Cortical border-zone infarcts: clinical features, causes and outcome.

OBJECTIVE: To report the clinical features, causes and outcome of cerebral cortical border-zone infarcts BZI (C-BZI). METHODS: The authors prospectively included patients with MRI-confirmed C-BZI among individuals consecutively admitted in Stroke Unit. RESULTS: Forty-five patients presented C-BZI out of 589 with MRI-confirmed cerebral infarcts (7.6%). Particular clinical characteristics existed in C-BZI in comparison with other cerebral infarctions as a whole, including: (1) frequent transient symptoms at onset (27% vs 9%; p<0.001) and low severity score (NIHSS=3.1±3.0 vs 5.2±6.1; p=0.02); (2) early seizures in first 2 weeks (7/45 (15.6%) vs 12/544 (2.2%); p<0.001), even when focusing only on other infarctions involving the cerebral cortex (15.6% vs 4.3%; p<0.01); (3) heterogeneous clinical presentation but specific transcortical aphasia allowing a clinical suspicion of BZI before MRI; and (4) frequently associated internal carotid disease (69%), with subsequent early surgery in 75% of the cases. Following adapted care in stroke unit, C-BZIs' prognosis appeared good (Rankin score ≤2 at D90) for 82% of the patients. CONCLUSION: Some clinical features are overrepresented in such infarctions, including initial transient symptoms preceding the onset of a completed deficit, transcortical aphasia and early seizures. Despite lower initial severity, C-BZIs justify early management in stroke unit, often followed by carotid surgery, leading to an overall good prognosis.

Diffusion-weighted MR imaging sequence in the detection of postoperative recurrent cholesteatoma.

PURPOSE: To prospectively evaluate a fast spin-echo (SE) diffusion-weighted sequence for magnetic resonance (MR) imaging of recurrent cholesteatoma in patients who have undergone middle ear surgery. MATERIALS AND METHODS: The study was approved by the institutional review board, and informed consent was obtained from all patients. Twenty-four patients (10 female and 14 male patients; mean age, 44 years) who had undergone resection of cholesteatoma were referred for MR imaging. MR imaging was performed with a 1.5-T unit by using unenhanced diffusion-weighted fast SE imaging at b factors of 0 and 800 sec/mm(2), unenhanced T2-weighted fast SE imaging, unenhanced T1-weighted SE imaging, and delayed contrast material-enhanced T1-weighted imaging. Two radiologists evaluated the diffusion-weighted fast SE images for the presence of a high-signal-intensity cholesteatoma. Results from MR imaging were compared with reports from second- or third-look surgery. Interobserver agreement was assessed with the kappa statistic. RESULTS: A recurrent cholesteatoma was correctly identified in 13 of 14 patients with diffusion-weighted fast SE images obtained with a b factor of 800 sec/mm(2), for a positive predictive value of 93%. In patients without recurrent cholesteatoma, all diffusion-weighted fast SE MR images obtained with a b factor of 800 sec/mm(2) were correctly interpreted as showing no high signal intensity. Thus, the negative predictive value was 100%. Sensitivity and specificity were 100% (13 of 13 patients) and 91% (10 of 11 patients), respectively. Interobserver agreement was excellent (kappa = 0.92). The smallest recurrent cholesteatoma was 5 mm in diameter, and this was correctly detected with the diffusion-weighted fast SE sequence. CONCLUSION: Diffusion-weighted fast SE imaging enables the depiction of recurrent cholesteatoma in patients who have undergone middle ear surgery.

Follicular adenoma in a juxtathyroidal thyroglossal duct cyst with papillary carcinoma in the adjacent thyroid gland.

This patient presented with a neck mass diagnosed as a papillary thyroid carcinoma by fine-needle aspiration. Preoperative computed tomography revealed a papillary carcinoma within a juxtathyroidal thyroglossal duct cyst. After surgery, the initial diagnosis was papillary thyroid carcinoma. After correlation with the computed tomography, the diagnosis was revised to a papillary thyroid carcinoma plus a follicular adenoma in a juxtathyroidal thyroglossal duct cyst. This case demonstrates the need for close clinical and radiographic correlation in such a complex case.