Traumatic Pseudoaneurysm of Middle Meningeal Artery with Delayed Presentation as Intracerebral Hematoma: A Report with Review of Literature

Background

Post-traumatic pseudoaneurysm of the middle meningeal artery is a rare entity. We report an atypical case of a delayed presentation as parenchymal hemorrhage due to a ruptured middle meningeal artery pseudoaneurysm.

Case Description

A 22-year-old man with an alleged history of cranial trauma following a road traffic accident presented 10 days later with a new right temporal intraparenchymal hemorrhage. The CT revealed a differentially hypodense circumscribed structure in the anterior temporal location eccentrically in the hematoma. The cerebral angiogram depicted a pseudoaneurysm arising from the middle meningeal artery. The patient underwent craniotomy and excision of the aneurysm. On follow up, the patient was asymptomatic and had no focal neurological deficits.

Conclusion

Despite its rare occurrence, meningeal artery pseudoaneurysm should be considered as a possible etiology of a post-traumatic delayed presentation as an intracerebral hematoma. Prompt diagnosis and management are warranted in view of the mortality and morbidity.

Posterior Circulation Intervention but Mind the Spinal Cord!

Spinal cord infarction (SCI), a rare complication following endovascular treatment of posterior circulation aneurysms, is infrequently recognized in the periprocedural period. We illustrate the same with digital subtraction angiography and diffusion-weighted magnetic resonance imaging in this series of two cases. Categorically, the anterior spinal artery was patent, post-procedure, in both instances. Likely, guiding catheter-induced local flow alterations initiates the pathogenesis. A subsequent insufficiency of radiculomedullary artery (RMA) reinforcements is the probable mechanism leading to hemodynamic compromise. Our observations further reiterate that periprocedural antiplatelet therapy is conceivably ineffective in preventing SCI. Besides, advanced age and uncontrolled hypertension could potentially exacerbate the periprocedural RMA compromise. Due vigilance is required to recognize this rare and potentially life-threatening complication in posterior circulation neurovascular intervention.

Computed tomography coronary angiography diagnosis of single right coronary artery with congenital absence of left coronary artery system equivalents

The present case report is computed tomography (CT) coronary angiographic depiction of an exceedingly rare entity-single right coronary artery arising from the right sinus of Valsalva with the absence of equivalent left coronary artery system branches and associated mitral valve prolapse. Even though a statistical rarity, it is potentially fatal and can cause myocardial ischemia, sudden cardiac death, and warrants immediate clinical attention. Further, the report reveals the decisive role of CT coronary angiogram in the diagnosis of such rare entities, in contrast to catheter angiography, which may be inconclusive.

Efficacy of culture filtrate protein preparations from Indian isolates of M. tuberculosis to activate T cells derived from healthy donors

SETTING

While culture filtrate proteins (CFPs) of Mycobacterium tuberculosis appear to be good vaccine candidates for tuberculosis, only CFPs derived from certain popular laboratory strains of M. tuberculosis have been studied for this purpose.

OBJECTIVE

To compare the relative efficacies of CFP preparations from two laboratory strains and four contemporary clinical isolates of M. tuberculosis to induce T-cell activation.

DESIGN

CFPs were isolated from six strains of M. tuberculosis and were used to induce 1) T-cell proliferation, 2) IFN-gamma secretion, and 3) IL-12 secretion from peripheral blood derived mononuclear cell (PBMC) preparations from 33 healthy donors.

RESULTS

Significant amounts of IL-12 were spontaneously secreted by PBMC preparations; CFP preparations from two clinical isolates (JNU-7 and JNU-51) significantly boosted this response. All six CFP preparations induced IFN-gamma secretion by PBMCs, but those from two contemporary strains of M. tuberculosis (JNU-7 and JNU-22) were most effective in this regard. The effect of CFPs from JNU-7 and JNU-22 was significantly better than those from the laboratory strains (H37Ra and Erdman). Similar results were obtained with the T-cell proliferation parameter.

CONCLUSION

These results suggest that CFPs derived from selected clinical isolates of M. tuberculosis may outperform those of standard laboratory strains, and may therefore be a better source of potential candidates for a tuberculosis vaccine.

Relative toxicity of metabolites of benzene in mice

Repeated ip administration of hydroquinone (10 mg/kg/day), benzoquinone (2 mg/kg/day) or benzenetriol (6.25 mg/kg/day) to rats for 6 weeks produced significant decreases in RBC and bone marrow cell counts and hemoglobin content, together with relative changes in organ weights. In addition, benzoquinone and benzenetriol elicited histological injuries in liver, thymus, spleen, kidney and peripheral lymph nodes which warrant further investigation.

Depletion of liver regulatory heme in benzene exposed rats

The effect of a single dose of benzene (0.5 ml/kg body wt i.p.) on the heme saturation of tryptophan pyrrolase activity in liver was examined. There was a significant decrease in the heme saturation of hepatic tryptophan pyrrolase, suggesting depletion of "regulatory heme". After benzene administration there was significant increase in delta-aminolevulinate (ALA) synthetase activity (approx. 2-fold) while delta-aminolevulinate dehydratase activity was significantly decreased, however, ferrochelatase and heme oxygenase activities were unaltered. Administration of tryptophan to benzene pretreated rats showed a reversal of benzene effects on heme synthesizing enzymes: there is an increase in the heme saturation of tryptophan pyrrolase and decrease in delta-aminolevulinate synthetase. However, there was no significant alteration in the activity of delta-aminolevulinate dehydratase.