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Karthikeyan Meenakshi K, S M, Sekhar CHN, Kumar J, Madhavan K. Cavernous Angioma: A Rare Cause of Multiple Cranial Nerve Palsies. Cureus 2024; 16:e67464. [PMID: 39310500 PMCID: PMC11416198 DOI: 10.7759/cureus.67464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2024] [Accepted: 08/21/2024] [Indexed: 09/25/2024] Open
Abstract
Acute onset of neurological deficit is highly suggestive of stroke; in such cases, computed tomography (CT) brain is the initial choice of investigation. While CT brain can differentiate between hemorrhagic and ischemic infarct, more often than not, it is unable to detect the underlying etiology of intracerebral hemorrhage. In these situations, magnetic resonance imaging (MRI) brain is crucial in determining the exact etiology and helps us tailor the specific management best suited for our patient. The case under discussion is of a 48-year-old male who presented with multiple cranial nerve palsies and ipsilateral cerebellar involvement in whom CT brain revealed a hemorrhage involving left hemipons and left middle cerebellar peduncle while an MRI brain revealed an unexpected cavernous angioma which changed the management and prognosis of the patient, proving its superiority over CT brain.
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Affiliation(s)
- Kavyaashree Karthikeyan Meenakshi
- Department of General Medicine, SRM Medical College Hospital and Research Centre, SRM Institute of Science and Technology (SRMIST), Kattankulathur, IND
| | - Madhumitha S
- Department of General Medicine, SRM Medical College Hospital and Research Centre, SRM Institute of Science and Technology (SRMIST), Kattankulathur, IND
| | - C H Naga Sekhar
- Department of General Medicine, SRM Medical College Hospital and Research Centre, SRM Institute of Science and Technology (SRMIST), Kattankulathur, IND
| | - J Kumar
- Department of General Medicine, SRM Medical College Hospital and Research Centre, SRM Institute of Science and Technology (SRMIST), Kattankulathur, IND
| | - Krishnaswamy Madhavan
- Department of General Medicine, SRM Medical College Hospital and Research Centre, SRM Institute of Science and Technology (SRMIST), Kattankulathur, IND
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Findlay MC, Kim RB, Putnam AR, Couldwell WT. Management of Symptomatic Hemorrhage From a Developmental Venous Anomaly. Cureus 2024; 16:e58130. [PMID: 38738135 PMCID: PMC11088928 DOI: 10.7759/cureus.58130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2024] [Indexed: 05/14/2024] Open
Abstract
Developmental venous anomalies (DVAs) are clinically benign, low-flow vascular malformations that classically hemorrhage only when associated with a cerebral cavernous malformation. It is very rare for an isolated DVA to hemorrhage. Resection of the DVA is generally contraindicated because of the high risk of venous infarct. We present the case of a large symptomatic hemorrhage stemming from an isolated DVA. The hematoma was evacuated and the hemorrhagic portion of the DVA was resected. This case demonstrates that in rare circumstances, careful resection can successfully treat hemorrhagic DVAs.
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Affiliation(s)
| | - Robert B Kim
- Department of Neurosurgery, University of Utah, Salt Lake City, USA
| | | | - William T Couldwell
- Department of Neurosurgery, University of Utah, Huntsman Cancer Institute, Salt Lake City, USA
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Motoyama Y, Sasaki H, Nakajima T, Hayami H, Matsuoka R, Fukutome K, Tei R, Shin Y, Aketa S. Eagle jugular syndrome accompanied by de novo brainstem cavernous malformation: a case-based systematic review. Acta Neurochir (Wien) 2024; 166:20. [PMID: 38231302 DOI: 10.1007/s00701-024-05900-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 12/12/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Eagle jugular syndrome (EJS), recently identified as a cause of cerebrovascular disease (CVD) due to venous obstruction by an elongated styloid process (SP), is reported here alongside a case of concurrent de novo cerebral cavernous malformation (CCM). This study aims to explore the potential causal relationship between EJS and de novo CCM through a comprehensive literature review. METHOD Systematic literature reviews, spanning from 1995 to 2023, focused on EJS cases with definitive signs and symptoms and de novo CCM cases with detailed clinical characteristics. Data on the pathophysiology and clinical manifestations of EJS, as well as potential risk factors preceding de novo CCM, were collected to assess the relationship between the two conditions. RESULT Among 14 patients from 11 articles on EJS, the most common presentation was increased intracranial hypertension (IIH), observed in 10 patients (71.4%), followed by dural sinus thrombosis in four patients (28.6%). In contrast, 30 patients from 28 articles were identified with de novo CCM, involving 37 lesions. In these cases, 13 patients developed CCM subsequent to developmental venous anomalies (43%), seven following dural arteriovenous fistula (dAVF) (23%), and two after sinus thrombosis (6%). In a specific case of de novo brainstem CCM, the development of an enlarged condylar emissary vein, indicative of venous congestion due to IJV compression by the elongated SP, was noted before the emergence of CCM. CONCLUSION This study underscores that venous congestion, a primary result of symptomatic EJS, might lead to the development of de novo CCM. Thus, EJS could potentially be an indicator of CCM development. Further epidemiological and pathophysiological investigations focusing on venous circulation are necessary to clarify the causal relationship between EJS and CCM.
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Affiliation(s)
- Yasushi Motoyama
- Department of Neurosurgery, Osaka Police Hospital, 10-31 Kitayama-Cho, Tennoji-Ku, Osaka City, 543-0035, Japan.
| | - Hiromitsu Sasaki
- Department of Neurosurgery, Osaka Police Hospital, 10-31 Kitayama-Cho, Tennoji-Ku, Osaka City, 543-0035, Japan
| | - Tsukasa Nakajima
- Department of Neurosurgery, Osaka Police Hospital, 10-31 Kitayama-Cho, Tennoji-Ku, Osaka City, 543-0035, Japan
| | - Hiromichi Hayami
- Department of Neurosurgery, Osaka Police Hospital, 10-31 Kitayama-Cho, Tennoji-Ku, Osaka City, 543-0035, Japan
| | - Ryuta Matsuoka
- Department of Neurosurgery, Osaka Police Hospital, 10-31 Kitayama-Cho, Tennoji-Ku, Osaka City, 543-0035, Japan
| | - Kenji Fukutome
- Department of Neurosurgery, Osaka Police Hospital, 10-31 Kitayama-Cho, Tennoji-Ku, Osaka City, 543-0035, Japan
| | - Rinsei Tei
- Department of Neurosurgery, Osaka Police Hospital, 10-31 Kitayama-Cho, Tennoji-Ku, Osaka City, 543-0035, Japan
| | - Yasushi Shin
- Department of Neurosurgery, Osaka Police Hospital, 10-31 Kitayama-Cho, Tennoji-Ku, Osaka City, 543-0035, Japan
| | - Shuta Aketa
- Department of Neurosurgery, Osaka Police Hospital, 10-31 Kitayama-Cho, Tennoji-Ku, Osaka City, 543-0035, Japan
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Wang X, Zhou Y, Deng D, Li H, Guan X, Fang L, Cai Q, Wang W, Zhou Q. Developing a deep learning model to predict epilepsy recurrence in patients with focal cortical dysplasia type III. Quant Imaging Med Surg 2023; 13:999-1008. [PMID: 36819249 PMCID: PMC9929418 DOI: 10.21037/qims-22-276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 12/08/2022] [Indexed: 01/06/2023]
Abstract
Background A sizable number of patients with focal cortical dysplasia (FCD) type III-related refractory epilepsy continue to experience seizures postsurgically. Deep learning models can automatically assess complex medical image characteristics and predict prognosis with higher efficiency. This study sought to determine whether T2-weighted fluid attenuated inversion recovery (T2W FLAIR) images could predict prognosis of FCD type III-related refractory epilepsy using a deep learning approach. Methods Magnetic resonance imaging (MRI) images of 266 patients with FCD type III diagnosed between 2015 and 2019 were included in this retrospective analysis. A deep learning algorithm utilizing a convolutional neural network (CNN) was trained to classify T2W FLAIR images according to Engel's classification. The preprocessed original image and the region of interest (ROI) outlined by clinicians were input into our neural network separately and then together. Precision, sensitivity, specificity, receiver operating characteristic (ROC) curves, and areas under the ROC curves (AUCs) were computed as part of the statistical analyses of the network performance with varied inputs of the network model assessed. Results The overall performance met the following metrics when the original image only was input: AUC of 96.22%, sensitivity of 84.47%, and specificity of 97.21%. The metrics were as follows when the ROI only was input: area under the ROC curve of 94.76%, sensitivity of 84.92%, and specificity of 96.24%. For the combined inputs, the metrics were as follows: AUC of 97.17%, sensitivity of 90.86%, and specificity of 96.63%. Conclusions Deep learning used with conventional MRI can effectively predict the recurrence conditions of epilepsy. Artificial intelligence may help the design of clinical management and enable more precise and individualized prediction for postsurgical prognosis of FCD type III-related refractory epilepsy.
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Affiliation(s)
- Xiaozhuan Wang
- Department of Radiology, Third Affiliated Hospital of Southern Medical University, Academy of Orthopedics, Guangzhou, China
| | - Yujia Zhou
- Guangdong Provincial Key Laboratory of Medical Image Processing, Guangdong Province Engineering Laboratory for Medical Imaging and Diagnostic Technology, School of Biomedical Engineering, Southern Medical University, Guangzhou, China
| | - Dabiao Deng
- Department of Radiology, Third Affiliated Hospital of Southern Medical University, Academy of Orthopedics, Guangzhou, China;,Department of Radiology, Guangdong 999 Brain Hospital, Guangzhou, China
| | - Honglin Li
- Department of Radiology, Third Affiliated Hospital of Southern Medical University, Academy of Orthopedics, Guangzhou, China
| | - Xueqin Guan
- Department of Radiology, Third Affiliated Hospital of Southern Medical University, Academy of Orthopedics, Guangzhou, China
| | - Liguang Fang
- Department of Radiology, Third Affiliated Hospital of Southern Medical University, Academy of Orthopedics, Guangzhou, China
| | - Qinxin Cai
- Department of Radiology, Third Affiliated Hospital of Southern Medical University, Academy of Orthopedics, Guangzhou, China
| | - Wensheng Wang
- Department of Radiology, Guangdong 999 Brain Hospital, Guangzhou, China
| | - Quan Zhou
- Department of Radiology, Third Affiliated Hospital of Southern Medical University, Academy of Orthopedics, Guangzhou, China
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Wang X, Deng D, Zhou C, Li H, Guan X, Fang L, Cai Q, Wang W, Zhou Q. Focal Cortical Dysplasia Type Ⅲ Related Medically Refractory Epilepsy: MRI Findings and Potential Predictors of Surgery Outcome. Diagnostics (Basel) 2021; 11:diagnostics11122225. [PMID: 34943462 PMCID: PMC8699898 DOI: 10.3390/diagnostics11122225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 11/16/2021] [Accepted: 11/18/2021] [Indexed: 11/16/2022] Open
Abstract
This study aims to explore the relationship between neuropathologic and the post-surgical prognosis of focal cortical dysplasia (FCD) typed-Ⅲ-related medically refractory epilepsy. A total of 266 patients with FCD typed-Ⅲ-related medically refractory epilepsy were retrospectively studied. Presurgical clinical data, type of surgery, and postsurgical seizure outcome were analyzed. The minimum post-surgical follow-up was 1 year. A total of 266 patients of FCD type Ⅲ were included in this study and the median follow-up time was 30 months (range, 12~48 months). Age at onset ranged from 1.0 years to 58.0 years, with a median age of 12.5 years. The number of patients under 12 years old was 133 (50%) in patients with FCD type Ⅲ. A history of febrile seizures was present in 42 (15.8%) cases. In the entire postoperative period, 179 (67.3%) patients were seizure-free. Factors with p < 0.15 in univariate analysis, such as age of onset of epilepsy (p = 0.145), duration of epilepsy (p = 0.004), febrile seizures (p = 0.150), being MRI-negative (p = 0.056), seizure type (p = 0.145) and incomplete resection, were included in multivariate analysis. Multivariate analyses revealed that MRI-negative findings of FCD (OR 0.34, 95% CI 0.45-0.81, p = 0.015) and incomplete resection (OR 0.12, 95% CI 0.05-0.29, p < 0.001) are independent predictors of unfavorable seizure outcomes. MRI-negative finding of FCD lesions and incomplete resection were the most important predictive factors for poor seizure outcome in patients with FCD type Ⅲ.
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Affiliation(s)
- Xiaozhuan Wang
- Department of Radiology, Academy of Orthopedics Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China; (X.W.); (D.D.); (H.L.); (X.G.); (L.F.); (Q.C.)
| | - Dabiao Deng
- Department of Radiology, Academy of Orthopedics Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China; (X.W.); (D.D.); (H.L.); (X.G.); (L.F.); (Q.C.)
- Department of Radiology, Guangdong 999 Brain Hospital, Guangzhou 510510, China
| | - Chengqian Zhou
- Department of Psychiatry and Behavioral Science, School of Medicine, John Hopkins University, Baltimore, MD 21278, USA;
| | - Honglin Li
- Department of Radiology, Academy of Orthopedics Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China; (X.W.); (D.D.); (H.L.); (X.G.); (L.F.); (Q.C.)
| | - Xueqin Guan
- Department of Radiology, Academy of Orthopedics Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China; (X.W.); (D.D.); (H.L.); (X.G.); (L.F.); (Q.C.)
| | - Liguang Fang
- Department of Radiology, Academy of Orthopedics Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China; (X.W.); (D.D.); (H.L.); (X.G.); (L.F.); (Q.C.)
| | - Qinxin Cai
- Department of Radiology, Academy of Orthopedics Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China; (X.W.); (D.D.); (H.L.); (X.G.); (L.F.); (Q.C.)
| | - Wensheng Wang
- Department of Radiology, Guangdong 999 Brain Hospital, Guangzhou 510510, China
- Correspondence: (W.W.); (Q.Z.)
| | - Quan Zhou
- Department of Radiology, Academy of Orthopedics Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China; (X.W.); (D.D.); (H.L.); (X.G.); (L.F.); (Q.C.)
- Correspondence: (W.W.); (Q.Z.)
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