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Catheter angiography is performed to exclude aneurysm as the cause of subarachnoid hemorrhage (SAH). Certain categories of SAH however are for the most part nonaneurysmal and the risk of catheter angiography not justified. Primary convexity SAH may be nonaneurysmal and adequately investigated noninvasively. Determine if primary convexity SAH is nonaneurysmal in origin. Five new cases with primary convexity SAH and seven from the literature are reviewed for etiology, diagnostic studies, and outcome. Diagnostic investigations included catheter angiography in 6 patients, MR in 11 patients, computed tomography (CT) in 10 patients, magnetic resonance angiography/magnetic resonance venography in 7 patients, CT angiography in 1 patient, and outcome of the 12 patients was benign without subsequent hemorrhage. No case of primary convexity SAH was caused by aneurysm and outcome was benign in all patients, suggesting a noninvasive evaluation is adequate to investigate this condition.

To correlate prognosis of hypoxic-ischemic white-matter injury with magnetic resonance imaging (MRI). In a retrospective review at an urban medical center, three adult and three pediatric patients with predominant white-matter involvement caused by hypoxic-ischemic injury were evaluated over a 15-month period. Five patients with MRI-defined hypoxic-ischemic leukoencephalopathy had a favorable outcome, and one with associated diffusion-weighted abnormality of deep gray structures died. The prognosis of hypoxic-ischemic leukoencephalopathy is more favorable than previously reported, and diffusion-weighted imaging abnormality of deep gray structures was associated with a poor outcome.

Isolated acute sphenoid sinusitis is an uncommon sinus infection, frequently misdiagnosed and not usually considered in the differential diagnosis of acute severe headache, with the potential of serious neurologic complications.To describe two patients with acute sphenoid sinusitis who presented with acute onset of severe headache and consider the role of surgical management.Case report.Tertiary care hospital.Patient 1 developed right cavernous sinus thrombosis and permanent visual loss in one eye, requiring sphenoidotomy following failure of medical treatment. Patient 2 experienced failure of the medical treatment. However, sphenoidotomy abated all his symptoms without any neurologic sequelae.It is important to be aware of acute sphenoid sinusitis in the setting of new onset severe headache, when imaging studies are unrevealing for intracranial pathology. Considering the serious consequences of failed medical treatment vis-à-vis the safety and efficacy of sphenoidotomy we propose surgical intervention at the time of diagnosis.

Multiple simultaneous intracerebral hemorrhages are rare and varied in etiology. In the absence of known risk factors or obvious underlying disease, determining the cause may be problematic. We outline a diagnostic approach to multiple simultaneous intracerebral hemorrhages in the context of three case studies. We conclude that when there are no apparent risk factors, neuroimaging and identification of underlying diseases are central to determining the cause of multiple simultaneous intracerebral hemorrhage.