William Adams

Spontaneous cranial extradural hematoma: case report and review of literature

Extradural hematoma (EDH) is usually a post‐traumatic sequel but a few cases of spontaneous EDH have been reported. Here we report a woman who presented with spontaneous acute EDH but was later found to have dural metastasis from lung carcinoma. Causal factors have been present in all reported cases, as well as in this case. We propose the term non‐traumatic EDH.

Demonstration of cerebral perfusion abnormalities in moyamoya disease using susceptibility perfusion- and diffusion-weighted MRI

Abstract We describe the use of diffusion-weighted imaging and perfusion MRI using a contrast-medium bolus in the preoperative investigation for young man presenting with a cerebral ischaemic episode as a manifestation of moyamoya disease.

Use of single-slice thick slab phase-contrast angiography for the diagnosis of dural venous sinus thrombosis

Abstract. The aim of this study was to examine the reliability of single-slice phase-contrast angiography (SSPCA) as a rapid technique for the investigation of suspected dural venous sinus occlusion. Images were obtained on 25 normal volunteers to document the accuracy of SSPCA in the demonstration of slow flow states. Normal volunteers were imaged using sagittal and coronal SSPCA (slice thickness 13 cm, matrix 256 × 256, TR 14 ms, TE 7 ms, flip angle 20 °, peak velocity encoding rate 30 cm/s). Sinus patency and flow rate were confirmed by measurement of flow in the superior sagittal and transverse sinuses using quantified single-slice phase difference images. Imaging was performed in 50 patients undergoing routine brain scans in order to determine the optimal slice orientation for clinical use. Twenty-one patients with suspected dural venous sinus thrombosis were also investigated with SSPCA and the diagnosis confirmed by one or more alternative imaging techniques. Imaging time was 29 s per acquisition and image quality was good in all cases. Variations in dural sinus patency and flow in normal volunteers were accurately predicted by SSPCA (kappa = 0.92). Use of a single angulated slice (130 mm thick, para-sagittal image angled 30 ° towards coronal and 30 ° towards transverse) provided sufficient separation of right- and left-sided venous structures to allow use of a single projection. The presence and extent of sinus occlusions in 14 patients and the absence of thrombosis in 7 were accurately identified by SSPCA. Sensitivity and specificity in this limited study were both 100 %. The SSPCA technique takes less than 30 s and provides a reliable and rapid technique for the diagnosis of dural venous sinus thrombosis.

Does black blood MRA have a role in the assessment of intracerebral aneurysms

The aim of this study was to assess whether the addition of a black blood (BB) sequence to standard three-dimensional time-of-flight (3D-TOF) imaging yields improved quantitative assessment of intracranial aneurysms. Thirty seven patients with 42 proven intracranial aneurysms underwent intra-arterial digital subtraction angiography, 3D-TOF and BB MRI imaging. This multimodality imaging was used to create a composite reference aneurysm description. The 3D-TOF and BB imaging were graded on a subjective seven-point scale to determine what improvement if any the addition of BB imaging yielded. Comparison of measurements from all imaging modalities demonstrated no significant difference (pu2009<u20090.01) in aneurysm length/width or parent vessel width. Aneurysm neck measurements were underestimated on 3D-TOF images although there was still a significant correlation (R2u2009=u20090.72, pu2009<u20090.05). Comparison of TOF and BB examinations to the composite reference using the Wilcoxon signed-rank test showed significant improvement in the demonstration of the aneurysm to parent/branch vessels and the morphology/size of the aneurysm neck, particularly in the setting of local haematoma or slow flow (pu2009<u20090.001). We propose the addition of the BB sequence as a useful adjunct to 3D-TOF imaging particularly when detailed aneurysm morphology is required or there is thrombus in subarachnoid space.

Time of Flight 3D Magnetic Resonance Angiography in the Follow-up of Coiled Cerebral Aneurysms

The use of Guglielmi Detachable Coil (CDC) for the endovascular treatment of intracerebral aneurysms is increasing, particularly in those aneurysms for which there is a high surgical morbidity and mortality. However, the long-term efficacy of GDC is not known. Until the natural history of GDC treatment is established long-term follow-up in this cohort of patients is required, of necessity involving repeated intraarterial angiography (IA DSA) with its known attendant risks and exposure to ionising radiation. Three dimensional time-of-flight magnetic resonance angiography (3D TOF MRA) is now readily accepted as a non-invasive screening tool for familial aneurysmal disease and has been used as an alternative to IA DSA in the surgical management of aneurysmal subarachnoid haemorrhage. MRA in patients treated with GDC is safe, imparts no radiation dose and provides acceptable image quality. The aim of this study was to assess 3D TOP MRA source data, maximum intensity projection (MIP) and 3D isosurface reconstruction in comparison to IA DSA in the follow-up of 25 patients treated with GDC. Images were assessed for parent and branch artery flow, the presence of neck recurrence and aneurysm regrowth. There was good correlation for all these features when 3D isosurface MRA and source data were compared with IA DSA. The correlation between MIP MRA and IA DSA was less robust. Additional confidence can be obtained by performing plain films of the skull to demonstrate change in coil ball configuration. MRA has the potential to replace IA DSA in the follow-up of GDC treated cerebral aneurysms.

Bilateral redundancy gain and callosal integrity in a man with callosal lipoma: a diffusion-tensor imaging study.

We investigated whether abnormalities in the structural organization of the corpus callosum in the presence of curvilinear lipoma are associated with increased facilitation of response time to bilateral stimuli, an effect known as the redundancy gain (RG). A patient (A.J.) with a curvilinear lipoma of the corpus callosum, his genetically-identical twin, and age-matched control participants made speeded responses to luminant stimuli. Structural organization of callosal regions was assessed with diffusion-tensor imaging. A.J. was found to have reduced structural integrity in the splenium of the corpus callosum and produced a large RG suggestive of neural summation.

Right PICA aneurysm with anomalous origins of the right subclavian artery and right vertebral artery: findings on angiography

Abstract Anomalous origin of the right vertebral artery from the right common carotid artery (VA-CCA) with an aberrant right subclavian artery (ARSCA) is an uncommon anatomical variant. We present a series of images from a case in which this was identified on angiography for the management of a right posterior inferior cerebellar artery (PICA) aneurysm. This combination has not been previously described in the literature. The embryological mechanism of this variation, the incidence of these individual findings and the clinical implications will be discussed.

Giant vertebrobasilar aneurysm: a rare cause of central sleep apnoea

Abstract We report a case of central sleep apnoea (CSA) due to a giant vertebrobasilar aneurysm with brainstem compression. A flow diverter stent was deployed with coil embolization of the right vertebral artery distal to the posterior inferior cerebellar artery (PICA) to occlude the aneurysm. The patient’s symptoms improved following therapy.

Middle cranial fossa cystic schwannoma

The authors present the unusual case of a 37-year-old man, with a history of hepatitis C, presenting with a 3 year history of progressive trigeminal, facial and vestibular nerve defects. Intracranial imaging demonstrated a cystic middle and posterior fossa lesion, that was ultimately diagnosed as a cystic trigeminal schwannoma. Due to the uncertainties of diagnosis he was managed in two stages with an open biopsy and then a subsequent partial resection. Surveillance of the tumour remnant is planned. The rare nature of this diagnosis is discussed, along with the more common findings in intracranial schwannoma, and the wide differential to be considered. Briefly, the authors describe the surgical option for a complex multi-fossa schwannoma and the importance of the multi-disciplinary team in the diagnosis and management of such patients.

An association between cerebral aneurysm re-bleed and CT angiography--more than a coincidence?

Rupture of cerebral aneurysm during CT angiogram is a rare occurrence. Here we present such a case where an aneurysmal re-rupture during CT angiogram was demonstrated.