The T2 hypointensity has been suggested to be associated with intracranial metastatic adenocarcinomas (IMA). The purpose of our study was to determine the association of T2 hypointensity with IMA.

All patients with pathologically confirmed metastatic brain tumors who had a magnetic resonance imaging (MRI) at our institution in the last 10 years were retrospectively assessed. Qualitative assessment of the lesions on MRI was done by two separate readers who were blinded to the pathological diagnosis. For qualitative assessment, the T2 hypointensity in the lesion was compared with the contralateral normal appearing white matter. Odds ratio, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated.

Of 107 patients with intracranial metastasis, only 73 (40 females; 33 males; mean age 61 years) had MRI available for review. Of these, only 46 (25 females; 21 males; mean age 61 years) had pathologically proven IMA. T2 hypointensity was seen in 20% of IMA. The odds ratio of T2 hypointensity in IMA was 3 compared to nonadenocarcinomas but was not statistically significant (p = 0.16). Intralesional hemorrhage was seen in 20. When controlled for hemorrhage, the odds ratio for T2 hypointensity in IMA was 4.7. The specificity, sensitivity, PPV, and NPV for T2 hypointensity to diagnose IMA were 92%, 19%, 81%, and 40%, respectively.

T2 hypointensity was seen only in 20% of IMA with an odds ratio of 4.7. T2 hypointensity showed a high specificity and PPV for diagnosis of IMA.

The objective of this article was to report a case of isolated, acute, right-sided sphenoid sinusitis that progressed to contralateral cavernous sinus thrombosis in an 18-year-old male patient. We describe the atypical presentation of this case and discuss the relevant anatomy, pathogenesis, presentation, diagnostic evaluation and treatment.

A case report of sphenoid sinusitis leading to contralateral cavernous sinus thrombosis was reviewed and presented along with a comprehensive literature review of the relevant anatomy, pathophysiology, microbiology, diagnostic work-up and treatment options.

Cavernous sinus thrombosis is a rare clinical entity in the antibiotic era. However, limited sphenoid sinusitis may progress to cavernous sinus thrombosis in spite of maximal medical treatment, as highlighted in this case report. The mainstay of treatment includes early diagnosis allowing aggressive intravenous antibiotics and appropriate surgical management.

Subclinical infection of the sinuses can result in delayed diagnosis and unusual presenting complications.

This paper describes the case of a 14-year-old boy with a rare combination of periorbital cellulitis, subgaleal abscess and superior sagittal sinus thrombosis following a late presentation of unilateral frontal sinusitis.

Following multiple surgical procedures, and antimicrobial and anticoagulation therapy, the patient made a full recovery.

Serious sinusitis complications still occur, and can do so in unusual combinations with minimal clinical signs. Systemic anticoagulation therapy is considered safe practice in the management of cerebral venous sinus thrombosis and may reduce morbidity and mortality.

Spontaneous pneumocephalus is a rare condition that has been reported infrequently. Alien limb syndrome is an uncommon phenomenon most often seen in patients with frontal and callosal lesions.

Case report of a patient with pneumocephalus presenting with alien limb syndrome. The patient underwent successful surgical management. A literature review and discussion of aspects of this presentation are also included.

In this case, a spontaneous pneumocephalus has formed a frontal space-occupying lesion and presented with alien limb phenomena.

Patients with acute, intracranial bleeding (ICB), particularly from intracranial aneurysms, are believed to be at high risk for rebleeding or neurologic deterioration if subjected to noise, motion, or stress, but are transported by helicopter with increasing frequency. This study was undertaken to examine the characteristics, safety, and outcomes of air transport for patients with acute subarachnoid hemorrhage (SAH) or other forms of acute ICB in an air medical system.

Charts of all patients with spontaneous, acute ICB who were transported by air from 1986 through 1989 were reviewed. Age, gender, time of transport, transport management measures, pre- and post-transport Glasgow Coma Scale (GCS) score, intensive care unit (ICU) and hospital days, operations, and mortality were compiled for all patients and analyzed.

Eighty-seven patients ranging in age from 2 to 83 years (mean: 47.5 ±18.5 years) met entry criteria. The source of bleeding was cerebral aneurysm in 37 patients; intraparenchymal hemorrhage in 29; an unidentified vascular source in 11; and arteriovenous malformation (AVM) in 10. Mean GCS score measured in 69 patients before and after transport was 10.5 ±4.5 Glasgow Coma Scale score did not change during transport in 61 patients (88%), improved in three (4%), and deteriorated in five (7%). Fifty-nine patients (69%) underwent operations, 36 (41%) within 24 hours of arrival. Mean ICU stay was 14 days (95% CI: 12–15); mean hospital stay was 36 days (95% CI: 27–45 days). Overall mortality was 25% (95% CI: 16–34 days). A GCS score of 3 to 8 at time of transport was associated with both increased hospital length of stay and higher mortality. Patients transported within eight hours of symptom onset had lower GCS scores, but out-come measures were not significantly different from those transported later.

Emergency air medical transfer of patients with acute ICB for definitive neurosurgical care appears to be both safe and effective, and facilitates early definitive diagnosis and operative intervention.