Occipital Lobe Lesions Research Articles

Prosopagnosia: face blindness and its relationship to neurological disorders

This study examines the neurological and neuropathological conditions, and clinical, imaging, and demographic traits linked to prosopagnosia. Out of 475 potential cases, 327 met criteria for probable or definite prosopagnosia. One patient had Niemann-Pick type C and another had a forkhead box G1 gene mutation; ten patients (80% male) had developmental prosopagnosia. Of 317 with acquired prosopagnosia, 228 had degenerative causes, primarily primary prosopagnosia syndrome, Alzheimer's disease dementia, posterior cortical atrophy, and semantic dementia. Non-degenerative cases often involved ischemic and hemorrhagic infarcts. Transient non-degenerative prosopagnosia, linked to hypoxic encephalopathy and migraines, improved over time. Degenerative prosopagnosia patients often showed temporal lobe involvement on PET scans, while non-degenerative patients had right temporal and occipital lobe lesions on MRI. Pathological findings included Alzheimer's, Lewy body disease, and frontotemporal lobar degeneration. Facial recognition loss spans various neurological illnesses.

HOMONYMOUS HEMIANOPIA IN CEREBRAL INFARCTION: CASE REPORT

Abstract
 Introduction : Homonymous hemianopsia is a visual field defect characterized by loss of half of the visual field in each eye. Cerebral infarction in the occipital lobe is the most common cause of homonymous hemianopsia. Sudden visual field loss should be considered as a cerebral infarction for prompt management.
 Case Illustration : Male 43 years old, vision in both eyes appears dark on the left side since 3 months ago, complaints occur suddenly. Patients with a history of hypertension (+) hypercholesterolemia (+). Ophthalmological examination revealed visual acuity in both eyes 6/6 with normal pupillary reflexesand normal fundoscopy in both eyes. Humphrey's visual field perimetry test showed left homonymous hemianopsia. A brain CT scan examination showed multiple cerebral infarctions in the right occipital lobe, cerebellum and basal ganglia bilaterally. The patient was referred to the neurology department for further treatment.
 Discussion : The visual field defect pattern is used to predict the location of the lesion in the visual pathway. Neurologic symptoms that may be present in occipital lobe lesions are migraine with aura and visual hallucinations. The patient had left homonymous hemianopsia where the results of brain CT scan showed multiple cerebral infarctions in the right occipital lobe.
 Conclusion : Manifestations of homonymous hemianopsia can predict the presence of cerebral infarction so that in the presence of visual field defects it can be used as a predictor of intracranial abnormalities for further evaluation and collaboration with the neurology department.

Correlation of visual field deficits and q-ball high-resolution fiber tractography of the optic radiation for adjacently located intracerebral lesions: preliminary results from a single-center prospective study

Visual field deficits (VFDs) are common in patients with temporal and occipital lobe lesions. Diffusion tensor fiber tractography (DTI-FT) is widely used for surgery planning to reduce VFDs. Q-ball high-resolution fiber tractography (QBI-HRFT) improves upon DTI. This study aims to evaluate the effectiveness of DTI-FT and QBI-HRFT for surgery planning near the optic radiation (OR) as well as the correlation between VFDs, the nearest distance from the lesion to the OR fiber bundle (nD-LOR), and the lesion volume (LV). This ongoing prospective clinical trial collects clinical and imaging data of patients with lesions in deterrent areas. The present subanalysis included eight patients with gliomas near the OR. Probabilistic HRFT based on QBI-FT and conventional DTI-FT were performed for OR reconstruction based on a standard diffusion-weighted magnetic resonance imaging sequence in clinical use. Quantitative analysis was used to evaluate the lesion volume (LV) and nD-LOR. VFDs were determined based on standardized automated perimetry. We included eight patients (mean age 51.7 years [standard deviation (SD) 9.5]) with lesions near the OR. Among them, five, two, and one patients had temporodorsal, occipital, and temporal lesions, respectively. Four patients had normal vision preoperatively, while four patients had preexisting VFD. QBI-FT analysis indicated that patients with VFD exhibited a significantly smaller median nD-LOR (mean, −4.5; range −7.0; −2.3) than patients without VFD (mean, 7.4; range −4.3; 27.2) (p = 0.050). There was a trend towards a correlation between tumor volume and nD-LOR when QBI-FT was used (rs = −0.6; p = 0.056). A meticulous classification of the spatial relationship between the lesions and OR according to DTI-FT and QBI-FT was performed. The results indicated that the most prevalent orientations were the FT bundles located laterally and intrinsically in relation to the tumor. Compared with conventional DTI-FT, QBI-FT suggests reliable and more accurate results when correlated to preoperative VFDs and might be preferred for preoperative planning and intraoperative use of nearby lesions, particularly for those with larger volumes. A detailed analysis of localization, surgical approach together with QBI-FT and DTI-FT could reduce postoperative morbidity regarding VFDs. The display of HRFT techniques intraoperatively within the navigation system should be pursued for this issue.

Two Cases of Alice in Wonderland Syndrome with a Right Occipital Lobe Lesion Caused by Isolated Cortical Venous Thrombosis.

Alice in Wonderland syndrome (AIWS) is extremely rare, occurring more often in young individuals than in older adults. Symptoms of this syndrome typically include an altered body image, size perception, and time perception. However, the pathophysiology and lesions responsible for this syndrome remain unclear. In most cases, specific lesions cannot be identified using computed tomography or magnetic resonance imaging. Two patients with isolated cortical venous thrombosis in the right occipital area experienced transient visual symptoms of AIWS. Furthermore, a literature search indicated that AIWS with visual distortions is associated with right occipital lobe lesions, supporting the findings of our study.

Clinical and radiologic differences between early onset, late onset, and very late onset adult multiple sclerosis

BackgroundPrevious studies suggested possible differences in clinical and radiologic characteristics between early-onset multiple sclerosis (EOMS) and late-onset MS (LOMS). However, differences between LOMS and very late onset MS (VLOMS) are largely unknown. MethodsWe performed a retrospective review of medical records of patients diagnosed with MS between 8/1/2017 and 3/1/2022 at the comprehensive MS center of the Froedtert and Medical College of Wisconsin. We included adult patients with MS diagnosis who were 60 years or older - VLOMS, 50–59 years old at diagnosis – LOMS, or were 18–30 years old at diagnosis – EOMS and had complete imaging and clinical records. Clinical presentation and location of demyelinating lesions at the onset of diagnosis were extracted and compared using the chi-square test, p<0.05. ResultsA total of 246 newly diagnosed patients were identified. Of which 54 were EOMS, 29 were LOMS, and 35 were VLOMS. The sex ratio was not different between groups. EOMS had a higher percentage of patients who self-identified as black, while LOMS had a higher percentage of patients who self-identified as white. LOMS and VLOMS showed significant differences in the presence of tremors and lesion distribution at the onset. Older onset patients were more likely to present with motor symptoms, sphincter dysfunction, fatigue, and tremor. EOMS was more likely to present with cerebellum and occipital lobe lesions, and lesions were more likely to show contrast enhancement on MRI at diagnosis. ConclusionOur findings revealed novel clinical and imaging characteristics differences between VLOMS and LOMS. The current classification of LOMS may benefit from revision to better align with chronological age classification for old age >60 instead of the current standard in the literature of >50 years.

A CASE ILLUSTRATION AND LITERATURE REVIEW OF THYROID CANCER METASTASIS TO THE PITUITARY FOSSA

Abstract AIMS To understand the clinico-radiological and histopathological features, treatment strategies and outcomes of patients with thyroid cancer metastasis to the pituitary fossa. METHOD A 71-year-old man presented with a few months’ history of headaches, blurred vision, diplopia and right sided ptosis. MRI head revealed a 2.5cm pituitary fossa lesion distorting the optic chiasm with right sided cavernous sinus invasion. It also showed frontal, temporal and parieto-occipital lesions. CT thorax, abdomen and pelvis found a retrosternal thyroid goitre. An open biopsy of the occipital lobe lesion revealed a metastatic papillary adenocarcinoma from the thyroid gland. An ultrasound-guided fine needle aspiration of the goitre and abnormal level IV lymph nodes revealed Thy5. The patient subsequently underwent an endoscopic transsphenoidal resection of the pituitary tumour which was confirmed to be a carcinoma. A date and language unrestricted literature search was performed across the MEDLINE, Embase (via Ovid) and Scopus databases using keywords relating metastasis, the pituitary &amp; thyroid glands, and the brain. Citations reporting patients with thyroid metastasis to the pituitary fossa were included. A predetermined proforma was used to extract and store data from the included citations. RESULTS After de-duplication, 2,833 citations were screened for eligibility and 42 citations met the inclusion criteria. CONCLUSIONS We present a rare case illustration and literature review of patients with thyroid cancer metastasis to the pituitary fossa.

Endoscopic fenestration of an enlarging giant occipital arachnoid cyst

This case demonstrates an endoscopic fenestration of an enlarging giant occipital arachnoid cyst. The patient is a 42-year-old woman presenting with headache, progressive vision loss, and nausea and vomiting. MRI demonstrates a large, nonenhancing cystic lesion in the right occipital lobe measuring up to 8.3 cm, consistent with an arachnoid cyst. This surgical video illustrates the technique for an endoscopic fenestration into the native ventricular system utilizing stereotactic MRI-guided stealth navigation. Postoperatively, the patient had full recovery with improvement of headaches and vision and was discharged on postoperative day 1 without complications. The video can be found here: https://stream.cadmore.media/r10.3171/2023.1.FOCVID22129.

Anatomy of the occipital lobe using lateral and posterior approaches: a neuroanatomical study with a neurosurgical perspective on intraoperative brain mapping.

A major concern of occipital lobe surgery is the risk of visual field deficits. Extending anatomical occipital lobectomy to the functional requires awake conditions because the anterior resection border comprises language-, motor- and visuospatial function-related areas within the temporal and parietal lobes. This study investigated the lateral and posterior perspectives of the occipital lobe anatomy when approaching intraaxial occipital lobe lesions. Ten adult cadaveric cerebral hemispheres were dissected after being prepared following the concept described by Klingler for the first time. The occipital lobe was located posteriorly to the parietotemporal line. Within the occipital lobe, the occipital horn of the lateral ventricle represented the only anatomical landmark. Laterally, optic radiation was identified as a part of the sagittal stratum. None of the intraoperatively identifiable tracts was found medial to the occipital horn. Language- and motor-related areas were identified anteriorly and should be actively identified when lobectomy based on function is planned. Subcortically, from a posterior perspective, the anterolateral border constituted the arcuate fascicle/superior longitudinal fascicle complex and was anteromedial to the thalamocortical tract. Remaining posterior to the line connecting the preoccipital notch with the superior Rolandic point avoided the cortical and white matter tracts related to language, motor and visuospatial function. Knowledge of occipital lobe anatomy and surrounding structures is essential to preoperatively assess the risk of the procedure and proper consultation of a patient in terms of the extent of resection, primarily concerning visual field deficits.

An epileptogenic intracranial cystic lesion lined with fallopian tube-type epithelium: illustrative case.

Intracranial cystic lesions are often a trigger for epileptic seizures. However, there has never been a report of a cystic lesion lined with fallopian tube-type epithelium. A 48-year-old female presented with a cystic lesion in the right occipital lobe, which gradually grew over 8 years. Right occipital lobe epilepsy was diagnosed based on visual aura, convulsive seizures, and electroencephalogram findings and the cyst was surgically removed. Further examination revealed the cyst was lined with ciliated cells, which had morphological and immunohistochemical features similar to those of fallopian tube epithelium. The characteristics of the cyst did not conform to any known types of benign cystic lesion. To the authors' knowledge, no such cyst has been reported before. The authors discuss the origins and pathogenesis of this unfamiliar cystic lesion.

NCMP-11. METASTATIC MENINGIOMA: AN UNUSUAL COURSE OF A COMMON DISEASE

Abstract BACKGROUND The most common central nervous system (CNS) tumor in adult patients is meningioma, accounting for 30% of all intracranial tumors. Despite this, extracranial meningioma metastases are exceedingly rare, accounting for 0.1% of cases, with common locations for metastases localized to the lungs, liver, lymph nodes, and bone. RESULTS We present a 55-year-old female with a past medical history of tobacco use, hypertension and depression, who initially presented due to a generalized tonic-clonic seizure. MRI brain revealed an intracranial lesion in the left occipital lobe with mass effect, requiring craniotomy and resection. Pathology was consistent with WHO grade I meningioma and post-operatively a small area of residual tumor remained. PET/CT found a left lung nodule, which was thought to be due to her smoking history and was followed with annual scans. Four years later, she had an increase in the size of the meningioma on surveillance MRI scans. The patient then required repeat craniotomy which redemonstrated pathology of WHO grade I meningioma, then treated with stereotactic radiation 14 Gy. The subsequent annual surveillance pulmonary scan showed a growth of left pulmonary nodule. She underwent a left lingual wedge resection and was found to have low grade spindle cell tumor, consistent with metastatic meningioma. CONCLUSION Although rare, metastatic meningioma should be included in the differential diagnosis of patients with concomitant extracranial lesions. Our case highlights the importance of annual, surveillance scans of extracranial lesions in meningioma patients.

How lesions at different locations along the visual pathway influence pupillary reactions to chromatic stimuli

PurposeTo examine systematically how prechiasmal, chiasmal, and postchiasmal lesions along the visual pathway affect the respective pupillary responses to specific local monochromatic stimuli.MethodsChromatic pupil campimetry (CPC) was performed in three patient groups (10 subjects with status after anterior ischemic optic neuropathy, 6 with chiasmal lesions, and 12 with optic tract or occipital lobe lesions (tumor, ischemia)) using red, low-intensity red, and blue local stimuli within the central 30° visual field. Affected areas - as determined by visual field defects revealed using conventional static perimetry - were compared with non-affected areas. Outcome parameters were the relative maximal constriction amplitude (relMCA) and the latency to constriction onset of the pupillary responses.ResultsA statistically significant relMCA reduction was observed in the affected areas of postchiasmal lesions with red (p = 0.004) and low-intensity red stimulation (p = 0.001). RelMCA reduction in the affected areas seemed more pronounced for low-intensity red stimulation (46.5% mean reduction compared to non-affected areas; 36% for red stimulation), however statistically not significant. In prechiasmal lesions, a statistically significant latency prolongation could be demonstrated in the affected areas with low-intensity red stimulation (p = 0.015).ConclusionOur results indicate that the choice of stimulus characteristics is relevant in detecting defects in the pupillary pathway of impairment along the visual pathway, favoring red stimuli of low intensity over blue stimuli. Such knowledge opens the door for further fundamental research in pupillary pathways and is important for future clinical application of pupillography in neuro-ophthalmologic patients.

Resection of bilateral occipital lobe lesions during a single operation as a treatment for bilateral occipital lobe epilepsy.

BACKGROUNDNeurosurgical treatment of severe bilateral occipital lobe epilepsy usually involves two operations several mos apart. AIMTo evaluate surgical resection of bilateral occipital lobe lesions during a single operation as a treatment for bilateral occipital lobe epilepsy. METHODSThis retrospective case series included patients with drug-refractory bilateral occipital lobe epilepsy treated surgically between March 2006 and November 2015.RESULTSPreoperative evaluation included scalp video-electroencephalography (EEG), magnetic resonance imaging, and PET-CT. During surgery (bilateral occipital craniotomy), epileptic foci and important functional areas were identified by EEG (intracranial cortical electrodes) and cortical functional mapping, respectively. Patients were followed up for at least 5 years to evaluate treatment outcome (Engel grade) and visual function. The 20 patients (12 males) were aged 4-30 years (median age, 12 years). Time since onset was 3-20 years (median, 8 years), and episode frequency was 4-270/mo (median, 15/mo). Common manifestations were elementary visual hallucinations (65.0%), flashing lights (30.0%), blurred vision (20.0%) and visual field defects (20.0%). Most patients were free of disabling seizures (Engel grade I) postoperatively (18/20, 90.0%) and at 1 year (18/20, 90.0%), 3 years (17/20, 85.0%) and ≥ 5 years (17/20, 85.0%). No patients were classified Engel grade IV (no worthwhile improvement). After surgery, there was no change in visual function in 13/20 (65.0%), development of a new visual field defect in 3/20 (15.0%), and worsening of a preexisting defect in 4/20 (20.0%). CONCLUSIONResection of bilateral occipital lobe lesions during a single operation may be applicable in bilateral occipital lobe epilepsy.

Trans-Sulcal Parafascicular Port-Based Resection of a Subcortical Occipital High-Grade Glioma: 2-Dimensional Operative Video.

Minimally invasive trans-sulcal parafascicular port-based approaches can provide safe access to a wide variety of deep brain lesions.1,2 This surgical video illustrates the use of a minimally invasive port-based approach for resection of a subcortical right medial occipital lobe lesion in a 63-year-old woman who presented with seizures and bilateral left homonymous hemianopia. MRI showed a 2.5-cm contrast enhancing lesion with a necrotic center and significant T2 and fluid-attenuated inversion recovery signal consistent with vasogenic edema. Diffusion tensor imaging revealed compromise of the right optic radiations and edema extending through the right corticospinal tract. A minimally invasive trans-sulcal parafascicular port-based approach to the deep occipital lobe and periatrial region was performed under full exoscopic visualization. A gross total tumor resection was achieved, and histopathology revealed an IDH1-mutant, MGMT-methylated-positive glioblastoma. The patient's presentation, rationale, key surgical steps, and outcomes are discussed, and informed consent for surgery was obtained. The participants and any identifiable individuals consented to the publication of their image. Images at 3:50 used with permission from Nico Corporation. All rights reserved.

Temozolomide Rechallenge in Patients With Recurrent High-Grade Glioma Treated With Re-Irradiation

To evaluate the clinical role of temozolomide rechallenge (TMZ) in patients with recurrent high-grade glioma (HGG) treated with re-irradiation (re-RT) regardless of surgical status.Single-center retrospective review of patients with a primary diagnosis of World Health Organization (WHO) Grade III anaplastic astrocytoma or Grade IV GBM treated from 2008 to 2016 for disease recurrence with re-RT (35 Gy in 10 fractions) with and without temozolomide rechallenge. Baseline characteristics were analyzed with pairwise tests. OS/PFS were assessed with the Kaplan-Meier method and multivariable cox regression models for OS.Two hundred and thirty patients were treated with re-irradiation (n = 67 with and n = 163 without concurrent TMZ), with a median follow-up of 13.4 months. Baseline characteristics were similar between the two groups. TMZ rechallenge did not improve OS (HR 0.81 [0.51-1.3] P = 0.39). Univariate regression analysis showed that higher KPS both at diagnosis and recurrence correlated with improved survival, whereas increasing histology grade of initial and recurrent disease and volume of recurrence were correlated with worse OS. Multivariate regression analysis showed primary tumor location to be a significant predictor of OS (P = 0.004) with occipital lobe lesions (P < 0.001) and in-field recurrence (P < 0.001) to be most favorably correlated with OS.TMZ rechallenge in patients with recurrent HGG treated with re-irradiation offered no survival benefit. Our findings suggest that patient selection may be important in TMZ rechallenge. Further studies in identifying this group of patients are warranted.M.M. Basree: None. A. Ali: None. S. Garg: None. J. Glass: None. L. Kim: None. C. Farrell: None. J. Evans: None. K. Judy: None. D.W. Andrews: None. W. Shi: Independent Contractor; Wenyin Shi. Research Grant; Novocure, Brainlab, Regeneron. Consultant; Varian, Brainlab, Zai lab. M. Werner-Wasik: Advisory Board; ASTRA Zeneca. Stock; Illumina. leading operations of the committee; NRG Oncology. J.D. Palmer: Research Grant; Varian Medical Systems, The Kroger Company. Consultant; Huron Consulting. Speaker's Bureau; Varian Medical Systems, Depuy Synthes. Advisory Board; Novocure. Member of panel; NCCN.

Glioblastoma Multiforme and Papillary Thyroid Carcinoma: Rare Combination of Primary Malignancies

Introduction: Studies have reported thyroid cancer patients are potentially at 30% increased risk of getting second primary cancer when compared to the general population. We are describing a young Caucasian male patient who was diagnosed with two synchronous cancers, papillary thyroid cancer (PTC) and glioblastoma multiforme (GBM). Case Report: A 52 year old Caucasian male with past medical history of hypertension, partial right thyroidectomy in 1999 for thyroid nodular disease, and postsurgical hypothyroidism on levothyroxine. He underwent FNA of left thyroid nodule found on routine monitoring of thyroid nodules showed to be suspicious for malignancy. He underwent left hemi-thyroidectomy in July 2019, revealing PTC, follicular variant, encapsulated, noninvasive type measuring 0.9 x 0.9 x 0.5 cm, completely excised with negative margins; reminder of the right hemi-thyroidectomy performed in February 2020, revealing cystic adenomatoid nodule and no evidence of malignancy. Postoperative thyroglobulin and thyroglobulin antibodies levels were undetectable. A diagnostic whole body iodine scan didn’t show metastasis hence Iodine-131 treatment was not warranted. A week following the right hemi-thyroidectomy he presents to the ER with apraxia, difficulty with concentration, visual difficulty, headaches. CT scan of the brain revealed left occipital region revealed a 3.7 x 2.3 cm lesion concerning for malignancy. A follow up contrast-enhanced MRI brain showing multiple ring-enhancing lesions identified within the left posterior occipital lobe measuring 1.7 x 1.8 cm, additional occipital lobe lesion measuring 2.7 cm, mid and posterior parietal lobe measuring 3.0 cm extending to collateral sulcus measuring 2 x 3 x 1.9 cm compressing the posterior horn of left lateral ventricle. Patient underwent suboccipital craniotomy, pathology revealing glioblastoma NOS, WHO grade IV; further biomarker analysis was not available. CT of the chest, abdomen, pelvis showed no evidence of metastatic disease. Postoperative MRI of the brain revealed postoperative changes with resection of the left occipital portion of the lesion with additional enhancing regions in the left parietal and temporal lobes and splenium unchanged. Patient underwent concurrent, definitive chemo-radiation with temozolomide, now on maintenance temozolomide and levothyroxine. Conclusion: PTC is the most common thyroid malignancy, affecting young patients less than 45 years old. GBM can occur in people of any age, but they are more frequent in older adults. Physicians should maintain high surveillance for second primary cancers at a variety of sites in patients who have been found or treated for primary cancers, especially at a young age. Further evaluation of genetic and environmental factors between papillary thyroid cancer and glioblastoma multiforme will improve our understanding of the etiology of these malignancies.

Local failure after stereotactic radiosurgery (SRS) for intracranial metastasis: analysis from a cooperative, prospective national registry.

Stereotactic radiosurgery (SRS) has been increasingly employed to treat patients with intracranial metastasis, both as a salvage treatment after failed whole brain radiation therapy (WBRT) and as an initial treatment. "Several studies have shown that SRS may be as effective as WBRT with the added benefit of preserving neuro-cognition". However, some patients may have local failure following SRS for intracranial metastasis, defined as increase in total lesion volume by 25% after at least 3months of follow up. The SRS registry, established by the Neuro point alliance (NPA) under the auspices of the American Association of Neurological Surgeons (AANS), was queried for patients with intracranial metastasis receiving SRS at the participating sites. Demographic, clinical symptoms, tumor, and treatment characteristics as well as follow up status were summarized for the cohort. A multivariable explanatory cox- regression was performed to evaluate the impact of each of the factors on time to local failure.at last follow-up. A total of 441 patients with 1255 intracranial metastatic lesions undergoing SRS were identified. The most common primary cancer histology was non-small cell lung cancer (43.8%, n = 193). More than half of the cohort had more than 1 metastatic lesion (2-3 lesions: 29.5%, n = 130; more than 3 lesions: 25.2% (n = 111). The average duration of follow-up for the cohort was found to be 8.4months (SD = 7.61). The mean clinical treatment volume (CTV), after adding together the volume of each lesion for each patient was 5.39cc (SD = 7.6) at baseline. A total of 20.2% (n = 89) had local failure (increase in volume by > 25%) with a mean time to progression of 7.719months (SD = 6.09). The progression free survival (PFS) for the cohort at 3, 6 and 12months were found to be 94.9%, 84.3%, and 69.4%, respectively. On multivariable cox regression analysis, factors associated with increased hazard of local failure included male gender (HR 1.65, 95% CI 1.03-2.66, p = 0.037), chemotherapy at or before SRS (HR = 2.39, 95% CI 1.41-4.05, p = 0.001), WBRT at or before SRS (HR = 2.21, 95% CI 1.16- 4.22, p = 0.017), while surgical resection (HR 0.45, 95% CI 0.21-0. 97, p = 0.04) and immunotherapy (0.34, 95% CI 0.16-0.50, p = 0.014) were associated with lower hazard of local failure. Factors found to be predictive of local failure included higher RPA score and those receiving chemotherapy, while patients undergoing surgical resection and those with occipital lobe lesions were less likely to experience local failure. Our analyses not only corroborate those previously reported but also demonstrate the utility of a multi-institutional registry to advance real-world SRS research for patients with intracranial metastatic lesions.

Retrograde degeneration of visual pathway

Optical coherence tomography (OCT) gives the opportunity to examine retrograde degeneration of visual pathway damaged at various levels. To estimate OCT data on retrograde degeneration of visual pathway damaged at various levels. Ganglion cell layer (GCL) thickness was measured by OCT in 79 patients with visual pathway damaged at various levels and known duration of visual disturbances. Twenty-One patients were diagnosed with traumatic lesions of the optic nerves and/or chiasma. Fifty-eight patients had retro-genicular visual pathway damage. Thirty-three patients were examined for postoperative homonymous hemianopia after surgery for drug-resistant temporal lobe epilepsy. Twenty-five patients were diagnosed with occipital lobe damage following stroke (12 patients), surgery for arteriovenous malformation (11 patients) and traumatic brain injury (2 patients). All patients underwent assessment of visual acuity, automatic static perimetry, MRI/CT of the brain. Retinal ganglion cell complex was analyzed during OCT. GCL thinning following anterior visual pathway damage was detected in 20 out of 21 patients after ≥22 days. In case of post-genicular visual pathway damage, GCL thinning was found in 25 out of 58 patients (9 out of 33 ones after surgery for temporal lobe epilepsy and 16 out of 25 patients with occipital lobe lesion). After surgery for temporal lobe epilepsy, minimum period until GCL thinning detection after previous visual pathway damage was 3 months, in case of occipital lobe lesion - 5 months. Retrograde visual pathway degeneration is followed by GCL thinning and depends on the level of visual pathway lesion.

Síndrome MELAS en pediatría. Reporte de caso

Introducción. El síndrome de encefalopatía mitocondrial, acidosis láctica y episodios similares a un accidente cerebrovascular (MELAS, por su sigla en inglés) es la enfermedad mitocondrial más frecuente. Estas patologías se caracterizan por ser hereditarias, multisistémicas y progresivas, y por causar un compromiso predominantemente neurológico que provoca discapacidad y mortalidad, por lo que el diagnóstico temprano y la consejería genética son de gran importancia para mejorar el pronóstico de estos pacientes.Presentación del caso. Paciente femenina de cinco años quien fue llevada a consulta al servicio de pediatría por crisis epiléptica, retraso psicomotor y ataxia. Aunque en la consulta inicial sus estudios de neuroimagen fueron normales, se observó hiperlactatemia. Además, se encontró una relación lactato/piruvato &gt;20, por lo que se sospechó enfermedad mitocondrial.Seis meses después, la paciente presentó deterioro progresivo. Se realizó tomografía axial computarizada de cráneo y resonancia magnética por espectroscopia que permitieron identificar una lesión isquémica occipital y aumento del lactato cerebral, respectivamente. Para confirmar el diagnóstico de síndrome MELAS, se solicitó estudio de ADN mitocondrial, en el que se observó la mutación m.3243A&gt;G. La paciente tuvo un rápido deterioro, presentando una involución de las capacidades adquiridas, y falleció a los cuatro años del inicio de los signos clínicos.Conclusión. Las enfermedades mitocondriales deben ser consideradas en pacientes con antecedentes de epilepsia y otras alteraciones neurológicas como ataxia e involución del neurodesarrollo.

Psychopathological peculiarities of vascular dementia with different localization of pathological focuses

Relevance. Vascular dementia, caused by various organic lesions, volume and location of organic damage to brain tissue, manifests itself in a wide range of concomitant neuropsychiatric symptoms. However, despite the obvious link between the location of vascular lesions and the patient's psychopathological symptoms, the effects of the physical characteristics of the brain damage that caused the vascular dementia and the corresponding neuropsychiatric symptoms remain poorly understood. The aim of the study was to investigate psychopathological features of cognitive impairment in patients with vascular dementia depending on the location of the lesion. Contingents and methods. 157 people with a diagnosis of vascular dementia were examined, divided into five groups: group 1 — 22 people with localization of the pathological process in the frontal lobe; group 2 — 18 patients with temporal lobe lesions; group 3 — 17 patients with parietal lobe lesions; group 4 — 15 patients with occipital lobe lesions and group 5 — 68 people with total lesions. Results: It was found that the lesion of the frontal lobes is characterized by a high frequency of euphoria and hallucinatory phenomena, as well as minor manifestations of apathy and anxiety; lesion of the temporal lobe — the highest frequency and severity of apathy; parietal lesions — low frequency of anxiety combined with its high intensity; occipital lesions — intense depressive experiences (in cases where they occurred), total brain damage — the lowest prevalence and intensity of delusional feelings, irritability and agitation. Conclusions. A comprehensive study of patients with vascular dementia identified specific to each localization of brain lesions spectra of neuropsychiatric symptoms, which creates the necessary conditions for early application of differentiated therapeutic and rehabilitation measures and, accordingly, to improve the quality of patients life in this category.

MULTIPLE POSTERIOR FOSA ASPERGILOMAS IN A PATIENT WITH CHRONIC GRANULOMATOSIS

The invasive infection with Aspergillus fumigatus usually occurs in immunocompromised patients. CNS involvement is extremely rare in children. Usually, the diagnosis is hard, often made after the death of the patient. We describe the first report of a pediatric case of multiple CNS aspergillomas confirmed by a biopsy. We present the case of 3 years old boy who was hospitalized for evolving intracranial hypertension with a cerebellar syndrome. A brain CT showed a left cerebellar mass and early tonsillar commitment and a supra-tentorial lesion in the right occipital lobe. Therefore, a metastatic tumor was suspected and an emergency surgical intervention with cerebral biopsy and ventriculocisternostomy was performed. The cerebral biopsy revealed an Aspergillus fumigatus granuloma and further investigations showed that the patient has chronic granulomatosis due to a homozygous mutation of CYBA gene encoding p22phox. After a favorable evolution in reanimation, he continued the treatment with Voriconazole. At last follow-up, the neurological examination finds no sign of motor focus, no cerebellar syndrome or nystagmus. Walking is difficult with the enlargement of the support base. CNS invasive infection with Aspergillus fumigatus in a child is extremely rare and the presentation might mimic that of a tumor especially with a location of aspergilloma as in our case both supratentorially and infratentorially.