Pial arteriovenous fistula with appearance of hemorrhagic tumor: A case report

INTRODUCTION

Pial arteriovenous fistula (PAVF) is a rare intracranial vascular disease, and its presentation with a huge tumor-resembling thrombus is rarer.

PATIENT CONCERNS

A 38-year-old female patient presented with a sudden left-side motor disorder and loss of consciousness. The patient was otherwise in good health and had no history of hypertension or diabetes. During the physical examination, she appeared lethargic and manifested left limb paralysis with level zero muscle strength and a positive pathological reflex.

DIAGNOSES

Because imaging failed to rule out a tumor stroke, an intracranial lesion resection was performed immediately. Because the lesion was considered to be a vascular structure, digital subtraction angiography was undertaken before the surgery, and PAVF was diagnosed.

INTERVENTIONS

Endovascular embolization was conducted, followed by PAVF and hematoma resection.

OUTCOMES

At the 3-month follow up, her left limb muscle strength was level 4, and she could live on her own (Modified Rankin Scale score = 2).

CONCLUSIONS

It is noteworthy that PAVF with a large thrombus may appear as a tumor in the initial diagnosis, and therefore it is necessary to perform an intracranial vascular examination in patients with tumor stroke symptoms.

Aspirin treatment does not increase microhemorrhage size in young or aged mice

Microhemorrhages are common in the aging brain and are thought to contribute to cognitive decline and the development of neurodegenerative diseases, such as Alzheimer’s disease. Chronic aspirin therapy is widespread in older individuals and decreases the risk of coronary artery occlusions and stroke. There remains a concern that such aspirin usage may prolong bleeding after a vessel rupture in the brain, leading to larger bleeds that cause more damage to the surrounding tissue. Here, we aimed to understand the influence of aspirin usage on the size of cortical microhemorrhages and explored the impact of age. We used femtosecond laser ablation to rupture arterioles in the cortex of both young (2–5 months old) and aged (18–29 months old) mice dosed on aspirin in their drinking water and measured the extent of penetration of both red blood cells and blood plasma into the surrounding tissue. We found no difference in microhemorrhage size for both young and aged mice dosed on aspirin, as compared to controls (hematoma diameter = 104 +/- 39 (97 +/- 38) μm in controls and 109 +/- 25 (101 +/- 28) μm in aspirin-treated young (aged) mice; mean +/- SD). In contrast, young mice treated with intravenous heparin had an increased hematoma diameter of 136 +/- 44 μm. These data suggest that aspirin does not increase the size of microhemorrhages, supporting the safety of aspirin usage.

A calvarial acute subdural hematoma migrating into the spinal canal in a young male

It is not common for an acute subdural hematoma (SDH) in the supratentorial region to show rapid resolution or migration during the clinical course. In this report, we present a rare case where the SDH in the supratentorial region was observed to rapidly migrate into the lumbar spinal canal, leading to severe radiculopathy. A 20-year-old male patient was admitted to the emergency department with severe headache after head trauma. The patient's overall condition was good, whereas his Glasgow Coma Scale score was 15 and blood pressure was normal. He had vomited 3 times after the onset of pain. No stiff neck was found, and the computed tomography showed an ASDH over the outer layer of the right hemisphere, causing a 7- to 8-mm shift. During the follow-up, the headache regressed and eventually resolved after 12 hours; however, another severe pain occurred in the lumbar region and in both legs. The pain worsened over time, progressing to sciatica in both legs. Acute SDH associated with a minor head trauma may migrate from the supratentorial compartment into the spinal canal by the help of elastic cerebral tissues in young adults and children.

[Photodocumentation during autopsy]

Photography during autopsy is an important part of forensic imaging and essential for the documentation of autopsy findings. A forensic photograph mainly serves the purpose of providing evidence and should be authentic. But aesthetic artwork may improve both the attractiveness and acceptance of autopsies and thus help to increase the autopsy rate. Different materials were compared to each other as photographic backdrop, particularly with regard to reflection and contrast, stability of exposure measurement and monitoring of colour fidelity. The photofoil 9010 Dove Grey proved to be a material of outstanding quality. In practical application, the foil was scratch-resistant and easy to clean. Furthermore, backdrop boards with a gap, e.g. for head and neck, allow special perspectives without a distracting background.

[Local fibrinolysis in treatment of non-traumatic intracerebral hematomas and ventricular hemorrhages]

Local fibrinolysis and aspiration in treatment of spontaneous intracerebral hematomas (SIH) and ventricular hemorrhages (VH) have become a wide spread technique in dedicated cerebrovascular centers. Forty four patients treated in Burdenko NSI in 2007-2011 were evaluated. Local fibrinolysis for SIH were perfomed in 30 pt., for isolated VH in 14. Puroplazan, a prourokinaze based derivative (mean dose - 50 000 ME) were used in 36 cases, Actilyse (tPA) (2.0 g mean) in 8 cases. Status at discharge was improved in 66.7% of patients with SIH and 57.1% of patients with isolated VH. Mortality comprised to 10 and 28.6% correspondingly. Local hematoma aspiration and fibrinolysis is an effective minimally-invasive method of primary and secondary non-traumatic SIH and VH evacuation. Dose of fibrinolytic agent should be selected individually and depends on hematoma volume. Applied dose clinically-wise should be decreased along with reducing of hematoma size and number of injections to minimize recurrent hemorrhage risk.

[The possibility and mechanism of spontaneous redistribution of acute intracranial subdural hematomas]

The author has undertaken the systematic search for the description of isolated and serial cases of spontaneous redistribution of acute intracranial subdural hematomas with their mandatory computed and magneto-resonance neurovisualization. Based on the results of the search and metaanalysis of statistical data, it is concluded that acute intracranial subdural are likely to undergo any possible dislocation over the surface of the large hemispheres of the brain as well as downward transtentorial and spinal migration. The non-linear regression analysis allowed to determine the spinal migration rate of acute intracranial subdural hematomas. At the same time, the analysis gave no evidence of the possibility of the upward transtentorial redistribution of acute intracranial subdural hematomas across the falx of the cerebrum. It is concluded that the results of the present study can be used for the porpose of practical forensic medical expertise and the identification of the sources of spontaneous redistribution of acute intracranial subdural hematomas.

Chronic emispheric subdural hematoma in a patient with antibodies antiphospholipid syndrome: case report

The treatment of chronic subdural hematoma (CSDH) was developed through a wide range of methods and technique. The excellent surgical treatment of CSDH is still controversial. The authors report a case of chronic subdural hematoma in a patient with antibodies antiphospholipidis syndrome (S. of Hughes). Antiphospholipid syndrome is characterized by arterial or venous thrombosis, and the presence of antiphospholipid antibodies (APL). APL are considered to be a cause of an acquired hypercoagulable state leading to stroke and transient ischemic attack (TIA).

A rare case of head injury associated with Albers Schonberg disease

Albers Schonberg disease commonly called as osteopetrosis is a disorder involving defective bone resorption. The severe autosomal recessive form of osteopetrosis is very rare and characterised by abnormalities in skeletal bones, delayed psychomotor development, optic and facial nerve dysfunction, hydrocephalus, anaemia, haematologic and bleeding disorder, and a diversity of other manifestation. We report a case of intracranial subdural haematoma following a trivial head injury in an infant with severe autosomal recessive form of osteopetrosis.

Traumatic brain injury in infants: the phenomenon of subdural hemorrhage with hemispheric hypodensity (“Big Black Brain”)

Clinical and experimental studies of traumatic brain injury during immaturity have been far less numerous than those involving adults, and many questions remain about differences in injury responses among patients of different ages. This chapter reviews a distinctive injury pattern common in infants, the so-called "big black brain" response to acute subdural hematoma. The pathophysiology of this injury remains incompletely understood. Insights from both clinical observation and experimental studies have helped to clarify the probable causes of this injury pattern, which appears to require a combination of stressors during a particular period of maturation.

Subacute spinal subdural hematoma associated with intracranial subdural hematoma

We describe a subacute spinal subdural hematoma in a patient with psot-traumatic subacute intracranial subdural hematoma. CT and MRI demonstrated hematoma within the interhemispheric subdural space and at the lumbar posterior subdural space which extended from the L1 to the S2 level. The lesion showed high signal intensity on both T1 and T2 weighted images. Surgical decompression of the spinal subdural hematoma was performed. The symptoms completely resolved after surgery. Spinal subdural hematoma may be concomitant with or may occur after intracranial subdural hematoma. If a patient with intracranial subdural hematoma complains of low back pain and weakness in both legs; lumbosacral MR examination should be performed to exclude spinal subdural hematoma.

Cervical syringohydromyelia secondary to chronic supratentorial subdural hematoma

INTRODUCTION

Syringohydromyelia associated with supratentorial space-occupying lesion has rarely been reported. We present a 28-year-old woman was admitted to the hospital with head and neck pain. Upon examination, there was only left central facial paralisia, with no evidence of papilledema.

METHODS AND RESULTS

Cranial magnetic resonance imaging (MRI) revealed a left parietal and temporal chronic subdural hematoma (CSH) with a 1-cm shift to the right from midline. Also, cervical MRI revealed a syringohydromyelic cavity at the level of C6/7. The patient was operated on for supratentorial CSH. A follow-up cervical MRI revealed no syringohydromyelic cavity after 2 months. No neurological deficit was reported, and overall outcome was excellent.

CONCLUSION

Syringohydromyelia was secondary to a space-occupying lesion in our case of supratentorial chronic subdural hematoma.