bluuebunny/crossref_metadata_2025 huggingface dataset:
Review of Corpus Callosum Topography, Analysis of Diffusion Values for the Different Callosal Fibers and Sex Differences
Authors: Pizzini F.B. , Tassinari G. , Zoccatelli G. , Magon S. , Alessandrini F. , Rizzo P. , Beltramello A.
Published: April 2015

Conventional MRI shows the morphology of the corpus callosum (CC), but does not reveal cortical connectivity or structural information on the CC. Here, we applied diffusion tensor imaging (DTI) in conjunction with a tract-tracing algorithm to incorporate cortical connectivity information on the CC in 40 subjects and to detect the main area and sex structural differences. CC parcellation was based on trajectories to different cortical (prefrontal, frontal motor/premotor/supplementary motor connections, parieto-occipital, temporal) and sub-cortical areas (capsular/basal ganglia connections). In agreement with recent DTI studies, we found that motor fibers occupy a much larger portion of the CC than previously believed on the basis of anatomical data. Differences in anisotropy values were instead in agreement with previous morphological evidence of smaller fibers in the anterior and posterior portions of the CC. The main sex difference was observed in anisotropy values in frontal fibers that proved to be lower in females than in males. Statistically significant differences in the regional diffusion parameters and between sexes give rise to many important questions regarding fiber organization patterns, CC microstructure and the functional relevance of these differences and provide evidence for the role of DTI, which reaches beyond the information given by morphological analysis.
The Preoperative Spine: Diagnostic Work up with fMRI
Authors: Elsig J.P. , Kaech D.L.
Published: April 2015

The advantages of the upright, open, multi-positional MRI, i.e. functional MRI (fMRI) are presented with illustrative cases and the literature is reviewed. In cases of not explained and especially in position-dependent spinal and/or neurological pain and/or dysfunction functional or dynamic MRI is able to reveal dynamic compressions/stenosis, as well as segmental dysfunction and instabilities in a noninvasive way. This new technology could become mandatory for the preoperative investigation of unexplained, mainly “dynamic, mobile or unstable” spinal pathologies. Allowing a better correlation of signs and symptoms with the imaging findings and thus a more targeted treatment, fMRI could help to decrease the rate of failed back surgery syndrome in the near future.
CT Angiography Covering Both Cervical and Cerebral Arteries Using Contrast Material with a Reduced Dose and Higher Concentration on a 16-Detector Row System: Effect of the Iodine Delivery Rate and a Saline Flush
Authors: Tsuchiya K. , Imai M. , Yoshida M. , Nitatori T.
Published: April 2015

We assessed the effect of iodine delivery rates (IDRs) and a saline flush in CT angiography that covered both cervical and cerebral arteries when a contrast material of higher concentration (350 mgI/mL) was employed. In three patient groups whose CT angiography was performed at different IDRs with or without a saline flush, we measured the attenuation of target vessels and visually evaluated the images obtained. Our results indicated that a higher IDR was effective to increase the attenuation value of both cervical and cerebral arteries without changing that of the venous system, although it did not significantly affect visualization of these vessels. Further, the addition of a saline flush could reduce the injection speed without a decrease in the attenuation of the target vessels.
Non-Alcoholic Partially Reversible Marchiafava-Bignami Disease: Review and Relation with Reversible Splenial Lesions
Authors: Caulo M. , Briganti C. , Notturno F. , Committeri G. , Mattei P. A. , Tartaro A. , Gallucci M. , Uncini A.
Published: April 2015

Marchiafava-Bignami disease (MBD) is a rare pathological condition characterized by progressive demyelination and necrosis of the corpus callosum (CC). MBD occurs in patients with chronic alcoholism although a few non-alcoholic cases have been reported. We describe a non-alcoholic, depressed patient, who developed MBD after psycho-active drug abuse. Magnetic resonance imaging (MRI) disclosed bilateral, symmetric, hyperintense regions in the genu, body and splenium of the CC associated with increased water diffusivity. Clinical and MRI findings showed a partial recovery after tapering/modification of psycho-active drugs. We reviewed the nine cases of non-alcoholic MBD reported in the literature. We conclude that most cases should have been diagnosed as a reversible isolated splenial lesion (MERS), a recently described condition semiotically similar to MBD but with a specific localization, restricted water diffusivity and reversibility at MRI. In conclusion, MBD is an extremely rare condition in non-alcoholic patients and the use of MRI for distinguishing between MBD and MERS is crucial.
Volumetric Examination of MS Plaques and Correlation with EDSS Ratings
Authors: Gurwara S. , Hailey B. , Thompson A. , Minagar A. , Hardjasudarma M. , Gonzalez-Toledo E.
Published: April 2015

This study is a retrospective analysis of 17 patients with multiple sclerosis. The total volume of plaques from three different MR image sets of the brain was correlated with the EDSS ratings of the patients. Each of the correlations showed a positive relationship, but none was statistically significant. A more extensive study is required in order to give significance to these relationships.
Correlation between Magnetic Resonance Imaging Findings and Pathological Observations in Tumefactive Multiple Sclerosis
Authors: Kobayashi M. , Ono Y. , Shibata N. , Kobayashi M. , Shimizu Y. , Ohta K. , Iwata M. , Uchiyama S.
Published: April 2015

Multiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system. Tumefactive MS (TMS) is a subtype of MS characterized by solitary or multiple mass lesions with open-ring enhancement on brain magnetic resonance imaging (MRI). Three TMS cases, diagnosed histopathologically by brain biopsy, that were difficult to distinguish from brain tumors or brain abscesses on MRI are presented. On T2-weighted imaging (T2WI) the lesions were high intensity in the center and periphery, with open-ring contrast enhancement at the periphery; iso- to low intensity areas (“T2 low rim”) were seen in the surrounding region. Histopathological examination revealed the characteristic features of TMS: severe central demyelination and focal necrosis, peripheral neovascularization and perivascular inflammatory cell infiltration, and perifocal edema. On immunochemistry, both the endothelial cells of the neovasculature and the surrounding macrophages in the periphery expressed vascular endothelial growth factor and monocyte chemoattractant protein-1, which mediate inflammation and angioneogenesis and increase vascular permeability. These findings correspond to the T2 low rim co-localizing with the site of gadolinium enhancement on MRI. Thus, the present study clearly demonstrates the correlation between the radiological features and the pathophysiological aspects of TMS, which may contribute to more precise diagnosis of TMS.
Diagnosis of Intracranial Epidermoid Rupture by MR Imaging
Authors: Karanam L.S.P. , Rajeswaran R. , Anupama C. , Santhosh J.
Published: April 2015

Intracranial epidermoids are benign tumours arising from retained ectodermal implants. Spontaneous rupture is an important though rare complication of intracranial epidermoid. To our knowledge, MR findings in spontaneous epidermoid rupture have not been well described to date. We report the case of a 60-year-old man who presented with a two day history of headache, altered sensorium and left hemiplegia. A diagnosis of ruptured epidermoid was made based on MR imaging findings which were subsequently proven by histopathology.
MRI Findings of Cerebral Malaria
Authors: Medhi N. , Das S.B. , Das R.R. , Medhi S. , Sarma P. , Duwara R. , Das P. , Saikia R.
Published: April 2015

Cerebral malaria is a protozoal disease affecting the brain caused by Plasmodium falciparum. The hallmark of cerebral malaria is progressive decline in the sensorium leading to coma and in some cases death. MR findings reported in cerebral malaria are diffuse cerebral swelling / edema, bilateral nearly symmetrical T2 hyperintense lesions in basal ganglia and similar lesions in thalamus, pons and cerebellum. The imaging findings of cerebral malaria depend on the duration of the illness and time of MR examination. We describe two patients of cerebral malaria having mixed Plasmodium falciparum and Plasmodium vivex infestation showing bilateral basal ganglia infarcts with cerebral swelling in one patient and bilateral basal ganglia and cerebellar lesions in the other.
Cerebral Venous Sinus Thrombosis: Unusual Imaging Appearance
Authors: Muttikkal T.J.E. , Shaikh R. , Nakhi A. Ben , Gupta R. , Sheikh M.
Published: April 2015

Cerebral venous sinus thrombosis (CVST) has widely varied clinical and radiological manifestations ranging from asymptomatic minimal brain oedema to severe haemorrhagic infarcts associated with focal deficits, coma and even death. Cerebral venous sinus thrombosis presenting with lobar or subdural hematomas are rare and the cause may easily be overlooked. We present a case of CVST with an atypical radiological picture of intra-arenchymal, subdural and subarachnoid haemorrhage.
Epidural Hematoma Caused by a Spinal Osseous Epidural Arteriovenous Fistula in a 14-Year-Old Patient
Authors: Rispoli R. , Mastrostefano R. , Passalacqua G. , Filauri P. , Fontana M.
Published: April 2015

Spinal dural arteriovenous fistulae are the most common type of spinal vascular malformations (AVMs). They have been classified into four types: dural AVM (type I), glomus AVM (type II), juvenile AVM (type III), and intradural direct arteriovenous fistula (type IV). Intradural AVMs manifest as subarachnoid or intramedullary hemorrhages, whereas dural AVM manifest as epidural hematoma. Spinal osseous epidural arteriovenous fistula (AVF) is not a well-defined vascular abnormality in the spine and consists in a high-flow vascular lesion outside the dura or spinal canal. It is located in the extradural space involving a bone at the area of the dilated venous sac to which all the feeders converge to the margin. We describe the case of a 14-year-old girl with cervical epidural hematoma caused by a spinal epidural arteriovenous fistula.
Rupture of Persistent Primitive Trigeminal Artery Aneurysm Associated with a Cavernous Sinus Fistula
Authors: Liu L. , He H. , Li Y. , Jiang C. , Wu Z.
Published: April 2015

We describe a patient with an aneurysm arising at a persistent primitive trigeminal artery ruptured to form a carotid-cavernous fistula. Coil occlusion of the carotid cavernous sinus fistula resulted in flow stasis of the persistent primitive trigeminal artery and resolution of symptoms. A ruptured aneurysm of the persistent primitive trigeminal artery can be associated with a carotid cavernous sinus fistula. Coil occlusion of the cavernous sinus and the PPTA is a safe and effective technique to treat this disease.
Y-configured Stent with a Double Microcatheter Technique for Ruptured Complex Basilar Tip Aneurysm
Authors: Ko Jh , Kim Yj , Cho Cs
Published: April 2015

A 79-year-old woman had a sudden onset severe headache and became somnolent. On the first day in the hospital, diagnostic cerebral angiography revealed a small broad-necked basilar tip aneurysm with a bleb near the neck. Due to the unfavorable configuration of aneurysm, we decided to use a Y-configured stent with a double microcatheter technique. Although procedural rupture on the bleb near the neck occurred, perioperative neurological state was not changed and her clinical course was uneventful. Because of the stent, complete packing of the aneurysm was possible, hemodynamic stress at the inflow area was reduced and consequently the chance of rebleeding may decrease. Stenting with a double microcatheter technique can be an effective treatment for highly complex intracranial aneurysms.
Neuroanatomic Analysis of Diffusion Tensor Imaging of White Matter Tracts with Dejerine Sections and Neuroimaging
Authors: Chou W. , Salamon G. , Orr N.B. , Salamon N.
Published: April 2015

We present a neuroanatomical comparison with stereotaxic precision correlating modern diffusion tensor imaging (DTI), MRI data and classical neuroanatomical textbooks. The neuroatlas compiled by J. and A. Dejerine deserves emphasis for its role of a bridge between precise classical neuroanatomy techniques with modern neuroimaging methods. We present its utility in identifying major white matter tracts of the brain in concert with DTI in the horizontal-plane axis to elucidate axonal directionality. The axonal directionality of DTI is necessary for understanding white matter connectivity in the brain. Many DTI studies publish findings in selective regions of the brain, and our study is mainly devoted to comparing our images with data from Dejerine for the entire brain.
The Brain-Heart Connection in Mitochondrial Respiratory Chain Diseases
Authors: Cordeiro M. , Scaglia F. , Da Silva S. Lopes , Garcia P. , Grazina M. , Moura C. , Diogol L.
Published: April 2015

Mitochondrial respiratory chain disorders (MRCD) are a heterogeneous group of diseases leading to an inadequate production of ATP. Brain and heart are among the most affected organs. Thus far, no specific relationship has been found between specific affected areas in the central nervous system and cardiac involvement. This study investigated the relationship between specific brain involvement and heart disease in mitochondrial disorders. We hypothesize that specific areas of brain lesions in children with MRCD are more frequently correlated to heart disease than others. A retrospective evaluation of the clinical records of 63 children with a definite MRCD, was performed searching for heart disease, namely, dilated and hypertrophic cardiomyopathy and arrhythmia. Brain MR images were evaluated and characterized regarding specific areas of atrophy and involvement. These findings were correlated using the Fischer exact test whose strength was determined with the Phi coefficient. During the period analyzed, 13 children (20.6%) developed cardiac disease, of whom nine (14.3%) exhibited isolated cardiomyopathy, one (1.6%) exhibited arrhythmia and three both. The main MRI abnormalities observed were brain atrophy (65.1%) and among this group 17.5% of subjects had cerebellar involvement. In addition, supratentorial, cerebellar and brainstem white and grey matter lesions were also found. There was a statistically significant relationship between progression to cardiac disease and cerebellar atrophy (Fisher's Exact Test −0.005 and Phi 0.394) and lesions in the cerebral peduncles (0.035/0.358). Moreover, there was an additional correlation between thalamic lesions and progression to hypertrophic myocardiopathy (0.029/0.397). A statistical relationship between thalamic, mesencephalic and cerebellar involvement and cardiac disease in children with definite MRCD was observed. The true significance of this connection warrants further assessment.
Cortical Blindness and Retrograde Amnesia following Cerebral Angiography Studied by Early Diffusion Weighted MR Imaging
Authors: Roccatagliata L. , Taveira-Lopes L. , Rossignol M.-D. , Biondi A.
Published: April 2015

Cortical blindness is a well described neuro-ophthalmologic complication of angiography due to neurotoxicity following contrast media exposure. A rarer association with retrograde amnesia has also been reported. Since ischemic stroke due to embolism remains the most common aetiology of neurological complications of diagnostic and therapeutic arterial catheterisation, prompt identification of the mechanism responsible for the clinical symptoms is essential for patient management. Although CT and conventional MRI findings have been reported in this condition, experience with diffusion weighted (DW) sequences is lacking especially in cases associated with memory impairment. A 65-year-old man with tinnitus underwent cerebral angiography for suspicion of a dural arteriovenous fistula. During the procedure the patient developed complete loss of vision and rapidly became confused. Brain CT showed bilateral cortical enhancement in the occipital lobes. MR with DWI was performed 3.5 hours after angiography. Early DWI showed no signal abnormalities thereby excluding an ischaemic complication. Gradual improvement of visual function occurred over the next 24 hours. After 48 hours the patient was alert and orientated but profound retrograde amnesia persisted with no memory for the events of the day of angiography. CT follow-up at one year was normal. DWI is invaluable in the evaluation of patients with cortical blindness with or without memory deficits precipitated by angiography and may advance understanding of the pathophysiology. Diffusion-weighted MRI is crucial in differentiating neuro-ophthalmologic complications precipitated by intracortical contrast leakage after angiography from an ischaemic stroke needing a prompt and often invasive treatment.
MRI in Multiple Sclerosis
Authors: Radü E.-W. , Mueller-Lenke N. , Thoeni A. , Palatini A. , Bendfeldt K.
Published: April 2015

The diagnosis of Multiple Sclerosis (MS) is based on clinical findings that are characterized by sudden neurological deficits in different parts of the CNS. Dissemination of lesions in space and time is the basic criterion. MRI can demonstrate most precisely any changes in the water content of brain tissue thus making it a very sensitive diagnostic tool to detect inflammatory processes like MS plaques. The following will briefly summarize the diagnostic features and procedures and will assess the appearance of typical MS lesions, their localization and configuration, which are essential for diagnosis and follow up examinations. It will propose the preferred sequences and technical parameters for standardized baseline examinations and follow-ups.
Heterogeneity of White Matter Hyperintensities in Alzheimer's Disease: Post-Mortem Quantitative MRI and Neuropathology
Authors: Gouw A. A. , Seewann A. , Vrenken H. , van der Flier W. M. , Rozemuller J. M. , Barkhof F. , Scheltens P. , Geurts J. J. G.
Published: April 2015

White matter hyperintensities (WMH) are frequently seen on T2-weighted MRI scans of elderly subjects with and without Alzheimer's disease. WMH are only weakly and inconsistently associated with cognitive decline, which may be explained by heterogeneity of the underlying neuropathological substrates. The use of quantitative MRI could increase specificity for these neuropathological changes. We assessed whether post-mortem quantitative MRI is able to reflect differences in neuropathological correlates of WMH in tissue samples obtained post-mortem from Alzheimer's disease patients and from non-demented elderly.

Thirty-three formalin-fixed, coronal brain slices from II Alzheimer's disease patients (mean age: 83 ± 10 years, eight females) and 15 slices from seven non-demented controls (mean age: 78 ± 10 years, four females) with WMH were scanned at 1.5 T using qualitative (fluid-attenuated inversion recovery, FLAIR) and quantitative MRI [diffusion tensor imaging (DTI) including estimation of apparent diffusion coefficient (ADC) and fractional anisotropy (FA), and T1-relaxation time mapping based on flip-angle array). A total of 104 regions of interest were defined on FLAIR images in WMH and normal appearing white matter (NAWM). Neuropathological examination included (semiquantitative assessment of axonal density (Bodian), myelin density (LFB), astrogliosis (GFAP) and microglial activation (HLA-DR). Patient groups (Alzheimer's disease versus controls) and tissue types (WMH versus NAWM) were compared with respect to QMRI and neuropathological measures. Overall, Alzheimer's disease patients had significantly lower FA ( P < 0.01) and higher T1-values than controls ( P = 0.04). WMH showed lower FA ( P < 0.01) and higher T1-values ( P < 0.001) than NAWM in both patient groups. A significant interaction between patient group and tissue type was found for the T1 measurements, indicating that the difference in T1-relaxation time between NAWM and WMH was larger in Alzheimer's disease patients than in non-demented controls. All neuropathological measures showed differences between WMH and NAWM, although the difference in microglial activation was specific for Alzheimer's disease. Multivariate regression models revealed that in Alzheimer's disease, axonal density was an independent determinant of FA, whereas T1 was independently determined by axonal and myelin density and microglial activation. Quantitative MRI techniques reveal differences in WMH between Alzheimer's disease and non-demented elderly, and are able to reflect the severity of the neuropathological changes involved.
MR Imaging of Bilateral Paramedian Thalamic and Mesencephalic Infarcts
Authors: Sparacia G. , Iaia A. , Cavarretta G. , Mularo V. , Fiamma M.E. , Di Giovanna E. , Midiri M.
Published: April 2015

We describe MR imaging of bilateral infarction of the paramedian portion of the mesencephalus and thalamus due to an occlusion of the Percheron artery. This entity is due to one of the anatomic variants of the perforating arteries supplying the thalamus and mesenchephalus. Clinically this kind of infarction presents with neurologic impairment as a disorder of consciousness, memory dysfunctions, various types of vertical gaze palsy and psychic changes, which need to be differentiated from delirium and coma. At MRI evaluation infarction of the paramedian portion of thalami and midbrain, with a “butterfly wings” pattern, was demonstrated as high signal intensity areas on FLAIR and FSE-T2W images and with diffusion restriction on DWI images.
64-Slice CT Angiography in the Detection of Intracranial Aneurysms: Comparison with DSA and Surgical Findings
Authors: Medenica S. Milošević , Vućković V. , Prstojević B.
Published: April 2015

The overall results of CT angiography on 64-slice MSCT published in the last five years are very close to results of DSA which is still a gold standard in the diagnosis of intracranial aneurysms. The aim of this study is to contribute to the confidence in reliability of this method and to try to answer the question of whether CTA should be used as the first diagnostic modality in patients with suspect intracranial aneurysms. In the period from October 2008 to August 2009 we diagnosed 118 aneurysms in 73 patients. We included in this study only those patients who underwent either DSA, surgical treatment or both after MSCTA, and the remainder of the above patients were not treated and are followed up, or died before treatment. So our group comprised 47 patients who were divided into two groups. The first group of 22 patients underwent DSA after MSCTA. We found 36 aneurysms in this group. One aneurysm was falsely positive compared to DSA, while 35 were in concordance with DSA. DSA revealed five aneurysms smaller than 4 mm not disclosed by MSCTA. The second group comprised 25 patients who were operated according to MSCTA findings only. There were 33 aneurysms in this group: 25 aneurysms were operated and surgical findings agreed with MSCTA. Eight aneurysms smaller than 4 mm were not operated and we do not have confirmation for them. In all false positive and false negative cases the misdiagnosed aneurysms were in fact 1–1.5 mm outpouchings that were not responsible for SAH. According to the available literature and our results, MSCTA has proved a very reliable method, simple and safe, competent to be used as a diagnostic modality of choice in the patients with SAH or suspect unruptured aneurysm. DSA should be used in cases of negative or uncertain findings on MSCTA, excluding cases of perimesencephalic SAH with negative MSCTA. The relative disadvantage of this method is its lower sensitivity in the detection of tiny outpouchings, especially in the infraclionid region where this method has still limited possibilities.
Combined Percutaneous and Endovascular Treatment of Symptomatic Aneurysmal Bone Cyst of the Spine: Clinical Six Months Follow-up of Six Cases
Authors: Guarnieri G. , Ambrosanio G. , Vassallo P. , Granato F. , Setola F.R. , Greco B. , Izzo R. , Muto M.
Published: April 2015

We describe the usefulness of endovascular and direct percutaneous treatment as a therapy option for aneurysmal bone cysts (ABCs) of the spine. From January 2007 to December 2008, we treated six consecutive patients with symptomatic ABCs resistant to continuous medical management or with acute clinical onset of paraparesis at cervical, thoracic and lumbar spine level. Two patients were treated after emergency laminectomy. All patients were studied with an MRI protocol and multidetector CT with MPR reconstructions followed by angiographic control before treatment. The procedure was performed under general anaesthesia for all patients. Under CT or fluoroscopy guidance, percutaneous treatment was performed either by direct injection of Glubran® diluted at 30% with Lipiodol® only, or combined with endovascular treatment by Onyx® injection. Clinical and X-ray follow-up was performed at three and six months. Combined endovascular and percutaneous treatment for ABCs was successful and led to an excellent outcome in five out of six patients with clinical improvement. There were no periprocedural or subsequent clinical complications and the glue resulted in successful selective permanent occlusion with intralesional penetration. Direct sclerotherapy resulted in immediate thrombosis of the malformation with no progression of symptoms. Complete healing was observed in five out of six aggressive lesions. No major complications were noted. At six month follow-up the symptoms had completely resolved and X-ray control showed a partial or total sclerotic reaction of the lesion with stable clinical results (no partial or clinical abnormalities). One patient had a recurrence of the ABC with spinal cord cervical clinical symptomatology. Combined endovascular and percutaneous treatment or direct percutaneous sclerotherapy with glue alone are important, safe, effective therapy options for symptomatic aneurysmal bone cyst. Results are stable and confirmed by clinical and X-ray follow-up six months after treatment.
Abdominal Cerebrospinal Fluid Pseudocyst Due to Infection with Enterococcus Faecalis
Authors: Muttikkal T.J.E. , Dashti K. , Muqim A.T. , Nakhi A. Ben , Hayat A.
Published: April 2015

Abdominal cerebrospinal fluid pseudocyst is a rare complication of ventriculo-peritoneal shunt occurring as a result of non-absorption of cerebrospinal fluid from the abdominal cavity due to inflammation. Usual presentations include abdominal symptoms; abdominal distention, pain, nausea, vomiting and symptoms of raised intracranial pressure like headache due to shunt dysfunction. The diagnosis may be delayed in severely handicapped patients due to poor communicability, multiple associated complications or co-morbidities. Radiological modalities are used for diagnosis as well as treatment.
MR and Diffusion Tensor Imaging of Vein of Galen Aneurysmal Malformation in an Infant Presenting with Spastic Diplegia and Seizures
Authors: Summa A. , Ormitti F. , Crisi G. , Ventura E. , Cerasti D.
Published: April 2015

A three-year-old girl developed spastic diplegia to the right and irregular tonc-clonic movements. Phenobarbital was started because of suspected seizure activity. The Pediatric unit asked for brain MR imaging to investigate neurological symptoms. MR and diffusion tensor imaging showed a haemorrhagic vein of Galen aneurysmal malformation (choroidal type) that shifted the corticospinal tract fibres to one side and the corpus callosum was moved forward. Vein of Galen aneurysmal malformations (VGAM) are characterized by multiple arteriovenous connections draining into a markedly enlarged median draining vein. This ectatic vein is not the vein of Galen, but its embryonic precursor, the median prosencephalic vein of Markowski. During normal development, the posterior portion of the median prosencephalic vein persists as the vein of Galen, while its anterior portion regresses in parallel with the formation of the internal cerebral veins (ICV). With the advent of endovascular neurointerventional techniques, the prospects for successful treatment of these lesions, once dismal, are now much improved. MR and diffusion tensor imaging can help in diagnosis and to guide endovascular interventional procedures.
Diastematomyelia
Authors: Saini H.S. , Singh M.
Published: April 2015

Diastematomyelia is a rare form of spinal dysraphism characterized by a sagittal cleft of varying extent in the spinal cord, conus medullaris or filum terminale with splaying of the posterior vertebral elements. This condition results from the presence of an osseous, cartilaginous or fibrous septum producing a complete or incomplete sagittal division of the spinal cord into two hemicords. It may be isolated or associated with other segmental anomalies of the vertebral bodies.
Mechanical Thrombolysis Using a Solitaire Stent
Authors: Bergui M. , Stura G. , Corsico M. , Daniele D. , Bradač G.
Published: April 2015

Mechanical offers several advantages over drug thrombolysis: in particular, the haemorrhagic risk may be not significantly increased while working out the indications got intravenous drug thrombolysis. Available tools were in our hands inefficient, stiff and dangerous. We found a retrievable stent efficient and easy to handle for this purpose. This experience is described.
Non Vascular Congenital Brain Malformations. An MR Study of 5000 Patients
Authors: Di Bella D. , Pizzo E.
Published: April 2015

Central nervous system (CNS) malformations are frequently severe and often fatal. Diagnosis during pregnancy is of fundamental importance for a correct clinical evaluation and pharmacological management or, where possible, surgery. Modern imaging technology, pre and post-natal ultrasound scans, but above all magnetic resonance (MR) imaging have revolutionized the diagnostic study of cerebral malformations. In particular, MR provides images of the various brain sections by means of a multidisciplinary non invasive study that today is particularly rapid. MR allows an accurate assessment of cortical development, normal myelinization and the evolution of malformations. We report here our experience with MR carried out after birth on 5000 patients for the study of non vascular cortical anomalies. In only one case was the examination carried out during pregnancy, following ultrasound investigations that showed a developmental anomaly of the corpus callosum. We confirmed 112 malformations with an incidence of 2.24%, greater in males and affecting principally the anatomy of the supratentorial encephalic structures. These cases were selected and MR was carried out based on the clinical picture present at the time of the examination or a suspected diagnosis formulated following ultrasound. The ultrasound investigations were carried out principally in the obstetrics department; only a few were carried out in our unit, together with most of the postnatal ultrasound scans. The percentage of the various malformations was higher than those reported in the literature.
Characteristic MR Imaging Findings of Neurocutaneous Melanosis
Authors: Srinivasan K.G. , Srividya S. , Nandhini K.P. Usha , Ramprabananth S. , Kumar M. Praveen
Published: April 2015

Neurocutaneous melanosis is a type of phakomatosis characterised by dermal, leptomeningeal and parenchymal melanocytic naevi. Here we describe a case of a 13-year-old boy with dermal and brain parenchymal melanosis without any leptomeningeal melanosis.
Multifocal Intramedullary Hemorrhages without Identifiable Predisposing or Precipitating Causes
Authors: Sharma S. , Sharma S.
Published: April 2015

Spinal cord disease can present in a variety of ways with acute, subacute or chronic onset, and clinical symptoms may vary from incomplete syndromes to complete quadriparesis. Acute quadriparesis beginning with excruciating pain in the chest and back progressing over a short period to quadriparesis is highly suggestive of spinal hemorrhage which can be epidural, subdural, subarachnoid or intramedullary. Intramedullary hemorrhage is the least common type and is mostly associated with predisposing focal diseases like tumor, AVM, cavernomas, spinal artery aneurysm, or due to generalized hematological coagulation abnormality. Nevertheless, spontaneous hematomyelia is also described which can be patchy with more than one segment involvement separated with a non involved segment of cord. We describe a young hematomyelia patient with such a multifocal long segment involvement of the spinal cord on MRI extending from the lower medulla to the conus.
MRI Eye-of-the-Tiger Sign in Organophosphate Poisoning
Authors: Srinivasan K.G. , Kumar M. Praveen , Ushanandhini K.P. , Ramprabananth S.
Published: April 2015

We describe the eye-of-the-tiger sign on magnetic resonance imaging (MRI) of the brain in a 40-year-old man presenting with extra pyramidal symptoms like chorea, flexion neck dystonia, tongue tremors, dysarthria and postural instability as the sequelae of organophosphorus poisoning six months previously. This typical radiological sign has been described in extrapyramidal parkinsonian disorders including cortical-basal ganglionic degeneration, early onset levodopa-responsive parkinsonism and Steele-Richardson-Olszewski syndrome (progressive supranuclear palsy) but hitherto has not been reported in insecticide poisoning. T2-weighted scans showed low signal intensity surrounding a central region of high signal intensity in the anteromedial globus pallidus (gliosis), producing an eye-of-the-tiger appearance with the central hyperintense signal intensity better appreciated in T2W and fluid attenuated inversion recovery (FLAIR) sequences.
Upward Oriented Sellar Spine. MRI Findings
Authors: Carpenzano M. , Marini E. , Valenti R.E. , Ambrosetto P.
Published: April 2015

The sellar spine is a rare congenital malformation due to the persistence of a notochord rest within the fetal sella turcica. We describe a unique case of a sellar spine vertically oriented displacing the pituitary stalk upwards and forwards. The MRI findings are briefly discussed.
An Unusual Presentation of Lipofibromatous Hamartoma in an Infant
Authors: Yalavarthy A. , Rajeswaran R. , Chandrasekhar A. , Murthy J.
Published: April 2015

Lipofibromatous hamartomas are rare benign tumors presenting in the third and fourth decades with a predilection for the upper extremity. We describe an unusual presentation of lipofibromatous hamartoma occurring in a one month old female child, where the lesion showed MR findings resembling that of a vascular malformation.
Magnetic Resonance Imaging for Spinal Cord Tumors
Authors: Houssaini A. Sqalli , Ouazzani A. , El Abdi B. , Benchaaboune H. , Hassani El , Chakir N. , Belfquih H. , Arkha Y. , Derraz S. , El Ouahabi A. , El Khamlichi A. , Jiddane M.
Published: April 2015

This paper discusses spinal cord tumors including imaging characteristics with emphasis on magnetic resonance imaging and advances in treatment. This is a retrospective study of 20 cases patients with neoplasms arising from the spinal cord. All of our cases were explored by magnetic resonance imaging (1.5T) using T1-weighted imaging (Spin Echo), T2-weighted imaging (Spin Echo) and T1-weighted imaging with Gadolinium administration. Pain is the earliest symptom, characteristically occurring at night when the patient is supine. Ependymoma were observed in 11 cases. Astrocytoma was noted in five cases. Other uncommon tumors were identified in four cases: oligodendroglioma (n=1), epidermoid cyst (n=1), hemangioblastoma and metastasis (n=1). In MRI most tumors are isointense or slightly hypointense compared to the normal cord signal with homogenous or irregular enhancement. We describe the characteristic magnetic resonance findings and differential diagnosis of spinal cord tumors. Spinal cord lesions comprise approximately 2–4% of all central nervous system neoplasms. Magnetic resonance imaging plays a central role in the imaging of spinal cord neoplasms.
Rare Bilateral Lipoma of the Internal Auditory Canals
Authors: Göbel A.B. , Kenny K. , Atlas S.W.
Published: April 2015

About 10% of all intracranial tumors are localized in the cerebellopontine angle and in the internal auditory canal. Less than 2% of these are lipomas. Furthermore, it can be expected that lipomas in this position with a bilateral localization are exceedingly rare. We describe a 70-year-old-woman with lipomas in both internal auditory canals presented in the literature for the first time and include a detailed literature research.
MR Tractography in Horizontal Gaze Palsy and Progressive Scoliosis
Authors: Chotai N. , Sitoh Y-Y.
Published: April 2015

Congenital brainstem malformation without associated cerebellar disorder is uncommon. Horizontal gaze palsy with progressive scoliosis is one such rare syndrome with brainstem hypoplasia without any disorder of the cerebellum. It has an autosomal recessive inheritance and is characterised by absent horizontal gaze and severe progressive scoliosis from birth. We describe a 58-year-old man with horizontal gaze palsy and severe thoracolumbar scoliosis with typical MR imaging findings of brainstem hypoplasia, and MR tractography confirmation of complete absence of decussation of the pyramidal tract fibers.
Pituitary Stalk Interruption Syndrome: The Role of MRI and Review of the Literature
Authors: Kyriacou V. , Mavridou Ch. , Bintoudi A. , Tzikos F. , Kotziamani N. , Tsitouridis I.
Published: April 2015

Magnetic resonance imaging (MRI) in patients with congenital growth hormone deficiency (GHD) has revealed several morphological abnormalities of the hypothalamo-pituitary region which include hypoplasia of the anterior pituitary lobe, the absence or marked thinning of the pituitary stalk and ectopia of the posterior pituitary lobe (EPP). This triad of abnormalities is called pituitary stalk interruption syndrome (PSIS). Our study reports the imaging findings of 23 patients with idiopathic GHD and short stature who were examined by MRI. The majority of the patients had abnormal MR studies with findings indicating the presence of the pituitary stalk syndrome. The high correlation between the clinical profile and the MR findings in cases of pituitary dysfunction (most often GHD), defines the significant role of MRI as additional tool for the diagnosis of pituitary hormone deficiency.
Imaging in Primary Central Nervous System Lymphoma
Authors: Lolli V. , Tampieri D. , Melançon D. , Cortes M. Delpilar
Published: April 2015

Primary central nervous system (CNS) lymphoma (PCNSL) accounts for approximately 3% of all primary CNS tumors. Congenital or acquired immunodeficiency is the only established risk factor for PCNSL. Rates decreased slightly in the mid-1990s, concordantly with the decreasing rates of AIDS. However, the incidence has been increasing in the elderly immunocompetent population, and this trend seems to be independent of improvements in diagnostic techniques, and of overall trends in the incidence of brain tumors and systemic lymphomas. This study presents our experience with the imaging features of PCNSL. Computed tomography (CT) and magnetic resonance imaging (MRI) findings were reviewed in a series of 38 cases of pathologically proven PCNSL. The incidence rate of PCNSL was higher in men than in women (58% versus 42%). Mean age at presentation was 63 years; 120 lesions were demonstrated in the 38 patients, with a 53% frequency of tumor multiplicity. Both CT and MR mainly showed solitary or multiple well-defined round or oval-shaped mass lesions, typically hyperdense on unenhanced CT scans, iso to hypointense on T2 MR weighted images. These lesions also showed an increased signal intensity on diffusion-weighted images. Virtually all lesions enhanced after intravenous administration of contrast medium. On 1H-magnetic resonance spectroscopy (1H-MRS) most lesions presented increased Cho/Cr, Cho/NAA and lactate/Cr ratios when compared to normal gray matter. No changes in the imaging presentation have occurred over the past two decades, apart from lesions now being smaller at diagnosis. Our imaging findings are in agreement with the existing literature data and with the reported increasing trend of multifocal tumors. Our epidemiologic results add value to the existing evidence of increasing incidence rates among the immunocompetent elderly population.
Isovoxel-Based Morphology of Hippocampi and Amygdalae: A Comparison of Manual and Automated Volume Measurements
Authors: Bertoni M.A. , Sclavi N.E.
Published: April 2015

This study evaluated the correlation between manual and automated morphometric measurements of hippocampi and amygdalae. Twenty-three patients with no history of seizures and normal electroencephalograms were examined with a standardized MRI protocol that included isovoxel volumetric acquisitions of the brain. Images were evaluated in axial-oblique plane to trace manually the grey matter contours of hippocampi and amygdalae obtaining their volumes. They were also processed automatically carrying out segmentation and sub segmentation aligning images (AC-PC) and standardizing them into Talairach space to obtain then comparable grey matter volumes. Tabled results were age, gender and volumes of each side from both, manual and automated measurements. Forward stepwise multiple regression analyses were carried out considering sex and age as independent and hippocampi-amygdalae as dependent variables. Linear regression analyses were then carried out considering for the total of cerebral hemispheres each manual measurement as independent and automatically obtained volumes as dependent variables. In the multiple regression analyses the following values were obtained: age-gender vs. manual measurements showed r=0.83; r2=0.69; adjustedr2=0.64; F(3,19)=14.36 while age-gender vs. automated values showed r=0.86; r2=0.74; adjustedr2=0.70; F(3,19)=18.81. Linear regression between manual and automated measurements for all hemispheres showed for hippocampus: r=0.97; r2=0.95; F(1,44)=896.59. For amygdala results were: r=0.94; r2=0.89; F(1,44)=391.11. The results of these analyses suggest that both manual and automated procedures of measurement are highly consistent. A regression between age and volumes of both hippocampus and amygdala was also noted.
Successful Management of Hemorrhagic Complications during Onyx-18 Embolization of Cerebral Arteriovenous Malformations
Authors: Liu L. , Li Y. , Yang X. , He H. , Wu Z.
Published: April 2015

The most frequent and devastating complication of the endovascular treatment of cerebral AVMs is hemorrhage. This report describes three patients with cerebral AVM who encountered bleeding during Onyx-18 embolization. The bleeding was discovered promptly during the procedure and hemorrhage quickly prevented using Onyx-18. All three patients recovered without any new neurological symptoms. Early detection and prevention of bleeding are very important during interventional procedures to avoid craniotomy and improve the prognosis of patients.
Intravenous Glycoprotein IIb/IIIa Inhibitor (Tirofiban) Followed by Low-dose Intra-Arterial Urokinase and Mechanical Thrombolysis for the Treatment of Stroke
Authors: Ihn Yon Kwon , Sung Jae Hoon , Kim Bum-Soo
Published: April 2015

We investigated the efficacy and safety of the combined use of IV tirofiban and IA urokinase and/or mechanical thrombolysis for treating acute stroke patients. Thirteen, consecutive patients who were treated with IV tirofiban and IA thrombolysis with mechanical and/or local IA urokinase infusion, were evaluated retrospectively. The amount of time before the beginning of treatment, urokinase dose, recanalization rates, and symptomatic hemorrhage were analyzed. Clinical outcome measures were assessed on admission, at discharge (National Institute of Health Stroke scale[NIHASS]), and three months after the end of their treatment (modified Rankin Scale scores[mRS]). There were 11 patients with internal carotid or middle cerebral artery occlusion treated within six hours of the onset of symptoms and two patients with basilar artery occlusion treated within 12 hours of their symptom onset. The median NIHSS score on admission was 18. The median amount of time from symptom onset to IV tirofiban infusion was 135 minutes, and the median time from symptom onset to IA therapy was 180 minutes. The median dose of urokinase was 200,000 U. Recanalization (thrombolysis in myocardial infarction grade 2 or 3) was achieved in 11 patients. No procedure-related complications were observed. There was one symptomatic hemorrhage. At discharge, the mean NIHSS score was 6.6 (range, 0- 15). Overall, at the time of the three-month follow-up the functional outcome was favorable (modified Rankin Scale score 0 −2) in eight of 13 (62%) patients. Death at 90 days occurred in two of the 13 (15%) patients. Combined IV tirofiban and IA thrombolysis with mechanical clot disruption seems to be a feasible treatment in acute stroke and may be successful in reestablishing vessel patency and result in a good functional outcome in patients with major cerebral arteries occlusions.
Diffusion Tensor Imaging in Movement Disorders: Review of Major Patterns and Correlation with Normal Brainstem/cerebellar White Matter
Authors: Reimão S. , Morgado C. , Neto L. , Ferreira J. , Coelho M. , Rosa M. , Campos J.
Published: April 2015

The authors reviewed the diffusion tensor imaging (DTI) and tractography (DTT) of the normal brainstem and cerebellar white matter in normal volunteers, correlating it with structural magnetic resonance (MR) imaging and DTI data obtained in patients evaluated in our institution with movement disorders, including multisystem atrophy (MSA), spinocerebellar ataxia (SCA), progressive supra-nuclear palsy (PSP) and idiopathic Parkinson's disease (PD). DTI and tractography data demonstrated major white-matter fibers within the brain stem and cerebellum, including cortico-spinal tracts, transverse pontine fibers, medial lemniscus and cerebellar peduncles. Visualization of selective degeneration of these individual fibre tracts with DTI, in our cases, added qualitative data to the differential diagnosis of movement disorders.
Stroke in Young People: The Increasing Role of Advanced Imaging
Authors: Ojeda A. , Nallino M.B. , Uriarte A.M. , Cruz D. Santa
Published: April 2015

Ischemic stroke in young people is an unexpected event due to a wider variety of causes compared to the older population. This study highlights the increasing role of neuroimaging in the diagnosis, prognosis and treatment of young stroke patients. Thirty young adult patients (age range, 15–45 years) with acute ischemic stroke diagnosis were retrospectively included and studied at our institution during 2009. The mean age of patients was 35 years and 50% were men. The stroke etiology was established in 86% of cases (n=26), 7% (n=2) were due to atherosclerosis of the main vessels, 10% (n=3) were related to cardioembolism, 27% (n=8) were due to arterial dissection and 43% (n=13) responded to miscellaneous etiologies. The cause remained unexplained in 14% (n=4) of cases. The aims of neuroimaging in the challenging study of young stroke patients are to confirm the ischemic nature of the lesion, to determine its location, and to verify the patency of major neck and intracranial arteries. Both MRI and MSCT offer the best sensitivity and spatial resolution.