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Spinal subarachnoid bleeding of unknown etiology is extremely rare. It has been suggested that these lesions have to be divided into two subtypes with different behaviour and prognosis according to their location around the spinal cord. The dorsally located bleeding would invariably cause severe spinal cord compression while the ventral lesions would have a very benign course in the absence of remarkable neurological deficit. We observed two patients with spontaneous spinal subarachnoid bleeding of unknown etiology. In both cases the disease was revealed by the sudden onset of severe back pain without subsequent signs of spinal cord compression. In one case the bleeding was ventral to the spinal cord while in the other it was located dorsally. The patients were evaluated with panspinal MRI and selective spinal angiography. They were treated conservatively and follow-up examinations at 18 and 24 months show they are neurologically intact in the absence of rebleeding episodes. We think the diagnosis of spontaneous subarachnoid bleeding of unknown etiology cannot be achieved without a panspinal MRI and a selective angiography have ruled out any other causes. We suggest their incidence is more prevalent than reported due to the difficulty/reluctance to employ MR in the presence of only minor symptoms. Our cases also show that these lesions may have a benign course independently from their location around the spinal cord.

Lymphocytic hypophysitis is a very unusual disease typically observed in the peripartum period but found also in non-pregnant women or in men. We report the case of a 50-year-old woman with a five-year history of erithema nodosus for which was treated with variable doses of steroids. One year before admission the patient began to complain of headache, amenorrhea and rapidly progressive hypopituitarism. Magnetic resonance imaging showed an expanding sellar mass with homogeneous contrast enhancement while lacking the hyperintense signal of posterior lobe. The MRI findings and the history of autoimmune disease raised the suspicion of hypophysitis. The growth of the lesion and its unresponsiveness to the prolonged steroid therapy made surgery, which is both diagnostic and therapeutic, mandatory. The pathogenesis, diagnosis and management of this unusual clinical condition are discussed.

The authors report a case of tension intraventricular pneumocephalus developed six months after the removal of an acoustic neuroma and a CSF ventriculoperitoneal shunt procedure due to a concomitant hydrocephalus. A review of the literature show only 19 cases of CSF shunt complicating pneumocephalus. The authors discuss both about the etiology of pneumocephalus and its therapeutic options. In our case we were unable to preoperatively localize the cranial base communication allowing intracranial air antry. The literature show however that eroded or thinned bone areas may be multiple and even diffuse their development depending upon several factors. We suggest in these cases a direct surgical repair through a craniotomy, as reported by others, is not mandatory. According to the etiology of pneumocephalus a temporary extraventricular drainage and the revision of the shunting pressure regimen may represent an effective treatment of this complication.

Metastatic tumors of the pituitary gland and parasellar region are unusual and are generally observed both in an advanced phase of the disease and at autopsy. The occurrence of symptomatic lesions is however quite rare. Though some clinical features may suggest the presence of a metastasis, the diagnosis is unlikely both clinically and radiologically and more common pituitary lesions are generally suspected. The Authors present two very unusual cases in which the pituitary lesions represented the onset symptoms of an otherwise unknown malignancy. Moreover the increased survival of cancer patients and the routine utilization of CT scan and MRI will probably induce, in the next years, a more frequent discovery of pituitary metastases. The Authors suggest that the diagnosis of pituitary metastases should be more closely considered even in the absence of a known primary tumor.

The authors test the effectiveness of extradural cooling for the reduction of local edema and metabolic demand in spinal cord injuries. They measure the intramedullar temperature before and during local perfrigeration with a different method as compared to those previously reported in the literature.

Four cases of CCF treated by embolization of the carotid by Fogarty catheter are reported. The results were excellent in three patient and good in one.

The authors report the case of a patient harbouring a parietal convexity tumor whose clinical and CT features were suggestive of a meningioma. Unexpectedly the tumor was a well differentiated adenocarcinoma from a colon cancer with a markedly PAS positive intragland content represented by wide areas of mucoid degeneration. Brain metastases from colon cancer are usually late occurrences and it is extremely rare that the brain lesion be discovered while the primary tumor is still unknown. The authors discuss about the pathogenesis of the CT appearance of adenocarcinoma which is, usually, slightly hyperdense. On the basis of the reported findings it is suggested that mucoid degeneration may induce the development of a well defined CT pattern represented by a very high density appearance with no contrast enhancement.