Intracranial progression of the epidermoid cyst to a white epidermoid cyst in a pediatric patient: a case report.

BACKGROUND: Epidermoid cysts are rare benign lesions that originate from remnants of ectodermal epithelial tissue, particularly infrequent in the pediatric population. They exhibit characteristic imaging features, with occasional variations leading to the development of a "white" epidermoid cyst. This transformation results from the presence of protein and lipid material within the cyst, causing intrinsic hyperintensity in T1-weighted images, signal hypointensity in T2-weighted images, and a bright signal in diffusion-weighted imaging. CASE PRESENTATION: We describe the case of a 5-year-old Latina pediatric patient initially diagnosed with a typical epidermoid cyst. After 13 years of follow-up, this typical epidermoid cyst underwent a transformation, becoming a "white" epidermoid cyst. CONCLUSIONS: Epidermoid cysts are rare intracranial lesions. The term "white epidermoid cyst" does not denote a variant; it represents a distinct transformation within an epidermoid cyst due to liquid and protein accumulation. This transformation should be considered in cases with specific imaging characteristics.

Dual Energy Computed Tomography in Head and Neck Imaging: Pushing the Envelope.

Multiple applications of dual energy computed tomography (DECT) have been described for the evaluation of disorders in the head and neck, especially in oncology. We review the body of evidence suggesting advantages of DECT for the evaluation of the neck compared with conventional single energy computed tomography scans, but the full potential of DECT is still to be realized. There is early evidence suggesting significant advantages of DECT for the extraction of quantitative biomarkers using radiomics and machine learning, representing a new horizon that may enable this technology to reach its full potential.

Isquemia talámica bilateral secundaria a trombosis venosa cerebral: tratamiento endovascular, presentación de un caso / Bilateral thalamic stroke due to cerebral vein thrombosis: endovascular treatment, case report

RESUMEN La trombosis venosa cerebral (TVC) es una entidad poco frecuente y potencialmente devastadora que se presenta con mayor frecuencia en adultos jóvenes, especialmente en mujeres. La TVC representa el 0,5 % a 1 % de todos los ACV, su amplio espectro clínico la convierte en un desafío diagnóstico, especialmente en aquellos casos de mujeres jóvenes sin factores protrombóticos conocidos que debutan con cefalea como único síntoma. La TVC puede ocasionar isquemia o infartos talámicos y gangliobasales bilaterales con delirio y deterioro del estado de conciencia, en especial cuando hay compromiso del sistema venoso profundo. El diagnóstico se confirma con resonancia magnética cerebral (RM) y venografía por resonancia. La anticoagulación sigue siendo la piedra angular del tratamiento; sin embargo, los pacientes que no responden a terapia médica intensiva pueden beneficiarse de la trombectomía endovascular mecánica (TEM). A continuación presentamos el caso clínico de una paciente de 29 años con una isquemia talámica y gangliobasal bilateral secundaria a trombosis venosa cerebral que fue llevada a trombectomía endovascular mecánica.

SUMMARY Thrombosis of the dural sinus and/or cerebral veins (CVT) is a rare but potentially devastating type of stroke that tends to occur in young adults, especially women. CVT represents about 0.5% of all strokes and can be challenging to diagnose because headache, rather than focal neurologic symptoms, is the prominent feature. However, some patients (especially those with deep cerebral venous occlusion) may present with bilateral thalamic or basal infarction and often will have decreased level of consciousness and rapid neurologic deterioration. The diagnosis of CVT is confirmed with MRI and magnetic resonance venogram (MRV). The mainstay of acute management is anticoagulation. However, some patients do not respond to medical therapy and these might benefit from endovascular mechanical thrombectomy. We present the case of a 29 year old female patient with bilateral thalamic and gangliobasal ischemia secondary to CVT, who was treated with anticoagulation and endovascular mechanical thombectomy.

The spinning dancer illusion and spontaneous brain fluctuations: an fMRI study.

The brain activation associated with the Spinning Dancer Illusion, a cognitive visual illusion, is not entirely known. Inferences from other study modalities point to the involvement of the dorso-parieto-occipital areas in the spontaneous switchings of perception in other bistable non-kinetic illusions. fMRI is a mature technique used to investigate the brain responses associated with mental changes. Resting-state fMRI is a novel technique that may help ascertain the effects of spontaneous brain changes in the top-down regulation of visual perception. The purpose of this report is to describe the brain activation associated with the subjective illusory changes of perception of a kinetic bistable stimulus. We hypothesize that there is a relationship between the perception phases with the very slow cortical spontaneous fluctuations, recently described. A single normal subject who was trained to produce voluntarily perception phase switches underwent a series of fMRI studies whose blocks were either defined post-hoc or accordingly with a predefined timeline to assess spontaneous and voluntarily evoked visual perception switches, respectively. Correlation of findings with resting-state fMRI and independent component analysis of the task series was sought. Phases of the rotation direction were found associated with right parietal activity. Independent component analysis of the task series and their comparison with basal resting-state components suggest that this activity is related to one of the very slow spontaneous brain fluctuations. The spontaneous fluctuations of the cortical activity may explain the subjective changes in perception of direction of the Spinning Dancer Illusion. This observation is a proof-of-principle, suggesting that the spontaneous brain oscillations may influence top-down sensory regulation.

MRI of cervical spinal cord infarction in a patient with sickle cell disease.

We report a patient with sickle cell disease who developed spinal cord ischemia. Initial conventional magnetic resonance imaging (MRI) was unremarkable, but diffusion-weighted imaging showed restricted diffusion in the cervical spinal cord. Follow-up MRI performed 3 days later showed development of findings on conventional images that confirmed the infarction.

Dolor dorsal en la edad pediátrica: un reto diagnóstico / Dorsal pain in the pediatric aged population: a diagnostic challenge

El dolor dorsal en la edad pediátrica es una consulta relativamente común, y se asocia a causas patológicas subyacentes, a diferencia de los adultos, en quienes es habitual una etiología inespecífica. El diagnóstico comienza con una historia y un examen clínico completo, y a menudo requiere evaluación imaginológica. Existe un amplio espectro en la etiología. Para la evaluación de nuestros pacientes hemos dividido las causas en: infecciosas, tumorales hematológicas, metabólicas, traumáticas y otras.

Dorsal pain in the pediatric aged population is a relative common cause of consultation. Frequently, in adults the etiology is non specific, in children there is almost always a subjacent pathology which is causing the pain. In order to make a right diagnosis, it is important to get a complete clinical history and a very detailed physical examination. Imaging evaluation is also frequently required. There is a broad spectrum of etiologies. For optimizing the diagnosis; we have divided the causes in: Infectious, tumoral, traumatic, metabolic diseases and others.

Síndrome del opérculo torácico: reporte de caso / Thoracic outlet syndrome: case report

Se reporta un caso de síndrome del opérculo torácico vascular en un hombre joven, diagnosticado por arteriografía del miembro superior. Este síndrome ocasiona embolias arterioarteriales repetidas, originadas en un aneurisma postestenótico de la arteria subclavia. Es de interés debido a su baja incidencia y al poco número de casos diagnosticados por arteriografía que se encuentran reportados. El opérculo torácico es el camino a través del cual pasan las estructuras vasculonerviosas del cuello a la axila; tiene tres estrecheces anatómicas que, al ser pronunciadas, pueden ocasionar compresión del plexo braquial o del paquete vascular subclavio, lo cual lleva a diversos síntomas y signos.

We report a case of vascular thoracic outlet syndrome in a young man, diagnosed with upper limb arteriography, leading to repeated arterio-arterial emboli originating from a post-stenotic subclavian artery aneurism. It is of our interest due to its low incidence and the small number ofcases reported that have been diagnosed by arteriography. The thoracic outlet is the path throughwhich vascular and neural structures goes from the neck to the axilla, and it has three anatomical strictures, that when pronounced, can compress the brachial plexus or subclavian vessels, leading to different symptoms and signs.