1,720,975 research outputs found
Computed assisted radiology (CAR) nello studio della patologia vascolare aneurismatica e malformativa atero-venosa del circolo intracranico: nostra esperienza con QuickTime VR ed OsiriX.
No full textPoster congresso nazionale SIRM. Verona, 11- 15 giugno 2010
HIPPOCAMPAL REVERSIBLE LESIONS IN A CASE OF TRANSIENT GLOBAL AMNESIA
No full textPURPOSE: We present a case of transient global amnesia (TGA) onset in a 52-year-old male with a medical history of migraine.
METHODS: Patient was taken to ER by his colleagues which reported that after an emotional stress he suddenly appeared perplexed and started asking repetitive questions. In ER a neurological examination excluded other neurological signs or symptoms and it was confirmed that cognitive impairment was limited to the amnesia domain; electroencephalography was unremarkable and he had no history of epileptic seizures or head trauma. At the neurologic examination Capland and Hodges criteria were fulfilled and the diagnostic hypothesis of TGA was placed. He underwent to a brain CT (Siemens SOMATOM Definition AS+ 128) and later he underwent to a brain MRI (GE Signa HDxt 1,5T). MRI protocol includes sagittal and axial T2w Fast Recovery Fast Spin Echo (FRFSE), axial and coronal T2w FLuid attenuated Inversion Recovery (FLAIR), axial T1w Fast Spin Echo (FSE), axial T2*w Gradient Echo (GE) and axial Echo-Planar Diffusion Weighted Imaging (EP-DWI, using a b value of 0 and 1000s/mm2). RESULTS: Brain CT and conventional MRI sequences did not show any relevant pathological findings but diffusion weighted imaging (DWI) showed two small areas of restricted diffusion in the right hippocampus. The amnesic syndrome resolved spontaneously within 24h; in a brain MRI follow-up performed two week later those findings were no more appreciable.
CONCLUSION: DWI is very sensitive identifying the typical TGA lesions especially when a high b value (b > 1000s/mm2) is used combined to a thin section thickness (<5mm). Even if the diagnosis of TGA is primarily clinical, MRI can give a positive diagnostic support. The etiology and pathogenesis of this rare neurologic syndrome is still unclear: several factors, such as migraine-related mechanism, focal ischemia, venous flow abnormalities, and epileptic-like phenomena, have been suggested and/or hypothesized. Further studies are needed but it’s plausible that more advanced imaging techniques and will help to better understand the underlying mechanisms
Accuracy of SWI sequences compared to T2*-weighted gradient echo sequences in the detection of cerebral cavernous malformations in the familial form
No full textThe purpose of this study was to assess the accuracy of susceptibility-weighted imaging (SWI), compared with T2*-weighted gradient echo (GRE) imaging in assessing cerebral cavernous malformations
Massiva emorragia intratumorale causa di atipica presentazione clinica di un neurinoma cistico del cui: caratteristiche TC ed RM e analisi morfovolumetrica.
No full textPoster per congresso nazionale AINR. Padova, 19-22 Ottobre 201
“The importance of being external”: review of the literature of the rare phenomenon of common carotid occlusion with bulb reverse-crossed stenosis and external collaterals activation. Is still correct speaking about carotid steal?
No full textCommon carotid artery occlusion (CCAO) is a rare phenomenon associated with the development of neurological symptoms. In CCAO, diversion of blood flow from the external carotid artery (ECA) to the internal carotid artery (ICA) via the carotid bulb (CB) may occur. This pathway activation has been called "carotid steal". Starting from a particular case we describe the ECD finding of a complete occlusion of CCA with patency of ICA and ECA. In case of occlusion of CCA, inversion of the ECA flow may occur, towards the ICA, and it can be damped by a significant stenosis crossed in retrograde direction that may concur to maintain the pressure balance between the two circulations. Usually, this particular compensation can guarantee normal flow velocities in middle cerebral arteries without signs of activation of anterior collateral pathways. In this review we underline the protective role of ECA and we propose a new definition for this phenomenon. The ECA may provide blood to the cerebral circulation through several anastomotic secondary channels. Finally, only with an extensive knowledge of hemodynamic information of all intracranial and extracranial arteries, including ECA, we can estimate cerebral ischemic risk of the patient and choose the correct management of this occlusion
DESCRIZIONE DI UN CASO DI LESIONE REVERSIBILE DELLO SPLENIO DEL CORPO CALLOSO IN PAZIENTE CON MONONUCLEOSI INFETTIVA DA COINFEZIONE EPSTEIN-BARR VIRUS (EBV) E CITOMEGALOVIRUS (CMV)
No full textSCOPO
Presentiamo un caso di encefalite virale con lesione reversibile dello splenio del corpo calloso (SCC) in un ragazzo di 16 anni con mononucleosi infettiva da coinfezione Epstein-Barr Virus (EBV) e Citomegalovirus (CMV).
MATERIALI E METODI
Il paziente, a causa della comparsa improvvisa di stato confusionale, irrigidimento e movimenti involontari alternati a tremori in corso di mononucleosi infettiva, giungeva in PS, dove eseguiva una TC encefalo (Siemens SOMATOM Definition AS+ - 128 strati) in condizioni di base ed in tecnica sequenziale, che non evidenziava reperti significativi. Veniva quindi ricoverato con il sospetto di encefalite virale e, il giorno successivo, veniva sottoposto ad un approfondimento diagnostico mediante RM encefalo con apparecchiatura da 1,5 Tesla (GE Signa HDxt), in tecnica FSE, FLAIR e DWI sui piani assiale, sagittale e coronale prima e dopo mdc e.v.
Si intraprendeva terapia antivirale, cortisonica ed antibiotica. Nelle giornate successive le condizioni generali del paziente miglioravano gradualmente. La comparsa di anticorpi anti virus capsidico di classe IgM (VCA IgM) e la presenza di DNA di CMV (CMV-DNA 250 copie/ml) consentivano di formulare la diagnosi di mononucleosi infettiva da coinfezione EBV-CMV.
Un nuovo controllo RM veniva eseguito a quattro giorni di distanza dal precedente.
RISULTATI
La prima RM encefalo evidenziava la presenza di una lesione ovalariforme a carico dello SCC, modicamente rigonfio, caratterizzata da iperintensità di segnale nelle ponderazioni a lungo TR, da restrizione della diffusività dell’acqua in DWI, in assenza di impregnazione post-contrastografica.
Nella seconda RM encefalo lo SCC non appariva più rigonfio e la lesione precedentemente descritta non era più apprezzabile.
CONCLUSIONI
Il quadro neuroradiologico e clinico-laboratoristico del paziente ci permettono di classificare il nostro caso tra le lesioni reversibili dello SCC. Tali lesioni sono state già descritte in letteratura ma non ci risulta sia mai stato presentato un caso da coinfezione EBV-CMV. Svariate sono infatti le condizioni che possono causare lesioni reversibili dello SCC; le più frequenti sono rappresentate da encefaliti virali, tossicità o rapida sospensione dei farmaci antiepilettici ed encefalopatia ipoglicemica.
L’iperintensità di segnale in DWI, correlata a restrizione della diffusività delle molecole d’acqua nelle mappe ADC, rappresenta il reperto di semeiotica RM più significativo di tali lesioni ed è verosimilmente riconducibile, in accordo con quanto riportato in letteratura, ad una condizione di edema eccitotossico intramielinico da aumento delle concentrazioni di glutammato nello spazio extracellulare, sebbene non possano essere del tutto escluse altre ipotesi etiopatogenetiche
Bolus-test VS bolus-tracking nello studio angio-TC dei vasi epiaortici e del circolo intracranico.
No full textPoster congresso nazionale SIRM. Verona, 11- 15 giugno 2010
The value of serial MR imaging in the assessment of brain metastases volume control during stereotactic radiosurgery
No full textPurpose: To evaluate early tumour control capabilities of Stereotactic Radiosurgery (SRS) in the treatment of brain metastasis and the role of follow-up MR imaging.
Methods and Materials: MR imaging of 54 metastases in 31 patients treated with SRS who underwent follow-up MR imaging within 12 months were retrospectively reviewed. Tumours were characterized as either enlarged (>20% volume increase), stable (follow-up volume ±20% of the initial volume), or decreased (> 0% volume decrease).
Results: Within the first 6 weeks following SRS a decrease was observed in 25 (52%) of the tumours in the extent of 63% in size. Tumour reduction varied according to histopathological subtype with 38% of non-small cell lung carcinomas, 41% of breast carcinomas, 14% renal cell carcinoma and 8% of melanomas. At 9 weeks, 7 out of the 25 lesions had a transient tumour volume increase followed by tumour regression at 12 weeks. At 12 months 19 (37%) of lesions increased in volume in the extent of 41% in size. There was a significant higher tumour reduction in those carcinoma types that are considered as radiation sensitive. The best timing for follow-up imaging is at 6, 9 and 12 weeks to provide clinicians useful information.
Conclusion: Stereotactic radiosurgery provide volume reduction in many brain metastases and it may be used alone or before whole brain radiation therapy to early tumour control. Follow-up MR imaging provide clinicians useful patient information aimed to make treatment decisions
Intratumoral Haemorrhage Causing an Unusual Clinical Presentation of a Vestibular Schwannoma.
Get PDFWe present a case of an elderly woman with no history of audiological disease with sudden onset of visual and hearing deficits associated with systemic clinical signs. On examination she had impairment of right CNs from V to X. CT and MR imaging demonstrated a cystic vestibu- lar schwannoma with a rare intralesional fluid-fluid level correlated to a recent bleed. We include high quality MR images to show the acute impairment of the cranial nerves next to the tumour after acute bleeding. Our case report includes a voxel-based morphometry (VMB) analysis of the tumour that, as far as we know, has never been done before for such a tumour. VBM analysis was performed to calculate the hypothesized volume changes after the acute bleed which likely resulted in a sudden increase in the overall size of the tumour resulting in atypical clinical signs and symptoms due to the establishment of a mechanical conflict with the adjacent cranial nerves
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