bluuebunny/crossref_metadata_2025 huggingface dataset:
The Pediatric Posterior Fossa: An Embryologist's View
Authors: Catala M. , Morgand C.
Published: April 2015

The paediatric posterior fossa is a complex structure made up of both neural elements and skeletal pieces. The first structures to be formed are the neural elements followed later by bones moulded around the already patterned neural elements. The nervous structures derive from the neural tube at the exact level of the rhombencephalon (also called the hindbrain). This neural tube is segmented into neuromeres called the rhombomeres. These structures form compartments in which cell migration is restricted. Furthermore, these compartments display specific gene expression and if the expression of a gene is forced into an aberrant rhombomere, a severe defect is determined in its own development. The cerebellum, that is one of the major neural components at this level, derives from rhombomere 1. It grows in a rostral to caudal direction like a curtain because its rostral progression is prevented by the cerebellar tentorium. The cerebellum arises as two distinct primordia that unite on the midline thanks to migration of the primordium of this structure. An impairment of this structure will generate a defective fusion at the midline. It is important to note that the different anatomical parts of the cerebellum are not regulated by the same molecular processes leading to a heterogeneity of this organ. Lastly, the bony structures of the posterior fossa derive from the mesoderm. We will review the exact contribution of both the somites and the cephalic mesoderm in such a context.
Do Recent Advances in MR Technologies Contribute to Better Gamma Knife Radiosurgery Treatment Results for Brain Metastases?
Authors: Hayashi M. , Yamamoto M. , Nishimura C. , Satoh H
Published: April 2015

The detection of intracerebral lesions has improved greatly with advancements in MR imaging, especially the greater sensitivity of the 1.5 Tesla unit versus the older 1.0 Tesla unit. We aimed to determine whether improvements in MR imaging have actually improved diagnostic capabilities and treatment outcomes in gamma knife radiosurgery (GKRS) for brain metastases (METs). Ours was a retrospective study of a consecutive series of 1179 patients (441 females, 738 males, mean age: 63 years, range: 19–92 years) with brain METs who underwent GKRS from 1998 to 2004. Our treatment policy was to irradiate all lesions visible on MR images during a single GKRS session. Mean and median tumor numbers were seven and three (range; 1–74). The 1179 patients were divided into two groups: a 1.0 T-group of 660 patients examined using a 1.0 Tesla MR unit before August, 2002, and a 1.5 T-group of 519 examined using a 1.5 Tesla MR unit after September 2002. In the 1.5 T-group, lesion volumes as small as 0.004 cc were detected with a 5 mm slice thickness. The corresponding lesion size was 0.013 cc in the 1.0 T-group. One or more lesions invisible on a 5 mm slice study were additionally detected on a 2 mm slice study in 47.8% of patients in the 1.0 T-group and 25.2% in the 1.5 T-group (p<.0001). The median survival time (MST) in the 1.5 T-group was significantly longer than that in the 1.0 T-group (8.4 vs. 6.3 months, p=.0004). Due to biases in patient numbers between the two groups, we analyzed subgroups with KPS of 80% or better, no neurological deficits, stable primary tumors, lung cancer, tumor numbers of four or less and tumor volumes of 10.0 cc or smaller. In every subgroup analysis, the MSTs of the 1.5-Tesla group were significantly longer than those of the 1.0-Tesla group. The prognosis of a cancer patient is undoubtedly influenced by multiple factors. Nevertheless, we conclude that application of the 1.5 Tesla MR unit has had a favorable impact on diagnosis and GKRS treatment results in patients with brain METs.
On Identifying Micro Level Error in Realignment Phase of Statistical Parametric Mapping
Authors: Rajesh R. , Satheeshkumar J. , Arumugaperumal S. , Kesavdas C.
Published: April 2015

Statistical parametric map of an fMRI time series is used to identify the sensor, motor and cognitive tasks in the specific regions of the brain. This process of obtaining statistical parametric map includes realignment of the slices in various volume acquired during the scanning. This article presents the identification of micro level (10−6) error in the realignment phase.
Glossopharyngeal Neuralgia Due to Vascular Compression by Tortuous Left Posterior Inferior Cerebellar Artery: A High Strength (1.5 T) MRI Study
Authors: Mudalgi B. , Gaikwad A. , Prabhu S. , Patil J.
Published: April 2015

Glossopharyngeal neuralgia is a rare condition with a frequency about 1% of that of trigeminal neuralgia. Vascular compression is a common and treatable cause of glossopharyngeal neuralgia. Microvascular decompression of the glossopharyngeal nerve is an effective treatment option for patients in whom the disease is caused by compression of the nerve by a blood vessel. Pre-operative detection of the pathology on imaging has become possible with high strength MRI imaging. We describe the case of a 54-year-old man with left glossopharyngeal neuralgia. Constructive interference in steady-state (CISS) and flow sensitive Gradient Echo MRI sequences clearly demonstrated the compression of the IX nerve by the left posterior inferior cerebellar artery (PICA). The patient was operated upon and a Teflon graft was put in between the nerve and the vessel. The intra-operative photographs and post-operative images are also presented here. After surgery, the patient improved symptomatically with no recurrence of the symptoms in the follow-up period of about eight months.
Apparent Diffusion Coefficient is Increased in Children with Tuberous Sclerosis Complex Personal Experience and Review of the Literature
Authors: Jurkiewicz E. , Jóźwiak S. , Bekiesińska-Figatowska M. , Walecki J.
Published: April 2015

Diffusion-weighted imaging (DWI) provides information on tissue integrity and shows increased sensivity in detecting brain white matter disease compared to traditional T2-weighted MRI. We compared apparent diffusion coefficient (ADC) values in brain lesions and normal appearing white matter (NAWM) in patients with tuberous sclerosis complex (TSC) to normal brain tissue in the control group. MRI and DWI were performed in 14 patients with TSC (age range 7–16 years) and in 18 age-matched normal control subjects. ADC values measured from 44 supratentorial cortical tubers, 37 white matter lesions, 80 NAWM were compared to those in control subjects. Statistical analysis was performed using Kruskal-Wallis and Mann-Whitney U tests. The highest ADCs were measured in cortical tubers (mean ADC, 1.24×10–3 mm2/s), followed in descending order by WM lesions (mean ADC, 1.07×10–3 mm2/s), NAWM (mean ADC, 0.83×10–3 mm2/s). We found a significant difference in ADC values of gray, WM lesions and NAWM in TSC patients compared to the control group (p<0,0001). Elevated ADC values in NAWM in TSC patients may be caused by subtle depletion of myelin sheaths and looseness of structures within the brain parenchyma due to underlying migration disorders.
Optic Chiasm Involvement Secondary to Herpetic Encephalitis
Authors: Scazzeri F. , Picchietti S. , Rosa C. , Prosetti D. , Roncucci P.
Published: April 2015

Herpes simplex (HSV) encephalitis is one of the most common central nervous system (CNS) viral infections in adults. Early diagnosis is essential for treatment. We describe the case of a 70-year-old man who reported sudden bilateral reduction of visus. Four days after admission the patient showed high fever, followed the next day by a generalised convulsive crisis and coma. A first magnetic resonance imaging (MRI) showed no alterations, whereas the second showed the usual patterns of HSV encephalitis. With a clinical suspicion of herpetic encephalitis an intravenous therapy with acyclovir was established. The diagnosis of herpetic encephalitis was confirmed by cerebrospinal fluid (CSF) detection of herpes simplex DNA sequences. A further ten days later we performed a third MRI, demonstrating the typical pattern of HSV encephalitis and an increase in size and signal of the optic chiasm.
Small Cell Carcinoma of the Lung Presenting with Ocular Metastasis
Authors: Mavili E. , Gorkem S. Burcu , Donmez H. , Ozturk M.
Published: April 2015

Metastasis to the eye is rare but it may be the presenting symptom. Therefore awareness of the radiological findings of metastasis may aid in establishing its diagnosis. Here we report an ocular metastasis of small cell carcinoma of the lung presenting with pulmonary and ocular manifestations.
Traumatic Retropharyngeal Pseudomeningocele with Atlanto-Occipital Dislocation in a Neurologically Intact Patient
Authors: Mathews M.S. , Owen C.M. , Hasso A.N. , Binder D.K.
Published: April 2015

Traumatic retropharyngeal pseudomeningoceles occur rarely, are associated with severe trauma, and have been reported in patients with significant neurologic deficits at presentation. We report the rare occurrence of a pseudomeningocele following a high-speed motor vehicle accident. Neurological examination showed the patient to be briskly following commands, with intact cranial nerve, motor, and sensory function. CT/MR imaging showed subarachnoid hemorrhage involving the interpeduncular cistern, a clivus fracture, a right occipital condyle fracture, an atlanto-occipital subluxation, aortic arch transection (stable and contained on CT angiogram), multiple rib fractures on the right side with associated pneumothorax, hemothorax and pulmonary contusions. His cervical spine was stabilized in a halo. He was subsequently managed in the intensive care unit and remained neurologically intact. A repeat MRI showed the interval development of a 2×1.5 cm pseudomeningocele at the craniocervical junction medial to the left occipital condyle communicating with the left anterolateral aspect of the spinal canal. Traumatic pseudomeningoceles are associated with large deceleration forces at the time of injury and are usually associated with significant neurologic deficits at presentation. However, they can arise and give rise to symptoms in a delayed fashion in trauma patients who are neurologically intact at initial presentation.
Resection of Orbital Rhabdomyosarcoma in an Infant with the Aid of Preoperative Partial Arterial Embolization
Authors: Naguliś M. , Prstojević B. , Simić R. , Majstorović B. , Nikolić I.
Published: April 2015

Since the introduction of non-invasive imaging techniques (CT, US, MRI), super selective cerebrospinal angiography has been playing a major role as a diagnostic tool as well as a therapeutic procedure prior to surgery or as an alternative. Surgical neuroangiography is currently a well-established therapeutic technique in neuropediatrics even in newborns or infants with vascular lesions in different parts of the body. Rhabdomyosarcoma is a malignant solid tumor arising from mesenchymal tissue that primarily affects children. We describe the procedure used to treat a large vascularized orbital rhabdomyosarcoma in a 38-day-old infant with application of partial tumor vascular bed embolization via external carotid end internal maxillary artery using PVA particles prior to gross excisional biopsy. We stress the significance of the preoperative embolization in infants with large highly vascularized tumor in order to reduce surgical blood loss and increase the probability of maximum lesion resection.
On Experimenting with Functional Magnetic Resonance Imaging of Lip Movement
Authors: Satheeshkumar J. , Rajesh R. , Arumugaperumal S. , Kesavdas C.
Published: April 2015

The analysis of functional magnetic resonance imaging (fMRI) time-series data can provide information on task-related activities, functional/effective connectivity among regions and the influences of behavioral/physiologic states on connectivity. This paper illustrates the importance of the neurobiological constraints involved in using statistical parametric mapping (SPM) through Matlab simulation and thus helping the radiologist to interpret the results better. This paper also presents the results and inferences from neuroimaging data of the lip movement experiment using statistical parametric mapping (SPM). The results match with the sensory/motor activation atlas by Penfield and Rasmussen (1950).
Osteoblastoma of the Orbit
Authors: Meli G.A. , Meli L. , Chiaramonte R. , Riva G. , Pero G.
Published: April 2015

We describe a case of benign orbital tumour involving the frontal sinus and ethmoidal cells. CT findings were typical of “bone tumour of the orbit”, histological analysis yielded a diagnosis of benign osteoblastoma. A review of the literature disclosed only 13 well documented cases. We compared out radiological findings with the features described in these reports. CT patterns were similar in most cases. The lesion generally appears as a heterogeneous mass where it is possible to appreciate both high density portions and low density areas. On MRI osteoblastoma shows an iso- low signal both in T1 and in T2 sequences. Less frequently the lesion may yield a high signal in T2 images. The orbit is rarely involved by bone tumours, but all bone tumours may theoretically involve the orbit, often making it difficult to establish the right differential diagnosis by imaging. Thirteen cases are insufficient to describe general radiological criteria to improve the specificity in detection of this disease and a broader outlook is essential. For this reason we also examined the radiological signs of bone tumours involving other portions of the body. Even though many literature reports suggest CT is the landmark in bone tumour diagnosis, we think it should always be accompanied by MRI. MRI is known to overestimate local staging, but its contribution to differential diagnosis among various tumours may be decisive.
Treatment of Multiple Oral and Oropharyngeal Venous Malformations in Maffucci's Syndrome with a Combination of Percutaneous Sclerotherapy and Ligation
Authors: Akan H. , Güneren E. , Şeşen T.
Published: April 2015

Maffucci's Syndrome is an osteochondromatous syndrome with congenital vascular malformations. Major ailments involved are habitual fractures, length discrepancy of the extremities, impediment of the affected parts, extremity overgrowth and pain. The vascular lesions, aside from their mass effects, tend to ulcerate and bleed. Endotracheal intubation is also troublesome in these patients. Malignant tranformation of mesodermal tissue is the major lethal factor in this syndrome. This report describes severe respiratory impairment caused by venous malformations in a young girl. Multiple bunched venous malformations within the tongue, oral cavity and oropharynx were treated with percutaneous sclerotherapy and a simple ligation technique. Airway obstruction was cleared following repetitive treatment sessions.
Paravertebral Arteriovenous Fistulas Presenting Acute Epidural Hematoma Associated with Paraplegia
Authors: Iizuka Y. , Suzuki M. , Yoshimura N. , Ohno S. , Konishi Y.
Published: April 2015

We report a unique case of paravertebral arteriovenous fistulas (PVAVF) presenting with acute epidural hematoma produced by dilated venous pouch. The involved level in this patient makes this an extremely rare case. The main feeding artery was the right thyrocervical trunk and the dilated venous pouch was the posterior internal venous plexus around the upper thoracic spine. The etiology of this abnormal arteriovenous communication remains unclear. This case demonstrates that a venous ectasic pouch comprises important etiological angioarchitecture of radiculopathy and myelopathy in PVAVF.
Bilateral Subdural Hemorrhage following Lumbar Puncture in a Case of Suspected Meningitis
Authors: Ben-Nakhi A. , Muttikkal T.J.E. , Ashebu S. D. , Chavan V. N Keluth
Published: April 2015

Intracranial subdural hemorrhage is a rare complication of lumbar puncture. Caudal traction and tear of the subdural veins due to negative pressure caused by leakage of cerebrospinal fluid (CSF) following lumbar puncture (LP) is the mechanism. Prolonged headache or neurological symptoms following LP should warrant cross-sectional imaging to rule out subdural hemorrhage as it can be fatal. We report a case of subdural hemorrhage following LP in a patient with suspected meningitis and communicating hydrocephalus.
Continuous EEG-fMRI in Pre-Surgical Evaluation of a Patient with Symptomatic Seizures: Bold Activation Linked to Interictal Epileptic Discharges Caused by Cavernoma
Authors: Avesani M. , Formaggio E. , Milanese F. , Baraldo A. , Gasparini A. , Cerini R. , Bongiovanni L.G. , Mucelli R. Pozzi , Fiaschi A. , Manganotti P.
Published: April 2015

We used continuous electroencephalography-functional magnetic resonance imaging (EEG-fMRI) to identify the linkage between the “epileptogenic” and the “irritative” area in a patient with symptomatic epilepsy (cavernoma, previously diagnosed and surgically treated), i.e. a patient with a well known “epileptogenic area”, and to increase the possibility of a non invasive pre-surgical evaluation of drug-resistant epilepsies. A compatible MRI system was used (EEG with 29 scalp electrodes and two electrodes for ECG and EMG) and signals were recorded with a 1.5 Tesla MRI scanner. After the recording session and MRI artifact removal, EEG data were analyzed offline and used as paradigms in fMRI study. Activation (EEG sequences with interictal slow-spiked-wave activity) and rest (sequences of normal EEG) conditions were compared to identify the potential resulting focal increase in BOLD signal and to consider if this is spatially linked to the interictal focus used as a paradigm and to the lesion. We noted an increase in the BOLD signal in the left neocortical temporal region, laterally and posteriorly to the poro-encephalic cavity (residual of cavernoma previously removed), that is around the “epileptogenic area”. In our study “epileptogenic” and “irritative” areas were connected with each other. Combined EEG-fMRI may become routine in clinical practice for a better identification of an irritative and lesional focus in patients with symptomatic drug-resistant epilepsy.
MR Diffusion Anisotropy Imaging of Spinal Cord Mechanical Compression and Injury on the Rat Model. In Vivo
Authors: Brzegowy P. , Jasiński A. , Banasik T. , Urbanik A. , Majcher K. , Sułek Z. , Banaś K. , Węglarz WP
Published: April 2015

The aim of this study was the application of magnetic resonance diffusion anisotropy imaging (MR DAI) for assessment of spinal cord compression (SCC) and injury (SCI) in rats depending on the time course from the moment of injury. Twenty rats were used, divided into three groups (five with no surgical operation, five with laminectomy only and ten with SCI produced using a dynamic weight — drop model). MR DAI was performed four times (1, 24, 48 and 168 hours after surgery) at 4.7 T with diffusion gradients applied parallel and perpendicular to the spine. Diffusion parameters (lADC, tADC and AI) were calculated for defined regions of white and gray matter. Epidural hematoma which appeared after laminectomy compressed spinal cord and caused a decrease of apparent diffusion coefficient (ADC) values in GM and WM. SCI in WM produced a decrease of lADC and increase in tADC. In GM an increase in both lADC and tADC values after SCI was observed. MR DAI will disclose dynamic changes in water diffusion during the first days after spinal cord contusion.
Swimmer's CT Angiography of Thoracic Outlet Syndrome
Authors: Marina R.
Published: April 2015

A pictorial essay is presented where the so-called swimmer's position is employed as a postural provocative maneuver to enhance the anatomic characteristics of the thoracic outlet in a symptomatic patient. Helical CT angiography showed severe axillary artery compression due to significant narrowing of the costoclavicular space.
Catheterization via Caudal Puncture of the Epidural Space with a 5F Angiography Catheter and a Coaxial Steerable 0.038″ Guidewire for Delivery of Drugs and Adhesiolysis
Authors: Gambacorta D. , Lunghi V. , Buontempo R. , Cirinei M. , Zocchi M. , Arrigucci U. , Gambacorta D. , De Falco D.
Published: April 2015

We describe a technique for epidural medication delivery with angiographic catheters and guidewires inserted via caudal puncture and advanced cephalad under fluoroscopic guidance in the treatment of painful spinal diseases. Methods: From November 2005 to September 2006 a total of 18 consecutive patients underwent adhesiolysis by an angiographic 5 French hockey-stick tip catheter and a coaxial 0.038″ steerable guidewire inserted at the sacral hiatus and advanced cephalad under fluoroscopic guidance up to the site of adhesion. We obtained pain relief for more than three months in 61% of patients. There were no periprocedural/postprocedural complications. Our system of accessing the epidural space provides a safe means of delivering epidural medication, performing mechanical adhesiolysis and may be useful in the treatment of selected patients with painful spinal diseases.
Chronic Tuberculous Retropharyngeal Abscess Due to Vertebral Tuberculosis with Associated Calvarial Tuberculosis
Authors: Goswami P. , Medhi N. , Sarma P. K. , Khaund G.
Published: April 2015

The occurrence of chronic tuberculous retropharyngeal abscess and calvarial tuberculosis is rare, even in isolated form. Chronic tuberculous retropharyngeal abscess is usually due to vertebral tuberculosis in adults. Calvarial tuberculosis is a rare manifestation of extra-pulmonary tuberculosis with limited reports in medical literature. We describe a rare case of chronic tuberculous retropharyngeal abscess due to vertebral tuberculosis with associated calvarial tuberculosis.
Klebsiella Meningitis
Authors: Medhi N. , Goswami P. , Sarma P. , Barkataky R.K. , Duarah R. , Saikia R.
Published: April 2015

Acute bacterial meningitis is a severe CNS infection occurring mostly in infants and older children. Bacterial meningitis caused by gram-negative bacteria is usually fatal. Klebsiella pneumoniae is an uncommon gram-negative bacteria causing meningitis with a poor outcome. Though the commonest presentation of bacterial meningitis is fever, patients usually seek medical attention for uncontrolled seizure and features of raised ICP. The commonest complications of gram-negative bacterial meningitis including Klebsiella meningitis are subdural hygroma / empyema, hydrocephalus, infarcts (both arterial and venous) and cortical blindness due to hypoxic ischaemic insult. MRI is the best modality for evaluating these patients for early diagnosis. Early institution of treatment significantly reduces the mortality and morbidity. We describe a case of acute bacterial meningitis caused by Klebsiella pneumoniae with MR evidence of sinus thrombosis, venous infarcts and subdural hygroma.
Radiation Dose Optimization in CT Planning of Corrective Scoliosis Surgery
Authors: Abul-Kasim K. , Gunnarsson M. , Maly P. , Ohlin A. , Sundgren P.
Published: April 2015

The aim of the study was to explore the possibility of obtaining a helical CT scan of a long segment of vertebral column, optimally reduce the radiation dose, compare the radiation dose of the low dose helical CT with that of some of the CT protocols used in clinical practice and finally assess the impact of such a dose reduction on the image quality. A chest phantom was examined with a 16-slice CT scanner. Six scans were performed with different radiation doses. The lowest radiation dose which had no impact on image quality with regard to the information required for surgical planning of patients with scoliosis, was 20 times lower than that of routinely used protocol for CT examination of the spine in children (0.38 mSv vs 7.76 mSv). Patients with scoliosis planned for corrective spinal surgery can be examined with low dose helical CT scan. The dose reduction systems (DRS) available in modern CT scanners contribute to dose reduction and should be used.
Persistent Trigeminal Artery with Bilateral Ophthalmoplegia and Contralateral Internal Carotid Artery Occlusion
Authors: Purkayastha S.
Published: April 2015

The most frequent persistent embryonic communication between the vertebrobasilar and carotid systems in adult life is a persistent trigeminal artery (PTA). Several anatomic variants of PTA have been described. The other associations of PTA mainly include aneurysm and vascular steal phenomena between basilar and carotid systems. We describe an interesting case of PTA with bilateral ophthalmoplegia and contralateral occlusion of the internal carotid artery.
CT Perfusion Evaluation of Cerebral Haemodynamics before and after Cranioplasty
Authors: Decaminada N. , Pernter P. , Imondi A. , Tomassini A.
Published: April 2015

CT Perfusion imaging is usually applied to assess perfusion abnormalities in acute stroke. This prospective study applied the technique to monitor cerebral haemodynamics before and after cranioplasty. Cranioplasty is the surgical correction of a skull defect using autologous or heterologous material to obtain cosmetic repair, restoration of brain protection and neurological improvement1. As far as we know the effect of cranioplasty on cerebral haemodynamics flow has been analysed by CT perfusion only in one article2. We tested the examination as method of monitoring intracranial haemodynamics in a larger number of patients evaluating its reliability and efficacy. We prospectively examined cerebral haemodynamics with Perfusion CT before and after (two weeks, three and six months) cranioplasty in ten patients. The data evaluation of dynamic CT was done by an application software package on a workstation (Leonardo) permitting the use of visual assessment combined with quantitative analysis with ROIs. There was a comparison of CBF, CBV and TTP values between the regions of interest and mirror-image control regions, and in the three different examinations for each patient. After cranioplasty there was clearly an improvement in neurological symptoms and CT perfusion in the majority of cases showed a slight increase in CBF, CBV and decrease of TTP in the cerebral parenchyma close to the cranioplasty, not only on the symptomatic side but also on the opposite side. Even though there was neurological improvement and improved cranial perfusion from the first to the last examinations, our data were not statistically significant. The method is easily reproducible, well tolerated by all patients but has several limitations related to data processing and radiation exposure.
Enhancement of Robin-Virchow Spaces MRI Evaluation
Authors: Tsitouridis I. , Papaioannou S. , Arvaniti M. , Tsitouridis K. , Rodokalakis G. , Papastergiou C.
Published: April 2015

The perivascular spaces are normally microscopic. Even in normal brain some Robin-Virchow spaces are usually seen in the area of substantia innominata at the level of anterior commissure. Many pathologic states result in abnormal dilatation with an increased number of spaces visible on MRI imaging. Dilatation is most commonly associated with anterior abnormalities that arise due to aging, diabetes, hypercholesterolemia, smoking, hypertension and other vascular risk factors. The precise etiology of dilatation is currently unknown.
Is Total Brain Volume Correlated to Cognitive Function and Education in Patients with Alzheimer Disease?
Authors: Papapostolou P. , Goutsaridou F. , Arvaniti M. , Emmanouilidou M. , Tezapsidis G. , Tsolaki M. , Tsitouridis I.
Published: April 2015

This study aimed to correlate whole brain volume measurements with MRI in patients with Alzheimer disease and the same Mini Mental State Examination (MMSE) but different levels of education. We describe the procedure we used to create 3D models of the brain from MRI images in patients with Alzheimer disease and then took volumetric measurements of the whole brain parenchyma. After this procedure we correlated the total brain volume measurements in patients with six or fewer years of education with those who had at least 12 years of education. Twenty patients with Alzheimer disease were examined with MRI. All of them had an MMSE score between 21 and 24 and were classified as mild Alzheimer disease. Ten of the patients had at least six years of education and the remaining ten had more than 12 years of education. The examinations were done by using a Siemens Expert Plus system of 1T and the MR images were studied using an automatic algorithm. The MRI images were segmented into grey, white matter and CSF. We then measured the volume of each component and classified those in each patient in relation to years of education. The whole procedure was completed successfully in 20 patients. After the volumetric study of the total brain volume by calculating separately grey matter, white matter and CSF, we classified the patients and made the correlation between those with six or fewer years of education and those with twelve or more years of study. Correlating the whole brain volume measurements of patients with Alzheimer disease and the same MMSE but different levels of education showed that there is no significant difference between the total brain volume of the two groups of our study.
The Value of Semi-Quantitative Analysis of 123I-FP-CIT SPECT in Evaluating Patients with Parkinson's Disease
Authors: Filippi L. , Bruni C. , Padovano F. , Schillaci O. , Simonetti G.
Published: April 2015

123I-FP-CIT SPECT binding to striatal dopamine transporter (DAT) is markedly reduced in patients with Parkinson's disease (PD) and it may also help in identifyng pre-symptomatic nigrostriatal dysfunction in subjects at risk. This study used semi-quantitative analysis of 123I-FP-CIT SPECT to evaluate the possibility of a more extensive and earlier diagnosis of dopaminergic damage. We used qualitative visual assessment and semiquantitative measures of striatal DAT binding using 123I-FP-CIT SPECT in 154 patients with suspected PD. A control group comprised 18 people age-matched to the PD group whose follow-up disclosed essential tremor. Abnormal striatal 123I-FP-CIT uptake was evident in 134 out of 154 patients (87%). Qualitative visual assessment showed striatal dopaminergic 123I-FP-CIT uptake was significantly reduced in 60.4% (controlateral putamen to the symptoms), in 31.3% (caudate nucleus) and in 8.3% (ipsolateral basal ganglia to the symptoms). Semi-quantitative analysis showed the following results: 32.8%, 50.7% and 16.5% respectively. We compared these two assessments and their correlation with PD clinical progression. At 24 month follow-up, patients with greater dopaminergic damage at semiquantitative analysis showed a more severe motor disability. Our findings indicate that 123I-FP-CIT SPECT with semiquantitative analysis can offer a more accurate characterization of the dopaminergic damage in patients with suspected Parkinson's disease.
Acute Onset Hemichorea-Hemiballism. MRI Signal Abnormality in a Metabolically Normal Patient
Authors: Purkayastha S.
Published: April 2015

Abnormal signals involving the basal ganglia on MR images have been reported with new-onset hemichorea-hemiballism, typically in elderly Asian patients. The most common cause is a vascular lesion, but many cases are reported in association with hyperglycemia. We describe one case of acute onset chorea-hemiballism with abnormal MRI signal in the basal ganglia but with no systemic abnormality.
Osmotic Demyelination Syndrome (Central Pontine and Extrapontine Myelinolysis with Coagulative Necrosis of the Putamina and Cortical Laminar Necrosis)
Authors: Burgetova A. , Vaneckova M. , Seidl Z. , Dolezal O.
Published: April 2015

Central pontine myelinolysis (CPM) and extrapontine myelinolysis (EPM) are disorders frequently associated with serum osmotic imbalance. The prognosis is very variable from complete regression of clinical symptomatology to signs of significant quadruparesis, a vegetative state and death. We report the case of a 25-year-old man with a diagnosis of osmotic demyelination syndrome. The patient was young healthy man with no history of chronic alcoholism or malnutrition. He underwent head trauma associated with consumption of alcohol, being diagnosed with cerebral commotion. Four days later he presented with generalised epileptic convulsions with unconsciousness. Laboratory findings showed significant hyponatremia and hypochlorinemia. Following the rapid correction of osmotic conditions of serum, spastic quadruparesis and coma developed. MRI of the brain showed finding of CPM and EPM, cortical laminar necrosis (CLN) and coagulative necrosis in the putamina. Our case is suggestive in the rare MRI appearance of myelinolysis in addition to CLN and coagulative necrosis in the basal ganglia following the rapid correction of serum osmolarity. We suggest that this finding is prognostically very unfavourable. In the reported patient clinically initial neurological deficit progressed to a vegetative state within one month.
Intracranial Hemorrhagic Arachnoid Cyst: The Role of Diffusion-Weighted Imaging
Authors: Katsaros V.K. , Flaskas T. , Stavrinou L.C. , Stranjalis G. , Chrysikopoulos C. , Sakas D.E.
Published: April 2015

The majority of hemorrhagic arachnoid cysts are correlated with trauma or aneurysmal rupture. We report on a 35-year-old woman with acute headache and an intracranial mass lesion that was hyperdense in CT and hyperintense in conventional MRI images. The history and imaging were negative for trauma or vascular anomaly. Diffusion-weighted imaging (DWI) clearly demonstrated a large right anterior and middle cranial fossa arachnoid cyst with associated subacute intracystic hemorrhage without subdural hematoma. DWI offers invaluable information for the differential diagnosis of hemorrhagic arachnoid cysts from other extra-axial space-occupying lesions.
Importance of Functional MRI and the Role of Stereotactic Biopsy in the Diagnosis of Cerebral Lymphoma
Authors: Khurjekar D. , Bonicelli C. , Bacci A. , Agati R. , Leonardi M.
Published: April 2015

Primary cerebral lymphoma has varied clinical and imaging presentations making the neuroradiologic diagnosis of primary cerebral lymphoma a challenge. We discuss here three cases of cerebral lymphoma, one primary and two secondary. Our aim is to highlight the importance of diffusion, perfusion and spectroscopy in addition to conventional morphological MRI, and the role of stereotactic biopsy in reaching a correct diagnosis.
3D MR Models and Volumetric Measurements of the Brain in Patients with Alzheimer's Disease
Authors: Papapostolou P. , Arvaniti M. , Goutsaridou F. , Emmanouilidou M. , Tezapsidis G. , Chondromatidou S. , Tsolaki M. , Tsitouridis I.
Published: April 2015

This study aimed to describe the procedure we use to create 3D models of the brain parenchyma from MRI images and calculate the volume of the whole brain and different compartments of the brain in patients with Alzheimer's disease. The utility of the 3D models and volumetric measurements of the whole brain parenchyma and different brain structures is discussed. Thirty-six patients with Alzheimer's disease were examined during the last six months with MRI. Fourteen of them were men and 22 were women. The patients were between 53 and 67 years old. MR images were studied using an automatic algorithm. The images from MRI were segmented and then three-dimensional models of brain were produced to calculate the brain volume and the volume of the white matter, gray matter and CSF separately. The whole procedure was completed successfully in 34 patients. The procedure was unsuccessful in two patients due to movement artifacts in MR images. It is relatively easy to create 3D models of MR images and to obtain volumetric studies. If this procedure is adjusted in patients with Alzheimer's disease, we can provide information more clearly and accurately than single images alone. The information obtained can be used in daily clinical practice such as pharmaceutical treatment planning and results or in basic clinical research.
Pituitary Apoplexy: A Rare Cause of Cerebral Infarction
Authors: Ben-Nakhi A. , Muttikkal T.J.E. , Chavan V.N.K. , Al-Turkomani A. Yt , Gupta R.
Published: April 2015

Pituitary apoplexy is usually the result of hemorrhagic infarction in pituitary adenoma. The clinical presentation of pituitary apoplexy varies widely and includes asymptomatic hemorrhage, classical pituitary apoplexy and even sudden death. Few cases of cerebral infarction associated with pituitary apoplexy have been reported in the literature. Pituitary apoplexy can cause narrowing of intracranial vessels by mechanical obstruction due to mass effect or by vasospasm resulting in cerebral ischemia. We report a case of pituitary apoplexy associated with cerebral infarction and the putative mechanisms.
Sacral Meningocele and Rectal Fistula Associated with Pneumorrhachis and Pneumocephalus
Authors: Vreto G. , Rroji A. , Stafa A. , Leka L. , Petrela M.
Published: April 2015

Pneumorrhachis (PR), the presence of air in the spinal canal, is a rare but suggestive radiographic finding, associated to different aetiologies and possible pathways of air entry into the spinal canal. It can be divided into primary and secondary PR, descriptively classified into extra- or intradural PR and aetiologically subsumed into iatrogenic, traumatic and non traumatic PR. Pneumoencephalus (PE), lack of air in the skull, is the equivalent intracranial phenomenon, associated mostly with traumatic or iatrogenic aetiology. Non traumatic PR and PE, especially when concurrent, are an uncommon radiological finding.
Functional MRI and Diffusion Tensor Imaging
Authors: Walecki J. , Ślubowska E.
Published: April 2015

Above discussed aspects, considerations and technical possibilities, as well as methodological requirements, guidelines and clinical applications of proton spectroscopy strengthens our belief in the power of this method used in neurooncological diagnosis.
Bilateral Posterior Periventricular Nodular Heterotopia with Cerebellar Hypoplasia, Communicating Hydrocephalus and Bilateral Hippocampal Sclerosis
Authors: Gurusamy S. , Saravanan S. , Premnath U. Kuttuva , Sivanandan R.
Published: April 2015

Heterotopias are foci of grey matter in abnormal locations in the brain and are secondary to arrest of neuronal migration. Bilateral periventricular nodular heterotopias (BPVNH) are a rare form of heterotopic disorders. Many varieties of BPVNH with various associations have been reported in the literature, the commonest being the classical X-linked variety usually associated with filamin A gene (FLNA) mutations. The relationship of other types of BPVNH to this gene is variable. We report a rare variety of this entity – BPVNH with cerebellar hypoplasia, communicating hydrocephalus and bilateral hippocampal sclerosis. An exostosis arising from the left petrous temporal bone was an added finding in our patient.
“Swimming Worms in a Bare Cistern”: A Sign for Moyamoya Disease
Authors: Purkayastha S.
Published: April 2015

Moyamoya disease is a rare cerebrovascular occlusive disorder most often found among the Japanese. It is angiographically defined as a progressive steno-occlusion of the bilateral internal carotid arteries with characteristic abnormal vascular networks, so-called Moyamoya vessels, at the base of the brain. MRI is the initial investigation of choice and we describe an MRI sign to diagnose Moyamoya disease warranting digital subtraction angiography.
Dynamics of Metabolic Changes in Intracranial Metastases and Distant Normal-Appearing Brain Tissue after Stereotactic Radiosurgery: A Serial Proton Magnetic Resonance Spectroscopy Study
Authors: Chernov M.F. , Hayashi M. , Izawa M. , Nakaya K. , Tamura N. , Ono Y. , Abe K. , Usukura M. , Yoshida S. , Nakamura R. , Suzuki T. , Muragaki Y. , Iseki H. , Kubo O. , Hori T. , Takakura K.
Published: April 2015

The present study evaluated the dynamics of metabolic changes in intracranial metastases and distant normal-appearing brain after stereotactic radiosurgery (SRS). Forty neoplasms were evaluated with single-voxel proton magnetic resonance spectroscopy (1H-MRS) both before and after treatment. From one to six examinations (median, 3) were done in each individual case during follow-up. At the time of each investigation additional 1H-MRS was obtained from the normal-appearing brain distant from the radiosurgical target. Investigated metabolites included N-acetylaspartate (NAA), choline-containing compounds (Cho), creatine (Cr), and mobile lipids (Lip). Within the first month after SRS responded tumors showed a statistically significant increase in NAA/Cho ratio, and decrease of Cho content and Lip-to-normal brain Cr (nCr) ratio. By contrast, statistically significant metabolic alterations were not detected in stabilized tumors. Statistically significant volumetric and metabolic changes were not marked between three and 12 months after treatment in non-progressing lesions. Alternatively, decrease of NAA/Cho ratio, NAA content and Cr content, and increase in Lip/nCr ratio and Cho content were evident in progressive neoplasms, and subtle metabolic alterations could be revealed even before the increase in the lesion volume. Metabolic characteristics of normal-appearing brain distant from the radiosurgical target did not show statistically significant changes within the first year after treatment. In conclusion, additional use of serial 1H-MRS during follow-up after SRS for intracranial metastases permits detailed evaluation of the metabolic tumor response and may be potentially helpful for early prediction of recurrence.
Do the Advantages of the FiberNet® Embolic Protection Device Translate into Technical Success and Comparable Event Rates in Carotid Artery Stenting?
Authors: D'Souza S.B. , Slovut D.P. , Bower T.C. , Bacharach J.M.
Published: April 2015

FiberNet® is a second generation non-conventional embolization protection device (EPD) that purports to offer several advantages: ability to capture debris as small as 40 μm, more flexibility with placement and positioning in curved segments requiring a small landing zone, ability to conform to asymmetric vessels, and improved deliverability. The design features a low profile with large surface area to capture debris. Legitimate concerns include inducement of obstruction or low flow with debris capture and requirements in the IFU to aspirate during re-capture and device removal. Our goal was to compare the results of carotid artery stenting (CAS) using FiberNet® against a multi-center experience of CAS using other filter devices to identify any differences in technical success or event rates. FiberNet® (n=25) results were compared to all CAS cases performed at the Mayo Clinic in Rochester, MN, St Mary's/Duluth Clinic in MN, and North Central Heart Institute in Sioux Falls, SD (n=250) from March 2001 to December 2008. Chi-square or means were used to compare variables, as appropriate. Bivariate logistic regression was used to identify possible correlates of adverse outcome. Statistical significance was set at < 0.05. FiberNet® patients were more likely to be older (78.1+5.4 vs 73.6+9.4, p=0.019), female (48% vs 29%, p=0.047), and have peripheral vascular disease (84.0% vs 37.2%, p=0.025), and less likely to have diabetes (8.0% vs 29.8%, p=0.012) than patients in the comparison group. FiberNet® patients had more lesion calcification (40.0% vs 18.9%, p=0.014) and increased number of type 2 and 3 arches (44.2% vs 73.9%, p=0.006). Procedural success rate was 100% in both groups. None of the FiberNet® patients showed evidence of stagnant flow. The thirty-day outcome for TIA, CVA, or death was 4% in FiberNet® versus 4.8% in the comparison group (p NS). None of the independent variables – age gender, serum creatinine, arch complexity, lesion length, lesion calcium, lesion thrombus, PVD, diabetes, contralateral carotid occlusion, or ipsilateral carotid endarterectomy – predicted adverse events. Although FiberNet® patients had more lesion calcium and more challenging arch anatomy, procedural success and adverse events were comparable between groups. The advantages of FiberNet® can be applied to CAS with good technical results and may be a promising EPD for certain high-risk situations.
Endovascular Treatment of Fusiform and Wide-Necked Intracranial Aneurysms with the Neuroform 3TM and Detachable Coils
Authors: Cui Lishan , Su Pengfei , Li Zhonghua , Lv Xianli
Published: April 2015

Reconstructive treatments using stents improve occlusion rate of broad-necked intracranial aueurysms and protect parent vessels. Recently, the Neuroform stent has been developed and we evaluated it use for the treatment of fusiform and broad-necked intracranial aneurysms. Seventeen fusiform and broad-necked intracranial aneurysms in 15 patients were treated electively. Eight aneurysms were located at the internal carotid artery, five in the vertebral artery, one in the basilar tip, one in the middle cerebral artery, one in the posterior cerebellar artery and one in the posterior inferior cerebellar artery. Previous attempts with the remodeling technique had been judged technically difficult in all cases, and combined stent placement across the aneurysm neck was performed with subsequent coiling of the sac. Aneurysm diameter varied from 4 to 30 mm. Sixteen aneurysms in 15 patients were treated with this procedure. There were no stent deployment failures. All aneurysms were initially stented, followed by coil placement. Complete or subtotal (>95%) occlusion was achieved in six patients, and partial occlusion (<95%) was achieved in nine. The periprocedural rate of stroke or death was 0%. Angiographic follow-up was obtained in ten patients. Neurological status remained well in all patients at a mean clinical follow-up of 6.2±3.2 months. Primary and recurrent treatment of fusiform and wide-necked intracranial aneurysms using the Neuroform stent is feasible and effective. No permanent neurological deficits were associated with stent deployment. Short-term follow-up identified intact parent arteries and stable occlusion rates in the majority of cases.
Multivoxel 1H MR Spectroscopic Approach to the Diagnosis of Intraventricular Central Neurocytoma
Authors: Balaji R. , Ramachandran K.
Published: April 2015

We describe the proton (1H) magnetic resonance spectroscopic (MRS) imaging of central neurocytoma (CNC), a rare benign intraventricular neuronal tumor. Multivoxel MR Spectroscopy is a feasible and reproducible non-invasive tool for the specific diagnosis of CNC and to distinguish CNC from other intraventricular tumor types. The detection of glycine and alanine peaks, high choline and lactate and low NAA levels are characteristic of CNC.
Bilateral Acute Foot Drop in a Case of Axonal Injury
Authors: Rispoli R. , Mastrostefano R. , Palladini I. E. , Koumpouros N. , Di Cosimo T.
Published: April 2015

Head trauma of varying severity may induce diffuse axonal injury. Areas most commonly affected are white matter in the hemispheres (particularly parasagittal zone), corpus callosum and the brain stem. We describe a case of diffuse axonal injury after brain trauma in a 51-year-old man. Diffuse axonal injury was localized in the white matter of the hemispheres (parasagittal zone) and the patient presents a complete motor deficit of the feet.
Subacute Combined Cord Degeneration: A Rare Complication of Nitrous Oxide Misuse
Authors: Wijesekera N.T. , Davagnanam I. , Miszkiel K.
Published: April 2015

We describe a severe case of subacute combined degeneration of the spinal cord precipitated by overuse of the analgesic Entonox Cavernous malformations (CMs) are one of the four major types of vascular malformations of the central nervous system (CNS). Literature reports also term them cavernomas, cavernous angiomas, angiographically occult vascular malformations and cavernous hemangiomas. CMs are composed of well-circumscribed vascular channels containing blood at various stages of evolution and show a low-flow vascular pattern. They have usually been considered developmental lesions of the intracranial vasculature, but recently the de novo appearance of these malformations has been observed with increasing frequency. We describe a case of sporadic de novo formation of a CNS cavernous malformation following radiation treatment in a child with medulloblastoma. We review the patient's clinical course and the literature focusing on the role of radiation therapy in the pathogenesis of CMs.