Black hole sign migration in short-term brain CT scans: A possible link with clot evolution and histology.

The black hole sign (BHS) is a rare radiological sign seen in the hyperacute phase of bleeding. It manifests within a hemorrhage in early hours, with limited studies exploring clot formation and evolution over a short duration. Despite various hypothesized mechanisms, the precise lifetime and dynamics of black hole sign development remain unclear. We describe the rare finding of a black hole sign within a deep brain hemorrhage, initially observed in the lateral portion of the clot during the first CT scan. Remarkably, in a subsequent CT scan, just 1 hour later, the BHS migrated towards the inner edge. Notably, while the hemorrhage size remained largely unchanged within this short timeframe, hyperacute bleeding led to increased perihematomal edema and sulci flattening. Histopathological features of the "evolving clot" are initially characterized by heightened cellularity. This increased cell density renders the hematoma less resistant to compressive forces, such as heightened endocranial pressure, offering a plausible explanation for the crushing and displacement of the BHS. Our study sheds light on the unique radiological progression of BHS within a deep brain ICH, emphasizing its association with dynamic clot formation and the consequential impact on surrounding structures.

Coexistence of mastoid, frontal and vertebral hemangiomas in a patient with diabetic neuropathy: Possible correlation between diabetic angiopathy and intraosseous neoangiogenesis.

Bony hemangiomas are benign vascular lesions with an expansive growth; usually they tend to obliterate the entire bony cavity. They are typical lesion of the spinal bones, but they can rarely arise within other bones of the neurocranium. Diabetic microangiopathy is a condition characterized by the development of aberrant vessel tangles anastomosed to each other due to dysregulated neoangiogenesis. We report the case of a 56-year-old woman, suffering from type 2 diabetes mellitus, admitted to the neurology department due to a reported worsening of paresthesias and dysesthesias of the upper and lower limbs. She performed a contrast-enhanced brain CT scan that showed the presence, at the level of the right mastoid process, of an hypervascular angioma. A subsequent MRI study of the brain and spine showed the presence of multiple bone angiomas, at the level of the right frontal theca and C7, Th3, and Th7 vertebral bodies. Due to the absence of further symptoms and clinical and radiological signs of intracranial compression, the patient did not perform surgery. A radiological follow-up was advised. Although possible pathophysiological correlations between diabetes and vertebral hemangiomas are mentioned in literature, vascular lesions of this type involving vertebrae and skull base simultaneously can be discovered in a patient with chronic diabetic disease. As long as these lesions remain asymptomatic, surgical treatment is not indicated, and the patient is followed over time with radiological follow-up.

Waste not, want not: Report of a completely calcified C1-C2 juxtafacet cyst and literature review.

BACKGROUND: Calcified juxtafacet cysts in the cervical spine are extremely rate. Such symptomatic cysts commonly cause neck pain, radiculopathy, or even myelopathy. MR and CT studies typically document cord/ root compression. On occasion, some of these cysts will spontaneously regress, while many others may warrant surgical removal. CASE DESCRIPTION: A 70-year-old male presented with a 2-year history of a progressive tetraparesis. The preoperative MR/CT studies showed a C1-C2 left extradural mass occupying more than half of the spinal canal. On MR, it was homogeneously hypointense on both T1- and T2-weighted images, while the CT showed a calcified cyst. Intraoperative and histopathological findings documented a calcified cervical juxtafacet cyst (i.e. ganglion subtype) that was fully excised without sequelae. CONCLUSION: C1-C2 juxtafacet cervical cyst should be considered when a patient presents with myelopathy due to a calcified MR/CT documented paraspinal lesion contributing to significant cervical cord/root compression.

Rapid malignant progression of an intraparenchymal choroid plexus papillomas.

BACKGROUND: Choroid plexus tumors (CPTs) are rare neoplasms accounting for only 0.3-0.6% of all brain tumors in adults and 2-5% in children. The World Health Organization (WHO) classification describes three histological grades: grade I is choroid plexus papilloma (CPP), grade II is atypical papilloma, and grade III is the malignant form of carcinoma. In adults, CPTs rarely have a supratentorial localization. CASE DESCRIPTION: Here we report a very rare case of an intraparenchymal parietal CPP with a rapid histological transition from grade I to grade III WHO in a 67-year-old man, in <7 months. CONCLUSION: Because of the rarity of these oncotypes, descriptions of each new case are useful, mostly to consider this diagnostic entity in extraventricular brain tumors of adults, despite an unusual location.