RESUMEN
OBJECTIVE: To review the clinical features, proposed pathophysiology, and the role of medical imaging in the diagnosis and treatment of idiopathic intracranial hypertension and spontaneous intracranial hypotension. METHODS: The authors conducted a narrative review of the current literature on intracranial hypertension and hypotension syndromes, with a focus on imaging findings and role of neurointerventional radiology as a therapeutic option for these pathologies. RESULTS: Idiopathic intracranial hypertension commonly presents in obese women of childbearing age, being headache and papilledema the main clinical manifestations. Characteristic radiological findings consist of increased cerebrospinal fluid around the optic nerve, partially empty sella turcica and stenosis of the transverse sinuses. Transverse sinus stenting is a treatment alternative that has proven valuable utility in the recent years. Spontaneous intracranial hypotension in most of cases presents with orthostatic headache and has predilection for female population. The typical radiological features in the brain consist of subdural fluid collections, enhancement of the dura, engorgement of the venous structures, pituitary enlargement, and sagging of the brain. In this pathology, a cerebrospinal fluid leak in the spine associated with a defect in the dura, meningeal diverticulum, or a cerebrospinal fluid-venous leak must be actively ruled out. CONCLUSIONS: Neurologic complaints secondary to changes in intracranial pressure exhibit certain clinical features that in combination with fairly specific radiological patterns allow a highly accurate diagnosis. The diverse specialists in neurosciences should be aware of the multiple image modalities in the study of these syndromes as well as the treatment alternatives by neurointerventional radiology.
Asunto(s)
Hipertensión Intracraneal , Hipotensión Intracraneal , Seudotumor Cerebral , Humanos , Femenino , Presión Intracraneal , Hipotensión Intracraneal/diagnóstico por imagen , Hipotensión Intracraneal/terapia , Hipotensión Intracraneal/complicaciones , Seudotumor Cerebral/complicaciones , Síndrome , Neuroimagen , Hipertensión Intracraneal/diagnóstico por imagen , Hipertensión Intracraneal/terapia , Imagen por Resonancia MagnéticaRESUMEN
OBJECTIVE: This pictorial essay will review the magnetic resonance imaging anatomy of the temporal lobes and describe the major pathologic processes of this complex area. CONCLUSIONS: Magnetic resonance imaging is an essential tool in the investigation of a patient with suspected temporal lobe pathology. Various conditions may affect this anatomic region, and, therefore, classification of imaging findings into specific groups may help provide a more focused differential diagnosis.
Asunto(s)
Encefalopatías/diagnóstico , Imagen por Resonancia Magnética , Lóbulo Temporal/anatomía & histología , Lóbulo Temporal/patología , Medios de Contraste , Humanos , Imagenología TridimensionalAsunto(s)
Pérdida Auditiva Sensorineural/patología , Anciano , Neoplasias del Sistema Nervioso Central/patología , Oído Interno/patología , Glioma/patología , Granulomatosis con Poliangitis/patología , Pérdida Auditiva Sensorineural/etiología , Herpes Zóster Ótico/patología , Humanos , Imagen por Resonancia Magnética , Masculino , Meningioma/patología , Persona de Mediana Edad , Neuroma Acústico/patología , Hueso Temporal/patología , Tomografía Computarizada por Rayos XRESUMEN
The lacrimal gland is a bilobed serous gland located in the superolateral aspect of the orbit. Lacrimal system pathologies can be broadly divided into pathologies of the lacrimal gland and those of the nasolacrimal drainage apparatus. These include distinct congenital, infectious, inflammatory, and benign, indeterminate, and malignant neoplastic lesions. Trauma and resultant fractures affecting lacrimal drainage apparatus is not part of this review; only non-traumatic diseases will be discussed. CT is the initial modality of choice because of its ability to delineate lacrimal system anatomy and demonstrate most lacrimal drainage system abnormalities and their extent. It also assesses bony architecture and characterizes any osseous changes. MRI is helpful in further characterizing these lesions and better assessing involvement of the surrounding soft tissue structures. In this pictorial review, we will review the anatomy of the lacrimal system, describe CT/MRI findings of the common and uncommon lacrimal system abnormalities and discuss relevance of imaging with regards to patient management.
Asunto(s)
Neoplasias del Ojo , Enfermedades del Aparato Lagrimal , Aparato Lagrimal , Diagnóstico Diferencial , Neoplasias del Ojo/diagnóstico por imagen , Humanos , Aparato Lagrimal/diagnóstico por imagen , Enfermedades del Aparato Lagrimal/diagnóstico por imagen , Enfermedades del Aparato Lagrimal/patología , Imagen por Resonancia Magnética , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVES: This study aimed to investigate changes in three intrinsic functional connectivity networks (IFCNs; default mode network [DMN], salience network [SN], and task-positive network [TPN]) in individuals who had sustained a mild traumatic brain injury (mTBI). METHODS: Resting-state functional magnetic resonance imaging (rs-fMRI) data were acquired from 27 mTBI patients with persistent postconcussive symptoms, along with 26 age- and sex-matched controls. These individuals were recruited from a Level-1 trauma center, at least 3 months after a traumatic episode. IFCNs were established based on seed-to-voxel, region-of-interest (ROI) to ROI, and independent component analyses (ICA). Subsequently, we analyzed the relationship between functional connectivity and postconcussive symptoms. RESULTS: Seed-to-voxel analysis of rs-fMRI demonstrated decreased functional connectivity in the right lateral parietal lobe, part of the DMN, and increased functional connectivity in the supramarginal gyrus, part of the SN. Our TPN showed both hypo- and hyperconnectivity dependent on seed location. Within network hypoconnectivity was observed in the visual network also using group comparison. Using an ICA, we identified altered network functional connectivity in regions within four IFCNs (sensorimotor, visual, DMN, and dorsal attentional). A significant negative correlation between dorsal attentional network connectivity and behavioral symptoms score was also found. CONCLUSIONS: Our findings indicate that rs-fMRI may be of use clinically in order to assess disrupted functional connectivity among IFCNs in mTBI patients. Improved mTBI diagnostic and prognostic information could be especially relevant for athletes looking to safely return to play, as well for individuals from the general population with persistent postconcussive symptoms months after injury, who hope to resume activity.
Asunto(s)
Conmoción Encefálica , Encéfalo/diagnóstico por imagen , Conmoción Encefálica/diagnóstico por imagen , Mapeo Encefálico , Humanos , Imagen por Resonancia Magnética , Red Nerviosa , Lóbulo ParietalRESUMEN
Changes in the brainstem were demonstrated with MR imaging in a patient with mycosis fungoides. Previous reports of CNS involvement in this rare disease have not had similar findings.
Asunto(s)
Neoplasias del Sistema Nervioso Central/secundario , Micosis Fungoide/patología , Neoplasias Cutáneas/patología , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/etiología , Tronco Encefálico/irrigación sanguínea , Tronco Encefálico/patología , Femenino , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Micosis Fungoide/diagnósticoRESUMEN
We report the initial and follow-up brain findings in a 42-year-old male patient with CNS involvement with African trypansomiasis. Initial MR imaging demonstrated diffuse hyperintensity in the basal ganglia bilaterally as well as involvement of the internal capsule, external capsule, and extreme capsule. Follow-up examination at 1 year revealed decreased signal intensity in the previously affected areas; however, ventricular enlargement indicative of atrophy was readily apparent.
Asunto(s)
Imagen por Resonancia Magnética , Tripanosomiasis Africana/diagnóstico , Adulto , Ganglios Basales/diagnóstico por imagen , Ganglios Basales/patología , Diagnóstico Diferencial , Humanos , Masculino , Seudolinfoma/líquido cefalorraquídeo , Seudolinfoma/diagnóstico , Radiografía , Tripanosomiasis Africana/líquido cefalorraquídeoRESUMEN
Magnetic resonance imaging (MRI) is the imaging modality of choice for the evaluation of the brachial plexus due to its superior soft tissue resolution and multiplanar capabilities. The evaluation of the brachial plexus however represents a diagnostic challenge for the clinician and the radiologist. The imaging assessment of the brachial plexus, in particular, has been traditionally challenging due to the complexity of its anatomy, its distribution in space and due to technical factors. Herein, we describe a modified technique used in our institution for the evaluation of the brachial plexus which led to a substantial decrease in scanning time and to better visualization of all the segments of the brachial plexus from the roots to the branches, in only one or two images, facilitating therefore the understanding of the anatomy and the interpretation of the study. To our knowledge, we are the first group to describe this technique of imaging the brachial plexus. We illustrate the benefit of this modified technique with an example of a patient with a lesion in the proximal branches of the left brachial plexus that was clinically suspected but missed on conventional brachial plexus imaging for six consecutive years. In addition, we review the common and infrequent benign and malignant pathology that can affect the brachial plexus.
Asunto(s)
Plexo Braquial/patología , Imagen por Resonancia Magnética/métodos , HumanosRESUMEN
Progressive multifocal leukoencephalopathy is a neurological infectious disease caused by the John Cunningham polyomavirus (JCV), an opportunistic agent with worldwide distribution. This disease is frequently seen in immunosuppressed patients and rarely associated with systemic lupus erythematosus. In the central nervous system PML demyelinating lesions occur in the supratentorial compartment. The authors describe a rare case of PML secondary to SLE treatment with atypical presentation restricted to the posterior fossa.
Asunto(s)
Leucoencefalopatía Multifocal Progresiva/etiología , Lupus Eritematoso Sistémico/complicaciones , Fosa Craneal Posterior , Humanos , Huésped Inmunocomprometido , Leucoencefalopatía Multifocal Progresiva/diagnóstico , Lupus Eritematoso Sistémico/diagnóstico , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos XAsunto(s)
Imagen por Resonancia Magnética/métodos , Neoplasias Orbitales/diagnóstico por imagen , Neoplasias Orbitales/patología , Tomografía Computarizada por Rayos X/métodos , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/patología , Carcinoma Adenoide Quístico/diagnóstico por imagen , Carcinoma Adenoide Quístico/patología , Neoplasias de la Coroides/patología , Neoplasias de la Coroides/secundario , Femenino , Granulomatosis con Poliangitis/diagnóstico por imagen , Granulomatosis con Poliangitis/patología , Hemangioma/diagnóstico por imagen , Hemangioma/patología , Humanos , Linfoma/diagnóstico por imagen , Linfoma/patología , Masculino , Persona de Mediana Edad , Neoplasias del Nervio Óptico/diagnóstico por imagen , Neoplasias del Nervio Óptico/patología , Neoplasias Orbitales/secundario , Seudotumor Orbitario/diagnóstico por imagen , Seudotumor Orbitario/patologíaRESUMEN
Progressive multifocal leukoencephalopathy is a neurological infectious disease caused by the John Cunningham polyomavirus (JCV), an opportunistic agent with worldwide distribution. This disease is frequently seen in immunosuppresed patients and rarely associated with systemic lupus erythematosus. In the central nervous system PML demyelinating lesions occur in the supratentorial compartment. The authors describe a rare case of PML secondary to SLE treatment with atypical presentation restricted to the posterior fossa.
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Leucoencefalopatía Multifocal Progresiva/etiología , Lupus Eritematoso Sistémico/complicaciones , Fosa Craneal Posterior , Huésped Inmunocomprometido , Leucoencefalopatía Multifocal Progresiva/diagnóstico , Lupus Eritematoso Sistémico/diagnóstico , Imagen por Resonancia Magnética , Tomografía Computarizada por Rayos XRESUMEN
El astrocitoma pilocítico es el tumor cerebral de origen glial más común en la edad pediátrica y su localización más frecuente es en la fosa posterior. Es considerado un glioma circunscrito (grado I de la Organización Mundial de la Salud) que, posterior a su resección quirúrgica completa, puede tener tasas de sobrevida hasta del 94 a diez años. La apariencia imaginológica clásica es descrita como una masa quística con un nódulo mural que realza con el medio de contraste en estudios de resonancia magnética y tomografía computarizada. El caso descrito es infrecuente, pues se presenta como una masa predominantemente sólida de localización frontal con un componente principalmente intraventricular.