ABSTRACT
We report unusual cases of brainstem encephalitis in two young boys. Both presented with acute febrile illness, progressive encephalopathy, and marked cerebrospinal fluid pleocytosis. Case one shared some of the clinical features that have been seen in previously reported cases of brainstem encephalitis, such as ophthalmoplegia, ataxia, and progressive encephalopathy. Case two presented with similar clinical features, although without ophthalmoplegia and ataxia. A review of magnetic resonance imaging revealed mild differences with respect to anatomic lesion localization and confirmed a neuroanatomic basis for the variance in each patient's symptoms. The features of these cases deviate from the classical symptoms described in the Miller-Fisher syndrome/Bickerstaff brainstem encephalitis/Guillain-Barré syndrome spectrum, although the cause for variability in clinical phenotypes is unknown.
Subject(s)
Brain Stem/pathology , Encephalitis/diagnosis , Child , Diagnosis, Differential , Disease Progression , Encephalitis/drug therapy , Encephalitis/pathology , Fever/etiology , Fever/pathology , Glucocorticoids/therapeutic use , Humans , Magnetic Resonance Imaging , Male , Methylprednisolone/therapeutic use , Phenotype , Treatment OutcomeABSTRACT
Orbital cavernous hemangioma usually has a typical clinical and imagery pattern. We present a patient with an enlarged lacrimal gland due to an intra-gland cavernous hemangioma.
Subject(s)
Eye Neoplasms/pathology , Hemangioma, Cavernous/pathology , Lacrimal Apparatus/pathology , Adult , Biopsy, Needle , Diagnosis, Differential , Eye Neoplasms/diagnostic imaging , Eye Neoplasms/surgery , Female , Follow-Up Studies , Gadolinium , Hemangioma, Cavernous/diagnostic imaging , Hemangioma, Cavernous/surgery , Humans , Immunohistochemistry , Magnetic Resonance Imaging/methods , Neoplasm Staging , Ophthalmologic Surgical Procedures/methods , Orbital Neoplasms/diagnosis , Radionuclide Imaging , Treatment OutcomeABSTRACT
An atypical presentation of fibrous dysplasia with a very large cystic component is described. The MR pattern was not diagnostic.
Subject(s)
Fibrous Dysplasia of Bone/pathology , Meningioma/pathology , Orbit/pathology , Orbit/surgery , Adolescent , Biopsy, Needle , Diagnosis, Differential , Exophthalmos/diagnosis , Exophthalmos/etiology , Female , Fibrous Dysplasia of Bone/diagnosis , Fibrous Dysplasia of Bone/surgery , Follow-Up Studies , Gadolinium , Humans , Immunohistochemistry , Magnetic Resonance Imaging/methods , Meningioma/diagnosis , Tomography, X-Ray Computed , Vision Disorders/diagnosis , Vision Disorders/etiologyABSTRACT
PURPOSE: To describe a rare orbital metastasis with atypical presentation. DESIGN AND METHODS: Retrospective case report. RESULTS: The patient presented with a rapid onset of a cystic orbital lesion after a presumptive diagnosis of endometrial carcinoma that had been completely excised eight months ago. This was the initial presentation of widespread metastasis. CONCLUSIONS: Endometrial carcinomas can metastasize to the orbit and may have a very atypical presentation.
Subject(s)
Endometrial Neoplasms/pathology , Orbital Neoplasms/secondary , Aged, 80 and over , Diagnosis, Differential , Female , Humans , Orbital Neoplasms/diagnosis , Orbital Neoplasms/surgeryABSTRACT
PURPOSE: The aim of this study was to evaluate the usefulness of multislice magnetic resonance spectroscopic imaging (MRSI) in combination with tissue segmentation for the identification of the epileptogenic focus in neocortical epilepsy (NE). METHODS: Twenty patients with NE (10 with MRI-visible malformations, 10 with normal MRI) and 19 controls were studied. In controls, N-acetylaspartate NAA/Cr and NAA/Cho of all voxels of a given lobe were expressed as a function of white matter, and thresholds were determined by calculating the 95% prediction intervals (PIs) for NAA/Cr and NAA/Cho. Voxels with NAA/Cr or NAA/Cho values less than the 95% PI were defined as "pathological." Z-scores were calculated. Depending on the magnitude of those z-scores, we used two different methods (score-localization or forced-localization) to identify in a given subject the lobe with the highest percentage of pathological voxels, which was supposed to represent the epileptogenic lobe. RESULTS: MRSI correctly identified the lobe containing the epileptogenic focus as defined by EEG in 65% of the NE patients. MRSI localization of the focus was correct in 70% of the patients with an MRI-visible malformation and in 60% of the patients with normal MRI. Of the patients, 15% had metabolically abnormal brain regions outside the epileptogenic lobe, and 35% of the patients had evidence for secondary hippocampal damage. CONCLUSIONS: MRSI may be helpful for the identification of the epileptogenic focus in NE patients, even in NE with normal MRI.
Subject(s)
Aspartic Acid/analogs & derivatives , Brain Mapping/methods , Epilepsy/diagnosis , Magnetic Resonance Spectroscopy/methods , Neocortex/metabolism , Adolescent , Adult , Aspartic Acid/metabolism , Choline/metabolism , Creatine/metabolism , Electroencephalography/statistics & numerical data , Epilepsies, Partial/diagnosis , Epilepsies, Partial/metabolism , Epilepsies, Partial/physiopathology , Epilepsy/metabolism , Epilepsy/physiopathology , Female , Hippocampus/metabolism , Humans , Male , Neocortex/physiopathologyABSTRACT
In an attempt to decrease the incidence of premature ovarian failure, three patients with prominent ovarian collateral vessels from the uterine artery (UA) underwent collateral vessel embolization before uterine fibroid embolization. UA anatomy and collateral pathways are reviewed.