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Background: Undifferentiated connective tissue disease (UCTD) is widely considered to be a distinct clinical entity, and now divided into two subgroups: stable UCTD and early UCTD. The most frequent onset symptoms of UCTD include arthralgias, arthritis, Raynaud's phenomenon, mucocutaneous involvement, and sicca symptoms. However, Neurologic involvement is rare, and intracranial lesion as onset symptom in a patient with early UCTD has not yet been reported., Case Presentation: A 51-year-old Chinese female experienced progressive left leg weakness for 14 days before hospitalizing in our department. The lesion on right parietal lobe was initially detected by brain magnetic resonance imaging. Although the patient declined a cerebral biopsy, the possibility of stroke, cerebral venous sinus thrombosis, NMOSD, MS, autoimmune encephalitis, intracranial infections, and malignant tumors as cause of the lesion was excluded by intracranial angiogram, CSF study, MRI enhancement and MRS examination. Moreover, immunologic studies showed high titer of antinuclear antibody, increased erythrocyte sedimentation rate and C-reactive protein. These results led to a diagnosis of early UCTD with central nerve system (CNS) involvement. After low dose corticosteroid and azathioprine therapy, the patient's symptoms, abnormalities in immunologic tests and cerebral radiologic examinations were all greatly improved within a short duration., Conclusions: This is the first report of intracranial lesion as onset symptom in a patient with early UCTD. Our case suggested that central nerve system (CNS) involvement could be the onset symptom in early UCTD, and should be recognized quickly with exclusion of other causative factors in the differential diagnosis. Prompt and adequate treatment with low-dose steroid and immunosuppressive drugs could improve the prognosis of both early UCTD and CNS involvement.

Introduction: Invasive aspergillosis (IA) is rare in immunocompetent patients. We present the case of a 44-year-old female with IA invading the lungs, mediastinum, heart, and brain, with a disease duration of 11 years. Case presentation: The patient was initially diagnosed with lung aspergillosis that had invaded the mediastinum on October 8, 2008. Irregular uptake of itraconazole led to the aggravation of lung lesions. Echocardiography and enhanced magnetic resonance imaging revealed a large irregular mass in the left atrium and an enhanced 1-cm nodular lesion in the right frontal lobe respectively in 2016. The patient refused to undergo a biopsy of the cardiac mass. Oral itraconazole (200 mg, twice daily) was recommended for subsequent days. The intracranial lesion gradually enlarged, and a complete tumor resection of the right frontal lobe was performed on February 23, 2017. The patient's condition was well controlled with oral voriconazole by the end of follow-up until April 11, 2019. We conducted a search across multiple databases, including PubMed, Web of Science, Scopus, and Science Direct. We aimed to identify cases of aspergillosis that simultaneously invaded the lungs, heart, and brain. The details of these cases are summarized. Results: Fourteen cases with available data met the requirements, and the mortality rate of these 14 cases was 100%. Conclusions: IA can occur even in immunocompetent patients receiving antifungal therapy. Therefore, timely diagnosis and effective longterm antifungal treatments are crucial. Voriconazole is an effective antifungal drug that is used to treat cerebral aspergillosis. [ABSTRACT FROM AUTHOR]

Background: Hemicrania continua is a primary unilateral headache characterized by ipsilateral parasympathetic and sympathetic autonomic features. A key diagnostic criterion is its dramatic response to indomethacin treatment; however, various vascular or structural abnormalities have been reported to cause secondary hemicrania continua, presenting with clinical features similar to those of the primary headache presentation. Objective: We reviewed the literature to compile secondary hemicrania continua cases, highlighting the importance of imaging during the evaluation. Additionally, we also contributed our three cases to the existing studies. Methods: We conducted a review of articles from the PubMed and EMBASE databases that described reported cases of secondary hemicrania continua, covering the period from 1993 to 2021. Our review included detailed patient information, signs, and symptoms of hemicrania continua, as well as information on indomethacin usage and headache resolution (if pertinent). Results: Secondary hemicrania continua can result from a remarkably diverse range of structural and vascular lesions, yet clinical reports on long‐term follow‐up are lacking. Notably, cases may exhibit a classical response to indomethacin, emphasizing the importance of neuroimaging in excluding secondary cases. Our search yielded 41 cases meeting our criteria. We excluded six cases that were not treated with indomethacin or were unresponsive to it. Additionally, we present three cases that highlight the necessity of neuroimaging in evaluating hemicrania continua, along with short‐ and long‐term clinical outcomes following indomethacin and lesion‐directed treatments. Case 1 presented with daily right‐sided headaches and cranial autonomic symptoms. Her pain completely resolved with indomethacin use. Neuroimaging of the brain revealed a laterally directed saccular aneurysm of the right internal carotid artery. Case 2 presented with continuous left‐sided unilateral headaches with superimposed exacerbations. She complained of left‐sided photophobia with a dull sensation in the left ear. Her symptoms decreased after 2 weeks of indomethacin use. Neuroimaging of the head indicated a benign tumor with mass effect into the left lateral medulla and inferior cerebellar peduncle. Case 3 presented with a right side‐locked headache with daily, severe superimposed exacerbations. She had photophobia in the right eye and a right‐sided Horner's syndrome, along with tearing during her exacerbations. Neuroimaging of the brain revealed a pituitary tumor and her pain completely resolved with indomethacin. Conclusion: Hemicrania continua is a rare headache disorder that can be either primary or secondary. Importantly, response to indomethacin can still occur in secondary hemicrania continua. Thus, neuroimaging should be considered to rule out underlying structural etiology in all cases, regardless of their clinical responsiveness to indomethacin therapy. Plain Language Summary: Hemicrania continua is a primary headache disorder, but in some patients the headache phenotype can be due to a secondary cause. We reviewed 46 published cases of patients with this headache phenotype and added three patients of our own; scans revealed additional serious, often treatable, problems in many of the cases. Clinicians should consider imaging studies when patients present with symptoms consistent with hemicrania continua, even if they respond to medication. [ABSTRACT FROM AUTHOR]

Addressing conventional neurosurgical navigation systems' high costs and complexity, this study explores the feasibility and accuracy of a simplified, cost-effective mixed reality navigation (MRN) system based on a laser crosshair simulator (LCS). A new automatic registration method was developed, featuring coplanar laser emitters and a recognizable target pattern. The workflow was integrated into Microsoft's HoloLens-2 for practical application. The study assessed the system's precision by utilizing life-sized 3D-printed head phantoms based on computed tomography (CT) or magnetic resonance imaging (MRI) data from 19 patients (female/male: 7/12, average age: 54.4 ± 18.5 years) with intracranial lesions. Six to seven CT/MRI-visible scalp markers were used as reference points per case. The LCS-MRN's accuracy was evaluated through landmark-based and lesion-based analyses, using metrics such as target registration error (TRE) and Dice similarity coefficient (DSC). The system demonstrated immersive capabilities for observing intracranial structures across all cases. Analysis of 124 landmarks showed a TRE of 3.0 ± 0.5 mm, consistent across various surgical positions. The DSC of 0.83 ± 0.12 correlated significantly with lesion volume (Spearman rho = 0.813, p < 0.001). Therefore, the LCS-MRN system is a viable tool for neurosurgical planning, highlighting its low user dependency, cost-efficiency, and accuracy, with prospects for future clinical application enhancements. [ABSTRACT FROM AUTHOR]

Head injury is the most common cause of child traumatology. However, there exist no treatment guidelines in children having intracranial lesions due to minor or moderate head trauma. There is little knowledge about monitoring, clinical exacerbation risk factors, or optimal duration of hospitalization. The aimof this retrospective study is to find predictive factors in the clinical course of non-severe head trauma in children, and thus to determine an optimal management strategy. Poor clinical progress was observed in only 4 out of 113 children. When there are no clinical signs and no eating disorders, an earlier discharge is entirely appropriate. Nevertheless, persistent clinical symptoms including headache, vomiting, and late onset seizure, especially in conjunction with hemodynamic disorders such as bradycardia, present a risk of emergency neurosurgery or neurological deterioration. Special attention should be paid to extradural hematoma (EDH) of more than 10 mm, which can have the most severe consequences. Clinical aggravation does not necessarily correlate with a change in follow-up imaging. Conversely, an apparent increase in the brain lesion on the scan is not consistently linked to a pejorative outcome. [ABSTRACT FROM AUTHOR]

Background: Undifferentiated connective tissue disease (UCTD) is widely considered to be a distinct clinical entity, and now divided into two subgroups: stable UCTD and early UCTD. The most frequent onset symptoms of UCTD include arthralgias, arthritis, Raynaud's phenomenon, mucocutaneous involvement, and sicca symptoms. However, Neurologic involvement is rare, and intracranial lesion as onset symptom in a patient with early UCTD has not yet been reported.Case Presentation: A 51-year-old Chinese female experienced progressive left leg weakness for 14 days before hospitalizing in our department. The lesion on right parietal lobe was initially detected by brain magnetic resonance imaging. Although the patient declined a cerebral biopsy, the possibility of stroke, cerebral venous sinus thrombosis, NMOSD, MS, autoimmune encephalitis, intracranial infections, and malignant tumors as cause of the lesion was excluded by intracranial angiogram, CSF study, MRI enhancement and MRS examination. Moreover, immunologic studies showed high titer of antinuclear antibody, increased erythrocyte sedimentation rate and C-reactive protein. These results led to a diagnosis of early UCTD with central nerve system (CNS) involvement. After low dose corticosteroid and azathioprine therapy, the patient's symptoms, abnormalities in immunologic tests and cerebral radiologic examinations were all greatly improved within a short duration.Conclusions: This is the first report of intracranial lesion as onset symptom in a patient with early UCTD. Our case suggested that central nerve system (CNS) involvement could be the onset symptom in early UCTD, and should be recognized quickly with exclusion of other causative factors in the differential diagnosis. Prompt and adequate treatment with low-dose steroid and immunosuppressive drugs could improve the prognosis of both early UCTD and CNS involvement. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To describe a simple technique for preoperative surface localization of intracranial lesions. Methods: 11 pills in total, including Alfarol (alfacalcidol) capsules, were affixed to a phantom with adhesive tape and a MRI scan was performed. The visibility of the pills and any spatial errors in determining their locations were evaluated. Between June 2006 and April 2009, we employed Alfarol capsules as a skin marker in MRI in clinical surgical cases. Results: Alfarol capsules, whose actual size is 5.6mm in diameter, were identified as a hyperintense spot at a size of 4.2, 4.2, and 4.5mm in diameter in T1-weighted, T2-weighted, and FLAIR (fluid attenuated inversion recovery) sequence images, respectively. The size discrepancies were within 1.4mm. The average spatial errors were 0.7, 0.6, and 0.7mm in T1-weighted, T2-weighted, and FLAIR sequence images, respectively. Other pills were not identified in the MRI scans. During this 35-month period, 8 patients underwent preoperative MRI-guided localization at our institution. There were 5 men and 3 women in whom 8 biopsies were performed. In all cases, the result of the biopsy was positive and useful for the treatment that followed. No perioperative complications were encountered. Conclusion: Alfarol capsule can be used as an external skin marker. Our simple and inexpensive method is a useful addition to preoperative evaluation of superficial intracranial lesions. [Copyright &y& Elsevier]

We present a case of a 65-year-old female with glioblastoma of the spinal cord, which disseminated to an intracranial lesion. Magnetic resonance imaging revealed diffuse swelling at levels C1 to 4, which was pathologically consistent with glioblastoma, and right side pontine parenchyma mass. The patient died after seven weeks of hospitalization. The confirmed diagnosis of glioblastomas was obtained as a result of autopsy. Spinal glioblastomas are rare lesions of the central nervous system with a prognosis as poor as that of their intracranial counterpart. There have been only nine reports in English since 1990, including this case in Japan. [ABSTRACT FROM AUTHOR]

BACKGROUND AND PURPOSE To present a rare case of a rheumatologic disorder with a central nervous system manifestation. METHODS A 48-year-old female with history of nasal and auricular pain and inflammation developed bilateral intermittent scleritis that was refractory to several immunosuppressive medications. She later presented with headaches and right upper extremity parasthesias. Brain magnetic resonance imaging (MRI) was obtained and she was referred to a neurosurgeon. RESULTS Neurological examination did not reveal any focal deficits. Laboratory analysis demonstrated an elevated erythrocyte sedimentation rate (ESR). Brain MRI with and without gadolinium contrast revealed an extra-axial, enhancing, left frontoparietal convexity lesion. The patient was taken to the operating room for biopsy and resection of the mass. Final pathology demonstrated dural granulomatosis with vasculitis, most consistent with intracranial Wegener's granulomatosis. The patient was discharged to follow-up with her rheumatologist for further medical management. CONCLUSIONS Enhancing, intracranial dural lesions are associated with a variety of disease entities. Wegener's granulomatosis is one such entity and should be considered in the correct context. [ABSTRACT FROM AUTHOR]