RESUMEN
A new percutaneous technique for the treatment of the backache and sciatica related to the lumbar disc herniation was applied in 34 patients at 40 levels. The technique is easy, safe, efficacious and without complications. In particular it is useful for the diagnosis and treatment of the underestimated "internal disc disruption" syndrome.
Asunto(s)
Cordoma/patología , Neoplasias Meníngeas/patología , Meningioma/patología , Progresión de la Enfermedad , Humanos , Inmunohistoquímica , Masculino , Neoplasias Meníngeas/diagnóstico por imagen , Neoplasias Meníngeas/cirugía , Neoplasias Meníngeas/ultraestructura , Meningioma/diagnóstico por imagen , Meningioma/cirugía , Meningioma/ultraestructura , Microscopía Electrónica , Persona de Mediana Edad , Recurrencia Local de Neoplasia/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
Flow artifacts or anatomic variants of venous sinuses often make MR venography (MRV) interpretation difficult. The authors investigated cerebral MRV in 111 subjects with normal CSF pressure to identify the most common flow abnormalities of transverse sinuses (TS). Disturbance of venous outflow in one transverse sinus was commonly observed in 30% of subjects whereas flow abnormalities of both TS occurred in 2 of 111 individuals. Subjects with flow gaps in both TS should undergo lumbar puncture to exclude increased CSF pressure.
Asunto(s)
Encéfalo/irrigación sanguínea , Presión del Líquido Cefalorraquídeo/fisiología , Senos Craneales/anatomía & histología , Senos Craneales/fisiología , Angiografía por Resonancia Magnética , Adolescente , Adulto , Anciano , Velocidad del Flujo Sanguíneo , Dominancia Cerebral/fisiología , Femenino , Humanos , Angiografía por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Flebografía/métodos , Valores de ReferenciaRESUMEN
Obesity has been shown to increase lumbar CSF pressure in healthy subjects. The authors studied lumbar CSF opening pressure in 18 obese, 33 overweight, and 49 nonoverweight subjects with normal MRI and MR venography (MRV) of the brain. No subject had a CSF pressure above 200 mm H2O. Obesity does not cause abnormal CSF pressure in subjects with normal MRV. Individuals with a CSF pressure higher than 200 mm H2O should undergo MRV to exclude cerebral venous thrombosis.
Asunto(s)
Presión del Líquido Cefalorraquídeo/fisiología , Circulación Cerebrovascular/fisiología , Obesidad/fisiopatología , Adolescente , Adulto , Anciano , Índice de Masa Corporal , Femenino , Lateralidad Funcional/fisiología , Humanos , Embolia y Trombosis Intracraneal/patología , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , FlebografíaRESUMEN
BACKGROUND: There is evidence that patients with chronic daily headache (CDH) may have isolated intracranial hypertension without papilledema (IHWOP). Recent studies have emphasized that isolated IH may be due to cerebral venous thrombosis (CVT). OBJECTIVE: To detect the occurrence of CVT in patients with CDH. METHODS: The authors investigated the occurrence of CVT in 114 consecutive patients with CDH by using MR venography (MRV). A portion of these patients underwent a lumbar puncture (LP) to measure CSF pressure. MRV and LP were also performed in 28 age-matched control subjects. RESULTS: In all the control subjects, both MRV and CSF pressure were normal. One hundred three of the 114 patients with CDH had normal MRV. Twenty-seven (Group 1) of these 103 patients underwent LP, and all of them had normal CSF pressure. Eleven (9.6%) of the 114 patients with CDH had CVT of one or both transverse sinuses. Six of these 11 patients had flowing abnormalities of one transverse sinus (Group 2), whereas the remaining five patients showed involvement of both transverse sinuses (Group 3). The CSF pressure of Group 2 was higher than that of either Group 1 or the control subjects, and one of the six patients showed isolated IHWOP. Patients of Group 3 displayed the highest CSF pressure, and four of five had isolated IHWOP. The headache profiles of patients with CDH and CVT did not differ from those of patients with CDH but normal MRV. CONCLUSIONS: CVT, as detected by MRV, occurred in 9.6% of patients who presented with CDH. Almost half of the patients with CVT had isolated IHWOP. These results suggest that MRV may be a useful tool for selecting patients with CDH who should have LP to exclude isolated IHWOP.
Asunto(s)
Venas Cerebrales , Ritmo Circadiano , Cefalea/complicaciones , Hipertensión Intracraneal/complicaciones , Trombosis de la Vena/complicaciones , Adulto , Presión del Líquido Cefalorraquídeo , Enfermedad Crónica , Femenino , Humanos , Hipertensión Intracraneal/diagnóstico , Hipertensión Intracraneal/fisiopatología , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Papiledema/complicaciones , Flebografía/métodos , Punción Espinal , Trombosis de la Vena/diagnósticoRESUMEN
A retrospective clinical-pathological review of 192 lumbar intervertebral discs removed via an interlaminar approach or percutaneous nucleotomy from patients suffering from sciatic pain was carried out in order to assess if routine examination is useful. Only for a case of our series, which showed ill defined features at preoperative neuroradiologic imaging, an intraoperative pathologic examination was necessary. Immunohistochemical study was never required. A routine examination with a hematoxilin-eosin stain was sufficient also to recognize postoperative scar in patients reoperated. In conclusion we think that routine examination of the intervertebral disc is a procedure which is not expensive and useful to assess the nature of the lesion in reoperated patients and in rare cases showing unclear radiologic pattern.
Asunto(s)
Disco Intervertebral/patología , Dolor de la Región Lumbar/patología , Vértebras Lumbares , Femenino , Humanos , Dolor de la Región Lumbar/etiología , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
OBJECTIVES: To describe a patient with a clinical picture suggestive of idiopathic hyperekplexia (IH), who was later found to harbour a subtle brainstem vascular anomaly. PATIENT: A 35-year-old man, 4 years earlier, developed sudden jumping and falling in response to unexpected sensory stimuli. RESULTS: Neurological examination was normal. Electromyography showed an excessively large and non-habituating motor startle response. There were no mutations of the alpha1 subunit of the inhibitory glycine receptor which cause hereditary hyperekplexia. Although all these findings were consistent with a diagnosis of IH, a blink reflex study showed an enhanced recovery curve suggestive of a brainstem lesion. A detailed MRI study revealed a subtle vascular anomaly involving the lower brainstem. CONCLUSION: This is the first report of sporadic hyperekplexia related to a brainstem vascular anomaly. Subtle damage to the brainstem should always be excluded in patients with sporadic hyperekplexia, regardless of the coexistence of additional clear-cut neurological symptoms.
Asunto(s)
Tronco Encefálico/irrigación sanguínea , Arterias Cerebrales/anomalías , Trastornos del Movimiento/diagnóstico , Trastornos del Movimiento/genética , Adulto , Parpadeo/genética , Parpadeo/fisiología , Análisis Mutacional de ADN , Electroencefalografía , Humanos , Imagen por Resonancia Magnética , Masculino , Mutación Puntual/genética , Sueño/fisiología , Vigilia/fisiologíaRESUMEN
Evidence suggests that isolated intracranial hypertension (iIH) is often associated with cerebral venous thrombosis (CVT). In eight patients referred to our Institution for iIH who were later shown to harbor CVT we have performed a comprehensive coagulation work-up, including genetic tests for inherited predisposition to thrombophilia, to clarify the etiology of sinus venous thrombosis. All subjects were women. All but one were overweight. There were high plasma concentrations of D dimer, thrombin-anti-thrombin complexes or prothrombin fragments 1 and 2, further supporting the neuroimaging diagnosis of CVT. Importantly, seven of eight cases had a raised level of plasminogen activator inhibitor 1, a well known inhibitor of fibrinolysis related to obesity. Tissue plasminogen activator levels were elevated accordingly. Factor V gene mutation was present in one subject, and the 20,210 prothrombin gene mutation was found in another individual. Three patients had elevated plasmatic levels of homocysteine. In conclusion, the present study provides solid evidence that impaired fibrinolysis probably related to overweight, acting in concert with other prothrombotic abnormalities, is involved in the pathogenesis of CVT presenting as iIH.
Asunto(s)
Venas Cerebrales , Fibrinólisis , Hipertensión Intracraneal/etiología , Obesidad/sangre , Obesidad/complicaciones , Trombosis de la Vena/sangre , Trombosis de la Vena/complicaciones , Adulto , Factor V/genética , Femenino , Humanos , Mutación/fisiología , Obesidad/genética , Inhibidor 1 de Activador Plasminogénico/sangre , Protrombina/genética , Trombosis de la Vena/genéticaRESUMEN
OBJECTIVE: To assess the efficacy of two different high doses of intravenous methylprednisolone (IVMP) for the treatment of relapses in MS. BACKGROUND: IVMP is the treatment of choice for MS relapses, but it is unknown whether its effects are dose related. METHODS: We conducted a double-blind, randomized study. Follow-up included serial clinical and MRI recordings at baseline and at 7, 15, 30, and 60 days after the beginning of treatment. Outcome measures were the number of brain and cervical spinal cord MRI contrast-enhancing lesions, and the Expanded Disability Status Scale score. RESULTS: Both treatment regimens improved clinical scores and reduced the number of MRI enhancing lesions during the follow-up period. The higher dose of IVMP was significantly more effective than the lower dose in reducing the number of MRI contrast-enhanced lesions at 30 and 60 days, mainly by decreasing the rate of new lesion formation. CONCLUSIONS: The higher dosage of IVMP has a more powerful and prolonged action in maintaining blood-brain barrier integrity after a clinical relapse.
Asunto(s)
Metilprednisolona/uso terapéutico , Esclerosis Múltiple/tratamiento farmacológico , Fármacos Neuroprotectores/uso terapéutico , Adulto , Encéfalo/patología , Evaluación de la Discapacidad , Relación Dosis-Respuesta a Droga , Método Doble Ciego , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Metilprednisolona/administración & dosificación , Metilprednisolona/efectos adversos , Esclerosis Múltiple/diagnóstico , Esclerosis Múltiple/fisiopatología , Cuello , Fármacos Neuroprotectores/administración & dosificación , Fármacos Neuroprotectores/efectos adversos , Recurrencia , Médula Espinal/patologíaRESUMEN
Childhood-onset partial epilepsy caused by focal cortical dysplastic lesions (FCDLs) is often severe. A few patients reported with a favorable outcome had a normal neuropsychological examination, and FCDLs were always localized around the opercular region, suggesting that extent and location of the lesion may account for the favorable outcome. We report two patients with extraopercular FCDLs, who had a spontaneous remission of their childhood-onset epilepsy, despite a severe neurological deficit. A 22-year-old girl (patient 1) and a 16-year-old boy (patient 2), began to have partial seizures at the age of 9 years and 1 year respectively. On neurological examination, patient 1 had left hemiparesis and patient 2 had low IQ. Interictal EEG recordings revealed repetitive epileptiform discharges involving the right temporo-parietal or frontal areas in patients 1 and 2 respectively. MRI study showed focal cortical thickening or abnormal gyration located over the right parietal and frontal region respectively in patients 1 and 2, but failed to evidence T2 prolongation in the white matter beneath the dysplastic cortex. Optimal antiepileptic regimen always stopped seizures. Their long-term course was favorable, with remission of the seizures and normalization of EEG recordings, even 4-5 years after medication withdrawal. In conclusion, FCDLs may cause epilepsy with a benign course even in patient with mental retardation or neurological abnormalities. This may be related to a morphologically milder dysplastic lesion than found in patients with FCDLs and severe epilepsy.
Asunto(s)
Corteza Cerebral/anomalías , Epilepsia/fisiopatología , Adolescente , Adulto , Electroencefalografía , Epilepsia/diagnóstico por imagen , Epilepsia/psicología , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , RadiografíaRESUMEN
We report the case of a 59-year-old man with primary intestinal T-cell non-Hodgkin's lymphoma who developed abnormal facial twitching synchronous with small palatal movements induced by attempts at speaking or swallowing. At rest, the electromyogram (EMG) showed no spontaneous muscular activity. Phonation triggered trains of synchronous, rhythmic EMG bursts at a frequency of 3-4 Hz lasting 10-20 s, with an average burst of 150 ms, which simultaneously involved palatal, facial, and neck muscles bilaterally with left-sided predominance. An enhanced blink reflex recovery curve was observed after stimulation of either side. Backaveraging electroencephalographic study revealed no activity that was time locked with the jerks. Axial T2-weighted magnetic resonance imaging showed an increased signal intensity and bilateral enlargement of the inferior olives. No antineuronal-specific antibodies were found in the blood or in the cerebrospinal fluid. All of these clinical findings were consistent with a symptomatic palatal tremor (PT). Because it was triggered by activation of cranial muscles, we termed this movement disorder action PT. To our knowledge, this is the first report of symptomatic PT displaying these features.
Asunto(s)
Deglución/fisiología , Neoplasias Intestinales/complicaciones , Linfoma de Células T/complicaciones , Actividad Motora/fisiología , Músculos Palatinos/fisiopatología , Paladar Blando/fisiopatología , Temblor/fisiopatología , Parpadeo/efectos de los fármacos , Parpadeo/fisiología , Clonazepam , Progresión de la Enfermedad , Electromiografía , Resultado Fatal , Moduladores del GABA , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Núcleo Olivar/patología , Temblor/etiologíaRESUMEN
We present a clinical case in which a patient with a brain metastasis had a clinical onset simulating a stroke. Computerized tomography showed a lesion which was diagnosed as ischaemic, whereas magnetic resonance imaging showed an expansive lesion surrounded by an aedematous region of probable neoplastic nature. Indeed histology confirmed the neoplastic origin of the lesion. This kind of presentation is very uncommon but when an hypodense area is detected on CT scan one should always think to this occurrence. Neuroradiology is often necessary for a correct diagnosis. CT scan might usefully be integrated by MRI to distinguish between stroke and brain neoplasty.
Asunto(s)
Neoplasias Encefálicas/complicaciones , Neoplasias Encefálicas/secundario , Trastornos Cerebrovasculares/etiología , Anciano , Humanos , MasculinoRESUMEN
A patient with subacute transverse myelitis (TM) had MRI studies, including scans after Gd-DTPA administration. The enhancement, with its intensity and persistence, seems to herald residual cord deficits. TM remains a clinical diagnosis of exclusion whereas MRI plays a valuable role in the assessment of the different abnormalities which may produce this syndrome and also defines accurately the location and extent of the intramedullary pathology.
Asunto(s)
Medios de Contraste , Gadolinio , Imagen por Resonancia Magnética , Mielitis Transversa/diagnóstico , Compuestos Organometálicos , Ácido Pentético , Gadolinio DTPA , Humanos , Aumento de la Imagen , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , PronósticoRESUMEN
Moya moya is an obstructive cerebrovascular disease characterised by peculiar cerebral angiographic features consisting of intracranial stenosis or occlusion of the internal carotid artery or its terminal branches associated with telangiectatic vessels at the base of the brain. Opinion is still divided between a congenital versus an acquired aetiology. Recurrent episodes of sudden hemiplegia, headache and convulsive manifestations occur more frequently in paediatric patients, while subarachnoid bleeding is usually the presenting finding in adults. After a progressive course for many years, the disease frequently stabilizes sometimes with residual disability. Surgical approach to improve cerebral blood flow has been developed but there is a high incidence of complications in pediatric patients. To minimize the defects during ischemic phase, a pharmacological therapy might be useful. We report a new case of childhood moya moya disease which developed a typical angiographic progressive pattern during three years between the first and the latest bilateral study. Clinical course of patient suggest that antiaggregating drugs and calcium antagonists might be useful in this disease although controlled studies are of course needed.
Asunto(s)
Arteriopatías Oclusivas/diagnóstico por imagen , Enfermedad de Moyamoya/diagnóstico por imagen , Angiografía Cerebral , Preescolar , Electroencefalografía , Femenino , Humanos , Enfermedad de Moyamoya/tratamiento farmacológico , Enfermedad de Moyamoya/fisiopatologíaRESUMEN
A 6-year-old girl, operated upon for an optic nerve astrocytoma (resection limited to the intraorbital portion of the nerve), developed 3 years later symptoms and signs of chiasmatic invasion. Nine years after surgery (1980), she suffered from pneumococcal meningitis, due to cerebrospinal rhinorrhea that had been present in the last few years. A repeated neuroradiological investigation showed the site of the fistula and cerebral ventricles of normal size. The case is argued for bulb-to-chiasm resection of an optic nerve glioma: a spontaneous cerebrospinal rhinorrhea with its potential dangers of meningitis seems to be one more complication of a limited resection of these tumors. It is felt that this is an unusual instance of spontaneous rhinorrhea from direct tumoral erosion. The diagnostic value of metrizamide cisternography for the assessment of presence and site of the fistulous leak is confirmed.
Asunto(s)
Astrocitoma/cirugía , Rinorrea de Líquido Cefalorraquídeo/diagnóstico por imagen , Neoplasias de los Nervios Craneales/cirugía , Meningitis Neumocócica/diagnóstico por imagen , Enfermedades del Nervio Óptico/cirugía , Adolescente , Niño , Neoplasias de los Nervios Craneales/diagnóstico por imagen , Femenino , Estudios de Seguimiento , Humanos , Recurrencia Local de Neoplasia/diagnóstico por imagen , Quiasma Óptico/diagnóstico por imagen , Enfermedades del Nervio Óptico/diagnóstico por imagen , Neumoencefalografía , Complicaciones Posoperatorias/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
Changes in brainstem auditory-evoked potential response were serially investigated in 20 head-injury patients with neurologic and computed tomographic signs of brainstem lesion. The reliability of computed tomography in the evaluation of indirect signs of brainstem lesion from the image was investigated with elaboration of the brainstem auditory-evoked potential response. The measurement of auditory brainstem response is thought to be useful in detecting the severity and predicting possible recovery in posttraumatic brainstem injury. Brainstem deformity on computed tomography was a bad prognostic sign, indicating irreversible structural change.
Asunto(s)
Tronco Encefálico/lesiones , Potenciales Evocados Auditivos , Tomografía Computarizada por Rayos X , Adolescente , Adulto , Tronco Encefálico/diagnóstico por imagen , Coma/diagnóstico por imagen , Humanos , Persona de Mediana EdadRESUMEN
14 young patients, operated upon for opto-chiasmatic arachnoiditis by craniotomy are presented. 2 main etiopathogenetic forms (and their respective clinical equivalents) of the disease could be recognized. Only 1 postoperative death occurred, in a patient with a dominant clinical picture of intracranial hypertension. Results of surgery (craniotomy and lysis of adhesions) could be distinguished as positive (functional improvement) in 5 cases, indifferent or negative in the others, with a follow-up duration of up to 23 years. The role of the diagnostic value of the pneumoencephalogram as a basis for surgical indication is discussed: it is felt that this examination, when reported as negative, is not of sufficient value to rule out the diagnosis, which must essentially rely upon clinical data.
Asunto(s)
Aracnoiditis/fisiopatología , Quiasma Óptico , Neuritis Óptica/fisiopatología , Adolescente , Adulto , Aracnoiditis/diagnóstico por imagen , Aracnoiditis/patología , Niño , Femenino , Humanos , Masculino , NeumoencefalografíaRESUMEN
We report 36 cases of post-traumatic "primary brain stem haemorrhage" visualized by the CT scan and confirmed at autopsy. Clinical experience shows that many technical factors influence the inability to visualize brain stem haemorrhages. Experimental injection of fresh blood into the pons and midbrain of cadavers shows that lesions as small as 0.25 ml in volume may be visualized. The volume and the anatomical configuration of traumatic lesions of the brain stem extended over a rostro-caudal direction, and their proximity to bony structures at the base of the skull are obstacles to the visualization of brain stem haemorrhages.