Cases reported "Cerebellar Diseases"

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1/36. Combining steady-state constructive interference and diffusion-weighted magnetic resonance imaging in the surgical treatment of epidermoid tumors.

    We describe the usefulness of three-dimensional Fourier transformation-constructive interference in steady-state (CISS) imaging and diffusion-weighted imaging (DWI) in the pre- and postoperative magnetic resonance imaging evaluation of intracranial epidermoid tumors. Two surgically proven epidermoid tumors in the cerebellopontine (CP) angle were not identified in conventional T1- and T2-weighted images because of a signal intensity similar to that of cerebrospinal fluid (CSF). CISS images clearly demonstrated displacement of the cranial nerves and a shift caused by a lesion in the cistern, but the signal intensity of the tumor by CISS was not sufficiently different from that of CSF to demonstrate the tumor directly. Using DWI, the tumor in the cistern was shown clearly by its increased signal intensity. Together, CISS and DWI compensated for each other's disadvantages, and this combination was useful in guiding surgical treatment of epidermoid tumors in the CP cistern.
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2/36. Postoperative brainstem high intensity is correlated with poor outcomes for patients with spontaneous cerebellar hemorrhage.

    OBJECTIVE: The outcomes for patients with cerebellar hemorrhage are thought to be influenced by anatomic damage to the brainstem. In this study, we investigated the magnetic resonance imaging findings in the brainstem, to examine the relationship between the degree of brainstem damage and the outcomes for patients with spontaneous cerebellar hemorrhage who are in poor-grade condition. methods: The results for 31 patients with spontaneous cerebellar hemorrhage, with Glasgow coma Scale scores of 8 or less at admission, who underwent magnetic resonance imaging examinations were reviewed. All patients underwent surgical intervention. The patients were divided into two groups according to their glasgow outcome scale scores at the time of discharge, i.e., patients who experienced good recoveries or exhibited moderate disabilities (Group I, n = 8) and patients who exhibited severe disabilities, were in a persistent vegetative state, or had died (Group II, n = 23). We investigated obliteration of the fourth ventricle and the perimesencephalic cistern and the presence of hydrocephalus in initial computed tomographic scans and the presence of areas of high signal intensity in the brainstem in T2-weighted images. RESULTS: Eight patients experienced good outcomes, and 23 patients experienced poor outcomes. The overall mortality rate was 32.3%. There were no significant differences between groups with respect to computed tomographic findings such as hematoma size, but the incidence of high signal intensities in the pons and midbrain in T2-weighted images for Group II was significantly higher than that for Group I (P < 0.01). CONCLUSION: magnetic resonance imaging clearly demonstrated brainstem damage, and high signal intensity in the brainstem was a significant prognostic factor for determining outcomes for patients with spontaneous cerebellar hemorrhage who were in poor-grade condition.
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3/36. Stereotactic radiosurgery for tentorial dural arteriovenous fistulae draining into the vein of Galen: report of two cases.

    OBJECTIVE AND IMPORTANCE: Treatment of tentorial dural arteriovenous fistulae (DAVFs) primarily draining into the vein of Galen remains a therapeutic challenge. We present two cases of ruptured galenic DAVFs that were successfully treated with gamma knife radiosurgery. CLINICAL PRESENTATION: Patient 1, a 66-year-old woman, experienced a sudden onset of headache and loss of consciousness. neuroimaging studies revealed intraventricular hemorrhage and a DAVF with aneurysmal dilation of the vein of Galen. The DAVF was supplied by tentorial branches of the right meningohypophyseal artery and bilateral supracerebellar arteries, which drained directly into the vein of Galen. Patient 2, a 64-year-old woman, experienced subarachnoid hemorrhage. cerebral angiography revealed a galenic DAVF at the falcotentorial junction, which was supplied by bilateral supracerebellar arteries. This patient had an aneurysm at the origin of the left supracerebellar artery. INTERVENTION: Both patients were treated with gamma knife radiosurgery. In each case, the fistula was exclusively targeted and a dose of more than 20 Gy was delivered. Complete obliteration of the fistula was confirmed 27 and 29 months after radiosurgery for patients 1 and 2, respectively, whereas the normal venous structures of the galenic system were preserved. CONCLUSION: Gamma knife radiosurgery is an effective treatment modality for DAVFs primarily draining into the vein of Galen. Irradiation doses of more than 20 Gy, strictly limited to the fistulae, seem to be sufficient for successful obliteration of these high-risk vascular lesions, with minimal invasiveness.
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4/36. Cerebellar involvement as a rare complication of pneumococcal meningitis.

    A 4-year old girl with meningitis, caused by streptococcus pneumoniae, developed a subcoma with respiratory insufficiency, followed by a severe cerebellar syndrome. Cerebellar involvement after regaining consciousness consisted of a symmetrical ataxia and mutism. This mutism changed into dysarthria and finally into normal speech. magnetic resonance imaging revealed lesions in both cerebellar hemispheres, suggesting cerebellitis. She recovered with prompt antibiotic treatment.
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5/36. Flaccid quadriplegia from tonsillar herniation in pneumococcal meningitis.

    A young woman with fulminant pyogenic meningitis became quadriplegic, areflexic and flaccid due to herniation of the cerebellar tonsils and compression of the upper cervical cord. This state of spinal shock was associated with absent F-waves. intracranial pressure was greatly elevated and there was an uncertain relationship of tonsillar descent to a preceding lumbar puncture. Partial recovery occurred over 2 years. Tonsillar herniation can cause flaccid quadriplegia that may be mistaken for critical illness polyneuropathy. This case demonstrates cervicomedullary infarction from compression, a mechanism that is more likely than the sometimes proposed infectious vasculitis of the upper cord.
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6/36. Auditory brainstem response and temporal bone pathology findings in a brain-dead infant.

    The criteria for assessing adult brain death have been already established, but those for infant brain death have not been yet established in japan. We report auditory brainstem response (ABR) and postmortem pathology of the temporal bone and brain of a brain-dead 9-month-old female. During the comatose state, her ABR showed only waves I and II bilaterally. autopsy revealed the presence of a left cerebellar astrocytoma, herniation and anoxic encephalopathy. The pathological examination of the temporal bone revealed the destruction of the inner ear particularly on the left side. In the auditory pathway of brain-dead patients, degeneration occurs first in the cerebrum, followed by the cochlear nerve. Thus, ABR is one of the useful means to assess brain death even in infants.
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7/36. Spastic eyelids. Failure of levator inhibition in unconscious states.

    Three patients exhibited tonic uninhibited lid elevation in unconscious states. In the two cases adequately studied at autopsy, the lesions were too large for precise localization but suggest that damage to the pons (and probably midbrain as well) can interfere with normal lid relaxation in coma and sleep.
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8/36. Cerebellar hemorrhage after supratentorial craniotomy.

    BACKGROUND: Cerebellar hemorrhage following supratentorial craniotomy is a very seldom described but serious complication. The present study evaluates the significance of presurgical and surgical factors that may predispose patients to these bleeding episodes. methods: The data of 52 cases of cerebellar hemorrhage following supratentorial craniotomy, 9 from our records and 43 from the literature, were analyzed with regard to various variables. RESULTS: The findings suggest that this clinical picture is unrelated to age, previous arterial hypertension, inherent or induced coagulopathies, type of primary underlying lesion, intraoperative positioning of the patient, type of anesthesia, or intracranial hypotension and its sequels. It entails significant morbidity, with one third of the patients left with cerebellar dysfunction or in a dependent state, and carries a mortality of about 25%. CONCLUSION: Not one single presurgical or surgical factor can reliably predict the occurrence of cerebellar hemorrhage after supratentorial craniotomy, and the etiology of this entity still remains unclear. The most important keys to minimize the hazardous sequelae are to be aware of this potential complication and to diagnose it early.
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9/36. A juvenile case of cerebellar arteriovenous malformation (AVM) with gradual onset of headache and ataxia.

    An 11-year-old male was admitted because of frequent vomiting and truncal ataxia which had lasted for over one week. He had clear consciousness but slowly-progressive mild headache and ataxic gait. Cranial CT revealed a 4 cm hematoma in the right cerebellar hemisphere. Angiography showed a 2 x 2 cm nidus of a pial arteriovenous malformation (AVM) in the right hemisphere fed from the right posterior inferior cerebellar artery and draining into the inferior hemispheric vein. We performed a surgical resection of the AVM after decompression therapy to counteract the brain edema. He recovered completely without any neurological deficits. This case suggests that cerebellar hemorrhage caused by AVM should be considered as a possible diagnosis when mild symptoms of headache and ataxia proceed gradually.
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10/36. brain stem and cerebellar dysfunction after lumbar spinal fluid drainage: case report.

    Lumbar spinal fluid drainage is a common procedure to reduce the risks of cerebrospinal fluid (CSF) fistula after skull base fractures or various transdural neurosurgical procedures. Nevertheless, this simple and effective technique can lead to overdrainage and CSF hypovolaemia. This report describes the case of a young patient who had a lumbar drain inserted, to avoid CSF fistula after a pterional craniotomy with opening of the frontal sinus for the clipping of a ruptured aneurysm. The drain was removed after 48 hours because of underdrainage (<1 ml/h). Three days after drain removal, she developed rapid deterioration of her level of consciousness and signs of cranial nerves involvement, brain stem and cerebellar dysfunction. intracranial pressure was low (<5 cm H(2)O) and MRI showed brain sagging and cerebellar foramen magnum herniation. The patient was successfully treated with epidural blood patch, ventricular drainage, and Trendelenburg position. The authors report this case because CSF hypovolaemia attributable to lumbar overdrainage is an insidious and threatening condition not easy to diagnose in the absence of detectable CSF leak. MRI and intracranial pressure monitoring confirm the diagnosis and permit better understanding of the physiopathology of brain sagging.
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