Patients with stroke mimics have a good safety profile when treated with rt-PA. In case of doubt, physicians should not postpone thrombolysis, because its potential benefit in confirmed ischaemic stroke might be higher than the risk of complications in stroke mimics. A combined analysis of such small series of cases would be useful to have a better delineation of the clinical profile of these patients.
AIm: To develop a specific rehabilitation protocol for patients who have undergone surgical repair of acute aneurysmal subarachnoid hemorrhage (aSAH), and to determine the time at which verticalization should be initiated after aSAH. mATERIAl and mEThODS: Sixty-five patients who underwent acute-term surgery for aSAH and early rehabilitation were evaluated in groups: Group 1 (n=34) started verticalization on days 2-5 post-bleeding whereas Group 2 (n=31) started verticalization approximately day 12 post-bleeding. All patients were monitored for early complications, vasospasm and ischemia.
ABSTRACTsignal intensity on T2-weighted images. The signal intensity on T2-weighted images may be either homogeneously hyperintense or it can show a characteristic high signal intensity in the periphery and low signal intensity in the central region of the lesion. This MR imaging finding corresponds with pathologic findings to fibrous tissue (with high collagen content) centrally and more myxoid tissue peripherally (20).Histopathologically, it consists of compact hypercellular Antoni A areas and myxoid hypocellular Antoni B areas. Cells are narrow, elongated and wavy with tapered ends interspersed with collagen fibers -spindle cells. Nuclear palisading around fibrillary processes (Verocay bodies) are often seen in cellular areas. Large irregularly spaced vessels, usually with thickened hyalinized walls and thrombi, are most prominent in Antoni B areas. Tumor cells have ill-defined cytoplasm, dense chromatin. It often displays degenerative nuclear atypia, but █ INTRODUCTION I ntracranial schwannomas are benign tumors that arise from Schwann cells. Since it is well known that optic and olfactory nerves do not have a Schwann cell sheath, schwannoma should not develop from these nerves (17).Schwannomas account for 8 -10 % of all intracranial tumors and occur mostly in patients between 20 and 50 years of age. Patients affected by schwannomas may be asymptomatic or present with various symptoms depending on the location, size and nerve of origin, and may include motor and sensory dysfunction, intracranial hypertension, headache and seizures (20).These tumors present on Magnetic Resonance Imaging (MRI) as well-circumscribed, encapsulated masses, low-to intermediate signal intensity on T1-weighted images and high Intracranial schwannomas are benign tumors that arise from Schwann cells. Since it is well known that optic and olfactory nerves do not have a Schwann cell sheath, schwannoma should not develop from these nerves.We report a very unusual case of a 73-year-old female who presented with generalized seizures and had radiological features of an intracranial aneurysm. Additional imaging showed an extracerebral mass 2.5 x 2.0 cm in size, which most likely corresponded to a meningioma. It was resected in total. Subsequent histological analysis revealed that the tumor was in fact ancient schwannoma WHO grade I.Only about 41 case of olfactory schwannoma have been reported in the literature. Olfactory groove schwannomas are extremely rare tumors, occurring less frequently than any other intracranial nerve schwannoma. As in this case, the schwannoma should be included in the differential diagnosis of the anterior cranial fossa tumor. Further research on the pathogenesis and the origin of olfactory groove schwannoma is needed.
Lymphocytic hypophysitis (LH) is an autoimmune inflammatory infiltration of the pituitary gland, usually with a benign evolution. In rare circumstances the inflammatory process may extend beyond the pituitary and infiltrate the surrounding structures. We present a 42-year-old woman affected by an aggressive form of LH with extension to the cavernous sinus causing internal carotid artery occlusion and right sixth cranial nerve palsy. Prednisone therapy caused severe iatrogenic Cushing's syndrome, and the patient underwent transsphenoidal decompression. The histopathology report was consistent with LH. The patient was symptom free for a short period with reappearance of severe headache, diplopia, and hearing loss (middle ear inflammation) 3 months after surgery. Corticosteroids were reintroduced with the addition of azathioprine, but there was no regression of the pituitary mass. The patient was referred for stereotactic radiosurgery (SRS) using Gamma Knife (15 Gy to the margin). After 26 months, azathioprine was stopped, and the dose of prednisone was gradually tapered to 7.5 mg/day. Sellar magnetic resonance imaging showed regression of the pituitary mass. After follow-up for > 3 years after SRS, there was no clinical or radiologic evidence of the disease, but carotid arteries remained occluded. The patient developed secondary hypothyroidism and hypogonadism as consequences of SRS. An aggressive form of LH extending beyond the pituitary gland infiltrating surrounding structures is described. It was successfully treated with SRS after failure of transsphenoidal surgery and combined immunosuppressive therapy (prednisone, azathioprine). The review of the literature presents timely information concerning treatment with azathioprine and SRS of patients with an aggressive form of LH.
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