We report a case in which a cavernous hemangioma in the midbrain was completely removed. Two days prior to hospitalization, a 32-year-old female patient, who had complained of intermittent headache, presented with deteriorated consciousness. Neurological examination revealed anisocoria, no response to lights, diplopia in a superior and inferior direction, increased deep tendon reflexes, and an unceratin response to examination. Radiology revealed a deep cavernous hemagioma in the midbrain and there was evidence of recurrent bleeding, especially on MRI. To remove the cavernous hemangioma, she underwent extraventricular drainage(EVD), craniotomy(using the suboccipital transtentorial approach), and ventriculoperitoneal shunt and recovered. She has now been followed up for 1 year and 6 months, and is leading a normal life. We have concluded that excellent results may be possible with in the case of symptomatic cavernous hemangioma, an awareness precise anatomical location, a well designed approach and of possible neurologic deficits, this is so even in the midbrain.
Adult ; Anisocoria ; Consciousness ; Diplopia ; Female ; Headache ; Hemangioma, Cavernous* ; Hemorrhage ; Hospitalization ; Humans ; Magnetic Resonance Imaging ; Mesencephalon* ; Neurologic Examination ; Neurologic Manifestations ; Reflex, Stretch ; Ventriculoperitoneal Shunt

BACKGROUND AND OBJECTIVES: Cardiac myxomas are uncommon. Early diagnosis and treatment are essential to reduce morbidity or mortality. Before 1970, preoperative diagnosis was difficult. With the development of echocardiography, a correct diagnosis is made before operation. We reviewed our clinical experience in diagnosis and management of 52 cases of myxomas seen over a 33-year period, 1966 to 1998. PATIENTS AND METHODS: There were 20 males (38%) and 32 females (62%);age range 7 - 80. All the patient's medical records were reviewed. In twenty-five patients in whom echocardiographic features could be reviewed, clinical fetures were compared according to two distinct echocardiographic features;Round and polypoid type. RESULTS: Eighty-four percents of the presenting symptoms were cardiac origin while systemic embolism (SE) accounted for 15%. Echocardiography was used most often for diagnosis. The myxomas were located in the left atrium in 50 (96%), right atrium in 2 (4%). One patient had multiple myxoma. The incidence of SE was significantly higher in polypoid type than in round type (58% vs 0%, p<0.05). Multivariate regression analysis revealed polypoid type was the only independent predictor of SE (p=0.0029). Follow-up duration was ranged from 1 to 266 months. There was no deaths associated with myxoma. One patient presented with a recurrence 3 years after resection, and reoperation was performed uneventfully. CONCLUSION: Due to the nonspecific presentation of myxoma, a high index of suspicion is needed. Surgical excision of myxoma can be considered curative with excellent long-term result. However, because of high possible occurrence of SE, a close attention should be given to those patients who have myxoma of polypoid type.
Diagnosis ; Early Diagnosis ; Echocardiography ; Embolism ; Female ; Follow-Up Studies ; Heart Atria ; Humans ; Incidence ; Male ; Medical Records ; Mortality ; Myxoma* ; Recurrence ; Reoperation

No abstract available.
Heart* ; Thoracic Surgery* ; Tricuspid Valve Insufficiency*