Large cystic target lesion: An unusual presentation of cavernoma - PDF document

See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/47661456 Large cystic target lesion: An unusual presentation of cavernoma Article in Neurology India · September 2010 DOI: 10.4103/0028-3886.72203 · Source: PubMed CITATIONS READS 0 26 5 authors , including: Chhitij Srivastava Sunil Singh King George's Medical University King George's Medical University 71 PUBLICATIONS 384 CITATIONS 54 PUBLICATIONS 349 CITATIONS SEE PROFILE SEE PROFILE Bal Krishna Ojha Anil Chandra King George's Medical University King George's Medical University 112 PUBLICATIONS 747 CITATIONS 75 PUBLICATIONS 320 CITATIONS SEE PROFILE SEE PROFILE All content following this page was uploaded by Bal Krishna Ojha on 24 May 2016. The user has requested enhancement of the downloaded file.

[Downloaded free from http://www.neurologyindia.com on Tuesday, May 28, 2013, IP: 122.163.246.255] || Click here to download free Android application for this journal Letters to Editor In our experience, ONSD measurement correlated well Sir, with CT evidence of raised ICP, clinical deterioration Imaging characteristics of a large cavernoma are variable; and response to therapeutic intervention. Our case they may be purely cystic or contrast-enhancing mass series illustrates a very important potential role for lesions. [1-3] This report presents a cavernoma with a large cystic target lesion with central core enhancement. a promising new diagnostic technique. Invasive ICP measurement is the gold standard for identifjcation of A 30-year-old lady presented with recurrent seizure, high ICP as well as monitoring following treatment headache and left hemiparesis. Contrast computerized and can be performed effectively even in resource- tomography (CCT) brain showed a well-defjned lesion constrained environments. [4] We believe that ICUs in resembling the target of shooting rifle with central developing nations that routinely care for patients with enhancing core and a well-demarcated surrounding severe brain injury must attempt to perform invasive hypodense halo along with perilesional edema ICP monitoring as the standard of care for patients [Figure 1]. On magnetic resonance imaging (MRI), the suspected to have raised ICP. Realistically, however, central core demonstrated mixed intensity on both T1- this is unlikely to happen in the near future. ONSD and T2-weighted images; the surrounding halo was measurement is inexpensive, appears to have relatively isointense on T1W and hyperintense on T2W images low inter-observer variability and is a relatively simple with blooming on Gradient Echo sequences. Contrast technique to teach to junior physicians. [3,5] Optic nerve study showed irregular enhancement of central core, ultrasonography is a promising tool for the detection while the peripheral rim of halo was perfectly spherical of intracranial hypertension in resource-constrained and brilliantly enhancing [Figure 2]. Cerebral angiogram environments. revealed no abnormality. At surgery, xanthochromic fmuid was aspirated from Venkatakrishna Rajajee, Prithiviraj Thyagarajan, the cystic lesion. Wall of the cyst was easily separable Ram E. Rajagopalan from the surrounding gliotic brain, and total excision Department of Critical Care Medicine, of the lesion was done. Cut section of the specimen Sundaram Medical Foundation, Shanthi Colony, 4 th Avenue, showed central area of soft, fragile reddish brown mass. Annanagar, Chennai 600040, India. E-mail: vrajajee@yahoo.com Histopathology confjrmed the diagnosis of cavernoma. At the 6-month postoperative follow-up, the patient is PMID: *** asymptomatic. DOI: 10.4103/0028-3886.72202 References 1. Geeraerts T, Launey Y, Martin L, Pottecher J, Vigué B, Duranteau J, et al . Ultrasonography of the optic nerve sheath may be useful for detecting raised intracranial pressure after severe brain injury. Intensive Care Med 2007;33:1704-11. 2. Kimberly HH, Shah S, Marill K, Noble V . Correlation of optic nerve sheath diameter with direct measurement of intracranial pressure. Acad Emerg Med 2008;15:201-4. 3. Moretti R, Pizzi B, Cassini F , Vivaldi N. Reliability of optic nerve ultrasound for the evaluation of patients with spontaneous intracranial hemorrhage. Neurocrit Care. 2009. 4. Joseph M. Intracranial pressure monitoring in a resource constrained environment: a technical note. Neurol India 2003;51:1538-43. 5. Le A, Hoehn ME, Smith ME, Spentzas T, Schlappy D, Pershad J. Bedside sonographic measurement of optic nerve sheath diameter as a predictor of increased intracranial pressure in children. Ann Emerg Med 2009;53:785-91. Accepted on: 27-07-2010 Large cystic target lesion: An unusual presentation of Figure 1: Contrast CT scan showing a target-shaped lesion having cavernoma a central enhancing core with a well-demarcated surrounding hypodense halo and marked edema Neurology India | Sep-Oct 2010 | Vol 58 | Issue 5 813

[Downloaded free from http://www.neurologyindia.com on Tuesday, May 28, 2013, IP: 122.163.246.255] || Click here to download free Android application for this journal Letters to Editor An unusual cause of entrapment of temporal horn: Neurocysticercosis Sir, Entrapment of temporal horn is a rare entity caused by obstruction at the trigone of the lateral ventricle, which seals off the temporal horn from the rest of the ventricular system. [1] Intraventricular cysticercosis accounts for 7% to 30% of NCC [2] and it causing an entrapped temporal horn has not been reported till date. We are reporting two interesting cases of entrapped temporal horn syndrome caused by giant intraventricular cysticercosis. Case 1: A 35-year-old woman presented with a 4-day history of headache and vomiting. Computerized tomography (CT) scan showed a large right temporal cystic lesion with a few intra-cystic and parenchymal Figure 2: On MRI, the central core of target lesion is micro calcifications. Contrast magnetic resonance irregularly enhancing, while the peripheral rim of halo is spherical and brilliantly enhancing imaging (MRI) showed multiple large cysts in the right temporal horn. Patient was taken up for surgery and the temporal horn was approached endoscopically. In brain lesions, central calcific nidus or central enhancement with surrounding enhancing ring has been Multiple cysts were removed and a stoma was made considered as target sign. This sign was fjrst described to connect with the ipsilateral atrium; but later, in intracerebral tuberculoma and was considered to be shunt surgery was required. There were no further pathognomic of this lesion. [4] Target sign has also been complications during 1-year of follow-up. reported in a case of metastatic adenocarcinoma. [5] Case 2: A 35-year-old woman presented with two months history of headache and left-sided focal Chhitij Srivastava, Sunil K. Singh, seizures. On examination, the Glasgow coma scale Bal Krishna Ojha, Anil Chandra, score was E3V3M5. Contrast CT scan brain showed a Swati Srivastava 1 non-enhancing right temporal cystic mass. Contrast MRI showed a huge 6-cm T1 hypointense and T2 Department of Neurosurgery, CSM Medical University, hyperintense lesion. The patient was taken up for Formerly King George’s Medical College, Lucknow - 226 003, 1 Department of Pathology, Vivekanand Polyclinic Institute of emergency surgery. The cyst was aspirated, yielding Medical Science, Lucknow - 226 007, U.P., India a lightly viscous straw-colored fmuid. The lesion was E-mail: drchhitij@yahoo.co.in approached through a trans-sulcal route until a well- PMID: *** defjned whitish translucent cyst wall was encountered. DOI: 10.4103/0028-3886.72203 The fluid earlier aspirated was actually from the entrapped horn as the cyst itself contained only clear References fmuid. The cyst was removed in toto without rupture and was found to contain multiple similar small cysts 1. Curling OD, Kelly DL, Elster AD, Craven TE. An analysis of the inside it measuring about 5 cm in diameter. natural history of cavernous angiomas. J Neurosurg 1991;75:702-8. 2. Chicani CF , Miller NR, Tamargo RJ. Giant cavernous malformation of Microscopically the typical cysticercus cyst wall was the occipital lobe. J Neuroophthalmol 2003;23:151-3. 3. Thiex R, Kruger R, Friese S, Gronewaller E, Kuker W. Giant cavernoma seen in both the cases. The lesion showed areas of of the brain stem: Value of delayed MR imaging after contrast injection. degeneration, including the scolex. The large cysts Eur Radiol 2003;13: L219-25. also contained multiple daughter cysts [Figure 1]. 4. Van Dyk A. CT of intracranial tuberculomas with specific reference to On follow-up CT scans, the size of the temporal horn the “target sign”. Neuroradiology 1988;30:329-36. 5. Kong A, Koukourou A, Boyd M, Crowe G. Metastatic adenocarcinoma had signifjcantly reduced in both patients [Figure 2] mimicking ‘target sign’ of cerebral tuberculosis. J Clin Neurosci Entrapment of the temporal horn is the term first 2006;13:955-8. used by Maurice-Williams et al. to describe a form of focal hydrocephalus. Temporal horn contains choroid Accepted on: 06-08-2010 Neurology India | Sep-Oct 2010 | Vol 58 | Issue 5 814 View publication stats View publication stats