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Brain swelling, raised intracranial pressure and hypoxia-related brain injury
Published in Helen Whitwell, Christopher Milroy, Daniel du Plessis, Forensic Neuropathology, 2021
A supratentorial mass may produce herniation of the ipsilateral uncus of the temporal lobe as well as the medial part of the parahippocampal gyrus (Figure 12.3). This is displaced through the tentorial opening. It is also known as lateral transtentorial herniation. Compression of the contralateral cerebral peduncle against the free edge of the tentorium may result in pressure-related secondary injury with or without haemorrhage in the dorsal part of the peduncle and adjacent tegmentum, a lesion referred to as Kernohan's notch. Ipsilateral cerebral peduncular compression may lead to contralateral limb weakness as a more common associated feature of severe asymmetric tentorial herniation. The oculomotor nerve may show kinking around the ipsilateral posterior cerebral artery and pressure related bleeding. Necrosis may occur along the parahippocampal gyrus. Compression of the anterior choroidal arteries may cause infarction in the medial part of the globus pallidus, internal capsule and optic tract. A not uncommon complication is compression of the posterior cerebral artery leading to infarction in the posterior inferior temporal lobe including the hippocampus, together with the medial and inferior surfaces of the occipital cortex and even thalamus. This is characteristically haemorrhagic in nature (Figure 12.4). Cerebellar infarction may also occur due to compression of a superior cerebellar artery (SCA). These infarctions are most commonly ipsilateral to the side of the mass lesion but can be bilateral.
Cranial Neuropathies I, V, and VII–XII
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Trigeminal neuralgia (TN) is a painful condition caused by irritation of the trigeminal nerve. The most common cause is neurovascular compression by a redundant or tortuous arterial loop impinging on the trigeminal nerve root adjacent to its entry zone into the pons causing focal demyelination. The superior cerebellar artery is the most frequently implicated vessel. TN is characterized by severe, paroxysmal, sharp lancinating pain in the distribution of one or more divisions of the trigeminal nerve (typically affecting V2 > V3). The condition is known as tic douloureux because of the typical lightning-like jabs of pain that may result in wincing.
Central nervous system
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
The brain is supplied with blood from two sources. The bilateral internal carotid arteries arise from the bifurcation of the common carotid arteries in the neck and branch off to form the left and right anterior and middle cerebral arteries, which supply the forebrain. The vertebral arteries arise from the subclavian arteries and come together at the level of the pons to form the midline basilar artery. The posterior cerebral, basilar and vertebral arteries supply the posterior circulation of the brain, comprising posterior cortex, the midbrain and the brainstem. Cerebellum is also supplied by dorsolateral arteries such as the posterior inferior cerebellar artery (PICA) and the anterior inferior cerebellar artery (AICA) and superior cerebellar artery. An arterial ring called the circle of Willis connects the anterior and posterior cerebral circulation; thus, in the event of loss of blood supply to one area of the brain, it may be possible for blood to be supplied via a different arterial route.
Neuro-Behcet Disease and Ocular Inflammation: A Case Report and Literature Review
Published in Ocular Immunology and Inflammation, 2022
Shaivi A. Patel, Chinwenwa Okeagu, Krystyna Jones, Ammar Chaudhry, Meghan K. Berkenstock
Once imaging confirms the presence of a CVST, previous studies agree that patients benefit from anticoagulation and the addition of immunosuppressive agents to prevent recurrent thromboses.41,43 In addition to the CNS, these patients are at increased risk for systemic thromboses and require vascular screening.37,38 Interestingly, studies differ on whether corticosteroids or immunosuppressant use alone provided better outcomes in these patients.38,43 The role serial MRV or CT for evaluation and/or resolution of thrombus is not well studied and follow-up MR/CT studies recommended based on the development of new neurological symptoms or physical exam findings.41 Vascular screening can also to identify supratentorial intracerebral aneurysms prior to the use of anticoagulation, as rupture of a superior cerebellar artery aneurysm has been described.44
Diagnostic value of eye movement and vestibular function tests in patients with posterior circulation infarction
Published in Acta Oto-Laryngologica, 2019
Xia Ling, Wenwen Sang, Bo Shen, Kangzhi Li, Lihong Si, Xu Yang
In patients with central isolated dizziness/vertigo of vascular etiology, infarction mostly involved the PICA and AICA regions. As the superior cerebellar artery (SCA) region does not provide blood supply for the vestibular structure, infarction in this region is rare. The PICA divides into the medullary branch, choroidal branch, medial branch, and lateral branch. The medullary branch supplies the dorsolateral medulla and the choroidal branch mainly supplies the choroid plexus of the fourth ventricle. The medial branch mainly supplies the inferior vermis/cerebellum (tuber, uvula, and pyramid of vermis) while the lateral branch supplies the inferior surface of the cerebellum (medial surface of the cerebellar tonsils, posterior part of the inferolateral surface, lobulus semilunaris inferior, lobulus biventer, lobulus gracilis, and dentate nucleus). AICA mainly supplies three areas: labyrinth and auditory nerves, inferolateral portion of the pons, anteroinferior surface of the cerebellum, and caudal cerebellum (including the vestibulo-cerebellum). Because both PICA and AICA regions are involved in the conduction of vestibular impulses, infarctions in the PICA and AICA blood-supply regions often cause dizziness/vertigo, unsteady gait, and nystagmus.
The meningeal branch of the superior cerebellar artery
Published in British Journal of Neurosurgery, 2018
Paul R. Krafft, Shih S. Liu, Pankaj K. Agarwalla, Harry R. Van Loveren
This method was applied in ten cases. Upon removal, a Barium-Gelatin suspension was injected into the arteries, which remained covered by dura mater. In nine cases we noticed a thin artery, which consistently originated from the left pars circulars of the posterior cerebral artery coursing around the brain stem before terminating in midline on the inferior surface of the tentorium (Figures 1 and 2). This artery has a diameter between 0.2 to 0.5 mm and is consistent in its origin, course, vascular territory, which comprises the median 3 to 4 cm on the inferior surface of the tentorium, across from the connection of the Falx cerebri and the tentorium. In only one case we observed a connection to the superior cerebellar artery. Such an artery has not been described in the existing literature. In order to achieve simplification, specification and distinction we named this artery: ‘the Artery of DAVIDOFF and SCHECHTER’1.