bluuebunny/crossref_metadata_2025 huggingface dataset:
Turbo-FLAIR Sequence in Brain MRI
Authors: Polonara G. , Salvolini U.
Published: April 2015

To compare a turbo-FLAIR sequence with Proton Density (PD) and T2-weighted Turbo Spin-Echo (TSE) sequences in several different brain diseases, 276 MRI examinations were performed on a 1.0 Tesla system.

The positive cases were assessed for lesion detection and lesion conspicuity. Four quantitative criteria were also used to compare the contrast of the two techniques: lesion to background contrast, lesion to background contrast to noise ratio (CNR), lesion to Cerobrospinal fluid (CSF) contrast, lesion to CSF contrast to noise ratio.

The turbo FLAIR sequence was found to be superior to PD and T2-weighted TSE for lesion detection: this sequence detected more lesions in 74 patients than PD and in 42 patients than T2, but missed some subtentorial lesions. For lesion conspicuity turbo-FLAIR was judged equivalent to PD and T2-weighted TSE respectively in 27% and 45% of the cases and better in 71% and 53% of the cases. Lesion to background contrast and lesion to background CNR were found to be significantly greater for turbo-FLAIR than for PD (p<0.001). Compared with T2-weighted TSE, turbo-FLAIR showed a significantly higher lesion to background contrast (p<0.001) and inferior lesion to background CNR (p<0.001).

Our study indicates that turbo-FLAIR can replace PD TSE scans in most cases and can be used as a first choice sequence for cerebrovascular diseases, multiple sclerosis and for the evaluation of gliosis.
Intra-arterial Thrombolysis in Acute MCA Occlusion from an Extracranial ICA Aneurysm
Authors: Guglielmi G. , Ciceri E. , Quinones D.
Published: April 2015

A case of acute occlusion of the right ICA and MCA from a fusiform/dissecting aneurysm of the upper cervical ICA was successfully treated with an entirely endovascular approach. Long-term clinical follow-up is available. This 41 year-old-woman presenting with TIAs underwent magnetic resonance angiography that showed total occlusion of the right ICA. The day after she suddenly became hemiplegic, hemianopic, and confused. Three vessel angiography demonstrated occlusion of the right ICA and MCA. Super-selective angiography showed a fusiform/dissecting aneurysm of the upper cervical ICA. Urokinase infusion in the occluded right MCA was performed, thus establishing collateral blood flow via the contralateral carotid artery within 4 hours from the onset of the symptomatology. To prevent further repeated thrombo-embolic events, the right ICA was permanently occluded with GDC coils, trapping the aneurysm. The patient gradually improved and, at the three-year follow-up she had resumed her previous occupation being completely independent, with only a mild difficulty in writing.

This is the first reported case of an acute MCA embolism from a fusiform/dissecting extracranial ICA aneurysm treated with MCA thrombolysis followed by aneurysm trapping. The possible aetiology of the underlying lesion and the different therapeutic options are discussed.
Jugular Foramen Syndrome with Miosis: A Sign of Internal Carotid Artery Dissection
Authors: Lupo F.A. , Perfetto S.C. , Sticchi G.
Published: April 2015

We describe a case of left extra and intracranial internal carotid artery dissection in a 59-year-old man who presented with the clinical features of left jugular foramen syndrome (dysphonia, dysphagia, ageusia, paralysis of the sternocleidomastoid muscle) and ipsilateral miosis with acute onset, worsening in the first 24 hours and spontaneous remission over the next thirty days.

The patient was investigated by computed tomography magnetic resonance and digital angiography and received conservative treatment.

The clinical aspects are discussed, emphasizing the major role of magnetic resonance in the diagnosis of the syndrome.
Ethical and Legal Aspects Relating to the Use of the Neural Microcomputer C40
Authors: Borea L.
Published: April 2015

My project deals with an instrument for neurosurgery and electronics, a neural microcomputer, together with its ethical and legal implications.

The essay is presented in the form of a report from the legal department of the CyberSys Corporation to the Board of Directors of the same firm. The introductory background information is followed by a description by the department of the ethical and legal observations made by the Ethical and Legal Commission of the European Court of Justice regarding the application of high technology.

The debate between the various members of the Commission is particularly delicate as the potential impact of this new technology could prove revolutionary.
Isolated Leptomeningeal Spinal Tuberculosis
Authors: Andreula C.F. , Recchia-Luciani A.N.M.
Published: April 2015

Leptomeningeal granulomatous radiculomyelitis is usually an extension of basal cisternal arachnoiditis or evolves from haematogeous or contiguous spread from juxtameningeal foci, choroid plexus foci or osseous infection. Isolated intradural and/or intramedullary lesions are much less common than leptomeningeal involvement of the basal cisterns. Furthermore, the frequency of isolated intradural TB lesions in non-AIDS patients is exceptional.

The type, severity and extent of the lesions depend on the number and virulence of acid fast bacilli, and the immune status of the patient. Alcohol abuse is known as an important immunosuppressant.

Herein we report one case of multiple intradural extramedullary tuberculomas without cranial involvement. Magnetic resonance imaging revealed intradural lesions confirmed as tuberculomata at pathology, with no evidence of tuberculosis elsewhere.
Intradiscal Gas and Disc Herniation
Authors: Muras I. , Conforti R. , Maisto M. , Scuotto A. , Bernini F.P.
Published: April 2015

The development of air within the degenerated disc is secondary to the movements of the spine. Because of the negative intradiscal tension produced with hyperextension of the spine, the vacuum phenomenon increases with extension and decreases with flexion. The presence of air in the epidural space is more uncommon and may be associated with a disc herniation and even located within the herniated disc itself.

We reviewed the clinical and CT findings of 750 patients. Intradiscal gas was found in 130 out of the 750 patients, 65 men and 65 women, whose age ranged from 17 to 81 years; 20 patients were under 40 years old. The gas was at a single level in 83 cases, mainly L5-S1 (43 cases) and L4-L5 (20 cases). In 22 other patients the gas collection was at a level other than disc herniation.
Reflections on the Nucleus Pulposus
Authors: Simonetti L. , Barbara C.
Published: April 2015

The intervertebral disc is usually divided into two parts, the anulus fibrosus and the nucleus pulposus. However, they are not considered two separate anatomic parts since one is essentially part of the other and this should be borne in mind to understand the process of ageing.

The intervertebral disc should therefore be thought of as a dynamically evolving anatomo-functional unit. The dynamics of this process were investigated by studying the histobiochemistry of the acellular matrix of the joint cartilage in general and that of the intervertebral disc in particular to understand the effects of this arrangement on the stuctural changes to the disc induced by biomechanical stress, especially during ageing. Lastly, we focussed on the disc's nutritional mechanisms in order to examine “disc degeneration” as a sign of metabolic impairment of the nucleus pulposus and “disc regeneration”.

This concept was unknown until recently and is currently monitored in percutaneous controls following treatment for disc disease.
Anomalie della migrazione neuronale e dell'organizzazione corticale nell'epilessia
Authors: Amato C. , Elia M. , Musumeci S.A. , Bisceglie P. , Vincenza S. , Moschini M.
Published: April 2015

In questo studio sono stati esaminati retrospettivamente gli esami di risonanza magnetica (RM), i dati anamnestico-clinici ed EEG di 266 pazienti con ritardo mentale, al fine di valutare la prevalenza di anomalie della migrazione neuronale e della organizzazione corticale (AMNOC) in questa popolazione e di analizzare l'eventuale correlazione tra alterazione neuroanatomica e quadro elettroclinico. Sono stati riscontrati complessivamente 22 casi di AMNOC (8,3%). Di questi 22 pazienti, 17 (77,3%) appartenevano alla popolazione con ritardo mentale ed epilessia, gli altri 5 presentavano solo ritardo mentale senza manifestazioni epilettiche e anomalie EEG. È stata trovata una correlazione spaziale tra anomalie EEG e alterazioni neuroradiologiche in 7/17 casi (41,2 %).

Viene discussa l'importanza di una corretta correlazione RM-EEG nei soggetti con AMNOC ed epilessia farmacoresistente, anche in un'eventuale prospettiva chirurgica.
Anatomia del condotto uditivo interno: Tecnica di studio RM con sequenze 3D Turbo Spin Echo
Authors: D'Aprile P. , Ettorre G.C. , Medicamento N. , Spagnolo P. , Stefanelli M. , Carella A.
Published: April 2015

Le sequenze RM veloci possono essere utilizzate per effettuare studi ad alta risoluzione spaziale in tempi di acquisizione comparabili con le sequenze tradizionali.

Le tecniche Turbo Spin Echo, rispetto a quelle ad eco di gradiente, risultano particolarmente indicate a questo scopo perché sono caratterizzate da una elevata risoluzione di contrasto delle immagini dipendenti dal vero T2, e non dal T2*. Esse presentano inoltre una minore incidenza di artefatti da suscettibilità magnetica, che può apparire uno svantaggio in determinate situazioni cliniche, ma che risulta invece assai utile nello studio RM dell'osso temporale, ove sono innumerevoli le interfaccie osso-aria.

La possibilità di ottenere sequenze Turbo Spin Echo di spessore di strato inferiore al millimetro consente di effettuare uno studio dettagliato del condotto uditivo interno e delle strutture vascolari e nervose che lo percorrono.
I traumi cranioencefalici dell'età pediatrica
Authors: Bernardi B. , Sandri E , Agati R. , Barbara C.
Published: April 2015

Il trauma cranico, isolato od associato ad altre lesioni traumatiche, è un'emergenza frequente in età pediatrica nonostante i tentativi di prevenzione di molte delle sue cause. Queste cambiano nelle diverse età del bambino, come pure cambiano le risposte al trauma che l'encefalo, in fase evolutiva, sviluppa. La comprensione della reale estensione del danno cerebrale e dei meccanismi attraverso i quali si realizza è fondamentale per la prognosi e la pianificazione del trattamento sia in emergenza che in riabilitazione.

Le informazioni neuroradiologiche che si vanno ad associare alle note scale di valutazione clinica (Glasgow Coma Scale) forniscono oggi una più corretta ed individualizzata prognosi del traumatizzato cranico.

Sebbene la tomografia computerizzata rimanga il principale esame neuroradiologico nell'emergenza, specie se il traumatizzato cranico è clinicamente instabile, essa non è in grado di competere con la risonanza magnetica sull'identificazione di alcuni tipi di lesioni non emorragiche e sugli aspetti prognostici. L'esame RM può essere completato con l'angio-RM che consente una diretta evidenziazione di un danno vascolare e/o con la spettroscopia protonica RM (H+sRM) metodica funzionale in grado di fornire elementi prognostici in situazioni evolutive relativamente precoci e nei comi vegetativi protratti.

La maggiore diffusione delle apparecchiature, l'esistenza di magneti con accesso più agevole e la riduzione dei tempi d'esame dovuta alle nuove sequenze introdotte, rendono la RM di più facile utilizzo anche nei traumi cranici. A questo contribuisce anche l'esistenza di apparecchiature di monitoraggio e supporto vitale al paziente, perfettamente compatibili con l'ambiente RM.

Head trauma, alone or associated with other lesions, is a common emergency in children despite measures aimed at prevention of many of its causes. Such causes vary with different age groups, as does the response of the developing brain. Evaluating the extent of impact damage and how head injury was caused are essential for the patientís prognosis and in planning appropriate treatment strategies both in the emergency room and later during rehabilitation.
Elementi per l'accettabilità delle apparecchiature radiologiche e criteri per il loro rinnovo programmato
Authors: Coppola V. , Coppola M. , Maraziti G. , Memoli L. , Lubritto C. , Pace S.
Published: April 2015

La necessità o meno di sostituire un'apparecchiatura radiologica viene basata attualmente sulla scorta di valutazioni prevalentemente di natura soggettiva. Nel nostro lavoro abbiamo proposto un metodo per valutare in maniera quanto più oggettiva possibile quando effettivamente tale sostituzione si rende necessaria.

Esso è basato su di un algoritmo di facile utilizzazione, che tiene conto di sette fattori diversi, a ciascuno dei quali viene attribuito valore 0 od 1. Conseguentemente al risultato ottenuto con tale formula, viene ricavata o meno l'indicazione alla sostituzione dell'apparecchiatura in esame.
Extensive Oedema Surrounding Meningioma
Authors: Scuotto A. , D'Avanzo R. , Soreca E. , Stavolo C. , Profeta M. , Federico V. , Cioffi F.A. , Bernini F.P.
Published: April 2015

We report a case of intracranial meningioma surrounded by severe oedema, unusually extending to the anterior segment of the internal capsule. The possible mechanisms involved in oedema formation are discussed.
Il mutismo cerebellare transitorio
Authors: Battistella P.A. , Carollo C. , Perilongo G. , Naccarella C. , Pellone M.
Published: April 2015

Il mutismo cerebellare costituisce una rara condizione di perdita transitoria del linguaggio verbale in giovani soggetti sottoposti ad intervento chirurgico per neoplasia cerebellare.

I 3 casi da noi osservati presentano il quadro tipico del MCT che può seguire l'exeresi chirurgica di neoplasie cerebellari. Il periodo di mutismo presenta un durata dalle 3 settimane ai 3 mesi e il recupero del linguaggio avviene senza necessità di riabilitazione.
Cystic Schwannoma of the Thyroid Gland
Authors: Prasad S. , Patankar T.
Published: April 2015

Thyroid schwannomas are exceptionally rare. We report a case of thyroidal cystic schwannoma incidentally detected in a patient with multiple schwannomas and confirmed by biopsy and histopathological examination.
Diffusion-Weighted MR Imaging in Brain Abscess
Authors: Chang Kee-Hyun , Kim Young Jun , Song In Chan , Kim Hong Dae , Seong Su Ok , Han Moon Hee , Han Man Chung
Published: April 2015

We illustrate the high signal intensity of brain abscess on echo-planar diffusion-weighted MR imaging (DWI). Five consecutive patients (mean age 42 years, 4 men and 1 woman) with proven brain abscess were evaluated with DWI. All the DWIs were performed on a 1.5 T system, using single shot spin-echo echo-planar imaging technique with b value of 1000 s/mm2. Diffusion gradients were applied in three directions (x, y, z) simultaneously.

In all patients, the signal intensity of abscess content was evaluated qualitatively and quantitatively. In the quantitative study, the signal intensity was measured in the central abscess content, surrounding edema, the normal white matter, and the lateral ventricle for the calculation of % contrast of abscess/edema, abscess/normal white matter, and the abscess/lateral ventricle. On the visual inspection all the abscess contents showed very bright high signal intensity, whereas surrounding edema revealed nearly isointensity with the normal white matter on DWIs.

The signal intensity of abscess content ranged from 233 to 571 (mean 399), whereas that of surrounding edema ranged from 80 to 144 (mean 105), the normal white matter 82 to 115 (mean 99), and the lateral ventricle 11 to 23 (mean 16). Mean % contrasts of abscess/edema, abscess/normal white matter, and the abscess/lateral ventricle were approximately 380%, 400%, and 2,400%, respectively. Abscess content revealed bright signal intensity on DWI, presumably due to high viscosity. The DWI may be used as an adjuvant method in differentiating brain abscess from the cystic or necrotic tumors.
CNS TB: Varying Features with Emphasis on the Atypical Types
Authors: Adapon B.D. , Apolinar N.D. , Adapon P.H. , Salonga A.M. , Dioquino C.C.
Published: April 2015

CNS TB is so varied in size, location and structural characteristics and may be so atypical that one must be aware of the possibility to obviate the need for unnecessary biopsy or surgery.
Evaluating Triple-Dose Gadolinium T1 and Enhanced Fast-Flair MR Studies in Neurologically Symptomatic HIV-Positive Patients
Authors: Weathers S.W. , Huang M.L. , Diaz-Marchan P.J. , Shandera W.X. , Mathur A.K. , Norton R.E. , Hayman L.A.
Published: April 2015

We compared delayed triple-dose gadolinium (Gd) (0.3 mmol/kg) T1-weighted (D3x-T1), triple-dose fluid-attenuated inversion-recovery fast spin-echo (fast-FLAIR) (3x-FF) and routine single-dose Gd (0.1 mmol/kg) T1-weighted (1x-T1) images in the detection of central nervous system (CNS) abnormalities in patients with human immunodeficiency virus (HIV) infection. Thirty-three brain MRI scans performed on 29 patients were reviewed by a panel of three neuroradiologists for lesion conspicuity, comparing D3x-T1 with 1x-T1 and D3x-T1 with 3x-FF For each pair of comparisons, the panel reached a consensus about which technique was superior in terms of the number of lesions revealed or lesion conspicuity. Note was made of cases in which a particular technique was judged to alter the radiologic diagnosis. Compared to 1x-T1, D3x-T1 improved lesion detection in 14/29 patients (48%). In three patients (10%), the improvement changed the radiologic diagnosis. Compared to D3x-T1, lesion detection on 3x-FF improved in 19/29 patients (66%), including 11 patients whose lesions were not visible on D3x-T1. However, 3x-FF was inferior to D3x-T1 in four patients. 3x-T1 and 3x-FF images are complementary in the assessment of CNS pathology in symptomatic HIV-positive patients and are especially helpful in the diagnosis of meningeal and white matter abnormalities.
Magnetic Resonance Imaging in Neurocysticercosis
Authors: De Almeida Magalhães A. Cebrian , Gomes G.C.
Published: April 2015

One handred and sixty-five patients (83 females, 82 males), ages ranging 4 to 70 years old with diagnosis of neurocysticercosis were examined in a 1.5 T magnet (Signa GE), using T1WI pre and post contrast and T2WI in axial coronal and sagittal planes. Parenchymal and ventricular lesions were found in 23 patients (14%). Meningeal lesions were found in nine patients (5.4%) and spinal lesions were found in one patient (0,6%). We conclude that MRI has an important role in the diagnosis of neurocysticercosis and in the evolution of the disease with different stages. Intraventricular, subarachnoid and peripheric parenchymal lesions are better seen with magnetic resonance.
Brainstem Anatomy of White Matter Tracts Using Diffusion Weighted Imaging
Authors: Fitzek C.M. , Speckter H. , Boor S. , Fitzek S. , Stoeter P.
Published: April 2015

We used diffusion weighted MR imaging with three different spatial gradients to show brainstem tracts. With a high b-level above 1000 s/mm2 it is possible to identify more than 20 tracts due to their fiber anisotropy. With these sequences it is possible to differentiate brainstem lesions from tracts 1–7 and show the topographic relation of lesions to tracts.
ADC and Diffusion Anisotropy Indices in Wallerian Degeneration
Authors: Tievsky A.L. , Wu O. , Gonzalez R.G. , Rosen B.R. , Sorensen A.G.
Published: April 2015

We compared the sensitivity of diffusion MRI to T2SI for early detection of Wallerian degeneration secondary to cerebral infarction. Serial full tensor DWI of 15 acute stroke patients with B=1221. ROI analysis of ADC, T2, DWI, eigenvalues, and anisotropy indices in bilateral intracerebral corticospinal tracts. 5/16 patients developed DWI hyperintensity and/or ADC/FA reduction, prior to T2 prolongation, during initial two weeks in ipsilateral corticospinal tracts. Mean FA and ADC reductions were 12% and 24% respectively. All were subsequently confirmed to be Wallerian degeneration on follow up MRI.

Another 6/15 patients without observable DWI signal changes demonstrated ipsilateral ADC and FA reductions at one or more levels in CS tracts without subsequent demonstration of Wallerian. Antegrade thalamic transneuronal degeneration was noted in 2/15. Changes in diffusion parameters precede T2 signal abnormalities in the evolution of Wallerian degeneration.
Functional Neuroimaging of a Complex Motor Task
Authors: Mathews V.P. , Lowe M.J. , White M.L. , Lurito J.T. , Phillips M.D. , Hutchins G.D.
Published: April 2015

Brain activation of cortical and subcortical foci during a complex motor task as demonstrated with spin-echo (SE) and gradient-echo (GE) FMRI and PET were compared in order to determine how signal changes in each of these FMRI techniques reflect cerebral blood flow changes shown by PET. Five normal volunteers performed bilateral fingering tapping in a defined sequential pattern during functional imaging. BOLD FMRI was performed at 1.5T. Five 32 second activation periods were alternated with five 32 second rest periods. MR signal detection was done by performing a least-squares fit of the time series data to a boxcar function. PET CBF measurements were performed using intravenous H215O. 4 pairs of control and task scans were obtained. PET activation maps were generated by subtracting the averaged activation and control scans. The statistical significance of regions of interest in sensorimotor cortex, basal ganglia and cerebellum for all three techniques were evaluated within each subject. GE-FMRI and SE-FMRI showed large amplitude (p<0.001) signal increases in regions of sensorimotor cortex, basal ganglia and cerebellum. PET also showed significant (p ⩽ 0.01) increases in CBF in sensorimotor cortex and cerebellum but less significant increases in CBF in the basal ganglia (p<0.16). The regions of cortical activation shown by SE-FMRI were smaller in size than those shown by GE-FMRI and corresponded more closely to the areas of increased CBF shown by PET. Both GE-FMRI and SE-FMRI are more sensitive for activation by this complex motor task along the entire motor pathway compared to H215O PET. SE-FMRI localizes areas of cortical activation more focally and corresponds more closely to areas of increased CBF on PET than does GE-FMRI.
fMRI Activation Paradigms for the Evaluation of Language Areas in the Human Brain Stability and Clinical Applications
Authors: Schlösser R. , Hunsche S. , Gawehn J. , Böcher-Schwarz H. , Perneczky A. , Gründer G. , Stoeter P.
Published: April 2015

Therapeutic approaches for intracerebral arteriovenous malformations (AVMs) and tumors require knowledge about the exact spatial relationship of these processes to functional brain parenchyma. In an ongoing project, flMRI and verbal fluency tasks are used for the evaluation of speech-related areas in these diseases. A sample of patients with either AVMs or intracerebral tumors was included in the study. flMRI was performed on a Siemens Magnetom (Vision) at 1.5 T with Single-Shot-EPI. Data were analyzed with SPM96. Word generation tasks were contrasted with baseline conditions and cognitive subtraction designs were applied. Data analysis demonstrated a consistent activation pattern during the covert verbal fluency condition in left prefrontal cortical areas when using forward-counting as a baseline condition in right handed subjects. The spatial relationship between pathological processes and “eloquent” brain areas couid be established in all patients. The present findings are consistent with the previously reported stability of the method2. Verbal fluency paradigms are suitable for the presurgical and preinterventional evaluation of hemispheric dominance and cortical language areas with fMRI.
Diffusion MR Imaging of Eclampsia
Authors: Corr P. , Keiseb J. , Moodley J. , Sanyika C. , Hoffmann M. , Mayat A.
Published: April 2015

We sought to identify early and possible reversible cerebral ischemia in patients with eclampsia. Consecutive postpartum patients with a clinical diagnosis of eclampsia were examined by a neurologist to determine whether there was any neurological deficit or cognitive impairment. Patients were prospectively imaged within 48 hours of presentation and if the scans were abnormal 72 hours later. Fast spin echo T2 weighted axial and diffusion weighted axial scans were performed. The diffusion weighted scans were performed through the basal ganglia, occipital lobes and centrum semiovale. The scans were read by two neuroradiologists blinded to the patient data. Ten patients were studied. All patients had evidence of cognitive impairment. Four patients had transient hemiparesis. All patients recovered after vasodilator treatment. T2 weighted scans were abnormal in five patients with bilateral subcortical occipital hyperintense lesions. Diffusion weighted images demonstrated abnormalities in eight patients with focal hyperintense lesions in the basal ganglia, subcortical occipital poles and watershed regions of the centrum semiovale. Two patients had normal scans. Repeat imaging 72 hours later demonstrated complete resolution of the focal lesions in all eight patients. Diffusion imaging is more sensitive than T2 weighted scans in the detection of early ischemia in patients with eclampsia. Ischemia appears to be global and predominantly affects watershed regions, occipital poles and the basal ganglia. These changes appear to be completely reversible after treatment.
Quantification of Carotid Stenosis in a Pig Model
Authors: Sørensen L.H. , Østergård L. , Simonsen C.Z. , Vestergård-Poulsen P. , Bjørnerud A. , Gyldensted C.
Published: April 2015

We compared blood pool agent enhanced MRA to (i) Time-of-Flight (TOF) and Phase Contrast (PC) MRA and (ii) digital subtraction angiography (DSA) in severe experimental carotid stenosis in pigs.
Measurement of Intracranial Arterial Wedge Pressure in Cases of Major Cerebral Arterial Occlusion
Authors: Terada T. , Ryujin Y. , Kinoshita Y. , Tsuura  , Yokote H. , Takehara R. , Matsumoto H. , Masuo O. , Hyotani G. , Nakai K. , Itakura T.
Published: April 2015

We considered wedge pressure might be a good indicator for the residual cerebral blood flow in cases of acute cerebral arterial occlusion. It was measured in eight cases of acute major cerebral arterial occlusion (seven MCA or MCA branch occlusion, one intracranial ICA occlusion) by navigating a microcatheter beyond the clot. It varied from 8 to 40 mmHg. All cases were treated by superselective infusion of the thrombolytic agent (six cases, tissue plasminogen activator; two cases, urokinase) following measurement of the wedge pressure. Three of them were completely recanalized and patients recovered with minimum neurological deficit. Two cases resulted in cerebral infarction in spite of partial recanalization. The other three non-recanalized cases within six hours also resulted in cerebral infarction, which was confirmed on CT immediately after treatment. A case of wedge pressure 33 mmHg tolerated 4 hours ischemia and other case of wedge pressure 40 mmHg tolerated 24 hours ischemia. Cases with wedge pressure lower than 35 mmHg could not tolerate 6 hours ischemia. Arterial wedge pressure distal to the clot supposed to be a good indicator of residual cerebral blood flow and useful for the determination of the thrombolytic therapy.
La risonanza magnetica nella diagnosi dei conflitti neurovascolari
Authors: Bassi P. , Calabrese G. , Stojkov B. , Bassi S.
Published: April 2015

Una delle cause più frequenti di sofferenza dei nervi cranici (n.c.), V,VII e VIII è un conflitto neurovascolare che si determina a livello dell'angolo pontocerebellare. La metodica diagnostica di elezione è la risonanza magnetica. Scopo di questo studio è stato quello di valutare l'utilità della sequenza 3D-FT CISS per la diagnosi di tale patologia.

Le immagini ottenute con questa metodica sono state in grado di identificare situazioni di conflitto neurovascolare in 5 casi su 16 di nevralgia trigeminale e nell'unico caso di emispasmo del facciale. Nei 69 pazienti con sofferenza dell'ottavo n.c. un conflitto era presente in 13 casi in cui era presente ipoacusia, variamente associata ad acufeni e vertigini; in 2 casi caratterizzati da acufeni e in 1 che lamentava solo vertigini. In 2 pazienti con sofferenza del VII n.c. ed in 24 di quelli con sofferenza dell'VIII era presente una situazione di contiguità tra il nervo ed un vaso, generalmente un'ansa vascolare della PICA o dell'AICA. Tuttavia solo nel 48% dei casi la condizione di contiguità si associava a manifestazioni cliniche a carico del 8° nervo cranico.

Alla luce dei dati clinici e neuroradiologici si può concludere che la sequenza 3D-FT CISS, grazie al suo elevato potere di risoluzione spaziale, è un valido ausilio diagnostico nel documentare una situazione di conflitto neurovascolare.
Trattamento di un kinking instabile sintomatico dell'arteria succlavia mediante stent
Authors: Bracco S. , Busa R. , Romitelli P. , Gennari P. , Vallone I. , Venturi C.
Published: April 2015

Un paziente di 56 anni sofferente da 3 anni di TIA vertebro-basilari (episodi vertiginosi con difficoltà a mantenere la stazione eretta e con amaurosi), presenta all'esame angiografico un kinking instabile dell'arteria succlavia sinistra, con una stenosi dell'80% circa, a sua volta responsabile di un inginocchiamento dell'ostio e del tratto iniziale della vertebrale sinistra. A destra l'arteria vertebrate è ipoplasica.

L'instabilità del kinking viene dimostrata durante un esame angiografico quando compare in associazione alla sintomatologia. Il trattamento si effettua mediante stenting dell'arteria succlavia sinistra nella sede dell'inginocchiamento con regressione del quadro clinico ed angiografico nel controllo ad un anno.
MRI in Acute Disseminated Encephalomyelitis following First-Generation Anti-Rabies Vaccine Administration in a Child
Authors: Bavdekar S.B. , Muranjan M.N. , Patankar T. , More V. , Jain M.K.
Published: April 2015

Anti-rabies vaccines containing animal-brain tissue give rise to a variety of neurological complications including ADEM. MRI performed in a child with ADEM following such vaccination showed hyper-intense signals in cortex, thalami and basal ganglia. The changes are similar to those in postinfectious ADEM. Demyelination seen following vaccination may be due to immune reaction against myelin.
Ipoplasia del verme cerebellare ed epilessia
Authors: Muras I. , Volpe E. , Guizzaro A. , Bravaccio F. , Bernini F.P.
Published: April 2015

Il cervelletto costituisce un'importante struttura inibitoria centrale. Numerose testimonialize di studi neurofisiologici, neurochimici e neurofarmacologici, hanno consentito di mettere a punto un'ipotesi “circuitale” secondo la quale il cervelletto eserciterebbe una influenza inibitoria a livello della formazione reticolare troncoencefalica e, attraverso il talamo, concorrerebbe a porre fine all'accesso epilettico. Recentissimi studi con SPECT e PET, integrando i risultati ottenuti con TC ed RM, hanno consentito ulteriori informazioni sui rapporti tra epilessia e cervelletto.

Gli autori presentano sei casi clinici di una certa singolarità, che realizzano un modello sperimentale, in cui al reperto di ipoplasia cerebellare, corrisponde una epilessia farmacoresistente. Detti casi vengono discussi alla luce dei reperti strumentali e dei dati della letteratura.
MR Imaging in Spontaneous Spinal Epidural Haematoma
Authors: Reddy J.J.M. , Chandra N.E. , Kalva S. Prasad , Murthy V. S.
Published: April 2015

Spontaneous Spinal Epidural Haematoma(SSEH) is a rare disorder presenting as a neurological emergency. In most cases it is due to rupture of the epidural venous plexus and are associated with minor trauma, anticoagulant therapy and coagulation abnormalities. Arteriovenous malformations, haemangiomas and other vascular lesions are less common causes.

Eight patients with SSEH over a four year period are included in the present study. Age range was 20–46 years. All were males. MR examination was performed in all patients. Epidural haematomas were hyperintense on T1 and T2 weighted images. Six patients underwent surgery. Coagulation abnormalities were found in five patients, four with long history of haemophilia, one patient with acute lymphocytic leukemia(ALL) and the other with hypoplastic anemia.

Magnetic resonance imaging is the imaging modality of choice in the diagnosis of SSEH. The exact site and extent of haematoma and the degree of cord compression were accurately delineated and correlated well with surgery when performed.
Alterazioni morfologiche dei nervi e vie ottiche nei pazienti con Neurofibromatosi tipo 1: Sono vere neoplasie?
Authors: Barbò R. , Facchinetti A. , Fera L. , Fiorentini P. , Ruggeri M. , Agostinis C. , Albertini F. , Manara O. , Pecoraro M.G. , Piazzalunga B. , Bonaldi G.
Published: April 2015

La diagnosi e la terapia delle lesioni delle vie ottiche, in pazienti affetti da Neurofibromatosi tipo 1, rappresentano argomenti problematici che non godono ancora di linee guida uniformemente accettate. In particolare il decorso benigno della maggior parte di queste alterazioni e soprattutto la loro non evolutività nel tempo, sembrerebbero giustificare una cauta sorveglianza clinico strumentale.

Anche la nostra osservazione permetterebbe di considerare benigno, simil amartomatoso displastico, il decorso delle lesioni che coinvolgono i nervi ottici od il chiasma: in tutti i nostri casi infatti, alla stabilità del quadro radiologico si sono associate assenza di rilevanti modificazioni cliniche o strumentali.

Un comportamento aggressivo ha caratterizzato invece le lesioni più posteriori, a sede ipotalamo-chiasmatica: in questi casi riteniamo indispensabili controlli radiologici ravvicinati nel tempo per stabilire il timing di un'eventuale terapia citoriduttiva.
Erythrophagocytic Lymphohistiocytosis: MR Findings in Five Cases
Authors: Cirillo S. , Caranci F. , Briganti F. , Elefante A. , D'Amico A. , Migliorati R. , Elefante R.
Published: April 2015

Erythrophagocytic Lymphohistiocytosis (EL) is a rare disease characterized by a haemophagocytic syndrome and multisystem involvement including visceral organs, lymph nodes, bone marrow and central nervous system.

We retrospectively assessed clinical, cytological and radiological data in five patients with EL. This study was aimed at assessing MR accuracy in the identification and characterization of central nervous system lesions.

Our brain MR reports, correlating with pathologic findings described in literature, show a diffuse supra- and infratentorial white matter involvement, associated with deep gray matter infiltration. The overall effect of these reports allows a correct differential diagnosis from other white matter pediatric pathologies. In the only case without neurologic symptoms, brain MR revealed a diffuse atrophy.

The only patient who received a bone marrow transplantation is currently in clinical remission; brain MR control showed a substantial stabilization of the central nervous system abnormalities.

MR findings show a good correlation with areas of parenchymal and meningeal lymphohistiocytic infiltration; in addition, MR shows the possible stabilization of brain parenchyma abnormalities following bone marrow transplantation.
Trigeminal Neuropathy: A Pictorial Essay
Authors: Roncallo F. , Turtulici I. , Macchia G. , Arena E. , Bisio N. , Bartolini A.
Published: April 2015

Trigeminal (cranial nerve V) neuralgia and/or palsy is quite common. Damage to this nerve produces characteristic clinical manifestations, of which unilateral facial pain and/or atrophy of the masticator musculature is the most important. When these clinical features are recognized, the radiologist, armed with knowledge of the normal anatomy of the area, can focus on each segment of the nerve in search of a cause. The trigeminal nerve and its branches is divided into four segments: the intraaxial, cisternal, gasserian, and peripheral segments. Because each segment is usually affected by different disorders, localizing a lesion to a particular segment allows the radiologist to narrow the differential diagnosis. In this way, the most efficient imaging strategy for evaluation of the symptoms can be developed. Both computed tomography and magnetic resonance imaging are useful in assessing dysfunction of the trigeminal nerve; the choice depends on the status of the patient, the presumed site of the lesion on the basis of clinical findings, and the preference of the radiologist.
Evaluation of Selective Arterially Enhanced CT and 3-D Reformatting for Pretherapeutical Assessment of Intracranial Aneurysms
Authors: Flandroy P.M. , Baghaie M. , Dondelinger R.F. , Martin D. , Lenelle J.
Published: April 2015

To evaluate selective arterially enhanced CT angiography (ACT) and 3-D reformatting in the pretherapeutical assessment of intracranial aneurysms. A combined interactive CT and DSA suite deserved by a single pivoting table was used. Reformatted images were obtained using maximum intensity projection, volume rendering and surface shaded display with slicing. Thirty-four patients, 13 male and 21 female, mean age: 50 years (16–73), were explored in a prospective study. Forty-one intracerebral aneurysms were diagnosed. The aneurysmal index was measured on the reformatted images. Radiological findings were compared with surgery. In 31 operative cases, the aneurysmal index and morphological description of the aneurysm as defined by ACT were in agreement with surgical findings. ACT gave specific information in 6 cases which led to a change of the therapeutical approach. ACT facilitated the choice between surgery and endovascular embolization in 19 complex cases (surgery: 12, endovascular embolization:?). ACT improves the pretherapeutical assessment of intracranial aneurysms, particularly in complex cases. Determination of the aneurysmal index is more precise with ACT than with DSA.
Post-Processing Algorithms of 3D MR Angiography in the Evaluation of Patients with Intracranial Aneurysms
Authors: Kollias S.S. , Binkert C. , Christoforidis G.A. , Valavanis A.
Published: April 2015

Our purpose was to evaluate whether useful information was gained with 3D surface rendering and endoscopic visualisation post-processing techniques of MR angiographic data when compared to standard rotated MIP image sets in patients with intracranial aneurysms. We prospectively studied 49 patients with 55 intracranial aneurysms confirmed by digital subtraction angiography (DSA) using MR angiography performed on a 1.5-T system. Our protocol included 3D time-of-flight (TOF) with magnetisation transfer and 3D phase-contrast (PC) following contrast administration. Each image set consisted of either 28 or 60 slices. Post-processing on a SUN work-station with GE software included: MIP, 3D surface rendering, and “advantage navigator” software for endoluminal imaging. The sac, neck and parent arteries of all aneurysms were depicted on both MIP projection and 3D surface rendering images.

Objective evaluation demonstrated that surface rendering delineated aneurysm direction, shape, neck size, and spatial relationship to parent vessels; the MIP method was unable to depict this information. 3D TOF acquisition was superior to 3D PC in small vessel visualisation due to implementation of higher spatial resolution resulting in isometric submillimeter voxels. Magnetisation transfer, selective reconstruction, real-time rotation, and subtraction of data further optimised imaging. Endoluminal reconstructions (possible in 52/55 aneurysms) were particularly useful in identifying parent artery incorporation by the aneurysm. Surface rendering and endoluminal reconstruction techniques provide useful information for therapy planning of intracranial aneurysms not provided by MIP projections. Objective analysis of the value of endoluminal 3D imaging regarding aneurysm and parent artery wall morphology awaits further optimisation of the technique.
Scalp AVMs: Results of Embolization and Clinical Outcome
Authors: Guelbenzu S. , Barrena R. , Asensio S. Garcia , Fernandez D. , Villalon M. , Cacicedo Y.
Published: April 2015

The pathogenesis of scalp AVM remains unclear. Some clinical experience suggests they might be also associated with a dural AVM or with vascular anomalies of the venous structures of the dura. In all our cases internal carotid angiograms and magnetic resonance scans were performed.

Treatment of scalp AVMs is difficult because of their high shunt flow, complicated vascular anatomy, and cosmetic problems.

The embolization alone could remedy a scalp arteriovenous fistula, without scalp ischemia.

In our cases, transvenous embolization with direct puncture has been very effective using sclerosant liquids or NBCA and circular compression to avoid venous migration.
Endovascular Treatment of Post-Operative Aneurysm Rests
Authors: Pierot L. , Boulin A. , Visot A. , Dupuy M. , Gaillard S. , Derome P.-X
Published: April 2015

Post-operative intracranial aneurysm rests are encountered in 4 to 10% of patients undergoing postoperative angiography.

Reoperation of postoperative aneurysm rests can be difficult and lead to significant morbidity and mortality. Endovascular treatment, using controlled detachable coils, was performed in 3 patients with such rests and proved successful as an alternative treatment of post-operative aneurysm rests.
PTA Assisted Stenting for Extracranial Vascular Disease
Authors: Tsai F.Y. , Koenigsberg R.A. , Roth T. , Eckard D. , Dhillon G. , McCormick D. , Higashida R.T. , Wang A.M.
Published: April 2015

We report 45 procedures in 43 patients with stenting for treatment of extracranial vascular disease. Lesions treated are supra-aortic extracranial arteries and jugular vein stenoses. There was no significant difference in the result of two stents (Palmaz or Wallstent) in our series. The stenting is feasible and relatively safe for treating traumatic aneurysm, stenosis or salvaging complications of PTA.

Endovascular stent placement for supraaortic artery stenosis is evolving from its controversial position to that of an acceptable alternate treatment. The number of patients receiving supraaortic stent is growing worldwide despite the limit in design and availability of stents.

The most common and widely used stents are Palmaz and Wallstent.
Kallmann Syndrome: MRI Findings
Authors: De Almeida Magalhães A. Cebrian , De Oliveira V. Ribeiro , Lo L. Su Sih
Published: April 2015

We used MR to study patients with anosmia or hypoanosmia associated with hypogonadotropic hypogonadism, also known as Kallmann syndrome. Nine patients who clinically had Kallmann syndrome were examined by MR to evaluated the olfactory sulci and to determine the presence or absence of the olfactory bulbs and tracts. The olfactory sulci were hypoplastic in 8 cases. Normal olfactory tract and bulb were never visible. One patient had dysplastic olfactory pathways. We conclude that MR is the method of choice to evaluate patients with Kallmann syndrome.
Hypogonadotrophic Pituitary Insufficiency in Transfusional Hemochromatosis Complicating Thalassemia Major: MR Imaging
Authors: Sparacia G. , Banco A. , Midiri M. , D'Angelo P. , Luca A. , Brancatelli G. , Caronia A. , Lagalla R.
Published: April 2015

To identify pituitary iron overload in patients with transfusion-dependent thalassemia major causing secondary hypogonadism, we prospectively evaluated signal intensity abnormalities of the anterior lobe of the pituitary gland of 30 patients comparing spin-echo, gradient-echo imaging and pituitary T2 relaxation times measurement.

We found that pituitary iron overload can best be assessed by MR imaging using gradient-echo T2*-weighted technique to establish signal reduction in the anterior lobe of the pituitary gland. This finding is correlated to increasing serum ferritin level — a parameter that reflects the severity of iron overload, and is more evident in patients with secondary hypogonadism. This finding is consistent with the hypothesis of hypogonadotrophic pituitary insufficiency due to iron-induced cellular damage.
Power Doppler Imaging of Infantile Intracranial Arteries
Authors: Ishikura R. , Ando K. , Tominaga S. , Takayasu Y. , Miura K. , Nakao N. , Funayama H. , Morikawa T.
Published: April 2015

39 infants underwent conventional and power Doppler sonography (PDUS). In 25 normal cases, PD US clearly visualized the main trunks and medium sized branches of intracranial arteries. Prominent lentriculo-striate arteries and thalamostriate arteries were also visualized. In 14 cases with intracranial abnormalities, PDUS was useful to detect the tumor vessels, cerebral infarction and intra-cranial hemorrhage. PDUS is suggested to be a useful tool for visualizing intracranial arteries and diagnosing intracranial abnormalities of infants.
Anatomy of success: 100 most cited articles in diabetes research
Authors: Shuaib Waqas , Costa Juan L.
Published: April 2015

Introduction:

The number of citations an article receives is an important indication of its impact and its contribution to academia. There is a paucity of literature concerning top article citations in diabetes. The main objective of this investigation was to bridge this gap and to provide readers with a practical guide in evaluating diabetes literature.

Methods:

Scopus Library was searched to determine the citations of all published diabetes articles. A total of 100 articles were included in our investigation under the subject category ‘Diabetes, diabetes mellitus, and diabetics’. Two databases were used to extract citations. We did not apply any time restriction in our search. The top 100 cited articles were selected and analyzed by two independent investigators. We extracted immediacy index from ResearchGate.

Results:

The journal with the highest number of top 100 cited articles was The New England Journal of Medicine with 23, followed by 22 in Diabetes Care. The top article on the list received 17,779 citations. A statistically significant association was found between the journal impact factor and the number of top 100 cited articles ( p < 0.005). The United States had the highest number of articles (59). Contrary to bibliometric analyses published in other medical fields, the largest subset of the diabetes articles ( n = 54) were published in the 10-year period between 2000 and 2009.

Conclusion:

Our analysis provides an insight on the citation frequency of top cited articles published in diabetes to help recognize the quality of the works, discoveries and the trends steering the study of diabetes.
Reframing Health Promotion for People With Intellectual Disabilities
Authors: Cardell Beth
Published: April 2015

The World Health Organization calls for health promotion to expand beyond the health care system by considering social determinants of health, engaging multiple levels, targeting policy change, and including social action. This qualitative study embraces this holistic stance as a means to address the health disparities and inequities experienced by people with intellectual disabilities (ID) by supporting the development of interventions that consider components of social justice along with embracing this population’s potential and acknowledging influences of the context. A content analysis of the data is presented to illustrate how an occupational viewpoint can promote positive health and well-being of people with ID. The four gerunds of Wilcock’s Occupational Perspective on Health—doing, being, belonging, and becoming—are utilized and supported by the literature to offer actions that can be taken by health promotion professionals to address the health needs of people with ID.