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Elendu C, Amaechi DC, Davidson G, Jingwa KA, Elendu TC. Lymphoma of the central nervous system originating from the septum pellucidum region: Two case reports with literature review. Medicine (Baltimore) 2024; 103:e37892. [PMID: 38669431 PMCID: PMC11049786 DOI: 10.1097/md.0000000000037892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 03/22/2024] [Indexed: 04/28/2024] Open
Abstract
RATIONALE Central nervous system lymphoma (CNSL) originating from the septum pellucidum is exceptionally rare, presenting unique diagnostic and therapeutic complexities. This case report aims to elucidate the diagnostic challenges, treatment strategies, and outcomes of this rare manifestation. By documenting this case, we seek to enhance understanding within the medical community and contribute valuable insights to the management of CNSL, particularly in atypical locations. PATIENT CONCERNS A 45-year-old female presented with persistent headaches, blurred vision, and motor weakness, prompting a thorough neurological evaluation. Imaging revealed an enhancing mass in the septum pellucidum, leading to the diagnosis of CNSL. The patient's concerns encompassed not only the physical symptoms but also the emotional impact of her diagnosis and treatment journey. DIAGNOSES Diagnostic confirmation of CNSL involved cerebrospinal fluid analysis and imaging findings, highlighting the challenge of distinguishing lymphoma from other intracranial pathologies. The case underscores the importance of comprehensive diagnostic evaluation in rare CNSL presentations. INTERVENTIONS Multidisciplinary management included high-dose methotrexate-based chemotherapy and corticosteroids, with consideration for neurosurgical intervention. Psychosocial support and self-care strategies were integrated into the treatment plan to address holistic patient needs. OUTCOMES Monitoring revealed a positive treatment response, with a reduction observed in the septum pellucidum mass. Regular assessments ensured adherence to interventions and management of treatment-related side effects, contributing to favorable outcomes and improved quality of life for the patient. LESSONS This case emphasizes the significance of meticulous diagnostic evaluation and personalized treatment approaches in managing rare CNSL presentations. Collaboration among specialists and comprehensive patient support is paramount in optimizing outcomes and addressing the multifaceted challenges posed by CNSL in unique anatomical locations.
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Chen D, Yan X, Lu L, Xue K, Dong X. Lymphoma of the central nervous system originating from the septum pellucidum region: Two case reports with literature review. Medicine (Baltimore) 2023; 102:e35954. [PMID: 37986283 PMCID: PMC10659664 DOI: 10.1097/md.0000000000035954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 10/10/2023] [Accepted: 10/13/2023] [Indexed: 11/22/2023] Open
Abstract
RATIONALE Non-Hodgkin lymphoma affecting the brain, eyes, and cerebrospinal fluid without systemic spread is known as primary central nervous system lymphoma (PCNSL). While intracerebroventricular PCNSL is commonly found in the lateral ventricles and the third and fourth ventricles, the occurrence of PCNSL originating from the septum pellucidum is extremely rare. PATIENT CONCERNS Two patients presented with recent memory loss and high cranial pressure. DIAGNOSES Magnetic resonance imaging revealed a clear enhancing lesion in the septum pellucidum region. Pathological examination confirmed that both cases were primary large B-cell lymphoma GCB (germinal center B-cell-like) subtypes located in an "immune-privileged" area. INTERVENTIONS Both patients underwent total tumor resection, and the procedures were successfully completed without surgical complications. OUTCOMES Over a 1-year period, treatment included four cycles of high-dose methotrexate combined with temozolomide. During the follow-up period (19-23 months), no recurrence of the lymphoma was observed. LESSONS In cases of PCNSL in the septum pellucidum, it is crucial to consider it as a potential differential diagnosis for intraventricular tumors. Surgical interventions should focus on maximizing tumor resection while ensuring the protection of critical structures like the fornix and peripheral neural components. The role of surgery compared to biopsy, as well as the long-term complications, necessitates extended follow-up. Additionally, an individualized treatment approach, considering factors such as age, Karnofsky performance score, and organ function assessment, can lead to positive outcomes.
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Affiliation(s)
- Dawei Chen
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Xu Yan
- Department of Pathology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Liuzhe Lu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Kun Xue
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Xuechao Dong
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin, China
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Obame FLO, El Asri AC. Hematoma of cavum septum pellucidum by ruptured aneurysm. Pan Afr Med J 2023; 46:39. [PMID: 38145197 PMCID: PMC10746875 DOI: 10.11604/pamj.2023.46.39.37692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 07/28/2023] [Indexed: 12/26/2023] Open
Affiliation(s)
| | - Abad Chérif El Asri
- Department of Neurosurgery, Mohammed V Military Teaching Hospital, Rabat, Morocco
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Salman MS, Hossain S, Rozovsky K. Neuroimaging Features in Children with Optic Nerve Hypoplasia and Septo-Optic-Pituitary Dysplasia. Can J Neurol Sci 2023:1-9. [PMID: 37492885 DOI: 10.1017/cjn.2023.263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
BACKGROUND Optic nerve hypoplasia (ONH) and septo-optic-pituitary dysplasia (SOD) are common causes of congenital visual impairment. Our primary aim was to investigate the prevalence of abnormal neuroimaging features in patients with these disorders in Manitoba, Canada, and compare them with published reports. METHODS A retrospective neuroimaging review was performed in patients resident in Manitoba with ONH/SOD. RESULTS There were 128 patients (M = 70) with ONH/SOD who had neuroimaging. Their mean age (SD) at the end of the study was 13.2 (7.5) years. Males were significantly more likely to have bilateral ONH and a small optic chiasm size, while females were more likely to have a left ONH and a small left optic chiasm size on neuroimaging (p = 0.049). ONH and small optic chiasm size were seen in most patients on neuroimaging. Absent septum pellucidum was noted in 40%, small pituitary gland size in 28%, neuronal migration disorders (NMD) in 20% (>1 type and bilateral in 13 cases), corpus callosum abnormalities were present in 9%, while olfactory bulbs-tracts and olfactory sulci were absent in 8.6% of cases. Unilateral ONH was not significantly associated with other structural brain abnormalities, while NMD were significantly associated with other midline brain abnormalities including a symmetrically small optic chiasm size. CONCLUSION The prevalence of structural neuroimaging abnormalities in our cohort with ONH/SOD was generally in the same range reported in other studies with corpus callosum abnormalities being relatively less common in our study. Bilateral NMD were relatively common among patients with NMD. The association between sex and ONH laterality requires further study.
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Affiliation(s)
- Michael S Salman
- Section of Pediatric Neurology, Winnipeg Children's Hospital and Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Shakhawat Hossain
- Department of Mathematics and Statistics, University of Winnipeg, Winnipeg, MB, Canada
| | - Katya Rozovsky
- Section of Pediatric Radiology, Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
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Wang JT, Chang TY. Ultrasound Assessment of the Fetal Optic Chiasm. J Med Ultrasound 2023; 31:195-200. [PMID: 38025017 PMCID: PMC10668906 DOI: 10.4103/jmu.jmu_69_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 06/28/2023] [Accepted: 07/04/2023] [Indexed: 12/01/2023] Open
Abstract
This article reviews the literature on different methods of prenatal ultrasound visualization of the optic chiasm (OC) and its applications. Prenatal imaging of the OC is feasible from 19 to 37 weeks of gestation. Evaluation of the OC has been shown crucial in differentiating isolated agenesis of the septum pellucidum from septo-optic dysplasia. Multiple methods can be applied for imaging of the OC, including three-dimensional and two-dimensional ultrasounds in different views, as well as color Doppler. According to the literature, both transabdominal and transvaginal routes produce equally acceptable images. OC visualization might be challenging but can be achieved by developing a standard scanning protocol and raising awareness.
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Affiliation(s)
- Jo-Ting Wang
- Department of Fetal Medicine, Taiji Clinic, Taipei, Taiwan
| | - Tung-Yao Chang
- Department of Fetal Medicine, Taiji Clinic, Taipei, Taiwan
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Khadka C, Gupta U, Bhandari P, Pandey P, Paudel S. A case of closedlip schizencephaly with absent septum pellucidum in an adult presenting with seizure disorder. Clin Case Rep 2023; 11:e7536. [PMID: 37323273 PMCID: PMC10264959 DOI: 10.1002/ccr3.7536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/08/2023] [Accepted: 05/29/2023] [Indexed: 06/17/2023] Open
Abstract
Key Clinical Message To rule out underlying developmental brain defects such as schizencephaly, pediatric seizures necessitate a thorough examination. Adults who receive a diagnosis later in life may face severe management and prognosis difficulties. To avoid underdiagnosis of developing brain abnormalities, imaging should be a part of the workup for pediatric seizures. Imaging is critical to the diagnosis and therapy of such cases. Abstract Closed-lip schizencephaly with the absence of the septum pellucidum is a rare congenital malformation of the brain that can be associated with a variety of neurological conditions. We report the case of a 25-year-old male with left hemiparesis who presented with recurrent seizures from childhood, poorly controlled with medications, and increased tremors. He has been taking anticonvulsant for the last 7 years and is under symptomatic management. Magnetic resonance imaging of the brain revealed closed-lip schizencephaly with absent septum pellucidum.
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Pillai RLI, He J, Madore L, Murphy K. A Prolonged Treatment Associated With Absent Septum Pellucidum in Neonatal Abstinence Syndrome: A Case Report. J Pediatr Health Care 2023; 37:311-314. [PMID: 36925347 DOI: 10.1016/j.pedhc.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/20/2023] [Accepted: 02/10/2023] [Indexed: 03/18/2023]
Abstract
Neonatal abstinence syndrome (NAS) involves a widely variable treatment course among affected individuals. Prognostic indicators that would help predict length of hospital stay and individualize treatment would be valuable to newborns, parents, and hospital staff, including advanced practice registered nurses. We describe a newborn with a prolonged NAS treatment course necessitating high doses of opioids and phenobarbital, found to have an isolated absent septum pellucidum (ASP). We hypothesize a mechanism for an association between an ASP and a difficult NAS treatment course. Should this be substantiated by other cases, it could provide a valuable prognosticator and indicate alternate treatment pathways.
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Lubinsky M, Encha-Razavi F. Delineating septo-optic dysplasia. Birth Defects Res 2022; 114:1343-1353. [PMID: 36200678 DOI: 10.1002/bdr2.2095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 08/05/2022] [Accepted: 09/08/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Septo-optic dysplasia (SOD), once a variable triad of septum pellucidum defects (SPDs), optic nerve hypoplasia (ONH), and hypopituitarism, has had multiple findings added, with uncertain causes, definitions, and limits. METHOD Literature review. RESULTS SOD is a complex vascular sequence with confounders. CONCLUSIONS Proximal anterior cerebral artery trunk disruptions cause overlapping primary effects, giving ONH alone most often, and isolated SPD less. ONH disruptions can spread to pituitary, SPD disruptions to the cerebral cortex, causing schizencephaly and related anomalies. Pituitary defects are rare without ONH, and cortical findings are rare without SPD. Extensions are unidirectional, so isolated pituitary or cortical defects are separate from SOD. Micro- an- ophthalmia, a suggested ONH variant, is not part of SOD. Disruption by-products can affect development, causing cognitive and endocrine issues, and structural anomalies such as corpus callosum thinning, ventriculomegaly, and hippocampal and olfactory findings. Limbic extensions may also contribute to the same structural defects as by-products. Midline CNS developmental anomalies can act as disruptive foci, most likely through vascular variants, but have separate pathogenesis. Relative frequencies of specific pituitary hormone defects change as SOD rates increase. Increasing relative rates of midline CNS developmental defects and cortical anomalies are consistent with rising levels of exogenous exposures sensitizing to midline predispositions.
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Di Pasquo E, Kuleva M, Arthuis C, Morganelli G, Ormitti F, Millischer AE, Grevent D, Ville Y, Ghi T, Salomon LJ. Prenatal diagnosis and outcome of fetuses with isolated agenesis of septum pellucidum: cohort study and meta-analysis. Ultrasound Obstet Gynecol 2022; 59:153-161. [PMID: 34396620 DOI: 10.1002/uog.23759] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/21/2021] [Accepted: 08/02/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To evaluate the postnatal outcome of children with a prenatal diagnosis of apparently isolated agenesis of the septum pellucidum (ASP). METHODS A retrospective cohort study of cases of prenatally diagnosed ASP followed in two tertiary centers and a meta-analysis combining data from the cohort study with data from published studies identified in a systematic review were carried out. Only cases with apparently isolated ASP on antenatal ultrasound and/or magnetic resonance imaging and with available postnatal follow-up data were considered eligible for inclusion. The following outcomes were analyzed: incidence of chromosomal anomalies, agreement between antenatal and postnatal findings, overall incidence of septo-optic dysplasia (SOD) and incidence of major neurological disability (motor, language, coordination or behavioral disorder or epilepsy) in non-SOD children. The incidence of SOD in infants with apparently normal optic pathways on antenatal imaging was also evaluated. RESULTS Fifteen cases of isolated ASP, with median postnatal follow-up of 36 months (range, 12-60 months), were selected from the two centers. Six previously published studies met the inclusion criteria for the systematic review and a total of 78 cases were eligible for the analysis, including the 15 cases from our series. Genetic tests were carried out antenatally in 30 fetuses, of which two had an abnormal result (pooled proportion, 9.0% (95% CI, 1.8-20.7%); I2 = 0%). Additional or discordant imaging findings were noted postnatally in 9/70 (pooled proportion, 13.7% (95% CI, 3.5-29.0%); I2 = 63.9%) cases. Of all 78 neonates with available follow-up, SOD was diagnosed postnatally in 14 (pooled proportion, 19.4% (95% CI, 8.6-33.2%); I2 = 51.2%). In 60 cases, the optic pathways were considered to be normal on antenatal imaging, and six of these (pooled proportion, 9.1% (95% CI, 1.1-24.0%); I2 = 62.0%) were diagnosed postnatally with SOD. Of the 46 infants with available neurological follow-up who were not affected by SOD, a major neurological disability was diagnosed in three (pooled proportion, 6.5% (95% CI, 0.5-18.6%); I2 = 40.1%). CONCLUSIONS In the vast majority of cases with a prenatal diagnosis of apparently isolated ASP, the prognosis is favorable. However, an additional anomaly is detected after birth in about 14% of cases and has a negative impact on clinical outcome. Detailed antenatal assessment of the brain and optic pathways is strongly recommended in order to identify the presence of associated anomalies. Antenatal visualization of apparently normal optic pathways does not rule out SOD. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- E Di Pasquo
- Department of Obstetrics and Gynecology, University Hospital of Parma, Parma, Italy
| | - M Kuleva
- Department of Obstetrics, Hôpital Intercommunal de Montreuil, Montreuil, France
- Department of Obstetrics and Fetal Medicine, Hôpital Necker-Enfants Malades, Assistance Publique-Hopitaux de Paris, Paris Descartes University, Paris, France
| | - C Arthuis
- Department of Obstetrics and Fetal Medicine, Hôpital Necker-Enfants Malades, Assistance Publique-Hopitaux de Paris, Paris Descartes University, Paris, France
| | - G Morganelli
- Department of Obstetrics and Gynecology, University Hospital of Parma, Parma, Italy
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
| | - F Ormitti
- Department of Radiology, University Hospital of Parma, Parma, Italy
| | - A-E Millischer
- Department of Pediatric Radiology, Hôpital Necker-Enfants Malades, APHP, Université Paris Descartes, Paris, France
| | - D Grevent
- Department of Pediatric Radiology, Hôpital Necker-Enfants Malades, APHP, Université Paris Descartes, Paris, France
| | - Y Ville
- Department of Obstetrics and Fetal Medicine, Hôpital Necker-Enfants Malades, Assistance Publique-Hopitaux de Paris, Paris Descartes University, Paris, France
| | - T Ghi
- Department of Obstetrics and Gynecology, University Hospital of Parma, Parma, Italy
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
| | - L J Salomon
- Department of Obstetrics and Fetal Medicine, Hôpital Necker-Enfants Malades, Assistance Publique-Hopitaux de Paris, Paris Descartes University, Paris, France
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Shrestha B, Gurung P, Dhakal S, Rajbhandari P, Basnet RB, Pant B. Ganglioglioma Arising from the Septum Pellucidum. J Neurosci Rural Pract 2021; 12:807-810. [PMID: 34737522 PMCID: PMC8558971 DOI: 10.1055/s-0041-1734007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
A 24-year-old gentleman presented to us with complaints of occasional headache for 2 years. Magnetic resonance imaging showed enhancing supra sellar mass with nonenhancing cystic components, extending superiorly up to the body of bilateral lateral ventricle, laterally displacing septum pellucidum, and compressing the third ventricle with obstructive hydrocephalus. Hormone profile depicted adrenocorticotropic hormone <5.00 pg/mL, growth hormone 1.32 ng/mL, insulin-like growth factor-1 <3.0 ng/mL. The patient underwent surgical resection. Histological finding was suggestive of ganglioglioma World Health Organization grade I. Customized immunohistochemistry panel was advised and revealed positive CD 56, NSE, and GFAP immunohistochemical stains. Gangliogliomas are less frequent neoplastic lesions confined to only a handful of case reports and studies. Accounting less than 2% of intracranial neoplasms, these lesions primarily affect those in the first 3 decades of their life. As ubiquitous it is in nature, we hereby present a case of ganglioglioma in a young adult male arising from septum pellucidum.
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Affiliation(s)
- Bishal Shrestha
- Department of Neurosurgery, Annapurna Neurological Institute and Allied Sciences, Maitighar, Kathmandu, Nepal
| | - Pritam Gurung
- Department of Neurosurgery, Annapurna Neurological Institute and Allied Sciences, Maitighar, Kathmandu, Nepal
| | - Sudan Dhakal
- Department of Neurosurgery, Annapurna Neurological Institute and Allied Sciences, Maitighar, Kathmandu, Nepal
| | - Pravesh Rajbhandari
- Department of Neurosurgery, Annapurna Neurological Institute and Allied Sciences, Maitighar, Kathmandu, Nepal
| | - Ranga Bahadur Basnet
- Department of Neuropathology, Annapurna Neurological Institute and Allied Sciences, Maitighar, Kathmandu, Nepal
| | - Basant Pant
- Department of Neurosurgery, Annapurna Neurological Institute and Allied Sciences, Maitighar, Kathmandu, Nepal
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Takigawa K, Hata N, Sangatsuda Y, Suzuki SO, Sirozu N, Hatae R, Akagi Y, Iwaki T, Nagata S, Mizoguchi M. Intraventricular mucin-producing glioblastoma arising in the septum pellucidum at the frontal horn of the lateral ventricle: A case report. Neuropathology 2021; 41:381-386. [PMID: 34382251 DOI: 10.1111/neup.12759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/05/2021] [Accepted: 05/07/2021] [Indexed: 01/01/2023]
Abstract
Glioblastoma (GBM) most commonly appears to be intraparenchymal tumor, and intraventricular GBMs are rarely reported. In previous reports, the sites of origin were not identified. Here, we report a rare case of intraventricular mucin-producing GBM in a 73-year-old woman who had a strongly enhancing tumor in the right anterior horn of the lateral ventricle. The tumor had previously been identified one and a half years ago as a small asymptomatic lesion attached to the septum pellucidum. It had been documented to gradually enlarge during subsequent follow-up examinations. The patient underwent a gross total resection of the tumor, and a soft and gelatinous mass was observed. The pathological diagnosis was compatible with GBM, and numerous tumor cells having cytoplasmic mucin vacuoles were observed. Genetic analysis revealed TP53 and NFKBIA deletions. The patient received postoperative concurrent chemotherapy with temozolomide and radiotherapy, followed by maintenance administration of temozolomide. A follow-up examination seven months later detected an asymptomatic local recurrent lesion, which was treated with gamma-knife therapy, followed by bevacizumab administration for six months. The patient has remained clinically well for five years following surgery. The origin of a rare tumor entity, intraventricular GBM, and the specific spatial and pathological findings in our case are discussed in this report.
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Affiliation(s)
- Kosuke Takigawa
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Nobuhiro Hata
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuhei Sangatsuda
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satoshi O Suzuki
- Department of Neuropathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Noritoshi Sirozu
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ryusuke Hatae
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yojiro Akagi
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toru Iwaki
- Department of Neuropathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shinji Nagata
- Department of Neurosurgery, Clinical Research Institute, National Kyushu Medical Center, Fukuoka, Japan
| | - Masahiro Mizoguchi
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Bhagat R, Smith E, Rizenbergs K, Sagi V. Isolated Agenesis of Septum Pellucidum and Adult-Onset Seizure Tendency With Eye Closure Sensitivity. Cureus 2021; 13:e15463. [PMID: 34258125 PMCID: PMC8256847 DOI: 10.7759/cureus.15463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2021] [Indexed: 11/17/2022] Open
Abstract
Septum pellucidum is a thin midline membrane that separates the anterior horns of the lateral ventricle. Agenesis of septum pellucidum (ASP) is considered a continuum of forebrain maldevelopment. Isolated ASP is a rare radiographic finding of unclear significance. We report a case of a 42-year-old male with ASP who presented with a new-onset seizure and eye closure sensitivity seen in the electroencephalogram. Magnetic resonance imaging of the brain confirmed the ASP. In the absence of data about the association between seizure and ASP, further studies are needed to determine its significance.
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Affiliation(s)
- Riwaj Bhagat
- Department of Neurology, University of Louisville School of Medicine, Louisville, USA
| | - Elizabeth Smith
- Department of Neurology, University of Louisville School of Medicine, Louisville, USA
| | - Kyle Rizenbergs
- Department of Neurology, University of Louisville School of Medicine, Louisville, USA
| | - Vishwanath Sagi
- Department of Neurology, University of Louisville School of Medicine, Louisville, USA
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Loft MK, Rafaelsen SR, Pedersen MRV. Spontaneous dissolution of a cyst located within the septum pellucidum in a patient with sarcoidosis: a case report. Acta Radiol Open 2021; 10:2058460120985519. [PMID: 33489313 PMCID: PMC7804360 DOI: 10.1177/2058460120985519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 12/09/2020] [Indexed: 11/16/2022] Open
Abstract
Sarcoidosis is a granulomatous multisystem disease of unknown etiology. Typically, the disease affects the lungs, causing enlargement of the mediastinal lymph nodes, but other organs can be affected. Neurosarcoidosis is reported in 5-10% of the patients. This case represents a 39-year-old male patient diagnosed with lung sarcoidosis. Due to neurological symptoms, a contrast-enhanced cerebral magnetic resonance imaging was performed. Neurosarcoidosis was presented with meningeal enhancement adjacent to a cyst located within the cavum septum pellucidum. The cyst dissolved spontaneously within six months. The finding of a cyst located within the septum pellucidum is rare.
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Affiliation(s)
- Martina Kastrup Loft
- Department of Radiology, Lillebaelt Hospital, Vejle Hospital, Vejle, Denmark.,Institute of Regional Health, University of Southern Denmark, Odense, Denmark
| | - Søren Rafael Rafaelsen
- Department of Radiology, Lillebaelt Hospital, Vejle Hospital, Vejle, Denmark.,Institute of Regional Health, University of Southern Denmark, Odense, Denmark
| | - Malene Roland V Pedersen
- Department of Radiology, Lillebaelt Hospital, Vejle Hospital, Vejle, Denmark.,Institute of Regional Health, University of Southern Denmark, Odense, Denmark
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Roberti F, Bell J. Septum Pellucidum Chronic Encapsulated Hematoma With Osseous Metaplasia Mimicking Recurrent Astrocytoma and Shunt-Related Foreign Body Granuloma. Cureus 2020; 12:e9839. [PMID: 32953346 PMCID: PMC7497210 DOI: 10.7759/cureus.9839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
We present a very rare case of chronic encapsulated intracerebral hematoma involving the septum pellucidum and the foramen of Monro that by location radiological appearance, and clinical history was mimicking a recurrent astrocytoma or a shunt-related foreign body granuloma. A young adult underwent the resection of a juvenile pilocytic astrocytoma as a child, and with a mass encasing the tip of an old non-functioning ventricular catheter, the differential diagnosis of shunt-related foreign body granuloma versus recurrent low-grade glioma was raised. Although chronic encapsulated intracerebral hematomas have been reported in the literature, the anatomical location of the lesion in the presented case was unique, with radiological and history findings also posing a peculiar diagnostic challenge. Chronic encapsulated intracerebral hematomas are benign entities that may also be found to involve deep and midline supra-tentorial structures usually not prone to spontaneous intraparenchymal hemorrhages. When symptomatic, surgical resection of the hematoma can be both diagnostic and curative.
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Affiliation(s)
- Fabio Roberti
- Neurosurgery, Cleveland Clinic Indian River Hospital, Vero Beach, USA.,Neurosurgery, George Washington University School of Medicine and Health Sciences, Washington, USA
| | - Julie Bell
- Pathology, Cleveland Clinic Indian River Hospital, Vero Beach, USA
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15
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Sagan L, Limanówka B, Herbowski L, Poncyljusz W, Giżewska M. Expanding Cyst of the Septum Pellucidum - Endoscopic Observations on the Mechanism of Development and Results of Treatment. Neurol Med Chir (Tokyo) 2020; 60:202-208. [PMID: 32132343 PMCID: PMC7174244 DOI: 10.2176/nmc.oa.2019-0001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Cysts of the septum pellucidum (CSP) are usually asymptomatic; however, in some cases they can begin expanding and cause neurological deterioration. The mechanism leading to the formation of an expanding cyst of the septum pellucidum (ECSP) is not known. Based on observations made during endoscopic treatment of ECSP we analyzed intraoperative findings in respect to cyst formation mechanism and treatment prognosis. A group of 31 patients was studied. Only cases with bulging cyst walls occupying the frontal horns observed on imaging studies were included. The main symptom was a severe, intermittent headache. In three cases short term memory deficits were diagnosed. In one case papilloedema was observed. All patients underwent endoscopic fenestration of the ECSP. There were no cases of cyst reocclusion during a follow-up period of 1–14 years (mean 6.2 years). In 30 cases headaches resolved completely and in one case its intensity was significantly smaller. There was one case of postoperative hemiparesis. In all but two cases the thin, translucent region in the anterior part of the cyst floor was found. In the region small fissures and in three cases choroid plexus were observed. Endoscopic fenestration is the efficient treatment for ECSP. ECSP is formed on the basis of not completely closed, developmental communication of the cyst with other fluid spaces. The communication is opened by transient elevation of intraventricular pressure, and acts as a valve leading to fluid accumulation among the walls of the previously asymptomatic cavum septum pellucidum.
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Affiliation(s)
- Leszek Sagan
- Department of Neurosurgery and Pediatric Neurosurgery, Pomeranian Medical University in Szczecin
| | - Bartosz Limanówka
- Department of Neurosurgery and Pediatric Neurosurgery, Pomeranian Medical University in Szczecin
| | - Leszek Herbowski
- Department of Neurosurgery and Neurotraumatology, Regional Public Hospital
| | - Wojciech Poncyljusz
- Department of Interventional Radiology, Pomeranian Medical University in Szczecin
| | - Maria Giżewska
- Department of Pediatrics, Endocrinology, Cardiology and Metabolic Diseases, Pomeranian Medical University in Szczecin
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16
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Lucas CHG, Villanueva-Meyer JE, Whipple N, Oberheim Bush NA, Cooney T, Chang S, McDermott M, Berger M, Cham E, Sun PP, Putnam A, Zhou H, Bollo R, Cheshier S, Poppe MM, Fung KM, Sung S, Glenn C, Fan X, Bannykh S, Hu J, Danielpour M, Li R, Alva E, Johnston J, Van Ziffle J, Onodera C, Devine P, Grenert JP, Lee JC, Pekmezci M, Tihan T, Bollen AW, Perry A, Solomon DA. Myxoid glioneuronal tumor, PDGFRA p.K385-mutant: clinical, radiologic, and histopathologic features. Brain Pathol 2019; 30:479-494. [PMID: 31609499 DOI: 10.1111/bpa.12797] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 10/07/2019] [Indexed: 02/06/2023] Open
Abstract
"Myxoid glioneuronal tumor, PDGFRA p.K385-mutant" is a recently described tumor entity of the central nervous system with a predilection for origin in the septum pellucidum and a defining dinucleotide mutation at codon 385 of the PDGFRA oncogene replacing lysine with either leucine or isoleucine (p.K385L/I). Clinical outcomes and optimal treatment for this new tumor entity have yet to be defined. Here, we report a comprehensive clinical, radiologic, and histopathologic assessment of eight cases. In addition to its stereotypic location in the septum pellucidum, we identify that this tumor can also occur in the corpus callosum and periventricular white matter of the lateral ventricle. Tumors centered in the septum pellucidum uniformly were associated with obstructive hydrocephalus, whereas tumors centered in the corpus callosum and periventricular white matter did not demonstrate hydrocephalus. While multiple patients were found to have ventricular dissemination or local recurrence/progression, all patients in this series remain alive at last clinical follow-up despite only biopsy or subtotal resection without adjuvant therapy in most cases. Our study further supports "myxoid glioneuronal tumor, PDGFRA p.K385-mutant" as a distinct CNS tumor entity and expands the spectrum of clinicopathologic and radiologic features of this neoplasm.
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Affiliation(s)
| | | | - Nicholas Whipple
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Utah, Salt Lake City, UT
| | - Nancy Ann Oberheim Bush
- Division of Neuro-Oncology, Department of Neurological Surgery, University of California, San Francisco, CA.,Department of Neurology, University of California, San Francisco, CA
| | - Tabitha Cooney
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of California, San Francisco, CA
| | - Susan Chang
- Division of Neuro-Oncology, Department of Neurological Surgery, University of California, San Francisco, CA.,Department of Neurology, University of California, San Francisco, CA
| | - Michael McDermott
- Department of Neurological Surgery, University of California, San Francisco, CA
| | - Mitchel Berger
- Department of Neurological Surgery, University of California, San Francisco, CA
| | - Elaine Cham
- Department of Pathology, UCSF Benioff Children's Hospital Oakland, Oakland, CA
| | - Peter P Sun
- Department of Neurosurgery, UCSF Benioff Children's Hospital Oakland, Oakland, CA
| | - Angelica Putnam
- Department of Pathology, University of Utah, Salt Lake City, UT
| | - Hong Zhou
- Department of Pathology, University of Utah, Salt Lake City, UT
| | - Robert Bollo
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Utah, Salt Lake City, UT
| | - Samuel Cheshier
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Utah, Salt Lake City, UT
| | - Matthew M Poppe
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Kar-Ming Fung
- Department of Pathology, University of Oklahoma, Oklahoma City, OK
| | - Sarah Sung
- Department of Neurology, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Chad Glenn
- Department of Neurosurgery, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Xuemo Fan
- Department of Pathology, Cedars Sinai Medical Center, Los Angeles, CA
| | - Serguei Bannykh
- Department of Pathology, Cedars Sinai Medical Center, Los Angeles, CA
| | - Jethro Hu
- Department of Neurology, Cedars Sinai Medical Center, Los Angeles, CA
| | - Moise Danielpour
- Department of Neurosurgery, Cedars Sinai Medical Center, Los Angeles, CA
| | - Rong Li
- Department of Pathology, Children's Hospital of Alabama, Birmingham, AL
| | - Elizabeth Alva
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Children's Hospital of Alabama, Birmingham, AL
| | - James Johnston
- Department of Neurosurgery, Children's Hospital of Alabama, Birmingham, AL
| | - Jessica Van Ziffle
- Department of Pathology, University of California, San Francisco, CA.,Clinical Cancer Genomics Laboratory, University of California, San Francisco, CA
| | - Courtney Onodera
- Department of Pathology, University of California, San Francisco, CA.,Clinical Cancer Genomics Laboratory, University of California, San Francisco, CA
| | - Patrick Devine
- Department of Pathology, University of California, San Francisco, CA.,Clinical Cancer Genomics Laboratory, University of California, San Francisco, CA
| | - James P Grenert
- Department of Pathology, University of California, San Francisco, CA.,Clinical Cancer Genomics Laboratory, University of California, San Francisco, CA
| | - Julieann C Lee
- Department of Pathology, University of California, San Francisco, CA
| | - Melike Pekmezci
- Department of Pathology, University of California, San Francisco, CA
| | - Tarik Tihan
- Department of Pathology, University of California, San Francisco, CA
| | - Andrew W Bollen
- Department of Pathology, University of California, San Francisco, CA
| | - Arie Perry
- Department of Pathology, University of California, San Francisco, CA.,Department of Neurological Surgery, University of California, San Francisco, CA
| | - David A Solomon
- Department of Pathology, University of California, San Francisco, CA.,Clinical Cancer Genomics Laboratory, University of California, San Francisco, CA
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17
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Barany L, Meszaros C, Ganslandt O, Buchfelder M, Kurucz P. Neural and vascular architecture of the septum pellucidum: an anatomical study and considerations for safe endoscopic septum pellucidotomy. J Neurosurg 2019; 133:1-10. [PMID: 31374555 DOI: 10.3171/2019.5.jns19754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 05/01/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The septum pellucidum is a bilateral thin membranous structure representing the border between the frontal horns of the lateral ventricles. Its most examined components are the septal veins due to their surgical importance during endoscopic septum pellucidotomy (ESP), which is a well-accepted method for surgical treatment of unilateral hydrocephalus. It is widely accepted that the septum pellucidum contains nerve fibers as well, but interestingly, no anatomical study has been addressed to its neural components before. The aim of the present study was to identify these elements as well as their relations to the septal veins and to define major landmarks within the ventricular system for neurosurgical use. METHODS Nine formalin-fixed human cadaveric brains (18 septa pellucida) were involved in this study. A central block containing both septa pellucida was removed and frozen at -30°C for 2 weeks in 7 cases. The fibers of the septum pellucidum and the adjacent areas including the venous elements were dissected under magnification by using homemade wooden spatulas and microsurgical instruments. In 2 cases a histological technique was used to validate the findings of the dissections. The blocks were sliced, embedded in paraffin, cut in 7-µm-thick slices, and then stained as follows: 1) with H & E, 2) with Luxol fast blue combined with cresyl violet, and 3) with Luxol fast blue combined with Sirius red. RESULTS The septum pellucidum and the subjacent septum verum form the medial wall of the frontal horn of the lateral ventricle. Both structures contain nerve fibers that were organized in 3 groups: 1) the precommissural fibers of the fornix; 2) the inferior fascicle; and 3) the superior fascicle of the septum pellucidum. The area directly rostral to the postcommissural column of the fornix consisted of macroscopically identifiable gray matter corresponding to the septal nuclei. The histological examinations validated the findings of the authors' fiber dissections. CONCLUSIONS The nerve elements of the septum pellucidum as well as the subjacent septum verum were identified with fiber dissection and verified with histology for the first time. The septal nuclei located just anterior to the fornix and the precommissural fibers of the fornix should be preserved during ESP. Considering the venous anatomy as well as the neural architecture of the septum pellucidum, the fenestration should ideally be placed above the superior edge of the fornix and preferably dorsal to the interventricular foramen.
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Affiliation(s)
- Laszlo Barany
- 1Laboratory for Applied and Clinical Anatomy, Department of Anatomy, Histology, and Embryology, Semmelweis University, Budapest, Hungary
| | - Cintia Meszaros
- 1Laboratory for Applied and Clinical Anatomy, Department of Anatomy, Histology, and Embryology, Semmelweis University, Budapest, Hungary
| | - Oliver Ganslandt
- 2Department of Neurosurgery, Katharinenhospital, Klinikum Stuttgart, Germany; and
| | - Michael Buchfelder
- 3Department of Neurosurgery, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Peter Kurucz
- 2Department of Neurosurgery, Katharinenhospital, Klinikum Stuttgart, Germany; and
- 3Department of Neurosurgery, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
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18
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Kozyolkin O, Kuznietsov A, Novikova L. Prediction of the Lethal Outcome of Acute Recurrent Cerebral Ischemic Hemispheric Stroke. Medicina (Kaunas) 2019; 55:medicina55060311. [PMID: 31242700 PMCID: PMC6631068 DOI: 10.3390/medicina55060311] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/17/2019] [Accepted: 06/20/2019] [Indexed: 01/04/2023]
Abstract
Background and objectives. Stroke-induced mortality is the third most common cause of death in developed countries. Intense interest has focused on the recurrent ischemic stroke, which rate makes up 30% during first 5 years after first-ever stroke. This work aims to develop criteria for the prediction of acute recurrent cerebral ischemic hemispheric stroke (RCIHS) outcome on the basis of comprehensive baseline clinical, laboratory, and neuroimaging examinations. Materials and Methods. One hundred thirty-six patients (71 males and 65 females, median age 74 (65; 78)) with acute RCIHS were enrolled in the study. All patients underwent a detailed clinical and neurological examination using National Institutes of Health Stroke Scale (NIHSS), computed tomography of the brain, hematological, and biochemical investigations. In order to detect the dependent and independent risk factors of the lethal outcome of the acute period of RCIHS, univariable and multivariable regression analysis were conducted. A receiver operating characteristic (ROC) analysis with the calculation of sensitivity and specificity was performed to determine the prediction variables. Results. Twenty-five patients died. The independent predictors of the lethal outcome of acute RCIHS were: Baseline NIHSS score (OR 95% CІ 1.33 (1.08-1.64), p = 0.0003), septum pellucidum displacement (OR 95% CI 1.53 (1.17-2.00), p = 0.0021), glucose serum level (OR 95% CI 1.28 (1.09-1.50), p = 0.0022), neutrophil-to-lymphocyte ratio (OR 95% CI 1.11 (1.00-1.21), p = 0.0303). The mathematical model, which included these variables was developed and it could determine the prognosis of lethal outcome of the acute RCIHS with an accuracy of 86.8% (AUC = 0.88 ± 0.04 (0.88-0.93), p < 0.0001).
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Affiliation(s)
- Olexandr Kozyolkin
- Department of Nervous Disease Zaporizhzhia State Medical University, 69035 Zaporizhzhia, Ukraine.
| | - Anton Kuznietsov
- Department of Nervous Disease Zaporizhzhia State Medical University, 69035 Zaporizhzhia, Ukraine.
| | - Liubov Novikova
- Department of Nervous Disease Zaporizhzhia State Medical University, 69035 Zaporizhzhia, Ukraine.
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Abstract
INTRODUCTION Cases of isolated septum pellucidum infarction have not yet been reported. To date, there are only 2 stroke reports involving septum pellucidum infarction. The etiology of septum pellucidum infarction was subcallosal artery (ScA) injury. The abnormalities were strictly confined to the septum pellucidum and the right cingulated gyrus, making this the first case to report such confined abnormalities. PATIENT CONCERNS In this report, we present a case of ischemic stroke confined to the septum pellucidum and cingulated gyrus in a 48-year-old male patient who presented with transient ischemic attack-like paroxysmal lower left limb weakness. DIAGNOSIS Even no obvious abnormalities were revealed by an emergency computed tomography, the infarction in the combined territories of the septum pellucidum and the cingulate gyrus was detected on magnetic resonance imaging. INTERVENTIONS Aspirin with clopidogrel was administered for 3 weeks as a secondary preventive drug. Clopidogrel was selected as a long-term antiplatelet drug based on a thromboelastogram. OUTCOMES The patient showed no positive signs related to the nervous system in the hospital, and there was no recurrence during the 3-month follow-up. CONCLUSIONS Infarction in the septum pellucidum and cingulate gyrus is rare and has atypical clinical manifestations. Physical examination may not yield obvious positive signs. False-negative computed tomography findings of the head may result in misdiagnosis. Thus, it is necessary to perform whole-brain magnetic resonance imaging in time. Moreover, ScA protection should be paid attention to during surgery for anterior communicating artery aneurysm.
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Affiliation(s)
- Sui-Yi Xu
- Department of Neurology, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi
- Department of Neurology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, Guangdong, China
| | - Fu-Chun Xi
- Department of Neurology, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi
| | - Xiao-Wei Wu
- Department of Neurology, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi
| | - Chang-Xin Li
- Department of Neurology, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi
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20
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Vawter-Lee MM, Wasserman H, Thomas CW, Nichols B, Nagaraj UD, Schapiro M, Venkatesan C. Outcome of Isolated Absent Septum Pellucidum Diagnosed by Fetal Magnetic Resonance Imaging (MRI) Scan. J Child Neurol 2018; 33:693-699. [PMID: 29944054 DOI: 10.1177/0883073818783460] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Improved fetal imaging has resulted in increased diagnosis of isolated absent septum pellucidum without other intracranial abnormalities. There is little literature regarding outcomes for these fetuses. This study hypothesized the majority of infants diagnosed by fetal magnetic resonance imaging (MRI) with isolated absent septum pellucidum would retain this diagnosis postnatally. Specifically, in the absence of postnatal endocrine or ophthalmologic abnormalities, postnatal imaging would find no additional related findings, and fetuses would be at low risk for developmental delay. Two of 8 subjects met postnatal criteria for septo-optic dysplasia; remaining subjects had normal postnatal endocrine and ophthalmologic evaluations and no significant related findings on postnatal MRI. One subject without septo-optic dysplasia had delays on developmental screening; all others had normal screening (range of follow-up 8-72 months). Our study questions the necessity of postnatal imaging for prenatally diagnosed isolated absent septum pellucidum. Majority of fetuses with isolated absent septum pellucidum retained this diagnosis postnatally.
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Affiliation(s)
- Marissa M Vawter-Lee
- 1 Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,2 Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Halley Wasserman
- 2 Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,3 Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Cameron W Thomas
- 1 Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,2 Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Beatrice Nichols
- 4 University of Cincinnati, College of Medicine, Cincinnati, OH, USA
| | - Usha D Nagaraj
- 5 Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Mark Schapiro
- 1 Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,2 Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Charu Venkatesan
- 1 Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,2 Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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21
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Abstract
Gliosarcomas are lesions with both glial and sarcomatous elements and are usually seen abutting the dura. Intraventricular location is extremely rare. Such an unusual intraventricular gliosarcoma is being reported.
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Affiliation(s)
| | | | - Kim Vaiphei
- Department of Histopathology, PGIMER, Chandigarh, India
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22
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Viñals F, Ruiz P, Correa F, Gonçalves Pereira P. Two-dimensional visualization and measurement of the fetal optic chiasm: improving counseling for antenatal diagnosis of agenesis of the septum pellucidum. Ultrasound Obstet Gynecol 2016; 48:733-738. [PMID: 26776289 DOI: 10.1002/uog.15862] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 12/25/2015] [Accepted: 01/08/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To develop an objective method for visualizing and measuring the fetal optic chiasm (OC) using transvaginal two-dimensional (2D) ultrasound in the coronal plane and to report measurements in fetuses with agenesis of the septum pellucidum (SP). METHODS This was a prospective cross-sectional study of 115 morphologically normal fetuses in low-risk pregnancies, between 21 and 30 weeks' gestation. The OC was measured in a coronal plane at the level of the third ventricle and was seen as a horizontally aligned dumbbell-shaped structure of moderate echogenicity. In addition, OC measurements from eight fetuses with agenesis of the SP and complete follow-up were compared with the reference range. RESULTS OC measurements were obtained in 110/115 normal fetuses and showed that OC increases linearly with gestational age. Our method of measurement demonstrated good intraobserver repeatability and excellent interobserver reproducibility. Among the eight fetuses with agenesis of the SP, five had normal OC measurements and five had normal vision postnatally. Pregnancy continued to term in all cases and the follow-up period varied from 6 months to 7 years. CONCLUSION Our study demonstrates that it is possible to visualize and measure the OC directly on a 2D ultrasound coronal plane. In fetuses with agenesis of the SP, the morphology and width of the OC visual pathway could prove a relevant tool for assessing its development. It would also help in the difficult task of providing antenatal counseling when faced with the diagnosis of agenesis of the SP. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- F Viñals
- Centro AGB Ultrasonografía, Clínica Sanatorio Alemán and Facultad de Medicina, Universidad de Concepción, Concepción, Chile
| | - P Ruiz
- Centro AGB Ultrasonografía, Clínica Sanatorio Alemán and Facultad de Medicina, Universidad de Concepción, Concepción, Chile
- Hospital Costa del Sol, Marbella, Spain
| | - F Correa
- Fetal and Neonatal Ultrasound Department, Hospital Fernando Fonseca, Lisbon, Portugal
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Milosevic G, Müller U, Niemann T. [An Uncommon Cerebral Lesion in Computed Tomography]. Praxis (Bern 1994) 2016; 105:343-346. [PMID: 26980686 DOI: 10.1024/1661-8157/a002305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We report the case of a 84-year-old man who suffered a hematoma of the septum pellucidum due to a fall. The development of the septum pellucidum and its implications on pathomechanisms in head injury are discussed. In the setting of trauma, a reliable differentiation to other septal lesions can be impossible in computed tomography alone, unless earlier examinations are availabe for comparison. Additional magnetic resonance imaging may be warranted in case of vicinity of the lesion to the interventricular foramina.
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Affiliation(s)
| | - Uta Müller
- 1 Institut für Radiologie, Kantonsspital Baden
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24
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Lauretti L, Mattogno PP, Bianchi F, Pallini R, Fernandez E, Doglietto F. Treatment of giant congenital cysts of the midline in adults: Report of two cases and review of the literature. Surg Neurol Int 2015; 6:S371-4. [PMID: 26421217 PMCID: PMC4553637 DOI: 10.4103/2152-7806.163317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 05/20/2015] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Giant cysts of the midline, not associated to a tumor, are exceptional finding in the brain of adults. Here we present two cases of symptomatic giant cerebral cysts of the midline occurred in an elderly and in a young adult patients both treated with mini-invasive unilateral neuroendoscopic procedure. In the recent literature (since 1999) similar cases have not been reported. Beside the clinical report, review of literature and major anatomical features of the region are described. CASE DESCRIPTION These two adults (82 and 41 years old respectively) had a slow progressive development of headache, gait disturbances, memory impairment and urinary incontinence. Magnetic resonance imaging showed giant cyst of the midline and hydrocephalus. Surgery with the endoscopic procedure, through a right frontal burr hole, was followed by clinical and radiological improvement. CONCLUSION Giant cerebral cysts of the midline in adults can be successfully treated through a neuroendoscopic monolateral approach that comprehends multiple openings, diffuse coagulation of the capsule, and careful releasing of capsule-ependyma adherences. Knowledge of major anatomical and developmental details of the septal region is necessary to avoid complication in a mini-invasive surgical procedure.
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Affiliation(s)
- Liverana Lauretti
- Institute of Neurosurgery, Catholic University School of Medicine, Rome, Italy
| | - Pier Paolo Mattogno
- Institute of Neurosurgery, Catholic University School of Medicine, Rome, Italy
| | - Federico Bianchi
- Institute of Neurosurgery, Catholic University School of Medicine, Rome, Italy
| | - Roberto Pallini
- Institute of Neurosurgery, Catholic University School of Medicine, Rome, Italy
| | - Eduardo Fernandez
- Institute of Neurosurgery, Catholic University School of Medicine, Rome, Italy
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25
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Hariri OR, Quadri SA, Farr S, Gupta R, Bieber AJ, Dyurgerova A, Corsino C, Miulli D, Siddiqi J. Third Ventricular Glioblastoma Multiforme: Case Report and Literature Review. J Neurol Surg Rep 2015; 76:e227-32. [PMID: 26623232 PMCID: PMC4648723 DOI: 10.1055/s-0035-1560048] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 06/12/2015] [Indexed: 12/27/2022] Open
Abstract
Background Glioblastoma multiforme (GBM) typically presents in the supratentorial white matter, commonly within the centrum semiovale as a ring-enhancing lesion with areas of necrosis. An atypical presentation of this lesion, both anatomically as well as radiographically, is significant and must be part of the differential for a neoplasm in this anatomical location. Case Description We present a case of a 62-year-old woman with headaches, increasing somnolence, and cognitive decline for several weeks. Magnetic resonance imaging demonstrated mild left ventricular dilatation with a well-marginated, homogeneous, and nonhemorrhagic lesion located at the ceiling of the third ventricle within the junction of the septum pellucidum and fornix, without exhibiting the typical radiographic features of hemorrhage or necrosis. Final pathology reports confirmed the diagnosis of GBM. Conclusion This case report describes an unusual location for the most common primary brain neoplasm. Moreover, this case identifies the origin of a GBM related to the paracentral ventricular structures infiltrating the body of the fornix and leaves of the septum pellucidum. To our knowledge this report is the first reported case of a GBM found in this anatomical location with an entirely atypical radiographic presentation.
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Affiliation(s)
- Omid R Hariri
- Department of Neurosurgery, Arrowhead Regional Medical Center, Colton, California, United States ; Department of Neurosurgery, Institute of Clinical Orthopedics and Neurosciences, Desert Regional Medical Center, Palm Springs, California, United States
| | - Syed A Quadri
- Department of Neurosurgery, Arrowhead Regional Medical Center, Colton, California, United States ; Department of Neurosurgery, Institute of Clinical Orthopedics and Neurosciences, Desert Regional Medical Center, Palm Springs, California, United States
| | - Saman Farr
- Division of Neurosurgery, Department of Surgery, College of Osteopathic Medicine, Western University of Health Sciences, Pomona, California, United States
| | - Ravi Gupta
- Department of Radiology, Harbor-UCLA Medical Center, Torrance, California, United States
| | - Andrew J Bieber
- Department of Neurosurgery, Arrowhead Regional Medical Center, Colton, California, United States ; Department of Neurosurgery, Institute of Clinical Orthopedics and Neurosciences, Desert Regional Medical Center, Palm Springs, California, United States
| | - Anya Dyurgerova
- Division of Neurosurgery, Department of Surgery, College of Osteopathic Medicine, Western University of Health Sciences, Pomona, California, United States
| | - Casey Corsino
- Division of Neurosurgery, Department of Surgery, College of Osteopathic Medicine, Western University of Health Sciences, Pomona, California, United States
| | - Dan Miulli
- Department of Neurosurgery, Arrowhead Regional Medical Center, Colton, California, United States
| | - Javed Siddiqi
- Department of Neurosurgery, Arrowhead Regional Medical Center, Colton, California, United States ; Department of Neurosurgery, Institute of Clinical Orthopedics and Neurosciences, Desert Regional Medical Center, Palm Springs, California, United States
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26
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Gardner RC, Hess CP, Brus-Ramer M, Possin KL, Cohn-Sheehy BI, Kramer JH, Berger MS, Yaffe K, Miller B, Rabinovici GD. Cavum Septum Pellucidum in Retired American Pro-Football Players. J Neurotrauma 2015; 33:157-61. [PMID: 25970145 DOI: 10.1089/neu.2014.3805] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Previous studies report that cavum septum pellucidum (CSP) is frequent among athletes with a history of repeated traumatic brain injury (TBI), such as boxers. Few studies of CSP in athletes, however, have assessed detailed features of the septum pellucidum in a case-control fashion. This is important because prevalence of CSP in the general population varies widely (2% to 85%) between studies. Further, rates of CSP among American pro-football players have not been described previously. We sought to characterize MRI features of the septum pellucidum in a series of retired pro-football players with a history of repeated concussive/subconcussive head traumas compared with controls. We retrospectively assessed retired American pro-football players presenting to our memory clinic with cognitive/behavioral symptoms in whom structural MRI was available with slice thickness ≤2 mm (n=17). Each player was matched to a memory clinic control patient with no history of TBI. Scans were interpreted by raters blinded to clinical information and TBI/football history, who measured CSP grade (0-absent, 1-equivocal, 2-mild, 3-moderate, 4-severe) and length according to a standard protocol. Sixteen of 17 (94%) players had a CSP graded ≥2 compared with 3 of 17 (18%) controls. CSP was significantly higher grade (p<0.001) and longer in players than controls (mean length±standard deviation: 10.6 mm±5.4 vs. 1.1 mm±1.3, p<0.001). Among patients presenting to a memory clinic, long high-grade CSP was more frequent in retired pro-football players compared with patients without a history of TBI.
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Affiliation(s)
- Raquel C Gardner
- 1 Memory and Aging Center, Department of Neurology, University of California , San Francisco, San Francisco, California.,2 Department of Veterans Affairs, San Francisco Veterans Affairs Medical Center , San Francisco, California
| | - Christopher P Hess
- 3 Department of Radiology and Biomedical Imaging, University of California , San Francisco, San Francisco, California
| | - Marcel Brus-Ramer
- 3 Department of Radiology and Biomedical Imaging, University of California , San Francisco, San Francisco, California
| | - Katherine L Possin
- 1 Memory and Aging Center, Department of Neurology, University of California , San Francisco, San Francisco, California
| | - Brendan I Cohn-Sheehy
- 1 Memory and Aging Center, Department of Neurology, University of California , San Francisco, San Francisco, California
| | - Joel H Kramer
- 1 Memory and Aging Center, Department of Neurology, University of California , San Francisco, San Francisco, California
| | - Mitchel S Berger
- 4 Department of Neurosurgery, University of California , San Francisco, San Francisco, California
| | - Kristine Yaffe
- 2 Department of Veterans Affairs, San Francisco Veterans Affairs Medical Center , San Francisco, California.,5 Department of Epidemiology and Biostatistics, University of California , San Francisco, San Francisco, California.,6 Department of Psychiatry, University of California , San Francisco, San Francisco, California
| | - Bruce Miller
- 1 Memory and Aging Center, Department of Neurology, University of California , San Francisco, San Francisco, California
| | - Gil D Rabinovici
- 1 Memory and Aging Center, Department of Neurology, University of California , San Francisco, San Francisco, California
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27
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Taif S, Al-Kindi H, Varghese R. A case of septum pellucidum subependymoma with a subtle imaging appearance simulating a cavum septum pellucidum. J Radiol Case Rep 2014; 7:7-16. [PMID: 24421918 DOI: 10.3941/jrcr.v7i10.1561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Subependymoma is a rare benign slowly growing tumor which usually appears as a well-defined lobulated entirely intraventricular mass, in the fourth or lateral ventricles. We report a case of subependymoma involving the septum pellucidum in a 28 year old female demonstrating a subtle and unusual radiological appearance. It showed very low attenuation on computed tomography, with very high signal on T2- and low signal on T1 weighted magnetic resonance images, merging with the ventricular wall, without definite focal mass. This appearance made the tumor difficult to differentiate from the cerebrospinal fluid and simulating a cavum septum pellucidum. The patient was treated by craniotomy and gross total resection of the mass.
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Affiliation(s)
- Sawsan Taif
- Department of Radiology, khoula hospital, Muscat, Oman
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28
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May FS, Chen QC, Gilbertson MW, Shenton ME, Pitman RK. Cavum septum pellucidum in monozygotic twins discordant for combat exposure: relationship to posttraumatic stress disorder. Biol Psychiatry 2004; 55:656-8. [PMID: 15013837 PMCID: PMC2794416 DOI: 10.1016/j.biopsych.2003.09.018] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2003] [Revised: 09/29/2003] [Accepted: 09/30/2003] [Indexed: 11/28/2022]
Abstract
BACKGROUND Abnormally large cavum septum pellucidum has been reported in posttraumatic stress disorder; however, the origin of this association is uncertain. METHODS We utilized magnetic resonance imaging to measure cavum septum pellucidum in pairs of identical twins discordant for combat exposure in Vietnam. RESULTS Presence of abnormal cavum septum pellucidum was significantly correlated between exposed and unexposed twins, indicating that it is partially determined by heredity and/or shared environment. There was a greater proportion of cavum septum pellucidum in combat-exposed twins with posttraumatic stress disorder and their noncombat-exposed co-twins. CONCLUSIONS The presence of abnormally large cavum septum pellucidum is a familial vulnerability factor for posttraumatic stress disorder.
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Affiliation(s)
- Flavia S May
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
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