bluuebunny/crossref_metadata_2025 huggingface dataset:
Trattamento endovascolare prechirurgico con colle acriliche
Authors: Avignone S. , Cinnante C. , Branca V.
Published: April 2015

We describe a female neonate with clinical features of neonatal suffering who underwent trans-fontanelle ultrasound scan. Ultrasound disclosed a hyperchoic expanding lesion, confirmed by subsequent MR scan which revealed large vascular structures and signs of bleeding within the lesion. Angiography was problematic given the weight of the neonate, the small vascular structures and the choice of angiographic materials. Three large vessels feeding the lesion were detected. Embolization was undertaken using acrylic glue to obtain rapid devascularization with a straightforward technique and minimum use of contrast medium and fluids in general.
Polimicrogiria perisilviana bilaterale
Authors: Piraccini A. , Passarelli D. , Ricciardelli P.
Published: April 2015

Bilateral perisylvian polymicrogyria is among the cortical abnormalities caused by late neuronal migration due to both genetic and environmental factors. It is associated with variable changes in motor development and facio-pharyngoglosso-masticatory diplegia with varying language disorders. Epilepsy is more common in lesions extending posteriorly. We describe two cases of non-familial bilteral perisylvian polymicrogyria with different clinical features but sharing signs of severe neonatal encephalopathy mimicking an anoxic-ischaemic lesion. MR studies were done at nine and 20 months in the first patient and at two weeks and three months in the second.
La displasia cerebrovascolare nella NF1: Specificità dell'età evolutiva
Authors: Pastorino M. , Tusacciu G. , Deriu E. , Conti M. , Achene A. , Tondi M. , Serra G.
Published: April 2015

We describe a 12-year-old boy with a diagnosis of familial NF1. Brain MR scan performed for right pyramidal hemiparesis disclosed a vascular dysplasia causing stenosis of the intracranial portion of the right internal carotid artery and compensatory cortical vascular congestion. This abnormality was not encountered in the other two family members affected. We discuss the pathogenesis of the hemiparesis as being ipsilateral to the vascular dysplasia and emphasize the different clinical expressions of NF1 within the same family. Given the rarity of cerebrovascular dysplasia in childhood NF1, we suggest specific study protocols be adopted to identify the true incidence of this abnormality. Brain MR scanning should be included in the diagnostic protocol of NF1 and NF1 entertained among the causes of stroke in childhood.
PEV e BAEP in bambini affetti da Neurofibromatosi
Authors: Grasso A. Coppolaro , De Rinaldis M. , Matricardi M. , Brinciotti M.
Published: April 2015

Visual evoked potentials (VEP) and brain stem acoustic evoked potentials (BAEP) were studied in 19 children with neurofibromatosis (13 males and six females aged from seven months to 17 years; average age 6.3 years) comparing them with those of a control group of 43 healthy children (25 males and 18 females). The patients had an increased average VEP latency (III wave = p < .01559; IV wave = p < .00001) and I-V interpeak of BAEP (right I-V interpeak = p < .04083; left I-V interpeak ? p < .00852). Impaired responses were relatively common in both VEP (40%) and BAEP (35%), with a moderate but not constant relation to neuroradiological findings. Altered potentials were also present in patients without structural abnormalities. Evoked potentials serve as a sensitive test for early diagnosis of neurofibromatosis.
L'impiego dei Potenziali Evocati nella Sclerosi Tuberosa
Authors: Brinciotti M.
Published: April 2015

Evoked potentials (EP) allow the assessment of the functional integrity and degree of maturation of the main pathways of sensory afference (visual, acoustic and somaesthetic). For this reason, EP can be used in the study of patients with tuberous sclerosis. In clinical practice, EP serve to give information for early diagnosis and a better prognostic assessment of the individual patient. A recent analysis of visual evoked potentials (VEP) and brain stem acoustic evoked potentiials (BAEP) in children with tuberous sclerosis disclosed an increased average latency of some components of both VEP (component IV or P2) and BAEP (V wave and I-V interpeak). Impaired responses were present in 80% of VEP and 85% of BAEP. In addition, impaired BAEP were also present in patients without subtentorial structural abnormalities. EP serve as a useful instrument for early diagnosis of tuberous sclerosis. Given the anatomofunctional differences of the systems stimulated and the preferential location of lesions in certain areas, the various different EP have varying degrees of sensitivity in disclosing abnormalities: visual and brain stem acoustic EP are more sensitive than somatosensory EP.
Imaging of Brain Perivascular Spaces
Authors: Osborn Anne G. , Weller Roy O. , Salzman Karen L. , Hewlett Richard
Published: April 2015

While they tend to cluster normally around the anterior commissure, prominent PVSs can be seen normally in virtually any location in the brain, at virtually all ages. Giant “tumefactive” PVSs can assume a spectrum of bizarre appearances and should not be mistaken for neoplasm. The pial-lined, interstial fluid-filled PVSs provide a natural route of spread for a spectrum of infectious, inflammatory, demyelinating and neoplastic diseases to involve the brain parenchyma.
Feasibility of a Diffusion Sequence to Investigate the Spinal Cord
Authors: Cavalleri F. , Oppenheim C. , Dormont D. , Lalam T. , Sahel M. , Marsault C.
Published: April 2015

Diffusion weighted imaging (DWI) may represent a valuable tool in the early diagnosis of spinal cord diseases. The purpose of this paper was to test the feasibility of a single shot fast spin echo (SSFSE) DWI in normal and abnormal spinal cord, and to evaluate its use in routine clinical imaging. We used a SSFSE sensitive to diffusion (b = 600 s/mm2) with multi-slice or single slice technique to study normal (32 cases) or abnormal (39 cases) spinal cords. Apparent diffusion coefficient (ADC) maps were calculated. Single slice sequences were significantly more reliable than multi-slice sequences for measurement of ADC. In normal subjects, mean ADC values were remarkably similar at both cervical and thoracic levels. Increased ADC values were detected in patients with cord trauma, myelitis, dural malformation, glioma, syringomyelia or metastasis, whereas decreased ADC values were detected in a patient with cervical intraspinal metastasis. This is the first report of the feasibility of a single slice SSFSE diffusion sequence for routine spinal cord imaging. The measurement of ADC may be of diagnostic value for the insight it offers on the pathophysiology of parenchymal damage.
Visualization of Central Nervous System Nerve Communications Using Diffusion Tensor Imaging
Authors: Mori H. , Masutani Y. , Abe O. , Aoki S. , Hayashi N. , Masumoto T. , Yoshikawa T. , Yamada H. , Ohtomo K.
Published: April 2015

Diffusion tensor imaging (DTI) is a magnetic resonance (MR) technique used to analyze diffusion anisotropy of the central nervous system (CNS) and can demonstrate subtle white matter anatomy. In particular, tractography is expected to be a unique, non-invasive tool to provide more pertinent insights into brain structure and orientation not accessible with conventional MRI. Data collection was performed in a normal volunteer on a 1.5-T MRI system using several techniques including six axis single-shot echo planar imaging (EPI), over six axis EPI, and periodically rotated overlapping parallel lines with enhanced reconstruction techniques. Tractography was generated by a continuous tracking method with our original software, Volume-One (for viewing volumetric image data) and VizDT-II (for analysis of DTI data). Using these data, estimated tracts were generated in arcuate fibers of cerebrum, cingulum, superior longitudinal fasciculus, uncinate fasciculus, inferior longitudinal fasciculus, corpus callosum, fornix, anterior thalamic radiation, central thalamic radiation, thalamo-parietal fibers, optic radiation, superior cerebellar peduncle, middle cerebellar peduncle, inferior cerebellar peduncle and intrinsic commissure paths of the hipoccampous. DTI including tractography allows differentiation between complex white matter tracts. The information regarding the detailed relationship may be useful for diagnosis of the location and extent of brain lesions, and preoperative planning.
Pachymeningitis and Epilepsy in Rheumatoid Arthritis, MRI Findings
Authors: Öztürk A. , Öztürk E. , Şafak A.A.
Published: April 2015

Rheumatoid arthritis is a systemic disease in which cerebral involvement and epilepsy association are rare. Here, we describe a 37-year-old woman with a three-year history of rheumatoid arthritis presenting with headache and convulsive attack. The patient complained of severe headache and two generalized convulsions during the previous week. Laboratory data revealed positive RA test. MRI disclosed rheumatoid pachymeningitis. After oral diphenylhydatoin, methylprednisolone administration her headache subsided. In a two-year follow-up no additional convulsion attacks occurred. Hypertrophy of the dura disappeared. It is difficult to diagnose pachymeningitis when patients manifest only headache or convulsions. We suggest carrying out MRI in these cases.
CT Angiographic Demonstration of Agenesis of the Internal Carotid Artery with Transsellar Cavernous Collateral and PCA Aneurysm
Authors: Bodhey N.K. , Gupta A.K. , Varma D.R. , Sonwalkar H.A. , Purkayastha S.
Published: April 2015

We report an unusual case of complete agenesis of the right internal carotid artery (ICA) with transsellar anastomosis from the cavernous segment of the contralateral ICA and presence of a posterior cerebral artery aneurysm and aberrant origin of the right subclavian artery.
Split Cord Types I and II in a Female Patient with Clinical Onset in Adulthood and Further Remission of Symptoms
Authors: Pero G. , Chiaramonte I. , Papa R. , Quattrocchi S. , Messina G.
Published: April 2015

Split cord malformations (SCMs) constitute a relatively uncommon type of occult spinal dysraphism, characterized by the presence of a septum within the spinal canal, dividing the spinal cord into two separate hemicords. The septum can be bony, with the hemicords retained within two separate dural sacs (SCM type I), or fibro-cartilaginous, with the presence of one dural sac containing both hemicords (SCM type II). Its clinical findings are much more common in childhood than in adulthood, and vary according to the age of the patient at onset. This is a case of a 46 year old woman who underwent Harrington rod spinal fusion at the age of 12 for thoracolumbar left-convex scoliosis. She did not have of any neurological disturbance until the age of 46, when she started to complain of low back pain together with weakness of lower limbs and bladder dysfunction. The neuroradiological findings were consistent with split cord malformation of both types (I and II). The patient was discharged because of partial remission of motor weakness and cessation of urinary symptoms, with an indication for periodical clinical follow-up.
Neuroradiological Assessment of Referrals for MR Brain Scan: Our Experience
Authors: Leonardi M. , Maffei M. , Battaglia S. , Barbara C. , Cenni P. , Trocino C.
Published: April 2015

The growing demand for brain MR scans in recent years has led to long waiting lists and indiscriminate referral with respect to the clinical need for imaging and appropriateness criteria for MR scanning. To overcome this problem, the Bologna Public Health Service in conjunction with S. Orsola-Malpighi Hospital devised an experimental project instituting a radiological assessment prior to booking MR scans, implemented on 1st November 2003. The assessment is carried out by doctors in the Radiology and neuroradiology units to establish whether referral for MR scan is appropriate and to draw up a priority scale for access to MR diagnosis. If MR investigation is deemed inappropriate, the project provides for an alternative procedure or specialist clinical examination. The patient is admitted to the charge of the service and followed throughout the diagnostic work-up, i.e. the doctor undertaking the assessment will prescribe a possible specialist clinical consultation or other radiological procedures, generally CT scans performed by the same Radiology or Neuroradiology unit. We report on neuroradiological assessment of referrals for brain MR scans on behalf of the Public Health Service and carried out at the Neuroradiology Unit in Bellaria Hospital, Bologna. From 1st November to 31st July 2004, 2659 assessments were undertaken. Of these 2163 were approved for MR scanning whereas 496 referrals were modified, mostly into CT scans and some patients were referred for otorhinolaringology, endocrinology or neurology specialist consultation. To assess the impact of this “filter”, we compared a sample period of six months from 1st February 2003 to 31st July 2003 before the radiological assessment project had been implemented with a period of the same length the following year. We found that the number of negative MR scans was halved after the project had been implemented (from 24.49% in 2003 to 12.18% in 2004), showing that in addition to shortening waiting lists for MR scans, there has been a sharp rise in the number of appropriate scans.
Chordoid Meningioma Mimicking Tuberculoma
Authors: Purkayastha S. , Gupta A.K. , Varma D.R. , Radhakrishnan V.V.
Published: April 2015

Meningiomas are common extra-axial brain tumors presenting a bewildering variety of histopathological patterns. The rare subtypes seldom demonstrate the imaging features classically described for meningiomas. Here we present the imaging features of rare histological varieties of meningiomas.
Emergency Endovascular Treatment of a Penetrating Vertebral Artery Injury with Detachable Coils
Authors: Akan H. , Atalay K. , Belet Ü. , Özmen Z. , Gelmez S.
Published: April 2015

The surgical approach is difficult and time-consuming in cases of injury to the bony canal segment of the vertebral artery. Diagnosis and treatment should be performed urgently if the patient has active bleeding. We present a patient with a left vertebral artery injury in a stab wound to the neck in whom emergency endovascular treatment was performed with detachable coils because of ongoing gross bleeding.
Posterior Fossa Tuberculous Abscess Mimicking as Mass Lesions. MRI Features
Authors: Bodhey N.K. , Purkayastha S. , Gupta A.K.
Published: April 2015

With rising incidences of immunosuppression including HIV infection and various other factors, a resurgence of tuberculosis has been observed. We herewith describe two cases of posterior fossa tuberculomas with presentation mimicking mass lesions. Tuberculomas in the brain are not uncommon in the developing countries. Although they can mimic neoplastic lesions, the early diagnosis of tuberculous lesion with MRI and MR spectroscopy results in prompt institution of antituberculous therapy. Hypointensity in T2-weighted sequence with ring enhancement and the presence of a prominent lipid-lactate peak on MR spectroscopy is highly suggestive of the tuberculous nature of the lesion.
Persistent Falcine Venous Sinus in Two Patients with Atretic Parietal Cephaloceles. An MRI and MRV Evaluation
Authors: Tsitouridis I. , Goutsaridou F. , Tsitouridis K. , Chondromatidou S. , Emmanouilidou M. , Papapostolou P. , Tarazi L.
Published: April 2015

We report two patients with persistent falcine vein associated with atretic parietal cephaloceles. Two children, aged two and eight months, were admitted to our department for MRI examination of the brain because of palpable parietal subscalp lesions. MRI study of the brain and MR-venography revealed a falcine sinus joining the superior sagittal sinus in a vertical position. The straight sinus was absent in its normal position. The parietal subscalp lesions were cyst-like formations under the skin associated with a small calvarial defect. The lesions were assumed to be atretic cephaloceles.
Functional Anatomy in Relation to Myelin Maturation
Authors: Montanaro D. , Martin-Fiori E. , Canapicchi R.
Published: April 2015

Neural organization of cerebral activity in adult and child can be investigated by means of MRI with fMRI and DTI: MRI with fMRI analyses cortical haemodynamic responses correlated to neuronal activity, whereas DTI describes the spatial orientations of the white matter fibres. The fMRI patterns of cortical activity in children more than eight years old overlap the anatomical localization in adults except for the frontal and posterior parietal cortical areas, where BOLD responses in children are often difficult to arouse. This confirms what is currently known: myelin maturation is complete in these areas only in young adulthood. In neonates and young children, depending on the higher cortical cell concentration than adults and the increase in synaptic density up to the age of four-eight years, signal changes detected by BOLD may vary drastically. BOLD signal amplitude may be lower than that found in adults due to the reduced dynamic range during haemodynamic responses, or negative due to the local increase in HbR not fully compensated by the rise in CBF. The administration of sedatives or anaesthesia in children to perform MR scans can influence the BOLD signal: signal amplitude could decrease dramatically and the activated areas could be smaller in extension, indicating a fundamental role of the level of consciousness. BOLD signal analysis can supply useful data on the maturation processes of myelin and the cerebral cortex.
Paediatric Cerebrovascular Disease: Neuroradiological Diagnosis
Authors: Polonara G. , Bove J. , Regnicolo L. , Herber N. , Cesaroni E. , Zamponi N.
Published: April 2015

The low incidence (2.6 cases in 100,000) of cerebrovascular disease in paediatric patients compared with the adult population makes it a diagnostic challenge. Etiological factors have changed over time: whereas in the past bacterial meningitis was the most frequent cause, heart disease, haematological disorders, vasculopathy and viral infections have now become the most common. Haemorrhagic stroke is most frequently due to arteriovenous malformations (AVMs), cavernous angioma, haematological disorders and intracranial aneurysms. Traumatic or fibrodyplastic arterial thrombosis is extremely rare. Venous thrombosis most commonly affects the upper sagittal sinus. In two thirds of cases the cause of stroke remains unknown. For years, symptoms of acute CNS deficits have been studied with computed tomography (CT), especially to rule out haemorrhage. To avoid exposing paediatric patients to ionizing radiation, magnetic resonance imaging (MRI), more sensitive and specific for the identification of acute ischaemic stroke, is currently the first-line diagnostic technique. In particular, diffusion-weighted sequences are capable of early identification of ischaemic areas. Association with perfusion techniques will define the areas at high risk of further damage and to attempt to estimate the final volume of the lesion. MR spectroscopy contributes to the characterization of ischaemic lesions. MR angiography (MRA) has proved to be a noninvasive technique with the same diagnostic effectiveness as conventional angiography for dissections, transient cerebral arteriopathy and moyamoya. The cervical arteries are studied using contrast-enhanced sequences. Conventional angiography remains the technique of choice for the study of small vessels disease and AVMs.
Some Radiosurgery Trials of Glomus Jugulare Tumours
Authors: Valentino V. , Benassi M. , Strigari L.
Published: April 2015

Between 1986 and 2001 radiosurgery was used to treat six glomus jugulare tumours, three of which histologically unverified, in patients aged from 31 to 71 years. One of the unverified tumours showed evidence of hormonal activity. All patients had to undergo repeat radiosurgery at varying times because of tumour re-growth or clinical deterioration. Neurological and neuroradiological follow-up periods ranged from three to 19 years, with an average of 8.3 years. Total target dose averaged 75.5 Gy from a minimum of 36 to a maximum of 117 Gy over targets not exceeding 25 mm in diameter. Technical handling was adjusted each time according to the clinical and neuroradiological results obtained. In accordance with the principle on which this technique is based, the stereotactic system of fixation must be non-invasive and at the same time should be as accurate as the classic Leksell (or other similar) systems. Radiosurgery results were highly positive in all six patients with no complications or side effects being noted in any of them. In keeping with findings reported in the literature, radiosurgery appears to be an attractive neurosurgical application also in cases of glomus jugulare tumours and can certainly be indicated not only for complementary post-surgical treatment but also as an alternative to neurosurgery itself.
Delayed Frontal Lobe Malignancy in a Child Treated for Medulloblastoma
Authors: Bodhey N.K. , Gupta A.K.
Published: April 2015

A high grade astrocytoma developing following radiotherapy for a medulloblastoma is reported in a six-year-old girl. The latency period was unusually short. The stigmata of Von Recklinghausen's disease in this patient suggest a genetic propensity, though radiation for the primary tumor is considered a more likely predisposing factor in addition to the increased likelihood of development of second malignant tumor in survivors of childhood cancer.
Effects of Glubran Acrylic Glue on the Subarachnoid Surface in Swine
Authors: Barbara C. , Pozzati E. , Marucci G. , Joechler M. , Pisoni L. , Bellei E. , Leonardi M. , Masetti L.
Published: April 2015

Glubran2 is a cyanoacrylate-based synthetic glue modified by addition of a second monomer. Among its many advantages over traditional cyanoacrylate products, Glubran2 has a much lower thermal polymerization temperature than that of cyanoacrylates used for cutaneous application. For many years, the new glue has been widely used in neuroradiology endovascular treatments. Our study aimed to assess the use of Glubran2 to treat possible complications arising during the embolization of aneurysms or vascular malformations like AVM or fistulae. A complication encountered in some of these cases is rupture of the vessel wall by the microguide or perforation of the aneurysmal sac by the coils used for embolization. This complication could be overcome by injecting Glubran2 into the rupture point but this would put the glue directly in contact with the subarachnoid space and possibly reach adjacent brain tissue. The aim of this experimental study was to place the glue in direct contact with brain tissue to ascertain its immediate compatibility and tolerability in vivo and any ensuing tissue damage. Three swine underwent neurosurgical procedures and survived for different times after which they were slaughtered and their brains explanted and sent for macroscopic and microscopic investigation by the Pathological Anatomy Service. As a whole, Glubran2 was well tolerated in vivo and did not cause major damage in direct contact with brain tissue.
Cerebral Amebiasis: MRI, DWI, Perfusion and MRS Features
Authors: Celik H. , Karaosmanoglu D.A. , Gultekin S. , Tokgoz N. , Tali T.E.
Published: April 2015

Entamoeba histolytica brain abscess is a rare clinical entity. Here we present a case with magnetic resonance imaging, diffusion weighted imaging (DWI), magnetic resonance perfusion imaging and magnetic resonance spectroscopy (MRS) findings of a patient with pathologically proven E. Histolytica brain abscess. To our knowledge, these findings have not been described before in a patient with E. Histolytica brain abscess. MRI examination revealed multiple mass lesions with vasogenic edema and prominent contrast enhancement located at both gray and white matter of the right temporal, left parietooccipital, and bilateral frontal regions. T2-weighted images demonstrated hypointense foci within the lesions thought to be consistent with hemorrhage. Despite the large size and the radiologically aggressive appearance of the lesions, the gyral configuration seems to be relatively well preserved. DWI study revealed increased diffusion particularly in the central portion of the lesions. Perfusion imaging of the lesions demonstrated decreased perfusion compared with normal brain parenchyma. MRS examination of the left frontal lesion showed decreased N-acetylaspartate (NAA)/choline (Cho) ratio, and increased Cho/creatine (Cr) ratio at the peripheral thick enhancing rim. A resonance peak for Cho (3.2 ppm), lipid (1.2 ppm), and negative lactate (1.3 ppm) was detected at the central non-enhancing part of the frontal mass lesion. Nearly all patients with amebic intracranial abscess reported in the medical literature died despite aggressive medical and surgical treatment. It is likely that intense pharmacologic treatment or early neurosurgical intervention in single lesions may be life-saving in these patients and late diagnosis may be a contributory factor in the high mortality rate. Although it is not at the top of the differential diagnosis list, we think that amebic encephalitis must be entertained in a patient with ancillary radiological and clinical findings.
Magnetic Resonance Imaging of the Human Spine and Spinal Cord at 3 Tesla
Authors: Riccioli L. Albini , Marliani A.F. , Ghedin P. , Clementi V. , Agati R. , Cevolani D. , Leonardi M.
Published: April 2015

Investigation of the spinal cord with a high field strength MR system is hampered by the inhomogeneous magnetic field, physiological movements and the small size of the anatomical area. We describe normal and pathological neuroradiological findings and the parameters of optimized sequences for use with the new 3T MR systems. Thanks to its high spatial resolution, temporal resolution and signal/noise ratio, use of a 3 Tesla MR device (Signa EXCITE 3T) and a dedicated phased array coil has dramatically improved spine and spinal cord imaging, clearly displaying the anatomic details most difficult to examine. The longer T1 longitudinal tissue relaxation time with 3T MR systems is proportional to the strength of the external magnetic field B0. Tissue contrast between white matter, grey matter, CSF and bone tissue is not optimal with traditional spin echo and/or fast spin echo sequences. Hence they are often replaced by T1 Flair acquisitions (Fast Spin Echo–IR with average inversion times of 800–1000ms) which yield T1 weighted images with satisfactory contrast. Unlike images produced by systems using a lower magnetic field strength, 3T MR T2 sequences are highly diagnostic, disclosing the finest anatomical details.
Spiral CT and Image Post-Processing in Patients with Elongated Styloid Processes and Eagle's Syndrome
Authors: Stafa A. , De Benedittis P. , Muzzi C. , Ruoti E.M. , Stasi G.
Published: April 2015

Spiral CT with multiplanar image reconstruction and other forms of 3D image post-processing is a valid instrument for morphological studies. Lesion morphology is strictly related to the pathological expression and clinical pattern of many abnormal conditions. Eagle's Syndrome is a typical example and a full morphological study may offer the right information to confirm the diagnosis. We discuss the possibilities of spiral CT and image post-processing in evaluating the morphology of the styloid processes and other osteoligamentous adjacent structures to complete the diagnosis of Eagle's Syndrome and plan possible surgical treatment.
Stent Treatment of Arterial Dissection
Authors: Berkefeld J.
Published: April 2015

Dissections of cerebral arteries are most often treated in a conservative manner with the use of antithrombotic drugs. This is justified by the relatively benign cause of the disease after the initial event. However, there are some exceptions from this rule: Stent treatment of stenotic dissections should be considered in patients who are hemodynamically compromised or recurrently symptomatic. Dissecting pseudoaneurysms must be treated after subarachnoid hemorrhage or in traumatic cases. Parent vessel occlusion is still the best option in this condition. Coiling with soft coils or stenting + coiling may be an alternative in cases without sufficient collaterals or in unruptured dissecting aneurysms.
Fetal Magnetic Resonance Imaging in Holoprosencephaly, Agenesis of Corpus Callosum and Chiari II Malformation
Authors: Resta M. , Burdi N. , Donatelli M. , Resta M.
Published: April 2015

We describe our experience based on 177 fetal MRI examinations performed in the last ten years, focusing on fetal brain anatomy and fetal brain anomalies, namely oloprosencephaly, agenesis of corpus callosum and Chiari II malformation. Magnetic resonance imaging (MRI) has been proposed as an alternative technique when an expert sonologist requires an in-depth morphological approach. However, there were few literature reports in the 1980s and early 1990s because of both the invasive technique of fetal curarization and later the technical difficulties of MRI “breath holding” sequences. Interest in fetal MRI increased in the late 1990s and many papers appeared after the introduction of MRI ultrafast sequences. Ultrasonography remains the first choice for investigation in pregnancy and technological progress in this diagnostic area with overall 3D ultrasound imaging has led to more accurate indications for fetal MRI in cerebral malformations. The main contribution of fetal MRI imaging is a clear “educational” demonstration of classic malformative patterns of the major pathologies, thanks to spectacular images. We conclude that fetal MRI examination is impressive but substantially unnecessary in the three malformative pathologies considered and in all major malformations. Current use of fetal brain MRI should be reserved for more subtle malformations like neuronal migration disorders, ventriculomegaly of the early second trimester of pregnancy and similar conditions where ultrasound is still ineffective.
Diffuse ‘Double Cortex’ Involving All Lobes of Brain
Authors: Purkayastha S. , Gupta A.K. , Kapilamoorthy T.R. , Devasia B.
Published: April 2015

‘Double cortex’ is characterized by the presence of a well-defined and well-marginated layer of neurons that lie in the white matter in a location in which their migration to the cerebral cortex has been prematurely arrested. Here, we report a case where band heterotopia was seen in all the lobes of brain.
Joubert Syndrome Associated with Total Corpus Callosum Agenesis
Authors: Asil T. , Utku U. , Unlu E. , Balci K.
Published: April 2015

Joubert syndrome was first described in 1969. It is a rare inherited disorder demonstrating one of the developmental defects of the cerebellar vermis. The main clinical signs of the syndome include developmental delay, hypotonia, ataxia, abnormal ocular movements and abnormal respiratory pattern of alternating episodic tachypnea-hyperpnea and apnea. Radiological findings comprise a midline cerebellar cleft in place of the vermis and a characteristic shape of the fourth ventricule. Associated supratentorial abnormalities such as callosal dysgenesis have been infrequently reported in patients with Joubert syndrome This report describes the clinical and neuroradiological findings of a rare patient presenting Joubert syndrome associated with total corpus callosum agenesis.
Solid Variant of Aneurysmal Bone Cyst in the Sacrum: Imaging Findings: Case Report
Authors: Mavili E. , Durak A.C. , Tucer B. , Kontaş O.
Published: April 2015

Little is known about the imaging findings of solid variant of aneurysmal cyst which is a rare entity. We found reports of 13 cases located in the spine but none of these lesions were located in the sacrum. Here we describe the plain x-ray, CT and MRI findings and one year follow-up of a solid variant of aneurysmal bone cyst located in the sacrum.
Maternal Seropositivity for Cytomegalovirus with Severe Foetal Hydrops: Foetal Analysis Focusing on Cerebral Changes
Authors: Salmaso R. , de Santis M. , Franco R. , Paternoster D.M. , Carollo C. , Suma V. , Righini A. , Manara R.
Published: April 2015

Congenital cytomegalovirus (CMV) infection may give rise to severe foetal damage: 40–50% of infants born to mothers with primary CMV infection become congenitally infected and of these 5–18% are symptomatic with a 30% mortality rate. Around 80% of surviving infants present central nervous system sequelae such as microcephaly, microgyria, impaired neuronal migration, retarded growth, visual impairment and deafness 1. Foetal infection may result from material primary infection, recurrent infection or reactivation of a latent infection. The earlier transmission of CMV to the foetus occurs in pregnancy, the worse the prognosis, and primary infection always gives rise to more severe damage than secondary infection 2. A 29-year-old woman, para 0, presented at the 21st week of pregnancy with positive CMV IgG and IgM antibody titres disclosed at the 11th week of gestation, indicating viral reactivation. In addition, CMV-DNA had been detected in the amniotic fluid at the 20th week showing foetal infection. Ultrasound disclosed severe foetal hydrops and the patient had an MR scan. After termination of pregnancy and autopsy on the foetus, all tissues were examined histologically. After fixation in a formaldehyde-acetic acid mixture, the brain was scanned again by MR and then sectioned along the coronal plane for histological analysis. Microscopic virus-induced cytopathic changes were evident in many organs. In addition the brain showed features of delayed neuronal migration due to underdevelopment of the gyri and a thicker germinal matrix than in brains of the same gestational age, changes in migration lines already noted in the nuclear MR scan, and a cortex with few neuronal cells. CMV infection, demonstrated by typical viral inclusions, is seldom encountered, especially in forms with multiorgan viral inclusions. Brain NMR proved particularly useful in identifying the findings not disclosed by routine ultrasound during pregnancy and subsequently confirmed at histology. A multidisciplinary approach comprising clinical, radiological and pathological skills is essential for the purposes of diagnosis and genetic analysis.
Intracranial Changes Secondary to Prolonged Phenytoin Therapy and Chronic Intracranial Hypotension
Authors: Bodhey N.K. , Purkayastha S. , Gupta A.K. , Somasundaram S.
Published: April 2015

We herewith describe the imaging features in a patient with intracranial hypotension secondary to shunting in hydrocephalus that was secondary to basal meningitis. In our patient the neonatal meningitis resulted in multiple parenchymal infarcts, hydrocephalus and intractable seizures. Hydrocephalus was managed by ventricular shunt and he was put on anticonvulsant therapy.
Endovascular Treatment of Intracranial Aneurysms: Long-Term Follow-up
Authors: Gupta A.K. , Sonwalkar H.A. , Purkayastha S. , Krishnamoorthy T. , Bodhey N.K. , Kapilamoorthy T.R. , Kesavadas C. , Thomas B.
Published: April 2015

Endovascular treatment of intracranial aneurysms is increasingly used and has evolved as an alternative to surgical clipping. However, its long-term efficacy has yet to be established. This retrospective hospital based (tertiary teaching hospital) study aimed to identify factors that might be important in predicting initial efficacy of this treatment and a long-term follow-up to study the clinical and angiographic results of treated aneurysms. A total of 80 aneurysms in 78 patients were treated and analyzed, and the percentage of occlusion calculated. Overall, 51/80 (64 %) cases were treated with selective endovascular coil occlusion and 29/80 (36 %) by parent artery occlusion. The shape of the aneurysm rest was noted on the immediate post treatment and follow-up angiograms. Immediate and follow-up clinical status was also noted using the Glasgow outcome scale. The clinical and radiological changes on follow-up were assessed and possible factors involved were analyzed. Of the 50 patients of intracranial aneurysms that underwent selective aneurysm coiling, good immediate outcome (Glasgow outcome scale 1 and 2) was seen in 36/50 (72 %) cases. Narrow necked aneurysms showed a good immediate result (90–100 % packing) in all cases 28/28 (100 %). Amongst the wide necked aneurysms, good packing (90–100 %) was achieved in 17/23 (73 %) cases. Amongst the cases treated with parent artery occlusion, complete occlusion was noted in 20/29 (69 %) cases. No subarachnoid hemorrhage was seen in any of the followed up cases of coiled aneurysms. A statistically significant relationship was noted between aneurysm neck size and immediate angiographic outcome. Long-term angiographic recurrences were found more often in large aneurysms. Endovascular treatment of intracranial aneurysms is a safe and effective treatment modality that offers protection from recurrent subarachnoid hemorrhage.
Endovascular Angioplasty-Stenting as a Definitive Treatment for Isolated Spontaneous Common Carotid Artery Dissection
Authors: Kervancioglu S. , Sirikci A. , Yigiter R. , Cakir Y. , Bayram M. Metin
Published: April 2015

Isolated spontaneous common carotid artery (CCA) dissection is rare. So far, surgical or medical treatment have only been reported in a few cases in the literature. We report a 39-year-old man, diagnosed as isolated spontaneous CCA dissection one year ago, who experienced a new minor stroke despite medical treatment. Because of the presence of new ischemic lesions on new magnetic resonance imaging despite medical treatment, and critical narrowing of internal carotid artery (ICA) orifice with jet and turbulence flow pattern at the bulbar portion of the ICA, endovascular management was performed with carotid stent deployment. To the best of our knowledge, this is the first case of spontaneous isolated CCA dissection treated with stenting of the carotid artery reported in literature.
MRI Evaluation of Diastematomyelia and Associated Abnormalities
Authors: Emmanouilidou M. , Chondromatidou S. , Goutsaridou F. , Papapostolou P. , Bintoudi A. , Siouggaris N. , Sidiropoulos D. , Economou I. , Tsitouridis I.
Published: April 2015

Fourteen children were studied with a 1Tesla scanner to assess the role of magnetic resonance (MR) imaging in the recognition and evaluation of diastematomyelia and associated abnormalities. With MRI divided spinal cord was well imaged in its entire craniocaudal extent. Fibrous bands or bony septum when it contained a marrow cavity, were also well depicted. Direct visualization of the spinal cord itself is probably the most rewarding feature of MR imaging compared with other more conventional techniques. MR imaging demonstrated associated syringohy-dromyelia, segmentation anomalies, scoliosis, low position of the conus medularis and intradural lipoma that they were not detected with other radiologic studies.
Dementia: What is it All About?
Authors: Almeida O.P.
Published: April 2015

Dementia is an increasingly frequent clinical syndrome that is characterised by deficits in multiple cognitive domains, changes in behaviour and functional deterioration. Alzheimer's disease, together with vascular dementia, account for 2/3 of all cases of dementia. Other less frequent causes of dementia include dementia with Lewy bodies and frontotemporal dementia. This paper reviews the clinical, pathophysiological and neuroimaging aspects of these four prevalent causes of dementia.
Pathogenesis, Natural History, and Treatment of Unruptured Intracranial Aneurysms
Authors: Wiebers David O. , Piepgras David G. , Meyer Fredric B. , Kallmes David F. , Meissner Irene , Atkinson John L. D. , Link Michael J. , Brown Robert D.
Published: April 2015

Unruptured intracranial aneurysms (UIAs) are a major public health issue. These lesions have become increasingly recognized in recent years with the advent of advanced cerebral imaging techniques. Epidemiological evidence from multiple sources suggests that most intracranial aneurysms do not rupture. Therefore, it is desirable to identify which UIAs are at greatest risk of rupture when considering which to repair. It is important to compare size-, site-, and group-specific natural history rates with size-, site-, and age-specific morbidity and mortality associated with UIA repair because increased natural history risk often is associated with increased risk of aneurysm repair. Patient age is crucial in decision making because of its major effect on operative morbidity and mortality; however, it does not substantially affect natural history. The effect of age is most notable in patients about 50 years of age and older for open surgery and about 70 years of age and older for endovascular procedures. In general, rupture risk is lowest for patients in asymptomatic group 1 (no history of subarachnoid hemorrhage) with UIAs less than 7 mm in diameter in the anterior circulation. Surgical morbidity and mortality are most favorable for asymptomatic patients younger than 50 years who have UIAs less than 24 mm in diameter in the anterior circulation and no history of ischemic cerebrovascular disease. Endovascular morbidity and mortality may be less age dependent, and this could favor endovascular procedures, particularly in patients aged 50 to 70 years. An important issue is determining immediate vs long-term risk regarding treatment effectiveness and durability. This issue emphasizes the importance of long-term follow-up in patients after surgical and endovascular procedures.
Central Nervous System Venous Thrombosis: The Role of CT & MRI. A Review
Authors: Chong W.K.W. , TerBrugge K.G.B.
Published: April 2015

The clinical presentation of central nervous system venous thrombosis (CNSVT) is variable and non specific. Advances in CT and MRI technology have redefined the role of these 2 modalities in assessing suspected CNSVT. T1, T2, FLAIR and DWI/ADC (diffusion weighted imaging/apparent diffusion coefficient) MRI (magnetic resonance imaging) sequences together with a gadolinium enhanced MRV (magnetic resonance venography) would the imaging of first choice in suspected venous thrombosis of the central nervous system. Where there are still problems with identifying the thrombus and this is crucial to the management, a CTV (computed tomographic venography) should be performed. Catheter angiography would be used as a last resort or associated with direct thrombolysis. There may be circumstances where CT may be used as the first choice. There may be contraindication to MRI such as pacemakers, aneurysms clips etc.
Early Brain Spect in Patients after Minor Craniocerebral Trauma
Authors: Marks W. , Lasek J. , Witkowski Z. , Lass P. , Deja W. , Białko M. , Stasiak M.
Published: April 2015

A prospective study made 57 measurements of cerebral blood flow (CBF) by Single Photon Emission Computed Tomography (SPECT) in post-traumatic patients. The aim of the investigation was to evaluate CBF in patients after minor craniocerebral trauma (mCCT) to ascertain the clinicotopographic correlation of the CBF changes, and to study SPECT in comparison with computed tomography (CT) findings. In addition, evaluation of the usefulness of SPECT for forensic medicine, assessment of secondary brain injury by SPECT and the predictive value of hypofrontalism were performed. A direct correlation was shown between mCCT and the observed CBF disorders, and between the CBF disorders and clinical symptoms as well as better SPECT sensitivity in comparison with CT. The usefulness of SPECT for forensic medicine purposes was also shown. Secondary brain injuries were disclose and the predictive value of hypofrontalism was confirmed. No correlation between GCS and CBF changes was found.
Isolated Unilateral Cerebellar Hypoplasia
Authors: Gupta P. , Hedgire S. , Kalyanpur T. , SR Jayesh , Madhavram B. , Sekhar N. , Ilayaraja V. , Raja D. , Mehta P. , Cherian M.
Published: April 2015

Isolated cerebellar malformations are relatively rare CNS anomalies, when they do occur they are frequently symptomatic. Some cases of asymptomatic cerebellar malformations have been reported. Unilateral cerebellar hypoplasia is one such entity. We describe a case of unilateral cerebellar hypoplasia presenting with non-specific neurological complaints.
Choroid Plexus Papillary Carcinoma Associated with Hemorrhage
Authors: Guan JT , Liu GR , Guo G. , Geng YQ , Cheng Y. , Li YK , Guo YL
Published: April 2015

Choroid plexus papillary carcinoma is a rare intracranial malignant epithelial tumor. We describe a case of choroid plexus tumor arising in the periventricular parenchyma. A 52-year-old man presented with headache for five months, aggravated by vomiting for three days. Brain computed tomography scan revealed an inhomogeneous density lesion in the right temporoparietal lobe with mild enhancement, and hemorrhage anterior to the lesion. Histological and immunohistochemical findings indicated a choroid plexus papillary carcinoma.
Falx Cerebri Ossification: CT and MRI Evaluation
Authors: Tsitouridis I. , Natsis K. , Goutsaridou F. , Tsitouridis K. , Tarazi L. , Chondromatidou S. , Papapostolou P. , Papastergiou C. , Emmanouilidou M.
Published: April 2015

During the last three years, CT and MRI brain scans of 40 patients revealed falx cerebri partial ossification as an incidental finding. The patients had been admitted for brain CT and MRI for several reasons. In most cases, there was no problem in the differential diagnosis of falx cerebri ossification during interpretation of the cases. In a few cases, the lesion should be distinguished from calcified meningioma, small hematoma in the interhemispheric fissure and in one case there was also meningeal infiltration of breast cancer. In these cases both CT and MRI scans of the brain were evaluated and a definite diagnosis was made.
Carotid Body Paraganglioma. Diagnosis and Treatment by Angiography
Authors: Meli G.A. , Chiaramonte R. , Cavallaro T. , Puglisi C. , Pero G.
Published: April 2015

Paraganglioma is a rare neoplasia of neural crest origin. It most commonly arises in carotid body, jugular bulb, tympanic plexus on the promontory, and along the vagal nerve pathway or anywhere along the paraganglia pathway. This review describes our experience of cervical paraganglioma. Although there is no consensus in the literature on preoperative angiographic embolization, we think angiography is the gold standard in the diagnosis and treatment of paraganglioma. A small paraganglioma probably does not usually require preoperative embolization because the risks may exceed the benefits. But angiography is mandatory in the diagnosis and treatment of large highly vascular paragangliomas. Imaging of the vascular map of the tumor, that is only possible by angiography, will help the neurosurgeon evaluate the real extension of the neoplasia and chose treatment modalities. Embolization is performed to decrease operative bleeding, shorten the surgery timing and avoid cranial nerve deficit. Cemal Umit Isik et al. studied four brothers with familial paragangliomas noting unexplained concomitant thyroid functional disorders in their patients. Because of the pedigree they thought this may have been a coincidence. Our reported case, unrelated to the Turkish family, also had hypothyroidism suggesting that the relation between paraganglioma and thyroid dysfunction may not be merely a coincidence.
Pneumosinus Dilatans Syndrome of the Sphenoid Sinus. A CT Evaluation
Authors: Tsitouridis I. , Bintoudi A. , Diamantopoulou A. , Sidiropoulos D. , Emmanouilidou M.
Published: April 2015

This study discusses the CT findings of pneumosinus dilatans of the sphenoid sinus, highlighting the clinically important CT characteristics. The CT findings of 26 patients with overpneumatization of the sphenoid sinus are presented in correlation with the clinical findings. Twenty-two patients had overpneumatization beyond the boundaries of the body of the sphenoid bone with or without bone remodelling but only two patients reported headaches. Thinning of the bone structures was also present in three patients but only one patient reported headaches. Overpneumatization of the sphenoid sinus with thinning of bunywalls reduced the width of the superior orbital fissure in one patient resulting in a gradual decrease of visual acuity. CT is an accurate method for the evaluation of overpneumatization of the sphenoid sinus due to its high sensitivity in depicting evidence of bone erosion using a bone window as imaging settings.