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Infectious Optic Neuropathies
Published in Vivek Lal, A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
Imran Rizvi, Ravindra Kumar Garg
Tuberculous optochiasmatic arachnoiditis is a common complication of tuberculous meningitis that presents with profound vision loss. In optochiasmatic arachnoiditis, there is dominant affection of optic nerve and optic chiasm secondary to marked basal exudates and associated cranial arachnoiditis. Exudates are dominantly present in interpeduncular, suprasellar and sylvian cisterns. Optochiasmatic arachnoiditis can paradoxically develop, while anti-tuberculosis drugs are being administered. Neuroimaging demonstrates multiple enhancing lesions in basal cisterns, particularly in middle cranial fossa, along with intense basal meningeal enhancement. Tuberculous optochiasmatic arachnoiditis is usually with corticosteroids. Thalidomide, methylprednisolone and hyaluronidase have also been tried with variable success32 (Box 8.2).
Imaging of head trauma
Published in Helen Whitwell, Christopher Milroy, Daniel du Plessis, Forensic Neuropathology, 2021
Traumatic subarachnoid haemorrhage is seen as hyperdense blood in sulcal and cisternal CSF spaces. This may arise from direct injury to small arteries and veins or extension from adjacent cerebral haemorrhagic contusions. More extensive subarachnoid haemorrhage in the basal cisterns may arise from direct arterial dissections of the supraclinoidal internal carotid (Figure 3.19) or the vertebrobasilar arteries. Caution must be exercised to suspect a spontaneous subarachnoid haemorrhage from an aneurysmal rupture as a prelude to the head injury, and if doubt, a CT angiogram can be helpful.
Role of radiodiagnosis in CSF rhinorrhea
Published in Jyotirmay S. Hegde, Hemanth Vamanshankar, CSF Rhinorrhea, 2020
Procedure: No matter the tracer, it is administrated via a lumbar intrathecal puncture and the patient is positioned in a Trendelenburg position, to facilitate the craniad flow of the tracer. Images are acquired when the radiotracer opacifies the basal cisterns. Images of the head and paranasal sinuses, anterior and lateral projections, are taken. The accumulation of the radiotracer within the nasal cavity or nasopharynx, suggests a CSF fistula and may detect the location of the communication.6,7
The rare manifestations in tuberculous meningoencephalitis: a review of available literature
Published in Annals of Medicine, 2023
Rong li He, Yun Liu, Quanhui Tan, Lan Wang
Subarachnoid haemorrhage refers to the blood flowing into the subarachnoid space after the blood vessels at the bottom of the brain or on the surface of the brain break, leading to the corresponding clinical symptoms. Subarachnoid haemorrhage is rare in tuberculous meningoencephalitis. Only a few literatures have reported this phenomenon. The main clinical manifestation is sudden severe headache, with or without nausea, vomiting and other symptoms [14]. At present, the aetiology of TBM with SAH is still unclear. At present, its pathogenesis is considered to be related to TBM vasculitis and late inflammatory reaction, which may lead to subarachnoid haemorrhage [15]. Pathological examination also showed that subarachnoid haemorrhage may be related to the rupture of inflammatory tuberculoma or fungal aneurysm [16]. The diagnosis of subarachnoid haemorrhage mainly depends on the clinical manifestations. Cranial CT is the first choice for imaging diagnosis, and the positive rate is about 85%. Head CT shows diffuse high-density images of basal cistern, ventricular system and convexity of brain. Intracranial arterial lesions can also be detected by digital subtraction DSA of the whole cranial artery and MRA of the intracranial artery magnetic resonance angiography. The main causes of subarachnoid haemorrhage are aneurysm rupture and haemorrhage [17]. The clinical manifestations of patients with nodular encephalopathy suddenly appear in the course of the disease, which can be diagnosed in combination with the corresponding changes of head CT.
Bilateral Tapia’s syndrome secondary to cervical spine injury: a case report and literature review
Published in British Journal of Neurosurgery, 2023
Alexandros G. Brotis, Jiannis Hajiioannou, Christos Tzerefos, Christos Korais, Efthymios Dardiotis, Kostas N. Fountas, Kostantinos Paterakis
From the anatomical perspective, the efferent fibers of the X and XII CN emerge from the ambiguous and hypoglossal nerve nuclei of the medulla, respectively. The X CN leaves the medulla at the postolivary sulcus, while the rootlets of the XII CN exit at the preolivary sulcus, after travelling ventromedially within the reticular formation, lateral to the medial lemniscus and the pyramidal tract. They both traverse the basal cisterns (cerebello-medullary for the X and premedullary for the XII) lateral to the vertebral artery and penetrate the dura. The X and XII CN exit the skull from the jugular foramen (pars venosa) and hypoglossal canal, respectively. After giving off two branches, the meningeal and the auricular branch of Arnold, the X CN joins the IX, XI and XII CN and run together within the carotid sheath for several centimeters. At the level of the transverse process of the atlas, the XII to ramifies into muscular branches, while the X CN gives-off a few additional branches, including the recurrent laryngeal nerve (RLN) and the cardiac branches. Of notice, the right RLN arises in front of the subclavian artery and ascends into the right tracheoesophageal sulcus to supply the vocal cords and all the laryngeal muscles except the cricothyroid. The left RLN descends below the aortic arch.
Contralateral approach for the treatment of a distal supraclinoid aneurysm: a technical case report
Published in British Journal of Neurosurgery, 2023
Eric S. Nussbaum, Kevin M. Kallmes
The lesion was treated using a standard pterional craniotomy. Our technique has been described previously.7 We use high-power magnification and sharp microsurgical dissection to open the Sylvian fissure, exposing the optic nerve and ICA. Arachnoid adhesions are taken down along with adhesions between the frontal lobe and optic nerve. The basal cisterns are opened widely to release cerebrospinal fluid and to provide brain relaxation, and the exposure is deepened gradually to expose the opposite optic nerve and frontal lobe (Figure 1). With patient, gentle retraction, the contralateral ICA comes into view. In this case, to expose the contralateral ICA aneurysm, slightly deeper retraction was needed as the arachnoid was opened and the opposite ICA exposed along its full length, following the contralateral A1 back to its origin. Once the aneurysm was exposed, standard microsurgical dissection exposed the aneurysm neck (Figure 2), which was occluded with a bayonet clip (Figure 3). We used intraoperative angiography and indocyanine green video angiography once the lesion had been clipped to confirm obliteration of the aneurysm and to ensure that the parent vessels had not been compromised.