Agenesis of the internal carotid artery: a family pathology?

The internal carotid artery agenesis is a rare malformation disorder. We report the case of a 12-year-old boy suffering migraine, who had presented an episode featuring amaurosis fugax, spontaneously regressed. CT angiography images show hypoplasia of the left common carotid artery with loss of opacification of the left internal carotid artery consistent to agenesis. Moreover CT scans through the skull base demonstrate absence of left petrous carotid canal and an hypertrophic left middle cerebral artery originating from an aberrant artery arising from the right cavernous carotid. All diagnostic examinations confirmed the presence of the internal carotid artery agenesis, as Lie's type IV. We started an annual follow up that over the next 7 years did not reveal any change in magnetic resonance angiography images.

Chiari type 1 malformation in Neurofibromatosis type 1: experience of a center and review of the literature.

OBJECTIVE: To evaluate the possible correlation and the true incidence between Neurofibromatosis type 1 and Arnold-Chiari malformation type I. MATERIALS AND METHODS: We reviewed all clinical charts, neurological consultations and MRI scans of 428 NF1 patients followed by 1994 to 2014 in our Department. NF1 patients in our clinic are seen usually every year by both the dermatologist and the neurologist. All patients also undergo a brain and spinal cord with the same 1.5 Tesla MRI scan. RESULTS: We found a diagnosis of Arnold Chiari malformation type I in 9 of the 428 NF1 cases (2%). CONCLUSION: This frequency is higher than that expected on the basis of a chance association. Therefore we underline the importance of serial MRI studies in patients with NF1 to assess the presence of cranio-cervical anomalies. Future studies should try to better understand what are the pathogenetic mechanisms underlying this close association.

Accuracy of transcranial ultrasound in the detection of mild white matter lesions in newborns.

Cranial Ultrasound (cUS) may not be sensitive enough to detect subtle white matter (WM) injuries. Our study compared serial cUS with MRI at term equivalent age (TEA) to determine if it is possible to identify an ultrasound representation of subtle diffuse WM injuries such as punctate lesions (PWMLs) and diffuse excessive high signal intensity (DEHSI). Fifty-six very preterm infants were scanned sequentially from birth to TEA, an MRI was performed at TEA. Each echodensity found on cUS was classified as absent, transient (≤7 days), or prolonged (>7 days). A transient periventricular echodensity was detected in seven infants (12.5%), and a prolonged echodensity in 15 (26.8%). MRI examinations were performed in all 56 infants. No altered signal intensity was found in 18 infants (32.1%). DEHSI was detected in 14 infants (25%), and PWMLs were detected in eight babies (14.3%). Both abnormalities were found in 16 infants (28.6%). The positive predictive values of the prolonged echodensity for DEHSI and PWMLs were 86.7% and 46.7% respectively. However, a significant statistical correspondence (p=0.002, Odds Ratio 11.9) was found comparing DEHSI with cUS abnormal echodensities. Serial cUS during the neonatal period in preterm infants is essential and cannot be replaced with MRI at TEA. MRI seems to be more reliable in detecting mild or moderate WM abnormalities. However, serial cUS performed by an experienced neonatologist can provide valuable information on early WM changes such as prolonged echodensities that could potentially lead to a diffuse injury.

Neurological Soft Signs and Corpus Callosum morphology in schizophrenia.

OBJECTIVE: Neurological Soft Signs (NSS) have been found to be more prevalent in schizophrenic patients. A breakdown in intracortical functional connectivity, including interhemispheric communication, has been suggested in the pathogenesis of schizophrenia. Indeed, problems with interhemispheric information transfer via the Corpus Callosum (CC) have been documented in schizophrenics. Our study goal was to relate NSS to CC morphology. METHODS: CC Magnetic Resonance Imaging (MRI) measurements were collected from 29 right-handed male schizophrenia inpatients. NSS were evaluated employing the Neurological Evaluation Scale (NES). We examined the scores obtained from the NES total and the three NES subscales: Integrative Sensory Function, Motor Coordination, and Sequencing Of Complex Motor Acts. We compared CC morphology of patients with "high" NSS with that of patients with "low" NSS. Correlation analyses were performed to further clarify the relationship between CC size, NSS, and total lifetime antipsychotic consumption. RESULTS: Patients with "high" scores at the Sequencing Of Complex Motor Acts subscale showed a smaller CC rostral body, whereas patients with "high" scores at the Integrative Sensory Function subscale showed a smaller CC splenium. For both the NES total and the Sequencing Of Complex Motor Acts subscale, "high" scores were accompanied by an increase of the CC genu. Correlation analyses revealed a significant inverse correlation between the CC rostral body size and the Sequencing Of Complex Motor Acts subscale score. In addition, a significant positive correlation was shown between the CC genu size and both the NES total and the Sequencing Of Complex Motor Acts subscale scores. The presence of NSS and the accompanying CC structural abnormalities were independent on antipsychotic treatment. CONCLUSIONS: Our data provide evidence for an association between NSS and CC morphology and further support the hypothesis of a disturbed interhemispheric functional connectivity in schizophrenia.

Influence of obstetric complication severity on brain morphology in schizophrenia: an MR study.

INTRODUCTION: The purpose of this study was to determine if a causal relationship exists between obstetric complications (OCs) severity and linear magnetic resonance (MR) measurements of brain atrophy in patients with schizophrenia. MATERIALS AND METHODS: Linear measurements of ventricular enlargement (bifrontal span, Evans ratio, and bicaudate ratio) and hippocampal atrophy (interuncal distance) were completed on MR images obtained in 47 patients with schizophrenia. Regression analysis was used to look at association with OCs severity, assessed by the "Midwife protocol" of Parnas and colleagues. The relationship between MR measurements and phenomenologic variables such as age at onset, illness duration, and exposure to antipsychotic medications was explored. The relationship between MR measurements, OCs severity, and symptom presentation was also investigated. RESULTS: OCs severity was significantly associated with MR measurements of ventricular enlargement (bifrontal span, Evans ratio). As the severity of OCs increased, bifrontal span and Evans ratio increased. This effect was independent of age at onset, illness duration, or even antipsychotic treatment. Interestingly, bifrontal span, Evans ratio, and OCs severity score all showed a significant positive correlation with hallucinatory symptomatology. CONCLUSION: Although confirmatory studies are needed, our findings would support the idea that environmental factors, in this case severe OCs, might partly contribute to ventricular abnormalities in schizophrenia.

[Intervertebral instability]. / Imaging dell'instabilità vertebrale lombare su base degenerativa.

The clinic diagnosis of degenerative lumbar intervertebral instability is a controversial topic and have not yet been clarified clinical criteria for to define this condition with accuracy. Although the lumbar pain is the most common symptom in patients who have lumbar intervertebral instability its clinical presentation is not specific; moreover in patients with lumbar pain there are no agreed signs and symptoms that can be truly attributable to instability. Despite better imaging techniques of testing spinal instability there is not a clear relations between radiologic signs of instability and clinical symptoms. It is, however, still far from unanimous definition of degenerative lumbar intervertebral instability accepted from all specialists involved in diagnosis and treatment of this condition; however, seem there is most agree about suspected vertebral instability. Nevertheless this unresolved topic, it is possible to state that imaging play an increasing role in diagnosis and management of patients with suspected instability. The aim of this study is to investigate the different imaging modalities most indicated in diagnosis if vertebral instability and whether degenerative change can be associated with lower back pain.

[Imaging of acute brain inflammatory disease]. / Imaging della patologia infiammatoria acuta dell'encefalo.

The central nervous system inflammatory disease can be due to any kind of infective agent (bacterial viral, fungal and parasitic), but entails also multiple sclerosis, a primary demyelinating disease in which the causal agent is unknown. MR imaging is, in most often, the procedure of choice, due to her multiplanar and multiparametric imaging, and to her better contrast resolution. The post-contrast imaging with double dose of gadolinium and late sequences enable visualisation of smallest pathologic foci or slightest blood-brain barrier alterations, with a sensibility very higher than post-contrast CT scan. In addition, RM provide to many functional informations, by means of diffusion, perfusion and spectroscopy studies, Bold technique for cortical activation studies and Fiber Tracking technique, in order to demonstrate pathologic modification earlier than they are evident on morphologic imaging. Functional imaging is also employed to monitor response to treatment and damage reversibility.

[Vertebral fractures: radiological diagnosis, differential diagnosis and prognostic implications]. / Fratture vertebrali: diagnosi radiologica, diagnosi differenziale e implicazioni prognostiche.

Vertebral fractures are a relevant problem for the heavy clinical implications and carrying disability. Vertebral fractures can be traumatic or pathologic, the latter can be benign or malignant, both mostly frequent in the elderly. An initial approach to this issue can use plain radiographs, but the correct extension and evaluation must involve CT and MR imaging. In particular MR is a useful tool for the prognostic evaluation of spine marrow injuries and the differential diagnosis of osteoporotic and metastatic fractures.

[Child abuse: imaging of multiorgan damages]. / Il bambino maltrattato: imaging dei danni multiorgano.

An abused child can present with every lesion known to medicine, but some of these lesions can be specific of child abuse. The most frequent skeletal lesions are that of the long bones, of the head and the chest. Head damages are responsible for 80% of the dead in abused child. These kind of lesions are very important because they can produce important neurological deficits. Most frequent are extraxial bleeding and intraparenchimal lesions. Abdominal damages are the second cause of dead in the abused child. They can be asymptomatic and so they can be misdiagnosed. They are not so frequent but if they are present, they are letal. Conventional radiology, CT and MRI are very important in the management of child abuse because they allow to reveal multiorgan damages which, in some instances, can be specific of a child abuse.

Brain abnormalities in schizophrenia. A qualitative comparative study of schizophrenic patients and control individuals assessed by magnetic resonance imaging.

The present study examined, by means of Magnetic Resonance Imaging (MRI), the qualitative brain abnormalities in a group of 58 schizophrenic patients compared to a group of 58 matched control individuals. The possible relationships between these abnormalities and the demographic and clinical features of the participants in the study were also investigated. Schizophrenic patients presented a higher percentage of bland-moderate enlargement of the periencephalic-subarachnoid spaces (p=0.01) and a widespread cerebral atrophy, the latter below the threshold of significance (p=0.06). In the subset of patients with ventricular asymmetry (right larger than left) the age was significantly lower compared to the age of patients without this abnormality (p=0.04). In the subset of patients with cerebellar cisterns enlargement the age as well as the age of onset was higher in comparison to the one of patients without this abnormality (p=0.02; p=0.006). Taking together with previous studies, these findings underline the importance of qualitative assessment of brain morphology in research and clinical evaluation of patients with schizophrenia.

[New CT and MR imaging techniques in non-traumatic neurological emergencies]. / Nuove metodiche di imaging TC e RM per le emergenze neurologiche non traumatiche.

New CT and MR imaging techniques used for non-traumatic neurologic emergencies (represented mostly by ischemic stroke) fulfil the exigency to know quickly and with high accuracy the presence of abnormalities in cerebral perfusion, with the final aim to practise immediately all the treatments needed to prevent the progression of the neurologic damage, by selecting those patients to undergo fibrinolysis, which is useless and not indicated in many occasions. The diagnosis of ischemia is only the first goal reached by these new diagostic tools, while it is nowdays possible and required to stratify the risk factors for the therapy and to accurate select those patients candidates to fibrolnilysis, in order to minimize the risck related to the inadequate treatment choice.

Spinal subarachnoid hematomas: our experience and literature review.

STUDY DESIGN: Spinal subarachnoid hematomas are unusual and difficult to diagnose and the outcome of treatment is influenced by the lesions that frequently accompany them. OBJECTIVES: To clarify the neuroradiological diagnostic aspects of spinal subarachnoid hematoma as well as the results of treatment. BACKGROUND: Only recently has subarachnoid hematoma been clearly distinguished from more common subarachnoid hemorrhage and its characteristics have still not been dealt with in detail. METHODS: A total of 69 cases (3 personal case, 66 published cases) were revised in terms of etiology, diagnostic imaging and the results of both surgical and conservative treatment. RESULTS: The most common causes of spinal subarachnoid hematoma are coagulopathies (either pharmacologically-induced or resulting from systemic diseases) (40.5%), lumbar puncture for diagnostic or anesthesiological purposes (44.9%) and traumatic injuries (15.9%): these factors may be present singly or variously combined. They may be spontaneous (17.3%) or, in rare cases, associated with aortic coarctation or degenerative vascular diseases. Overall mortality is 25.7%. In the 50 cases in whom long-term follow-up was possible, the outcome of treatment, which is almost exclusively always surgical, was good in 93.5% of 31 patients in whom neurological status on admission was satisfactory and in 15.8% of 19 cases with severe neurological deficits. CONCLUSIONS: MRI and CT are not usually diagnostic because they are not able to differentiate between a subarachnoid lesion and a subdural one. However, diagnosis may be possible when these investigations detect the CSF or the contrast medium surrounding the hematoma. Although the risks of producing spinal subarachnoid hematoma as a result of LP are remote, this is, in fact, the primary cause in patients with coagulopathies. The results of treatment depend on the patient's initial neurological condition, the severity of any concomitant pathologies, the position of the hematoma and the eventual association of a subdural hematoma.

[Neuroimaging of Alzheimer disease: current role and future potential]. / Neuroimaging del morbo di Alzheimer: ruolo attuale e potenzialità future.

Alzheimer disease (AD), the most common cause of dementia in the elderly, is a progressive neurodegenerative disorder, associated with deterioration in cognition and behaviour. With the availability of newer drugs for symptoms treatments there is a general agreement to the need of an early diagnosis and an the development of new sensitive tools, to identify and/or monitor early cerebral changes, suggestive for AD. CT and MRI are recommended for routine evaluation, in order to exclude treatable causes of dementia and to exactly evaluate the degree of cerebral atrophy and the presence of parenchymal signal abnormalities. Functional imaging, including PET, SPECT and functional MR techniques, are able to investigate physiological cerebral function, such as blood perfusion, metabolism, activation, molecular composition and water diffusibility, and have the potential to detect subtle pathological changes earlier during course of disease. MRI can provide both an accurate morphological assessment and a functional evaluation. Further investigations are needed to precisely define which will be the role of the different MR techniques. Most likely an exhaustive evaluation of AD will include information obtained by conventional and functional imaging, combined with clinical, laboratory and genetic findings.

[Role of magnetic resonance in shoulder disease]. / Ruolo della risonanza magnetica nella patologia della spalla.

Next to the knee, the shoulder is the most common joint to be referred for MRI. Excellent soft tissue contrast and multiplanar acquisition provide optimal assessment of muscle, tendons, hyaline and fibrous cartilage, joint capsule, fat, bursae and bone marrow. In this article the most common indications for shoulder MRI are reviewed and discussed, but we focused primarily on the rotator cuff syndrome and shoulder instability. Correct diagnosis requires the use of appropriate pulse sequences and imaging planes, proper patient positioning, and a satisfactory surface coil. Moreover, technical improvements continuously augment the ability of MRI to study the shoulder; for example Magnetic Resonance arthrography is superior to the other imaging techniques in evaluation of glenohumeral joint. This interdependence between technical development in MRI and clinical advance in shoulder therapy ensures that MRI will continue to play an important role in the routine management of patients with shoulder disease.

[The role of TC and MRI in the identification, characterization and staging of tumors of the spinal vertebrae]. / Ruolo della TC e della RM nella identificazione, caratterizzazione e stadiazione della patologia neoplastica della colonna vertebrale.

The early detection and characterization of primary and metastatic spinal bone tumors permits early and appropriate surgical or nonsurgical intervention directed toward preserving life and function. The sensitivity and multiplanar capabilities inherent in Magnetic Resonance imaging make it the imaging procedure of choice in detecting and characterizing a spinal bone lesion. Spiral Computed Tomography with multiplanar reconstruction may be a useful supplementary procedure, especially when detailed bony anatomy, particular of the posterior elements, is required for surgical intervention. Plain films play little if any role in modern imaging. The may be used as screening procedures in situations in which MR and CT are not available.

[The role of MRI in the valuation of disorders involving the bone marrow]. / Ruolo della RM nella valutazione delle affezioni coinvolgenti il midollo osseo.

MR is the most accurate imaging technique in bone marrow evaluation since it allows to recognize and distinguish its red and yellow components. MR shows high sensitivity but low specificity. At present, its role in bone marrow diseases evaluation is that of depicting the extent of the disease process and monitoring the effects of treatment.

[Tumors of the nose, paranasal sinuses and facial bones: the role of computerized tomography and MRI in the assessment of the damage]. / Tumori del naso, dei seni paranasali e delle ossa facciali: apporto della tomografia computerizzata e della risonanza magnetica nell'accertamento della estensione della malattia.

The authors examine the use of CT and MR comparatively in tumours of nose, paranasal sinuses and facial bones. Both CT and MR are much more useful to assess the real extent of the pathology than to give specific diagnose. The resolution of the images and the possibility of examining them on many different planes give evident advantage to MR as regards the evaluation of tumors in this region. Nevertheless, CT with bone algoritme gives better details about bone structure.

[Magnetic resonance of the encephalon in 17 patients with ocular Behçet's disease]. / Risonanza magnetica dell'encefalo in 17 pazienti affetti da malattia di Behçet oculare.

Behçet's disease is a chronic relapsing disorder of unknown etiology characterized by oral aphthous ulcerations, uveitis, genital ulcerations and bone lesions. A variety of other signs including polyarthritis, vascular conditions (blood vessel occlusions and aneurysms), epididymitis, gastrointestinal, pulmonary and heart lesions may also occur. Central nervous system (CNS) involvement is reported in 10-49% of cases and it is the first symptom of the disease in 5% of subjects. The neuro-Behçet's syndrome may appear as a brainstem syndrome, meningoencephalitis and an organic confusional syndrome or dementia. Cranial hypertension, mostly related to cerebral venous thrombosis, is also present in neuro-Behçet's disease and its incidence is reported in up to 10% of Behçet's patients. MRI is reportedly the most sensitive neuroradiologic approach to detect the focal lesions related to neuro-Behçet's disease and several single cases or series of Behçet's patients with neurologic signs have been examined with MRI. We used MRI to investigate CNS involvement in Behçet's disease patients with and without previous neurologic signs. MRI was carried out on 17 patients with ocular Behçet's disease without neurologic symptoms to assess the possible subclinical involvement of the CNS. Cerebrospinal fluid spaces were enlarged in 8 patients and 5 patients exhibited cortical atrophy. PD and T2-weighted hypersignal foci were demonstrated in parietal, frontal, subcortical and periventricular white matter in 6 subjects. Neuroradiologic abnormalities were found only in the patients with complete disease and with the disease diagnosed more than 10 years earlier. Even though the pathogenesis of these neuroradiologic abnormalities and their correlation with Behçet's disease remain to be clarified, our study suggests the possibility of subclinical CNS involvement in these patients, which may affect the therapeutic approach and their prognosis.