Bilateral Carotid-Cavernous Fistula Following Traumatic Fall: A Case Report.

Carotid-cavernous fistulas (CCFs) are abnormal connections between the carotid arteries and the cavernous sinus, posing significant neuro-ophthalmologic risks. This report presents a rare case of bilateral post-traumatic CCFs, focusing on clinical presentation, diagnosis, and management. Symptoms mimic conjunctivitis, causing diplopia, exophthalmos, and ophthalmoplegia. Diagnosis relied on computed tomography, magnetic resonance angiography, and digital subtraction angiography. Management involved transarterial embolization with coils, achieving successful outcomes. This highlights the importance of timely intervention and comprehensive imaging to prevent complications. Teaching point: This case report details a rare instance of bilateral post-traumatic carotid-cavernous fistulas, emphasizing clinical presentation, diagnostic evaluation, and management.

Coumadin ridge mass assessed on three-dimensional transoesophageal echocardiography.

Transoesophageal echocardiography is often recommended in the evaluation of cryptogenic stroke, especially in those patients with no or few risk factors. We report the case of 66-year-old male with a history of multiple ischaemic strokes, admitted to our stroke unit following the discovery of multiple and diffuse new ischaemic lesions on a cerebral magnetic resonance imaging. Transoesophageal echocardiography led to the discovery of a very small mass attached to the tissue fold between the left superior pulmonary vein and the left atrial appendage (often referred to as"coumadin ridge"). The three-dimensional acquisition allowed detailed characterization of this mass. No other source of emboli was detected.The mass was considered to be most likely a tumour and was probably the cause of the multiple strokes. Due to the already advanced neurological disease and the small dimensions of the mass surgery was considered inappropriate. The patient was initiated on oral anticoagulants. This case highlights the importance of three-dimensional ultrasound in the detection and evaluation of intracardiac masses.

Occipital Epilepsy With Subcortical Atrophy in Celiac Disease: A Case Report.

We report a 50-year-old man with celiac disease who presented with occipital epilepsy. Brain MRI showed right occipital subcortical white matter hyperintensities, consistent with the posterior epileptic focus suggested by the clinical features of the seizures and documented on EEG. Shortly after the introduction of a gluten-free diet, the white matter abnormalities resolved. The patient went on to develop simultagnosia. Follow-up MRI showed right occipital lobe atrophy. This report emphasizes the importance of recognizing gluten-associated neurologic manifestations and usefulness of thegluten-free diet.

Acute Susac Syndrome in a Recent User of Adulterated Cocaine: Levamisole as a Triggering Factor?

Susac syndrome (SS) is a central nervous system vasculitis characterized by the clinical triad of encephalopathy, sensorineural hearing loss, and visual disturbance caused by branch retinal artery occlusion. It is considered as an inflammatory disorder, and an autoimmune etiology is suggested. A 29-year-old man with a history of recent cocaine abuse developed the clinical features of SS. Toxicological analysis including hair testing revealed that cocaine had been adulterated with levamisole. After an initial clinical improvement following corticosteroid therapy, the introduction of mycophenolate mofetil was justified a few weeks later by the progression (or relapse) of the retinal injury, followed by complete recovery. The presence of levamisole has been documented in patients with multifocal inflammatory leukoencephalopathy (MIL). Further investigations are needed to determine if levamisole as an adulterant of cocaine could also play a role in the development of rapidly progressive leukoencephalopathy in young men, with Susac or Susac-like syndromes as possible variants of MIL.

Teaching neuroimages: isolated sphenoiditis: an uncommon cause of abducens nerve palsy.

A 35-year-old woman presented with a headache lasting 2 weeks and complained of recent diplopia. Neurologic examination showed limited left eye abduction. Initial brain CT scan was considered normal (figure, A). Brain MRI showed left sphenoiditis (figure, B). The patient was treated with amoxicillin/clavulanic acid and corticosteroids with rapid symptom improvement which deferred endoscopy that could provide a bacteriologic diagnosis.

Post-mortem high-field magnetic resonance imaging: effect or various factors.

PURPOSE: To evaluate image quality and diagnostic accuracy of high-field post-mortem (PM) magnetic resonance imaging (MRI) on fetuses below 20 weeks of gestation before and after the freeze-thaw process. MATERIALS AND METHODS: Nine fetuses were scanned with three different scanning procedures: "fresh", just after termination of pregnancy (TOP), "non-fresh short scan" and "non-fresh long scan" after being kept at -20 °C, followed by a conventional autopsy. The brain, thorax except the heart, heart and abdomen were studied. The qualities of the images for the four different fetal regions and for the three different scanning procedures were reported. Regression analysis was used to investigate the effect on image quality of different factors. Additionally, the diagnostic accuracy was also evaluated. RESULTS: Fetuses at 12.0-19.6 weeks were included. Regression analysis showed that better image quality was correlated to advanced gestation at TOP and scan on fresh fetuses. PM-MRI on fresh fetuses was always diagnostic for the brain and in more than half of cases on non-fresh fetuses and was nearly equally diagnostic for thoracic and abdominal structures. CONCLUSION: High-field PM-MRI seems to offer a quite reliable alternative to the parents declining conventional PM for fetuses before 20 weeks whether these fetuses are freshly scanned or after being frozen.