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Introduction: Posterior reversible encephalopathy syndrome (PRES) is an acute form of encephalopathy. Main characteristic of this syndrome is the development of subcortical/cortical edema in the occipital lobes. The most common causes are diseases such as pre-eclampsia, autoimmune diseases, allogeneic stem cell transplantation and after treatment with immunosuppressants or cytostatics. However, PRES is also occasionally observed in connection with neurosurgical procedures, particularly in the posterior fossa in pediatric patients., Research Question: PRES in adults is extremely rare. After cranial surgery, the impaired consciousness caused by this syndrome may be misdiagnosed., Material and Methods: We present a rare case of PRES associated with vestibular schwannoma (VS) surgery and metronidazole use and have conducted a literature review., Results: We found only two cases of PRES after surgery of a VS in the literature and three cases in connection with the administration of metronidazole. All cases involved women but the onset of symptoms was highly variable. The constellation of surgery and administration of metronidazole has not yet been described., Discussion and Conclusion: The purpose of this review is to raise awareness of a very rare complication such as PRES in this setting. Antibiotics should be chosen carefully after such an operation, as this syndrome can be triggered by certain substances., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2025 The Authors.)

Posterior reversible encephalopathy syndrome (PRES) is an acute neurological condition associated with different etiologies, including antibiotic therapy. To date, most data regarding antibiotic-related PRES are limited to case reports and small case series. Here, we report a novel case description and provide a systematic review of the clinico-radiological characteristics and prognosis of available cases of PRES associated with antibiotic therapy. We performed a systematic literature search in PubMed and Scopus from inception to 10 January 2024, following PRISMA guidelines and a predefined protocol. The database search yielded 12 subjects (including our case). We described the case of a 55-year-old female patient with PRES occurring one day after administration of metronidazole and showing elevated serum neurofilament light chain protein levels and favorable outcome. In our systematic review, antibiotic-associated PRES was more frequent in female patients (83.3%). Metronidazole and fluoroquinolones were the most reported antibiotics (33.3% each). Clinical and radiological features were comparable to those of PRES due to other causes. Regarding the prognosis, about one third of the cases were admitted to the intensive care unit, but almost all subjects (90.0%) had a complete or almost complete clinical and radiological recovery after prompt cessation of the causative drug. Antibiotic-associated PRES appears to share most of the characteristics of classic PRES. Given the overall good prognosis of the disease, it is important to promptly diagnose antibiotic-associated PRES and discontinue the causative drug., (© 2024. The Author(s).)

The invention of flow diverting stents (FDS) is a novel milestone in the field of endovascular aneurysm therapy, promoting physiological healing of the vessel segment contrary to prior deconstructive treatment strategies, such as coiling. The effects of FDS are based on changes in flow patterns, segmental wall stabilization, and the growth of a neointima. Although flow diversion is already well established for cerebral aneurysms in proximal segments, peripheral locations remain challenging. Especially the middle cerebral artery (MCA) with its predominance of non-collateralized perforators and functional end arteries that supply the eloquent areas of the brain is of major concern.The literature was reviewed for flow diversion of the MCA and antiplatelet therapy.Resulting from the special anatomical characteristics of the MCA, FDS implantation in this territory is completely different from the proximal vessel segments. Still, flow diversion represents an effective endovascular strategy, especially in otherwise non-accessible or sufficiently treatable lesions. However, the risk of ischemic adverse events might be increased. Special attention to the individual decision regarding device selection, antiplatelet regimen, and exact definition of the proximal and distal landing zone considering the jailed side branches is essential for a good angiographic and clinical outcome. · MCA aneurysms can be sufficiently treated by FDS.. · The anatomic and hemodynamic characteristics of the MCA result in an increased risk of thromboembolism.. · Individual device selection and antiplatelet regimen are essential for treatment success.. · Schüngel M, Wohlgemuth WA, Elolf E et al. Review: Flow Diversion for the Treatment of Middle Cerebral Artery Aneurysms. Fortschr Röntgenstr 2024; DOI 10.1055/a-2343-0046., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Object: Trigeminal neuralgia (TGN) occurring after radiosurgical treatment of cerebellopontine or petroclival tumors may be very difficult to control. Our aim was to determine the efficacy of neurosurgical treatment in regards to pain control and to evaluate the procedure-related complication and morbidity rates., Methods: Retrospective study of a series of operated patients with radiosurgery-induced TGN. The primary goal of the surgery was to inspect and decompress the trigeminal nerve; the second goal was to remove the tumor remnant completely, if safely feasible. The main outcome measures were pain control, time to onset of pain relief and its duration, occurrence of new neurological deficits or worsening of the existing one and completeness of tumor removal., Results: The four patients met the inclusion criteria: 2 with vestibular schwannomas, 1 with petroclival meningioma and 1 with an epidermoid. TGN occurred 12-60 months after radiosurgery (mean 39 months). At presentation the pain attacks occurred multiple timesdaily and lasted from a few seconds to 2-3min. The Complete tumor removal via the retrosigmoid approach was achieved in all cases. There were no major operative complications or persistent morbidity, besides one patient with trochlear nerve palsy. All patients experienced immediate pain relief after surgery. At follow-up (median duration - 42.5 months) the three patients reported complete pain resolution. One patient had occasional slight pain but did not need any medications., Conclusion: Surgery is safe and effective treatment option of patients with intractable radiosurgery-induced TGN. It leads to excellent pain control and is curative in regards to the neoplastic disease., (Copyright © 2014. Published by Elsevier B.V.)

Background: We report the rare case of an adult transsphenoidal meningoencephalocele and outline the microneurosurgical strategy. Clinical history, the findings of computerized tomography (CT) scans and magnetic resonance imaging (MRI), the microsurgical procedure, and histopathology are reported., Case Report: A 54-year-old female patient complained about cerebrospinal fluid (CSF) rhinorrhea; a transnasal biopsy of a mass in the maxillar sinus prior to diagnostic work-up was performed elsewhere. Persisting CSF leakage prompted CT and MRI, which showed brain tissue extending from the left middle cranial fossa into the left sphenoid sinus through several bony defects. The diagnosis of a transsphenoidal meningoencephalocele was made, and the lesion was targeted via a subtemporal intradural approach with resection of the herniated brain tissue and closure of the bony as well as of dural defects. The postoperative course was uneventful without recurrence of the CSF fistula., Conclusion: The transsphenoidal subtype of basal meningoencephaloceles is exceedingly rare. Nonetheless, it has to be considered as a differential diagnosis if a nasal or intrasphenoidal mass is diagnosed. Otherwise, unjustified biopsy or unsuccessful management of CSF leakage could not be avoided. The intradural subtemporal approach is effective to treat the transsphenoidal type of basal meningoencephaloceles., (Georg Thieme Verlag KG Stuttgart · New York.)

Background: Radiation induced optic neuropathy (RION) is a rare but severe consequence of radiation therapy that is associated with adjuvant chemotherapy, specifically therapy with vincristine or nitrosoureas. However, there is very little evidence regarding the occurrence of RION after concomitant radiochemotherapy with temozolomide., Case Presentation: The case of a 63 year old woman with glioblastoma multiforme and concomitant radiochemotherapy with temozolomide is described. Due to a slight depressive episode the patient also took hypericum perforatum. Five months after cessation of fractionated radiation and adjuvant chemotherapy with temozolomide (cumulative dose of 11040 mg) the patient developed bilateral amaurosis due to RION. Tumor regrowth was excluded by magnetic resonance imaging. After the application of gadolinium a pathognomonic contrast enhancement of both prechiasmatic optic nerves could be observed., Conclusions: In this patient, the occurrence of RION may have been the result of radiosensitization by temozolomide, which could have been strengthened by hypericin. Consequently, physicians should avoid a concomitant application of hypericum perforatum and radiochemotherapy.

Purpose: To optimize contrast-to-noise and spatial resolution of a FLASH-based magnetization transfer (MT) protocol for visualization of substructures in human thalamus., Materials and Methods: Healthy adults were examined at 3 Tesla with a three-dimensional (3D) spoiled gradient-echo sequence. The signal-to-noise ratio (SNR) was increased by averaging eight bipolar echo acquisitions (mean echo time = 12.3 ms; bandwidth = 370 Hz/pixel). Three isotropic datasets with different weighting (proton density: flip angle/repetition time = 7 degrees /30 ms; T(1): 20 degrees /30 ms and MT: 10 degrees /48 ms, Gaussian MT prepulse) yielded maps of T(1), signal amplitude, MT ratio and MT saturation for comparison to MP-RAGE images. Measuring time was 23 min using partial k-space acquisition. First, the SNR of MT saturation maps in thalamus was optimized by means of the excitation flip angle. Then, noise and partial volume effects were traded off by means of the resolution. Finally, the contrast within the thalamus and to adjacent structures was compared between different maps., Results: The optimized MT saturation maps at 0.95 mm isotropic resolution provided the highest contrast. It was most prominent between structures of high axonal content (internal medullary lamina, ventral nuclei) and those containing predominantly neuronal somata (pulvinar, mediodorsal thalamus, geniculate bodies)., Conclusion: Semiquantitative MT saturation maps provide an enhanced intra-thalamic contrast. The borders and nuclear groups of the thalamus are reliably delineated; individual assignment of singular nuclei seems feasible.

Background and Purpose: The purpose of this work was to provide an intraindividual comparison of angiographic CT (ACT) and multisection CT (MSCT) in lumbar myelographic imaging and to evaluate possible benefits of ACT, which is a further development of rotational angiography providing image data of high spatial and CT-like contrast resolution., Materials and Methods: In 26 patients with degenerative lumbar spine disease a lumbar ACT was performed in combination with conventional lumbar myelography and followed by postmyelographic MSCT. Conventional lumbar myelography and lumbar ACT were performed with a flat panel detector-equipped angiographic device. Postmyelographic MSCT was performed with a 16-section CT scanner. Three experienced neuroradiologists rated anonymized sets of multiplanar reformatted CT and ACT images regarding diagnostic and technical parameters. The ratings were repeated after 2 months. Weighted kappa statistics were calculated to describe the levels of intraobserver and interobserver agreement., Results: The analysis shows that MSCT achieves higher ratings than ACT in all of the parameters asked. An adequate diagnostic quality was only assigned to 80% of the ACT acquisitions compared with 97% of the MSCT acquisitions. All of the mean kappa values were above 0.60, demonstrating a substantial intraobserver and interobserver agreement for MSCT, as well as for ACT., Conclusion: Using ACT, radiographic myelography and myelographic CT can be performed at the same imaging system. However, the results of our study show that the current myelographic ACT image quality fails to apply diagnostic standards. We, therefore, cannot recommend ACT as a general alternative to postmyelographic MSCT.

Reliable identification of the subthalamic nucleus (STN) is a critical step in deep brain stimulation for Parkinson disease but difficult on T1-weighted stereotactic MR imaging. By simultaneous imaging of multiple gradient echoes, susceptibility contrast is added to conventional T1-weighted high-resolution MR image. Thus, the visibility of the STN is enhanced on a second co-localized dataset by exploiting the sensitivity of the T2*-relaxation to local iron deposits. The feasibility is underpinned by quantitative measurements on healthy adults.

We evaluated the feasibility of angiographic computed tomography (ACT) for diagnostic imaging in a patient with degenerative lumbar spine disease. ACT provides a volume data set out of a rotational acquisition with a c-arm-mounted flat-panel detector. Using this technique, radiographic myelography and myelographic computed tomography can be performed in a single session at the same imaging system. The quality of the reconstructed ACT slice images is comparable to those acquired by postmyelographic computed tomography.