bluuebunny/crossref_metadata_2025 huggingface dataset:
MRI Findings in Spinal MRI of 306 Children with Scoliosis
Authors: Abul-Kasim K. , Gomez-Hassan D. , McCormick L. , Maly P. , Sundgren P.C.
Published: April 2015

The aim of this study was to analyze the MRI findings and assess the prevalence of different associated structural abnormalities in children with scoliosis and to determine if the age of onset is a possible indicator of intraspinal pathology. This is a retrospective analysis of 663 consecutive MR examinations (319 patients). Thirteen patients with known intraspinal tumors were excluded and a total of 306 patients aged 2–18 years with scoliosis were subjected for analysis. The scoliosis was regarded as idiopathic in 62% of patients. Among the remaining 38% the most commonly seen abnormality was syrinx and Chiari malformations. There was no statistically significant difference in the occurrence of syrinx only or syrinx associated with Chiari I malformation in patients younger than ten years and those older than ten years. MRI examination is an essential part of the work up of scoliosis in the pediatric population especially before any corrective surgery. This study and a review of the current literature suggest there is no clinical marker that would definitely serve as an indicator of the presence of intraspinal pathology in these patients.
Localized Amyloidosis and Alzheimer's Disease: The Rationale for Weekly Long-Term Low Dose Amyloid-Based Fractionated Radiotherapy
Authors: Bistolfi F.
Published: April 2015

Amyloidosis, a plasma cell dyschrasia, is characterized by accumulation in the intercellular spaces of fibrillar proteins with a typical beta-sheet pattern. Vascular-cerebral amyloidosis is the hallmark of Alzheimer's disease and spongiform encephalopathy (Creutzfeldt-Jacob and the like). Current treatment of primary systemic amyloidosis is neither free from complications nor - in some presentations - a mortality rate. Localized tracheo-bronchial amyloidosis (TBA) has been successfully treated with high energy beams of radiation (20 Gy in 10×200 cGy in two weeks). The CT response to radiation takes several months after completion of treatment. As 20 Gy in two weeks are followed by inflammatory reactions, this dosage cannot be suggested in the treatment of amyloidotic radiosensitive organs (e.g. kidneys, liver), or in the hypothetical treatment of Alzheimer's disease. On the basis of the following points: 1) plasma cells in amyloid deposits are not numerous; 2) plasma cells are radioresistant, both in vitro and in vivo (radiotherapy of solitary plasmocytoma); 3) the effects of radiotherapy (20 Gy/2 w) on TBA localizations cannot be exclusively due to plasma cell killing, this study postulates a biophysical mechanism of radiation-induced H-bond breaks in the beta-sheet structure of amyloid, together with depolymerization of glucosaminoglycans, very radiosensitive molecules invariably associated with amyloid fibrils. As both biophysical effects are DNA-independent, the adoption of a definite time/dose ratio (e.g. 20 Gy/2 w) loses much of its importance. Therefore an innovative alternative might be a weekly long-term low-dose fractionated radiotherapy, matching the very slow response of amyloid to radiation. Before being applied to Alzheimer's disease, the proposed radiotherapy (RT) schedule should be tried in TBA patients to compare the new results of long-term fractionated RT with the old results of 20 Gy/2 w. Should long-term fractionated RT prove equally (or almost equally) effective, but certainly much less toxic than 20 Gy/2 w, its application to Alzheimer patients might become an effective and safe treatment, provided clinical and objective control by means of current imaging techniques (MRI, PET) can be assured.
Possible Role of Local Hypoxia in the De Novo Formation of Dural and Osteodural Arteriovenous Fistulas after Encephalitis
Authors: Iizuka Y. , Yamashiro Y. , Suzuki M. , Sumi Y. , Oizumi H. , Yoritaka A. , Tanaka S.
Published: April 2015

A rare case of de novo formation of dural and osteodural arteriovenous fistulas after encephalitis is presented. We review and discuss the etiological angiogenetic factors and processes in intracranial dural arteriovenous fistulas formation. Local tissue hypoxia may have played a role in the initial step causing sprouting angiogenesis as the main pathogenesis of DAVFs formation.
Can a Warning Leak in a Patient with Unruptured Aneurysm Mask an Underlying Gastrointestinal Pathology?
Authors: Poon W.L. , Suh D.C. , Choi J.W. , Choi B.S. , Cha E.Y. , Bang J.Y. , Hahm K.D. , Jang H.J. , Do K-H. , Lee M.C.
Published: April 2015

Aggravating headache accompanied by nausea and epigastric discomfort suggesting a warning leak in a 39-year-old woman with a giant thrombosed intracranial aneurysm prompted us to undertake coiling of the aneurysm. After uneventful coil embolization of the aneurysm, collapse of the lung related to bronchospam developed, and was found to have a gastrointestinal pathology which had gone undetected before the procedure. Despite its rarity, gastrointestinal pathology mimicking warning leak should have been considered in a patient with a warning leak sign.
On the Efficient Compression of fMRI Data Series of Brain
Authors: Rajeswari R. , Rajesh R.
Published: April 2015

Four dimensional medical images, namely fMRI, require a large volume of memory to store the data. Compression techniques are therefore used for the storage and transmission of these medical images. This paper proposes a coding scheme for volumetric images which in the first stage recognizes significant images and in the second stage compresses those images using a JPEG-LS coding scheme. An example implementation for 4D fMRI data series of brain stored in ANALYZE file format is illustrated in this paper. The proposed scheme provides efficient compression for 4D fMRI medical images.
MR-Cisternography with T2-Weighted Single-Shot Fast Spin Echo Sequence in the Diagnosis of a Spontaneous CSF Fistula of the Sphenoid Sinus Causing Massive Pneumocephalus
Authors: Tedeschi E. , Iaccarino C. , Covelli E.M. , Rapanà A. , Barretta M.L. , Piscitelli V. , Belfiore G.
Published: April 2015

A spontaneous CSF fistula of the sphenoid sinus was preoperatively diagnosed in a young woman presenting with massive pneumocephalus and rhinorrhea. Diagnosis was established by MR cisternography using a heavily T2-weighted 3D single-shot FSE sequence with half-Fourier analysis (3D-EXPRESS®), originally developed for imaging the inner ear. While unenhanced CT failed to detect the site of the fistula, MR permitted complete evaluation of the sellar/sphenoid region and tracked the CSF signal down to the nasal cavity.
Multiple Symmetric Lipomatosis in Two Chinese Patients, One Typical and One Unusual
Authors: Shen C.-Y. , Ou C.-H. , Tsao T.-F. , Wu M.-C. , Tyan Y.-S.
Published: April 2015

Multiple symmetric lipomatosis (MSL; Madelung disease) is an uncommon disorder with diffuse multiple symmetrical unencapsulated accumulations of fat located in the neck and the upper trunk. MSL usually occurs in middle aged Caucasian men of Mediterranean ancestry with a history of alcoholism. In the past decade, an increasing number of cases in the Chinese population have been reported which appear to be limited to the head and neck regions. We describe two Chinese patients with MSL who have a history of alcoholism. The MR and CT findings disclosed that one patient had the typical accumulation of unencapsulated fat in the neck and upper back, while the other patient had more than the typical neck involvement and an unusual distribution of fat in the scrotum.
Spontaneous Resolution of Cavum Veli Interpositi
Authors: Vattoth S. , Kim Y.S. , Norman E. , Roberson G.H.
Published: April 2015

Cavum veli interpositi is an open CSF space in the roof of the third ventricle that surrounds the internal cerebral veins, and is a forward extension of the quadrigeminal plate cistern. To the best of our knowledge, spontaneous resolution of a cavum veli interpositi has not been reported in the literature to date. Interestingly, case reports of spontaneous resolution of cystic cavum septum pellucidum in three patients and eighteen arachnoid cyst cases has been described in the literature. We describe the spontaneous resolution of a cavum veli interpositi or cyst in cavum veli interpositi in a 35-year-old man and review the literature of spontaneous resolution of cavum septum pellucidum and arachnoid cysts.
Quantitative Assessment of Water Diffusion Changes in Brains of Children with Neurofibromatosis Type I Using Apparent Diffusion Coefficient
Authors: Mizukoshi W. , Kozawa E. , Kuramochi A. , Uchino A. , Kimura F.
Published: April 2015

We measured diffusion changes in the brains of children with neurofibromatosis type 1 (NF1). Using diffusion-weighted and conventional magnetic resonance (MR) images of 42 children with NF1 (19 girls, 23 boys; 7 months-16 years, mean 6.8 years) and 42 age-matched controls (20 boys, 22 girls; 6 months-17 years, mean, 6.9 years), we calculated the apparent diffusion coefficient (ADC) from the automatically generated ADC maps and placed regions of interest in the pons, middle cerebellar and cerebral peduncles, thalami, globus pallidi and frontal white matter. Evaluating only normal-appearing regions on conventional images, we compared mean ADCs using the unpaired Student t test. Means were not significantly different in frontal white matter but were larger in the other regions in the NF1 (P < 0.01). Although conventional MR showed normal intensity, ADCs of the pons, middle cerebellar and cerebral peduncles, thalami and globus pallidi were significantly larger in the NF1.
Arterial Occlusion following Embolization of an Orbital Arteriovenous Malformation
Authors: Kamalden T.A. , Choo M.M. , Kadir K. , Khaliddin N.
Published: April 2015

Orbital arteriovenous malformation is a rare condition which poses a management problem in view of the complexity of the vessels involved, and the potentially blinding and life-threatening complications from the modes of treatment. Treatment requires obliteration of the abnormal vascular communication. Vision may be adversely affected by the condition itself, as well as a result of invasive treatment modalities. This case reports such a situation where the visual outcome was severely affected following embolization of the feeding vessels.
Tumour-like Lesions
Authors: Demaerel P.
Published: April 2015

The relevant intracranial cysts and tumour-like lesions according to the World Health Organization will be reviewed but most attention will be paid to non tumoral pathology that may behave like a tumour on imaging. It is important to depict these non-tumoral lesions because of the different therapeutic approach.
Amyloidoma Involving the Orbit, Meckel's Cave and Infratemporal Fossa: 3T MRI Findings
Authors: Menetti F. , Bartolomei I. , Ambrosini-Spaltro A. , Salvi F. , Agati R. , Leonardi M.
Published: April 2015

Amyloidoma is a rare lesion characterized by tissue deposition of an abnormal fibrillary protein (amyloid). It is the focal and localized counterpart of systemic amyloidosis, where the deposition of amyloid diffusely involves several organs. The few literature reports of intracranial amyloidomas include lesions involving the pituitary gland, orbit, cerebral hemispheres, temporal bone, cerebellopontine angle and jugular foramen. We describe the case of a 27-year-old woman presenting with painless slowly progressive proptosis of the right eye. The patient underwent a contrast-enhanced CT study of the head, followed by 3T MRI which disclosed a homogeneous mass in the right Meckel's cave and cavernous sinus, extending through an enlarged foramen ovale to the infratemporal fossa. The right optic nerve and ocular muscles were enlarged and infiltrated along with the retrobulbar fat by contrast-enhancing tissue. Thin contrast-enhanced MRI scans through the area of interest showed the mass to extend posterior to the gasserian ganglion, involving the cerebellopontine angle cistern, where the intracisternal parts of the III, V, and VI nerves bilaterally appeared enlarged and showed perineural enhancement. The lesion closely mimicked a malignant tumor with perineural tumor infiltration, so we performed fine needle biopsy of the portion of the lesion near the right foramen ovale under fluoroscopic guidance. Histopathology revealed that the lesion was an amyloidoma. Further clinical and blood examinations, serum chemistry, followed by biopsy of the periumbilical fat showed no signs of systemic amyloidosis or an underlying inflammatory or neoplastic disorder. No further treatment was instituted, follow-up MRI six months later showed no enlargement of the mass.
Perfusion MRI in the Evaluation of Cerebral Blood Volume and Mean Transit Time in Untreated and Recurrent Glioblastomas
Authors: Principi M. , Italiani M. , Ottaviano P.
Published: April 2015

Perfusion MRI by means of dynamic contrast-enhanced T2-weighted MR imaging allows quantitative analysis of cerebral blood volume (CBV) and mean transit time (MTT) in intraaxial brain tumors. Our aim was to compare recurrent glioblastomas to untreated glioblastomas, determining if there are differences in perfusion parameters between the two groups. Serial MR examinations were performed in 26 patients with glioblastoma histologically demonstrated before surgical resection and in 19 patients with recurrent glioblastoma after surgery and radiotherapy. Tumor recurrence was established using both histological and clinical criteria. Normalized CBV and MTT ratios were considered and compared between the two groups. A statistically significant difference, both in average and maximum normalized CBV ratios between the two groups was found. In particular, average and maximum normalized CBV ratios were greater in untreated than in recurrent glioblastomas. On the contrary, average and maximum normalized MTT ratios were greater in the recurrent glioblastomas, than in untreated tumors. Perfusion MRI by means of dynamic contrast-enhanced T2-weighted MR imaging is a valuable adjunct to conventional MR imaging in assessing different hemodynamic features between untreated and recurrent glioblastomas. In particular, tumor recurrence must be suspected even if the average and maximum normalized CBV ratios are far below those of untreated glioblastomas. In addition, increased average and maximum MTT ratios could be considered typical markers of neoplastic recurrence in irradiated cerebral tissue.
Atypical MRI Findings of Synchronous Cerebral Metastasis
Authors: Karaca S. , Karatas M. , Yildirim T. , Hurcan C.E.
Published: April 2015

Intracranial metastases represent 7% to 17% of all brain tumors. Metastases may appear before, after or synchronously with the primary tumor. Synchronous tumor presentation means that that metastasis is found within two months of primary tumor diagnosis. A 60-year-old man was seen 15 days after the acute onset of confusion and gait disturbance. Results of a neurologic examination revealed disorientation, dysarthria, and left-sided ataxia. Results of nonenhanced computed tomography scanning of the brain were unremarkable. Cerebral magnetic resonance imaging showed multiple miliary, round, small (maximum diameter, 1 cm) lesions located infra- and supratentorially. Gradient-echo magnetic resonance images of these lesions were compatible with hemorrhage and were more pronounced compared with other sequences. Hemorrhagic cerebral metastases were suspected, and the patient was examined for primary tumors. Chest computerized tomography revealed a tumor in the posterior, superior lobe of the right lung; a cervical lymph node biopsy suggested a metastatic carcinoma. Our case illustrates that magnetic resonance imaging findings of synchronous cerebral multiple metastases presenting with neurologic symptoms may be atypical while the results of cerebral computerized tomography are normal. Contrast-enhanced cerebral magnetic resonance imaging, especially gradient-echo magnetic resonance sequences, should always be considered for diagnosing hemorrhagic metastases in patients presenting neurologic findings with a known or unknown cancer.
CT Diagnosis of Cerebral Venous Thrombosis: Importance of the First Examination for Fast Treatment
Authors: Palena L.M. , Toni F. , Piscitelli V. , Maffei M. , Leonardi M.
Published: April 2015

This study is a retrospective investigation of the role of non contrast-enhanced CT (NCCT) in the diagnosis of cerebral venous thrombosis (CVT) in clinical practice. We retrospectively identified 24 patients discharged with a diagnosis of CVT between January 2002 and December 2008 who had undergone NCCT as the first imaging modality. NCCT had been evaluated by a general radiologist and subsequently by a neuroradiologist in five cases. Final diagnosis was established by CT angiography (CTA), magnetic resonance (MR) and digital subtraction angiography (DSA). NCCT diagnosis was defined as “positive” when the neuroradiologist suggested the diagnosis of CVT on the report, as opposed to the “negative” diagnosis group. All NCCT examinations were reviewed by a neuroradiologist experienced in cerebrovascular pathology. We compared his evaluation and analysed the location and number of direct signs found on NCCT. The neuroradiologist strongly suggested an NCCT diagnosis of CVT in 63% (15/24) of patients: 80% (4/5) with deep venous thrombosis (DVT) and 57% (11/19) with sinus venous thrombosis (SVT). The general radiologist's NCCT evaluation was incorrect in four cases, subsequently diagnosed at NCCT by the neuroradiologist. After reviewing the NCCT examination the experienced neuroradiologist identified the CVT direct sign in two that belonged to the NCCT negative diagnosis group. Thus the direct sign was present in 71% (17/24) of the cases: all the patients with DVT and 63% (12/19) of the patients with SVT. NCCT still plays an important role for fast and accurate diagnosis of CVT in the emergency setting. NCCT displayed the CVT direct sign more frequently than previously thought and it was correctly interpreted in most cases. Neuroradiological consultation adds value to the general radiologist's evaluation.
Callosal Holes: An Unusual Imaging Appearance in Systemic Lupus Erythematosus
Authors: Shaikh R. , Muttikkal T.J.E. , Chavan V.N.K.
Published: April 2015

Systemic lupus erythematosus (SLE) has diverse imaging features. However, focal lesions in the corpus callosum are extremely rare in SLE with only few cases mentioned in the literature, with no mention of callosal holes in SLE. Callosal holes have been described as a characteristic finding in Susac syndrome and have been mentioned in Nipah virus encephalitis, Marchiafava Bignami disease and periventricular leukomalacia. We describe a case of SLE with callosal holes. The demonstration of callosal holes in this case brings the imaging appearance of SLE a step closer to that of Susac syndrome which is considered a clinically and radiologically close condition. It also adds to the list of imaging appearances of central nervous system SLE.
Chemotherapy-Induced Posterior Reversible Encephalopathy Syndrome in Childhood Chronic Myeloid Leukemia
Authors: Balaji R. , Ramachandran K. , Nair M. , Kusumakumari P.
Published: April 2015

Posterior reversible encephalopathy syndrome (PRES) is a clinico-radiological phenomenon seen in a wide spectrum of clinical conditions and is characterized clinically by headache, altered mental status, visual loss and seizures and reversible neuroimaging findings. This study evaluated MR imaging in PRES in a clinical oncology setting. MR findings may be helpful in disclosing the underlying pathophysiological mechanisms of the syndrome. The MR imaging protocol consisted of T2–weighted, fluid attenuation inversion recovery (FLAIR), diffusion weighting imaging (DWI) and apparent diffusion coefficient (ADC) sequences. Contrast enhanced computed tomography (CT) of the brain revealed bilateral symmetric subcortical hypodense lesions in the parieto-occipital regions. T2–weighted and FLAIR sequences showed bilateral, symmetrical focal cortical and subcortical hyperintensities involving the parietal and occipital lobes. These areas appeared hyperintense on DWI while the ADC (Apparent Diffusion Coefficient) maps demonstrated higher apparent diffusion coefficients in areas of FLAIR abnormalities thus confirming vasogenic edema. Follow-up scan five days later showed improvement or resolution of the abnormalities. Transient DWI hyperintensities seen in cortical watershed areas corresponding to the hyperintense foci in FLAIR imaging are suggestive of foci of vasogenic edema secondary to vasospasm in highly ischemia-sensitive cerebral tissue.
Craniosynostosis: Correlation with Cranial Vault Shape and Osseous Defects
Authors: Damianidis Ch. , Kyriakou V. , Vachtsevanos N. , Tzikos F. , Konstantinou D. , Tsitouridis I.
Published: April 2015

This study assessed the value of three-dimensional CT (3D CT) in the diagnosis of craniosynostosis, and correlated the cranial deformity with the presence of osseous defects in cranial vault's bones. One hundred and two children (55♀ and 47♂) with a clinical suspicion of craniosynostosis, underwent spiral computed tomography with 3D reconstruction using the shaded surface display (SSD) and volume rendering (VR) algorithms. We evaluated the presence of osseous defects in cranial bones in correlation with the type of craniosynostosis and the shape of the cranial vault. 3D CT allowed the evaluation of craniosynostosis in all patients. All patients had combined forms of craniosynostosis. Osseous defects in the bones of cranial vault were found in 56 patients of whom nine had scaphocephaly, eight plagiocephaly and one trigonocephaly. CT of the skull with three-dimensional reconstruction can safely and reliably identify craniosynostoses in children and could be used for the identification of osseous defects in the cranial vault.
Virchow-Robin Spaces in Health and Disease
Authors: Mohan S. , Verma A. , Sitoh Y-Y. , Kumar S.
Published: April 2015

Virchow-Robin spaces are pial-lined, interstitial fluid-filled structures that do not directly communicate with the subarachnoid space, and accompany penetrating arteries and veins. They are common, incidental, “leave me alone” lesions that should not be mistaken for more ominous disease. They are frequently seen in the supratentorial white matter, basal ganglia region, around the anterior commissure, and surrounding penetrating lenticulostriate arteries, thalamus, midbrain, cerebellum, insular cortex, corpus callosum, cingulate gyrus, extreme capsule, along the optical tracts, and in the hippocampus. Most are small, well-defined fluid-filled cysts less than five mm in diameter, and are isointense to CSF on all pulse sequences. They are often mistaken for lacunar infarcts, cystic neoplasms or infectious cysts. We retrospectively analyzed various appearances of VRS as seen on magnetic resonance imaging of brain in 100 cases, in an attempt to provide a better understanding of these lesions and their significance in various physiological and pathological conditions.
Venous Stroke Can Be the Unusual Clinical Presentation of an Arising Naso-Ethmoidal Encephalo-Meningocele in Adulthood
Authors: Della Puppa A. , Fabbri M. , Manara R. , Carollo C. , Fattorello C. Salimbeni , D'Avella D. , Scienza R.
Published: April 2015

Trans-ethmoidal encephalo-meningocele is an extremely rare event among the adult population. It mainly affects young people who have previously reported a head injury. Even though early treatment is mandatory to avoid septic complications, the diagnosis is usually late because of the misleading symptomatology. We describe the unusual clinical history of an adult patient with a giant trans-ethmoidal encephalo-meningocele. A 61-year-old woman presented progressively more intense headache and rhinorrhea. No trauma was reported. We learned that she had a history of misunderstood spontaneous rhinorrhea beginning two years before, followed one year later by a lateral sinus thrombosis which worsened the cerebrospinal fluid leakage. Some months after stroke a new cerebral magnetic resonance scan revealed a giant trans-ethmoidal encephalo-meningocele. The brain herniation was surgically removed by a subfrontal intradural approach through a frontal craniotomy. Even rare, giant naso-ethmoidal encephalo-meningocele has to be considered in adult patients presenting with rhinorrhea even without a history of meningitis or neurological defects. Venous stroke can affect patients in whom prolonged CSF leakage occurs because of misunderstood cerebrospinal fistula. These patients must be monitored after stroke for the possible onset of an encephalo-meningocele.
Typical Neuroradiological Diagnosis of Maple Syrup Urine Disease as a Precursor to Clinical Diagnosis
Authors: Srinivasan K.G. , Ramprabananth S. , Ushanandhini K.P. , Srividya S.
Published: April 2015

Maple syrup urine disease (MSUD) is a rare inherited metabolic disorder. It is due to decreased de-carboxylation of branched-chain amino acids (leucine, valine, and isoleucine) so their accumulation gives a characteristic maple syrup odour in urine and leads to severe neurological deterioration. Early diagnosis and dietary intervention prevent complications and may allow for normal intellectual development. Various types of MSUD exist, classical MSUD being the most common and severe form of this disease. We describe a case of classical MSUD in a four-month-old infant where the MR imaging suggested the diagnosis of MSUD prior to the clinical diagnosis which was further confirmed by laboratory techniques.
Clinical Features and Classification of Brain AVMs and Cranial DAVFs
Authors: De Blasi R. , Salvati A. , Medicamento N. , Chiumarulo L.
Published: April 2015

The clinical findings of intracranial vascular malformations are strictly related to their morphologic, angioarchitectural and hemodynamic characteristics. An overall study of these features is the first step to understand the different classifications for arteriovenous malformations, dural arteriovenous fistulas and carotid-cavernous fistulas. This evaluation will also suggest the correct timing of endovascular treatment and which part of the lesion should be the target of the therapy. Conventional cerebral angiography is mandatory when a correct classification of intracranial arteriovenous malformative shunts must be achieved. The angioarchitectural classification of brain arteriovenous malformations considers all angiographic features of each component of the malformation, both morphologically and hemodynamically, and relates them to the clinical course of the disease. The correlation between clinical findings, angiographic features and classifications is even stronger for cranial dural arteriovenous fistulas, in which cortical venous drainage is typical of “aggressive” fistulas and is usually absent in the “benign” type. Similarly, carotid-cavernous fistulas can be differentiated at angiography into high or low flow lesions according to the flow rate of the shunt, and into direct or indirect fistulas, according to the origin of arterial feeders. This paper focuses on the existing relation between the hemodynamics of brain arteriovenous malformations, cranial dural arteriovenous fistulas, carotid-cavernous fistulas, and their most frequent clinical findings, through an analysis of the most widely used different classification systems.
Evolution of Giant P2-Posterior Cerebral Artery Aneurysm over 16 Years: Saccular to Serpentine
Authors: Sharma S.
Published: April 2015

Giant intracranial aneurysms account for only about 5% of all intracranial aneurysms. Giant intradural aneurysms are associated with severe natural history, yet remain potentially curable. These aneurysms cause symptoms due to their mass effect, and only 14–35% of cases present with subarachnoid haemorrhage (SAH). The present case report is an imaging evolution of a giant posterior cerebral artery (PCA) aneurysm in a patient who was lost on follow-up from 1992 to 2008 giving insight into the natural history and morphologic evolution of giant serpentine aneurysms. Attempted surgery 16 years previously for a saccular PCA aneurysm produced encephalomalacia and created a more spacious perianeurysmal environment, preventing any mass effect on vital structures in its vicinity. This allowed the patient to have a long symptom-free period and also allowed the aneurysm to follow a morphologic evolution over a long period without causing symptoms which would have called for intervention. This unusual development gave a unique opportunity to study the evolution of a gaint serpentine aneurysm from a saccular aneurysm and also the clinical and morphologic changes in an aneurysm if it can be prevented from producing mass effect. The Coanda effect, or boundary wall effect, has been considered responsible for the development of the serpentine channel in the original globular aneurysm. However many Authors conclude that giant serpentine aneurysms are not derived from saccular aneurysms.
3-Tesla Study of the Spinal Cord White Matter
Authors: Riccioli L. Albini , Marliani A.F. , Leonardi M.
Published: April 2015

Spinal cord as soon as brain, can be affected by dysmyelinating and demyelinating diseases, as Multiple Sclerosis (MS), Acute Disseminated Encephalomyelitis (ADEM), Neuromyelis Optica (NMO) and Transverse Myelitis. Investigation of the spinal cord with a high field strength MR system is hampered by the inhomogeneous magnetic field, physiological movements and the small size of the anatomical area. We describe normal and pathological neuroradiological findings in spinal cord white matter and the parameters of optimized sequences for use with the 3T MR systems.
Voxel-Based Morphometry in Patients with Cryptogenic Occipital Epilepsies
Authors: Bilo L. , De Leva M.F. , Meo R. , Tortora F. , Esposito F. , Aragri A. , Elefante A.
Published: April 2015

We evaluated the differences in grey matter concentration (GMC) by voxel-based morphometry (VBM) in patients with cryptogenic occipital epilepsies. VBM analysis was performed in 11 patients with cryptogenic occipital epilepsies compared to 11 healthy controls. VBM analysis in patients revealed focal areas of reduced GMC in the occipital cortex and, more interestingly, increased GMC in the midbrain tegmentum and basal ganglia (globus pallidus and thalamus). VBM may disclose slight structural abnormalities in the brain of cryptogenic epilepsy patients, not evident with standard MRI. To the best of our knowledge, this is the first literature report describing areas of altered GMC in patients with occipital epilepsy. We hypothesize that these findings might be related to epileptic discharges and/or their diffusion and suggest that midbrain, globus pallidus and thalamus may be part of a functional network originating from the occipital areas.
Increasing Exophthalmia after Carotid—Cavernous Fistula Closure with a Detachable Balloon: Problems of Incomplete Treatment
Authors: Ghanaati H. , Motevalli M. , Jalali A.H. , Firouznia K.
Published: April 2015

A 30-year-old woman with pulsating exophthalmia due to posttraumatic carotid-cavernous fistula underwent embolization with a detachable balloon. Because of balloon dislodgement, the drainage was derived to the superior ophthalmic vein and clinical worsening occurred. Complete ophthalmoplegia developed and visual acuity decreased. After a second embolization we inserted two balloons but the same findings were exaggerated. Finally coiling of the internal carotid artery was done and orbital decompression achieved. Ophthalmoplegia, proptosis, chemosis and nerve paralysis intraocular pressure improved.
Giant Axonal Neuropathy: A Pictorial Essay and Review of Literature
Authors: Vasudev M.K. , Bhat M.D. , Bharath R.D. , Prasad C. , Arvinda H. , Kulkarni G. , Gayathri N.
Published: April 2015

Giant axonal neuropathy (GAN) is a neurodegenerative disorder classified within the hereditary motor and sensory neuropathies, affecting both the peripheral and central nervous systems. GAN typically presents in early childhood before the age of five years and progresses to death usually by early adulthood. Various imaging findings in giant axonal neuropathy have been described and documented in literature in the form multiple case reports. We here present a pictorial essay of all the major imaging GAN findings described in the literature. In addition, involvement of the dentate nucleus hitherto not described in the literature was noted in the present case.
Aberrant Mid-Sagittal Fiber Tracts Visualized by Diffusion Tensor MR
Authors: Ormitti F. , Summa A. , Ventura E. , Todeschini A. , Pisani F. , Cantalupo G.
Published: April 2015

In hemimegalencephaly, MR imaging often reveals mid-sagittal band-like structures between the lateral ventricles. We describe the clinical presentation, morphologic abnormalities, conventional MR imaging, diffusion tensor MR and fiber tract (FT) reconstruction in a 14-year-old boy with unilateral hemimegalencephaly. We retrospectively examined MR images to determine whether these structures are aberrant mid-sagittal fibers.
The Use of Flow-Diverting Stents in the Treatment of Giant Cerebral Aneurysms: Preliminary Results
Authors: Cirillo L. , Dall'Olio M. , Princiotta C. , Simonetti L. , Stafa A. , Leonardi F. Toni. M.
Published: April 2015

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.
Medical Therapy and Multilevel Vertebroplasty in Osteoporosis: When and Why
Authors: Lavanga A. , Guarnieri G. , Muto M.
Published: April 2015

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.
Differentiating Components of Cerebral Arteriovenous Malformations Using T1-Weighted Gradient Recall Echo MR Imaging
Authors: Wu E-H. , Wong H-F. , Toh C-H. , Ng S-H. , Wu Y-M. , Wong A.M.
Published: April 2015

Cerebral arteriovenous malformation (AVM) typically shows signal void on conventional MR images, making differentiation of each component difficult. We analyzed the MR signal intensity of AVM components on T1-weighted gradient recalled echo pulse sequence images. We retrospectively studied 29 patients with AVM between 2006 and 2008. Patients were excluded if they had 1) intracranial hemorrhage, 2) previous intervention for AVM. All patients underwent MR study on a 3T system (Magentom TIM Trio, Siemens). Pulse sequences included T1-weighted gradient recalled echo (T1GRE), T2-weighted (T2), time-of-flight (TOF), and contrast-enhanced T1-weighted (cT1) images. Digital subtracted angiography (DSA) was performed in all patients as a diagnostic standard. Signal intensity of each AVM component was recorded and compared between pulse sequences. Nine patients were studied (five men; mean age 39.1 years) and nine AVM were identified (mean size, 3.9 cm). Three different signal intensities (hypo-, iso-, and hyper-intensity) were observed in all nine patients on T1GRE. Only one signal intensity was seen on T2 (flow void) and cT1 images (hyperintensity) in nine patients. Two different signal intensities were observed in all seven patients with TOF images. The T1GRE image showed the largest number of different signal intensities of AVM when compared with other pulse sequences, thus providing clearer structural delineation. Routine use of the T1GRE pulse sequence can help pre-therapeutic planning or follow-up of AVM.
Evaluation of a Patient with Klumpke's Palsy
Authors: D'Amore A. , Conte G. , Viglianesi A. , Chiaramonte R. , Pero G. , Chiaramonte I.
Published: April 2015

Klumpke's palsy is a rare form of paralysis involving the muscles of the forearm and hand, resulting from a brachial plexus injury in which the eighth cervical (C8) and first thoracic (Th1) nerves are injured either before or after they have joined to form the lower trunk. We report a case of a 45 years-old woman with post-traumatic left cervical-brachial pain afflicted by obstetric brachial plexus palsy on the right side. Magnetic Resonance Imaging (MRI) examination of the cervical spine revealed a meningeal stretch in the left side at C7-Th1 level, responsible for pain, and also multiple intraforaminal pseudomeningoceles at C5-C6, C6-C7 and C7-Th1 intersomatic spaces in the right side, due to the perinatal trauma that had determined the obstetric brachial plexus palsy. Spinal pseudomeningocele is an extradural collection of CSF in the surrounding soft tissues due to a dural breach and can represent a predictive finding of injury of the brachial plexus. We obtained clinical and electrophysiological findings of Klumpke's palsy, but MRI examination showed the lack of visualization of C8 and the integrity of Th1 nerve roots and to our knowledge there is no evidence in literature about the possibility to have a partial Klumpke's palsy without Th1 avulsion. The aim of this article was to underline that for the correct assessment of patients with brachial plexus palsy the only use of MRI is insufficient: it is necessary an integration of the information obtained from clinical, electromyographic and MRI study.
Magnetic Resonance Imaging and Ultrasonographic Evaluation of Retinal Detachment in Orbital Uveal Melanomas
Authors: Damianidis C.H. , Konstantinou D. , Kyriakou V. , Arvaniti M. , Kotziamani N. , Rodokalakis G. , Agriou A. , Emmanouilidou M. , Tsitouridis I.
Published: April 2015

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.
Morphology and TGF-beta1 Concentration Analysis of Ligamentum Flavum in Patients with Lumbar Canal Stenosis and Lumbar Disc Herniation
Authors: Rispoli R. , Mastrostefano R. , Brunelli F.
Published: April 2015

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.
Evaluation of Angiographic Findings in Spontaneous Aneurysmal Subarachnoid Hemorrhage Patients
Authors: Firouznia K. , Ghanaati H. , Sadeghi S. Rahmat , Shakiba M. , Jalali A.H.
Published: April 2015

This paper describes the angiographic findings of spontaneous aneurysmal subarachnoid hemorrhage (SAH) patients, including frequency, anatomic location and multiplicity of cerebral aneurysms. We retrospectively reviewed the records of 796 SAH patients at our university affiliated hospital. After confirming SAH by lumbar puncture or CT scan, all patients underwent digital subtraction angiography to find the definite anatomic location. The male to Female ratio in SAH patients was 9:10. The mean (SD) age of all patients with SAH was 47.9±14.7 years. The mean (SD) age of men with SAH was 46.6±15.6 years and women with SAH was 49.3±13.5 years (P=0.015). 357 (44.8%) patients had aneurysms. The mean (SD) age of aneurysmal patients was 49.8±14.3 years. The mean (SD) age of men with aneurysm was 47.8 ±15.9 years and women with aneurysm was 51.3±12.9 years (P ? 0.03). The male to female ratio in aneurysms was 0.72:1. The most common aneurysm location was in the anterior communicating artery (N=166, 39%). The second most common anatomic location was the middle cerebral artery bifurcation (66 left, 60 right). The total number of patients with single aneurysms was 303 (84.9%) while 54 (15.1%) patients had multiple aneurysms. Among these patients, 49 had two aneurysms, three had three aneurysms and two had four aneurysms. In all, 418 aneurysms were detected. Of 357 patients with aneurysms 150 (42%) had vasospasm during angiography. In conclusion, the most common aneurysm location was the anterior communicating artery and the rate of multiplicity was also higher in our patients.
Endovascular Treatment of a Fusiform Cerebral Aneurysm by Stenting Alone
Authors: Guarnieri G. , Lavanga A. , Granato F. , Vassallo P. , Cavaliere C. , Capobianco E. , Izzo R. , Ambrosanio G. , Muto M.
Published: April 2015

This paper illustrates two cases of stent-in-stenting treatment of unruptured, symptomatic, fusiform intracerebral aneurysms. Two unruptured symptomatic fusiform intracerebral aneurysms were treated by the stent-in-stent only technique. The first patient, a 35-year-old woman, had a partially thrombosed fusiform aneurysm in the left carotid siphon with the chief complaint of headache and left ophthalmoplegia. The second patient, a 60-year-old man, had a symptomatic fusiform aneurysm of the left V4 with recurrent transient ischemic attacks. No cervical trauma or infection was present in either patient. A CT, CTA and DSA were performed on hospital admission. Both patients were previously premedicated with Clopidrogel + ASA for five days before treatment. By DSA, both patients were treated under general anesthesia with a heparin protocol plus ASA (500mg) at stent placement. A double stent-in stent was placed in both patients. Post-intervention medical therapy was clopridogel and ASA for three months, then aspirin (100mg) daily for six months. CTA and DSA were performed at six and 12 months. Both stents were positioned without any difficulty and could be navigated within cerebral arteries without any exchange procedure, and thanks to their retractability, they were accurately positioned. No bleeding at post-treatment CT was noted. At 12 months follow-up, a complete disappearance of the aneurysm and preservation of the parent vessel was observed for both patients. No procedure-related complication occurred. No intra-stent stenosis or intimal hyperplasia was observed. Stenting for fusiform aneurysms is a safe procedure without complications. Medical therapy pre-post procedure associated with follow-up is necessary to prevent/establish the incidence of occlusion.