OBJECTIVE AND IMPORTANCE: Coccidioidomycosis was once confined to the southwest United States and northern Mexico. It has become a larger concern because of the concentration of military bases in these areas, the increasing mobility of populations, and the rising population of immunocompromised persons. Outside endemic areas, the diagnosis is rarely ...

We report a 55-year-old man presenting with symptoms of cluster headache, including throbbing pain behind the left eye, tearing, and rhinorrhea. Magnetic resonance imaging and magnetic resonance angiography revealed no abnormalities. Two days of intravenous dihydroergotamine resolved his pain. His headaches were somewhat relieved with a treatment regimen of 100 ...

According to the recently established molecular basis for phenotypic heterogeneity of sporadic Creutzfeldt-Jakob disease (CJD), six different phenotypes are characterized by the size of the protease-resistant fragment of the pathological prion protein (types 1 and 2) and homozygosity or heterozygosity for methionine or valine at codon 129 of the prion ...

A 74 year-old patient with a nocturnal onset of neck and chest pain was brought to an emergency clinic. Physical examination and cardiac assessment were normal. Three hours after the addmittance, a flaccid paralysis of the four limbs supervened. Suspecting of an unusual onset of central nervous system infection, a ...

The authors report the use of neuroendoscopic third ventriculostomy to treat successfully both hydrocephalus and syringomyelia associated with fourth ventricle outlet obstruction. A 27-year-old woman presented with dizziness, headache, and nausea. Magnetic resonance (MR) imaging demonstrated dilation of all ventricles, downward displacement of the third ventricular floor, obliteration of the ...

In some young adults non-shunted myelomeningocele (MMC) patients without symptoms or with unspecific clinical findings, moderate or severe stabilised ventriculomegaly are observed in control CT scans. Physicians are then faced with the so-called 'Arrested Hydrocephalus' (AH) syndrome. The present study is part of a prospective protocol in which patients with ...

OBJECT: The purpose of this prospective study was to evaluate aqueductal cerebrospinal fluid (CSF) flow after endoscopic aqueductoplasty. In all patients, preoperative magnetic resonance (MR) imaging revealed hydrocephalus caused by aqueductal stenosis and lack of aqueductal CSF flow. METHODS: In 14 healthy volunteers and in eight patients with aqueductal stenosis ...

We describe five cases of high signal in the cerebrospinal fluid (CSF) on fast-FLAIR images 24-48 h after onset of stroke. All the patients had undergone perfusion-weighted MRI within 6 h of the onset of the symptoms. The CSF was far brighter than the cortical gyri. The high signal was ...

We report a case of spontaneous intracranial hypotension diagnosed with unenhanced cranial MRI, showing laminar subdural fluid and engorgement of the hypophysis and perisellar sinuses. Cerebrospinal fluid pressure was low. MRI was normal after resolution of symptoms. Prior reports emphasise the enhancing pachymeninges seen in this syndrome. We maintain that, ...

Traumatic spinal epidural hematoma (TSEH) is rare in children. Only three cases of TSEH were documented in the pediatric literature. This clinical note presents an infant with TSEH but no risk factors. Without magnetic resonance imaging examination, children with TSEH and minor symptoms may be missed and under reported. Signs ...

The authors report a patient with progressive cognitive and gait decline in association with sarcoid meningitis. The patient had evidence of active inflammation as determined by cerebrospinal fluid examination and was steroid dependent. Magnetic resonance imaging and radionucleotide cisternography were complementary in establishing the diagnosis of communicating hydrocephalus, and suggested ...

OBJECT: The goal of this study was to assess the value of the Codman Hakim programmable valve to settings in the range of 30 to 200 mm H2O. This valve can be adjusted noninvasively for cerebrospinal fluid (CSF) drainage. METHODS: The authors conducted a single-center retrospective study of 583 patients ...

Following excision of pilocytic astrocytoma, a 12-year-old girl underwent posterior cranial fossa synthetic duraplasty with polyglactin 910 mesh. On the 8th postoperative day, unusual extradural collection was diagnosed by spinal magnetic resonance imaging. On the 14th postoperative day, cerebrospinal fluid leakage in the upper part of the postoperative wound was ...

OBJECT: Long-standing overt ventriculomegaly in adults (LOVA) is a unique form of hydrocephalus that develops during childhood and manifests symptoms during adulthood. The aim of the present study was to analyze the specific pathophysiological characteristics of LOVA. METHODS: The specific diagnostic criteria for LOVA include severe ventriculomegaly in adults that ...

A 73-year-old man with multiorgan failure requiring mechanical ventilation and haemodialysis developed herpes labialis infection during his stay in the ICU. This was treated with enteral acyclovir. He developed persistent neurologic impairment soon after acyclovir administration, which, over the course of seven days, progressed to coma, the aetiology of which ...

PURPOSE: To compare the spinal-epidural spread of gas following loss of resistance (LOR) technique for detection of the epidural space using air or nitrous oxide (N2O). METHODS: Comparison of the spread of air and N2O in the epidural space following LOR technique was performed by using Magnetic Resonance Imaging (MRI). ...

A case of myelomatous involvement of the dura mater is reported. The patient presented with blurring of vision in the right visual field and left sided facial numbness. A magnetic resonance imaging scan of the head revealed extensive infiltration of the dura mater. Cerebrospinal fluid (CSF) analysis showed no plasmacytosis ...

The authors describe a case of spontaneous intracranial hypotension in which the leakage site was determined by using magnetic resonance (MR) myelography. This technique demonstrated the route of cerebrospinal fluid (CSF) leakage, whereas other methods failed to show direct evidence of leakage. Magnetic resonance myelography is a noninvasive method that ...

OBJECTIVE: To correlate the pathophysiology of intracranial hypotension syndrome with abnormalities in the brain and spine found through magnetic resonance imaging. METHODS: In a series of 11 patients with intracranial hypotension syndrome, brain magnetic resonance scans were evaluated for the thickness, distribution, morphology, and pattern of meningeal enhancement coincident with ...

Meningeal enhancement on magnetic resonance (MR) imaging is considered the hallmark radiological feature of intracranial hypotension. The authors report on a patient who exhibited progressively symptomatic intracranial hypotension due to a lumbar cerebrospinal fluid (CSF) leak, but in whom MR imaging demonstrated no pachymeningeal enhancement. This 24-year-old man presented with ...

The authors report on a series of patients who underwent lumbar drainage of cerebrospinal fluid (CSF) for treatment of posterior fossa pseudomeningoceles and who subsequently developed an acute posterior fossa syndrome. These patients were found to have similar radiological findings demonstrating acute mass effect secondary to movement of CSF from ...

In this study, we evaluated the role of 67Ga whole-body and single photon emission tomographic (SPET) imaging in the early diagnosis and lesion localization of spinal epidural abscess before confirmation by gadolinium-enhanced magnetic resonance imaging (MRI). Six patients with fever of unknown origin had a 67Ga whole-body scan, four of ...

We describe three cases of women with hot bath-related headache who reported that their severe paroxysmal headache could be provoked by pouring hot water over themselves or by soaking in a hot bath. In one patient, the headache was also brought on by exposure to cold wind. Another patient had ...

Two young men, aged 34 and 30 years, developed transient recurrent multifocal neurological symptoms with associated severe headache over a 2-week period. Both had a lymphocytic pleocytosis in their cerebrospinal fluid. Cranial imaging studies were normal. All symptoms resolved without recurrence. Although the cause and pathogenesis are undefined, this self-limited ...

Spinal pseudomeningoceles and cerebrospinal fluid (CSF) fistulas are uncommon extradural collections of CSF that may result from inadvertent tears in the dural-arachnoid layer, traumatic injury, or may be congenital in origin. Most pseudomeningoceles are iatrogenic and occur in the posterior lumbar region following surgery. The true incidence of iatrogenic pseudomeningoceles ...

Ventriculoperitoneal (VP) shunt placement in patients with aqueductal stenosis has recently been reported as a cause of pneumocephalus. We report on a patient with pneumocephalus associated with aqueductal stenosis treated by VP shunting. A 29-year-old woman who had undergone a shunt operation for aqueductal stenosis 7 years previously sustained a ...

Transsphenoidal cephalocele rarely occurs in adults. We describe two adult cases with transsphenoidal cephaloceles. The first case was a 53-year-old female who presented with spontaneous cerebrospinal fluid (CSF) rhinorrhea. Magnetic resonance (MR) imaging demonstrated a transsphenoidal meningocele. Surgical repair was attempted via the transsphenoidal route. Rhinorrhea recurred at one month ...

OBJECTIVE: To investigate the radiological features of the nutrient canal in the fibula. DESIGN AND PATIENTS: One hundred and seventy-nine dried fibulae were studied regarding the type, number, location, and direction of the nutrient canal. They were classified into a usual type (type I: a radiolucent line confined to the ...

Spontaneous spinal cerebrospinal fluid (CSF) leaks are an increasingly recognized cause of intracranial hypotension. In this report the authors review the indications for surgery, surgical techniques, and surgery-related outcomes for these lesions. The major presenting symptoms include postural headaches, nausea, vomiting, and diplopia. Often, there is no history of traumatic ...

We report a case of delayed cerebrospinal fluid (CSF) pseudocyst following shunt malfunction in a 20-year-old patient with myelomeningocele. Magnetic resonance (MR) images and a radioimmunoassay shunt-gram detected the CSF fistula at the old scar of the myelomeningocele repaired 20 years before. Since the revision of the shunt system failed ...

The frequent use of invasive procedures at the spinal cord such as epidural injections has led to an increased incidence of iatrogenic abscesses. We report the case of a patient who suffered from low back pain. During epidural lumbar injections of steroids the patient developed severe radicular symptoms, resulting in ...

Serial magnetic resonance imaging findings are described in a patient with a sporadically occurring pilocytic astrocytoma that underwent spontaneous regression over 6 years. To the authors' knowledge, this is the first report in which spontaneous involution of a pilocytic astrocytoma not associated with neurofibromatosis type 1 has been described. A ...

Our objective was to determine the extension and duration of a stable segmental thoracic or lumbar epidural blockade by lidocaine in the 20 to 25-kg pig. Fourteen anaesthetised pigs were investigated. The radioactive isotope technetium99 (Tc99) was added to lidocaine to evaluate the spread in the epidural space. One ml ...

Cerebrospinal fluid (CSF) volume depletion, due to CSF leakage or CSF shunt overdrainage, is typically indicated when patients present with orthostatic headaches, with or without several other symptoms: neck or interscapular pain, nausea, emesis, diplopia, changes in hearing, visual blurring, facial numbness or weakness, and radicular upper-limb symptoms. Cerebrospinal fluid ...

Chemical meningitis developed in a boy with acute lymphoblastic leukemia during central nervous system (CNS) prophylaxis. Cerebrospinal fluid examination showed pleocytosis and a high protein level. There were no malignant cytological findings. Calculated permeability of albumin across the blood-brain barrier (BBB) was more elevated than that of immunoglobulin or alfa2-macroglobulin. ...

Intracranial hypotension causes orthostatic headaches and diffuse pachymeningeal gadolinium enhancement on magnetic resonance imaging with or without subdural fluid collections or imaging evidence of descent of the brain. A review of the literature and my experience and investigations in the past decade reveal a broadening clinical and imaging spectrum of ...

BACKGROUND: Small rinds of free fluid are frequently seen in the right anterior subphrenic space. Therefore, we investigated patients undergoing abdominal computed tomography (CT) to see whether early fluid collections are seen preferentially at this or any other site. METHODS: CT examinations of 59 randomly selected patients with minor or ...

PURPOSE: Leptomeningeal disease (LMD) significantly affects the prognosis and treatment of pediatric patients with medulloblastoma or primitive neuroectodermal tumor (PNET). Examination of CSF for malignant cells, detection of LMD on spinal magnetic resonance imaging (MRI), or both are the methods routinely used to diagnose LMD. A recent study suggested 100% ...

OBJECTIVE: This study was designed to evaluate the safety, MR imaging characteristics, and clinical response to intrathecal gadopentetate dimeglumine (gadolinium) administration in human patients. SUBJECTS AND METHODS: Eleven adult patients were included in this prospective study. Via lumbar puncture, a single dose of either 0.2 ml, 0.5 ml, or 1.0 ...

A case of parasagittal meningioma causing subarachnoidal haemorrhage (SAH) is reported. Computed tomography (CT) was found negative in the patient with acute severe headache and haemorrhage was observed on cerebrospinal fluid (CSF) examination. Digital subtraction angiography (DSA) showed an avascular space over the convexity and Magnetic resonance imaging (MRI) revealed ...

OBJECT: Syringomyelia causes progressive myelopathy. Most patients with syringomyelia have a Chiari I malformation of the cerebellar tonsils. Determination of the pathophysiological mechanisms underlying the progression of syringomyelia associated with the Chiari I malformation should improve strategies to halt progression of myelopathy. METHODS: The authors prospectively studied 20 adult patients ...

Diagnostic confusion often exists between tuberculous meningitis and other meningoencephalitides. Newer diagnostic tests are unlikely to be available in many countries for some time. This study examines which clinical features and simple laboratory tests can differentiate tuberculous meningitis from other infections. Two hundred and thirty two children (110 tuberculous meningitis, ...

Local anaesthetics injected into the epidural space may deform the dural sac to a variable degree, thereby contributing to variability in the extent of the block. We investigated deformation of the lumbar dural sac after injection into the lumbar epidural space. The subjects were 26 patients with low-back pain who ...

OBJECTIVE: The purpose of this study is to demonstrate the utility of a modified transcochlear obliteration of the petrous apex in repair of persistent cerebrospinal fluid (CSF) leaks. A review of temporal bone computed tomography (CT) scans and histological preparations for potential air cells leading to such leaks is also ...

The lumbar epidural region was studied using computerized tomography. This technique allows examination of the region in vivo. It confirmed that the spinal canal is oval in the upper lumbar region, becoming triangular lower down, and that the ligamenta flava form a posterior recess to the vertebral canal. Epidural fat ...

OBJECTIVE: To describe a case of spontaneous intracranial hypotension with a previously unreported constellation of presenting features. DESIGN: Case report. SETTING: Tertiary care center. MAIN OUTCOME AND RESULTS: We describe a patient with intracranial hypotension who presented with a parkinsonian syndrome and later development of ataxia and prominent bulbar symptomatology. ...

Actinomycosis is an uncommon cause of intracranial infection. Epidural empyema represents about 6% of CNS actinomycotic lesions. A case of an epidural empyema with parietal bone osteomyelitis caused by Actinomyces israelii is presented. Relevant neuroimaging features were bone erosions and a multiloculated collection with annular contrast enhancing on CT. Postoperative ...

We describe a 4-month-old male patient with severe developmental delay and elevated lactate in blood and CSF. The MR images showed abnormalities differing from the typical pattern found in association with Leigh's disease. The examination of fibroblast cultures showed diminished activity of mitochondrial complexes I and III. The patient died ...

We report a patient who experienced a severe vertiginous episode with bilateral tinnitus and progressive right-sided hearing loss. She had Marfan's disease and was on anticoagulant treatment. The fluid in the labyrinth gave higher signal than cerebrospinal fluid on T1-weighted images, suggesting haemorrhage. The radiological follow-up is discussed.

PURPOSE: To describe a patient with classic presentation of spontaneous intracranial hypotension and subsequent improvement with targeted epidural blood patch. METHODS: Report of one case and review of the literature. RESULTS: Examination of cerebrospinal fluid after lumbar puncture disclosed a reduced opening pressure, an increased level of protein, and lymphocytic ...