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1.
J Neurol Neurosurg Psychiatry ; 93(4): 360-368, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35078916

RESUMO

BACKGROUND: To analyse the clinical characteristics of COVID-19 with acute ischaemic stroke (AIS) and identify factors predicting functional outcome. METHODS: Multicentre retrospective cohort study of COVID-19 patients with AIS who presented to 30 stroke centres in the USA and Canada between 14 March and 30 August 2020. The primary endpoint was poor functional outcome, defined as a modified Rankin Scale (mRS) of 5 or 6 at discharge. Secondary endpoints include favourable outcome (mRS ≤2) and mortality at discharge, ordinal mRS (shift analysis), symptomatic intracranial haemorrhage (sICH) and occurrence of in-hospital complications. RESULTS: A total of 216 COVID-19 patients with AIS were included. 68.1% (147/216) were older than 60 years, while 31.9% (69/216) were younger. Median [IQR] National Institutes of Health Stroke Scale (NIHSS) at presentation was 12.5 (15.8), and 44.2% (87/197) presented with large vessel occlusion (LVO). Approximately 51.3% (98/191) of the patients had poor outcomes with an observed mortality rate of 39.1% (81/207). Age >60 years (aOR: 5.11, 95% CI 2.08 to 12.56, p<0.001), diabetes mellitus (aOR: 2.66, 95% CI 1.16 to 6.09, p=0.021), higher NIHSS at admission (aOR: 1.08, 95% CI 1.02 to 1.14, p=0.006), LVO (aOR: 2.45, 95% CI 1.04 to 5.78, p=0.042), and higher NLR level (aOR: 1.06, 95% CI 1.01 to 1.11, p=0.028) were significantly associated with poor functional outcome. CONCLUSION: There is relationship between COVID-19-associated AIS and severe disability or death. We identified several factors which predict worse outcomes, and these outcomes were more frequent compared to global averages. We found that elevated neutrophil-to-lymphocyte ratio, rather than D-Dimer, predicted both morbidity and mortality.


Assuntos
Isquemia Encefálica , COVID-19 , AVC Isquêmico , Acidente Vascular Cerebral , Isquemia Encefálica/epidemiologia , Isquemia Encefálica/etiologia , Isquemia Encefálica/virologia , COVID-19/complicações , Humanos , AVC Isquêmico/epidemiologia , AVC Isquêmico/etiologia , AVC Isquêmico/virologia , Pessoa de Meia-Idade , Estudos Retrospectivos , SARS-CoV-2 , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/virologia , Trombectomia , Resultado do Tratamento
2.
Radiographics ; 38(4): 1201-1222, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29995620

RESUMO

The ability to localize the three spinal tracts (corticospinal tract, spinothalamic tract, and dorsal [posterior] columns) involved in incomplete spinal cord syndromes at cross-sectional imaging and knowledge of the classic clinical manifestations of the various syndromes enable optimized imaging evaluation and provide clinicians with information that aids in diagnosis and treatment. The requisite knowledge for localizing these tracts is outlined. The authors review the spinal cord anatomy, blood supply, and course of these tracts and describe the various associated syndromes: specifically, dorsal cord, ventral cord, central cord, Brown-Séquard, conus medullaris, and cauda equina syndromes. In addition, they describe the anatomic basis for the clinical manifestation of each syndrome and the relevant imaging features of the classic causes of these entities. Knowledge of the anatomy and clinical findings of the spinal cord is essential for examining and treating patients with cord abnormalities. ©RSNA, 2018.


Assuntos
Doenças da Medula Espinal/diagnóstico por imagem , Medula Espinal/anormalidades , Diagnóstico Diferencial , Humanos , Medula Espinal/anatomia & histologia , Síndrome
7.
Radiol Case Rep ; 15(9): 1683-1688, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32742528

RESUMO

Gliomatosis Cerebri (GC) is a rareand rapidly progressive pattern of growth of diffusely infiltrating gliomas with limited treatment options. Imaging findings are usually nonspecific and can mimic other neurologic disorders, including demyelination, encephalitis, and multicentric/multifocal glioma. In this report, we describe a case of a 53-year-old female who presented with left hemiparesis, global headache, and gait ataxia with imaging features initially thought to represent demyelinating disease. A combination of conventional and advanced imaging findings with brain biopsy was utilized to make the diagnosis of GC. In patients with widespread abnormalities on brain imaging, GC should strongly be considered when cortical expansion, involvement of the septum pellucidum and elevated myoinositol levels are observed and the clinical and laboratory findings are atypical for demyelination or infection. Considering GC in such cases can facilitate early biopsy with prompt diagnosis and avoid delay in appropriate treatment.

8.
Clin Imaging ; 60(1): 95-99, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31865216

RESUMO

Pineal glioblastoma is an exceedingly rare potential etiology for a pineal region mass. The presentation, imaging appearance, and changes in treatment have been documented in a select number of cases since its first description in 1954. Through these cases, changes in treatment have shown to improve outcomes in select patients, some of which have had survival times over two or three years. We present a case of a 39 year old female with biopsy proven pineal glioblastoma who demonstrates improvement on imaging and survival >12 months after treatment with radiation therapy and chemotherapy. Our case and the prior reported cases enable future research into improving treatment, classification, and imaging recognition for this unlikely disease.


Assuntos
Neoplasias Encefálicas/diagnóstico por imagem , Glioblastoma/diagnóstico por imagem , Glândula Pineal/diagnóstico por imagem , Pinealoma/diagnóstico por imagem , Adulto , Biópsia , Neoplasias Encefálicas/patologia , Feminino , Glioblastoma/patologia , Humanos
9.
J Clin Neurosci ; 72: 114-118, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31980274

RESUMO

Fluoroscopic-guided lumbar puncture (LP) is a procedure commonly performed by radiologists, which in some circumstances may be difficult or impossible using a traditional posterior interspinous or interlaminar approach. Alternatives to LP include cervical and cisternal punctures, placement of an Ommaya reservoir, and lumbar laminectomy. More recently, however, there has been a move toward access of the thecal sac through a transforaminal approach in patients with challenging anatomy. This report outlines our approach and experience using transforaminal LP (TFLP) in patients with spinal muscular atrophy (SMA) with a 100% success rate. We discuss its utility in other patients with difficult access and compare TFLP with other techniques to access the intrathecal space.


Assuntos
Laminectomia/métodos , Complicações Pós-Operatórias/epidemiologia , Punção Espinal/métodos , Feminino , Fluoroscopia/métodos , Humanos , Laminectomia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Atrofia Muscular Espinal/diagnóstico por imagem , Atrofia Muscular Espinal/patologia , Atrofia Muscular Espinal/cirurgia , Complicações Pós-Operatórias/etiologia , Punção Espinal/efeitos adversos
10.
Radiol Case Rep ; 14(10): 1188-1192, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31428214

RESUMO

Spontaneous intracranial hypotension (SIH) associated with cerebrospinal fluid leak classically presents with postural headache. It is most commonly caused by the spontaneous dehiscence of a meningeal diverticulum or as a consequence of dural tears. The association between connective tissue disease and SIH is well known. However, the occurrence of SIH associated with systemic lupus erythematosus has rarely been reported. We present a 53 years old female with a history of systemic lupus erythematosus who was diagnosed with SIH. The patient was worked up with Magnetic resonance imaging and Computed tomographic myelography, and successfully treated with a nontargeted epidural blood patch. Furthermore, we review the current literature and focus on the various imaging techniques that can be used in the workup of a cerebrospinal fluid leak.

11.
Am J Case Rep ; 18: 1039-1043, 2017 Sep 28.
Artigo em Inglês | MEDLINE | ID: mdl-28955030

RESUMO

BACKGROUND Gradenigo's syndrome includes the triad of suppurative otitis media, ipsilateral sixth (abducens) cranial nerve palsy and facial pain in the distribution of the fifth (trigeminal) cranial nerve. Gradenigo's syndrome is rare, and the diagnosis is easily overlooked. This case is the first to report Gradenigo's syndrome presenting with meningitis on a background of chronic suppurative otitis media (CSOM) and petrous apicitis (apical petrositis). CASE REPORT A 58-year-old male African American presented with headaches and confusion. Magnetic resonance imaging (MRI) of the head showed petrous apicitis with mastoiditis and abscess formation in the cerebellomedullary cistern (cisterna magna). The case was complicated by the development of palsy of the fourth (trochlear) cranial nerve, fifth (trigeminal) cranial nerve, and sixth (abducens) cranial nerve, with radiological changes indicating infection involving the seventh (facial) cranial nerve, and eighth (vestibulocochlear) cranial nerve. Cerebrospinal fluid (CSF) culture results were positive for Klebsiella pneumoniae, sensitive to ceftriaxone. The patient improved with surgery that included a left mastoidectomy and debridement of the petrous apex, followed by a ten-week course of antibiotics. Follow-up MRI showed resolution of the infection. CONCLUSIONS This report is of an atypical case of Gradenigo's syndrome. It is important to recognize that the classical triad of Gradenigo's syndrome, suppurative otitis media, ipsilateral sixth (abducens) cranial nerve palsy and facial pain in the distribution of the fifth (trigeminal) cranial nerve, may also involve chronic suppurative otitis media (CSOM), which may lead to involvement of other cranial nerves, petrous apicitis (apical petrositis), and bacterial meningitis.


Assuntos
Meningites Bacterianas/complicações , Otite Média Supurativa/complicações , Petrosite/complicações , Doença Crônica , Confusão/etiologia , Doenças dos Nervos Cranianos/etiologia , Cefaleia/etiologia , Humanos , Infecções por Klebsiella/diagnóstico , Klebsiella pneumoniae , Imageamento por Ressonância Magnética , Masculino , Meningites Bacterianas/diagnóstico por imagem , Meningites Bacterianas/microbiologia , Pessoa de Meia-Idade , Otite Média Supurativa/microbiologia , Petrosite/diagnóstico por imagem
12.
Curr Probl Diagn Radiol ; 46(6): 441-451, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28341385

RESUMO

Sinusitis is a common disease. Complications, however, are less common and can be life threatening. Major complications occur from extension of disease into the orbit and intracranial compartment and often require emergent treatment with intravenous (IV) antibiotics or operative intervention. Immunocompromised patients with acute sinusitis are susceptible to atypical infections, such as invasive fungal sinusitis, which is a surgical emergency. Therefore, it is important to accurately and promptly identify potentional complications of acute sinusitis to ensure appropriate treatment and minimize negative outcomes. This article reviews the imaging features of a spectrum of complications associated with acute sinusitis and atypical infections.


Assuntos
Encefalopatias/complicações , Encefalopatias/diagnóstico por imagem , Doenças Orbitárias/complicações , Doenças Orbitárias/diagnóstico por imagem , Sinusite/complicações , Encéfalo/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética/métodos , Órbita/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos
14.
Emerg Radiol ; 15(3): 161-9, 2008 May.
Artigo em Inglês | MEDLINE | ID: mdl-18189150

RESUMO

We attempted to investigate whether computed tomography pulmonary angiography (CTPA) in the expiratory phase can improve contrast enhancement of the pulmonary arteries and mitigate the effect of inspiratory transient attenuation artifact, potentially salvaging nondiagnostic studies. Eighteen patients with indeterminate inspiratory CTPA, despite proper contrast bolus were studied. Patients were rescanned in expiration using the same contrast bolus and scanning parameters. The attenuation of each pulmonary arterial segment, superior and inferior vena cava, and atria and ventricles during the two phases of respiration was measured independently by three radiologists. All pulmonary segments were evaluated for filling defects during the two phases. In addition, the studies were graded for diagnostic quality of enhancement and probable impact on management. A statistically significant increase in pulmonary arterial enhancement was seen during expiration from the pulmonary trunk to the segmental pulmonary arteries (P < 0.001) and for the inferior vena cava, the right atrium, and the ventricle. The incidence of nondiagnostic inspiratory studies ranged from 89 to 100%, depending on the observer. All studies were upgraded to fully acceptable diagnostic quality with follow-up expiratory imaging (P < 0.0001). Expiratory phase imaging was observed to have diagnostic impact in 78 to 88% of cases, with overall good to moderate interobserver agreement. In one case, pulmonary embolism was detected on the expiratory scan, which was not seen on the inspiratory scan. Expiratory imaging for nondiagnostic CTPA improves pulmonary arterial enhancement and improves diagnostic quality of CTPA by eliminating transient attenuation artifact, thus facilitating more accurate diagnosis and providing earlier treatment of pulmonary embolism.


Assuntos
Angiografia/métodos , Meios de Contraste/administração & dosagem , Expiração , Iohexol/administração & dosagem , Artéria Pulmonar/diagnóstico por imagem , Embolia Pulmonar/diagnóstico por imagem , Intensificação de Imagem Radiográfica/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Artefatos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Interpretação de Imagem Radiográfica Assistida por Computador , Estudos Retrospectivos , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Superior/diagnóstico por imagem
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