Primary neurolymphomatosis of the lower cranial nerves presenting as Dysphagia and hoarseness: a case report.

Primary neurolymphomatosis is an extremely rare tumor. We report the case of a 74-year-old patient presenting with dysphagia and hoarseness. Initial contrast-enhanced computed tomography of the head, neck, and chest did not reveal any lesions. His symptoms improved with short-term administration of prednisone but recurred and deteriorated. Magnetic resonance (MR) imaging revealed a tumor along the ninth and tenth cranial nerves across the jugular foramen. Fluorine-18 fluorodeoxyglucose positron emission tomography indicated this was a primary tumor. Repeated MR imaging after 2 months revealed considerable tumor enlargement. A left suboccipital craniotomy was performed to remove the tumor that infiltrated the ninth and tenth cranial nerves. The histopathologic diagnosis was diffuse large B-cell lymphoma. Although focal radiation therapy was administered to ensure complete eradication of the tumor, the patient died of aspiration pneumonia with systemic metastasis. To our knowledge, this is the first reported case of primary neurolymphomatosis in the lower cranial nerves.

Detection of tumor progression by signal intensity increase on fluid-attenuated inversion recovery magnetic resonance images in the resection cavity of high-grade gliomas.

Increased signal intensity (SI) on fluid-attenuated inversion recovery (FLAIR) magnetic resonance (MR) images in the resection cavity is sometimes observed after partial resection of gliomas. SI in the resection cavity of 44 high-grade gliomas was retrospectively investigated. Twelve of 35 patients with progressive disease (PD) showed SI increase in the resection cavity, and SI increase preceded PD in 6 of these 12 patients. None of nine patients without PD showed SI increase during the follow-up period. The analysis of SI on FLAIR images in the resection cavity had a specificity of 100% and a sensitivity of 34%. Higher sensitivity was found in grade IV tumors than in grade III tumors. SI increase is thus considered as a potent highly specific hallmark for subsequent or coincident tumor progression, which is clinically useful since MR imaging is easily performed during routine clinical examinations.

Behavioral performance at early (4 weeks) and later (6 months) stages in rats with unilateral medial forebrain bundle and striatal 6-hydroxydopamine lesions.

Our previous studies showed differences in striatal D(2) receptor functional activity between two different rat parkinsonian models, with lesions induced by 6-hydroxydopamine injection in the striatum and in the medial forebrain bundle (MFB) at both early (4 weeks) and later (6 months) stages after lesioning. The present study compared behavioral changes, including rotational movements induced by methamphetamine and bromocriptine, and the stepping test, in both models at both stages. No differences in behavioral performance were observed between the early and later stages in both striatal and MFB lesion models, whereas simultaneous D(2) receptor study showed dynamic change in D(2) receptors in MFB lesion rats. Behavioral characteristics might be controlled by comprehensive effects of the whole dopaminergic system, instead of variation in a few parameters of the dopaminergic system. More behavioral tests of different mechanisms with simultaneous molecular studies are needed for evaluation of parkinsonian animal models and the efficacy of treatments.

Repeated brain infarction caused by atherosclerosis of the bovine aortic arch successfully treated with arch replacement: case report.

A 62-year-old man presented with repeated embolic infarction over the last 3 years. Computed tomography angiography of the aortic arch revealed that the patient had a common trunk for the innominate and left carotid arteries, the so-called bovine aortic arch, with stenosis extending to both the left common carotid artery and innominate artery. Since antiplatelet therapy was not adequate for prevention of recurrent infarction, total replacement of the aortic arch was performed. Since then, no further ischemic events have manifested. Endovascular procedures are not safe enough for atherosclerotic lesions in the aortic arch, especially in a patient with bovine aortic arch, so surgical aortic arch replacement should be considered.

Cerebral hemorrhage due to posterior reversible encephalopathy syndrome associated with autonomic dysreflexia in a spinal cord injury patient.

A 37-year-old man with C4-5 spinal cord injury (SCI) presented with abnormally high blood pressure after vesicocutaneous catheter exchange and was treated with antihypertensive agents. Two weeks later, he developed headache and visual disturbance, and presented with fluctuating blood pressure. Multiple subcortical hemorrhages in the left occipital and right frontal lobes occurred on the next day, and he died of increased intracranial pressure 3 weeks later. Based on the symptoms and computed tomography findings, the retrospective diagnosis was posterior reversible encephalopathy syndrome (PRES) due to autonomic dysreflexia (AD). AD occurs frequently in patients with quadriplegia and high paraplegia by distention of the bladder and bowel. PRES secondary to AD is very rare, but we must always be aware of this life-threatening complication in SCI patients.

Ruptured extracranial vertebral artery aneurysm associated with neurofibromatosis type 1. Case report.

A 31-year-old man presented with a ruptured right extracranial vertebral artery aneurysm associated with neurofibromatosis type 1, manifesting as acute onset of right neck and shoulder pain, and right supraclavicular mass. Three-dimensional computed tomography angiography showed a large aneurysm involving the right extracranial vertebral artery associated with a pseudoaneurysm. The aneurysm was successfully treated by transarterial endovascular trapping with detachable coils. Extracranial vertebral artery aneurysm is rare, but the mortality of ruptured cases is extremely high, so early diagnosis and early treatment are important. The present case shows that endovascular treatment was very effective.

Disproportionately large communicating fourth ventricle associated with syringomyelia and intradural arachnoid cyst in the spinal cord successfully treated with additional shunting. Case report.

A 44-year-old woman presented with a rare case of disproportionately large communicating fourth ventricle (DLCFV) associated with syringomyelia and intradural arachnoid cyst in the spinal cord. Ventriculoperitoneal shunt operation was performed for hydrocephalus after subarachnoid hemorrhage. She developed DLCFV, which was then associated with syringomyelia and spinal intradural arachnoid cyst. Shunting of the fourth ventricle improved DLCFV, and then the syringomyelia and arachnoid cyst. Although the aqueduct was patent, independent pressure control of the fourth ventricle and the other ventricles was necessary to improve the symptoms. Shunting of the fourth ventricle should be considered for patients with DLCFV when the symptoms persist despite adequate pressure control of the other ventricles.