[Autopsy of a suspected venous circulatory disturbance localized in the medulla oblongata and upper cervical cord accompanied by an aneurysm].

We describe an autopsied case of an 86-year-old woman who presented with acute tetraparesis, bulbar palsy, and respiratory insufficiency. MRI showed a T2 hyperintensity lesion in the medulla oblongata and C1 and C2 level cervical cord, and an unruptured aneurysm in the left posterior inferior cerebellar artery. With an initial diagnosis of Bickerstaffs brainstem encephalitis, we started corticosteroid therapy. Initially, the corticosteroid treatment gradually improved her general condition; however, about two weeks later she died of an acute respiratory insufficiency. From the postmortem pathological examination, we considered a venous circulatory disturbance of the medulla oblongata and upper cervical cord. No arteriovenous shunt was found in the intramedulla and the medulla oblongata was partially compressed on the left side by an unruptured aneurysm. However, neither inflammatory nor malignant cells were found in the lesion. What caused the venous circulatory disturbance was unclear, but the dural arteriovenous fistula could have been responsible. Our case suggested that venous circulatory disturbances accompanied with an aneurysm need rapid consideration by angiography followed by intervention.

A patient with delayed posthypoxic demyelination: a case report of hyperbaric oxygen treatment.

A 62-year-old man who developed akinetic mutism with delayed white matter demyelination after hypoxia was treated with hyperbaric oxygen (HBO). HBO in the subacute period markedly improved the patient's activity in daily life, cognitive function and organization on EEG. 1H-MRS showed a recovery of aerobic metabolism of the neurons. However, dementia and cerebral atrophy slowly progressed despite HBO treatment. Thus, HBO had a beneficial effect on the activity of depressed neurons but did not improve the prognosis.