Brain CT Research Articles

ETMR-21. PRIMARY DIFFUSE LEPTOMENINGEAL MELANOMATOSIS (PDLM) ASSOCIATED WITH INTRACRANIAL BLEEDING AND RAPID PROGRESSION IN A CHILD

Abstract BACKGROUND PDLM is a rare and aggressive disease with limited cases reported worldwide and few cases in the pediatric population. Herein we report on clinical, histologic, and molecular/genetic findings of a young child with PDLM and rapid clinical progression. CASE STUDY A 12-year-old right-handed male presented with two months of intermittent fevers, progressive frontal headaches, lethargy, vomiting, and weight loss, and one month of focal seizures with altered awareness, speech arrest, eye deviation, and tonic posturing. Examination revealed bilateral papilledema and signs of increased intracranial pressure. A brain CT demonstrated increased density of the anterosuperior right frontal lobe and punctate focus of increased density along the left frontal lobe suggestive of hemorrhage. MRI revealed diffuse leptomeningeal thickening and enhancement throughout the brain and spinal cord. At biopsy, the frontal lesion was noted to be grossly abnormal and discolored, and on pathology demonstrated a melanocytic neoplasm infiltrating the subarachnoid space and extending into Virchow-Robin spaces. Tumor cells stained strongly for HMB45, vimentin, Melan-A, and PRAME and were BRAFV600E negative. RNA sequencing was negative for structural variants, Whole exome sequencing revealed a Tier I missense variant in NRAS (c.181C>A) among other copy number variations and loss of heterozygosity. Comprehensive ophthalmologic and dermatologic examinations as well as whole body PET/CT did not reveal any other sites of disease. He was due to commence immunotherapy with combination PD-1/CTLA-4 inhibitors but developed status epilepticus and raised intracranial pressure, warranting ventriculoperitoneal shunt insertion. Three days later, he had further deterioration with altered level of consciousness, hypertension, eye deviation, and vomiting. CT brain revealed large bifrontal hematomas with mass effect and care was redirected to palliation. CONCLUSION PDLM can be challenging to diagnose with a rapidly progressive course. Advanced molecular diagnostics may provide new targets for precision therapy, though overall outcomes remain dismal.

OTHR-08. CLINICAL MANAGEMENT OF TWO PEDIATRIC CASES OF INTRACRANIAL MESENCHYMAL TUMORS WITH FET::CREB FUSIONS

Abstract BACKGROUND Intracranial mesenchymal tumors (IMTs) with FET::CREB fusion are a newly described provisional entity lacking standard management options. This group of neoplasms occur in children and young adults, and is molecularly characterized by a FET family gene (most commonly EWSR1, rarely FUS) fused with a CREB family transcription factor (ATF1, CREB1, or CREM). Histologically, the Ki-67 index is typically low (<5%) and only rarely elevated (15-20%). Treatment consists of surgical resection. Cases achieving gross total resection (GTR) are observed without adjuvant therapy, while subtotal resection (STR) is followed by radiation therapy. Regardless of resection status, patients are at risk for local recurrence. METHODS Case report. RESULTS We present two patients with IMTs harboring FET::CREB fusions. Patient 1 is a 12-year-old male with a known left choroid plexus lesion and hydrocephalus, who presented with acute loss of balance, headaches, and emesis. CT head revealed progression of the choroid plexus lesion with intraventricular hemorrhage and worsening hydrocephalus. Following GTR of the tumor, pathology revealed an IMT without high-grade features and a Ki-67 index of 5%. RNA-sequencing revealed an EWSR1::ATF1 fusion. In consideration of GTR and the tumor being low-grade, he is being followed with surveillance scans. Patient 2 is a 14-year-old male who presented with headaches and seizures and was found to have an enhancing left occipital lesion on MRI. Following GTR, pathology revealed an IMT with abundant mitotic figures (15 per 10 high power fields), increased Ki-67 index of 30-40%, and a FUS::CREM fusion. Due to the high-grade histopathology, he was treated with focal proton beam radiotherapy (5400 cGyRBE). An MRI three months post-therapy was negative for tumor recurrence. CONCLUSIONS We describe two adolescents with IMTs harboring FET::CREB fusions and their management, including one with high-grade histology managed with upfront radiation therapy, which has not been previously reported in the literature.

Quantitative evaluation using carotid ultrasonography-based high-frame-rate vector flow imaging in patients with low carotid stenosis.

To explore the role of quantitative evaluation using carotid ultrasonography (US)-based high-frame-rate vector flow (V Flow) imaging in patients with low carotid stenosis. This single-centre cross-sectional study consecutively recruited volunteers without carotid plaque and patients with low carotid stenosis from August 2022 to May 2023. Patients were divided into symptomatic and asymptomatic groups according to their head CT or MRI results within 8 weeks. All V Flow imaging examinations were performed using a Mindray Resona R9 US system. The wall shear stress (WSS) values, oscillatory shear index (OSI) values, and turbulence (Tur) indexes in the normal common carotid artery (CCA), normal carotid bifurcation (CB), and on the upstream and downstream surface of carotid plaque were measured. Pearson Chi-square test and Fisher exact test were used for counting data according to their type. For measurement data, independent sample t test and non-parametric rank sum test were used. The results proved that patients have higher WSS values and Tur indexes of CB than volunteers, and higher WSS values were detected on the surface of the plaques in symptomatic patients. What's more, the downstream side of the plaque was more vulnerable to plaque rupture than the upstream side due to more dynamic blood flow. Therefore, carotid US-based high-frame-rate V Flow imaging provides reliable mechanical biomarkers for assessing the haemodynamic change in patients with low stenosis. Our study may provide a new imaging tool for monitoring the progression of atherosclerosis and aiding the management of early atherosclerotic patients. Our study firstly investigated the difference of V Flow parameters on the surface of carotid plaques between symptomatic and asymptomatic patients with low carotid stenosis, which is expected to provide haemodynamic information and the mechanical basis for plaque rupture.

Mikulicz’s disease combined with IgG4-related hypophysitis: a case report

BackgroundIgG4-related diseases are very uncommon, and its diagnosis and treatment are complicated as it encompasses multiple disciplines.Case presentation: A 77-year-old woman was admitted with a jaw mass and nausea and vomiting. Laboratory tests showed elevated serum IgG4, pituitary MRI suggested thickening of the pituitary stalk, and head and neck CT suggested orbital and mandibular masses. Patients with mandibular mass were diagnosed with Mikulicz’s disease with IgG4-related hypophysitis. We found no other evidence of causing thickening of the pituitary stalk. She was given oral prednisolone 30 mg daily, and her nausea and vomiting improved significantly, and the mandibular and ocular masses decreased in size.ConclusionMikulicz’s disease combined with IgG4-related hypophysitis is a rare case of IgG4-RD in elderly women. IgG4-RD is one of the causes of head and neck exocrine gland mass and pituitary stalk thickening in the elderly.

Acute synchronous bilateral extradural hematoma, a scarcely reported, rare entity

Objective: Extradural hematomas (EDHs) are contact injuries resulting from blunt trauma to the skull. It may be unilateral or bilateral. Bilateral acute extradural hematoma (EDH) was rarely reported before the advent of computed tomography. Mortality rates vary from 10.0%-40.0% and are an index of alertness and efficiency of health care and hospital set-up. EDH is an injury with preventable mortality in most cases. Bilateral acute extradural hematomas no longer confer high mortality of pre-CT era because of early diagnosis on CT, and prompt neurosurgical intervention. We present our experience with Bilateral EDH cases with an aim to investigate clinical, GCS score, and radiological features and also to analyse outcomes in these patients. Material and methods: We analyzed cases of EDH who presented at our centre from January 2023 to December 2023 and further investigated ten cases of bilateral EDH. All the patients were examined clinically and a plain computerized tomography scan of the head was performed. The clinical details of all patients, GCS at admission and discharge, radiological findings on CT and neurosurgical intervention performed, and GOS (Glasgow outcome score) were noted. Results: Road traffic accident was the reason for traumatic brain injury in all the cases. The GCS at admission was between 13–15 in 2 patients, 8–12 in 6 and 3–7 in 2 patients. Bilateral EDH was found in all of our patients .9 out of 10 cases were males. On CT head underlying fracture was seen in all cases. The localization of epidural hematomas in CT scans was bifrontal in four of the cases. All cases were treated with surgical management. The GOS Score was 5 in eight of the patients. Conclusion: Posttraumatic bilateral acute extradural hematoma is a rare entity, but now does not show the high mortality previously seen in the preCT era. This is due to early radiological diagnosis on CT and profuse monitoring combined with expeditious operative procedures.

Upfront vascular imaging in acute stroke: Impact on thrombectomy transfer time at a primary stroke center

ObjectivesEarly cerebral arterial imaging is currently only recommended in the subgroup of acute ischemic stroke (AIS) patients suspected of having large vessel occlusion (LVO). There is limited data on the impact of early cerebrovascular imaging in all suspected AIS patients presenting within 24 h of symptom onset and the impact on door in-door out (DIDO) time. Materials and methodsIn January 2020, our Primary Stroke Center implemented a protocol to perform upfront head and neck CT angiography (CTA) with initial non-contrast CT head for all suspected ischemic stroke patients screening positive for BE-FAST stroke symptoms within 24 h from last known normal time. We retrospectively reviewed IV alteplase and thrombectomy-eligible patients before (January 1-December 31, 2019) and after protocol implementation (January 1, 2020-June 30, 2022). ResultsOf 86 patients meeting study criteria, up-front CTA was associated with significant reductions in door-to-CTA start (median 37 vs 15 min, p = 0.003), door-to-CTA result (median 83 vs 52 min, p = 0.023) and DIDO times (median 150 vs 106 min, p = 0.023). There was no significant difference in door-to-needle time before and after protocol implementation (median 48 vs 43 min, p = 0.450). ConclusionUp-front cerebrovascular imaging with CTA in suspected AIS patients presenting within 24 h resulted in shorter DIDO times without delaying door-to-needle times. Primary Stroke Centers should consider this approach to detect LVO early and expedite patient transport to thrombectomy capable centers.

Brain Meningioma Mimicking Eclampsia: A Report of Two Cases

Seizures occurring during pregnancy and postpartum may lead to the suspicion of eclampsia. However, it is essential to conduct paraclinical examinations (brain CT scan and brain MRI) to rule out cerebral expansive processes. In this main article, we report two cases of patients admitted for eclampsia, in whom a diagnosis of meningioma was made. Based on the observations, we discuss the different entities of this pathology with data from the literature.

The Application of Pneumatic Arm in Neuroendoscopic Transsphenoidal Pituitary Adenoma Resection.

To summarize the application experience of the pneumatic arm in transnasal sphenoidal pituitary adenoma resection under neuroendoscope. A retrospective analysis was conducted on the clinical data of 52 patients with pituitary adenoma who underwent endoscopic transsphenoidal surgery with pneumatic arm fixation in the Neurosurgery Department of the First Affiliated Hospital of Anhui Medical University from July 2021 to March 2024. Among them, there were 5 cases of pituitary microadenoma, 35 cases of macroadenoma, and 12 cases of giant adenoma. Head CT and a full set of hormones were re-examined within 24 hours after surgery to evaluate the surgical effect. Follow-up was conducted by the outpatient department after surgery to assess the clinical symptoms, hormone level, and imaging of all patients. Among 52 patients, gross total resection was achieved in 48 cases (92.3%), subtotal resection in 3 cases (5.8%), and partial resection in 1 case (1.9%). Preoperatively, 43 patients had diminished vision, with 40 showing improvement postoperatively, 1 worsening, and 2 having no significant improvement. Thirty-eight patients had headaches preoperatively, and all showed varying degrees of improvement postoperatively. Routine hormone examination within 24 hours after surgery showed that all 20 prolactinoma patients had restored normal hormone levels, 10 of 12 growth hormone-secreting adenoma patients normalized, and 4 of 6 cases of adrenocorticotropic hormone-secreting adenoma immediately relieved after surgery. Postoperative complications included intracranial hematoma in 1 case, cerebrospinal fluid leakage in 2 cases, transient diabetes insipidus in 6 cases, intracranial infection in 1 case, and no death cases. The median follow-up time of 52 patients was 18.6 months (range: 1-32 mo). During the follow-up period, the initial clinical symptoms of all patients improved to varying degrees, and they were able to work and live normally. At the last follow-up, 1 patient had recurrent tumor and 1 patient had progression. Transnasal sphenoidal resection of pituitary adenoma using a pneumatic arm-fixed neuroendoscope allows the operator to perform the surgery with both hands, resulting in satisfactory overall tumor resection and fewer surgical complications. This technique has good clinical value for promotion.

Focal leptomeningeal vascular anomalies on brain MRI: A mimic of leptomeningeal metastatic disease

Abstract Background The diagnosis of leptomeningeal metastatic disease has major prognostic and therapeutic implications. We report 13 patients with a radiologically distinct kind of focal, enhancing leptomeningeal lesion on brain MRI that mimics leptomeningeal metastatic disease. Methods These patients were assessed at University Health Network (Toronto, Canada) between January 2001 and December 2023. Results Median age was 68 years (range, 55–78 years) and 10 patients were women. All patients had brain magnetic resonance imaging (MRI) including contrast-enhanced T2-weighted fluid attenuation inversion recovery (FLAIR) and T1-weighted spin echo sequences. MRI in all 13 patients showed a focal enhancing lesion located along the leptomeningeal surface of the brain. The MRI exams were reported as possible or likely leptomeningeal metastatic disease for the majority (9/13) of patients. Each lesion was curvilinear rather than sheet-like, and some lesions consisted of multiple connected/branching curvilinear structures with the appearance of abnormal vessels. The lesions were distinct from normal blood vessels. Some lesions had a visible connection with a nearby cortical vein. Follow-up contrast-enhanced brain MRI for 8/13 (62%) patients at a median of 3.9 years (IQR 2.4–6.6 years) showed all lesions were unchanged over time. Another 2/13 (15%) patients had clinical and CT brain follow-up after one year with no evidence of metastatic disease. Conclusions We describe a distinct kind of focal, enhancing leptomeningeal lesion on brain MRI that mimics metastatic disease. These lesions are likely a type of low-flow vascular anomaly. Their curvilinear/branching shape and intense enhancement particularly on T2-weighted FLAIR images distinguish these lesions from tumors.

Radiation doses and diagnostic reference levels for common CT scans in adults in Northwest region of Iran.

This study aims to estimate organ dose and cancer risks, establish region-specific diagnostic reference levels (DRLs), and determine achievable doses (ADs) for common CT procedures in adults in the northwest of Iran. Effective and organ doses were estimated using VirtualDoseCT software in a sample of 480 adult patients who underwent head, sinus, chest, and abdomen-pelvis (AP) CT scans. The guidelines provided by the BEIR VII report were utilized to estimate cancer risks. Effective and organ doses for specific procedures were determined, with the highest mean organ dose being observed in the brain during head CT examinations, with a value of 54.02mGy. It was observed that the lungs in chest examinations and the colon in AP examinations had the highest risk of cancer, with rates of 30.72 and 21.37 per 100,000 persons, respectively. Higher cancer risk values were generally exhibited by females compared to males. The DRLs for common CT examinations were established as follows: Head CT (CTDIvol 41 mGy, DLP 760 mGycm), Sinus CT (CTDIvol 16 mGy, DLP 261 mGycm), Chest CT (CTDIvol 8 mGy, DLP 287 mGycm), and AP CT (CTDIvol 9 mGy, DLP 508mGycm). Significant variations in dose distribution among facilities were identified, indicating the need for optimization. The study highlights the importance of minimizing radiation exposure to critical organs and promoting patient safety in CT examinations. The establishment of region-specific DRLs and ADs can help optimize radiation doses and reduce cancer risks for patients.

Cerebral Vascular Accidents Occurring During Type 2 Diabetes in the CHU-PG Internal Medicine Department

Introduction: Diabetes is a major cause of death and disability worldwide. It also represents a significant risk factor for stroke. The excess stroke risk associated with diabetes is significantly higher in women than in men, independent of sex differences observed for other major cardiovascular risk factors. Materials and Method: This retrospective descriptive study was carried out in the Internal Medicine department of Point G University Hospital from January 2008 to December 2012. Included in this work were all type 2 diabetic patients hospitalized in the department during the duration of the study, presenting clinical signs of sentivo-motor deficit with performance of a brain CT scan. Results: At the end of this work, 358 patients were hospitalized, among whom 19 cases of established stroke were recorded, i.e. a frequency of 5.3%. Dilated cardiomyopathy represented 36.8% of cases. LVH and repolarization disorders accounted for 21.1% each. Composite ischemic stroke represented 79% of cases followed by mixed stroke or 16% of cases. The evolution was marked by after-effects such as left hemiparesis 36.8%, right hemiplegia 10.5% and death in 5.3% of cases. Dyslipidemia 82%, hypertension 84.21% were the risk factors most associated with diabetes. Conclusion: Strokes are common in type 2 diabetic patients. Their prevention requires better management of diabetes and its associated risk factors.

More Is Actually Less: Practitioners' Perspective of Unnecessary Medical Testing in Saudi Arabian Emergency Departments.

Background Theoveruse of medical testing, be it ancillary testing or imaging, has been identified as a problem in all healthcare systems in the world. As the Kingdom of Saudi Arabia marches towards the 2030 vision of healthcare transformation, we have sought to get a perspective on medically unnecessary tests being conducted in Saudi Arabian emergency departments (EDs), the reasons behind this phenomenon, and possible solutions to it. Methods This is a cross-sectional survey among emergency medicine physicians (EMPs) working in Saudi Arabian EDs, taken through a self-filled online questionnaire, about their ordering habits, what they believe to be unnecessary testing in their practice, the practice of their colleagues, and other Saudi EMPs as a whole. Subjects have also been asked about the reasons why such practices are occurring and possible solutions to reduce such overuse of unnecessary tests in Saudi EDs. Results A total of 182 EMPs were surveyed from the different regions of the Kingdom, and CT head for patients presenting with asymptomatic stroke, and asymptomatic TBI were the most overused scans (both 44%). The most overused advanced body imaging was CT kidney-ureters-bladder (KUB) at 41.5%, while the most overused ancillary tests were complete blood count (CBC) and liver transaminases. The most common reason for the practice was found to be fear of medicolegal proceedings (70.9%). Continuous education of EMPs and increasing ED staffing were found to be the most helpful solutions to reduce unnecessary testing in the ED (70.9% and 67%, respectively). Conclusion It is clear from our data that overuse of medical tests and imaging is still a prominent practice. CT head in asymptomatic patients seems to be the most commonly overused imaging in Saudi EDs. Ancillary testing and unnecessary ordering of CBCs and transaminases seem to stem from fear of EMPs from legal consequences. More control over medical test ordering needs to be exercised to reduce these practices.

Out-of-pocket cost modeling of adjuvant radiation therapy duration in standard-of-care treatment of glioblastoma across Medicaid and Medicare plans.

2045 Background: The optimal radiation treatment (RT) length (6 weeks of 60 Gy in 30 fractions versus 3 weeks of 40 Gy in 15 fractions) for older adults with glioblastoma is debatable, with Level 1 evidence (PMID 15051755) revealing no difference in survival between RT regimens. However, there remains a paucity of evidence describing the role of insurance on out-of-pocket (OOP) costs for patients undergoing varying lengths of RT. This project aims to quantify expenses by insurance plans, enhancing transparency in treatment cost understanding. Methods: We utilized the National Comprehensive Cancer Network guidelines to determine the standard treatment protocol, including 30-fraction or 15-fraction RT with concurrent and post-radiation temozolomide for 12 cycles. The model assumes a Medicare- and/or Medicaid-eligible patient ≥ 65 years of age with glioblastoma. The total aggregate out-of-pocket (OOP) costs were determined from the sum of treatment costs, deductibles, and copays/coinsurance based on Medicaid, Original Medicare, Medigap Plan G, and Medicare Part D Rx plan over a two-year time horizon (not adjusted for inflation). All procedures were assumed to take place within the premises of an Ohio hospital. Results: Treatment charges include neurosurgery, neuro-oncology, and radiation oncology initial consultation, follow-up visits, diagnostic head CT, MRI, craniotomy with maximum safe resection, surveillance brain MRI, temozolomide, antiemetics, prophylactic TMP-SMX, weekly CBC, and tumor treating fields. RT-specific treatment charges include treatment planning, simulation and verification, RT delivery, and on-treatment visits. Original Medicare beneficiaries face an OOP cost of 20% for Medicare Part B claims with no cost cap for approved procedures after the deductible. Medications are covered under Medicare Part D with copays. This results in a total OOP treatment charge of $4,454.01 for 30 fractions and $3,913.86 for 15 fractions. Medigap Plan G beneficiaries face a total OOP charge of $2,387.22 for 30 fractions and $2,369.61 for 15 fractions. For Medicaid beneficiaries (assuming all treatments are approved by Medicaid), all expenses are covered without limit, resulting in no OOP expense for either treatment plan. Conclusions: Three-week versus six-week RT for GBM reduces OOP costs facing patients by 10%. By understanding the financial implications, healthcare providers, policymakers, and patients can make informed decisions about treatment options, and healthcare systems can develop strategies to mitigate the economic burden associated with GBM care.

PEDIATRIC OCULAR TRAUMA MANAGEMENT: A CASE STUDY OF EFFECTIVE INTRA-ORBITAL FOREIGN BODY IOFB EXTRACTION

Highlights: The rare nature of Orbitocranial Injury with Intraorbital Foreign Body (IOFB). Utilizing a 3D Head CT Scan to ascertain the precise location of the IOFB and its impact on anatomical structures is pivotal in shaping immediate treatment strategies, thereby reducing the potential for complications. Abstract: Introduction: Penetrating intraorbital foreign body (IOFB) injuries are a rare form of traumatic injury. Recognized as a surgical emergency, meticulous history-taking and a thorough examination are essential for determining the trauma's mechanism and cause, facilitating accurate diagnosis and effective disease management. Case Illustration: In the emergency room, a 5-year-old female patient was presented with a craniofacial injury resulting from an IOFB. An evacuation procedure, conducted through a subsidiary incision, was performed to extract the foreign body. Interestingly, the object removed from the orbital cavity was a plastic foreign body, initially suspected to be a fractured orbital bone. Discussion: The clinical presentation, management, and outcomes of orbital foreign body injuries can differ based on the material composition of the foreign body. In cases of intraorbital foreign body trauma, the primary treatment goal is foreign body removal. Conclusion: Precise and accurate initial management in the emergency department is crucial. Early diagnosis, aided by a 3D head CT scan, is instrumental in locating the IOFB and identifying the involved anatomical structures. This, in turn, enables timely treatment decisions to minimize the risk of complications.

Assessing the effectiveness of artificial intelligence (AI) in prioritising CT head interpretation: study protocol for a stepped-wedge cluster randomised trial (ACCEPT-AI)

IntroductionDiagnostic imaging is vital in emergency departments (EDs). Accessibility and reporting impacts ED workflow and patient care. With radiology workforce shortages, reporting capacity is limited, leading to image interpretation delays....

Head Injury Evaluation and Ambulance Diagnosis (HOME) Study protocol: a feasibility study assessing the implementation of the Canadian CT Head Rule in the prehospital setting

IntroductionTraumatic brain injury (TBI) is a common presentation in the prehospital environment. At present, paramedics do not routinely use tools to identify low-risk patients who could be left at scene...

The relationship between sphenoidal sinus and sella turcica morphometry in the Turkish population: a retrospective study.

The anatomical position of the sphenoidal sinus (SS) is very important for neurosurgeons because of the transsphenoidal approach to the pituitary gland. Therefore, the aim of this study was to determine the volume and shape of the SS and its relationship with the morphometry of the sella turcica. This study included CT images of 282 males and 258 females with a mean age of 50.52 years (range 18-75) who underwent head CT. The morphometric values of the sella turcica and the volume of the SS were measured on the included radiologic images. Measurements were made on the sagittal slice closest to the midline in T1 sequence. Morphometric measurements were made with Micro Dicom Viewers software program and volume measurements were made with ITK SNAP software program. In this study, 4 types of SS shapes were obtained in the whole population: amorphous, pentagonal, triangular and quadrilateral. The mean SS volume was 7055.88 mm3 in males and 5694.48 mm3 in females and a statistically significant difference was observed (p < 0.001). In addition, a statistically significant difference was found between the sexes in the width and surface area parameters of the sella turcica (p < 0.05). In this study, the morphometric relationship between the shape of the sinus sphenoidale and sella turcica was demonstrated between men and women. In particular, the shape of the sinus sphenoidale was found to be anthropometrically different between men and women in the Turkish population. It is hypothesised that the data obtained in our study will guide surgeons performing transsphenoidal approach.

Arachnoid Cyst Burst in Presence of Contralateral Nomura IV Subdural Hematoma: After Effects of Traumatic Kickback and Intracranial Pressure

Intracranial arachnoid cysts are benign fluid-filled sacs located between the brain and the arachnoid membrane. Their rupture is an uncommon event, often associated with trauma or an underlying pathology. Here, we present a case of a 61-year-old woman with a ruptured arachnoid cyst coinciding with a contralateral subdural hematoma. The patient manifested a persistent headache, balance disorders and right facial paresthesia. Brain CT study showed a right temporo-polar cyst (known to the patient) and a right parietal chronic Subdural Hematoma (cSDH). Although the kickback may contribute to bursting or weakening of cyst integrity, the CT-density pattern of the cSDH, according to Nomura classification is to be considered associated with increased fibrinolysis activity and potentially with parenchyma compression. This case highlights the importance of considering arachnoid cyst rupture as a potential indirect consequence of head trauma kickback, particularly in the presence of contralateral intracranial hemorrhage.

Arachnoid Cyst Burst in Presence of Contralateral Nomura IV Subdural Hematoma: After Effects of Traumatic Kickback and Intracranial Pressure

Intracranial arachnoid cysts are benign fluid-filled sacs located between the brain and the arachnoid membrane. Their rupture is an uncommon event, often associated with trauma or an underlying pathology. Here, we present a case of a 61-year-old woman with a ruptured arachnoid cyst coinciding with a contralateral subdural hematoma. The patient manifested a persistent headache, balance disorders and right facial paresthesia. Brain CT study showed a right temporo-polar cyst (known to the patient) and a right parietal chronic Subdural Hematoma (cSDH). Although the kickback may contribute to bursting or weakening of cyst integrity, the CT-density pattern of the cSDH, according to Nomura classification is to be considered associated with increased fibrinolysis activity and potentially with parenchyma compression. This case highlights the importance of considering arachnoid cyst rupture as a potential indirect consequence of head trauma kickback, particularly in the presence of contralateral intracranial hemorrhage.

Advancements in AI-driven diagnostic radiology: Enhancing accuracy and efficiency

Background: Healthcare delivery has transformed significantly with the integration of clinical decision support systems (CDS) and medical imaging. Convolutional neural networks (CNNs), a type of artificial intelligence (AI) algorithm, have exhibited remarkable accuracy in discerning intricate patterns and anomalies within medical images, surpassing human capability. Aim: This study aims to explore the impact of AI augmentation on diagnostic tasks, focusing on enhancing sensitivity, accuracy, and interrater agreement across various medical conditions. Additionally, it seeks to investigate how AI simplifies complex processes and integrates with existing technologies, extending its role in CDS systems beyond diagnostic accuracy. Methods: The research examines the effectiveness of AI in interpreting CT imaging and diagnosis. Furthermore, it assesses the integration of AI with radiology to enhance the detection of cerebral hemorrhages on head CT scans in time-pressed clinical settings. The research was performed using search engines such as google scholar and Pubmed. Results: The findings indicate that AI augmentation significantly enhances diagnostic capabilities, improves physician confidence, reduces interpretation time, and optimizes workflow efficiency. AI not only improves accuracy but also simplifies processes, thereby revolutionizing healthcare delivery. Conclusion: As artificial intelligence continues to evolve, its revolutionary potential in healthcare becomes increasingly evident.