RESUMO
MRI is the cornerstone in the evaluation of brain metastases. The clinical challenges lie in discriminating metastases from mimickers such as infections or primary tumors and in evaluating the response to treatment. The latter sometimes leads to growth, which must be framed as pseudo-progression or radionecrosis, both inflammatory phenomena attributable to treatment, or be considered as recurrence. To meet these needs, imaging techniques are the subject of constant research. However, an exponential growth after radiotherapy must be interpreted with caution, even in the presence of results suspicious of tumor progression by advanced techniques, because it may be due to inflammatory changes. The aim of this paper is to familiarize the reader with inflammatory phenomena of brain metastases treated with radiotherapy and to describe two related radiological signs: "the inflammatory cloud" and "incomplete ring enhancement", in order to adopt a conservative management with close follow-up.
Assuntos
Neoplasias Encefálicas , Lesões por Radiação , Radiologia , Humanos , Radiografia , Neoplasias Encefálicas/diagnóstico por imagem , Tratamento ConservadorRESUMO
PURPOSE: Our aim was to study the association between abnormal findings on chest and brain imaging in patients with coronavirus disease 2019 (COVID-19) and neurologic symptoms. MATERIALS AND METHODS: In this retrospective, international multicenter study, we reviewed the electronic medical records and imaging of hospitalized patients with COVID-19 from March 3, 2020, to June 25, 2020. Our inclusion criteria were patients diagnosed with Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) infection with acute neurologic manifestations and available chest CT and brain imaging. The 5 lobes of the lungs were individually scored on a scale of 0-5 (0 corresponded to no involvement and 5 corresponded to >75% involvement). A CT lung severity score was determined as the sum of lung involvement, ranging from 0 (no involvement) to 25 (maximum involvement). RESULTS: A total of 135 patients met the inclusion criteria with 132 brain CT, 36 brain MR imaging, 7 MRA of the head and neck, and 135 chest CT studies. Compared with 86 (64%) patients without acute abnormal findings on neuroimaging, 49 (36%) patients with these findings had a significantly higher mean CT lung severity score (9.9 versus 5.8, P < .001). These patients were more likely to present with ischemic stroke (40 [82%] versus 11 [13%], P < .0001) and were more likely to have either ground-glass opacities or consolidation (46 [94%] versus 73 [84%], P = .01) in the lungs. A threshold of the CT lung severity score of >8 was found to be 74% sensitive and 65% specific for acute abnormal findings on neuroimaging. The neuroimaging hallmarks of these patients were acute ischemic infarct (28%), intracranial hemorrhage (10%) including microhemorrhages (19%), and leukoencephalopathy with and/or without restricted diffusion (11%). The predominant CT chest findings were peripheral ground-glass opacities with or without consolidation. CONCLUSIONS: The CT lung disease severity score may be predictive of acute abnormalities on neuroimaging in patients with COVID-19 with neurologic manifestations. This can be used as a predictive tool in patient management to improve clinical outcome.
Assuntos
Encéfalo/diagnóstico por imagem , COVID-19/diagnóstico por imagem , COVID-19/patologia , Pulmão/diagnóstico por imagem , Adulto , Idoso , Encéfalo/patologia , COVID-19/complicações , Humanos , Pulmão/patologia , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Neuroimagem , Prevalência , Estudos Retrospectivos , SARS-CoV-2 , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X/métodosRESUMO
Congenital vesicovaginal fistula (CVVF) is a rare, complex female genital malformation that is difficult to diagnose, classify and treat. Symptoms include menouria, cyclical haematuria and urinary incontinence from birth. The aim of this review was to highlight the importance of correct diagnosis and treatment of this congenital anomaly. A comprehensive literature review was conducted to identify articles on CVVF with and without menouria. Forty-one articles were found, of which 31 described 37 original cases of congenital fistula (30 CVVF, six uterovesical fistula and one urethrovaginal fistula): 14 in girls and 23 in adults. The cases were classified according to clinical, diagnostic and therapeutic parameters in order to unify concepts and terms. Menouria occurred in 21 of the 23 adults: 14 cases were CVVF, six cases were congenital uterovesical fistula, and one case was congenital urethrovaginal fistula in a young woman without congenital adrenal hyperplasia. Sixteen (53%) of the 30 patients with CVVF had urinary incontinence or hydrocolpometra, and 14 (47%) had menouria. There were associated anomalies in 91% of cases, 29 (48%) of which involved the urinary tract. Various diagnostic and therapeutic methods were used, and there was confusion surrounding the aetiopathogenesis in most cases. CVVF should be suspected in any girl with urinary incontinence, urinary tract infections from birth, vaginal swelling or hydrocolpometras, as well as in adults with menouria. Diagnosis should be based on physical examination and imaging (cystoscopy during menouria, ultrasound and magnetic resonance imaging). Surgical treatment should be based on correction of the vaginal defects (obstructive problem opening or vaginal reconstruction) and CVVF closure. The embryological origin of CVVF lies in the abnormal persistence of the urogenital sinus due to lack of formation and caudal growth of the urogenital wedge, combined with distinct degrees of agenesis or hypoplasia of the entire urogenital ridge or the mesonephric ducts (which affects development of the Müllerian ducts).
Assuntos
Fístula Vesicovaginal/congênito , Feminino , Humanos , Distúrbios Menstruais/etiologia , Fístula Vesicovaginal/complicações , Fístula Vesicovaginal/diagnóstico , Fístula Vesicovaginal/terapiaRESUMO
BACKGROUND: Multiple sclerosis patients who discontinue using natalizumab are at risk of a rebound in disease activity. However, the optimal alternative therapy is not currently known. AIMS OF THE STUDY: We report on clinical and MRI data and patient safety in a group of relapsing-remitting multiple sclerosis patients who tested seropositive for the JC virus and who have switched from natalizumab to fingolimod because of concerns regarding PML risks. METHODS: The test for JC virus antibodies was performed in 18 relapsing-remitting multiple sclerosis patients who were being treated with natalizumab for more than 1 year. Eight seropositive patients switched to fingolimod while the seronegative patients continued with natalizumab. RESULTS: After switching to fingolimod, five of eight patients (63%) experienced clinical relapses, and MRI activity was detected in six of eight patients (75%). Neither clinical relapses nor MRI activity was observed in the patients who continued with natalizumab. No serious adverse effects were detected. CONCLUSIONS: Natalizumab is an effective treatment for relapsing-remitting multiple sclerosis, but its discontinuation continues to be a complex problem. All of the therapies tried thus far, including fingolimod, have been unable to control the reactivation of the disease. Further studies addressing alternative therapies after natalizumab discontinuation are necessary.
Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Substituição de Medicamentos , Imunossupressores/uso terapêutico , Esclerose Múltipla Recidivante-Remitente/tratamento farmacológico , Propilenoglicóis/uso terapêutico , Esfingosina/análogos & derivados , Adulto , Feminino , Cloridrato de Fingolimode , Humanos , Interferon beta/imunologia , Vírus JC/imunologia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla Recidivante-Remitente/diagnóstico , Natalizumab , Observação , Esfingosina/uso terapêutico , Resultado do Tratamento , Adulto JovemRESUMO
INTRODUCTION: Acute disseminated encephalomyelitis (ADEM) is an inflammatory disease that damages the white matter of the central nervous system. Its clinical course is monophasic and multifocal. The outcome is usually favourable. We report our experience in the management of the hyperacute form of ADEM. PATIENTS AND METHODS: A retrospective chart review was performed on five patients admitted in coma with a diagnosis of ADEM in the Paediatric Intensive Care Unit (PICU). We describe their epidemiological, clinical, microbiological, magnetic resonance imaging features and their treatment and outcomes. RESULTS: The mean age was 5.2 years and all were male. None of them fulfilled radiologic criteria for acute haemorrhagic leukoencephalitis. At admission all patients were in a coma, and all were on controlled mechanical ventilation support. Before their admission all patients had fever. In all cases the time between the first neurological symptom and coma was ≤ 24hours. The cerebrospinal fluid examination was abnormal in three patients, and in one case, oligoclonal bands were detected. The first brain magnetic resonance imaging (MRI) showed white matter and basal ganglia lesions in all patients, and in three cases the spinal medulla was affected by demyelination. All patients were treated with a course of high-dose methylprednisolone. Four patients were also treated with high-dose immunoglobulins, and one of them received plasmapheresis. Two patients died, and one patient had severe sequelae at discharge from the PICU. At discharge the lesions in the white matter were still present in the MRI. After nine months the three survivors had a Glasgow Outcome Scale score of five and no one relapsed. CONCLUSIONS: There is a hyperacute clinical form of ADEM which has a high mortality rate. In the short term, the clinical improvement of hyperacute ADEM is not accompanied by a decrease of severity of the brain MRI.
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Encefalomielite Aguda Disseminada , Criança , Pré-Escolar , Encefalomielite Aguda Disseminada/diagnóstico , Encefalomielite Aguda Disseminada/terapia , Feminino , Humanos , Lactente , Masculino , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
Serous oligocystic or macrocystic adenoma of the pancreas is a very uncommon morphological variant of what was classically termed microcystic adenoma of the pancreas. This is a benign neoplasm; however, its radiological appearance mimicks that of potentially malignant mucinous neoplasms of the pancreas. Therefore, radiologists need to be familiar with this entity to ensure the most appropriate therapeutic management and help to avoid unnecessary surgery.