Cycloserine is a broad spectrum antibiotic used as a second drug for treatment of drug resistant tuberculosis. Inappropriate usage in excessive doses can give rise to neurological problems. We report a case who developed aphasia, anxiety and seizure during anti-tuberculosis medication. MRI of the brain showed reversible cytotoxic edema in dentate nuclei. Clinical and MRI findings were consistent with cycloserine toxicity.

PURPOSE: To determine the significance of vascular MR contrast enhancement in carotid stenosis. MATERIALS AND METHODS: Forty patients that had angiographically proved carotid stenosis were selected for the study. A blind interpretation of vascular enhancement on an enhanced T1 weighted image, the lesion pattern on a DWI (diffusion weighted image), a perfusion defect on a MR perfusion image, the degree of stenosis, and collateral flow on cerebral DSA (digital subtraction angiography) was made by two observers, retrospectively. DWI lesion patterns were classified as having no high signal intensity, small PAI (perforating artery infarcts), large PAI, pial infarcts, territorial infarcts, and border zone infarcts. We evaluated the statistical correlation between vascular enhancement and the degree of stenosis, collateral flow, the DWI lesion pattern and the presence of a perfusion defect, respectively. RESULTS: The degree of carotid stenosis and the frequency of vascular enhancement correlated statistically (p=0.000). The presence of retrograde collateral flow on cerebral DSA and the border zone infarcts pattern on DWI were related with the occurrence of vascular enhancement (p=0.002, p=0.004). In 23 patients that underwent a MR perfusion study, the presence of a perfusion defect was also related to the occurrence of vascular enhancement (p=0.002). CONCLUSION: Vascular MR contrast enhancement may indicate a cerebral hypoperfusion in carotid stenosis.
Arteries ; Carotid Stenosis* ; Constriction, Pathologic ; Humans ; Perfusion ; Retrospective Studies

Meningioma is a common neoplasm of the central nervous system; however, primary extracranial meningioma of the paranasal sinus, especially the maxillary sinus, is rare. We report a case of primary extracranial meningioma (fibrous type) of the maxillary sinus and present a literature review of the imaging features that correlate with fibrous meningioma.

Knowledge of the venous anatomy is essential for appropriately treating dural arteriovenous fistulas (AVFs). It is challenging to determine the overall venous structure despite performing selective angiography for dural AVFs with feeder from multiple selected arteries. This is because only a part of the veins can be observed through the shunt in the selected artery. Therefore, after performing selective angiography of all vessels to understand the approximate venous anatomy, the venous anatomy can be easily understood by closely examining the source image of computed tomographic angiography or magnetic resonance angiography. Through this, it is possible to specify the vein that is to be blocked (target embolization), thereby avoiding extensive blocking of the vein and avoiding various complications. In the case of dural AVF with feeder from single selected artery, if the multiplanar reconstruction image of the three-dimensional rotational computed tomography obtained by performing angiography is analyzed thoroughly, a shunted pouch can be identified. If embolization is performed by targeting this area, unnecessary sinus total packing can be avoided.

The incidence of skull tuberculosis is very rare, with only a few cases reported as a result of a simple radiography and computed tomographic findings. In this study, we report the magnetic resonance image (MRI) findings of a case of skull tuberculosis, which was confirmed histologically.
Frontal Bone ; Incidence ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Skull ; Tuberculosis ; Tuberculosis, Osteoarticular

In-stent restenosis occurs in approximately 30% of patients after receiving a Wingspan stent to treat symptomatic intracranial atherosclerosis. This report describes a 55-year-old man with intracranial atherosclerotic internal carotid artery terminus stenosis who developed significant in-stent restenosis. Follow-up angiogram 5 years later demonstrated the regression of restenosis without invasive intervention.

The two distinct types of axonal degeneration that occur after neuronal injury include Wallerian degeneration (WD) and transneuronal degeneration. The most commonly recognizable cause of secondary degeneration is cerebral infarction, but may also include a variety of conditions including hemorrhage, trauma, necrosis, and focal demyelination. Herein, we present a rare case of WD of the cerebellar peduncles accompanied by unilateral hypertrophic olivary degeneration following pontine hemorrhage.

BACKGROUND/AIMS: The purpose of this study was to assess the value of acoustic radiation force impulse (ARFI) for predicting the extent of radiofrequency ablation (RFA) in hepatocellular carcinoma (HCC) by correlating the elasticity of HCC and peritumoral parenchyma (as measured by ARFI) with the extent of ablation determined by computed tomography (CT). METHODS: From September 2009 to June 2011, 158 patients underwent RFA ablation for HCC (single, < or =3 cm). We evaluated the data of a total of 38 prospectively enrolled patients who underwent both ARFI imaging and contrast-enhanced CT after one session of 12 minutes of RFA without a change in needle position. The ARFI imaging indices, including the mean shear wave velocity (SWV) of HCC, mean SWV of the peritumoral parenchyma and tumor size, were evaluated to determine the statistical correlation with RFA extent after one session of 12 minutes of RFA. RESULTS: A stiffer liver parenchyma in patients with cirrhosis results in a smaller ablation zone. CONCLUSIONS: SWV of ARFI in liver parenchyma was well correlated with RFA extent. After evaluating the correlation between ARFI and RFA extent, we suggest that the SWV in liver parenchyma might be a non-invasive supplementary tool for predicting the extent of RFA.
Acoustics ; Carcinoma, Hepatocellular ; Elasticity ; Elasticity Imaging Techniques ; Fibrosis ; Humans ; Liver ; Needles ; Prospective Studies

OBJECTIVE: Aneurysms originating from the proximal segment (A1) of the anterior cerebral artery are rare; however, because of their small size, the risk of injury of perforating arteries, and the location of the aneurysm in the surgical field, they are challenging to treat. We report on 15 patients with A1 aneurysms and review surgical views according to the direction of aneurysms. METHODS: Fifteen patients were diagnosed with A1 aneurysms and underwent surgical clipping or endovascular coiling at our institution between January 2006 and March 2012. We conducted a retrospective review of clinical and radiological features of all patients with A1 aneurysms. RESULTS: Nine patients underwent surgical clipping, and six patients received endovascular coiling. Six patients (40%) had multiple aneurysms. A1 aneurysms ranged in size from 1.5 to 8.2 mm, with an average size of 3.26 mm. Most A1 aneurysms (73%) had a posterior direction. In the surgical view, A1 aneurysms projecting posteriorly were located behind the A1 trunk. The A1 aneurysm projecting posteroinferiorly was completely eclipsed by the parent artery. In A1 aneurysms with a posterosuperior or superior direction, finding and clipping the aneurysm neck was relatively easy. Thirteen patients (87%) had an excellent outcome, one had moderate disability, and one died. CONCLUSION: A1 aneurysms have certain characteristics; small size, multiple aneurysms, and, usually, a posterior direction. A1 aneurysms with a posterosuperior or superior direction are relatively easy to assess, however, clipping of A1 aneurysms with a posterior or posteroinferior direction is more difficult. Endovascular coiling is an alternative therapeutic option when surgical clipping is expected to be difficult.
Aneurysm ; Angiography ; Anterior Cerebral Artery ; Arteries ; Humans ; Neck ; Parents ; Retrospective Studies ; Subarachnoid Hemorrhage ; Surgical Instruments

BACKGROUND: Higher reperfusion rates have been established with endovascular treatment for acute ischemic stroke patients. There are limited data on the comparative performance of mechanical thrombectomy devices. This study aimed to analyse the efficacy and safety of the stent retriever device (Solitaire stent) by comparing procedure time, angiographic outcome, complication rate and long term clinical outcome with previous chemical thrombolysis and mechanical thrombectomy using penumbra system. METHODS: A retrospective single-center analysis was undertaken of all consecutive patients who underwent chemical thrombolysis and mechanical thrombectomy using Penumbra or Solitaire stent retriever from March 2009 to March 2014. Baseline characteristics, rate of successful recanalization (modified Thrombolysis in Cerebral Infarction score 2b-3), symptomatic intracerebral hemorrhage, procedure time, mortality and independent functional outcomes (mRS < or =2) at 3 month were compared across the three method. RESULTS: Our cohort included 164 patients, mechanical thrombectomy using stent retriever device had a significant impact on recanalization rate and functional independence at 3 months. In unadjusted analysis mechanical thrombectomy using Solitaire stent retriever showed higher recanalization rate than Penumbra system and chemical thrombolysis (75% vs. 64.2% vs. 49.4%, p=0.03) and higher rate of functional independence at 3 month (53.1% vs. 37.7% vs. 35.4%, p=0.213). In view of the interrelationships between all predictors of variables associated with a good clinical outcome, when the chemical thrombolysis was used as a reference, in multiple logistic regression analysis, the use of Solitaire stent retriever showed higher odds of independent functional outcome [odds ratio (OR) 2.62, 95% confidence interval (CI) 0.96-7.17; p=0.061] in comparison with penumbra system (OR 1.57, 95% CI 0.63-3.90; p=0.331). CONCLUSION: Our initial data suggest that mechanical thrombectomy using stent retriever is superior to the mechanical thrombectomy using penumbra system and conventional chemical thrombolysis in achieving higher rates of reperfusion and better outcomes. Randomized clinical trials are needed to establish the actual benefit to specific patient populations.
Cerebral Hemorrhage ; Cerebral Infarction ; Cohort Studies ; Humans ; Logistic Models ; Mortality ; Reperfusion ; Retrospective Studies ; Stents* ; Stroke* ; Thrombectomy ; Urokinase-Type Plasminogen Activator*