gramshield2
gramshield2
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Dural sinus thrombosis (DST) is a potentially fatal neurological condition that can be reversed with early diagnosis and prompt treatment. Non-enhanced CT scan is often the first imaging investigation in patients presenting with acute neurological symptoms; however, its poor sensitivity in detecting DST is a major drawback. Magnetic resonance (MR) imaging offers multiple advantages such as excellent contrast resolution and unenhanced venography possibilities, making it the mainstay in the non-invasive diagnosis of DST. However, physiological variations, evolution of thrombi, and incorrect selection/application of MR techniques can lead to false positive and false negative interpretations impacting patient management and outcome. This article discusses the MR techniques useful to diagnose DST and describes pitfalls, with troubleshooting methods, to ensure an accurate diagnosis. We have used multiple diagrammatic illustrations and MR images to highlight pertinent take-home points and to serve as an easy guide for day-to-day clinical practice. Neurocysticercosis is the most common parasitic disease affecting the central nervous system. Isolated sellar cysticercosis cysts are rare and can mimic other sellar lesion as cystic pituitary adenoma, arachnoid cyst, Rathke cleft cyst, or craniopharyngioma. The surgical resection is mandatory because the cysticidal drugs are ineffective, however, new microsurgical approaches are emerging to reduce complications and need to test in this condition. We present a patient with a sellar cysticercosis cyst treated by transciliar supraorbital keyhole approach. A 45-year-old female with presented with chronic severe headaches, progressive deterioration of 6 months in visual acuity and bitemporal hemianopia. The pituitary hormonal levels were normal. Magnetic resonance findings showed a sellar and suprasellar cyst and underwent a microsurgical supraorbital transciliar keyhole approach for lesion resection. Pathologically, the lesion demonstrated a parasitic wall characterized by wavy, dense cuticle, and focal glob surgical outcome. Double epidural hematomas (EDHs) have a higher mortality rate compared to single EDHs and same Glasgow Coma Scale (GCS), although double EDHs incidence is less common. We present the case of a 34-year-old female who underwent single skin incision and frontotemporal and suboccipital craniotomies for fatal traumatic double acute EDHs, then, a literature review was performed. Double EDHs in association with low GCS at presentation and traumatic diastasis of cranial sutures or other maxillofacial injuries are associated to an unfavorable outcome.Double EDHs in association with low GCS at presentation and traumatic diastasis of cranial sutures or other maxillofacial injuries are associated to an unfavorable outcome. Although transcranial magnetic stimulation (TMS) has been indicated as a potential therapy for several neurologic conditions, there is little known regarding its use during the postoperative rehabilitation period in patients with brain tumors. Furthermore, seizures, a common presentation in these patients, are regarded as a major contraindication for TMS therapy. We demonstrate that postoperative continuous theta burst stimulation (cTBS), a patterned form of repetitive TMS, was safely tolerated in addition to current neurorehabilitation techniques in two brain tumor patients, including one patient with a history of tumor-related epilepsy. We administered navigated 5 Hz cTBS to two patients within 48 h following awake craniotomy for tumor resection. Active motor thresholds were measured in both patients before TBS administration to determine stimulus intensity. We used resting-state fMRI to identify likely damaged networks based on postoperative deficits. This aided in TMS planning and allowed deficit targeted therapy contralateral to the lesioned network node. Both patients tolerated TBS therapy well and had no adverse effects, including posttreatment seizures, despite one patient having a history of tumor-related epilepsy. TBS may be safe in the immediate postoperative period for patients following brain tumor resection. GW0918 Additional studies are needed to quantify the efficacy of TMS in improving neurologic deficits following tumor resection.TBS may be safe in the immediate postoperative period for patients following brain tumor resection. Additional studies are needed to quantify the efficacy of TMS in improving neurologic deficits following tumor resection. Alagille syndrome is a rare genetic syndrome, which arises due to defects in the Notch signaling pathway, resulting in liver, cardiopulmonary, renal, skeletal, and ophthalmologic problems, among others. Epidermoid cysts are rare congenital benign lesions that develop from ectopic ectodermal cell rests formed during neurulation. A 24-year-old Alagille syndrome patient presented with hearing loss and was found to have a sizable posterior fossa mass. He underwent craniotomy for uneventful resection of the lesion, which was found to be an epidermoid cyst. While our case may represent a coincidental occurrence of two pathologies presenting together, given that epidermoid cysts arise from aberrant neurulation, and in light of the crucial role of the Notch signaling pathway both in normal neurogenesis and in the pathogenesis of Alagille syndrome, we hypothesize a possible association between these entities.While our case may represent a coincidental occurrence of two pathologies presenting together, given that epidermoid cysts arise from aberrant neurulation, and in light of the crucial role of the Notch signaling pathway both in normal neurogenesis and in the pathogenesis of Alagille syndrome, we hypothesize a possible association between these entities. Hemifacial spasm (HFS) caused by vertebral artery (VA) aneurysms is rare. Several cases of HFS caused by VA aneurysms treated by endovascular parent artery occlusion (PAO) have been reported. Recently, we treated a rare case of HFS caused by a saccular VA aneurysm at the bifurcation of the posterior inferior cerebellar artery (PICA), which was successfully treated by endovascular coil embolization, preserving the parent artery, and PICA. We discuss endovascular treatment for HFS induced by VA aneurysms with a literature review. A 59-year-old man presented with the left HFS persisting for 2 months. Magnetic resonance imaging revealed a left saccular VA-PICA aneurysm and demonstrated that a left facial nerve was compressed by the aneurysm at the root exit zone. Angiography revealed that the PICA was branching from the aneurysm neck. Endovascular coil embolization was performed using the balloon remodeling technique to preserve the left VA and PICA. HFS disappeared after treatment. Although microvascular decompression was commonly accepted for the standard treatment of HFS, coil embolization of aneurysms without PAO may be an effective treatment for HFS caused by VA aneurysms.

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