1,721,012 research outputs found
Spinal cord infarction due to fibrocartilaginous embolization: the role of diffusion weighted imaging and short-tau inversion recovery sequences.
No full textFibrocartilaginous embolization is a rare cause of ischemic myelopathy caused by embolization of intersomatic disk nucleus pulposus into spinal vasculature during Valsalva-like maneuvers. Diagnostic criteria are based on patients clinical history, magnetic resonance evidence of T2-hyperintense spinal cord lesion, and exclusion of other causes of ischemic myelopathy. These criteria do not take into account the development of magnetic resonance techniques able to enhance signal abnormalities within the neighboring intersomatic disc or vertebral body and to early characterize central nervous system lesions according to the presence of cytotoxic edema. We present 2 pediatric cases of progressive paraplegia attributed to fibrocartilaginous embolization in which short-tau inversion recovery and diffusion-weighted imaging sequences played a pivotal role showing the ischemic nature of spinal cord lesions. Due to its specificity, diffusion-weighted imaging should be included in the magnetic resonance criteria of fibrocartilaginous embolization and in standard magnetic resonance analysis when dealing with acute transverse myelopathy. © The Author(s) 2010
Hypophyseal Triplication: Case Report and Embryologic Considerations
Full text linkSUMMARY: Hypophyseal triplication is malformation that has not been described previously. We present a child with midline abnormalities who underwent epignathus excision at birth. Brain MR imaging revealed 2 paired lateral pituitary glands and an oval midline gland, each with an independent stalk, connected to a thickened third ventricle floor. Because malformations represent a failure in embryogenesis, this case may provide interesting clues on the normal development of the hypophysis
Early cortical cytotoxic edema in meningococcal meningitis.
No full textAbstract
Meningococcal disease frequently presents neurologic sequels via vascular, metabolic, or inflammatory processes. Understanding the underlying pathogenic mechanisms may influence both treatment and outcome. We present a 2-year-old child affected by Neisseria meningitidis sepsis, who on the second day from clinical onset manifested recurrent partial motor seizures and focal neurologic signs. An early magnetic resonance angiography of the circle of Willis produced normal results, whereas magnetic resonance imaging of the brain disclosed cortical signal abnormalities consistent with cytotoxic edema, without involvement of the adjacent white matter. Six-month follow-up magnetic resonance imaging of the brain indicated faint cortical atrophy in the same regions, although the neurologic picture had resolved. The literature contains few data on early magnetic resonance parenchymal changes, and their pathogenic mechanism is controversial. Diffusion-weighted images may contribute to an understanding of the mechanisms of such brain damage. (C) 2009 by Elsevier Inc. All rights reserved
Spinal subtraction MRI for diagnosis of epidural leakage in SIH
No full textOBJECTIVE: To explore the efficacy of spinal MRI study with subtraction analysis as a rapid, reliable, and noninvasive procedure to detect epidural CSF collection in spontaneous intracranial hypotension (SIH) syndrome.
METHODS: Seventeen patients (mean age 42 years, age range 17-65 years; 11 female) with SIH diagnosed using the International Classification of Headache Disorders criteria and 13 age-matched control subjects underwent standard sagittal spinal MRI. Postprocessing image analysis with subtraction of T1-weighted from T2-weighted MRI scans was performed and tested for the detection of the CSF leak.
RESULTS: The CSF epidural collection was visible in all patients with SIH and was detected at the dorsal (16 of 17), cervical (13 of 17), lumbar (13 of 17), and sacral (12 of 17) levels. None of the control subjects showed a CSF leak. Diverticula were present in 23% of patients, whereas the actual site of the CSF leak was recognized in only one patient. Eight patients were treated conservatively, whereas 9 patients required an epidural blood patch, performed at a fixed L2-L3 or L3-L4 spinal level, with complete recovery.
CONCLUSIONS: Spinal MRI with dedicated subtraction analysis could represent the first-line diagnostic tool in the management of patients with SIH, thus leaving invasive investigation for selected patients, such those requiring dural surgery
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