Quantitative arterial spin labeling magnetic resonance imaging analysis of reversible cerebral vasoconstriction syndrome: A case series.

OBJECTIVE: This study aimed to quantify chronological cerebral blood flow (CBF) changes using arterial spin labeling (ASL) magnetic resonance imaging in patients with reversible cerebral vasoconstriction syndrome (RCVS). BACKGROUND: Quantitative ASL analyses in RCVS have not been well described in the literature. METHODS: Quantification of ASL using an automated region-of-interest placement software and a 5-point visual scale of vasoconstriction severity was performed in five RCVS patients. The association between CBF changes and RCVS-related complications was evaluated. RESULTS: Quantitative ASL revealed variable patterns of decreasing CBF in the first week, followed by subsequent increases. Notably, arterial vasoconstriction paradoxically progressed despite an increase in CBF from the first to the second week; this increase was relatively higher in patients with both cortical subarachnoid hemorrhage and posterior reversible encephalopathy syndrome. CONCLUSIONS: Quantitative ASL revealed that CBF initially decreased and subsequently increased, especially in the second week. These changes may serve as surrogate imaging markers for RCVS-related complications, and could further contribute to understanding the pathology of RCVS.

Cerebral venous thrombosis with subarachnoid hemorrhage: a case report.

Cerebral venous thrombosis (CVT) presenting as subarachnoid hemorrhage (SAH) is infrequent. We present the case of a man with CVT of the right transverse sinus who presented with a SAH in the right parietal sinus. In this case, we describe a hyper-homocysteinemia in a heterozygous patient for the methylenetetrahydrofolate reductase C667T mutation. Our report highlights the value of an early diagnosis of CVT, the importance of identifying possible causes that could be reversed with an appropriate treatment, and the controversy about the timing for starting anticoagulation therapy in such cases.

Meningeal disease masquerading as transient ischemic attack.

BACKGROUND: Cortical subarachnoid hemorrhage and meningitis sometimes present as episodes of transient neurologic dysfunction mimicking transient ischemic attack (TIA). In the present study, we sought to determine the frequency of meningeal disease among patients treated in a TIA clinic. METHODS: Data from patients consecutively admitted to a TIA clinic were retrospectively analyzed. Patients were classified as ischemic events (TIA or minor stroke) or nonischemic events using clinical data and findings from brain imaging and ultrasound studies. RESULTS: Of 529 patients (mean age 63.5 years), 134 (25.3%) were classified as nonischemic events. Meningeal disease was the likely cause of clinical symptoms in 9 patients (1.7%; 95% confidence interval, .6%-2.8%) including 5 patients with meningitis (1 meningeal sarcoidosis, 1 rheumatoid meningitis, 1 myelomatous meningitis, 1 lymphomatous meningitis, and 1 herpes simplex virus 1 meningoencephalitis) and 4 patients with cortical subarachnoid hemorrhage (probably or possibly related to cerebral amyloid angiopathy in 3 patients). Clinical symptoms comprised motor deficit, sensory deficit, aphasia, and dysarthria. Transient neurologic dysfunction was recurrent in 7 of 9 patients. Duration of transient episodes ranged from 5-30 minutes. No patient suffered headache. No patient had nuchal rigidity. Magnetic resonance imaging (MRI) showed evidence of meningeal or meningocerebral disease in all 9 patients. CONCLUSIONS: Our study confirmed that serious meningeal disease could present as TIA, but this disease was relatively uncommon among patients treated in a TIA clinic. The findings highlight the diagnostic value of MRI in patients with suspected TIA.

[Classical cortical superficial siderosis presenting as extensive higher brain dysfunction with hypoperfusion in the frontoparietal lobe on the 123I-IMP-SPECT: a case report].

A 72-year-old male developed neurological symptoms such as difficulty in charging his electronic money card and making his mobile-phone call ten months before admission. On admission, neurological examination revealed extensive higher brain dysfunction such as impairment in recent memory, executive function disorders, constructional disturbance, agraphia and acalculia. Brain MRI revealed a low intensity lesion on the surface of the cerebral cortex diffusely and symmetrically on T2*-weighted images. MRI images are consistent with superficial siderosis. However, the lack of hemosiderin deposition in the brain stem and cerebellar hemisphere was atypical of the classical type of superficial siderosis. 123I-IMP-SPECT revealed hypoperfusion dominantly in the left hemisphere, particularly in the left frontal and parietal lobes. According to the Boston criteria, the patient with the cerebral microbleeds and cortical superficial siderosis was diagnosed with probable CAA (cerebral amyloid angiopathy).

Isolated Cortical Venous Thrombosis as a Mimic for Cortical Subarachnoid Hemorrhage.

Isolated cortical venous thrombosis is very rare and poorly understood. The clinical presentation is also not well described in the literature. We report here a case of isolated cortical venous thrombosis that mimicked cortical subarachnoid hemorrhage (SAH). A 62-year-old man with a history of chronic subdural hemorrhage visited our hospital with headache. Brain computed tomography (CT) revealed a linear hyperdense area in the right central sulcus (cord sign), suggestive of isolated cortical SAH. Magnetic resonance imaging (MRI) revealed susceptibility in the corresponding area. CT angiography revealed no specific finding. However, transfemoral cerebral angiography (TFCA) identified filling defects in the right cortical veins. Under isolated cortical venous thrombosis, anticoagulation therapy was used to prevent the propagation of thrombosis. The patient had no recurrence of symptoms. If a cord sign is present on noncontrast CT images, further studies (MRI/magnetic resonance venography or TFCA) should be performed in a step-wise manner. Such considerations could prevent a fatal outcome and poor prognosis.