1/62. Idiopathic pinealitis. Case report.This 63-year-old man presented with complaints of "having a feeling of falling backward" over a 3-month period. Results of his general physical examination, laboratory studies, and neurological examination were unremarkable. A magnetic resonance image revealed a 1.8 x 1.4 x 1.2-cm enhancing mass in the posterior third ventricle just above the corpora quadrigemina. The pineal gland was found to be diffusely enlarged at operation and separable from the posterior thalamus and was totally resected. The patient had an uneventful postoperative course but continues to be somewhat confused. The lesion consisted of a remarkable chronic inflammatory cell infiltrate permeating the pineal lobules and was composed of T and B lymphocytes, macrophages, eosinophils, and mast cells. Immunoperoxidase studies did not demonstrate langerhans cells, and a search for microorganisms was unrevealing. There was no evidence of neoplasia; results of immunostaining for germ cell markers and other tumor-associated antigens were negative.- - - - - - - - - - ranking = 1keywords = posterior (Clic here for more details about this article) |
2/62. Acute confusional state as presenting feature in aneurysmal subarachnoid hemorrhage: frequency and characteristics.In many patients with subarachnoid hemorrhage (SAH) there is a delay between the onset of symptoms and admission to hospital. An important cause for the delay is an initially erroneous diagnosis. The goal of this study was to determine the frequency of acute confusional state (ACS) as a presenting symptom of SAH and to describe the clinical and radiological characteristics of these patients. We studied all 717 patients registered from January 1989 to July 1997 in the SAH database of the University Medical Center Utrecht. For patients who presented with ACS we reviewed the computed tomography scans for baseline characteristics: the amount of cisternal blood, intraventricular or intracerebral hemorrhage, and hydrocephalus. Details about features of onset were known for 646 patients. Nine patients (1.4%) presented with ACS. In five patients ACS was either preceded by a period of loss of consciousness or accompanied by severe headache. Subtle focal deficits were found at initial neurological examination in four patients. Computed tomography demonstrated a frontal hematoma in three patients and hydrocephalus in four. The site of the ruptured aneurysm was at the anterior communicating artery in four patients, at the internal carotid artery in two, and at the basilar artery in two. In our series, one per 70 patients with SAH presents with ACS. Keys to early diagnosis of SAH in patients presenting with ACS are a preceding period of loss of consciousness and severe headache on neurological assessment.- - - - - - - - - - ranking = 20.37410985628keywords = cerebral, artery (Clic here for more details about this article) |
3/62. Pure topographic disorientation: A distinctive syndrome with varied localization.Pure topographic disorientation (TD), defined as impaired recall of routes in familiar surroundings, has been attributed to lesions of the right parahippocampus. The authors present three patients encountered consecutively with TD and compare them to previously published cases. Lesions causing TD included a right splenial/cuneus infarct, a right > left medial temporo-occipital infarct, and a left splenial infarct. TD as an isolated symptom may occur from lesion in a variety of posterior medial locations, including the parahippocampus, splenium, and retrosplenial cortex.- - - - - - - - - - ranking = 0.5keywords = posterior (Clic here for more details about this article) |
4/62. Postoperative confusion preceded by decreased frontal lobe haemoglobin oxygen saturation.We describe a 58-year-old male patient with confusion and prolonged recovery after liver transplantation. A cause was not apparent for the confusion, but during surgery, monitoring of the frontal lobe cerebral haemoglobin oxygen saturation by near-infrared spectrophotometry showed cerebral hypo-oxygenation despite optimization of conventional cardiovascular parameters. It is possible that intraoperative cerebral ischaemia is the cause of postsurgical confusion and with near-infrared spectrophotometry this hypothesis may be tested clinically.- - - - - - - - - - ranking = 42.138589241219keywords = cerebral (Clic here for more details about this article) |
5/62. Chronic subdural hematoma with vasogenic edema in the cerebral hemisphere--case report.An 80-year-old male with a history of hypertension presented with chronic subdural hematoma manifesting as progressive consciousness disturbance and left hemiparesis. T1-weighted and fluid attenuation inversion recovery (FLAIR) magnetic resonance imaging showed a fresh hematoma in the right subdural space with a midline shift of 15 mm. FLAIR and diffusion-weighted imaging showed a hyperintense area in the right paraventricular white matter compressed by the hematoma. Apparent diffusion coefficients (ADCs) corresponding to the hyperintense area in the central area of the affected cerebral hemisphere on FLAIR images were measured before and one month after the operation. The motion probing gradient was applied in the right-left direction to the body axis. Since the central area in the cerebrum includes nerve fibers perpendicular to the direction of the gradient, the measured ADC appeared to be anisotropic. Preoperative ADC in the right paraventricular white matter was anisotropic and greater than in age-matched normal subjects, so the edema was identified as the vasogenic type. The edema in the right paraventricular white matter resolved promptly with improvement of the midline shift and normalization of the ADC.- - - - - - - - - - ranking = 70.230982068698keywords = cerebral (Clic here for more details about this article) |
6/62. Seizure disorder mimicking an acute confusional state as clinical presentation of neurocysticercosis: neuroimaging, EEG findings and clinical correlations.epilepsy is the main clinical manifestation of neurocysticercosis (NC). We studied an adult subject who presented a seizure disorder mimicking an acute confusional state as clinical expression of NC. Diagnosis was made with neuroimaging and western blot determination of specific antibodies on serum. Computed tomography and magnetic resonance imaging displayed multiple calcifications and a few transitional cysts in the cerebral parenchyma. electroencephalography showed a pattern of periodic lateralized epileptiform discharges (PLEDs) which could be related topographically to a cystic lesion located in the left parietal lobe. In our view there was a clear pathogenic correlation between the seizure disorder and the parasitic cyst located in the left parietal lobe. Neither antiepileptic drugs nor steroids were prescribed. Follow-up to one year ruled out other clinical manifestations of the disease. This case is an example of acute symptomatic seizure related to a transitional cystic lesion of NC.- - - - - - - - - - ranking = 14.04619641374keywords = cerebral (Clic here for more details about this article) |
7/62. Effect of posterior temporal-parietal hematoma on orbital frontal chemistry in relation to a cognitive and anxiety state: a combined 1H-MRS and neuropsychological study of an unusual case as compared with 16 healthy subjects.The authors report the unusual case of a 58-year-old woman (MJP) suffering from left temporal throbbing headache, associated with confusion. magnetic resonance imaging showed a 5 x 3 x 2 cm hematoma at the left posterior temporal--parietal junction (PTPJ). Repeated MRI of MJP's brain performed during a 4-month follow-up period showed decrease in hematoma size (2.3 x 1.5 x 1) with evidence for development of encephalomalacia and resorption of blood products involving the area of hemorrhage. MJP had mild transcortical sensory aphasia characterized by difficulty with reading and processing, with semantic paraphasic errors while speaking and some difficulty with repetition. MJP had remained normotensive and seizure free, on Vasotec therapy and Dilantin prophylaxis. An in vivo proton magnetic resonance spectroscopy (1H-MRS) performed during an 8-month follow-up period showed reduced concentration for N-acetyl aspartate (NAA) by 19.3% (F=4.09, P<0.04), and myo-inositol by 32.0% (F=5.16, P<0.02) in the left orbital frontal cortex (OFC) as compared with 16 healthy subjects (age- and sex-matched). Cognitive tests (the Wechsler abbreviated scale of intelligence (WASI) and the Stroop color--word interference) showed a significant impairment suggesting involvement of higher-order cognitive functioning (memory, learning, and general intelligence) and attentional system. The Spielberger state-trait anxiety inventory (STAI) showed increased anxiety at the moment of the current examination and decreased tendency to be anxious over a long period of time. The Beck anxiety and depression Inventory revealed minimal anxiety and mild to moderate levels of depression. It is hypothesized that the PTPJ hematoma triggered long-distance pathways linking PTPJ area and frontal lobe, including OFC, which resulted in abnormal chemical changes in the left OFC and in cognitive tests impairment, and in long-term anxiety state changes.- - - - - - - - - - ranking = 2.5keywords = posterior (Clic here for more details about this article) |
8/62. Diffuse metabolic abnormalities in reversible posterior leukoencephalopathy syndrome.Two cases of reversible posterior leukoencephalopathy syndrome were examined with proton MR spectroscopic imaging. Widespread metabolic abnormalities, consisting of increased choline and creatine levels and mildly decreased N-acetylaspartate, occurred in regions with both normal and abnormal MR imaging appearances. In one case for which proton MR spectroscopic imaging follow-up was available, all metabolite levels had returned to normal by 2 months. Proton MR spectroscopic imaging may be helpful for the diagnosis and investigation of the underlying pathophysiology of reversible posterior leukoencephalopathy syndrome.- - - - - - - - - - ranking = 3keywords = posterior (Clic here for more details about this article) |
9/62. Cerebral aneurysms in a child with acquired immune deficiency syndrome during rapid immune reconstitution.A 12-year-old boy with perinatally acquired human immunodeficiency virus infection an d Centers for disease Control and Prevention class C3 disease presented with acute onset of confusion and a right-sided movement disorder 5 months after beginning a new antiretroviral regimen. His CD4 count had been below 50 cells/microL for 4 years but had abruptly risen to more than 250 cells/microL. Computed tomographic and magnetic resonance imaging scans showed cerebral aneurysms and new cerebral lesions consistent with ischemic strokes. The presentation during immune reconstitution suggests that cerebral aneurysms in pediatric patients with acquired immune deficiency syndrome can result from an immune-mediated response to chronic vascular infection.- - - - - - - - - - ranking = 42.138589241219keywords = cerebral (Clic here for more details about this article) |
10/62. Posterior leukoencephalopathy in a girl with acute haemorrhagic leukoencephalitis.In children, posterior leukoencephalopathy is frequently associated with hypertensive encephalopathy, anticancer chemotherapy, treatment with immunosuppressive drugs in patients with organ transplantation, transfusion or human immunodeficiency virus infection. Posterior leukoencephalopathy in these children appears as a complicating illness and resolves once precipitating factor (e.g. cancer chemotherapy) is removed. Here we are reporting a fatal case of acute haemorrhatic leukoencephalitis in a 13 year old girl, imaging abnormalities are also suggestive of posterior leukoencephalopathy. Posterior leukoencephalopathy in our patient possibly, is a part of post-infectious haemorrhagic leukoencephalitis, rather than because of ischaemia or cerebral oedema secondary either to abrupt increase in blood pressure or following administration of immunosuppressive drugs.- - - - - - - - - - ranking = 15.04619641374keywords = cerebral, posterior (Clic here for more details about this article) |
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