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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).
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
Tuberculosis in Childhood and Pregnancy
Published in Lloyd N. Friedman, Martin Dedicoat, Peter D. O. Davies, Clinical Tuberculosis, 2020
Lindsay H. Cameron, Jeffrey R. Starke
Computed tomography or magnetic resonance scans often help establish the diagnosis of tuberculous meningitis and can aid in evaluating the success of therapy. The classic imaging finding of tuberculous meningitis is abnormal enhancement in the posterior fossa (basal enhancement), which may involve the meninges or cisterns.77 Both computed tomography and magnetic resonance imaging are capable of demonstrating hydrocephalus, the most common complication of tuberculous meningitis. Computed tomography is capable of identifying abnormal enhancement in the basal cisterns but cannot distinguish between vessels and cistern enhancement as with magnetic resonance imaging. Contrasted magnetic resonance imaging is more sensitive for the identification of miliary foci/nodules in the leptomeninges and inflammatory pan-arteritis (and associated cerebral infarction) which are rarely identified on computed tomography imaging.78–80 Any child with a triad of imaging findings including basal enhancement, hydrocephalus, and cerebral infarction has tuberculous meningitis until proven otherwise.
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.
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.
Alien sign as bad prognostic factor in basilar tip aneurysm
Published in British Journal of Neurosurgery, 2023
Muhammad Reza Arifianto, Khrisna Rangga Permana, Nur Setiawan Suroto, Asra Al Fauzi
A 44-year-old pregnant women presented with sudden onset coma. Upon arrival, GCS was E2V2M4 with positive meningeal sign. CT showed massive subarachnoid haemorrhage around the basal cisterns and communicating hydrocephalus. We performed emergency extraventricular drainage. CT Angiography showed a basilar tip aneurysm measuring 1.4 × 0.8 × 0.4 cm. The patient suddenly deteriorate to GCS E1V1M2 with fresh blood in the EVD suggesting re-rupture of the aneurysm and died before the aneurysms could be secured. The CTA with surface rendering gave a distinctly alien anthropomorphic appearance with the aneurysm as the head, basilar artery as the body and superior cerebellar arteries and vertebral arteries as the arms and legs. We call this disproportion of head–body ratio, which normally in humans is 1:8, the ‘Alien sign’ (Figure 1). It denotes a large aneurysm and hence a poor1–4.