br Discussion Aneurysms of the VA complex are relatively

Discussion Aneurysms of the VA complex are relatively uncommon. More than 80% of PICA aneurysms arise from where the PICA originates from the VA. The mean age at onset in such patients has been shown to be 46.1 years (range 22–71), and most patients have been males. There is a high incidence of fusiform nonsaccular aneurysms at vertebrobasilar locations, much more frequent than in the anterior circulation. Many fusiform aneurysms that occur at the VA are due to dissections and carry a high risk of bleeding. The most frequent clinical presentation of VA or PICA aneurysms is SAH. These aneurysms typically present with neck pain over the posterior cervical and occipital region, but may also be expressed by generalized severe headache and even by altered consciousness. In PICA aneurysms, the patients may manifest headache, and in a majority, vertigo and drowsiness. In addition, unruptured VA, PICA, or vertebrobasilar aneurysms can display lower cranial nerve dysfunction, brainstem compression, or posterior fossa symptoms such as nausea, vomiting, imbalance, or ataxia. Early treatment for ruptured aneurysms is critical because of a high re-bleeding rate and the potential risk of direct brainstem myd88 inhibitor leading to a high mortality rate. Postoperative temporary or permanent lower cranial nerve palsies occur in almost half of all cases. Endovascular occlusion of PICA aneurysms increases the risk of ischemia in the PICA territory. However, the risk of permanent morbidity is fairly low. Patients with cervical myeloradiculopathy may have pain in the neck or arm, and most have symptoms of limb dysfunction. The symptoms of upper extremities may include weakness, stiffness, or clumsiness. Similarly, the symptoms of lower extremities may include weakness, difficulty in walking, and loss of balance. The translational motion in discs of the cervical spine accelerates further degeneration. Static spinal cord compression in intervertebral spaces of disc degeneration and dynamic compression in upper adjacent spaces are occasionally found. In our patient, as there was a history of cervical myelopathy at C4/5 and cervical disc degeneration and stenosis at C5/6 and 6/7, we thought first that his progressively unsteady gait had been caused by these degenerative discs. The symptoms of loss of balance and unstable gait may occur in PICA aneurysms and cervical myelopathy, but it is rare that the symptoms of clumsiness of the hands and spasticity are observed in PICA aneurysms. In this case, the patient felt relief of the symptoms of bilateral arm pain after surgery, but his neck pain and unsteady gait persisted. The persistent symptoms should have promptly warned us to consider other causes, and we now recognize the symptoms may be the early signs of PICA aneurysm and must be quickly addressed.
Conclusions
Introduction Mesenchymal chondrosarcoma is an extremely rare central nervous system (CNS) tumor. It is a variant of chondrosarcoma, itself quite rare and accounting for only 0.16% of all cranial and intracranial tumors. Mesenchymal chondrosarcoma, first described by Lightenstein and Bernstein in 1959, has distinct pathological findings that differentiate it from classical chondrosarcoma. The tumor comprises two components: undifferentiated mesenchymal cells and islets of cartilage. We present a case of mesenchymal chondrosarcoma and review published reports of this entity.
Case report An outpatient magnetic resonance imaging (MRI) of the brain showed a large lobulated tumor in the right middle cranial fossa, causing compression of the right lateral ventricle and a midline shift to the left. The signal intensity was isointense to gray matter on T1- and T2-weighted images. The lesion enhanced strongly after contrast administration (Fig. 1). The preoperative diagnosis was Schwannoma or meningioma of the right middle fossa. An operation was scheduled. Two days before the scheduled surgery, however, the patient was brought to the emergency room with severe headache and fever. She was initially alert but rapidly deteriorated and had a Glasgow Coma Scale score of E3M4V1. The pupils were dilated bilaterally and without light reflex. Brain computed tomography (CT) revealed a lobulated tumor in the right middle cranial fossa with focal bony erosion of the base of the skull and scattered calcification within the mass. There was compression of the right lateral ventricle, right-to-left subfalcine herniation, and right uncal herniation. Perifocal edema was present (Fig. 2A).