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Embryologic Association of Tornwaldt's Cyst with Cerebral Artery Abnormalities and Infarction: A Case Report.

Osborn MF, Buchanan BK, Akle N, Badr A, Zhang J - Case Rep Pediatr (2012)

Bottom Line: Summary of Case.Conclusions.This paper suggests an etiologic connection between Tornwaldt's cysts and cerebral vasculature abnormalities by way of notochordal dysfunction during development, likely the result of perturbation of notochord-derived molecular cues during development or biogenesis.

View Article: PubMed Central - PubMed

Affiliation: COE in Neurosciences and Departments of Anesthesiology and Biomedical Sciences, Texas Tech University Health Science Center, El Paso, TX 79905, USA.

ABSTRACT
Background and Purpose. Tornwaldt's cysts are rare nasopharyngeal lesions that develop from remnants of the embryonic notochord. Summary of Case. We reported a twelve-year-old female stroke patient with Tornwaldt's cysts, whose father also suffered a stroke at age fifty two with the presence of an abdominal aortic aneurysm, suggesting a genetic influence in this case. Conclusions. This paper suggests an etiologic connection between Tornwaldt's cysts and cerebral vasculature abnormalities by way of notochordal dysfunction during development, likely the result of perturbation of notochord-derived molecular cues during development or biogenesis.

No MeSH data available.


Related in: MedlinePlus

Magnetic resonance images from patient depicting abnormal findings. (a) Axial T2 weighted MR image through the nasopharynx demonstrating a small well-circumscribed T2 hyperintense, CSF-like cyst nestled between the longus colli muscles deep to the nasopharyngeal mucosa consistent with an uncomplicated Tornwaldt's cyst (arrow). (b) 3D time-of-flight MRA of the intracranial circulation demonstrating narrowing and irregularities with the wall of the M1 segment of the right middle cerebral artery (arrow) indicating, but not limited to, arteritis or dissection.
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fig2: Magnetic resonance images from patient depicting abnormal findings. (a) Axial T2 weighted MR image through the nasopharynx demonstrating a small well-circumscribed T2 hyperintense, CSF-like cyst nestled between the longus colli muscles deep to the nasopharyngeal mucosa consistent with an uncomplicated Tornwaldt's cyst (arrow). (b) 3D time-of-flight MRA of the intracranial circulation demonstrating narrowing and irregularities with the wall of the M1 segment of the right middle cerebral artery (arrow) indicating, but not limited to, arteritis or dissection.

Mentions: Upon admission, the patient again complained of facial drooping and drooling in addition to left-sided upper extremity weakness, bilateral ear pain, right-sided facial throbbing, a pulsating headache, and episodic dizziness. The patient had experienced similar episodes for the past few months in addition to seizures for several years. The patient's father reported suffering a stroke at age fifty-two and the presence of an abdominal aortic aneurysm. The remainder of the family history was noncontributory. Upon physical examination, the patient was found to have pronator drift, 2+ deep tendon reflexes, boggy nasal turbinates, and intact cranial nerves two through nine. No systemic symptoms were noted. Upper extremity blood pressure was measured initially at 97/42 and later at 105/64 (50th percentile for a 12 year old is 106/52 [11]). An EEG was normal. Blood tests showed anti-nuclear antibody negative. Further preoperative MRI demonstrated displacement of the right lateral ventricle from mass effect, a focal area of abnormal signal intensity extending from the ventricle to the centrum semiovale and internal carotid artery, and enhancement in the caudate and putamen. These findings suggested an infarct rather than a tumor. A follow-up MRI without contrast demonstrated remodeling of the stroke area and a Tornwaldt's cyst was also noted (Figure 2). A 3D time-of-flight magnetic resonance angiography was then performed which showed narrowing and irregularity of the M1 segment of the right middle cerebral artery (Figure 2). From these images, the patient was diagnosed with arteritis, Bell's palsy, and Tornwaldt's cyst. The patient was discharged from the hospital with a treatment plan for arteritis.


Embryologic Association of Tornwaldt's Cyst with Cerebral Artery Abnormalities and Infarction: A Case Report.

Osborn MF, Buchanan BK, Akle N, Badr A, Zhang J - Case Rep Pediatr (2012)

Magnetic resonance images from patient depicting abnormal findings. (a) Axial T2 weighted MR image through the nasopharynx demonstrating a small well-circumscribed T2 hyperintense, CSF-like cyst nestled between the longus colli muscles deep to the nasopharyngeal mucosa consistent with an uncomplicated Tornwaldt's cyst (arrow). (b) 3D time-of-flight MRA of the intracranial circulation demonstrating narrowing and irregularities with the wall of the M1 segment of the right middle cerebral artery (arrow) indicating, but not limited to, arteritis or dissection.
© Copyright Policy
Related In: Results  -  Collection

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Show All Figures
getmorefigures.php?uid=PMC3472527&req=5

fig2: Magnetic resonance images from patient depicting abnormal findings. (a) Axial T2 weighted MR image through the nasopharynx demonstrating a small well-circumscribed T2 hyperintense, CSF-like cyst nestled between the longus colli muscles deep to the nasopharyngeal mucosa consistent with an uncomplicated Tornwaldt's cyst (arrow). (b) 3D time-of-flight MRA of the intracranial circulation demonstrating narrowing and irregularities with the wall of the M1 segment of the right middle cerebral artery (arrow) indicating, but not limited to, arteritis or dissection.
Mentions: Upon admission, the patient again complained of facial drooping and drooling in addition to left-sided upper extremity weakness, bilateral ear pain, right-sided facial throbbing, a pulsating headache, and episodic dizziness. The patient had experienced similar episodes for the past few months in addition to seizures for several years. The patient's father reported suffering a stroke at age fifty-two and the presence of an abdominal aortic aneurysm. The remainder of the family history was noncontributory. Upon physical examination, the patient was found to have pronator drift, 2+ deep tendon reflexes, boggy nasal turbinates, and intact cranial nerves two through nine. No systemic symptoms were noted. Upper extremity blood pressure was measured initially at 97/42 and later at 105/64 (50th percentile for a 12 year old is 106/52 [11]). An EEG was normal. Blood tests showed anti-nuclear antibody negative. Further preoperative MRI demonstrated displacement of the right lateral ventricle from mass effect, a focal area of abnormal signal intensity extending from the ventricle to the centrum semiovale and internal carotid artery, and enhancement in the caudate and putamen. These findings suggested an infarct rather than a tumor. A follow-up MRI without contrast demonstrated remodeling of the stroke area and a Tornwaldt's cyst was also noted (Figure 2). A 3D time-of-flight magnetic resonance angiography was then performed which showed narrowing and irregularity of the M1 segment of the right middle cerebral artery (Figure 2). From these images, the patient was diagnosed with arteritis, Bell's palsy, and Tornwaldt's cyst. The patient was discharged from the hospital with a treatment plan for arteritis.

Bottom Line: Summary of Case.Conclusions.This paper suggests an etiologic connection between Tornwaldt's cysts and cerebral vasculature abnormalities by way of notochordal dysfunction during development, likely the result of perturbation of notochord-derived molecular cues during development or biogenesis.

View Article: PubMed Central - PubMed

Affiliation: COE in Neurosciences and Departments of Anesthesiology and Biomedical Sciences, Texas Tech University Health Science Center, El Paso, TX 79905, USA.

ABSTRACT
Background and Purpose. Tornwaldt's cysts are rare nasopharyngeal lesions that develop from remnants of the embryonic notochord. Summary of Case. We reported a twelve-year-old female stroke patient with Tornwaldt's cysts, whose father also suffered a stroke at age fifty two with the presence of an abdominal aortic aneurysm, suggesting a genetic influence in this case. Conclusions. This paper suggests an etiologic connection between Tornwaldt's cysts and cerebral vasculature abnormalities by way of notochordal dysfunction during development, likely the result of perturbation of notochord-derived molecular cues during development or biogenesis.

No MeSH data available.


Related in: MedlinePlus