Reversible and irreversible cranial MRI findings associated with status epilepticus.

OBJECTIVE: There is limited information on neuroimaging changes in status epilepticus (SE). The objective of this study was to characterize the abnormalities associated with SE in cranial MRI of patients with SE. METHODS: A retrospective review of our records from 2001 to 2010 identified 203 patients with SE. Magnetic resonance imaging (MRI) changes considered were not attributable to any neurological disorder. RESULTS: Ten patients who met the inclusion criteria were found to have significant abnormalities. Magnetic resonance imaging findings included increased T2 signal changes in the gray and/or white matter with corresponding diffusion-weighted imaging (DWI) abnormalities (n=9). Apparent diffusion coefficient (ADC) values were both reduced (n=3) and increased (n=3). Other findings included changes affecting one hemisphere, a perilesional and homologous region, hippocampal changes, and findings in the thalamus, basal ganglia, brain stem, and cerebellum. CONCLUSIONS: Magnetic resonance imaging changes were diffuse. Notably, MRI changes were found to involve the brain stem, cerebellum, basal ganglia, and thalamus. Magnetic resonance imaging changes in the latter areas have not been previously well described. In addition, MRI changes tended to evolve after 1week; therefore, serial MRI is recommended in order to follow and highlight the MRI changes related to the neuroanatomic involvement seen in status epilepticus.

Involuntary craniofacial lingual movements in intensive care-acquired quadriplegia.

BACKGROUND: The syndrome of involuntary craniofacial lingual movements in the setting of acute intensive care-acquired quadriplegia (critical illness neuromyopathy) following sepsis-associated encephalopathy has not been previously described. We suggest a localization and treatment for this disabling condition. METHODS: Three patients (2 female) from our center were quadriplegic from critical illness neuromyopathy when they developed involuntary craniofacial lingual movements following sepsis-associated encephalopathy. RESULTS: Extensive investigations failed to identify an etiology for the abnormal movements. Movements were of large amplitude, of moderate speed, and semi-rhythmic in the jaw, tongue, and palate, persistent and extremely bothersome to all patients. Injection with Botulinum toxin type A was very beneficial. CONCLUSIONS: Involuntary craniofacial lingual movements in the setting of flaccid quadriplegia following sepsis-associated encephalopathy are consistent with focal craniofacial brainstem myoclonus and constitutes a new syndrome. Botulinum toxin type A treatment maybe helpful in treatment.

CT evaluation of mediastinal lymphadenopathy: noncontrast 5 mm vs postcontrast 10 mm sections.

OBJECTIVE: Two CT techniques were compared in the assessment of mediastinal lymph nodes: 5 mm thick sections without intravenous contrast medium and 10 mm thick sections with intravenous contrast medium. MATERIALS AND METHODS: Seventy-nine adult patients were examined by chest CT. From the level of the aortic arch through the level of the right middle lobe bronchus 5 mm thick sections were performed without intravenous contrast medium, followed by 10 mm thick sections of the same region with intravenous contrast medium. Two chest radiologists separately reviewed each CT method for each patient. Mediastinal lymph nodes were localized according to the American Thoracic Society scheme. Lymph node diameter was measured on the short axis. RESULTS: The 5 mm thick noncontrast sections permitted identification of more mediastinal lymph nodes than the 10 mm thick contrast enhanced sections (p < 0.01, signed rank test). The 5 mm thick unenhanced sections tended to show slightly (1-2 mm) larger nodes than the 10 mm thick contrast enhanced sections (stations 7, 10R, both reviewers, p < 0.05, signed rank test). Nodes with a short axis diameter > or = 8 mm were identified comparably well using either CT technique. CONCLUSION: The present study indicates that CT of the mediastinum using 5 mm thick sections, without intravenous contrast medium, is an appropriate scanning technique for evaluation of mediastinal lymphadenopathy.

Choledochal cyst. Imaging by Telepaque-enhanced computed tomography.

A choledochal cyst is an uncommon anomaly of the biliary system requiring surgical intervention. A case of a choledochal cyst imaged by computed tomography following oral administration of cholangiography contrast material (Telepaque) is reported. Telepaque-enhanced computed tomography is an easy, noninvasive method to demonstrate pertinent preoperative anatomy in cases of choledochal cysts, and is especially useful in the pediatric patient.

Pericardial effusion and cardiac hemangioma in the neonate.

In the absence of hydrops or sepsis, a pericardial effusion is a rare occurrence in the neonate. We report a case of a neonate with a pericardial effusion in which there was an associated intracardiac hemangioma. Our literature review found 32 cases of pericardial effusion without hydrops in infants under 3 months of age; twelve of these cases were associated with intracardiac and pericardial tumors; 20 others were discovered to be randomly associated with other problems.