Hemorrhagic Onset of Hemangioblastoma Located in the Dorsal Medulla Oblongata Presenting with Tako-Tsubo Cardiomyopathy and Neurogenic Pulmonary Edema: A Case Report

Gekka, Masayuki; Yamaguchi, Shigeru; Kazumata, Ken; Kobayashi, Hiroyuki; Motegi, Hiroaki; Terasaka, Shunsuke; Houkin, Kiyohiro

doi:10.1159/000361041

Cited by 16 publications

(11 citation statements)

References 7 publications

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“…Their imaging findings are similar to those in other locations but have higher risks of hemorrhage and neurological deficits . Rarer causes of medullary hemorrhages are tumoral (eg, hemangioblastoma) and hypertensive bleeding that are not found in our study …”

Section: Discussionsupporting

confidence: 75%

MRI Patterns of Isolated Lesions in the Medulla Oblongata

Prakkamakul

Schaefer

González

et al. 2016

Journal of Neuroimaging

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Section: Discussionsupporting

confidence: 75%

MRI Patterns of Isolated Lesions in the Medulla Oblongata

Prakkamakul

Schaefer

González

et al. 2016

Journal of Neuroimaging

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“…Neurogenic pulmonary edema is considered a rapidly developing, life‐threatening complication in patients with severe craniocerebral lesions . Two distinct clinical forms of NPE have been described: an early form that develops within minutes to hours following neurological injury and a delayed form that develops 12–24 hr after a CNS insult .…”

Section: Discussionmentioning

confidence: 99%

Melatonin attenuates neurogenic pulmonary edema via the regulation of inflammation and apoptosis after subarachnoid hemorrhage in rats

Chen

Qian

Duan

et al. 2015

Journal of Pineal Research

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Neurogenic pulmonary edema (NPE) is a serious non-neurological complication that can occur after a subarachnoid hemorrhage (SAH) and is associated with decreased survival and a poor neurological outcome. Melatonin is a strong antioxidant that has beneficial effects against SAH in rats, including reduced mortality and reduced neurological deficits. The molecular mechanisms underlying these clinical effects in the SAH model, however, have not been clearly identified. This study was undertaken to determine the influence of melatonin on SAH-induced NPE and the potential mechanism of these effects using the filament perforation model of SAH in male Sprague Dawley rats. Either melatonin (150 mg/kg) or a vehicle was given via an intraperitoneal injection 2 hr after an SAH induction. Lung samples were extracted 24 hr after SAH. The results show that the melatonin treatment attenuated SAH-induced NPE by preventing alveolar-capillary barrier dysfunctions via inhibiting the disruption of tight junction proteins (ZO-1 and occludin). Moreover, the treatment downregulated the levels of mature interleukin (IL) -1β, myeloperoxidase (MPO), and matrix metallopeptidase (MMP) 9 expression/activation, which were increased in the lung; also, melatonin treatment improved neurological deficits. Furthermore, the melatonin treatment markedly reduced caspase-3 activity and the number of TUNEL-positive cells in the lung. Taken together, these findings show that administration of melatonin attenuates NPE by preventing alveolar-capillary barrier dysfunctions via repressing the inflammatory response and by anti-apoptosis effects after SAH.

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“…[ 9 ] To this date, 56 cases of acute hemorrhage have been described with an underlying HGB. [ 1 2 3 5 6 7 10 11 15 16 17 18 20 22 23 24 25 31 33 34 35 37 41 ] A total of 19 cases have been described in the posterior fossa. Large hemorrhages related to HGBs have been described more commonly in spinal locations.…”

Section: Discussionmentioning

confidence: 99%

Recurrent hemorrhage in hemangioblastoma involving the posterior fossa: Case report

Marvin¹,

Akhter²,

Coppens³

2017

Surg Neurol Int

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Background:Hemangioblastomas (HGBs) are the most common primary intra-axial posterior fossa tumor in adults. Although spontaneous hemorrhage of these tumors is exceedingly rare, despite their vascular nature, we describe a case of recurrent hemorrhage with associated tonsillar herniation, and demonstrate that a surgical approach can provide a suitable outcome.Case Description:A 54-year-old female with von Hippel-Lindau (VHL) syndrome presented with acute loss of consciousness and Glasgow Coma Scale (GCS) was 4. Computed tomographic (CT) images demonstrated large volume subarachnoid hemorrhage of the posterior fossa with intraventricular extension and intraparenchymal hemorrhage involving the right cerebellar tonsil. Magnetic resonance imaging (MRI) displayed three lesions in the posterior fossa, two near the hemorrhage site. Patient underwent suboccipital craniectomy with a decent recovery followed by radiosurgery as she refused resection. A second hemorrhage occurred ultimately prompting surgical resection of the three posterior fossa lesions, with a reasonable postoperative course.Conclusion:Hemorrhage of HGBs of the posterior fossa can present in conjunction of tonsillar herniation. Re-hemorrhage appears to be likely if prior acute hemorrhage has occurred. A stepwise approach of surgical decompression and resection may provide the best outcome.

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Hemorrhagic Onset of Hemangioblastoma Located in the Dorsal Medulla Oblongata Presenting with Tako-Tsubo Cardiomyopathy and Neurogenic Pulmonary Edema: A Case Report

Cited by 16 publications

References 7 publications

MRI Patterns of Isolated Lesions in the Medulla Oblongata

MRI Patterns of Isolated Lesions in the Medulla Oblongata

Melatonin attenuates neurogenic pulmonary edema via the regulation of inflammation and apoptosis after subarachnoid hemorrhage in rats

Recurrent hemorrhage in hemangioblastoma involving the posterior fossa: Case report

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