An 85-year-old man underwent emergency right trepanation and drainage for a symptomatic chronic subdural hematoma. Pseudohypoxic brain swelling (PHBS) was suspected because magnetic resonance imaging revealed diffuse brain swelling. Although cerebrospinal fluid (CSF) leakage was not obvious during or after surgery, most of the reported PHBS cases have leaked CSF during craniotomy or spine surgery. PHBS has not been previously reported in patients without obvious CSF leakage or after unilateral burr hole drainage. Herein, we report an extremely rare case with a literature review investigating its pathogenesis and clinical features.

Background/Objectives: Primary central nervous system lymphoma (PCNSL) has a markedly high proliferation rate, making early diagnosis and prompt therapeutic intervention essential. To accelerate diagnosis, our institution adopted flow cytometry (FCM) in conjunction with conventional histopathology, and this study therefore evaluated the diagnostic performance of FCM for PCNSL. Methods: We retrospectively analyzed 67 consecutive patients with suspected PCNSL who underwent intraoperative FCM between 2010 and 2023 based on preoperative imaging. B-cell clonality was defined as ≥20% CD19/CD20-positive cells with a κ/λ ratio of >3.0 or <0.5. Results: Using histopathology, we confirmed the presence of PCNSL in 42 patients, all diagnosed as having diffuse large B-cell lymphoma. Six cases (14.3%) were discordant (FCM-D). The sensitivity, specificity, and positive predictive value of FCM were 85.7%, 100%, and 100%, respectively. T-cell markers were significantly elevated in FCM-D cases (p < 0.01), although these were pathologically diagnosed as diffuse large B-cell lymphoma based on histology and immunohistochemistry. Conclusions: FCM yields reliable diagnostic information within hours of tissue collection and supports early therapeutic decisions in PCNSL. Discordant results may reflect reactive T-cell infiltration. This is the first study to present detailed subset analyses in PCNSL using FCM in correlation with pathology, underscoring its utility as a rapid diagnostic tool.

Objective: Persistent left superior vena cava (PLSVC) is rare, occurring in approximately 0.3%–0.5% of the population. In endovascular treatment (EVT), the left internal jugular vein (IJV) is approached via the left innominate vein from the superior vena cava; however, the left innominate vein is occasionally absent in patients with PLSVC. Careful consideration is required when performing EVT, particularly transvenous embolization (TVE).Case Presentation: A 70-year-old female presented with a left cavernous sinus dural arteriovenous fistula. Left external carotid angiography findings showed that multiple feeders from the ascending pharyngeal artery, accessory meningeal artery, middle meningeal artery, and the artery of the foramen rotundum had formed a shunted pouch posterolateral to the left cavernous sinus. We initially planned to perform a TVE via the right femoral vein. However, PLSVC was detected on common carotid artery angiography. Consequently, a TVE via the left IJV and coil embolization were performed, resulting in the disappearance of the shunt. The patient was discharged without neurological deficits. PLSVC is a rarely observed thoracic venous malformation, with few reports concerning its management in cerebrovascular EVT. Contrast-enhanced computed tomography is useful for diagnosis; however, most patients with PLSVC are clinically asymptomatic and this abnormality is typically an incidental finding, remaining challenging to detect during a preoperative examination.Conclusion: It is essential to consider the possibility of PLSVC and to verify the appropriate access route, including the right atrial level and the venous phase, during preoperative cerebral angiography.

Background/Objectives: Diagnosing hemangioblastomas using magnetic resonance imaging (MRI) is challenging, especially when the tumors appear as solid posterior fossa masses. This study aimed to evaluate the diagnostic performance of perfusion MRI and identify the most useful quantitative features for differentiating hemangioblastomas from other posterior fossa tumors. Methods: Forty-five posterior fossa tumors were analyzed, including 18 hemangioblastomas (HB group) and 27 non-hemangioblastoma tumors (NHB group; 8 metastatic brain tumors, 6 pilocytic astrocytomas, 5 malignant lymphomas, 4 glioblastomas, 2 medulloblastomas, and 2 other tumors). All patients underwent 3.0-T MRI. Arterial spin labeling (ASL) was used to calculate the relative tumor blood flow normalized to the contralateral gray matter. Dynamic susceptibility contrast (DSC) imaging was used to obtain regional cerebral blood flow, regional and corrected cerebral blood volume (CBV), and permeability index (K2) values. Regions of interest (ROIs) were placed within the contrast-enhancing areas. Results: The relative ASL values and corrected CBV were significantly higher in hemangioblastomas than in other tumors (p < 0.001). Relative ASL showed the highest diagnostic performance (sensitivity, 100%; specificity, 93.3%). Conclusions: Non-contrast ASL showed strong diagnostic performance for identifying posterior fossa hemangioblastomas and may serve as a practical alternative to contrast-enhanced DSC, although ROI placement can be challenging in very small mural nodules.

Internal carotid artery intima-media thickness (IMT) and pulse wave velocity (PWV) are risk factors of cerebrovascular disease and coronary artery disease. They are known as independent predictors of arteriosclerotic disease. It has been reported that IMT and PWV are useful factors for predicting stroke subtype and/or outcome. Coronary artery disease onset is proportional to atherosclerosis progression, and the Framingham Risk Score (FRS) and Suita score (SS) are standard risk predictors. This study examined whether FRS and SS can be useful for patient outcomes with acute infarction in the lenticulostriate artery (LSA) region without special tests or invasive procedures while using IMT or PWV as predictive factors. We screened 629 consecutive patients with ischemic stroke and reviewed 84 patients with acute infarction in the LSA region who were admitted between January 2018 and December 2020. An early deterioration (ED) group was defined. In addition, the clinical characteristics, FRS, SS, treatment therapy, and neurovascular findings were evaluated. FRS and SS (FRS: 11.6 vs. 8.3, p < 0.01, SS: 58.2 vs. 53.7, p = 0.01, respectively), pre-symptomatic modified Rankin Scale (mRS) (p = 0.03), mRS at discharge (p < 0.01), and deterioration of manual muscle test (MMT) (<0.01) were significantly higher in patients in the ED (34 patients) group than in the no-ED group (54 patients). FRS and SS were correlated with mRS deterioration (FRS: r = 0.47; p < 0.01, SS: r = 0.23; p = 0.03). Among the laboratory parameters, total cholesterol (TC) (p < 0.01) and low-density lipoprotein cholesterol (LDL-C) (p < 0.01) were significantly higher in the ED group, and no significant differences in any acute therapeutic interventions. Atherosclerosis risk scores, such as FRS and SS, may be useful for predicting outcomes in patients with acute LSA-region infarctions within 48 hours of onset.