Bacterial meningitis is an uncommon complication of pituitary macroadenoma. Bacterial meningitis can occur in patients with pituitary macroadenoma who have received sphenoidal surgery or had cerebrospinal fluid (CSF) rhinorrhea. A 62-year-old male visited our hospital for headache and fever. Brain magnetic resonance imaging showed a pituitary macroadenoma. CSF study revealed acute bacterial meningitis. Intravenous antibiotics and hydrocortisone replacement therapy were started, and lead to good clinical outcome. Bacterial meningitis should be considered in patients with a pituitary macroadenoma who present with meningitis symptoms, even though in the absence of rhinorrhea or surgical history.

Reversible cerebral vasoconstriction syndrome (RCVS) is a clinic-radiologic syndrome characterized by severe headache and reversible multifocal arterial constrictions that resolve within 3 months. RCVS can be either spontaneous or related to a trigger, such as vasoactive drugs. The authors present the case of a 53-year-old woman who presented with recurrent thunderclap headache. Initial computed tomography angiography demonstrated segmental vasoconstriction of bilateral anterior cerebral arteries. Fourteen days after, initial vasoconstriction was improved as determined by follow up CT angiography. Our patient had recurrent thunderclap headache for a considerable time (around 24 months). However, although she visited many hospitals, the headache was not controlled by any treatment. Fortunately, she did not have any neurological complication and her symptoms relieved after nimodipine treatment. Clinicians should be aware of possible RCVS when a patient has recurrent thunderclap headache for a protracted period.

A 67-year-old man presented with painful whitish mucosal rashes on the left side of his palate at initial presentation, and subsequently, multiple, grouped erythematous vesicular eruptions developed on the left side of his face (V2-V3 distribution). In this case, the distribution pattern of oral lesions were atypical of herpes zoster infection. Attention should be paid to the possibility that such symptoms could be early signs of herpes zoster infection.

High-resolution magnetic resonance (HR-MR) imaging in intracranial atherosclerotic disease poses a greater challenge in the neurologic fields. Because a high in-plane resolution and a high signal-to-noise ratio are required for vessel wall imaging. HR-MR can depict the morphologies of atherosclerotic plaques, arterial walls, and surrounding structures in the intracranial and cervical carotid arteries. HR-MR also can be observed with traditional luminal evaluation. Differentiating vulnerable from stable plaques and characterizing atherosclerotic plaques are vital parts of the early diagnosis, prevention, and treatment of stroke with atherosclerosis. HR-MR is the most important and popular vessel wall imaging technique for directly evaluating the vascular wall and intracranial artery disease. Intracranial artery atherosclerosis, dissection, moyamoya disease, vasculitis, and reversible cerebral vasoconstriction syndrome also can be diagnosed and differentiated by using HR-MR. Here, we review the radiologic features of intracranial artery disease and vertebral artery dissection on HR-MR.

For patients suffering from acute ischemic stroke from cerebral artery occlusion, reperfusion is necessary to save the ischemic penumbra. Therefore, early and complete recanalization of an occluded artery is the main therapeutic goal of acute ischemic stroke. Among the many advances in management of acute ischemic stroke, thrombolysis with intravenous (IV) tissue plasminogen activator (t-PA) within 4.5 hours after symptom onset has been the only approved pharmacological therapy. However, IV t-PA has many limitations in clinical practice, low eligible patients and low recanalization rates, particularly in cases of larger proximal artery occlusions. In addition, there are many complications, including symptomatic intracranial hemorrhage (approximately 6%). In contrast, higher recanalization rates and an extended therapeutic time window have been reported for intra-arterial (IA) thrombolysis. According to studies until 2013, no studies proving the advantages of IA thrombolysis have been reported. However it was reported that studies in 2015 showed its possibility. Therefore, the purpose of this article is to cast a light on failures of previous studies, and try to assess the differences with studies in 2015. In addition, crucial points for successful IA thrombolysis will be discussed.