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Thrombosis of the cerebral veins and sinuses is an infrequent cerebrovascular disorder. Because the highly variable symptoms, recent neuroimaging plays a key role in the diagnosis. Abducens nerve palsy as a focal neurological deficit is a rare clinical manifestation in these patients. We present two cases with sudden onset of diplopia and headache. Case 1: A 3-year old girl with B cell lymphoblastic leukemia developed bilateral abducens deficit and bilateral optic disc edema after treatment including L-asparaginase. Thrombosis of the right jugular vein, sagittal and right sigmoid sinuses was visualized on magnetic resonance imaging (MRI) and magnetic resonance venography (MRV). Symptoms gradually resolved after treatment with enoxiparine and MRV demonstrated recanalization. Case 2: A 75-year old female with medical history of arterial hypertension presented with headache and sudden left abduction deficit. Computerized tomography (CT) scan was normal. MRI and MRV revealed aging brain and disruption of venous flow at the left internal jugular vein, suspecting thrombosis. Extracranial colour duplex sonography and CT angiography proved haemodinamic equivalent of left internal jugular vein thrombosis due to sclerotic pathology of aortic arch. Our first case illustrates the role of improved neuroimaging techniques as the best method for diagnosis of cerebral veins and sinuses thrombosis, presenting with abducens nerve palsy. With second case the potential neuroimaging pitfalls concerning the accurate diagnosis of these cerebrovascular disorders with neuro-ophthalmologic manifestation are discussed.

353 ABSTRACT Introduction: Refractory epilepsy is common in patients with structural brain lesions including acquired disorders and genetic abnormalities. Recently, MRI is a precise diagnostic tool for recognition of different structural causes underlying medically intractable seizures. Objective: To evaluate the usefulness of MRI for detection of brain lesions associated with refractory epilepsy. Material and methods: 49 patients (20M and 29F; aged 48.6±24.7 years) with refractory epilepsy were included in the study. They presented with partial (46.0%), secondary (31.0%) or primary (23.0%) generalized tonic-clonic seizures. Clinical diagnosis was based on the revised criteria of ILAE. Structural neuroimaging (MRI), EEG recording, and neurological examination were performed Results: MRI detected different structural brain abnormalities totally in 36 (73.5%) patients, including cerebral tumors (21p), cerebrovascular accidents (5p), hyppocampal sclerosis (3p), developmental malformations (2p), postencephalitic lesions (2p), arachnoid cysts (2p), and tuberous sclerosis (1p). Neuroimaging revealed normal findings in 13 (27.5%) cases. EEG recordings showed focal epileptic activity in 38 (77.6%) patients, including 33 cases with and 5 without structural brain abnormalities. Conclusion: This study revealed that structural brain lesions are commonly associated with refractory epilepsy. We suggested that MRI is a useful diagnostic method for assessment of patients with uncontrolled seizures or altered epileptic pattern

Germinomas are the most frequent type of germ cell tumors that constitute only 2-5% of all central nervous system malignancies. Most of them arise in the pineal and suprasellar regions but in about 5% to 10% the simultaneous location is found. Although their strategic location, they respond well to surgery, radiation and chemotherapy and the prognosis is very good. We report a case of 23years young male presented with gait disturbance, weakness in lower extremities, visual impairment and moderate fatigue. His medical history revealed that he was symptomatic by DI (polyuria, polydypsia and weight loss) and received treatment with adiuretin for a period of 3 years. Computed tomography (CT) scans demonstrated well circumscribed tumor lesions with a homogeneous contrast enhancement in the suprasellar and pineal regions. A germinoma was verified histologically. A good treatment response to surgery, radiation, chemotherapy and management of endocrine insufficiency was achieved. The postoperative neurological, CT and immunological follow-up corresponded with the clinical course of the disease and the results of therapeutic procedures.

Idiopathic intracranial hypertension (IIH) or benign intracranial hypertension is a neurological syndrome characterized by elevated intracranial pressure. This uncommon disorder occurs primarily in obese women aged 10 to 50 years, sometimes in association with endocrine and metabolic dysfunction, with systemic diseases or when treated with multiple medications. We describe a case of IIH in a 43-year-old woman with schizophrenia treated with risperidone, demonstrating a typical clinical picture of benign intracranial hypertension. For the 5 years of treatment with risperidone she put on 35 kg in total (BMI> 35); for the last 2-3 months she began to complain of visual obscurations, nausea with vomiting. Ophthalmoscopy revealed bilateral asymmetric papilledema (OD>OS). Magnetic resonance imaging was normal, intracranial pressure was elevated IIH was diagnosed. Risperidone was discontinued and replaced with Seroquel 200 mg daily. Treatment with furosemide and mannitol 10% was initiated. Papilledema resolved completely over the next 2 months. The patient was followed-up for four years after risperidone withdrawal. Weight loss of 28 kg was noted for four years. There were no relapses of headache, nausea, visual obscuration. Ophthalmologic examination revealed no papilledema. We suggest that prolonged use of antipsychotics, such as risperidone, should require proper surveillance for possible development of IIH and routine ophthalmologic examinations should be performed.

Introduction : Multiple sclerosis (MS) is a progressive demyelinating neurologic disease characterized by a different extent of comorbidity. Everydaily life is challenging for these patients because of physical and psychological impairments. The purpose of this study was to comparatively analyze the relationships between several health-related quality of life aspects of MS patients` in case of accompanying diseases. Material and methods : Health-related uality of life of 80 MS patients, 56 females and 24 males, at a mean age of 49 years, was examined by means of Short Form-36 questionnaire. Forty patients presented with at least one accompanying chronic disease. Results : These patients presented with similar Expanded Disability Status Scale scores of 2.0 or 2.5. Most questionnaire scores differed between MS patients without and with comorbidity. Usually, comorbidity additionally worsened patients` quality of life. There were statistically significant differences between the patients with MS alone and those with MS and comorbidity concerning the depression ( t =5.877; p

Intracranial lipomas are rare lesions, infrequently indicated for neurosurgical treatment due to their benign course and significant surgery-related complications rate. The aim of this study was to collect, describe and analyze the patients with intracranial lipomas verified by PET-CT and reported in the literature up to date. The literature search was performed through Pub Med using the combination of the terms intracranial lipomas, CT, MRI and PET-CT. The thorough review of the relevant papers did not find even one case with PET-CT images of intracranial lipomas. The first two personal illustrative cases were demonstrated by our report. The value of PET-CT in the primary and differential diagnosis of intracranial lipomas was analyzed, in comparison with CT, MRI and PET-MRI.

Lyme disease is a multi-system disorder caused by the spirochete Borrelia burgdoferi. Eye manifestations are a rare involvement. We report two cases of patients who developed a retrobulbar optic neuritis and a cystoid macular edema as a sole clinical presenting in Lyme disease. A 42-year-old female presented with left eye decreased visual acuity and painful ocular movement. Dilated funduscopy and neurological examination were normal. A diagnosis of left eye retrobulbar optic neuritis was made. The brain and spinal cord MRI showed typical lesions characteristic of MS. Serological tests for Lyme disease revealed positive results for IgM ELISA and Western blot. The possible serologically proven Lyme disease was diagnosed. Visual acuity returned to normal following a course of high-dose steroids and intravenous antibiotic, after by oral antibiotic. A 28-year-old male presented with left eye blurred vision and intermittent blurring vision in his right eye. Dilated funduscopy revealed bilateral cystoid macular edema (left more than right). He was positive for Lyme serology, IgM ELISA and Western blot, and intravenous antibiotic therapy was commenced, followed by oral antibiotic. Visual acuity was restored and fuduscopy was normal. In summary, although Lyme disease is an uncommon cause of these neuro-ophthalmic complications, our two patients highlight the importance of considering this disorder as a differential diagnosis and to initiate an early adequate therapy.

Introduction : Progressive supranuclear palsy is a neurodegenerative disorder, described as a tauopathy. The neuroimaging and visual symptoms are among the most important in the diagnosis of this disease. The ophthalmoparesis mainly concerns voluntary eye movements. Patients mostly present with vertical palsy, involuntary eye movements, convergence insufficiency, and diplopia. Case report : A 62-year-old female patient was admitted to the hospital because of the gait disturbance and frequent falls. She had impaired memory, handwriting and speech for one year. On neurological and neuro-ophthalmological examinations, the patient presented with vertical gaze palsy, involuntary eye movements, dysarthria, tremor in the right hand, and cerebellar ataxia. Blood tests were normal. (18F)-FDG PET revealed bilateral zones of moderate hipometabolism in the regions of posterior frontal cortex, anterior cingulum, left thalamus, head of left striatum, and left temporal lobe. Neuropsychological tests revealed cognitive impairment (MMSE-26; IADL-1). Conclusion : Based on the literature review and our own notices, we suggest that (18F)-FDG PET scanning and neuro-ophthalmological examination in addition to structural neuroimaging and clinical findings play a crucial role in the differential diagnosis of PSP and other parkinsonian syndromes.