J Neurocrit Care.  2021 Dec;14(2):98-102. 10.18700/jnc.210034.

Bilateral posterior cerebral artery stroke following transtentorial herniation caused by a subependymal giant cell astrocytoma in a patient with tuberous sclerosis: a case report

• Kim JG
• Choi JC
• Kim HJ
• Rhim JK
• Jung TJ
• Hyun CL
• Joo JD

• KMID: 2523719
• DOI: http://doi.org/10.18700/jnc.210034

Abstract

Background
Acute increased intracranial pressure (IICP) is a life-threatening condition that requires urgent treatment. Rapid IICP with hydrocephalus may be complicated by ischemic stroke, convulsions, loss of consciousness, brain herniation, and death. Extremely rare complications include intracranial vessel entrapment and ischemic stroke due to sudden IICP in cases with benign tumors.
Case Report
We report a case of bilateral posterior cerebral artery region infarction and complicated hydrocephalus with subependymal giant cell astrocytoma in a patient with tuberous sclerosis.
Conclusion
We postulate that the temporary IICP induced by seizure led to transient bilateral posterior cerebral artery entrapment, causing ischemic stroke without vascular occlusion.

Keyword

Tuberous sclerosis; Astrocytoma; Stroke; Intracranial pressure increase

Figure

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  Fig. 1. (A) The axial/coronal/sagittal contrast-enhanced T1-weighted sequence from 16 years earlier showed a solid homogeneous lesion in the left lateral ventricle, extending toward the foramen of Monro without hydrocephalus. (B) Immediately preoperatively, the contrast-enhanced T1-weighted sequence showed marked heterogeneous enhancement and proximal aqueduct occlusion with marked hydrocephalus. Coronal and sagittal magnetic resonance imaging images showed marked dilatation of the lateral and third ventricles, with a normal-sized fourth ventricle. Note the downward bowing of the third ventricle floor with expanded infundibular and optic recesses. (C) Postoperative contrast-enhanced T1 axial scans showed no residual tumor with marked meningeal enhancement.

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  Fig. 2. (A) Diffusion-weighted image showed hyperintensity suggesting acute ischemic stroke in the region of the bilateral posterior cerebral artery (PCA). (B) Conventional angiography showed patency of the lumens of both PCAs, which have normal diameters.

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  Fig. 3. (A, B) Microscopically, the tumor comprised mainly of large polygonal cells resembling astrocytes or ganglion cells. The tumor cells have abundant, finely granular eosinophilic cytoplasm with large round to oval nuclei and prominent nucleoli (H&E, A: ×100, B: ×200). (C, D) Tumor cells show positive immunoreactivity for S-100 and glial fibrillary acidic protein (immunohistochemical stain, ×200).

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