bluuebunny/crossref_metadata_2025 huggingface dataset:
Asymptomatic Self-Limiting Diffuse White Matter Lesions in Subacute to Chronic Stage of Herpes Simplex Encephalitis
Authors: Tokumaru A.M. , Kamakura K. , Terada H. , Kobayashi O. , Kanemaru A. , Kato T. , Murayam S. , Yamakawa M. , Mizuno M.
Published: April 2015

This study evaluated white matter changes in the subacute and chronic stages of herpes simplex encephalitis (HSE). Subjects comprised 15 patients with HSE. All patients were examined using MRI at onset, and then at seven to ten days, three to five weeks and two to three months after onset. In addition, the six patients who displayed white matter signal abnormalities were examined at six months and >one year after onset. Cell count, protein levels, polymerase chain reaction (PCR) of herpes simplex virus in cerebrospinal fluid (CSF), and exacerbation of neurological symptoms as well as dose of acyclovir were compared between patients with and without white matter abnormalities. Diffuse white matter signal changes were identified at the subacute stage (3-5 weeks after onset) of HSE in six patients (6/15, 40%). No significant relationship was observed between the presence of white matter signal abnormalities and laboratory data, acyclovir dose or clinical symptoms. These signal abnormalities disappeared or improved by two years without any clinical treatment. Diffuse white matter signal abnormalities occur frequently in the subacute stage of HSE. Although the mechanisms underlying these white matter lesions have not been elucidated, subclinical immune-mediated processes may be considered. Repeat MRI studies over a long period are necessary for evaluating the clinical process of patients with HSE.
Differentiation of High-Grade and Low-Grade Gliomas Using Pattern Analysis of Long-Echo Single-Voxel Proton Magnetic Resonance Spectroscopy (1H-MRS)
Authors: Chernov M.F. , Ono Y. , Muragaki Y. , Kubo O. , Nakamura R. , Iseki H. , Hori T. , Takakura K.
Published: April 2015

The usefulness of proton magnetic resonance spectroscopy (1H-MRS) for glioma grading is not clear, particularly due to the absence of standard criteria for data analysis. Previously we had developed an original classification of the pathological 1H-MR spectra based on the identification of the predominant metabolite peak, N-acetylaspartate (NAA) for Type I, choline-containing compounds (Cho) for Type II, and mobile lipids (Lip) for Type III, and presence or absence of other metabolite peaks: lactate (Lac), Lip, or Cho. The present study evaluated the effectiveness of this classification in grading of previously non-treated gliomas. A total of 38 low-grade and 33 high-grade neoplasms were investigated. Four tumors had 1H-MR spectra Type I, and all of those were low-grade. Three tumors had 1H-MR spectra Type III, and all those were glioblastomas. Fifteen tumors with 1H-MR spectra Type II had a Lip/NAA ratio more than 1 (Type II C with moderate elevation of lipids), and 12 of those neoplasms were high-grade. The differences in distribution of high-grade and low-grade gliomas among another 49 gliomas with 1H-MR spectra Type II did not depend on the presence of Lac and/or Lip peaks, and in this subgroup NAA/Cho ratio was also evaluated. Inclusion of both characteristics (type of the 1H-MR spectrum and NAA/Cho ratio with defined cut-off level of 0.6) into the diagnostic algorithm yielded 72% diagnostic accuracy (95% confidence interval: 62%–82%) in discriminating high-grade and low-grade neoplasms. In conclusion, pattern analysis of the pathological 1H-MR spectra using the proposed classification along with evaluation of NAA/Cho ratio might be helpful for non-invasive glioma grading.
Spinal Segmental Dysgenesis: Presentation of a Rare Spinal Congenital Abnormality
Authors: Emmanouilidou M. , Chondromatidou S. , Arvaniti M. , Goutsaridou F. , Papapostolou P. , Tsitouridis I.
Published: April 2015

Segmental spinal dysgenesis is a rare spinal congenital abnormality in which a segment of the spine and spinal cord fails to develop completely. This entity is often associated with other congenital anomalies such as multiple vertebral segmentation defects, congenital vertebral displacement, tethered cord, hydromyelia and syringohydromyelia.
High Resolution Computed Tomography Analysis of the Temporal Bone
Authors: Chung Hsiung-Kwang , Wang Chin-Yuan , Lin Chia-Der , Lo Yu-Chien , Tsai Ming-Hsui
Published: April 2015

Detailed radiological assessment by high resolution computed tomography (HRCT) of temporal bone is demanded before any temporal bone or skull base surgery. The aim of this study was to measure the relations between the anatomical landmarks of the temporal bone and to assist the otolaryngologist in establishing accurate preoperative evaluation. We enrolled 43 patients who underwent temporal bone HRCT between February 2004 and May 2004. Contiguous axial and coronal images at 1.0 mm thickness were obtained. Some landmarks such as the superior and inferior lips of the internal acoustic canal (IAC), the malleoincus joint, and the posterior semicircular canal were labeled in the coronal and axial views. Then we measured the distance between them. Average IAC diameter in the coronal and axial views was 5.33 mm and 6.92 mm. Average IAC length in the coronal and axial views was 12.29 mm and 11.09 mm. The thickness of the retrolabyrinthine bone was 3.78 mm. The incidence of thinning bone overlying the superior semicircular canal was 2.3%. Our data could be applied to normal distribution because there were no statistical differences between the measurements of normal ears and diseased ears. Several specific measurements can be applied to the preoperative evaluation of vestibular schwannoma including the retrosigmoid approach, the translabyrinthine approach and the middle fossa approach.
Transvenous Treatment of Cavernous Dural Arteriovenous Fistulae with Onyx and Coils
Authors: Jiang Chuhan , Lv Xianli , Li Youxiang , Wu Zhongxue
Published: April 2015

We report on patients with cavernous dural arteriovenous fistulae (CDAVFs) who underwent transvenous embolization via different transvenous approaches with Onyx and coils. Twelve patients presenting with clinically symptomatic CDAVFs who were treated between August 2005 and November 2007 at Beijing Tiantan Hospital were reviewed. The approach routes, angiographic results and clinical outcome were assessed. Retrospective analysis of data for 12 patients (age range 36–75 yrs, mean age 59.3 yrs) with CDAVFs was performed. The CDAVFs were treated with Onyx and coils via different transvenous approaches in 14 procedures. Cerebral angiography was performed to confirm the treatment and diagnosis. The mean clinical follow-up period was 5.5 months. A total of 13 transvenous procedures and one transarterial procedure were performed for 12 CDAVFs. Eleven patients with CDAVFs of the CS were cured with respect to clinical symptoms, and one patient experienced improvement. The approach via the internal jugular vein and inferior petrosal sinus (n=10) was possible, with complete occlusion of the fistula in all cases. With the approach via the facial vein (n=2), there was a good success rate. We encountered no complications in any of the cases. Transvenous treatment of CDAVFs with Onyx and coils can be an effective option for different transvenous approaches.
High-flow Paraspinal Osseous Epidural Arteriovenous Fistula
Authors: Iizuka Yuo , Suzuki Mitimasa , Suzuki Kazuhiro , Shimoji Keigo , Komura Shinji
Published: April 2015

We report the clinical and neuroradiological imaging findings of a 26-year-old man who presented with lumbago related to high flow paraspinal osseous epidural arteriovenous fistulas in the thoracic spine. This case was of particular interest because of his exclusive epidural and paraspinal venous drainage and the presence of a prominent dilated venous pouch in the spinal canal. Angiography demonstrated multiple high flow arteriovenous fistulas with an osseous nidus. Transarterial glue embolization was performed by multistage sessions. Clinical symptoms improved dramatically. The unusual features of this case have important implications for therapeutic management.
Effect of a Static Magnetic Field (1.5T) on Brain Oscillatory Activities in Resting State Condition
Authors: Formaggio E. , Avesani M. , Storti S.F. , Milanese F. , Gasparini A. , Acler M. , Cerini R. , Mucelli R. Pozzi , Fiaschi A. , Manganotti P.
Published: April 2015

The aim of the present study was to compare the EEG signal recorded outside and inside a 1.5T magnetic resonance (MR) scanner. The EEG was recorded in eyes open and eyes closed conditions using a digital recording MR-compatible system. To characterize how a static magnetic field induces changes in EEG signal, EEG data were analyzed using FFT frequency analysis. No significant difference between the alpha powers recorded outside and inside the magnetic field was observed in eyes closed conditions. However, in eyes open condition there was a significant increase in alpha power inside the magnet in comparison to the outside position. The changes in alpha power according to the eyes open/closed conditions could be inversely correlated to a subject's state of wakefulness and due to some physiological changes, rather than an effect of the magnetic field. This experiment suggests that subjects' state of wakefulness is of prime concern when performing functional MRI.
Long-term Follow-up Angiography of Intracranial Aneurysms Treated with Cook Detachable Coil System
Authors: Pardo M.I. , Pumar J.M. , Abal D. , Garcia-Allut A. , Blanco M. , Vazquez F.
Published: April 2015

The long-term outcome of detachable coil embolization of cerebral aneurysms is still unknown. The purpose of this study was to evaluate the stability of the anatomic occlusion of aneurysms treated with the Cook detachable coil system and assess the rate of recanalization and recurrence. A study involving 250 patients with 271 ruptured aneurysms treated with the Cook detachable system between January 1997 and September 2003 who subsequently underwent six month, one year and two year follow-up angiography were enrolled in the study. Angiographic findings were reviewed to determine the percentage of aneurysm occlusion. Long-term follow-up angiograms (at two years) demonstrated complete occlusion in 75% of cases, and subtotal occlusion in 25% of cases. Overall morbidity was 7.3%, aneurysm recurrence 3.2%, and aneurysm re-treatment 3.2%. Recurrent subarachnoid hemorrhage occurred in only one patient. Angiographic follow-up demonstrated the stability and durability of treatment with the Cook detachable coil system.
Acquired Anterior Basal Encephalocele in Idiopathic Hypertrophic Pachymeningitis
Authors: Singh C. , Kesavadas C. , Nair M.D. , Sarada C.
Published: April 2015

This report describes a 49-year-old woman diagnosed as idiopathic hypertrophic pachymeningitis (IHCPM) with imaging evidence of diffuse dural sinus thrombosis. Over the years, secondary to the raised intracranial pressure, she had developed an anterior basal encephalocele through the defects in the cribriform plate of the ethmoid bone. The relation between elevated intracranial pressure and encephalocele is discussed.
Neurosarcoidosis with Intraparenchymal Cystic Lesions
Authors: Hajri F.A. Al , Muqim A.T. , Muttikkal T.J.E.
Published: April 2015

Sarcoidosis is a chronic multi-system granulomatous disorder of unknown etiology. Central nervous system involvement is relatively uncommon in sarcoidosis. Clinical manifestations and radiological appearances of neurosarcoidosis vary widely depending on the site and activity of the lesions. In most cases, the imaging appearance is nonspecific. We report a very rare case of extensive neurosarcoidosis with progressively enlarging cystic lesions in the right temporal lobe.
Isolated Bilateral Pyramidal Tract Lesions? An Unusual Case of Demyelination following Trauma
Authors: Muttikkal T.J.E. , Ashebu S.D. , Ben-Nakhi A. , Pulikkottil M.P. , Sheikh M.
Published: April 2015

This paper describes the case of a young woman who developed quadriparesis due to isolated bilateral pyramidal tract lesions suggestive of demyelination following trauma.
Gliosarcoma: An Unusual Cause of Cerebral Mass Lesion in a Patient with AIDS
Authors: Corti M. , Trione N. , Muzzio E. , Yampolsky C. , Lewi D. , Schtirbu R. , Sevlever G.
Published: April 2015

Malignant glioma is the most common primary brain neoplasm. Generally, gliomas are not included in the differential diagnosis of enhancing lesions of the central nervous system in patients infected by the human immunodeficiency virus. We report a case of gliosarcoma in a patient with AIDS presenting as a single cerebral lesion. Stereotactic brain biopsy was obtained and definitive histopathological diagnosis of gliosarcoma was made. A decline in the incidence of opportunistic infections associated with highly active antiretroviral therapy suggest the importance of early stereotactic biopsy to confirm the diagnosis of these neoplasms.
Myoinositol Trends in Different Types of Brain Lesions
Authors: Salzedo E. , Cortes MdP , Melançon D. , Tampieri D.
Published: April 2015

Myoinositol (Myo) is a not yet well known metabolite detected using short echo time proton magnetic resonance spectroscopy (HMRS). We examined the role of Myo in 26 patients with new diagnosis of brain lesions including tumors, inflammatory and infectious processes. Histological confirmation of the diagnosis was obtained during gross total surgical resection or stereotactic biopsy of the lesions. The highest ratios of Myo/Cr were found in the hemangiopericytoma and meningioma followed by cortical dysplasia, low grade gliomas, gliobastomas, lymphomas, demyelinating lesions and toxoplasmosis. There was no Myo detected in the cases of metastasis and abscess. Increased Myo levels correlated with low grade gliomas suggesting its potential use in the differentiation of glial tumor. Myo demonstrated a unique pattern in hemangiopericytoma.
Apparent Diffusion Coefficient Histograms in the Follow-up of Relapsing-Remitting Multiple Sclerosis
Authors: Paavilainen T. , Kurki T. , Korhonen K. , Airas L.
Published: April 2015

Diffusion-weighted (DW) magnetic resonance (MR) imaging in addition to conventional magnetic resonance MR images provide valuable information in multiple sclerosis (MS). Increased diffusivity measured with diffusion-weighted imaging (DWI) has been demonstrated in normal appearing brain tissue in MS. So far, longitudinal changes taking place in whole-brain histograms in patients with active relapsing-remitting MS have not been evaluated. The aim of this study was to evaluate how apparent diffusion coefficient (ADC) histograms are altered during the follow-up of active relapsing-remitting MS patients. Nine patients were studied twice by MRI with a three-month interval. All patients had active newly diagnosed MS with two to three relapses during the year preceding the first MRI, and interferon-beta treatment was initiated after obtaining the first image. ADC histograms were produced after removing extracranial tissues and cerebrospinal fluid from the images. Additionally, brain volume index (BVI) and lesion volume on FLAIR images were measured. Five patients had signs of disease activity in the follow-up MRI. In the four patients without signs of disease activity the change in ADC histogram parameters was less than 2%. In patients with disease activity both increase (one case) and decrease (four cases) in histogram parameters were detected. Changes in BVI or lesion volume did not significantly correlate with histogram changes. The number of new T2-lesions showed a positive correlation with mean (r=0.79, P=0.014) and upper quartile (r=0.77, P=0.021) value change. Alterations in disease activity lead to histogram changes; both shifts to lower values and shifts to higher values are possible. The histogram changes are mostly related to subtle inflammatory changes in normal appearing brain tissue during inflammatory activity and their resolution during less active inflammatory conditions.
Endovascular Treatment of Intracranial Wide-Necked Aneurysms with GDCs Combined with Balloon or Stent
Authors: Xu N. , Wang H. , Luo Q.
Published: April 2015

This article introduces our experience in embolizing wide-necked intracranial aneurysms with GDCs combined with balloon or stent. Fifty-five patients with wide-necked intracranial aneurysms (aneurysm neck ranged 2.1–7.0 mm, body/neck ≤2) underwent embolizing treatment with GDCs combined with balloon or stent. Twenty patients were treated with balloon technique. Only one complication occurred when one loop of a coil herniated into the parent artery after the GDC were detached, but no parent artery obstruction occurred. One patient died because from aneurysm rupture caused by herniation of the balloon through the over wide neck into the aneurysm during inflating. Thirty-five patients were treated with the stent technique. Five aneurysms were treated using a stent alone. Two of the five aneurysms could not be recognized from DSA after the stents were released (three and six month follow-ups showed no recurrence), one of the five ruptured leading to the patient's death two weeks after the operation. There was no aneurysm recurrence seen by DSA in the post operative follow-up of six to 12 months. GDCs combined with balloon or stent techniques are safe and effective in treatment of wide-necked intracranial aneurysms.
A Comparison of Minimally Invasive Techniques in Percutaneous Treatment of Lumbar Herniated Discs
Authors: Guarnieri G. , Vassallo P. , Pezzullo M.G. , Laghi F. , Zeccolini F. , Ambrosanio G. , Galasso R. , Muto M. , Izzo R.
Published: April 2015

Low back pain is the commonest spine disease causing absence from work in developed countries. Low back pain with classical irradiation along the course of the nerve root affected is more frequently due to disc disease. In 60–80% of patients with herniated disc, radicular symptoms disappear with conservative treatment after about six weeks, the remainder are treated surgically with a 2–6% of incidence of true recurrence of herniation post-intervention and with failed back surgery syndrome in 15% of cases. Recently minimally invasive techniques have developed as “alternative” treatments to surgical intervention. This review aimed to assess the pathogenesis of low back pain caused by lumbar disc hernia as a basis for action of minimally invasive techniques; to illustrate the techniques already used or currently in use, to compare them in technical guidance, indications and complications, exposing for each of them the inclusion/exclusion criteria in enrolling patients and the imaging guide technique of choice. Minimally invasive techniques can be a valuable alternative to traditional surgery with low cost, low risk of complications, easy feasibility, and in the event of failure they do not exclude subsequent surgery.
Association between Developmental Venous Anomalies and Cavernous Angiomas: A Retrospective MR Study
Authors: Marasco R. , Spagnoli M. , Leonardi M.
Published: April 2015

Developmental venous anomalies (DVA) are large veins usually arranged in a cluster around a collector vein draining directly into the superficial and deep venous systems. Since the introduction of magnetic resonance imaging DVA have been disclosed more frequently. Many studies suggested and then confirmed the association between cavernous angioma and developmental venous anomaly, described for the first time by Roberson in 1974. The aim of our study was a retrospective assessment of the case series at our institution, namely to determine the frequency of the association between developmental venous anomaly and cavernous and analyse the relation between the two lesions.
Acute Interhemispheric Subdural Haematoma
Authors: Rispoli R. , Mastrostefano R. , Koumpouros N. , Blasetti A.G. , Coletta R.P.
Published: April 2015

Acute interhemispheric subdural haematoma (AISH) was considered extremely rare until identification with imaging studies. Interhemispheric subdural hematoma in adults is a rare complication of head injury with no more than 100 cases reported since 1940. The classical presentation of this disorder is a contralateral monoparesis of the leg or a hemiparesis more pronounced in the leg1. Treatment may consist of conservative observation or craniotomy and is dictated by the clinical course. Conservative management is the treatment of choice for patients without disturbances of consciousness and for patients with stable clinical conditions. Surgical treatment is necessary in patients with progressive neurological deterioration. We describe the case of traumatic AISH in a 31-year-old patient who presented a contralateral monoparesis of the leg.
Clinical Outcomes of Basilar Artery Aneurysms
Authors: Qu S. , Lv X. , Wu Z.
Published: April 2015

To evaluate the effects of endovascular treatments, we retrospectively analyzed a consecutive series of patients with basilar artery aneurysms (BAAs) treated endovascularly. During a seven year period, 43 patients (mean age 42.2 years, male/female ratio 21:22) with BAAs were treated mainly with endovascular techniques at Beijing Tiantan Hospital. Pretreatment clinical grades were determined using the Hunt-Hess scale. Outcome was evaluated using the Glasgow Outcome Scale scores (GOS) during a mean follow-up period of 21.1 months (range, 1 to 72 months). Forty-three patients had 44 BAAs, one MCA aneurysm and one P1 aneurysm. Endovascular treatment was technically feasible in 40 patients. One aneurysm thrombosed spontaneously after initial angiography. Four (9.3%) patients died periprocedurally. Immediate postprocedural angiograms in 44 BAAs showed that complete occlusion was achieved in 33 BAAs, subtotal occlusion in one and incomplete occlusion in seven. Follow-up angiographic results in 30 patients confirmed complete occlusion of 27 aneurysms, subtotal occlusion in one, and incomplete occlusion in two. Two patients with vertebrobasilar atheromatous fusiform aneurysms were treated with antiplatelet medications. Long-term outcome was good (GOS Score 4 or 5) in 39 patients (90.7%) and fatal (GOS Score 1) in four (9.3%). Favorable overall long-term outcome can be achieved in patients with BA apex aneurysms, and in 78.6% of those with BA trunk aneurysms when using endovascular techniques. Endovascular coil embolization of BAAs is an effective treatment in the long-term. Patients with vertebrobasilar atheromatous fusiform aneurysms can be treated with antiplatelet medications.
MRA Evidence of Superior Sagittal Sinus — Torcular Herophili Divisions in a New Type of Occipital Sinus
Authors: La Montanara P. , Crisi G.
Published: April 2015

We describe a new type of occipital sinus: absence (or hypoplasy) of the right transverse sinus, patent right sigmoid sinus and a well formed left occipital sinus draining into the left marginal sinus. The lateral and occipital sinus variations were classified into five groups by Kalbag. This classification was modified in 1980 by Dora and Zileli.

We speculate on the possible MRA evidence of “divisions” of the superior sagittal sinus (SSS), as reported by Shao et Al (2009) who examined the lumen of the SSS and torcular Herophili with the aid of an endoscope.
An Interpretation of Optic Nerve Tortuosity
Authors: Viglianesi A. , Messina M. , Chiaramonte R. , Meli G.A. , Meli L. , Chiaramonte I. , Pero G.
Published: April 2015

Magnetic resonance imaging disclosed both optic nerve tortuosity and kinking in a 64-year-old man with orbital pain and monolateral abducens nerve palsy. The association between optic nerve tortuosity and abducens nerve palsy is often described in literature reports of idiopathic intracranial hypertension. However the diagnosis of idiopathic intracranial hypertension was excluded in our patient because of the absence of other signs such as papilledema (universally present in the cases of idiopathic intracranial hypertension), visual loss, headache and flattening of the posterior sclera. Other possible diagnoses to be considered when looking at a case of optic nerve tortuosity are neurofibromatosis and/or optic nerve glioma. Tortuosity of both optic nerves seems to be isolated in our patient and not associated with other diseases or disorders. We suggest that in some patients optic nerve tortuosity could be correlated with an aberrant anatomical development of the optic nerve. Further studies are necessary to confirm this hypothesis which currently remains conjectural.
Listerial Rhombencephalitis MR Findings
Authors: Summa A. , Crisi G. , Cerasti D. , Ventura E. , Ormitti F.
Published: April 2015

We describe a case of listerial rhombencephalitis in a previously healthy 37-year-old woman. The diagnosis was based on the clinical findings, results of cerebrospinal fluid analysis, blood culture and MR imaging. The specific treatment was started after culture results were available, and the patient made a full clinical recovery.
Brain Edema after Carotid Revascularization: Benign Syndrome or Prelude to Hemorrhage?
Authors: Parrilla G. , Zamarro J. , De Rueda M. Espinosa , Lüttich A. , Morales A. , Lopez M. , Moreno A.
Published: April 2015

Brain edema (BE) post carotid revascularization (CR) is considered a benign presentation of the hyperperfusion syndrome. Its physiopathology has been related to production of vasogenic edema that tends to progressive spontaneous resolution. Its relation with post-CR hemorrhage remains unclear. Three cases of BE post-CR are described and compared to controls. Clinical evolution, medical management, and plain-CT and perfusion-CT (PCT) results are analysed. Two cases of BE had a benign course, with a progressive resolution of edema and disappearance of neurologic deficits. Effective blood pressure control was achieved in these patients. The third case suffered massive hemorrhage 24h after initial BE and died. This patient reached peak systolic levels of 220 mmHg before conversion to hemorrhage. Plain-CT and PCT findings were similar in the three patients with BE. CT showed signs of hemispheric brain swelling ipsilateral to CR. PCT showed low MTT and high CBF values on the hemisphere ipsilateral to CR compared to the contralateral hemisphere, with symmetric CBV values. Plain-CT and PCT in controls showed no abnormalities. BE post CR can be reversible but may also herald a hemorrhagic complication. A common physiopathology of post-CR BE and hemorrhage is suggested by PCT findings, related to failure of autoregulation and secondary blood-brain-barrier dysfunction. Spontaneous resolution of BE post-CR should not be routinely expected in clinical practice. Conversion to hemorrhage might be related with deficient blood pressure control and secondary rupture of the already damaged vessel wall.
Neuroimaging Studies in Alzheimer's Disease
Authors: Cuellar H. , Gómez-Ramos P. , Riascos R. , De Alba L.
Published: April 2015

Alzheimer's Disease (AD) is a progressive neurodegenerative disease associated with memory loss and gradual behavioral, functional and cognitive impairment. Conventional imaging studies, such as magnetic resonance or computed tomography have played a secondary role in AD diagnosis: While other causes of memory loss and cognitive deficit can be evaluated by these imaging methods, AD structural changes are not detected until very late in the course of the disease. Recent and more precise techniques have been developed to detect subtle changes not visualized with those imaging methods. This article presents a review of the neuroimaging techniques used as a diagnostic aid for AD.
Chronic Pituitary Failure Resembling Sheehan's Syndrome following a Bite of Russell's Viper
Authors: Srinivasan K.G. , Srividya S. , Nandhini K.P. Usha , Ramprabananth S.
Published: April 2015

Hypopituitarism can be the sequela of a variety of causes like postpartum pituitary necrosis or Sheehan's syndrome, lymphocytic hypophysitis, trauma and encephalitis. A very rare cause is envenomation by a bite of a Russell's viper. Very few cases with documented imaging findings of chronic pituitary failure resulting from snake bite have been reported. We describe a case of hypopituitarism with clinical, endocrine and magnetic resonance (MR) imaging studies occurring as a delayed complication of snake bite.
Vertebroplasty as a Treatment for Primary Benign or Metastatic Cervical Spine Lesions: Up to One Year of Follow-up
Authors: Guarnieri G. , Vassallo P. , Ambrosanio G. , Zeccolini F. , Lavanga A. , Varelli C. , Fabozzi G. , Izzo R. , Muto M.
Published: April 2015

This paper illustrates the validity of vertebroplasty (VP) in patients with primary benign or metastatic lesion in the cervical spine. From January 2006 to December 2007, ten consecutive patients were treated with VP for a total of ten vertebral bodies: two symptomatic vertebral haemangiomas at C5 and C4.3, multiple myeloma at C2 (two cases) and one case at C4, five patients with vertebral metastasis from breast or lung cancer at C2, C4 (three cases) and C5. All the patients complained of pain resistant to continuous medical management. All procedures were performed under general anaesthesia by anterolateral approach under CT or fluoroscopy control with manual dislocation of the carotid axis. A transoral approach under fluoroscopy was performed to treat the C2 lesion. Bone biopsy was never performed. VP was performed to prevent fracture after implantation of a double discal prothesis in two patients. For patients with multiple myeloma, VP was performed to prevent new vertebral fracture. VP was performed before of radiotherapy in three patients with metastasis, and just after radiotherapy in two. Two metastatic patients were lost at one year follow-up due to death from systematic diffusion. Results were evaluated on the Visual Analogue Scale (VAS) and the Oswestry Disability Index (ODS). A successful outcome was observed with a complete resolution or partial reduction of pain in 90% of patients 24–72 hours after VP. At 12 months follow-up, we recorded a reduction of four points in the VAS evaluation and a 45% reduction in the ODS score. No extravertebral vascular or discal cement leakage was observed. At 12 months, X-ray follow-up showed a stable result. Percutaneous treatment with VP for benign or malignant cervical spine lesions is a valuable, mini-invasive and quick method that allows a complete and enduring resolution of painful vertebral symptoms without fracture of the adjacent or distal vertebral bodies.
Desmoplastic Fibroma of the Mandible: Usefulness of CT and MR Imaging in Diagnosis and Treatment
Authors: Summa A. , Cerasti D. , Crisi G. , Ormitti F. , Ventura E. , Sabato M.
Published: April 2015

Desmoplastic fibroma (DF) is a rare non-metastasizing benign neoplasm of the bone characterized by aggressive local infiltration, also known as desmoid tumour. Desmoplastic fibroma of the mandible may recur locally when incompletely excised. In particular it can occur adjacent to and display contiguous extension along the mandibular nerve. This case report describes the imaging findings of a histopathologically proven desmoplastic fibroma involving the right mandibular region in a three-year-old Italian girl. We also discuss the usefulness of different imaging modalities (CT and MRI) in DF diagnosis and treatment.
Updates in the Determination of Brain Death
Authors: Beltramello A. , Ricciardi G.K. , Pizzini F.B. , Piovan E.
Published: April 2015

The concept of brain death must be accurately determined and defined, especially in the light of the latest legislation on brain blood flow measurements.
Non-Alcoholic Wernicke Encephalopathy: MR Imaging and Review of the Literature
Authors: Saturnino P.P. , Conforti R. , Amoroso V. , D'Agostino V. , Ferrara M. , Cirillo S.
Published: April 2015

We describe a patient with non-alcoholic Wernicke's encephalopathy caused by long-term parenteral nutrition. The diagnosis is based on clinical and magnetic resonance findings. We also reviewed the literature review in typical and atypical findings at MR examination.
A Little Talk on Adamkiewicz's Artery. Some Practical Considerations on the Pre-Operative Identification of This Artery Starting from a Single Team Experience in Pre-Surgical Selective Embolization of Vascularized Spinal Lesions
Authors: Stafa A. , Barbara C. , Boriani S. , Simonetti L. , Leonardi M.
Published: April 2015

The major radicular artery eponymically named “Adamkiewicz's artery” (AKA) is an important vessel supplying the spinal cord, especially the lumbar enlargement. This report emphasizes the importance of anatomical knowledge of this artery and highlights the concept of the potential risk of neurological complications during different procedures: spine orthopedic/neurosurgery, aortic repair (vascular surgery) and endovascular selective embolizations performed by interventional neuro/radiologists. Anatomical considerations are made on the spinal cord arterial circulation with a special focus on the AKA. Our review of the literature considered this anatomical element essential to compare the potential risk of spinal cord ischemic damage during orthopedic/ neurosurgical spine procedures, aortic vascular surgery repair procedures and endovascular selective arterial embolizations. Evaluation of the endovascular selective arterial spine embolization risk was based on our series of 410 embolization procedures. Spinal cord infarction and transient or permanent paraplegia may result from inadvertent interruption of the AKA. The presence of intersegmental collaterals may decrease the risk of spinal cord ischemia: this is an important element to bear in mind that may help in spine surgery or aortic repair procedures performed by vascular surgeons. Nevertheless, during aortic repair (open surgery or stent-graft procedures) interruption of bilateral segmental arteries at multiple consecutive levels including that of the AKA may occur thereby increasing the ischemic spinal cord risk, annulling the benefit of intersegmental collaterals. Accidental embolizations of the AKA during endovascular spine procedures (i.e. selective arterial embolizations) performed by interventional neuro/radiologists will cause an almost certain spinal cord infarction due to the consequent embolizations of the anterior spinal artery (ASA).
Role of Contrast-Enhanced Magnetic Resonance Angiography in Spinal Dural Arteriovenous Fistula
Authors: Toni F. , Cirillo L. , Marliani A.F. , Riccioli L. Albini , Leonardi M.
Published: April 2015

Spinal dural arteriovenous fistulae (SDAVF) are the most common vascular malformations of the spine. Although digital subtraction angiography (DSA) remains the standard of reference to diagnose and classify vascular spinal lesions, we investigated the clinical value of contrast-enhanced MR angiography (CE-MRA), equipped with TRICKS sequences, in localizing SDAVF before selective catheter angiography and possible subsequent treatment. We studied 16 consecutive patients suspected of harbouring vascular spinal cord malformations and we tried to determine the level and the side of the arterial feeder to the arteriovenous abnormality. In 12 cases the results were compared with DSA and/or possible post-operative findings. In nine cases CE-MRA correctly depicted the origin of the fistula: in particular one patient was treated surgically only on the basis of MRA results. Thanks to its elevated spatial and temporal resolution, spinal contrast-enhanced MRA using TRICKS sequences proved reliable in detecting and localizing the SDAVF arterial feeders and can be used as a guide to subsequent selective DSA examination.
Lipid Resonance on In Vivo Proton MR Spectroscopy: Value of other Metabolites in Differential Diagnosis
Authors: Mohan S. , Verma A. , Lim C.C.T. , Hui F. , Kumar S.
Published: April 2015

In vivo proton MR spectroscopy (1H-MRS) can non-invasively provide biochemical information at the same examination as conventional magnetic resonance imaging (MRI). Lipid resonance (0.9–1.5 ppm) is a marker of cell membrane breakdown and tissue necrosis, but its diagnostic significance has not been well described. We retrospectively analyzed spectra to study the different pathological conditions in patients with abnormal lipid resonance. All patients with neurological diseases showing lipid resonance on 1H-MRS (1.5T) in a tertiary hospital over two years were retrospectively analyzed. 1H-MRS was performed using the single voxel PRESS technique (TR/TE=3000/144 ms, eight excitations). Spectra were analysed for the presence of NAA (2.0 ppm), creatine (3.0 ppm), choline (3.2 ppm), acetate (1.92 ppm), succinate (2.4 ppm), cytosolic amino acids (0.9 ppm), lactate (1.3 ppm) and lipid (0.9–1.5 ppm) peaks. Ninety-two spectra from 69 patients (38 males, 31 females; aged 9 to 89 years) were analyzed. The final diagnosis was infective (n = 33), (tuberculoma n = 17, pyogenic abscess n = 8, fungal abscess n = 3, sterile abscess n = 3, tubercular abscess n = 2), neoplastic (n = 21) (glial tumors n = 9, metastasis n = 8, lymphoma n = 4), and other (n = 15) abnormalities (subacute and chronic stroke n = 6, postictal edema n = 4, multiple sclerosis n = 2, Erdhiem Chester disease n ? 2, Rosai Dorfmann disease n = 1). Succinate and acetate were detected only in pyogenic abscesses (2/4 cases), but amino acids were present in both pyogenic (4/8) and fungal (3/3) abscesses. Choline was seen not only in neoplasms (18) but also in tuberculomas (11/17), but was consistently absent in the abscesses. Lactate was present in glioblastoma (7/9), pyogenic (3/8) tubercular (2/2) and fungal (3/3) abscess. Isolated lipid resonance was found in Erdheim Chester disease (2/2) of the orbit, and lipid and choline was seen in Rosai Dorfmann's disease (1/1). Brain lesions containing lipid on 1H-MRS could be differentiated by the presence of succinate and acetate in pyogenic abscess, and amino acids in pyogenic/fungal abscesses. Choline was seen in neoplasms and in tuberculomas, but not in the abscesses. Thus, the presence of a lipid peak, when combined with features on other MR pulse sequences and available clinical data can help arrive at a specific diagnosis. 1H-MRS should not be interpreted in isolation: it should always be correlated with conventional imaging features, and performing 1H-MRS in isolation remains an important pitfall.
Three-Dimensional Image Analysis of the Temporal Bone in Patients with Unilateral Attic Cholesteatoma
Authors: Tsai L.-T. , Wang C.-Y. , Lo Y.-C. , Lin C.-D. , Tsai M.-H.
Published: April 2015

We determined temporal bone anatomy in patients with unilateral attic cholesteatoma. We compared the affected and normal ears of ten patients with unilateral attic cholesteatoma using three-dimensionally reconstructed high-resolution computed tomography images of the temporal bone. We determined the eustachian tube angle, eustachian tube length, sizes of the tympanic orifice of the eustachian tube, the pars flaccida, and the mastoid cavity, and distances of the pars flaccida and the tympanic orifice of the eustachian tube from the epitympanic roof. No significant differences were found between the normal and affected ears with regard to the size of the eustachian tube orifice, eustachian tube length or distances of the pars flaccida and the tympanic orifice of the eustachian tube from the epitympanic roof. By contrast, the mastoid cavity and the eustachian tube angle were significantly larger in the normal ears than in the affected ears [mean, 6.99 cm3 (S.D., 4.9 cm3) vs. 1.28 cm3 (0.81 cm3) and 16.7° (4.12°) vs. 13.89° (5.30°), respectively]. The pars flaccida was significantly smaller in the normal ears [1.07 cm (0.31 cm)] than in the affected ears [2.19 cm (0.77 cm)]. The inherent anatomy of the eustachian tube may be particularly important in the formation of attic cholesteatomas.
Frontoethmoidal Encephalocele with Subependymal Nodular Heterotopia: An Unusual Association
Authors: Balaji R. , Mangaleswaran B. , John R.
Published: April 2015

Frontonasal encephaloceles involve herniation of meninges and brain tissue through defects in the floor of the anterior cranial fossa affecting the frontal, ethmoid and nasal bones. Subependymal nodular heterotopias are malformations of cortical development resulting from abnormal neuronal migration. This report describes the coexistence and association of these two entities which is extremely rare. We describe an unusual case of a six-year-old girl with a frontonasal encephalocele in whom further imaging disclosed subependymal nodular heterotopias. Clinically she presented with swelling over the glabella since birth but otherwise was asymptomatic. CT and MRI showed herniation of brain tissue with the overlying dura and CSF through a defect in the frontal, ethmoid and nasal bones. In addition, MRI revealed heterotopic nodules in the subependymal regions of the lateral ventricles that were isointense with grey matter on all sequences. The patient underwent one stage surgery for correction of the encephalocele.
Hydromyelia Secondary to Spinal Epidural Abscess
Authors: Saponiero R. , Toriello A. , Locatelli G. , Narciso N. , Posteraro L. , Panza M. P. , Napoli A.N. , Romano F. , Pugliese N.D.
Published: April 2015

Spinal epidural abscess (SEA) is a rare condition that can be fatal if untreated. Risk factors are immunocompromised states as well as spinal procedures including epidural anesthesia and spinal surgery. The signs and symptoms of SEA are nonspecific and can range from low back pain to sepsis. The treatment of choice is surgical decompression followed by four to six weeks of antibiotic therapy. The most common causative organism in SEA is staphylococcus aureus and spread is usually haematogenous or contiguous from psoas, paraspinal or retropharyngeal abscesses. The exact mechanism by which an epidural abscess causes spinal cord damage is unclear. In fact, the damage is often out of proportion to the degree of compression demonstrated radiologically. There is only a report of a patient with syrinx formation secondary to epidural abscess. We describe the case of a 48-year-old woman with a two-week history of thoracic back pain and evidence of dorsal SEA probably from contiguous psoas abscess. Neurological examination revealed flaccid paraplegia and loss of sphincter control. A spinal MRI scan with Gd-enhancement revealed focal high intensity signal in the T2-weighted and FLAIR images at the level of the vertebral bodies in segments D3-D11. The patient was treated with posterior decompression and drainage of the SEA, but with a poor outcome. Six weeks after the onset of symptoms, an MRI scan showed a newly-formed hydromyelia formation from D4 to D8. The case reported is the second to describe hydromyelia formation secondary to epidural abscess and a poor outcome, experiencing partial improvement without recovery. For this reason, we confirmed that the essential problem of SEA lies in the need for early diagnosis, because the early signs and symptoms may be vague and the “classic” triad of back pain, fever and variable neurological deficits occur in only 13% of patients by the time of diagnosis. Only timely treatment will avoid or reduce permanent neurological deficits before massive neurological symptoms occur. The clear message is that a high index of suspicion and modern imaging techniques are essential.
Hippocampal Asymmetry with Hippocampal Sulcus Remnants in a Patient with Mild Cognitive Impairment
Authors: Conforti R. , Ronza F.M. , Di Costanzo A. , De Cristofaro M. , Cirillo M. , Cirillo S.
Published: April 2015

A 65-year-old woman underwent MRI for a mild cognitive impairment (MCI) at Mini-Mental State Examination (MMSE). MRI showed hippocampal sulcus remnants bilaterally, although they were larger on the right, and left hippocampal atrophy with increased left fimbrio-subicular distance (right side: 1.2 mm; left side: 2.0 mm). The meaning of these findings in relation to clinical aspects is discussed and reviewed according to data from the literature.
Radiation-Induced Mineralizing Microangiopathy in a Case of Recurrent Craniopharyngioma
Authors: Srinivasan K.G. , Ramprabananth S. , Ushanandhini K.P. , Srividya S. , Kumar M. Praveen
Published: April 2015

Mineralizing microangiopathy is a late complication of radiation-induced brain injury that occurs during the treatment of CNS malignancies in children and adults. Early diagnosis of the radiation-induced brain injury helps to tailor the radiation dose and prevent further complications. Here we describe an operated oatient with craniopharyngioma who underwent external beam radiotherapy. The patient developed gradual loss of vision after two years and a review CT scan revealed the local recurrence of tumour with dystrophic calcification of the basal ganglia, frontal and temporal subcortical regions representing recurrent craniopharyngioma with radiation-induced mineralizing microangiopathy.
Primary Hypothyroidism Presenting as a Sellar Mass Which Regressed with Thyroid Hormone Therapy
Authors: Babu S. , Venkataramana N.K. , Kamble R.B. , Rao S.A.V. , Naik A. , Shetty R.V.
Published: April 2015

We describe a15-year-old girl presenting with compensatory pituitary enlargement due to primary hypothyroidism. The hyperplasia regressed following thyroxine administration. The clinical, laboratory and MRI features of the patients are described and the mechanisms of pituitary gland enlargement are discussed.
Prospective Quantitative Imaging Study by Magnetisation Transfer for Appearance of Perilesional Gliosis in Solitary Cerebral Cysticercal Lesion
Authors: De Souza A. , Nalini A. , Kovoor J.M.E. , Yeshraj G. , Siddalingaiah H.S. , Thennarasu K.
Published: April 2015

This study aimed to detect perilesional gliosis around solitary cerebral cysticerci (SCC) by magnetisation transfer imaging (MTI), to compare its incidence between patients administered and not administered albendazole. We prospectively randomised patients with SCC and new-onset seizures to treatment with albendazole plus antiepileptics (treatment), or antiepileptics only (control), and performed MRI scans at zero, three, six, 12 and 24 months. Data were analysed for lesion characteristics, perilesional MT hyperintensity and MT ratios, calculated from the lesion and perilesional area. Eighty-one patients' data were analysed (M-41, F-40; ages 6–52 years). About 13% scolices appeared hyperintense on MTI at baseline. T1-isointense cyst walls and perilesional area showed MT hyperintensity in 30 – 41.4%; this proportion increased over time. Persistently visible SCC and stage of degeneration at enrolment did not predict development of MT hyperintensity. MT ratios (range - 98.75 to 49.79) increased over time and differed significantly from normal parenchyma. No difference in MT ratios was noted between treatment and control groups. Qualitative perilesional MT hyperintensity was more often seen in control group. Perilesional gliosis is present in >20% of SCC at six months, and continues to appear on later scans. Gliosis is independent of lesion persistence and stage of degeneration. Pre- and post-contrast MT imaging is equally useful in detection of gliosis. MT ratios from the lesion and perilesional parenchyma are significantly lower than from normal brain tissue at all stages of degeneration, but increase as degeneration occurs and healing progresses. Albendazole therapy does not affect the formation of perilesional gliosis
Neuroimaging in a Three-Year-Old Girl — MRI without Anesthesia: Easier Than One Thinks
Authors: Goericke S.L. , Dudda M. , Schweiger B. , Forsting M.
Published: April 2015

Magnetic resonance imaging (MRI) is the imaging modality of choice in the diagnosis of structural brain abnormalities in children. Routine scans are usually not reliable in pediatric neuroimaging without sedation before the age of seven. Before this age sedation or general anesthesia with procedural risks and additional costs might be needed. We report on MRI in a 3.1-year-old patient referred after a first seizure performed with a combination of role model and self-experience. MRI with high imaging quality was performed without the need for anesthesia in our daily routine. The imaging procedure was performed without previous preparation needed and within target date. Our reported technique of a combination of role model and self-experience, avoiding anesthesia in a 3.1-year-old girl is suitable for children and it is applicable in the daily routine.