Horn Of Lateral Ventricle Research Articles

Diagnostic Accuracy of Posterior/Anterior Periventricular WMH Ratio to Differentiate CAA From Hypertensive Arteriopathy.

Periventricular white matter hyperintensities (PVWMHs) in cerebral amyloid angiopathy (CAA) have been reported posterior predominant using semiautomated segmentation method and logarithmic transformation. We aimed to compare PVWMH extent and posterior/anterior distribution between patients with CAA and patients with hypertensive arteriopathy with radiological tools available in daily practice. We retrospectively analyzed confluent PVWMH directly adjacent to lateral ventricles on axial FLAIR (fluid-attenuated inversion recovery) from 108 patients with CAA and 99 patients with hypertensive arteriopathy presenting with hemorrhage-related symptoms consecutively recruited in our stroke database (Nîmes University Hospital, France) between January 2015 and March 2022. For each of the left (L), right (R), anterior (A), and posterior (P) horns of lateral ventricles, the maximal distance between the outer PVWMH border and ventricle border was measured. The sum of anterior left PVWMH and anterior right PVWMH, and posterior left PVWMH and posterior right PVWMH resulted in anterior and posterior extent, respectively. Compared with hypertensive arteriopathy, patients with CAA were older (median, 77 versus 71; P=0.0010) and less frequently male (46% versus 64%; P=0.012) and had less frequent hypertension (45% versus 63%; P=0.013) and more chronic hemorrhages (P<0.0001). CAA showed slightly more extensive anterior right PVWMH (median, 6.50 versus 5.90 mm; P=0.034), far more extensive (all P<0.0001) posterior left PVWMH (median, 13.95 versus 6.95 mm), posterior right PVWMH (median, 14.15 versus 5.45 mm), posterior (median, 27.95 versus 13.00 mm), and total (median, 39.60 versus 24.65 mm) PVWMH, and higher posterior/anterior ratios (median, 1.82 versus 1.01). Age-/sex-adjusted model predicting CAA incorporating total PVWMH extent and posterior/anterior ratios for the given score (-4.3683+0.0268×PVWMH-T+0.3749×posterior/anterior PVWMH ratio+0.0394×age+0.3046 when female) showed highest area under the curve (0.76 [0.70-0.83]), with a 72% [62.50-80.99] sensitivity and 76% [67.18-84.12] specificity. Values above the optimal threshold of 0.22 for the score showed a crude relative risk of 2.75 (2.26-2.37; P<0.0001). Severe posterior PVWMH and high posterior/anterior PVWMH ratio assessed by radiological tools used in daily practice are associated with probable CAA versus hypertensive arteriopathy. URL: https://www.clinicaltrials.gov; Unique identifier: NCT05486897.

Moving silicone oil particles in the ventricle: a case report and updated review

BackgroundThe movement of intraventricular silicone oil observed in the supine position is extremely rare. Herein, we describe a patient who presented with dynamically moving silicone oil particles in the ventricle when changing position and provide an updated review of this phenomenon.Case presentationWe report a case of a 70-year-old woman who presented with intraventricular hyperdensities that were occasionally found on brain computed tomography (CT). Initial nonenhanced brain CT demonstrated nondependent hyperdensities in the bilateral anterior horns of the lateral ventricles, the third ventricle, and the right suprasellar cistern, mimicking an intraventricular hemorrhage. Further brain magnetic resonance imaging (MRI) in the supine position revealed abnormal signals in the bilateral anterior horns of the lateral ventricles, the posterior horn of the right lateral ventricle, the third ventricle, the right suprasellar cistern, and the bilateral eyeballs, with isosignal intensities surrounded by low-signal chemical shift artifacts on T1-weighted imaging and variable signals (hypo- or hyperintensity) on T2-weighted imaging. The lesion in the anterior horn of the right ventricle largely moved to the posterior horn of the ipsilateral ventricle. The final craniocervical CT angiography showed that the lesion in the posterior horn had moved back to the anterior horn of the right lateral ventricle. These features were consistent with intraventricular silicone oil migration. The final spinal MRI did not demonstrate a migration of silicone oil into the spinal subarachnoid space.Discussion and conclusionsThis case report describes a dynamic process of silicone oil displacement in the supine position and provides a comprehensive imaging presentation. The moving pattern and a characteristic chemical shift artifact on MRI are key to the diagnosis and may help prevent unnecessary examinations or intervention.

Rare Case of Young Patient with Intraventricular Angiomatous Meningioma

Pediatric meningiomas are rare and account for only 2.2% of CNS tumors. In this age group, they are more frequently located in atypical sites, such as, mainly, the ventricular system, with a frequency of 8.8 to 13.6%. Adding this to the fact that the angiomatous subtype constitutes only 2.1% of all meningiomas, the rarity of the case reported here i s corroborated. We report a 17-year-old female patient diagnosed with intraventricular angiomatous meningioma; she underwent surgical resection of the tumor in the body and frontal horn of the right lateral ventricle, and there was no neurological sequela. With a follow-up of 4 years, there was no recurrence and the patient had clinical stability. Intraventricular tumors usually have slow growth and reach considerable size until they cause symptoms and then are diagnosed. In addition, the tumor’s deep location and proximity to eloquent areas make such tumors an neurosurgical challenge. The angiomatous subtype, due to the presence of hypervascularization (consisting of more than 50% of vascular components), may, in some cases, hinder surgical resection as well as be erroneously diagnosed. However, surgical treatment aimed at total resection of the lesion remains the conduct of choice in the case reported here, especially in patients in the first two decades of life, in which the use of radiation is avoided. Specifically when it comes to the surgery, we chose a transcallosal approach that allows a good transoperative visualization of the lesion when located in the body and frontal horn of the lateral ventricle.

Morphometric Study of Frontal Horn of Lateral Ventricle of Brain and Its Correlation with Age, Gender and Side among Adults in the University of Gondar Comprehensive Specialized Hospital, Gondar, Northwest Ethiopia, 2019

Background: Knowledge of the frontal horn size is necessary for the initial and precise analysis of Ventriculomegaly. Therefore, having a baseline reference value of the frontal horn size will be beneficial in a huge vary of medical pathologies. The purpose of this study was to determine the frontal horn of lateral ventricle size and its correlation with age among adult patients in the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, 2019. Methods: Hospital-based cross-sectional study design was conducted on 169 patients in the age group of 20-79 years in the University of Gondar Comprehensive Specialized Hospital. The study participants were assessed by way of structured questionnaires and checklists. Radiological residents were performed computerized tomography measurements of the frontal horn of lateral ventricle size. The data were entered using EPI INFO version 7 and analyzed by SPSS version 20. By Pearson’s product moment correlation coefficients, the correlations of frontal horn size with associated factors were evaluated. A paired t-test (between left and right side), independent t-test (between male and female) ANOVA (mean the difference between age groups) were performed. The p-value of less than 0.05was considered being significant. Results: The mean right and left frontal horn length, width, and frontal horn tips diameter were 27.57 (±3.72) mm, 28.47 (±3.77) mm, and 4.90 (±1.54) mm, 5.08 (±1.58) mm, and 30.36 (±3.04) mm, respectively. In relation to gender, the measurement of the frontal horn is greater in males as compared to females. Conclusion: In total, 169 patients satisfied the inclusion criteria. This study found a direct relationship between the frontal horn of lateral ventricle size with the age of both male and female adult participants. In all measurements, the frontal horn of the lateral ventricle size of male participants was greater than that of female participants.

Pediatric Air Gunshot Penetrating Head Injury with Good Outcome: A Case Report

Abstract: Ball bearing (BB) and pellet guns are non-power guns but their related injuries have been reported worldwide. They represent a significant cause of injury especially among children and teenagers. Their potentially harmful and lethal effects have been well documented in the medical literature since the early 1980s. Fatality rate is closely related to the damaged part of the brain and the level of the damage. In this Case Report we documented a 6-years-old girl was getting shot at the head by herself, who initially want to play around, using her neighbour’s Air gun rifle. The pellet trajectory passed through the left frontal lobe, left temporal lobe, left posterior putamen, posteriorly left crus posterior of internal capsule, left occipital horn of lateral ventricle, left occipital lobe, and ended at left cerebral falx between both medial surfaces of occipital lobes. Directional slope of the pellet was medially upward, with its tracking left Intracerebral Hemorrhage (ICH) with perifocal edema and Intraventricular Hemorrhage (IVH) dominant in the left lateral ventricle. After 8 days management, the patient was discharged from our hospital with stable condition, GCS 15 without any significant neurological deficits. Intracranial intracerebral pellet due to air gun shot injury, may have fatal and lethal manifestation if the pellet damage the eloquent area and/or deep area of the brain (hypothalamus, thalamus and brain stem). If accessible the foreign body or pellet should be removed immediately for better outcome. Keywords: Head Injury, Air Gun Shot, Intracerebral Haemorrhage

Paradoxical Pupillary Dilation in a Case of Entrapped Temporal Horn of Lateral Ventricle with Evidence of Uncal Herniation on Imaging

Paradoxical Pupillary Dilation in a Case of Entrapped Temporal Horn of Lateral Ventricle with Evidence of Uncal Herniation on Imaging

Presence of Toxoplasma gondii infection in brain as a potential cause of risky behavior: a report of 102 autopsy cases

Toxoplasmosis was linked to impairment in brain function, encompassing a wide range of behavioral and neuropsychiatric changes. Currently, the precise localization of Toxoplasma gondii in the human brain is limited and the parasite DNA was not found in population-based screening of autopsy cases. The aim of proposed study was to identify the presence of parasite DNA within the brain and its association with risky behavior and alcohol consumption in postmortem examination. Preliminarily, 102 cases with certain circumstances of death at time of forensic autopsy was included. Due to high risk of bias, the females were excluded from the analysis and final study group consists 97 cases divided into three groups: risky behavior, inconclusively risky behavior, and control group. The obtained tissue samples for Nested PCR covered four regions of the brain: symmetric left/right and anterior/posterior horns of lateral ventricles comprising lining ependyma and hippocampus. The second type of material comprised blood evaluated for antibodies prevalence using ELISA and alcohol concentration using HS-GC-FID. Analysis demonstrated 16.5% prevalence concerning the parasite DNA presence in examined brain tissue samples without specific distribution and association with age at death or days after death until an autopsy was performed. Results have shown correlation between occurrence of risky behavior leading to death and higher proportions of positive parasite DNA presence within the brain. Correlation was not observed between parasite DNA presence and excessive alcohol consumption. Conducted screening demonstrated correlation between parasite DNA presence in the brain with risky behavior and provided new information on possible effects of latent toxoplasmosis.

Curative effect and complication of neuronavigation guided puncture ventricle peritoneal shunt and traditional ventriculoperitoneal shunt for hydrocephalus

Objective To compare the accuracy of placement of ventricular shunt tube, the efficacy and complications of the neuronavigation-assisted ventriculoperitoneal shunt (group A) and traditional ventriculoperitoneal shunt (group B). Methods A retrospective study was made on 40 cases of hydrocephalus managed with neuronavigation-assisted ventriculoperitoneal shunt or ventriculoperitoneal shunt from January 2012 to June 2016. There were 18 cases [12 males, 6 females; (47.5±8.5) years of age] in group A and 22 cases [14 males, 8 females; (44.5±7.5) years of age] in group B. Therapeutic effect and complications were analyzed postoperatively. The accuracy rate in ventricular end shunt placement that was free from the frontal horn of lateral ventricle and flush the Moro hole had also been studied. Results The position of ventricular shunt of all the patients were postoperative timely review of the CT view, and hospital outpatient follow-up periodical for 3-24 months after discharge from hospital. Patients with postoperative timely review of head CT and found that group A of ventricular end of the shunt tube position reach a set position in 16 cases, 2 cases had not reached the set position, the accuracy rate was 88.89%. There were 8 cases in group B reach to the set position and 14 cases did not and the accuracy rate was 36.36%. After the statistical analysis there were significant differences (P 0.05). Postoperative complications included bleeding, infection, obstruction of the shunt, excessive shunt, shunt insufficiency and so on. During follow-up, group A appeared excessive shunt in 1 case; group B incision infection in 1 case, 4 cases of shunt obstruction, excessive shunt in 1 case, 2 cases of deficiency of shunt. Two groups of patients were recovery well through the drainage tube pressure adjustment or set it once again. The incidence of complications in group A was 5.56%, group B was 36.36%. There was no significant difference between group A and group B (P>0.05). In group A, there was no obstruction of shunt tube, ventricular end of the shunt tube blockage occurred in 4 cases in group B, the incidence rate was 18.18%(P>0.05). Conclusion Neuronavigation guided ventriculoperitoneal shunt placement to the accuracy of position setting has significant advantages over traditional ventriculoperitoneal shunt in the ventricular end of the shunt tube and it has some advantages in reducing postoperative complications. Key words: Neuronavigation; Hydrocephalus; Postoperative complications; Ventriculoperitoneal shunt

Morphometric Study of Anterior Horn of Lateral Ventricle of Brain and Its Correlation with Age, Gender and Side: A CT Study

Morphometric Study of Anterior Horn of Lateral Ventricle of Brain and Its Correlation with Age, Gender and Side: A CT Study

Morphometric Study of Posterior Horn of Lateral Ventricle by Computerised Tomography and Dissection Method

Morphometric Study of Posterior Horn of Lateral Ventricle by Computerised Tomography and Dissection Method

A Study of Morphometric Variability of Temporal and Occipital Horns of Lateral Ventricle of Human Brains: A Dissection Study

A Study of Morphometric Variability of Temporal and Occipital Horns of Lateral Ventricle of Human Brains: A Dissection Study

Value of CT perfusion imaging in pressure modulation after ventriculoperitoneal shunt

Objective To investigate the value of CT perfusion imaging(CTP) in pressure modulation after ventriculoperitoneal shunt (VP) and determine the relationship between consciousness variation and cerebral perfusion. Methods Thirty cases in a vegetative or minimally conscious state after VP for posttraumatic hydrocephalus were included. There were 26 males and 4 females, aged (56.4±9.2) years. Duration of disease was (88.7±38.0)d. Consciousness evaluation and CT perfusion scan were performed before and two weeks after pressure modulation. Based on the consciousness state, the patients were allocated into consciousness unimproved (n=17) and improved groups (n=13). Relative cerebral blood flow (rCBF), relative cerebral blood volume (rCBV), relative mean transit time (rMTT) and relative time to peak (rTTP) were evaluated before and after pressure modulation. Results In consciousness improved group rCBF in the alba around anterior horn of lateral ventricle was significantly improved after pressure modulation compared to that before pressure modulation (1.08±0.55 vs. 0.75±0.32, P 0.05). In consciousness improved group all the measures showed no significant changes in other regions such as encephalomalacia focus, forehead lobe, temporal lobe, basal ganglia and occipital lobe (P>0.05). However, none was significantly different in consciousness unimproved group (P>0.05). Conclusions CTP has some reference value on pressure modulation of posttraumatic hydrocephalus patients treated with VP. Consciousness improvement is related to the increased cerebral perfusion in the alba around anterior horn of lateral ventricle. Key words: Perfusion imaging; Hydrocephalus; Ventriculoperitoneal shunt

Persistent Brain Herniation after Decompressive Hemicraniectomy: Role of Lumbar Drainage for Cranioplasty. Case Report

Hydrocephalus and ex-vacuo ventricular dilatations which cause persistent brain herniation with impossibility to perform cranioplasty, are well known late complications after decompressive hemicraniectomy; concerning the physiopathologic mechanism leading to these complications, there are several theories. We report the particular case of a patient suffering from persistent brain herniation after decompressive hemicraniectomy, due to development of subdural hygroma, intraparenchymal multiple liquoral cysts and only mild enlargement of frontal horn of right lateral ventricle. A fifty-five years old male patient was treated with decompressive right hemicraniectomy for acute hemispheric swelling consequent to right internal carotid artery dissecation. After several months, evaluating the patient for cranioplasty, brain herniation was clinically evident and brain MRI confirmed it due to subdural hygroma, intraparenchymal multiple liquoral cysts and mild enlargement of frontal horn of right lateral ventricle. According to several reported theories, communication between right frontal horn of lateral ventricle, intraparenchymal liquoral cysts and subdural hygroma was supposed, and CSF lumbar drainage was placed. Regression of brain herniation was achieved and cranioplasty was possible; after few days lumbar drainage was removed: neither operative, nor short and long follow-up period complications were observed. Temporary CSF lumbar drainage resulted effective to obtain regression of a particular case of persistent brain herniation developed after decompressive hemicraniectomy; moreover this safe procedure, not previously described to forerun cranioplasty surgery to our knowledge, allowed performing cranioplasty in absence of complications and avoiding temporary or permanent ventricular shunts which present a major rate of risks and possible complications.

Sexual Dimorphism of Ventricles of the Brain in Rajasthan Population

40 Male and 40 Female, normal adult age between 25 to 35 were selected for study. Their Ventricles of the Brain were studied with C.T Scan. Mean Values Height of Fourth Ventricle of males was 1.476 cm (SD ±0.008) and Females was 1.121 cm (SD ±0.013) and t=test result was 147.07 cm which was statistically highly significant (P < 0.001) Mean Value of width of fourth Ventricle of male was 1.628 cm (SD ±0.016) and females was 1.235 cm (SD ±0.014) and t=test Value was 118.30 cm which was statistically highly significant (P < 0.001) mean value of length of Right frontal horn of lateral ventricle of male was 3.265 cm (SD ±0.014) and female was 2.944 (SD ±0.159) and value of t=test was 12.68 cm which was highly significant P value (P < 0.001) and mean Value of length of left front horn of lateral ventricles in males 3.315 cm (SD ±0.012) t=test value was 148.63 cm which was highly significant P value (P < 0.001). Classification of Functional coefficient of a) Height of Fourth Ventricle in males was 7.72 E3 while in Females 5.23 E3. b) Width of Male fourth Ventricle coefficient was 2.37 E while female was 1.15 E. c) Coefficient Values of length of Right frontal horn of lateral ventricle in males was 171.9 and in females 148.6. d) Coefficient Values length of left frontal horn of lateral ventricle in males was 2.75 E4 and in Females was 2.52 E4.

Hidrocefalijos revizinių operacijų priežastys

Darbo tikslasNustatyti pacientų, sergančių hidrocefalija, pakartotinių operacijų dažnį ir priežastis. Įvertinti šunto revizijos poreikio bei vožtuvo gedimo dažnio priklausomybę nuo hidrocefalijos etiologijos, likvoro priešoperacinio slėgio, implantuoto vožtuvo gamintojo bei drenuoto smegenų skilvelio rago.Ligoniai ir metodaiRetrospektyviai išanalizuoti operacijų protokolai bei epikrizės visų 130 pacientų, kuriems nuo 2007 m. vasario 1 d. iki 2014 m. sausio 31 d. VšĮ Respublikinės Vilniaus universitetinės ligoninės (RVUL) Neurochirurgijos skyriuje atlikta 214 ventrikuloperitoneostomijos (VPS) operacijų dėl hidrocefalijos (HC). Rinkti duomenys: HC etiologija, likvoro slėgis prieš operaciją, operacijų skaičius, pakartotinių operacijų priežastys, drenuotas ragas, implantuotas vožtuvas bei nustatytas vožtuvo atsidarymo slėgis. Tarpusavyje lyginant pacientus pagal implantuotus skirtingų gamintojų vožtuvus, HC priežastis ir likvoro slėgį prieš operaciją, ieškota statistiškai patikimų koreliacijų su vožtuvo gedimo ir revizijos poreikio dažniu. Duomenys statistiškai apdoroti SPSS 22.0 programa.RezultataiPasiskirstymas pagal lytį: 49 % vyrų, 51 % moterų. Amžius svyravo nuo 20 iki 83 metų, amžiaus vidurkis 55±15,0 metų. 55 metų amžiaus arba jaunesni buvo 61 (46,9 %) pacientas, vyresni nei 55 metų – 69 (53,1 %) pacientai. Aptariamuoju laikotarpiu atlikta 214 VPS operacijų. Vieną kartą operuoti 84 (64,6 %) pacientai, pakartotinai – 46 (35,4 %) pacientai, kai kurie po keletą kartų. Nustatytos pakartotinės operacijos priežastys – galvinio kateterio užsikimšimas konstatuotas 2,17 % atvejų, vožtuvo gedimas – 30,43 % atvejų, pilvinio kateterio užsikimšimas – 10,87 %, mišrus šunto sistemos blokas – 23,92 %, šunto migracija – 10,87 %, sistemos šalinimas dėl infekcijos – 19,57 %, tiksli priežastis nenustatyta – 2,17 %. Dažniausia pakartotinės operacijos priežastis – vožtuvo gedimas. Tarpusavyje lyginant implantuotų skirtingų gamintojų vožtuvų – „Codman“, „Sophysa“, „Medtronic“ – gedimo dažnį, statistiškai reikšmingo skirtumo nerasta (p&gt;0,05). Taip pat vožtuvo gedimo dažnis nesiskyrė drenavus priekinį ar užpakalinį ragą (p&gt;0,05). Tačiau 55 metų amžiaus ir jaunesniems pacientams šunto revizijos reikėjo dažniau nei vyresniems (p=0,047). Be to, vožtuvas gedo gerokai dažniau, kai likvoro slėgis prieš operaciją buvo žemas, palyginti su vidutiniu (p=0,035) ir aukštu (p=0,036) likvoro slėgiu prieš operaciją. Nustatyta patikima atvirkštinė koreliacija – likvoro takų stenozės atveju vožtuvas genda daug rečiau nei esant kitoms HC priežastims (p=0,012).IšvadosPakartotinės VPS operacijos prireikė 35,4 % pacientų. Dažniausia pakartotinės operacijos priežastis – vožtuvo gedimas. Pacientų amžius pirmosios operacijos metu, HC etiologija, likvoro slėgis prieš operaciją reikšmingai susiję su vožtuvo gedimo dažniu ir revizijos poreikio dažniu. Vožtuvo gedimo dažnis ir šunto revizijos poreikis nepriklauso nuo implantuoto šunto gamintojo ir drenuoto rago.

MRI in NMO: How to differentiate from MS

Neuromyelitis Optica (NMO) is characterized by simultaneous or sequential acute transverse myelitis and optic neuritis. Spinal cord lesions extending over 3 or more vertebral segments are the typical MRI finding in NMO. Shorter MRI lesions can be found very early during relapse or in residual atrophic stages. Some of the lesions may appear hypointense on corresponding T1-weighted images which reflects sever inflammation with necrosis. T1-weighted hypointensities may help in differentiating NMO lesions from MS in spinal cord. “Snake-eye” or “owl-eye” sign a common feature of spinal artery ischemia has been reported to be transiently observed at an early stage of NMO. Brain MRI is initially normal in most patients with NMO but serial imaging may depict lesions in up to 85% of the patients at later stages. Brain lesions are usually nonspecific but may fulfill the Barkhof criteria for dissemination in space. Acute, large, edematous callosal lesions with a heterogeneous intensity occasionally develop in patients with NMO (marbled pattern). In contrast, in MS, callosal lesions are small, non-edematous, and the intensity was homogeneous in the acute phase and located at the lower margin of the corpus callosum. Multiple patchy enhancements with blurred margins (cloudlike enhancement) have been reported to be typical for NMO. Pencil-like ependymal enhancement is another type of enhancement around the anterior horns of lateral ventricles. Extensive hemispheric lesions, periependymal lesions surrounding the aqueduct, the third and fourth ventricles and brain stem lesions should raise the diagnosis of NMO. Actually NMO should be considered in any atypical lesion for MS in appropriate clinical settings. The extensive hemispheric lesions differed from those observed in regions of high AQP4 expression and were likely related to vasogenic edema; they sometimes looked like “spilled ink” and followed the white-matter tracts.

Analysis of Amygdala Nucleus in the Rat Brain: A review study.

Amygdale is one of the limbic related sub-cortical nuclei lying in the depth of temporal lobe and rostral of the inferior horn of lateral ventricle. In fact, amygdale is a nucleus complex that plays an important role in the emotional response, anger, fear, regulation of cardiovascular system, memory processes and learning and in pathophysiology of many diseases such as epilepsy, schizophrenia, Alzheimer, anxiety and depression. With regard to important of the amygdala in many critical functions, the cerebral disease and because of ethical problems most studies were done on animal models especially rats. Hence, in this review paper we tried to investigate different aspects of the rat amygdala complex including cyto, myelo and receptoarchitectonic.

Significance of fatal head injuries associated with subependymal hemorrhage at the anterior horns of lateral ventricles

We hypothesize the following items based on 41 autopsy cases with or without head injuries especially on subependymal injuries at the anterior horns of the lateral cerebral ventricles. The subependymal injuries at the regions (1) are not seen in fatal cases that did not have intracranial injuries, (2) have nothing to do with technical procedures for removal of the whole brain at autopsy, (3) are frequently associated with axonal injuries, (4) are presumed to be formed by rotating head injuries in a sagittal direction.

Intracranial Germinoma as a Very Rare Cause of Panhypopituitarism in a 23-year Old Man

A 23 year-old patient was referred to the endocrine outpatient clinic with the suspicion of diabetes insipidus as he complained of nycturia and polydipsia since 2-3 months. Further he presented with nausea, vomiting, loss of appetite, rapid weight loss, diffuse body pain and fatigue. No headache, blurred vision, or fever were reported. The clinical examination showed sexual infantilism (poor beard, pubic and axillary hair growth, small testis). The patient's skin was strikingly pale as well as dry and scaly. Lymph node palpation was unremarkable. Endocrine evaluation revealed diabetes insipidus as well as complete anterior pituitary insufficiency. MR imaging demonstrated contrast-enhancing mass lesions at the pineal gland, hypothalamus, and anterior horn of lateral ventricles bilaterally. The localization pattern deemed to be highly suspicious for intracranial germinoma. As beta-HCG and AFP were negative in serum and cerebrospinal fluid the diagnosis of germinoma was confirmed histologically. After radiotherapy with cranio-spinal radiation therapy with 24 Gy followed by two weeks of local tumor boost with 16 Gy, the posttherapy MRI scan indicated complete tumor removal. This case demonstrates a very rare and potentially curable tumor as the cause of panhypopituitarism in adults.

Normal variation in asymmetric frontal horns of lateral ventricles

Normal variation in asymmetric frontal horns of lateral ventricles