Cerebral Aneurysm Associated with an Arachnoid Cyst: 3 Case Reports and a Systematic Review of the Literature.

BACKGROUND: Arachnoid cysts and intracranial aneurysms are not rare, but it is unusual for an aneurysm to be associated with an arachnoid cyst. The objective of this study was to reveal the association between arachnoid cysts and intracranial aneurysms. METHODS: Methods included to report 3 cases with these 2 pathologies and to perform a systematic review of the English and Japanese literature using PubMed, Scopus, and Ichushi Web. RESULTS: The first case was of a 46-year-old man with a subarachnoid hemorrhage on the basal cistern and bilateral arachnoid cysts in the middle fossa, the second was that of a 29-year-old woman with a subarachnoid hemorrhage at the basal cistern and an arachnoid cyst in the left middle fossa, and the third was that of a 60-year-old man with a right putaminal hemorrhage and contralateral unruptured aneurysm and arachnoid cyst. A literature search for similar cases found 27 patients. CONCLUSIONS: It was difficult to diagnose a ruptured aneurysm in some cases with an arachnoid cyst because computed tomography scan showed atypical findings, such as no hemorrhage, intracystic localized hemorrhage, or subdural hematoma. This review revealed that aneurysms and arachnoid cysts were significantly located ipsilaterally and that they occurred together in relatively young patients.

[Basilar artery occlusion with benign outcome--two case reports and a review on the role of collateral circulation and therapeutic time window].

We reported two cases of acute basilar artery occlusion (BAO) with favorable prognosis and discussed the role of collateral circulation. Patient 1 presented with minor brainstem dysfunction for 24 hours due to a short-segment embolic BAO at the mid-pontine level. Carotid angiogram demonstrated reversed basilar flow through the posterior communicating artery distal to the occlusion. Subsequently, the patient suddenly went into coma and developed tetraplegia due to spontaneous displacement and lodging of the embolus to the top of the basilar artery. Immediate recanalization was achieved by intra-arterial thrombolysis, and she recovered and was independent at 3 months after onset. Patient 2 developed progressive brainstem and cerebellar dysfunction due to thrombotic occlusion of the intracranial vertebral and the proximal basilar artery. Angiographic studies demonstrated that reversed basilar flow from the carotid system and meningeal anastomosis arising from the proximal vertebral artery filled the basilar artery distal to the occlusion. The patient recovered after conservative treatment leaving only residual signs of lateral medullary infarction. Recent case series show varied prognosis of BAO. Individual differences in the effectiveness of collateral circulation may be one of the reasons that accounts for this variability. The interval of reversible brainstem ischemia supported by the collaterals may widen the therapeutic time window up to recanalization following acute basilar artery occlusion.

A family with spinal anaplastic ependymoma: evidence of loss of chromosome 22q in tumor.

Familial ependymal tumors are a very rare disease, the pathogenesis of which is unknown. Previous studies indicate an involvement of tumor suppressor genes localized within chromosomal region 22q, whereas details are still unclear. Here we report a non-neurofibromatosis type-2 (non-NF2) Japanese family in which two of the four members are affected with cervical spinal cord ependymoma, and one of the four is affected with schwannoma. Loss of heterozygosity (LOH) studies were carried out searching for common allelic loss at chromosomal region 22q11.2-qtel in two of the affected patients. Our findings support a prediction for existence of a tumor suppressor gene on chromosome 22 especially related to the tumorigenesis of familial ependymal tumors.