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A 63-year-old man presented with hypoglycemia-induced hemiparesis manifesting as diffusion-weighted magnetic resonance (MR) imaging changes in the splenium of the corpus callosum and internal capsule which disappeared after glucose administration. Clinicians should be aware that hypoglycemia can cause reversible splenium abnormalities on MR imaging, although the underlying mechanism still remains unclear, as this may be helpful in the differential diagnosis of hypoglycemia-induced hemiparesis and stroke.

A 52-year-old woman presented with a partially thrombosed giant aneurysm of the vertebral artery (VA) manifesting as a 3-month history of left hemiparesis. She developed subarachnoid hemorrhage during hospitalization and underwent emergency surgery for surgical proximal clipping and ventricular drainage with decompressive suboccipital craniectomy. She underwent additional surgery for endovascular coil embolization of the aneurysm and the affected distal VA on the 7th postoperative day. Although she suffered transient lower cranial nerve pareses and respiratory failure, her neurological condition improved gradually and she returned home with only slight ataxia and hoarseness 3 months after surgery. Magnetic resonance imaging obtained 28 months postoperatively revealed a remarkable decrease in the size of the aneurysm as well as reduction of the mass effect on the brainstem. Combined proximal clipping and internal trapping can solve the problems associated with treatment of giant aneurysms of VA by either direct surgery or endovascular surgery, and should be considered as a therapeutic option for giant aneurysms of the VA.

An 83-year-old male exhibited cognitive impairment and deteriorated in few days. MRI T2WI and FLAIR image showed high signal intensity and low signal intensity on T2 * WI in the thalami. Angiographical images showed small dural arteriovenous fistula at the falco-tentorial junction with straight sinus thrombosis. A part of the venous drainage refluxed and congested to the area of bilateral internal cerebral vein. Based on these findings, the venous congestion of thalami caused the patient to cognitive decline. The dural arteriovenous fistula was treated by transvenous embolization with coil via occluded straight sinus. The cognitive function of the patient made a remarkable recovery about 1 month after the embolization. We report a rare case of cognitive dysfunction with bithalamic lesion caused by falcotentorial dural arteriovenous fistula with thrombosed straight sinus.