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The reported prevalence of cavum septum pellucidum (CSP) and cavum Vergae (CV) in brain computed tomography (CT) is 5.5% in Great Britain and 1.24% in China but unknown in Taiwan. Moreover, CSP and/or CV has generally been thought to decrease as age progresses, but the evidence of actual prevalence at different age levels is still limited in the literature.A total of 19,031 patients with brain CT at a regional hospital in northern Taiwan from July 2008 to August 2010 were included in this study. Their radiological official reports were retrospectively reviewed to check for CSP and/or CV. An X2 test was used for statistical analysis (α = .05).The prevalence of CSP and/or CV in all brain CT was 0.93% (n = 177), which was lower. than that in the Chinese and British studies. Among them, 2.8% (n = 5) had only CSP, 1.7% (n = 3) had only CV, and 95.5% (n = 169) had coexistent CSP and CV. There is a significant difference in prevalence between the age groups (p = .009), and the prevalence is the highest in the group aged 20-29 years (1.56%) and lowest in the group aged above 80. After age 20-29, the prevalence tends to decrease with increasing age.This is not only the first study of CSP and CV in the Taiwanese population but the study population is also larger than those in the literature. The prevalence was found to approximately decrease as age progresses, but would reach the peak in the young adult group rather than the children or adolescent group.

To investigate whether patients with vestibular migraine (VM) are more susceptible to carsickness than patients with non-vestibular migraine (NVM) or Meniere's disease (MD).Consecutive patients with a diagnosis of definite VM, probable VM, NVM, or MD at our Headache and Dizziness clinics were interviewed using the same three questions to investigate the history of carsickness. The patients who had experienced carsickness in their lifetime and those who had still experienced carsickness in the past ten years were identified. The rates of carsickness were compared between groups.78.4% of the VM patients had experienced carsickness in their lifetime, which was significantly higher than the patients with NVM (43.6%) and MD (18.2%). Both the lifetime rate of carsickness and the rate in the past ten years were highest in the patients with definite VM, followed by probable VM, NVM, and MD (p less than 0.05, chi-square test). The odds ratio of lifetime carsickness for VM versus MD was high (8.7).Both patients with definite VM and probable VM were more susceptible to carsickness than the patients with NVM or MD. This reinforces the theory of vestibular hypersensitivity in VM. We suggest that a past history of carsickness may help in the diagnosis of VM, and especially in distinguishing VM from MD.

Vestibular paroxysmia is defined as paroxysmal, brief, and carbamazepine-responsive vertigo. Although neurovascular cross-compression (NVCC) of the vestibulocochlear nerve is believed to be the cause of vestibular paroxysmia, the mechanism remains controversial. Herein, we describe the case of a man with NVCC who presented with paroxysmal vertigo associated with paroxysmal pulsatile tinnitus.A 68-year-old man presented with paroxysmal vertigo for one month. Paroxysmal pulsatile tinnitus in the right ear occurred simultaneously with the vertigo. Magnetic resonance imaging demonstrated that the right anterior inferior cerebellar artery was compressing the right vestibulocochlear nerve. The vertigo and tinnitus completely disappeared within one week after treatment with carbamazepine.The pulsatile nature of the patient's tinnitus implied that the auditory nerve was being compressed by a pulsating artery and was found to consolidate the causal relationship between NVCC and vestibular paroxysmia.

We describe a patient who presented with unilateral paresthesia after acute isolated infarct of the splenium.A 74-year-old woman presented with acute onset of right sided numbness and tingling. MR imaging of the brain showed hypointensity on T1-weighted images and on apparent diffusion coefficient maps, and hyperintensity on T2-weighted and on diffusion-weighted images in the splenium, suggestive of acute infarction. MR angiography showed narrowing of left posterior cerebral artery with decreased branches. On detailed high cortical function assessment, she did not have frontal lobe dysfunction, alien hand syndrome, apraxia, optic ataxia, cortical sensation dysfunction, alexia, agraphia, visual field defect, nor color agnosia.Infarcts of the splenium are not common. Splenial lesion may be associated with altered mental status, ataxia, recent seizure, hemispheric disconnection, and dysarthria. The presentation of isolated unilateral paresthesia makes the patient different from those previously described. The paresthesia could be caused by selective lacunar infarcts in the diencephalic and mesencephalic regions or could be caused by the diaschisis in the parietal cortex. Single photon emission CT may be indicated to provide further information of central nervous system dysfunction in splenial lesion.

Hypertensive encephalopathy (HE) is one of the acknowledged hypertensive emergencies. Isolated hypertensive brainstem encephalopathy (HBE) without concomitant typical parietooccipital lesion is unusual. Patients with HBE may or may not present with symptoms attributable to brainstem and the diagnosis is challenging in an emergency setting. The most important differential diagnosis in HBE is brainstem infarction, because the goals of blood pressure treatment are different. Evidence of vasogenic edema on magnetic resonance image, i.e. absence of high signal lesions on diffusion weighted images and increased value of apparent diffusion coefficient are diagnostic indicators of HBE, but not brainstem infarction. Prompt recognition of HBE and adequately lowering blood pressure offer the best outcomes.