bluuebunny/crossref_metadata_2025 huggingface dataset:
The Main Neuroimmune Diseases in Childhood: Multiple Sclerosis and Acute Disseminated Encephalomyelitis
Authors: Andreula C.F.
Published: April 2015

Demyelination is the hallmark of neuroimmune disease. It is caused by a breakdown of myelin already formed, relative sparing of myelin producing oligodendrocytes, neurons and astrocytes, and venous inflammation with perivenous infiltration. The neuroradiological investigation of choice in this setting is magnetic resonance (MR) due to its ability to monitor the neuropathological process. Acute disseminated encephalomyelitis (ADEM), also known as postinfectious or hyperergic encephalomyelitis, disseminated vasculoencephalomyelitis and perivenous encephalitis, is the commonest neuroimmune disorder of childhood. Neuroradiological investigation is highly sensitive for a diagnosis of demyelinating disease. MR is highly sensitive but not specific. Spectroscopy is useful for diagnosis: the reduction in axonal density leads to a decrease in N-acetylaspartate with a concomitant increase in choline and myoinositol due to glial proliferation. Spectroscopic findings positive for a decrease of NAA and an increase in choline during the first episode of demyelinating disease in adolescence are suggestive of an evolution to MS.
MRI Assessment of Hippocampal Sclerosis
Authors: Lefkopoulos A. , Tzinas A. , Papadopoulou E. , Haritanti A. , Karanikolas D. , Tsifountoudis I. , Dimitriadis A.S.
Published: April 2015

Hippocampal Sclerosis (HS) is the most common cause of refractory temporal lobe epilepsy in adults. The aim of our study was to evaluate the diagnostic accuracy of conventional MRI sequences in HS and devise a cost-effective protocol of choice. Forty-eight patients, 26 men and 22 women, aged 16–55 years (mean age 29 years) with seizures refractory to medical treatment were evaluated by MR imaging. Hippocampal formation was assessed by transverse spin-echo (SE) T1-weighted (WI) and fast spin-echo (FSE) T2-WI sequences and by coronal Fluid Attenuated Inversion Recovery (FLAIR) and Inversion Recovery (IR) images. Increased signal intensity in FLAIR (93.2%), hippocampal atrophy (84.8%) and decreased signal intensity in IR images (72.7%) were the most common pathological findings of HS, while loss of the ipsilateral temporal lobe gray/white matter demarcation (66,7%) and amygdala sclerosis (15.1%) were encountered less frequently. FLAIR sequence was found to be more sensitive than FSE T2-WI in detecting HS. Thin coronal images were particularly helpful in assessing hippocampal formation, while IR images were additionally useful for the detection of possible co-existent cortical abnormalities. A brief review of the imaging findings of HS in more recent MR sequences is also made, though emphasizing that conventional SE T1-WI, FSE T2-WI, FLAIR and IR sequences, with a total examination duration of less than eight minutes, provide high sensitivity and specificity in the assessment of HS.
Neuroimaging in Leptomeningeal Carcinomatosis: The Importance of Gadolinium-Enhanced MRI
Authors: Bodhey N.K. , Purkayastha S. , Gupta A.K.
Published: April 2015

CNS parenchymal metastases are common as is metastatic meningeal involvement. However, the high index of suspicion and contrast enhanced MRI also help in detecting meningeal deposits. We herewith report cases of leptomeningeal deposits in patients with a known primary tumour elsewhere. The importance of gadolinium enhanced MRI is stressed.
Spinal Cord Ischemia due to Vertebral Artery Dissection
Authors: Bergui M. , Ventilii G. , Ferrio F.M. , Daniele D.R. , Bradač G.B.
Published: April 2015

We reviewed clinical and neuroradiological findings in 37 consecutive patients with cervical cord infarction due to vertebral artery dissection diagnosed at our institution from 1996 to 2004. Four patients had clinical and neuroradiological findings consistent with spinal cord ischemia. Three patients had “pencil-like” infarction at C3-C5 level; one patient had an infarction of the anterior horns of the spinal grey matter at C3-C4 level. Symptoms were crural sensory deficit with mild tetraparesis and proximal strength deficit of the arms, respectively. Spinal cord infarction complicated vertebral artery dissection in about 10% of patients of our series. Infarctions involved the most central regions of the spinal cord, with relative sparing of the peripheral white matter tracts. Clinical and MRI pictures were almost typical, and consistent with a hemodynamic mechanism for the lesions. Vertebral artery dissection must be considered in the differential diagnosis in patients with cervical cord infarction.
High Resolution Contrast-Enhanced MR Angiography in the Evaluation of Rabbit Carotid Artery
Authors: Wu R.-H. , Kallmes D.F.
Published: April 2015

This study compared a high resolution contrast-enhanced MR angiography (MRA) sequence to conventional contrast-enhanced MRA sequence for imaging of rabbit carotid artery. Fifteen rabbits underwent an evaluation using both high resolution contrast-enhanced MRA sequence and conventional contrast-enhanced MRA sequence. Siemens 1.5 Tesla Magnetom Vision system was utilized. The parameters of high resolution sequence were: TR/TE= 6.2/2.0 msec, flip angle 25°, matrix 130×512, pixel size 0.96×0.49 mm, partition thickness 1.58 mm, acquisition time 24 sec. The parameters of conventional sequence were: TR/TE=3.8/1.4 msec, flip angle 35°, matrix 110×256, pixel size 1.48×1.02 mm, partition thickness 2mm, acquisition time 10 sec. Maximum intensity projection (MIP) images were created. Both original single slices and MIP images were used for image quality evaluation. Contrast-to-noise ratio (CNR), signal-to-noise ratio (SNR), distinctness of artery edge, and venous contamination were analyzed for both techniques. Higher average CNR and SNR were obtained with high resolution contrast-enhanced MRA, compared to average CNR and SNR with conventional contrast-enhanced MRA. The differences were statistically significant (P<0.01). The artery edge with high resolution method was more distinct than conventional method. Jugular venous contamination was found in five of 15 cases with high resolution contrast-enhanced MRA and in four of 15 cases with conventional contrast-enhanced MRA. High resolution contrast-enhanced MRA has significant potential for high quality noninvasive vascular imaging. The image quality with high resolution contrast-enhanced MRA sequence is better than conventional contrast-enhanced MRA sequence.
CT Cisternography of Paradoxical Cerebrospinal Fluid Rhinorrhea after Operation for Acoustic Neuroma
Authors: Thomas B. , Purkayastha S. , Vattoth S. , Gupta A.K.
Published: April 2015

Cerebrospinal fluid (CSF) rhinorrhea after acoustic neuroma surgery is a well-known complication. CT cisternography can be used to demonstrate the entry of CSF from cerebellopontine angle cistern into the mastoid air cells, middle ear and then into nasopharynx via Eustachian tube. We report a case of paradoxical CSF rhinorrhea after surgery for acoustic neuroma in which the path of CSF leak was accurately demonstrated using CT cisternography.
Multiple Intracerebral Hemorrhages following Electroconvulsive Therapy
Authors: Koc F. , Yerdelen D. , Koc Z.
Published: April 2015

Electroconvulsive therapy is the most effective treatment for endogenous depression. Possible adverse effects include confusion, memory loss, headache, hypotension, and tachycardia. We describe a 22-year-old woman treated for unconsciousness four hours after electroconvulsive therapy. She had no history of recent head trauma, hypertension or cerebrovascular symptoms. Complete blood count, platelet count, prothrombin and partial thromboplastin time were normal. Multiple intracerebral hemorrhages were seen on computed tomography. This unusual finding has not been reported previously.
Biomechanics of the Spine II
Authors: Izzo R. , Diano A.A. , Lacquaniti F. , Zeccolini F. , Muto M.
Published: April 2015

Spine biomechanics represents a traditional area of research by orthopaedists, neurosurgeons, bioengineers and physicists. Working in an emergency setting and managing spinal traumas every day we began a study on extended literature devoted to biomechanics of the spine, to see beyond the usual static evaluation of neuroimaging patterns. After our earlier paper on biomechanics of the spine16, we have reviewed and broadened some topics such as the role of the ligaments and introduced the main mechanisms of primary spinal traumas and deformations. The spine is a multiarticular complex structure controlled by the muscles whose correct function presupposes its stability. Several “stability factors” ensure spinal stability and correct movements. A number of biomechanical studies analysed the contribution of individual bony and soft spinal elements to stability and the effects of traumas. Several theories have been derived from these studies to account for the distribution of loads and vector forces, including failure-producing loads, among the components of functional spinal units (FSU). Holdsworth's initial two column concept, the three column models by Louis and Denis up to most recent four column theory by Cartolari all represent evolutions in assessing the distribution of loads and the presence and degree of instability in spinal traumas. Whether acute or chronic spinal instability means a partial or complete loss of one or both functions of the spine: load-bearing and cord protection. The diagnosis of spinal instability is crucial to establish the most appropriate strategy of management, namely in acute conditions. Biomechanical concepts are fundamental to understand the factors deciding the type, location and extent of spinal traumas, possible instability and the primary mechanism of the main types of injuries.
The Intrasacral Meningocele
Authors: Rinaldi F. , Cioffi L. , Cioffi F.A. , Krasagakis G. , Columbano L. , Bernini F.P.
Published: April 2015

Meningeal diverticula arising as a protrusion of the arachnoid through a weak place in the dura are called sacral meningoceles. They occur in the sacral region and produce local vertebral erosions. Eleven cases of this rare and potentially progressive lesion were detected on 3250 CT examinations of the lumbosacral spine. The pathogenesis and clinical picture of the condition are reviewed. Intrasacral meningoceles are well displayed on CT and MRI scans, although the diagnosis may also be established at myelography. Such arachnoid cysts should be distinguished from lumbosacral dural anomalies observed in von Recklinghausen neurofibromatosis. Surgical excision should be carried out before irreversible nerve root changes occur.
Arterial Dissection and Vascular Trauma
Authors: Pongpech S.
Published: April 2015

Traumatic intra-extracranial arterial injuries still represent common events of both closed head injury and penetrating head trauma. These injuries include arterial dissection, pseudoaneurysms and fistulas, both direct and indirect. Although these lesions may be identified while still asymptomatic, they usually present in a delayed fashion with intracranial hemorrhage, focal cerebral ischemia or life-threatening epistaxis. Endovascular therapy has played a major role in the management of these lesions but only with senior full trained neurointerventionists and on the principles of a neurologic critical care team to minimize secondary brain injuries.
Neurocutaneous Syndromes: Developmental Dysplasias of the Early Period of Gestation. A Clinical and MRI Study
Authors: Varsik P. , Mihale J. , Kucera P. , Kollar B. , Buranova D. , Stofko J. , Bilicky J. , Kadlecik R.
Published: April 2015

The neurocutaneous syndromes, also called phakomatoses or hamartomatous syndromes, are a highly variable and heterogenic group of dermatologic, somatic and nervous system disorders. Much attention is paid to these syndromes by neurologists because they are usually accompanied by epilepsy and mental retardation. Dermatological symptomatology is relatively variable, and somatic disturbances are very common, but nervous system disorders, both in clinical and in MRI pictures, are regularly observed. The normal process of neural crest formation in the 4th week of gestation is characterized by a period of rapid proliferation and differentiation of the neuroependymal cells and this process of neuroblast migration is often considered to be the most important developmental period of the brain. This process continues between the 10th and 22nd weeks of gestation and ends with the cellular apoptosis of 30–50% of participating neuroblasts. In some cases, the neuroblasts will not reach their predetermined site within the cerebral cortex and abnormal layers or bands of heterotopias in the subependymal or subcortical spaces may form. These defects in the cortical grey matter manifest themselves as flat cortex (lissencephaly or agyria), pachygyria (macrogyria) or polymicrogyria. The process of neuroblast migration is intertwined with the earlier stages of brain embryogenesis. After four weeks of gestation, in 5–6 mm sized embryos, two branches of the carotid artery are visible, and in 15–16 mm sized embryos two branches of the vertebro-bazilar arterial system are identifiable. The most frequent cause of malformations is genetic chromosomal defects, but similar developmental disturbances are seen in sporadic cases where the developing embryo has been subjected to harmful exogenic influences (i.e. congenital mononucleosis infections, drug dependence, or fetal alcohol syndrome). Here we demonstrate MRI changes in some typical cases of neurocutaneous diseases generally accepted as denoting lissencephaly. Together with lissencephaly some other ventricular (hydrocephalus, mid-line defects) and vascular system abnormalities with variable skin phacomas are observed. In some cases of undiagnosed idiopatic epilepsy, variable skin morphas may be found which serves to emphasize the importance of MRI examination as a diagnostic tool. We frequently observed lissencephaly combined with vascular dysplasias or abnormal ventricular configurations.
Bilateral Asymmetric Perisylvian Parietal and Frontal Polymicrogyria, the Perisylvian Syndrome. MRI and CT Findings
Authors: Balaji R. , Kesavdas C. , Kapilamoorthy T.R. , Chacko S. , Gupta A.K.
Published: April 2015

CT and MR imaging have been used to diagnose polymicrogyria and determine the topological involvement of bilateral frontal, perisylvian, parietal or occipital cortices. We present CT and MR appearances of bilateral asymmetrical frontal and parietal perisylvian polymicrogyria in an eighteen year-old-girl.
Neurohypophysis NMR Signal Anomalies
Authors: Greggio N.A. , Amaina A. , Lorusso A. , Manara R. , Palozzo A.C.
Published: April 2015

Hypothalamic or central diabetes insipidus (HD or CDI) is a heterogeneous condition characterized by polydipsia and polyuria due to deficient arginine vasopressin (AVP) synthesis from the supraoptic and paraventricular nuclei of the hypothalamus and/or secretion from the neurohypophysis which have been stored as a complex with neurophysin (NP). Over one third of CDI cases are classified as idiopathic. Absence of the physiological neurohypophyseal hyperintense signal or bright spot on sagittal T1-weighted magnetic resonance imaging (MRI) is a common feature of all cases of CDI. The finding of a thickened infundibulum or pituitary stalk (or both), although not specific, suggests the presence of an infiltrative disease. We investigated the clinical presentation, morphologic characteristics of the pituitary region on MRI and the size of the pituitary stalk over time in two young girls who both later developed another hormone deficiency.
MR Spectroscopy When Brain Tumours Mingle
Authors: Rahbar H. , Björkman-Burtscher I.M. , Sundgren P.C.
Published: April 2015

Magnetic Resonance Spectroscopy (MRS) is a complement to Magnetic Resonance Imaging (MRI) in the characterization of intracranial lesions. Its role in the workup of space-occupying brain lesions continues to evolve. In this pictorial essay we demonstrate the important complementary role of MRS to conventional MRI in the diagnosis of brain tumors and tumour like lesions.
MR Spectroscopy of Cervical Spinal Cord in Patients with Clinical and/or Electrophysiologic Signs of Spinal Cord Compression
Authors: Kendi A.T.K. , Bademci G. , Kara S.A. , Keskil S. , Erdal H.H.
Published: April 2015

We evaluated the efficiency of MR spectroscopy compared with conventional MR imaging in 14 patients with clinical and/or electrophysiologic signs of spinal cord compression. Cervical spinal cord was evaluated for the presence of abnormal signal intensity on T1 and T2 weighted images. MR spectroscopy was performed at the level of spinal cord compression seen on conventional MR images. Clinical and/or electrophysiological studies were also obtained to confirm the presence of a suspected spinal cord compression for these areas. MR spectroscopy was also performed at a normal site of spinal cord without any clinical and/or electrophysiological finding of compression and without any sign of compression on conventional MR images. MR spectroscopy findings of suspected areas were compared with the normal areas for each patient. Twenty levels of cervical spinal cord with both clinical and/or electrophysiological and conventional MR signs of compression were evaluated with MR spectroscopy. MR spectroscopy was also performed at the normal areas of the cervical spinal cord selected adjacent to the level of compression as vascularity and metabolism of cervical spinal cord significantly change between different levels. All patients except one had a decrease in N-acetylaspartate level at the suspected areas compared to the normal areas without any sign or suspicion of compression. Creatine levels were increased in 14 suspected area but decreased in six. Choline levels were decreased in 12 and increased in eight levels. Lactate levels were increased at eight levels and decreased in 12 levels. MR spectroscopy of the spinal cord can yield results supporting both clinical and electrophysiological evaluation. MR spectroscopy of the spinal cord at the level of compression observed on conventional MR images can support neuronal loss and disruption of axonal integrity.
Imaging Findings in Pediatric Nonaccidental Head Injury
Authors: Foerster B.R. , Petrou M. , Eldevik P.O. , Carlson M.D. , Strouse P.J. , Sundgren P.C.
Published: April 2015

Nonaccidental head injury can be a very serious result of child abuse with the clinical outcome being poor and including mental retardation, long-term disability and even death. Skull radiographs, head CT and increasingly MRI are very useful tools in making this very serious diagnosis. Radiologists must be familiar with the radiologic patterns of child abuse and must maintain a high level of suspicion. We review and present several of the common radiologic findings in pediatric nonaccidental head injury.
Reversible Hypertensive Encephalopathy in Childhood
Authors: Finotti E. , Battistella P.A. , Laverda A.M. , Drigo P. , Carollo C. , Calderone M. , Manara R. , Zanato S. , Calore E. , Zanesco L.
Published: April 2015

Reversible hypertensive encephalopathy (RHE) is clinically characterized by sudden onset of headache, visual changes, altered mental functioning and seizures. Typical MRI features include bilateral cerebral lesions depicted as hyperintense in T2 sequences and iso or hypointense in T1 images. These areas of vasogenic oedema are best visualized by diffusion-weighted imaging (DWI) sequences and apparent diffusion coefficient (ADC) maps. The neuroradiological changes usually resolve completely at follow-up. The pathogenesis of RHE is poorly understood. A number of factors have been implicated including an elevated systemic blood pressure breaking through the autoregulation capacity of the cerebral vascular system, but also immunosuppressant medication like ciclosporine A and tacrolimus as well as interferon alfa. A retrospective study of the five-year period 1999–2004 was undertaken on patients admitted to our Institution with clinical and neuroradiological features compatible with a diagnosis of RHE. Neuroradiological investigation disclosed hypodense areas on CT scan in four out of five cases and hyperintense images in T2 and FLAIR MRI sequences in eight out of eight patients, mainly affecting the unilateral or bilateral occipitoparietal regions. Clinical symptoms and MRI findings had normalized at follow-up in five cases between 2 and 11 weeks, whereas three patients died from complications of the underlying disease. RHE is not an uncommon complication arising in childhood cancer. MRI with DWI sequences is the gold standard for the detection and differential diagnosis of RHE-induced changes allowing adequate treatment and follow-up monitoring.
Adult-Onset Moyamoya Disease with Angiographically Verified Progression
Authors: Ezaki Y. , Kaminogo M. , Tsutsumi K. , Kitagawa N. , Ochi M. , Nagata I.
Published: April 2015

We describe an adult case of Moyamoya disease (MMD) with progression, and review the clinical and radiographic records obtained in previous published reports of adult-onset (over 20 years) MMD with progression. A 43-year-old Japanese woman presented with MMD with angiographically verified progression. The first angiogram depicted severe stenoses at the terminations of both internal carotid arteries. Four years later, she was readmitted to our hospital for surgical treatment because of recurrent TIA once or more per month. An angiogram demonstrated marked progressive appearance. We confirmed only 19 cases of MMD with progression including our present one. We could roughly divide these cases into two groups by angiographic appearance (unilateral or bilateral lesions at diagnosis). Ischemic stroke was the most common initial presentation, and there were only two cases with hemorrhagic stroke. The mean period until follow-up angiography was 35.3 months, and most cases (84.2%) progressed to advanced stage within five years. About half (42.9%) of the patients were asymptomatic when angiographic progression was confirmed. Adult-onset MMD with progression includes several different pathological patterns. We suggest that careful observation is needed for at least five years after initial presentation to assess progression of MMD even in adult-onset cases.
Glioblastoma Multiforme in the Pineal Region
Authors: Bodhey N.K. , Purkayastha S. , Gupta A.K. , Radhakrishnan V.V.
Published: April 2015

Pineal region tumors are rare, comprising 0.4% to 1% of adult brain tumors 1,2. Germinomas are the most common histological type, comprising 50–60% of all pineal tumors 3,4. Gliomas in this region are mainly low-grade astrocytomas 1,4. Glioblastoma multiforme (GBM) is rare in this location and few cases have been reported 1,5–13. We describe a patient with GBM of the pineal region and review the literature.
CT and MR Imaging of Cervical Lipoblastoma with Epidural Extension
Authors: Balaji R. , Ramachandran K. , Krishnakumar A.S. , Venugopal M. , Kesavdas C. , Kusumakumari P. , Peethambaran A.K.
Published: April 2015

Lipoblastoma is a benign tumor of embryonic fat cells occurring in infancy and childhood. The tumor usually presents as a slow growing non tender superficial mass in the extremities. This case report describes the CT and MR findings in an exceedingly rare case of a cervical lipoblastoma with a long segment epidural extension. Surgical and pathological findings correlate well with the imaging features.
Determination of Brain Volumes Using Quantitative MR Imaging in Patients with Multiple Sclerosis
Authors: Alper F. , Gundogdu C. , Varoglu A.O. , Kantarci M. , Bulucu Z. , Malkoc I. , Unal B.
Published: April 2015

The purpose of this study was to determine the amount of atrophy occurring in the cerebrum of patients with multiple sclerosis compared with controls, and to show the relationship between clinical status and distribution of atrophy. MR images were obtained on 12 relapsing-remitting (RR) and 11 secondary progressive (SP) multiple sclerosis patients and 24 control subjects (all patients and controls were female). The Cavalieri method by modern design stereology was used to measure the cerebral volume. It was found that volumes for RR and SP with multiple sclerosis and control subjects were 757242 mm3, 716867 mm3 and 912499 mm3 respectively. Mean estimates of volume loss in RR and SP were 20.5% and 27.2% respectively compared to controls for the cerebrum. In addition the volume difference between RR and SP was 5.6%. There were statistically significant differences between both RR (P<0.05) and SP (P<0.05) compared with control subjects but no differences between RR and SP volumes. MRI-estimated cerebrum volumes may be help to evaluate patients' clinical status and provide a simple index to assess the efficiency of therapy.
Creutzfeldt-Jakob Disease the Value of Diffusion-Weighted MRI
Authors: Purkayastha S. , Gupta A.K. , Bodhey N.K.
Published: April 2015

Creutzfeldt-Jakob disease (CJD) is a transmissible, progressive, fatal spongiform encephalopathy. An early and accurate diagnosis is important to prevent disease transmission, but diagnosis is not easy, especially in the early stage of the disease. MRI plays an important role in the early diagnosis and differentiating the entity form other disorders.
Functional MRI in Patients with Intracranial Lesions near Language Areas
Authors: Hakyemez B. , Erdogan C. , Yildirim N. , Bora I. , Bekar A. , Parlak M.
Published: April 2015

We aimed to depict Broca's area and Wernicke's area by word generation and sentence formation paradigms in patients with various intracranial lesions adjacent to language areas using functional MRI technique and to evaluate the ability of functional MRI to lateralize the hemispheric dominance for language. Twenty-three right-handed patients were included in this study. Lesions were classified as low-grade glioma (n=8), high-grade glioma (n=9), metastasis (n=1), meningioma (n=1), arteriovenous malformation (n?2) and mesial temporal sclerosis (n=2). We performed blood-oxygenated-level-dependant functional MRI using a 1.5-T unit. Word generation and sentence formation tasks were used to activate language areas. Language areas were defined as Brodmann 44, 45 (Broca's area) and Brodmann 22 area (Wernicke's area). Laterality index was used to show the dominant hemisphere. Two poorly cooperative patients showed no activation and were excluded from the study. Broca's area was localized in 21 patients (100 %). Wernicke's area, on the other hand, could only be localized in eight of the 21 patients (38 %). The left hemisphere was dominant in 86% of patients while atypical language lateralization (right or bilateral) was demonstrated in 14% of the patients. Bilateral activation areas were shown in 10% of those patients while right cerebral hemisphere was dominant in 4% of the patients. Word generation and sentence formation tasks are especially helpful in localizing Broca's area. Wernicke's area could also be demonstrated in some of the cases. Functional MRI can be used as an important and useful means of demonstrating language areas in patients with lesions adjacent to those areas and depicting the hemispheric dominance.
Intracranial Lipoma of the Sylvian Fissure: MR and CT Findings
Authors: Tosun O. , Kurt A. , Tosun H. , Kahvecioglu N. , Tas I.
Published: April 2015

We present the CT and MR features of a rare intracranial lipoma located in the right sylvian fissure in a patient who presented with a five-year history of headache. The lesion was well demonstrated on Fluid Attenuated Inversion Recovery (FLAIR), Turbo Spin Echo (TSE), T1 weighted and fat supressed T2 weighted sequences.
Short, Medium and Long Term Efficacy of Epidurally Injected Anaesthetic-Corticosteroid Mixture in Lumbocruralgia and Lumbosciatalgia
Authors: Gambacorta D. , Lunghi V. , Zocchi M. , Cirinei M. , Arrigucci U. , De Falco D.
Published: April 2015

We assessed the efficacy of an epidural sited anaesthetic-corticosteroid mixture with transforaminal or interlaminar/interspinous access, in subjects with chronic lumbocruralgia or lumbosciatalgia caused by discal pathology or degenerative foraminal stenosis. From September 2003 to June 2005, 84 patients were treated in the transforaminal region and 32 in epidural space through back access (interlaminar or interspinous) with 2 ml cortisone (megacort) and 2ml anaesthetic (naropine 7.5mg/ml). All 116 patients underwent a minimum of two and a maximum of three treatment sessions. The results were evaluated for a follow-up period of ten months by comparing the answers given by the patients with the Visual Analogic Score. This was done prior to and after every single injection and during the follow-up period. Out of 142 spaces treated, improvement of symptoms for a period varying from one to three months was recorded in 74 cases (52%), for a period of more than three months in 53 (37%) cases, while in the remaining 15 (11%) cases no sufficient regression of pain was reported. In many cases of chronic lumbago/lumbosciatalgia, the percutaneous injection of an anaesthetic-cortisone mixture can be useful in relieving or even killing pain for a period of more than three months. No major complication was reported.
Percutaneous Sclerotherapy for Lymphangioma and Soft-Tissue Venous Malformation Located in the Maxillofacial Region in Children and Young Adults
Authors: Graziuso S. , Ormitti F. , Cerasti D. , Menozzi R. , Piazza P. , Cerasoli G. , Crisi G. , Zompatori M.
Published: April 2015

To demonstrate that percutaneous sclerotherapy for lymphangioma using a new fibro-sing agent (OK-432) and for soft-tissue venous malformation with alcoholization can improve management of these congenital vascular abnormalities. Between February 2003 and November 2005 five patients with lymphangioma, ranging in age from 23 months to 18 years (mean age ? 9 years) and four patients with soft-tissue venous malformation, raging in age from 25 months to 18 years (mean age = 11 years) underwent percutaneous sclerotherapy. Ultrasound Computed tomography and/or Magnetic Resonance imaging were performed beforehand to evaluate the anatomic boundaries of the malformation. General anesthesia is mandatory for children under three years. Direct puncture of the mass with a 23-gauge venous infusion set (butterfly) was performed by means of palpation alone or with ultrasonographic guidance using OK-432 PICIBANIL (0.1–0.2 mg dilute in 10 ml normal saline) for lymphangioma and alcohol in venous malformation. The volume of sclerosing solution varied from 0.2 to 15 ml per injection course. Processing time was less than 20 minutes. Swelling of lesion, pain, local inflammatory reactions and mild fever (37.5°-39°) in lymphangioma, were constant findings after sclerotherapy. Satisfactory results (when the regression was estimated to be more than 50% of the initial volume; negative in inspection, but positive in palpation and imaging study) were obtained in four patients with head and neck lymphangioma. One patient was completely cured with an excellent (when there was a complete regression of malformations; negative in inspection, palpation and imaging study) result. All patients with soft-tissue venous malformation were satisfied with the results. In conclusion, in consideration of its low cost, rare complications and good results, we strongly recommend percutaneous sclerotherapy in the treatment of head and neck lymphangioma and soft-tissue venous malformation in children.
Radiological Assessment of Hydrocephalus: New Theories and Implications for Therapy
Authors: Greitz Dan
Published: April 2015

It is almost a century since Dandy made the first experimental studies on hydrocephalus, but its underlying mechanism has been unknown up to now. The conventional view is that cerebrospinal fluid (CSF) malabsorption due to hindrance of the CSF circulation causes either obstructive or communicating hydrocephalus. Analyses of the intracranial hydrodynamics related to the pulse pressure show that this is an over-simplification. The new hydrodynamic concept presented here divides hydrocephalus into two main groups, acute hydrocephalus and chronic hydrocephalus. It is still accepted that acute hydrocephalus is caused by an intraventricular CSF obstruction, in accordance with the conventional view. Chronic hydrocephalus consists of two subtypes, communicating hydrocephalus and chronic obstructive hydrocephalus. The associated malabsorption of CSF is not involved as a causative factor in chronic hydrocephalus. Instead, it is suggested that increased pulse pressure in the brain capillaries maintains the ventricular enlargement in chronic hydrocephalus. Chronic hydrocephalus is due to decreased intracranial compliance, causing restricted arterial pulsations and increased capillary pulsations. The terms “restricted arterial pulsation hydrocephalus” or “increased capillary pulsation hydrocephalus” can be used to stress the hydrodynamic origin of both types of chronic hydrocephalus. The new hydrodynamic theories explain why third ventriculostomy may cure patients with communicating hydrocephalus, a treatment incompatible with the conventional view.
Dynamic MR and Quantitative MR Applied to the Study of Intervertebral Disk Degeneration
Authors: Haughton V.M.
Published: April 2015

MR and CT demonstrate morphological changes in intervertebral disks. However the images do not provide an effective means to document interval changes in the disk due to degeneration, aging or healing. Functional imaging that may assesses the biomechanical or the biochemical integrity of the disk, may provide a measure of changes in the disk over time. To study the biomechanical function of the disk, translation and rotation of spinal vertebrae can be measured with CT or MR as the spine is subjected to a specific load or torque. Biochemical integrity of the disk can be assessed by the estimation of the water content from a measurement of the T2 relaxation time of disk tissue.
Endovascular Therapy for Intracranial Dural Arteriovenous Fistulas
Authors: Chong W.K.W. , Holt M.
Published: April 2015

A retrospective study was conducted on 17 consecutive patients with DAVF admitted to Monash Medical Centre over 12 years. 15 patients, 82.4%, were treated by endovascular means with the intention to obliterate the fistula. Three of these patients also had surgery following embolisation. Angiographic cure was achieved when we have successfully embolised both the arterial and the venous side whether by penetration of liquid adhesive or packing with coils. Our cure rate of 60% (95% CI: 37–83%) compare favourably with published results of 50 to 70%. Our clinical complication rate is 1/15, 6%; and technical complication is1 from 32 embolisation sessions, 3.1%. Endovascular therapy is effective in achieving a durable angiographic and clinical cure in the treatment of intracranial DAVF. Both arterial and venous side need to be occluded.
Proton Magnetic Resonance Spectroscopy in Patients with Normal Pressure Hydrocephalus
Authors: Kubas B. , Kułak W. , Sobaniec W. , Walecki J. , Lewko J.
Published: April 2015

The objective of this prospective study was the application of proton magnetic resonance spectroscopy (1HMRS) in patients with normal pressure hydrocephalus (NPH) to determine the metabolite profile in the white matter next to left lateral ventricle and to assess the relationship of this profile with Evan's index. The study included 26 patients with NPH. Diagnosis of NPH was confirmed by clinical symptoms such as gait disturbance, dementia or urinary incontinence and CT study with ventricular enlargement. Ratios of NAA/Cr, Cho/Cr, Lac/Cr and mI/Cr from deep white matter were measured and compared with Evan's index and diameter of the IIIrd ventricle. Patients with hydrocephalus showed decreased ratios of N-acetylaspartate (NAA)/Cr (creatine), and increased ratios of Lac(lactate)/Cr in the white matter near the left frontal horn of the lateral ventricle compared with a well-matched control group. There was no correlation between NAA/Cr, Ch/Cr, Lac/Cr, mI (myo-Inositol)/Cr and Evan's index. A significant correlation was found between Lac/Cr and third ventricle diameter. A positive correlation was noted between Cho/Cr and dementia in patients with NPH. Our preliminary results of 1 H MRS support the idea that NPH is associated with white matter ischemia. Proton MRS is a very useful tool for evaluating major changes in metabolic levels in deep white matter in NPH patients.
Emergency Use of Stent and rtPA with Mechanical Cloth Defragmentation for a Thromboembolic Complication during GDC Coil Treatment of an Acutely Ruptured Basilar Tip Aneurysm
Authors: Poncyljusz W. , Falkowski A. , Kojder I. , Sagan L.
Published: April 2015

Thrombotic occlusion of both posterior cerebral arteries occurred during embolization of an acutely ruptured basilar tip aneurysm. Intracranial stenting and continuous superselective infusion of rtPA was administered combined with mechanical clot fragmentation to reestablish normal vessel flow. DSA disclosed that normal vessel patency was achieved within 30 min. There were no adverse events related to rtPA administration and the patient recovered from the embolization with minor neurologic deficit as present before the procedure.
Comparison of Diffusion-Weighted MR Imaging and T2-Weighted MR Imaging in Patients with Amyotrophic Lateral Sclerosis
Authors: Wu R.H. , Bruening R.
Published: April 2015

The purpose of this study was to compare diffusion-weighted MR imaging with conventional MR sequences in patients with amyotrophic lateral sclerosis (ALS) and controls, and to assess the diagnostic value of diffusion-weighted imaging in the ALS patients. Twelve patients with ALS (ten men and two women, mean age 56 years) and 12 age-matched control subjects were studied with axial diffusion-weighted imaging and conventional MR imaging. Three adjacent slices of diffusion-weighted imaging were obtained at the level of the internal capsule. The diffusion-weighted imaging was performed with a b-value from 165–600 s/mm2. Identical slices of diffusion-weighted images and conventional MR images were evaluated by a consensus reading. Diffusion-weighted images showed high signal intensity in the corticospinal tract at the level of the internal capsule in 11/12 patients with ALS (92%) and 5/12 control subjects (42%), whereas T2-weighted images (T2WI) revealed high signal intensity in the corticospinal tract in 11/12 patients with ALS (92%) and 8/12 control subjects (67%). The proton-weighted images (PDWI) disclosed the high signal corticospinal tract in 5/12 patients with ALS (42%), but not in any of the control subjects. Considering ALS patients versus control subjects, statistical analysis demonstrated that diffusion-weighted imaging (p=0.027, X2 test) and proton-weighted imaging (p=0.037) were more specific than T2-weighted imaging. Diffusion-weighted imaging and proton-weighted imaging were more specific than T2-weighted imaging. The combination of diffusion-weighted imaging and T2WI/PDWI seems a promising tool in the diagnosis of amyotrophic lateral sclerosis.
Bilateral Cerebellar Dysplastic Gangliocytomas (Lhermitte Duclos Disease) with Cerebellar Ectopia and Presyrinx Cord Changes
Authors: Puri A.S. , Garg A. , Mishra N.K. , Gaikwad S.B. , Mehta V.S.
Published: April 2015

Lhermitte-Duclos disease (LDD) is a rare cerebellar lesion with features of both malformation and benign neoplasm. However, the fundamental nature of the entity, its pathogenesis, and the exact genetic alterations remain unknown. We describe a rare case of bilateral LDD with cerebellar ectopia and presyrinx spinal cord changes. Bilaterality of lesions should argue against a neoplastic origin and support a hamartomatous origin.
Delayed Symptomatic Cyst Formation following Gamma-Knife Radiosurgery
Authors: Shah H. , Garg A. , Mishra N.K. , Kale S.S. , Gaikwad S.B.
Published: April 2015

We report a case of symptomatic cyst formation as a delayed complication of gamma knife radiosurgery for treatment of intracranial arteriovenous malformation. The cyst was discovered six years after GKS. Initially it was asymptomatic, presenting with symptoms of mass effect after another six months. It was decompressed by a cystoperitoneal shunt following which the symptoms were relieved.
Orbital Cysticercosis: Comparing Multi-Slice CT and Steady State MR to Identify Scolex
Authors: Srikanth S. Govindappa , Nagarajan K. , Jayakumar P.N. , Chavan R.G.
Published: April 2015

Orbital cysticercosis with both ocular and extraocular involvement is common in endemic areas. The presence of scolex is considered diagnostic of cysticercosis. We sought to compare multi-slice CT and 3D steady state MR in the identification of scolex in orbital cysticercosis. Three patients with orbital cysticercosis (two extra-ocular, one ocular) were studied using multi-slice CT with thin coronal and sagittal reformations and 3D steady state MR (CISS 3D — Constructive Interference in Steady State) sequence.
Extracentral Nervous System Metastases from Medulloblastoma
Authors: Battaglia S. , Marliani A.F. , Stafa A. , Franceschi E. , Agati R.
Published: April 2015

Medulloblastoma belongs to the group of highly malignant neuroepithelial tumours and is the commonest tumour in childhood (12–25 %)1, but is rare in adults (0.4–1%) of all primary brain tumours)1,2. Medulloblastomas usually arise in the posterior fossa and spread readily throughout the CSF, although 10–30% of patients develop extracentral nervous system metastases 2. We describe a 30-year-old woman presenting bone metastases from medulloblastoma located predominantly in the spine.
Three-Dimensional Computer Reconstruction of a Fourth Ventricle Ependymoma
Authors: Fan Songhua , Yao Yu , Zhou Jiayin
Published: April 2015

It is very important to establish the surgical strategy for fourth ventricle ependymoma with the aim of total tumor resection because improving the degree of surgical removal is the most promising means of improving outcome. We present our experience in reconstructing a three-dimensional (3-D) image of a fourth ventricle ependymoma perioperation. We used computer-assisted 3-D reconstruction to visualize a fourth ventricle ependymoma. Tumor outlines were manually traced out and imported to a 3-D visualization tool for 3-D reconstruction. The patient was operated through a median infratentorial approach. Perioperation by rotating the 3-D image and observing from various angles, we acquired abundant information such as 3-D tumor contour, the relation between the tumor and the wall of the fourth ventricle, the origin and invasion of the tumor, which were very useful to monitor tumor resection, adjust the approach to the ependymoma, and avoid inadvertent injury of important anatomic structures. Computer-assisted 3-D reconstruction may not only provide useful information before and during surgery, but also simplify the surgical procedure. It may be a useful aid to surgery making neurosurgery less invasive and more effective.
De Novo Formation of the Ventriculus Terminalis?
Authors: Tancioni F. , Di Ieva A. , Gaetani P. , Aimar E. , Pisano P. , Levi D. , Rognone F. , Baena R. Rodriguez Y
Published: April 2015

The ventriculus terminalis is an ependymal cystic cavity in the conus medullaris, sometimes found in children. Persistence of the ventriculus terminalis in adults can cause lower back pain or neurological disturbances. However, there are no literature reports of de novo formation of a ventriculus terminalis in the conus medulallaris, as in the case we illustrate here.
Biomechanics of the Spine III. The Cranio—Cervical Junction
Authors: Izzo R. , Ambrosanio G. , Cigliano A. , Cascone D. , Gallo G. , Muto M.
Published: April 2015

By virtue of its unique anatomy and functions the cranial-cervical junction was excluded in previous reviews on the general biomechanics of the spine, being a world apart. The special design of the cranial-cervical (CCJ) junction responds to seemingly opposed necessities being at same time loose enough to allow a great variety of movements and strong enough to preserve the spinal cord and vertebral arteries and to resist the head weight and muscular action. The primary goal of the CCJ is to ensure the maximal mobility of the head for visual and auditory exploration of space. Like a cardan joint the CCJ allows simultaneous independent movements about three axes in order to repeat and extend eye movements under the control of vestibular receptors. Several muscular groups and a number of ligaments control the movements of the CCJ and ensure its stability. Although composed of two seemingly distinct joints the CCJ forms a unique functional complex whose stability is ensured by ligaments and bony restraints often operating on both joint components: the occipitoatlantal and atlantoaxial joints.
Evaluation of an Intracranial Arteriovenous Malformation by Multi-Detector CT Angiography
Authors: Fu J.H. , Hsu S.S. , Yip C.M. , Weng M.J. , Chen K.H. , Huang J.S. , Yang T.L. , Lai P.H.
Published: April 2015

Intracranial arteriovenous malformations are congenital vascular lesions characterized by localized arteriovenous shunting. Digital subtraction angiography is the gold standard for diagnosis. We herein report a case of intracranial arteriovenous malformations diagnosed by multi-detector computed tomographic (MDCT) angiography. The findings of MDCT angiography were confirmed by digital subtraction angiography. CT angiography might be a useful first-line screening tool, especially in an emergency situation.
Cerebral Infarction Due to Vasoconstriction after a Hymenoptera Sting
Authors: Peisker T. , Kalvach P.
Published: April 2015

A 22-year-old woman developed an anaphylactic reaction after two hornet stings. Left-sided hemiparesis and gaze paresis were revealed after extubation 24 hours later. The vasoconstriction of the right MCA together with hypotension are the suggested pathogenetic determinants of the stroke.
MR Myelography in Degenerative Spinal Disease
Authors: Ruggiero R. , De Bellis A. , Caiazzo P. , De Bellis M.
Published: April 2015

This study aimed to establish the possible role of magnetic resonance myelography in degenerative spinal disease. A high magnetic field strength MR system is required for this technique with a high slew rate and expertise in standard MR techniques. MR myelography is obtained by a strongly T2-weighted TSE sequence with suppression of the signal from stationary tissues and adipose tissue. The data obtained are processed using the MIP algorithm. Between April 2004 and July 2006, 278 patients were examined. Of these, 47 were negative, 210 had herniated discs, 16 had tumours, four had synovial cysts and one had traumatic cervical nerve root avulsion. 163 patients with degenerative disease underwent surgery which confirmed the MR examination with the myelographic sequence. Our findings show that MR myelography is useful in neuroradiological diagnosis, namely in patients lacking exhaustive CT or MR documentation of their severe clinical symptoms.
Double Stenting Procedure and Coil Embolization in a Patient with Carotid Stenosis and Incidental Ipsilateral Intracranial Aneurysm
Authors: Thyrion F. Zappoli , Azzaretti A. , Di Maria F. , Saluzzo C. Massa , Quaretti P. , Rodolico G. , Scagnelli P. , D'ercole L. , Mantovani L. , Bocchiola M.
Published: April 2015

We describe a case of incidental detection of an intracranial left ICA wide-necked aneurysm during digital subtraction angiography performed to assess a sub-occlusive and calcified stenosis in the extracranial portion of the same artery. Angioplasty and stenting of ICA stenosis, plus intracranial stent deployment across the aneurysm neck was performed during the same procedure. Aneurysm coil embolization was postponed to a further session one month later. The radiation dose and irradiated areas were also evaluated during endovascular procedures.
Craniospinal Involvement in a Patient with Isolated Bone Marrow Mastocytosis
Authors: Bulakbasi N. , Kocaoglu M. , Karademir I. , Ustunsoz B.
Published: April 2015

Central nervous system involvement in systemic mastocytosis (SM) is very rare. This case report describes the computed tomography and magnetic resonance (MR) imaging findings of central nervous system involvement in a patient with isolated bone marrow mastocystosis. Bone marrow infiltration in SM caused cranial nerve dysfunction and meningeal irritation secondary to narrowing of cranial apertures and meningeal involvement, respectively. MR imaging is the modality of choice in both detection and follow-up of SM and also useful for differential diagnosis and detection of complications.