Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 40.558
Filtrar
1.
Rev Med Liege ; 75(2): 75-77, 2020 Feb.
Artículo en Francés | MEDLINE | ID: mdl-32030929

RESUMEN

Moyamoya disease is a rare cerebral vasculopathy. Disease onset is mainly sudden presenting as an ischemic stroke but also sometimes as a brain hemorraghe. Cerebral angiography is the gold standard to confirm the diagnosis. Different therapeutic approaches have been described such as conservative management or endoscopic and surgical approaches. We report the case of a young patient who was diagnosed with a brain hemorraghe following a sudden loss of consciousness.


Asunto(s)
Enfermedad de Moyamoya , Accidente Cerebrovascular , Encéfalo/diagnóstico por imagen , Angiografía Cerebral , Humanos , Enfermedad de Moyamoya/complicaciones , Enfermedad de Moyamoya/diagnóstico por imagen , Accidente Cerebrovascular/etiología
2.
Isr Med Assoc J ; 22(1): 27-31, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31927802

RESUMEN

BACKGROUND: Congenital heart defects (CHD) may be associated with neurodevelopmental abnormalities mainly due to brain hypoperfusion. This defect is attributed to the major cardiac operations these children underwent, but also to hemodynamic instability during fetal life. Advances in imaging techniques have identified changes in brain magnetic resonance imaging (MRI)in children with CHD. OBJECTIVES: To examine the correlation between CHD and brain injury using fetal brain MRI. METHODS: We evaluated 46 fetuses diagnosed with CHD who underwent brain MRI. CHD was classified according to in situs anomalies, 4 chamber view (4CV), outflow tracts, arches, and veins as well as cyanotic or complex CHD. We compared MRI results of different classes of CHD and CHD fetuses to a control group of 113 healthy brain MRI examinations. RESULTS: No significant differences were found in brain pathologies among different classifications of CHD. The anteroposterior percentile of the vermis was significantly smaller in fetuses with abnormal 4CV. A significantly higher biparietal diameter was found in fetuses with abnormal arches. A significantly smaller transcerebellar diameter was found in fetuses with abnormal veins. Compared to the control group, significant differences were found in overall brain pathology in cortex abnormalities and in extra axial findings in the study group. Significantly higher rates of overall brain pathologies, ventricle pathologies, cortex pathologies, and biometrical parameters were found in the cyanotic group compared to the complex group and to the control group. CONCLUSIONS: Fetuses with CHD demonstrate findings in brain MRI that suggest an in utero pathogenesis of the neurological and cognitive anomalies found during child development.


Asunto(s)
Lesiones Encefálicas/embriología , Feto/diagnóstico por imagen , Cardiopatías Congénitas/etiología , Adulto , Encéfalo/diagnóstico por imagen , Encéfalo/embriología , Encéfalo/patología , Lesiones Encefálicas/complicaciones , Lesiones Encefálicas/diagnóstico por imagen , Lesiones Encefálicas/patología , Estudios de Casos y Controles , Ecocardiografía , Femenino , Cardiopatías Congénitas/diagnóstico por imagen , Humanos , Imagen por Resonancia Magnética , Neuroimagen , Embarazo , Diagnóstico Prenatal/métodos
3.
Medicine (Baltimore) ; 99(4): e18877, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31977892

RESUMEN

RATIONALE: Posterior reversible encephalopathy syndrome (PRES), a rare neurologic disorder, manifests as headache, altered mental status, seizures, visual disturbances, and other focal neurologic signs with typically reversible clinical symptoms and image changes. Although the underlying mechanism remains unknown, a current theory indicates cerebral autoregulation failure as the primary cause. We report a case of PRES with stroke in an adult with intrauterine fetal death (IUFD). PATIENT CONCERNS: A 35-year-old Asian woman with twin pregnancy underwent cesarean section at 32 weeks of gestation because of IUFD. She presented with focal seizures and visual field defect 2 days after undergoing cesarean section. Her blood pressure and kidney, liver, and coagulation functions were normal without proteinuria. DIAGNOSIS: PRES was diagnosed based on a series of brain magnetic resonance imaging findings. Ischemic infarction in the right frontal lobe eventually developed to encephalomalacia. INTERVENTIONS: The patient received levetiracetam and valproate for seizure management. OUTCOMES: Five days after the onset, seizures were under control. All neurologic deficits completely improved after 21 days of admission. LESSONS: PRES can occur in women with IUFD without preeclampsia or eclampsia symptoms. Although most cases result in vasogenic edema of the brain and exhibit good prognosis, PRES can cause cytotoxic edema and permanently damage the brain.


Asunto(s)
Muerte Fetal/etiología , Síndrome de Leucoencefalopatía Posterior/diagnóstico , Complicaciones del Embarazo/diagnóstico , Accidente Cerebrovascular/etiología , Adulto , Encéfalo/diagnóstico por imagen , Encéfalo/patología , Cesárea , Electrocorticografía , Femenino , Humanos , Síndrome de Leucoencefalopatía Posterior/complicaciones , Embarazo , Embarazo Gemelar , Convulsiones/etiología
4.
J Comput Assist Tomogr ; 44(1): 65-69, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31939884

RESUMEN

OBJECTIVE: Our objective is to document the imaging appearance in the intracranial compartment at the time of the infants' first postnatal brain MR imaging after fetal repair for spinal dysraphisms. METHODS: Twenty-nine patients were evaluated on fetal and postnatal magnetic resonance imaging for a series of features of Chiari II malformation. RESULTS: Of the 29 infants, 55% had resolution of tonsillar ectopia, and 62% showed a dorsal outpouching of the near the foramen magnum on postnatal magnetic resonance imaging. The majority had persistence of Chiari II features including: prominent massa intermedia (93%), tectal beaking (93%), towering cerebellum (55%), flattening of the fourth ventricle (90%), hypoplastic tentorium (97%), and tonsillar hypoplasia (59%). CONCLUSIONS: Normally positioned or minimally descended, oftentimes hypoplastic tonsils in the presence of a posterior fossa configuration typical of Chiari II, was the most common presentation. An additional documented feature was an outpouching of the dorsal thecal sac between the opisthion and the posterior arch of C1.


Asunto(s)
Malformación de Arnold-Chiari/epidemiología , Encéfalo/diagnóstico por imagen , Disrafia Espinal/cirugía , Malformación de Arnold-Chiari/diagnóstico por imagen , Femenino , Edad Gestacional , Humanos , Recién Nacido , Imagen por Resonancia Magnética , Masculino , Atención Posnatal , Embarazo , Disrafia Espinal/diagnóstico por imagen
6.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 51(1): 107-112, 2020 Jan.
Artículo en Chino | MEDLINE | ID: mdl-31950799

RESUMEN

Cerebral amyloid angiopathy associated with inflammation (CAA-ri) is characterized by an inflammatory response to the vascular deposits of ß-amyloid within the brain that is a very rare subtype of cerebral amyloid angiopathy.The most common clinical manifestation of CAA-ri was headache, epilepsy, and cognitive dysfunction. Magnetic resonance imaging (MRI) showed focal or multiple white matter lesions, lobar intracerebral hemorrhage, extensive cortical or subcortical microbleeds. We reported 6 cases of probable CAA-ri diagnosed and treated in our hospital from January 2017 to September 2019 according to the revised diagnostic criteria in 2016.We found that 5 patients also had microbleeds and cortical superficial siderosison T2 and fluid-attenuated inversion recovery (FLAIR), suggesting that if the patients had a long course of disease, older age and heavy microbleeds load, the lesions could be found in the routine MRI, which is a clue for the diagnosis of CAA-ri. Clinicians should attach great importance to this phenomenon, and can further verify by susceptibility weighted imaging (SWI).


Asunto(s)
Angiopatía Amiloide Cerebral , Inflamación , Imagen por Resonancia Magnética , Anciano , Encéfalo/diagnóstico por imagen , Angiopatía Amiloide Cerebral/complicaciones , Angiopatía Amiloide Cerebral/diagnóstico por imagen , Hemorragia Cerebral/diagnóstico por imagen , Humanos , Inflamación/etiología , Inflamación/terapia
7.
Nervenarzt ; 91(1): 18-25, 2020 Jan.
Artículo en Alemán | MEDLINE | ID: mdl-31919551

RESUMEN

Imaging methods have become the main approach for identifying dysfunctional neuronal networks in schizophrenia. This review article presents recent results of disorders of neuronal networks at structural and functional levels and summarizes the current developments. Large multicenter analyses have further established patterns of regional brain alterations, while novel methods in magnetic resonance (MR) morphometry have contributed to differentiating early from delayed brain structural changes. The use of machine learning approaches has not only enabled the establishment of classification models using biological data for future differential diagnostic use, it has also facilitated multivariate models for outcome prediction following therapeutic interventions. Novel methods, such as BrainAGE, a surrogate marker of accelerated brain aging processes, have added to longitudinal studies to gain insights into the brain structural dynamics from early brain developmental alterations to progressive structural brain changes after disease onset.


Asunto(s)
Imagen por Resonancia Magnética , Esquizofrenia , Encéfalo/diagnóstico por imagen , Humanos , Aprendizaje Automático , Neuroimagen , Esquizofrenia/diagnóstico por imagen
8.
N Engl J Med ; 382(3): 233-243, 2020 01 16.
Artículo en Inglés | MEDLINE | ID: mdl-31940698

RESUMEN

BACKGROUND: High-dose erythropoietin has been shown to have a neuroprotective effect in preclinical models of neonatal brain injury, and phase 2 trials have suggested possible efficacy; however, the benefits and safety of this therapy in extremely preterm infants have not been established. METHODS: In this multicenter, randomized, double-blind trial of high-dose erythropoietin, we assigned 941 infants who were born at 24 weeks 0 days to 27 weeks 6 days of gestation to receive erythropoietin or placebo within 24 hours after birth. Erythropoietin was administered intravenously at a dose of 1000 U per kilogram of body weight every 48 hours for a total of six doses, followed by a maintenance dose of 400 U per kilogram three times per week by subcutaneous injection through 32 completed weeks of postmenstrual age. Placebo was administered as intravenous saline followed by sham injections. The primary outcome was death or severe neurodevelopmental impairment at 22 to 26 months of postmenstrual age. Severe neurodevelopmental impairment was defined as severe cerebral palsy or a composite motor or composite cognitive score of less than 70 (which corresponds to 2 SD below the mean, with higher scores indicating better performance) on the Bayley Scales of Infant and Toddler Development, third edition. RESULTS: A total of 741 infants were included in the per-protocol efficacy analysis: 376 received erythropoietin and 365 received placebo. There was no significant difference between the erythropoietin group and the placebo group in the incidence of death or severe neurodevelopmental impairment at 2 years of age (97 children [26%] vs. 94 children [26%]; relative risk, 1.03; 95% confidence interval, 0.81 to 1.32; P = 0.80). There were no significant differences between the groups in the rates of retinopathy of prematurity, intracranial hemorrhage, sepsis, necrotizing enterocolitis, bronchopulmonary dysplasia, or death or in the frequency of serious adverse events. CONCLUSIONS: High-dose erythropoietin treatment administered to extremely preterm infants from 24 hours after birth through 32 weeks of postmenstrual age did not result in a lower risk of severe neurodevelopmental impairment or death at 2 years of age. (Funded by the National Institute of Neurological Disorders and Stroke; PENUT ClinicalTrials.gov number, NCT01378273.).


Asunto(s)
Eritropoyetina/administración & dosificación , Recien Nacido Extremadamente Prematuro , Enfermedades del Prematuro/prevención & control , Trastornos del Neurodesarrollo/prevención & control , Encéfalo/diagnóstico por imagen , Preescolar , Método Doble Ciego , Eritropoyetina/efectos adversos , Femenino , Estudios de Seguimiento , Humanos , Lactante , Recién Nacido , Enfermedades del Prematuro/mortalidad , Masculino , Trastornos del Neurodesarrollo/epidemiología , Ultrasonografía
9.
Adv Exp Med Biol ; 1232: 3-9, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31893387

RESUMEN

Neonates with hypoxic-ischaemic (HI) brain injury were monitored using a broadband near-infrared spectroscopy (NIRS) system in the neonatal intensive care unit. The aim of this work is to use the NIRS cerebral oxygenation data (HbD = oxygenated-haemoglobin - deoxygenated-haemoglobin) combined with arterial saturation (SaO2) from pulse oximetry to calculate cerebral blood flow (CBF) based on the oxygen swing method, during spontaneous desaturation episodes. The method is based on Fick's principle and uses HbD as a tracer; when a sudden change in SaO2 occurs, the change in HbD represents a change in tracer concentration, and thus it is possible to estimate CBF. CBF was successfully calculated with broadband NIRS in 11 HIE infants (3 with severe injury) for 70 oxygenation events on the day of birth. The average CBF was 18.0 ± 12.7 ml 100 g-1 min-1 with a range of 4 ml 100 g-1 min-1 to 60 ml 100 g-1 min-1. For infants with severe HIE (as determined by magnetic resonance spectroscopy) CBF was significantly lower (p = 0.038, d = 1.35) than those with moderate HIE on the day of birth.


Asunto(s)
Lesiones Encefálicas , Encéfalo , Circulación Cerebrovascular , Oximetría , Oxígeno , Espectroscopía Infrarroja Corta , Encéfalo/irrigación sanguínea , Encéfalo/diagnóstico por imagen , Lesiones Encefálicas/diagnóstico por imagen , Humanos , Recién Nacido , Oximetría/instrumentación , Oximetría/métodos , Oxígeno/metabolismo
10.
Adv Exp Med Biol ; 1232: 347-354, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31893430

RESUMEN

In preterm infants, there is a risk of long-term cognitive, motor and behavioral impairments due to hemorrhagic and/or ischemic lesions. If detected early, lesions can be prevented. A bedside imaging modality, capable of early detection of both disorders, is necessary. We present the state of development of a tomographic imager (named Pioneer), that will be capable of determining the oxygenation of the preterm-infant brain with high spatial resolution. Pioneer is a time-resolved near-infrared optical tomography (TR NIROT) instrument. It employs multiple wavelength laser light in short pulses on 11 distinct locations and measures the re-emerging light in a contactless fashion by means of a time-correlated single-photon counting (TCSPC) camera (named Piccolo) covering ~4.9 cm2 with 300 detectors. Timing response of the entire system is 116 ps. An in-house designed biocompatible source ring ensures fixed relative positions of sources and detectors and provides a secure interface between the patient and the probe. At the present state, the NIROT Pioneer system successfully detected a 6x6x50 mm3 inclusion 3 cm deep inside a phantom. These results confirm that the Pioneer imager is working as expected and is on a solid path towards full 3D tissue oxygenation imaging.


Asunto(s)
Encéfalo , Recien Nacido Prematuro , Oximetría , Oxígeno , Encéfalo/diagnóstico por imagen , Humanos , Recién Nacido , Oximetría/instrumentación , Oximetría/métodos , Oximetría/normas , Oxígeno/metabolismo , Fantasmas de Imagen
11.
Life Sci ; 240: 117091, 2020 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-31760102

RESUMEN

Mounting evidences indicated that elevated iron levels in the substantia nigra (SN) have been concerned as the underlying mechanisms of neurodegenerative diseases, including Parkinson's disease (PD). The present study used the 1-Methyl-4-phenyl-1, 2, 3, 6 -tetrahydropyridine (MPTP)-treated cynomolgus monkeys for PD to evaluate the usability of SWI for assessing iron deposition in the cerebral nuclei of PD. The results showed that susceptibility-weighted imaging (SWI) phase values of the ipsilateral (MPTP-lesion side) SN of MPTP-treated monkeys were lower than those in the contralateral SN of MPTP-treated monkeys and the same side of Control monkeys, suggesting that iron deposition were elevated in the affected side SN of MPTP-treated monkeys. Whereas MPTP has not effects on the SWI phase values in other detected brain regions of monkeys, including red nucleus (RN), putamen (PUT) and caudate nucleus (CA). Furthermore, ICP-MS results showed that MPTP increased the iron levels in MPTP injection side, but no in the ipsilateral striatum. Additionally, MPTP treatment did not affect the calcium and manganese levels in the detected brain regions of monkeys. However, Pearson correlation analysis results indicated that there were not relationship between SWI phase values in MPTP-lesion side of SN with the behavioral score, tyrosine hydroxylase (TH)-positive cells number and iron levels in the MPTP-lesion side of midbrain. Taken together, the results confirm the involvement of SN iron accumulations in the MPTP-treated monkey models for PD, and indirectly verify the usability of SWI for the measurement of iron deposition in the cerebral nuclei of PD.


Asunto(s)
Hierro/metabolismo , Intoxicación por MPTP/metabolismo , Trastornos Parkinsonianos/metabolismo , Animales , Conducta Animal , Encéfalo/diagnóstico por imagen , Calcio/metabolismo , Intoxicación por MPTP/diagnóstico por imagen , Macaca fascicularis , Imagen por Resonancia Magnética , Masculino , Manganeso/metabolismo , Espectrometría de Masas , Trastornos Parkinsonianos/inducido químicamente , Trastornos Parkinsonianos/diagnóstico por imagen , Sustancia Negra/metabolismo , Sustancia Negra/patología , Tirosina 3-Monooxigenasa/metabolismo
12.
World Neurosurg ; 133: 212-215, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31605850

RESUMEN

BACKGROUND: Development of a delayed acute epidural hematoma (DEDH) represents a rare event, characterized by a high mortality rate. It is defined as an extradural bleeding not evident at the first brain computed tomography (CT) scan performed after traumatic brain injury but evidenced by further radiologic evaluations. CASE DESCRIPTION: A 22-year-old male was admitted to our unit after brain injury due to an assault. Immediate brain CT scan revealed a right frontal epidural hematoma (EDH) and a smaller left anterior temporal EDH with multiple, bilateral skull fractures in the frontal, parietal, and temporal bones. Both EDHs were surgically treated in the same session. Another immediate CT scan showed a third left parietal acute DEDH. The patient was retransferred to the operating room for a further left parietal craniotomy and EDH evacuation. The postoperative period was uneventful: the patient effectively improved. After 15 days, the patient left the hospital and was admitted to a rehabilitation center. CONCLUSIONS: To the best of our knowledge, this is the first report of a synchronous acute bilateral EDH with the development of a third DEDH located in a separate site. This finding is certainly related to the presence of multiple and bilateral skull fractures. In our experience, we suggest performing an intraoperative CT scan, if available, to early detect the possible development of DEDH.


Asunto(s)
Encéfalo/diagnóstico por imagen , Hematoma Epidural Craneal/diagnóstico por imagen , Fracturas Craneales/diagnóstico por imagen , Encéfalo/cirugía , Craneotomía , Hematoma Epidural Craneal/etiología , Hematoma Epidural Craneal/cirugía , Humanos , Masculino , Procedimientos Neuroquirúrgicos , Fracturas Craneales/complicaciones , Fracturas Craneales/cirugía , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Adulto Joven
13.
World Neurosurg ; 133: 188-191, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31605857

RESUMEN

BACKGROUND: Cerebrospinal fluid (CSF) drainage reduces the risk of paraplegia in thoracoabdominal aortic aneurysm (TAAA) repair. Intracranial hemorrhage after TAAA repair has been reported as a rare complication of CSF drainage; however, spinal subarachnoid hematoma has never been reported. Here, we present a case of lumbosacral subarachnoid hematoma after CSF drainage in TAAA repair. CASE DESCRIPTION: The patient was a 76-year-old man who was hospitalized for TAAA repair. Just before the operation, a CSF drainage catheter was inserted into the L4/5 vertebral interspace. Continuous CSF drainage was performed during the operation. The CSF drain was clamped just after the operation, and the drainage catheters were removed at 24 hours after the operation. On postoperative day 1, the patient experienced pain and paralysis in both lower limbs that worsened over time. Magnetic resonance imaging of the brain and spinal cord was indicative of a spinal subarachnoid hematoma. Removal of hematoma with thoracolumbar and lumbosacral laminectomy was performed, and immediately after the surgery, the pain and paralysis in both lower limbs improved. Six months after the removal of the hematoma, the paralysis in both lower limbs completely resolved and the patient achieved the preinjury activity level. CONCLUSIONS: We present a rare case of lumbosacral subarachnoid hematoma after CSF drainage in TAAA repair. We should consider spinal subarachnoid hematoma when paralysis in the lower limbs occurs after CSF drainage.


Asunto(s)
Aneurisma de la Aorta Abdominal/cirugía , Aneurisma de la Aorta Torácica/cirugía , Paraplejía/etiología , Hemorragia Subaracnoidea/etiología , Anciano , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Encéfalo/diagnóstico por imagen , Drenaje/efectos adversos , Humanos , Imagen por Resonancia Magnética , Masculino , Paraplejía/diagnóstico por imagen , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/etiología , Médula Espinal/diagnóstico por imagen , Hemorragia Subaracnoidea/diagnóstico por imagen , Procedimientos Quirúrgicos Vasculares/efectos adversos
14.
World Neurosurg ; 133: 221-226, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31606497

RESUMEN

BACKGROUND: A rare but important complication related to otherwise uneventful brain and spine surgery is becoming more recognized and more frequently reported in the medical literature. This has been variably labeled as pseudohypoxic brain swelling or postoperative hypotension-associated venous congestion. This poorly understood condition occurs in the setting of surgical intervention and is thought to be related to cerebrospinal fluid leak or evacuation, decreased intracranial pressure, and subsequent development of deep venous congestion affecting the basal ganglia, thalami, and cerebellum. Clinically, patients may have global neurologic deficit and outcomes range from full recovery to vegetative state or death. The imaging correlate includes atypical edema, infarction, or hemorrhage and can overlap the appearance of diffuse hypoxic injury, for which this condition can be mistaken both clinically and radiologically. Although this deep brain tissue edema can be associated with other signs of cerebrospinal fluid hypotension such as dural thickening, brain sagging, and cerebellar herniation, it can be isolated, making the diagnosis challenging. CASE DESCRIPTION: We present 2 cases of unexpected clinical deterioration occurring in patients with otherwise uncomplicated neurosurgery, 1 with craniotomy and the other with lumbar spine intervention. Both patients exhibit similar appearing edema in the deep gray structures on postoperative magnetic resonance imaging scans. In addition to reviewing the prior literature and imaging findings, we evaluate the imaging findings to determine if there are unique features or signatures that might allow differentiation of PHBS from hypoxic-ischemic encephalopathy. CONCLUSIONS: The lentiform rim sign can be helpful for differentiation of pseudohypoxic brain swelling versus hypoxic-ischemic encephalopathy.


Asunto(s)
Edema Encefálico/diagnóstico por imagen , Encéfalo/diagnóstico por imagen , Hipotensión Intracraneal/diagnóstico por imagen , Procedimientos Neuroquirúrgicos/efectos adversos , Anciano , Anciano de 80 o más Años , Edema Encefálico/etiología , Craneotomía/efectos adversos , Femenino , Humanos , Hipotensión Intracraneal/etiología , Imagen por Resonancia Magnética , Masculino , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/etiología
15.
World Neurosurg ; 133: 10-13, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31550543

RESUMEN

BACKGROUND: Epstein-Barr virus (EBV)-positive diffuse large B-cell lymphoma (DLBCL) in an immunocompromised patient with organ transplantation demonstrated unusual brain magnetic resonance imaging (MRI) findings. Recognition of EBV-positive DLBCL by radiologists on MRI may prevent unnecessary neurosurgical resection, and it could be important to obtain viable cells for accurate diagnosis on stereotactic biopsy because of extensive necrosis. CASE DESCRIPTION: A 62-year-old woman presented to the emergency department with left hemiparesis grade III and dysarthria lasting for 3 weeks. She underwent kidney transplantation in 2007 and was taking immunosuppressants and had hypothyroidism. Brain MRI showed a 3.8-cm peripheral enhancing lesion with extensive central necrosis in association with marked perilesional edema. The irregular ringlike enhancing lesion showed diffusion restriction and mildly increased regional cerebral blood volume in the rim portion of the mass. 11C-Methionine positron emission tomography revealed slightly increased uptake in the peripheral lesion. The provisional diagnosis was a high-grade glioma. Stereotactic multiple biopsies were performed for the central necrotic area and peripheral enhancing lesion. The nonenhancing areas showed only necrotic material, without viable cells, and the enhancing portion showed viable cells for an accurate diagnosis in a frozen biopsy specimen. The pathologic diagnosis was EBV-positive DLBCL with extensive necrosis. Positron emission tomography of the chest, abdomen, pelvis, and neck soft tissues ruled out systemic diseases. She underwent whole-brain radiotherapy at a dose of 30.6 Gy. Eight months later, her neurologic symptoms had improved, with a stable brain lesion and improved perilesional edema. CONCLUSIONS: We report an immunocompromised patient with EBV-positive DLBCL, which showed atypical MRI findings, including extensive necrosis. Multiple biopsies were required for final diagnosis.


Asunto(s)
Encéfalo/patología , Infecciones por Virus de Epstein-Barr/patología , Linfoma de Células B Grandes Difuso/patología , Biopsia , Encéfalo/diagnóstico por imagen , Encéfalo/virología , Infecciones por Virus de Epstein-Barr/complicaciones , Infecciones por Virus de Epstein-Barr/diagnóstico por imagen , Femenino , Humanos , Huésped Inmunocomprometido , Trasplante de Riñón , Linfoma de Células B Grandes Difuso/complicaciones , Linfoma de Células B Grandes Difuso/diagnóstico por imagen , Imagen por Resonancia Magnética , Persona de Mediana Edad , Necrosis/diagnóstico por imagen , Necrosis/patología , Necrosis/virología , Receptores de Trasplantes
16.
World Neurosurg ; 133: 205-211, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31525480

RESUMEN

BACKGROUND: Diverse clinical manifestations have characterized reports of central nervous system involvement in Behcet disease. There is a limited number of published case reports of neuro-Behcet disease mimicking brain tumor. CASE DESCRIPTION: We present a rare case of neuro-Behcet disease exhibiting mixed systemic and neurological symptoms mimicking malignant lymphoma. Delayed presentation of oral aphthae and rapid improvement of symptoms with steroid treatment led to a diagnosis of neuro-Behcet disease without brain biopsy. The patient also underwent surgery for the resection of an arterio-venous fistula. CONCLUSIONS: We recommend management of neuro-Behcet disease based on perceived natural history risks, with the understanding that no data exist on this within patients population. A multidisciplinary team approach is always recommended because neuro-Behcet disease is an uncommon condition, especially in neurosurgical practice.


Asunto(s)
Síndrome de Behçet/diagnóstico por imagen , Neoplasias Encefálicas/diagnóstico por imagen , Encéfalo/diagnóstico por imagen , Malformaciones Vasculares del Sistema Nervioso Central/diagnóstico por imagen , Linfoma/diagnóstico por imagen , Adulto , Síndrome de Behçet/complicaciones , Malformaciones Vasculares del Sistema Nervioso Central/complicaciones , Diagnóstico Diferencial , Humanos , Masculino , Tomografía Computarizada por Rayos X
17.
BJOG ; 127(3): 355-362, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31505103

RESUMEN

OBJECTIVE: To define the predictive value (PV) of known prognostic factors of fetal infection with Cytomegalovirus following maternal primary infection <14 weeks of gestation, at different time points of pregnancy: the end of the second trimester; following prenatal magnetic resonance imaging (MRI) at 32 weeks of gestation; and using all ultrasound scans performed in the third trimester (US3rdT). DESIGN: A retrospective study. SETTING: Reference fetal medicine unit. POPULATION: Sixty-two fetuses infected <14 weeks of gestation. METHODS: We defined second-trimester assessment (STA) as the combination of ultrasound findings <28 weeks of gestation and fetal platelet count at cordocentesis. Three groups were defined: normal, extracerebral, and cerebral STA. MAIN OUTCOME MEASURES: For each group, the PV of STA alone, STA + MRI, and STA + US3rdT were assessed retrospectively. Outcome at birth and at follow-up were reported. RESULTS: The STA was normal, and with extracerebral and cerebral features, in 43.5, 42.0, and 14.5%, respectively. The negative PV of normal STA and MRI for moderate to severe sequelae was 100%. The residual risk was unilateral hearing loss in 16.7% of cases. Of pregnancies with cerebral STA, 44% were terminated. Following extracerebral STA, 48% of neonates were symptomatic and 30% had moderate to severe sequelae. In those cases, the positive and negative PV of MRI for sequelae were 33 and 73%, respectively. STA + US3rdT had a lower negative PV than MRI for symptoms at birth and for moderate to severe sequelae. Any false-positive findings at MRI were mostly the result of hypersignals of white matter. CONCLUSIONS: Serial assessment in the second and third trimesters by ultrasound and MRI is necessary to predict the risk of sequelae occurring in 35% of pregnancies following fetal infection in the first trimester of pregnancy. TWEETABLE ABSTRACT: Serial ultrasound prognostic assessment following fetal CMV infection in the 1st trimester is improved by MRI at 32 weeks.


Asunto(s)
Encéfalo/diagnóstico por imagen , Infecciones por Citomegalovirus , Citomegalovirus/aislamiento & purificación , Enfermedades Fetales , Imagen por Resonancia Magnética/métodos , Polimicrogiria , Complicaciones Infecciosas del Embarazo , Ultrasonografía Prenatal/métodos , Aborto Eugénico/estadística & datos numéricos , Adulto , Autopsia , Infecciones por Citomegalovirus/diagnóstico , Infecciones por Citomegalovirus/epidemiología , Femenino , Enfermedades Fetales/etiología , Enfermedades Fetales/patología , Francia , Humanos , Lactante , Recién Nacido , Masculino , Polimicrogiria/etiología , Polimicrogiria/patología , Valor Predictivo de las Pruebas , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/epidemiología , Trimestres del Embarazo , Pronóstico
20.
J Forensic Sci ; 65(1): 314-317, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31361917

RESUMEN

Intravascular lymphoma (IVL) is a rare subtype of extranodal lymphomas that is characterized by the selective growth of neoplastic cells within the lumen of small vessels. Authors document the case of an unexpected death caused by an undiagnosed intravascular large B-cell lymphoma with multi-organ involvement, which had initially manifested as an infection and then as an unclarified central nervous system pathology. Histological examination showed a diffuse intravascular large B-cell brain lymphoma with prominent cerebral involvement. The relevance of the case report reveals the importance of an autopsy of an extremely rare and threatening pathology that in most cases is diagnosed only postmortem. As a result, the role of the forensic pathologist becomes particularly important. When specifically performing an in-depth autopsy evaluation with a specific histologic analysis, it is possible to identify the intravascular lymphoma and declare a more accurate cause of death.


Asunto(s)
Neoplasias Encefálicas/diagnóstico , Linfoma de Células B Grandes Difuso/diagnóstico , Neoplasias Vasculares/diagnóstico , Encéfalo/diagnóstico por imagen , Encéfalo/patología , Neoplasias Encefálicas/patología , Errores Diagnósticos , Resultado Fatal , Femenino , Humanos , Inmunohistoquímica , Linfoma de Células B Grandes Difuso/patología , Imagen por Resonancia Magnética , Persona de Mediana Edad , Infección de la Herida Quirúrgica/diagnóstico , Tomografía Computarizada por Rayos X , Neoplasias Vasculares/patología
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA