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Stroke
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
In subarachnoid hemorrhage, the bleeding is located between the arachnoid and pia mater. Head trauma is the most common cause. However, traumatic subarachnoid hemorrhage is a distinctly separate disorder from nontraumatic subarachnoid hemorrhage. The cause of primary (spontaneous) subarachnoid hemorrhage is usually a ruptured aneurysm. In about 85% of patients, the aneurysm is classified as a congenital intracranial saccular aneurysm, or a berry aneurysm. The bleeding can resolve without treatment in some patients. Less common causes include arteriovenous malformations, bleeding disorders, and mycotic aneurysms.
Radiology of Infectious Diseases and Their Potential Mimics in the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
Jocelyn A. Luongo, Boris Shapiro, Orlando A. Ortiz, Douglas S. Katz
Meningitis is an inflammatory infiltration of the pia mater, the arachnoid, and the CSF. The disease can have an infectious or non-infectious etiology. Early in the course of disease, the initial diagnosis is made on clinical evaluation, including lumbar puncture, as imaging findings are often normal. On CT, there may be hydrocephalus with enlargement of the subarachnoid space and effacement of the basal cisterns. There is enhancement within the sulci and cisterns after IV contrast administration, secondary to breakdown in the blood–brain barrier, as well as areas of low attenuation from altered perfusion patterns. On MR, exudate in the subarachnoid space is isointense on T1-weighted images and hyperintense on T2-weighted images. Again, there is leptomeningeal enhancement after IV contrast administration, which is typically smooth and linear (Figure 5.17). Diffusion-weighted imaging findings depend on altered perfusion and the presence of vascular complications, including arterial occlusion [62,64].
The Spinal Cord and the Spinal Canal
Published in Bernard J. Dalens, Jean-Pierre Monnet, Yves Harmand, Pediatric Regional Anesthesia, 2019
Bernard J. Dalens, Jean-Pierre Monnet, Yves Harmand
The spinal cord is covered with three membranes, or meninges, which contain a liquid, the cerebrospinal fluid. From within outwards, the meninges (Figure 1.16) are The pia mater, a thin and vascular layer that closely invests the spinal cord and sends numerous septa into the nervous tissueThe arachnoid, a thin avascular and transparent membrane tightly attached to the external meningeal layerThe dura mater, a thick membrane formed by numerous collagen fibers which are arranged longitudinally
Detection of co-infection with Orientia tsutsugamushand and hemorrhagic fever with renal syndrome by next-generation sequencing
Published in International Journal of Neuroscience, 2023
Qianhui Xu, Wenyi Zhang, Qian Wang, Xuejun Fu, Jing Han, Ying Huang
In the initial examination, the patient’s complete blood count showed a white blood cell count of 7.94 × 109/L (93.3% neutrophils) and a platelet count of 63 × 109/L. The biochemistry results were as follows: C-reactive protein, 132.61 mg/L; procalcitonin, 1.46 ng/mL; erythrocyte sedimentation rate, 33 mm/h; and creatine phosphokinase, 483 U/L. The initial Widal test and the cold agglutinin test were negative, and the Weil-Felix test was negative on the 15th day after the onset of the disease. A thoracic computed tomography scan revealed chronic bronchitis in both lungs and mild pericardial effusion. Cranial magnetic resonance imaging revealed a T1-weighted hyperintense lesion in the pia mater. Lumbar puncture was performed with a cerebrospinal fluid (CSF) pressure of 160 mm H2O, chlorine, and glucose, and the total protein concentration levels were normal. The total nuclear cell count was 56/uL; 19.7% for the single karyotype and 80.3% for the polykaryotype. To lead to a diagnosis, next-generation sequencing (NGS) was performed. The number of sequence reads identified corresponding to O. tsutsugamushi was 239 (Figure 2A), with a genomic coverage of 0.9178% (Figure 2B).
Secondary cerebellopontine angle oligodendroglioma after cranial irradiation: a case report and literature review
Published in International Journal of Neuroscience, 2023
Zhifei Guo, Dekun Li, Yongsheng Xie, Jin Qian, Bing Zhao
On CT scan, oligodendrogliomas primarily exhibit isodense or slightly low densities, uneven densities, calcified cystic necrosis, and intratumoral hemorrhage. Enhanced CT scans demonstrate mild, moderate, or obvious heterogeneous enhancement. There are various enhancement modes, such as spot, patchy, nodular, or annular enhancement. On MRI, there are isointense or hypointense signals on T1-weighted images and hyperintense signals on T2-weighted images without enhancement [12]. Our patient’s cranial MRI showed obvious homogeneous enhancement in the CPA. Oligodendrogliomas easily invade the pia mater and cause obvious connective tissue reactions. The characteristics of oligodendrogliomas are strip and mass calcification inside the lesion. The incidence rate is as high as 50%–80% [2,13]. In general, low-grade oligodendrogliomas (grade II) often have calcification, while anaplastic oligodendrogliomas (grade III) do not calcify [14]. In our case, although it was a low-grade oligodendroglioma, there was no typical calcification on CT scan (Figure 1A), and the enhancement of the tumor was obvious on MRI. The CPA oligodendroglioma described by Ellenbogen had calcification [8], and the other two cases were not described in detail. Therefore, CPA oligodendrogliomas may not have calcification, which makes them easy to confuse with meningiomas in the CPA. Our patient was misdiagnosed with meningioma before the operation.
Cerebrospinal fluid leaks secondary to dural tears: a review of etiology, clinical evaluation, and management
Published in International Journal of Neuroscience, 2021
Jason Gandhi, Andrew DiMatteo, Gunjan Joshi, Noel L. Smith, Sardar Ali Khan
The meninges are composed of three membrane structures that encapsulate the brain and spinal cord. The three membranes of the meninges from most superficial to deep are respectively the: dura, arachnoid, and pia mater. The dura mater is also referred to as the pachymeninx or “thick meninx”, while the pia and arachnoid mater collectively are referred to as the leptomeninx or “thin meninx” [5]. The dura itself is composed of three layers: the most superficial layer called the endosteal (i.e. periosteal), the meningeal layer, and the deepest layer called the dural border cell layer [6,7]. The dural border cell layer interacts with the arachnoid barrier cell layer and basement membrane of the arachnoid mater. It is in the arachnoid reticular layer and subarachnoid space that the CSF is contained. The depth of the subarachnoid space is variable depending on the relationship between the arachnoid and pia mater [7].