bluuebunny/crossref_metadata_2025 huggingface dataset:
Acute Encephalitis of Unknown Etiology: Early Diagnosis and Follow-up of Disease Evolution. MRI
Authors: La Tessa G. , Tedeschi E. , Covelli E.M. , Pasqualetto L. , Cirillo M. , Belfiore G.
Published: April 2015

Two women with viral encephalitis of unknown etiology were studied with serial MR studies at 1.5 Tesla using: Spin-Echo (SE) T1-weighted (T1w) sequences before and after i.v. administration of paramagnetic contrast agent, with/without magnetization transfer (MT), Fast SE and Fluid-attenuated Inversion Recovery (FLAIR) T2-weighted sequences, Echo-Planar Single-Shot sequences for the assessment of water diffusivity (Diffusion Weighted, DW, and Apparent Diffusion Coefficient maps, ADC). The DW and T1w sequences with MT after contrast were most useful to detect the initial pathologic alterations, thereby reinforcing the clinical diagnostic hypothesis and prompting appropriate drug treatment, even if the laboratory data were not conclusive for viral etiology. In a later phase, both cases showed MR evidence of lacunar foci in the grey matter, and cortical laminar necrosis, probably indicating a concomitant hypoxic/ischemic mechanism.
CT and MR Imaging in Choroid Plexus Carcinoma
Authors: Balaji R. , Ramachandran K. , Kusumakumari P. , Krishnakumar A.S. , Venugopal M.
Published: April 2015

This case report describes the CT and MR appearances of choroid plexus carcinomas in children less than two years of age. MR and CT imaging of this rare tumor revealed intensely enhancing mass lesions in an intraventricular location, the atrium of the lateral ventricle being the preferred site in children. The tumors were associated with hydrocephalus and cerebral parenchymal invasion.
MRI Determination of Conus Medullaris Level in an Adult Population in Turkey
Authors: Sevinc O. , Is M. , Barut C. , Eryoruk N. , Kiran S. , Arifoglu Y.
Published: April 2015

The level of the conus medullaris (CM) in adults has been described in many studies with cadavers and living people. T1-weighted sagittal spin-echo MR images of the lumbar spine were reviewed in 364 consecutive patients (207 women, 157 men) with a mean age of 45 years (range 18–80). The most common level of CM was the L1-L2 intervertebral disc level in females and the T12-L1 intervertebral disc level in males. The distribution of CM location in a large adult population was shown to range from the T11-T12 intervertebral disc level to L2-L3 intervertebral disc level.
Synovial Cyst of Dens Axis
Authors: Riva G. , Puglisi C.G. , Giudice A. , Papa R. , Cavallaro T. , Chiaramonte I. , Pero G.
Published: April 2015

Synovial cyst of dens axis is a rare pathology accounting for 0.5%-1% of all cases of spinal synovial cysts. The lesion is normally found in the final part of the lumbar tract. The etiopathogenesis is uncertain and many theories abound Clinical inspection is important and the symptoms are caused by compression of posterior roots of spinal nerves and by spinal canal stenosis. Differential diagnosis is with disc herniation or tumours, but the diagnosis can only be established after CT and MRI examination. We describe the case of an 83-year-old man who underwent radiological exmaination after ten years of symptoms. The pathology was diagnosed only after the CT and MRI investigation.
An Unmasked Neurological Pathology (Schwannoma) following Spinal Anesthesia
Authors: Yagci B. , Ozturk E. , Celebi H. , Gunaydin B. , Kaymaz M.
Published: April 2015

A neurological deficit occurred following spinal anaesthesia that unmasked a relatively important neurological pathology. Spinal anesthesia was performed between L3 and L4 by midline approach at the first attempt. Postoperative clinical examination of the patient showed sensory loss below the T5 segment. Whenever new neurological signs are seen after regional anesthesia, further investigations should be done immediately for differential diagnosis.
La Lunga Attesa: Towards a Molecular Approach to Neuroimaging and Therapeutics in Alzheimer's Disease
Authors: Villemagne V.L. , Ng S. , Cappai R. , Barnham K.J. , Fodero-Tavoletti M.T. , Rowe C.C. , Masters C.L.
Published: April 2015

Alzheimer's disease (AD) is a progressive neurodegenerative disorder characterised by the gradual onset of dementia. The pathological hallmarks of the disease are Aβ amyloid plaques, neurofibrillary tangles (NFT), synaptic loss and reactive gliosis. Current diagnosis of AD is made by clinical, neuropsychologic, and neuroimaging assessments. Routine structural neuroimaging evaluation with computed tomography (CT) and magnetic resonance imaging (MRI) is based on nonspecific features such as atrophy, a late feature in the progression of the disease, hence the crucial importance of developing new approaches for early and specific recognition at the prodromal stages of AD. Functional neuroimaging techniques such as functional magnetic resonance imaging (fMRI), magnetic resonance spectroscopy (MRS), positron emission tomography (PET) and single photon emission computed tomography (SPECT), possibly in conjuction with other related Aβ biomarkers in plasma and CSF, could prove to be valuable in the differential diagnosis of AD, as well as in assessing prognosis. With the advent of new therapeutic strategies aimed at reducing the Aβ amyloid burden in the brain, there is increasing interest in the development of MRI contrast agents and PET and SPECT radioligands that will permit the assessment of Aβ amyloid burden in vivo.
Follow-up on Percutaneous Vertebroplasty Using PMMA in Osteoporotic Patients
Authors: Teng Michael Mu Huo , Yuan Wei-Hsin , Chang Cheng-Yen , Sadikin Cindy , Luo Chao-Bao , Chang Feng-Chi , Wei Chao-Jun
Published: April 2015

We reviewed the follow-up findings of patients who received percutaneous vertebroplasty, in order to understand the effects of vertebroplasty on following issues: pain relief, height restoration, wedge deformity correction, kyphosis correction, and other radiological findings found in follow up studies, such as new fractures. Generally, the pain relieving effect after vertebroplasty is long lasting except when new fracture occurred, or presence of other problems that caused the back pain. Height restoration and wedge deformity correction last for more than one year. The effect of kyphosis angle correction may vanish one year after procedure due to occurrence of new fracture in adjacent vertebral bodies.
MRI Findings in Patients with Hemiparetic Cerebral Palsy
Authors: Koroglu M. , Turedi A. , Kisioglu N. , Ergurhan I. Ilhan
Published: April 2015

Given the more severe and extensive unilateral brain abnormalities in hemiparetic cerebral palsy (HCP) patients than in other spastic cerebral palsy patients we focused exclusively on the localization of brain lesions in children with HCP. The relationship between neuroradiological findings and side of hemiparesis was investigated in a group of 30 children with HCP. Seventeen boys and 13 girls aged four to 18 years (mean age 9.7±4.2 years) were included in this study. Computed tomography and magnetic resonance imaging examinations were correlated with the birth histories, obstetrical records and clinical summaries. Of the 30 patients with HCP, 2 (6.6%) had normal neuroradiological examinations, 20 (66.6%) had unilateral and eight (26.6%) bilateral brain lesions. A brain lesion on the contralateral side of hemiparesis was found in 93.3% of the neuroradiological examinations. The commonest neuroradiological findings in our study were periventricular leukomalacia (PVL, 80%), atrophy (70%) and porencephalic cyst (50%). There was a significant relationship between the symptomatic side and contralateral PVL, atrophy and porencephalic cyst (40%). PVL, atrophy and porencephalic cyst were significantly concomitant on the same side (46.6%). We demonstrated for the first time in the literature that PVL, atrophy and porencephaly are usually observed concomitantly and contralateral to the side of motor impairement in HCP patients.
Primary Neurocytoma in the Spinal Cord
Authors: Wu Chinchun , Yen Yu-Shu , Ho Donald M , Guo Wanyuo
Published: April 2015

Central neurocytoma is defined as an intraventricular benign brain tumor. Extra-ventricular location of central neurocytoma is rare: only nine cases of spinal neurocytoma had been reported in the English literature. We hereby present a case of atypical neurocytoma involving unusual long segments (8-segment) of cervico-thoracic spinal cord in a 29-year-old woman with emphasis on pre- and post-surgical neuroimaging, pathological correlation, and review the pertinent literature.
Traumatic Nerve Root Avulsion and Pseudomeningocele Diagnosed by Three Dimensional MRI Technique (CISS Sequence)
Authors: Oncu J. , Ovali G.Y. , Kitis O. , Ozturk C. , Hepguler S. , Calli C. , Yunten N.
Published: April 2015

This case report demonstrates the importance of the CISS sequence, a fast imaging technique in MRI, in case of suspected nerve root avulsion. We present a case of traumatic pseudomeningoceles at T1-T2 root levels with right T2 ventral root avulsion without associated skeletal fracture diagnosed by MRI using the three dimensional CISS technique. A 28-year-old man presented to the Emergency Department following a motorcycle accident. Clinical examination revealed paresis in intrinsic muscles of the right hand. Traumatic pseudomeningoceles at T1-T2 root levels bilaterally with right T2 ventral root avulsion without associated skeletal fracture were diagnosed by three dimensional cervicothoracic MRI with CISS technique.
Hemifacial Spasms and Involuntary Facial Movements. Role of Magnetic Resonance in the Diagnostic Work-up
Authors: Cavallaro T. , Meli G.A. , Chiaramonte R. , Riva G. , Pero G.
Published: April 2015

Caution is required when dealing with patients presenting hemifacial spasm as the symptom is common to many disorders (tumours, herpes zoster, a frigore paralysis, neurovascular conflict…). Often no reasonable cause of the spasm is found, but treatment must be attempted because hemifacial spasm can be highly debilitating. We describe a case of hemifacial spasm, initially deemed idiopathic, in which MRI demonstrated neurovascular conflict as the cause.

It is not always easy to find a clear MRI pattern, but if the scan identifies the tortuousness of the arteries in the vicinity of the VII nerve root exit, it is highly probable that this is the true cause of hemifacial spasm. Even when it is not possible to identify this pattern, neurovascular compression cannot be ruled out. The good results of microvascular decompression in patients without a typical MRI pattern suggest that MRI is specific, but not always sensitive. There is no consensus in the literature on the sensitivity of MRI in the detection of neurovascular compression and values vary widely. It is generally believed that experience and different performance of the MR systems strongly influence the diagnosis of neurovascular conflict.
A Case of Inborn Choroid Plexus Carcinoma
Authors: Bekiesinska-Figatowska M. , Wagiel K.
Published: April 2015

This is a short comment on the article by Balaji et al. “CT and MR Imaging in Choroid Plexus Carcinoma. Report of Two Cases” (The Neuroradiology Journal 2006, 19: 330–333).
MRI Disturbances Caused by Dental Materials
Authors: Bryll A. , Urbanik A. , Chrzan R. , Jurczak A. , Kwapińska H. , Sobiecka B.
Published: April 2015

Dental materials are common sources of artifacts during brain MRI studies. The aim of the present study was to estimate the degree of image disturbance caused by dental materials during an MRI examination, and the risk of ferromagnetic materials being dislocated in the magnetic field. MR sequences where dental materials containing metals produced the smallest artifacts was also calculated. Thirty-five dental material samples containing metals were examined using the 1.5 T MR system. They consisted of the most commonly used dental restorations and root-canal instruments left in the oral cavity for iatrogenic reasons. Additionally, cubes (10×5×5 mm) and balls (10 mm diameter) were cast from commonly used dental alloys. No dislocation of the examined samples in the gelatin medium was observed. All the materials were found to produce artifacts characterised by similar images. The study showed that the presence of distant artifacts, besides those located in the area immediately surrounding the object, depends on the shape of the given material. The size of artifacts generated by the most commonly used fixed restorations was graded. The sequences in which artifacts were least pronounced were selected. No dislocation of samples in the 1.5 T field was observed during the examination. However they produced artifacts; the typical image of an artifact — a signal void zone surrounded by a hyperintensive rim. Alloys consisting of Ag-Pd, dental gold and amalgam distorted the MR image to the least degree. In the case of a routine spin echo (SE) sequence examination the smallest artifacts were generated in the FSE T2 and PD sequences.
Measuring Anisotropic Brain Diffusion in Three and Six Directions: Influence of the Off-Diagonal Tensor Elements
Authors: Dambe R. , Hähnel S. , Heiland S.
Published: April 2015

Diffusion tensor imaging (DTI) has been proposed for examination of cerebral white matter. However, this measurement needs sophisticated postprocessing and is susceptible to eddy current artefacts. The aim of this study was to examine whether diffusion measured in three anatomically well defined directions provides full and reliable information on diffusion anisotropy. Measurements were performed in water and gelatine phantoms and in 14 healthy volunteers. Diffusion was measured in six independent directions. For the full tensor DTI we diagonalised the diffusion tensor, for measurements with three directions we used only the diagonal elements. We then calculated the diffusion trace and the linear anisotropy index (AIl). We measured a slight anisotropy in the phantoms, which was larger in the case of the full tensor DTI (AIl = 0.022) then for the three orthogonal diffusion directions (0.008–0.019). The linear anisotropy index measured in white matter regions within the right and left hemisphere ranged between 0.33 and 0.42. AIl values were moderately correlated between right and left hemisphere regions (correlation factor: 0.35–0.64). DTI using the full tensor information is more susceptible to systematic errors resulting from eddy current effects than the measurement of diffusion in three orthogonal directions. However, in the latter method the anisotropy index is systematically underestimated in anatomical structures that do not exhibit a principal diffusion parallel to one of the diffusion directions. Therefore it is recommended to use the full tensor method together with sophisticated methods for eddy current correction.
Protected Carotid Stenting: The Usefulness of Filter Protection Devices
Authors: Gambacorta D. , Buontempo R. , Zocchi M. , Lunghi V , Cirinei M. , Arrigucci U. , De Falco D.
Published: April 2015

We report our experience in carotid artery stenting using a filter protection device. From July 2003 to September 2006 we treated 62 patients by internal carotid stenting using a filter protection device. Procedural success was achieved in 100% of cases. There were five periprocedural complications: one dissection of the internal carotid artery, two TIAs and two groin haematomas at the site of needle access. Neurological examination performed after the procedure and during the 30 days of follow-up did not reveal major neurological complications. Cerebral protection with a filter during carotid artery stenting seemed feasible and safe.
Influence of User-Defined Parameters on Diffusion Tensor Tractography of the Corticospinal Tract
Authors: Parizel P.M. , Van Rompaey V. , Van Loock R. , Van Hecke W. , Van Goethem J.W. , Leemans A. , Sijbers J.
Published: April 2015

This study discusses the influence of user-defined parameters on fiber tracking results obtained from a standard deterministic streamline tractography algorithm. Diffusion tensor imaging with fiber tractography was performed in five healthy volunteers. A region of interest was highlighted in the ventral part of the pons at the level of the middle cerebellar peduncle. The parameters studied were angle threshold, fractional anisotropy threshold, step length and number of seed samples per voxel. Changes in fiber tracts were described for increasing values per parameter. Increasing the angle threshold resulted in more and longer fibers. A higher fractional anisotropy threshold resulted in decreased length and fiber tracts that were not representative. Increasing the step length decreased the fiber continuity and altered its position. A higher number of seed samples per voxel resulted in a higher fiber tract density. When interpreting diffusion tensor images, the reader should understand the influence of user-defined settings on the results, and should be aware of the inter-dependency of fiber tracking parameters.
Functional Magnetic Resonance Imaging for Cranial Neuronavigation: Methods for Automated and Standardized Data Processing and Management
Authors: Nennig E. , Heiland S. , Rasche D. , Sartor K. , Stippich C.
Published: April 2015

Preoperative fMRI is one of the best established clinical fMRI applications. Due to the difficulties in recording and coregistration of functional image data, we present methods to standardize and automate these procedures. We used a self-made interactive software package (AFI — Automated Functional Imaging) to automate the time consuming and complex analysis of fMRI data. AFI controls the BrainVoyager program, a postprocessing software package, and furthermore facilitates data management, anonymization of patient data, storage, documentation, data export to neuronavigation systems and the opportunity of spatial transformation of image data for use in group studies. By the end of 2006 we have used this method on 123 patients with brain tumors and 47 patients with trigeminal neuralgia. The fundamental basis of multimodal neuronavigation is precise coregistration. EPI images contain spatial distortions of 5–15 mm. We were able to reduce the misregistration of EPI and FLASH images in a selectable region of interest to 1–2 mm. Furthermore AFI reduces the average evaluation time for a standard clinical fMRI study (four functional measurements, one anatomical data set) by approx. 50% from 140 minutes to about 70 minutes in comparison to manual evaluation by an expert. More importantly, the personal attendance time required for the evaluation decreases by 84% to 23 minutes as the remainder of the program runs automatically. In comparison to currently available online postprocessing software tools which are more limited in use, BrainVoyager can be used for coregistration, data export to neuronavigation systems and spatial transformation.
MRI Findings of Globe and Optic Nerves in Tilted Disk Syndrome
Authors: Orguc S. , Toprak A.B. , Demiray B. , Tarhan S. , Güler C.
Published: April 2015

We assessed the anatomical variations of the globe and optic nerve in tilted disk (TD) syndrome using magnetic resonance imaging (MRI) findings and compared them with a control group. Eleven patients diagnosed with TD syndrome during eye examination were referred for MRI of the sella and chiasm to exclude intracranial mass lesions. The shape of the globe, the chiasmal angle, the insertion angles of the optic nerve in axial and parasagittal planes determined by lines parallel to the optic nerve and tangent to the globe in TD syndrome were compared with a control group consisting of 53 cases. Gender ratios were 7/4 (F/M) for the TD group and 35/18 for the control group (p>0.05). The insertion angle of the optic disk to the globe was wider in the temporal quadrant (p<0.05) and narrower in the nasal quadrant (p<0.05) in TD syndrome than in the control group. There was no significant difference in the superior and inferior insertion angles between the groups. The anterior-posterior (AP) diameter of the globe was significantly longer in patients with TD (p<0.05). There was no significant difference between the optic chiasm angles.

The relationships of the optic disk and the globe were significantly different in patients with TD syndrome in comparison to the control group. TD syndrome is related to the malalignment of optic nerve and globe in the horizontal plane.
Bilateral Staphylomas Presenting as Bitemporal Hemianopia
Authors: Mathews M. , Hasso A.
Published: April 2015

Bitemporal hemianopia is usually secondary to pituitary and suprasellar masses. We present a case of bitemporal hemianopia secondary to bilateral staphylomas of the ocular globe. Staphylomas are degenerative outpouchings of the eyeball also known as scleral ectasia, secondary to congenital weakness of scleral tissue. Staphylomas can cause complications such as choroidal neovascularizations and hemorrhage. Early diagnosis and counselling are the mainstays of management. Bilateral staphylomas should be considered in the differential diagnosis of bitemporal hemianopia especially when imaging rules out sellar and suprasellar masses.
‘Eiffel-by-Night’: A New MR Sign Demonstrating Reactivation in Idiopathic Hypertrophic Pachymeningitis
Authors: Thomas B. , Thamburaj K. , Kesavadas C.
Published: April 2015

A forty- seven-year-old man presented with chronic headache with lower cranial nerve palsies of ten year duration with recent aggravation of symptoms. MRI revealed hypointensity — predominantly of the posterior falx cerebri and the tentorium cerebelli — on all sequences with intense peripheral contrast enhancement on CE SE T1, which on coronal images mimicked the illuminated Eiffel tower by night.
Transalar Sphenoidal Encephalocele
Authors: Jurkiewicz E. , Pakula-Kosciesza I. , Walecki J.
Published: April 2015

Classification of cranial encephalocele is based on the anatomic location of the skull defect. Basal sphenoidal encephaloceles are the least common form of encephalocele whose pathogenesis can be congenital, traumatic, tumoral or spontaneous. We present a case of a very rare basal encephalocele protruding through a defect in the greater wing of the sphenoid bone into the pterygoid fossa.
Parasagittal Arachnoid Markings on the Inner Skull on Three-Dimensional CT: Relation between Hydrocephalus and Arachnoid Granules
Authors: Taoka T. , Ida Y. , Nakagawa H. , Iwasaki S. , Sakamoto M. , Fukusumi A. , Takayama K. , Wada T. , Myochin K. , Wuttikul C. , Kichikawa K.
Published: April 2015

The purpose of the study was to evaluate the number and size of arachnoid markings on the inner plate of the skull on 3D-CT. The subjects included 16 hydrocephalus and 26 non-hydrocephalus cases. We evaluated the correlation between age and both the number and sizes of the arachnoid markings, and compared them between hydrocephalus and non-hydrocephalus cases. We also evaluated cases exhibiting a “smooth cranium” that had no arachnoid markings at all on the inner plate. There was a positive correlation between age and the number of the arachnoid markings. There were no statistically significant differences in arachnoid markings between hydrocephalus and non-hydrocephalus cases, while, there were statistically significant differences in the frequency of “smooth cranium” findings in the population under ten years old. The “smooth cranium” can only be seen in hydrocephalus cases. These findings may be a clue to the morphological or functional changes of the arachnoid villi in hydrocephalus cases.
Diffusion Weighted MRI of Primary Pituitary Abscess
Authors: Anik Y. , Koc K. , Anik I. , Meric M. , Demirci A.
Published: April 2015

Pituitary abscess is a rarely seen entity that can lead to serious neuroendocrine disorders or even be fatal if not diagnosed or treated correctly. Preoperative diagnosis plays an important role in planning the operation and treatment strategies. This report describes the diagnostic value of diffusion-weighted imaging (DWI) in addition to conventional magnetic resonance imaging (MRI) of primary pituitary abscess formation caused by Klebsiella ozaenea in a 33-year-old man.
Giant Mesencephalothalamic Virchow-Robin Spaces Causing Obstructive Hydrocephalus
Authors: Ahmad F.U. , Garg A. , Singh M. , Mishra N. K.
Published: April 2015

Virchow-Robin spaces accompany arteries for a variable distance into the brain substance. They are usually small but can be identified on high resolution MRI images in patients of all age groups. We report a rare case of a 40-year-old woman with giant mesencephalothalamic Virchow-Robin spaces which caused hydrocephalus requiring CSF diversion. After right ventriculoperitoneal shunt the patient recovered completely.
Percutaneous Closure after Inadvertent Carotid Artery Cannulation. Puncture Repair with Angio-Seal Deployment
Authors: Marina R. , Vincenti A. , Ratti L. , Pozzi M. , Maldini F. Fumagalli
Published: April 2015

Inadvertent placement of an introducer sheath in an artery during central venous cannulation is rare and can result in devastating complications. Although traditional closure devices have been employed as prompt and adequate treatment, more innovative devices such as collagen plugs are being studied for their efficacy. We report a case of inadvertent insertion of an 8 French sheath into the right carotid artery which occurred in the electrophysiological laboratory during scheduled transjugular measurement of portal pressure gradient. The consultant neuroradiologist successfully removed the arterial sheath and the puncture site was sealed with a collagen-based vascular closure device (Angio-Seal STS Plus). Accidental insertion of an arterial sheath is an uncommon but potentially serious complication of jugular venous catheterization. When the carotid artery is inadvertently cannulated, sheath removal can be complicated by significant hemorrhage and acute dyspnea due to location of the vessel near the upper airways. Although traditional manual compression and closure devices have been effective at restoring hemostasis, collagen seals or plugs may be more viable to treat this precarious situation. This averted an otherwise emergent open surgical procedure to remove the sheath and repair the carotid artery in a high-risk patient.
Polyostotic Paget's Disease with Sarcomatous Change in a Skull Lesion
Authors: Srinivasan K.G. , Gaikwad A. , Ushanandhini K.P. , Ritesh K.
Published: April 2015

The most serious complication of Paget's disease is sarcomatous degeneration of pagetic bone. Multifocal sarcomatous degeneration occurs mainly in polyostotic Paget's disease. Paget sarcomas are the most threatening sarcomas of bone irrespective of the histopathology, their prognosis being far more negative than primary sarcomas. Paget's disease is a common entity but osteosarcoma arising in Paget's disease is an infrequent complication. The skull involvement is even rarer. We report a case of malignant transformation of a skull lesion in a patient of polyostotic Paget's disease. Skull radiographs, computed tomography and magnetic resonance imaging scans of the tumour area show interesting results.
Neuritis of the Sixth Cranial Nerve
Authors: Gomez E. , Glait P. , Cousillas J. , Cirio J
Published: April 2015

Neuritis is an uncommon cause of sixth cranial nerve palsy. We describe the case of a young man with sixth cranial nerve palsy. Magnetic resonance examination revealed thickening and post contrast enhancement of the sixth cranial nerve interpreted as a sixth cranial neuritis.
Transverse Sinus Thrombosis after Posterior Fossa Surgery for Cerebellar Tumor Treated by Endovascular Thrombectomy
Authors: Puppa A. Della , Tosatto L. , Amistà P. , Munari M. , Scienza R.
Published: April 2015

Dural sinus thrombosis is a rare complication after posterior fossa surgery, particularly in cerebellar tumour surgery. The authors describe the case of a young male patient who presented a postoperative neurological deterioration due to transverse sinus thrombosis after surgery for cerebellar medulloblastoma. He was treated by mechanical clot thrombectomy using an endovascular catch system technique without anticoagulation therapy. Final angiographic recanalization was obtained. This kind of endoluminal mechanical revascularization is an efficacious method to treat dural sinus thrombosis during perioperative time but speed in diagnosis is crucial for clinical outcome.
Diffusion Tensor Imaging and 3D Tractography of the Cervical Spinal Cord Using the ECG-Gated Line-Scan Technique
Authors: Hori M. , Ishigame K. , Aoki S. , Kumagai H. , Araki T.
Published: April 2015

Diffusion tensor (DT) magnetic resonance (MR) imaging in addition to conventional MR images provide valuable information on the brain. This study compared line scan DT imaging with and without the ECG-gating technique to estimate clinical usefulness of the line scan diffusion tensor image (LSDTI) with ECG-gating in evaluating spinal cord diseases in vivo. First, five healthy volunteers participated in the comparison study. LSDWI was performed in three to five sagittal sections with a pulsed-field-gradient diffusion preparation pulse employing two different b-values (0 and 700 s/mm2) along six directions. Apparent diffusion coefficient (ADC) maps and fractional anisotropy (FA) were calculated and three-dimensional tract reconstruction and color schemes of the spinal cord were obtained. Image quality and the acquisition time of each LSDTI were compared. Second, LSDTI with ECG-gating was performed in eighteen patients with cervical spinal cord disorders and evaluated by two neuroradiologists. Images with the ECG-gated technique were all superior to those without ECG—gating. Mean extended time for LSDTI with ECG-gating was approximately two minutes. In clinical use, the ADC and FA of spinal cord in patients with cervical spondylotic myelopathy statically changed. Moreover, demonstration of fibers was correlated with clinical symptoms. ECG-gating technique is preferable to LSDTI. The ADC and FA measurements and 3D fiber tracking of LSDTI with ECG-gating are promising methods to estimate cervical spinal cord pathology in clinical use.
Extremely Low-Frequency Pulsed Magnetic Fields and Multiple Sclerosis: Effects on Neurotransmission Alone or Also on Immunomodulation? Building a Working Hypothesis
Authors: Bistolfi F.
Published: April 2015

This paper outlines the current state of knowledge on the pathology and treatment of multiple sclerosis (MS) and critically analyses the vast clinical experience of Sandyk in the use of pulsed magnetic fields of 5 Hz at 7.5 pT to treat many symptoms of MS. A complete regression of symptoms, or at least a major improvement, is sometimes so rapid as to suggest that ELF fields exert a greater effect on axonal and synaptic neurotransmission than on the processes leading to demyelination. Pulsed magnetic fields of 50–100 Hz and a few mT (whose flux intensity is 109 times greater than that of the fields used by Sandyk) have been seen to induce profound morphological changes (the Marinozzi effect) in the plasma membrane of several cell types, including Raji human lymphoblastoid cells. These observations underlie the author's hypothesis on the possible use of such fields in the treatment of MS. Indeed, these fields should induce the functional arrest of the cells (B- and T-lymphocytes, macrophages, microglia, dendritic cells) of the MS plaque, thereby providing an ‘electromagnetic immunomodulatory boost’ to the effects of drug therapy. To test this working hypothesis, it is suggested that preliminary experimental research be carried out to ascertain: 1) the Marinozzi effect in vivo; 2) the Marinozzi effect on microglia and dendritic cells; and 3) the duration of the membrane changes and their relaxation rate. ELF magnetic fields in the picotesla and millitesla ranges are aimed at improving neurotransmission and correcting local immune pathology, respectively. Both types of field might find application in the treatment of MS patients who no longer respond to or tolerate currently used drugs.
Neuroform Stent Applications in Ruptured Intracranial Aneurysms with Small Parent Vessels
Authors: Kwon Ou Young , Cho Chun-Sung , Kim Jin Kyung , Kim Young Jin , Lee Sang Koo , Cho Maeng Ki , Kim Young-Joon
Published: April 2015

The Neuroform stent is a device specifically designed for use in cerebral vessels and is increasingly being used in the embolization of broad-necked aneurysms, but long-term results are unsatisfactory. Reconstructive treatments using stents improve the occlusion rate and protect parent vessels. Stent-assisted coiling of broad-necked cerebral aneurysms is a technique that has rendered most aneurysms amenable to coiling. Recently, the use of stent-assisted coiling with preservation of the parent vessel lumen has been described in some series. Several studies have shown that with the advances in device technology intracranial stenting is feasible even in the distal part of the ICA. But, endovascular treatment of these aneurysms (small parent vessel less than 2.0 mm) in Neuroform stent-assisted coiling has no clinical applications. These lesions have seemed more difficult to treat than other aneurysms because of subsequent thrombus formation and vessel trauma after stent deployment and navigation. The purpose of this study was to review the safety and durability of our aneurysms treated with stent-assisted coiling of ruptured aneurysms with small parent vessesl.
Transvenous Embolization with Onyx for Cavernous Sinus Dural Arteriovenous Fistula
Authors: Jiang Chuhan , Lv Xianli , Li Youxiang , Liu Aihua , Wu Zhongxue
Published: April 2015

Previous treatments for cavernous dural arteriovenous fistulas (DAVF) include transarterial embolization with NBCA and transvenous embolization with platinum coils. This paper presents two cases of cavernous sinus dural arterial venous fistula successfully treated via a transvenous approach with Onyx. Case 1. A 54-year-old man presented with blepharotosis, diplopia and chemosis. Cerebral angiography demonstrated a cavernous DAVF, which was successfully treated via inferior petrosal sinus with a combination of Onyx and platinum coils. Case 2. A 36-year-old woman was admitted after incomplete transarterial embolization of a dural cavernous fistula. The patien's symptoms resolved almost completely after embolization with Onyx-34 via the superior ophthalmic vein. To our knowledge, only two such cases have been reported in the literature. The advantages of Onyx make it an attractive alternative to the various platinum coils already described.
Diffuse Cerebral Vasculopathy in a HIV-Positive Patient with Recurrent Strokes
Authors: Kao Hung-Wen , Chen Cheng-Yu , Hsueh Chun-Jen , Lo Chung-Ping , Juan Chun-Jung , Chang Wei-Chou , Huang Guo-Shu
Published: April 2015

The causes of ischemic stroke in the young adult are diverse. Human immunodeficiency virus (HIV) infection-related vasculopathy is usually not included in the list of differential diagnoses. HIV-positive patients may present with acute neurologic dysfunction of different causes, among which cerebral infarction is an uncommon one. Herein, we report a HIV-infected young man who suffered from recurrent ischemic strokes with evidence of cerebral vasculopathy on serial magnetic resonance images.
Microwire Strategy for the Endovascular Treatment of an Aneurysm at the Origin of the Posterior Inferior Cerebellar Artery
Authors: Pumar J.M. , Castiñeira J.A. , Vazquez F. , Blanco M. , Ares M. , Garcia-Allut A. , Guimaraens L.
Published: April 2015

The ultimate goal of endovascular treatment of intracranial aneurysms is complete occlusion of the aneurysm without compromising the parent artery. Several techniques have been described for the treatment of wide-necked aneurysms. An innovative method is proposed for the treatment of wide-necked aneurysms with the neck incorporated in the parent artery.
Angioplasty as the First-Line Therapeutic Option for Venous Hypertension with Outlet Obstruction of Dural Sinus
Authors: Yang Ming-Shiang , Chen Clayton Chi-Chang , Hung Hao-Chun , Chen Wen-Shien
Published: April 2015

We describe a nonconventional endovascular approach to the treatment of pseudotumor cerebri with venous outlet stricture or obstruction. In three patients presenting with acute visual loss, angiograms showed sinus occlusion and stasis of contrast material, with an increased pressure gradient in the venous system. We used venous sinus angioplasty as the first therapeutic option. This treatment was effective, and symptoms and signs of all three patients subsided quickly. In our initial and limited experience, sinus balloon angioplasty appeared to be a good first-line treatment for patients with pseudotumor cerebri, sinus outlet obstruction and acute vision loss. We prefer to use sinus stent placement as a second-line option when initial attempts are unsuccessful, especially in pediatric and young-adult patients, as illustrated in our cases.
Endovascular Treatment of Posterior Cerebral Artery Aneurysms
Authors: Li Youxiang , Lv Xianli , Jiang Chuhan , Liu Aihua , Wu Zhongxue
Published: April 2015

Previous reports of outcome after endovascular treatment of posterior cerebral artery (PCA) aneurysms have been limited. This study aimed to describe the clinical outcome and angiographic results obtained in the endovascular therapy of PCA aneurysm over a six year period. Endovascular treatment strategies were determined. A retrospective analysis was performed on 18 patients with PCA aneurysms evaluated at Beijing Tiantan Hospital between December 2000 and December 2006. Nine patients presented with subarachnoid hemorrhage (SAH): one of these patients had additional seizure and hemiparesis, one had additional memory loss and oculomotor palsy and one had additional vitreous hemorrhage. One patient had an intracerebral hematoma causing hemipalsy. Nine patients demonstrated unruptured PCA aneurysms. Ten aneurysms were = or >15 mm and the other eight were <15 mm. Ten aneurysms were saccular, four were fusiform and four were giant serpentine. Eighteen aneurysms were successfully treated with one patient deceased and one with a permanent deficit, 11 with selective occlusion of the aneurysm with platinum coils, one with NBCA and five with simultaneous occlusion of the aneurysm and parent PCA with detachable coils. One patient underwent complete spontaneous thrombosis after angiography. One patient had recanalization one year after coiling and one patient (patient 13) had persistent homonymous hemianopsia and mild hemipalsy. Five patients had parent vessels were occluded with intact visual field. Clinical presentation of PCA aneurysms varied with SAH, oculomotor palsy, heminumbness, hemiparalysis, memory loss, seizure or a combination. Various aneurysms of the posterior cerebral artery can be managed effectively with endovascular treatment.
Magnetic Resonance Imaging in Balo's Concentric Sclerosis
Authors: Al-Turkomani A.Y.T. , Muttikkal T.J.E. , Ben-Nakhi A.
Published: April 2015

Concentric high signal intensity zones on T2-weighted magnetic resonance images of brain strongly suggest Balo's concentric sclerosis (BCS), a rare but recognized variant of multiple sclerosis. Differentiating BCS from multiple sclerosis or neoplasm can be difficult clinically. The pathognomonic MRI appearance can dramatically influence the course of the disease, allowing earlier diagnosis and therapy of the disease which was once considered to have an invariably fulminant and fatal course.
Invasive Cerebral Aspergillosis in an Immunocompetent Patient
Authors: Ducolin C. , Zuiani C. , Sbuelz M. , Bazzocchi M. , Viale P.
Published: April 2015

Although the central nervous system is a common site of dissemination in immunocompromised patients with invasive aspergillosis, it is a very rare site of primary infection in immunocompetent patients. We describe the case of a 53-year-old man, without any identified factor risk for aspergillosis, who developed brain aspergillosis abscesses after streptococcal pneumonia. Computed tomography, magnetic resonance and diffusion weighted imaging findings of cerebral lesions are reported.
Right Third Nerve Palsy Caused by Extra-Axial Cavernoma in a Patient with Multiple Intracranial Cavernomas
Authors: Patro S. , Kesavadas C. , Kapilamoorthy T.R.
Published: April 2015

We report an unusual case of a 54-year-old man with third nerve palsy caused by an extra-axial cavernoma in relation to the cisternal portion of the oculomotor nerve. In addition to this lesion, the patient had multiple intracranial cavernomas. Interestingly, an initial MRI without T2* gradient sequence missed the multiple cavernomas. A subsequent MRI done after one month showed an increase in size with fluid level within the extra-axial cavernoma.
Metabolite Changes in Normal Appearing Cervical Spinal Cord in Two Patients with Multiple Sclerosis
Authors: Maffei M. , Marliani A.F. , Salvi F. , Clementi V. , Agati R. , Leonardi M.
Published: April 2015

We describe two cases of multiple sclerosis (MS) analyzed with Proton MR Spectroscopy (1H-MRS) with the voxel placed along the main axis of the normal appearing cervical spinal cord over three main space planes, orthogonally set. Relative concentrations expressed by the absolute concentration ratios of total NAA (tNAA), choline (Cho), myo-inositol (mI) and creatine plus phosphocreatine (Cr) were compared with the metabolites of ten healthy volunteers. We found a significant increase in mI/Cr and a small increase in Cho/Cr in the first patient, whereas the second patient had a decrease in NAA/Cr and NAA/Cho ratios. 1H-MRS will disclose biochemical changes in MS, even in normal appearing spinal cord, as already described in normal appearing cerebral tissue: these biochemical changes may provide significant information on disease prognosis.
Coil Embolization of Two Flow-Related Aneurysms in P1 Segment of the Posterior Cerebral Artery in a Patient with Occlusion of the Ipsilateral Internal Carotid Artery
Authors: Guzinski M. , Hendrich B. , Sasiadek M.
Published: April 2015

Aneurysms of the posterior cerebral artery (PCA) are uncommon (about 1% of all intracranial aneurysms) and their neurosurgical treatment is associated with high operative risk. We report on two saccular aneurysms of the P1 segment of the right PCA, combined with occlusion of the C1 segment of the internal carotid artery (ICA) detected during routine diagnostic studies in a 58-year-old patient with slight sensory loss in the left extremities. The aneurysms were embolized during two consecutive sessions, without subsequent complications. Endovascular intervention is an efficient method in the treatment of multiple aneurysms in the P1 segment of the PCA.
Spontaneous Bilateral Carotid Artery Dissection: Diagnosis and Follow-up with MDCT
Authors: Kurt S. , Sarikaya B. , Acu B. , Karaer H. , Firat M. Murat
Published: April 2015

Carotid artery dissection is usually unilateral. Rarely bilateral forms can be seen. Recent studies have shown the efficacy of computed tomography angiography (CTA) in the diagnosis of carotid dissection. Herein we report a case with bilateral carotid artery dissection diagnosis and follow-up which was carried out using mainly CTA.
Cervical Meningioma in Childhood
Authors: Vaneckova M. , Seidl Z. , Kemlink D. , Zamecnik J. , Burgetova A.
Published: April 2015

We report on a meningioma of the cervical spine in a 12-year-old boy with atypical clinical presentation. Meningiomas are relatively rare neoplasms in childhood, representing only 1 to 2% of all pediatric intracranial tumors. The distinction between the meningioma and another extramedullary, intradural tumors like schwannoma might pose difficulties. This case report points out that although a very rare tumor in children, it must be taken into account in differential diagnostics.
Extrapontine Myelinolysis in a Child: A Rare Case with MRI, DWI and MRS Follow-up
Authors: Dincer A. , Isik U. , Kosak E. , Özet M.
Published: April 2015

We describe a case of extrapontine myelinolysis in a child presenting with chorea and parkinsonian symptoms after treatment for hyponatremic dehydration. Although both extrapontine myelinolysis (EPM) in childhood and extrapyramidal presentation of EPM are very rare in children, the patient presented with pure extrapyramidal symptoms. Besides basal ganglia involvement and sparing brain stem, MRI demonstrated involvement of the amygdala bilaterally hitherto never reported in EPM patients. While single voxel proton spectroscopy (MRS) of the basal ganglia at the beginning was normal, the follow-up MRS showed moderate to severe NAA and mI decrease. Diffusion-weighted imaging abnormalities appeared relatively late during the disease course, also an unexpected finding. In addition, there were apparent increases in apparent diffusion coefficient (ADC) values of the affected basal ganglia instead of diffusion restriction.
Internal Carotid Bifurcation Aneurysms: Anatomical Features and Outcome of Endovascular Treatment
Authors: Uemura A. , Musacchio M. , Cardoso M. , Mostoufizadeh S. , Tournade A.
Published: April 2015

This study reports the anatomical presentation of internal carotid bifurcation aneurysms and the angiographic results of their endovascular treatment. We treated 17 patients with internal carotid bifurcation aneurysms by endovascular treatment using detachable coils. Follow-ups were conducted for three to 30 months. The pre- and postprocedural anatomical features of the aneurysms, procedural complications, and postprocedural angiographic outcomes were evaluated. The aneurysmal necks were located just above the internal carotid artery bifurcation or at the origins of anterior cerebral artery or the middle cerebral artery. Immediate angiography demonstrated complete occlusion, neck remnant, or residual aneurysms. Post-treatment, two aneurysms that were initially residual spontaneously progressed to complete occlusion, and two large aneurysms that initially demonstrated complete occlusion or neck remnants showed coil compaction and recanalization. Procedural complications occurred in two cases. Endovascular treatment is effective for ruptured and unruptured carotid terminal aneurysms with various anatomical features.
Venous Infarction Associated with a Sigmoid Sinus Dural Arteriovenous Fistula
Authors: Lv Xianli , Li Youxiang , Jiang Chuhan , Zhang Jingbo , Wu Zhongxue
Published: April 2015

Dural arteriovenous fistulas with restricted antegrade venous flow and reflux into a dural sinus or cortical veins lead to intracranial venous hypertension. This type of venous hypertension in return may cause parenchymal damage by mechanisms similar to those proposed for venous infarction. A 42-year-old man presented with homonymous hemianopsia of the right upper visual field. Computed tomography demonstrated hypointensity in the left occipital lobe. Angiography confirmed dural arteriovenous fistula of the left sigmoid sinus, severe stenosis and occlusion of the left sigmoid sinus and reversal of the flow in the cortical veins. This fistula was treated with Onyx-18. This report emphasizes an unusual coexistence of venous infarction with sigmoid sinus dural arteriovenous fistula causing neurological symptoms.
Visualization of Calvarial Fractures from MRI Volumetric Datasets
Authors: Moschnegootz S.V. , Barbarash L.S.
Published: April 2015

We present a simple yet effective technique for visualization of skull vault pathology associated with calvarial outer table damage from magnetic resonance volumetric datasets using a personal computer as a workstation and Amira software as a visualization tool. We show that rendered pictures are informative and convey a good impression of pathology features bearing a strong resemblance to computed tomography three-dimensional images.