BackgroundDermoid cysts are non-neoplastic tumors that arise from defects in the separation of the neuroectoderm. Cyst rupture rarely occurs spontaneously and the most common symptom is headache, followed by seizure. Although many cases of ruptured dermoid cysts present with symptoms, reports of cases that are asymptomatic, or where symptoms disappear, are rare.Case presentationWe report the case of a 66-year-old Asian man with a history of sudden onset headache who was found to have high amounts of fat material in the subarachnoid space and a fat suppression mass in the left cavernous sinus. He underwent oral steroid therapy. Five days after starting medication his headache symptoms disappeared. Routine neurological imaging was then performed without surgical procedure. Magnetic resonance imaging revealed evidence of the remains of a static lesion 6 months after his first visit. He has remained headache free for 10 months since the initial event.ConclusionsAlthough cases of ruptured dermoid cysts presenting with consistent symptoms have been commonly reported, until now there were few reports on asymptomatic cases or cases where symptoms disappeared. We believe that surgical intervention is unnecessary for ruptured dermoid cysts with minimal symptoms.
IntroductionPituicytoma is a rare neoplasm of the neurohypophysis. To the best of our knowledge there have been no reports of pituicytoma in which long-term magnetic resonance imaging observation was performed. We calculated the doubling time of the tumor volume and described the growth pattern of a pituicytoma.Case presentationA 52-year-old Japanese man with a history of decreased libido was found to have a sellar and suprasellar mass. He underwent transsphenoidal surgery, but only a small specimen was obtained because of intraoperative bleeding. The tentative histological diagnosis was schwannoma. He noticed bitemporal hemianopsia 7 years later. A follow-up magnetic resonance imaging disclosed a tumor volume doubling time of 3830 days. Transcranial gross-total tumor resection was performed. The lesion consisted of elongated and plump tumor cells that were arranged in a fascicular or storiform pattern and were positive for S-100 protein and focally positive for glial fibrillary acidic protein. The final histological diagnosis was pituicytoma.ConclusionPituicytoma is a slow-growing tumor, but the growth rate may change during follow-up.
We report a case of infected subdural hematoma ISH. We followed up an 81 year old man with asymptomatic chronic subdural hematoma CSDH. After half a year, he came to our hospital because of reduced activities of daily living and a high fever. Although his inflammatory markers were high, various cultures and imaging studies yielded negative results. Right hemiparesis developed 5 days later. Burr hole surgery was performed to treat the CSDH. The hematoma proved to be mixed with pus, suggesting ISH. The ISH recurred twice despite antibiotic therapy and repeated irrigation. Finally, inflammatory parameters normalized and computed tomography disclosed an organized CSDH. ISH should be suspected in patients with CSDH presenting with high fever.
Cerebral vasospasm is a well documented occurrence of aneurysmal subarachnoid hemorrhage but has not been sufficiently analyzed in cases with arteriovenous malformation. Moreover, cerebral vasospasm following arteriovenous malformation rupture is a rare and critical complication. We describe a case of symptomatic cerebral vasospasm following cerebellar arteriovenous malformation rupture.An 8 year old girl presented with deteriorated consciousness. Computed tomography revealed packed intraventricular and diffuse thin subarachnoid hemorrhages due to cerebellar arteriovenous malformation. Immediate endoscopic evacuation of intraventricular hemorrhage was performed. Subsequently, total arteriovenous malformation resection was achieved surgically after preoperative glue embolization. Twelve days posthemorrhage, cerebral angiogram revealed severe vasospasm at both internal carotid arteries. Although emergency intra arterial fasudil hydrochloride injection and balloon angioplasty resolved the vasospasm successfully, postoperative magnetic resonance imaging showed bifrontal cerebral infarction.The characteristic features of cerebral vasospasm after arteriovenous malformation rupture are discussed. In the present case, packed intraventricular hemorrhage could strongly affect significant vasospasm. Treatment of patients with intraventricular hemorrhage related to arteriovenous malformations should consider the risk of severe delayed vasospasm.
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