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Cerebral cavernous venous malformations (also called cavernous hemangiomas or cavernomas) are the third most common cerebral vascular malformations having an incidence of 0.4-0.8% in the general population and being diagnosed more frequently incidentally during an imaging procedure. Usually solitary, but cavernomas can also be present as multiple lesions with autosomal dominant inheritance pattern. We present a rare case and the MRI imaging of a type I Zabramski cavernoma that bleeded, localized in the medulla oblongata of a 41-year-old man, admitted with paresthesia of the right upper limb, very mild right hemiparesis and impaired fine motor movements of the right hand and intractable persistant hiccups.

Introduction: Chorea, hyperglycemia, basal ganglia syndrome (CHBG) is a rare neurological complication of nonketotic hyperglycemia which occurs more often in elderly female patients with undiagnosed or poorly controlled diabetes mellitus. Case report: We present the case of a 82-year old female, diagnosed with type 2 diabetes mellitus, but untreated, admitted with non-ketotic hyperglycemia and hemiballistic movements in her left limbs, with acute onset, that changed to choreic movements and then disappeared. Brain magnetic resonance imaging (MRI) showed characteristic hyper intensity in the right (contralateral) putamen on the T1-weighted images. Other secondary causes for ballismus and chorea were excluded. Hemiballismus/hemichorea non-ketotic hyperglycemic basal ganglia (CHBG) syndrome was considered and blood glucose was lowered using insulin. As symptomatic treatment, Haloperidol was started but, due to adverse effects, it was stopped and Clonazepam was associated. The movement disorders disappeared in two weeks after glycemic control. Signifi cance: Movement disorders, like chorea and/or ballismus (hemichorea/hemiballismus) can be a marker of uncontrolled known diabetes mellitus or a presenting sign for an undiagnosed diabetes mellitus. The chorea hyperglycemia basal ganglia (CHBG) syndrome is rare and likely undiagnosed but, being aware of it’s existence is of high importance, as normalising blood sugar values severe neurological complications can be avoided.

Spinal meningiomas represent almost one third of all intradural extramedullary tumors and occur rarely in men. They arise from arachnoid cap cells in the arachnoid cell rests within the meninges and can compress and displace the spinal cord and the nerve roots leading to motor and sensory impairment and also sphincter dysfunction. Most of them are benign with very good outcome after complete surgical resection. Imaging can be challenging in differentiating them from nerve sheath tumors including spinal schwannoma and spinal neurofibroma.

Spinal hydatic disease must be considered in the differential diagnosis of the spinal cord compression syndrome especially in endemic areas. The disease is highly prone to recurrence, despite the introduction of modern surgical and pharmacological therapies. The prognosis is poor, comparable to that of malignancies.

Optic nerve sheath meningiomas (ONSM) are rare, frequently unilateral, benign, slowly growing tumors, arising from the meningo-epithelial cells surrounding the optic nerve intraorbital or intercanalicular. Their localization directly impair vision and indirectly impair aesthetics, making a safe classical surgical intervention very difficult and recommending stereotactic fractionated radiotherapy. Women are more affected, the survival rate is good and imaging can sustain differential diagnosis with optic neuroglioma or orbital schwannoma, lymphoma or pseudo tumor.

Visual acuity loss can be due to eyeball diseases or to lesions of the optic nerves, visual pathway or cortical projection of vision. The differential diagnosis can be challenging and though patients go first to the ophthalmologist, there is not always the ophthalmologist who can diagnose and treat the patient. For a great number of causes/diseases, a neurologist should also see the patient, even if there is a transient or persistent monocular or binocular visual acuity loss a disturbance of the visual fi eld or of the perception of colours. Visual acuity loss can be more than this. It can be a symptom or a sign of a neurological or systemic disease and a rapid diagnosis and specific treatment are mandatory in order to treat the symptoms and improve the patient’s quality of life.

Acute encephalopathy is frequently seen in Neurology and Internal Medicine Departments, it makes for a wide spectrum of neuropsychiatric abnormalities, but its brain magnetic resonance imaging appearance in the adult population is not well recognised. We present the case of an acute hyperammonemic encephalopathy in the setting of ischemic hepatitis secondary to global heart failure and its MRI findings with a review of the literature.

Chronic subdural hematoma is a common type of intracranial hemorrhage with higher incidence and unpredictable evolution among elderly people. We present the case of a 73 years old male patient, diagnosed in October 2013 with subacute bilateral subdural hematomas who was admitted in our clinic for worsening of motor function in his left limbs. The cerebral CT performed revealed a right massive chronic subdural hematoma which met the criteria for neurosurgical approach requiring a large craniotomy for complete removal. In this article we review the risk factors associated with an unpredictable evolution and postoperative subdural hematoma recurrence in the elderly.

Cavernomas are frequent low-flow vascular malformations with a characteristic MRI aspect due to their specific morphology. We present the case of a 64-year old male diagnosed in 2008 with multiple cerebral cavernomas and symptomatic epilepsy, who developed left face, arm and leg paresthesia during the last 6 days. The MRI examination performed in our clinic showed increased number of infracentimetric lesions with no signs of hemorrhage or growth of the previous documented ones. Considering MRI findings and the patient being seizure free for the last three years there is no current indication for invasive treatment. The presence of multiple lesions along with their aspect on T2* MRI sequences suggest a hereditary form in absence of familial history of cerebral cavernous malformations.

We report the case of a 68 year-old female (O.F.), referred to our clinic for a neurological evaluation after an episode of loss of consciousness that occurred three days before admittance. She was also diagnosed with cognitive impairment (July 2011). Case particularity: the MRI examination, which was the investigation of choice in this case, revealed structural brain abnormalities – dysgenesis of the corpus callosum.

We present the case of T.F., a 28 year-old woman diagnosed with corpus callosum dysgenesis and colpocephaly. The diagnosis is based on cerebral imaging – magnetic resonance imaging (MRI) and computerised tomography (CT)

We present the case of a 60 year-old woman diagnosed with meningiomatosis (multiple sporadic meningiomas), in the absence of neurofibromatosis type 2. The cerebral computerized axial tomography (CT scan) revealed six expansive lesions (one isodense and five spontaneously hyperdense partially or completely calcified), which at the cerebral magnetic resonance imaging (MRI) examination showed typical features of meningiomas. Case particularity: the very low incidence of sporadic multiple meningiomas and a rare cause of secondary epilepsy.

The possibility of myasthenia gravis must be considered in patients persistently complaining of weakness and fatigue. There may be many difficulties and pitfalls in differentiating myasthenia gravis from other disorders in which muscular weakness is a common complaint. Myasthenia gravis is an autoimmune disease caused by a defect of neuromuscular transmission due to antibodymediated attack. Dysphagia and dysarthria are two of the common symptoms and are due to oropharyngeal muscles involvement. They can be the first symptoms of the disease and sometimes can be mistaken for manifestations of emotional problems, usually anxiety or depression. The disease may be underappreciated as a cause of bulbar weakness. If clinical findings and history are highly suggestive, complementary tests should be performed (and sometimes maybe repeated) in order to confirm the diagnosis before psychasthenia or another psychiatric diagnosis is considered. We report the case of a 42-year-old woman who was admitted in our clinic for swallowing difficulties leading at the end of the day to total dysphagia, dysarthria, fluctuating limb muscle weakness and bilateral eyelids ptosis with incomplete occlusion.