NMC case report journal最新文献

Posterior condylar canal dural arteriovenous fistula is rare, and cases of posterior condylar canal dural arteriovenous fistula directly related to trauma have been reported even less frequently. We describe a case of posterior condylar canal dural arteriovenous fistula that presented with tinnitus soon after head trauma and was successfully treated with transarterial embolization. A 60-year-old man presented with right-sided tinnitus that had persisted for 2 weeks after sustaining a right temporal injury. Digital subtraction angiography revealed a posterior condylar canal dural arteriovenous fistula with venous drainage from the posterior condylar vein to the suboccipital cavernous sinus, without cortical venous reflux. The shunt was supplied by a single feeder, the jugular branch of the occipital artery. Transarterial embolization using N-butyl cyanoacrylate and coils achieved complete occlusion of the shunt. The patient's tinnitus resolved immediately after the procedure, and follow-up angiography demonstrated persistent complete occlusion of the fistula, with no evidence of recurrence. Posterior condylar canal dural arteriovenous fistula is a rare lesion that may occur following head trauma. Bone-window three-dimensional angiographic reconstruction is useful for diagnosis, as it clearly delineates the relationship between the skull base canal and the shunt. Transarterial embolization can be a curative treatment option when performed with a thorough understanding of the relevant vascular anatomy and potentially hazardous anastomoses.

Isolated middle cerebral artery dissection is a rare cause of acute ischemic stroke, accounting for approximately 2.4% of anterior circulation events. Due to its rarity, no optimal management strategy has been established, and evidence regarding the safety and efficacy of endovascular therapy remains limited. We report a 26-year-old male who presented with sudden-onset headache, vomiting, right hemiparesis, and aphasia. Magnetic resonance imaging revealed multiple faint diffusion-restricted lesions in the left hemisphere (DWI-ASPECTS 7), and magnetic resonance angiography demonstrated occlusion of the left middle cerebral artery (M2 segment). Emergency mechanical thrombectomy using a combined stent retriever and aspiration technique achieved complete recanalization (Thrombolysis in Cerebral Infarction 3), although significant residual stenosis persisted. Balloon angioplasty restored satisfactory luminal patency without stent placement. Postoperative contrast-enhanced vessel wall imaging showed mural thickening and marked enhancement of the left M2 segment, confirming arterial dissection. The patient recovered well, and no infarct progression or re-occlusion occurred during the 6-month follow-up. The present case suggests that endovascular therapy employing mechanical thrombectomy as the first-line strategy may be one of the therapeutic options for acute middle cerebral artery occlusion secondary to arterial dissection. The procedural strategy and device selection should be individualized to minimize vessel injury. Furthermore, given the potential for dynamic vascular changes, long-term radiological surveillance remains essential.

Neurogenic pulmonary edema is a rare but severe complication of acute central nervous system injury, such as subarachnoid hemorrhage, typically presenting with immediate onset. This report describes an uncommon case of delayed-onset neurogenic pulmonary edema following subarachnoid hemorrhage. A 68-year-old man with subarachnoid hemorrhage, caused by a ruptured left posterior communicating artery aneurysm, developed tachypnea and hypoxemia with bilateral pulmonary infiltrates 96 hours after symptom onset. Echocardiography was normal, ruling out cardiogenic causes, and neurogenic pulmonary edema was diagnosed. The patient improved rapidly with fluid restriction and diuretic therapy, and subsequently underwent successful aneurysm coil embolization. Neurogenic pulmonary edema is thought to result from an excessive sympathetic activation leading to pulmonary vasoconstriction, increased capillary pressure, and endothelial injury. Delayed cases may involve secondary sympathetic surges due to intracranial pressure fluctuations, vasospasm, or inflammatory injury. This case highlights the need for clinicians to consider delayed neurogenic pulmonary edema when respiratory deterioration occurs several days after subarachnoid hemorrhage to ensure timely diagnosis and life-saving management.

Eight years after resection of hypopharyngeal carcinoma with neck dissection and ligation of the left internal jugular vein, a man in his 50s presented with an incidentally discovered isolated left transverse sinus dural arteriovenous fistula. Transvenous embolization was performed to achieve complete obliteration. The patient likely developed venous hypertension due to stenosis of the left transverse sinus, limiting contralateral drainage and the absence of collateral communication between the internal jugular vein and the suboccipital cavernous sinus. A retrospective review of serial imaging revealed progression of venous drainage from the initial development of transverse sinus dural arteriovenous fistula to an eventual isolated sinus configuration. Although dural arteriovenous fistula formation is associated with venous hypertension, this case suggests that anatomic venous variants may predispose individuals to delayed dural arteriovenous fistula formation, with abrupt alterations in venous flow serving as triggers. The serial imaging demonstrates the progressive nature of this pathology. Assessment of venous anatomy in patients undergoing planned occlusion of major venous pathways may help predict long-term complications.

A 50-year-old male who had undergone ventriculoperitoneal shunt for hydrocephalus following acoustic neurinoma surgery 18 months earlier presented with progressive fatigue and loss of appetite. Three months prior to visiting our hospital, he fell off his bicycle and sustained a skin laceration just above the tube on the right clavicle. He exhibited tenderness in the right upper quadrant but no other neurological symptoms. A contrast-enhanced abdominal computed tomography scan revealed a large well-defined lesion in the right lobe of the liver, with the shunt tube having migrated into the lesion. Ultrasound-guided percutaneous drainage was performed, resulting in a diagnosis of liver abscess. Culture of the drainage fluid confirmed the presence of methicillin-resistant Staphylococcus aureus, and vancomycin therapy was initiated. Later, an increased cell count, predominantly neutrophils, was observed in his cerebrospinal fluid. We then removed the entire shunt system and administered linezolid, after which the cerebrospinal fluid cell count normalized within almost one month. Liver abscesses as a complication of ventriculoperitoneal shunt are rare, with only 11 cases reported in the previous literature. This is possibly the first case associated with traumatic skin injury occurring long after ventriculoperitoneal shunt placement. With proper management of the shunt tube and administration of the appropriate antibiotic treatment, a favorable prognosis can be expected.

Classification of neuroendocrine tumors in the paranasal sinuses is difficult, and the management of olfactory neuroblastoma with epithelial differentiation remains unclear. Recently, a group of tumors that exhibit neuroectodermal differentiation while maintaining distinct epithelial characteristics has been proposed as olfactory carcinoma, with reports indicating that these tumors have distinct clinical features and a worse prognosis than olfactory neuroblastoma. Here, we present a rare case in which an initial biopsy from the nasal cavity yielded a diagnosis of cylindrical cell papilloma, but surgical resection via combined transnasal endoscopic and transcranial approaches ultimately revealed a diagnosis of olfactory carcinoma. An accurate diagnosis is of the utmost importance for paranasal sinus tumors because it significantly impacts the treatment strategies and prognosis. In cases of olfactory carcinoma, sampling the glandular structure only may result in a misdiagnosis of papillary epithelial neoplasm. Therefore, sufficient tissue samples must be collected, and the entire tumor must be evaluated.

Spinal neuromas related to chronic irritation or remote trauma may arise from unrecognized repetitive minor injury to the spinal cord or nerve roots, yet detailed descriptions with precise preoperative imaging findings are rare. We report a 59-year-old man with a 6-month history of severe dysesthesia and numbness in the neck and left upper limb, followed by progressive weakness over 2 months. He had undergone splenectomy after a traffic accident 23 years earlier. Computed tomography revealed ossification of the posterior longitudinal ligament, osteophytes, and a disc herniation at the left C5/C6 level. Magnetic resonance imaging demonstrated a slightly enhancing peripheral mass compressing the spinal cord. The differential diagnosis included meningioma and sequestrated cervical disc herniation. During surgery, only the swollen, non-functioning C6 ventral root filaments were resected, while functioning filaments were preserved. Histopathological examination confirmed a neuroma composed of disorganized axonal bundles consistent with chronic irritation- or remote trauma-related changes. The patient showed mild postoperative improvement. Chronic irritation appears to be the predominant contributor. Irritation-related neuromas should be considered in the differential diagnosis of intradural extramedullary lesions arising from C6 ventral root filaments, even when the trauma history is remote.

We report a rare case of an isolated superior sagittal sinus dural arteriovenous fistula successfully treated by transcranial direct puncture transvenous Onyx embolization using a steerable microcatheter. With reduced arterial inflow and sinus balloon protection, Onyx injection through the steerable catheter achieved complete occlusion of the shunted pouch without complications. The patient showed marked improvement in cortical venous dilatation and cerebral edema. This case highlights the feasibility and safety of combining transarterial flow reduction, sinus balloon protection, and steerable microcatheter navigation for the curative embolization of isolated sinus dural arteriovenous fistulas.

Anti-neutrophil cytoplasmic antibody-associated vasculitis is an autoimmune disorder characterized by inflammation of small vessels, with potential for multi-organ involvement. Anti-neutrophil cytoplasmic antibody-associated vasculitis can affect blood vessels throughout the body, but involvement of cerebral vessels is relatively rare. We report a case of anti-neutrophil cytoplasmic antibody-associated vasculitis complicated by a subarachnoid hemorrhage due to the rupture of a cerebral artery pseudoaneurysm, which was successfully managed with endovascular intervention. A 61-year-old man presented with headache, purpura on the extremities, profound fatigue, and diffuse myalgia. Computed tomography revealed subarachnoid hemorrhage. Based on clinical, laboratory, brain magnetic resonance imaging, and cerebral angiography findings, the patient was diagnosed with anti-neutrophil cytoplasmic antibody-associated vasculitis and subarachnoid hemorrhage secondary to the rupture of pseudoaneurysm formed in perforating branch arising from the vertebral artery. Parent artery occlusion of the vertebral artery resulted in the complete obliteration of the aneurysm and no rebleeding occurred during the course. Despite intensive care management, the patient developed renal and putaminal hemorrhages, resulting in a fatal outcome. Anti-neutrophil cytoplasmic antibody-associated vasculitis may involve the cerebral vessels, and in cases complicated by ruptured aneurysms, implementing appropriate re-rupture prevention alongside adequate treatment of anti-neutrophil cytoplasmic antibody-associated vasculitis may help improve clinical outcomes.

Anterior choroidal artery aneurysms, in which the anterior choroidal artery arises from the aneurysmal sac, pose significant therapeutic challenges, as treatment risks include branch occlusion and devastating ischemic complications, including hemiplegia and hemianopia. We report a patient in their 70s with an incidentally diagnosed 12.2 mm unruptured right anterior choroidal artery aneurysm, in which three-dimensional angiography demonstrated that the anterior choroidal artery originated from the center of the aneurysm dome. During conservative observation, the aneurysm enlarged to 14.1 mm, necessitating intervention. We employed overlapping flow diverters (2 Pipeline Shield devices) with minimal loose coiling to facilitate controlled thrombosis. To prevent rapid aneurysm thrombosis and subsequent anterior choroidal artery occlusion, we administered modified triple antithrombotic therapy comprising dual antiplatelet agents (prasugrel 3.75 mg and aspirin 100 mg) and reduced-dose rivaroxaban (10 mg daily) for 30 days postoperatively. At 12-month follow-up, angiography demonstrated near-complete aneurysm occlusion (O'Kelly-Marotta grade C3) and a significant reduction in aneurysm size. Critically, during gradual aneurysmal shrinkage, the orifice of the anterior choroidal artery progressively migrated toward the aneurysm neck, allowing branch preservation while the sac underwent organized thrombosis. No perioperative or delayed ischemic complications occurred, and magnetic resonance imaging confirmed the absence of new infarction. This controlled thrombosis strategy combining mechanical flow diversion with time-limited pharmacological modulation successfully achieved aneurysm occlusion while preserving the sac-originating branch through gradual vascular remodeling. This approach addresses the fundamental therapeutic dilemma posed by anterior choroidal artery aneurysms with incorporated branches. It may represent a paradigm shift from acute treatment to controlled, gradual occlusion strategies for similarly challenging lesions.