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Erdheim-Chester disease is a rare, non-Langerhans form of systemic histiocytosis of unknown etiology. The disease affects multiple organ systems, including musculoskeletal, cardiac, pulmonary, gastrointestinal, and central nervous systems, producing protean manifestations. Neurological manifestations are less frequent. We present a 44-year-old patient with Erdheim-Chester disease who had bilateral carotid artery occlusion and cavernous sinus infiltration.

SUMMARY: Brucellosis is a zoonotic disease characterized by multisystem involvement. Nervous system involvement is rare, with a reported incidence of 3%–13%. Brucellosis can also be manifested in the form of vasculopathy. Cerebral vasculopathy due to brucellosis is a very rare entity, with only a few cases reported in the literature. We present a patient with neurobrucellosis who had involvement of cerebral vasculature demonstrated by angiography.

Summary: The risk of fatal injury of the internal carotid artery (ICA) and surrounding anatomy during transsphenoidal surgery for pituitary adenoma is the most severe potential complication associated with this particular approach. We present a case in which iatrogenic injury to a patient’s ICA and resultant carotid cavernous fistula and massive hemorrhage was successfully managed with the emergency placement of an endovascular stent-graft. Both findings in the relevant literature and practical considerations concerning both stent-grafts and other more commonly used options for the treatment of iatrogenic ICA injury are discussed.

Summary: Multiple, symmetrical brain lesions affecting the bilateral thalami and cerebral white matter, which often show a concentric structure on CT and MR images, characterize acute necrotizing encephalopathy (ANE) of childhood. We describe the imaging findings of a 2-year-old child with ANE obtained with diffusion-weighted MR imaging. We discuss the significance of these findings, as well as the pathophysiology of ANE lesions, with reference to the appearance of the disease as revealed by diffusion-weighted MR imaging.

Summary: We report the case of a 43-year-old man who underwent endovascular treatment for posterior inferior cerebellar aneurysm. Significant hemodynamic changes were observed as electric stimulation was applied during coil detachment for a PICA aneurysm. We postulate that changes in heart rate and blood pressure during coil detachment were due to the electric stimulation of the tonic vasomotor center located in the rostral ventrolateral medulla, which was very close to the PICA aneurysm.

Summary: Involvement of the brain and meninges is rare in cases of Wegener granulomatosis, occurring in 2% to 8% of cases. Meningeal involvement in association with Wegener granulomatosis has scarcely been reported as being confined to the dura mater of brain on images and is thought to represent granulomatous infiltration. There are a few reported cases of Wegener granulomatosis that document involvement of dura at the level of the spinal cord. We present the case of a 52-year-old man with Wegener granulomatosis involving the cervical spinal dura and include detailed MR imaging findings.