Transient reduced diffusion on magnetic resonance imaging due to transneuronal degeneration of the striatum. / Restricción transitoria de la difusión en resonancia magnética debido a degeneración transneuronal del cuerpo estriado.

TITLE: Restricción transitoria de la difusión en resonancia magnética debido a degeneración transneuronal del cuerpo estriado.

Imaging secondary neuronal degeneration.

OBJECTIVE: Distal nerve degeneration refers to the process of disintegration of a neuron or neuronal circuit as a consequence of distal damage. The end result of multiple etiologies, this finding is becoming common due to the increasing number of imaging tests done. This paper aims to define the different types of distal nerve damage, review the anatomy and function of the most commonly affected tracts, and illustrate distal nerve damage through diagrams and representative cases from routine practice. CONCLUSION: Knowing the distant response that can be expected according to the topography of a neuronal lesion is crucial to avoid diagnostic errors. Axonal degeneration and transsynaptic degeneration can be both antegrade and retrograde. Studies of cerebral metabolism, perfusion sequences, and diffusion sequences are showing increasingly earlier changes related to the same process; radiologists need to be aware of these changes.

Carretera perdida: imagen de la degeneración neuronal secundaria / Imaging secondary neuronal degeneration

Objetivo: La degeneración neuronal distal (DND) define el proceso de desintegración de una neurona o un circuito neuronal como consecuencia de una noxa localizada a distancia. Es un hallazgo frecuente debido al creciente número de realización de pruebas de imagen y a que refleja un desenlace común a múltiples etiologías. El objetivo de este artículo es definir los distintos tipos de daño neuronal a distancia, revisar la anatomía y función de los tractos más frecuentemente afectados e ilustrar la DND con esquemas y casos representativos de la práctica habitual. Conclusión: El conocimiento de la respuesta a distancia esperable según la topografía de una lesión neuronal es crucial para evitar errores diagnósticos. La degeneración axonal y transináptica puede ser tanto anterógrada como retrógrada. Los estudios de metabolismo cerebral, las secuencias de perfusión y de difusión muestran cambios cada vez más precoces del mismo proceso con los que debemos estar familiarizados.(AU

Objective: Distal nerve degeneration refers to the process of disintegration of a neuron or neuronal circuit as a consequence of distal damage. The end result of multiple etiologies, this finding is becoming common due to the increasing number of imaging tests done. This paper aims to define the different types of distal nerve damage, review the anatomy and function of the most commonly affected tracts, and illustrate distal nerve damage through diagrams and representative cases from routine practice. Conclusion: Knowing the distant response that can be expected according to the topography of a neuronal lesion is crucial to avoid diagnostic errors. Axonal degeneration and transsynaptic degeneration can be both antegrade and retrograde. Studies of cerebral metabolism, perfusion sequences, and diffusion sequences are showing increasingly earlier changes related to the same process; radiologists need to be aware of these changes.(AU)

Radiological evaluation of the postsurgical middle ear.

OBJECTIVE: The radiological evaluation of the postsurgical middle ear is complex due to the intricate anatomy of this region and the wide variety of procedures and materials used iin middle ear surgery. Knowledge of these factors will enable normal postsurgical changes to be differentiated from complications. This article describes the most common surgical procedures in the middle ear, their indications, and the normal radiological appearance after these procedures. It reviews the most common causes of failure in stapes surgery, in surgery for chronic otitis media, and in surgery for cholesteatoma, suggesting the best imaging method to assess the middle ear in each case. CONCLUSION: Computed tomography enables the evaluation of prostheses and the aeration of the cavities, whereas magnetic resonance imaging makes it possible to characterize the possible occupation of the cavities and is the technique of choice for the follow-up of closed mastoidectomy for cholesteatomas.

Hematoma cerebral agudo en la evolución de una encefalitis por virus herpes simple tipo 1. Una complicación infrecuente / Acute cerebral haematoma in the course of herpes simplex 1 encephalitis. A rare complication

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Papel de la radiología en el síndrome de pseudotumor cerebral / Role of Imaging in pseudotumor cerebri syndrome

El síndrome de pseudotumor cerebral (SPTC) es una alteración caracterizada por el aumento de presión intracraneal que afecta predominantemente a mujeres jóvenes obesas. El objetivo del trabajo es definir los conceptos de SPTC primario, sin causa identificable y denominado también hipertensión intracraneal idiopática (HII), y de SPTC secundario, con etiología identificable. Se revisa el papel actual de las pruebas de imagen en su diagnóstico y los hallazgos por imagen típicos del SPTC, algunos de los cuales se incluyen entre los criterios diagnósticos propuestos en 2013. También se remarca el papel fundamental de la radiología intervencionista en el tratamiento, puesto que la colocación de stent en las estenosis de senos venosos constituye una alternativa terapéutica novedosa en pacientes resistentes al tratamiento clásico. Por último, se describen aquellos biomarcadores de imagen que han sido evaluados para aproximar el diagnóstico de la HII y predecir la respuesta al tratamiento

Pseudotumor cerebri is a disorder characterized by increased intracranial pressure that predominantly affects obese young women. This paper aims to define the concepts of primary pseudotumor cerebri, in which the cause cannot be identified (also known as idiopathic intracranial hypertension), and secondary pseudotumor cerebri, in which the cause can be identified. We review the current role of imaging techniques in diagnosing pseudotumor cerebri and describe and illustrate the most characteristic imaging findings of the disorder, some of which are included in the diagnostic criteria proposed in 2013. We also consider the fundamental role of interventional radiology in the treatment of pseudotumor cerebri because placing a stent in stenosed venous sinuses is a novel treatment option in patients who are refractory to classical treatment. Finally, we describe the imaging biomarkers that have been evaluated for diagnosing primary pseudotumor cerebri and predicting the response to treatment

Role of Imaging in pseudotumor cerebri syndrome. / Papel de la radiología en el síndrome de pseudotumor cerebral.

Pseudotumor cerebri is a disorder characterized by increased intracranial pressure that predominantly affects obese young women. This paper aims to define the concepts of primary pseudotumor cerebri, in which the cause cannot be identified (also known as idiopathic intracranial hypertension), and secondary pseudotumor cerebri, in which the cause can be identified. We review the current role of imaging techniques in diagnosing pseudotumor cerebri and describe and illustrate the most characteristic imaging findings of the disorder, some of which are included in the diagnostic criteria proposed in 2013. We also consider the fundamental role of interventional radiology in the treatment of pseudotumor cerebri because placing a stent in stenosed venous sinuses is a novel treatment option in patients who are refractory to classical treatment. Finally, we describe the imaging biomarkers that have been evaluated for diagnosing primary pseudotumor cerebri and predicting the response to treatment.

Valor de la secuencia de susceptibilidad magnética en formas subagudas de embolismo graso cerebral / Usefulness of susceptibility-weighted imaging in subacute cerebral fat embolism

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Imagen de la hipoacusia postraumática / Imaging of post-traumatic hearing loss

Objetivo. La hipoacusia es la complicación más frecuente del traumatismo del hueso temporal. El papel del radiólogo es de gran importancia; la adecuación y la selección de las pruebas radiológicas, así como su correcta interpretación, son cruciales para establecer el diagnóstico y el pronóstico, y para seleccionar el tratamiento idóneo. Con el objetivo de sistematizar los conceptos más relevantes en la valoración de los estudios de imagen en este contexto, se esquematizará el desarrollo del tema según el tipo de hipoacusia que condicione el traumatismo. De forma ordenada se valorarán las potenciales lesiones de sus componentes; en cada caso se sugerirá la técnica de imagen para su evaluación y se describirán e ilustrarán los hallazgos. Conclusión. En la hipoacusia postraumática, la tomografía computarizada es la técnica de elección inicial y permitirá la detección de alteraciones que condicionen hipoacusia conductiva; la resonancia magnética es útil en la valoración de la hipoacusia neurosensorial

Objective. Hearing loss is the most frequent complication of temporal bone trauma. The role of the radiologist is of great importance; the adequacy and selection of the imaging technique, as well as its correct interpretation, are crucial to establish the diagnosis, prognosis and enable the selection of appropriate treatment. With the aim of systematizing the most relevant concepts in the evaluation of image studies in this scenario, this review will be outlined according to the hearing loss type. The potential lesions of its components will be assessed; In each case the most appropriate imaging technique will be suggested and the findings will be described and depicted. Conclusion. In postraumatic hearing loss, computed tomography is the initial technique of choice and will allow the detection of alterations that cause conductive hearing loss; magnetic resonance imaging will be useful in the evaluation of sensorineural hearing loss

Imaging of post-traumatic hearing loss. / Imagen de la hipoacusia postraumática.

OBJECTIVE: Hearing loss is the most frequent complication of temporal bone trauma. The role of the radiologist is of great importance; the adequacy and selection of the imaging technique, as well as its correct interpretation, are crucial to establish the diagnosis, prognosis and enable the selection of appropriate treatment. With the aim of systematizing the most relevant concepts in the evaluation of image studies in this scenario, this review will be outlined according to the hearing loss type. The potential lesions of its components will be assessed; In each case the most appropriate imaging technique will be suggested and the findings will be described and depicted. CONCLUSION: In postraumatic hearing loss, computed tomography is the initial technique of choice and will allow the detection of alterations that cause conductive hearing loss; magnetic resonance imaging will be useful in the evaluation of sensorineural hearing loss.

Grasa y hemorragia en el espacio subaracnoideo intracraneal por fractura sacra con disociación espondilopélvica / Intracranial subarachnoid fat and hemorrhage secondary to sacral fracture with spondylopelvic dissociation

Se describe un caso de aparición de grasa y sangre en el espacio subaracnoideo cerebral en un paciente con fractura sacra compleja sin traumatismo craneal asociado, tras varios días de ingreso. Según la literatura revisada, solo hay un caso publicado con hallazgos similares al presentado sin una lesión subyacente como causa. Se explican las diferencias en el mecanismo de producción entre esta migración grasa directa y el síndrome de embolia grasa cerebral, que es intravascular y presenta manifestaciones radiológicas diferentes. Se detallan las características más importantes de la fractura sacra con disociación espondilopélvica. Finalmente, la entidad presentada debe tenerse en cuenta en el diagnóstico diferencial de las escasas causas de grasa en el espacio subaracnoideo y, en el contexto de un traumatismo de alta energía, deben buscarse fracturas en el sacro o en la columna vertebral como posible causa de este hallazgo intracraneal tan poco frecuente (AU)

We describe a case of fat droplets and blood in the cerebral subarachnoid space secondary in a patient with a complex sacral fracture without associated cranial trauma, a few days after admission. To our knowledge, there is only one published case with similar findings and without any other underlying lesion as cause. We explain the differences in the mechanism of production between this direct fat embolism and brain fat embolism syndrome, which is an intravascular embolism with different radiological appearance. The most important features of sacral fracture with spondylopelvic dissociation are described. Finally, this entity should be taken into account in the differential diagnosis of the few causes of fat in the subarachnoid space. In the context of high-energy trauma fractures of the sacrum or spine must be ruled out as a potential cause of this uncommon intracranial finding (AU)

Malformaciones del oído interno: una aproximación diagnóstica práctica / Inner ear malformations: a practical diagnostic approach

La hipoacusia neurosensorial pediátrica es una causa mayor de discapacidad. Pese a que solo en el 20-40% de los casos se identifica una malformación del oído interno, su detección es de vital importancia para el tratamiento de estos pacientes. En este artículo se repasan la anatomía y la embriogénesis del oído interno. Se valora el papel de la neuroimagen en la hipoacusia neurosensorial pediátrica y en el estudio preimplante coclear. Se destaca la necesidad de la utilización de un sistema universal de clasificación de las malformaciones del oído interno con implicaciones pronósticas y terapéuticas. Por último, se describen e ilustran de forma concisa los hallazgos radiológicos clave de cada tipo de malformación. La tomografía computarizada y la resonancia magnética desempeñan un papel crucial en la caracterización de las malformaciones del oído interno y permiten la valoración de las estructuras anatómicas que posibilitan la selección del tratamiento y del abordaje quirúrgico idóneos (AU)

Pediatric sensorineural hearing loss is a major cause of disability; although inner ear malformations account for only 20-40% of all cases, recognition and characterization will be vital for the proper management of these patients. In this article relevant anatomy and development of inner ear are surveyed. The role of neuroimaging in pediatric sensorineural hearing loss and cochlear preimplantation study are assessed. The need for a universal system of classification of inner ear malformations with therapeutic and prognostic implications is highlighted. And finally, the radiological findings of each type of malformation are concisely described and depicted. Computed tomography and magnetic resonance imaging play a crucial role in the characterization of inner ear malformations and allow the assessment of the anatomical structures that enable the selection of appropriate treatment and surgical approach (AU)

Intracranial subarachnoid fat and hemorrhage secondary to sacral fracture with spondylopelvic dissociation. / Grasa y hemorragia en el espacio subaracnoideo intracraneal por fractura sacra con disociación espondilopélvica.

We describe a case of fat droplets and blood in the cerebral subarachnoid space secondary in a patient with a complex sacral fracture without associated cranial trauma, a few days after admission. To our knowledge, there is only one published case with similar findings and without any other underlying lesion as cause. We explain the differences in the mechanism of production between this direct fat embolism and brain fat embolism syndrome, which is an intravascular embolism with different radiological appearance. The most important features of sacral fracture with spondylopelvic dissociation are described. Finally, this entity should be taken into account in the differential diagnosis of the few causes of fat in the subarachnoid space. In the context of high-energy trauma fractures of the sacrum or spine must be ruled out as a potential cause of this uncommon intracranial finding.

Inner ear malformations: a practical diagnostic approach. / Malformaciones del oído interno: una aproximación diagnóstica práctica.

Pediatric sensorineural hearing loss is a major cause of disability; although inner ear malformations account for only 20-40% of all cases, recognition and characterization will be vital for the proper management of these patients. In this article relevant anatomy and development of inner ear are surveyed. The role of neuroimaging in pediatric sensorineural hearing loss and cochlear preimplantation study are assessed. The need for a universal system of classification of inner ear malformations with therapeutic and prognostic implications is highlighted. And finally, the radiological findings of each type of malformation are concisely described and depicted. Computed tomography and magnetic resonance imaging play a crucial role in the characterization of inner ear malformations and allow the assessment of the anatomical structures that enable the selection of appropriate treatment and surgical approach.

Radiología del oído externo: indicaciones, anatomía normal y procesos patológicos / Radiology of external ear: indications, normal anatomy, and pathological processes

El oído externo (OE) es accesible al examen directo. En la mayor parte de las enfermedades, la historia clínica y la otoscopia son suficientes para su diagnóstico y tratamiento. Nuestro objetivo es describir la anatomía normal del OE, especificar las indicaciones de pruebas de imagen y revisar las manifestaciones clínicas y radiológicas de las enfermedades más frecuentes, que clasificaremos según su origen en patología congénita, inflamatoria e infecciosa, tumoral ósea benigna, traumática y tumoral maligna. Las pruebas de imagen no desempeñan un papel importante en la patología del OE, pero en determinados escenarios clínicos pueden ser cruciales para alcanzar el diagnóstico concreto y establecer el tratamiento idóneo. La tomografía computarizada es la técnica de elección para la mayor parte de las enfermedades. La resonancia magnética es complementaria, permite discriminar tejidos de diferente naturaleza y evaluar con precisión la extensión de la enfermedad (AU)

The external ear is accessible to direct examination; the clinical history and otoscopy are sufficient to diagnose and treat most diseases of the external ear. We aim to describe the normal anatomy of the external ear, specify the indications for imaging tests, and review the clinical and radiological manifestations of the most common diseases affecting the external ear. We classify these diseases according to their origin into congenital, inflammatory, infectious, or traumatic disease or benign bone tumors or malignant tumors. Imaging does not play an important role in diseases of the external ear, but in certain clinical scenarios it can be crucial for reaching a concrete diagnosis and establishing the best treatment. Computed tomography is the first-choice technique for most diseases. Magnetic resonance imaging complements computed tomography and makes it possible to differentiate among different tissue types and to evaluate the extension of disease accurately (AU)

Radiology of external ear: indications, normal anatomy, and pathological processes. / Radiología del oído externo: indicaciones, anatomía normal y procesos patológicos.

The external ear is accessible to direct examination; the clinical history and otoscopy are sufficient to diagnose and treat most diseases of the external ear. We aim to describe the normal anatomy of the external ear, specify the indications for imaging tests, and review the clinical and radiological manifestations of the most common diseases affecting the external ear. We classify these diseases according to their origin into congenital, inflammatory, infectious, or traumatic disease or benign bone tumors or malignant tumors. Imaging does not play an important role in diseases of the external ear, but in certain clinical scenarios it can be crucial for reaching a concrete diagnosis and establishing the best treatment. Computed tomography is the first-choice technique for most diseases. Magnetic resonance imaging complements computed tomography and makes it possible to differentiate among different tissue types and to evaluate the extension of disease accurately.

Neoplasias hematológicas: interpretación de los hallazgos pulmonares en la tomografía computarizada torácica / Hematologic neoplasms: interpreting lung findings in chest computed tomography

La patología pulmonar en la historia de un paciente con neoplasia hematológica es muy frecuente y variable en función de la enfermedad de base y la terapia recibida. La morbimortalidad asociada es alta, por lo que requiere un tratamiento correcto y precoz. La tomografía computarizada (TC) torácica, junto con el análisis de muestras biológicas, son las herramientas de diagnóstico de primera línea empleadas en estos pacientes, y en determinados casos se requieren métodos invasivos. La interpretación de las imágenes exige el análisis de un contexto clínico en muchas ocasiones complejo. Partiendo del conocimiento que adquiere el radiólogo en su formación sobre el diagnóstico diferencial de los hallazgos pulmonares, el objetivo de este trabajo es explicar los aspectos clínicos y radiológicos claves que permiten orientar correctamente el diagnóstico y asimilar el papel actual de la TC en la estrategia terapéutica de este grupo de enfermos (AU)

Lung disease is very common in patients with hematologic neoplasms and varies in function of the underlying disease and its treatment. Lung involvement is associated with high morbidity and mortality, so it requires early appropriate treatment. Chest computed tomography (CT) and the analysis of biologic specimens are the first line diagnostic tools in these patients, and sometimes invasive methods are necessary. Interpreting the images requires an analysis of the clinical context, which is often complex. Starting from the knowledge about the differential diagnosis of lung findings that radiologists acquire during training, this article aims to explain the key clinical and radiological aspects that make it possible to orient the diagnosis correctly and to understand the current role of CT in the treatment strategy for this group of patients (AU)