A controlled Valsalva Maneuver causes neither Diffusion-Positive Hippocampal Lesions nor Clinical Symptoms after Transient Global Amnesia.

Valsalva maneuver (VM) precedes frequently transient global amnesia (TGA) and up to 84% of the patients with TGA present hippocampal diffusion-weighted imaging-positive (DWI+) lesions on brain magnetic resonance imaging (MRI). We studied 20 patients with TGA and hippocampal DWI+ lesions. Median age (range) of the patients was 67 (57-80) years and 55% were women. TGA had been preceded by a VM-associated activity in 14 patients (70%), and brain MRI had been performed at a median (range) of 47.5 (42-79) h after TGA. These patients underwent a second MRI after a controlled-induced VM at least 3 months after TGA. This MRI was performed at a median (range) of 46.8 (41-138) h after the controlled-induced VM. None of the patients who reproduced TGA symptoms presented new DWI+ lesions on the second MRI. In patients with a previous episode of TGA, VM cannot elicit TGA in isolation and the interplay of other simultaneous factors is needed.

Simultaneous transient global amnesia and right MCA stroke after Valsalva manoeuvre.

A 61-year-old man suffered an episode of transient confusion and anterograde amnesia after a Valsalva-related manoeuvre. The MRI diffusion weighted imaging (DWI) sequences showed a left hippocampal and two right parietal lesions that were deemed as acute. The MR angiography disclosed a high-grade stenosis in the right middle cerebral artery as was described by a transcranial colour-coded ultrasound as well. Ultrasound investigation of the jugular veins showed a right jugular venous reflux after a Valsalva manoeuvre. The patient was diagnosed with transient global amnesia based on clinical grounds and the right parietal lesions were considered as silent strokes. The Valsalva manoeuvre could have played as a common trigger for both diseases.

Atypical delayed intracranial haematoma following stereotactic biopsy of a right parietal anaplastic oligodendroglioma.

The history of a 73-year-old woman with an anaplastic oligodendroglioma is presented, in whom cerebral magnetic resonance imaging (MRI) and brain single-photon emission tomography (SPECT) revealed an intracerebral lesion 17 months before, which was misinterpreted as cerebral infarction. Stereotactic biopsy confirmed the diagnosis, but 4 days after biopsy an unexpected fatal subdural and intraparenchymal bleeding occurred on the biopsy site. Neuroradiological aspects in the differential diagnosis of cerebral lesions as well as the role of small silent postbiopsy haematoma concerning further clinical deterioration are discussed.

Neuroradiological findings in primary cerebral lymphomas of non-AIDS patients.

Primary central nervous system lymphomas (PCNSL's) are rare tumours which generally accounted for 1.0-1.5% of all intracranial neoplasms. However, within the last decade the frequency of cerebral lymphomas has dramatically increased. We retrospectively analysed the neuroradiological findings (computed tomography (CT), MRI, angiography) in 37 patients with PCNSL. Thirty patients with the clinically and neuroradiologically suspected diagnosis of cerebral lymphoma underwent CT- or MRI-guided stereotactic biopsy. In seven cases an open surgical intervention was performed. Preoperatively, CT with and without contrast medium was performed in all but two cases. Twenty-eight patients received MRI (axial SE T2 weighted, triplanar SE T1 weighted, triplanar SE T1+Gadolinium). Additionally, in 9 patients cerebral angiography was performed. Typical neuroradiological patterns are: (1) iso- or hyper-density (85.5%) on unenhanced CT scan with marked contrast enhancement (87.7%); (2) infiltration/contact of leptomeningeal and/or ependymal spaces (97.3%); (3) hyperintensity on T2 with moderate oedema (80.3%). Histopathological work-up included conventional and immunohistochemical stains performed on formalin fixed and paraffin embedded bioptical specimen. Despite widely used preoperative dexamethasone treatment, an accurate histopathological diagnosis of PCNSL of B cell type was established in all cases except one. The high percentage of accurate histopathological diagnosis was based on: (1) great mean sample volume per biopsy site; (2) great number of biopsies in patients suspected to have cerebral lymphomas; and (3) MR-guided stereotactic procedures if the lesion was not clearly identifiable on CT scan.