Krishnan Ravindran

Histopathological Demonstration of Subacute Endothelialization Following Aneurysm Retreatment with the Pipeline Embolization Device

BACKGROUND Endothelial cell coverage along the Pipeline embolization device (PED) is 1 of 2 primary proposed mechanisms of action of the device, along with induction of intra-aneurysmal thrombosis. The temporal course of endothelialization following device deployment is poorly understood in human patients. CASE DESCRIPTION A 63-year-old female with a persistent aneurysm in the communicating segment of the internal carotid artery was treated with a second PED 14 months after the deployment of a first PED and subsequently developed a fatal intraparenchymal hemorrhage at 3 weeks postimplantation. Histopathological analysis at autopsy showed evidence of endothelialization along the second PED at this time, as well as neointimal growth between both devices. Patency of the vessel lumen with no intraluminal thrombus but thrombus showing early organization (endothelial cell ingrowth) was observed within the aneurysm dome. To our knowledge, this case represents the earliest demonstration of intimal cell growth along the PED. CONCLUSIONS Aneurysm healing via endothelialization following flow diverter treatment may occur subacutely and not chronically as previously stipulated.

Angiographic Findings in the Tolosa–Hunt Syndrome and Resolution after Corticosteroid Treatment

ABSTRACT The Tolosa–Hunt syndrome is a rare clinical condition characterized by painful opthalmoparesis associated with idiopathic granulomatous inflammation of the orbital apex and cavernous sinus. Historically, this condition was thought to result from arteritic changes in the internal carotid artery and cavernous sinus. Modern digital angiographic techniques were unavailable when THS was initially described, and few reports exist on its high-resolution angiographic findings. Painful ophthalmoparesis, especially of the oculomotor nerve, warrants vascular imaging because of the concern for an underlying aneurysm. Here, we describe angiographic findings of THS which may be useful for clinicians when encountering patients presenting with painful ophthalmoplegia.

Distant spread of a supratentorial glioblastoma to the spinal cord.

Extracranial spread from a glioblastoma is rare. We present a case of a 48year-old man with a previously radiologically-stable left temporal lobe glioblastoma presenting with symptoms referrable to the spinal cord. MRI revealed a spinal cord lesion, with the differential including transverse myelitis and tumour. Open surgical biopsy revealed high-grade astrocytoma. Genetic analysis of both the supratentorial and spinal tumours revealed R132H IDH1 mutations, providing evidence that the spinal cord lesion had spread from the supratentorial tumour.

Spontaneous subdural haemorrhage due to meningioma in the post-partum setting

An acute presentation of a meningioma with spontaneous haemorrhage is rare, with mechanisms of haemorrhage remaining unclear. Here, we present a case of a meningioma causing spontaneous intra-tumoural and subdural haemorrhage in the post-partum setting, to our knowledge not previously described, with review of pertinent literature.

Bilateral traumatic abducens nerve avulsion: A case series and literature review

Although abducens nerve palsy is an established sequela of head trauma - given the prolonged intracranial course of the nerve - bilateral injury is rare. Here, we present two cases of bilateral traumatic abducens nerve avulsion, in the absence of regional fractures, one of which presented two months following the initial trauma. Additionally, we review the current literature on bilateral abducens nerve palsy secondary to trauma, discussing the anatomy of the nerves course and potential mechanisms of injury.