Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Jul 2009
Review Case ReportsAdult medulloblastoma and the "dural-tail" sign: rare mimic of a posterior petrous meningioma.
The authors describe clinical and radiological features of a 32-year-old male patient with a posterior fossa lesion. The radiological characteristics resembled an extra-axial lesion; a meningioma, with attachment to the tentorium and petrous bone. ⋯ We review literature of this atypical presentation of medulloblastoma and "dural-tail" sign, which can be associated with other benign or malignant lesions. The role of magnetic resonance spectroscopy in the diagnosis of primitive neuroectodermal tumors is discussed.
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Clin Neurol Neurosurg · Jul 2009
Case ReportsIntraventricular thrombolysis for massive intraventricular hemorrhage due to periventricular arteriovenous malformations: no absolute contraindications as rescue therapy prior to surgical repair or embolization?
Intraventricular hemorrhage (IVH) after bleeding from a cerebral aneurysm or an arteriovenous malformation (AVM) results in a high mortality. A limited number of publications have shown that intraventricular thrombolysis with e.g. recombinant tissue plasminogen activator (rt-PA) can be a therapeutic option in IVH. However, this treatment is considered as an absolute contraindication prior to the treatment of the bleeding source. ⋯ Our observations, together with nine comparable published cases, illustrate that this treatment might be useful to clear the intraventricular blood and lower intracranial pressure. It might also improve neurological outcome and mortality in these selected patients. This suggests that hemorrhage from a periventricular AVM, even before surgical resection or endovascular embolization, is not necessarily an absolute contraindication for intraventricular thrombolysis in patients with massive IVH.
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Clin Neurol Neurosurg · Jul 2009
ReviewThe complexity of neurobiological processes in acute ischemic stroke.
There is an urgent need for improved diagnostics and therapeutics for acute ischemic stroke. This is the focus of numerous research projects involving in vitro studies, animal models and clinical trials, all of which are based on current knowledge of disease mechanisms underlying acute focal cerebral ischemia. ⋯ In this review, we summarize the actual knowledge on the pathophysiology of acute ischemic stroke. We focus on the ischemic cascade, which is a complex series of neurochemical processes that are unleashed by transient or permanent focal cerebral ischemia and involves cellular bioenergetic failure, excitotoxicity, oxidative stress, blood-brain barrier dysfunction, microvascular injury, hemostatic activation, post-ischemic inflammation and finally cell death of neurons, glial and endothelial cells.
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Clin Neurol Neurosurg · Jul 2009
Comparative StudySpectroscopy-supported frame-based image-guided stereotactic biopsy of parenchymal brain lesions: comparative evaluation of diagnostic yield and diagnostic accuracy.
Comparative evaluation of diagnostic efficacy of stereotactic brain biopsy performed with and without additional use of spectroscopic imaging ((1)H-MRS) for target selection was done. ⋯ While in the present study the diagnostic yield of (1)H-MRS-supported frame-based stereotactic brain biopsy was 100%, its statistically significant diagnostic advantages over MRI-guided technique were not proved. Optimal selection of the spectroscopic target for tissue sampling remains unclear.
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Clin Neurol Neurosurg · Jul 2009
Case ReportsMedulloblastoma mimicking Lhermitte-Duclos disease on MRI and CT.
Although previous reports purport that the unique magnetic resonance imaging (MRI) features of Lhermitte-Duclos disease (LDD) obviates the need for biopsy, medulloblastoma can have an indistinguishable imaging appearance. ⋯ In those patients where imaging is highly suggestive of LDD but lack other manifestations of Cowden syndrome, biopsy is required and advanced imaging with magnetic resonance spectroscopy (MRS) should be strongly considered.