BACKGROUND: Intracranial lipomas are uncommon benign lesions of the central nervous system. They preferentially occur near the midline, most frequently in the pericallosal cistern, and are often associated with various neurologic and systemic anomalies. Since the advent of CT scanning and MR imaging, unexpected findings of intracralial lipomas have increased. We identified 11 cases of intracranial lipomas diagnosed by CT and MR and analyzed their characteristic clinical and radiologic findings. METHODS: We retrospectively reviewed 11 cases of intracranial lipomas. MR was used in all cases and CT in three. RESULTS: There were seven men and four women whose ages ranged from six months to 76 years, with a mean of 39 years. Six (55%) lipomas were located in the quadrigeminal plate and five (45%) in the pericallosal area. The pericallosal lipomas were divided into three cases of curvilinear type and two cases of tubulonodular type. Of the six quadrigeminal lipomas, five cases (83%) were associated with either hypoplasia of the unilateral (four) or bilateral (one) superior and/or inferior colliculus. One case of quadrigeminal lipoma was associated with hypoplasia of the cerebellar vermis, agenesis of the septum pellucidum, and glioblastoma multiforme. All cases of pericallosal tubulonodular type were associated with dysgenesis of the corpus callosum and enlarged ventricles. However, all cases of pericallosal curvilinear type were not associated with other anomalies. Four (36%) cases found incidentally were asymptomatic. Seizure was the most frequent clinical presentation in five (45%) cases, followed by headaches in three (27%) and mental retardation in one (9%). Of five seizures cases, three had secondary generalized seizures and two had generalized tonic clonic seizures. CONCLUSIONS: Quadrigeminal and pericallosal lipomas were the most common types of intracranial lipomas. Sixty-three percent of the lesions were associated with adjacent brain malformations of varying degrees. Four cases were asymptomatic, while the others presented with seizures, headache, and mental retardation. (J Korean Neurol Assoc 19(2):149~154, 2001)
Brain ; Brain Neoplasms ; Central Nervous System ; Corpus Callosum ; Female ; Glioblastoma ; Headache ; Humans ; Inferior Colliculi ; Intellectual Disability ; Lipoma* ; Magnetic Resonance Imaging ; Male ; Retrospective Studies ; Seizures ; Septum Pellucidum ; Tectum Mesencephali ; Tomography, X-Ray Computed

BACKGROUND: Intracranial lipomas are uncommon benign lesions of the central nervous system. They preferentially occur near the midline, most frequently in the pericallosal cistern, and are often associated with various neurologic and systemic anomalies. Since the advent of CT scanning and MR imaging, unexpected findings of intracralial lipomas have increased. We identified 11 cases of intracranial lipomas diagnosed by CT and MR and analyzed their characteristic clinical and radiologic findings. METHODS: We retrospectively reviewed 11 cases of intracranial lipomas. MR was used in all cases and CT in three. RESULTS: There were seven men and four women whose ages ranged from six months to 76 years, with a mean of 39 years. Six (55%) lipomas were located in the quadrigeminal plate and five (45%) in the pericallosal area. The pericallosal lipomas were divided into three cases of curvilinear type and two cases of tubulonodular type. Of the six quadrigeminal lipomas, five cases (83%) were associated with either hypoplasia of the unilateral (four) or bilateral (one) superior and/or inferior colliculus. One case of quadrigeminal lipoma was associated with hypoplasia of the cerebellar vermis, agenesis of the septum pellucidum, and glioblastoma multiforme. All cases of pericallosal tubulonodular type were associated with dysgenesis of the corpus callosum and enlarged ventricles. However, all cases of pericallosal curvilinear type were not associated with other anomalies. Four (36%) cases found incidentally were asymptomatic. Seizure was the most frequent clinical presentation in five (45%) cases, followed by headaches in three (27%) and mental retardation in one (9%). Of five seizures cases, three had secondary generalized seizures and two had generalized tonic clonic seizures. CONCLUSIONS: Quadrigeminal and pericallosal lipomas were the most common types of intracranial lipomas. Sixty-three percent of the lesions were associated with adjacent brain malformations of varying degrees. Four cases were asymptomatic, while the others presented with seizures, headache, and mental retardation. (J Korean Neurol Assoc 19(2):149~154, 2001)
Brain ; Brain Neoplasms ; Central Nervous System ; Corpus Callosum ; Female ; Glioblastoma ; Headache ; Humans ; Inferior Colliculi ; Intellectual Disability ; Lipoma* ; Magnetic Resonance Imaging ; Male ; Retrospective Studies ; Seizures ; Septum Pellucidum ; Tectum Mesencephali ; Tomography, X-Ray Computed

Schizencephaly is a congenital brain anomaly, a disorder of cell migration characterized by gray matter-lined clefts, which is caused by faulty migration of the subependymal neuroblasts. The cleft may be closed (Type I) or open by a cavity communicating with the lateral ventricle (Type II). We identified the characteristic features of schizencephaly on CTs in one patient and on MRIs in 15 patients. Age at detection ranged from 16 months to 37 years. Three patients had bilateral clefts and 13 patients had unilateral cleft. Twelve patients had closed lip cleft whlle four patients had open lip cleft. Small sized unilateral closed cleft, the most comrnon type, was found in ten patients. Three patients had multiple clefts. Clinically these patients presented with seizures in 15 patients, motor disturbance in six patients, speech impairment in five patients, developemental delay in four patients, and mental retardation in three patients. The presence and severity of these symptoms correlated with the size and location of the lesions. Associated cerebral anomalies included ventricular dilatation in seen patients, agenesis of septum pallucidum in seven patients, other neuronal migration disorder in four patients, agenesis or dysgenesis of corpus callosum in three patients, septo-optic dysplasia in two patients, abnormal extension of svlvian fissure in one patient, and arteriovenous malformation in one patient.
Arteriovenous Malformations ; Brain ; Cell Movement ; Corpus Callosum ; Dilatation ; Humans ; Intellectual Disability ; Lateral Ventricles ; Lip ; Magnetic Resonance Imaging ; Malformations of Cortical Development* ; Neuronal Migration Disorders ; Seizures ; Septo-Optic Dysplasia

The efficacy and safety of oral sumatriptan as a 100mg conventional tablet was evaluated in the acute treatment of migrame in a single-blind, randomized, placebocontrolled, parallel-group study. Thirty patients were assigned to the sumatriptan group And other 30 to placebo group. Each patient was treated a total of three attacks. Patients recorded details of each attack and response to treatment on a diary card. Sumatriptan was significantly more effective than placebo in relieving headache(moderate/severe reduced to mild/none) at 4 hr(67.2 vs 15.4%; P< 0.001). Overall therapeutic effect of sumatriptan was excellent(89.6 vs 23%; P< 0.001). Compared with placebo, more patients on sumatriptan were pain7free by 2 hr(33.6 vs 0%; P< 0. 001) and 4 hr (25.7 vs 2. 0%; P< 0.001). The proportion of patients who required rescue medication was significantly (P< 0. 001) lower 'in the sumatriptan group when compared with the placebo group(2.4 vs 21%). The overall incidence of patients reporting a dverse events was 39% in sumatriptan group and 10% in placebo (P= 0. 005). The most commonly reported events in the sumatriptan-treated patients were nausea and/or vomiting, chest discomfort, general weakness, tightness of head; these were however generally mild, transient and tolerable. It is concluded that oral sumatriptan is an effective, well-tolerated prompt remedy for acute attacks of migraine.
Head ; Humans ; Incidence ; Migraine Disorders* ; Nausea ; Sumatriptan* ; Thorax ; Vomiting

Neuronal migration disorder is a rare group of congenital malfomations of the brain caused by insults to migrating neuroblasts during the six to fifteen gestational weeks. We identified 36 neuronal migration disorders on CTs in two patients and on MRIs in 34 patients and analyzed their characteristic radiologic, clinical, and EEG findings. These 36 patients with neuronal migration disorders consisted of 18 with schizencephaly, eight with pachygyria, five with heterotopias, three with lissencephaly, and two with polymicrogyria. Patient ranged in age from 6 months to 37 years old and mean age was 18.2 years old. Associated cerebral anomalies included ventricular dilatation in 13 patients, agenesis of septum pallucidum and hypoplasia of corpus callosum in nine patients. Lissencephaly was associated with other cerebral anomalies most frequently and all of them had ventricular dilatation and hypoplasia of corpus callosum. Only one patient with pachygyria had ventricular dilatation. Clinically, these patients presented with seizures in 91.7%, speech impairment in 33.3%, abnormal motor function in 30.5%, developmental delay in 27.8%, mental retardation in 25%. Patients with large or medium size of neuronal migration disorders had significantly more severe developmental delay(p=0.001), mental retardation (p=0.004) and speech impairment (p=0.01) than those with small size. Abnormal motor dysfunctions were not significantly associated with lesion size statistically. Seizures did not correlate with lesion size.
Adult ; Brain ; Corpus Callosum ; Dilatation ; Electroencephalography ; Humans ; Intellectual Disability ; Lissencephaly ; Magnetic Resonance Imaging ; Malformations of Cortical Development ; Neuronal Migration Disorders* ; Neurons* ; Seizures

OBJECTIVE: The purpose of this study is to investigate the results of treatment using stent-angioplasty for symptomatic middle cerebral arterial (MCA) stenosis and comparison of in-stent restenosis between drug-eluting stents (DES), bare metal coronary stents (BMS) and self-expanding stents (SES). MATERIALS AND METHODS: From Jan. 2007 to June. 2012, 34 patients (mean age +/- standard deviation: 62.9 +/- 13.6 years) with MCA stenosis were treated. Inclusion criteria were acute infarction or transient ischemic attacks (TIAs) and angiographically proven symptom related severe stenosis. Stents used for treatment were DES (n = 8), BMS (n = 13) and SES (n = 13). National Institutes of Health Stroke Scale (NIHSS) at admission was 2.5 +/- 3.1 and mean stenosis rate was 79.0 +/- 8.2%. Assessment of clinical and angiographic results was performed retrospectively. RESULTS: Among 34 patients, periprocedural complications occurred in four cases (11.8%), however, only two cases (6.0%) were symptomatic. All patients were followed clinically (mean follow-up period; 40.7 +/- 17.7 months) and 31 were followed angiographically (91.2%. 13.4 +/- 8.5 months). There was no occurrence of repeat stroke in all patients; however, mild TIAs related to restenosis occurred in three of 34 patients (8.8%). The mean NIHSS after stent-angioplasty was 1.7 +/- 2.9 and 0.8 +/- 1.1 at discharge. The modified Rankin score (mRS) at discharge was 0.5 +/- 0.9 and 0.3 +/- 0.8 at the last clinical follow-up. In-stent restenosis over 50% occurred in five of 31 angiographically followed cases (16.1%), however, all of these events occurred only in patients who were treated with BMS or SES. Restenosis rate was 0.0% in the DES group and 20.8% in the other group (p = 0.562); it did not differ between BMS and SES (2/11 18.2%, 3/13 23.1%, p = 1.000). CONCLUSION: Stent-angioplasty appears to be effective for symptomatic MCA stenosis. As for restenosis, in our study, DES was presumed to be more effective than BMS and SES; meanwhile, the results did not differ between the BMS and SES groups.
Angioplasty ; Constriction, Pathologic ; Drug-Eluting Stents ; Follow-Up Studies ; Humans ; Infarction ; Ischemic Attack, Transient ; Middle Cerebral Artery ; National Institutes of Health (U.S.) ; Stents ; Stroke

Spontaneous bilateral cerebellar infarction in the territory of the superior cerebellar arteries is extremely rare. Occasionally there have been reports of bilateral cerebellar infarction due to vertebrobasilar atherosclerotic occlusion or stenosis, whereas no report of bilateral cerebellar infarction due to complicated hemodynamic changes. In this report, we present a patient with bilateral cerebral infarctions related to stenoses of bilateral internal carotid arteries, in whom vertebrobasilar system was supplied by multiple collaterals from both posterior communicating arteries and right external carotid artery. We performed stent-angioplasty of bilateral internal cerebral arterial stenosis, and then acute infarction developed on bilateral superior cerebellar artery territories. The authors assumed that the infarction occurred due to hemodynamic change between internal carotid artery and external carotid artery after stent-angioplasty for stenosis of right internal carotid artery.
Arteries* ; Carotid Artery, External ; Carotid Artery, Internal* ; Carotid Stenosis* ; Cerebral Infarction ; Constriction, Pathologic ; Hemodynamics ; Humans ; Infarction*

The persistent trigeminal artery(PTA) is the most common type of persistent carotid-basilar anastomosis, usually diagnosed by cerebral angiography or autopsy. PTA is usually associated with hypoplasia or atresia of the vertebrobasilar artery and may result in symptoms of vertebrobasilar insufficiency caused by decreased perfusion of the brainstem. We report a patient with PTA who presented with symptoms of vertebrobasilar insufficiency. An 80-year-old woman with a history of hypertension, hyperlipidemia, and unstable angina pectoris presented with recurrent dizziness, dysarthria, and a tendency to fall to the left side. PTA was identified with hypoplasia of the vertebrobasilar system and mild stenosis of the bilateral proximal internal carotid arteries on brain MR angiography and cerebral angiography.
Aged, 80 and over ; Angina, Unstable ; Angiography ; Arteries ; Autopsy ; Brain ; Brain Stem ; Carotid Artery, Internal ; Cerebral Angiography ; Constriction, Pathologic ; Dizziness ; Dysarthria ; Female ; Humans ; Hyperlipidemias ; Hypertension ; Magnetic Resonance Angiography ; Perfusion ; Vertebrobasilar Insufficiency

Rasmussen's encephalitis is a rare autoimmune disorder characterized by intractable epilepsy and progressive unilateral hemispheric dysfunction as well as mental deterioration. Although the disorder typically begins in childhood, a few cases have been reported with symptom onset in adulthood showing variable clinical characteristics. We report a 63-year-old woman with adult-onset partial seizure with intermittent secondary generalization, progressive right hemiparesis, and aphasia, who showed positive response to high-dose steroid and antiepileptic drugs.
Anticonvulsants ; Aphasia ; Encephalitis* ; Epilepsy ; Female ; Generalization (Psychology) ; Humans ; Middle Aged ; Paresis ; Seizures

Cerebrospinal fluid (CSF) plays an important role in providing brain tissue with a stable internal environment as well as in absorbing mechanical and thermal stresses. From its initial composition, derived from the amniotic fluid trapped by the closure of neuropores, CSF is modified by developing and differentiating ependymal cells lining the ventricular surface or forming the choroid plexus. Its osmolarity and ionic composition brings about a change through the action of many channels expressed on the ependymal cells. Some newly discovered transient receptor potential (TRP) channels are known to be expressed in the choroid plexus ependyma. To detect additional TRP channel expression, immunohistochemical screening was performed at the choroid plexus of 13-, 15-, 17-, and 19-day embryos, using antibodies against TRPV1, TRPV3, and TRPA1, and the expression was compared with those in the adult TRP channels. The level of TRP channel expression was higher in the choroid plexus which suggests more active functioning of TRP channels in the developing choroid plexus than the ventricular lining ependyma in the 15- and 17-day embryos. All the expression of TRP channels decreased at the 19th day of gestation. TRPA1 was expressed at a higher level than TRPV1 and TRPV3 in almost all stages in both the choroid plexus and ventricular lining epithelium. The highest level of TRPV1 and TRPV3 expression was observed in association with the glycogen deposits in the cytoplasm of the choroid plexus ependymal cells of the 15- and 17-day embryos.
Adult ; Amniotic Fluid ; Animals ; Antibodies ; Brain ; Choroid Plexus ; Cytoplasm ; Embryonic Development ; Embryonic Structures ; Ependyma ; Epithelium ; Female ; Glycogen ; Humans ; Mass Screening ; Osmolar Concentration ; Pregnancy ; Rats ; Transient Receptor Potential Channels