RESUMO
The first author is a left-handed, 51-year-old nephrologist who experienced a neurologic event. She underwent neurosurgery complicated by hemorrhage. Postoperatively, she developed persistent vertigo and unilateral tongue pain which persisted for over 5 years. Early neuroimaging revealed expected encephalomalacia but no neuroanatomical basis for her symptoms. A functional neurological disorder was suspected, and she was seen by several psychiatrists and psychotherapists. However, she suspected a neuroanatomical lesion would better explain her unrelenting symptoms. After seeing many neurologists, a neuroanatomical diagnosis was finally made. The theory and practice of medicine mandate that subjective complaint guides the modality and interpretation of objective evidence. The final neurologist knew where on neuroimaging to look because she was guided by the patient's complaints - vertigo and unilateral tongue pain. In this case, detailed scrutiny of neuroimaging by a neurologist, after encephalomalacia and gliosis were fully completed, gave a more accurate neuroanatomical diagnosis and a more realistic prognosis.
Assuntos
Transtorno Conversivo , Médicos , Acidente Vascular Cerebral , Feminino , Humanos , Pessoa de Meia-Idade , Progressão da Doença , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico por imagem , DorRESUMO
ABSTRACT: One in 3 patients with lumbar spinal stenosis undergoing decompressive laminectomy (DL) to alleviate neurogenic claudication do not experience substantial improvement. This prospective cohort study conducted in 193 Veterans aimed to identify key spinal and extraspinal factors that may contribute to a favorable DL outcome. Biopsychosocial factors evaluated pre-DL and 1 year post-DL were hip osteoarthritis, imaging-rated severity of spinal stenosis, scoliosis/kyphosis, leg length discrepancy, comorbidity, fibromyalgia, depression, anxiety, pain coping, social support, pain self-efficacy, sleep, opioid and nonopioid pain medications, smoking, and other substance use. The Brigham Spinal Stenosis (BSS) questionnaire was the main outcome. Brigham Spinal Stenosis scales (symptom severity, physical function [PF], and satisfaction [SAT]) were dichotomized as SAT < 2.42, symptom severity improvement ≥ 0.46, and PF improvement ≥ 0.42, and analyzed using logistic regression. Sixty-two percent improved in 2 of 3 BSS scales (ie, success). Baseline characteristics associated with an increased odds of success were-worse BSS PF (odds ratio [OR] 1.24 [1.08-1.42]), greater self-efficacy for PF (OR 1.30 [1.08-1.58]), lower self-efficacy for pain management (OR 0.80 [0.68-0.94]), less apparent leg length discrepancy (OR 0.71 [0.56-0.91]), greater self-reported alcohol problems (OR 1.53 [1.07-2.18]), greater treatment credibility (OR 1.31 [1.07-1.59]), and moderate or severe magnetic resonance imaging-identified central canal stenosis (OR 3.52 [1.06-11.6]) moderate, OR 5.76 [1.83-18.1] severe). Using opioids was associated with lower odds of significant functional improvement (OR 0.46 [0.23-0.93]). All P < 0.05. Key modifiable factors associated with DL success-self-efficacy, apparent leg length inequality, and opioids-require further investigation and evaluation of the impact of their treatment on DL outcomes.
Assuntos
Estenose Espinal , Veteranos , Descompressão Cirúrgica , Humanos , Laminectomia , Vértebras Lombares/cirurgia , Estudos Prospectivos , Estenose Espinal/complicações , Estenose Espinal/cirurgia , Resultado do TratamentoRESUMO
Dementia is a clinical syndrome with many causes. There often is overlap in the clinical manifestations of various forms of dementia, making them difficult to categorize. Neuroimaging can play an important role in distinguishing one form of dementia from another. Advanced imaging techniques continue to provide greater insight into the underlying pathologic processes in patients who have dementia. Conventional MRI and CT, however, still can contribute useful information when interpreting radiologists are familiar with the patterns of volume loss and signal or density changes that are characteristic of various forms of dementia.
RESUMO
Nasal septal perforation is a rarely reported complication of rhinitis medicamentosa. We describe such a complication in a 54-year-old man, and we discuss the clinical, pathologic, and imaging aspects of this case.
Assuntos
Hipersensibilidade/complicações , Descongestionantes Nasais/efeitos adversos , Septo Nasal/patologia , Doenças Nasais/etiologia , Fístula do Sistema Respiratório/etiologia , Rinite/complicações , Aerossóis , Biópsia , Humanos , Hipersensibilidade/etiologia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Descongestionantes Nasais/administração & dosagem , Mucosa Nasal/patologia , Exame Físico , Rinite/induzido quimicamente , Transtornos Relacionados ao Uso de Substâncias , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Neuroimaging can play an important role in distinguishing one form of dementia from another. Advanced imaging techniques continue to provide greater insight into the underlying pathologic processes in patients who have dementia. Conventional MRI and CT, however, can contribute useful information when interpreting radiologists are familiar with the patterns of volume loss and signal or density changes that are characteristic of various forms of dementia.
Assuntos
Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Demência/diagnóstico , Imageamento por Ressonância Magnética/métodos , Tomografia Computadorizada por Raios X/métodos , Idoso , HumanosRESUMO
Developmental venous anomalies (DVAs) are common variants of cerebral venous drainage that are typically incidental findings on contrast-enhanced MR imaging studies. We present four cases of asymptomatic DVAs that demonstrate increased cerebral blood flow, cerebral blood volume, mean transit time, and time to peak on perfusion MR images. Our study indicates that alterations in perfusion MR imaging parameters can be seen with uncomplicated DVAs and do not necessarily imply a more ominous underlying etiologic factor, such as hypervascular tumor or stroke.
Assuntos
Neoplasias Encefálicas/diagnóstico , Angioma Venoso do Sistema Nervoso Central/diagnóstico , Aumento da Imagem , Processamento de Imagem Assistida por Computador , Angiografia por Ressonância Magnética , Adulto , Velocidade do Fluxo Sanguíneo/fisiologia , Volume Sanguíneo/fisiologia , Núcleo Caudado/irrigação sanguínea , Núcleo Caudado/patologia , Córtex Cerebral/irrigação sanguínea , Córtex Cerebral/patologia , Líquido Cefalorraquidiano/fisiologia , Diagnóstico Diferencial , Dominância Cerebral , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Giant cell angiofibroma (GCA) is a benign pathologic entity that has recently been reported in the literature. Originally described in the orbit, extraorbital sites of disease have also been reported. Herein, we describe the clinical, imaging, and pathologic findings of a case of GCA of the orbit.
Assuntos
Angiofibroma/diagnóstico por imagem , Tumores de Células Gigantes/diagnóstico por imagem , Neoplasias Orbitárias/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Angiofibroma/patologia , Angiofibroma/cirurgia , Biópsia , Descompressão Cirúrgica , Diagnóstico Diferencial , Tumores de Células Gigantes/patologia , Tumores de Células Gigantes/cirurgia , Células Gigantes/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Órbita/diagnóstico por imagem , Órbita/patologia , Órbita/cirurgia , Neoplasias Orbitárias/patologia , Neoplasias Orbitárias/cirurgia , ReoperaçãoRESUMO
Cranial fasciitis is a benign fibroblastic tumor of the skull found almost exclusively in young children. It is histologically identical to nodular fasciitis. We present the clinical, radiologic, and pathologic findings of a 7-month-old male infant with cranial fasciitis of the skull. Herein, we include the first description of this entity's diffusion-weighted imaging appearance. Although rare, cranial fasciitis can mimic more aggressive processes both clinically and radiographically.
Assuntos
Fasciite/diagnóstico , Fasciite/patologia , Diagnóstico Diferencial , Granuloma Eosinófilo/diagnóstico , Granuloma Eosinófilo/patologia , Humanos , Lactente , Imageamento por Ressonância Magnética , Masculino , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVE: To evaluate the efficacy of renal sonography performed in intensive care units on patients with the diagnosis of acute or acute-on-chronic renal failure. METHODS: We reviewed all renal sonograms performed in our institution during 1 year on critically ill patients for evaluation of renal failure. Renal failure was defined as a serum creatinine level greater than 1.5 mg/dL or an increase of greater than 20% from the baseline creatinine level. Exclusion criteria included patient age younger than 18 years and signs or symptoms of obstructive uropathy. Using the electronic medical record, we recorded patient age, sex, blood urea nitrogen level, serum creatinine level, blood urea nitrogen-creatinine ratio, and clinical indication for intensive care unit admission. Sonographic reports were reviewed for the presence or absence of hydronephrosis. The total cost of these examinations was estimated with the use of Medicare reimbursement rates for 2000. RESULTS: One hundred five renal sonographic examinations were performed on 104 patients meeting all inclusion criteria. Only 1 study had positive results for hydronephrosis, which was graded as mild. Incidental findings not immediately affecting patient care and including ascites and simple renal cysts were identified in 91 patients. The estimated total cost of the examinations was $13,350.75. CONCLUSIONS: In critically ill patients with acute renal failure and no physical findings suggesting obstructive uropathy, renal sonography to evaluate for hydronephrosis is probably not indicated. This holds true regardless of patient age, sex, medical or surgical disposition, and blood urea nitrogen-creatinine ratio.