PHACE syndrome (OMIM 606519) is a rare neurocutaneous vascular disorder, characterized by posterior fossa malformations, large cervicofacial infantile hemangiomas, arterial anomalies, aortic coarctation, cardiac abnormalities, and eye abnormalities. The long-term outcome of PHACE syndrome patients is unclear; however, it seems that they are at risk for childhood stroke. The radiologist has an important role on diagnosis of PHACE syndrome and in the assessment of potential complications. Investigation of infants with segmental craniofacial hemangiomas should include cranial magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) of the cerebral and cervical arteries. Brain MRI and MRA findings of a 5-year-old female patient with PHACE syndrome are presented.
Introduction: Subdural hematoma without subarachnoid hemorrhage secondary to intracranial aneurysm rupture is rare and may complicate patient management due to delay in diagnosis and subsequent treatment. Herein, we describe a case presenting with pure SDH secondary to the rupture of a posterior communicating artery infundibular dilatation (PcoA-ID). To the best of our knowledge, this is the first case of rupture of a PcoA-ID with SDH in the convexity and tentorium, which also tracked into the upper cervical spine along the subdural space. Additionally, we briefly discuss the previously published cases of pure SDH secondary to intracranial aneurysm rupture. Case Report: A 44-year-old female presented with headache, dizziness, nausea and left-sided diplopia to an outside institution. Initial diagnostic work-up showed no intracranial hemorrhage, however, magnetic resonance angiography and subsequent digital subtraction angiography revealed left posterior communicating artery infundibular dilatation. Two days later, the patient presented with a loss of consciousness. Computed tomography was positive for bilateral hemispheric subdural hematoma with no evidence of subarachnoid hemorrhage. Digital subtraction angiography showed left posterior communicating artery infundibular dilatation and pseudoaneurysm originating from the inferior area of the infundibular dilatation, concerning recent rupture. Balloon assisted coil embolization was performed and the patient had a good outcome without any neurological deficit. Conclusion: Subdural hematoma in a young adult without a history of trauma or coagulopathy warrants additional vascular imaging to search for underlying vascular lesions. It should also be kept in mind that infundibular dilatation may rupture and cause a pure subdural hematoma.
Purpose: The aim of this study is to determine and define differential magnetic resonance imaging (MRI) findings of pituitary adenomas and craniopharyngiomas. Materials and methods: This retrospective analysis was performed on MR imaging findings of 45 pituitary adenomas and 41 craniopharyngiomas with solid and cystic mixed appearance. MRI findings including shape ovoid, snowman, lobulation, chiasma compression, cavernous sinus invasion, 3rd ventricle compression, calcification, predominant type – cystic vs solid, contrast enhancement patterns – homogenous, reticular and extension were assessed. Results: Among MRI findings superiorly lobulated shape, third ventricle compression and reticular enhancement of solid parts were common in craniopharyngiomas while snowman shape, predominantly solid content, homogenous enhancement of solid parts were compatible with adenomas significantly at p <0.05 for all. Conclusion: Tumor shape and contrast enhancement patterns of solid parts seem discriminative MRI features for pituitary adenoma and craniopharyngiomas.
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