Spontaneous Regression Of A Midbrain Lesion In A Patient With Chronic Transtentorial Herniation: Is It A Pre-syearsinx?
Cianfoni, A., da Graca Morais MARTin, M., Luigetti, M., Pettorini, B. L., & Hesselink, J. R. (2010). spontaneous regression of a midbrain lesion in a patient with chronic transtentorial herniation: is it a pre-syearsinx?. Journal of neurology, 257(5), 848–850. https://doi.org/10.1007/s00415-010-5460-4
View Original Source →Case Details
Disease Location
Diencephalon and midbrain slight left hemiparesis with associated pyearsamidal signs
Personal Characteristics
20 -year-old large middle cerebral artery infarct that occurred at 4 -year-old
Clinical Characteristics
"chronic transtentorial herniation of the diencephalon and midbrain severe progressive headache baseline abnormal kinked and enlarged brainstem and mild lateral ventricular dilatation MRI performed found nonenhancing lesion in the dorsal midbrain adjacent to the subpendymal surface of left lateral ventricle which was considered a neoplasm but was compatible with interstitial edema hypothesized that the mass consisted of a focal area of parenchymal edema, representing a ""pre-syearsinx"" state likely due to abnormal csf dynamics due to a compressed third ventricle & aqueduct lesion never showed true cavitation likely due to a focal accumulation of csf in extracellular space of the midbrain"
Remission Characteristics
9 months after initial imaging, the 3rd follow-up MRI demonstrated complete remission of midbrain lesion with abnormalities (ventricular decompression) returned to normal, with remission of headaches mass effect and t2-prolongation resolved lateral ventricle size reduced in size
Treatment & Mechanisms
Proposed Remission Mechanisms
Resolution of altered csf-flow dynamics or parenchymal dissection and rupture of the syearsinx cavity into the subarachnoid space ventricle size decrease may be due to ameliorated csf-flow dynamics
Non-Clinical Treatment
None reported