PRES with asymptomatic spinal cord involvement. Is this scenario more common than we know?

INTRODUCTION: Posterior reversible encephalopathy syndrome (PRES) is an entity characterized by neurologic symptoms such as headaches, altered mental status, seizures and visual changes, and it is associated with white matter vasogenic edema predominantly affecting the posterior occipital and parietal lobes of the brain. CASE REPORT: A 19-year-old patient developed PRES after the use of chemotherapy for a testicular teratocarcinoma and after the development of a blood pressure elevation. DISCUSSION: Few cases described the involvement of the spinal cord in this syndrome. In the majority of these cases, the spinal cord involvement was asymptomatic or with few symptoms of spinal cord disease.

Anatomic variations of anterior cerebral artery cortical branches.

The anterior cerebral artery (ACA) is a major vessel responsible for the blood supply to the interhemispheric region. The ACA segment after the anterior communicating artery (AComA) origin is called the distal ACA and has central and cortical branches. The cortical branches are distributed in the different regions of the orbital and medial part of the brain. The objects of this study are the anatomical variations found in the distal ACA. In 76 hemispheres the ACA distal branches were injected with latex and dissected under microscope magnification. Vessel diameters and distances between vessel origins and anterior communicating artery were recorded and analyzed. Microsurgical dissection was carried out to demonstrate anatomic variations of these vessels. Average diameter of ACA at origin was 2.61 +/- 0.34 mm and average diameter of cortical branches diameter ranged from 0.79 +/- 0.27 mm to 1.84 +/- 0.3 mm. Distances between vessel origin and AComA ranged from 7.68 +/- 3.91 mm (orbitofrontal) to 112.6 +/- 11.63 mm (inferior internal parietal). This study found anatomical variations: a single (azygos) ACA was present in one case and three in three cases. Crossing branches of the distal ACA to the contralateral hemisphere were present in 26% of the cases. In some cases a single ACA may supply the posterior hemispheric region through crossing branches. This calls attention to potential bilateral brain infarcts due to a single unilateral ACA occlusion.

Study of the trabecular projections (Chordae Willisii) of the superior sagittal sinus.

The trabecular projections or Chordae Willisii were studied in the internal surface of the human superior sagittal sinus, being defined and quantified as to having relation with afferent veins to the sinus, as to their lateral or medial location and also in the anteroposterior direction. The results indicate a predominance of trabecular projections with no relation to afferent vessels to the sinus in its medial portion and central region, as well as predominance of these projections on the left side. The number of trabecular projections related to afferent vessels was nearly the same when left and right sides of the superior sagittal sinus were compared.

Intercavernous venous communications in the human skull base.

The intercavernous communications of the skull base were studied in 32 sphenoid blocks using electrolytic decalcification techniques, vascular filling, x-rays, and serial anatomical sections. In this study four intercavernous connections were found: anterior intercavernous sinus (AIS), posterior intercavernous sinus (PIS), inferior intercavernous sinus (IIS), and basilar plexus (BP). The AIS was present in 100% of the cases, with diameters ranging from 0.57 mm to 5.43 mm; in 17 cases (53.12%) it took up the whole anterior wall of the hypophyseal fossa. The PIS was also detected in 100% of the cases, and its diameters ranged from 0.71 mm to 4.14 mm. The IIS was identified in 31 cases (96.9%), assuming three different forms: plexuslike, venous lake, and mixed. The BP was found in 100% of the material analyzed; in 23 cases (71.9%) it proved to be the widest intercavernous communication.In 12 cases of this series the hypophysis was completely enveloped by venous structures, except at the level of the sellar diaphragm.

Microsurgical study of the pre-central, central and post-central arteries of the human brain cortex.

The pre-central, central and post-central arteries of 29 human brains were studied after the injection of Batson's resin. The purpose was to establish their position in relation to the central sulcus and nearby sulci and convolutions. With the Batson resin injection was observed that the pre-central, central and post-central arteries were coincident with the sulci in more than 75% of the cases and the central and post-central arteries when coincident to their sulci were deep inside in 75% of the hemispheres.

Anatomo-surgical study of the human parieto-occipital artery (angular artery).

The parieto-occipital artery, angular artery or "du pli courbe" artery was injected with Batson's resin, and thus it was possible to study its point of origin, diameter, length and superficial course. An assessment was made of the possibility of this vessel functioning as receptor artery in the surgical anastomoses between the superficial temporal artery and cortical branches of the middle cerebral artery in the cerebral revascularization neurosurgical technique.

Acquired inflammatory superior oblique tendon sheath syndrome. A clinicopathologic study.

To our knowledge, this is the first reported clinicopathologic study of a patient with acquired inflammatory Brown's syndrome. The superior oblique tendon, trochlea, and anterior superior oblique muscle were surgically removed en bloc and studied by light microscopy. Surprisingly, the entire specimen was normal, without signs of inflammation or intrasheath scarring. The only abnormal finding was found during surgery, which consisted of perisheath adhesions anterior to the trochlea. These findings indicate that the cause of acquired inflammatory Brown's syndrome may, in many cases, be from scarring around the tendon sheath rather than an intrasheath pathologic condition, as proposed by recent literature.