bluuebunny/crossref_metadata_2025 huggingface dataset:
Intracranial Lipomas: A Retrospective Study
Authors: Seidl Z. , Vaneckova M. , Vitak T.
Published: April 2015

Between 1996 and 2006, 17 patients with intracranial lipomas underwent MR imaging examination. Of these, two patients also had CT examination. Lipoma is not a typical tumor and could instead be called intracranial lipoma hamartoma or cerebral malformation. The predominant localization of the lipomas was close to midline structures, such as the area around the corpus callosum, quadrigeminal cisterns, etc. Interpreting the MRI it is necessary to differentiate epidermoid, dermoid and hemorrhage in the metahemoglobin stage from lipoma. Clinically, 47% of patients complained of headache, two presented with epileptic seizures and the remainder had different symptoms. The lipoma was just an incidental finding not related to the clinical symptomatology.
Isolated Unilateral Sixth Nerve Palsy as a Presenting Symptom of Cerebral Aneurysms
Authors: Er U. , Fraser K. , Lanzino G.
Published: April 2015

We describe two patients with intracranial aneurysms who presented with isolated sixth nerve palsy. A 68-year-old woman with gradual onset of horizontal lateral diplopia was found to have a giant aneurysm at the junction of the petrous and cavernous portion of the internal carotid artery. A 58-year-old man presented with gradual onset of occipital pain followed by a sixth nerve palsy. He was found to have a distal anterior inferior cerebellar artery aneurysm which spontaneously thrombosed on subsequent neuroimaging studies. Although uncommon, isolated sixth nerve palsy can be the only neurological sign of an intracranial aneurysm.
Trigeminal Perineural Spread of Head and Neck Tumors
Authors: Bartiromo F. , Cirillo L. , Caranci F. , Elefante A. , D'Amico A. , Tortora F. , Brunetti A. , Cirillo S.
Published: April 2015

Perineural tumor spread (PNS) of head and neck malignancies is a well-known form of metastatic disease in which a lesion can migrate away from the primary site along the endoneurium or perineurium. MR imaging is considered the primary method for evaluating patients with symptoms related to the trigeminal nerve in most clinical settings. Both CT and MR imaging can detect perineural spread, but MRI is the modality of choice because of its capability to detect direct signs (nerve enlargement and enhancement) and indirect signs (neuropathic muscular atrophy, obliteration of fat planes). In addition, MRI is more sensitive because of its superior soft-tissue contrast, its multiplanar capability and decreased artifacts from dental hardware. Fat suppression images after contrast injection are mandatory to better detect nerve enhancement. CT is useful in detecting foraminal enlargement or more destructive bone patterns. Nerve function can be perserved until later in the course of the disease: patients with perineural spread demonstrated at radiologic or pathologic examination may have normal or nonspecific nerve function at clinical examination (patients are misdiagnosed with Bell's palsy or trigeminal neuralgia). Hence MRI assessment of perineural tumor location and extension is important.
Osteogenic Sarcomatous Degeneration of the Temporal Bone Squama in Paget's Disease
Authors: Scazzeri F. , Picchietti S. , Rosa C. , Gaglianone S. , Prosetti D. , Simi U.
Published: April 2015

Paget's bone disease is a common disorder affecting approximately 3–4% of the population over 40 and up to 10–11% of the population older than 80 years. It is characterized by excessive and abnormal bone remodelling. The disease predominates in bones containing red marrow, with a clinical course characterized by active and quiescent periods; pelvis, sacrum, spine and skull are the most affected parts. We report the case of a 79-year-old woman with polyostotic Paget's disease who had a focal sarcomatous degeneration diagnosed by CT and MR.
Spontaneous Subdural Hematoma in the Setting of Immune Thrombocytopenia Complicated by Ischemic Infarcts
Authors: Mathews M.S. , Yu W. , Chappell E.T.
Published: April 2015

The occurrence of spontaneous subdural hematoma (SDH) in immune thrombocytopenia (ITP) is rare. We report a spontaneous subacute subdural hematoma in a patient with chronic ITP. The patient presented with headache and a noncontrast head CT scan showed an 11 mm subacute right frontoparietal SDH causing an 8 mm right to left midline shift. The patient underwent medical management with platelets, FFP and packed RBC transfusions, steroids, IVIG and mannitol, which failed to prevent deterioration of her clinical condition. The patient then underwent burr hole drainage of the SDH. Her postoperative course was complicated by ischemic infarcts in the right posterior cerebral artery territory leaving her with a residual left homonymous hemianopia. Our patient was unique in the concurrent development of ischemic infarcts postoperatively, following burr hole drainage of the SDH in the setting of ITP. This case highlights the diagnostic and therapeutic dilemmas involved in taking care of such patients.
Mitochondrial Leukodystrophy: An Unusual Manifestation of Leigh's Disease
Authors: Ganesan K. , Desai S. , Udwadia-Hegde A. , Ursekar M.
Published: April 2015

Leigh's disease is an inherited, progressive neurodegenerative disorder of infancy and early childhood. This metabolic disease is biochemically and genetically a heterogeneous disorder with defects involving various enzymes involved in the respiratory chain mechanism. Due to the multitude of enzyme defects known to occur in patients afflicted with Leigh's disease, this condition is known to have a variable clinical, pathological and radiological pattern of presentation. Isolated deficiency of cytochrome oxidase (COX) enzyme is one of the commonest abnormalities seen in patients afflicted by Leigh's disease. A primary white matter pattern of involvement representing a mitochondrial leukodystrophy is rare. Symmetric hyperintensities on T2WI involving the subthalamic nuclei and brainstem have been reported in patients with COX deficiency with SURF 1 mutations and are considered almost a hallmark of Leigh's disease with COX deficiency. We describe three cases of Leigh's disease with a primary white matter involvement diagnosed at our institution on the basis of clinical features, radiological appearance and laboratory findings.
Acute Ruptured Intracranial Aneurysm Packing with HydroCoil Embolic System: Initial Clinical Experience
Authors: Ya Peng , Jing-Gang Xuan , Yi-Lin Yang , Sui-Nuan Wang
Published: April 2015

The HydroCoil Embolic System (HES; MicroVention, Aliso Viejo, CA, USA) was developed to improve the efficacy of endovascular treatment of cerebral aneurysms. The HES may reduce recurrences of aneurysms by allowing for increased packing density compared with platinum coils. We report our initial experience with the HES in the treatment of 31 patients with acute ruptured cerebral aneurysms. The HES is another safe and effective material for aneurysms embolization, which provided substantially improved volumetric packing of the aneurysm lumen.
Interferon Beta-1b May Reverse Axonal Dysfunction in Multiple Sclerosis
Authors: Takeuchi C. , Ota K. , Ono Y. , Iwata M.
Published: April 2015

Progression of the disability of multiple sclerosis (MS) is thought to be related to axonal damage that is seen even in normal appearing white matter (NAWM) of patients' brains. Interferon beta (IFNβ) treatment for MS reduces the frequency of clinical exacerbations and the appearance of new inflammatory demyelinating lesions on magnetic resonance imaging (MRI). However, the effect of IFNβ treatment on axonal damage in MS is not known. The present study aimed to assess the effect of IFNβ on axonal function by comparing the data from localised single voxel proton MR spectroscopy (MRS) performed on eight MS patients given IFNβ-1b treatment and 11 untreated patients. Brain MRI and MRS were performed before the initiation of IFNβ-1b treatment and 24 months after treatment initiation. Levels of N-acetylaspartate (NAA), choline-containing compounds (Cho) and creatine (Cr) were calculated as the areas under their peaks shown on MRS and the ratios of NAA/Cr and Cho/Cr were calculated. In the patients treated with IFNβ-1b there was a significant increase in the ratio of NAA/Cr in NAWM (p=0.028) at 24 months after the initiation of treatment. In contrast, there was no significant change in the NAA/Cr ratio in the untreated patients. These results suggest that IFNβ-1b treatment might recover axonal function in NAWM of MS patients.
MR Imaging of Hippocampal Sulcus Remnant: Age-Related Differences
Authors: Suzuki M. , Matsui O. , Ueda F. , Ougi T. , Inoue D. , Endo T. , Kawashima H. , Takemura A. , Ichikawa K.
Published: April 2015

The hippocampal sulcus remnant (HSR) is often observed at the medial temporal lobe on MR images. In the present study, we made a retrospective assessment of the frequency and age-related differences in HSR in routine brain MR examinations of 1000 patients, 494 females and 506 males. Cases with one or several spots that were hypointense on T1-weighted and FLAIR images and hyperintense on T2-weighted images were defined as positive for HSR. Abnormal spots with the same intensity as cerebrospinal fluid were observed in 210 out of 506 males and in 193 out of 494 females. No significant sex-related differences were observed in the frequency of HSR. The HSR was seen more frequently with age in both males and females. Patients with hypertension had a significantly higher frequency of HSR.
Have a Look at the Three Dimensional View of T-Statistics! — Isn't it Cute Ginger?
Authors: Rajesh R. , Satheeshkumar J. , Arumugaperumal S. , Kesavdas C.
Published: April 2015

This article visualizes the three-dimensional view of t-statistics for the lip movement experiment. It also visualizes the t-contrast image. These three dimensional views help the radiologist to understand the volume of activations in the brain. The 3D view of the t-statistics of the subject under study looks like a piece of ginger and hence is called the “ginger effect of t-statistics”.
Lipoma of the Parotid Gland
Authors: Husain N. , Bandhauer F. , Kurrer M. , Kollias S.S.
Published: April 2015

We describe three cases of parotid gland lipoma, a relatively rare, asymptomatic, slow growing, freely movable, soft tissue mass. Preoperative clinical diagnosis is generally difficult but MRI using fat saturation techniques provides accurate diagnostic information regarding this benign parotid gland tumor, enabling better treatment planning.
f-MRI in Epilepsy with Spike and Wave Activity Evoked by Eye Closure: Different Bold Activation in a Patient with Idiopathic Partial Epilepsy with Occipital Spikes and a Control Group
Authors: Avesani M. , Formaggio E. , Storti S. , Alessandrini F. , Bongiovanni L.G. , Cordioli C. , Beltramello A. , Fiaschi A. , Manganotti P.
Published: April 2015

We performed functional magnetic resonance imaging (fMRI) in a 30-year-old man with idiopathic partial epilepsy with occipital spikes whose scalp EEG activity was characterized by persistent epileptiform discharges on eye closure, ceasing upon eye opening. We compared BOLD activation in the patient and in a control group of three normal volunteers. f-MRI showed that occipital cortex and frontal areas were activated in relation to eye movement in normal subjects during eye opening but not during eye closing. While persistent interictal spike and wave activity was present over the posterior and anterior scalp in the patient upon eye closing, f-MRI showed bilateral activation of the parietal and temporal regions. This fMRI study documents the activation of posterior and temporal areas related to continuous intercritical spikes evoked by eye closure, which are diffuse over the scalp. This activation was absent in the control group during eye closure.
A Dual Echo Steady State Pulse Sequence in Evaluation of Brain Cerebrospinal Fluid Flow
Authors: Moschnegootz S.V. , Barbarash L.S.
Published: April 2015

This paper summarizes our experience of exploiting a Dual Echo Steady State (DESS) pulse sequence for the fast qualitative assessment of cerebrospinal fluid (CSF) flow dynamics at the aqueduct of Sylvius and Monro's foramina levels of the brain liquor pathways using a low-field magnetic resonance imager. Normal and pathologic CSF flow patterns are discussed. The capabilities of the described method as an effective extra tool for deriving the additional diagnostic information via visualization of flow voids in the brain CSF pathways are shown.
Abnormal Flow in the Cavernous Sinus Caused by an Asymptomatic Dural Arteriovenous Fistula of the Contralateral Transverse-Sigmoid Sinus
Authors: Uchino A. , Egashira R. , Nomiyama K. , Takase Y. , Mineta T. , Kudo S.
Published: April 2015

A 53-year-old asymptomatic man underwent cranial MR imaging to rule out cerebrovascular disease. On T2-weighted axial images abnormal flow voids were detected at the right cavernous sinus, suggesting a dural carotid-cavernous fistula (CCF). On the MR angiogram, abnormal high intensity signals were observed at the right cavernous sinus and the left transverse-sigmoid (T-S) sinus, suggestive of coexisting right dural CCF and dural arteriovenous fistula (AVF) of the left T-S sinus. Selective cerebral angiography of the left external carotid artery revealed abnormal flow in the right cavernous sinus caused by the dural AVF of the left T-S sinus via the right inferior petrosal sinus due to occlusion of both the distal left sigmoid sinus and proximal right internal jugular vein.
Medium-Term Results Using the Leo Self-Expanding Stent in the Treatment of Complex Intracranial Aneurysms
Authors: Pardo M.I. , Pumar J.M. , Blanco M. , Vazquez F. , Guimaraens L. , Casasco A.
Published: April 2015

The preliminary experience with the Leo microstent in combination with detachable coils for the treatment of patients with wide-necked cerebral aneurysms is reported, and the technical complications and recommendations for optimum placement and deployment are discussed. Thirty two patients identified as harboring wide-necked aneurysm were selected for stent-assisted coiling. Aneurysms were paraophthalmic-cavernous in 13 cases, eight were located at the posterior communicating artery, four at the basilar artery, three at the vertebral arteries, two at the posterior cerebral arteries, one at the right middle artery, and one at the right posterior inferior cerebellar artery. After appropriate antiplatelet therapy, the Leo stent was delivered to the aneurysm site and positioned without difficulty, except in four cases requiring the use of steam to shape the tip of the Vasco microcatheter. Angiographic follow-up was undertaken at six months in 32 patients, at one year in 27 patients, and at two years in 20 patients. Stent placement in the desired position with complete or near complete occlusion of the aneurysm was feasible in all patients. In one patient, the stent was slightly displaced during microwire manipulation for aneurysm microcatheterization. Two-year angiography in 20 patients showed 18 complete occlusions and two aneurysms with a minimal residual neck. The Leo stent represents a significant advancement in the vascular treatment of intracranial aneurysms providing high radial force and an easy delivery system i.e., it is a feasible, secure and effective system.
Intraventricular Hemorrhage Caused by Peripheral Anterior Choroidal Artery Aneurysm Rupture
Authors: Pavesi G. , Amistà P. , Munari M. , Gardiman M.P.
Published: April 2015

Intraventricular hemorrhage is a severe ictal event secondary to several pathological conditions (anticoagulation therapies, hypertension, post-surgical, traumatic, neoplastic, vascular malformations), leading to blockage of CSF flow and possible hydrocephalus, often justifying surgical intervention. We describe an uncommon source of intraventricular hemorrhage in a 54-year-old woman caused by a peripheral anterior choroidal artery aneurysm rupture.
The Role of Diffusion-Weighted Magnetic Resonance Imaging in Intracranial Cystic Lesions
Authors: Yikilmaz A. , Durak A.C. , Mavili E. , Donmez H. , Kurtsoy A. , Kontas O.
Published: April 2015

We aimed to define the diffusion-weighted magnetic resonance (MR) imaging features of intracranial cystic lesions and to investigate possible special features for the differential diagnosis. One hundred and twenty patients with intracranial cystic lesions were included in the study. There were 29 arachnoid cysts, eight epidermoid cysts, 34 primary tumors, 18 abscesses, 29 metastases and two hydatid cysts. Echo-planar diffusion-weighted MR imaging was obtained in addition to conventional cranial MR scans. The morphologic features of the cystic portion and the wall of the cyst and signal intensities on diffusion-weighted images were evaluated. All abscesses and epidermoid cysts were hyperintense on diffusion-weighted images. Arachnoid cysts, hydatid cysts, primary tumors, and metastases were hypointense except five cystic tumors. These five primary or metastatic necrotic tumors showed high signal intensity on diffusion-weighted images due to hemorrhage or superinfection. The walls of the cystic tumors were usually hyperintense on diffusion-weighted images in contrast to the wall of the abscesses, which were iso-hypointense. This was a statistically significant finding for the differentiation between tumors and abscesses (P<0.05). Diffusion-weighted MR imaging is a useful technique for the evaluation of the intracranial cystic lesions and provides additional beneficial information to conventional MR imaging. However, the presence of hemorrhage and superinfection of the tumors may cause a signal increase that results in misinterpretetations. In these cases, the appearance of tumor wall may be useful for differentiating abscesses from tumors.
Significance of Radio-Pathological Correlations: Differentiating Severe Central Nervous System Infection from Acute Embolic Infarction
Authors: Tokumaru A.M. , Hasebe T. , Terada H. , Saito Y. , Kanemaru K. , Yamakawa M. , Mizuno M. , Murayama S.
Published: April 2015

We describe two educational autopsy cases of severe central nervous system (CNS) infection and septic emboli, such cases having been difficult to differentiate from acute infarctions via emergency MR imaging studies. We briefly discuss the pathology and MR findings along with radiopathological correlation.
The Value of Contrast Administration in the MRI Evaluation of Scoliosis in the Pediatric Population
Authors: Abul-Kasim K. , Hassan D. Gomez , McCormick L. , Maly P. , Sundgren P.C.
Published: April 2015

The aim of this study was to analyze the added utility of contrast administration for spine MRI in children with scoliosis. A retrospective review of 663 consecutive contrast-enhanced spine MRI performed in 319 patients as part of the work up of scoliosis in children 2–18 years with clinically suspected or known scoliosis over a seven year period. Those patients with known tumors (13 patients) being evaluated for scoliosis were excluded from the study. In 306 patients with scoliosis and no history of tumor pathologic contrast enhancement was seen in seven (2%) patients. Lack of enhancement helped to characterize benign lesions in 31 (10%) of the patients. Although MRI is often recommended to exclude intraspinal pathology in pediatric patients with scoliosis, the need for contrast enhanced imaging is very limited and contrast medium should not be administered unless questionable pathology is detected on noncontrast MR spine imaging.
Genetics of Brain Tumors
Authors: Sąsiadek M.M. , Trusewicz A. , Łaczmañska I. , Gil J. , Pesz K.
Published: April 2015

In brain tumours a variety of genetic alterations has been observed. Some of them were found to be characteristic of more than one type of neuroepithelial tissue tumours (NTT), thus suggesting the presence of alterations critical for NTT development in these regions. The most frequently observed chromosomal aberrations in NTT include: polisomy of chromosome 7, amplification of 7p, 12q13-q21, monosomy of either a part or the whole chromosome 10, as well as aberrations of chromosomes: 1p, 9 13, 17 and 19q. A model of two distinct molecular pathways in primary and secondary glioma development has recently been proposed. In the former pathway up-regulation of EGFR and MDM2, accompanied by loss of function of PTEN, while in the latter up-regulation of PDGFRA and CDK4, together with down-regulation of p53 as well as CDKN2A and Rb1 are of critical value. Many different genes seem to play a role in the processes of invasion and metastasis such as genes coding for proteins involved in adhesion and angiogenesis.

Identification of the mechanisms and proteins involved in cancerogenesis and metastasis led to the development of new targeted therapy.
Intraoperative MRI for Brain Tumor Resection
Authors: Ono Y. , Muragaki Y. , Ozawa N. , Maruyama T. , Iseki H. , Abe K. , Hori T.
Published: April 2015

Computer aided neurosurgery is now a highly advanced and essential technique, especially for the gliomas in the vicinity to the eloquent areas or deep inside of the brain. The intraoperative MRI (iMRI) is an important tool for the computer navigation system, considering brain shift under craniotomy. Real time navigation by the iMRI with brain mapping by subcortical stimulation and verbal confirmation by awake craniotomy can lead to the safe and precise tumor resection. The usefulness of an intraoperative low-field open MRI is defined for neuronavigation, especially for demonstration of the pyramidal tract in relation to the precise tumor location, considering brain shift during the operative procedure, to avoid tract injury.
Cryptogenic Stroke in Hanging
Authors: Garaci F.G. , Bazzocchi G. , Velari L. , Gaudiello F. , Goldstein A.L. , Manenti G. , Floris R. , Simonetti G.
Published: April 2015

This paper reports the unique neuroimaging findings of a 37-year-old woman who attempted suicide by hanging. To our knowledge, this is the first reported case describing neuroimaging findings of unilateral lesions instead of the well-documented bilateral lesions after a hanging event. Computed tomography demonstrated a low density area in the right thalamus and no hemorrhage. 3.0 T Magnetic resonance revealed a hyperintense area on both T2-weighted and FLAIR images on the right thalamus. Diffusion weighted images demonstrated no area of diffusivity restriction. Another smaller lesion with the same signal characteristics was found in the left cerebellum. A second relevant point of this report is the observation that the most probable cause of the documented unilateral lesions was an ischemic-arterial event.
Endovascular Treatment of Isolated PICA Insufficiency
Authors: Donmez H. , Mavili E. , Gümüş G. O. , Ozcan N.
Published: April 2015

The vertebral artery terminating in the posterior inferior cerebellar artery is rare but it may cause cerebellar infarction when total occlusion of the vertebral artery occurs. Therefore treatment of vertebral artery stenosis in these patients is crucial. Surgical treatment of osteal vertebral artery stenosis is possible but is associated with approximately 4% mortality and up to 20% risk of procedural complications including perioperative VA occlusion, Horner syndrome, lymphatic injury and injury to the phrenic, vagus, laryngeal and thoracic nerves. Therefore percutaneous angioplasty with or without stent placement is emerging as an alternative treatment method with a high success rate and good initial angiographic outcome. Percutaneous angioplasty of the VA origin is associated with an approximately 15% restenosis rate. Stent placement is believed to decrease the incidence of elastic recoil and restenosis. Herein we present a rare symptomatic case with an anomalous, small-caliber right VA terminating in the PICA which was successfully treated with a drug-eluting stent.
Dyke-Davidoff-Masson Syndrome Demonstrated by Current MR Images
Authors: Hori M. , Mizuno M. , Katagiri N. , Takeshi K. , Tsujino N. , Araki T. , Shiraga N.
Published: April 2015

Current magnetic resonance imaging techniques demonstrated MR findings of Dyke-Davidoff-Masson syndrome in a 44-year-old man. Statistical parametric mapping analysis of the T1-weighted images showed focal atrophy in the basal ganglia. Three-dimensional white matter fibers of corticospinal tracts, corpus callosum and cingulate bundle were demonstrated using diffusion tensor data correlated to the patient's clinical conditions.
Bilateral Congenital Absence of Internal Carotid Arteries in a Woman with Dementia
Authors: Viglianesi A. , Messina M. , Chiaramonte R. , Chiaramonte I. , Vecchio I. , Pero G.
Published: April 2015

Dysgenesis of THE internal carotid artery is considered a rare condition, present in about 0.01% of subjects. This anomaly is generally asymptomatic and often represents an incidental finding in radiological examinations of the head performed for other reasons. A 75-year-old woman with symptoms of dementia was admitted to our hospital. Computed tomography and magnetic resonance examinations were performed. They showed the absence of both internal carotid arteries and the congenital nature of this abnormality. The usefulness of CT and MRI examinations in patients with this vascular abnormality is discussed.
MRI in a Woman with Late Onset Ornithine Transcarbamylase Deficiency
Authors: Manto A. , De Gennaro A. , Serino A. , Cozzolino A. , Colasante A.G. , La Rocca M.R.
Published: April 2015

We describe the brain MR imaging findings of a woman who developed neurologic symptoms due to an acute hyperammonemic encephalopathy resulting from late onset ornithine transcarbamylase deficiency (OCTD). MR images revealed injury (hyperintense foci on long TR images) to the subcortical white matter of the left precentral and supramarginal gyrus and in the left frontal lobe. These findings presumably reflect the distribution of brain injury from hypoperfusion secondary to severe hyperammonemia. If MR findings suggesting hypoperfusion are detected in a patient with hyperammonemia, the diagnosis of OCTD should be considered. Knowledge of the physiopathological mechanisms of OTCD and of MR imaging of hyperammonemic injury may help expedite diagnosis and treatment and prevent the exitus of patients with this genetic disorder.
Disseminated Paracoccidioidomycosis with a Single Brainstem Lesion
Authors: Corti M. , Trione N. , Risso D. , Soto I. , VillafañE M.F. , Yampolsky C. , Negroni R.
Published: April 2015

Paracoccidioidomycosis is a systemic disease endemic to subtropical areas in Central and South America caused by a dimorphic fungus known as Paracoccidioides brasiliensis. Central nervous system involvement is a severe complication of the systemic disease, and has been found in approximately 13% of patients. This paper describes the case of a patient whose computed tomography scan and magnetic resonance imaging showed a single tumor-like lesion in the brainstem. Histopathological and mycological examinations of stereotactic biopsy smears showed the characteristic yeast cells that confirmed the diagnosis of neuroparacoccidioidomycosis.
A Solitary Convexity Dural Chondroma: The Proposed Role of Diffusion-Weighted MR Imaging in the Differential Diagnosis of Intracranial Chondroma and Meningioma
Authors: Kawabata Y. , Miyake H. , Horikawa F.
Published: April 2015

Chondromas arising from the dura mater are rare intracranial tumors. We describe a case of intracranial chondroma originating from the durra mater of the convexity, mimicking a meningioma. The neuroradiological and surgical findings are described. The diagnostic clues for the differential diagnosis between chondromas and meningiomas are discussed and reviewed.
Advanced Contrast-Enhanced MR Imaging of the CNS
Authors: Essig M. , Gerigk L.
Published: April 2015

One of the most frequent uses of magnetic resonance imaging (MRI) since its introduction has been in the assessment of the CNS for neoplasm. In recent years there has been a substantial improvement in the MR protocol for tumors that includes the use of functional imaging techniques. As shown in multiple experimental and clinical studies an optimized use of high quality contrast media and the introduction of these functional MRI methods has improved the detection and delineation of CNS tumors. This results not only in more confident diagnoses, but also in a substantially improved differential diagnostic process. The article reviews and summarizes the technical advances in functional techniques and their impact on the assessment of cerebral pathologies, namely brain tumors, and gives practical information on how to optimize sequence parameters to achieve the optimal tissue and pathology contrast.
MRI Aspects of Neuro-Vascular Conflict of the VIII Nerve
Authors: Serra A. , Chiaramonte R. , Viglianesi A. , Messina M. , Maiolino L. , Pero G. , Chiaramonte I.
Published: April 2015

The vascular cross compression syndrome of the vestibule-cochlear nerve is an abnormal contact between the VIII nerve and a vessel leading to tinnitus and/or vertigo due to the nerve irritation. MRI is an important diagnostic tool as it will display the whole course of the nerve and identify the site and the type of neuro-vascular contact. However, MR findings are not specific and diagnosis can only be made on the basis of clinical and otolaryngologic features, after ruling out other possible diseases causing the same symptomatology. We describe 15 patients with neuro-vascular conflict disclosed by MRI examination which was associated with non specific neuro-othologic symptoms.
MR Venographic Patterns in Chronic Intractable Headache
Authors: Valk J. , Van Vucht N. , Pevenage P.
Published: April 2015

MR imaging (MRI) and MR venography (MRV) were performed in 110 consecutive patients referred for chronic intractable headache (ChIHA). This study was prompted by a number of incidental findings in this group showing abnormalities of cerebral venous return (CVR). MRV was therefore included in the workup of patients with ChIHA. The synchronicity of this study with the worldwide renewed interest in CRV as a result of the Zamboni hypotheses about the role of obstruction of CVR in multiple sclerosis(MS) and the suggested improvement by venous dilation or stenting (“liberation” therapy), is coincidental. The concept of a venous cause for MS is not new, but felt always short in explaining many of the features of MS.
MR Imaging in Multiple Sclerosis: The Accuracy of 3D Double Inversion Recovery at 3 Tesla and the Potential for Single Sequence Imaging
Authors: Khangure S.R. , Khangure M.S.
Published: April 2015

To compare the accuracy of a three dimensional, T2-weighted double inversion recovery (DIR) sequence with two dimensional fluid attenuated inversion recovery (FLAIR) and dual echo T2 (DE T2) sequences at 3 Tesla in the detection of intracranial demyelinating lesions in patients with known or suspected multiple sclerosis (MS), and to consider the appropriateness of a stand-alone DIR sequence in MS imaging. The studies of 98 patients who underwent imaging with DE T2, FLAIR and DIR sequences for known or suspected multiple sclerosis were retrospectively reviewed. In 42 cases, a diagnosis of MS had been clinically suspected. In the remaining 56 cases, a diagnosis of MS had been previously established. All patients were imaged on a 3T MRI unit. Coronal and sagittal FLAIR, axial DE T2, and three dimensional T2-weighted DIR sequences were utilised. Of the 42 patients with suspected multiple sclerosis, 11 demonstrated lesions characteristic of the disease. Demyelinating plaques were seen in all of the 56 patients with known MS. In all cases, all lesions seen on DE T2-or FLAIR sequences were visible and more conspicuous on the DIR sequence. In 22 of the 67 patients (33%) with demyelinating lesions, the DIR sequence showed additional lesions not visible on any of the other sequences. Additional detected lesions predominantly involved grey matter. At 3 Tesla, a T2 weighted, three dimensional DIR sequence is as accurate at detecting the presence of intracranial demyelinating lesions as two dimensional FLAIR and DE T2 sequences combined. A greater number of lesions were detected with the DIR sequence, and all lesions were more conspicuous. A single, stand alone DIR sequence may be considered appropriate for monitoring MS.
Venous Hypertension and Cerebral Aneurysm Rupture
Authors: Tsai Fong Y , Yen Andrew , Guo Wan-Yuo , Wu Chih-Chun
Published: April 2015

To investigate the correlation between the sinus asymmetry and aneurysm rupture. We retrospectively reviewed all diagnostic and therapeutic conventional angiograms of patients with cerebral aneurysms in our hospital from January 2000 to April 2008. Cases were categorized according to gender, presence or absence of aneurysm rupture, and presence or absence of symmetric dural sinuses. Exclusion criteria included patients with underlying fibromuscular dysplasia, dissecting aneurysms, pseudoaneurysms, and the presence of arteriovenous malformations or fistulas. The venous pressure was measured by MR phase contrast with standard fluid dynamics notation as Poiseuille's Law. A total of 193 cases (131 females and 62 males) were included for Chi-squared analysis, which showed significant difference (p < 0.05) between aneurysm rupture and venous asymmetry in the entire group as well as in females, but not in males. There was an association between side of rupture and side of asymmetry as well as between the size of hemorrhage. Ruptured aneurysm is more frequent at the same side of dominant dural sinus than the side of hypoplasia venous sinus. MRA phase contrast is able to show the venous pressure gradient of asymmetrical dural sinuses. With our preliminary data, we propose that dural sinus asymmetry is associated with aneurysm rupture.
Cerebral Amyloid Angiopathy-Related Inflammation: An Emerging Disease
Authors: Savoiardo M. , Erbetta A. , Di Francesco J.C. , Brioschi M. , Silani V. , Falini A. , Storchi G. , Brighina L. , Ferrarese C. , Ticozzi N. , Messina S. , Girotti F.
Published: April 2015

Three elderly patients with, respectively: mild cognitive impairment, severe and progressive neurologic involvement, and focal neurologic deficit, were observed. MRI showed multiple areas of white matter edema, at times partially involving the cortex, in the first two patients, and a single area in the third. Treatment with steroids determined the disappearance of the lesions and clinical amelioration. The key to the diagnosis of cerebral amyloid angiopathy-related inflammation (CAA-ri) was the demonstration, with appropriate MRI sequences, of microbleeds consistent with cerebral amyloid angiopathy (CAA). This diagnosis was supported by genetic analysis of APOE with demonstration of ε4/ε4 genotype, found in about 80% of CAA patients who develop inflammatory changes. In the appropriate clinical setting, MRI demonstration of microbleeds supported by results of genetic analysis of APOE may strongly support the diagnosis of CAA-ri thus avoiding cerebral biopsy.
Radiological Appearances of Oropharyngeal Soft Tissue Reduction with Bipolar Radio-Frequency Ablation in Sleep Disordered Breathing
Authors: Ghosh-Ray S. , Kotecha B. , Chawda S.
Published: April 2015

To demonstrate and track the changes of bipolar radiofrequency volumetric tissue reduction (BRFVTR) induced lesions of the tongue base and soft palate in the treatment of sleep disordered breathing (SDB) in a pilot study.
Congenital Cystic Eye with Corpus Callosum Hypoplasia: MRI Findings
Authors: Pinto P.S. , Ribeiro V. , Moreira B.
Published: April 2015

Congenital cystic eye is an extremely rare congenital anomaly with fewer than 40 cases reported. Although its aetiology remains unknown, it results from partial to complete failure in invagination of the primary optic vesicle. It is usually unilateral and presents as a heterogeneous lesion with a cyst bulging the upper eyelid and a solid component consisting in neuroglial tissue. We describe a rare case of congenital cystic eye with corpus callosum hypoplasia with special focus on the magnetic resonance imaging (MRI) features and their role in the diagnosis. We conclude that MRI is not only useful in the diagnosis and management of this rare entity, but it can also be helpful in diagnosing associated brain abnormalities.
Examination Portability
Authors: Fernandes A. , Bernardes P. , Cordeiro M. , Castro M. Do CÉu , Velho I. , Ratilal B.
Published: April 2015

Truly global radiology would exist if patients could visit any European physician without their CDs or films. It would be possible for patients to go to a hospital or a clinic in any European country and have their examinations done in a different country, analyzed and eventually compared with the examination done at that hospital. This paper analyzes two national projects that should be documented and analyzed: Scotland with a national archive with radiology images and Finland which is implementing a system that will create an online personal health record of the citizen with all health-related information. This possibility would improve quality in European radiology and create a true network of images and knowledge that can be the seed to improve efficiency by reducing costs and exposure to radiation and increasing knowledge sharing among European radiologists/neuroradiologists. We present here the idea of a network between three centers in three different countries that can be the start for a global project.
Abnormalities of the Spinal Dura Mater: Are Multiple Clinical Syndromes with Dural Lesions Associated with Abnormal Connective Tissue?
Authors: Quiñones D. , Viaño J.
Published: April 2015

We review several clinical and radiological entities that present with abnormalities of the spinal dura that may be related to each other. These include: the syndrome of spontaneous intracranial hypotension, neuroenteric cysts, spontaneous spinal cord herniation, degenerative disc disease associated with disc clefts or associated with intradural complications, and Hirayama disease. Our observations focus on common imaging findings of dural tears, abnormal peridural fluid and associated degenerative disc disease. We propose that T2 fat sat sequences should be routinely used in spinal imaging protocols to evaluate extradural fluid.
Incidental Finding of a Proatlantal Intersegmental Artery
Authors: Donmez H. , Kahriman G. , Serifov E. , Mavili E. , Ozcan N.
Published: April 2015

We describe the case of a 70-year-old woman who had a left proatlantal intersegmental artery disclosed during carotid artery angiography with the findings of carotid-basilar anastomosis which originated from the petrous segment of the ICA and was filling the horizontal segment of the vertebral artery. Awareness of this vascular variation can prevent morbidity and mortality associated with carotid ligation or carotid endarterectomy, especially when an incomplete circle of Willis is present.
A Case of Ophthalmoplegic Migraine: Some Observations
Authors: Patro S. , Banerjee T.
Published: April 2015

We describe a 43-year-old man with a long-standing history of headache and ophthalmoplegia. Brain MRI showed a nodular enhancing lesion at the root exit zone of the left oculomotor nerve. Contrast enhancement on follow-up MRI and clinical symptoms showed a partial resolution on starting prophylactic anti-migraine medications. This was confirmed to be a case of ophthalmoplegic migraine. Here we describe a rare case of OM in an adult patient with its characteristic imaging pattern and the differential diagnosis considered.
Non-Traumatic Sphenoidal Intradiploic Arachnoid Cyst as a Cause of Trigeminal Neuralgia
Authors: Granata F. , Alafaci C. , Passalacqua M. , Cacciola F. , Caffo M. , Salpietro F.M. , Vinci S.L. , Longo M.
Published: April 2015

Non-traumatic intradiploic arachnoid cyst is a rare condition. We describe a young man with typical trigeminal neuralgia and intradiploic arachnoid cyst at the greater wing of the sphenoid. The patient was successfully treated with medical therapy. To our knowledge, this is the first case report of a possible correlation between trigeminal neuralgia and intraosseous arachnoid cyst. We describe the clinical case, the possible pathogenetic mechanism and briefly review the literature.
Intracranial Aneurysms and Vascular Malformations: Diagnosis for Therapy
Authors: Grobovschek M. , Himmer M. , Wolfsgruber P. , Weymayr F.
Published: April 2015

In the second part of our overviewstudy the diagnosis for the treatment of our patients with intracranial vascular malformations (aneurysms / AVMF– arteriovenous malformations) is again shown in a region of about 500.000 inhabitants and just an overview of the outcome. This second part will be an overall comparison between the former diagnostic for the treatment and the here described diagnostic for the treatment (CTA, MRA, DSA rot / microsurgery, endovascular interventional techniques etc.), concerning also the topography and the demography. The future trends are also outlined.
Early Encephalic Toxicity after Inadvertent Intrathecal Injection of Low Osmolar Contrast Medium
Authors: Lonjaret L. , Geeraerts T. , Albucher J-F. , Dugert E. , Gigaud M. , Dupuy M. , Fourcade O. , Cognard C.
Published: April 2015

Only nonionic contrast media are allowed for intrathecal use because of their lower neurotoxicity. In case of inadvertent intrathecal administration of an ionic contrast medium, the typical following syndrome is called ascending tonic clonic seizure syndrome. We describe the case of a 61-year-old woman with low back pain who underwent myelography. Ioxaglate, a water-soluble ionic low osmolar contrast medium was accidentally injected intrathecally. She first presented encephalic signs of neurotoxicity, followed by opisthotonic spasms and respiratory distress. In our case, ioxaglate is a low osmolar agent, leading to early encephalic toxicity (preceding medullary signs), because of its cephalic migration. The patient was successfully treated by sedation, anticonvulsant therapy and fluid hydration. Intrathecal administration of an ionic contrast medium is clearly contraindicated. In case of inadvertent injection of a low osmolar product, encephalic signs are seen first.
Ipsilateral Stroke with Uncrossed Pyramidal Tracts and Underlying Right Internal Carotid Artery Stenosis Treated with Percutaneous Transluminal Angioplasty and Stenting
Authors: Alurkar A. , Karanam L. Sudha P. , Atre A. , Nirhale S. , Nayak S. , Oak S.
Published: April 2015

We present a unique case of ipsilateral stroke in a 55-year-old right-handed hypertensive man with proven uncrossed pyramidal tract demonstrated by tractography. Diffusion-weighted imaging disclosed small acute ischemic infarcts in the right corona radiata with MR angiography showing narrowing of the right internal carotid artery. Significant carotid stenosis of right internal carotid artery (ICA) was detected on digital subtraction angiography as the underlying cause and subsequently treated with percutananeous transluminal angioplasty and stenting with good outcome. The presence of uncrossed pyramidal tract was confirmed by diffusion tensor imaging tractography. To our knowledge there are few reports of ipsilateral stroke with proven uncrossed pyramidal tracts described in the literature. This is the first documented report of ipsilateral stroke with uncrossed fibre tracts due to underlying critical stenosis of the ICA treated successfully with a good recovery.
An Occult Spinal Neurenteric Cyst Associated with Congenital Hemivertebrae
Authors: Guarrera V. , Conte G. , Cavallaro T. , Chiaramonte R. , D'Amore A. , Caltabiano R. , Chiaramonte I.
Published: April 2015

We describe a case of an occult spinal neurenteric cyst associated with congenital hemivertebrae. Different intraspinal anomalies, such as neurenteric cysts (representing 0.3 to 0.5 % of all spinal tumors) have been reported in association with congenital hemivertebrae. Indeed, although CT is the best examination to study vertebral anomalies, MRI should be performed in order to exclude a more complex dysraphic condition.
A Single Center Experience of Stenting in Symptomatic Intracranial Atherosclerosis
Authors: Castaño C. , García-Bermejo P. , García M.R.
Published: April 2015

Atherosclerotic intracranial arterial stenosis is an important cause of stroke that is increasingly being treated with percutaneous transluminal angioplasty and stenting (PTAS) to prevent recurrent stroke. However, PTAS has been compared with medical management in a randomized trial (SAMMPRIS), where aggressive medical management was superior to PTAS with the use of the Wingspan stent system, however in our experience we have had good results and have experienced no complications with this therapy. In a retrospective, single-center study we enrolled seven consecutive patients with a symptomatic angiographically proven atherosclerotic intracranial arterial stenosis of the anterior and posterior circulation. All cases received adjuvant therapy (aspirin and clopidogrel or ticlopidine) before and after deployment of the device. The procedures were performed with the patient under general anesthesia. We use the Wingspan stent system. The occlusion site was middle cerebral artery (MCA) in three patients, proximal internal carotid artery (ICA) in one patient and vertebrobasilar artery in three patients. Primary interventional successful revascularization was achieved in all cases. Four patients had no residual stenosis, and the other three had 20%, 30% and 40% residual stenosis (Table 1). All patients showed a clinical improvement after stent deployment. No peri-interventional events or neurologic complications occurred directly related to the technique. Patency rate was 100% at the last examination in six cases, one case had a pre-occlusive stenosis, requiring angioplasty. No patients died during the follow-up period, and 100% of patients showed good functional outcome at three months (modified Rankin Scale score ≤ 2). Although the SAMMPRIS study showed that aggressive medical management was superior to PTAS, our results suggest that intracranial stenting is safe and effective, probably due to an extraordinary selection of candidates and to an exquisite technique.
Pediatric Inflammatory Diseases
Authors: Catalucci A. , Anselmi M. , Splendiani A. , Smith J.D. , Limbucci N. , Giangaspero F. , Gallucci M.
Published: April 2015

Multiple sclerosis (MS) is an inflammatory CNS disease characterized by multifocal areas of demyelination; usually it arises in young adults, but can also occur in children (under the age of 10) and adolescents (under the age of 18). As in adult, pediatric MS (PMS) diagnosis is based on the demonstration of multiple demyelination episodes separated in time and spaces. Diagnostic criteria realized for childhood are similar to those employed for adults. Although clinical and imaging features of PMS can be similar to those of adults, the disease is often characterized by a more aggressive course and atypical imaging findings, with giant and pseudotumoral plaques. Differential diagnosis between PMS and ADEM could be difficult: clinical findings and MRI are necessary; sometimes MRI follow-up is required for definitive diagnosis.
Endovascular Treatment of a Large Venous Pouch Direct Carotid Cavernous Fistula
Authors: Mahmoud M. , Elsissy M.H.
Published: April 2015

Endovascular treatment of direct carotid cavernous fistula (CCF) can be performed by either arterial or venous approaches. The aim is to disconnect the fistula with or without preservation of the internal carotid artery (ICA). The aim of this article is to describe a technique for embolization of the cavernous sinus and the ICA in direct CCF using coils. Trapping the distal aspect of the fistula using a retrograde navigation via the vertebrobasilar system and the posterior communicating artery was performed in two cases. Clinical and radiological evolutions are described.
Ischemic Stroke Penumbra and Extracorporeal Ozone Treatment
Authors: Wasser G.
Published: April 2015

The course of events in ischemic strokes is normally seen from a point in which the penumbra is already in place. Since there is no known treatment for edema reduction, mainstream medicine focuses on re-opening the occluded vessel. Here we show that reducing the penumbra saves neuronal units from undergoing apoptosis.