Objective: We report a case of cerebral embolism from a bacterial embolus due to infective endocarditis (IE) during treatment of bacterial meningitis.Case Presentation: During treatment of bacterial meningitis, an 82-year-old woman developed left middle cerebral artery embolism. Mechanical thrombectomy was performed, and the yellowish-white emboli were retrieved. From the culture and pathological findings of the embolus, the same bacteria as the meningitis, Streptococcus gordonii, was identified and was considered to originate from IE. She was treated by postoperative antibiotics, but was transferred to the rehabilitation hospital on the 37th postoperative day due to slight right hemiparesis.Conclusion: We should always consider bacterial embolism in acute ischemic stroke combined with bacterial meningitis.
The reported growth rate of vestibular schwannoma varied widely in the literature. However, emergence of vestibular schwannoma remains unsolved. We presented three patients who had undergone previous magnetic resonance imaging (MRI) confirming the absence of tumor and were diagnosed with a unilateral vestibular schwannoma with a diameter of 18–30 mm, 6–9 years after the initial MRI. One patient had solid tumor and experienced stereotactic radiosurgery. Following stereotactic radiosurgery, continuous tumor growth led to hydrocephalus and trigeminal dysfunction, resolved by surgical removal. Other two patients had the tumor with cystic component and experienced surgical removal as first treatment. All tumors were pathologically diagnosed as schwannomas without evidence of high potential of proliferation. This is the first report of three patients with de novo vestibular schwannoma, showing tumor emergence and rapid growth in a short period. Considering a de novo aspect, the “wait and scan” policy may not be appropriate for the subset of VS such as de novo VS.
Spinal cord lipomas concurrent with spinal arteriovenous fistulas (SAVFs) are rare, and their natural history and optimal treatment remain unclear. We report the case of a 44-year-old woman with a history of surgical intervention at 2 months of age for myelomeningocele, with the possibility of lipmyelomingocele based on the surgical history, who presented with progressive paralysis and paresthesia in both lower extremities over 3 years. She was diagnosed with an SAVF concurrent with a congenital spinal lipoma, and transarterial embolization was performed after confirming the absence of neurological symptoms during a provocation test. Postoperative imaging showed reduced T2-weighted high-intensity signals in the spinal cord, and 3 months after the procedure, her neurological symptoms improved significantly, allowing her to transition from nonambulatory wheelchair dependence to ambulation with a double cane. This case highlights the need for detailed imaging and vascular evaluation in patients with spinal lipomas and SAVFs, especially in cases involving the filum terminale type, which is closely associated with the anterior spinal artery. Proximal occlusion may occur if feeders have multiple branches or a long distance to the drainer, increasing the risk of incomplete treatment. A provocation test before embolization can enhance both safety and efficacy.