Unique image findings around "kissing" distal anterior cerebral artery aneurysms in addition to perianeurysmal edema: A case report.

Background: Some aneurysms cause edema formation in the surrounding brain parenchyma and are thought to reflect various phenomena occurring in the aneurysm. Some authors highlighted perianeurysmal edema (PAE) as a finding that indicates higher risk of rupture of the aneurysm. On the other hand, there are no reports of image changes in the surrounding brain parenchyma of aneurysm other than edema formation. Case Description: We describe a 63-year-old man with unique signal change in the surrounding brain parenchyma of "kissing" distal anterior cerebral artery aneurysms completely different from PAE. The large and partially thrombosed aneurysm presented well-defined signal change surrounding brain parenchyma in addition to PAE. Intraoperative findings revealed the signal change as a space of retaining serous fluid. Drain the fluid and clipping was made for the both anterior cerebral artery aneurysms. The postoperative course was uneventful and his headache was improved the day after the surgery. The perianeurysmal signal change was also disappeared immediately after the surgery except for the PAE. Conclusion: This case demonstrates a rare phenomenon of signal change around the aneurysm, and there is a possibility that the unique finding exists as an early manifestation of intracerebral hematoma associated with aneurysm rupture.

The prevalence of calcification around odontoid process and the incidence of crowned dens syndrome in the neurosurgical ward: A single institution's analysis.

OBJECTIVE: The objective of this study is to assess the prevalence and natural history of odontoid calcification and to identify factors related to its progression to crowned dens syndrome (CDS). METHODS: We reviewed a consecutive series of patients who underwent head CT upon admission to the neurosurgical ward of Niigata Prefectural Shibata Hospital. We evaluated the relationship between the presence of odontoid calcification and the patient's age, sex, and primary disorder for admission. The incidence of CDS was also determined, and factors related to the progression of odontoid calcification to CDS were analyzed. RESULTS: Odontoid calcifications were found in 88 out of 554 patients (15.9%) undergoing CT scans. Age, female, and stroke were predictive of odontoid calcification. The odds ratios (95% CIs) for age, female, and stroke estimated from the logistic analysis were 1.084 (1.054-1.114; p < .0001), 1.746 (1.06-2.875; p = .029), and 1.909 (1.123-3.247; p = .017), respectively. Eleven (12.5%) of the 88 patients with odontoid calcification developed CDS. The age, sex, and primary disorder for admission were not associated with the onset of CDS. CONCLUSIONS: Odontoid calcification is observed incidentally on head CT. Clinicians should keep in mind that patients with odontoid calcification might develop CDS, even if they are asymptomatic at the time of CT examination.

[Hydrocephalus Associated with Small Clinoidal Meningioma that Resolved after Tumor Removal:A Case Report].

PURPOSE: Small meningiomas causing hydrocephalus without obstruction of the ventricular system are rare. Herein, we report a case of small clinoidal meningioma with communicating hydrocephalus, which resolved after tumor removal. CASE PRESENTATION: A 70-year-old woman presented with a 1-month history of memory disturbance followed by gait disturbance. MR images revealed a right clinoidal meningioma, 2 cm in diameter, and dilatation of the ventricles suggesting communicating hydrocephalus. The cerebrospinal fluid(CSF)pressure was 130 mmH2O, as determined via a lumbar puncture. High concentrations of protein(65mg/dL)were detected in the lumbar CSF. The tumor was completely removed via a frontotemporal craniotomy. Higher protein concentrations(94mg/dL)were detected in the CSF obtained intraoperatively from the sylvian cistern. The histopathological diagnosis was meningothelial meningioma. The patient's symptoms improved markedly after surgery. Postoperative MR images revealed resolution of the hydrocephalus. The lumbar CSF protein concentration returned to normal(43mg/dL). Neither tumor recurrence nor progression of hydrocephalus has been observed for 4 years. DISCUSSION: Communicating hydrocephalus, associated with a small meningioma at the supratentorial region, has not been described. Previous studies have shown that patients with meningioma may develop communicating hydrocephalus after tumor removal or stereotactic radiosurgery. Thus, it is interesting that the small supratentorial meningioma in our case developed communicating hydrocephalus without any therapeutic intervention. Considering the CSF protein concentration, we speculate that the hydrocephalus was the result of CSF malabsorption associated with high CSF protein concentration and CSF pathway obstruction at the suprasellar cistern caused by the tumor.

[Computed Tomography Criteria for Mild Head Trauma in Childhood: A Retrospective Study].

We retrospectively investigated 459 computed tomography (CT) scans of head injuries in children who were 7 years of age or younger that we experienced at our institute from 2008 to 2014, and investigated whether or not the algorithm created by the Pediatric Emergency Care Applied Research Network and the guidelines by the National Institute for Health and Care Excellence, which are the standards for CT scans of head injuries in infants, are adequate. As a result, all 12 cases that required surgery or resulted in serious brain damage fell into the category for CT recommendation according to both standards. Although several cases that fell into the category for consideration of CT involved intracranial lesions, all such cases were mild. There were some cases with negligible CT findings that were excluded by both standards. We believe that adapting these standards is significant for reducing the degree to which children are exposed to irradiation.

Efficacy and safety of postoperative early mobilization for chronic subdural hematoma in elderly patients.

BACKGROUND: The incidences of chronic subdural hematoma (CSDH) will probably increase with the aging of the population; thus, postoperative care of elderly CSDH patients may play a more important role in surgical management. The aim of this study was to evaluate the efficacy of and adverse effects after postoperative early mobilization (EM) for elderly CSDH patients. METHODS: This is a single-institution historical control study. One hundred eighty-two patients with CSDH aged 65 years and older underwent one burr-hole surgery between 2001 and 2008. This institution has prospectively conducted an EM protocol after surgery since 2005. The emphasis of the EM was helping patients not only to an upright position but also to walk beginning the day of operation. The incidences of postoperative complications and recurrence of CSDH were compared between the EM group (n = 91; 76.5 +/- 6.5 years old) and a delayed mobilization (DM) group (n = 91; 77.9 +/- 7.5 years old). RESULTS: Postoperative complications, such as pneumonia and urinary tract infection, was observed in 24 (26.4%) in the DM group and 11 (12.1%) in the EM group (p < 0.05). The rate of recurrence did not differ between the two groups (6.6% and 8.8%, respectively; p = 0.58). CONCLUSIONS: The results suggest that EM after one burr-hole surgery prevents postoperative complications without increasing the risk of recurrence in CSDH patients > or =65 years of age.

Bilateral medial medullary infarction due to bilateral vertebral artery dissection.

We describe a 52-year-old woman who experienced transient motor weakness and numbness of the left extremities and presented 2 days later with severe hemiparesis and sensory impairment of the right extremities and right lingual palsy. Magnetic resonance imaging (MRI) revealed bilateral upper medial medullary infarction, primarily in the left ventral portion. The findings of both three-dimensional (3D) computed tomographic and conventional angiography suggested dissection of both intracranial vertebral arteries (VAs). Medial medullary infarction is generally caused by atherosclerosis within a VA or anterior spinal artery. This is the first report of bilateral medial medullary infarction due to dissection of both intracranial VAs.

Unilateral oculomotor nerve paresis associated with anterior communicating artery aneurysm rupture--two case reports.

Two cases of complete unilateral oculomotor nerve palsy occurred after subarachnoid hemorrhage (SAH) due to a ruptured anterior communicating artery aneurysm. A 61-year-old female suffered left oculomotor nerve paresis after mild SAH. This paresis was probably related to pre-existing oculomotor nerve stretching caused by abnormal positioning of the posterior cerebral and superior cerebellar arteries in the premesencephalic cistern. A 70-year-old female suffered right oculomotor nerve paresis after severe SAH. Elevated intracranial pressure might have caused this paresis, but the reason for the unilateral occurrence was undetermined. Both patients were treated by clipping of the aneurysm, and the signs of oculomotor nerve paresis gradually resolved. A pattern of pupil-sparing paresis was observed during the early recovery stage in both patients.

[Ruptured frontopolar artery aneurysm: two cases].

We report two very rare cases of subarachnoid hemorrhage due to a ruptured frontopolar artery aneurysm in the cingulate sulcus. Only two surgically treated cases have been reported. Case 1: A 69-year-old woman suffered headache and was admitted to our hospital the next day. Computed tomography (CT) revealed focal subarachnoid hemorrhage (SAH) in the interhemispheric fissure. Cerebral angiography on admission failed to show an aneurysm, but follow-up study on day 14 revealed a small aneurysm in the cingulate sulcus at the origin of the frontopolar artery arising from the callosomarginal trunk. The aneurysm was successfully clipped on day 15 and the post-operative course was uneventful. Case 2: A 43-year-old man was transferred to our hospital complaining of severe headache. CT revealed diffuse SAH in the basal and interhemispheric cistern. Cerebral angiography showed an aneurysm at the origin of the callosomarginal trunk arising from the anterior communicating artery complex and another at the callosomarginal-frontopolar bifurcation in the cingulate sulcus. Both aneurysms were successfully clipped on the day of admission, and the frontopolar artery aneurysm was shown to be the cause of the SAH.

[Shotgun injury of head and neck: case report].

A 48-year-old male was hit by a shotgun blast from behind while he was hunting. He was only 7 meters away when one of his colleagues pulled the trigger accidentally. About 180 lead pellets penetrated his head and neck. When he was brought to our hospital, he was alert and complained of occipital and nape pain, but had no apparent neurological deficits. We administered 200 mg of dimercaprol immediately and removed 77 pellets by midline suboccipital incision on the next day. Afterwords, we performed four minor operations using a fluoroscope, and removed another 70 pellets by day 29. In addition, we administered a 100 mg x 3 dose of dimercaprol every other week. He was discharged 41 days after the accident without any acute signs of lead poisoning. Though serum lead level did not rise to critical level, EDTA was continued after his discharge to prevent delayed lead poisoning from the retained pellets. Since we seldom encounter this type of patient in Japan, delayed lead poisoning by shotgun injury was discussed with reference to the literature.