bluuebunny/crossref_metadata_2025 huggingface dataset:
L-2 Hydroxyglutaric Aciduria: Magnetization Transfer Contrast and Diffusion Weighted Magnetic Resonance Imaging Findings
Authors: Galluzzi P. , Grosso S. , Cerase A. , Monti L. , Balestri P. , Bellini M. , Venturi C.
Published: April 2015

We describe the case of a 13-year-old male with ù aciduria. Conventional magnetic resonance imaging and diffusion weighted imaging disclosed some previously unreported findings. In particular, we observed an almost total sparing of early myelinated regions, and a restricted diffusion pattern in the dentate nuclei. Magnetization transfer contrast showed a normal range of values in early myelinated regions, and revealed abnormal values in the subcortical temporal white matter, internal capsule and globi palladi.
Spontaneous Temporal Cerebrospinal Fluid Leak
Authors: Caltabiano G.A. , Viglianesi A. , Bellomia D. , Chiaramonte R. , Pero G. , Chiaramonte I.
Published: April 2015

An abnormal communication between the subarachnoid spaces and the tympanic cavity and mastoid cells can determine a cerebrospinal fluid (CSF) leak in the air spaces of the temporal bone. The etiology of CFS leak in the temporal air cells includes acquired, congenital and spontaneous causes. Spontaneous CSF leak, defined as a leak without a manifest cause, is present in about 4% of cases and often occurs in the middle cranial fossa. We describe a case of spontaneous CSF leak in the right temporal air cells that mimicked a skull fracture in a subject with headache and apparent rhinorrhea after a head trauma. Both CT and MRI play a key role in the differential diagnosis between post-traumatic temporal CSF leak due to a fracture and spontaneous leak: traumatic CSF leak often does not require a surgical approach, whereas spontaneous CSF leak may need surgical treatment because of the risk of meningitis.
Cerebral High Grade Glioma with Crossed Cerebellar Metastases: A Report of Three Cases
Authors: Kamble R.B. , Venkataramana N.K. , Shetty R.V. , Naik A.L. , Rao S. , Diwakar N.
Published: April 2015

We describe three patients with high grade supratentorial gliomas who were operated and later presented with cerebellar mass lesions on the opposite side. Supratentorial infarct with crossed cerebellar atrophy is a well-known entity called crossed cerebellar diaschisis. We hypothesize that supratentorial high grade tumours might also spread to the opposite cerebellum through crossed cerebrocerebellar fiber tracts similar to crossed cerebellar diaschisis.
An Unusual Cause of Blepharospasm
Authors: Muda A. Sobri , Kwah Y.G. , Al-Edrus S.A. , Wong S.L. , Norzaini M.Z. , Viswanathan S.
Published: April 2015

We describe a rare case of multiple dilated Virchow-Robin spaces in the brainstem in a patient presenting initially with blepharospasm with subsequent spread to involve the face and neck. On magnetic resonance imaging (MRI), these lesions demonstrated an isointense signal to cerebrospinal fluid on all sequences with no mass effect or enhancement. Although rare, this condition should be considered part of the differential diagnosis when evaluating cystic abnormalities in the brainstem. This is the first reported case of blepharospasm with subsequent orofacial and neck dystonia caused by dilated Virchow-Robin spaces. The imaging findings and differential diagnoses are discussed.
Endovascular Treatment for Complex Intracranial Aneurysms: Lessons Learnt in Five Patients
Authors: Wu Z. , Lv X. , Li Y. , Jiang C. , Yang X.
Published: April 2015

We describe our experience in five cases of endovascular treatment for complex intracranial aneurysms. The senior author (ZW) has clinical experience with more than 6000 cases of brain aneurysms treated with endovascular techniques. Multiple endovascular therapies, such as treatment with Onyx, parent vessel occlusion, stent-assisted coiling, covered stent, can be used in an attempt to provide a solution to various clinical dilemmas associated with the management of these difficult lesions. Here, we focus on the latest five patients and lessons learnt in endovascular techniques for complex intracranial aneurysms. On the basis of the knowledge obtained over the years, multimodality endovascular techniques should be re-evaluated to improve patient outcomes.
Unusual Presentation of Recurrent Pituitary Abscess
Authors: Bladowska J. , Bednarektupikowska G. , Sokolska V. , Czapiga E. , Czapiga B. , Sąsiadek M.
Published: April 2015

Pituitary abscess is a rare pituitary pathology which may be potentially life-threatening if not treated. Therefore, early accurate diagnosis and therapy are extremely important. However, the clinical diagnosis is difficult because there are no clinical symptoms characteristic of pituitary abscess. It is frequently indistinguishable clinically or with neuroimaging studies from other pituitary lesions. The MR diagnosis of pituitary abscess must be suspected in cases of sellar cystic mass with a peripheral rim enhancement after contrast administration. It must be highlighted that pituitary abscess may show various signal intensity on T1-weighted images, as in our case, making the diagnosis even more difficult. We report an unusual case of a 66-year-old woman who presented with a recurrent pituitary abscess, initially misdiagnosed as a pituitary adenoma because of its high signal intensity on T1-weighted images. The woman was operated on three times, using transsphenoidal access with a good final outcome.
Vertebral Aggressive Hemangioma
Authors: Bellomia D. , Viglianesi A. , Messina M. , Caltabiano G.A. , Chiaramonte R. , Pero G. , Chiaramonte I.
Published: April 2015

Aggressive hemangiomas are rare and can compress the spinal cord, nerve roots or both, producing myelopathy or radiculopathy. This report describes an aggressive and compressive hemangioma of the body of the Th9 vertebra in a woman with symptoms of medullary sufferance, treated with embolization of the afferent vessels of the lesion followed by radiotherapy.
Perfusion CT: Additional Diagnostic and Clinical Information in MCA Stroke
Authors: Lopes L.
Published: April 2015

With multidetector computed tomography equipment it is possible to identify early signs of ischemia on non-enhanced CT (NECT) and have access to cerebral hemodynamics using perfusion CT (PCT). Based on specific patterns of hemodynamic changes of cerebral blood flow, cerebral blood volume and mean transit time it is feasible to create probability maps of brain tissue and calculate de potential recuperation ratio. The difference between irreversible and reversible brain damage or “tissue at risk” is essential for choosing an appropriate therapy. We evaluated the sensitivity of NECT and PCT in the diagnosis of middle cerebral artery (MCA) ischemic stroke, established their correlation with the clinical evaluation and analysed their changes in time. Thirty patients with MCA ischemic stroke underwent NECT and PCT in the acute T1 (M=7,0 h; min=0,50; max=24), subacute T2 (M=5,0 d; min=2,0; max=14,0) and chronic phase T3 (M=39,1 d; min=28,0; max=61,0). Clinical assessment and outcome were rated using the modified National Institute of Health Stroke Scale (mNIHSS). In the diagnosis of MCA stroke, PCT was more sensitive (83%) than NECT (70%). On admission, compared MTT values (r=0,560) and cerebral ischemic volume (CIV) (r=0,486) correlated with the clinical severity. Initial NECT changes correlated with the clinical evolution in T2 (r=-0,403) and T3 (r=-0,363). The PRR decreased over time, but it demonstrated a large variation for the same time period. The association of NECT with PCT can yield an early stroke diagnosis. It may possibly predict clinical severity and outcome. In addition, this association could provide an insight into the extent of penumbra and quantify the PRR, which is of paramount importance in therapeutic decision-making.
Event-Related Functional Magnetic Resonance Images during the Perception of Phantom Limb. A Brushing Task
Authors: Pasaye E.H. , Gutiérrez R.A. , Alcauter S. , Mercadillo R.E. , Aguilar-Castañeda E. , De Iturbe M. , Romero-Romo J. , Barrios F. A.
Published: April 2015

The phantom limb phenomenon has been used in amputee patients as a paradigm to study plasticity, mainly of the sensorimotor cortex. Nevertheless, most functional studies have been done in upper limb amputee patients using magnetoencephalography and functional magnetic resonance image imaging (fMRI). In addition, the actual experience of phantom limb sensation has not been widely used to study the neural mechanism of the human brain as a conscious knowledge of the phantom limb perception like the integration of the body image in amputee patients. fMRI studies of patients with lower limb amputation have recently been published, but none of these used an event-related design to try to observe only the stimulus application, correlating images with the subject's indication of phantom perception and discarding images with no phantom perception. In this work, we used the event-related fMRI design in two right-handed patients with identical right, transfemoral amputations, performing the same sensitive stimulation in a 3.0 T MR scanner. For comparison, we applied the same paradigm to six control subjects to compare the resulting functional maps. We found areas with statistical significance in the sensorimotor cortex contralateral to the site of stimulation, in the parietal lobe in Brodmann areas 3 in both cases (Patients and Control Subjects), but we also found activation in the Brodmann areas 6, 40, and 5 with stimulation of the stump. We observed a specific activation of the frontoparietal circuit during phantom limb perception in both amputee patients.
Persistent Trigeminal Artery Variant: MR Angiographic Demonstration
Authors: Soens J. , Vrabec M. , Demaerel P. , Wilms G.
Published: April 2015

A variant (PTAV) is the persistence after birth of the fetal carotid-basilar anastomosis between the internal carotid artery and a cerebellar artery. We describe two cases of a PTAV demonstrated on MR angiography. A comparison with a persistant trigeminal artery is made and an explanation of the extended Saltzman classification is given. These variants have only little clinical significance, but their recognition is crucial before surgical or interventional procedures or to understand paradoxical cerebellar lesions. MRA appears inferior to selective angiography in diagnosing these variants.
Role of Magnetic Resonance Imaging in Duane's Retraction Syndrome: Presence of the Abducens Nerve Depending on Type
Authors: Taglialatela G. , Conforti R. , Notaro M. , Cotticelli L. , Caranci F. , Cirillo S.
Published: April 2015

This study correlated anatomical findings and clinical evidence in Duane's Retraction Syndrome using brain MRI. The study included 11 patients with different types of Duane's Retraction Syndrome (DRS). Each patient underwent brain MRI. The VIth nerve was absent in all patients with DRS-I, present in all patients with DRS-II, while findings varied in patients with DRS-III. Our study confirms the literature on the usefulness of brain MRI in diagnosis of Duane's Retraction Syndrome in children.
Giant Intradiploic Epidermoid Cyst of Occipital Bone
Authors: Kumaran S.P. , Gupta K. , Priyadarshini H. , Ghosal N.
Published: April 2015

Intradiploic epidermoid cysts are congenital benign lesions. They commonly occur intracranially. Intradiploic epidermoid cyst of the calvarium is very rare and few cases have been reported to date. We describe a giant intradiploic epidermoid cyst of the occipital bone with CT and MRI characteristics including DW imaging and ADC values.
The Impact of Imaging on Management of Cervical Cystic Hygromas
Authors: El Beltagi A. , Dashti F. , Hayat A. , Al Sabah B. , Al Shaiyer D.
Published: April 2015

Cystic hygromas occur most commonly in the neck, axilla, groin or retroperitoneal space. Occasionally a portion of a cervical cystic hygroma may reside within the mediastinum. It is also extremely rare for cystic hygroma to present in the back of the neck. Hence, we describe our experience of two cases of cystic hygromas in the neck, an extensive cervicomediastinal, and posterior cervical lesion. The different location and extent of each lesion, and different management decisions are discussed.
A P1 Aneurysm and Diabetes Insipidus Caused by Traumatic Brain Injury
Authors: Lv M. , Lv X. , Jiang C. , Wu Z.
Published: April 2015

We describe a patient with a P1 aneurysm of the posterior cerebral artery (PCA) with diabetes insipidus (DI) caused by traumatic brain injury. A 21-year-old woman presented with epidural hematoma, left temporal contusion and subarachnoid hemorrhage caused by head trauma. DI occurred with normal anterior hypophyseal function on the second day after admission and cerebral angiography demonstrated an aneurysm at the right P1 portion after one month. DI was treated with administration of desmopressin and the aneurysm and P1 portion of the right PCA were occluded completely. After three months, her DI recovered and decompressin was discontinued. The six month follow-up angiogram confirmed cure of the P1 aneurysm. P1 aneurysm and DI can be caused by traumatic brain injury. Cranial DI caused by head injury with perturbations in water balance may be transitory and resolve.
CSF Flow in Chiari I and Syringomyelia from the Perspective of Computational Fluid Dynamics
Authors: Støverud K.-H. , Mardal K.-A. , Haughton V. , Langtangen H. P.
Published: April 2015

Phase contrast MR in patients with the Chiari I malformation demonstrates abnormal CSF flow in the foramen magnum and upper cervical spinal canal, related to abnormal pressure gradients. The purpose of this study was to analyze the role of CSF pressure in the pathogenesis of syringomyelia, with computational models. The spinal cord was modeled as a cylindrical poro-elastic structure with homogenous and isotropic permeability. The permeability was then made heterogeneous and anisotropic to represent the different properties of the central canal, gray and white matter. Fluid with a defined pressure, varying both in time and space, was prescribed in the SAS. Simulations were performed to quantify deformations and fluid movement within the cord. In the simulations with uniform permeability fluid moved into the cord in regions of higher pressure and out of the cord in regions of lower pressure. With permeability differences simulating gray and white matter the pattern was more complex, but similar. Adding the central spinal canal, fluid moved into the cord as in the previous case. However, preferential flow along the central canal hindered fluid from flowing back into the SAS. Pressure gradients in the SAS produce movement of fluid in the spinal cord. Assuming different relative permeability in gray matter, white matter and the central spinal canal, abnormal CSF gradients lead to accumulation of fluid within and adjacent to the spinal cord central canal.
Radiological Aspects of Genetic Disorders with Adult-onset CNS Symptoms
Authors: Raininko R. , Melberg A.
Published: April 2015

Genetic disorders affecting the central nervous system have a wide age range regarding onset of symptoms. A specific disease entity may have childhood onset or adult onset forms, whereas other disease entities may only yield symptoms in adulthood. Symptoms may be neurological or psychiatric including early dementia. It is important to recognize such diseases because the correct diagnosis may yield information on the mode of inheritance, prognosis and have an impact on the patient's treatment. Radiological examinations also provide further knowledge about these diseases and help us in understanding pathophysiology. Examples of some genetic diseases with adult-onset will be presented.
Change in Regional Cerebral Function in L'Aquila Earthquake Survivors with Post-Traumatic Stress Disorder: Preliminary Findings
Authors: Catalucci A. , Mazza M. , Fasano F. , Ciutti E. , Anselmi M. , Roncone R. , Di Salle F. , Gallucci M.
Published: April 2015

Subjects with post-traumatic stress disorder (PTSD) present a diminished or blunted emotional response, sometimes called “emotional numbing” (EN), that constitutes one of the central symptoms in PTSD. Symptoms of EN include diminished interest in activities, feeling detached or estranged from others, and restricted range of affect (American Psychiatric Association, 2000). The present work studied the emotional components in individuals with PTSD with the principal aim of investigating subjects' functional alteration in the limbic regions, insula and frontal cortex during an emotional task compared with healthy subjects. Ten subjects with PTSD (survivors of the 6.3 magnitude earthquake of April 6, 2009 in L'Aquila) and ten healthy controls underwent fMRI. PTSD was diagnosed according to DSM-IV-R (APA 2000). All subjects underwent fMRI while viewing content-neutral and emotional stimuli. Data analysis revealed that PTSD subjects had significantly greater cerebral activation in particular in the right anterior insula and in bilateral inferior frontal gyrus. Our data suggest that there is a change in the activation of brain areas responsible for emotional processing in patients with PTSD and are consistent with previous findings demonstrating hyperactivation in frontolimbic structures during emotional tasks. Our study suggests that close personal experience may be critical in engaging the neural mechanisms underlying the emotional modulation of memory. Our findings provide evidence that significant alterations in brain function, similar in many ways to those observed in PTSD, can be seen shortly after major traumatic experiences, highlighting the need for early evaluation and intervention for trauma survivors.
The Effect of Spatial Resolution on Wall Shear Stress Measurements Acquired Using Radial Phase Contrast Magnetic Resonance Angiography in the Middle Cerebral Arteries of Healthy Volunteers
Authors: Chang W. , Frydrychowicz A. , Kecskemeti S. , Landgraf B. , Johnson K. , Wu Y. , Wieben O. , Mistretta C. , Turski P.
Published: April 2015

We have recently implemented radial phase-contrast techniques that allow high resolution angiograms with velocity information to be acquired within clinically-useful imaging times. 10 healthy volunteers were scanned using PC-VIPR and PC-SOS, two high resolution phase-contrast techniques at spatial resolutions of 0.67×0.67×0.67 mm3 and 0.4×0.4×1 mm3 respectively. The velocity measurements from the two acquisitions were imported into a custom Matlab runtime environment that automatically calculated WSS values using Green's Theorem and B-spline interpolation. Time average axial WSS was 1.069 N/m2 (95% confidence interval: 0.8628< × < 1.276) in the left and right middle cerebral arteries of the 10 healthy volunteers (n=20) when scanned by PC-VIPR, and 1.670 N/m2 when scanned by PC-SOS (95% confidence interval: 1.395 < × < 1.946). This difference in means was statistically significant (p < 0.002). Previous investigators have found that higher spatial resolution results in higher WSS measurements because smaller voxel size results in fewer partial volume effects. This was true in our study as well. In this study, we found that PC-SOS has significantly higher spatial resolution than PC-VIPR and this followed in the WSS measurements. Higher in-plane spatial resolution allows WSS calculations to be performed more accurately because of increased precision near the vessel boundary.
The Anatomy of the Medial Lemniscus within the Brainstem Demonstrated at 3 Tesla with High Resolution Fat Suppressed T1-Weighted Images and Diffusion Tensor Imaging
Authors: Romanowski C.A.J. , Hutton M. , Rowe J. , Yianni J. , Warren D. , Bigley J. , Wilkinson I.D.
Published: April 2015

The medial lemniscus is part of the main somatosensory pathways ascending within the brainstem. It is formed by the heavily myelinated axons of the second order neurones of the dorsal column nuclei. This pathway ascends through the rostral medulla, pons and mesencephalon to finally terminate by synapsing with third order neurones in the ventral posterior nucleus of the thalamus. The medial lemniscus conveys proprioception and fine tactile discrimination as part of the somatosensory system. Conventional MRI studies of the brainstem have been relatively poor in demonstrating these fibre pathways. Diffusion tensor imaging and tractography may demostrated fibre pathways in the brainstem. These techniques do however suffer from relatively poor spatial resolution and some degree of image distortion – especially if based on echo planar imaging techniques. Knowledge of the anatomical relationships of the medial lemniscus is important for the understanding of clinical manifestations of disease processes affecting the somatosensory pathways and also to demonstrate important adjacent structures. Specifically, the pedunculopontine nucleus (PPN) lies in close anatomical relationship to the medial lemniscus and the decussation of the superior cerebellar peduncle. This nucleus is a promising target for deep brain stimulator placement for alleviation of non-dopamine responsive dystonias. Six healthy male volunteers (mean age 33 years) were imaged at 3 Tesla. Imaging protocols consisted of thin section, high resolution, fat suppressed T1-weighted sequences as well as thin section, high isotropic resolution diffusion tensor imaging (DTI), which was analysed to generate colour fractional anisotropy (FA) maps. These were correlated with the fat suppressed T1 weighted images. In all volunteers the medial lemniscus was seen as a pair of bands of low signal on axial, high resolution, fat suppressed T1-weighted images. They were indentified through the upper medulla, pons and mesencephalon. They correlated well with the head to foot orientated fibres on the colour FA maps generated from the DTI data. This study of normal volunteers has illustrated the value of high resolution, fat suppressed T1-weighted images in demonstrating the anatomy of the heavily myelinated medial lemniscus within the brainstem. These high resolution images with good spatial accuracy can potentially be used to aid the localisation of other nuclei, such as the PPN.
Bilateral Polymicrogyria and MELAS/A3243G Mutation. A Very Uncommon Association
Authors: Vidal A. , Castillo M.
Published: April 2015

A3243G mutation is associated with several mitochondrial disorders, MELAS syndrome being the most common. Polymicrogyrias constitute an extensive group of malformations of cortical development due to abnormal cortical organization. The association between MELAS/A3243G mutation and polymicrogyria is extremely rare; in 18 years of investigation regarding A3243G mutation and related disorders only one case has been reported. We describe a female patient with proven MELAS/A3243G mutation, developmental delay and mild left hemiparesis in whom MRI showed extensive bilateral polymicrogyria. The association of these two disorders and their possible relation are discussed.
Intervention in Stroke. The Future Ahead
Authors: Nayak S.
Published: April 2015

The treatment for acute stroke is evolving and we present the initial results of 18 patients presenting to our institution over a period of eight months with acute stoke where CTA confirmed the presence of a thrombus. These patients were resistant to IV rtPA and underwent partial to complete clot retrieval with IA thrombolysis or in conjunction with mechanical thrombectomy. 13 of the 18 patients underwent mechanical thrombectomy and Solitaire AB device was used in 12 of these patients. Efficacy was assessed radiologically by post-treatment thrombolysis in myocardial infarction (TIMI) scores and clinically by a 30-day Modified Rankin Scale (MRS) score A TIMI score of 3 was achieved in 91% of patients undergoing mechanical thrombectomy with Solitaire AB device. 61% of our patient group had a discharge MRS of ≤ 2.
An Early MRI Change following Reversible Hypoxic Brain Injury
Authors: Ishige N. , Numata T. , Shibuya M. , Tanno H. , Ozaki H. , Fuse Y.
Published: April 2015

We describe a patient who suffered reversible hypoxic brain injury. The initial MRI taken 3.5 hours after asphyxiation showed an abnormal lesion on DWI, but he recovered completely from coma. The presence of cytotoxic edema in the acute stage may not necessarily indicate a poor prognosis.
Characteristic Dynamic Enhancement Pattern of MR Imaging for Malignant Thyroid Tumor
Authors: Hwang H. , Park Y.N. , Shim Y.S. , Byun S.S. , Kim H.S.
Published: April 2015

The purpose of this study was to determine the characteristic dynamic enhancement pattern of MR imaging for malignant thyroid tumor. Eight patients were collected, who had pathology confirmed malignant thyroid tumor preoperatively. There were five papillary carcinomas, one medullary carcinoma, one follicular carcinoma and one FNAB proven atypical cell. All images were obtained with a 3.0-T MR imaging system with and without iv contrast administration. Pathologic report and US imaging finding were collected retrospectively. Based on preoperative MR imaging, we compared dynamic MR enhancement pattern relating to pathologic type. All biopsy proven malignant thyroid tumors show hypoechogenicity on previous US imaging, except one follicular carcinoma (isoechogenicity). On T1-weighted images, one papillary carcinoma showed high SI and one medullary carcinoma showed low SI. The other cases were not differentiated with normal parenchyma. On T2-weighted images, three papillary carcinomas and one follicular carcinoma showed high SI and one papillary carcinoma showed low SI. The other case was not differentiated with normal parenchyma. On contrast agent-enhanced dynamic T1WI, five papillary carcinomas and one medullary carcinoma showed delayed enhancement compared to normal parenchyma. One follicular carcinoma showed stronger enhancement than normal parenchyma, one papillary carcinoma showed persistently decreased enhancement than normal parenchyma. Although this study is limited by the small patient population, the data suggest that delayed enhancement on enhanced dynamic T1WI may be a characteristic MR finding of malignant thyroid tumor.
A Possible Role of BA8 in Pre-surgical fMRI
Authors: Valk J.
Published: April 2015

More than 100 years ago Korbinian Brodmann published an article on the cytoarchitecture of the cortical areas of the human brain. This article is meant to honor this great neuroscientist and his incredible thorough analysis of the cortical layers, a work that still remains a valid reference to present day neuroscientists. This is illustrated by the fMRI observation of co-activation of Brodmann's area 8 with activation of Broca, confirming Broca's activation even when the Broca area is displaced by tumor. This connection helps to ascertain and even quantify uni - or bilateral presence of the executive language area's. Although DTI-fiber tracking allows visualization of the connection between Broca's and Wernicke's area by the arcuate fasciculus, no such “wiring” could be shown between Broca's area and Brodmann's area 8.
Development of the Hippocampal Region Demonstrated by Fetal MRI
Authors: Bajic D. , Moreira N. Canto , Wikström J. , Raininko R.
Published: April 2015

Coronal slices of three fetal MRIs performed post mortem and 37 performed in utero, all without intracranial pathology, was assessed. Progress of the hippocampal inversion was analyzed, the left and right sides were compared and occurrence of the collateral sulcus was revealed. The fetuses in the post mortem examinations were at gestation weeks (GW) 17–18 and in the in utero examinations at GW 19–35. The symmetric development of the hippocampal sulcus was revealed in 26 subjects and asymmetric in 14. The non-ovoid hippocampal formation could be evaluated at GW 24 at earliest and an ovoid hippocampus at GW 29. The collateral sulcus could be recognized at GW 17 in post mortem and at GW 22 in in utero examinations. From GW 29 onwards it was seen in all fetuses and it was symmetric in all but one case. Evaluation of the hippocampi is difficult on fetal MRI, especially in in utero examinations. The hippocampal development is not fulfilled at GW 21 as presumed. There is a wide temporal variation in the development of the hippocampal region, and the developmental process does not progress simultaneously in the right and left side of the same individual.
New Imaging Strategies in Degenerative Disease of the Intervertebral Disks: Functional Spine Imaging
Authors: Haughton V.
Published: April 2015

As it does for the brain, functional imaging provides additional clinically valuable information on the spine, especially in the problem of back and neck pain. While conventional anatomic spine imaging demonstrates many abnormalities, such as herniation of the intervertebral disk, with nearly perfect accuracy, it does not effectively distinguish incidental degenerative changes in the disk from those that results in pain production. Functional imaging of the spine, still under development and evaluation, will facilitate the identification of painful disks and the selection of patients for innovative treatments that are presently under development. Functional imaging of the spine includes: MR spectroscopy, fMRI of the spinal cord, diffusion imaging, T2 relaxation time, T1 rho measurement and dynamic imaging. The purpose of this presentation is to review the status of these functional MR techniques. MRS: MR spectroscopy demonstrates tissue constituents that have characteristic resonant frequencies. For the disk, the substances that can be recognized in MR spectra and quantified include lactic acid and glycosaminoglycans. Lactic acid has been documented by direct sampling of the disk in painful degenerating disks. With MRS, the concentration of lactic acid is measured non-invasively. In pilot studies, lactic acid concentration effectively distinguishes symptomatic from asymptomatic degenerating disks.
The “Dehydrated” Lumbar Intervertebral Disk on MR, its Anatomy, Biochemistry and Biomechanics
Authors: Haughton V.
Published: April 2015

MR imaging of the lumbar spine often is requested to identify the cause of back or radicular pain. Official reports of lumbar spine images tend to focus on changes in the disk margin that may cause nerve root compression. The potential role of the dark disk, in back pain has not been adequately emphasized. The purpose of this review is to discuss the dark disk that has not produced nerve root compression. On T2-weighted images, a disk that has diminished signal intensity is called a dark disk or a dehydrated disk. It corresponds to a stage III disk in the Pfirrmann or the Thompson scale. Such a disk has specific morphologic, chemical and biomechanical properties, which will be reviewed in this presentation. The goal is to suggest the clinical significance of finding a dark disk on an MR image.
Assessment of the Correlation between Apparent Diffusion Coefficient and Intervertebral Disk Degeneration Using 3 Tesla MRI
Authors: Maasumi K. , Tehranzadeh J. , Muftuler L.T. , Gardner V. , Hasso A.N.
Published: April 2015

The objective is to use DW-MR imaging using 3 Tesla MRI to assess the correlation between the mean ADC with degenerative disk disease (DDD). We recruited 34 subjects and used DWI-MR to image lumbar intervertebral disks. We acquired a T2W scan and DWIs. The disks were graded for DDD. Assessment of correlation between mean ADC was made. 170 disks were evaluated. The observed sample correlation between mean ADC and disk degeneration was r = 0.65 [0.55–0.73]. The observed sample correlation between mid-sagittal ADC and disk degeneration was r = 0.61 [0.51–0.70]. The differences between mean ADC of each grade were significant, except between grades 4 and 5. There is a correlation of 0.65 between the mean ADC and disk degeneration. This correlation is not strong enough to use the ADC to determine DDD in clinical settings. There was no evident difference in ADC between the studied anatomic lumbar levels.
Vertebral Body Stenting System for the Treatment of Osteoporotic Vertebral Compression Fracture: Follow-up at 12 Months in 20 Cases
Authors: Muto M. , Greco B. , Setola F. , Vassallo P. , Ambrosanio G. , Guarnieri G.
Published: April 2015

We describe our preliminary experience with the vertebral body stenting system (VBS) for the treatment of osteoporotic vertebral fracture or traumatic vertebral fracture showing our clinical results at 12 months follow-up. Twenty patients (16 women, four men, mean age 71 years): four with traumatic vertebral fracture (Magerl A1 fractures) and 16 with osteoporotic vertebral compression fracture (VCFs) resistant to conservative therapy, were treated by vertebral body stenting system (VBS) as follows: two at level T11, four at T12, one at L1, two at L2, five at L3 and six at L4. All patients were studied by MR (protocol: sagittal T1W, T2W and T2 STIR) and MDCT with MPR reconstructions. All procedures were performed under local anesthesia with fluoroscopy guidance and a bipeduncular approach. VBS, a new system of implantation of endovertebral stent used as an alternative to conventional vertebroplasty (VP), was implanted in all patients to restore the loss of height in the fractured vertebral body. A clinical and x-ray follow-up was performed at six and 12 months evaluating the result by VAS and ODS scale. New vertebral fractures at a distant level were observed in two cases and treated by VP. VBS was successful and led to an excellent outcome in all patients with clinical improvement stable at six months and one year follow-up. The height in the fractured vertebral body was increased in 12 of the 20 VCFs by an average of 1.5 mm. No vascular, extraforaminal or epidural leakage or other adverse events were observed. In the clinical 12 months follow-up we recorded a reduction of four scores in the VAS evaluation and a 40% reduction in the ODS score compared with the pre-treatment values. Endovertebral stents were stable at 12 months at x-ray control in 19/20 patients. No new vertebral fracture located in adjacent vertebrae were observed at 12 month follow-up. By using a stent, the VBS system reduces the collapsed vertebral body and offers good height restoration. The mechanical scaffold of the stent restores the height and at the same time offers a cavity for injection of highly viscous PMMA bone cement without increasing the rate of new vertebral fracture post-VP. A long-term follow-up is recommended.
Outcomes of Endovascular Coiling in Patients with Intracranial Aneurysms Presenting with Poor Clinical and SAH Grade
Authors: Mehta P. , Kalyanpur T. , Narsinghpura K.S. , Krishnan R. , Raja D. , Yadav M. , Cherian M.
Published: April 2015

Although the treatment of intracranial aneurysms has made significant advances, prediction of outcomes in poor grades has always been difficult. We present our findings of patients in poor clinical and SAH grade treated with endovascular coiling. We aimed to evaluate the clinical outcomes in patients presenting with poorer neurological and SAH grades treated by endovascular techniques. Of 190 patients who presented with SAH over a period of nine years, 34 were of poorer clinical grade (Hunt & Hess Grades 4 and 5), of whom 30 presented with H&H grade 4 and four with grade 5. 44.1% of the 34 patients belonged to Fischer grade 4. We assessed the technical success and final outcomes based on the Glasgow outcome scale. Of the 30 patients with grade 4, 81.4% had a good outcome. Two out of four patients with grade 5 had a poor outcome. 82.5% of the patients with Fischer grade 4 had a good outcome. None of the poor outcomes were procedure-related. Endovascular treatment with its higher rates of technical success, lower complication rates and better outcomes should be recommended as the treatment of choice in patients with intracranial aneurysms even in patients with poorer clinical and SAH grades.
Endovascular Treatment of Basilar Trunk Saccular Aneurysms
Authors: Higa T. , Ujiie H. , Kato K. , Ono Y. , Okada Y.
Published: April 2015

Basilar artery (BA) trunk aneurysms are rare and still remain a formidable surgical challenge. The purpose of this retrospective study was to report the clinical entities and results of endovascular surgery of BA trunk saccular aneurysms. Between 1995 and 2009, 14 patients with 14 BA trunk saccular aneurysms underwent endovascular surgery. Six patients presented subarachnoid hemorrhage (SAH), three patients had another associated aneurysm which developed SAH, one patient presented with mass effect to the brain stem, and four patients were incidentally discovered. Five ruptured and seven unruptured aneurysms were successfully treated by endovascular surgery. Another one incompletely embolized aneurysm had grown to huge size five years later and the patient underwent a Hunterian ligation with a radial artery graft between the extracranial vertebral artery and the posterior cerebral artery. In one ruptured case, we attempted neck clipping, but this was abandoned because of concern for neck tearing by clipping. The aneurysm was embolized using detachable coils later. BA trunk aneurysms showed characteristic features such as so-called lateral aneurysm (43%), multiple aneurysms (43%) and four BA fenestrations (36%). The unusual high incidence of associated various vascular anomalies suggests that focal wall weakness must be based on the mechanism of aneurysm initiation on the BA trunk. Most patients presented with SAH. Pre-treatment neurological state was predictive for clinical outcome. Endovascular surgery is an effective therapeutic alternative that is associated with low morbidity and mortality rates, and should be considered the first choice treatment.
Endovascular Management of Pediatric Aneurysms
Authors: Saleh E. , Dawson R.C.
Published: April 2015

Although the general principles of endovascular aneurysm treatment in adults hold true in children, these young patients pose unique challenges: small anatomy, longer life expectancy, associated conditions and morphological characteristics of the aneurysms. Few publications in the literature address the role of endovascular treatment for pediatric aneurysms; including series by Agid et al. (2005)1 revisiting the Toronto series, Lasjaunias et al. (2005)2 updating the Bicêtre series and Sanai et al (2006)8 presenting the San Francisco series. In their conclusions, the authors of the former two publications favored endovascular treatment over microsurgery. On the other hand, the authors of the latter publication favored microsurgery over endovascular treatment. The authors reviewed Louisiana State University experience regarding endovascular treatment of pediatric aneurysms focusing on outcomes. A retrospective chart review was performed of children under 18, who underwent endovascular treatment for intracranial aneurysms between 2000 and 2009 in our institution. Twelve patients harboring seventeen aneurysms were identified. The patients ranged in age from seventeen months to seventeen years. Complete aneurysm obliteration following endovascular treatment was around 95%. Our results showed unique features for pediatric aneurysms when compared to adult aneurysms. No intra operative mortality was recorded. One aneurysm recurred (5% recurrence rate among total number of aneurysms). In this case, six months after treatment, a control angiogram showed that the coils were displaced toward the dome of the aneurysm. This recurrence occurred before the introduction of the hydro coils. One patient died during the post intervention period (8% occurrence rate among total number of patients). Outcomes were better in anterior circulation aneurysms than in posterior circulation lesions. We had no mortality, morbidity or disability in the anterior circulation aneurysm group. In the posterior circulation group, there was one death representing 14% of the nine patients with aneurysms in this group. One recurrence occurred in the posterior circulation group representing 11% of the nine aneurysms in this group. Follow-up of all patients ranged from two to eight years. Endovascular treatment of pediatric intracranial aneurysm is safe and efficacious. Endovascular treatment in many instances provides less morbidity and mortality for treatment of pediatric aneurysms in inaccessible or eloquent locations than microsurgical clipping. The result of endovascular treatment depends on the location of the aneurysms and the underlying pathology. We advocate a multidisciplinary approach when choosing the therapeutic modality for treatment of pediatric aneurysms.
Embolization of a Wide Neck Giant Basilar Tip Aneurysm Using Two Coils
Authors: Derakhshani S. , Rosa S. , Kleidona I.A. , Haliasos N. , Chawda S.
Published: April 2015

Pictorial demonstration of aneurysm lumen thrombosis and diversion of flow hemodynamics with the use of a minimum number of coils in the treatment of hemorrhagic basilar tip aneurysm. We present a 62-year-old lady who underwent endovascular treatment for acute subarachnoid hemorrhage due to a giant basilar tip aneurysm and a left carotico-ophthalmic aneurysm. Following deployment of two of the longest available coils, the procedure was terminated due to a sudden change of jet flow within the aneurysm and unsustainable coil and microcatheter positions in spite of further attempts. Post-procedural follow-up angiogram on day 22, revealed an approximately 90% occlusion of the giant basilar tip aneurysm. Significant reduction in flow dynamic by minimum number of coils can achieve remarkable and near complete thrombosis and occlusion of a giant basilar tip aneurysm.
CT Angiographic Diagnosis of a Ruptured Intraventricular Arteriovenous Malformation in a Teenager Playing a Video Game
Authors: Chen Y-L. , Kao H-W. , Juan C-J. , Hsueh C-J. , Huang G-S. , Lo H-C. , Chen C-Y.
Published: April 2015

Intraventricular arteriovenous malformation (AVM) is a rare congenital vascular disorder that is often associated with primary intraventricular hemorrhage (IVH) and a rapid clinical course. Acute imaging diagnosis requires depiction of both the location of hemorrhage and vascular nidus for emergent management. In this report, a 17-year-old teenager developed primary IVH with presentation of consciousness change during a video game. Multidetector-row computed tomographic angiography (CTA) demonstrated an AVM in the right lateral ventricle and its angioarchitectural relationship to the surrounding intracranial structures. Although selective angiography is essential both in planning treatment for cerebral AVMs and in establishing the final diagnosis, CTA can be an important first-line imaging modality to quickly confirm the diagnosis and hence initiate prompt management.
High-flow Neonatal Macrocerebral Arteriovenous Fistulas in Hereditary Hemorrhagic Telangiectasia
Authors: Iizuka Y. , Murata N. , Kohda E. , Tsutsumi Y. , Nosaka S. , Morota N. , Konishi Y.
Published: April 2015

Although some cases of vein of Galen aneurysmal malformation (VGAM) present initial clinical symptoms such as cardiopulmonary disturbance in the neonatal period, pial arteriovenous fistula is very seldom present as a clinical symptom immediately after birth. A neonatal patient, the first-born to his family, presented with tachypnea postpartum. This baby had a family history of hereditary hemorrhagic telangiectasia. A cerebral MR image revealed multiple macrocerebral arteriovenous fistulas (MCAVFs), resulting in a large partially thrombosed venous pouch within the cerebral cortex. Trans-arterial embolizations of the main two fistulas were performed using N-butyl cyanoacrylate (NBCA) with tantalum powder six months after birth. Post-embolization angiography confirmed the obliteration of the fistulas and magnetic resonance imaging (MRI) revealed thrombosis and reduction in size of the venous component. His tachypnea disappeared completely. There were no neurological complications due to the treatment. The prognosis of multiple MCAVFs mainly depends on the presence of medullar signs and symptoms and a delay before treatment. Pure glue endovascular intervention, as used in our case, is considered to be the first therapeutic choice to decrease the risk of neurological consequences.
Unusual Acute Complications of Carotid Cavernous Fistula: Therapeutic Options
Authors: Tsai F.Y. , Lee K-W. , Chen C-J. , Cheng S-J.
Published: April 2015

We aimed to demonstrate the complications of carotid-cavernous fistula (CCF) and their correlation with venous hypertension. From August 2000 to April 2008 we performed more than 2400 catheter angiographic procedures. Among those, six unusual cases presented acute complications of CCF. The presented complications of CCF from our cases showed a possible correlation with venous hypertension. With the experiences from our cases, venous hypertension may complicate CCF with a poor prognosis. The condition should be carefully evaluated and if present prompt treatment is necessary.
Dengue Encephalitis Associated with Hydrocephalus
Authors: Kamble R.B. , Venkataramana N.K. , Raghunath C.N.
Published: April 2015

We describe a case of dengue encephalitis with bilateral thalamus and cerebellum involvement. The cerebellar mass effect led to hydrocephalus requiring drainage. The patient recovered completely on follow-up.
Characteristics of Brain Arteriovenous Malformations Presenting with Seizures without Acute or Remote Hemorrhage
Authors: Jiang P. , Lv X. , Wu Z. , Li Y. , Jiang C. , Yang X. , Zhang Y.
Published: April 2015

We report on the predictors of seizure presention in unruptured brain arteriovenous malformations (AVMs). Between 1999 and 2008, 302 consecutive patients with AVMs were referred to our institution for endovascular treatment. Seventy-four patients (24.5%) experienced seizures without hemorrhage before treatment. We tested for statistical associations between angioarchitectural characteristics and seizure presentation. When we compared the 74 patients with seizures without hemorrhage with the 228 patients who did not experience seizures initially (total of 302 patients), male sex, cortical AVM location, AVM size of more than 3 cm, superficial venous drainage and presence of varices in the venous drainage were statistically associated with seizures (P=0.016, P=0.002, P=0.022, P=0.005, and P=0.022, respectively). Posterior fossa and deep locations and coexisting aneurysms were statistically associated with no seizures. The angioarchitectural characteristics of AVM associated with seizure presentation include male sex, cortical AVM location, AVM size of more than 3 cm, superficial venous drainage and presence of varices in the venous drainage.
Intravenous Glycoprotein IIb/IIIa Inhibitor (Tirofiban) Followed by Low-Dose Intra-Arterial Urokinase and Mechanical Thrombolysis for the Treatment of Acute Stroke
Authors: Ihn Y.K. , Sung J.H. , Kim B-S.
Published: April 2015

We investigated the efficacy and safety of the combined use of IV tirofiban and IA urokinase and/or mechanical thrombolysis for treating acute stroke patients. Thirteen, consecutive patients treated with IV tirofiban and IA thrombolysis with mechanical and/or local IA urokinase infusion were evaluated retrospectively. The amount of time before the beginning of treatment, urokinase dose, recanalization rates, and symptomatic hemorrhage were analyzed. Clinical outcome measures were assessed on admission, at discharge (National Institute of Health Stroke scale [NIHSS]), and three months after the end of their treatment (modified Rankin Scale scores [mRS]). There were 11 patients with internal carotid or middle cerebral artery occlusion treated within six hours of the onset of symptoms and two patients with basilar artery occlusion treated within 12 hours of their symptom onset. The median NIHSS score on admission was 18. The median amount of time from symptom onset to IV tirofiban infusion was 135 minutes, and the median time from symptom onset to IA therapy was 180 minutes. The median dose of urokinase was 200,000 U. Recanalization (thrombolysis in myocardial infarction grade 2 or 3) was achieved in 11 patients. No procedure-related complications were observed. There was one symptomatic hemorrhage. At discharge, the mean NIHSS score was 6.6 (range, 0–15). Overall, at the time of the three-month follow-up the functional outcome was favorable (modified Rankin Scale score 0–2) in eight out of 13 (62%) patients. Death at 90 days occurred in two of the 13 (15%) patients. Combined IV tirofiban and IA thrombolysis with mechanical clot disruption seems to be a feasible treatment in acute stroke and may be successful in re-establishing vessel patency and result in a good functional outcome in patients with major cerebral arteries occlusions.