bluuebunny/crossref_metadata_2025 huggingface dataset:
A Case of Parietal Meningoencephalocele Associated with Multiple Intracranial Anomalies
Authors: Ercan N. , Emmez H. , Dogulu F. , Kurt G. , Tali E.T. , Baykaner K.
Published: April 2015

Parietal cephaloceles are rare congenital anomalies usually associated with significant underlying brain anomalies. Further investigations with cranial magnetic resonance examination and MR venography is important to reveal associated intracranial anomalies and to show the relationship of the cephalocele sac with the dural venous sinuses. These examinations are also crucial to predict the prognosis before surgical correction of the encephalocele. We present MR findings of an infant with a parietal meningoencephalocele associated with microcephaly and multiple other congenital central nervous system anomalies including partial callosal agenesis, gray matter heterotopia, ventricular dysplasia, and right retrocerebellar arachnoid cyst.
Spondylolysis at C6 Level and Associated Laminar Fracture of C5
Authors: Leone A. , Cerase A. , Cianfoni A. , Buquicchio G.L. , Costantini A.M.
Published: April 2015

We describe a 42-year-old woman with bilateral spondylolysis of the sixth cervical vertebra, unusual in that it was associated with a traumatic laminar fracture of C5. Cervical spondylolysis is a relatively rare condition associated with dysplastic changes of posterior elements at the same or adjacent levels. The lesion must be differentiated from traumatic articular pillar fractures in patients who have had cervical spine trauma. A combined multistudy approach is necessary to reach a definitive diagnosis and to decrease the potential for misdiagnosis and inappropriate therapy in most cases.
CT Evaluation of Cerebral Atrophy in Medicolegal Opinions in Murder Cases
Authors: Wyrobek-Renczyńska M. , Chrzan R. , Zyss T. , Urbanik A. , Kamieniecka B. , Uhl H.
Published: April 2015

This study evaluated the prevalence and intensity of cerebral atrophic lesions, considering age, in murderers subjected to CT as an element of medicolegal assessment in the course of legal proceedings in manslaughter cases. Brain CT was performed in 65 murderers (59 men, six women, aged 15–72 years) by court order in the course of criminal proceedings. The width of the ventricular system, distance between skull lid bones and width of the subarachnoid space were measured and values of indices such as: frontal horn index, Evans index, ventricular index, cella media Schiersmann index and Huckman number were calculated. Mean values of measurements and indices were calculated for both the whole group examined and separately for four age groups (up to 20, 21–40, 41–60 and from 61). Results were compared to norms of physiological brain ageing according to Meese with Kuśmiderski's modifications. In the murderers examined, cortical atrophy exceeding physiological values was observed only in the group up to 20 years old. Subcortical atrophy exceeding physiological values was observed in groups up to 20 and to a lesser extent 21–40 years old. Width of the third ventricle and cella media index were within the limits for normal brain ageing in all groups. Values of frontal horn index and Huckman number, corresponding to frontal lobe atrophy, exceeded physiological values in groups up to 20 and to a lesser extent 21–40 years old. Cerebral atrophy, particularly subcortical frontal lobe atrophy exceeding physiological values, indicating characteropathy as one of the potential reasons for aggressive behaviour, was statistically significant in people up to 40 years old, however in people more than 40 years old it did not differ from values regarded as normal.
Intradural Extramedullary Aspergilloma Complicating Acute Lymphatic Leukaemia
Authors: Purkayastha S. , Gupta A.K. , Kapilamoorthy T.R. , Sonwalkar H.A.
Published: April 2015

A case of thoracic spinal cord compression caused by intradural extramedullary fungal granulomatous lesion associated with acute lymphatic leukaemia is presented. The specific diagnosis on imaging was difficult and required specialized histopathological studies. A high index of clinical suspicion of fungal infection, surgical decompression of spinal cord, and tissue biopsy confirmation are particular features of our case.
A Noise Reduction Method Based on a Statistical Test of High Dimensional Pixel Vectors for Dynamic and Volumetric Images
Authors: Nambu K. , Iseki H.
Published: April 2015

A noise reduction method applicable for dynamic and three-dimensional imaging modalities was evaluated. We applied our method to images obtained by CT, MRI, SPECT, angiography, and numerical phantom data, and measured the reduction of image noise. The standard deviation of the noise was reduced to 12–13% in a numerical dynamic phantom, 35–46% in dynamic CT, 19%-23% in a dynamic scintigram, 6–8% in dynamic SPECT, 13–15% in volumetric MRI of PVA resolution phantom, 12–17% in volumetric MRI of a PVA head phantom, and 50–53% in angiography of a moving phantom. The method reduced noise effectively, while spatial and temporal resolution remained satisfactory.
Measurement of Cerebrospinal Fluid Flow: Technique Validation in a Patient with Idiopathic Normal Pressure Hydrocephalus
Authors: Romano A. , Bozzao A. , Trillò G. , Bonamini M. , Fasoli F. , Giugni E. , Ferrante M. , Finocchi V. , Fantozzi L.M. , Ferrante L.
Published: April 2015

This study aimed to assess anatomical and functional changes disclosed by magnetic resonance imaging in a patient with suspect normal pressure hydrocephalus following surgical third ventriculostomy with placement of a ventriculoperitoneal shunt. The patient was investigated by phase contrast sequences to calculate CSF flow in the Sylvian aqueduct before and after the two surgical procedures. In addition, T1-weighted volumetric MPRAGE images were acquired using voxel-based morphometry to study any changes in size of the ventricular system and CSF in the subarachnoid spaces before and after surgery. CSF flow measurements were closely correlated with the patient's clinical course, increased CSF flow coinciding with worsening symptoms, and a decrease in flow noted after surgery. There were no significant changes in the CSF volumes analyzed. Phase contrast technique proved reliable and effective for the purposes of diagnosis and long-term follow-up in patients with suspect normal pressure hydrocephalus eligible for surgery
Occipital Eosinophilic Granuloma Presenting as Throbbing Headache with a “Bump”
Authors: Cherubin E. , Battistella P.A. , Calderone M. , Carollo C. , Faggin R.
Published: April 2015

A case of occipital eosinophilic granuloma (EG) presenting as right occipital throbbing headache with a “bump” is reported. Even if cranial X-rays and CT scan showed a typical lytic lesion, to make a definite diagnosis of EG histological examination with immunohistochemical detection of S-100 and CD1a antigens was necessary. A total bone scintigraphy ruled out other bone lesions. Treatment of EG depends on the extent of the disease at the time of diagnosis. When no systemic disease is found some authors suggest “wait and see” management. Twelve months after surgery our patient had no recurrences.
Intracranial Aneurysm Associated with Perianeurysmal Fat Tissue Lesion and Parenchymal Cystic Changes
Authors: Cerase A. , Vallone I.M. , Atesalp A. , Demirci A. , Venturi C. , Vural M.
Published: April 2015

The purpose of this report is to describe the seven-year clinical and neuroradiological follow-up of a perianeurysmal fatty lesion and perianeurysmal parenchymal cystic changes accompanying an asymptomatic unruptured wide-neck saccular aneurysm of the right middle cerebral artery trifurcation incidentally discovered in a 27-year-old male. The possible mechanisms of development are discussed. Notably, the close anatomical association between the two malformative lesions should rule out an incidental coexistence. Possible explanations include i) congenital structural deficiency of the cerebral vessel wall occurring at the same time of the formation of the fatty lesion, ii) fatty lesion inducing degeneration of the cerebral vessel wall possibly by limiting the nutrition of the smooth muscle cells, and iii) fatty lesion secreting some factors inducing weakness of the arterial wall to hemodynamic stress. Finally, both these lesion should lead to further impairment of perforating arteries resulting in areas of perianeurysmal encephalomalacia.
Neuroradiological Diagnostic Tools: New MRI Perspectives
Authors: Agati R. , Simonetti L. , Marliani AF. , Riccioli L. Albini , Battaglia S. , Cevolani D. , Ghedin P. , Leonardi M.
Published: April 2015

MR angiography5,17 is traditionally divided into “non-contrast enhanced” (NCE MRA) and “contrast-enhanced” (CE MRA) techniques. Contrast-enhanced techniques were initially developed to solve some of the problems encountered with non-contrast-enhanced methods, namely the long examination times, pulsatile flow artefacts, saturation when the mean blood flow is slow or when the imaging slice is parallel to the vessel, the characteristic problems of time of flight (TOF) acquisitions, and the need to define a priori beforehand the velocity sensitivity for phase contrast (PC) acquisitions. Currently used contrast-enhanced techniques 7,8,15,18 are based on the acquisition of 3D gradient-echo sequences synchronized at the first passage of contrast medium by different strategies (detection of a test bolus injection, automated triggering, fluoroscopic imaging). Basically, contrast medium is administered to counteract saturation induced by slow blood flow or flow directed parallel to the imaging slice. Contrast medium serves to obtain a “static” image of vascular structures with acquisitions times ranging from a few seconds to 1–2 minutes. To avoid venous contamination, different methods have been used to collect data (centric-approach, elliptical-centric phase encoding order, etc.) in an attempt to record first the information relating to low spatial frequencies (contrast data) with respect to high spatial frequencies (detail and contour data).
3T Pediatric Brain Imaging
Authors: Zimmerman R.A. , Bilaniuk L.T. , Pollock A.N. , Feygin T. , Zarnow D. , Simon E.M. , Harris C.
Published: April 2015

Three Tesla imaging of the pediatric brain is feasible without significant SAR limitations and provides improved diagnostic information relative to 1.5 T for MRA, thin section T1 and T2 images, susceptibility scans, and conspicuity of contrast enhancement.
Inherited White Matter Diseases
Authors: Zimmerman R.A.
Published: April 2015

Recent advances in molecular genetics, together with further understanding of cerebral biochemical metabolism affecting the white matter, when taken together with the information provided by MRI and MRS, provide new insights into the inherited white matter diseases.
Sensitivity of Foetal MRI in Studying the Germinal Matrix: Comparison with Autopsy
Authors: De Santis M. , Salmaso R. , Franco R. , Righini A. , Paternoster D.M. , Manara R.
Published: April 2015

Our study aimed to combine in vivo foetal cerebral magnetic resonance findings and histopathological analysis to chart details of the development and characteristics of the germinal matrix not disclosed by ultrasound, and to establish standard normal parameters for in vivo investigation. We enrolled pregnant women between the 18th and 23rd weeks of gestation awaiting voluntary termination of pregnancy. The patients had a foetal cerebral magnetic resonance scan and the aborted foetus subsequently underwent autopsy. Both investigations focused on the germinal matrix, measured at the floor of the lateral ventricles, to disclose any impairment of neuronal migration. Three foetuses were chosen for the study, one presented CMV infection with multiorgan involvement disclosed at autopsy. The brain, however, did not show signs of infection but presented impaired sulcal formation compared to brains of the same gestational age. This finding had not been disclosed by MRI. The study is still underway but our preliminary findings show that magnetic resonance clearly displays the germinal matrix and can measure its thickness but does not yield accurate information on sulcal formation early in pregnancy. Autopsy subsequently demonstrated that failure of neuronal migration in the foetus results in a thicker germinal matrix whereas the cortex is thinner and underdeveloped. This finding emphasizes that migration abnormalities are not disclosed by MRI confined to macroscopic assessment of sulcal formation, especially in the early stages of pregnancy (18–22 weeks), but can be suspected and indirectly diagnosed by measurement of germinal matrix thickness. Our study showed that MRI is highly sensitive in identifying the germinal matrix and cerebral cortex and can measure these structures to yield new information for the diagnosis of impaired neuronal migration.
Rapid Recurrent Brain Metastases after Complete Surgical Resection for a Single Cerebellar Metastatic Carcinoma
Authors: Chen F. , Yu W.H. , Yao Y. , Zhu Q. , Xu P.Y.
Published: April 2015

Rapid recurrent brain metastases are reported in a 51-year-old farmer. He did not receive post-operative whole-brain radiotherapy (WBRT) after complete resection of one single cerebellar tumor that was subsequently confirmed to be a metastasis from lung squamous cell carcinoma. The mechanisms of such a rapid relapse are discussed together with the roles of adjuvant WBRT.
Morphologic and Volumetric Analysis of Amygdala, Hippocampus, Fornix and Mamillary Body with MRI in Patients with Temporal Lobe Epilepsy
Authors: Hakyemez B. , Yucel K. , Yildirim N. , Erdogan C. , Bora I. , Parlak M.
Published: April 2015

Our aim was to demonstrate lateralization morphometrically and volumetrically measuring the main limbic structures like hippocampus, amygdala, fornix and mamillary bodies in patients with temporal lobe epilepsy (TLE) and to establish the contribution of each anatomical structure to lateralizing the pathological site. Forty-two patients with complex partial seizures originating from the temporal lobe and 42 control healthy volunteers were included in the study. T2-weighted FSE sequences in axial and oblique coronal planes and T1-weighted SE sequences in the sagittal plane were used. A high-resolution IR sequence was used for the volumetric analysis of amygdala and hippocampus and for the measurement of fornix and mamillary body thickness. Intensity changes and atrophy of limbic structures were observed qualitatively and measurement of these structures was performed quantitatively. Student's t test and Mann-Whitney U-test were used for the statistical analysis. The p values <0.05 was taken as statistically significant. Ten out of 42 patients had intracranial masses and were excluded from the study. Qualitative analysis revealed atrophy in 84% and intensity increase in 60% of cases. Quantitative measurement demonstrated that control cases had a larger hippocampus than the patients (p<0.001). There was unilateral hippocampal volume loss in 88% and bilateral volume loss in 13% of patients. There was no difference in the volume of amygdala between the groups (p>0.05). According to the difference in the volumes of the right and left sides, there was unilateral atrophy in 34% of patients. Bilateral atrophy was not observed. There was a significant difference in fornix and mamillary bodies of the patients and control subjects (p<0.005). In 62.5% of cases, there were abnormalities in the fornix with bilateral involvement in 13% of cases. Mamillary bodies were abnormal in 37% of patients with bilateral involvement in 15%. Lateralization was accomplished in 65% of the patients according to the percentage difference ratios of fornix and in 38% of the patients according to the mamillary bodies. It is important to demonstrate hippocampus atrophy in patients with TLE. In the decision of lateralization of the epileptic side, evaluation of the fornix could be a good and practical solution. However, hippocampal volumetry is an indispensable criterion in demonstrating hippocampal atrophy more accurately. Atrophy of the amygdala and thickness of mamillary bodies have the least importance for lateralization.
Is There a Role for Apparent Diffusion Coefficients in the Differential Diagnosis of Brain Tumors?
Authors: Tokgoz N. , Celik H. , Gultekin S. , Voyvoda N.K. , Oner A.Y. , Tali E.T.
Published: April 2015

We determined the potential benefits of apparent diffusion coefficient (ADC) values of enhancing-nonenhancing solid portions, cystic-necrotic areas and surrounding edema in the differential diagnosis of brain tumors. Eighty-eight patients with brain tumors: 16 low-grade gliomas, 21 high-grade gliomas, 26 metastases and 25 meningiomas were imaged prospectively in a 1.5 Tesla magnetic resonance (MR) unit. Routine MR imaging and echo-planar diffusion-weighted imaging (DWI) with b values of 0 and 1000 mm2/s were performed. ADC values were obtained in different tumor parts and peritumoral edema. The ADCs of contrast-enhancing tumor regions were higher in high-grade gliomas than meningiomas (p<0.05). No significant differences were found in ADCs of contrast-enhancing regions comparing other tumor groups (p≥0.05). The ADCs in nonenhancing tumor regions did not differ between low-grade and high-grade gliomas (p≥0.05). The ADCs in cystic-necrotic regions of tumors and surrounding edema were not significantly different comparing all tumor groups (p≥0.05). There were no significant differences between ADCs of contrast-enhancing and nonenhancing regions of high-grade and low-grade gliomas (p≥0.05). No significant differences were found in ADCs of contrast-enhancing and nonenhancing areas of tumors comparing to surrounding edema (p≥0.05). ADC was not found to be useful in distinguishing different tumor types and its value in the diagnosis of brain tumors is limited due to considerable overlaps.
Magnetic Resonance Imaging in a Case of Wernicke's Encephalopathy with Hyperemesis Gravidarum
Authors: Xiangyu Zhu , Lebin Wu , Guangbin Wang , Xiangtao Lin , Tao Wang
Published: April 2015

We describe a 29-year-old pregnant woman presenting with neurological signs and diagnosed to have Wernicke's encephalopathy. The patient had a full recovery after prompt intravenous thiamine therapy. The clinical, pathological and MR features of Wernicke's encephalopathy are discussed.
‘Torch Fire Sign’: A New MR Sign in Profound Hypoxic Ischemic Brain Injury in a Term Infant
Authors: Thomas B. , Krishnamoorthy T. , Kapilamoorthy T.R.
Published: April 2015

Hypoxic-ischemic injury can produce diverse patterns of brain damage detected on MR imaging which mainly depend on the severity of brain ischemia and the maturity of the brain at the time of insult1. In a term infant severe ischemia produces maximum damage in the lateral thalami, posteromedial putamen, hippocampi and the dorsal brain stem in addition to the perirolandic cortex2. This is because these areas are the most metabolically active sites in the neonate3.
Persistent Primitive Trigeminal Artery in Monochorial Twins
Authors: Scazzeri F. , Picchietti S. , Lonzi S. , Ferrito G. , Prosetti D. , Paoli C.
Published: April 2015

The trigeminal artery is one of the arterial structures that constitute anastomosis between the carotid and the posterior circulation during fetal life and usually regress. However these arterial structures may persist in adult life and the trigeminal artery is the one that most frequently show such behaviour. We describe the case of two monochorial female twins with a persistent primitive trigeminal artery revealed by magnetic resonance angiography.
Giant Prolactinoma Mimicking Bone Tumor
Authors: Al-Zadjali N.K. , Tali E. Turgut , Al Azzaz A.
Published: April 2015

Prolactinomas are the most common of the hormone-secreting pituitary tumours. Most of them are small in size <10 mm (microprolactinomas) and few are >10 mm (macroprolactinomas). It is well known that clinical presentations of prolactinomas are quite different between genders4,5. The vast majority (95%) of prolactinomas in women are microadenomas which present with the clinical manifestations of hyperprolactinaemia. In contrast, men with prolactinomas often present because of symptoms due to the size of the tumour rather than impotence, loss of libido or infertility1,3. Giant pituitary tumours (larger than 4 cm) are rare and most of them are nonfunctional. Giant prolactinomas with massive extrasellar extension are also rare and their clinical management is sometimes problematic. Radiological examinations are of great value in tumour evaluation.
Thalamic Changes in Mesial Temporal Sclerosis: A Limbic System Pathology
Authors: Caranci F. , Bartiromo F. , Cirillo L. , Aiello A. , Cirillo S. , Brunetti A.
Published: April 2015

Hippocampal abnormalities correlated with mesial temporal sclerosis (MTS) are well documented. MTS may be associated with extrahippocampal anomalies involving limbic structures along a known neuroanatomic pathway (Papez circuit). We report a patient with MTS and thalamic changes. Seizure-related thalamic damage could have been caused by abnormal electric discharges from the mamillary body to the anterior thalamus through the mamillothalamic tract. This suggests that MTS is not limited to the temporal lobe but could represent a limbic system pathology.
Endovascular Treatment of Intracranial Giant Serpentine Aneurysms
Authors: Xianli Lv , Youxiang Li , Liu Aihua , Jiang Peng , Lv Ming , Wu Zhongxue
Published: April 2015

Giant serpentine aneurysms have recently been successfully treated with endovascular parent artery occlusion with or without distal by-pass. This report retrospectively analyses the outcome of endovascular parent artery occlusion for intracranial giant serpentine aneurysms. Medical records and cerebral angiograms from our endovascular center were analyzed retrospectively. Five patients with serpentine aneurysms were treated by endovascular occlusion of the parent artery at the site of the aneurysm. These patients had selective treatment. The clinical and angiographic outcomes in five patients were assessed at three months to three years. No cerebral infarction occurred. Of the patients, five made excellent recoveries at follow-up. No recurrence or rebleeding was noted. Endovascular parent artery occlusion may be a safe and effective way to treat intracranial giant serpentine aneurysms.
Treacher-Collins Syndrome and Associated Abnormalities
Authors: Tsitouridis I. , Bintoudi A. , Diamantopoulou A. , Michaelides M.
Published: April 2015

Treacher-Collins syndrome or mandibulofacial dysostosis is an autosomal dominant disorder of craniofacial development. In this familial syndrome there is an arrest in the development of the facial bones, manifested by a depression of the malar bones, an antimonogoloid slant of the palpebral fissures, mandibular hypoplasia with retrognathia, coloboma of the lower eyelids and deformities of the ear structures derived from the branchial arches. Frequently, there is external auditory canal atresia and deformity of the pinnae. Other uncommon anomalies include congenital heart defects and cryptorchidism. This study describes a rare case of Treacher-Collins syndrome associated with congenital cardiopathy and megacolon, with a review of the literature.
Imaging of Isolated Cerebral Mucormycosis
Authors: Cuellar H. , Riascos R. , Palacios E. , Rojas R. , Molina P.
Published: April 2015

Mucormycosis is a rare infection in immunosupressed patients caused by fungi from the family Mucoraceae. Three types of disease spread have been described: rhinocerebral, systemic and isolated. Isolated spread is the most uncommon form, usually resulting in death. It has been described in diabetics, immunosupressed patients and intravenous drug abusers. Neuroimaging can aid the diagnosis of this entity, but biopsy remains the only reliable method. Imaging findings of Mucormycosis include abscesses and hemorrhagic or ischemic infarcts, usually in the basal ganglia and frontal lobes. Single or multiple lesions have been described as well as meningoencephalitis. Understanding these findings can help to detect the infection in an early stage. We describe three cases of isolated cerebral mucormycosis; all of them were intravenous drug abusers with one patient also being HIV positive.
Anatomical Subcategorization for Pediatric Vein of Galen Aneurysmal Dilatation
Authors: Iizuka Y. , Kakihara T. , Yoshimura N. , Kimizuka T. , Sumi Y. , Kaneko K.
Published: April 2015

Vein of Galen aneurysmal dilatation is generally considered an abnormal deep-seated arteriovenous shunt that drains into the Vein of Galen. We herein present three pediatric cases of vein of Galen aneurysmal dilatation (VGAD). The locations of these shunts are anatomically different from just parenchymal as previously reported, but are also cisternal and intraventricular. Clinical symptoms, neuroradiological diagnostic points and therapeutic endovascular management are reported. Three boys had abnormal findings on brain computed tomography. Using magnetic resonance images, magnetic resonance angiography, three dimensional computed tomographical angiography and digital subtraction angiography, these patients were diagnosed with VGAD. The different locations of their shunts were the intraventricular choroidal plexus, cistern verum interpositive, and thalamus pulvinar nucleus. The boy presenting a single hole arteriovenous shunt at the cistern verum interpositive and an arteriovenous malformation at the choroidal plexus in the left lateral ventricle were treated by endovascular glue embolization. The patient with a single hole fistula in the left thalamus was followed only with observation. Treated patients had their abnormal shunts closed without any neurological complications. VGADs should be classified by shunt location according to whether they are ventricular, cisternal, or parenchymal. Although the therapeutic decision for pediatric VGAD should consider individual radiological, clinical and familial factors, endovascular intervention should be chosen as a first therapeutic option. Endovascular management of these lesions result in excellent angiographic and clinical outcome.
Frontoethmoidal Mucoceles: CT and MRI Evaluation
Authors: Tsitouridis I. , Michaelides M. , Bintoudi A. , Kyriakou V.
Published: April 2015

Paranasal sinus mucocele is an expanded, airless, mucus-filled sinus caused by obstruction of the sinus ostium. It is a benign slow growing epithelial lined lesion, bulging against adjacent anatomical structures, without infiltrating them. The purpose of our study is to describe the CT and MR findings in 19 patients (ten women, nine men, 18–72 years, mean age: 48.1) with surgically confirmed frontoethmoidal mucoceles between 1999–2005. CT scans displayed mucoceles as non enhancing soft tissue density lesions, generally isodense to the brain parenchyma, expanding the sinuses in most cases, eroding adjacent bones and extending intraorbitally or intracranially. Signal intensity in T2WI and T1WI MR images varied, but generally lesions had high signal intensity in T2WI and low to intermediate signal intensity in T1WI. Some of the lesions demonstrated regular linear peripheral enhancement after administration of contrast medium. The causes of mucoceles included mucosal thickening from chronic sinusitis, adhesions from previous operation in the nasal cavity, previous trauma, small nasal polyps and a small osteoma, while in six patients (31.5%) the cause of the mucocele remained unrecognized even after surgery. No underlying malignant tumor was found in any of the cases as the cause of obstruction. CT and MRI established the correct diagnosis in all patients. CT was more sensitive in determining bone erosions, while MRI had the advantage of multiplanar imaging and was much more sensitive for differentiating mucocele from a tumor on the basis of MR signal intensity characteristics. In conclusion, CT and MRI are the methods of choice for diagnosing mucoceles of the paranasal sinuses and are of major importance for the treatment plan. Each method seems to have its own advantages and should be used as complementary investigations of sinonasal pathology. Enhanced CT scan should only be performed in the absence or contraindication for enhanced MR imaging.
CT-Cisternography in Post-Surgical CSF Rhinorrhea
Authors: Pasqualetto L. , La Tessa G. , De Bellis L. , Paonessa A. , Iannaccone G. , De Bellis M. , Sirabella G.
Published: April 2015

Cerebrospinal fluid (CSF) rhinorrhea is a dangerous problem. CSF rhinorrhea implies an abnormal communication between the subarachnoid space and the nasal cavity, with subsequent leakage of CSF through the anterior nasal apertures. requiring surgical repair. Imaging techniques have evolved from conventional cranial radiography to polytomography, thin-section computed tomography (CT) and intrathecal water-soluble iodinated contrast agent-enhanced CT cisternography. We present two cases of post-surgical CSF rhinorrhea in which the best diagnostic findings were obtained by CT cisternography.
Mini-Invasive Surgery for Chiari Type I Malformation
Authors: Massimi L. , Caldarelli M. , Paternoster G. , Novegno F. , Tamburrini G. , Di Rocco C.
Published: April 2015

Surgical treatment of Chiari I malformation and associated syringomyelia includes several different techniques with various degrees of invasiveness. Most extensive procedures may provide good long-term outcome in a good proportion of cases but are burdened by a quite high risk of postoperative complications. Thirty children operated on by simple bone decompression are retrospectively reviewed to assess the effectiveness of a less invasive technique. The present series comprises 30 children (18 females, 12 males; mean age: 68 months) treated from 1993 to 2005. All patients underwent foramen magnum decompression by means of suboccipital craniectomy and resection of the fibrous band at the level of foramen itself. Twenty-one children also required C1 laminectomy while a dural delamination was performed in 11 cases. The mean current follow-up is 4.3 years (1–12.6 years). Head and/or neck pain was the most frequent preoperative finding (56.7%), followed by upper and lower extremity weakness (20.0%), ataxia (20.0%) and vertigo (27.7%). Syringomyelia was present in 12 patients. A significant improvement of preoperative clinical symptoms and signs was observed in 28 patients (93.3%). Two children required adjunctive surgery. Neuroimaging revealed minor postoperative modifications in most cases regardless of tonsils location, while syringomyelia was reduced in size in 50% of the cases. Complication rate and length of hospital stay were significantly reduced compared with the literature data and our own experience using more invasive techniques. These data, compared with the literature, allow us to conclude that suboccipital craniectomy and Cl laminectomy (possibly integrated by dural delamination) is an effective and safe treatment for symptomatic children with Chiari I malformation and syringomyelia.
Dynamic Exophthalmos Secondary to an Orbital Varix
Authors: Er U. , Belen D. , Ozturk M.H. , Bavbek M.
Published: April 2015

We present a case of dynamic exophthalmos secondary to an orbital varix. Objectives of this paper are to describe this rare entity and review its etiology, diagnosis and treatment options. A 21-year-old woman presented complaining of exophthalmos in the right eye on bending forward. Neuroimaging studies revealed an irregularly shaped mass located in the posterior intra-extraconal region adjacent to the orbital roof. Surgical and interventional endovascular therapies were considered, but due to the complex nature of the lesion the patient was followed-up conservatively. Orbital varix may cause dynamic exophthalmos and most patients may be managed conservatively. Patients harboring non-treatable orbital varix should be advised to avoid any strenuous exercises and postures which may increase intraorbital pressure.
Giant Intracerebral Telangiectasia in a Case of Blue Rubber-Bleb Nevus Syndrome
Authors: Sedat J. , Chau Y. , Popolo M. , Lonjon M.
Published: April 2015

Blue rubber-bleb nevus syndrome is a rare condition that consists of multiple venous malformations involving several organ systems, mainly the skin and gastrointestinal tract. Involvement of the central nervous system is particularly rare. We describe a patient with a huge intracerebral telengiectasia revealed by a progressive neurological deficit.
Acute Necrotizing Encephalopathy in an Infant: Observations by CT, Contrast-Enhanced MRI and Diffusion MRI
Authors: Sener R. Nuri , Atalar Mehmet H.
Published: April 2015

Acute necrotizing encephalopathy is characterized by bilateral necrotic, hemorrhagic lesions which occur symmetrically in the thalami, dorsal brainstem and dentate nuclei. Development of an extensive breakdown of the blood–brain barrier in the prominent lesions of acute necrotizing encephalopathy was demonstrated in a seven-month-old boy with the disorder, within 14 h after hospitalization by an initially negative post-contrast CT scan, and subsequently positive post-contrast T1-weighted MRI. Diffusion MRI demonstrated concomitant cytotoxic and vasogenic edema in the lesions. By the fortieth day, the lesions apparently regressed with remaining hemorrhagic material in the thalami.
Perfusion Weighted MR Imaging May Differentiate Primary CNS Lymphoma from other Homogeneously Enhancing Brain Tumors
Authors: Abul-Kasim K. , Maly P. , Strömbeck A. , Svensson J. , Sundgren P.C.
Published: April 2015

Primary central nervous system lymphoma (PCNSL), glioblastoma multiforme (GBM) and metastases may be difficult to differentiate based on conventional imaging alone. The aim of this study was to investigate the value of perfusion weighted imaging (PWI) in differentiating homogeneously enhancing PCNSL from homogeneously enhancing GBM and metastases. Seven consecutive patients presenting with homogeneously enhancing intraaxial tumors on MRI were retrospectively analyzed. All seven patients (three immunocompetent patients with PCNSL, three with GBM, and one with cerebral metastases) were examined with identical MR-sequences including PWI. The relative regional Cerebral Blood Volume (rrCBV) and the rrCBV ratio (rrCBVratio) were calculated. In lymphomas rrCBVratio was 0.93 ± 0.42 (mean ± SD) compared with 7.93 ± 1.44 in GBM and metastases. All lymphomas had rrCBVratio < 1.43 while all GBM and metastases had rrCBVratio > 1.43 (Fischer exact test; p < 0.001). PWI may be a valuable method in differentiating homogenously enhancing PCNSL from GBM and metastases.
Is Bone Enhancement a Helpful Finding in the Diagnosis of Convexity Meningiomas?
Authors: Mammen T. , Cortes M.DP. , Melançon D. , Tampieri D.
Published: April 2015

We have assessed the enhancement of the overlying bone as a new finding in patients with convexity meningioma. This finding was present in 68.6% of cases in our series. This finding was found very helpful in the differential diagnosis of atypical and cystic meningiomas.
MR and CT Evaluation of Dysembryoplastic Neuroepithelial Tumor
Authors: Balaji R. , Ramachandran K. , Krishnakumar A.S. , Venugopal M.
Published: April 2015

A 33-year-old man presented with a long history of intractable partial seizures with the first episode at the age of 18 years. The seizure frequency had increased in the recent past. CT imaging revealed a low attenuation lesion in the left frontal cortex with calvarial scalloping. MR imaging revealed a heterogeneous signal intensity lesion with involvement of the cortex and the sub-cortical white matter. In dysembryoplastic neuroepithelial tumor the neoplastic elements adjacent to the cortex might cause disorganization of cortical layers in the developmental stage leading to cortical dysplasia. Architectural dysplasia is characterized by cortical thickening and ectopic neurons in the white matter. MR imaging features reflect the characteristics of cortical dysplasia and ectopic neurons in the sub-cortical white matter.
Molecular Imaging and Magnetic Resonance Imaging in Early Diagnosis of Alzheimer's Disease
Authors: Schillaci O. , Travascio L. , Bruni C. , Bazzocchi G. , Testa A. , Garaci F.G. , Melis M. , Floris R. , Simonetti G.
Published: April 2015

Alzheimer's disease (AD), a progressive neurodegenerative disorder, is the most common cause of dementia in the elderly. Magnetic resonance (MR) or computed tomography (CT) imaging is recommended for routine evaluation of dementias. The development of molecular imaging agents and the new techniques of MR for AD are critically important for early diagnosis, neuropathogenesis studies and assessing treatment efficacy in AD. Neuroimaging using nuclear medicine techniques such as SPECT, PET and MR spectroscopy has the potential to characterize the biomarkers for Alzheimer's disease. The present review summarizes the results of radionuclide imaging and MR imaging in AD.
Neuroradiological and Neuropsychological Study of a Callosal Infarct
Authors: Toriello A. , Pugliese N.D. , Izzi F. , Siani A. , Locatelli G. , Saponiero R.
Published: April 2015

Corpus callosum infarcts are rare, constituing 0.6% of cerebral infarcts, most likely due to a rich blood supply from three main arterial systems. These infarcts may present with slowly evolving and non-localizing neurologic signs and symptoms that suggest the diagnosis of neoplasm rather than infarct. In addition, they may exhibit radiologic features more often associated with neoplasm, such as mass-like enhancement or extension across the midline. We describe a patient with corpus callosum infarct presenting with a non specific ataxia-like gait disorder, speech difficulty and left-side weakness. MR imaging disclosed an ischemic area in the body and splenium of the corpus callosum with extension to the right semiovalis centre. Neuropsychological study revealed constructive apraxia, attention reduction, motor programming and inhibiting control involvement. The atypical clinical presentation suggested involvement of the posterior circulation, while apraxia and attention impairment were in accordance with lesion localization. In-depth neuropsychological study is essential in patients with suspected corpus callosum involvement because the neurological signs and symptoms are confounding. The infarct localization in the body and semiovalis centre is an interesting neuroradiological feature.
Intracranial Tumours. Neurosurgeons View
Authors: Trojanowski T.
Published: April 2015

The role of imaging in the treatment of brain tumours viewed from the neurosurgeons perspective is described. The importance of evaluating various aspects of intracranial tumours for the prognosis, selection of treatment and execution of the operation is reviewed. The impact of imaging on operation planning, intraoperative use of neuronavigation, MRI CT and USG on the outcome of treatment is presented. Close cooperation between neuroradiologist and neurosurgeon guarantees better outcomes for the patients and further improvements in brain tumour treatment.
Typical Neuroradiological Features of Sjogren-Larsson Syndrome
Authors: Srinivasan G. , Ushanandhini P. , Srividya S. , Ramprabhanath S.
Published: April 2015

Sjogren-Larsson syndrome is a rare inherited autosomal recessive neurocutaneous disorder with typical findings on MRI. We describe the typical MRI and MR Spectroscopy findings in a clinically diagnosed case of Sjogren-Larsson syndrome.x
Pseudotumoural Hemicerebellitis: Conventional MR Imaging and MR Spectroscopy Evolution
Authors: Summa A. , Squarcia A. , Ormitti F. , Ventura E. , Cerasti D. , Todeschini A. , Crisi G.
Published: April 2015

Acute cerebellitis is an inflammatory process commonly involving both cerebellar hemispheres. Bilateral cerebellar hemispheres involvement is the most common finding. It typically occurs as a primary infectious, post-infectious or post-vaccination disorder, but is also a disease entity with heterogeneous pathogenesis including paraneoplasia. Acute cerebellitis is usually a benign, self-limiting and rarely fatal disease. Typically, cerebellar atrophy is a late consequence of the syndrome. We describe the radiological features of a case of pseudotumoural hemicerebellitis with emphasis on MRI and spectroscopy findings as non-invasive diagnostic tools to avoid unnecessary surgical procedures.
Brain Metastases from Ewing's Sarcoma
Authors: Bekiesinska-Figatowska M. , Jurkiewicz E. , Raciborska A.
Published: April 2015

Ewing's sarcoma accounts for approximately 30% of primary malignant bone tumors, mainly in children and young adults. At the time of diagnosis many patients already have metastatic spread of the disease, most often to the lungs and skeletal system. Intracerebral metastases are rare — the reported incidence is up to 4.3%. We describe two cases of metastatic deposits within the brain tissue. Signal intensity of the lesions was similar to that of meningioma on all sequences. Strong homogenous enhancement after gadolinium administration was also similar to meningioma.
Potential of High Field Functional MRI in the Neuroradiological Diagnosis of Brain Tumours
Authors: Bonicelli C. , Bacci A. , Agati R. , Leonardi M.
Published: April 2015

Functional 3 tesla magnetic resonance imaging (MRI) techniques such as diffusion and perfusion imaging and MR spectroscopy (MRS) allow a more accurate diagnosis of central nervous system tumours. This retrospective study analysed the MRI scans of 121 consecutive patients with a diagnosis of glial brain tumours who underwent surgery and/or biopsy and whose histological reports were available. Our aim was to establish if and how functional MRI techniques had enhanced the diagnostic accuracy with respect to morphological examination. To quantify the diagnostic contribution of these techniques and their predictive value, a questionnaire was compiled by an observer blinded to the neuroradiological diagnosis and to the histological results after surgery/biopsy. Patients were divided into two groups based on the time of 3T MRI examination performed: before or after surgery/biopsy. In the group of non-operated patients low grade gliomas could be distinguished from high grade malignant tumours, whereas in the group of operated patients signs of tumour persistence or recurrence could be distinguished from the effects of previous treatments. Functional MRI techniques improved the accuracy of diagnosis with respect to morphological examination alone in both groups of patients: areas of increased cellularity, neoangiogenesis or metabolic changes were identified confirming diagnosis, whereas methodological errors were disclosed in cases of incorrect diagnosis.
An Ischaemic Thalamic Lesion Extending to the Mammillothalamic Tract Associated with Absent Ipsilateral Mammillary Body in a Patient with Temporal Lobe Epilepsy
Authors: Marliani A.F. , Maffei M. , Cirillo L. , Leonardi M.
Published: April 2015

We describe a patient with right temporal lobe epilepsy with MR findings of an ischaemic thalamic lesion extending to the mammillothalamic tract and absent visualization of the mammillary body without signal changes in the hippocampus.
Comparative Study Evaluating the In Vivo Characteristics of Ruptured and Unruptured Aneurysms Using serial Digital Subtraction Angiography
Authors: Bharath R.D. , Vasudev M.K. , Jayakumar P.N. , Goel G. , Kovoor J.M.E. , Ravishankar S. , Thennarasu K.
Published: April 2015

Over the past decade preventive endovascular treatment is increasingly being considered for intracranial aneurysms irrespective of whether ruptured or unruptured. Few studies have dealt with in-vivo characteristics of intracranial aneurysms. We compare the angiographic morphology of ruptured and unruptured intracranial aneurysms using short interval serial DSA. 37 patients with intracranial aneurysms and who underwent at least two digital subtraction angiograms were included in the study. Based on the clinical presentation there were two subgroups of patients, Group A patients presenting acutely with Sub arachnoid haemorrhage (SAH) and Group B patients who had no clinical or imaging features suggestive of bleed. Clinical and serial angiographic data were correlated. Aneurysms in Group A (1.04 mm3) were significantly (p=0.010) smaller than in Group B (4.53 mm3). Aneurysms in group A showed increase in size and those in Group B showed a decrease in size (p=0.019). Hypertensive patients in both the groups showed a tendency for a decrease in the size of the aneurysms. Aneurysms having stasis at the time of initial angiogram had significantly reduced in size on follow up (p=0.013) at a faster rate (p=0.017). Presence of spasm in adjacent vessels was associated with increase in size of aneurysm on follow up in both Groups. There are significant differences between a ruptured aneurysm and an unruptured one. Ruptured aneurysms are small and show rapid increase in size. The presence of spasm increased the size of the aneurysm in the post rupture period and anti hypertensive medication and stasis were associated with decrease in size.
Occasional Finding of a Dural Arteriovenous Fistula in a Newborn with Orbital Lymphangioma
Authors: Ventura E. , Ormitti F. , Summa A. , Menozzi R. , Cerasti D. , Crisi G.
Published: April 2015

Dural arteriovenous fistulas (DAVF) are vascular malformations rarely occurring in the paediatric population1,2,3. Prompt diagnosis and treatment are mandatory to prevent life-threatening complications including congestive heart failure and severe brain injury1,2. We describe the case of a female newborn with an orbital lymphangioma treated for a posterior fossa DAVF. We emphasize the role of MR imaging as a useful non-invasive tool in the diagnosis of these malformations and in the evaluation of associated brain parenchymal lesions.
Vasospasm and Cerebral Infarction from Pituitary Apoplexy
Authors: Cerase A. , Tarantino A. , Muzii V. F. , Vittori C. , Venturi C.
Published: April 2015

Pituitary apoplexy is a potentially life-threatening acute or subacute clinical syndrome occurring from enlargement of the pituitary gland, and pituitary insufficiency, from hemorrhage or ischemia from an unknown pituitary lesion, most frequently being a non-functioning macroadenoma. A close, and multidisciplinary management is required. The purpose of this case report is to increase awareness to pituitary apoplexy presentation and management by reporting clinical features and neuroradiological findings observed in a 70-year-old patient with an unknown pituitary lesion. He presented with pituitary apoplexy and brain ischemia at magnetic resonance imaging (MRI) including diffusion-weighted imaging (DWI), and apparent diffusion coefficient (ADC) maps. MR angiography (MRA) showed diffuse vasospasm of anterior and posterior circulation. Both MRI and cytochemical examination of the cerebrospinal fluid ruled out subarachnoid hemorrhage. Due to concomitant diseases, and absence of visual deficit, the management was conservative by medical and substitutive therapy, without surgery. Clinical follow-up showed clearcut improvement, and this was consistent with MRI and MRA evidence of vasospasm regression, and clearcut pituitary lesion shrinkage. Pituitary lesions with hemorrhagic infarction presenting with pituitary apoplexy may be associated with vasospasm and brain ischemia at diagnosis, also in the absence of subarachnoid hemorrhage. A correct MR evaluation of patients with PA should include DWI, ADC maps, and MRA. Notably, early diagnosis of PA-associated vasospasm and cerebral ischemia avoids the possibility of their detection only after neurosurgery