1/8. An angiographically occult arteriovenous malformation in the medial parietal lobe presenting as seizures of medial temporal lobe origin.We present an unusual case of a patient who was diagnosed with temporal lobe epilepsy and whose seizures were reduced markedly after excision of an angiographically occult arteriovenous malformation (AVM) located in the left medial parietal lobe. A 38-year-old man had complex partial seizures characterized by motionless staring with oroalimentary and behavioral automatisms since the age of 15 years. magnetic resonance imaging (MRI) demonstrated a small lesion extending from the left posterior cingulate gyrus to the precuneus. There was no MRI evidence of mesial temporal sclerosis. Intracranial EEG recordings showed ictal onset from the left medial parietal lobe propagating to the medial temporal lobes. Clinical signs appeared when these discharges reached the temporal lobes. After excision of the lesion (which was histologically confirmed as an AVM), together with the marginal cortex, seizures were reduced significantly. Careful diagnostic evaluation of lesions such as the this one may reveal an epileptogenic lesion (zone) far from the region where scalp ictal discharges seem to arise. In our case, we hypothesize that false localization was due to propagation of ictal discharges from the parietal focus through the limbic system.- - - - - - - - - - ranking = 1keywords = sclerosis (Clic here for more details about this article) |
2/8. Intractable epilepsy following radiosurgery for arteriovenous malformation.radiosurgery is often used to treat arteriovenous malformations (AVMs) located in deep brain locations. Most of these procedures are successful not only in obliterating the AVM but also in decreasing the frequency and severity of associated seizures. Although radiosurgery is occasionally associated with the development of easy-to-control seizures immediately postoperatively, there have been no reports of intractable epilepsy developing after radiosurgery. In this report, however, a case is presented in which a patient underwent gamma knife surgery (GKS) for an AVM, after which intractable epilepsy and mesial temporal sclerosis (MTS) gradually developed. A 37-year-old right-handed woman underwent GKS for a right mesial parietotemporooccipital AVM. One year later, the AVM had reduced in size, but the patient began to experience complex partial seizures (CPSs). These CPSs initially occurred at a frequency of one per month, but 6 months later they were occurring every other week. She also started having secondarily generalized tonic-clonic seizures (GTCSs) once per month. Over the next year the frequency of her seizures gradually increased to several CPSs per day and two to three GTCSs per week, despite treatment with various combinations of antiepileptic drugs. By this time her AVM had decreased to one half of its original size. Video-electroencephalography monitoring demonstrated that both the CPSs and GTCSs were arising from the right posterior quadrant. magnetic resonance imaging revealed not only the presence of the right-sided AVM, but also right-sided MTS. The patient underwent surgical resection of the AVM and right temporal lobectomy. She has been free from seizure for longer than 1 year. radiosurgery may be associated with intractable epilepsy and MTS.- - - - - - - - - - ranking = 1keywords = sclerosis (Clic here for more details about this article) |
3/8. Clinical presentations of vascular malformations of the brain stem: comparison of angiographically positive and negative types.Clinical and radiographic features of 63 patients with a vascular malformation of the brain stem are described. On radiological grounds they were divided into two groups: one with angiographically visible lesions (AVAVMs), the other with lesions not seen angiographically, that is, occult (AOVMs). In the first group the initial clinical manifestation was due to haemorrhage in 20 of the 33 cases and consisted of a progressive neurological deficit in 12. In the second group 29 of the 30 initially presented with a brain stem haemorrhage. The latter was often characterised by development of symptoms over two days or more (16 cases), absence of headache (48 cases) and tendency to recurrence (20 cases). Clinical diagnosis was difficult in many cases especially in the AOVM group. Several of the patients were misdiagnosed as having multiple sclerosis. Clinical data in conjunction with magnetic resonance imaging were helpful in determining the nature of these lesions.- - - - - - - - - - ranking = 10.676895551049keywords = multiple sclerosis, sclerosis (Clic here for more details about this article) |
4/8. Occult arteriovenous malformation of the brainstem simulating multiple sclerosis.A patient who proved to have an angiographically occult arteriovenous malformation of the brainstem and cerebellum was thought to have multiple sclerosis for 20 years, because of fluctuating brainstem symptoms and signs. Although the computed tomographic (CT) appearance of the lesion suggested a vascular malformation, because it bridged the subarachnoid space between the brainstem and cerebellum, an arteriogram was normal. This report stresses the importance of CT in making the diagnosos of occult arteriovenous malformations of the brainstem. On CT scan, these lesions generally have a high-density multiform appearance, which may enhance with contrast infusion. This lesion should be suspected clinically when there are fluctuating neurologic symptoms and signs attributable to the same neuroanatomic location within the brainstem. Surgical biopsy may confirm the diagnosis, but attempts to remove these lesions from the brainstem parenchyma are hazardous and probably are not indicated, considering the chronic and relatively benign course.- - - - - - - - - - ranking = 53.384477755245keywords = multiple sclerosis, sclerosis (Clic here for more details about this article) |
5/8. Concurrence of multiple sclerosis and primary intracranial neoplasms.The concurrence of multiple sclerosis and primary intracranial neoplasms is uncommon. The literature contains 20 cases of multiple sclerosis associated with gliomas and nine cases with non-gliomatous neoplasms. This report describes a protoplasmic astrocytoma and arteriovenous malformation found incidentally at autopsy of a 63-year-old woman with a 25-year history of multiple sclerosis. This is the first demonstrated association of multiple sclerosis with an arteriovenous malformation. Although neoplastic transformation of reactive glial cells in multiple sclerosis plaques has been proposed as the source of gliomas, the association of multiple sclerosis with astrocytoma and arteriovenous malformation in the present case is considered to be coincidental. Gliomas reported in association with multiple sclerosis are more frequently (30%) multicentric than are uncomplicated gliomas.- - - - - - - - - - ranking = 117.44585106154keywords = multiple sclerosis, sclerosis (Clic here for more details about this article) |
6/8. The clinical and pathological spectrum of brain-stem vascular malformations. Long-term course stimulates multiple sclerosis.Three cases of brain-stem vascular malformation with progressive and fluctuating clinical courses of longer than one year were studied. One patient with a rare brain-stem arteriovenous malformation lived for 20 years with symptoms notably similar to those of multiple sclerosis (MS). One case each of cavernous hemangioma and capillary telangiectasis are also described. The clinical, roentgenographic, and pathologic features of these three cases plus 18 other cases of brain-stem vascular malformations from the literature, with progressive or intermittent clinical courses and with survival of longer than one year from the onset of symptoms, are reviewed. Since nearly all of these cases were once mistakenly diagnosed as MS, a diagnostic approach is proposed to help distinguish brain-stem vascular malformations from MS prior to an obvious subarachnoid hemorrhage.- - - - - - - - - - ranking = 53.384477755245keywords = multiple sclerosis, sclerosis (Clic here for more details about this article) |
7/8. Cerebral arterial ectasia and tuberous sclerosis: case report.OBJECTIVE AND IMPORTANCE: tuberous sclerosis is associated with a wide variety of central nervous system abnormalities. Cerebrovascular anomalies are extremely rare, but a case of cerebral arterial ectasia and giant fusiform aneurysm formation in a young child is reported. CLINICAL PRESENTATION: A 5-month-old male patient with tuberous sclerosis presented with seizures, a subependymal tumor, and intraventricular hemorrhage. cerebral angiography demonstrated a large fusiform aneurysm of the left cavernous internal carotid artery as well as arterial ectasia of the proximal left anterior cerebral and middle cerebral arteries. The patient developed hydrocephalus and died of infectious complications after repeated shunt procedures. CONCLUSION: tuberous sclerosis is commonly associated with central nervous system lesions. Although rare, cerebrovascular anomalies and aneurysms should be considered in the differential diagnosis of mass lesions to avoid an ill-advised biopsy of a vascular lesion, which could have disastrous consequences.- - - - - - - - - - ranking = 7keywords = sclerosis (Clic here for more details about this article) |
8/8. Strokes in children.Nine cases have been presented in detail to illustrate some of the varied causes of sudden neurological deficit in childhood: arteriovenous malformation, cryptic hamartoma, berry aneurysm, mycotic aneurysm, intraspinal arteriovenous malformation, brain tumor, migraine, arteritis, and multiple sclerosis. The boston Children's Hospital experience with aneurysms and intracranial arteriovenous malformation has been summarized. It is noteworthy that a cutaneous hemangioma overlay one cranial and one intraspinal arteriovenous malformation. One small but deep cerebral arteriovenous malformation apparently destroyed itself after its second hemorrhage. Not only have multiple sclerosis and a brain tumor mimicked a vascular lesion, but a series of vascular accidents was misdiagnosed first as multiple sclerosis then as a thalamic tumor. The many possible causes of childhood strokes has been thoroughly cataloged in the Report of the Joint Committee for stroke Facilities in 1973 (11). Children may be more susceptible to strokes because of congenital abnormalities such as congenital heart disease, hemophilia, and sickle cell anemia, or by diseases which more commonly occur in this age group, such as leukemia. The likelihood of brain abscess in cyanotic congenital heart disease is stressed. Arteriographic studies in our series have been safe; however, there have been reports of probable worsening of symptoms in children with multiple cerebral occlusive lesions in the presence of homocystinuria.- - - - - - - - - - ranking = 32.030686653147keywords = multiple sclerosis, sclerosis (Clic here for more details about this article) |