Encefalopatía hepática: el manganeso también brilla en T1 / Hepatic encephalopathy: manganese also shines in T1

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[Posterior reversible encephalopathy and renal failure. Value of the diffusion magnetic resonance]. / Encefalopatía posterior reversible e insuficiencia renal. Valor de la resonancia magnética por difusión.

INTRODUCTION: Posterior reversible encephalopathy (PRE) is a radiological clinical syndrome described for the first time in 1996. The most frequent symptoms are headache, visual disorders, altered mental states and seizures. The basic characteristics is the presence of reversible cerebral injuries generally. They mainly affect the later regions of the brain of bilateral form and they are more prominent in the white matter. It is mainly associated with severe arterial hypertension of fast development and states of immunosuppression. CASE REPORT: An 11-year-old male child with renal failure that it developed a PRE with extensive affectation corticosubcortical of the cerebral white matter of posterior predominance. Also injuries in frontal lobes, hard body and bulb existed. Its precocious diagnosis by means of conventional magnetic resonance (MR) and diffusion MR allowed a fast treatment, that caused a complete recovery, clinical as much radiological. CONCLUSION: The MR and the diffusion MR allow to make a diagnosis of certainty of the PRE and to differentiate it from other injuries. The diffusion MR is a fast sequence and of easy essential handling in the precocious diagnosis of this syndrome.

Encefalopatía posterior reversible e insuficiencia renal. Valor de la resonancia magnética por difusión / Posterior reversible encephalopathy and renal failure. Value of the diffusion magnetic resonance

Introducción. La encefalopatía posterior reversible (EPR) es un síndrome clinicorradiológico descrito por primera vez en 1996. Los síntomas más frecuentes son cefalea, vómitos, alteraciones del estado mental, trastornos visuales y convulsiones. La característica principal es la presencia de lesiones cerebrales generalmente reversibles. Afectan sobre todo a las regiones posteriores del cerebro de forma bilateral y son más prominentes en la sustancia blanca. Se asocia principalmente con hipertensión arterial grave de rápido desarrollo y estados de inmunosupresión. Caso clínico. Niño de 11 años con insuficiencia renal, que desarrolló una EPR con extensa afectación corticosubcortical de la sustancia blanca cerebral de predominio posterior. También existían lesiones en lóbulos frontales, cuerpo calloso y bulbo. Su diagnóstico precoz mediante resonancia magnética (RM) convencional y RM por difusión permitió un tratamiento rápido, que propició una recuperación completa, tanto clínica como radiológica. Conclusión. La RM y la RM difusión permiten realizar un diagnóstico de certeza de la EPR y diferenciarla de otras entidades. La RM difusión es una secuencia rápida y de fácil tratamiento, imprescindible en el diagnóstico precoz de este síndrome (AU)

Introduction. Posterior reversible encephalopathy (PRE) is a radiological clinical syndrome described for the first time in 1996. The most frequent symptoms are headache, visual disorders, altered mental states and seizures. The basic characteristics is the presence of reversible cerebral injuries generally. They mainly affect the later regions of the brain of bilateral form and they are more prominent in the white matter. It is mainly associated with severe arterial hypertension of fast development and states of immunosuppression. Case report. An 11-year-old male child with renal failure that it developed a PRE with extensive affectation corticosubcortical of the cerebral white matter of posterior predominance. Also injuries in frontal lobes, hard body and bulb existed. Its precocious diagnosis by means of conventional magnetic resonance (MR) and diffusion MR allowed a fast treatment, that caused a complete recovery, clinical as much radiological. Conclusion. The MR and the diffusion MR allow to make a diagnosis of certainty of the PRE and to differentiate it from other injuries. The diffusion MR is a fast sequence and of easy essential handling in the precocious diagnosis of this syndrome (AU)

[Early subdural haematoma as the first symptom of intracranial hypotension syndrome: results from magnetic resonance imaging]. / Hematoma subdural precoz como forma de inicio del sindrome de hipotensión intracraneal: hallazgos en resonancia magnética.

INTRODUCTION: Subdural haematoma associated to intracranial hypotension syndrome (IHS) is an infrequent complication. Its sudden early appearance in this female patient allowed us to diagnose and treat the syndrome at an early stage of development. CASE REPORT: We describe the case of a 29-year-old patient who had a caesarean with spinal anaesthesia and, 48 hours afterwards, presented IHS accompanied by focal neurological symptoms as a consequence of a subdural haematoma. Performing an emergency computerised tomography scan and magnetic resonance imaging (MRI) at 14 hours allowed early diagnosis and treatment to be established. CONCLUSIONS: MRI is essential to confirm the clinical suspicion of IHS and thus avoid the need to submit the patient to invasive tests. In this way, treatment for the IHS can be initiated at an early stage and the subdural haematoma can be resolved without the need for surgical drainage.

Hematoma subdural precoz como forma de inicio del síndrome de hipotensión intracraneal: hallazgos en resonancia magnética / Early subdural haematoma as the first symptom of intracranial hypotension syndrome: results from magnetic resonance imaging

Introducción. El hematoma subdural asociado al síndrome de hipotensión intracraneal (SIH) es una complicación infrecuente. Su aparición brusca y temprana en esta paciente permitió diagnosticar y tratar precozmente el síndrome. Caso clínico. Mujer de 29 años sometida a una cesárea con raquianestesia, que presentó a las 48 horas un SIH, acompañado de síntomas neurológicos focales, como consecuencia de un hematoma subdural. La realización de una tomografía computarizada en condiciones de urgencia y de una resonancia magnética a las 14 horas permitió acometer un diagnóstico y un tratamiento tempranos. Conclusiones. La resonancia magnética es fundamental para confirmar la sospecha clínica del SIH y evitar el empleo de pruebas invasivas para el paciente. De este modo, se puede instaurar de forma precoz el tratamiento del SIH y tener la posibilidad de conseguir la resolución del hematoma subdural sin necesidad de un drenaje quirúrgico (AU)

Introduction. Subdural haematoma associated to intracranial hypotension syndrome (IHS) is an infrequent complication. Its sudden early appearance in this female patient allowed us to diagnose and treat the syndrome at an early stage of development. Case report. We describe the case of a 29-year-old patient who had a caesarean with spinal anaesthesia and, 48 hours afterwards, presented IHS accompanied by focal neurological symptoms as a consequence of a subdural haematoma. Performing an emergency computerised tomography scan and magnetic resonance imaging (MRI) at 14 hours allowed early diagnosis and treatment to be established. Conclusions. MRI is essential to confirm the clinical suspicion of IHS and thus avoid the need to submit the patient to invasive tests. In this way, treatment for the IHS can be initiated at an early stage and the subdural haematoma can be resolved without the need for surgical drainage (AU)

[Congenital absence of a cervical spine pedicle. Incidental finding in patient with cervical pain. Diagnostic approach by helical CT]. / Agenesia congénita del pediculo en una vértebra cervical. Hallazgo casual en pacientes con cervicalgia. Diagnóstico de certeza mediante TC espiral.

Congenital absence of a cervical pedicle is usually an incidental finding in radiological studies made after trauma in patients with cervical pain. We report the case of a patient with congenital absence of the right pedicle in a cervical vertebra. Recognition of this anomaly is important to avoid confusion with more clinically significant anomalies, such as unilateral facet dislocation, that may result in inappropriate surgical intervention.

[Dilation of the ventriculus terminalis, an infrequent cause of lower back pain. Magnetic resonance findings]. / Dilatación del ventrículo terminal, causa infrecuente de lumbalgia. Hallazgos en resonancia magnética.

INTRODUCTION: Ventriculus terminalis is the name given to a congenital disorder that consists in the appearance of a small oval ependymal cystic cavity in the conus medullaris. It is formed during embryogenesis as a result of the differentiation between the canalisation and regression of the spinal cord. The aim of this study is to describe the findings obtained by magnetic resonance (MR) imaging concerning the dilation of the ventriculus terminalis in a symptomatic patient. CASE REPORT: A 41-year-old female with a three-year history of lower back pain and irradiated pain in the left leg, together with paresthesias. The physical exploration revealed hypoesthesia with a low level of sensitivity in D12, L1 and L2. MR images revealed the presence of a cystic lesion located in the conus medullaris, with a well defined outline, and which was not enhanced following contrast IV. CONCLUSION: The ventriculus terminalis is the ependymal cavity that lies in the conus medullaris. It may present an abnormal dilation and we need to know of its existence, where it is typically located and its signal characteristics in MR in order to be able to diagnose and differentiate it from cystic tumours situated in the same place, which can display a similar appearance in MR images. The therapeutic management of these patients will depend on their clinical progress. MR scanning is fundamental for diagnosing and monitoring symptomatic patients.

Dilatación del ventrículo terminal, causa infrecuente de lumbalgia. Hallazgos en resonancia magnética / Dilation of the ventriculus terminalis, an infrequent cause of lower back pain. Magnetic resonance findings

Introducción. Se llama ventrículo terminal a una alteración congénita que consiste en la aparición de una pequeña cavidad quística ependimaria ovalada que se localiza en el cono medular. Se forma durante la etapa de la embriogénesis como resultado de la diferenciación en la canalización y regresión de la médula espinal. El objetivo de este caso es describir los hallazgos por resonancia magnética (RM) de la dilatación del ventrículo terminal en un paciente sintomático. Caso clínico. Mujer de 41 años con historia de lumbalgia y dolor irradiado a la pierna izquierda, junto con parestesias, de tres años de evolución. En la exploración física presentaba hipoestesia con nivel sensitivo suspendido en D12, L1 y L2. Las imágenes de RM mostraron la presencia de una lesión quística que se localizó en el cono medular, de contorno bien definido y que no se realzaba tras el contraste IV. Conclusión. El ventrículo terminal es la cavidad ependimaria que se halla en el cono medular. Puede presentar una dilatación anormal y es necesario conocer su existencia, su localización típica y sus características de señal en la RM para poder diagnosticarlo y diferenciarlo de tumoraciones quísticas de esta localización, que pueden presentar un aspecto similar por RM. El manejo terapéutico de estos pacientes dependerá de la evolución clínica. La RM es fundamental para el diagnóstico y el seguimiento de los pacientes sintomáticos (AU)

Introduction. Ventriculus terminalis is the name given to a congenital disorder that consists in the appearance of a small oval ependymal cystic cavity in the conus medullaris. It is formed during embryogenesis as a result of the differentiation between the canalisation and regression of the spinal cord. The aim of this study is to describe the findings obtained by magnetic resonance (MR) imaging concerning the dilation of the ventriculus terminalis in a symptomatic patient. Case report. A 41-yearold female with a three-year history of lower back pain and irradiated pain in the left leg, together with paresthesias. The physical exploration revealed hypoesthesia with a low level of sensitivity in D12, L1 and L2. MR images revealed the presence of a cystic lesion located in the conus medullaris, with a well-defined outline, and which was not enhanced following contrast IV. Conclusion. The ventriculus terminalis is the ependymal cavity that lies in the conus medullaris. It may present an abnormal dilation and we need to know of its existence, where it is typically located and its signal characteristics in MR in order to be able to diagnose and differentiate it from cystic tumours situated in the same place, which can display a similar appearance in MR images. The therapeutic management of these patients will depend on their clinical progress. MR scanning is fundamental for diagnosing and monitoring symptomatic patients (AU)