Showing papers in "Rivista Di Neuroradiologia in 2010"
TL;DR: The imaging findings of PCNSL are in agreement with the existing literature data and with the reported increasing trend of multifocal tumors, and add value to the existing evidence of increasing incidence rates among the immunocompetent elderly population.
Abstract: Primary central nervous system (CNS) lymphoma (PCNSL) accounts for approximately 3% of all primary CNS tumors. Congenital or acquired immunodeficiency is the only established risk factor for PCNSL. Rates decreased slightly in the mid-1990s, concordantly with the decreasing rates of AIDS. However, the incidence has been increasing in the elderly immunocompetent population, and this trend seems to be independent of improvements in diagnostic techniques, and of overall trends in the incidence of brain tumors and systemic lymphomas. This study presents our experience with the imaging features of PCNSL. Computed tomography (CT) and magnetic resonance imaging (MRI) findings were reviewed in a series of 38 cases of pathologically proven PCNSL. The incidence rate of PCNSL was higher in men than in women (58% versus 42%). Mean age at presentation was 63 years; 120 lesions were demonstrated in the 38 patients, with a 53% frequency of tumor multiplicity. Both CT and MR mainly showed solitary or multiple well-defined round or oval-shaped mass lesions, typically hyperdense on unenhanced CT scans, iso to hypointense on T2 MR weighted images. These lesions also showed an increased signal intensity on diffusion-weighted images. Virtually all lesions enhanced after intravenous administration of contrastmedium. On (1)H-magnetic resonance spectroscopy ((1)H-MRS) most lesions presented increased Cho/Cr, Cho/NAA and lactate/Cr ratios when compared to normal gray matter. No changes in the imaging presentation have occurred over the past two decades, apart from lesions now being smaller at diagnosis. Our imaging findings are in agreement with the existing literature data and with the reported increasing trend of multifocal tumors. Our epidemiologic results add value to the existing evidence of increasing incidence rates among the immunocompetent elderly population.
53 citations
TL;DR: After intradiscal, intraforaminal, epidural and intramuscular injection of Discogel® no morpho-structural changes in nuclear tissue and annulus were found and further studies on pigs with immunohistochemical analysis after treatment will confirm the morphological alterations induced by discogel and its action.
Abstract: This study assessed the impact and modification of intradiscal, intraforaminal, epidural and intramuscular swine injection of a new material, Discogel®- radiopaque gelified ethanol-recently introdu...
20 citations
TL;DR: The case of a 60-year-old man who presented sudden paraplegia is described, with an epidural mass extending from T11 to L1, causing spinal cord compression, and a significant improvement of neurologic deficits.
Abstract: Spinal epidural haematomas are infrequent events caused mainly by trauma or are iatrogenic following invasive spinal procedures (lumbar puncture, surgery or peridural anaesthesia). Spontaneous spinal epidural haematoma is a rare entity requiring emergency intervention in most cases. The incidence is estimated at about two to six cases per year. Early recognition, accurate diagnosis and rapid treatment may result in decreased morbidity and improved outcome. Here, we describe the case of a 60-year-old man who presented sudden paraplegia. Magnetic resonance imaging of thoracolumbar spine demonstrated an epidural mass extending from T11 to L1, causing spinal cord compression. Emergent decompressive surgery was performed and the patient had a significant improvement of neurologic deficits.
20 citations
TL;DR: The Silk stent seems a very interesting curative device to treat giant aneurysms with preservation of the parent artery and small adjacent branches and technical improvements will certainly reduce the thrombogenic effect with the related risks.
Abstract: The treatment of giant cerebral aneurysms has always been a challenge for neurosurgeons and neuroradiologists. Flow-diverting stents (Silk; Pipeline Embolization Device) are new endovascular devices introduced for the treatment of intracranial aneurysms without release of intrasaccular coils. They are tubular bimetallic endoluminal devices with low porosity. We have employed these stents in the Neuroradiology Unit of Bellaria Hospital (Bologna, Italy) since the end of 2008, treating nine patients with giant carotid cerebral aneurysms using nine Silk stents as soon as the device obtained the CE mark. All patients were pretreated with dual antiplatelet medications before surgery. The Silk stents were deployed through a 4F Balt introducer, which ensured an uneventful and very quick procedure. Control CT angiography or MR angiography was typically performed at discharge and one, three, six and 12 months after treatment. Post-treatment results were: four complete occlusions, three near complete occlusions (residual neck flow) with reduced volume of the aneurysm and two more than 50% reduction of intra-aneurysmal flow. A fatal hemorrhagic complication occurred in one patient, probably due to the antiplatelet treatment. The Silk stent seems a very interesting curative device to treat giant aneurysms with preservation of the parent artery and small adjacent branches. Technical improvements will certainly reduce the thrombogenic effect with the related risks.
19 citations
TL;DR: Combined endovascular and per cutaneous treatment or direct percutaneous sclerotherapy with glue alone are important, safe, effective therapy options for symptomatic aneurysmal bone cyst.
Abstract: We describe the usefulness of endovascular and direct percutaneous treatment as a therapy option for aneurysmal bone cysts (ABCs) of the spine. From January 2007 to December 2008, we treated six consecutive patients with symptomatic ABCs resistant to continuous medical management or with acute clinical onset of paraparesis at cervical, thoracic and lumbar spine level. Two patients were treated after emergency laminectomy. All patients were studied with an MRI protocol and multidetector CT with MPR reconstructions followed by angiographic control before treatment. The procedure was performed under general anaesthesia for all patients. Under CT or fluoroscopy guidance, percutaneous treatment was performed either by direct injection of Glubran(®) diluted at 30% with Lipiodol(®) only, or combined with endovascular treatment by Onyx® injection. Clinical and X-ray follow-up was performed at three and six months. Combined endovascular and percutaneous treatment for ABCs was successful and led to an excellent outcome in five out of six patients with clinical improvement. There were no periprocedural or subsequent clinical complications and the glue resulted in successful selective permanent occlusion with intralesional penetration. Direct sclerotherapy resulted in immediate thrombosis of the malformation with no progression of symptoms. Complete healing was observed in five out of six aggressive lesions. No major complications were noted. At six month follow-up the symptoms had completely resolved and X-ray control showed a partial or total sclerotic reaction of the lesion with stable clinical results (no partial or clinical abnormalities). One patient had a recurrence of the ABC with spinal cord cervical clinical symptomatology. Combined endovascular and percutaneous treatment or direct percutaneous sclerotherapy with glue alone are important, safe, effective therapy options for symptomatic aneurysmal bone cyst. Results are stable and confirmed by clinical and X-ray follow-up six months after treatment.
14 citations
TL;DR: US has an important role in the depiction of uveal melanomas and associated retinal detachments and appears to be more sensitive than MRI in detecting retinal detachment in patients with orbital uvea melanomas.
Abstract: We assess the role of ultrasonography (US) in the evaluation of retinal detachment in patients with uveal melanomas, in correlation with magnetic resonance imaging (MRI) findings. Twenty-six patients (13♂ and 13♀) with uveal melanomas underwent MRI and US examination. The signal intensity of the tumors and retinal detachments were depicted using MRI. The position of retinal detachment in correlation with the position of intraocular tumor was also evaluated performing ultrasound examination. MRI and US identified uveal melanoma in all 26 patients. In 11 of the 26 patients (42.3%) uveal melanoma was accompanied by retinal detachment. MRI demonstrated retinal detachment in nine patients. US disclosed retinal detachment in two more cases. US has an important role in the depiction of uveal melanomas and associated retinal detachment. It also appears to be more sensitive than MRI in detecting retinal detachment in patients with orbital uveal melanomas.
13 citations
TL;DR: It is suggested that the reduction in afferent information contributes to and coalesces with the higher-level reorganization resulting in the subjective conscious awareness of the phantom limb.
Abstract: Phantom limb (PL), a phenomenon experienced by most patients after amputation, has mostly served as a paradigm to study experiences that appear to be associated with neural plasticity within the CNS. However, the subjective nature of PL experiences has had no definitive means of reliable assessment other than using patients' direct reports, nor was there a way to study the neural mechanisms involved in the conscious awareness of this mental phenomenon. Here we obtained patients' indirect responses to PL experiences for an objective evaluation using functional magnetic resonance imaging (fMRI). Six control subjects and six lower limb (LL) amputees participated in a motor imagery task for both the intact and the particular phantom toes. While all subjects shared neural processing of distinctive regional cerebral activations during motor imagery of the intact toes (prefrontal (PF), supplementary motor area (SMA), primary motor cortex (M1), superior temporal gyrus (STG)), it was only during motor imagery of the amputated toes in amputees that we observed an increased blood oxygen level-dependent (BOLD) signal in the contralateral basal ganglia at the medial globus pallidus (MGP), substantia nigra (SN), and thalamus. This increased BOLD signal in the basal ganglia-thalamus-cortex pathway during imaginary movement of the phantom toes may reflect an abnormal open loop functioning of the thalamocortical system underlying the conscious awareness of the phantom phenomenon. We suggest that the reduction in afferent information contributes to and coalesces with the higher-level reorganization resulting in the subjective conscious awareness of the phantom limb.
13 citations
TL;DR: The main imaging findings are abnormal enhancement of the thickened choroid plexus, asymmetric hydrocephalus with sequestrated temporal horn, periventricular edema and intraventricular septae formation, highlighting the imaging features of this rare manifestation of CNS tuberculosis.
Abstract: The majority of intracranial infections that cause meningitis are considered to start in the choroid plexus of the ventricles, but lesions involving the choroid plexus are rare. There are isolated case reports of the involvement of choroid plexus in tuberculous meningitis. The main imaging findings are abnormal enhancement of the thickened choroid plexus, asymmetric hydrocephalus with sequestrated temporal horn, periventricular edema and intraventricular septae formation. Six patients having tubercular involvement of choroid plexus were treated at our institution. This is probably the largest series of tubercular involvement of choroid plexus highlighting the imaging features of this rare manifestation of CNS tuberculosis.
11 citations
TL;DR: The event-related fMRI design in two right-handed patients with identical right, transfemoral amputations, performing the same sensitive stimulation in a 3.0 T MR scanner is used and a specific activation of the frontoparietal circuit is observed during phantom limb perception in both amputee patients.
Abstract: The phantom limb phenomenon has been used in amputee patients as a paradigm to study plasticity, mainly of the sensorimotor cortex. Nevertheless, most functional studies have been done in upper limb amputee patients using magnetoencephalography and functional magnetic resonance image imaging (fMRI). In addition, the actual experience of phantom limb sensation has not been widely used to study the neural mechanism of the human brain as a conscious knowledge of the phantom limb perception like the integration of the body image in amputee patients. fMRI studies of patients with lower limb amputation have recently been published, but none of these used an event-related design to try to observe only the stimulus application, correlating images with the subject's indication of phantom perception and discarding images with no phantom perception. In this work, we used the event-related fMRI design in two right-handed patients with identical right, transfemoral amputations, performing the same sensitive stimulation in a 3.0 T MR scanner. For comparison, we applied the same paradigm to six control subjects to compare the resulting functional maps. We found areas with statistical significance in the sensorimotor cortex contralateral to the site of stimulation, in the parietal lobe in Brodmann areas 3 in both cases (Patients and Control Subjects), but we also found activation in the Brodmann areas 6, 40, and 5 with stimulation of the stump. We observed a specific activation of the frontoparietal circuit during phantom limb perception in both amputee patients.
10 citations
TL;DR: The aim of this study was to test the diagnostic impact of two MR devices and to discuss the diagnostic, clinical usefulness and the cost-benefit ratio of the MR systems.
Abstract: Hearing loss greater than 30 dB over three contiguous pure-tone frequencies occurring within a three day period is defined as sudden hearing loss. It is usually sensorineural (SSNHL), unilateral an...
10 citations
TL;DR: Medical treatment appears to be too slow to prevent the natural history of patients with VBF, and multilevel VP can be performed in selected cases to treat VBF related to osteoporosis, preventing fractures or refracture without any further thrombo-embolic or fat uncontrolled embolism peri or post-procedural complications.
Abstract: Vertebroplasty (VP) is a mini-invasive percutaneous technique for the treatment of symptomatic, vertebral body fracture (VBF) caused by porotic or other diseases and its outcome has now been demonstrated by many trials. Beyond the results of these trials on the efficacy and safety of VP, the real problem for patients with osteoporotic and non-osteoporotic vertebral fractures is the risk of new fractures to adjacent or distant vertebra following VP that is reported to range from 10% to 30%. It is still unclear whether this is related to the natural history of the underlying disease (osteoporotic and non-osteoporotic diseases) or to the treatment, especially when a single vertebral fracture in an osteoporotic patient is highly predictive of future fractures. To prevent new fractures to adjacent or distant vertebra following VP in porotic patients multiple non-pharmacologic interventions are recommended (diet with vitamin D or calcium supplements, smoking cessation, exercise) in addition to a specific medical therapy to block the activation of osteoclast cells responsible for bone resorption, and to re-establish correct bone remodeling. These drugs include anti-catabolic drugs: bisphosphonate, oestrogen hormone, and anabolic drugs: PTH analogues and strontium ranelate. Bisphosphonate are the most commonly used compounds to treat postmenopausal osteoporosis. However, medical treatment appears to be too slow to prevent the natural history of patients with VBF. One session multilevel VP could be performed to prevent vertebral refracture risk in porotic or non-porotic patients with recurrent VBFs also after the first VP even if there is not a true vertebral collapse. Even if there are no limits to how many body levels can be treated in one session, European and American guidelines suggest doing no more than three body levels in the same session to reduce patient discomfort, and to prevent peri-procedural anesthesiologic problems, like uncontrolled fat-embolism, cement leakage, and pulmonary embolism, that could be increased. How many vertebrae could be treated in same session could be analyzed beforehand based on MDCT vertebral morphology and trabecular structure, or on MRI-signal changes. Added to medical therapy, multilevel VP can be performed in selected cases to treat VBF related to osteoporosis, preventing fractures or refracture without any further thrombo-embolic or fat uncontrolled embolism peri or post-procedural complications.
TL;DR: Brain lesions containing lipid on 1H-MRS could be differentiated by the presence of succinate and acetate in pyogenic abscess, and amino acids in Pyogenic/fungal abscesses, and lipid and choline was seen in Rosai Dorfmann's disease.
Abstract: In vivo proton MR spectroscopy ((1)H-MRS) can non-invasively provide biochemical information at the same examination as conventional magnetic resonance imaging (MRI). Lipid resonance (0.9-1.5 ppm) is a marker of cell membrane breakdown and tissue necrosis, but its diagnostic significance has not been well described. We retrospectively analyzed spectra to study the different pathological conditions in patients with abnormal lipid resonance. All patients with neurological diseases showing lipid resonance on (1)H-MRS (1.5T) in a tertiary hospital over two years were retrospectively analyzed. (1)H-MRS was performed using the single voxel PRESS technique (TR/TE=3000/144 ms, eight excitations). Spectra were analysed for the presence of NAA (2.0 ppm), creatine (3.0 ppm), choline (3.2 ppm), acetate (1.92 ppm), succinate (2.4 ppm), cytosolic amino acids (0.9 ppm), lactate (1.3 ppm) and lipid (0.9-1.5 ppm) peaks. Ninety-two spectra from 69 patients (38 males, 31 females; aged 9 to 89 years) were analyzed. The final diagnosis was infective (n= 33), (tuberculoma n=17, pyogenic abscess n= 8, fungal abscess n= 3, sterile abscess n= 3, tubercular abscess n= 2), neoplastic (n= 21) (glial tumors n= 9, metastasis n= 8, lymphoma n= 4), and other (n= 15) abnormalities (subacute and chronic stroke n= 6, postictal edema n= 4, multiple sclerosis n= 2, Erdhiem Chester disease n= 2, Rosai Dorfmann disease n= 1). Succinate and acetate were detected only in pyogenic abscesses (2/4 cases), but amino acids were present in both pyogenic (4/8) and fungal (3/3) abscesses. Choline was seen not only in neoplasms (18) but also in tuberculomas (11/17), but was consistently absent in the abscesses. Lactate was present in glioblastoma (7/9), pyogenic (3/8) tubercular (2/2) and fungal (3/3) abscess. Isolated lipid resonance was found in Erdheim Chester disease (2/2) of the orbit, and lipid and choline was seen in Rosai Dorfmann's disease (1/1). Brain lesions containing lipid on (1)H-MRS could be differentiated by the presence of succinate and acetate in pyogenic abscess, and amino acids in pyogenic/fungal abscesses. Choline was seen in neoplasms and in tuberculomas, but not in the abscesses. Thus, the presence of a lipid peak, when combined with features on other MR pulse sequences and available clinical data can help arrive at a specific diagnosis. (1)H-MRS should not be interpreted in isolation: it should always be correlated with conventional imaging features, and performing (1)H-MRS in isolation remains an important pitfall.
TL;DR: Clinical features and neuroradiological findings observed in a 70-year-old patient with an unknown pituitary lesion and early diagnosis of PA-associated vasospasm and cerebral ischemia avoids the possibility of their detection only after neurosurgery.
Abstract: Pituitary apoplexy is a potentially life-threatening acute or subacute clinical syndrome occurring from enlargement of the pituitary gland, and pituitary insufficiency, from hemorrhage or ischemia from an unknown pituitary lesion, most frequently being a non-functioning macroadenoma. A close, and multidisciplinary management is required. The purpose of this case report is to increase awareness to pituitary apoplexy presentation and management by reporting clinical features and neuroradiological findings observed in a 70-year-old patient with an unknown pituitary lesion. He presented with pituitary apoplexy and brain ischemia at magnetic resonance imaging (MRI) including diffusion-weighted imaging (DWI), and apparent diffusion coefficient (ADC) maps. MR angiography (MRA) showed diffuse vasospasm of anterior and posterior circulation. Both MRI and cytochemical examination of the cerebrospinal fluid ruled out subarachnoid hemorrhage. Due to concomitant diseases, and absence of visual deficit, the management ...
TL;DR: A case of spontaneous CSF leak in the right temporal air cells that mimicked a skull fracture in a subject with headache and apparent rhinorrhea after a head trauma is described.
Abstract: An abnormal communication between the subarachnoid spaces and the tympanic cavity and mastoid cells can determine a cerebrospinal fluid (CSF) leak in the air spaces of the temporal bone. The etiology of CFS leak in the temporal air cells includes acquired, congenital and spontaneous causes. Spontaneous CSF leak, defined as a leak without a manifest cause, is present in about 4% of cases and often occurs in the middle cranial fossa. We describe a case of spontaneous CSF leak in the right temporal air cells that mimicked a skull fracture in a subject with headache and apparent rhinorrhea after a head trauma. Both CT and MRI play a key role in the differential diagnosis between post-traumatic temporal CSF leak due to a fracture and spontaneous leak: traumatic CSF leak often does not require a surgical approach, whereas spontaneous CSF leak may need surgical treatment because of the risk of meningitis.
TL;DR: According to the available literature and results, MSCTA has proved a very reliable method, simple and safe, competent to be used as a diagnostic modality of choice in the patients with SAH or suspect unruptured aneurysm, especially in the infraclionid region where this method has still limited possibilities.
Abstract: The overall results of CT angiography on 64-slice MSCT published in the last five years are very close to results of DSA which is still a gold standard in the diagnosis of intracranial aneurysms. The aim of this study is to contribute to the confidence in reliability of this method and to try to answer the question of whether CTA should be used as the first diagnostic modality in patients with suspect intracranial aneurysms. In the period from October 2008 to August 2009 we diagnosed 118 aneurysms in 73 patients. We included in this study only those patients who underwent either DSA, surgical treatment or both after MSCTA, and the remainder of the above patients were not treated and are followed up, or died before treatment. So our group comprised 47 patients who were divided into two groups. The first group of 22 patients underwent DSA after MSCTA. We found 36 aneurysms in this group. One aneurysm was falsely positive compared to DSA, while 35 were in concordance with DSA. DSA revealed five aneurysms smaller than 4 mm not disclosed by MSCTA. The second group comprised 25 patients who were operated according to MSCTA findings only. There were 33 aneurysms in this group: 25 aneurysms were operated and surgical findings agreed with MSCTA. Eight aneurysms smaller than 4 mm were not operated and we do not have confirmation for them. In all false positive and false negative cases the misdiagnosed aneurysms were in fact 1-1.5 mm outpouchings that were not responsible for SAH. According to the available literature and our results, MSCTA has proved a very reliable method, simple and safe, competent to be used as a diagnostic modality of choice in the patients with SAH or suspect unruptured aneurysm. DSA should be used in cases of negative or uncertain findings on MSCTA, excluding cases of perimesencephalic SAH with negative MSCTA. The relative disadvantage of this method is its lower sensitivity in the detection of tiny outpouchings, especially in the infraclionid region where this method has still limited possibilities.
TL;DR: The case of a patient whose computed tomography scan and magnetic resonance imaging showed a single tumor-like lesion in the brainstem is described, which showed the characteristic yeast cells that confirmed the diagnosis of neuroparacoccidioidomycosis.
Abstract: Paracoccidioidomycosis is a systemic disease endemic to subtropical areas in Central and South America caused by a dimorphic fungus known as Paracoccidioides brasiliensis. Central nervous system in...
TL;DR: In this article, the temporal bone anatomy in patients with unilateral attic cholesteatoma was determined using three-dimensional (3D) stereo images of the ears of ten patients.
Abstract: We determined temporal bone anatomy in patients with unilateral attic cholesteatoma. We compared the affected and normal ears of ten patients with unilateral attic cholesteatoma using three-dimensi...
TL;DR: Close interdisciplinary collaboration between hemato-oncologists and neuroradiologists is of paramount importance to provide affected children with an early diagnosis and proper treatment of Hemolymphoproliferative diseases and brain tumors.
Abstract: Hemolymphoproliferative diseases and brain tumors are among the most common causes of morbidity and mortality in children. In the past few years, increased effectiveness of treatment modalities has significantly increased overall survival, but has also disclosed new aspects of the natural history of these disorders, among which central nervous system involvement due to iatrogenic side-effects. Magnetic resonance imaging plays an important, often crucial, role in the diagnosis of several of these disorders. Close interdisciplinary collaboration between hemato-oncologists and neuroradiologists is of paramount importance to provide affected children with an early diagnosis and proper treatment.
TL;DR: A case of bleeding cerebral AVM in a pregnant women at the second quarter of gestation is described and diagnosed by digital subtraction angiography showing a large principal arterial nidus supply.
Abstract: Cerebral arteriovenous malformations (AVMs) represent congenital anomalies of blood vessels composed of a nidus of anomalous arterial and venous vessels without a capillary network. We describe a case of bleeding cerebral AVM in a pregnant women at the second quarter of gestation and diagnosed by digital subtraction angiography showing a large principal arterial nidus supply. The AVM was treated by endovascular embolization at the 27th week of gestation. The post-operative course was uneventful and a caesarean section was performed at the 37th week of gestation. The endovascular approach may represent a safe method in the treatment of this cerebral condition during pregnancy.
TL;DR: A histopathologically proven desmoplastic fibroma involving the right mandibular region in a three-year-old Italian girl is described and the usefulness of different imaging modalities in DF diagnosis and treatment is discussed.
Abstract: Desmoplastic fibroma (DF) is a rare non-metastasizing benign neoplasm of the bone characterized by aggressive local infiltration, also known as desmoid tumour. Desmoplastic fibroma of the mandible may recur locally when incompletely excised. In particular it can occur adjacent to and display contiguous extension along the mandibular nerve. This case report describes the imaging findings of a histopathologically proven desmoplastic fibroma involving the right mandibular region in a three-year-old Italian girl. We also discuss the usefulness of different imaging modalities (CT and MRI) in DF diagnosis and treatment.
TL;DR: The high correlation between the clinical profile and the MR findings in cases of pituitary dysfunction (most often GHD), defines the significant role of MRI as additional tool for the diagnosis of pituitsary hormone deficiency.
Abstract: Magnetic resonance imaging (MRI) in patients with congenital growth hormone deficiency (GHD) has revealed several morphological abnormalities of the hypothalamo-pituitary region which include hypoplasia of the anterior pituitary lobe, the absence or marked thinning of the pituitary stalk and ectopia of the posterior pituitary lobe (EPP). This triad of abnormalities is called pituitary stalk interruption syndrome (PSIS). Our study reports the imaging findings of 23 patients with idiopathic GHD and short stature who were examined by MRI. The majority of the patients had abnormal MR studies with findings indicating the presence of the pituitary stalk syndrome. The high correlation between the clinical profile and the MR findings in cases of pituitary dysfunction (most often GHD), defines the significant role of MRI as additional tool for the diagnosis of pituitary hormone deficiency.
TL;DR: The observation of a 17-year-old female who presented with lost of consciousness and seizure while jogging on a hot summer day followed by multi-organ failure challenges the view of a close correlation between the imaging findings and prognosis in heat stroke.
Abstract: The prognosis of heat stroke has considerably improved with a mortality rate drop to 10% when therapeutic measurements including external cooling and aggressive rehydration are adopted. The role of imaging in predicting prognosis is uncertain. Some noted that development of cortical cerebellar atrophy is associated with development of a pancerebellar syndrome, while others suggested that evidence of cerebral cortical damage due to hypoxic-ischemic injury implies a poor prognosis. We observed a 17-year-old female who presented with lost of consciousness and seizure while jogging on a hot summer day followed by multi-organ failure. Brain MRI revealed a symmetric area of T2 hyperintensity and decreased diffusion in the cortical gyri of the frontal lobes. The patient made a complete recovery. MRI two years later showed disappearance of signal changes in the frontal cortex, but progressive atrophy of the cerebellum which was clinically silent. Our observation challenges the view of a close correlation between the imaging findings and prognosis in heat stroke.
TL;DR: An operated oatient with craniopharyngioma who underwent external beam radiotherapy developed gradual loss of vision after two years and a review CT scan revealed the local recurrence of tumour with dystrophic calcification of the basal ganglia, frontal and temporal subcortical regions representing recurrent craniophysioma with radiation-induced mineralizing microangiopathy.
Abstract: Mineralizing microangiopathy is a late complication of radiation-induced brain injury that occurs during the treatment of CNS malignancies in children and adults. Early diagnosis of the radiation-induced brain injury helps to tailor the radiation dose and prevent further complications. Here we describe an operated oatient with craniopharyngioma who underwent external beam radiotherapy. The patient developed gradual loss of vision after two years and a review CT scan revealed the local recurrence of tumour with dystrophic calcification of the basal ganglia, frontal and temporal subcortical regions representing recurrent craniopharyngioma with radiation-induced mineralizing microangiopathy.
TL;DR: A case of hypopituitarism with clinical, endocrine and magnetic resonance (MR) imaging studies occurring as a delayed complication of snake bite is described.
Abstract: Hypopituitarism can be the sequela of a variety of causes like postpartum pituitary necrosis or Sheehan's syndrome, lymphocytic hypophysitis, trauma and encephalitis. A very rare cause is envenomation by a bite of a Russell's viper. Very few cases with documented imaging findings of chronic pituitary failure resulting from snake bite have been reported. We describe a case of hypopituitarism with clinical, endocrine and magnetic resonance (MR) imaging studies occurring as a delayed complication of snake bite.
TL;DR: In this article, the authors measured the thickness of the ligamentum flavum in patients with lumbar spinal canal stenosis and/or herniated LBS disc through axial T1 weighted lumbo-sacral MR images.
Abstract: The most common spinal disorder in elderly patients is lumbar spinal canal stenosis, causing low back and leg pain and paresis. The aetiology of degenerative changes occurring in lumbar stenosis remain unclear: some authors hypothesize hyperplasia and others hypertrophy of the LF. The change in LF is known to be related to degenerative changes secondary to the aging process or mechanical instability. This study aimed to analyse the ligamentum flavum (LF) of patients with lumbar canal stenosis and lumbar disc herniation to evaluate the morphology and concentration of the Transforming Growth Factor-beta 1 (TGF-beta 1). The study was undertaken in three phases: A) Measurement of the thickness of the ligamentum flavum in patients with lumbar stenosis and/or herniated lumbar disc through axial T1 weighted lumbo-sacral MR images; B) Removal of ligamentum flavum in patients undergoing intervention for lumbar stenosis and lumbar disc herniation (control group); C) Optical microscopy study of the morphology of degenerated ligamentum and immunohistochemical analysis to assess the concentration of TGF-beta 1 in the LF. Morphological analysis of the LF (i.e. the increase in the number of fibres or distension and relaxation of the same as a result of degenerative processes) and the presence or absence of a high concentration of TGF-beta1 (then more fibroblasts involved in the degenerative process) can be important to establish whether there is hypertrophy or hyperplasia of the LF in lumbar canal stenosis. The current study showed that decreased elasticity of the LF in the elderly is due to a loss of elastic fibres that are degenerated and a concomitant increase in collagenous fibres (hypertrophy). TGF-beta1 concentrations of the LF were higher in lumbar spinal stenosis than in disc herniations. This suggest that LF of lumbar canal stenosis is hypertrophic: LF hypertrophy could be due to thickening of the normal elastic layer and the abnormal collagenous layer and to higher expression of TGF-beta 1 by fibroblasts.
TL;DR: An unusual case of a 66-year-old woman who presented with a recurrentpituitary abscess, initially misdiagnosed as a pituitary adenoma because of its high signal intensity on T1-weighted images.
Abstract: Pituitary abscess is a rare pituitary pathology which may be potentially life-threatening if not treated. Therefore, early accurate diagnosis and therapy are extremely important. However, the clinical diagnosis is difficult because there are no clinical symptoms characteristic of pituitary abscess. It is frequently indistinguishable clinically or with neuroimaging studies from other pituitary lesions. The MR diagnosis of pituitary abscess must be suspected in cases of sellar cystic mass with a peripheral rim enhancement after contrast administration. It must be highlighted that pituitary abscess may show various signal intensity on T1-weighted images, as in our case, making the diagnosis even more difficult. We report an unusual case of a 66-year-old woman who presented with a recurrent pituitary abscess, initially misdiagnosed as a pituitary adenoma because of its high signal intensity on T1-weighted images. The woman was operated on three times, using transsphenoidal access with a good final outcome.
TL;DR: A unique case of a sellar spine vertically oriented displacing the pituitary stalk upwards and forwards is described and the MRI findings are briefly discussed.
Abstract: The sellar spine is a rare congenital malformation due to the persistence of a notochord rest within the fetal sella turcica. We describe a unique case of a sellar spine vertically oriented displacing the pituitary stalk upwards and forwards. The MRI findings are briefly discussed.
TL;DR: A 30-years-old woman admitted to the authors' hospital 18 hours after stroke onset and treated with mechanical and pharmacological intra-arterial thrombolysis showed a rapid improvement of symptoms and new evidence suggests that DWI lesions may be reversible, especially with reperfusion, by now well demonstrated in animal models.
Abstract: We report our case and review the literature on reversal DWI lesions, ADC thresholds and correlation between DWI lesion and outcome measured with clinical scales. A 30-years-old woman was admitted ...
TL;DR: A giant intradiploic epidermoid cyst of the occipital bone is described with CT and MRI characteristics including DW imaging and ADC values.
Abstract: Intradiploic epidermoid cysts are congenital benign lesions. They commonly occur intracranially. Intradiploic epidermoid cyst of the calvarium is very rare and few cases have been reported to date. We describe a giant intradiploic epidermoid cyst of the occipital bone with CT and MRI characteristics including DW imaging and ADC values.
TL;DR: Percutaneous treatment with VP for benign or malignant cervical spine lesions is a valuable, mini-invasive and quick method that allows a complete and enduring resolution of painful vertebral symptoms without fracture of the adjacent or distal vertebral bodies.
Abstract: This paper illustrates the validity of vertebroplasty (VP) in patients with primary benign or metastatic lesion in the cervical spine. From January 2006 to December 2007, ten consecutive patients were treated with VP for a total of ten vertebral bodies: two symptomatic vertebral haemangiomas at C5 and C4.3, multiple myeloma at C2 (two cases) and one case at C4, five patients with vertebral metastasis from breast or lung cancer at C2, C4 (three cases) and C5. All the patients complained of pain resistant to continuous medical management. All procedures were performed under general anaesthesia by anterolateral approach under CT or fluoroscopy control with manual dislocation of the carotid axis. A transoral approach under fluoroscopy was performed to treat the C2 lesion. Bone biopsy was never performed. VP was performed to prevent fracture after implantation of a double discal prothesis in two patients. For patients with multiple myeloma, VP was performed to prevent new vertebral fracture. VP was performed before of radiotherapy in three patients with metastasis, and just after radiotherapy in two. Two metastatic patients were lost at one year follow-up due to death from systematic diffusion. Results were evaluated on the Visual Analogue Scale (VAS) and the Oswestry Disability Index (ODS). A successful outcome was observed with a complete resolution or partial reduction of pain in 90% of patients 24-72 hours after VP. At 12 months follow-up, we recorded a reduction of four points in the VAS evaluation and a 45% reduction in the ODS score. No extravertebral vascular or discal cement leakage was observed. At 12 months, X-ray follow-up showed a stable result. Percutaneous treatment with VP for benign or malignant cervical spine lesions is a valuable, mini-invasive and quick method that allows a complete and enduring resolution of painful vertebral symptoms without fracture of the adjacent or distal vertebral bodies.