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A 35-year-old woman with a history of infertility, was presented to our hospital because of impaired consciousness and cerebellar ataxia, 14 days after in vitro fertilization. She received an embryo transfer under controlled ovarian hyper-stimulation. Magnetic resonance images revealed acute infarction in the cerebellum and brainstem. Magnetic resonance angiography showed a basilar artery occlusion at the end point. Following immediate intravenous rt-PA treatment, the symptoms disappeared completely. A transesophageal echocardiography revealed an atrial septal defect with a continuous left to right shunt. In addition, a Valsalva maneuver trans-esophageal echocardiography with injected saline showed the presence of jet bubbles in the left atrium crossing via the atrial septal defect. She was diagnosed with paradoxical cerebral embolism. Anticoagulant therapy was continued and she gave birth to a healthy baby. Deep vein thrombosis was associated with the ovarian hyper-stimulation syndrome that occurred during infertility treatment. As anti-phospholipid antibodies were weakly positive, the possibility of anti-phospholipid antibody syndrome was suggested. If a woman of childbearing age is presented because of stroke, it is important to administer initial therapy by keeping fertility in mind. Thrombolytic therapy for pregnant women should be carefully considered, because of the associated hazards; however, it is a very important treatment for maternal function after birth.

The recognized incidence of extra- and intracranial carotid artery dissection has increased concomitantly with the progress and development of diagnostic methods. However, management for this condition is still controversial. We report in the present study the management and long-term follow-up results of 15 patients with carotid artery dissection. Mean age of the patients at onset was 47.8 years old, and male/female ratio was 12:3. Two patients were considered to be traumatic dissections and the other 13 patients were spontaneous dissections. Dissection occurred in 10 patients at the extracranial carotid artery, in 4 at the intracranial carotid artery and in 1 at the middle cerebral artery. Nine of 15 patients demonstrated hemiparesis and 5 complained of headache or facial pain. However, it was not possible to identify a characteristic symptom of dissection. Final diagnosis of dissection was made by cerebral angiography in all patients. Serial angiography was carried out in 10 of those, and 5 of the 10 patients showed some improvements of dissection in the cerebral angiogram. Treatment for those patients was selected according to the neurological and angiographical changes. Five patients were managed conservatively and 10 patients underwent surgical revascularization. During the follow-up period (mean 77.6 months), none of them showed any symptoms of reattack, and all but one, who died of heart failure 193 months after revascularization surgery, have lived independently. Although diagnosis of dissection was difficult because of the lack of characteristic symptom, serial angiography was a useful method for diagnosis and adequate management has led to a good clinical outcome.

A 44-year-old woman was admitted to our department because of a painless lump on her forehead. Physical examinations were normal except for this lump. Both laboratory data and neurological findings were normal. Plain skull radiograph showed a 4.5 X 5.0 cm honeycombed radiolucent defect in the frontal bone. CT scan demonstrated this lucent defect as a reticular pattern by means of changing the window levels. Moreover, invasive lesion of the inner table which could not be identified in the plain radiographs, was also demonstrated on CT. A left common carotid angiogram showed irregular pooling of contrast material in the radiolucent area of the frontal bone. Angiographically, blood supplies to this tumor were mainly contributed by the frontal branches of the middle meningeal artery and a meningeal branch of the anterior falx artery from the terminal portion of the ophthalmic artery. A bone scintigram revealed accumulation of radioisotope in the lesion. A highly vascular tumor, which was partially adherent to the underlying dura, was removed as en bloc. Postoperative course was uneventful. The histology revealed thin-walled dilated vessels between the trabeculae, and it was diagnosed as cavernous hemangioma of the bone. Hemangioma of the calvarium is estimated to constitute 0.2% of all osseous neoplasms and 10% of primary benign neoplasms the of the skull. Hemangioma of the skull frequently involves the frontal bone. The condition is often found in middle-aged females. The symptom is only a slowly growing, painless lump in most of the cases.(ABSTRACT TRUNCATED AT 250 WORDS)