberculoma. We highlight the need to integrate different imaging modalities in arriving at a diagnosis of an intracranial mass and discuss atypical features of intracranial tuberculomas.- - - - - - - - - - ranking = 0.25keywords = vessel (Clic here for more details about this article) |
7/19. Postpartum cerebellar infarction and haemolysis, elevated liver enzymes, low platelet (HELLP) syndrome.pregnancy is considered to be a hypercoagulable state per se with an increased risk for cerebrovascular events, however cerebellar infarction has been rarely described in pregnant women. A nulliparous pre-eclamptic woman at 25 weeks' gestation was submitted to an echocardiographic exam that showed an impaired cardiac structure and function. After 2 h, the patient underwent caesarean section for diagnosis of haemolysis, elevated liver enzymes, low platelet (HELLP) syndrome. Afterwards her platelet count raised, and eight days later she developed nystagmus, ataxia, dysmetria and motor deficit in the right limbs and sensory impairment in the right side of the face and in the left limbs. Cerebral magnetic resonance imaging (MRI) demonstrated a right cerebellar and median posterior bulbar infarction. Colour-coded sonography of cerebral vessels showed an occlusion of the right vertebral artery. Coagulation pattern analysis evidenced double heterozygosis of the methylenetetrahydrofolate reductase (MTHFR) gene and single mutation of the prothrombin gene. This case report gives evidence of the importance of considering the different risk factors involved in stroke occurrence during pregnancy.- - - - - - - - - - ranking = 0.25keywords = vessel (Clic here for more details about this article) |
8/19. Distal posterior inferior cerebellar artery aneurysms: clinical characteristics and surgical management.BACKGROUND: Aneurysms located on the distal posterior inferior cerebellar artery (pica) are rare, and their underlying clinical features and surgical management are poorly understood. We report our series of 16 patients with 18 distal pica aneurysms. METHOD: All patients with distal pica aneurysms were treated between March 1996 and August 2004. We excluded all pica aneurysms that involved the vertebral artery. patients were analysed in the light of their clinical profiles, radiological studies, intraoperative findings and outcomes. All patients underwent non-enhanced and contrast enhanced CT scans followed by 4-vessel cerebral angiography on admission. The hemorrhagic patterns on initial CT scans were assessed using the Fisher Grading Score. The outcomes were documented using the glasgow outcome scale at time of discharge and at three or twelve months follow-up. FINDINGS: The series included 6 men and 10 women. Massive intraventricular haemorrhage was found in 13 patients with proven CT subarachnoid haemorrhage, one patient revealed SAH without intraventricular components, one presented with only intraventricular blood in the occipital horns and 3 aneurysms were found incidentally without presence of blood. Fourteen aneurysms were saccular and four were fusiform. Nine cases were associated with another cerebrovascular lesion. A lateral transcondylar or a median suboccipital approach was used to secure the aneurysms in 15 patients, either by direct clipping (14 lesions) or vessel sacrifice (3 lesions). One aneurysm was treated by an endovascular approach. At long-term follow up, an excellent or good outcome was achieved in 75% of cases. One patient died due to pre-existing cardiopulmonary complications. CONCLUSIONS: Most of our cases of ruptured distal pica aneurysms presented with haematocephalus. These were frequently associated with another vascular abnormality and 22% were fusiform or multilobulated. These specific features require special management strategies entailing an appropriate surgical approach to the aneurysm, clipping method, haematoma removal, ventricular drainage and when suitable choice of endovascular interventions.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
9/19. Multiple cerebellar hemorrhagic infarctions following surgery for a huge atlantoaxial neurinoma.BACKGROUND CONTEXT: There have been only five reported cases with cerebellar hemorrhagic infarction after spinal surgery, and the underlying pathomechanism remains obscure. PURPOSE: To describe a case with multiple cerebellar hemorrhagic infarctions after surgery for a huge atlantoaxial neurinoma. STUDY DESIGN/SETTING: Case report methods: A 36-year-old man underwent uneventful surgery for a huge atlantoaxial neurinoma. After surgery, the patient was lethargic with slurred speech and subsequently developed cerebellar symptoms, although preoperative myelopathic symptoms did not worsen. The clinical and radiological findings are presented, and possible causes of the hemorrhages are discussed. RESULTS: magnetic resonance imaging of the brain after surgery showed multiple cerebellar hemorrhagic infarctions. However, magnetic resonance angiography revealed no occlusion or stenosis in the vertebrobasilar system, and a duplex scan of the neck vessels confirmed normal flow in the vertebral arteries after surgery. In response to the conservative treatment, the patient exhibited neurological recovery with disappearance of cerebellar symptoms. CONCLUSIONS: In the present case with multiple cerebellar hemorrhagic infarctions, venous infarction appears more likely to be the cause of cerebellar hemorrhagic infarction than arterial infarction. The most likely underlying pathomechanism is a cerebellar venous disturbance precipitated by loss of a large amount of cerebrospinal fluid, although the exact etiology remains elusive.- - - - - - - - - - ranking = 0.25keywords = vessel (Clic here for more details about this article) |
10/19. fatal outcome following foetal cerebellar haemorrhage associated with placental thrombosis.Cerebellar haemorrhage is a rare prenatal event. Possible aetiologies for foetal intracranial haemorrhage include: trauma, asphyxia, infection, vascular defects, blood dyscrasias, ingestion of drugs and alloimmune and isoimmune thrombocytopenia. We report the ultrasonographic diagnosis of a cerebellar haematoma at 21 weeks of gestation. The foetus succumbed at 33 weeks of gestation following rupture of a subcapsular liver haematoma. An autopsy demonstrated a placental foetal thrombotic vasculopathy and thrombi in the chorionic vessels. We assume that hypercoagulability was responsible for the multiple infarcts in the foetus with haemorrhagic transformation in the cerebellum and liver. The differential diagnosis of foetal cerebellar haemorrhage includes maternal hypercoagulability; in this case multiple haemorrhagic/ischaemic events may be encountered during the pregnancy. A thorough investigation to elucidate the aetiology is pertinent in every case of foetal cerebellar haemorrhage in order to enable accurate counselling and correct management.- - - - - - - - - - ranking = 0.25keywords = vessel (Clic here for more details about this article) |
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