Scalp arteriovenous fistulas (AVFs) are rare vascular anomalies characterized by abnormal connections between arterial and venous systems in the scalp. These lesions can lead to significant complications, including chronic headaches, tinnitus, cosmetic deformities, and in severe cases, high-output cardiac failure or intracranial hemorrhage. We present a case of a middle-aged female patient with a 20-year history of a pulsating mass on the left parietal scalp. Magnetic resonance imaging and cerebral angiography confirmed the presence of a scalp AVF with multiple arterial feeders from the external carotid artery and venous drainage into the left external jugular vein. Due to the tortuosity of the feeding arteries, a transarterial approach was unsuccessful, leading to the decision to perform transvenous embolization with balloon occlusion using Onyx-18. The procedure resulted in complete obliteration of the AVF without complications. This case highlights the efficacy of transvenous embolization with balloon occlusion as a treatment option for complex scalp AVFs, particularly when transarterial access is challenging.

Purpose: While symptomatic basilar artery (BA) stenosis is associated with a higher risk of recurrent stroke or death, there is no consensus on the management of these patients who are refractory to antiplatelet therapy. This study retrospectively assesses the outcomes of endovascular treatment (EVT) for symptomatic BA stenosis. Materials and Methods: We conducted a retrospective review of patients with symptomatic BA stenosis who underwent EVT, including angioplasty or stenting, from 2006 to 2018. A total of 15 patients, who experienced transient ischemic attacks or strokes despite dual antiplatelet therapy, were included. EVT was performed under local anesthesia after pretreatment with antiplatelet medications. Angiographic follow-up was performed at 12 and 24 months post-EVT. Clinical outcomes were evaluated using the modified Rankin Scale (mRS). Results: EVT was successfully completed in all patients. Peri/post-procedural complications occurred in 33% of cases, including in-stent thrombosis, intracranial hemorrhage, and pontine infarction. At long-term follow-up (mean 98.5±80.5 months), 73.3% of patients achieved a favorable functional outcome (mRS≤2) without disability or mortality. Patients with unfavorable outcomes had previous infarcts, with 2 experiencing new pontine infarctions after stenting. Conclusion This study suggests that EVT, including angioplasty and stenting, may offer promise as a treatment option for symptomatic BA stenosis refractory to medical therapy. However, the procedure carries a notable risk of complications, especially in patients with severe stenosis and previous infarcts. Careful patient selection, based on clinical and radiological criteria, is crucial.

Background: Wallenberg’s syndrome (WS) is caused by dorsal lateral medulla infarction. Clinical symptoms include hoarseness, dysphagia, sensory disturbance, vertigo, ataxia, and Horner’s syndrome. Recently, lateral difference of body surface temperature (BST) has been reported as a symptom of WS, resulting from the disturbances of the sympathetic nerve tract. Although sensory dysfunction is the major symptoms of WS, there is no evidence that BST influences these symptoms. We sought to evaluate the relationship between BST and sensory symptoms in WS using infrared thermography. Methods: Patients with WS within 7 days of symptom onset from June 2018 to December 2020 were enrolled. Infrared thermography was conducted at 7±30 days and 90±30 days after the onset of stroke. Laterality of BST was defined as being positive when macroscopically different and discrepancy >0.5°C in thermography. Results: The final analyses included 12 patients with a mean age of 59.9±11.85 years. Sensory symptoms in nine patients were most often described as numbness (56%), cold (44%), burning (33%), and heaviness (11%). Of these, burning symptoms lasted at 100%, cold 75%, and numbness 50% during 3 months follow-up. All patients with sensory dysfunction showed lateral BST differences. The BST laterality persisted in patients with remaining sensory dysfunction at 3 months follow-up. Conclusions All patients with sensory dysfunction in WS showed lateral BST differences which was detected with thermography. Laterality of BST and sensory dysfunction in WS might be associated with the disturbance of the connecting pathway of skin blood flow descending from the rostral ventrolateral medulla.

Background: Wallenberg’s syndrome (WS) is caused by dorsal lateral medulla infarction. Clinical symptoms include hoarseness, dysphagia, sensory disturbance, vertigo, ataxia, and Horner’s syndrome. Recently, lateral difference of body surface temperature (BST) has been reported as a symptom of WS, resulting from the disturbances of the sympathetic nerve tract. Although sensory dysfunction is the major symptoms of WS, there is no evidence that BST influences these symptoms. We sought to evaluate the relationship between BST and sensory symptoms in WS using infrared thermography. Methods: Patients with WS within 7 days of symptom onset from June 2018 to December 2020 were enrolled. Infrared thermography was conducted at 7±30 days and 90±30 days after the onset of stroke. Laterality of BST was defined as being positive when macroscopically different and discrepancy >0.5°C in thermography. Results: The final analyses included 12 patients with a mean age of 59.9±11.85 years. Sensory symptoms in nine patients were most often described as numbness (56%), cold (44%), burning (33%), and heaviness (11%). Of these, burning symptoms lasted at 100%, cold 75%, and numbness 50% during 3 months follow-up. All patients with sensory dysfunction showed lateral BST differences. The BST laterality persisted in patients with remaining sensory dysfunction at 3 months follow-up. Conclusions All patients with sensory dysfunction in WS showed lateral BST differences which was detected with thermography. Laterality of BST and sensory dysfunction in WS might be associated with the disturbance of the connecting pathway of skin blood flow descending from the rostral ventrolateral medulla.

OBJECTIVE: Emoticon as well as face is a tool for the communication of emotion. However, little is known about behavioral response to emoticon, unlike face. To explore the characteristics of behavioral response of emoticon and face, we measured both response time and accuracy in healthy young subjects. METHODS: The 29 subjects were asked to respond to emoticons or faces which contained one among happy, sad, angry/fearful or neutral emotion. Using univariate analysis of variance, behavioral responses were analyzed for three main effects of stimulation (face, emoticon), emotion (happy, sad, angry/fearful, neutral), gender (male, female) and also their interactions. RESULTS: The response to face was faster and more accurate than that to emoticon. Female's response to face, not to emoticon, was faster than male. A common finding of face and emoticon stimuli was that their responses were slower and less accurate in angry/fearful condition than in the rest emotional ones. There was not any interaction among three factors. The different finding was that neutral condition was less informative in only emoticon, not in face, condition. CONCLUSION: Our results demonstrated emoticon is different from face in terms of the characteristics in the transfer ability of emotion and in gender effect.
Humans ; Male ; Reaction Time ; Transfer (Psychology)

OBJECTIVE: To determine the usefulness of perfusion MR imaging in assessing the histologic grade of cerebral gliomas. MATERIALS AND METHODS: In order to determine relative cerebral blood volume (rCBV), 22 patients with pathologically proven gliomas (9 glioblastomas, 9 anaplastic gliomas and 4 low-grade gliomas) underwent dynamic contrast-enhanced T2*-weighted and conventional T1- and T2-weighted imaging. rCBV maps were obtained by fitting a gamma-variate function to the contrast material concentration versus time curve. rCBV ratios between tumor and normal white matter (maximum rCBV of tumor / rCBV of contralateral white matter) were calcu-lated and compared between glioblastomas, anaplastic gliomas and low-grade gliomas. RESULTS: Mean rCBV ratios were 4.90'+/-1.01 for glioblastomas, 3.97'+/-0.56 for anaplastic gliomas and 1.75'+/-1.51 for low-grade gliomas, and were thus sig-nificantly different; p < .05 between glioblastomas and anaplastic gliomas, p <.05 between anaplastic gliomas and low-grade gliomas, p < .01 between glioblas-tomas and low-grade gliomas. The rCBV ratio cutoff value which permitted dis-crimination between high-grade (glioblastomas and anaplastic gliomas) and low-grade gliomas was 2.60, and the sensitivity and specificity of this value were 100% and 75%, respectively. CONCLUSION: Perfusion MR imaging is a useful and reliable technique for esti-mating the histologic grade of gliomas.
Adult ; Astrocytoma/*pathology ; Brain/pathology ; Brain Neoplasms/*pathology ; Cerebrovascular Circulation ; Contrast Media ; Female ; Gadolinium DTPA/diagnostic use ; Glioblastoma/*pathology ; Human ; *Magnetic Resonance Imaging ; Male ; Support, Non-U.S. Gov't

PURPOSE: To obtain preliminary data for understanding the central auditory neural pathway by means of functional MR imaging (fMRI) of the cerebral auditory cortex during linguistic and non-linguistic auditory stimulation. MATERIALS AND METHODS: In three right-handed volunteers we conducted fMRI of auditory cortex stimulation at 1.5 T using a conventional gradient-echo technique (TR/TE/flip angle: 80/60/40 degree). Using a pulsed tone of 1000 Hz and speech as non-linguistic and linguistic auditory stimuli, respectively, images-including those of the superior temporal gyrus of both hemispheres-were obtained in sagittal plases. Both stimuli were separately delivered biaurally or monoaurally through a plastic earphone. Images were activated by processing with homemade software. In order to analyze patterns of auditory cortex activation according to type of stimulus and which side of the ear was stimulated, the number and extent of activated pixels were compared between both temporal lobes. RESULTS: Biaural stimulation led to bilateral activation of the superior temporal gyrus, while monoaural stimulation led to more activation in the contralateral temporal lobe than in the ipsilateral. A trend toward slight activation of the left (dominant) temporal lobe in ipsilateral stimulation, particularly with a linguistic stimulus, was observed. During both biaural and monoaural stimulation, a linguistic stimulus produced more widespread activation than did a non-linguistic one. CONCLUSION: The superior temporal gyri of both temporal lobes are associated with acoustic-phonetic analysis, and the left (dominant) superior temporal gyrus is likely to play a dominant role in this processing. For better understanding of physiological and pathological central auditory pathways, further investigation is needed.
Acoustic Stimulation ; Auditory Cortex* ; Auditory Pathways ; Ear ; Linguistics* ; Magnetic Resonance Imaging* ; Neural Pathways ; Plastics ; Temporal Lobe ; Volunteers