bluuebunny/crossref_metadata_2025 huggingface dataset:
Individually Fitted Hearing Aid Device Manufactured Using Rapid Prototyping Based on Ear CT
Authors: Chrzan R. , Miechowicz S. , Urbanik A. , Markowska O. , Kudasik T.
Published: April 2015

Rapid prototyping is the technology of automatic freeform fabrication of physical objects from virtual CAD (computer aided design) models. For medical objects the models may be created using data from CT, MR or rotational angiography. We descriobe the case of a 83-year-old woman with essential bilateral hearing impairment as the effect of chronic otitis media. An individually fitted hearing aid was produced for the patient using stereolithography technology and vacuum casting based on data obtained during ear CT. Rapid prototyping may help in manufacturing individually adjusted biomedical prostheses, reducing the time of device production and improving its fitting.
CT Angiography Covering Both Cervical and Cerebral Arteries on a 16-Detector Row System: Modification of Contrast Dose and Injection Rate by Patient Weight
Authors: Imai M. , Tsuchiya K. , Yoshida M. , Nitatori T.
Published: April 2015

We assessed the feasibility of modifying the contrast dose and injection rate based on patient weight in four patient groups in whom CT angiography was performed with contrast agent 350 mgI/mL at different injection doses in combination with a saline flush (40 mL). Patients were assigned to one of four groups: group A: injection dose (ID) of 1.3 mgI/kg; group B: ID of 1.1 mgI/kg; group C: ID of 0.9 mgI/kg; and group D (the control group): a fixed dose of 75 mL at 3 mL/s (25 s). In groups A to C, the injection time was fixed at 20 s. We measured the attenuation of target vessels and visually assessed the images obtained. The average dose and rates were 81.3/4.1, 63.8/3.2, and 49.4/2.5 (mL/mL/s) for groups A, B, and C, respectively. The doses of groups B and C were significantly smaller that that of group D. Cerebral vessels showed no significant attenuation difference between group D and groups A and B, but the attenuation of only a few assessed regions was significantly lower in group C than in group D. In the visual assessment, no difference was found among the four groups. Cervical and cerebral CT angiograms can be obtained at a dose of 1.1 mgI/kg, which can effectively reduce the contrast dose.
Ruptured “Occult” Aneurysm Disclosed by Three-Dimensional Angiographic Reconstructions
Authors: Dall'Olio M. , Princiotta C. , Leonardi M.
Published: April 2015

Rotational angiographic sequences and their three-dimensional reconstructions have led to major improvements in angiographic diagnostics, especially in the study of brain aneurysms. Reconstructions accurately depict the morphology of the aneurysm, namely any wall irregularities and the possible origin of arterial branches from the aneurysmal sac, and display the aneurysm on multiple spatial planes, measuring its different diameters and ratios (particularly the dome to neck ratio). Lastly, three-dimensional angiographic reconstructions will sometimes disclose ruptured or intact aneurysms not depicted by digital subtraction angiography. A 43-year-old woman was admitted to the emergency room of Maggiore Hospital, Bologna Local Health Trust, presenting severe headache, confusion and nuchal rigidity. Emergency CT scan disclosed cisternal subarachnoid haemorrhage. Subsequent 3D sequences revealed an aneurysm of the left carotid artery siphon. This occult aneurysm found in our patient had been masked by the overlying infundibular origin of the posterior communicating artery. This prevented detection of the lesion not only in standard oblique anteroposterior, craniocaudal and lateral sequences but also in the rotational sequence. Identification of the aneurysm in our patient was the result of the diagnostic strategy adopted. When cisternal subarachnoid haemorrhage is detected, our protocol routinely includes a rotational angiographic sequence centred on the anterior circulation and on the posterior circulation when the standard examination fails to depict the course of all the vessels or when the features of subarachnoid haemorrhage strongly suggest aneurysm rupture in that anatomical location. Three-dimensional angiographic reconstructions are extremely useful not only to characterize brain aneurysms, but also to disclose ruptured occult aneurysms and additional zero grade lesions.
Refractures in Cemented Vertebrae after Percutaneous Vertebroplasty and Pain Relief after a Second Procedure: A Retrospective Analysis
Authors: Summa A. , Crisi G. , Cerasti D. , Ventura E. , Menozzi R. , Ormitti F.
Published: April 2015

Refractures of cemented vertebrae occasionally occur after vertebroplasty. It is unclear whether such fractures are procedure-related or part of the natural course of osteoporosis and neoplasy. Our aim was to identify why there is an increased risk of subsequent fracture in cemented vertebrae. We retrospectively analyzed the incidence and possible causative mechanism of refracture in patients who had received vertebroplasty for multiple levels of vertebral compression fracture and the reduction of pain after a subsequent vertebroplasty procedure. A total of 356 patients were evaluated with follow-up from June 2003 to September 2008. We identified 59 refractured patients (54 osteoporotic and four neoplastic). Refractures of cemented vertebrae after vertebroplasty occurred in 59 patients (16%: 98% osteoporotic and 2% neoplastic). Refractures occurred in 8% at the same level as the first vetebroplasty, 31% at an inferior level, 19% at a superior level, 41% at superior and inferior levels and 1% at superior and same levels. Pain was significantly reduced after retreatment in 45 patients (76%) with a moderate reduction in 14 patients (24 %). In conclusion, significant anterior vertebral height restoration increases the risk of subsequent fracture in cemented vertebrae.
Differentiation between Supratentorial Single Brain Metastases and High Grade Astrocytic Tumors: An Evaluation of Different DSC MRI Measurements
Authors: Zhang H. , Rödiger L.A. , Zhang G. , Oudkerk M.
Published: April 2015

This study evaluated the role of different perfusion MRI measurements in the pre-operative differentiation between single brain metastases and high grade astrocytic tumors. 24 high-grade astrocytic tumors and 29 single metastases were studied. A gradient echo-planar sequence was used for DSC MRI. Relative cerebral blood volume, cerebral blood flow and mean transit time in both tumor parenchyma (T rCBV, T rCBF and T rMTT) and peritumoral edema (P rCBV, P rCBF and P rMTT) were measured. Mann-Whitney tests were used to assess differences between single brain metastases and high grade astrocytic tumors. Receiver operating characteristic analyses were performed to determine optimum thresholds for tumor differentiation. Sensitivity, specificity and accuracy for identifying brain metastases were calculated. Mean T rCBV, T rCBF, P rCBV and P CBF of brain metastases (2.75±1.72, 2.51±2.09, 1.05±0.53, 0.87±0.40) differed statistically (P <0.05) from those of high grade astrocytic tumors (6.00±2.17, 5.68±2.35, 1.77±1.19 and 1.58±0.99). No statistical difference was found between mean rMTTs of these two entities (P >0.05). Based on the area under the ROC curves (AUC), the efficiency of T rCBV and T rCBF for correct diagnosis of brain metastases is almost identical (AUC: 0.899, 0.890 respectively) and superior to other measurements. A threshold value of 3.50 for T rCBF provided the same specificity (86.7) as that of T rCBV but higher sensitivity (86.2) and accuracy (86.3). Different perfusion measurements can be used to differentiate single metastases from high-grade astrocytic tumors. T rCBF showed the highest diagnostic efficiency among these measurements.
Imaging Findings of Cavernous Sinus Hemangiomas
Authors: Diamantopoulou A. , Kotziamani N. , Tsitouridis I.
Published: April 2015

Extra-axial cavernous sinus hemangiomas are rare and account for less than 1% of parasellar tumors. These lesions have characteristic radiological features but the differential diagnosis from parasellar meningiomas and schwannomas can be difficult. Preoperative diagnosis is important due to the risk of severe intraoperative bleeding and the complex neurovascular structures of the cavernous sinus. We describe two cases of cavernous sinus hemangiomas and review the imaging findings of these lesions.
Meningocerebral Angiodysplasia: Post-Mortem Magnetic Resonance Imaging and Autopsy
Authors: Vaněčková M. , Seidl Z. , Goldova B. , Vitkova I. , Baxova A. , Calda P.
Published: April 2015

This case report describes a finding of vascular malformation of an aborted foetus of gestational age of the 22nd week. This concerns meningocerebral angiodysplasia, located in the posterior fossa and around the thalami. This disease is rare and is often accompanied by renal agenesis. The finding was complicated by hydrocephalus. Our report compares all three diagnostic methods (prenatal ultrasonography, post-mortem MR and autopsy). Prenatal ultrasonography described only hydrocephalus and reduction of cerebral parenchyma. MR displayed the extent of the malformation, the exact diagnosis was however determined by histological examination. MR described agenesis of structures of midbrain, which was confirmed by autopsy.
Typical Radiological Findings of Lipoid Proteinosis of Urbach and Wiethe
Authors: Srinivasan K.G. , Ramprabananth S. , Srividya S. , Ushanandhini K.P.
Published: April 2015

Lipoid proteinosis is a rare autosomal recessive dermatosis, which can be congenital or have onset in infancy. It is characterized by the progressive deposition of an amorphous hyaline substance with a glycoprotein constitution in the skin and mucous membranes and presents as papular lesions that can aggregate forming plaques with a yellowish discoloration. We present a case of lipoid proteinosis in a seven-year-old boy where characteristic calcifications in the medial temporal lobe helped in early initiation of treatment.
Diastematomyelia in Adults
Authors: Callari G. , Arrigo A.
Published: April 2015

We describe two cases of incidentally discovered split cord malformations in adults undergoing MR for symptoms unrelated to that malformation. Case 1 is an 80-year-old woman with pain due to a D7 and D8 vertebral body compression fracture resistant to medical treatment where we performed D7 and D8 percutaneous vertebroplasty with no complications and satisfactory pain control. Case 2 is a 59-year-old woman with L5 radiculopathy due to L5-S1 spondilolysthesis who had a satisfactory pain relief under medical treatment. The implementation and worldwide diffusion of MR revealed that diastematomyelia, split cord malformations traditionally seen in children, may be less rare than we thought in adults and can remain asymptomatic.
3T MRI in the Evaluation of Brain Aneurysms Treated with Flow-Diverting Stents: Preliminary Experience
Authors: Toni F. , Marliani A.F. , Cirillo L. , Battaglia S. , Princiotta C. , Dall'Olio M. , Simonetti L. , Leonardi M.
Published: April 2015

Deployment of stents across the neck of intracranial aneurysms to isolate the lesion from the circulation is a recently introduced endovascular treatment. These devices are known as flow-diverting stents because the stent mesh design drastically slows the blood flow within the aneurysm sac, thereby stimulating thrombus formation. Treated aneurysms require close follow-up monitoring using an effective minimally invasive method. We devised a dedicated follow-up protocol using a high field strength magnetic resonance system (MR) with gadolinium administration to monitor 11 patients treated by insertion of flow-diverting stents. Findings were compared with the results of a reference imaging procedure (CT angiography). MR accurately demonstrated patency of the stent lumen and monitored the evolution of the aneurysmal sac in all patients. Gadolinium administration proved essential in two patients to depict the complete exclusion of the flow within the aneurysmal sac.
Classification of Spinal Vascular Malformations
Authors: Krings T. , Lasjaunias P.L. , Geibprasert S. , Hans F.J. , Thron A.K. , TerBrugge K.G. , Reinges M.H.T.
Published: April 2015

Spinal vascular malformations are rare diseases with a wide variety of neurological presentations. Their classification depends on the differentiation of shunting versus non-shunting lesions, the latter being the spinal cord cavernomas. In the shunting lesions, the next step in the proposed classification scheme is related to the feeding artery which can subdivide the dural vascular shunts from the pial vascular malformations: while those shunts that are fed by radiculomeningeal arteries (i.e. the counterparts of meningeal arteries in the brain) constitute the dural arteriovenous fistulas, the shunts that are fed by arteries that would normally supply the spinal cord (i.e. the radiculomedullary and radiculopial arteries) are the pial cord arteriovenous malformations (whose cranial counterparts are the brain AVMs). Depending on the type of transition between artery and vein the latter pial AVMs can be further subdivided into glomerular (plexiforme or nidus-type) AVMs with a network of intervening vessels in between the artery and vein and the fistulous pial AVMs. The last step in the classification then describes whether the type of fistula has a high or a low shunting volume which will differentiate the “Macro-” from the “Micro-”fistulae. The proposed classification is therefore based on a stepwise analysis of the shunt including its arterial anatomy, its nidus-architecture and its flow-volume evaluation. The major advantage of this approach is that it leads to a subclassification with direct implications on the choice of treatment, thereby constituting a simple and practical approach to evaluate these rare diseases.
Basilar Dependence on a Persistent Hypoglossal Artery Visualized at CT Angiography
Authors: Summa A. , Crisi G. , Ventura E. , Cerasti D. , Ormitti F. , Menozzi R.
Published: April 2015

The persistent hypoglossal artery is a rare perseverance of an embryonic vessel connecting the anterior and posterior circulations and is generally considered an incidental finding. This report describes a patient with a basilar dependence on a persistent hypoglossal artery visualized at CT angiography. The pertinent findings and clinical implications of this anomalous vessel are discussed.
Brain SPECT and Neuropsychological Examination in Patients with a History of Minor Craniocerebral Trauma Nine Years after Head Injury
Authors: Dawid S. , Marks W. , Lasek J. , Witkowski Z. , Gołąbek-Dropiewska K. , Sitek E.J. , Wieczorek D. , Brockhuis B. , Lass P.
Published: April 2015

Focal perfusion deficits disclosed by single photon emission computerized tomography (SPECT) show more diffuse brain dysfunction than computed tomography (CT) examinations in case of head trauma. The aim of the study was to evaluate SPECT as an enhancing and complementary diagnostic method in patients after minor craniocerebral trauma (mCCT) and establish a possible correlation between clinical symptoms and disturbances of cerebral blood flow (CBF). SPECT examination and neuropsychological assessment was performed in seven patients about nine years after head injury, scoring 13–15 points on the Glasgow COMA SCALE and without evidence of structural brain damage. Neuropsychological assessment addressed global cognitive status, verbal and visual memory, working memory, object and space perception, executive function, self-assessment of memory, mood and health-related complaints. A direct relationship was shown between mCCT and the observed CBF disorders, and between the CBF disorders and cognitive dysfunction. Because of its sensitivity, SPECT, should be regarded as a method complementary to CT in mCCT.
Clinical Recovery despite Cortical Cerebral and Cerebellar Damage in Heat Stroke
Authors: De Cori S. , Biancofiore G. , Bindi L. , Cosottini M. , Pesaresi I. , Murri L. , Mascalchi M.
Published: April 2015

The prognosis of heat stroke has considerably improved with a mortality rate drop to 10% when therapeutic measurements including external cooling and aggressive rehydration are adopted. The role of imaging in predicting prognosis is uncertain. Some noted that development of cortical cerebellar atrophy is associated with development of a pancerebellar syndrome, while others suggested that evidence of cerebral cortical damage due to hypoxic-ischemic injury implies a poor prognosis. We observed a 17-year-old female who presented with lost of consciousness and seizure while jogging on a hot summer day followed by multi-organ failure. Brain MRI revealed a symmetric area of T2 hyperintensity and decreased diffusion in the cortical gyri of the frontal lobes. The patient made a complete recovery. MRI two years later showed disappearance of signal changes in the frontal cortex, but progressive atrophy of the cerebellum which was clinically silent. Our observation challenges the view of a close correlation between the imaging findings and prognosis in heat stroke.
Transient Bilateral Basal Ganglia Lesions in Rotavirus Encephalopathy
Authors: Messina M. , Meli G.A. , Viglianesi A. , Scavone G. , Belfiore G. , Di Bella D.
Published: April 2015

Rotavirus gastroenteritis may be associated with the onset of an acute reversible encephalitis. We describe a case of transient bilateral basal ganglia lesions after a prodromal gastroenteritis which completely resolved four months later. Diffusion weighted images were determinant to depict the basal ganglia abnormalities and were helpful to evaluate the prognosis. A review of the literature indicates that many diseases may be accompanied by signal abnormalities within the basal ganglia and that differential diagnosis is possible only through the simultaneous evaluation of imaging, clinical and laboratory findings.
Multiple Cerebral Aneurysms Associated with Atrial Myxoma
Authors: De Marco A. , La Tessa G. , De Falco A. , De Falco F.A. , Merola A. , Sirabella G.
Published: April 2015

Cardiac myxoma is a tumor of mesenchymal origin accounting for half of all primary cardiac neoplasms. Intracranial involvement by atrial myxoma is a rare cause of neurologic deficit. When the myxoma arises in the left atrium, systemic emboli from a cardiac myxoma can lead to infarction, cerebral hemorrhage and aneurysm formation. In the light of the potentially preventable nature of these lesions, the diagnosis of myxomatous aneurysms should be considered in any patient with neurologic symptoms and a history of cardiac myxoma. Because aneurysms are often stable over several years, conservative management with careful clinical and radiological follow-up with MRI and angiography seems sensible. We describe a case in which MR imaging and angiography were used to diagnose multiple cerebral aneurysms caused by left atrial myxoma.
Spontaneous Spinal Epidural Haematoma
Authors: Rispoli R. , Mastrostefano R.
Published: April 2015

Spinal epidural haematomas are infrequent events caused mainly by trauma or are iatrogenic following invasive spinal procedures (lumbar puncture, surgery or peridural anaesthesia). Spontaneous spinal epidural haematoma is a rare entity requiring emergency intervention in most cases. The incidence is estimated at about two to six cases per year. Early recognition, accurate diagnosis and rapid treatment may result in decreased morbidity and improved outcome. Here, we describe the case of a 60-year-old man who presented sudden paraplegia. Magnetic resonance imaging of thoracolumbar spine demonstrated an epidural mass extending from T11 to L1, causing spinal cord compression. Emergent decompressive surgery was performed and the patient had a significant improvement of neurologic deficits.
Sudden Sensorineural Hearing Loss: MR Imaging
Authors: Canapicchi R. , De Marchi D. , Lombardo F. , Fortunato S. , De Cori S. , Montanaro D. , Berrettini S.
Published: April 2015

Hearing loss greater than 30 dB over three contiguous pure-tone frequencies occurring within a three day period is defined as sudden hearing loss. It is usually sensorineural (SSNHL), unilateral and appears as an otologic emergency. SSNHL has many possibile etiologies such as: labyrinthine viral infection, ischemic or hemorrhagic illness, trauma, immuno-mediated inner ear disease, tumor, inner ear malformation, and an imbalance between perilymphatic and endolymphatic fluid pressure. Nevertheless in almost 80% of cases SSNHL belongs to the idiopathic category because the etiology is unknown. The aim of this study was to test the diagnostic impact of two MR devices. Fifteen cases of SSNHL studied with a 1.5 T unit in our hospital between January 2006 and December 2008 within two weeks of the onset were retrospectively evaluated. Since January 2009 three more patients affected by SSNHL have been scanned with a 3T MR unit. We discuss the diagnostic sensitivity, clinical usefulness and the cost-benefit ratio of the MR systems.
Diffusion Tensor MR Imaging Tractography of the Pyramidal Tracts and Corpus Callosum in Children with Right-Sided Congenital Hemiparesis
Authors: Ormitti F. , Ventura E. , Summa A. , Pisani F. , Cantalupo G. , Squarcia A. , Cerasti D. , Crisi G.
Published: April 2015

This study used diffusion tensor tractography to evaluate the diffusion parameters of the corpsus callosum and asymmetry in the diffusion parameters of the corticospinal tracts in children with congenital hemiparesis. Precision moving critically correlates with the integrity of the pyramidal tracts as evidenced in congenital hemiparesis by the correlation found between corticospinal lesions and motor deficits. Therefore we hypothesize that diffusion parameters correlate with the severity of hemiparesis measured using the Bayley Scales of Infant Development.
Deep Sedation in Paediatric MR: A Review of Our Case Histories
Authors: Zanchi A. , Sticchi G. , Musaio M. , Torsello P. , Pauciulo A. , Lupo F.A. , Caione R.
Published: April 2015

Sedation in paediatric MR is a necessary choice because very often we are dealing with uncooperative patients about to undergo lengthy examinations. The aim of this a retrospective study is to demonstrate that profound sedation with halogenated vapour Sevorane, together with specific systems for monitoring vital signs, is a safe and reliable technique. In accordance with current guidelines, it is considered essential to have an expert anaesthetist present in order to reduce the risk of incidents, which, in the case of difficulty in the airways, as seen in literature, could have fatal outcomes.
Stenting and Coil Embolization of a Ruptured Dissecting Basilar Artery Aneurysm Associated with Coil Embolization of a Pericallosal Artery Aneurysm
Authors: Lazzarotti G.A. , Cosottini M. , Puglioli M.
Published: April 2015

We describe the case of a 54-year-old woman who underwent endovascular treatment in the setting of a massive subarachnoid haemorrhage due to rupture of a dissecting basilar trunk aneurysm treated with stent implantation and coiling. A further saccular aneurysm in the left pericallosal artery disclosed by four-vessel angiography was treated with coiling during the same procedure. Follow-up DSA performed after six months confirmed complete occlusion of both aneurysms and patency of the stent.
Combined Treatment with Stenting and Coiling for Complex Cerebral Aneurysms: Preliminary Experience of Twenty Aneurysms Treated by New Generation Intracranial Stents
Authors: Ambrosanio G. , Vassallo P. , Guarnieri G. , Granato F. , Muto M.
Published: April 2015

We describe our preliminary experience of a combined treatment with stenting and coiling for ruptured and unruptured complex cerebral aneurysms (AA) using new generation stents (Enterprise®, LeoPlus®, Solitaire®). Eighteen patients, 20 AA, were treated by stenting and coiling. Some had sacciform wide-necked partially thrombosed aneurysms, other had fusiform AA. Six ruptured AA were treated early, while the other 14 were treated electively. In four out of 20 AA coiling was performed by Jailing technique and in three cases a remodelling technique was also performed. Patients with ruptured AA were previously administered a heparin protocol during the procedure and given aspirin (500 mg) after stenting. Patients with unruptured AA were administered plavix and aspirin for seven days before the procedure. Post-intervention medical therapy was plavix and aspirin for six months, then aspirin (100 mg). MRA and DSA at were performed after six to 12 months. Treatment was successfully performed in all cases. The stent could be navigated within the cerebral arteries without any exchange procedure, and thanks to its retractability, it was positioned accurately. No procedure-related complication occurred. Complete occlusion of the aneurysm was observed in 14/20 AA, partial occlusion with residual sac in 2/20. At four months a residual neck was observed in 4/20 with an increase in residual sac at one year in one case treated by coiling. At one year, MRA showed a reduction of the neck in one case and a stable residual neck in the other. Stenting and coiling for sacciform wide-necked or fusiform aneurysms is a safe procedure without complications. Medical-therapy pre and post procedure associated with follow-up are necessary to establish the occlusion rate.
Intradiscal and Intramuscular Injection of Discogel® — Radiopaque Gelified Ethanol: Pathological Evaluation
Authors: Guarnieri G. , De Dominicis G. , Muto M.
Published: April 2015

This study assessed the impact and modification of intradiscal, intraforaminal, epidural and intramuscular swine injection of a new material, Discogel®- radiopaque gelified ethanol-recently introduced for the mini-invasive treatment of herniated disc. Discogel® is a sterile viscous solution containing ethyl alcohol, cellulose derivative product, added to a radio-opaque element, tungsten. The pig was sedated and under fluoroscopy guidance a needle was positioned within disc L1-L2 followed by intradiscal, intraforaminal, epidural and intramuscular injection of 1 ml of Discogel. As disc control level L4-L5 was considered where nothing was injected. The pig was sacrifed 48 h after injection of discogel and the spine from D10 to S1 was removed and fixed in 10% buffered formalin. The anatomical specimens were cut with an electric saw and analyzed by routine technique then stained with formalin. The specimens containing bone material were treated by DEKAL solution. The specimens were stained with hematoxylin-eosin method and then analyzed by histochemical (Masson — Van Gieson PAS and trichromic stains) and immunochemical methods. Morphostructural examination disclosed a granular material coloured black by hematoxylin-eosin method (tungsten) in paravertebral tissue both in the muscular and connective tissue. Some inflammatory elements like lymphomonocyte cells and venous stasis were found. No alteration was found where discogel was injected, and the nucleus pulposus, disc, chondromixoid and root ganglium were normal. After intradiscal, intraforaminal, epidural and intramuscular injection of Discogel® no morpho-structural changes in nuclear tissue and annulus were found. Further studies on pigs with immunohistochemical analysis after treatment will confirm the morphological alterations induced by discogel and its action.
Diffuse Axonal Injury: CT Findings and Clinical Profiles in Six Consecutive Cases
Authors: Moschnegootz S. , Ushakov A. , Gatin D. , Shalyakin K. , Rokhlenko O.
Published: April 2015

Diffuse axonal injury is a relatively rare type of brain trauma when prolonged coma with generally poor clinical outcome is often associated with negative neuroimaging findings. Although magnetic resonance imaging is the method of choice for evaluation of diffuse axonal injury, computed tomography still plays an important role as an emergency visualization modality. We compared computed tomography findings with clinical data, short and medium-term outcomes and, if available, autopsy results of six consecutive patients admitted to our hospital during the year of 2009. We found that corpus callosum lesions were most closely associated with diffuse axonal injury, followed by subdural hematoma or hygroma.
Diffuse Axonal Injury: A Brief Review and Examples of the Use of Neurofunctional Imaging (Tc-99m HMPAO SPECT) in Diagnosis and Follow-up
Authors: Gołąbek-Dropiewska K. , Marks W. , Brockhuis B. , Lass P. , Wieczorek D. , Zapaśnik A. , Lasek J. , Witkowski Z. , Dawid S.
Published: April 2015

Diffuse axonal injury (DAI) is a growing problem nowadays as its social and economic costs amount to millions of dollars. DAI is now thought to be the predominant mechanism of injury in almost half the cases of traumatic brain injury connected with loss of consciousness. Computed tomography and magnetic resonance imaging are substantial techniques to diagnose DAI but they have their limitations. Neuropsychological tests used in follow-up disclose persistent disabilities in patients with total regression of CT and MRI changes. In those situations SPECT is appropriate as it shows lesions not disclosed by other imaging techniques. This article describes two cases in which usefulness of SPECT has been proved. A brief review of DAI has been included.
Bilateral Hippocampal DWI Lesions in Transient Global Amnesia
Authors: Crisi G.
Published: April 2015

Transient global amnesia (TGA) is characterized by anterograde memory disturbance of sudden onset that lasts for 1 to 24 hours. The etiology and pathogenesis of TGA are still uncertain, although an hypoxic-ischemic origin has been recently suggested on the basis of infarct-like diffusion-weighted imaging (DWI) lesions in the hippocampus of some affected individuals. Recent diffusion-weighted imaging (DWI) studies have indicated the presence of focal hyperintensities involving the hippocampus in TGA patients. These lesions detected by DWI, which peak at 48 to 72 hours, are small and punctate (1–3 mm) and in most studies are reported as unilateral. We describe one TGA patient with high signal-intensity lesions in the bilateral hippocampus on DWI at the acute stage. The mechanisms related to the pathophysiology are discussed with emphasis on the hypoxic-ischemic origin underlying the observation of infarct-like diffusion-weighted imaging (DWI) abnormalities.
Endovascular Embolization for Deep Basal Ganglia Arteriovenous Malformations
Authors: Sun Y. , Lv X. , Li Y. , Jiang C. , Wu Z. , Li A.M.
Published: April 2015

We report our experience with basal ganglia AVM embolization and clinical outcomes after embolization. We retrospectively evaluated consecutive 15 patients with AVMs in the basal ganglia with respect to the endovascular treatment of these lesions. Treatment consisted of embolization and radiosurgery in combination. The angiographic follow-up after the last management was 24–36 months (mean 27 months). Clinical follow-up monitoring (range, 24–120 months, mean 76 months) was measured by the Modified Rankin Scale (mRS). The 15 patients studied had a mean age of 25.1 years at diagnosis, and 33.3% were male. Intracranial hemorrhage (ICH) was the event leading to clinical detection in eight patients (53.3%), and 85.5% of these patients were left with hemiparesis. At presentation, eight (53.3%) patients bled a total of 11 times. Twenty-four embolization procedures (16 pedicles embolized) were performed in 15 patients with embolization as the adjunct to radiosurgery. There were three clinically significant complications. Excellent or good outcomes (mRS≤2) were observed in 13 (86.7%) patients. Unfavorable outcomes (mRS≤2) were 13.3% at follow-up, without mortality. Seven (46.7%) patients had complete AVM obliteration at follow-up. The risk of incurring a neurological deficit with basal ganglia AVM is high. Treatment of these patients is endovascular embolization with a combination of radiosurgery to prevent neurological injury from a spontaneous ICH.
An Unusual Case of Coil Migration
Authors: Cherian M. , Mehta P. , Hedgire S. , Kalyanpur T.
Published: April 2015

Migration of endovascular coils from aneurysms has been reported in the past. However, we report a case where the entire coil mass migrated out of the aneurysm into the anterior cerebral artery with associated doubling of aneurysm diameter in the intervening two weeks period post-coiling.
A High CSF Signal on FLAIR: It is Not Always Blood
Authors: Goericke S.L. , Schlamann M. , Hagenacker T. , Gartzen K. , Wanke I. , Forsting M.
Published: April 2015

We describe a patient with progressive neurologic deficit due to middle cerebral branch occlusion. Temporary partial balloon occlusion of the abdominal aorta led to an increased signal in the subarachnoid space on fluid-attenuated inversion recovery images with no evidence of subarachnoid hemorrhage. After spontaneous recanalization, the increased signal of the subarachnoid space returned to normal. We assume that signal changes in the subarachnoid space were due to a temporary increase in blood volume in the superficial brain vessels.
Non-von Hippel-Lindau Hemangioblastoma in the Hippocampus: Characterization with Time-Resolved MRA Using TRICKS Sequence at 3T
Authors: Crisi G. , Giombelli E. , Ventura E.
Published: April 2015

Supratentorial hemangioblastomas (HBs) are exceedingly rare tumors accounting for 5%-10% of all HBs and usually present in the setting of von Hippel-Lindau (VHL) disease. Isolated HBs of the central nervous system also occur as a result of spontaneous mutation in the absence of any clinical manifestations of VHL disease. Of 13 temporal lobe HBs, only one non-VHL case was reported in the hippocampus. We describe the TRICKS findings in a case of isolated hemangioblastoma in the hippocampus without VHL disease. To our knowledge, this is the second case report of a hippocampal non-VHL hemangioblastoma.
Spontaneous Resolution of Eosinophilic Granuloma in a Patient with a Psychotic Disorder
Authors: Conforti R. , Porto A. , Cirillo M. , Sgambato A. , Galderisi S. , Cirillo S.
Published: April 2015

A 16-year-old female who manifested psychotic symptoms underwent CT and MRI for the evaluation of an incidentally discovered asymptomatic palpable mass of the right occipital region of the skull. The correlation between clinical and radiological data and biopsy data led to the diagnosis of eosinophilic granuloma. The radiological finding is discussed and reviewed in relation to clinical aspects and literature data.
Crossed Cerebellar Atrophy
Authors: Goswami P. , Das R.R. , Medhi N. , Sarma P.K.
Published: April 2015

Crossed cerebellar atrophy is an uncommon sequelae of contralateral cerebral hemispheric lesion. This condition has been described in patients with supratentorial infarct, tumor, arteriovenous malformation and hemorrhage. Crossed cerebellar atrophy possibly occurs due to interruption of the corticopontocerebellar pathway at supratentorial level.
Giant Vertebrobasilar Aneurysm Treated with Bilateral Vertebral Artery Occlusion
Authors: Liu L. , He H. , Li Y. , Jiang C. , Wu Z.
Published: April 2015

Giant vertebrobasilar aneurysms constitute a relatively uncommon subgroup of aneurysms with a high mortality rate. These aneurysms are often difficult to treat with conventional clipping or coiling because of their location and their morphology. Here we describe two patients with giant vertebrobasilar aneurysms, both of which were successfully treated with bilateral vertebral artery occlusion. This approach is suggested as a definitive treatment for vertebrobasilar aneurysms in appropriate circumstances.
Endovascular Treatment of Cerebral Arteriovenous Malformation Bleeding during Pregnancy
Authors: Granata F. , Alafaci C. , Giacobbe A. , De Vivo A. , Mancuso A. , Conti A. , Pontoriero A. , Pitrone A. , Longo M.
Published: April 2015

Cerebral arteriovenous malformations (AVMs) represent congenital anomalies of blood vessels composed of a nidus of anomalous arterial and venous vessels without a capillary network. We describe a case of bleeding cerebral AVM in a pregnant women at the second quarter of gestation and diagnosed by digital subtraction angiography showing a large principal arterial nidus supply. The AVM was treated by endovascular embolization at the 27th week of gestation. The post-operative course was uneventful and a caesarean section was performed at the 37th week of gestation. The endovascular approach may represent a safe method in the treatment of this cerebral condition during pregnancy.
Endovascular Embolization of Intracranial Iatrogenic Pseudoaneurysms
Authors: Hjortoe S. , Wagner A. , Cortsen M.
Published: April 2015

Iatrogenic pseudoaneurysm is a rare but severe complication of intracranial surgery. Treatment of the condition is difficult. The purpose of this report is to draw attention to the fact that endovascular embolization of pseudoaneurysms with parent artery preservation is possible. We describe two cases of endovascular embolization and review the literature. The conclusion is that endovascular treatment can be safe and curative.
Involvement of the Choroid Plexus in Neurotuberculosis: MR Findings in Six Cases
Authors: Bhattacharyya A. , Boruah D.K. , Handique A. , Singh V. , Kalita J. , Misra U.K. , Phadke R.V. Vishnu
Published: April 2015

The majority of intracranial infections that cause meningitis are considered to start in the choroid plexus of the ventricles, but lesions involving the choroid plexus are rare. There are isolated case reports of the involvement of choroid plexus in tuberculous meningitis. The main imaging findings are abnormal enhancement of the thickened choroid plexus, asymmetric hydrocephalus with sequestrated temporal horn, periventricular edema and intraventricular septae formation. Six patients having tubercular involvement of choroid plexus were treated at our institution. This is probably the largest series of tubercular involvement of choroid plexus highlighting the imaging features of this rare manifestation of CNS tuberculosis.
Follow-up Outcomes of Self-Expanding Stents for Carotid Artery Angioplasty at a Single Hospital
Authors: Kawabata Y. , Fumihiko H. , Miyake H. , Ueno Y.
Published: April 2015

Carotid artery angioplasty and stent placement (CASP) is widely accepted as a valuable alternative to carotid endarterectomy, particularly among high-risk patient populations. We analyzed the follow-up data of patients who underwent CASP with self-expanding stents for carotid lesions. Since 2001, self-expanding stents have been deployed in 59 lesions in 56 patients. Forty-seven patients were male, and nine were female. The median age was 73 years, ranging 50 to 83 years. There were 31 asymptomatic lesions and 28 symptomatic lesions. The median follow-up period was 27 months, ranging six to 102 months. All lesions received stents and technical success was achieved in 58 (98.3%) out of 59 lesions. The 30-day transient ischemic attack rate was 8.6%, the stroke rate was 3.4%, and the death rate was 0%. No ischemic attack was observed on the ipsilateral side after 30 days. Recurrent stenosis (>50%) was observed in three patients (5.1%) and in two (3.4%) of these, revascularization was performed. Kaplan-Meier analysis showed that the rates for one year and two year freedom from any stroke or death were 93.1% and 90.9%, respectively. The incidence of recurrent carotid stenosis is acceptably low after CASP. CASP is effective to prevent ipsilateral ischemic stroke in symptomatic and asymptomatic patients.
Clinical Application of Susceptibility Weighted Imaging: Exploring from Routine Service
Authors: Chawalparit O. , Tritrakarn S.-O. , Charnchaowanish P. , Pornpunyawut P. , Chobaroom S.
Published: April 2015

To evaluate the usefulness of susceptibility weighted imaging (SWI) in clinical brain MRI. Retrospective study was performed after approval from institution Ethical Committee. The brain MRIs with SWI were selected from data base of the radiology department. Only cases with no abnormality in extra-axial location were included into the study. Two neuroradiologists revealed the images without knowledge of patients' history and diagnosis. The SWI was first interpreted. Then conventional MRI (cMRI) was interpreted after finishing data collection from SWI. Clinical data and final diagnosis were collected from information given on requested forms and followed up imaging studies. Descriptive analysis was performed. From January 2007 to December 2009, 82 cases were satisfied the inclusion criteria. There were 40 males and 42 females with age 7–79 years old (means = 47.45). The final diagnosis were normal brain imaging 4 cases (4.9%), dementia/atypical Parkinson disease 2 cases (2.4%), cerebrovascular disease 24 cases (29.3%), parenchymal brain tumors 35 cases (42.7%), infection 4 cases (4.9%), multiple sclerosis (MS) 6 cases (7.3%) and inconclusive diagnosis 7 cases (8.5%). The abnormalities found on SWI were related to cMRI in 67 cases (81.7%). Three cases (3.7%) had lesions on SWI not demonstrated on cMRI The information got from SWI added on cMRI for interpretation and diagnosis in 43 cases (52.4%). SWI were shown more detectable microbleed and changing visualization of cortical and transmedullary veins. Microvascular structure inside the mass was demonstrated on SWI in brain tumor group. The increased transmedullary veins on SWI helped to confirm the non-neoplastic lesions. In selected cases with suspected or diagnosis of vascular disease and tumor, SWI added more information on cMRI especially microbleed and microvascular structure.
Developmental Venous Anomalies (DVA): What Are They Really?
Authors: Chong W. , Patel H. , Holt M.
Published: April 2015

Purpose: The aim of this paper is to analyse the pathophysiology of 3 DVA cases from our institution, review the literature and propose a classification of these lesions. Materials & Methods: The pathophysiology of DVAs were analysed with CT perfusion (CTP), 4 dimensional dynamic computed tomography angiography (4D CTA) and catheter digital subtraction angiography. Results: Symptomatic DVAs may be caused by associated lesions and compression of neural structures by the DVAs. The imbalance between the inflow and outflow of these lesions, including venous ischaemia, has also been postulated as a cause. Our analysis showed that increased cerebral blood flow (CBF) and cerebral blood volume (CBV) and decreased mean transit time (MTT) and time to peak (TTP) were found in DVAs with micro arteriovenous shunting. DVAs without shunting had raised MTT and TTP instead. Conclusion: We postulate that the arteriovenous shunting resulted in arterial steal and chronic hypoxia which could be a pathophysiological mechanism for symptomatic DVAs. CTP and 4D CTA are effective non invasive tools to study DVAs. A classification is proposed.
MRI Findings in Patients with Clinical Onset Consistent with Infantile Neuroaxonal Dystrophy (INAD), Literature Review, Clinical and MRI Follow-up
Authors: Bernardi B. , Pini A. , Santucci M. , Cenacchi C. , Garavaglia B. , Ucchino V. , Garrone C. , Guerra A. , Faggioli R. , Barzaghi C. , Preda P. , Franzoni E. , Gobbi G. , Parmeggiani A.
Published: April 2015

Infantile neuroaxonal dystrophy (INAD) is a rare autosomal recessive neurodegenerative disorder characterized by infantile onset and rapid progression of psychomotor regression and hypotonia evolving into spasticity. The neuroradiologic hallmark of the disease is represented by progressive cerebellar atrophy. Prior to the discovery of mutations in the PLA2G6 gene in family with INAD, the clinical diagnosis of the disease had been confirmed by the presence of spheroid bodies (SB) in a peripheral nerve biopsy. Various studies have found that some patients with mutations lacked SB and some without mutations had SB, indicating incomplete detection using either pathologic or molecular methods 7. This, together with the observation that the spectrum of clinical features associated with mutations in PLA2G6 is broader than previously described, has increased the usefulness of Magnetic Resonance (MR) in INAD diagnosis, particularly in the frequent occurrence of atypical cases, especially in the early stages of the disease. We retrospectively reviewed the MR studies of eight patients in whom clinical and imaging onset met the typical criteria for INAD. Their clinical and MR imaging (MRI) onset and follow-up were evaluated together with the neuroradiological findings reported in the literature in order to identify MRI features useful in differentiating INAD from other diseases with similar clinical onset and to discuss which of them are the most important, thus suggesting INAD diagnosis. Our contribution included the use of Proton Spectroscopy (1H-MR), diffusion weighted MR imaging (DWI) and diffusion tensor imaging (DTI) in the follow-up of seven of the eight patients. The literature reviewed included attempts to correlate clinical and MR data with the genotype in the group of patients carrying PLA2G6 mutations. From the limited and inhomogeneous cohort of patients included in our study, a correlation between the MR features, phenotype and genotype was not exhaustive.
Striatal Distribution of Dopamine Transporters and Dopamine D2 Receptors at Different Stages of Parkinson's Disease
Authors: Mishina M. , Ishii K. , Suzuki M. , Kitamura S. , Ishibashi K. , Sakata M. , Oda K. , Hamamoto M. , Kominami S. , Kobayashi S. , Katayama Y. , Ishiwata K.
Published: April 2015

We investigated the alteration of dopaminergic system in striata of Parkinson's disease (PD) at different stages using positron emission tomography (PET), [11C]2β-carbomethoxy-3β-(4-fluorophenyl)tropane (CFT) for dopamine transporter (DAT), and [11C]raclopride (RAC) for dopamine D2 receptor (D2R). We studied eight elderly healthy volunteers (Group A), 13 drug naïve patients with PD (Group B), and seven advanced PD patients with mild dyskinesia (Group D). Six patients in Group B were re-examined after antiparkinsonian therapy (Group C). Regions of interest were drawn on the cerebellar hemisphere, head of the caudate nucleus (CN), and anterior (AP) and posterior putamen (PP) in the PET images. We calculated uptake ratio index (URI), asymmetry index (AI) and presynapse-to-postsynapse ratio (PPR) to evaluate dopaminergic function. DAT was smaller in the three PD groups than the Group A. URI of RAC in the PP was significantly larger in Group B than in Groups A and C. AI of CFT in the putamen was larger in the PD groups than in normal subjects, and AI of RAC in the PP was the largest in the Group B. PPRs in the AP and PP were smaller in the three PD groups than in Group A. DAT decreased with disease progression in patients with PD. Binding of RAC was largest in the putamen of drug-naïve PD patients, but the enhanced binding could not be detected in the therapeutic patients with PD because of weak D2R affinity of RAC.
Superficial Siderosis of the Central Nervous System
Authors: Nunes J. , Gomes B.C. , Veiga R. , Pais R.P. , Garcia M.T.
Published: April 2015

Superficial siderosis of the central nervous system (CNS) is a rare entity characterized by the deposition of hemosiderin in the leptomeninges. In most cases it is caused by chronic and recurrent bleeding into the subarachnoid space as a subclinical form and for long periods of time. The cases described in the literature are associated with tumors, aneurysms, arteriovenous malformations, changes in post-surgical, traumatic cervical and brachial plexus injuries. However, the cause of bleeding is unclear in 40–50% of cases. This report describes the case of a 38-year-old man with a history of trauma with a complete lesion of the left brachial plexus. The patient presented progressively worsening gait imbalance, bilateral deafness, tinnitus and memory loss over two years. Neurological examination disclosed bilateral hearing loss, left upper limb plegia with atrophy of muscle mass, spastic paraparesis with pyramidal signs and gait ataxia. The analytical/genetic study was consistent with hereditary hemochromatosis. In addition to typical findings of siderosis, MR disclosed pseudomeningocele while CT angiography and angiography revealed an aneurysm of the internal carotid artery. Although rare, we should be aware of superficial siderosis especially in imaging studies in patients with deafness or ataxia and in those with lesions of the brachial plexus. The imaging signals are subtle and can easily go unrecognized. The radiological investigation must be extensive to find the primary cause.