bluuebunny/crossref_metadata_2025 huggingface dataset:
Osteopetrosi autosomica recessiva Diagnosi neonatale
Authors: Cuneo G. , Cesarini C. , Cianfrini D. , Gambi B.
Published: April 2015

Le osteopetrosi sono un raro gruppo eterogeneo di condizioni patologiche, caratterizzate da aumento della densità dell'osso dovuto ad un disordine del riassorbimento da parte degli osteoclasti. Esse sono più frequenti in gruppi etnici all'interno dei quali sono presenti consanguinei. Ne sono state descritte almeno cinque tipi, ma le forme più note sono la autosomica recessiva (AROP, detta anche maligna), la intermedia (IOP, anch'essa recessiva ma con insorgenza più tardiva), la forma con acidosi tubulare e la autosomica dominante (ADOP).

Riportiamo un caso di AROP diagnosticato in epoca neonatale (3 settimane). Esso dimostra come alcune caratteristiche radiologiche (ma non tutte), siano già presenti alla nascita. Alla luce delle recenti acquisizioni terapeutiche (soprattutto trapianto di cellule staminali), una diagnosi precoce della malattia potrebbe, pertanto, prevenire importanti modificazioni patologiche alcune delle quali gravemente invalidanti.
Embolizzazione percutanea di malformazione arterovenosa del cuoio capelluto
Authors: Nistri M. , Mangiafico S. , Cellerini M. , Innocenti A. , Dini M. , Giordano G. P.
Published: April 2015

Le malformazioni arterovenose (MAV) del cuoio capelluto sono rare malformazioni vascolari ad alto flusso che tendono ad accrescersi con il tempo causando spesso gravi disturbi estetici.

Il trattamento chirurgico radicale è spesso impossibile per le complicanze di ordine estetico e l'elevato rischio di sanguinamento.

Riportiamo il caso di una bambina di 9 anni con una MAV del cuoio capelluto in regione fronto-parietale destra alimentata da entrambe le arterie temporali superficiali e dal ramo sovraorbitario dell'arteria oftalmica di destra che è stata devascolarizzata completamente mediante embolizzazione arteriosa per via femorale e venosa per via percutanea.
Current Indications for Cerebral Protection in Surgery and Endovascular Therapy
Authors: Coppi G. , Moratto R. , Nicolosi E.
Published: April 2015

Carotid angioplasty, until recently carried out in selected patients at a few specialist centres, is currently growing at a rate of 20% a year. The main limitation on its development to date was the risk of cerebral embolization demonstrated experimentally at each stage of the procedure. Rapid advances in materials, especially the introduction of cerebral protective devices, has opened the way to a rapid expansion in the use of this method thanks to a significant drop in complications during the method's learning curve. Current outcomes are increasingly close to those of traditional surgery.

Carotid angioplasty is now a first choice treatment in patients at high risk or unsuitable for surgery. Angioplasty is also growing as an adjuvant rather than alternative treatment to surgery especially in patients presenting anatomical problems. Cerebral protection devices enhancing treatment outcome are not so much an option as a necessity in all these patients as confirmed by ongoing studies (CARESS, PACE, Italian SICVE register) assessing the efficacy of carotid angioplasty using cerebral protection devices.

The final results of these studies should establish the best method of cerebral protection and confirm the role of carotid angioplasty in the treatment of carotid artery stenotic disease.
Intracranial Stenting for Cerebrovascular Pathology
Authors: Levy E.I. , Boulos A.S. , Bendok B.R. , Horowitz M.B. , Kim S.H. , Qureshi A.I. , Guterman L.R. , Hopkins L.N.
Published: April 2015

After reading this article, the participant should be able to:

Describe the use of stent-assisted angioplasty for intracranial atherosclerotic disease. Recall the present status of stent-assisted managment of intracranial aneurysms. Describe the role of stenting and its technical aspects in the treatment of arteriovenous fistulae and acute stroke.
Atrofia olivopontocerebellar sporadica: Studio con risonanza magnetica
Authors: Bonetti M. , Cotticelli B.S. , Albertini F. , Volta G. Dalla , Troianiello B. , Guindani M.
Published: April 2015

L'atrofia olivopontocerebellare sporadica (sOPCA o MSA-C) è considerata una delle possibili manifestazioni dell'atrofia multisistemica (MSA). Nel periodo gennaio 2000-settembre 2002 sono giunti alla nostra osservazione 8 pazienti affetti da MSA-C di età variabile (42.8 +/- 18.7) che presentavano sintomatologia clinica compatibile con la diagnosi di atassia spinocerebellare. La RM ha documentato atrofia del tronco encefalico e del cervelletto con alterazione del segnale a livello delle fibre traverse del ponte ed a livello del peduncolo cerebellare medio nelle sequenze a TR lungo. In un solo paziente è stata evidenziata una alterazione dell' intensità di segnale a livello putaminale, facendo ipotizzare pertanto una possibile concomitanza con la degenerazione nigrostriatale (SND o MSA-P) considerata anch'essa una possibile espressione di MSA con pesanti ripercussioni sulle aspettative di vita del paziente. La RM, evidenziando le alterazioni delle strutture anatomiche coinvolte nella MSA-C, si rivela strumento essenziale sia per confermare una diagnosi già formulata sulla base delle manifestazioni cliniche peculiari, sia per indirizzare verso una corretto inquadramento diagnostico quei pazienti non ancora inquadrati correttamente sul piano neurologico. Risulta, inoltre, esame indispensabile per il monitoraggio dell'evoluzione della malattia.
Encefalopatia ipossico-ischemica
Authors: Cappellini A.
Published: April 2015

The term hypoxic-ischaemic encephalopathy, often used to cover the whole spectrum of perinatal brain damage, should be confined to neonatal suffering at term presenting specific physiopathological, clinical and radiological features. Most perinatal brain lesions are secondary to perinatal or post-natal hypoxic-ischaemic injury and can be classified on the basis of the predominant morphological characteristics (table 1). The different locations and morphological expression of brain damage in the premature infant and the neonate born at term reflect the different levels of brain maturation (table 2). These tables summarize the different pathogenetic and anatomopathological features of hypoxic-ischaemic lesions with clinical and radiological references in the premature infant and neonate born at term.
Malformazioni dell'orecchio nelle anomalie congenite cranio-facciali
Authors: Calzolari F. , Sarti E. , Sensi A. , Garani G. , Clauser L. , Martini A.
Published: April 2015

The aim of this study is to describe external, middle and inner ear malformations in children with congenital craniofacial abnormalities.

Seventeen patients with craniofacial and external ear anomalies, aged between 12 days and 15 years (mean 3.4 years), were studied. The majority of children had conductive hearing loss. High-resolution CT of the petrous bone was performed in all cases; in 9 cases three-dimensional reconstructions were done. For each child CT findings of external, middle, inner ear, facial nerve and skull base were analysed. Ear malformations have been correlated with anomalies of the auricle.

The most serious auricular anomalies were more frequently associated with external auditory canal atresia, dysplasia of the tympanic cavity and malleo-incudal joint and aberration of the mastoid segment of the facial nerve. These anomalies are probably related through a common embryological origin.

Inner ear malformations were diagnosed more rarely, but we emphasize that these malformations are more frequent in “syndromic” forms with craniofacial abnormalities rather than in isolated anomalies of the auricle; it is very important because inner ear abnormalities are considered a contraindication to functional surgery in patients with atresia. Diagnostic imaging is useful for an early and complete characterization of the craniofacial and ear malformations; a precise analysis of the ear abnormalities is necessary to give an indication for the eventual audiological treatment.

High-resolution CT is the method of choice for the analysis of the external and middle ear; CT and MR should be integrated for the study of the inner ear and facial nerve. CT and MR are helpful to determine the extent of craniofacial abnormalities; MR should be done when encephalic malformations are suspected. Finally, three-dimensional CT is useful for the maxillofacial surgeon to plan surgical treatment.
Trombosi spontanea di un angioma venoso in piccolo paziente
Authors: Costa A. , Sina C. , Miserocchi G. , Branca V.
Published: April 2015

We describe an 11-year-old girl investigated after spontaneous thrombosis of a venous angioma. The case is discussed in relation to the diagnostic difficulties and rarity of the event. In the presence of headache with nausea and left hemiparesis, two CT investigations were done with and without contrast administration. The scans disclosed an intraparenchymal haematoma with nodular enhancement from a deep location to the surface, suggesting a possible vascular origin. MR scans disclosed thrombosis of the drainage vein of a vascular abnormality. Angiography confirmed the finding of thrombosis of a venous collector in a venous angioma.
Aspetti neuroradiologici della sindrome adreno-genitale
Authors: Egitto M.G. , Uggetti C. , Bergamaschi R. , Livieri C.
Published: April 2015

We describe the results of a study on 21 patients with adrenogenital syndrome without neurological symptoms who underwent neurological examination, neurophysiological tests and MR scan. Only five patients (23.8%) had a negative neuroradiological examination, whereas 14 (66.3%) presented focal or diffuse white matter hyperintensity, ten (47.6%) had supratentorial cortical atrophy and seven (33.3%) inferior ectopia of the cerebellar tonsils. The frequency of white matter changes was not a chance finding and the lesions are speculated to be demyelinating. This hypothesis is interesting because the gene responsible for a deficit of the 21 beta-hydroxylase enzyme implicated in adrenogenital syndrome is near to the TNF gene implicated in the origin of multiple sclerosis. The possible causes of supratentorial atrophy and tonsillar ectopia are also discussed.
Proton MR Spectroscopic Imaging in Pelizaeus-Merzbacher Disease
Authors: Pizzini F. , Fatemi A. , Barker P.B. , Moser H.W. , Naidu S. , Beltramello A.
Published: April 2015

We describe the MR spectroscopy findings in three patients with Pelizaeus-Merzbacker disease, a rare leukodystrophy associated with mutations of the PLP gene on chromosome X. The patients studied had different PLP gene mutations and presented different metabolic patterns, indicating a different phenotypic expression of mutations of the same gene.
Studio in follow-up della giunzione craniocervicale con TC ed RM in un caso di mucopolisaccaridosi tipo IV
Authors: Sticchi G. , Lupo F.A. , Perfetto S.C.
Published: April 2015

We describe a 12-year-old girl with mucopolysaccharidosis VI (Maroteaux-Lamy's syndrome) caused by aryl sulphatase B deficiency. The characteristic changes in the craniocervical junction described in literature reports of these patients were studied by serial CT and MR scans. Imaging disclosed the spinal bone changes, evolution of lesions and their direct or indirect effect on the neuraxis. In addition to causing clinical signs of bulb-spinal cord compression, narrowing of the foramen magnum and the cervical canal can lead to the development of hydrocephalus often encountered in patients with mucopolysaccharidosis. In our patient, the hydrocephalus was caused by impaired CSF drainage rather than compensatory hypertrophy secondary to the dysmyelinating nature of the disease. Serial CT and MR scans allowed us to monitor the clinical and morphological evolution of the mucopolysaccharidosis lesions, devising appropriate therapeutic strategies.
Evoluzione neuropsichiatrica a lungo termine in soggetti con encefalopatia ipossico-ischemica neonatale
Authors: Allemand D. , Allemand F. , Cortesi F. , Costa A. , Labellarte V. , Vagnoni C.
Published: April 2015

We studied the neuropsychiatric evolution at school age in a population of children born at term with perinatal asphyxia, focusing on the assessment of cognitive disorders and psychopathological problems such as anxiety, depression and behavioural disorders.

The cohort comprised 33 children aged between seven and 12 years, born at term and presenting hypoxic-ischaemic encephalopathy at birth. History-taking and neurological examination were done (according to Towen) and the following tests administered: WISC-R, test CBCL, childhood anxiety scale (Busnelli), CDI (Kovacs). A control group consisted of children aged between eight and 12 years without perinatal suffering.

Results disclosed a number of evolutive disorders even though patients with severe neuromotor deficit were excluded from the study. Disorders included minor neurological syndromes, specific language and learning disorders, positivity on the scale for anxiety and depression: in particular 50% of the sample with minor neurological syndrome had symptoms of anxiety and depression.

We divided the neonatal hypoxic-ischaemic encephalopathy into three degrees on the basis of brain scan and neurological examination. Relating the degree of neonatal hypoxic-ischaemic encephalopathy to some neuropsychological and psychiatric variables (cognitive level, anxiety, depression), only the correlation with anxiety was significant: the incidence of anxiety symptoms at school age was greater in the intermediate degree of neonatal hypoxic-ischaemic encephalopathy.

Our findings further support the postulated link between neurological injury/dysfunction (perinatal asphyxia) and the subsequent onset of psychiatric and/or neuropsychological disorders.
Time-of-Flight MR Angiography of Dyke-Davidoff-Masson Syndrome: Clinical and Radiological Correlations
Authors: Kantarci M. , Ceviz N. , Onbas O. , Alper F. , Okur A. , Karaca L.
Published: April 2015

The objective of the present study was to determine the presence and level of occlusion in the cerebral arteries using three-dimensional time-of-flight (TOF) MR angiography. Routine axial T1-weighted, axial or coronal T2-weighted MR imaging, proton MR spectroscopy, diffusion-weighted MR imaging and TOF MR angiography of the brain were performed in nine patients with DDMS (five congenital and four acquired). Of congenital cases, three with an occlusion at the root of the MCA (cases 3,4,5) and one with an occlusion on M1, M2 and M3 (case 7) had severe clinical findings, and one with an occlusion on M2 and M3 (case 8) had moderate clinical findings. Cerebral encephalomalacia was found in four congenital DDMS cases (cases 3,4,7,8). Of four acquired DDMS cases; one with an occlusion on M1, M2 and M3 (case 1), and one with an occlusion on M2 and M3 (case 6) had moderate clinical findings, and one with an occlusion on M2 (case 2) and one with an occlusion on M3 (case 9) had mild clinical findings. Contrary to the congenital DDMS cases (4/5), only one of acquired cases (1/4) had encephalomalacia. Our results suggest that unilateral cerebral arterial occlusion is the main factor which results in DDMS, and the level of occlusion has a significant effect on the severity of clinical findings. TOF MR angiography, which is a non-invasive technique, provides prognostic information by showing the occluded arteries and the level of occlusion.
Solitary Thoracic Intramedullary Schwannoma Report of Two Cases
Authors: Panagiotopoulos K. , Tortora F. , Elefante A. , Bruno M.C. , Santangelo M. , Cirillo S. , Briganti F. , Cerillo A.
Published: April 2015

Schwannomas are the most common tumors of the spinal cord. Nevertheless, sporadic intramedullary location of this entity is a very rare condition. We present two cases of solitary thoracic intramedullary schwannoma, located at the T6 and T10 levels respectively, in patients without evidence of Von Recklinghausen's disease. Two males, 71 and 51 years old respectively, presented with signs and symptoms of progressive thoracic myelopathy. In both cases, magnetic resonance imaging disclosed a spinal cord tumor, located at T6 and T10 levels respectively. Both patients were treated surgically. Patient 1 underwent an operation via a posterolateral extrapleural approach. The second patient was submitted to surgical resection of the tumor via a posterior approach. In both patients, total excision of an intramedullary lesion was achieved and histological and immunohistochemical findings were consistent with a typical schwannoma. Postoperative magnetic resonance imaging demonstrated no evidence of residual tumor in either case. The first patient is currently symptom-free and neurologically intact, almost five years after surgery. About one year after operation, patient 2 presents nearly complete resolution of his motor and sensory disturbances. Solitary intramedullary schwannomas are rare. Controversy remains regarding the origin of these tumors. In the majority of the cases, intramedullary schwannomas are benign, non-infiltrating tumors, hence amenable to aggressive surgery. Radical excision remains the gold standard in the treatment of such lesions.
Local Distribution of a Low Dose of Anesthetic for Cervical Plexus Block in Carotid Endarterectomy
Authors: Sardanelli F. , Fausto A. , D'Orta G. , Pavesi M. , Tealdi D. , Grossi P.
Published: April 2015

Cervical plexus block (CPB) for carotid endarterectomy is typically performed with a large amount of anesthetic solution (20–40 ml). Our aim was to demonstrate the local distribution of a low dose of anesthetic solution for CPB. Ten patients (aged 66–79 years) underwent CPB with a single injection technique using 8 ml of ropivacaine 0.75% mixed with 1 ml of iodinated non-ionic contrast agent. Digital fluoroscopy and computed tomography (CT) were performed to define the anesthetic distribution before carotid endarterectomy. Effectiveness of the block was evaluated during and after surgery. The cranial-caudal extent of the anesthetic solution in the paravertebral space was demonstrated by both digital fluoroscopy and CT: C2–C4 (n=1), C2–C5 (n=1), C2–C6 (n=1), C2–C7 (n=5), and C3–C7 (n=2). In addition, CT showed an anterior-posterior spreading of 2–3 cm in diameter in five patients and of more than 3 cm in five patients. All patients had a sufficient deep and superficial CPB; superior cervical ganglion block was obtained in three patients, with a prevalent anterior spreading of the anesthetic in two of them. Out of the seven patients without superior cervical ganglion block, none had a prevalent anterior spreading and two had mild pain during artery dissection. We observed phrenic nerve block in ten, brachial plexus block in eight, and laryngeal block in one patient, other side effects in none. Digital fluoroscopy and CT demonstrate the anesthetic distribution in neck spaces. A dose of anesthetic low as 8 ml of ropivacaine 0.75%, seems to be sufficient to obtain CPB for carotid endarterectomy.
An Unusual Case of Arteriovenous Fistula following Lumbar Disc Repair Presenting with Pulmonary Embolism
Authors: Eren S.
Published: April 2015

Traumatic arteriovenous fistulas (AVF) frequently occur following gunshot injury. Traumatic iliac AVF are uncommon and iliac AVF occurring after lumbar disc operation are rare. There are many causes of pulmonary embolism (PE). Although the most common cause of PE is venous thrombophlebitis of the lower extremities, iliac AV fistula with thrombophlebitis due to lumbar disc operation as a cause of PE are very rare. We describe a patient with iliac AV fistula with common iliac vein thrombophlebitis due to previous lumbar discectomy presenting with PE.
The Quest for the Cause of Spinal Cord Ischemic Lesions: Impaired Arterial Supply or Venous Drainage?
Authors: Varsik P. , Pancak J. , Mihale J. , Zigrai M. , Klobucnikova K. , Pauliny P.
Published: April 2015

Incomplete transverse spinal cord lesion after ischemic insult of arterial origin is not uncommon, but ischemic spinal cord lesion caused by impairment of the venous drainage system is very rare. A 33-year-old man with the postinfective hypercoagulation syndrome and incomplete cervical spinal cord ischemic lesion with a typical clinical course as in Foix-Alajouanine's syndrome is described. Postischemic and postnecrotic gliosis of the spinal cord tissue in segments C6-Th2 was confirmed at MRI examination. The location of the postischemic medullar lesion did not have the typical “pencil-like” appearance usually present in the impairment of arterial supply. Instead, the lesion had an atypical distribution of ischemic changes in the ventral marginal part of the spinal cord near the sulcomarginal incisura suggesting impairment of the venous drainage system. After low-molecular heparins and antibiotic treatment, the patient made a very good recovery with functional restitution. Spinal MR-angiography showed a normal arterial blood supply.
Diagnostic and Functional Neuroradiology
Authors: Montanaro D. , Lombardo F. , Frijia F. , Canapicchi R.
Published: April 2015

Recent technological advances have had a major impact on hardware and software used in the neurosciences leading to the development of highly sophisticated magnetic resonance (MR) sequences and image processing techniques closely correted to neuronal activity (functional MNR with BOLD contrast, fMRI; Diffusion MR, DWI-DTI). These imaging procedures disclose eloquent cortical brain areas and their respective connecting pathways (mediated by bundles of white matter fibres) allowing a better correlation in clinical practice between functional impairment and brain lesion. This has transformed MR from a scanning technique offering purely morphological information on brain pathology ( dysfunctional neuroradiology) into functional neuroradiology. In the wake of functional neuroradiology research confined to physiological investigation, the new technique is now an important tool in the field of neurorehabilitation and neuropharmacology, pre-surgical mapping and the study of post-lesional plasticity. Pre-surgical planning is used not only for cerebral tumours but also for epilepsy surgery and interventional neuroradiological procedures for which fMRI and DTI findings may yield useful information on brain hemispheric dominance and the mechanisms responsible for the reorganization of brain functions.
Double Wire Technique in Angioplasty with Stent for Symptomatic Middle Cerebral Artery Stenosis with Extremely Tortuous Access Vessel
Authors: Jiang W.-J. , Cao Y.-B. , Du B. , Jin M. , Qu H. , Xu X.-T. , Li Y.-H. , Zhu Y.-F.
Published: April 2015

We present our initial experience with a double wire technique in the intracranial stenting of two patients with symptomatic middle cerebral artery stenosis associated with extreme tortuosity of the carotid siphon. In both of these patients the clinical picture was characterized by hemispheric transient ischemic attacks. Cerebral digital subtraction angiography revealed a high grade stenosis of the MCA main trunk (M1 segment) associated with extreme tortuosity of the ipsilateral internal carotid artery siphon. Initial attempts at endovascular stenting using standard techniques had failed. Both patients were eventually successfully treated with intracranial stent placement using a double wire technique. They had no complication during or after the procedure. There have been no ischemic events in either patient during a short-term follow-up. Our limited experience suggests the double wire technique is a safe and effective method to overcome a tortuous access vessel for intracranial stenting.
Cutting Balloon Angioplasty in Type 1 Aortoarteritis
Authors: Gupta A.K. , Vattoth S. , Trkapilamoorthy TR , Purkayastha S. , Chandran V.
Published: April 2015

Percutaneous transluminal angioplasty (PTA) of steno-occlusive lesions in the supra-aortic arch vessels in aortoarteritis is associated with suboptimal results and higher restenosis rates, particularly in those with diffuse disease. We report a patient with aortoarteritis who presented with critical stenosis of the right common carotid artery, right subclavian artery and 50 percent stenosis of the brachiocephalic artery. Left common carotid and left subclavian arteries were occluded and were reforming via collaterals. Cutting balloon PTA of right subclavian, right common carotid and brachiocephalic arteries was done with good anatomic patency and clinical results on six month follow up.
3 T MR Assessment of Pituitary Microadenomas
Authors: Agati R. , Maffei M. , Bacci A. , Cevolani D. , Battaglia S. , Leonardi M.
Published: April 2015

Demonstration and accurate localisation of pituitary microadenomas in the adenohypophysis are essential to institute appropriate medical management and aid surgical planning, especially when an endoscopic procedure is envisaged. Given the features of pituitary microadenomas, ideally, high spatial and temporal resolution is required for neuroradiological investigation. There is a consensus in the literature that MR scanning is the method of choice for pituitary imaging and dynamic studies offer greater sensitivity in identifying pituitary microadenomas. However, the spatial resolution and limited number of slices acquired constitute major drawbacks using 1.5 T MR devices. A 3 Tesla Signa Excite MR system (GE Medical Systems) was recently installed in the Neuroradiology Unit of Bellaria Hospital, Bologna. The new device was tested specifically for the study of pituitary microadenomas using an FSE dynamic sequence allowing the acquisition of nine slices (slice thickness 2.5 mm) over the pituitary gland with high spatial resolution in a few seconds. This sequence, repeated six times after gadolinium administration through an injector, displays the gradual enhancement of the adenohypophysis and any microadenomas present in the gland. As the microadenoma uptake of gadolinium is lower than the adenohypophysis uptake, the possible microadenoma presence becomes appreciable only in some of the six sequences as a negative image with respect to the normal parenchyma. Pituitary microadenomas undetected in previous scans using a 1.5 T system were disclosed by this imaging technique with highly accurate morphological localisation.
MRI Assessment of Peritumoral Brain Edema in Human Astrocytomas: Correlation with Angiogenesis Biomarkers
Authors: Wei G.Q. , He H.D. , Liu W.P. , Zhen H.N. , Zhao J. , Li J. , Han Y.D. , Yang Y. , Huan Y.
Published: April 2015

Mass effect due to peritumoral brain edema (PTBE) is one of the most common imaging characteristics encountered in glial tumors. The severity and variety of the PTBE may increase the difficulties of cancer treatment. However, its pathogenesis is not well documented. Recently, more attention has been paid to vascular endothelial growth factor (VEGF), the polypeptides mediating tumor angiogenesis and microvascular permeability. The purpose of this study was to investigate PTBE index in astrocytomas obtained from MRI and its correlation with angiogenesis biomarkers, VEGF and microvessel density. Our results demonstrated that PTBE in human astrocytomas correlated with both VEGF expression and vessel density. The relationship of PTBE with angiogenesis biomarkers allows a better understanding its molecular mechanisms, and may have implications for clinical management of brain edema associated with human astrocytomas.
Magnetic Resonance Evaluation of a Case with Cerebrorenal Oxalosis
Authors: Kantarci M. , Onbas O. , Alper F. , Durur I. , Okur A. , Karaca L. , Ceviz N.
Published: April 2015

Oxalosis is a rare metabolic disorder in which an enhanced production of oxalic acid leads to hyperoxalemia and deposition of calcium oxalate in different organs. Although the findings related to oxalosis in other organs have been reported, cerebrorenal oxalosis has been mentioned but their radiological finding has not been described. Therefore we aimed to describe the magnetic resonance imaging findings of an interesting case with cerebrorenal oxalosis manifesting as cerebral infarcts.
Spontaneous Disappearance of Juxta-Sylvian Cyst: MRI Study and Clinical Evaluations
Authors: Falcone C. , Tinelli E. , Pierallini A. , Caramia F. , Bruti G. , Paonessa A. , Shaiban M. , Pignataro N.M.R. , Cerbo R. , Bianco F. , Bozzao L.
Published: April 2015

Several cystic lesions may involve the temporal lobe including arachnoid, choroidal fissure and juxta-sylvian cysts. We reported a case of appearance, increase and spontaneous disappearance of a juxta-sylvian cyst in a young girl with headache studied by MRI between 1990 and 2003. In agreement with previous reports, the sudden disappearance, without a history of trauma, could be the result of an osmotic effect that shifted CSF inside the cyst, leading to an increase in osmotic pressure and rupture of the cyst wall.
Single Metastatic Adenocarcinoma in the Cerebellopontine Angle presenting as an Extra-Axial Tumor
Authors: Simonetti L. , Riccioli L. Albini , Barbanera A. , Agati R.
Published: April 2015

We present the case of a 67-year-old woman referred to our hospital with an eight week history of walking difficulties and nausea. On CT scans a tumour in the right cerebellopontine angle (CPA) was diagnosed. The tumour was resected and histopathological examination revealed an adenocarcinoma, suspected to be a metastasis from breast carcinoma treated surgically twelve years earlier.
Contribution of Distensibility and Intima-Media Thickness to the Etiology of Stroke
Authors: Chlumský J. , Charvát J.
Published: April 2015

We evaluated carotid artery distensibility (D) and intima-media thickness (IMT) in patients with stroke (S), and its relationship to diabetes and atrial fibrilation. We measured D and IMT in 89 stroke patients. 59 patients had type II diabetes and 64 patients had atrial fibrillation. D was determined using the Reneman formula (mm/100mm Hg). D was consistently lower in diabetic patients then in non-diabetic patients (0.14 v. 0.17, p=0.039) and showed a relation to IMT. In atrial fibrillation patients IMT was consistently lower (67 v.79 mm, p=0.033) and D was increased (0.19 v. 0.10, p=0.023). Type II diabetes is characterized by wall stiffening and thickening of the carotid artery. D and IMT can contribute to the differentiation of embolic and thrombotic etiology of stroke.
Prenatal Diffusion-Weighted MRI of Fetal Brain Lesions
Authors: Zirpoli S. , Righini A. , Bianchini E. , Parazzini C. , Baldoli C. , Nicolini U. , Mrakic F. , Lembo G. , Rizzuti T. , Triulzi F.
Published: April 2015

Prenatal Diffusion-Weighted Imaging (DWI) was recently demonstrated to be feasible in the normal fetal brain. We report our preliminary experience of abnormal prenatal DWI findings in the brains of eight fetuses with suspected lesions on the basis of clinical and ultrasound findings. The diffusion-weighted echo-planar sequence, which had an acquisition time of 14–18 seconds, was performed with the mother holding her breath. Slice thickness varied from 5 to 6 mm, the TR was 4000–5000 ms, the TE was 81 ms, the in plane resolution was 2.5×2.5 mm. Apparent Diffusion Coefficient (ADC) trace maps were calculated on the basis of three axes diffusion-sensitized images. In two cases, hypoxic-ischemic focal lesions showed a DWI signal compatible with the acute or subacute stage. In two cases of recent fetal death, the brain ADC was markedly decreased. In a case of fetus papyraceus, the intracranial ADC value suggested the brain having a solid structure. In a case of intraventricular hemorrhage, the lesion was more conspicuous on DWI than on conventional images. In a case of brain developmental malformations, the ADC showed values compatible with decreased cellular proliferation disorders. In a case of intracranial cystic mass, DWI readily differentiated between an arachnoid and an epidermoid cyst. DWI appears to enhance the prenatal MRI capability of characterizing hypoxic-ischemic lesions. Moreover, prenatal DWI seems to provide valuable information on the timing of fetal death. ADC determination can provide additional data on the nature of brain malformations in cases of abnormal development.
Zero-Filling Interpolation Processing Technique Can Efficiently Suppress Segmental Stenosis Artifact on Small Arteries of Anatomical Phantoms
Authors: Lin R. , Wu R. , Xiao Z. , Liu G. , Kong K. , Lang Z.
Published: April 2015

The purpose of this study was to evaluate the zero-filling interpolation processing (ZIP) technique for contrast-enhanced MR angiography (CE-MRA). Phantoms of arteries were made with different lumen diameters. Gadolinium-enhanced three-dimensional MR angiography was performed on a GE 1.5T scanner. The parameters of FSPGR pulse sequence were: flip angle 30°, TR 6ms, TE 1.4ms, bandwidth 31.25 kHz, slice thickness 1.2 mm, matrix 256×256. The sequence parameters were kept constant for the studies, whereas four selections were chosen: 1) with ZIP1024 and ZIP×4 techniques; 2) only with ZIP1024 technique; 3) only with ZIP×4 technique; 4) without ZIP technique. For image quality evaluation, MR maximum intensity projection (MIP) images were created. Signal-to-noise ratio (SNR) was measured on MIP images. Vessel edge was determined using full width at half maximum (FWHM) for lumen diameter calculation and results were compared with the actual lumen diameter. The distinctness of the vessel edge and the artifacts on the phantoms were compared for all sequences. Three experienced radiologists made consensus evaluation. The FWHM results of lumen measurements for all the sequences with ZIP techniques were more accurate than that of the sequence without ZIP technique in all phantoms, no matter what the size of the artery. The vessel edge with ZIP1024 technique was more distinct. However, the highest average SNR was obtained with the sequence without ZIP technique. The segmental stenosis artifacts on small artery of phantoms were only efficiently suppressed with the ZIP×4 technique. ZIP technique is excellent for CE-MRA to obtain high quality MR angiography. It not only can improve the spatial resolution and the distinctness of the vessel edge on CE-MRA, but can also efficiently suppress segmental stenosis artifact on small arteries of phantoms.
Tuberculous Meningitis: Comparison of Contrast Enhanced T1-Weighted and Flair MR Imaging with Magnetization Transfer Contrast
Authors: Mutlu H. , Silit E. , Pekkafali Z. , Basekim C.C. , Kantarci M. , Kizilkaya E.
Published: April 2015

Fluid-attenuated inversion recovery (FLAIR) imaging with contrast enhancement is highly sensitive for detecting subarachnoid space disease. We hypothesized that contrast-enhanced FLAIR imaging with magnetization transfer would offer superior sensitivity to contrast-enhanced T1-weighted MR imaging with magnetization transfer in detecting TB meningitis. Forty-four patients referred for suspected TB meningitis underwent MR imaging studies. The patients had either proven TB meningitis or negative TB meningitis. The MR imaging examinations included both contrast-enhanced FLAIR and T1-weighted MR images with magnetization transfers that were independently reviewed by two neuroradiologists. Each of the sequences was reviewed individually and separately and was assigned a score of positive or negative for TB meningitis. Of the 21 studies of patients with proven TB meningitis, nine were positive based on contrast-enhanced FLAIR images with magnetization transfer, and 13 were positive based on contrast-enhanced T1-weighted MR images with magnetization transfer. Of the 23 studies of patients without TB meningitis, 19 were negative based on contrast-enhanced FLAIR images, and 20 were negative based on contrast-enhanced T1-weighted MR images with magnetization transfer. The sensitivity and specificity for contrast-enhanced FLAIR images for detecting TB meningitis were 43% (nine of 21) and 82% (19 of 23), respectively. The sensitivity and specificity of contrast-enhanced T1-weighted MR images with magnetization transfer for detecting TB meningitis were 62% (13 of 21) and 87% (20 of 23), respectively. Contrast-enhanced FLAIR imaging with magnetization transfer is less sensitive than contrast-enhanced T1-weighted MR sequences with magnetization transfer in detecting TB meningitis.
Sonographic Findings of Median Nerve and Prevalence of Carpal Tunnel Syndrome in Computer Mouse Users
Authors: Yucel A. , Yaman M. , Acar M. , Haktanir A. , Albayrak R. , Degirmenci B.
Published: April 2015

The purpose of this study was to evaluate the median nerve sonographically and estimate the prevalence of carpal tunnel syndrome (CTS) in computer mouse users. Forty-nine right wrists of 49 employees who had used a computer mouse were included in the study. Thirty-three right wrists of 33 non-mouse user employees were studied as a control group. Both the mouse user and non-mouse user employees underwent sonography and electromyography (EMG). Axial sonograms of the median nerve were obtained proximally, in the middle and distally in the carpal tunnel. At each level, flattening ratio and the cross-sectional area of the median nerve were calculated. We found no significant difference in any parameters between mouse users and control group ( p>0.05). However, when we compared mouse users according to the presence of pain, there was a significant increase in the cross-sectional area of the median nerve proximally in the mouse users having pain ( p<0.05). Of all mouse users, eight (16.3%) were diagnosed as sensory CTS, four (8.2%) as motor CTS by EMG. We also found that four (50%) CTS patients had a proximal cross-sectional area of median nerve exceeding 10 mm2 and five (62.5%) had a distal flattening ratio over three. Prolonged use of a mouse may pose an occupational risk for employees. Sonography can serve as an initial step in symptomatic patients for diagnosis of CTS.
Diffusion Tensor (DT)-MRI of the Brain. Review of Clinical Pediatric Applications
Authors: Bernardi B. , Price G. , Thomas E. , Makki M.
Published: April 2015

Diffusion tensor imaging (DTI), is a new MR-based technique allowing, in-vivo, the assessment of the water diffusive transport in cerebral tissues, depending on the molecular and biochemical environment. Over the past decade, DTI has become an indispensable part of the MR evaluation of pediatric brain in the clinical practice. Quantitative analysis of fractional anisotropy (FA) and apparent diffusion coefficient (ADC), the two most common indices used to describe the diffusion characteristics, helps the comprehension of the childhood brain maturation and enables the early detection of several brain diseases. DTI also allows us to look at anisotropic diffusion within white matter tracts. To better demonstrate the location and orientation of the white matter tracts, new and/or more sophisticated methods such as Color-Encoded Map and Fiber Tracking have been proposed. We review the theoretical background of DT-MRI, the modality of its data acquisition and processing and some of its commonest applications, particularly in Pediatric Neuroradiology.
Occipital Plagiocephaly
Authors: Stefani S. , Drigo P. , Faggin R. , Laverda A.M.
Published: April 2015

After the “Back to Sleep” campaign, promoted in 1992 by the American Academy of Paediatrics to prevent the Sudden Infant Death Syndrome (SIDS), it was recommended to place babies in a supine sleeping position. The incidence of SIDS has fallen dramatically since 1992, whereas there has been a major increase in the incidence of occipital plagiocephaly (OP). We report the data relative to the OP cases observed in the Paediatric Department of Padua Hospital between 1998 and 2003. 122 (63%) of the 194 cases of craniosynostosis observed presented OP. The 64 children that took part to the study were contacted and underwent neurological examination with an evaluation of skull shape and previous radiograms. We proposed to parents a questionnaire to define the risk factors and estimate the skull deformity over time. 58 of the 64 children presented positional plagiocephaly (PP), six had synostotic plagiocephaly (SP). Since 1998 there has been a progressive increase in cases of PP. There is a male prevalence (65%), but no side prevalence. Firstborns accounted for 33 (51%), whereas 11 were preterm infants (17%). 82% had a gestational age between the 38th and 40th week. The mean value of the Apgar Index was 8 at the first minute and 9 at the 5th minute. At birth the clinical presentation was: occipital flattening already present at birth in 23 children, preferential head orientation in 18, congenital torticollis in 12, ear asymmetry in 12, frontal bossing in ten. We noticed a mild developmental delay in 8 children (13%). The maximum degree of cranial asymmetry was observed in two peaks in cases of PP: at the third and fourth months (34 cases) and then at the sixth and seventh months (13 cases). The SP presented a progressive exacerbation of the deformity until surgery (done at the sixth to seventh months). PP improved by hygienic postural norms in six months; only three patients required surgery for aesthetic reasons. We observed a strict correlation between side of flattening and sleep head position ( χ2 test, p-value=2,256e-09) and a higher degree of occipital flattening at birth in patients with associated congenital torticollis (Mann-Whitney test, p-value=0.002744). In conclusion, OP is a common condition but essentially benign; it does not cause medical consequences but aesthetic problems. It is necessary to recognize the mild deformity in the newborns so as to intervene early with hygienic postural norms that can correct the asymmetry. The diagnosis is largely clinical and only in case of doubt are radiological examinations required (ultrasonography for sutures, 3D CT scans).
Acute Disseminated Encephalomyelitis
Authors: Battistella P.A. , Fontanin M.
Published: April 2015

Acute disseminated encephalomyelitis (ADEM) is an acute inflammatory disease of the central nervous system (CNS) which is diagnosed more frequently today than in the past, but for which there are no controlled epidemiological data. In children, especially in the first ten years of age, the disease shows a mainly “encephalitic” pattern, albeit with varying clinical features, while in adults ADEM may be more “indolent”, sometimes with an unfavourable prognosis. Although ADEM was considered a monophasic disease until a decade ago, cases characterized by a recurrent-relapsing course have been reported, making the differential diagnosis with multiple sclerosis (MS) more difficult. Due to the wide clinical variability of ADEM, little is known about its etiology or patient predisposition. Prognosis is also difficult, since there are no guidelines as to the choice and length of treatment. For differential diagnosis with MS, careful monitoring not only of clinical findings but also of neuroradiological (MRI), biological (cerebrospinal fluid), and neurophysiological (EEG and EP) data is necessary.
Clinical and Histological Changes of Intrathecally Administered Gadopentate Dimeglumine (Gd-DTPA) in Normal Rats
Authors: Mavioglu H. , Tuglu I. , Temiz C. , Ozbilgin K. , Cilaker S. , Selcuki D. , Selcuki M.
Published: April 2015

Objectives:

This study is carried out to explore clinical and histological changes induced in rats by intrathecal administration of Gd-DTPA via suboccipital spinal injection. 2.5, 5, 10 μmol/g-brain of Gd-DTPA were injected intrathecally to 43 adult male rats and sucrose as control solution with same volume and osmolarity were injected to 18 rats. Animals were sacrificed on day 4 and 14. Sections from the cortex, brain stem, cerebellum and medulla spinalis were obtained to examine for cell loss and apoptosis. In this study, no clinical abnormalities were observed in 69.8 % of rats of Gd-DTPA group and in 83.3 % of rats of sucrose group. Transient neurological signs such as ataxia and paresis were seen in 11.6 % of rats in the Gd-DTPA group and in 5.5 % of rats in the sucrose group. They were seen more frequently in the Gd-DTPA group especially in the highest dose and volume. Histological examination did not revealed necrosis or apoptosis in both groups. This study suggests that intrathecally administered Gd-DTPA may be safe in humans when lower doses per gram of brain are used than rats.
Non-Neoplastic Dural Sinus Thrombosis
Authors: Tsitouridis I. , Papapostolou P. , Rudolf J. , Natsis K. , Tarazi L. , Goutsaridou F. , Emmanouilidou M. , Chondromatidou S. , Papastergiou C.
Published: April 2015

Magnetic Resonance Imaging (MRI) study of the brain and Magnetic Resonance Venography (MRV) offer major advantages in evaluating patients suspected of having dural sinus thrombosis. Since 2002, we have examined 49 patients in our department with definite dural sinus thrombosis. MRI and MRV revealed the thrombosis of the dural sinus, and the underlying cause in most patients. There is consensus in the literature that MRI scanning in combination with MRV is the method of choice for evaluating dural sinus thrombosis, and this is also the end result of our study. We also compared the 3D-TOF technique and 2D-PC technique for MRV examination and found that the 3D-TOF technique is clearly the method of choice.
Venous Strokes
Authors: Limaye U.S.
Published: April 2015

Management of Venous strokes with the KEM Protocol. Our experience in management of acute and sub-acute cases of venous strokes with heparin or local thrombolysis with urokinase according to KEM Hospital, INR protocol will be presented. All patients included had angiographically proven cerebral venous sinus thrombosis. Patients were classified according to clinical status scale into mild1–3 and severe clinical grade4–6. The study was divided into three phases. Phase I included 27 patients all treated with systemic heparin. Phase Il included 72 patients, 30 were in severe clinical grade and 52 in mild. 26 were thrombolysed with 14 in severe and 12 in mild clinical grade. A prospective study was carried out in 180 patients according to a defined protocol in Phase 111. 133 of these were in mild clinical grade and 47 in the severe. 67 patients were thrombolysed. In the thrombolysed group 27 patients were in mild & 40 in severe clinical grade. 113 patients were treated with systemic heparin. Adjunctive medical therapy was given as required. Following acute management all were anticoagulated for 6 months. Phase I showed 100% mortality in severe clinical group and 23.53% in mild clinical grade. In Phase II mortality in severe clinical group was 75% in non-thrombolysed group and 57.14% in thrombolysed group. There were no deaths in mild clinical grade patients who were thrombolysed. In Phase 111 in Severe clinical grade, mortality in thrombolysed group was 35% and non-thrombolysed group was 100%. In mild clinical group there was 100% recovery in thrombolysed group and 94.4% in non-thrombolysed group. There was complete clinical recovery in 84.4% of patients in Phase 111. 2 patients had intracranial haemorrhage on Urokinase therapy. The line of treatment of venous strokes with heparin or local thrombolysis can be decided according to the KEM protocol. Patients with Cerebral venous sinus thrombosis had better outcome when managed according to our protocol.
Diffuse Capillary Telangiectasia of the Brain
Authors: Dall'Olio M. , Marliani A.F. , Maye H. Ahmed Sheikh , Bacci A. , Leonardi M.
Published: April 2015

Capillary telangiectasia is one of four forms of cerebral vascular malformations consisting of an area of dilated capillaries like a small petechial patch on the brain surface. The lesions are located mainly in the pons and cerebellum. We describe a case of diffuse capillary telangiectasia of the brain in a patient presenting with epilepsy who underwent morphological and function investigation using a 3T MR system.