Epstein-Barr Virus-Associated Smooth-Muscle Tumor of the Brain.

Epstein-Barr virus, a herpesvirus, has been associated with a variety of cancers, including Burkitt, Hodgkin, and non-Hodgkin lymphomas; posttransplant lymphoproliferative disorders; gastric carcinoma; and nasopharyngeal carcinoma, in both immunocompetent and immunocompromised individuals. Previous studies have established a connection between Epstein-Barr virus and the development of smooth-muscle tumors. Smooth-muscle tumors of the brain are very rare and are often misdiagnosed as meningiomas on imaging. To our knowledge, advanced imaging findings such as MR perfusion of smooth-muscle tumors of the brain have never been reported. We describe the radiologic and pathologic features of the Epstein-Barr virus-associated smooth-muscle tumors of the brain in a person with newly diagnosed advanced HIV.

Clinical uncertainty in large vessel occlusion ischemic stroke: does automated perfusion imaging make a difference? An intra-rater and inter-rater agreement study.

BACKGROUND: Limited research exists regarding the impact of neuroimaging on endovascular thrombectomy (EVT) decisions for late-window cases of large vessel occlusion (LVO) stroke. OBJECTIVE: T0 assess whether perfusion CT imaging: (1) alters the proportion of recommendations for EVT, and (2) enhances the reliability of EVT decision-making compared with non-contrast CT and CT angiography. METHODS: We conducted a survey using 30 patients drawn from an institutional database of 3144 acute stroke cases. These were presented to 29 Canadian physicians with and without perfusion imaging. We used non-overlapping 95% confidence intervals and difference in agreement classification as criteria to suggest a difference between the Gwet AC1 statistics (κG). RESULTS: The percentage of EVT recommendations differed by 1.1% with or without perfusion imaging. Individual decisions changed in 21.4% of cases (11.3% against EVT and 10.1% in favor). Inter-rater agreement (κG) among the 29 raters was similar between non-perfusion and perfusion CT neuroimaging (κG=0.487; 95% CI 0.327 to 0.647 and κG=0.552; 95% CI 0.430 to 0.675). The 95% CIs overlapped with moderate agreement in both. Intra-rater agreement exhibited overlapping 95% CIs for all 28 raters. κG was either substantial or excellent (0.81-1) for 71.4% (20/28) of raters in both groups. CONCLUSIONS: Despite the minimal difference in overall EVT recommendations with either neuroimaging protocol one in five decisions changed with perfusion imaging. Regarding agreement we found that the use of automated CT perfusion images does not significantly impact the reliability of EVT decisions for patients with late-window LVO.

Giant cavernous internal carotid aneurysm presenting with dizziness and bradycardia: A case report and a review of literature.

Giant cavernous carotid aneurysms are rare pathologic entities that are typically benign and are considered less life-threatening due to the low risk of rupture of bleeding. They present with clinical features usually due to localized mass effects on adjacent neural structures, mainly the III, IV, V, and VI cranial nerves. There are various treatment options, including occlusion of the feeding vessel, immediate surgery on the aneurysm, bypass procedures, and use of endovascular devices. We present a case of a 36-year-old male presented to the emergency department with 5 days history of right retro-orbital pain and diplopia. The patient's imaging workup revealed a right giant cavernous carotid aneurysm. Along with the conventional symptoms, physical examination revealed sinus bradycardia. Internal carotid artery occlusion was performed, and his symptoms gradually resolved.

Leiomyosarcoma: a rare presentation as multifocal lesion.

Leiomyosarcoma is a rare type of connective tissue cancer, accounting for 5-10% of all soft tissue sarcomas. We present a case of leiomyosarcoma as unusual multifocal presentation. Retroperitoneal, mediastinal, pulmonary, uterine and bony regions were all involved at the time of presentation. The liver was normal without detected lesions.

Solitary bone plasmacytoma: the unusual case of extra-cranial mini brain.

Solitary plasmacytoma is an uncommon tumor. We present a case in an unusually young patient demonstrating the mini brain sign that has been published in a couple of reports as a diagnostic radiological pattern produced by plasmacytoma. Identification of "mini brain appearance" on imaging can direct the radiologist and clinicians to the diagnosis of plasmacytoma and obviate the necessity of pre-operative biopsy.

Ruptured Berry Aneurysm as the initial presentation of Polycystic Kidney Disease: A case report and review of literature.

Intra-cranial saccular aneurysms, also known as Berry aneurysms, have a well-known association with autosomal dominant polycystic kidney disease (ADPKD). Aneurysmal rupture can be the initial presentation of the disease. ADPKD has two types of gene mutations: PKD1 and PKD2. The latter one is of a milder form presenting later in life. Imaging plays a crucial role in the diagnosis and assessment in order to provide adequate management of these patients however, there are no official standardized guidelines established for screening of these intracranial aneurysms.