Schizophrenia-like psychiatric symptoms in patients with MELAS are rarely reported. A 34-year-old male was admitted because of visual hallucinations, persecutory delusions and generalized seizure. He also presented with repeated headache, vomiting, and left homonymous hemianopsia. We report a 34-year-male with MELAS presenting psychiatric symptoms before the establishment of the diagnosis by gene analysis.
Adult ; Delusions ; Diagnosis ; Hallucinations ; Headache ; Hemianopsia ; Humans ; Male ; MELAS Syndrome* ; Schizophrenia ; Seizures ; Vomiting

A 19-year-old man presented with bitemporal hemianopsia and was found to have a large sellar and suprasellar tumor, resembling a pituitary macroadenoma. Emergency transsphenoidal approach was attempted because of rapid visual deterioration with headache. However, the approach was complicated and stopped by uncontrolled hemorrhage from the tumor. After conventional cerebral angiography and recognition of an unusual pathology, transcranial approach was achieved to prevent permanent visual loss. The final pathological diagnosis was pituicytoma with epithelioid features. Pituicytoma is a rare low-grade tumor (WHO Grade I) of pituicytes involving the sellar and suprasellar region, and originating from special glial cells of the neurohypophysis. Because of the high vascularity, the firm consistency, and invasion to surrounding neurovascular structures, a pituicytoma should be included in the differential diagnosis of a mass in the sellar and suprasellar area if the tumor shows high enhancement with vascular components. We report a case of rare pituicytoma mimicking a pituitary macroadenoma with massive hemorrhage to disturb surgery.
Cerebral Angiography ; Diagnosis ; Diagnosis, Differential ; Emergencies ; Headache ; Hemianopsia ; Hemorrhage ; Humans ; Neuroglia ; Pathology ; Pituitary Gland, Posterior ; Young Adult

This study aimed at identifying the frequency and final diagnoses of stroke mimics (SMs) among suspected stroke cases, and seeking differences in clinical & imaging features between SMs and true strokes. It was retrospective with data taken from an ongoing stroke registry for patients admitted to a Stroke Unit between 1 May and 31 October 2011. Baseline characteristics, clinical & imaging features, complications, and outcomes of SMs were compared to those with true strokes by appropriate statistical tests. The total number of cases admitted was 537. Only 232 (43.2%) of them presented during the critical time thrombolytic intervention. SMs comprised 15.9% of all suspected stroke cases. The commonest mimics were psychiatric disorders (43.2%), migraines (16.2%), seizures (8.1%), brain tumors (5.4%), and systemic infections (5.4%). SMs were younger, more common in females, with less evidence of preexisting hypertension (43.2% vs. 56.9% for true strokes). Hemianopia (p = 0.001), sensory inattention, neglect or both (p < 0.001) were more associated with true strokes, while cerebellar, brainstem signs or both (p = 0.045) excluding dysarthria were linked only to SMs. Acute ischemic signs in imaging scans were found linked to true strokes. Some clinical and imaging characteristics were found to differentiate to some extent between SMs and true strokes.
Brain Neoplasms ; Brain Stem ; Diagnosis ; Diagnosis, Differential ; Dysarthria ; Female ; Hemianopsia ; Humans ; Hypertension ; Migraine Disorders ; Retrospective Studies ; Seizures ; Stroke* ; Thrombolytic Therapy

We present a rare case of a pituitary adenoma revealing a sedimentation level on MRI, which has not been previously documented. This 55-year-old woman was referred with the diagnosis of craniopharyngioma. She presented with four-month history of progressive headache and visual dimness. Neurological examination revealed a bitemporal hemianopsia and decreased visual acuity. Laboratory data including endocrine examination were unremarkable. An additional three-dimensional MRI was taken for further evaluation, and demonstrated a sedimentation level within the tumor. The patient underwent transcranial removal of the tumor. About 12cc of dark-red blood was aspirated from the tumor. Histological examination revealed a pituitary adenoma with hemorrhage. Postoperatively, the patient showed gradual improvement of visual function. Considering that the pituitary adenoma is one of more common tumors that cause tumoral bleeding, a cystic sellar tumor that has a sedimentation level should be sought first for a pituitary adenoma rather than a craniopharyngioma. This may have an important impact when deciding surgical approach.
Craniopharyngioma ; Diagnosis ; Female ; Headache ; Hemianopsia ; Hemorrhage ; Humans ; Magnetic Resonance Imaging* ; Middle Aged ; Neurologic Examination ; Pituitary Apoplexy ; Pituitary Neoplasms* ; Visual Acuity

A 42-year-old male with headache, right homonymous hemianopsia, seizure, and right hemiparesis had been treated. A CT scan revealed a large ovoid well-definded area of cerebrospinal fluid densty in the left posterior parietal lobe, which appeared to communicate with the body of the ipsilateral lateral ventricle. A conray ventriculogram showed a cavity of 6+/-5cm in the left posterior parietal lobe, and a communication with the body of the ipsilateral lateral ventricle was visualized. The porencephaly was managed by creation of as large a window as possible to the ipsilateral ventricle, because the communication with the body of the lateral ventricle was very narrow. Microscopic, pathological evaluation confirmed the diagnosis of porencephaly due to an inflammatory lesion of an undetermined origin. The patient was discharged without any evidence of neurological deficit except the right homonymous hemianopsia.
Adult ; Cerebrospinal Fluid ; Diagnosis ; Headache ; Hemianopsia ; Humans ; Lateral Ventricles ; Male ; Paresis ; Parietal Lobe ; Seizures ; Tomography, X-Ray Computed

We present a series of 42 patients with the lateral ventricular mass lesions who underwent operative removal between 1979 and 1992 at the Seoul National University Hospital. These lesions included 29 tumors, 10 benign cysts and 3 arteriovenous malformations. There were 20 lesions in the trigone, 14 in the frontal horn, 6 in the body, and 2 in the temporal horn. Together with the age of the patient, the location in the lateral ventricle and the CT or MR patterns, the range of the differential diagnosis of the lesions can be narrowed. The mass were removed by various surgical approaches;11 by the middle frontal gyrus, 10 by the superior parieto-occipital, 13 by the middle temporal gyrus, 4 by the anterior transcallosal, 2 by the posterior transcallosal and 3 by the combined approaches. The superior parieto-occipital approach left postoperative morbidities in 64% and other approaches in 20 to 25% of the cases. These morbidities included hemiparesis, hemianopsia, aphasia, memory distubance and seizure. Most hydrocephalus disappeared without the shunting procedure after removal of the lateral ventricular mass. The high frequency of postoperative complications in the superior parieto-occpital approach require meticulous consideration in the selection of this approach.
Animals ; Aphasia ; Arteriovenous Malformations ; Diagnosis, Differential* ; Hemianopsia ; Horns ; Humans ; Hydrocephalus ; Lateral Ventricles ; Memory ; Paresis ; Postoperative Complications ; Seizures ; Seoul

Unruptured cerebral aneurysms sometimes present with visual symptomsdue to compression of the visual pathways. However, until now, unruptured anterior communicating artery (ACoA) aneurysms presenting visual field defects have been extremely rare. The authors report the case of a 51-year-old woman who presented with left homonymous hemianopsia. Radiological findings demonstrated an ACoA aneurysm filled with thrombus, that was compressing the optic chiasm and post-chiasmal tract. The patient underwent clipping of the aneurysm, which resolved the visual field defect. In cases of visual field defects, an ACoA aneurysm should be included in the differential diagnosis.
Aneurysm ; Arteries ; Diagnosis, Differential ; Female ; Hemianopsia* ; Humans ; Intracranial Aneurysm* ; Middle Aged ; Optic Chiasm ; Thrombosis ; Visual Fields ; Visual Pathways

Cartilaginous tumors of the skull base are rare. The authors recently encountered a case of parasellar myxochondrosarcoma. The clinical and more important differential diagnosis of the tumors of skull base are presented. A 49 years old Korean housewife was admitted to the dept. of Neurosurgery, Seoul National University Hospital because of the progressive visual disturbance of 3 years' duration. She had had mild headaches for 7 years. On physical examination, left homonymous hemianopia was noted. She could only see the moving hand in front of her right eye. Left visual acuity was quite normal. Other cranial nerves were not involved. Plain skull x-rays showed multiple stippled irregular calcifications around the right parasellar area. There was no evidence of bony destruction on the axial view. Right carotid angiogram showed the opening of carotid siphon, elevation of the bifurcation point of ICA, nonvisualization of the right ACA, and the forward-upward displacement with the thinning of the right internal carotid artery by the compression of the parasellar mass. There was no tumor blush or abnormal vessels. At surgery, a huge white avascular mass in the parasellar region, compressing and enveloping the right optic nerve and internal carotid artery was subtotally removed. The tumor mass extended far posterior to the dorsum sellae. The exact site of the origin was difficult to identify. The histologic diagnosis was myxochondrosarcoma. She was recommended the radiation therapy and discharged without improvement of her visual field in 3 weeks postoperatively.
Carotid Artery, Internal ; Cranial Nerves ; Diagnosis ; Diagnosis, Differential ; Hand ; Headache ; Hemianopsia ; Humans ; Middle Aged ; Neurosurgery ; Optic Nerve ; Physical Examination ; Seoul ; Skull ; Skull Base ; Visual Acuity ; Visual Fields

Cartilaginous tumors of the skull base are rare. The authors recently encountered a case of parasellar myxochondrosarcoma. The clinical and more important differential diagnosis of the tumors of skull base are presented. A 49 years old Korean housewife was admitted to the dept. of Neurosurgery, Seoul National University Hospital because of the progressive visual disturbance of 3 years' duration. She had had mild headaches for 7 years. On physical examination, left homonymous hemianopia was noted. She could only see the moving hand in front of her right eye. Left visual acuity was quite normal. Other cranial nerves were not involved. Plain skull x-rays showed multiple stippled irregular calcifications around the right parasellar area. There was no evidence of bony destruction on the axial view. Right carotid angiogram showed the opening of carotid siphon, elevation of the bifurcation point of ICA, nonvisualization of the right ACA, and the forward-upward displacement with the thinning of the right internal carotid artery by the compression of the parasellar mass. There was no tumor blush or abnormal vessels. At surgery, a huge white avascular mass in the parasellar region, compressing and enveloping the right optic nerve and internal carotid artery was subtotally removed. The tumor mass extended far posterior to the dorsum sellae. The exact site of the origin was difficult to identify. The histologic diagnosis was myxochondrosarcoma. She was recommended the radiation therapy and discharged without improvement of her visual field in 3 weeks postoperatively.
Carotid Artery, Internal ; Cranial Nerves ; Diagnosis ; Diagnosis, Differential ; Hand ; Headache ; Hemianopsia ; Humans ; Middle Aged ; Neurosurgery ; Optic Nerve ; Physical Examination ; Seoul ; Skull ; Skull Base ; Visual Acuity ; Visual Fields

PURPOSE: To report brain metastasis of hepatocellular carcinoma presenting as homonymous hemianopia. CASE SUMMARY: A 51-year-old female with a history of hepatectomy and diagnosis of hepatocellular carcinoma (HCC) 19 months earlier was referred to our neuro-ophthalmology clinic for evaluation due to headache and decreased visual acuity over the past several months. Best visual acuity was 20/20, and the results of all other aspects of our examination were normal except Humphrey automatic perimetry, which showed complete left homonymous hemianopia. Brain magnetic resonance imaging showed a large mass in the right occipital lobe. Craniotomy and removal of tumor were performed. HCC was confirmed by histopathologic examination. CONCLUSIONS: Metastasis of hepatocellular carcinoma to the occipital lobe is extremely rare but can present as homonymous hemianopia. Therefore, clinicians should be aware of this when examining a patient with a history of HCC.
Brain ; Brain Neoplasms ; Carcinoma, Hepatocellular* ; Craniotomy ; Diagnosis ; Female ; Headache ; Hemianopsia* ; Hepatectomy ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Neoplasm Metastasis* ; Occipital Lobe* ; Visual Acuity ; Visual Field Tests