RESUMO
Transient neuroimaging features indicating primary cortical and secondary subcortical white matter cytotoxic oedema have been described in association with prolonged or intense seizures. We describe the unusual condition of recurrent ictal cortical blindness due to focal occipital status epilepticus, in the context of chronic hepatic failure. There was a close association between the onset and disappearance of clinical, electrophysiological and magnetic resonance imaging abnormalities.
Assuntos
Cegueira Cortical/etiologia , Encefalopatia Hepática/complicações , Falência Hepática/complicações , Estado Epiléptico/complicações , Anticonvulsivantes/uso terapêutico , Cegueira Cortical/tratamento farmacológico , Cegueira Cortical/fisiopatologia , Edema Encefálico/tratamento farmacológico , Edema Encefálico/etiologia , Edema Encefálico/fisiopatologia , Doença Crônica , Eletroencefalografia , Evolução Fatal , Feminino , Encefalopatia Hepática/fisiopatologia , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Recidiva , Estado Epiléptico/tratamento farmacológico , Estado Epiléptico/fisiopatologia , Córtex Visual/efeitos dos fármacos , Córtex Visual/fisiopatologiaRESUMO
BACKGROUND: Thyroid-Associated Orbitopathy (TAO) is an autoimmune disease characterized by orbital inflammation involving both adipose tissue and extra-ocular muscles (EOM). Whereas bilateral and possibly asymmetric orbital involvement is commonly found at radiological work-up, mono-orbital involvement is poorly documented, and ascribed to an initial and/or transient stage of subsequent bilateral TAO. METHODS: From a cohort of two hundred TAO patients, we selected retrospectively fourteen patients with initial clinical unilateral TAO. Five of them were excluded because of clinical bilateralization. RESULTS: The sex ratio was 0.8 (4M, 5F), and mean age 44.6 years (range: 18-63). All patients were euthyroid when the initial magnetic resonance imaging (MRI) was performed. One patient was treated with Levothyroxine, because of subclinical hypothyroidism. Eight patients (six smokers) suffered from Graves' disease, of 1-4 years duration, for which they were treated with antithyroid drugs. A thyroidectomy was performed in two patients. None of the patients ever received radioiodine. Six patients remained euthyroid after stopping of the antithyroid regimen, and two became hypothyroid. Seven patients had active, and two severe TAO. Four of nine patients exhibited bilateralization of TAO on initial MRI. Clinical status ultimately improved or normalized in all. In two patients, MRI performed after 9 years demonstrated partial shrinkage of previously enlarged EOMs, together with fatty involution of involved muscles. CONCLUSIONS: Unilateral TAO is not different and just as severe as bilateral TAO. At initial work-up MRI shows signs of bi-laterality in 45% (4/9), with mild involvement of 1 or 2 extra-ocular muscles. The radiological status of affected muscles does not normalize, even in the very long term.
Assuntos
Oftalmopatia de Graves/patologia , Imageamento por Ressonância Magnética , Doenças Orbitárias/patologia , Tecido Adiposo/patologia , Adolescente , Adulto , Idoso , Antitireóideos/uso terapêutico , Bases de Dados Factuais , Feminino , Seguimentos , Oftalmopatia de Graves/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Músculos Oculomotores/patologia , Doenças Orbitárias/tratamento farmacológico , Recuperação de Função Fisiológica , Adulto JovemRESUMO
Neuroimaging is a sub-specialized field of radiology experiencing major and rapid changes in both the day-to-day clinical practice and the investigative field. In the present review article we summarize which are ongoing debates and challenges, and which are the domains of excellence of Belgian Neuroradiology.
Assuntos
Diagnóstico por Imagem/tendências , Neurologia/tendências , Radiologia/tendências , Bélgica , Humanos , Imageamento Tridimensional/tendências , Imageamento por Ressonância Magnética/tendências , Radiologia Intervencionista/tendências , Tomografia Computadorizada por Raios X/tendênciasRESUMO
We report the magnetic resonance (MR) findings in a male patient presenting with a variant chronic idiopathic demyelinating polyneuropathy (CIDP). He developed a slowly progressive weakness of the right leg associated with sensory dysfunction. Electrophysiologic studies were pathognomonic for a lower limb demyelinating polyneuropathy based on the slowed conduction velocities of the nerves. MRI showed the two major features of the disease: marked asymmetric enlargement of the lumbar plexus nerve roots and strong hypersignal of the enlarged roots on STIR images.