Katsuyuki Hirakawa

A post-traumatic ligamentum flavum progressive hematoma: a case report.

STUDY DESIGN A case report. OBJECTIVES To understand a rare case of ligamentum flavum progressive hematoma. SUMMARY OF BACKGROUND DATA Previously there were only two reports about ligamentum flavum hematoma. METHODS A patient was surgically treated for ligamentum flavum hematoma causing progressive L5 radiculopathy. Clinical and neuroradiologic features were reported, and the literature was reviewed. RESULTS The etiology of this case could not be defined except by minor back injury. In spite of conservative therapy, the symptoms were progressive for 7 months. Magnetic resonance imaging demonstrated the epidural mass lesion at L4-L5 that was continuous with the ligamentum flavum. The mass was hypointense in T1-weighted images and central hyperintense and marginal hypointense in T2-weighted images. The margin was well enhanced by Gd-DTPA administration. After removal of the mass lesion, the patients symptoms completely resolved. Before surgery, accurate diagnosis was difficult even based on magnetic resonance imaging and was achieved after histologic examinations. CONCLUSIONS Surgery could be a choice of the treatment modality to resolve symptoms in ligamentum flavum hematoma.

Intraventricular craniopharyngioma: Its characteristics in magnetic resonance imaging and successful total removal

We experienced a craniopharyngioma in the third ventricle which was removed totally by a staged operation through the lamina terminalis and then through the foramen of Monro using a transventricular approach. In magnetic resonance imaging, chiasmal thickening with pot-belly expansion and bilobed shape of the mass were found, and postoperative magnetic resonance imaging showed indentation of the chiasm and flattening of the floor of the third ventricle.

Primary calvarial meningiomas.

Two cases of primary calvarial meningioma developing epidurally and protruding extracranially without subdural involvement are reported. The relevant literature on calvarial meningioma is reviewed.

A case of choroid plexus papilloma with stromal sclerosis and indistinct papillary structures

We present a case of choroid plexus papilloma with unusual histopathological findings. A 41-year-old Japanese man presented with dizziness. Brain magnetic resonance imaging scan showed a distinct mass in the fourth ventricle. Histopathological examination showed proliferation of cuboidal cells forming irregular trabeculae, small nests, and pseudoglandular and indistinct papillary structures, accompanied by a variable degree of stromal sclerosis. The tissue sections also showed rare mitotic activity, no hypercellularity, cellular pleomorphism, or necrosis. The immunohistochemical findings were tumor cells positive for cytokeratin 7, vimentin, S-100 protein, and transthyretin but negative for cytokeratin 20, BerEP4 and carcinoembryonic antigen. These findings were consistent with choroid plexus papilloma. The combination of these immunohistochemical markers was helpful in establishing the diagnosis, although the morphological finding of stromal sclerosis is rare for choroid plexus papilloma.

Using Diastolic Blood Pressure to Diagnose Acute Stroke in Isolated Acute Vestibular Syndrome

Background: Although diagnosis of isolated acute vestibular syndrome (AVS) via physical examination has been reported, a great deal of experience is needed to interpret the results. Patients with AVS often cannot participate in a physical examination, and not every emergency department (ED) is equipped with a magnetic resonance imaging machine. Therefore, in isolated AVS, clinical factors other than those used by general physicians and/or residents are required to identify strokes in these patients. The aim of this study was to determine those clinical factors useful in differentiating stroke patients from isolated AVS patients in the ED setting.