bluuebunny/crossref_metadata_2025_split huggingface dataset:
Storia naturale degli aneurismi “large-giant”
Authors: Pasqualin A. 
Published: April 2015

The natural history of large (20–25 mm) and giant (> 25 mm) intracranial aneurysms is still undefined. Most frequently giant aneurysms present with haemorrhage (45% of cases) or symptoms of expanding mass lesion (39% of cases), rarely with ischemic deficits (5% of cases) or epilepsy (2% of cases). Endoluminar thrombosis is present in 48% of large and 73% of giant aneurysms (according to the Italian Cooperative Study of 1988) and constitutes a dynamic process, with possible evolution to: a) sudden mass effect, b) progressive enlargement of the aneurysm, or c) complete spontaneous occlusion; moreover, endoluminar thrombosis does not prevent haemorrhage. According to the ISUIA Study (1998), the risk of haemorrhage for intact aneurysms is highest for aneurysms larger than 25 mm, especially if located on the posterior communicating artery or in the posterior circulation. From a more recent and still preliminary analysis of the ISUIA Study, the five-year haemorrhage rate is roughly 40% for giant anterior circulation and 50% for giant posterior circulation aneurysms.
Usefulness of Imaging Fusion for Therapeutic Planning in Skull Base Lesions
Authors: Puglielli E. , Galzio R. , Ricci A. , Splendiani A. , Iannessi F. , Masciocchi C. , Tombolini V. , Gallucci M. 
Published: April 2015

We propose critical considerations on the usefulness of CT, MRI, and fMRI imaging fusion for the treatment of skull base lesions evaluating 41 cases (24 meningiomas: six petroclival, seven clinoidal, four olfactory, two in the foramen magnum, two spheno-petro-clival, one in the planum sphenoidale, one in the posterior pyramid and one in the PCA; five acoustic schwannomas, three epidermoids, two pituitary adenomas, two craniopharingiomas, two posterior fossa aneurysms, one trigeminal schwannoma, one dermoid and one juvenile angiofibroma). Data were collected, fused, integrated and reconstructed by a dedicated Stealth-Station system for Neuronavigation. CT images were acquired on axial non-overlapping slices, 1–3 mm thick; MRI images were obtained with a 1.5 T system, same FOV and thickness. During surgery the Mean Fiducially Error measured at 6 cm depth and anatomical distortion due to CSF loss was evaluated. Neuronavigation was possible in all cases and successfully applied in preoperative planning and during surgical procedures. The Mean Fiducially Error at 6 cm was 1.7 mm. CSF loss during surgery produced modifications on planned anatomy in a mean value of 0.6 mm. In all cases, imaging fusion for pre and intra-operative neuronavigation provided great advantages in the choice of the best approach, placing of bone flap, correct definition of tumour boundaries and meningeal implant, relationship with functional areas, early identification and real-time correction of the surgical route with respect of deep normal or distorted anatomic or pathologic structures and their eventual encasement or involvement by the pathologic primary process. Neuronavigation appeared ideal for skull base meningiomas making surgical manoeuvres safer, more effective and less invasive. In skull base lesions, CSF loss appeared not significant due to the fact that posterior fossa structures are strictly connected to each other and to the bone, thus are poorly affected by surgical deliquoration. We propose the possible extension of imaging fusion technique with the aim of optimizing the target in radiotherapy for intracranial tumours.
Un caso di Neurofibromatosi di tipo 1 “complicata” da processo espansivo cerebellare maligno con aspetti TC/RM atipici
Authors: Tedeschi E. , Cirillo S. , Del Basso De Caro M.L. , Covelli E. M. , Belfiore G. 
Published: April 2015

A 13 year-old boy, previously diagnosed as having Neurofibromatosis Type 1 (NF1) but otherwise healthy, was referred to our Department for headache, vomiting, ataxia and VI-VII left cranial nerve palsy. Emergency head CT scan was performed, immediately followed by contrast-enhanced MR scan with Echo-Planar (EPI) water diffusibility study. A large ovalar mass lesion was evident in the left cerebellar hemisphere, hyperdense on CT, hypointense in T2-weighted images, isointense to grey matter in FLAIR and T1-weighted images, with clear mass effect on the surrounding structures, but only mild peripheral contrast-enhancement in the anterior part of the mass, these features resembling those of a desmoplastic medulloblastoma. However, the EPI Diffusion-weighted images (DWI) and corresponding Apparent Diffusion Coefficient (ADC) maps consistently showed increased water diffusivity, a pattern not compatible with the dense cell-packing typical of medulloblastomas. The pathological analysis of the surgical specimen indeed showed focal neoplastic cell clusters interspersed in a diffusely altered cerebellar cortex. Neoplastic cells exhibited large eosinophilic cytoplasma, hyperchromatic and multinucleolated nuclei, and frequent mitoses, a pattern indicative of anaplastic astrocytoma. The case presented supports the evidence that NF1 is associated with increased risk of developing several different neoplasms, beside the well-known pilocytic astrocytomas of the optic pathway. As these neoplasms may exhibit misleading imaging features at CT or “conventional” MRI study, the assessment of water diffusivity may provide useful data for reaching a correct pre-operative diagnosis, since it reflects the histological architecture of the neoplastic tissue.
Case Report of Congenital Muscular Dystrophy, Frontal Lissencephaly and Temporal Pachygyria
Authors: Doni D. , Cappellini A. , Ferrari E. , Grimaldi M. , Zorloni C. , Paterlini G. , Tagliabue P. 
Published: April 2015

The etiology of isolated lissencephaly is related to genetic defects but a minority of cases is associated with a vascular or an infection insult. We report a case of a preterm infant, small for gestational age (birthweight < 3° centile) associated with microcephaly. The first examination at birth revealed joint deformities such as arthogryposis and neurological abnormalities. Parents were not consanguineous. The brain ultrasound scan raised the possibility of the suspect of lissencephaly and the cerebral MR imaging showed a frontal temporal absence of gyration with a smooth and thin cortex, enlarged subarachnoid spaces and white matter hypomyelination. The muscle biopsy specimen was studied and immunohistochemical method demonstred an abnormal glycosylation of the protein α-dystroglican in some muscle fibers. The chromosomal analysis was normal and we also excluded the classical type I lissencephaly associated with the 17 chromosome. The autopsy confirmed lissencephaly in the frontal and the parietal brain regions and pachygiria in the temporal ones. Moreover macroscopic examination demonstred the muscular atrophy and the severe arthrogryposis. So the patient had a first diagnosis of congenital muscular dystrophy and the brain has still been evaluating to search for the same histochemical pattern seen in the muscle.
Pseudotumor Cerebri dell'età infantile e adolescenziale
Authors: Erbetta A. , Estienne M. , Zibordi F. , Balestrini MR , Chiapparini L. , Ciceri E. , D'Incerti L. , Savoiardo M. 
Published: April 2015

In a retrospective fashion we reviewed the clinical aspects and the neuroradiological findings in 23 young patients (mean age at the onset 9.2 year-old) affected by Pseudotumor Cerebri, examinated at our Institution in the last ten years. The syndrome is characterized by high CSF pressure value without hydrocephalus, expansive lesions or biochemical modifications of the liquor. The aim of this study is to evaluate the importance of the neuroradiological examinations in the diagnosis of Pseudotumor Cerebri.
Empiema subdurale interemisferico in una ragazza di 15 anni
Authors: Catalucci A. , Zugaro L. , Tarquini P. , Di Giammartino D. , Bigossi F. , Lucantoni D. , Gallucci M. 
Published: April 2015

The Intracranial Complications of infection of the paranasal sinuses are uncommon and subdural empyema is rarer still. Roughly half of the cases of subdural empyema are caused by sinusitis and the most common source of infection is the frontal sinuses. MR scan is the method of choice for the diagnosis and monitoring of subdural empyema, allowing prompt institution of appropriate treatment thereby reducing mortality. We describe a 15-year-old girl with interhemispheric subdural empyema caused by fronto-ethmoidal sinusitis. Clinical onset was characterised by high fever, severe headache, nausea, vomiting and diplopia. CT scan showed evidence of a left parafalcial hypodense collection. MR scan, especially after contrast administration, showed the exact extension and location of the interhemispheric subdural empyema, also displaying the associated leptomeningitis and fronto-ethmoidal sinusitis. Prompt medical treatment led to a remission of symptoms and sinus infection with associated leptomeningitis as documented by serial MR monitoring. However, the slow progressive increase in size of the subdural collection was deemed an indication for neurosurgical management (evacuation of the collection by ventricular drainage catheters inserted under stereotaxic control) leading to a complete resolution of the subdural empyema without neurological sequelae.
RM in pediatria
Authors: Sabatini M. , Puglielli E. , D'Emidio F. , Splendiani A. , Arrigoni G. , Gallucci M. , Masciocchi C. 
Published: April 2015

We describe the anaesthesiological protocol and monitoring system for children receiving sedation or general anaesthesia during MR investigation at our hospital. Constant recourse to sedation and analgesia during diagnostic procedures in children makes non-invasive monitoring of vital parameters essential in these patients. The use of short-acting drugs has the advantage of offering effective sedation with an increasingly low incidence of side effects. We report the ten year experience of a single anaesthetist monitoring children undergoing MR scans. Diagnostic quality MR investigation was possible in all cases. The personal experience of a single anaesthetist optimized an effective and safe anaesthesiological protocol.
Pneumorachide cervicale
Authors: D'Emidio F. , Carafa S. , Puglielli E. , Splendiani A. , Masciocchi C. , Gallucci M. 
Published: April 2015

We describe an eight-year-old girl who developed cervical pneumorachis after traumatic injury. The child presented subcutaneous and mediastinal emphysema and subluxation of the large horns of the hyoid bone disclosed by CT scan a few hours after an accidental fall with mandibular impact. The CT scan also showed a left paramedian collection of air in the spinal canal probably caused by a minor tracheal lesion with passage of air in the posterior mediastinum, paravertebral soft tissues and through the nerve sheaths in the extradural spine. The CT picture normalized after ten days. The presence of air in the epidural space of the spinal canal is more commonly associated with epidural abscess, disc degeneration and sometimes lumbar puncture. Some literature reports describe cases of pneumorachis secondary to pelvic trauma.
Follow up Study of Embolized Brain Aneurysms
Authors: Raffi L. , Simonetti L. , Cenni P. , Agati R. , Bacci A. , Leonardi M. 
Published: April 2015

We describe our experience at the Neuroradiology Service, Bellaria Hospital, Bologna, using three-dimensional time-of-flight magnetic resonance angiography (3D TOF MRA) with Maximum Intensity Projection reconstructions without gadolinium administration in 50 asymptomatic patients with saccular cerebral aneurysms following microcoil embolization. 3D TOF MRA follow-up was done one, three and six months and one year after treatment. The first MRA was compared with the angiogram obtained immediately after treatment and served as a reference for subsequent MRA monitoring. Angiographic follow-up was only undertaken in some patients, when a flow signal was present in the coil mesh or neck region or in the aneurysmal sac, and in relation to the degree of occlusion obtained by embolization. Eight out of the 50 patients underwent redo embolization after MRA disclosed recanalization confirmed by angiography. 3D TOF MRA was fast, straightforward and very useful in the short and long-term follow-up of patients after embolisation, proving a first choice method with a good correlation between the reference angiogram and MRA findings. 3D TOF MRA was also valid in the diagnosis of clinically significant findings confirmed by angiography in all cases, thereby selecting patients requiring further diagnostic investigation by angiography and possible redo embolization.
Pharmacological Mechanisms Underlying Oxygen-Ozone Therapy for Herniated Disc
Authors: Simonetti Luigi , Raffi Luisa , Cenni Patrizia , Agati Raffaele , Leonardi Marco 
Published: April 2015

In the light of our present knowledge, pain caused by nerve root compression should be deemed a symptom of multifactorial origin in which the neural and perineural inflammatory reaction and its biohumoral mediators play a major role, flanked by venous stasis due to mass effect on the perineural circulation. Nerve compression appears to play an adjuvant role by generating nerve conduction abnormalities due to fibre demyelination with a direct or indirect anoxic-ischaemic mechanism. As pain is multifactorial, ozone may also have a multifactorial pharmacological effect alleviating disc compression by shrinkage and triggering pro-fibrosing mechanisms in the herniated disc thereby counteracting the inflammatory cascade of biohumoral and cell-mediated components and improving the hypoxic status linked to arterial compression and venous stasis. Lastly, ozone may have a reflex therapy effect (“chemical acupuncture”) breaking the chain of chronic pain stimulating anti-nociceptor analgesic mechanisms.
Hemifacial Spasms and Involuntary Facial Movements. Role of Magnetic Resonance in the Diagnostic Work-up
Authors: Cavallaro T. , Meli G.A. , Chiaramonte R. , Riva G. , Pero G. 
Published: April 2015

Caution is required when dealing with patients presenting hemifacial spasm as the symptom is common to many disorders (tumours, herpes zoster, a frigore paralysis, neurovascular conflict…). Often no reasonable cause of the spasm is found, but treatment must be attempted because hemifacial spasm can be highly debilitating. We describe a case of hemifacial spasm, initially deemed idiopathic, in which MRI demonstrated neurovascular conflict as the cause. It is not always easy to find a clear MRI pattern, but if the scan identifies the tortuousness of the arteries in the vicinity of the VII nerve root exit, it is highly probable that this is the true cause of hemifacial spasm. Even when it is not possible to identify this pattern, neurovascular compression cannot be ruled out. The good results of microvascular decompression in patients without a typical MRI pattern suggest that MRI is specific, but not always sensitive. There is no consensus in the literature on the sensitivity of MRI in the detection of neurovascular compression and values vary widely. It is generally believed that experience and different performance of the MR systems strongly influence the diagnosis of neurovascular conflict.
MRI Findings of Globe and Optic Nerves in Tilted Disk Syndrome
Authors: Orguc S. , Toprak A.B. , Demiray B. , Tarhan S. , Güler C. 
Published: April 2015

We assessed the anatomical variations of the globe and optic nerve in tilted disk (TD) syndrome using magnetic resonance imaging (MRI) findings and compared them with a control group. Eleven patients diagnosed with TD syndrome during eye examination were referred for MRI of the sella and chiasm to exclude intracranial mass lesions. The shape of the globe, the chiasmal angle, the insertion angles of the optic nerve in axial and parasagittal planes determined by lines parallel to the optic nerve and tangent to the globe in TD syndrome were compared with a control group consisting of 53 cases. Gender ratios were 7/4 (F/M) for the TD group and 35/18 for the control group (p>0.05). The insertion angle of the optic disk to the globe was wider in the temporal quadrant (p<0.05) and narrower in the nasal quadrant (p<0.05) in TD syndrome than in the control group. There was no significant difference in the superior and inferior insertion angles between the groups. The anterior-posterior (AP) diameter of the globe was significantly longer in patients with TD (p<0.05). There was no significant difference between the optic chiasm angles. The relationships of the optic disk and the globe were significantly different in patients with TD syndrome in comparison to the control group. TD syndrome is related to the malalignment of optic nerve and globe in the horizontal plane.
Reversible and Asymptomatic Gyral and Subarachnoid Contrast Enhancement after Carotid Stenting
Authors: Vangosa Alessandra Briatico , Tortora Domenico , Modestino Francesco , Cotroneo Antonio R , Caulo Massimo 
Published: April 2015

The presence of sulcal hyperdensity in patients after endovascular procedures is not necessarily attributable to hemorrhage. It may frequently indicate the absolute or concomitant extravasation of contrast material into the subarachnoid spaces. This case report describes the clinical case of an 84-year-old patient with 90% stenosis of the right internal carotid who presented with a diffuse gyral and sulcal hyperdensity in the right temporal-occipital and frontal lobes at routine post-carotid stenting (CAS) brain CT scan. The patient was asymptomatic and CT findings were interpreted as contrast enhancement hyperattenuation and no therapeutic decisions were made. A 24-hour follow-up brain CT demonstrated the complete resolution of the hyperdensity, confirming the diagnosis. In this patient we considered the concomitant presence of gyral and sulcal hyperdensity as the consequence of reversible damage to the blood-brain barrier (BBB) determining a transitory extravasation of contrast material. Asymptomatic gyral and subarachnoid contrast enhancement following CAS is generally indicative of benign and transitory damage to the BBB and is not to be misinterpreted as hemorrhage.
Unusual primary central nervous system lymphoma location involving the fourth ventricle and hypothalamus
Authors: Cellina Michaela , Fetoni Vincenza , Baron Pierluigi , Orsi Marcello , Oliva Giancarlo 
Published: April 2015

A previously healthy 65-year-old man presented with a two-week history of weight loss, headaches, blurred vision, asthenia and quickly worsening walking impairment. He denied photophobia, neck stiffness, fever, nausea or vomiting. Neurological examination showed global motor slowing, tendency to fall asleep during the clinical examination, generalized weakness against resistance to head and limbs, and osteotendon reflexes present in the upper limbs, but not evoked in the lower limbs. No sensitive deficit or focal neurologic sign was recognizable. Non-contrast multislice computed tomography (MSCT) of the head was performed in the emergency department, showing diffuse periventricular white matter and thalamic mild hyperdensity. Lumbar puncture, blood tests, including serology for HIV and other infections, were negative. On the third day the patient, showing decreased consciousness, underwent magnetic resonance imaging (MRI) with contrast medium injection. MRI revealed the presence of multiple pseudonodular avidly enhancing lesions, supra and infratentorial, crossing the midline, involving the ventricular system, including the fourth ventricle, with extension into the surrounding white matter, the corpus callosum, the thalamus and the hypothamalus. A stereotactic biopsy led to a diagnosis of diffuse large B-cell lymphoma, primarily located in the central nervous system (PCNSL). After the completion of the first phase of treatment (immunotherapy with intravenous Rituximab and corticosteroid), the MRI showed a marked regression of tumor masses.
Angiografia ed embolizzazione dei tumori vascolarizzati del rachide
Authors: Perini S. , Maschio A. , Beltramello A. , Faccioli F. , Benati A. 
Published: April 2015

Viene discusso il ruolo dell'angiografia terapeutica per la diagnosi ed il trattamento di lesioni rachidee benigne e maligne. L'embolizzazione è stata effettuata come trattamento prechirurgico, nei tumori benigni, negli emangiomi vertebrali (18), nelle cisti aneurismatiche (2), negli osteoblastomi (2) e negli osteoclastomi (2). Come atto curativo, non seguito dall'interveno, l'embolizzazione è stata usata con successo nel trattamento di una malformazione arterovenosa metamerica complessa (Sindrome di Cobb) caratterizzata da una MAV superficiale, vertebro-epidurale e spinale. Gli autori sottolineano il valore della metodica nella diagnosi e nel trattamento pre-chirurgico di tutte le lesioni benigne ipervascolarizzate, ma in particolare degli emangiomi che comprimano il midollo spinale. Sono stati inoltre trattati due tumori maligni primitivi e nove metastasi. In cinque casi sono stati iniettati agenti antiblastici chimici in associazione alle particelle embolizzanti (Adriamicina 50 mg, 3 casi; Mitomycina C in microcapsule, 2 casi).
Trattamento dei craniofaringiomi cistici mediante tecniche di drenaggio percutaneo TC guidate
Authors: Spaziante R. , Cirillo S. , Elefante R. , Smaltino F. , De Divitiis E. 
Published: April 2015

Un trattamento derivativo rivolto alla eliminazione della componente fluida costituisce un utile provvedimento terapeutico che, nella forme completamente o prevalentemente cistiche (60%) di craniofaringioma, può servire ad ovviare molto rapidamente, anche se in maniera temporanea e palliativa, a gran parte dei problemi causati dal tumore. Il drenaggio intermittente è utile per un controllo temporaneo unito ad eventuali trattamenti intracavitari; la ventricolo-cistostomia è potenzialmente provvista di un effetto autonomo e di più lunga durata.
Fattori di rischio e profilassi
Authors: Dicuonzo F. 
Published: April 2015

La somministrazione di mezzi di contrasto comporta «Fattori di rischio» che possiamo considerare «relativi al paziente» e, quindi, connessi alla sua condizione clinica e «relativi all'esame» e, quindi, dipendenti dalle modalità di somministrazione del mezzo di contrasto e, soprattutto, dal tipo di mezzo di contrasto. Il perfezionamento della ricerca farmacologica negli ultimi quindici anni, soprattutto nel campo dei mezzi di contrasto, ha permesso di attuare una «profilassi» dei cosiddetti «fattori di rischio». Momento fondamentale di tale profilassi è proprio la scelta del m.d.c. I mezzi di contrasto a bassa osmolarità non ionici consentono una minore tossicità ed una maggiore maneggevolezza. Non indicate in assoluto, tali sostanze sono altresì consigliabili nei «pazienti a rischio» e negli «esami a rischio», intendendo per essi anche quelli con ampia dose di mezzo di contrasto.
Mezzi di contrasto paramagnetici
Authors: Lorusso V. , Tirone E. P. 
Published: April 2015

Vengono descritti i parametri che influenzano l'intensità del segnale nella RMN ad immagini. I tempi di rilassamento T1 e T2 e la densità protonica vengono descritti come parametri tissutali e vengono esaminate le possibiltà di influenzare tali parametri mediante ioni, complessi e gas paramagnetici.