No abstract

A 66-year-old woman presented with subarachnoid hemorrhage(SAH) caused by a ruptured aneurysm of the left middle cerebral artery. Electrocardiography (ECG) disclosed abnormalities resembling acute myocardial infarction. She underwent neck clipping of the aneurysm uneventfully. Sixteen days after admission, ECG again disclosed abnormalities resembling acute myocardial infarction, and echocardiography suggested heart failure. Coronary angiography showed no abnormalities, but left ventriculography showed severe hypokinesia in the apex of the heart consistent with so-called ampulla (takotsubo) cardiomyopathy. The heart failure was treated with catecholamines and her heart function gradually recovered. Ampulla (takotsubo) cardiomyopathy associated with SAH requires careful management of heart function.

No abstract

A 26-year-old man presented with an unusual multilobulated cystic formation in the brain stem with normal pressure hydrocephalus, followed by fluctuating cyst volume and Benedikt's syndrome. Ventriculoperitoneal shunting to relieve the hydrocephalus caused an increased cystic size, resulting in worsened neurological deficits. Cystectomy and an additional shunt resolved the symptoms. Immunohistochemical and electron microscopic examinations of the surgical specimen revealed no epithelial lining but numerous astrocytic processes on the luminal surface, probably resulting from expansion of the cyst. This case suggests that cystectomy before shunt emplacement is recommended in similar cases.

A 75-year-old woman presented with intracranial B-cell lymphoma associated with Behcet's disease manifesting as headache and dizziness. She had been treated with prednisolone for 17 years, and colchicine for 4 years under a diagnosis of incomplete Behcet's disease. Computed tomography revealed a 4-cm high density mass surrounded with diffuse edema in the right frontal lobe. Surgery removed a discolored red mass together with hematoma. The histological diagnosis was B-cell type malignant lymphoma. Malignant lymphoma is rarely associated with Behcet's disease, as only 10 cases have been reported.