Is vasospasm requisite for posterior leukoencephalopathy in patients with primary thunderclap headaches?

Primary thunderclap headache (TCH) is sometimes associated with cerebral vasospasm. However, the role of vasospasm in relation to the development of reversible or irreversible posterior leukoencephalopathy among patients with primary TCH has never been fully addressed. This paper includes a report on a 51-year-old woman with primary TCH complicated with posterior leukoencephalopathy and a literature review of 16 further patients with the same illness. Their magnetic resonance or conventional angiographic findings were clearly described. Our review found that all these 17 patients showed evidence of cerebral vasospasm. Eleven (65%) of them developed permanent ischaemic infarctions, almost exclusively located at the watershed zones. We suggest that the presence of vasospasm might be requisite for posterior leukoencephalopathy as well as for permanent infarctions in these patients. Therefore, searching for any clue of vasospasm is mandatory in treatment of patients with primary TCH. Absence of an accompanying vasospasm might predict a good outcome.     

Reduction in hypothalamic 1H-MRS metabolite ratios in patients with cluster headache

OBJECTIVE: To determine the 1H-MR spectroscopic (MRS) findings in the hypothalamus in patients with episodic cluster headache. METHODS: 47 patients were recruited with episodic cluster headache (35 in cluster period and 12 in remission), 21 normal controls, and 16 patients with chronic migraine. The hypothalamic 1H-MRS metabolite ratio changes in patients with cluster headache were evaluated and compared with results in the normal controls as well as patients with chronic migraine. Seven patients in the cluster period group underwent a follow up hypothalamic MRS study five to six months after remission. RESULTS: In patients with cluster headache, the hypothalamic N-acetylaspartate (NAA)/creatine (Cr) and choline (Cho)/Cr ratios were similar between those in cluster period and in remission. As a group, both NAA/Cr and Cho/Cr levels were significantly lower in patients with cluster headache in comparison with either the control or chronic migraine groups. In those with a follow up MRS study, the levels of metabolite ratios did not differ between the cluster and remission periods. CONCLUSIONS: This study provides evidence of persistent biochemical change of the hypothalamus in patients with episodic cluster headache. Low levels of NAA/Cr and Cho/Cr suggest that cluster headache might be related to both neuronal dysfunction and changes in the membrane lipids in the hypothalamus.     

Neuroradiological findings in atypical teratoid/rhabdoid tumor of the central nervous system

PURPOSE: To evaluate the computed tomography (CT) and magnetic resonance imaging (MRI) findings of atypical teratoid tumor/rhabdoid tumor (AT/RT) of the central nervous system (CNS). MATERIAL AND METHODS: Twenty cases of CNS AT/RT have been found over the past 23 years in our hospital; these involving 11 boys and 9 girls whose mean age at diagnosis was 5.5 years. Their clinical data, the CT, and MRI findings were reviewed retrospectively. RESULTS: AT/RT was located in the cerebellum in 15 cases. Four cases arose from the supratentorial region, while only one occurred primarily in the lumbar spinal cord. Almost all cases revealed heterogeneous intensity and heterogeneous enhancement. Peripheral cystic components were common. Survival time ranged from 2 months to 3 years, with a mean survival of 11.6 months. CONCLUSION: Most cases of AT/RT are located in the cerebellum. The radiologic manifestations are non-specific. The diagnosis mainly depends on the pathologic findings. However, AT/RT should still remain in the differential diagnosis of brain tumors in young children, especially those located in the cerebellar hemisphere and with eccentric cysts.     

Endovascular embolization of recurrent traumatic carotid-cavernous fistulas managed previously with detachable balloons

BACKGROUND: This study investigated the causes of recurrent traumatic carotid-cavernous fistulas (RTCCFs) after detachable balloon embolization and evaluated the selection of embolic materials for endovascular treatment of the RTCCFs. METHODS: Over a 10-year period, 116 patients underwent transarterial balloon embolization with occlusion of the fistulas and preservation of the parent arteries. In 15 patients, 18 RTCCFs developed. The causes of RTCCFs included premature balloon deflation and migration (n = 13) or bony fragment puncture of balloons (n = 5). A second or third embolization involved balloons (n = 6), balloons with coils (n = 2), and N-butyl-2-cyanoacrylate with coils (n = 7), or balloon, coils, and N-butyl-2-cyanoacrylate (n = 3). RESULTS: In this study, 17 RTCCFs were successfully occluded after repeat embolization with preservation of parent arteries. One case resulted in recurrent epistaxis. The recurrent fistula and parent artery were occluded with balloons. No significant complications or recurrent fistulas occurred after the last embolization (mean follow-up period, 16 months). CONCLUSIONS: Balloon puncture or premature deflation and migration occasionally cause RTCCFs. Sacrifice of the parent artery rarely is needed. Transarterial embolization remains the best approach, with balloons used first, then coils, N-butyl-2-cyanoacrylate, or both.     

Repetitive phenomena in dementia

OBJECTIVE: Both repetitive talk and behaviors (repetitive phenomena) are common in demented patients and are bothersome to their caregivers and families. The purpose of this preliminary report was to explore these repetitive phenomena in demented patients admitted to a geropsychiatric ward. METHOD: The sample population consisted of 141 demented patients. Patients' caregivers were asked if patients had presented a repetitive fixed pattern of physical action or talk since the onset of dementia. RESULTS: Of the 141 demented patients included in the study, seventy-nine had repetitive phenomena. Patients with these phenomena had various presentations and developed them in the early stage of dementia. CONCLUSIONS: Repetitive phenomena are widespread in dementia, especially for older patients, and may be an early sign of dementia. The characteristics of repetitive phenomena and some likely underlying mechanisms are discussed.     

Posterior cranial fossa tumours in childhood

We reviewed clinical and CT findings in 133 posterior cranial fossa tumours in children. All had histological diagnosis, apart from 20 cases of brain stem glioma. The majority were intra-axial tumours, including 53 medulloblastomas (40%), 31 cerebellar astrocytomas (23%), 28 brain stem gliomas (21%), 14 ependymomas (11%), and single cases of ganglioglioma, haemangioblastoma and teratoma. Extra-axial tumours formed only 3%, including 2 chordomas and 2 schwannomas. The clinical data and CT findings are reviewed. Cerebellar astrocytoma involved the sexes equally, while medulloblastoma, brain stem glioma, and ependymoma were more common in males. Most cerebellar astrocytomas were in the midline, and presumably arose from the vermis. The frequency of calcification was similar to that in previous reports, being highest in ependymoma (69%), followed my medulloblastoma (29%), cerebellar astrocytoma (17%), and brain stem glioma (8%).