Traumatic labyrinthine concussion in a patient with sensorineural hearing loss.

Blunt head trauma without any temporal bone fracture or longitudinal temporal bone fracture, with an associated fracture of the labyrinth may cause labyrinthine injury with sensor neural hearing loss and vertigo because of a concussive injury to the membranous labyrinth. Sudden sensory neural hearing loss is relatively frequent. In most cases, the etiology is not discovered. One of the possible causes for sudden deafness is inner labyrinth bleeding or concussion, which were difficult to diagnose before the advent of magnetic resonance imaging. Vertigo without a demonstrable fracture may also be the result of labyrinthine concussion, cupololithiasis and perilymphatic fistula. We describe the clinical case of a patient with acute traumatic hearing loss and vertigo, without skull base fracture detected on computed tomography. Magnetic resonance study was also performed. We have integrated the discussion with features that allow the differential diagnosis from other similar conditions.

Spontaneous ruptured cavernous aneurysm treated by stenting and embolization in a young patient. A case report and literature review.

We describe a case of endovascular management of a ruptured aneurysm of the intracavernous portion of the left internal carotid artery with sphenoid extension. The exclusive use of coils to embolize the aneurysm in acute and young patients offers the advantage of avoiding both pre-implant antiplatelet therapy and long-term anticoagulant therapy required after stent or vascular plug placement, but it is complicated by the non-negligible risk of recurrence. Indeed, the only secure method to treat ruptured aneurysms of the intracavernous portion of the internal carotid artery is to use coils in the first stage to stop the haemorrhage without antiplatelet therapy and to use stents in the second narrow stage to prevent revascularization.

Guillain-barré syndrome associated with acute onset bilateral facial nerve palsies. A case report and literature review.

Guillain-Barré syndrome is a post infectious, immune-mediated disease with cranial nerve involvement observed in 45-75% of patients. Bilateral facial nerve palsy is rather uncommon and occurs in 0.3% to 2% of all facial palsies. We describe a rare case of a 29-year-old man with bilateral facial palsy caused by a Guillain-Barré syndrome with an unusual onset and progression of neurological symptoms. Neuroradiological findings in our patient are described and compared with data from literature on bilateral facial palsies to make differential diagnosis easier for neuroradiologists.

Advanced ossification of the posterior longitudinal ligament in a mildly symptomatic patient. A case report and literature review.

We describe the imaging findings of a man who developed neurologic symptoms due to ossification of the posterior longitudinal ligament with narrowing of the spinal canal and compression of the spinal cord. CT study allowed a detailed evaluation of the stenosis and the extension of the ossification while MRI gave an excellent visualization of the spinal lesions caused by spinal cord compression by the mass. The neurological status of patients with ossification of the posterior longitudinal ligament depends on many factors such as the degree of spinal canal stenosis, life style, accidental mechanical stress and trauma.

An orbital lymphoma involving the pterygopalatine and infratemporal fossae. A case report.

Lymphoma is the most common malignant orbital tumor. We describe the imaging features of diffuse orbital follicular lymphoma with extension into the pterygopalatine fossa and infratemporal fossa without bony infiltration.

Bilateral congenital absence of internal carotid arteries in a woman with dementia. A case report.

Dysgenesis of THE internal carotid artery is considered a rare condition, present in about 0.01% of subjects. This anomaly is generally asymptomatic and often represents an incidental finding in radiological examinations of the head performed for other reasons. A 75-year-old woman with symptoms of dementia was admitted to our hospital. Computed tomography and magnetic resonance examinations were performed. They showed the absence of both internal carotid arteries and the congenital nature of this abnormality. The usefulness of CT and MRI examinations in patients with this vascular abnormality is discussed.

Transient bilateral Basal Ganglia lesions in rotavirus encephalopathy. A case report.

Rotavirus gastroenteritis may be associated with the onset of an acute reversible encephalitis. We describe a case of transient bilateral basal ganglia lesions after a prodromal gastroenteritis which completely resolved four months later. Diffusion weighted images were determinant to depict the basal ganglia abnormalities and were helpful to evaluate the prognosis. A review of the literature indicates that many diseases may be accompanied by signal abnormalities within the basal ganglia and that differential diagnosis is possible only through the simultaneous evaluation of imaging, clinical and laboratory findings.

Evaluation of a Patient with Klumpke's Palsy. A Case Report.

Klumpke's palsy is a rare form of paralysis involving the muscles of the forearm and hand, resulting from a brachial plexus injury in which the eighth cervical (C8) and first thoracic (Th1) nerves are injured either before or after they have joined to form the lower trunk. We report a case of a 45 years-old woman with post-traumatic left cervical-brachial pain afflicted by obstetric brachial plexus palsy on the right side. Magnetic Resonance Imaging (MRI) examination of the cervical spine revealed a meningeal stretch in the left side at C7-Th1 level, responsible for pain, and also multiple intraforaminal pseudomeningoceles at C5-C6, C6-C7 and C7-Th1 intersomatic spaces in the right side, due to the perinatal trauma that had determined the obstetric brachial plexus palsy. Spinal pseudomeningocele is an extradural collection of CSF in the surrounding soft tissues due to a dural breach and can represent a predictive finding of injury of the brachial plexus. We obtained clinical and electrophysiological findings of Klumpke's palsy, but MRI examination showed the lack of visualization of C8 and the integrity of Th1 nerve roots and to our knowledge there is no evidence in literature about the possibility to have a partial Klumpke's palsy without Th1 avulsion. The aim of this article was to underline that for the correct assessment of patients with brachial plexus palsy the only use of MRI is insufficient: it is necessary an integration of the information obtained from clinical, electromyographic and MRI study.

Spontaneous temporal cerebrospinal fluid leak. A case report and literature review.

An abnormal communication between the subarachnoid spaces and the tympanic cavity and mastoid cells can determine a cerebrospinal fluid (CSF) leak in the air spaces of the temporal bone. The etiology of CFS leak in the temporal air cells includes acquired, congenital and spontaneous causes. Spontaneous CSF leak, defined as a leak without a manifest cause, is present in about 4% of cases and often occurs in the middle cranial fossa. We describe a case of spontaneous CSF leak in the right temporal air cells that mimicked a skull fracture in a subject with headache and apparent rhinorrhea after a head trauma. Both CT and MRI play a key role in the differential diagnosis between post-traumatic temporal CSF leak due to a fracture and spontaneous leak: traumatic CSF leak often does not require a surgical approach, whereas spontaneous CSF leak may need surgical treatment because of the risk of meningitis.

Vertebral aggressive hemangioma. A case report and literature review.

Aggressive hemangiomas are rare and can compress the spinal cord, nerve roots or both, producing myelopathy or radiculopathy. This report describes an aggressive and compressive hemangioma of the body of the Th9 vertebra in a woman with symptoms of medullary sufferance, treated with embolization of the afferent vessels of the lesion followed by radiotherapy.

MRI Aspects of Neuro-Vascular Conflict of the VIII Nerve.

The vascular cross compression syndrome of the vestibule-cochlear nerve is an abnormal contact between the VIII nerve and a vessel leading to tinnitus and/or vertigo due to the nerve irritation. MRI is an important diagnostic tool as it will display the whole course of the nerve and identify the site and the type of neuro-vascular contact. However, MR findings are not specific and diagnosis can only be made on the basis of clinical and otolaryngologic features, after ruling out other possible diseases causing the same symptomatology. We describe 15 patients with neuro-vascular conflict disclosed by MRI examination which was associated with non specific neuro-othologic symptoms.

An interpretation of optic nerve tortuosity. A case report.

Magnetic resonance imaging disclosed both optic nerve tortuosity and kinking in a 64-year-old man with orbital pain and monolateral abducens nerve palsy. The association between optic nerve tortuosity and abducens nerve palsy is often described in literature reports of idiopathic intracranial hypertension. However the diagnosis of idiopathic intracranial hypertension was excluded in our patient because of the absence of other signs such as papilledema (universally present in the cases of idiopathic intracranial hypertension), visual loss, headache and flattening of the posterior sclera. Other possible diagnoses to be considered when looking at a case of optic nerve tortuosity are neurofibromatosis and/or optic nerve glioma. Tortuosity of both optic nerves seems to be isolated in our patient and not associated with other diseases or disorders. We suggest that in some patients optic nerve tortuosity could be correlated with an aberrant anatomical development of the optic nerve. Further studies are necessary to confirm this hypothesis which currently remains conjectural.