Cerebral Computed Tomography Research Articles

Assessment of cerebrovascular disease with computed tomography in COVID-19 patients: correlation of a novel specific visual score with increased mortality risk

PurposeCerebrovascular disease (CVD) is considered a major risk factor for fatal outcome in COVID-19. We aimed to evaluate the possible association between computed tomography (CT) signs of chronic CVD and mortality in infected patients.Materials and methodsWe performed a double-blind retrospective evaluation of the cerebral CT scans of 83 COVID-19 patients looking for CT signs of chronic CVD. We developed a rapid visual score, named CVD-CT, which summarized the possible presence of parietal calcifications and dolichosis, with or without ectasia, of intracranial arteries, areas of chronic infarction and leukoaraiosis. Statistical analysis was carried out with weighted Cohen’s K test for inter-reader agreement and logistic regression to evaluate the association of in-hospital mortality with CVD-CT, chest X-ray (CXR) severity score (Radiographic Assessment of Lung Edema-RALE) for radiological assessment of pulmonary disease, sex and age.ResultsCVD-CT (odds ratio 1.6, 95% C.I. 1.2-2.1, p = 0.001) was associated with increased risk of mortality. RALE showed an almost significant association (odds ratio 1.05, 95% C.I. 1-1.1, p 0.06), whereas age and sex did not.ConclusionCVD-CT is associated with risk of mortality in COVID-19 patients. The presence of CT signs of chronic CVD may be correlated to a condition of fragility of the circulatory system, which constitutes a key risk factor for death in infected patients.

Circadian rhythms of melatonin, cortisol, and clock gene expression in the hyperacute phase of wake-up stroke: study design and measurement.

Circadian rhythms of melatonin, cortisol, and clock gene expression in the hyperacute phase of wake-up stroke: study design and measurement.

Unusual enhancement patterns from inadvertent arterial contrast injection during CT angiography

Investigation of cerebrovascular incidents typically involve non-contrast intracranial computed tomography (CT) and CT angiography (CTA) of the arch of aorta to vertex with or without CT perfusion. Though rare, inadvertent direct arterial contrast injection is a potentially serious complication which can alter contrast distribution and timing resulting in non-diagnostic intracranial studies. If unnoticed, they can be misinterpreted as pathology leading to further unnecessary investigations, increasing patient radiation dose and delaying appropriate management.To date, there have been two documented case reports describing arterial contrast injection in cerebral CTA or CT perfusion. We describe two further cases of arterial contrast administration. Furthermore, by describing various contrast enhancement patterns in normal and variant anatomy – such as bovine aortic arch, vertebral artery dominance, posterior inferior cerebellar artery (PICA) continuation of vertebral artery and fetal posterior communicating artery (PCOM) – we hope to improve clinician recognition of inadvertent arterial contrast injection in a timely fashion.

Management of Hydrocephalus in Brain Tumors to Fann Teaching Hospital in Dakar

Introduction: Tumoral hydrocephalus (TH) is an increasingly common pathology in our service. It is a diagnostic and especially therapeutic emergency. Its treatment is mainly surgical and the prognosis closely depends on the type of tumor. The objective of our study was to determine the efficiency of the various bypass procedures used for the treatment of hydrocephalus in patients with brain tumors. Patients and Methods: We conducted a retrospective study of 146 patients with tumoral hydrocephalus, collected from 1 January 2014 to 31 December 2018 (5 years) in the Neurosurgery Department of Fann Teaching Hospital. Results: The frequency of tumoral hydrocephalus cases in our series was rated at 25% of all hydrocephalus operated during this period with 29.2 cases per year. The sex ratio was 1.39 with a mean age of 35 years (range from 1 month to 77 years). Children under 15 accounted for 53.42%. Cerebral computed tomography (CT) was performed in 93.75% of patients and magnetic resonance imaging (MRI) in 20.83%. Tumors of the posterior fossa (PFT) accounted for 60.3% followed by ventricular tumors 15.5% and sellar 7.5%. Surgically, endoscopic third ventriculostomy (ETV), ventriculoperitoneal shunt (VPS), and external ventricular derivation (EVD) were performed respectively in 58.24%, 30.13% and 10.27% of cases. The surgical average time was 3 days with extremes of 24h and 150 days. Two patients benefited from a ventriculo –atrial shunt (VAS) complementary to the persistence of hydrocephalus. The main complications were ascites of great abundance in 4 patients and infections in 10 patients (6.84%). In our series, 30.82% (45 patients) received additional etiological treatment. The average time between the two interventions was 14 days. We noted 17 cases of death including 7 cases attributed to hydrocephalus. Conclusion: The endoscopic third ventriculostomy is currently the gold standard as an alternative to other methods in the management of tumoral hydrocephalus, but remains a palliative treatment. Etiological treatment is the core therapeutic approach for this hydrocephalus.

A RARE CASE OF NEUROENTERIC CYST INVOLVING THE ANTERIOR FOSSA; REPORT OF A CASE AND REVIEW OF LITERATURE

Neuroenteric cysts, are rare benign endodermal lesions which mostly occur in the central nervous system. We report a case of a neuroenteric cyst in a 30-year-old man who presented with rhinoliquorrhea at the ENT department. After clinical examination, a semisolid mass was revealed in the left nostril. The Computer Tomography Scan revealed a frontal ethmoidal nasal meningoencephalocele with inferior extension into the left nostril. Gadolinium-enhanced T1-weighted MR images showed a well-defined frontal mass with ring-like enhancement and extension into the cribriform plate of the ethmoid bone and into the left nostril. The lesion measured 10/10/20 mm. The tumor was totally resected using a unilateral subfrontal approach. At five months’ follow-up, the patient showed significant amelioration of symptoms and remission of cerebrospinal fluid leakage. Native and Contrast-enhanced Cerebral Computer Tomography, as well as Magnetic Resonance Imaging showed total surgical resection of the cyst. Supratentorial neurenteric cysts involving the anterior fossa are rare. Intracranial neurenteric cysts should be differentiated by any well-demarcated cystic tumors. The gold standard treatment remains complete surgical resection with favorable outcome.

Computed Tomography Perfusion Imaging Quality Affected by Different Input Arteries in Patients of Internal Carotid Artery Stenosis.

BackgroundThe aim of this study was to explore the influence of different input arteries on the parameters of computed tomography (CT) perfusion imaging for patients with different degree of stenosis of internal carotid artery (ICA).Material/MethodsForty patients were enrolled in the present study and divided into mild, moderate, severe stenosis and occlusion groups respectively with each 10 patients in each group. In reconstruction of cerebral CT perfusion (CTP) images, each raw perfusion image was reconstructed 3 times based on different reference input artery, including bilateral middle cerebral artery (MCA) and basilar arteries (BA). Region of interest (ROI) was drawn in the central territories of bilateral anterior cerebral artery, middle cerebral artery and posterior cerebral artery. And regional cerebral blood flow (rCBF) regional cerebral blood volume (rCBV), mean transit time (MTT), time to peak (TTP) and delay time (DT) were obtained from those ROI corresponding perfusion images.ResultsIn patients with mild and moderate ICA stenosis, there was no significant difference of perfusion parameters based on different input arteries (P>0.05). However, in severe ICA stenosis and occlusion CBF, MTT, and DT were significant different in affect side of the MCA group compared to the others (P<0.05).ConclusionsLarge intracranial artery can be selected as the input artery for patients with mild to moderate ICA stenosis, while for patients with severe stenosis and occlusion of ICA, the contra lateral middle cerebral artery or basilar artery would be better choice.

Direct Oral Anticoagulant Treatment and Mild Traumatic Brain Injury: Risk of Early and Delayed Bleeding and the Severity of Injuries Compared with Vitamin K Antagonists.

The risk of intracranial hemorrhage (ICH) in patients taking direct oral anticoagulants (DOACs) after mild traumatic brain injury (MTBI) is unclear. To assess the differences in the risk of developing early, delayed, and comprehensive bleeding after MTBI among patients treated with DOACs as compared with those treated with vitamin K antagonists (VKAs). All MTBI patients taking oral anticoagulants in our emergency department between June 2017 and August 2018 were included. All patients on oral anticoagulants underwent immediate cerebral computed tomography (CT) and a second CT scan after 24h of clinical observation. There were 451 patients enrolled: 268 were on VKAs and 183 on DOACs. Of the DOAC-treated patients, 7.7% (14/183) presented overall intracranial bleeding, compared with 14.9% (40/268) of VKA-treated patients (p=0.026). Early bleeding was present in 5.5% (10/183) of DOAC-treated patients and in 11.6% (31/268) of VKA-treated patients (p=0.030). Multivariable analysis showed that VKA therapy (odds ratio [OR] 2.327), high-energy impact (OR 11.229), amnesia (OR 2.814), loss of consciousness (OR 5.286), Glasgow Coma Scale score<15 (OR 4.719), and the presence of lesion above the clavicles (OR 2.742) were associated with significantly higher risk of global ICH. A nomogram was constructed to predict ICH using these six variables. Discrimination of the nomogram revealed good predictive abilities (area under the receiver operating characteristic curve: 0.817). DOAC-treated patients seem to have lower risk of posttraumatic intracranial bleeding compared with VKA-treated patients.

Left Subclavian-Bilateral External Carotid Artery Bypass for Symptomatic Carotid Artery Dissection Secondary to Open Repair of Type A Aortic Dissection.

Symptomatic carotid dissection, secondary to surgical repair of Stanford type A acute aortic dissection (AAD), requires prompt intervention. A 56-year-old man who underwent total arch replacement with frozen elephant trunk for AAD presented with left hemiplegia and unilateral spatial neglect 16 h after the surgery. Cerebral computed tomography (CT) revealed no fresh lesions, and CT angiography showed severe bilateral carotid dissection. The patient’s neurological symptoms improved soon after left subclavian-bilateral external carotid artery bypass to correct symptomatic severe right cerebral ischemia. Therefore, this technique can be a good option for symptomatic carotid dissection in selected patients.

Statistical properties of cerebral CT perfusion imaging systems. Part I. Cerebral blood volume maps generated from nondeconvolution-based systems.

The development and clinical employment of a computed tomography (CT) imaging system benefit from a thorough understanding of the statistical properties of the output images; cerebral CT perfusion (CTP) imaging system is no exception. A series of articles will present statistical properties of CTP systems and the dependence of these properties on system parameters. This Part I paper focuses on the signal and noise properties of cerebral blood volume (CBV) maps calculated using a nondeconvolution-based method. The CBV imaging chain was decomposed into a cascade of subimaging stages, which facilitated the derivation of analytical models for the probability density function, mean value, and noise variance of CBV. These models directly take CTP source image acquisition, reconstruction, and postprocessing parameters as inputs. Both numerical simulations and in vivo canine experiments were performed to validate these models. The noise variance of CBV is linearly related to the noise variance of source images and is strongly influenced by the noise variance of the baseline images. Uniformly partitioning the total radiation dose budget across all time frames was found to be suboptimal, and an optimal dose partition method was derived to minimize CBV noise. Results of the numerical simulation and animal studies validated the derived statistical properties of CBV. The statistical properties of CBV imaging systems can be accurately modeled by extending the linear CT systems theory. Based on the statistical model, several key signal and noise characteristics of CBV were identified and an optimal dose partition method was developed to improve the image quality of CBV.

Acute Stroke Treatment in Patients with Basilar Artery Occlusion: A Single-Center Observational Study

Background: Acute ischemic stroke (AIS) due to basilar artery occlusion (BAO) represents 1–4% of all ischemic strokes. BAO results in strokes associated with a high risk of a poor functional outcome and, in 86–95% of the untreated cases, it results in death because of the vital cerebral structures involved. Diagnosis can be delayed because of the variability in presenting symptoms, and acute treatment is often attempted even beyond 6 h from symptoms onset because of the high risk of a fatal prognosis. Objective: In this observational study, we retrospectively analyzed patients with AIS due to BAO referred to the stroke center of the University Hospital of Messina. We aimed to assess prognostic factors and to evaluate the association between clinical outcome and posterior circulation Alberta Stroke Program Early CT Score (pc-ASPECTS) and collateral status. Method: BAO was confirmed by cerebral computed tomography (CT) angiography or cerebral angiography. All patients underwent CT scan and magnetic resonance imaging (MRI). We assessed the pc-ASPECTS on diffusion-weighted imaging (DWI) MR images and the Posterior Circulation Collateral Score (PC-CS) for every patient. Functional outcome was assessed at 3 months using the modified Rankin Scale (mRS). Results: The study population consisted of 27 patients; 16 males and 11 females. The mean age was 66 (±14) years. We observed a favorable outcome (mRS 0–3) in 40.7% of cases, 25.9% reached mRS 0–2, and 29.6% had a poor clinical outcome (mRS 4–5). Patient survival was 70.4%, whereas 8 patients died (29.6%). In 7 patients, pc-ASPECTS was ≥7. According to the PC-CS, 33.3% had moderate collaterals and 63.0% had good collateral status prior to receiving the treatment. Favorable outcome was significantly associated with age, NIHSS score at admission, pc-ASPECTS, hypercholesterolemia, and female sex but not with the other risk factors. Conclusions: In our study, we found that younger age, low NIHSS score at admission, and high pc-ASPECTS, but not onset to treatment time, are associated with a favorable clinical outcome. Transferred patients did not have a significantly poorer outcome. These findings confirm that acute stroke treatment improves clinical outcome in BAO patients, in spite of a delayed diagnosis and an extended therapeutic window, considering lesion volume and localization in DWI MRI.

Spontan subaraknoid kanamayı takiben gelişen vazospazm sonrası serum ve serebrospinal sıvıda endotelin-1 düzeyleri

Purpose: The aim of the present study was to analyse endothelin-1 levels in serum and cerebrospinal fluid samples in patients with subarachnoid haemorrhage and evaluated the effects on vasospasm. Material and Methods: The patients were selected among those who referred to intensive care unit of neurosurgery department within several hours following subarachnoid haemorrhage. Subarachnoid haemorrhage was diagnosed through cerebral computed tomography and lumbar punction. First neurological examinations of the patients were evaluated according to Hunt-Hess classification and the blood quantity was detected by cerebral computed tomography according to Fisher classification. Results: Serum and cerebrospinal fluid samples of 20 patients enrolled into the present study were collected at days 1, 3, 5, and 7 after subarachnoid haemorrhage. Ten individuals without any vascular diseases, nervous system trauma or inflammatory disease were enrolled into the study as the control group. Samples were analyzed through micro-ELISA method and endothelin-1 levels in the serum and cerebrospinal fluid were detected. According to Hunt-Hess classification, 6 patients were evaluated as Stage I, 10 patients as Stage II, 2 patients as Stage III and 2 patients as Stage IV. Seventeen patients were detected as Stage II whereas 3 patients were Stage IV according to Fisher classification. Vasospasm was detected in cases 3, 6, 11 and 18 by digital subtraction angiography. Conclusion: It was determined that as the Fisher and Hunt-Hess classifications increased, the risk of cerebral vasospasm increased. The present study revealed that endothelin-1 levels increase after subarachnoid haemorrhage and Endothelin-1 particularly may play an important role in the vasospasm following spontaneous subarachnoid haemorrhage.

Intraosseous contrast administration for emergency computed tomography: A case-control study.

ObjectiveThe aim of the study was to evaluate the feasibility of intraosseous (i.o.) contrast media injection (CMI) for emergency computed tomography (CT) of severe trauma and the associated image quality compared to intravenous (i.v.) CMI.Materials and methodsThe authors retrospectively analysed objective (contrast-to-noise ratio (CNR)) and subjective (4-point Likert scale) image quality of CTs after i.o. (n = 4, mean age (y) 57.0±11.0) versus i.v. (n = 20, mean age (y) 58.8±4.4) CMI. All patients underwent a native head CT scan, a cerebral CT angiography (CTA) and CTA of the supra-aortic vasculature as well as a chest and abdominal CT scan in the venous phase; one patient with an i.o. access additionally received a CTA of the lower limbs. Electronic patient records have been reviewed to determine i.o. access related complications.ResultsBoth groups were consistent in age, heart rate, scan parameters including the flow rate of the contrast agent, resulting in comparable radiation dose levels. The image noise and CNR had no significant difference between the two groups. Scoring the delineation of the main vessels after i.o. CMI showed no significant difference to the i.v. group. There were no CT or i.o. access related complications observed.ConclusionThe i.o. access is a safe and suitable alternative for emergency CMI in CT. Using established protocols good to very good image quality can be achieved, comparable to i.v. CMI. We show for the first time, that i.o. CMI is also feasible for CTA imaging of the head and neck region as well as of pelvic and leg vessels.

Augmentation of Electrocardiographic QRS R-Amplitude Precedes Radiocontrast-Induced Hypotension during Mobile Computed Tomography Scanning.

Although intravenous administration of contrast media may trigger a variety of adverse reactions, sedated patients undergoing computed tomography (CT) scanning usually are not able to report their symptoms, which may delay detection of adverse reactions. Furthermore, changes in vital signs cannot be typically measured during mobile CT scanning, which worsens the situation. We aimed to characterize contrast-related hemodynamic changes that occur during mobile CT scanning and predict sudden hypotension based on subtle but robust changes in the electrocardiogram (ECG). We analyzed the digitized hemodynamic data of 20 consecutive patients who underwent clipping of a cerebral artery aneurysm and contrast-enhanced CT scanning following the surgical procedure. Hemodynamic variables, including ECG findings, invasive blood pressure (BP), pulse oximetry results, capnography findings, cardiac output, and systemic vascular resistance, were monitored simultaneously. We measured morphological changes in ECG-derived parameters, including the R–R interval, ST height, and QRS R-amplitude, on a beat-to-beat basis, and evaluated the correlation between those parameters and hemodynamic changes. After the radiocontrast injection, systolic BP decreased by a median 53 mmHg from baseline and spontaneously recovered after 63 ± 19 s. An increase in QRS R-amplitude (median 0.43 mV) occurred 25 ± 10 s before hypotension developed. The receiver operating characteristic curve showed that a 16% increase in QRS R-amplitude can predict a decrease in systolic BP of >25% (area under the curve 0.852). Increased cardiac output (median delta 2.7 L/min from baseline) and decreased systemic vascular resistance (median delta 857 dyn·s/cm5 from baseline) were also observed during hypotension. During mobile CT scanning, profound but transient hypotension can be observed, associated with decreased vascular resistance. Augmentation of QRS R-amplitude from an ECG represents a sensitive surrogate for onset of a hypotensive episode after contrast injection, thereby serving as a simple and continuous noninvasive hemodynamic monitoring tool.

Irreversible fatal contrast-induced encephalopathy: a case report

BackgroundContrast-induced encephalopathy (CIE) is a well-known complication of iodinated contrast agents during angiography and vascular interventions. It can manifest as hemiparesis, cortical blindness, speech changes, Parkinsonism, confusion, seizure, and coma. Most of the reported CIE cases have been transient and reversible. Irreversible fatal CIE cases have been rarely reported. All the fatal CIE cases reported involved the use of ionic high osmolar contrast agents. Here, we document a heretofore unreported fatal CIE after digital subtraction angiography (DSA) using iopamidol, which is a type of non-ionic monomer low osmolar contrast agent.Case presentationA 71-year-old woman was admitted to our Department of Neurology for tinnitus in the head. The cerebral magnetic resonance angiography (MRA) detected atherosclerotic cerebral arteries and bilateral stenosis of the middle cerebral arteries. The patient underwent DSA for further diagnostic work-up. The total amount of iopamidol used during the procedure was 110 ml. The patient experienced headache during the procedure, followed by dizziness with nausea and vomiting. Despite treatment with anti-oedema medications, her clinical status was gradually deteriorating and ended up with deep coma due to irreversible cerebral oedema which was confirmed by cerebral computed tomography (CT). Finally, the patient died 56 days after the procedure due to irreversible fatal cerebral oedema.ConclusionsThis report documents that iopamidol-induced encephalopathy may not always have a benign outcome and can result in irreversible fatal cerebral oedema.

Septic cerebral thrombosis in neonates: A case report and review of the literature

Introduction: Septic dural-sinus thrombosis is rare; it is one of the most misdiagnosed conditions of our time. It is often associated with a high level of mortality. Especially in neonates who have an underdeveloped immune system and haphazard clinical manifestation. Septic sinus thrombosis frequently involves cavernous sinuses. The superior sagittal sinuses’ involvement is exceptional as it is often associated with a fatal outcome. Studies demonstrate that heparin therapy in sagittal sinus septic thrombosis is unnecessary and that the focus of treatment shall be intravenous antibiotics and early surgical drainage of purulent collections who can be a source of widespread infections. Case Report: We report the case of a three months old boy, without pathological history, admitted in the intensive care unit (ICU) for febrile convulsion resistant to first line therapy. Cerebrospinal fluid analysis results were in favor of pneumococcus pathogens. Cerebral computed tomography (CT) has shown a superior longitudinal sinus thrombophlebitis complicating an encephalitis, with multiple venous infarcts. After which antibiotherapy was changed and anticoagulation added. Six days later, the sedation was stopped to evaluate the neurological state. The patient has shown a persistence of the coma state. After a multidisciplinary discussion, a transcranial Doppler was realized only to confirm the brain death state. The evolution was marked by the death of the patient after three days. Conclusion: In general, cerebral venous thrombosis (CVT) is a disease with complex clinical manifestations, atypical in many patients. If an alteration of consciousness is the main symptom in a CVT patient, the prognosis can be bleak. Most patients with CVT have a good prognosis after early anticoagulant and antibiotherapy. Since cerebral hernia is the most common cause of death in CVT, intensive care should be given special attention to the detection and treatment of focal lesions occupying space.

Correlation between acute myocardial infarction complicated with cerebral infarction and expression levels of MMP-2 and MMP-9.

To investigate the correlation between the acute myocardial infarction (AMI) complicated with cerebral infarction (CI) and expression levels of matrix metalloproteinase-2 (MMP-2) and MMP-9. A total of 50 AMI patients treated in our hospital were enrolled, including 23 AMI patients complicated with CI in the AMI-CI group, and 27 patients with AMI alone in the AMI group. Venous blood was collected from each patient after admission. The serum levels of MMP-2 and MMP-9 were detected via enzyme-linked immunosorbent assay (ELISA), and their mRNA expressions were measured via quantitative Polymerase Chain Reaction (qPCR). The cerebral computed tomography (CT) scan was performed for calculating the CI size. The neurological function was evaluated using the neurological deficit score. The correlations between the levels of MMP-2 and MMP-9 with CI size and neurological deficit score were investigated using Pearson correlation analysis. The expression levels of MMP-2 and MMP-9 in the AMI-CI group were significantly higher than those in the AMI group with significant differences (p<0.05). The mRNA expressions of MMP-2 and MMP-9 in AMI-CI group were also significantly higher than those in the AMI group, and the differences between the two groups were statistically significant (p<0.05). Larger CI size was observed in the AMI-CI group than that in the AMI group, showing a statistically significant difference between the two groups (p<0.05). The neurological deficit score in the AMI-CI group was significantly higher than that in the AMI group, with a statistically significant difference between the two groups (p<0.05). The expression levels of MMP-2 and MMP-9 were positively correlated with the CI size and neurological deficit score in AMI patients complicated with CI. Disease severity of AMI complicated with CI is positively correlated with the expression levels of MMP-2 and MMP-9. Higher expression levels of MMP-2 and MMP-9 are expected to indicate a higher risk of AMI complicated with CI.

Haemorrhage Secondary to Cerebral Aneurysm in a Senegalese Patient with Systemic Lupus Erythematosus: A Case Report

Introduction: Hemorrhage by ruptured cerebral aneurysm is a rare and severe complication of systemic lupus erythematosus (SLE). We reported a case of this complication. Observation: A 24-year-old woman black Senegalese patient was followed in our department since for a systemic lupus with cutaneous and articular involvement and class III and V Lupus nephritis. She was readmitted for acute headache and early postprandial vomiting. The examination showed a meningeal syndrome, a subacute lupus eruption in the trunk, panniculitis and fever. The cerebral computer tomography showed spontaneous haemorrhage from saccular aneurysm. She was managed by immediate aneurysm clipping and medical treatment including bolus of methylprednisolone and immunosuppressive therapy was maintained. The outcome was favourable, but there was neurological damage such as brachial weakness. Conclusion: Hemorrhage by ruptured cerebral aneurysm is a rare and severe complication of SLE. The risk of damage is also significant. Immediate neurosurgical management and aggressive medical treatment may improve the prognosis.

A Singular Manifestation of Contrast-induced Encephalopathy Following Coronary Angiography

Contrast-induced encephalopathy is an uncommon complication of coronary angiography. The clinical presentation may be very puzzling, leading to an unnecessary and hazardous therapy. The prognosis is believed to be benign, with spontaneous resolution. We report a 71-year-old woman with a past medical history of hypertension, type two diabetes and no history of renal disease. She was admitted to our cardiology department with symptoms of recurrent angina. She had a history of unstable angina two years ago and had undergone a percutaneous coronary intervention without incident. Three hours after un-elective coronary angiography, she experienced a sudden, transitory deterioration in her consciousness's level with neurovegetative symptoms (high blood pressure, high temperature). The cerebral Computer Tomography scan ruled out any acute hemorrhagic or ischemic stroke. In less than 24 hours, she recovered spontaneously with a complete resolution of the neurological symptoms.

Case Presentation: Unusual Association Between Possible Bilateral Intraventricular Xanthogranulomas, Postero-inferior Cerebellar Artery Aneurysm and Thrombophilia

Abstract Introduction: Xanthogranulomas are rare, benign, usually asymptomatic, cutaneous tumors most frequently seen in children (juvenile xanthogranulomas). Some lesions can be found accidentally at randomly performed cerebral computer tomography (CT) or magnetic resonance imaging (MRI) or even on autopsy. Case report: We present the case of a 44 year-old woman, known with a thrombophilic disorder (PAI-1 gene mutation, MTHFR C677T and A1298C) on chronic anticoagulant treatment. The onset of symptoms was in 2010, when she presented paresthesia and lower limbs weakness. Two years later the patient presents with severe intermittent headache and left hemicrania and a cerebral angio-MRI is performed showing a left postero-inferior cerebellar artery aneurysm and two choroid plexus intraventricular masses in the lateral ventricles. The patient developed a new symptom, dysarthria in 2014 and in 2015 has multiple episodes of loss of consciousness, interpreted as epileptic seizures. Routine blood tests were within normal range, except for a high cholesterol level. The patient was tested for autoimmune, infectious, endocrine and metabolic diseases that were negative. Surgical treatment and biopsy from the lesion was proposed, however the patient refused both procedures. Conclusions: There is an association between xanthogranulomas localization and the choroid plexus, the most frequent CNS origin being in the trigon of the lateral ventricle. Our case does not resemble with any other case published, mostly because the unusual presentation, symptomatology and the association between xanthogranulomas, thrombophilia and postero-inferior cerebellar artery aneurysm which were never reported before in other cases of xanthogranulomas from the literature.

Impaired cerebral compensatory reserve is associated with admission imaging characteristics of diffuse insult in traumatic brain injury

BackgroundContinuous assessment of cerebral compensatory reserve is possible using the moving correlation between pulse amplitude of intra-cranial pressure (AMP) and intra-cranial pressure (ICP), called RAP. Little is known about the behavior and associations of this index in adult traumatic brain injury (TBI). The goal of this study is to evaluate the association between admission cerebral imaging findings and RAP over the course of the acute intensive care unit stay.MethodsWe retrospectively reviewed 358 adult TBI patients admitted to the Addenbrooke’s Hospital, University of Cambridge, from March 2005 to December 2016. Only non-craniectomy patients were studied. Using archived high frequency physiologic signals, RAP was derived and analyzed over the first 48 h and first 10 days of recording in each patient, using grand mean, percentage of time above various thresholds, and integrated area under the curve (AUC) of RAP over time. Associations between these values and admission computed tomography (CT) injury characteristics were evaluated.ResultsThe integrated AUC, based on various thresholds of RAP, was statistically associated with admission CT markers of diffuse TBI and cerebral edema. Admission CT findings of cortical gyral effacement, lateral ventricle compression, diffuse cortical subarachnoid hemorrhage (SAH), thickness of cortical SAH, presence of bilateral contusions, and subcortical diffuse axonal injury (DAI) were all associated with AUC of RAP over time. Joncheere-Terpstra testing indicated a statistically significant increase in mean RAP AUC across ordinal categories of the abovementioned associated CT findings.ConclusionsRAP is associated with cerebral CT injury patterns of diffuse injury and edema, providing some confirmation of its potential measurement of cerebral compensatory reserve in TBI.