Occipital emissary vein existence and its impact on the diagnosis of idiopathic intracranial hypertension in pediatric patients.

PURPOSE: This study aimed to investigate the efficacy of occipital emissary vein (OEV) detection in the diagnosis of idiopathic intracranial hypertension (IHH) in the pediatric age group, and to compare the prevalence and luminal diameter of OEV in patients with IHH and in healthy control subjects. METHODS: Conventional magnetic resonance imaging findings were assessed in the patients with IHH and in healthy control subjects who were under the age of 18, by two observers. The presence and luminal dimension of OEV and transverse sinus stenosis were also evaluated and compared between these two groups with magnetic resonance venography techniques. RESULTS: The rate of OEV existence was 7 times higher in the IIH group compared to the control group based on the second observer outcome (p = 0.010, OR = 7.0), with a very good interobserver agreement (Ƙ = 0.85). The dimension of OEV ranged between 0.6 and 2.5 mm. There was no correlation found between the opening pressure and the dimension of OEV (p = 0.834). CONCLUSION: In conclusion, OEV existence could be an additional radiological finding for diagnosing IHH among pediatric patients, alongside other conventional findings.

The Basal or Sphenopetrosal Superficial Middle Cerebral Vein Type.

Background and Objectives: The adult superficial middle cerebral vein (SMCV) commonly drains into the middle cranial fossa. However, different embryonic types persist, in which the SMCV drains into the lateral sinus. The basal type of SMCV coursing on the middle fossa floor is a scarce variant. Materials and Methods: During a retrospective study of archived computed tomography angiography (CTA) and magnetic resonance angiography (MRA) files, three rare adult cases of the basal or sphenopetrosal type of SMCV were found and further documented. Results: In the first case, which was evaluated via CTA, the basal type of SMCV formed a sagittal loop. It continued on the middle fossa floor, over a dehiscent tegmen tympani, to drain into the lateral sinus. In the second case, documented via MRA, the basal type of SMCV's anterior loop was in the coronal plane and closely related to the internal carotid artery and the cavernous sinus. It continued with the basal segment over a dehiscent glenoid fossa of the temporomandibular joint (TMJ). In the third case, documented via CTA, the initial cerebral part of the SMCV had a large fenestration. The middle fossa floor coursed within a well-configured sulcus of the SMCV and received a tributary through the tympanic roof. Its terminal had a tentorial course. Conclusions: Beyond the fact that such rare variants of the SMCV can unexpectedly interfere with specific approaches via the middle fossa, dehiscences of the middle fossa floor beneath such variants can determine otic or TMJ symptoms. Possible loops and fenestrations of the SMCV should be considered and documented preoperatively.

Macroscopic and histological examination of human bridging veins.

In infantile abusive head injury (AHT), subdural haemorrhage (SDH) is commonly held to result from traumatic damage to bridging veins traversing from the surface of the brain to the dura and dural venous sinuses. However, there are limited published radiological or autopsy demonstrations of ruptured bridging veins and several authors also assert that bridging veins are too large to rupture due to the forces associated with AHT. There have been several studies on the size, locations and numbers of adult bridging veins and there is one small study of infant bridging veins. However, there are no microscopic studies of infant bridging veins and only a select few ultrastructural investigations of adult bridging veins. Hitherto, it has been assumed that bridging veins from infants and younger children will display the same anatomical characteristics as those in adulthood. At 19 neonatal, infant and young child post-mortem examinations, we macroscopically examined and sampled bridging veins for microscopy. We compared the histology of those samples with bridging veins from an older child and two adults. We demonstrate that adult bridging veins are usually surrounded by supportive meningeal tissue that appears to be lacking or minimally present around the bridging veins of younger children. Neonatal, infant and young children's veins had a free 'bridging' section. Neonatal and infant bridging veins had smaller diameter ranges and thinner walls (some only 5-7 µm) than those seen in older children and adults. Bridging vein walls contained both fine strands of elastic fibers and a more pronounced elastic lamina. The presence of an elastic lamina occurred more frequently in the older age groups These anatomical differences between the veins of adults and young children may help to explain apparent increased vulnerability of neonatal/infant bridging veins to the forces associated with a shaking-type traumatic event.

Dynamic Mechanism of Cerebral Venous Disruption: Longitudinal Evidence From a Community-Based Cohort.

BACKGROUND: This study aims to investigate the temporal and spatial patterns of structural brain injury related to deep medullary veins (DMVs) damage. METHODS AND RESULTS: This is a longitudinal analysis of the population-based Shunyi cohort study. Baseline DMVs numbers were identified on susceptibility-weighted imaging. We assessed vertex-wise cortex maps and diffusion maps at both baseline and follow-up using FSL software and the longitudinal FreeSurfer analysis suite. We performed statistical analysis of global measurements and voxel/vertex-wise analysis to explore the relationship between DMVs number and brain structural measurements. A total of 977 participants were included in the baseline, of whom 544 completed the follow-up magnetic resonance imaging (age 54.97±7.83 years, 32% men, mean interval 5.56±0.47 years). A lower number of DMVs was associated with a faster disruption of white matter microstructural integrity, presented by increased mean diffusivity and radial diffusion (ß=0.0001 and SE=0.0001 for both, P=0.04 and 0.03, respectively), in extensive deep white matter (threshold-free cluster enhancement P<0.05, adjusted for age and sex). Of particular interest, we found a bidirectional trend association between DMVs number and change in brain volumes. Specifically, participants with mild DMVs disruption showed greater cortical enlargement, whereas those with severe disruption exhibited more significant brain atrophy, primarily involving clusters in the frontal and parietal lobes (multiple comparison corrected P<0.05, adjusted for age, sex, and total intracranial volume). CONCLUSIONS: Our findings posed the dynamic pattern of brain parenchymal lesions related to DMVs injury, shedding light on the interactions and chronological roles of various pathological mechanisms.

Central Vein Sign, Cortical Lesions, and Paramagnetic Rim Lesions for the Diagnostic and Prognostic Workup of Multiple Sclerosis.

BACKGROUND AND OBJECTIVES: The diagnosis of multiple sclerosis (MS) can be challenging in clinical practice because MS presentation can be atypical and mimicked by other diseases. We evaluated the diagnostic performance, alone or in combination, of the central vein sign (CVS), paramagnetic rim lesion (PRL), and cortical lesion (CL), as well as their association with clinical outcomes. METHODS: In this multicenter observational study, we first conducted a cross-sectional analysis of the CVS (proportion of CVS-positive lesions or simplified determination of CVS in 3/6 lesions-Select3*/Select6*), PRL, and CL in MS and non-MS cases on 3T-MRI brain images, including 3D T2-FLAIR, T2*-echo-planar imaging magnitude and phase, double inversion recovery, and magnetization prepared rapid gradient echo image sequences. Then, we longitudinally analyzed the progression independent of relapse and MRI activity (PIRA) in MS cases over the 2 years after study entry. Receiver operating characteristic curves were used to test diagnostic performance and regression models to predict diagnosis and clinical outcomes. RESULTS: The presence of ≥41% CVS-positive lesions/≥1 CL/≥1 PRL (optimal cutoffs) had 96%/90%/93% specificity, 97%/84%/60% sensitivity, and 0.99/0.90/0.77 area under the curve (AUC), respectively, to distinguish MS (n = 185) from non-MS (n = 100) cases. The Select3*/Select6* algorithms showed 93%/95% specificity, 97%/89% sensitivity, and 0.95/0.92 AUC. The combination of CVS, CL, and PRL improved the diagnostic performance, especially when Select3*/Select6* were used (93%/94% specificity, 98%/96% sensitivity, 0.99/0.98 AUC; p = 0.002/p < 0.001). In MS cases (n = 185), both CL and PRL were associated with higher MS disability and severity. Longitudinal analysis (n = 61) showed that MS cases with >4 PRL at baseline were more likely to experience PIRA at 2-year follow-up (odds ratio 17.0, 95% confidence interval: 2.1-138.5; p = 0.008), whereas no association was observed between other baseline MRI measures and PIRA, including the number of CL. DISCUSSION: The combination of CVS, CL, and PRL can improve MS differential diagnosis. CL and PRL also correlated with clinical measures of poor prognosis, with PRL being a predictor of disability accrual independent of clinical/MRI activity.

Occipital bi-transtentorial/falcine approach for falcotentorial meningioma: case report

Grandes lesões que ocupam bilateralmente o espaço incisural posterior são de difícil abordagem cirúrgica pelos acessos clássicos. Recentemente, Kawashima et al. descreveram, em peças anatômicas, uma modificação do acesso occipital transtentorial, o acesso occipital bitranstentorial-falcino, para abordagem de grandes lesões que ocupam bilateralmente o espaço incisural posterior. Retata-se um caso de grande meningioma falco-tentorial que ocupava o espaço incisural posterior bilateralmente. O acesso occipital bitranstentorial-falcino permitiu exérese completa da lesão sem déficit no pós-operatório.

Vasculitis silviana aislada como presentación de una endocarditis bacteriana subaguda / Isolated Sylvian vasculitis as presentation of a subacute bacterial endocarditis

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Trombosis venosa cerebral: cuando la etiología marca la diferencia / Cerebral venous thrombosis: when etiology makes the difference

Objetivos. Estudio retrospectivo de aspectos clínicos, etiológicos, diagnósticos y pronósticos de las trombosis venosas cerebrales y de senos durales (TVCSD) diagnosticadas en nuestro centro. Métodos. Revisión sistemática de historias clínicas de la base de datos de nuestro hospital universitario (1977-2009) con los términos de búsqueda «trombosis venosa o tromboflebitis de senos cerebrales». Resultados. Se encontraron 95 posibles casos, de los que 16 se excluyeron por diagnóstico incierto o alternativo. Se analizaron 79 TVCSD (43 mujeres), con edad mediana de 46 años (2-82). Se encontró trombofilia hereditaria o adquirida en 22 casos (27,8%): mutación G20210A de protrombina (10), factor V Leyden (3), deficiencia de proteína C (2), mutación homocigótica MTHFR C677T (1), síndrome antifosfolípido (7) y trastornos hematológicos (3). La TVCSD se asoció a infección en 17 casos, a neoplasia intracraneal en 9, a neoplasia sistémica en 13, a fármacos protrombóticos en 20 (hormonales, antineoplásicos, anovulatorios) y a otras causas en 8. Trece casos (16,5%) fueron idiopáticos. La TVCSD se presentó con hipertensión intracraneal en el 83,5%, déficit focal en el 45,6% y crisis comiciales en el 12,6 %. El seno transverso (57%) y el sagital superior (49,4%) fueron los más afectados. Como complicaciones se encontraron crisis (25,3%), infarto venoso (41%) e hipertensión intracraneal grave (22,8%). El 31,6% precisó drenaje quirúrgico, craniectomía o derivación ventricular. Hubo enfermedad tromboembólica periférica en 9 casos y 4 recurrencias de TVCSD. El 74,7% tuvo una evolución favorable (escala de Rankin modificada [ERm] 0-2) a los 3 meses. La mortalidad fue del 13,9% (11 pacientes). El origen infeccioso y neoplásico se asoció significativamente a mayor mortalidad y dependencia. Conclusión. Describimos una extensa serie de TVCSD en que las etiologías infecciosa y neoplásica constituyen factores pronósticos desfavorables (AU)

Dinámica de la córticoangiogénesis en el sistema nervioso central / Dinamics of the cortico-angiogenesis in the central nervous system

This study analyzes the temporal-spatial correlation between angio-and corticogenesis in the developing chick optic tectum (OT) by means of NADPH-diaphorase and immunolabeling methods. Qualitative and quantitative parameters were used to analyze a new vessels formation and growth of preexisting ones as a function of time and space...

Seudoemesis gravídica causada por angioma venoso cerebral complicado / Pseudo-emesis gravidarum caused by complicated cerebral venous angioma

Introducción. La emesis en el embarazo es una patología frecuente que rara vez requiere hospitalización para controlar alteraciones hidroelectroliticas y metabólicas. Aunque es típica del primer trimestre del embarazo, puede aparecer en cualquier momento de la gestación. Por otra parte, el angioma venoso (AV) constituye el tipo de malformación vascular cerebral más frecuente. En realidad es una variante del drenaje venoso normal del cerebro y suele ser un hallazgo casual. Raramente es sintomático, a no ser que se relacione con la existencia de cavernomas. Aunque infrecuentes, las complicaciones clínicas son muy variadas, siendo el sangrado la más severa. Caso clínico. Se trata de una mujer sana, gestante de 27 semanas, con vómitos de repetición que se catalogó como una emesis gravídica. La reaparición de los vómitos, acompañados de cefalea, bradipsiquia y estado confusional hizo ampliar el estudio. Las pruebas de neuroimagen revelaron la presencia de un hematoma del plexo coro ideo del ventriculo lateral izquierdo que llegaba hasta el 111 ventrículo, secundario a la existencia de un AV parietal izquierdo, sin encontrar un cavernoma asociado. Conclusiones. Aunque es excepcional, un AV supratentorial, sin cavernoma asociado, puede complicarse con una hemorragia intraventricular. El único factor de riesgo asociado al AV que se encontró fue la propia gestación ya que por sí misma supone una tendencia a desarrollar complicaciones vasculares arteriales y venosas, tanto isquémicas como hemorrágicas

Introduction. Emesis gravidarum is a common pathology rarely requiring hospitalization to control hydroelectrolytic and metabolic alterations. Although it is typical in the first quarter of pregnancy, it can appear in any moment of the gestation. On the other hand, venous angioma (VA) is the most frequent cerebral vascular malformation. In fact, it is a variant of the normal venous drainage of the brain and it is usually an incidental finding. VA is rarely symptomatic, unless associated with cavernous angiomas. Although uncommon, the clinical complications are very varied, bleeding being the most severe one. Case report. We describe a 27 weeks pregnant healthy woman, with repetitive vomiting that was classified like emesis gravidarum. The study was enlarged due to the reappearance of vomiting, accompanied by migraine, bradypsychia and confusional state. Neuroradiological studies showed a choroid plexus haematoma from left lateral ventricle to third ventricle, secondary to the existence of a left parietal VA, without demonstration of associated cavemous angioma. Conclusions. Although it is rare, a supratentorial VA, without associated cavemous angioma, may lead to intraventricular hemorrhage. Gestation is the only risk factor associated to VA. By itself, it supposes a tendency to develop ischemic and hemorragic, arterial and venous vascular complications

Trombosis venosa cerebral secundaria a síndrome antifosfolípido y déficit de antitrombina III / Cerebral venous thrombosis secondary to antiphospholipid syndrome and dificit of antithrombin III

La trombosis venosa cerebral es menos frecuente que la arterial como causa de stroke, sin embargo aún continua subdiagnosticada. Fisiopatológicamente se caracteriza por un desequilibrio entre factores trombogénicos y fibrinolíticos. Los desórdenes hematológicos tienen un rol protagónico importante, destacándose entre ellos el sindrome antifosfolipídico, el cual debe particularmente sospecharse cuando el accidente cerebrovascular ocurre en individuos jóvenes (AU)

Trombosis de la vena ovárica derecha / Thrombosis of right ovarian vein

La trombosis de la vena ovárica es una complicación rara del posparto (0,1 por ciento). Es potencialmente letal, ya que puede ser origen de sepsis, tromboembolismo pulmonar y trombosis de la vena cava inferior, o de las venas renales. La tomografía computarizada (TC) y la resonancia magnética (RM) son las técnicas de elección, para su diagnóstico, teniendo los ultrasonidos un valor limitado, dada su baja sensibilidad y especificidad. Presentamos el caso de una mujer que en el puerperio tuvo como complicación una trombosis de la vena ovárica derecha, cuya clínica, imagen ecográfica y por TC simulaban una apendicitis. Descubrimos los signos radiológicos y subrayamos la necesidad de sospechar su diagnóstico en pacientes puérperas (AU)

La tromboflebitis cerebral de la embarazada: revisión del tema y presentación de los tres primeros casos en América Latina

Se reportan tres casos de flebotrombosis cerebral en puerperas de menos de tres días, insistiéndose como la complicación neurológica más frecuente de la puerpera y de la embarazada. La mayoría de los casos la marcha clínica puede sintetizarse, casi inalterablemente y en sucesión sintomática o sindrómica, en cefalalgia intensa, pérdida de fuerza de las extremidades, síndrome convulsivo tónico-clónico, fiebre, hemiplejias, afasia y recuperación satisfactoria en menos de quince días. Se insiste en la necesidad de tener en cuenta los síntomas descritos en una puérpera y en una embarazada, principalmente en su último semestre, para hacer un diagnóstico apropiado e instituír un tratamiento lógico, evitando con esto la frecuente confusión de este síndrome neurológico con otros de naturaleza distinta...(AU)