Bilateral neck paragangliomas.

Paragangliomas of the head and neck are rare neoplasms presented as cervical mass, generally bilateral, that arise from chemoreceptors located at the carotid bifurcation (carotid body tumors), along the vagus nerve (vagal paragangliomas), and in the jugular fossa and tympanic cavity (jugulotympanic paragangliomas). They are typically asymptomatic at the beginning, highly vascular, slow-growing and compressing the surrounding anatomic structures. Only radical surgery is the curative treatment for paragangliomas. We present a case of a 62- year-old woman with a diagnosis of bilateral neck paragangliomas where surgical removal was judged burdened by excessive risk because of the size of the tumor.

Persistent primitive trigeminal artery in monochorial twins. A case report.

The trigeminal artery is one of the arterial structures that constitute anastomosis between the carotid and the posterior circulation during fetal life and usually regress. However these arterial structures may persist in adult life and the trigeminal artery is the one that most frequently show such behaviour. We describe the case of two monochorial female twins with a persistent primitive trigeminal artery revealed by magnetic resonance angiography.

Osteogenic Sarcomatous Degeneration of the Temporal Bone Squama in Paget's Disease. A Case Report.

Paget's bone disease is a common disorder affecting approximately 3-4% of the population over 40 and up to 10-11% of the population older than 80 years. It is characterized by excessive and abnormal bone remodelling. The disease predominates in bones containing red marrow, with a clinical course characterized by active and quiescent periods; pelvis, sacrum, spine and skull are the most affected parts. We report the case of a 79-year-old woman with polyostotic Paget's disease who had a focal sarcomatous degeneration diagnosed by CT and MR.

Optic chiasm involvement secondary to herpetic encephalitis. A case report.

Herpes simplex (HSV) encephalitis is one of the most common central nervous system (CNS) viral infections in adults. Early diagnosis is essential for treatment. We describe the case of a 70-year-old man who reported sudden bilateral reduction of visus. Four days after admission the patient showed high fever, followed the next day by a generalised convulsive crisis and coma. A first magnetic resonance imaging (MRI) showed no alterations, whereas the second showed the usual patterns of HSV encephalitis. With a clinical suspicion of herpetic encephalitis an intravenous therapy with acyclovir was established. The diagnosis of herpetic encephalitis was confirmed by cerebrospinal fluid (CSF) detection of herpes simplex DNA sequences. A further ten days later we performed a third MRI, demonstrating the typical pattern of HSV encephalitis and an increase in size and signal of the optic chiasm.

Idiopatic spinal cord herniation: a treatable cause of Brown-Séquard syndrome.

We report two cases of thoracic idiopathic spinal cord herniation (ISCH) focusing on the peculiar diagnostic and therapeutic issues posed by this rare disorder. In particular MR evaluation of CSF dynamic with a 2D PC cine-MR technique and demonstration of progressive cord herniation on consecutive MR examinations allowed insight on the differential diagnosis and pathophysiological mechanisms of ISCH.

Case report. MRI and MR angiography of basilar artery dissection in a child.

MRI showed a pontine infarct and mural thickening of intermediate signal in T1-weighted images proximal to occlusion of the basilar artery in a 10-year-old boy. Two days later the mural thickening was of high signal, consistent with methaemoglobin formation and MR angiography (MRA) showed nonspecific lack of flow in the mid-segment of the basilar artery, which corresponded to a tapered occlusion at arteriography. MRI is more useful than MRA for noninvasive diagnosis of basilar artery dissection.

Identification of the feeding arteries of spinal vascular lesions via phase-contrast MR angiography with three-dimensional acquisition and phase display.

PURPOSE: To determine whether identification of the feeding arteries of spinal vascular lesions with phase-contrast MR angiography benefits from the higher spatial resolution of three-dimensional (volume) acquisitions and flow-direction information provided by the phase reconstruction of two-dimensional acquisitions. METHODS: Fifteen patients with high- or low-flow spinal vascular lesions proved by spinal arteriography underwent MR angiography with phase-contrast techniques. Arteriographic and MR angiographic studies were reviewed to identify the arterial feeders of spinal vascular lesions. RESULTS: On modulus reconstructions of coronal 2-D or 3-D acquisitions, three of four arteries feeding high-flow lesions and three of 14 arteries feeding low-flow lesions were identified as hypertrophic vessels joining the parent intercostal or cervical arteries. Of 11 intradural veins draining dural arteriovenous fistulas, three were identified on coronal 2-D acquisitions and six on coronal 3-D acquisitions as vessels that coursed from a neural foramen to a midline tangle of vessels. Phase reconstruction showed ascending and descending flow patterns in two patients with intramedullary arteriovenous malformations, and diverging flow in perimedullary veins draining a hemangioblastoma. In nine patients with dural arteriovenous fistulas, phase reconstruction provided information as to the level of the arterial feeders. Phase reconstruction in coronal plane acquisitions also provided evidence of centripetal flow. CONCLUSION: Three-dimensional acquisitions and phase display of 2-D acquisitions improved the visibility of arterial pedicles of spinal vascular lesions at phase-contrast MR angiography.

Dural arteriovenous fistula at the craniocervical junction with perimedullary venous drainage.

MR imaging showed swelling and diffuse signal changes in the spinal cord in two patients with progressive myelopathy. MR angiography revealed slow-flow perimedullary vessels extending to the skull base, which are consistent with drainage vessels of a dural arteriovenous fistula at the craniocervical junction. This fistula was subsequently seen in both patients on selective arteriograms of the ascending pharyngeal and vertebral arteries.

Balloon occlusion of the carotid artery in the treatment of cavernous giant aneurysms: two cases.

Over recent years, endovascular occlusion of the carotid artery has become a valid alternative to its more traditional surgical ligation in the treatment of cavernous giant aneurysms. The authors report two cases treated with balloon occlusion in two patients with clinical signs of cavernous sinus syndrome. The procedure consisted of occluding the aneurysm and the carotid by means of detachable balloons. This was preceded by a 30-minute clinically monitored occlusion test aimed at evaluating the functioning of Willis' circle. The treatment was carried out under neuroleptoanalgesia, so optimal control of the neurological condition of the patient was possible. Partial symptom regression was obtained in both cases.

Neuroma of the facial nerve masked by chronic otitis media.

The absence of facial twitching, weakness, or palsy makes the diagnosis of facial neuroma difficult. The authors report a case of neuroma of the horizontal portion of the facial nerve masked by the presence of a chronic ear. A woman with a long history of discharge and hypoacousia in her left ear presented with acute dizziness. Examination revealed grade 3 horizontal right nystagmus, left anacousia, and the appearance of an epitympanic cholesteatoma. Computed tomography (CT) was performed after the vestibular condition improved. The clinical diagnosis of chronic otitis media with cholesteatoma together with the radiologic finding of the mastoid and tympanic cavity completely occupied by soft tissue were enough to send the radiologist astray. The radiologic diagnosis confirmed that the bony destruction of the vestibule and lateral semicircular canal could be caused by a cholesteatoma. A neuroma of the horizontal portion of the facial nerve was discovered during surgery performed for the chronic ear. The postoperative study of the CT scans showed that there was no erosion of the malleus or incus, despite wide erosion of the vestibule and lateral semicircular canal. This finding would be enough to suggest the presence of pathology other than cholesteatoma. The patient refused exeresis of the neuroma. The authors recognize the difficulty in urging a patient to an operation that surely will result in worsening of the facial function. Follow-up in this case has revealed no change in tumor dimension or facial function over 3 years.

[Venous angioma associated with cavernous angioma. Presentation of three cases]. / Associazione di angioma venoso ed angioma cavernoso. Presentazione di tre casi.

Cavernous angiomas and venous angiomas may be discovered as associated lesions in the same patient. Most Authors report that Venous angiomas are not true vascular malformation; they should be considered as variant of normal venous drainage, consisting of tortuous medullary veins converging into a dilated draining one. By rule, they are quite asymptomatic, and very rarely bleed. On the other side, cavernous angiomas are true vascular malformations, usually angiographically occult. Their association is relatively rare, but it is important because of the possibility of bleeding, which should be related to the presence of the cavernous malformation. We report the cases of three patients studied by Computed Tomography, Magnetic Resonance and Digital Angiography in our Neuroradiologic Department.