I. Chiaramonte

Traumatic labyrinthine concussion in a patient with sensorineural hearing loss.

Blunt head trauma without any temporal bone fracture or longitudinal temporal bone fracture, with an associated fracture of the labyrinth may cause labyrinthine injury with sensor neural hearing loss and vertigo because of a concussive injury to the membranous labyrinth. Sudden sensory neural hearing loss is relatively frequent. In most cases, the etiology is not discovered. One of the possible causes for sudden deafness is inner labyrinth bleeding or concussion, which were difficult to diagnose before the advent of magnetic resonance imaging. Vertigo without a demonstrable fracture may also be the result of labyrinthine concussion, cupololithiasis and perilymphatic fistula. We describe the clinical case of a patient with acute traumatic hearing loss and vertigo, without skull base fracture detected on computed tomography. Magnetic resonance study was also performed. We have integrated the discussion with features that allow the differential diagnosis from other similar conditions.

Parietal atretic cephalocele: Associated cerebral anomalies identified by CT and MR imaging.

We describe a case of atretic cephalocele (AC) characterized by the presence of various cerebral anomalies of different midline structures. In our patient the presence of a parietal AC was associated with an embryonic position of the straight sinus, fenestration of the superior sagittal sinus, an abnormal insertion of the cerebellar tentorium with prominence of the superior cerebellar cistern and a septum pellucidum cyst. These findings, associated with AC, could lead to a worse prognosis with regard to neurodevelopmental milestones. This suggests that even if AC is a benign lesion, a complete evaluation of the brain structures should always be performed in these young patients.

Vascular Cerebral Anomalies Associated with Septo-Optic Dysplasia A Case Report

We describe a case of Septo-Optic Dysplasia (SOD) characterized by the presence of anomalous cerebral vessels. In our young patient the classical features of SOD were associated with vascular anomalies including absence of the vein of Galen, right Rosenthal vein leading to the superior petrosal sinus, and anomalous origin of the anterior choroidal arteries. These findings have never been associated with SOD in the literature but their revelation supports the hypothesis of a vascular disruption as a possible cause of the SOD.

Guillain-Barré Syndrome Associated with Acute Onset Bilateral Facial Nerve Palsies A Case Report and Literature Review

Guillain-Barré syndrome is a post infectious, immune-mediated disease with cranial nerve involvement observed in 45–75% of patients. Bilateral facial nerve palsy is rather uncommon and occurs in 0.3% to 2% of all facial palsies. We describe a rare case of a 29-year-old man with bilateral facial palsy caused by a Guillain-Barré syndrome with an unusual onset and progression of neurological symptoms. Neuroradiological findings in our patient are described and compared with data from literature on bilateral facial palsies to make differential diagnosis easier for neuroradiologists.

Bilateral Congenital Absence of Internal Carotid Arteries in a Woman with Dementia A Case Report

Dysgenesis of THE internal carotid artery is considered a rare condition, present in about 0.01% of subjects. This anomaly is generally asymptomatic and often represents an incidental finding in radiological examinations of the head performed for other reasons. A 75-year-old woman with symptoms of dementia was admitted to our hospital. Computed tomography and magnetic resonance examinations were performed. They showed the absence of both internal carotid arteries and the congenital nature of this abnormality. The usefulness of CT and MRI examinations in patients with this vascular abnormality is discussed.

Spontaneous Temporal Cerebrospinal Fluid Leak: A Case Report and Literature Review

An abnormal communication between the subarachnoid spaces and the tympanic cavity and mastoid cells can determine a cerebrospinal fluid (CSF) leak in the air spaces of the temporal bone. The etiology of CFS leak in the temporal air cells includes acquired, congenital and spontaneous causes. Spontaneous CSF leak, defined as a leak without a manifest cause, is present in about 4% of cases and often occurs in the middle cranial fossa. We describe a case of spontaneous CSF leak in the right temporal air cells that mimicked a skull fracture in a subject with headache and apparent rhinorrhea after a head trauma. Both CT and MRI play a key role in the differential diagnosis between post-traumatic temporal CSF leak due to a fracture and spontaneous leak: traumatic CSF leak often does not require a surgical approach, whereas spontaneous CSF leak may need surgical treatment because of the risk of meningitis.

Developmental Venous Anomaly Responsible for Hemifacial Spasm

Hemifacial spasm (HFS) is a facial movement disorder characterized by involuntary, unilateral and intermittent contractions of the facial muscles. It is one of the syndromes related to neurovascular conflict, first described by Jannetta et al. in 1979. Typically, HFS is due to pulsatile compression by the anterior inferior cerebellar artery. We describe a rare case of left developmental venous anomaly in a 59-year-old man referred to us with a six-month history of left-sided HFS. We performed an MR study of the brain and cerebellopontine angles, which demonstrated a compression of the ipsilateral facial nerve by the developmental venous anomaly.

Spontaneous ruptured cavernous aneurysm treated by stenting and embolization in a young patient. A case report and literature review.

We describe a case of endovascular management of a ruptured aneurysm of the intracavernous portion of the left internal carotid artery with sphenoid extension. The exclusive use of coils to embolize the aneurysm in acute and young patients offers the advantage of avoiding both pre-implant antiplatelet therapy and long-term anticoagulant therapy required after stent or vascular plug placement, but it is complicated by the non-negligible risk of recurrence. Indeed, the only secure method to treat ruptured aneurysms of the intracavernous portion of the internal carotid artery is to use coils in the first stage to stop the haemorrhage without antiplatelet therapy and to use stents in the second narrow stage to prevent revascularization.

An occult spinal neurenteric cyst associated with congenital hemivertebrae. A case report.

We describe a case of an occult spinal neurenteric cyst associated with congenital hemivertebrae. Different intraspinal anomalies, such as neurenteric cysts (representing 0.3 to 0.5 % of all spinal tumors) have been reported in association with congenital hemivertebrae. Indeed, although CT is the best examination to study vertebral anomalies, MRI should be performed in order to exclude a more complex dysraphic condition.

Elderly patient with dural sinus thrombosis leading to abnormal medullary veins and cerebral venous infarctions

We present a patient affected by a rapid neurological decline that was connected to subacute partial thrombosis of the straight sinus and associated with dilated superficial and deep medullary veins. An MRI scan confirmed signal alterations compatible with vascular disease and partial thrombosis of the straight sinus associated with dilated superficial and deep medullary veins of the cerebral white matter. Later, another MRI scan showed a replacement of the extensive white matter signal abnormalities, on FSE T2 and FLAIR sequences, by chronic vascular lesions.