Fetal brain MR angiography at 1.5 T: a feasible study.

PURPOSE: The use of magnetic resonance angiography (MRA) for assessing CNS fetal vasculature has been limited. The aim of this study was to determine the feasibility and added value of 2D time-of-flight (TOF) MRA of the fetal brain vasculature with a 1.5 T scanner. METHODS: We conducted a prospective study (September 2018 to October 2022) by consecutively selecting pregnant women (≥ 18 years) with clinical indication to fetal brain MRI. On a 1.5 T scanner, a 2D TOF MRA acquisition was obtained at the end of the clinical protocol. Two neuroradiologists independently reviewed all MRIs; a qualitative scale of motion artifacts was applied to MRA images; represented vessels in MRA and T2 images were registered. RESULTS: Thirty-five fetal brain MRIs. Mean maternal age: 32 years; mean fetal gestational age (GA): 31 weeks. Artifacts were found in 74% of MRA. The number of MRAs performed without artifacts increased with GA. On MRA, the identification of the majority of vessels increased with GA; statistical significance was reached in the identification of torcular Herophili (p = 0.026), vein of Galen (p < 0.001), internal cerebral veins (p = 0.002), basilar artery (p = 0.027), vertebral arteries (p = 0.025), and middle cerebral arteries (p = 0.044). Significantly, MRA depicted the sigmoid sinuses and internal jugular veins more frequently. Vascular pathology was found in 3/35 fetal brain MRIs. CONCLUSION: Although artifacts were found in 74% of cases, MRA acquisitions were informative and of sufficient diagnostic quality in most studies. This technique may represent a valuable complimentary tool in CNS prenatal vascular studies.

Symptomatic Subdural Hygroma Following Acinetobacter Meningitis in an Infant.

We present a case of a full-term newborn with prenatal congenital heart disease, admitted to a level III neonatal intensive care unit. After undergoing a surgical palliation procedure, he experienced a complicated recovery, including nosocomial sepsis with isolation of Acinetobacter nosocomialis in both blood and cerebrospinal fluid. Subsequently, he developed focal clonic seizures that were refractory to antiepileptic drugs, and imaging studies revealed the presence of a subdural hygroma. Surgical drainage was performed, resulting in the resolution of the seizures. This report highlights the rare occurrence of Acinetobacter meningitis unrelated to neurosurgery and its progression to subdural hygroma in an infant, emphasizing the importance of recognizing such complications as potential causes of refractory seizures following infectious processes.

Neuroimaging of pediatric tumors of the sellar region-A review in light of the 2021 WHO classification of tumors of the central nervous system.

Sellar/suprasellar tumors comprise about 10% of all pediatric Central Nervous System (CNS) tumors and include a wide variety of entities, with different cellular origins and distinctive histological and radiological findings, demanding customized neuroimaging protocols for appropriate diagnosis and management. The 5th edition of the World Health Organization (WHO) classification of CNS tumors unprecedently incorporated both histologic and molecular alterations into a common diagnostic framework, with a great impact in tumor classification and grading. Based on the current understanding of the clinical, molecular, and morphological features of CNS neoplasms, there have been additions of new tumor types and modifications of existing ones in the latest WHO tumor classification. In the specific case of sellar/suprasellar tumors, changes include for example separation of adamantinomatous and papillary craniopharyngiomas, now classified as distinct tumor types. Nevertheless, although the current molecular landscape is the fundamental driving force to the new WHO CNS tumor classification, the imaging profile of sellar/suprasellar tumors remains largely unexplored, particularly in the pediatric population. In this review, we aim to provide an essential pathological update to better understand the way sellar/suprasellar tumors are currently classified, with a focus on the pediatric population. Furthermore, we intend to present the neuroimaging features that may assist in the differential diagnosis, surgical planning, adjuvant/neoadjuvant therapy, and follow-up of this group of tumors in children.

Pituitary Adenoma "Pneumo-Apoplexy".

Tension pneumosella has been recognized as a very rare complication of pituitary transsphenoidal surgery. To the best of our knowledge, we report the second case of a pituitary adenoma "pneumo-apoplexy", which is characterized by findings consistent with tension pneumosella in the context of apoplexy of a pituitary adenoma; although it is an extremely rare diagnosis, it should be considered in patients with compatible clinical and radiological findings, particularly with a previous history of transsphenoidal pituitary surgery.

Successful technical note-Identification of the Adamkievicz artery with 1.5 Tesla MR angiography in a 14-month-old child.

Posterior mediastinal tumors surgery may be complicated by their proximity to the artery of Adamkiewicz (AKA) and its segmental supplier, increasing the risk of ischemia of the spinal cord. We describe a case of preoperative identification of the AKA with magnetic resonance angiography (MRA) in a 14-month-old boy diagnosed with a thoracic neuroblastoma, thus allowing an accurate surgical planning in order to avoid injury to those vessels. Given the relatively high incidence of posterior mediastinal tumors in the pediatric age, MRA may establish itself as a viable alternative for this purpose, even in young children.

O envelhecer na sétima arte: o capitão américa e seus retratos biopsicossociais / Aging in the seventh art: captain america and his biopsychosocial portraits

Este artigo propõe uma análise das representações sociais da velhice, do lazer e dos aspectos biopsicossociais relacionados ao processo de envelhecimento, tendo como base as idades cronológica, biológica, psicológica e social do indivíduo, a partir da trajetória do Capitão América - personagem de histórias em quadrinho criado nos anos 1940. Os resultados desta pesquisa apontam que as temáticas relativas à longevidade necessitam de rearranjos de ideias e de valores, no sentido de assegurar um envelhecimento ativo e socialmente inserido, tendo o entretenimento e as produções cinematográficas um potencial para auxiliar nesse movimento.

This article proposes an analysis of the social representations of old age, leisure, entertainment and biopsychosocial aspects related to the aging process, based on the individual's chronological, biological, psychological and social ages, based on the trajectory of Captain America - character of comic books created in the 1940s. The results of this research show that the themes related to old age need rearrangements of ideas and values, in order to ensure an active and socially inserted aging, with leisure and film productions a potential for assist in this movement.

Aplicativos móveis para a saúde e o cuidado de idosos / Mobile applications for the health and care of elderly / Aplicaciones móviles para la salud y el cuidado de los ancianos

O crescente uso de smartphones, aliado ao envelhecimento populacional, fez surgirem no mercado diversos aplicativos voltados para o público idoso. Diante dessa realidade, o objetivo do estudo aqui apresentado foi descrever os aplicativos direcionados à saúde e ao cuidado de idosos. Realizou-se uma busca de aplicativos em smartphones com sistema operacional Android e iOS. Os descritores utilizados na busca foram: 'idoso','saúde do idoso', 'envelhecimento', 'elderly' e 'salud de los ancianos'. Foram encontrados 25 aplicativos que abrangem três temas: saúde dos idosos, cuidado de idosos e informações sobre a saúde e o cuidado de idosos. Os aplicativos objetivam a prática de exercício físico, a prevenção ou detecção de quedas, a estimulação cognitiva, a busca de profissionais ou serviços, o auxílio ao cuidado de idosos e a divulgação de informações sobre saúde e sobre doenças e tratamentos. Esses recursos podem trazer grande contribuição à saúde e ao aperfeiçoamento do cuidado ao idoso, sendo um instrumento de monitoramento, informação e promoção de hábitos saudáveis.(AU)

The increasing use of smartphones, coupled with the aging of the population, has brought to the marketseveral applications aimed at the elderly public. Faced with this reality, the objective of the study presentedon this article was to describe the applications directed to the health and care of the elderly. We searchedfor applications on smartphones with Android and iOS operating systems. The descriptors used in thesearch were: 'idoso', 'saúde do idoso', 'envelhecimento', 'elderly' and 'health of the elderly'. 25 applicationscovering three themes were found: elderly health, elderly care, and health and care information about the elderly. The applications aim the practice of physical exercise, the prevention or detection of falls,the cognitive stimulation, the search for professionals or services, the assistance of elderly care and the dissemination of information on health and on diseases and treatments. Applications for smartphones can make a great contribution to health and the improvement of elderly care, being an instrument formonitoring, information and promotion of healthy habits.

El creciente uso de teléfonos inteligentes, aliado al envejecimiento de la población, hizo que surgiesen en el mercado diversas aplicaciones destinadas al público anciano. Ante esa realidad el objetivo del estudio ahora presentado fue describir las aplicaciones dirigidas a la salud y al cuidado de los ancianos.Se realizó una búsqueda de aplicaciones en teléfonos inteligentes con sistema operativo Android e iOS. Los descriptores utilizados en la búsqueda fueron: 'idoso', 'saúde do idoso', 'envelhecimento', 'elderly' e'salud de los ancianos'. Fueron encontradas 25 aplicaciones que abarcan tres temas: salud de los ancianos,cuidado de los ancianos y información sobre salud y cuidados de los ancianos. Las aplicaciones objetivan la práctica de ejercicios físicos, la prevención o detección de caídas, la estimulación cognitiva, la búsqueda de profesionales o servicios, la ayuda al cuidado del anciano y la divulgación de información sobre la saludy sobre las enfermedades y los tratamientos. Las aplicaciones para teléfonos inteligentes pueden aportar una gran contribución a la salud y para mejorar el cuidado del anciano, siendo un recurso de vigilancia, información y promoción de hábitos saludables.

Development of an application for mobile devices to evaluate the balance and risk of falls of the elderly / Desenvolvimento de um aplicativo para dispositivos móveis de avaliação do equilíbrio e risco de quedas em idosos

Abstract Objective: to develop an application for mobile devices to evaluate the balance and risk of falls of the elderly. Method: A cross-sectional study with a sample composed of 54 elderly individuals with an average age of 71 years submitted to three balance and risk of falls evaluation tests, was performed. The Timed Up and Go (TUG) and Performance Oriented Mobility Assessment (POMA) tests were employed. Results: The results were closely correlated, identifying three groups of volunteers: low, medium and high risk of falls. When these values were compared with the analyzes performed by the application, some of the variations in the results generated by the application were not related to the classic tests, as the software could discriminate between individuals with a high and low risk of falls. Conclusion: The developed application was able to verify the oscillations present in the maintenance of static balance of the elderly and could differentiate the results into two groups of high and low risk of falls. AU

Resumo Objetivo: desenvolver um aplicativo para dispositivos móveis para avaliação do equilíbrio e risco de queda em idosos Método: estudo transversal para validação do mesmo, com 54 idosos submetidos a três testes de avaliação do equilíbrio e risco de queda: os testes Timed Up and Go (TUG) e Teste de Avaliação da Mobilidade Orientada pela Performance (POMA). Resultado: Os resultados apresentaram uma boa correlação, possibilitando agrupar os voluntários em três grupos de baixo, médio e alto risco de queda. Quando esses valores foram confrontados com as análises realizadas pelo aplicativo, parte da variação dos resultados do aplicativo não estava relacionada com os testes clássicos, de forma que o software conseguiu diferenciar os idosos com baixo e alto risco de quedas. Conclusão: O aplicativo desenvolvido foi capaz de verificar as oscilações presentes na manutenção do equilíbrio estático de idosos e diferenciar os resultados em grupos de baixo e alto risco de queda. AU

Detailed magnetic resonance imaging features of a case series of primary gliosarcoma.

Objective We aimed to characterise the magnetic resonance imaging (MRI) features of a case series of primary gliosarcoma, with the inclusion of diffusion-weighted imaging and perfusion imaging with dynamic susceptibility contrast MRI. Materials and methods We conducted a retrospective study of cases of primary gliosarcoma from the Pathology Department database from January 2006 to December 2014. Clinical and demographic data were obtained. Two neuroradiologists, blinded to diagnosis, assessed tumour location, signal intensity in T1 and T2-weighted images, pattern of enhancement, diffusion-weighted imaging and dynamic susceptibility contrast MRI studies on preoperative MRI. Results Seventeen patients with primary gliosarcomas had preoperative MRI study: seven men and 10 women, with a mean age of 59 years (range 27-74). All lesions were well demarcated, supratentorial and solitary (frontal n = 5, temporal n = 4, parietal n = 3); 13 tumours abutted the dural surface (8/13 with dural enhancement); T1 and T2-weighted imaging patterns were heterogeneous and the majority of lesions (12/17) showed a rim-like enhancement pattern with focal nodularities/irregular thickness. Restricted diffusion (mean apparent diffusion coefficient values 0.64 × 10-3 mm2/s) in the more solid/thick components was present in eight out of 11 patients with diffusion-weighted imaging study. Dynamic susceptibility contrast MRI study ( n = 8) consistently showed hyperperfusion in non-necrotic/cystic components on relative cerebral volume maps. Conclusions The main distinguishing features of primary gliosarcoma are supratentorial and peripheral location, well-defined boundaries and a rim-like pattern of enhancement with an irregular thick wall. Diffusion-weighted imaging and relative cerebral volume map analysis paralleled primary gliosarcoma with high-grade gliomas, thus proving helpful in differential diagnosis.

Torcular pseudomass: a potential diagnostic pitfall in infants and young children.

BACKGROUND: Incidental findings on brain MRI may constitute a diagnostic pitfall. We observed an incidental extra-axial midline rounded pseudomass between the torcular Herophili and the occipital squama, with spontaneous resolution, which we called "torcular pseudomass." OBJECTIVE: We investigated the frequency, imaging features, natural history and developmental background of this finding in a large group of infants and young children. MATERIALS AND METHODS: We conducted a single-center retrospective study by reviewing all brain MRIs performed in children younger than 3 years between 2007 and 2013 in a specialized pediatric hospital. We looked for soft tissue (minimum 2 mm thick) interposed between the torcula and the occipital squama on midsagittal T1 and T2 images; we recorded the maximal diameters and outcome. RESULTS: Of 2,283 the children who had brain MRIs during the study period, 291 (12.7%, 95% confidence interval [CI] 0.11, 0.14) presented with a torcular pseudomass (median age 4 months, range 0 days to 35 months, 56% male). MRI features were the same in all of these children: T1 isointensity and T2 hyperintensity to the cerebral cortex, facilitated diffusion on diffusion-weighted imaging and apparent diffusion coefficient maps, and contrast enhancement. The median diameters were: anteroposterior, 5.8 mm; transverse, 10.5 mm; cranio-caudal, 20.6 mm. Follow-up MRI was available in 34.7% (95% CI: 0.20, 0.40) of the children; median follow-up time was 18 months. Among these children, 35.6% (95% CI: 0.26, 0.45) had total involution, 52.5% (95% CI: 0.26, 0.62) had partial involution and 4.1% (95% CI: 0.05, 0.18) showed stability. CONCLUSION: Redundant soft tissue in the torcular region, or torcular pseudomass, is not an infrequent finding in infants and young children. It should be considered a physiological tissue, reflecting the postnatal developmental process of the brain and cranial vault, without the need for further investigation or follow-up imaging studies.

Brain magnetic resonance in status epilepticus: A focused review.

PURPOSE: Status epilepticus (SE) is a neurological emergency with multiple etiologies and a complex pathophysiology, which is incompletely understood. Brain magnetic resonance imaging (MRI) represents a noninvasive tool to increase our knowledge about epileptogenesis. This paper aims to review the main MRI findings in SE. METHOD: We conducted a search in Medline database using the terms "MRI", "brain" and "status epilepticus" and further crossed for "diffusion-weighted image" (DWI), "perfusion", "spectroscopy", "susceptibility-weighted image" (SWI), "mortality", "morbidity" and "outcome". INCLUSION: original articles written in English and selected case reports published from 1995 to 2015. Exclusion: reviews. RESULTS: MRI may play a pivotal role in the disclosure of the etiology of SE, epileptic focus location and seizure propagation. Several techniques have been used. Concerning DWI, experimental models and clinical studies have complementary results. Periictal abnormalities may occur with cytotoxic and/or vasogenic edema involving both cortical and subcortical structures, but literature is controversial regarding their significance. DWI changes can be transient, but their maintenance could mean irreversible neuronal damage leading to focal brain atrophy and gliosis (mostly in the hippocampal region), possibly developing a new epileptic focus. Perfusion studies, including arterial spin labeling data, showed changes in cerebral blood flow. We also explore the possible vascular insight provided by SWI. CONCLUSION: Ongoing imaging technical advances, particularly regarding MRI, may shed a light on SE pathophysiology and its structural or functional consequences, in a noninvasive way. Its findings may have implications in prognosis, potentially allowing the development of new and more individualized therapeutic.

Second-Line Chemotherapy in Recurrent Glioblastoma: A 2-Cohort Study.

BACKGROUND: Glioblastoma (GB) is the most common malignant primary central nervous system tumor in adults. Standard-of-care therapy includes surgical resection, radiotherapy and temozolomide, but nearly all patients experience disease progression. The purpose of this study was to describe 2 cohorts of patients with recurrent GB submitted to second-line treatment with procarbazine/lomustine/vincristine (PCV) or bevacizumab/irinotecan (BI). MATERIAL AND METHODS: Retrospective analysis of GB patients treated in our center with PCV or BI, after progression with temozolomide, between 2004 and 2012. RESULTS: Among 60 patients, 41 were treated with BI and 19 with PCV. According to the Macdonald criteria, the overall response rate in the BI group was 66% (n = 27) while it was 11% (n = 2) in the PCV group. The median progression-free survival was 5 and 3 months in the BI and PCV group, respectively. The median overall survival (OS) since second-line chemotherapy was 9 months in the BI group and 5 months in the PCV group. The latter group had a worse toxicity profile (grade 3-4: 52.6% vs. 22.0%; grade 1-2: 89.5% vs. 68.3%). CONCLUSIONS: The BI cohort had higher response rates, almost twice the OS and a lower degree of toxicity in contrast to the PCV group. The small number of patients and historical cohorts limits these comparisons.