Complex Indirect Carotid-Cavernous Fistula With Contralateral Ophthalmic Manifestations.

A carotid-cavernous fistula (CCF) involves an abnormal communication between the carotid artery and the cavernous sinus. For indirect CCF, it usually occurs in post-menopausal women. Contralateral symptoms for indirect CCF are rare.

Navigating Diagnostic Complexities and Treatment Strategies of Moyamoya Syndrome: A Case Report.

Moyamoya syndrome (MMS) is characterized by progressive narrowing of intracranial arteries and the development of collateral vessel networks, often presenting with recurrent ischemic or hemorrhagic strokes. MMS poses significant challenges in diagnosis due to its overlapping symptoms with other cerebrovascular conditions. Treatment aims to improve cerebral blood flow, reduce symptom frequency, and prevent future strokes.

Herpes Zoster Optic Neuritis: A Catastrophe of a Disease.

Isolated herpes zoster optic neuritis is a rare sequelae of herpes zoster ophthalmicus (HZO). It can occur in the acute phase of HZO, or as post-herpetic complications. We report a case of a young patient with poorly controlled diabetes who developed herpes zoster optic neuritis one month after the initial skin manifestation despite completing a two-week course of oral acyclovir 800 mg five times a day.

The Spectrum of Vessel Wall Imaging (VWI) Findings in COVID-19-Associated Neurological Syndromes: A Review.

Since the start of the pandemic, there have been extensive studies from all over the world reporting on coronavirus disease 2019 (COVID-19)-associated neurological syndromes. Although initially thought of as primarily a respiratory pathogen, it became increasingly clear that the virus does have other systemic manifestations, including on the neurological system. Since then, the discovery of the many neuroimaging features of COVID-19-associated neurological syndromes have puzzled researchers and physicians in terms of interpretation, and how best to manage these findings to benefit patients.

Establishing a hyperacute stroke service during the COVID-19 pandemic: our institution's one year experience.

Background And Aims: The corononavirus 2019 (COVID-19) pandemic resulted in modifications in the workflow and redistribution of human resources, causing challenges in setting up of an acute stroke service. We would like to share our preliminary outcome amid this pandemic, to determine if the implementation of COVID-19 standard operating procedures (SOPs) affected the delivery of our hyperacute stroke service.

Methods: We retrospectively analyzed one-year data from our stroke registry that began with the establishment of our hyperacute stroke service at Universiti Putra Malaysia Teaching Hospital from April 2020 until May 2021.

The Utility of Vessel Wall Imaging in the Postulation of Acute Ischemic Stroke With Spontaneous Recanalization Pathophysiology.

Recent advances in technology, particularly in the field of magnetic resonance imaging, have brought forth new sequences, including vessel wall imaging (VWI). Traditionally, the workup for intracranial vascular pathology has always turned to luminal imaging using computed tomography angiography, magnetic resonance angiography, or digital subtraction angiography. Since its introduction, VWI has enabled researchers and practicing clinicians to better understand disease processes and manage patients to the best standard of care possible.

The prominent hypointense vessel sign on susceptibility-weighted imaging (SWI) as a potential imaging biomarker for poor clinical outcome in acute ischemic stroke (AIS).

Susceptibility-weighted imaging (SWI) is a relatively new magnetic resonance imaging (MRI) technique used in the workup and diagnosis of brain pathologies. In the context of acute ischemic stroke (AIS), it is increasingly becoming useful in the diagnosis, treatment, and further management of these patients. An elderly man with metabolic syndrome presented to us with an acute onset of right sided body weakness and aphasia.

Vessel wall imaging in COVID-19 associated carotid atherothrombosis and stroke: a case report and literature review.

COVID-19 associated neurological syndromes, including acute ischemic stroke, pose a challenge to treating physicians. The role of MRI in aiding diagnosis and further management is indispensable. The advent of new MRI sequences such as vessel wall imaging (VWI) allows an avenue in which these patients could be better investigated and treated.

The middle cerebral artery (MCA) dot sign.

The middle cerebral artery (MCA) dot sign is an important radiological sign in patients presenting with acute ischemic stroke (AIS). If identified and intervened early, a good clinical outcome may be achieved.

Accidental Puncture of a Dialysis Catheter into the Brachiocephalic Trunk.

A 22-year-old male with underlying end-stage renal failure was referred to our center for a malpositioned dialysis catheter. Imaging showed the tip of the catheter to be placed in the brachiocephalic trunk; the patient was, however, asymptomatic. Surgical removal of the malpositioned catheter followed, with no postoperative complications.

Myelin oligodendrocyte glycoprotein-antibody (MOG-IgG) associated disease with centrally located long spinal cord lesion in a 14-month old child.

Myelin oligodendrocyte glycoprotein-antibodies (MOG-IgG) are associated with acquired inflammatory demyelinating syndromes, seen predominantly in children and young adults. The overlapping clinical and radiological features of the heterogenous spectrum of demyelinating central nervous system (CNS) diseases makes the detection of MOG-IgG antibodies important for prognosis and treatment decisions. Herein, we describe the occurrence of MOG-IgG associated disease presenting as acute disseminated encephalomyelitis (ADEM), with spinal MRI findings of centrally located long cord lesion in a 14-month old child.

Tuberculous Myelopathy Associated with Longitudinally Extensive Lesion: A Clinicoradiological Review of Reported Cases.

Acute transverse myelitis is an inflammatory disorder of the spinal cord in which there is no evidence of spinal cord compression. Longitudinally extensive transverse myelitis (LETM) is a specific subtype of acute transverse myelitis that usually affects three or more vertebral levels and produces marked neurological deficits. While the most-common cause of LETM is neuromyelitis optica or neuromyelitis optica spectrum disorder, there are rare cases of other causes mimicking this condition, including tuberculosis (TB).

A case of anti--methyl-d-aspartate receptor encephalitis.

Anti--methyl-d-aspartate receptor encephalitis is characterized by the clinical manifestation of neuropsychiatric symptoms, predominantly affecting young adults, and frequently associated with neoplasms. It is the second most common cause of autoimmune and paraneoplastic encephalitis. Early diagnosis is often missed, as patients are commonly diagnosed with psychiatric illnesses and are treated with antipsychotics - which rarely gives complete resolution of symptoms.

Delayed Presentation of Metastatic Renal Cell Carcinoma as an Arteriovenous Malformation Mimicking Vascular Tumour of the Forearm.

Introduction: The development of metastatic renal cell carcinoma (RCC) many years after a nephrectomy is not common but has been reported. A metastasis appearing as a hypervascular tumour, mimicking an arteriovenous malformation (AVM), is a highly unusual phenomenon, with a biopsy required for diagnostic confirmation. Surgery is an option for a solitary metastatic lesion amenable to complete excision, with proven survival benefits.

Development of pseudo-subarachnoid hemorrhage secondary to hypoxic-ischemic injury due to bleeding pulmonary arterio-venous malformation.

Background: The computed tomography (CT) finding of a pseudo-subarachnoid hemorrhage (SAH) may lead the treating physician into a diagnostic dilemma. We present a case of a pseudo-SAH in a patient with post-resuscitative encephalopathy, secondary to a newly diagnosed bleeding pulmonary arterio-venous malformation (AVM).

Case Presentation: A 19-year-old female presented acutely with massive hemoptysis.

A case of metastatic adenocarcinoma from an unknown primary involving the aortic bifurcation.

Aortic malignant neoplasms are rare; these may be primary or secondary (metastatic). Increasing use of cross-sectional imaging has allowed better detection and diagnosis of these conditions. We encountered a young woman presenting with acute abdomen who was found on cross-sectional imaging to have a malignant tumor involving the aortic bifurcation.

Dyke-Davidoff-Masson syndrome: a case report.

Background: Dyke-Davidoff-Masson syndrome is a rare condition of unknown frequency resulting from brain injury due to a multitude of causes; especially in early life. Characteristics include cerebral hemiatrophy/hypoplasia, contralateral hemiparesis, seizures, and compensatory osseous hypertrophy.

Case Presentation: We present a case of a 13-year-old girl who initially presented with headaches, followed by episodic complex-partial seizures; which was controlled via medication.

Supraclinoid direct carotid-cavernous sinus fistula.

Carotid-cavernous fistulas (CCFs) are vascular shunts between the carotid arterial system with direct drainage into the cerebral venous system, mainly to the cavernous sinus. Direct CCF is a well-recognised complication following head trauma. Classically in direct or traumatic CCF, vessel wall tear occurs at the cavernous segment of the internal carotid artery, between the fixed and free segment.

Successful febuxostat desensitization in a patient with febuxostat hypersensitivity: A Malaysian experience.

Over the years, allopurinol has been widely used as the preferred choice of urate lowering therapy in patients with gout. However, its role in patients with renal impairment is limited; and adverse reactions are well documented. Febuxostat, a newer oral non-purine xanthine oxidase inhibitor has been proven in several trials to be more effective and tolerable compared to allopurinol and may be used in patients with renal impairment.

Incremental Role of Fluorine 18-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in the Assessment of Computed Tomography-Inconspicuous Pancreatic Lesions.

Pancreatic malignancies encompass a heterogenous group of disorders, with poor prognosis at diagnosis. Traditionally, conventional computed tomography (CT) has been used for diagnosis, staging, and follow up. However, this technique lacks functional information; and is limited in diagnosis of occult pancreatic disease.