[Consideration of the Mechanism for Anterior Condylar Confluent Dural AVF Diagnosed with Neck Pain].

OBJECTIVE: Anterior condylar confluent dural arteriovenous fistula(ACC-dAVF)constitutes 3.7% of the total dAVF cases reported and has been regarded as a rare disease in the past. However, encounters with this disease are increasing due to MRI and awareness of this condition. The symptoms of this disease have been reported as tinnitus(75%), ocular symptoms(31%), sublingual nerve palsy(12%), spinal cord symptoms(11%), and intracranial bleeding(5%). Here, we report our identification of a case of ACC-dAVF, which is different from conventional reports, and the associated findings. CASE PRESENTATIONS: We experienced a series of 3 cases of ACC-dAVF with the chief complaint of neck pain. The symptoms in all three patients disappeared after transvenous embolization. Based on the pathophysiology of cervical pain, we presumed that the blood flow dynamics of the odontoid arcade was involved. As expected, after the blood flow near the transverse ligament of the atlas was normalized the symptoms disappeared. CONCLUSION: We could not find previous reports of ACC-dAVF where the main symptom was cervical pain. We report the possibility of a mechanism of dAVF different from those reported previously.

Use of a stent-retriever for treatment of iatrogenic vasospasm secondary to mechanical thrombectomy.

The treatment strategy for iatrogenic intracranial vasospasm has not been established. We reported a rare case of stent-retriever use for the treatment of iatrogenic vasospasm after mechanical thrombectomy. The patient presented acute ischemic stroke due to the occlusion of the left middle cerebral artery (MCA). The patient underwent a successfully mechanical thrombectomy, however, severe stenosis was visualized in MCA, which was considered to be an iatrogenic mechanical vasospasm. This vasospasm was successfully treated with the Solitaire stent device, and the patient recovered from ischemic symptoms. A stent-retriever is a safe and effective treatment for iatrogenic vasospasm after mechanical thrombectomy.

[Multiple cerebral embolism caused by a patent foramen ovale and a uterine myoma].

Recently, patent foramen ovale(PFO) has been highlighted as an important risk factor of cerebral infarctions in young adults. We report a patient of multiple cerebral embolism associated with PFO and deep venous thrombosis caused by a uterine myoma. A 40-year-old woman suddenly suffered from right hemiparesis with motor aphasia. Brain angiography showed an occlusion of M2 portion of the left middle cerebral artery, but atherosclerotic changes were not seen. She developed left facial paresis 23 days later and admitted to our hospital. Brain MRI revealed multiple cerebral infarcts in the left insular cortex, the deep white matter of the right frontal lobe, and bilateral thalamus. Hypoxia with the perfusion defects of S1 and S2 sections of the right lung demonstrated by scintigraphy suggested pulmonary embolism. Transesophageal echocardiography showed a PFO with spontaneous left-to-right shunt and right-to-left shunt evoked by the Valsalva maneuver. Although venography could not detect thrombi, it revealed severe compression of the right external iliac vein by a uterine myoma. These findings suggested thrombi in the right external iliac vein were the embolic source when combined with elevated coagulation markers. An uterine myoma should be considered as an important risk factor for an embolic source in case of cerebral embolism with PFO.

A case of extrapleural empyema.

A 49-year-old man with diabetes mellitus and alcoholic liver cirrhosis presented with dyspnoea and fever. A chest computed tomography scan revealed three areas of loculated pleural effusion. Initially, the patient was thought to have an intrapleural empyema and was treated with intravenous antibiotics and closed drainage. However, as he did not improve, he was then treated with open drainage. During open drainage, the patient was diagnosed to have an extrapleural empyema and improved following open drainage treatment.