Does the superior ophthalmic vein dilate in acute intracranial hypertension due to hemorrhagic stroke?

A 65-year-old man presented with coma. The cranial computed tomography (CT) revealed a massive hematoma in the left cerebral hemisphere, accompanied by intraventricular hemorrhage (IVH) and ventriculomegaly. Contrast examination revealed ectatic superior ophthalmic veins (SOVs). The patient underwent emergent hematoma evacuation. Contrast CT performed on postoperative day (POD) 2 showed a remarkable reduction in the diameters of both SOVs. A second patient, a 53-year-old man, presented with consciousness disturbance and right hemiparesis. CT revealed a large hematoma in the left thalamus, accompanied by massive IVH. Contrast CT demonstrated the bold delineation of the SOVs. The patient underwent endoscopic IVH removal. Contrast CT performed on POD 7 showed a remarkable reduction in the diameters of both SOVs. A third patient, a 72-year-old woman, presented with severe headache. CT revealed diffuse subarachnoid hemorrhage and ventriculomegaly. Contrast CT demonstrated a saccular aneurysm on the internal carotid artery-anterior choroidal artery branching site with the bold delineation of the SOVs. The patient underwent microsurgical clipping. Contrast CT performed on POD 68 showed a remarkable reduction in the diameters of both SOVs. The SOVs may function as an alternative venous drainage pathway in the setting of acute intracranial hypertension due to hemorrhagic stroke.

Atypical convexity meningioma presenting with photophobia and skull erosion.

A 41-year-old man presented with photophobia. The patient showed a choked disc and right-sided quadrantanopia with an intact sphincter reaction to light stimulation. Computed tomography revealed an isodense mass in the right frontal convexity, accompanied by extensive perifocal brain edema and smooth-contoured skull erosion. On cerebral magnetic resonance imaging, the tumor was dural-based, appeared inhomogeneous intensity on both T1- and T2-weighted sequences, and was intensely enhanced. Magnetic resonance angiography revealed unusually ectatic right-sided middle meningeal and superficial temporal arteries. The tumor, which was elastic hard, highly vascular, and severely adhered to the frontal cortices, was completely resected. The microscopic findings of the resected specimen were consistent with angiomatous meningioma. The patient's photophobia resolved after surgery, with resolution of the optic chiasm compression. Meningiomas arising in the frontal convexity may cause photophobia. Angiomatous meningioma should be considered when a broad-based tumor is found in the cerebral convexity accompanied by skull erosion and extensive perifocal edema.

Calvarial angiomatous meningioma developed in the diploe.

Background: Angiomatous meningioma is a rare subtype of meningiomas. To the best of our knowledge, there have been no reports of intradiploic angiomatous meningioma. Case Description: A 53-year-old previously healthy woman was diagnosed with a calvarial lesion during a brain checkup. Cerebral magnetic resonance imaging showed an intradiploic tumor, 11 × 14 × 12 mm, in the right parietal bone. It was an enhancing, lobular tumor presenting as isointensity on T1- and hyperintensity on T2-weighted sequences, with an intense enhancement of the adjacent dura mater. Computed tomography revealed bone erosion at the tumor site, extending predominantly into the inner side, and sclerotic changes in the surrounding bone. Total resection was performed. Microscopically, the tumor tissue comprised cells with low-grade meningioma and intervening prominent vasculatures, consistent with angiomatous meningioma. Conclusion: Angiomatous meningioma should be considered as a differential diagnosis when an intradiploic tumor shows a lobular structure, intense enhancement of the adjacent dura mater, and sclerotic changes in the surrounding skull. These findings can support prompt tumor resection.

Subsequent bilateral intracerebral hemorrhages in the putamen and thalamus: A report of four cases.

Background: Subsequent bilateral intracerebral hemorrhage (SBICH) in the putamen and thalamus is a rare condition. Herein, we report four such cases. Case Description: Case 1: A 47-year-old woman presented with the left hemiparesis and elevated blood pressure. Neuroimaging revealed a right thalamic hemorrhage and a small left thalamic hemorrhage accompanying the hyperdense rim on computed tomography (CT) and the hypointense rim on gradient-echo T2*-weighted imaging (T2*WI). Case 2: A 53-year-old man presented with a disturbance of consciousness and elevated blood pressure. Neuroimaging revealed a left putaminal hemorrhage and a small right thalamic hemorrhage that appeared hyperdense on CT and hypointense on T2*WI. Case 3: A 65-year-old woman presented with the right hemiparesis and elevated blood pressure. Neuroimaging revealed a left putaminal hemorrhage and a small right thalamic hemorrhage accompanied by a hyperdense rim on CT and a hypointense rim on T2*WI. Case 4: A 75-year-old woman presented with the right hemiparesis and elevated blood pressure. Neuroimaging revealed a left thalamic hemorrhage and small hemorrhages in the right thalamus and cerebellar hemisphere. These hemorrhages appeared hyperdense on CT and hypointense on T2*WI. Conclusion: SBICHs are rare bilateral hemorrhages that may present with asymptomatic microbleeds in the putamen or thalamus coupled with symptomatic, subsequent hemorrhages in the contralateral counterparts. The latter hemorrhage may develop during the subacute phase of microbleeds in the putamen or thalamus.

Calvarial Langerhans cell histiocytosis in an adult presenting rapid growth.

Background: Langerhans cell histiocytosis (LCH) arising in the skull is rare in adulthood. Case Description: A 58-year-old woman experienced a durable headache. Cerebral magnetic resonance imaging (MRI) at presentation showed no abnormalities; however, MRI and computed tomography (CT) performed 6 weeks later revealed the emergence of a well-demarcated, heterogeneously enhancing calvarial tumor accompanied by irregular-shaped bone erosion. On MRI, the temporalis muscle and subcutaneous tissue adjacent to the tumor were extensively swollen and enhanced. The patient underwent en bloc resection. The microscopic appearance of the tumor was consistent with that of LCH. Postoperative systemic 18F-fluorodeoxyglucose positron emission tomography/CT did not detect any abnormal accumulation. Conclusion: LCH may develop within a short period. It should be considered as a differential diagnosis when a rapidly growing calvarial tumor is encountered, even when the patient is an adult. Prompt histological verification is recommended in such cases.

A case of microcystic meningioma associated with acute subdural hematoma in the posterior cranial fossa.

A 53-year-old woman was brought to the emergency room with headache and progressive deterioration of consciousness. Radiological examinations revealed acute subdural hematoma extending along the cerebellar tentorium to the falx cerebri, and a mass lesion with hemorrhage in the left cerebellum, with acute hydrocephalus. Emergency tumor and hematoma removal with decompressive craniectomy of the occiput was performed. Histopathological diagnosis was microcystic meningioma. Postoperatively, the patient recovered to clear consciousness with sequelae of left cerebellar ataxia, cerebellar dysarthria, and vertigo. This case of tentorial microcystic meningioma associated with acute subdural hematoma in the posterior cranial fossa is extremely rare, with only reported 4 similar cases.

Prominent hyperintense areas in swollen optic pathway: An indicator of congestive glymphatic pathway?

A 34-year-old woman presented with progressive visual impairment for 2 months. Computed tomography and magnetic resonance imaging (MRI) revealed a suprasellar cyst. The patient underwent endoscopic endonasal surgery, which resulted in gross total resection with a diagnosis of craniopharyngioma. Postoperatively, the patient's visual function improved. The constructive interference steady-state (CISS) sequence revealed a remarkable resolution of hyperintense areas in the swollen optic nerve and tract. A 36-year-old woman sustained an abrupt visual loss. She had been diagnosed with cavernous malformations (CMs) in the right frontal lobe and suprasellar region 11 years ago, with an intact optic tract. Cerebral MRI at presentation revealed marked enlargement of the suprasellar CM and swelling of the right optic tract, accompanied by predominant hyperintense areas in the optic pathway. The patient's visual function showed significant improvement with conservative management. The CISS sequence performed 3 months later showed remarkable resolution of hyperintensity in the optic pathway. Prominent hyperintense areas in the optic pathway may indicate congestion of glymphatic flow. Reduction in such areas may be a radiological biomarker reflecting the improvement of visual impairment.