Signo del tridente en la neurosarcoidosis medular / Trident sign in spinal cord neurosarcoidosis

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[Trident sign in spinal cord neurosarcoidosis]. / Signo del tridente en la neurosarcoidosis medular.

TITLE: Signo del tridente en la neurosarcoidosis medular.

Ischemic stroke of the "hand knob area": A case series and literature review.

Isolated hand paresis may reflect an infarction of the "hand knob area", which represents less than 1% of all ischemic strokes. In this type of stroke, a potential source of embolism is often identified. There are no large case series regarding this topic in Latin America. Herein we present the largest cohort of this entity in the region and we compare our results with those previously published. We analyzed all stroke patients admitted to our hospital between May 2015 - June 2018. Only patients with motor +/- sensory deficits restricted to the hand and ischemic stroke confirmed by MRI were included. We assessed stroke mechanism, clinical characteristics and outcome. From 339 patients admitted with ischemic stroke, 12 (3.53%) were included (9 men, 75%). Mean age: 60.4 years-old (range:24-79). Localization of stroke: 8 patients (66%) precentral gyrus, 3 (25%) postcentral; in 1 both gyri were affected. Stroke mechanism according to TOAST classification was as follows: two patients (16%) large artery atherosclerosis, two cardioembolic, one other determined etiology (thrombophilia), seven (58%) undetermined etiology (SUE). Nine patients (75%) received antiplatelets and statins, and three (25%) anticoagulants. The mean follow-up period was 11 months (range 1-26). Stroke recurrence was observed in one patient. At follow up, eight patients (66%) had a modified Rankin Score (mRS) of 0 and one a mRS of 1. In conclusion, in this series the most prevalent stroke mechanism was SUE, mainly embolic stroke of undetermined source. The outcome was excellent regardless of stroke mechanism.

Usefulness of the apparent diffusion coefficient for the evaluation of the white matter to differentiate between glioblastoma and brain metastases. / Utilidad del coeficiente de difusión aparente en la evaluación de la sustancia blanca para diferenciar glioblastoma de metástasis cerebral.

OBJECTIVE: To determine whether there are significant differences in the apparent diffusion coefficient (ADC) between the apparently normal peritumor white matter surrounding glioblastomas and that surrounding brain metastases. MATERIAL AND METHODS: We retrospectively reviewed 42 patients with histologically confirmed glioblastomas and 42 patients with a single cerebral metastasis. We measured the signal intensity in the apparently normal peritumor white matter and in the abnormal peritumor white matter on the ADC maps. We used mean ADC values in the contralateral occipital white matter as a reference from which to design normalized ADC indices. We compared mean values between the two tumor types. We calculated the area under the receiver operator characteristic curve and estimated the sensitivity and specificity of the measurements taken. RESULTS: Supratentorial lesions and compromise of the corpus callosum were more common in patients with glioblastoma than in patients with brain metastases. The maximum diameter of the enhanced area after injection of a contrast agent was greater in the glioblastomas (p<0.001). The minimum ADC value measured in the apparently normal peritumor white matter was higher for the glioblastomas than for the metastases (p=0.002). Significant differences in the ADC index were found only for the minimum ADC value in apparently normal peritumor white matter. The sensitivity and specificity were less than 70% for all variables analyzed. CONCLUSIONS: There are differences in the ADC values of apparently normal peritumor white matter between glioblastomas and cerebral metastases, but the magnitude of these differences is slight and the application of these differences in clinical practice is still limited.

[Applied anatomy of the fontanelles]. / Anatomía aplicada de las fontanelas.

OBJECTIVE: To make a description of the anatomy of fontanelles and to update what is currently known about their applications. METHOD: 7 cadaveric heads, 2 dry skulls and 2 frontal bones of foetus were used, and 48 anterior fontanelles from paediatric patients with or without associated pathology were examined. Surgical cases and neurosonography were also used. All the structures were measured and subsequently analysed. RESULTS: The size, structure and limits of the fontanelles were evidenced in the cadaveric head and skulls, as well as the evaluation of paediatric patients and the size of their fontanelles in different pathologies. CONCLUSION: Owing to their anatomical characteristics, fontanelles are a true window to the inside of the skull, which determines their multiple clinical and surgical applications.

Anatomía aplicada de las fontanelas / Applied anatomy of the fontanelles

Objetivo. Describir la anatomía de las fontanelasy actualizar las aplicaciones del conocimiento de lasmismas.Métodos. Se utilizaron 7 preparados cadavéricos decabezas fetales, 2 cráneos secos y 2 huesos frontales,se analizaron 48 fontanelas anteriores de pacientespediátricos con y sin patología asociada, así comotambién casos quirúrgicos y neuroecografías. Dichasestructuras fueron sometidas a mediciones y posterioranálisis.Resultado. Se evidenció las medidas, estructura ylímites de las fontanelas en las cabezas y cráneos fetales,así como la evaluación de pacientes pediátricos y lasmedidas de las fontanelas en diferentes patologías.Conclusión. Debido a sus características anatómicas,las fontanelas son una verdadera ventana alendocráneo, lo que determina sus múltiples aplicacionesclínico-quirúrgicas (AU)

Objective. To make a description of the anatomyof fontanelles and to update what is currently knownabout their applications.Method. 7 cadaveric heads, 2 dry skulls and 2 frontalbones of foetus were used, and 48 anterior fontanellesfrom paediatric patients with or without associatedpathology were examined. Surgical cases and neurosonographywere also used. All the structures were measuredand subsequently analysed.Results. The size, structure and limits of the fontanelleswere evidenced in the cadaveric head and skulls, aswell as the evaluation of paediatric patients and the sizeof their fontanelles in different pathologies.Conclusion. Owing to their anatomical characteristics,fontanelles are a true window to the inside ofthe skull, which determines their multiple clinical andsurgical applications (AU)