Rupture of an intracranial dermoid cyst is a rare event with considerable associated morbidity and potential mortality. We present a case of intracranial rupture of a dermoid cystic tumor with consequent dissemination of subarachnoid fat droplets resulting in acute aseptic chemical meningitis. Radiographic findings, operative treatment, and pathologic features are described.

Mechanical clot lysis is a powerful technique for immediate restoration of antegrade venous flow in dural sinus thrombosis. In most patients, the superior sagittal sinuses and contralateral transverse sinuses could be accessed with the 5-French rheolytic catheter.

Patients often present to the emergency department with a wide variety of nontraumatic infectious, inflammatory, and neoplastic conditions of the head and neck. Because the use of cervical and neck computed tomography (CT) has become routine in the emergency setting, knowledge of the imaging findings of common acute conditions of the head and neck is essential to ensure an accurate diagnosis of these potentially life-threatening conditions, which include oral cavity infections, tonsillitis and peritonsillar abscess, sialadenitis, parotiditis, diskitis, thrombophlebitis, periorbital and orbital cellulitis, infectious cervical lymphadenopathy, and various neoplasms. Less common conditions that require rapid diagnosis and treatment include epiglottitis, invasive fungal sinusitis, angioedema, and deep neck abscess. Familiarity with these conditions enables the radiologist to make a prompt diagnosis, assess the extent of disease, and evaluate for potential complications. CT is the first-line imaging modality in the emergency setting; however, magnetic resonance imaging plays an important secondary role.

Pineal region tumors make up less than 1% of all intracranial neoplasms, with the majority being of germ cell origin. We describe the diagnostic evaluation and treatment of a patient presenting with neurological deficits who was found to have a germinoma of the pineal gland.

Meningiomas are common tumors of the central nervous system that account for approximately 15% of all intracranial tumors and are the most common extra-axial neoplasm. Most meningiomas are benign, although atypical and malignant meningiomas also exist. Typical imaging characteristics include a well-circumscribed, homogeneously enhancing, extra-axial mass on both computed tomography and magnetic resonance imaging. The presence of an associated cyst is an uncommon imaging feature that may make it difficult to distinguish the tumor from a primary intra-axial glial neoplasm. The presence of peritumoral edema can also be a misleading finding. We present a case of a woman who presented with a history of multiple recent falls, decreased energy, and increased somnolence and was found to have a "cystic meningioma." Typical imaging characteristics, histologic subtypes, treatment, and prognosis are also discussed.

A 57-year-old African American woman with a history of sickle cell b-thalassemia presented to the hospital with a 3-day history of chest and back pain unresponsive to oxygen and analgesic therapy. Her medical history included multiple painful crises due to sickle cell-induced vaso-occlusion, multiple blood transfusions, hypertension, and diabetes mellitus. The evening of her admission, she developed a fever and hypotension, and a sepsis evaluation was initiated. She was treated with empirical antimicrobial agents and received oxygen, a red blood cell transfusion, and medications for pain. Two nights later, she became mildly confused. Unenhanced computed tomography (CT) of the head was performed. The following morning, magnetic resonance (MR) imaging of the brain and MR angiography of the head and neck were performed. Later that day, the patient's hypotension worsened, and she became difficult to arouse. Intubation was performed to protect her airway, and she was transferred to the intensive care unit. Thrombocytopenia was diagnosed, and the prophylactic antithrombotic therapy initiated at admission was temporarily withheld. Multiple studies for infectious agents returned negative results. The patient's status continued to deteriorate with the development of respiratory failure, renal failure, and ischemic hepatitis ("shock liver"). Sedation was discontinued, and 48 hours later, with the patient still unresponsive, comfort measures were instituted. The patient died on the 10th day of her hospitalization.

Background: Three patients received solid organ transplants from a common donor and were subsequently discharged from the hospital following an uneventful hospital course. Within 30 days, all 3 organ recipients returned to the hospital with varying symptoms that progressed to rapid neurological deterioration, coma, and death.Objective: To describe the clinical, neuroradiological, and pathological findings of rabies virus infection in organ transplant recipients infected from a common donor.Design: Case series involving a common donor and 3 organ recipients ascertained through review of clinical course and autopsy findings. A fourth case was determined by review of pending autopsy cases in which death occurred within the same time interval. Portions of postmortem central nervous system and organ tissues were frozen and formalin-fixed. Fluids and tissues were also collected for cultures, serology, and molecular studies. Postmortem fluids and tissues and antemortem fluids and tissues from all 4 transplant recipients and serum and banked lymphocyte or spleen cells from the donors were sent to the Centers for Disease Control and Prevention for further evaluation.Setting: Transplant unit of an urban teaching hospital.Results: Antemortem cerebrospinal fluid analysis for 3 of the 4 recipients was consistent with a viral etiology. Neuroimaging and electroencephalogram studies were suggestive of an infectious encephalitis or a toxic encephalopathy. Initial laboratory testing did not demonstrate an infectious etiology. Postmortem histologic analysis, immunohistochemistry, electron microscopy, and direct fluorescence antibody testing revealed rabies virus infection. Serological testing done postmortem confirmed rabies virus infection in the common donor.Conclusions: These cases demonstrate a risk for transmitting rabies virus infection through solid organ and tissue transplantation, and this diagnosis should be considered in any rapidly progressing neurological disease.

Kummell disease, or avascular necrosis of a vertebral body, presents as vertebral osteonecrosis typically affecting a thoracic vertebra with compression deformity, intravertebral vacuum cleft, and exaggerated kyphosis weeks to months after a minor traumatic injury. This rare disease is increasing in prevalence secondary to an aging population and the associated rise in osteoporosis. Treatment with vertebroplasty or surgical decompression and fusion is often required. We present a classic case of Kummell disease to illustrate the salient features of the condition, with associated imaging findings on computed tomography and magnetic resonance imaging.