Mesencephalic developmental venous anomaly causing obstructive hydrocephalus: illustrative case.

BACKGROUND: Developmental venous anomalies (DVAs) are congenital anatomical variants of the normal deep parenchymal veins. DVAs are occasionally found incidentally on brain imaging, and most cases are asymptomatic. However, they rarely cause central nervous disorders. Herein, a case of mesencephalic DVA that caused aqueduct stenosis and hydrocephalus and discuss its diagnosis and treatment is reported. OBSERVATIONS: The patient was a 48-year-old female who presented with depression. Computed tomography and magnetic resonance imaging (MRI) of the head revealed obstructive hydrocephalus. Contrast-enhanced MRI revealed an abnormally distended linear region with enhancement on the top of the cerebral aqueduct, which was confirmed as a DVA by digital subtraction angiography. An endoscopic third ventriculostomy (ETV) was performed to improve the patient's symptoms. Intraoperative endoscopic imaging showed obstruction of the cerebral aqueduct by the DVA. LESSONS: This report describes a rare case of obstructive hydrocephalus caused by DVA. It highlights the usefulness of contrast-enhanced MRI for diagnosing cerebral aqueduct obstructions due to DVAs and the effectiveness of ETV as a treatment option.

Successful treatment of granulomatous amoebic encephalitis with combination antimicrobial therapy.

Granulomatous amoebic encephalitis (GAE) is a rare but fatal infection. Due to its nonspecific symptoms and laboratory and neuroradiological findings, it is rarely diagnosed antemortem. We herein present the case of a 72-year-old Japanese woman who was diagnosed with GAE following the detection of a pathogen similar to Balamuthia mandrillaris under a microscopic examination of cerebrospinal fluid sediment and who achieved remission with combination antimicrobial therapy. There are no previous reports of pathogens similar to B. mandrillaris being detected in cerebrospinal fluid antemortem; therefore, this case may be used as a benchmark for further studies.

Hypothermia enhances the colocalization of calmodulin kinase IIα with neuronal nitric oxide synthase in the hippocampus following cerebral ischemia.

Hypothermia has been shown to have neuroprotective effects against neurotrauma and cerebrovascular disease. Cerebral ischemia induces the activation of calcium/calmodulin kinase II (CaM-KII), which modulates many enzymes. We have previously demonstrated that CaM-KIIα downregulates neuronal nitric oxide synthase (nNOS) activity. However, precise details regarding the neuroprotective mechanism of hypothermia largely remain to be elucidated. Therefore, in this study, we investigated the neuroprotective mechanism of hypothermia, focusing on the association between CaM-KIIα and nNOS in CA1 hippocampus after focal cerebral ischemia in mice. The temperature was maintained at normothermia (36.5-37.5°C) or mild hypothermia (31.5-32.5°C) during these procedures. Focal cerebral ischemia induced significant dissociation of CaM-KIIα from nNOS in the CA1 hippocampus but not in the cerebral cortex under normothermia. Hypothermia did not change the expression of nNOS, but it significantly induced the colocalization of CaM-KIIα with nNOS in CA1 hippocampus immediately after cerebral ischemia. These results presumably result in the attenuation of nNOS activity and could contribute to the tolerance to post-ischemic damage. This effect could be one of the neuroprotective mechanisms of hypothermia.

Concomitant cerebral infarction and intraventricular hemorrhage in moyamoya disease. Case report.

Moyamoya disease is categorized as either ischemic or hemorrhagic type, and the pathogenesis of this disease is unknown. In this paper, the authors report on a patient with moyamoya disease who suffered concomitant cerebral infarction and intraventricular hemorrhage (IVH). Endoscopic removal of the intraventricular hematoma and ventricular drainage were both performed. The patient did not experience further ischemic complications. Patients with moyamoya disease have intracranial hemodynamic insufficiency. Adequate control of intracranial pressure and removal of the intraventricular hematoma is important to prevent progression of cerebral infarction and hydrocephalus. To the authors' knowledge, this is the first report of concomitant cerebral infarction and IVH, or true mixed-type moyamoya disease. A possible pathogenesis of this rare condition is discussed.