bluuebunny/crossref_metadata_2025 huggingface dataset:
Spontaneous Internal Carotid Artery Pseudoaneurysm in a Patient with Behçet Disease
Authors: Márquez J.C. , Granados A.M. , Castillo M.
Published: April 2015

We describe the uncommon case of a patient with Behçet disease who developed a giant spontaneous cervical internal carotid artery pseudoaneurysm confirmed at surgery. We also discuss the implications of this rare complication.
Rupture of a Left Internal Jugular Vein
Authors: Impiombato F. Ambesi , Gambacorta D. , Zocchi M. , De Nisi M.C. , Rossi A.
Published: April 2015

A 60-year-old woman with neurofibromatosis type 1 presented with a nonpainful swelling in the left laterocervical region that had suddenly arisen after mild exertion the previous evening. Computed tomography with and without contrast enhancement revealed a rupture of the wall of the left internal jugular vein, with a diffuse subcutaneous hematoma. Postoperative histopathologic examination reported diffuse proliferation of plexiform neurofibromatous tissue within the vessel wall.
MR Imaging Findings of Giant Trichilemmal Carcinoma on the Scalp
Authors: Shi S. , Zhao Y.
Published: April 2015

We describe the magnetic resonance imaging findings of a huge trichilemmal carcinoma (TLC) on the parietal and occipital region of the scalp in one patient. Our aim is to discuss the clinical, radiologic, and pathologic features of scalp TLC and to review relevant literature regarding this tumor. One patient with recent rapid tumor growth in the parietal and occipital region of the scalp underwent MR studies and subtotal resection. The tumor was seen as a poorly marginated and lobulated soft-tissue mass with isointense signal on T1-weighted images and hyperintense signal on T2-weighted images. Necrosis and ulceration were also found on the tumor surface. The TLC has been massively invading the nearby skull, meninges, brain tissue, and superior sagittal sinus. After exhibiting contrast, the tumor showed significant enhancement, with small portions remaining unenhanced. Subtotal excision of the mass and reconstruction of the scalp were performed. Microscopically, the mass was composed of trabecular growth of tumor cells with clear cytoplasm, prominent nucleoli, frequent mitoses, and foci of trichilemmal keratinization. Tumor on the scalp with heterogeneous, mixed signals on T2-weighted images, significant enhancement of solid portion, and local infiltration accompanied by surface deep ulceration may indicate a TLC. Wide surgical excision with tumor-free margins remains the best choice for treatment.
Multiple Sclerosis Lesions in the Brain: Computer-Assisted Assessment of Lesion Load Dynamics on 3D FLAIR MR Images
Authors: Bilello M. , Arkuszewski M. , Nasrallah I. , Wu X. , Erus G. , Krejza J.
Published: April 2015

The detection and monitoring of brain lesions caused by multiple sclerosis is commonly performed with the use of magnetic resonance imaging. Analysis of a large number of images is a time-consuming challenge to the neuroradiologist, that can be accelerated with the assistance of computer-detection software. In 98 baseline and follow-up brain magnetic resonance studies from 88 patients with a diagnosis of multiple sclerosis, we employed locally developed lesion-detection software to assess temporal change in the load of brain lesions and compared its results to routine clinical reports. Analyzing the differences between the follow-up study and the baseline study, the software displays the results in the form of a scrollable axial volume, with the changed lesions highlighted in different colors and superimposed on the baseline reference scan. Disagreements between the software and the clinical readers in the detection of changed lesions were observed only in 11 (11.2%) cases, and the difference did not reach statistical significance (p=0.07). The mean interpretation time with assistance of the software was 2.7±2.2 minutes. We conclude that the performance of the software-assisted interpretation in the analysis of change over time in multiple sclerosis brain lesions is comparable to the performance of clinical readers, with a possibly shorter assessment time. Our study demonstrates the potential of including lesion-detection software in the workflow of neuroradiology practice.
Leukocoria in a Child with Sturge-Weber Syndrome
Authors: Geraldo A.F. , Bastos-Carvalho A. , Neto L.L. , Sousa R.F. , Sequeira P.T. , Campos J.
Published: April 2015

A five-year-old girl with Sturge-Weber syndrome (SWS) presented with unilateral leukocoria. Imaging excluded retinoblastoma and revealed a choroidal hemangioma, a non-traumatic vitreous hemorrhage and a cataract. To the best of our knowledge, this is the first case report in the radiologic literature of these ophthalmologic findings presenting together and conditioning leukocoria in the setting of SWS. We discuss possible mechanisms and review the literature, emphasizing the role of neuroimaging in pediatric patients with SWS and ophthalmologic complaints.
Unilateral Basal Ganglia Infarcts: A Red Flag for Ipsilateral Cranio-Cervical Arterial Occlusive Disease
Authors: El Beltagi A.H. , El-Nil H. , Norbash A. , El-Sheikh A. , Asbeutah A.
Published: April 2015

Steno-occlusive disease of the internal carotid arteries and/or the circle of Willis with development of collateral perforator vessels attempting to supply under-perfused parenchyma are the basis for moya-moya phenomenon with the classic “puff of smoke” appearance on cerebral angiogram. We describe two cases of moya-moya with unilateral macroangiopathy of the internal carotid artery and ipsilateral middle cerebral artery in two 11-year-old girls: a Down's syndrome patient, and a second idiopathic patient. The arteriopathy in our cases differs from typical or classically described moya-moya disease in that it was exclusively unilateral rather than symmetric and bilateral. The association of predominant deep grey matter (basal ganglia) strokes in children with coexisting ipsilateral parainsular infarcts, as in our cases, is potentially a red flag for ipsilateral macroangiopathy.
An Uncommon Manifestation of a Common Tropical Disease: Disseminated Cysticercosis
Authors: Gangadhar K. , Santhosh D.
Published: April 2015

Disseminated cysticercosis is a rare form of cysticercosis in which the cysticerci spread throughout the body. We describe the case of a seven-year-old child with disseminated cysticercosis. He presented with a one month history of swelling of the whole body, unable to walk for one month and swelling of both eyes for 20 days. After extensive investigation from superficial musculoskeletal ultrasound B-scan of eye, brain computed tomography, brain magnetic resonance imaging (MRI), whole body MRI and pathologic biopsy, the child was diagnosed as having cysticercosis involving the brain, retina and skeletal muscles throughout the whole body.
Quantitative Evaluation of Changes in the Selected White Matter Tracts Using Diffusion Tensor Imaging in Patients with Alzheimer's Disease and Mild Cognitive Impairment
Authors: Zimny A. , Szewczyk P. , Bladowska J. , Trypka E. , Wojtynska R. , Leszek J. , Sasiadek M.
Published: April 2015

This study evaluated the damage to the extensive range of white matter tracts in patients with Alzheimer's disease (AD) and mild cognitive impairment (MCI). Thirty-four patients with AD (mean age 71.5 yrs, MMSE 17.6), 23 patients with MCI (mean age 66 yrs, MMSE 27.4) and 15 normal controls (mean age 69 yrs, MMSE 29.8) were enrolled. Diffusion tensor imaging (DTI) was performed in 25 directions on 1.5 T MR scanner. Fractional anisotropy (FA) values were obtained with a small ROI method in several association tracts including posterior cingulum fibers, in commissural tracts (genu and splenium of corpus callosum) and projection tracts (middle cerebellar peduncles and posterior limbs of internal capsules). In MCI significant reductions of FA were found in the inferior longitudinal fascicles, left superior longitudinal fascicle and posterior cingulum fibers compared to normal controls. In AD significantly decreased FA values were detected in the same fascicles as in MCI and additionally in inferior fronto-occipital tracts and commissural tracts. In both AD and MCI the most severe changes were found within posterior cingulum fibers. No abnormalities were detected in projection tracts in both groups. Accuracy of DTI in detecting AD and MCI reached 0.95 and 0.79, respectively. FA measurements strongly correlated with neuropsychological tests. DTI is capable of depicting microstructural changes within white matter fiber tracts in dementia and may aid the differential diagnosis of AD and MCI.
A Rare Differential Diagnosis for Cause of Proptosis: Skull Plasmacytoma
Authors: Gangadhar K. , Santhosh D. , Kallahalli S.
Published: April 2015

True solitary plasmacytoma of the skull without signs of systemic myelomatosis is very rare as is orbital involvement. It can be part of generalized disease (multiple myeloma) or localized disease, presenting as orbital tumor. We describe a case of solitary osseous plasmacytoma of the orbit. This 40-year-old man presented with a four month history of proptosis of the left eye, swelling in the left orbito-temporal region with a mild decrease in visual acuity. Multidetector row computed tomography scan showed a geographic osteolytic, well-demarcated lesion involving the greater wing of the sphenoid bone showing homogeneous contrast enhancement with extra-axial extension to the middle and anterior cranial fossa extension with extraconal extension into the orbit at the right side. Fine needle and later biopsy of the lesion revealed plasmacytoma.
Cerebral Fat Embolism Detection with Susceptibility-Weighted Images in Sickle Cell Disease
Authors: Medina F.J. , Marquez J.C. , Castillo M.
Published: April 2015

Cerebral fat embolism is a known but feared complication of sickle cell disease, which leads to significant morbidity. Although trauma-related fat embolism is more frequent and its diagnosis is straightforward, fat embolism secondary to bone infarcts after vaso-occlusive events can be unrecognized. Lack of criteria make the clinical diagnosis of sickle cell disease related fat embolism challenging. The neuroimaging findings are helpful to support the clinical diagnosis. Magnetic resonance imaging findings of fat embolism have been described including those seen on susceptibility-weighted imaging. Even though susceptibility-weighted imaging has been used for the diagnosis of cerebral fat embolism due to trauma, to the best of our knowledge its use has not been described in patients with sickle cell disease. We report an uncommon case of a 60-year-old woman with sickle cell disease who developed cerebral fat embolism and in which the findings on susceptibility-weighted imaging were characteristic and established the diagnosis.
Giant Dilatations of Virchow-Robin Spaces in the Midbrain
Authors: Algin O. , Conforti R. , Saturnino P.P. , Ozmen E. , Cirillo M. , Di Costanzo A. , De Cristofaro M. , Rotondo M. , Cirillo S.
Published: April 2015

Virchow-Robin spaces are lesions often seen in the brain parenchyma but their etiopathogenesis remains unsettled. Giant Virchow-Robin spaces placed in the midbrain are extremely rare. We describe three patients with a diagnosis of giant Virchow-Robin spaces in the midbrain, and their clinical and radiologic findings. We reviewed the literature in terms of the etiopathology, anatomic and radiologic appearance and differential diagnosis of the giant Virchow-Robin spaces. The diagnostic role of the high Tesla magnetic resonance devices and new sequences techniques such as three dimensional isotropic acquisition and diffusion tensor imaging were also evaluated in this case series.
Intraosseous Tumors of the Skull
Authors: Nakamura H. , Wang H. , Westesson P.L. , Hoshikawa M. , Takagi M. , Nakajima Y.
Published: April 2015

Radiologists often encounter intraosseous tumors of the calvarium. Compared with parenchymal lesions, information is limited. In this review, we list the calvarial tumors and correlate the radiologic appearance with the pathologic findings. We discuss primary intraosseous tumors and tumor secondary to systemic disease as well as metastatic malignant tumor. Differentiation between primary tumors and tumors secondary to systemic disease can be difficult. Physicians should explore the systematic disease. In the case of primary tumors, it is important to verify any soft-tissue component since this is an important differential diagnostic feature with the potential for malignant transformation.
Paget's Disease
Authors: Conforti R. , Galasso R. , Marrone V. , Urciuoli L. , Cirillo S.
Published: April 2015

Paget's disease (PD) is a common focal progressive osteometabolic disorder characterised by a disturbance in bone modelling and remodelling, because of an increase in osteoblastic and osteoclastic activity. It is a condition of unknown aetiology affecting approximately 3% of the population over 40 years of age and, approximately 10% of those over the age of 85 years. It is most common in Northern Europe and Australia and is rare in Asia and Africa. We describe the case of a 71-year-old man diagnosed with PD confined to the sacrum. After laboratory test, an imaging study with radiography, scintigraphy, computed tomography (CT) and magnetic resonance imaging (MRI) was performed disclosing findings compatible with Paget's disease in middle pathologic phase. The diagnosis was confirmed at biopsy. The structural modification of the sacrum with spongiosa rarefaction, thickening of bone and intact bone cortical, confirmed by CT, are tipical of an intermediate phase of PD. This was also supported by signal MRI changes showing substitution of the red by the fat medulla, visualized by FS sequences. Once the treatment for the bone disease was established, the patient no longer complained of pain. Special attention should be paid to male and elderly patients with pain in the lumbar spine because of the potential risk cancer development 21. The radiologist must be attentive to the possible presentations and complications of PD, even in uncommon sites, trying whenever possible to correlate the radiological features with the patient's clinical symptoms.
Pulmonary Embolism Caused by Cement Leakage during Percutaneous Vertebroplasty
Authors: El-Rahman A.M. Abd , Lazzarotti A.G. , Cosottini M. , Puglioli M.
Published: April 2015

Percutaneous vertebroplasty (PV) is considered a minimally invasive procedure, yet cement leakage into the circulation may result in serious complications. Here, we are reporting a case of pulmonary embolism following PV for treatment of osteoporotic compression vertebral fracture.
Congenital X-linked Stapes Gusher Syndrome
Authors: El Beltagi A.H. , Elsherbiny M.M. , El-Nil H.
Published: April 2015

X-Linked sensorineuronal hearing loss (SNHL) is a rare but recognized cause of bilateral SNHL associated with CSF gusher. We report a case presenting a varied imaging spectrum and clinical scenario of a one year old boy with unilateral profound hearing loss and recurrent meningitis due to spontaneous oval window gusher. Imaging showed a unilateral abnormality, with the fistula leaking from the oval window into the middle ear cleft.
Susceptibility-Weighted Imaging, an Additional Tool to Diagnose Brain Death: Initial Experience
Authors: Tsai F.Y. , Lee K-W. , Kao H-W. , Chen C-Y.
Published: April 2015

We describe findings suggestive of brain death on susceptibility-weighted imaging. We retrospectively reviewed brain magnetic resonance (MR) images of 15 patients who had cardiac arrest and found four cases with evidence of brain death. We then reviewed susceptibility-weighted imaging (SWI) findings on these cases. SWI images in the four cases with brain death showed deoxygenated blood in intracranial arteries. This preliminary result suggests that SWI may be used to diagnose brain death.
Endovascular Treatment of A1 Aneurysms
Authors: Alurkar A. , Karanam L.S.P. , Nayak S. , Oak S.
Published: April 2015

Aneurysms of the A1 segment of the anterior cerebral artery are rare and represent less than 1% of intracranial aneurysms. There are few reports available in the literature describing the role of endovascular management of these rare aneurysms. In the present series we describe five patients with A1 aneurysms presenting at our institution with various clinical presentations, treated successfully by endovascular method with a good clinical outcome. From January 2008 to July 2011, five patients (two males and three females) with A1 aneurysms were treated by endovascular means. Four of the patients presented with subarachnoid hemorrhage due to rupture of the A1 aneurysm and one patient presented with symptoms of mass effect in the form of headache and ophthalmoplegia. The age group ranges from eight to 52 years with a mean age of 34.2 years. Four of the patients were treated by coiling without any assisted technique whereas one patient who had a dissecting fusiform aneurysm was treated with stent-assisted coiling. Technical success was achieved in all the patients. We did not encounter any procedure-related complications in any of our cases. All the patients had an uneventful course with good clinical outcome. Angiographic follow-up was available in four patients (80%). Endovascular treatment of this rare group of aneurysms is an effective and safe treatment modality, however large series are required to support our findings.
Traumatic Dissecting Posterior Cerebral Artery Aneurysm
Authors: Salehi M.G. , Ghanaati H. , Abedini M. , Jalali A.H.
Published: April 2015

Dissecting posterior cerebral artery (PCA) aneurysms are among rare cerebrovascular malformations accounting for 2% to 6% of all aneurysms. Herein we describe a case of pediatric dissecting aneurysm located in the PCA with documentation of aneurysm development. In addition, we discuss its treatment with a new therapeutic method involving glue injection.
Imaging Characteristics of Primary Spinal Primitive Neuroectodermal Tumors
Authors: Hung S-C. , Lu Y-J. , Lin S-C. , Ho D.M-T. , Guo W-Y. , Chang C-Y.
Published: April 2015

Primary spinal primitive neuroectodermal tumors (PNETs) are rare and classified into peripheral and central types because the treatment strategy and outcome are different. This study describes five cases of primary spinal peripheral type PNETs. Magnetic resonance imaging showed large extradural masses in the cervical and thoracic spine with bony invasion and paraspinal extension in four cases and a transdural mass in the sacral spinal canal in one case. We also briefly summarize the imaging characteristics of 36 peripheral type and six central type primary spinal PNETs in the literature.
MRI Findings in Low Grade Tumours Associated with Focal Cortical Dysplasia
Authors: Tarsi A. , Marliani A.F. , Bartiromo F. , Giulioni M. , Marucci G. , Martinoni M. , Volpi L. , Leonardi M.
Published: April 2015

Magnetic resonance imaging (MRI) is mandatory to identify the epileptogenic zone in refractory temporal lobe epilepsy (TLE). The correct identification of lesions is essential to obtain good post-surgery seizure control. Low grade tumours (LGT) and focal cortical dysplasia (FCD) are common findings in symptomatic TLE, and frequently coexist. The aim of this study was to identify the MRI characteristics in the diagnosis of FCD associated with LGT. We analyzed 24 subjects with TLE who underwent tailored surgery. They all had LGTs. Two expert neuroradiologists analyzed the imaging data and compared them with histological results, hypothesizing the causes of diagnostic errors in the identification of FCD. We selected three exemplary cases to report the most important causes of errors. In the diagnosis of FCD we reported false positives and false negatives due to different causes. An incomplete MRI protocol, the large dimensions of the tumour, infiltration and related oedema were the most important factors limiting MRI accuracy. MRI can be limited by an incomplete protocol. In addition, the presence of an LGT may limit the neuroradiological diagnosis of FCD in the temporal lobe. Advanced MRI techniques could help reveal subtle lesions that eluded a previous imaging inspection.
Large Capillary Telangiectasia and Developmental Venous Anomaly of the Basal Ganglia: An Unusual Finding
Authors: De Gennaro A. , Manzo G. , Serino A. , Fenza G. , Manto A.
Published: April 2015

Brain capillary telangiectasias are small, benign, asymptomatic, angiographically occult lesions that are incidentally discovered either at autopsy or on MR imaging in most cases. They are commonly located in the pons and can be associated with other vascular malformations. We describe a case of an unusually large capillary telangiectasia associated with a developmental venous anomaly involving the basal ganglia in a young woman, in which MR serial imaging suggested the diagnosis and avoided an unnecessary stereotaxic biopsy.
Progressive AVM Thrombosis after Onyx Embolization with Angiographic Cure
Authors: Ahmad I. , Tejada J.G.
Published: April 2015

Intracranial arteriovenous malformations (AVMs) have a cumulative risk of hemorrhage and refractory seizures. Pre-surgical Onyx embolization of cerebral AVMs improves clinical outcome. A 45-year-old man with a history of seizures was diagnosed with a Spetzler-Martin grade 4 AVM in the right occipital lobe. As per initial assessment, three to four sessions were required for adequate devascularization of the AVM before offering either surgery or gamma knife treatment. We achieved 10% and 70% devascularization in the first and second stage Onyx18 embolization respectively. Subsequent bilateral internal carotid, external carotid, vertebral and right posterior cerebral artery superselective angiography performed six weeks after the second stage of embolization demonstrated unexpected complete angiographic cure of the AVM.
Diffusion Tensor Magnetic Resonance Imaging in Patients with Multiple Sclerosis and its Relationship with Disability
Authors: Temel Ş. , Kekliğkoğlu H.D. , Vural G. , Deniz O. , Ercan K.
Published: April 2015

Multiple sclerosis is a chronic inflammatory demyelinating disease of the central nervous system. Diffusion tensor magnetic resonance imaging (DTI) can yield important information on the in vivo pathological processes affecting water diffusion. The aim of this study was to quantitatively define water diffusion in normal-appearing white matter (NAWM) distant from the plaque, in the plaque, and around the plaque, and to investigate the correlation of these changes with clinical disability. Conventional MRI and DTI scans were conducted in 30 patients with MS and 15 healthy individuals. Fractional anisotropy maps and visible diffusion coefficients were created and integrated with T2-weighted images. Regions of interest (ROIs) were placed on the plaques on the same side, white matter around the plaques and NAWM on the opposite side. Only the white matter of healthy individuals in the control group, and FA and ADC values were obtained for comparison. The highest FA and lowest ADC were detected in the control group at the periventricular region, cerebellar peduncle and at all ROIs irrespective of location. There was a significant difference in comparison to the control group at all ROIs in patients with MS (p < 0.001 for all comparisons). No significant correlation between diffusion parameters and expanded disability state scale (EDSS) scores was found in patients with MS. DTI may provide more accurate information on the damage due to the illness, compared to T2A sequences, but this damage may not be correlated with the clinical disability measured by EDSS score.
A Case of McLeod Phenotype of Neuroacanthocytosis Brain MR Features and Literature Review
Authors: Shah J.R. , Patkar D.P. , Kamat R.N.
Published: April 2015

Huntington's disease and neuroacanthocytosis may present similar clinical and MRI features. It is important to differentiate these findings since treatment and prognosis vary vastly between them. The aim of this article is to familiarize radiologists with the differentiating features of Huntington's disease and various diseases comprising neuroacanthocytosis. A 40-year-old Indian man with extrapyramidal symptoms was referred for MRI. The clinical diagnosis was Huntington's disease, but there were a few atypical clinical features such as a history of biting the tongue, tics, marked hyporeflexia and lower limb muscle wasting. MR showed atrophy of the caudate nucleus and putamen with iron deposition in the basal ganglia, which can be seen in Huntington's disease and in neuroacanthocytosis. An increased blood acanthocyte level was subsequently confirmed. Further work-up revealed increased serum creatine phosphokinase levels, normal serum lipoprotein levels and depressed K cell antigen activity on serological studies, confirming the diagnosis of McLeod syndrome. McLeod syndrome is one of the distinct phenotypes of neuroacanthocytosis. Neuroacanthocytosis is a group of disorders with increased serum acanthocyte counts and neurological involvement. Various causes of neuroacanthocytosis are discussed. It is important to consider the possibility of neuroacanthocytosis when features typical of Huntington's disease are encountered on imaging.
Wernicke's Encephalopathy following Hyperemesis Gravidarum
Authors: Kotha V.K. , De Souza A.
Published: April 2015

Wernicke's encephalopathy (WE) due to causes other than chronic alcohol abuse is an uncommon and often misdiagnosed condition. In the setting of hyperemesis gravidarum, an acute deficiency of thiamine results from body stores being unable to meet increased metabolic demands. The condition produces typical clinical and radiological findings and when diagnosed early and treated promptly has a good prognosis. Magnetic resonance imaging (MRI) is sensitive and specific for diagnosis. We describe three patients with hyperemesis gravidarum who developed WE, and highlight a range of clinical and imaging features important for appropriate diagnosis. A high degree of clinical suspicion is essential. Treatment is often empirical pending results of investigation, and consists of parenteral repletion of thiamine stores. Reversal of MRI findings parallels clinical improvement. Neurologic outcomes are usually good, but half the pregnancies complicated by this condition do not produce healthy children.
Distribution of Amyloid Burden Differs between Idiopathic Normal Pressure Hydrocephalus and Alzheimer's Disease
Authors: Kondo M. , Tokuda T. , Itsukage M. , Kuriyama N. , Matsushima S. , Yamada K. , Nakanishi H. , Ishikawa M. , Nakagawa M.
Published: April 2015

This study aimed to elucidate the incidence and distribution of the cortical retention of Pittsburgh compound B (PIB) in patients with idiopathic normal pressure hydrocephalus (iNPH) and clarify the differences from those in patients with Alzheimer's disease (AD). Ten patients with iNPH without any clinical signs indicative of AD were enrolled in this study. Cerebral retention of PIB in positron emission tomography (PET) in iNPH patients was compared with those in seven age-matched AD patients. The CSF levels of β-amyloid 1–42 peptide (Aβ42), which inversely decrease with cerebral amyloid burden, were also measured. Three of the ten patients with iNPH showed increased cortical PIB retention. Although the mean cortical SUV ratios were similar, the distribution of PIB retention differed widely between the patients with iNPH and AD. PIB retention was limited to the high-convexity parasagittal areas in iNPH patients, whereas it spread over the frontal and parietotemporal areas in AD. The coronal images of PIB-PET were more informative than conventional transverse images in evaluating the distribution pattern of cortical PIB retention. Two iNPH patients with higher cortical PIB retention had the lowest levels of CSF Aβ42, indicating that PIB retention in iNPH would not reflect a simple delay in PIB clearance but its binding to existing Aβ amyloid in the brain. Our results indicate that iNPH is one of the diseases exhibiting cortical PIB retention. The characteristic distribution of PIB retention in iNPH could be useful in the differential diagnosis between iNPH and AD.
Neonatal Dural Arteriovenous Fistula at the Confluence Presenting with Paralysis of the Orbicularis Oris Muscle
Authors: Iizuka Y. , Koda E. , Tsutsumi Y. , Konishi Y. , Ashida H. , Funabiki T.
Published: April 2015

A male neonate presented a dural arteriovenous fistula (DAVF) at the confluence with paralysis of the orbicularis oris muscle. The interesting features in our case were the clinical symptoms (orbicularis oris muscle paralysis at birth), angioarchitecture (high-flow arteriovenous shunts at the confluence) and the size and hemodynamic flow (mid-sized venous pouch) of the fistula. Additionally, the embolization technique (i.e., occipital artery approach, closing shunts with pure glue) automatically resulted in the immediate and complete closure of accessory feeders without any additional treatment, and the midterm clinical outcome was good. We succeeded improving the symptoms of a neonate with a congenital high-flow DAVF by closing a fistula using a small amount of glue.
Brain MRI Findings as an Important Diagnostic Clue in Glutaric Aciduria Type 1
Authors: Nunes J. , Loureiro S. , Carvalho S. , Pais R.P. , Alfaiate C. , Faria A. , Garcia P. , Diogo L.
Published: April 2015

Glutaric aciduria type 1 is an autosomal recessive disorder caused by deficiency of glutaryl-coenzyme A dehydrogenase, with accumulation of glutaric acid, 3-hydroxyglutaric acid and glutaconic acid. Increased blood glutarylcarnitine levels are the basis for identification of affected infants by newborn screening. Despite the highly variability, this disease usually presents with an acute encephalitis-like encephalopathy in infancy or childhood after a period of normal development. The characteristic neurological sequel is a complex movement disorder due to acute bilateral striatal injury. Frequently, the only abnormality preceding the first episode is a progressive macrocephaly. Although neuroimaging findings are quite variable, the widening of the Sylvian fissures combined with abnormalities of the basal ganglia in a child with macrocephaly should raise the suspicion of this diagnosis. We describe two patients in whom macrocephaly was the only presenting symptom and whose diagnosis was suggested by the brain MRI findings. Our purpose is to illustrate the clinical value of neuroimaging in the diagnosis of glutaric aciduria type 1 even before the onset of neurologic symptoms, which is particularly important if newborn screening is not available.
Paravertebral High Cervical Chordoma
Authors: Elefante A. , Caranci F. , De Caro M.L. Del Basso , Peca C. , Guadagno E. , Severino R. , Mariniello G. , Maiuri F.
Published: April 2015

Spinal chordomas are more often located on the midline and are associated with marked destruction of the vertebral bodies. We report a rare case of large cervical (C2-C3) right lateral paravertebral chordoma extending into the spinal canal through a very enlarged intervertebral foramen. The tumor was initially diagnosed as a mucous adenocarcinoma on a percutaneous needle biopsy. However, the neuroradiological features, including the well-defined tumor margins, the regular and sclerosing lytic bone changes with regular enlargement of the intervertebral C2-C3 foramen, were in favor of a more slowly growing lesion, such as schwannoma or neurofibroma. At surgery a well-demarcated capsulated tumor involving the nerve root was partially resected. Histology was in favor of a low-grade chordoma (Ki-67/MIB-1<1%). Postoperative proton beam therapy was also performed. The differential neuroradiological diagnosis is discussed.
Management of Unruptured Brain Aneurysms: Retrospective Analysis of a Single Centre Experience
Authors: Moscato G. , Cirillo L. , Dall'Olio M. , Princiotta C. , Simonetti L. , Leonardi M.
Published: April 2015

Embolization is very effective in preventing bleeding of unruptured aneurysms with lower rates of mortality and morbidity than surgical treatment. Neurosurgery remains, however, a good alternative. This retrospective analysis examined data stored the digital database of Bellaria Hospital Radiology Department, evaluating patients, treatments and devices used as well as outcomes and complications. Therapy should be tailored to each individual case to offer each patient the best treatment. Out of 265 unruptured intracranial aneurysms detected, 182 were treated by embolization. 16 cases presented complications (12 only radiologically found); severe clinical consequences occurred in 3%: one ischaemia and five haemorrhages. Conservative treatment was adopted in 21 patients. Long-term follow-up is mandatory as aneurysms could increase their size and develop an irregular morphology in ten years' time. Endovascular embolization is a very effective treatment with positive outcomes in the majority of cases and a percentage of retreatments of 8%. In order to increase the number of successful cases, a multidisciplinary cooperation with neurosurgeons is strongly recommended.
Endovascular Treatment of a Small Aneurysm of the Superior Cerebellar Artery with a Flow-Diverter Device
Authors: Briganti F. , Marseglia M. , Leone G. , Briganti G. , Piccolo D. , Napoli M. , Caranci F.
Published: April 2015

We describe the case of a 62-year-old woman who presented with a small fusiform left superior cerebellar artery (SCA) aneurysm. Aneurysms located on the SCA are uncommon and their presentation, natural history and clinical management are poorly understood. Reports on the endovascular or surgical management of SCA aneurysms are rare and usually incorporated in clinical series of basilar artery or posterior circulation aneurysms. The patient was treated by delivery of a flow-diverter Pipeline Embolization Device (PET) - Chestnut Medical/ev3) at the origin of vessel. She had no procedural complications and the aneurysm volume was reduced. This paper presents additional evidence to literature reports suggesting that the new endovascular flow-diverter devices are an effective and well-tolerated treatment for complex aneurysms. Our review contributes data on the incidence of recurrence as a measure of long-term efficacy of this therapeutic approach.
A Juvenile Case of Cerebellar Arteriovenous Malformation with Gradual Onset of Dysphoria and Headache
Authors: Rispoli R. , Di Chirico A. , Sibille M. , Carletti S.
Published: April 2015

A 25-year-old woman was admitted because of frequent vomiting and headache which had lasted over one week. She had initially clear consciousness but slowly progressive mild headache and dysphoria. Emergency cranial CT revealed a 4 cm haematoma in the left cerebellar hemisphere. CT angiography showed a 2×2 cm nidus of an arteriovenous malformation (AVM) in the left hemisphere fed from the left posterior inferior cerebellar artery and draining into the inferior hemispheric vein. We performed a surgical resection of the AVM after decompression therapy to counteract the brain oedema. She recovered completely without any neurological deficits. This case recalls the importance of cooperation between diagnostic neuroradiology and neurosurgery in emergency, considering AVM, even if infrequent, among possible diseases.
Intradural Extramedullary Ewing's Sarcoma Recurrence with Acute Clinical Presentation and Literature Review
Authors: Bazzocchi Alberto , Bacci Antonella , Serchi Elena , Salerno Angela , Salizzoni Eugenio , Leonardi Marco
Published: April 2015

The intradural extramedullary space is an extremely unusual site for the onset of Ewing's sarcoma. We describe a case of recurrence of intradural extramedullary Ewing's sarcoma and review the literature available on this topic.
Susceptibility-Weighted Angiography of Intracranial Blood Products and Calcifications Compared to Gradient Echo Sequence
Authors: Docampo Jorge , Gonzalez Nadia , Bravo Fernando , Sarroca Daniel , Morales Carlos , Bruno Claudio
Published: April 2015

This study evaluated the sensitivity of susceptibility-weighted angiography (SWAN) compared with gradient echo (GRE) sequence in the depiction of haemorrhagic and calcium lesions by virtue of correlation analysis between the number, area and contrast index. The study included 21 patients (15 women, 6 men; age range 18 to 80 years) in whom intracranial haemorrhage or calcifications were previously diagnosed with CT and/or MR. GRE and SWAN sequences were performed as part of a conventional Brain MR study using a 3T scanner. Pathologic findings were: cavernoma (n=8), chronic intraparenchymal haemorrhage (n=5), petechial bleeding (n=3), parenchymal calcifications (n=2), sequelae of haemorrhagic contusion focus (n=1), post-surgical glioma (n=1) and venous angioma (n=1). In eight patients, more lesions were found in the SWAN sequence than in GRE. In the measurement of the largest area, in all cases the measured area was larger in the SWAN sequence than in GRE. The SWAN sequence was reported to have shown higher contrast between the lesion and the healthy white matter than in GRE. The SWAN sequence is more sensitive than GRE in the identification of cerebral haemorrhage and calcifications. The SWAN sequence also obtained significantly larger images than with GRE, and a higher contrast difference between the lesion and the healthy parenchyma.
Same Day Tri-Modality Functional Brain Mapping Prior to Resection of a Lesion Involving Eloquent Cortex: Technical Feasibility
Authors: Choudhri Asim F. , Narayana Shalini , Rezaie Roozbeh , Whitehead Matthew T. , McAfee Samuel S. , Wheless James W. , Boop Frederick A. , Papanicolaou Andrew C.
Published: April 2015

Non-invasive functional evaluation of the brain complements structural MRI imaging and has largely supplanted invasive techniques such as awake craniotomy. Techniques used for functional mapping of the brain include BOLD-functional MRI (fMRI), magnetoencephalography (MEG), and transcranial magnetic stimulation (TMS). We describe the case of a right-handed patient with a lesion centered in the left inferior perirolandic cortex who underwent fMRI, MEG, and TMS on a single day to facilitate maximal lesion resection while preserving eloquent cortex and eloquent white matter tracts.
Wake-up (or Wake-up for) Stroke: A Treatable Stroke
Authors: Bracco Sandra , Tassi Rossana , Gennari Paola , Grazzini Irene , Leonini Sara , D'Andrea Paolo , Martini Giuseppe , Cerase Alfonso
Published: April 2015

A 74-year-old man was admitted to the Emergency Room of our institution with worsening dysarthria, left-side weakness and hypoesthesia (NIHSS score: 5) since his awakening at 7:30 a.m. The evening before, he had gone to sleep at 10:30 p.m. Brain computed tomography (CT) and cervicocranial CT angiography showed low density attenuation of the right caudate nucleus head and lenticular nucleus and sub-total occlusion of ipsilateral middle cerebral artery (MCA) pre-bi/trifurcation Ml segment. Brain CT perfusion showed an ischemic core in the right striatal region, surrounded by a wide region of ischemic penumbra. Although the onset of symptoms, defined as “time last-seen well”, was 14 hours before presentation, the following worsening of neurological conditions (NIHSS score: 12) and the evidence of cerebral blood flow / cerebral blood volume mismatch at CT perfusion led us to propose neuroendovascular treatment on the basis of an off-label use. Neuroendovascular treatment by Penumbra system was achieved and the right MCA was only partially recanalized. The patient was discharged with NIHSS score of 12. At six months, modified Rankin scale score was 3. To the best of our knowledge, this is the first Italian case report describing a patient who underwent successful neuroendovascular treatment for a “wake-up stroke” without clinical worsening nor major complications and an acceptable clinical outcome. This was possible thanks to an extension of the therapeutic window guided by CT perfusion.
Reversible and Asymptomatic Gyral and Subarachnoid Contrast Enhancement after Carotid Stenting
Authors: Vangosa Alessandra Briatico , Tortora Domenico , Modestino Francesco , Cotroneo Antonio R , Caulo Massimo
Published: April 2015

The presence of sulcal hyperdensity in patients after endovascular procedures is not necessarily attributable to hemorrhage. It may frequently indicate the absolute or concomitant extravasation of contrast material into the subarachnoid spaces.

This case report describes the clinical case of an 84-year-old patient with 90% stenosis of the right internal carotid who presented with a diffuse gyral and sulcal hyperdensity in the right temporal-occipital and frontal lobes at routine post-carotid stenting (CAS) brain CT scan. The patient was asymptomatic and CT findings were interpreted as contrast enhancement hyperattenuation and no therapeutic decisions were made. A 24-hour follow-up brain CT demonstrated the complete resolution of the hyperdensity, confirming the diagnosis.

In this patient we considered the concomitant presence of gyral and sulcal hyperdensity as the consequence of reversible damage to the blood-brain barrier (BBB) determining a transitory extravasation of contrast material. Asymptomatic gyral and subarachnoid contrast enhancement following CAS is generally indicative of benign and transitory damage to the BBB and is not to be misinterpreted as hemorrhage.
Intraosseous Hemangioma of the Middle Turbinate: A Case Report of a Rare Entity and Literature Review
Authors: Goff Ryan , Weindling Steven , Gupta Vivek , Nassar Aziza
Published: April 2015

Intraosseous hemangiomas arising from the nasal turbinate are exceedingly rare, with few reported cases in the literature. We describe a 61-year-old man found to have a nasal cavity mass on sinus computed tomograph (CT) and magnetic resonance imaging (MRI). Although an atypical site of occurrence, distinctive internal honeycomb bony trabeculations demonstrated on CT allowed the correct diagnosis of an intraosseous hemangioma to be prospectively proposed by the interpreting radiologist which had direct clinical and surgical impacts.
Neural loss aversion differences between depression patients and healthy individuals: A functional MRI investigation
Authors: Chandrasekhar Pammi V S , Pillai Geethabhavan Rajesh Purushothaman , Kesavadas Chandrasekharan , Rappai Mary Paramban , Seema Satish , Radhakrishnan Ashalatha , Sitaram Ranganatha
Published: April 2015

Neuroeconomics employs neuroscience techniques to explain decision-making behaviours. Prospect theory, a prominent model of decision-making, features a value function with parameters for risk and loss aversion. Recent work with normal participants identified activation related to loss aversion in brain regions including the amygdala, ventral striatum, and ventromedial prefrontal cortex. However, the brain network for loss aversion in pathologies such as depression has yet to be identified. The aim of the current study is to employ the value function from prospect theory to examine behavioural and neural manifestations of loss aversion in depressed and healthy individuals to identify the neurobiological markers of loss aversion in economic behaviour. We acquired behavioural data and fMRI scans while healthy controls and patients with depression performed an economic decision-making task. Behavioural loss aversion was higher in patients with depression than in healthy controls. fMRI results revealed that the two groups shared a brain network for value function including right ventral striatum, ventromedial prefrontal cortex, and right amygdala. However, the neural loss aversion results revealed greater activations in the right dorsal striatum and the right anterior insula for controls compared with patients with depression, and higher activations in the midbrain region ventral tegmental area for patients with depression compared with controls. These results suggest that while the brain network for loss aversion is shared between depressed and healthy individuals, some differences exist with respect to differential activation of additional areas. Our findings are relevant to identifying neurobiological markers for altered decision-making in the depressed.
Unusual primary central nervous system lymphoma location involving the fourth ventricle and hypothalamus
Authors: Cellina Michaela , Fetoni Vincenza , Baron Pierluigi , Orsi Marcello , Oliva Giancarlo
Published: April 2015

A previously healthy 65-year-old man presented with a two-week history of weight loss, headaches, blurred vision, asthenia and quickly worsening walking impairment. He denied photophobia, neck stiffness, fever, nausea or vomiting.

Neurological examination showed global motor slowing, tendency to fall asleep during the clinical examination, generalized weakness against resistance to head and limbs, and osteotendon reflexes present in the upper limbs, but not evoked in the lower limbs. No sensitive deficit or focal neurologic sign was recognizable.

Non-contrast multislice computed tomography (MSCT) of the head was performed in the emergency department, showing diffuse periventricular white matter and thalamic mild hyperdensity.

Lumbar puncture, blood tests, including serology for HIV and other infections, were negative.

On the third day the patient, showing decreased consciousness, underwent magnetic resonance imaging (MRI) with contrast medium injection. MRI revealed the presence of multiple pseudonodular avidly enhancing lesions, supra and infratentorial, crossing the midline, involving the ventricular system, including the fourth ventricle, with extension into the surrounding white matter, the corpus callosum, the thalamus and the hypothamalus.

A stereotactic biopsy led to a diagnosis of diffuse large B-cell lymphoma, primarily located in the central nervous system (PCNSL).

After the completion of the first phase of treatment (immunotherapy with intravenous Rituximab and corticosteroid), the MRI showed a marked regression of tumor masses.
Angiografia ed embolizzazione dei tumori vascolarizzati del rachide
Authors: Perini S. , Maschio A. , Beltramello A. , Faccioli F. , Benati A.
Published: April 2015

Viene discusso il ruolo dell'angiografia terapeutica per la diagnosi ed il trattamento di lesioni rachidee benigne e maligne.

L'embolizzazione è stata effettuata come trattamento prechirurgico, nei tumori benigni, negli emangiomi vertebrali (18), nelle cisti aneurismatiche (2), negli osteoblastomi (2) e negli osteoclastomi (2). Come atto curativo, non seguito dall'interveno, l'embolizzazione è stata usata con successo nel trattamento di una malformazione arterovenosa metamerica complessa (Sindrome di Cobb) caratterizzata da una MAV superficiale, vertebro-epidurale e spinale. Gli autori sottolineano il valore della metodica nella diagnosi e nel trattamento pre-chirurgico di tutte le lesioni benigne ipervascolarizzate, ma in particolare degli emangiomi che comprimano il midollo spinale.

Sono stati inoltre trattati due tumori maligni primitivi e nove metastasi. In cinque casi sono stati iniettati agenti antiblastici chimici in associazione alle particelle embolizzanti (Adriamicina 50 mg, 3 casi; Mitomycina C in microcapsule, 2 casi).
Trattamento dei craniofaringiomi cistici mediante tecniche di drenaggio percutaneo TC guidate
Authors: Spaziante R. , Cirillo S. , Elefante R. , Smaltino F. , De Divitiis E.
Published: April 2015

Un trattamento derivativo rivolto alla eliminazione della componente fluida costituisce un utile provvedimento terapeutico che, nella forme completamente o prevalentemente cistiche (60%) di craniofaringioma, può servire ad ovviare molto rapidamente, anche se in maniera temporanea e palliativa, a gran parte dei problemi causati dal tumore.

Il drenaggio intermittente è utile per un controllo temporaneo unito ad eventuali trattamenti intracavitari; la ventricolo-cistostomia è potenzialmente provvista di un effetto autonomo e di più lunga durata.
Neurotossicità dei mezzi di contrasto iodati
Authors: Belloni G. , Bonaldi G. , Moschini L.
Published: April 2015

I m.d.c. iodati impiegati nelle indagini neuroradiologiche presentano una neurotossicità che dipende sia dalla via di introduzione che dal contrasto usato. I m.d.c. non ionici e quelli a bassa osmolarità, pur non essendo privi di effetti collaterali, si dimostrano adeguati a soddisfare tutte le esigenze diagnostiche e presentano una buona tollerabilità.