[Simultaneous suprasellar and pineal germinoma: a case report]. / Germinoma pineal y supraselar sincrónico: a propósito de un caso.

INTRODUCTION: Tumours in the pineal region are rare (0.3-2.7%) and most of the ones that do occur are germ cell tumours, of which germinoma is the most frequent. They are chiefly located in the pineal gland, the next most common being site being the suprasellar region and the fourth ventricle, although simultaneous presentation in these locations is relatively rare (5-10% of cases). The main aim of this study is to review the differential diagnosis of neoplasias in the pineal region. CASE REPORT: Here we report the case of a 20-year-old male who was admitted to hospital due to irregularities affecting the field of vision, with clinical signs and symptoms of panhypopituitarism and normal levels of tumour markers in blood and cerebrospinal fluid. Magnetic resonance imaging of the craniospinal axis was performed and results showed the presence of two masses with significant enhancement, one located in the pineal region with a signal similar to that of grey matter and the other in the hypothalamus, which had a more heterogeneous aspect with cystic areas inside it. Imaging with paramagnetic contrast agents revealed dissemination with ependymal uptake in relation to the frontal horns and in the fourth ventricle; a possible simultaneous origin was also suggested in this latter location. CONCLUSIONS: Magnetic resonance imaging plays a decisive role in establishing the diagnosis and therapy plan. The imaging factors that must be taken into account are the origin of the mass, heterogeneity, contrast enhancement, presence of fat or calcium, a signal similar to that of grey matter and possible dissemination, above all into the subarachnoid space. The patient's medical record (age, sex or tumour markers) must also be taken into consideration.

Germinoma pineal y supraselar sincrónico: a propósito de un caso / Simultaneous suprasellar and pineal germinoma: a case report

Los tumores de la región pineal son poco frecuentes (0,3-2,7%) y la mayoría corresponde a tumoresde células germinales; de éstos, el germinoma es el más frecuente. Se localizan principalmente en la glándula pineal, y le siguen en frecuencia la región supraselar y el cuarto ventrículo, pero la presentación sincrónica en estas localizaciones es relativamentepoco frecuente (5-10% de los casos). El objetivo principal de este estudio consiste en revisar el diagnóstico diferencial de las neoplasias de la región pineal. Caso clínico. Varón de 20 años de edad que ingresa por alteración del campo visual,con clínica de panhipopituitarismo y marcadores tumorales en sangre y líquido cefalorraquídeo normales. Se le realizó resonancia magnética del eje craneoespinal y se evidenció la presencia de dos masas con significativo realce, una de localizaciónpineal con señal similar a la sustancia gris, y otra en el hipotálamo, de aspecto más heterogéneo, con áreas quísticas en el interior.Con contraste paramagnético se demostró diseminación con captación ependimaria en relación con las astas frontalesy en el cuarto ventrículo, localización esta última en la que se plantea también un posible origen sincrónico. Conclusiones. La resonancia magnética desempeña un papel determinante en el establecimiento de su diagnóstico y plan terapéutico. Los factoresque deben considerarse son el origen de la masa, la heterogeneidad, el realce de contraste, la presencia de grasa o calcio, la señal similar a la sustancia gris y la posible diseminación, sobre todo al espacio subaracnoideo. También debe tenerse encuenta la historia clínica (edad, sexo o marcadores tumorales)

Tumours in the pineal region are rare (0.3-2.7%) and most of the ones that do occur are germ celltumours, of which germinoma is the most frequent. They are chiefly located in the pineal gland, the next most common being site being the suprasellar region and the fourth ventricle, although simultaneous presentation in these locations is relatively rare (5-10% of cases). The main aim of this study is to review the differential diagnosis of neoplasias in the pineal region. Casereport. Here we report the case of a 20-year-old male who was admitted to hospital due to irregularities affecting the field of vision, with clinical signs and symptoms of panhypopituitarism and normal levels of tumour markers in blood and cerebrospinalfluid. Magnetic resonance imaging of the craniospinal axis was performed and results showed the presence of twomasses with significant enhancement, one located in the pineal region with a signal similar to that of grey matter and the other in the hypothalamus, which had a more heterogeneous aspect with cystic areas inside it. Imaging with paramagnetic contrastagents revealed dissemination with ependymal uptake in relation to the frontal horns and in the fourth ventricle; a possible simultaneous origin was also suggested in this latter location. Conclusions. Magnetic resonance imaging plays a decisive rolein establishing the diagnosis and therapy plan. The imaging factors that must be taken into account are the origin of the mass, heterogeneity, contrast enhancement, presence of fat or calcium, a signal similar to that of grey matter and possible dissemination, above all into the subarachnoid space. The patient’s medical record (age, sex or tumour markers) must also betaken into consideration

[Wallenberg syndrome: a review of 25 cases]. / Síndrome de Wallenberg: revisión de 25 casos.

INTRODUCTION: Wallenberg's syndrome is one of the most common clinically recognized conditions due to brain stem infarct, which can nowadays be identified thanks to modern neuro-imaging techniques. We present a retrospective study of 25 cases admitted to our hospital in the past eight years, to evaluate epidemiological aspects and clinical findings and to correlate these with magnetic resonance topography. MATERIAL AND METHODS: Patients diagnosed in the Neurology Section of Hospital Xeral-Calde in Lugo between January 1989 and December 1997 as having Wallenberg's syndrome. RESULTS: There was a predominance of middle aged men presenting at 55.06 years of age (range 30- 78). Arterial hypertension was the main risk factor (52%). There was a progressive form of onset in most cases. The commonest symptom was dysphonia followed by dysphagia. The commonest finding on physical examination was ataxic gait (24 patients) MR was positive in 22 of the 23 cases in which this was done. There were different clinical findings depending on the site of the lesion, whether rostral, caudal or medial. This is considered in the discussion. In most cases the prognosis was good. The commonest sequel was ataxia. CONCLUSIONS: The results are similar to those in the literature. We emphasize the excellent correlation of clinical data and neuroimaging findings.

[Reversible changes in magnetic resonance images in two cases of complex partial status epilepticus]. / Alteraciones reversibles en la resonancia magnética en 2 casos de status de crisis parciales complejas.

Magnetic resonance imaging (MR) is the imaging method of choice for studying epilepsy, particularly when the focus is in the temporal lobe. MR is useful for diagnosing many pathological anomalies in this site; nevertheless, transient alterations that can mimic structural lesions are sometimes observed. We describe 2 patients in complex partial status epilepticus with MR alterations in the temporal lobe signals, on the left in one case and on the right in the other. After symptoms subsided and electroencephalographic alterations disappeared, new MR showed the disappearance of the changes in both patients. Transient changes of MR in epileptic patients may be a product of local blood flow disruption of the hematoencephalic barrier or local edema during seizure. Awareness of such transient changes can reduce the number of unnecessary diagnostic procedures and/or aggressive treatments.