DWI-SSFSE with ADC values provides objective information in the differential diagnosis of Rathke's cleft cysts from other sellar cystic lesions. In addition, DWI-SSFSE with ADC values is useful for differentiating Rathke's cleft cysts from craniopharyngiomas and haemorrhagic pituitary adenomas.

Cerebrospinal fluid (CSF) shunts are frequently used to treat hydrocephalus. The use of a programmable shunt valve allows physicians to easily change the opening pressure. Since patients with adjustable CSF shunt valves may use portable game machines, the permanent magnets in these machines may alter the shunt valve programmed settings or permanently damage the device. This study investigated the risk of unintentional valve adjustment associated with the use of game machines in patients with programmable CSF shunt valves. Four adjustable valves from 4 different manufacturers, Sophysa Polaris model SPV (Polaris valve), Miethke proGAV (proGAV), Codman Hakim programmable valve (CHPV), and Strata II small valve (Strata valve), were evaluated. Magnetic field interactions were determined using the portable game machine, Nintendo DS Lite (DS). The maximum distance between the valve and the DS that affected the valve pressure setting was measured by x-ray cinematography. The Polaris valve and proGAV were immune to unintentional reprogramming by the DS. However, the settings of the CHPV and Strata valves were randomly altered by the DS. Patients with an implanted shunt valve should be made aware of the risks posed by the magnetic fields associated with portable game machines and commonly used home electronics.

BackgroundIn Lemierre’s syndrome, patients first exhibit pharyngitis and peritonsillar abscessation, followed by the development of anaerobic bacterial (usually Fusobacterium necrophorum) septicemia and metastatic infections throughout the body. However, these infections rarely affect the liver. We describe a case of Lemierre’s syndrome, in which the first disease manifestation was liver abscess, for drawing attention of emergency physicians to this rare but fatal disease.Case presentationA 28-year-old Asian ethnicity Filipino male, who was previously healthy, entered the emergency department presenting with fever and pharyngeal pain that had persisted for 5 days. Contrast-enhanced abdominal computed tomography revealed a 3-cm area of low density in segment 6 of the liver, consistent with an abscess. Chest computed tomography also revealed that multiple nodes in both lungs were enlarged, and septic emboli were suspected. The patient was hospitalized and antibiotic treatment was initiated. On hospital day 6, blood culture results confirmed Fusobacterium necrophorum septicemia. The patient was diagnosed with Lemierre’s syndrome, as pharyngitis developed into bacteremia associated with hepatic and pulmonary lesions. The patient’s condition improved with antibiotics and he was discharged following three weeks of treatment in the hospital.ConclusionWith the widespread use of antibiotics, Lemierre’s syndrome is rarely encountered anymore, but it can be fatal if not properly diagnosed. It is a crucial differential diagnosis in young patients exhibiting septicemia or multiple metastatic infection of unknown origin.

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Objective:The objectives of treating dural arteriovenous fistula (dAVF) are to achieve complete occlusion of the arteriovenous (AV) shunt and restoration of anterograde venous flow. We report a patient with complex dAVF who was managed by double overinflated balloon protection of the torcula and percutaneous transluminal angioplasty (PTA) for the occluded venous sinus. Case Presentation:A 62-year-old woman was admitted with gradually worsening nausea and vomiting, as well as progressive memory disturbance and left hemiparesis. Head MRI/MRA demonstrated a dAVF involving the region from the right sigmoid sinus (SS) to transverse sinus (TS) along with occlusion of the left TS and right proximal SS. There was associated dilatation of the right TS, torcula, and superior sagittal sinus (SSS). The intracranial venous circulation was impaired, with venous reflux draining into the deep cerebral veins as well as the cortical veins. Transarterial embolization (TAE) and transvenous embolization (TVE) were performed with double overinflated balloon protection of the torcula, and shunt flow was completely abolished. The occluded sinus was recanalized by PTA. Her symptoms gradually improved after treatment. Conclusion:In this patient, double overinflated balloon protection was effective for maintaining the torcula.