Endovascular therapy using flow diversion for giant internal carotid artery pseudoaneurysm arising in the setting of an invasive pituitary macroadenoma.

This report illustrates the unusual occurrence of a pseudoaneurysm arising in the setting of a skull base mass and describes the first reported use of endovascular flow diversion therapy in such a setting. A 63-year-old man with occasional headaches during the preceding month presented with the acute onset of severe left retroorbital headache and oculomotor nerve palsy. Computed tomography (CT) and CT angiogram revealed a destructive skull base mass with an associated giant probable pseudoaneurysm of the cavernous segment of the left internal carotid artery. The patient underwent endoscopic transsphenoidal biopsy with a subsequent diagnosis of prolactinoma. Endovascular therapy utilizing two Pipeline™ flow diversion embolization devices was performed with subsequent resolution of the patient's headache and improvement in his cranial nerve deficits/cavernous sinus syndrome.

Bilateral cavernous sinus and superior ophthalmic vein thrombosis in the setting of facial cellulitis.

Cavernous sinus thrombosis is a rare, potentially fatal cause of cerebral venous thrombosis. Infectious causes typically arise from the mid face, orbit, or sinonasal region. We present a case of bilateral cavernous sinus and superior ophthalmic thrombosis secondary to an extreme case of facial cellulitis.

Solitary supratentorial Listeria monocytogenes brain abscess in an immunocompromised patient.

We describe an 81-year-old man receiving azacitidine monotherapy for myelodysplastic syndrome who was improving from Listeria monocytogenes bacteremia after receiving antibiotic therapy during an earlier hospital admission. Shortly after discharge he developed new-onset seizure activity, with brain imaging on subsequent admissions demonstrating a posterior right frontal lobe mass. Specimen cultures after resection of the mass revealed this to be a cerebral abscess related to L. monocytogenes. Brain abscesses related to this organism are rare.

Intracranial germinoma.

Pineal region tumors make up less than 1% of all intracranial neoplasms, with the majority being of germ cell origin. We describe the diagnostic evaluation and treatment of a patient presenting with neurological deficits who was found to have a germinoma of the pineal gland.

Advances in diagnostic imaging for pathologic conditions of the jaws.

Advances in dental and maxillofacial imaging are delineated along with the advantages and disadvantages of each imaging modality. The imaging modalities that are included are intraoral radiography, panoramic radiography, cone-beam computed tomography, multidetector computed tomography, magnetic resonance imaging, nuclear medicine, and ultrasound.

Basilar artery thrombosis in the setting of antiphospholipid syndrome.

Antiphospholipid syndrome is an autoimmune disorder characterized by arterial or venous thrombosis, recurrent first-trimester pregnancy loss, and multiple additional clinical manifestations. We describe a man with severe atherosclerotic basilar artery stenosis and superimposed in situ thrombus who was found to have antiphospholipid syndrome.

Spinal cord ependymoma presenting with neurological deficits in the setting of trauma.

Ependymomas represent 4% of all primary central nervous system neoplasms in adults, with 30% occurring in the spinal cord. We describe a young man with neurological deficits following a motor vehicle accident who was found to have an intramedullary cervicothoracic ependymoma.

Ganglioglioma and migraine headache.

Mixed neuronal/glial neoplasms represent a minority of intracranial neoplasms, typically associated with a more favorable prognosis than the more common higher-grade glial neoplasms. We describe a young man with headache, confusion, and slurred speech who was found to have a ganglioglioma.

Kummell disease.

Kummell disease, or avascular necrosis of a vertebral body, presents as vertebral osteonecrosis typically affecting a thoracic vertebra with compression deformity, intravertebral vacuum cleft, and exaggerated kyphosis weeks to months after a minor traumatic injury. This rare disease is increasing in prevalence secondary to an aging population and the associated rise in osteoporosis. Treatment with vertebroplasty or surgical decompression and fusion is often required. We present a classic case of Kummell disease to illustrate the salient features of the condition, with associated imaging findings on computed tomography and magnetic resonance imaging.

Impact of sham-controlled vertebroplasty trials on referral patterns at two academic medical centers.

Debate persists regarding the merit of vertebroplasty following publication of blinded vertebroplasty trials in 2009, one of which was the Investigational Vertebroplasty Efficacy and Safety Trial (INVEST). This study was performed to determine whether referring physicians at two academic medical centers were aware of the trial results and to assess if this awareness prompted a change in their treatment of osteoporotic fractures. E-mail surveys were distributed to physicians within the Mayo Clinic and Baylor Health Care System (BHCS). Of 1390 surveys sent, 194 (14%) were returned. Results showed that 92 of 158 respondents (58%) reported familiarity with INVEST; 66 of 92 (72%) agreed that INVEST changed their understanding of vertebroplasty efficacy; and 64 of 92 (70%) agreed that INVEST diminished their enthusiasm to refer patients for vertebroplasty. However, 105 of 159 respondents (66%) felt vertebroplasty was an effective procedure in appropriate patients. Mayo physicians were more likely than BHCS physicians to be aware of INVEST (73% vs 67%, P < .0001), respond that INVEST changed their understanding of the appropriate treatment for osteoporotic compression fractures (79% vs 57%, P = 0.026), view vertebroplasty less favorably (45% vs 21%, P = 0.005), and treat osteoporotic compression fractures with medical therapy/pain management alone (73% vs 48%, P = 0.003). INVEST changed referring physicians' understanding of the role of vertebroplasty and diminished their willingness to refer osteoporotic compression fracture patients; the impact varied by location.

Endolymphatic sac tumor and otalgia.

Otalgia is a common complaint seen by general practitioners, but its etiology is vast. Rarely, otalgia could be secondary to a neoplasm. We describe a case of otalgia and ear discharge in which the imaging revealed a rare neoplasm, an endolymphatic sac tumor, which contributed to the patient's symptoms. The primary diagnosis was made via characteristic imaging features that were later confirmed by histology.

Fourth ventricular subependymoma presenting as worsening headache.

Subependymomas are rare, slow-growing benign neoplasms. Although most are asymptomatic, they can present with symptoms related to increased intracranial pressure and hydrocephalus. We describe a 47-year-old man with worsening headaches who was found to have a subependymoma, with a focus on the imaging findings, differential diagnoses, pathology, and treatment.

Dementia caused by dural arteriovenous fistulas reversed following endovascular therapy.

We describe two patients who presented with dementia as the primary neurological manifestation of their dural arteriovenous fistula (dAVF). Although dementia is not the most common presentation for a dAVF, these cases show that obliterating the fistula can eliminate this dreadful manifestation. This awareness may facilitate the diagnosis of dementia in cases caused by dAVF and allow for a minimally invasive treatment that restores cognitive function back to baseline.

A pictorial review of complications of acute coalescent mastoiditis.

This case study highlights the extracranial and intracranial manifestations of severe otomastoiditis. A 35-year-old man presented with numerous symptoms, including ear and neck pain, headache, temporary vision loss, fever, malaise, and nausea and vomiting. Imaging studies led to the diagnosis of coalescent mastoiditis with septic dural sinus thrombosis, venous hemorrhagic infarctions, brain abscesses, and subdural empyema.

Fatal toxic leukoencephalopathy secondary to overdose of a new psychoactive designer drug 2C-E ("Europa").

We present a case of a fatal toxic leukoencephalopathy following ingestion of a new psychoactive designer drug known as 2C-E or "Europa." Recreational drugs, particularly hallucinogenic substances, appear to be growing in popularity, with increasing amounts of information available via the Internet to entice potential users. In addition, some newer "designer" psychoactive substances are available for purchase online without adverse legal consequences, therefore adding to their popularity. We describe magnetic resonance imaging (MRI) findings to include selective diffuse toxic injury of the cerebral white matter with sparing of the cortex and most of the deep gray nuclei. To our knowledge, this is the first reported description of cerebral findings on MRI that are likely related to a lethal ingestion of 2C-E.

Ruptured intracranial dermoid cyst.

Rupture of an intracranial dermoid cyst is a rare event with considerable associated morbidity and potential mortality. We present a case of intracranial rupture of a dermoid cystic tumor with consequent dissemination of subarachnoid fat droplets resulting in acute aseptic chemical meningitis. Radiographic findings, operative treatment, and pathologic features are described.