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BACKGROUND: Performing routine brain magnetic resonance imaging (MRI) is widely accepted as the standard of care for disease monitoring in multiple sclerosis (MS), but the utility of performing routine spinal cord (SC) MRI for this purpose is still debatable. OBJECTIVE: This study aimed to measure the frequency of new isolated cervical spinal cord lesions (CSLs) in people with MS (pwMS) undergoing routine brain and cervical SC-MRI for disease monitoring and determine the factors associated with the development of new CSLs and their prognostic value. METHODS: We retrospectively identified 1576 pwMS who underwent follow-up 3T brain and cervical SC-MRI over a 9-month period. MRI was reviewed for the presence of new brain lesions (BLs) and CSLs. Clinical records were reviewed for interval relapses between sequential scans and subsequent clinical relapse and disability worsening after the follow-up MRI. RESULTS: In 1285 pwMS (median interval: 13-14 months) who were clinically stable with respect to relapses, 73 (5.7%) had new CSLs, of which 49 (3.8%) had concomitant new BLs and 24 (1.9%) had new isolated CSLs only. New asymptomatic CSLs were associated with ⩾ 3 prior relapses (p = 0.04), no disease-modifying therapy (DMT) use (p = 0.048), and ⩾ 3 new BLs (p < 0.001); ⩾ 3 new BLs (OR: 7.11, 95% CI: 4.3-11.7, p < 0.001) remained independently associated with new CSLs on multivariable analysis. Having new asymptomatic CSLs was not independently associated with subsequent relapse or disability worsening after the follow-up MRI (median follow-up time of 26 months). CONCLUSION: Routine brain and cervical SC-MRI detected new isolated CSLs in only < 2% of clinically stable pwMS. Developing new asymptomatic CSLs was associated with concomitant new BLs and did not confer an independent increased risk of relapse or disability worsening. Performing SC-MRI may not be warranted for routine monitoring in most pwMS, and performing only brain MRI may be sufficient to capture the vast majority of clinically silent disease activity.
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Médula Cervical , Esclerosis Múltiple , Enfermedades de la Médula Espinal , Humanos , Esclerosis Múltiple/diagnóstico por imagen , Esclerosis Múltiple/patología , Médula Cervical/diagnóstico por imagen , Médula Cervical/patología , Estudios Retrospectivos , Progresión de la Enfermedad , Médula Espinal/diagnóstico por imagen , Médula Espinal/patología , Imagen por Resonancia Magnética/métodos , Enfermedades de la Médula Espinal/patología , Encéfalo/diagnóstico por imagen , Encéfalo/patología , RecurrenciaRESUMEN
We present 2 rare cases of mixed schwannoma with meningioma. The first case was sporadic, in a 38-year-old female in cervical spine (C2). The second case was a 24-year-old female, associated with NF-2, involving bilateral cerebellopontine angle with extension into the left cavernous sinus, sellar region with erosion of the petrous ridge and multiple intradural extramedullary lesions in the spinal cord suggestive of neurofibromas. To date only 12 cases of such tumors are documented in the literature. To the best of our knowledge this is the first case of sporadic mixed schwannoma with meningioma in cervical spine (C2).
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Neoplasias Meníngeas/patología , Meningioma/patología , Neoplasias Complejas y Mixtas/patología , Neurilemoma/patología , Adulto , Biomarcadores de Tumor/análisis , Neoplasias Encefálicas/metabolismo , Neoplasias Encefálicas/patología , Femenino , Humanos , Inmunohistoquímica , Neoplasias Meníngeas/metabolismo , Meningioma/metabolismo , Neoplasias Complejas y Mixtas/metabolismo , Neurilemoma/metabolismo , Neoplasias de la Médula Espinal/metabolismo , Neoplasias de la Médula Espinal/patología , Adulto JovenRESUMEN
Spontaneous pneumorrhachis, non-traumatic, non-iatrogenic air within the spinal canal, is a very rare occurrence. We report a case of spontaneous pneumorrhachis, multiple air pockets in the epidural space, with vacuum discs and spndylolisthesis. Probably this is the first report of such case.
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Vértebras Lumbares/patología , Neumocéfalo/complicaciones , Sacro/patología , Espondilolistesis/complicaciones , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana EdadRESUMEN
PCNSL (primary central nervous system lymphoma) is a chemosensitive and radiosensitive tumor, and early diagnosis has a significant impact on management. Unlike many other brain tumors, radical surgical excision of PCNSLs is not indicated because these lesions are highly infiltrative and even partial resection leads to a bad prognosis. The goal of this study is to highlight the unusual radiological presentation of PCNSLs and increase the awareness, familiarity, and global database of our observations that pose a challenge on management.
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When surgical decompression of cervical spine is considered, multilevel cervical corpectomy with long strut grafts is the preferred treatment. This procedure is used in a variety of pathologies including degenerative disease, tumors, trauma and infection. Corpectomy with interbody grafting helps in adequate spinal canal and neural decompression compared to multilevel discectomy, which could be difficult as well as inadequate. Fibular/iliac strut grafts are used for reconstruction along with a stabilizing hardware in this procedure. So far, complete imaging spectrum of complications exclusive to strut graft has not been reported in the literature. This pictorial essay presents complications exclusive to the strut graft, utility of advanced imaging in diagnosis and a brief note on the clinical management of complications.
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We describe a case of dural-based homogenously enhancing fungal granuloma in a 29-year-old male who presented with 3 months history of headache. The peculiarity of the case was that there were streaky areas of enhancement around the lesion in the brain parenchyma which resembled tree-in-bud like appearance. The patient underwent surgery and histopathological analysis revealed numerous Aspergillus hyphae. To the best of our knowledge, this is the first case report of a fungal granuloma with atypical parenchymal enhancement pattern.
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We report a rare case of recurrent chordoid glioma in suprasellar region with extension into the third ventricle diagnosed peroperatively. On MRI, a brilliantly contrast enhancing lesion in the suprasellar region extending superiorly into the third ventricle and measuring 2.5 × 3 × 3.5 cm was identified. Patient had a previous history of subtotal removal of the tumor 8 months back and had received 56 Gy of postoperative radiotherapy. On smear preparation the tumor was composed of cells arranged in chords and rows in a myxoid background with sprinkling of lymphocytes. The individual cells were polygonal with moderate amount of faintly eosinophilic cytoplasm with cytoplasmic vacoules in few cells. The nuclei showed fine chromatin with small prominent nucleoli. Paraffin sections confirmed the diagnosis and on immunohistochemistry the tumor cells showed strong positivity for GFAP and focal weak positivity for EMA with low MIB-1 labeling index (<1%). To the best of our knowledge this is the first documented case of chordoid glioma described on crush cytology.
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Neoplasias Encefálicas/patología , Glioma/patología , Recurrencia Local de Neoplasia , Biomarcadores de Tumor/análisis , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/radioterapia , Neoplasias Encefálicas/cirugía , Citodiagnóstico , Glioma/diagnóstico , Glioma/radioterapia , Glioma/cirugía , Humanos , Inmunohistoquímica , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Proteínas del Tejido Nervioso/análisis , Ubiquitina-Proteína Ligasas/análisisRESUMEN
Arachnoiditis ossificans is a rare chronic disorder characterized by the presence of calcification/ ossification of the spinal arachnoid. We describe the computed tomography (CT) and magnetic resonance imaging (MRI) findings of arachnoiditis ossificans as sequelae to trauma in a 30-year-old patient. This imaging diagnosis becomes important to alert the clinician as most of them can be treated by conservative management.
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Intracranial epidermoid cysts are relatively rare congenital inclusion cysts. They are the third most common cerebellopontine angle cistern mass after vestibular schwannoma and meningioma. White epidermoid is a rare variant. We present the first case, to our knowledge, of a white epidermoid cyst anterior to the pontomedullary junction, emphasising its imaging appearance, location and the importance of pre-operative diagnosis, which may reduce operative complications.
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Enfermedades Cerebelosas/diagnóstico , Ángulo Pontocerebeloso/diagnóstico por imagen , Quiste Epidérmico/diagnóstico , Acúfeno/etiología , Adolescente , Enfermedades Cerebelosas/complicaciones , Quiste Epidérmico/complicaciones , Humanos , Masculino , Tomografía Computarizada por Rayos XRESUMEN
We describe a case report where the diagnosis of sporadic Creutzfeldt-Jakob disease(CJD) was suspected by the magnetic resonance imaging (MRI) radiologist in a 75-year-old lady who presented with rapid cognitive decline. MRI revealed cortical T2 and FLAIR(fluid attenuation and inversion recovery) hyperintensities in bilateral fronto-parietal and temporo-occipital locations and showed significant restriction on diffusion-weighted images(DWI). In this case report, we discuss the role of MRI to suspect the diagnosis of CJD in appropriate clinical settings.