Vascular loop in the cerebellopontine angle: Clinical-radiological correlation.

BACKGROUND: The brainstem, situated in the posterior fossa, connects the brain to the spinal cord. Owing to its location, the nerves of the brainstem are closely related with vascular structures. OBJECTIVES: To correlate the finding of vascular loops in the cerebellopontine angle on imaging with symptoms indicative of vestibulocochlear involvement. MATERIALS AND METHODS: This retrospective descriptive study included all patients evaluated between 2011 and 2017 with findings suggestive of vascular loops in the cerebellopontine angle for whom the clinical history and imaging studies were available. RESULTS: A total of 102 patients (63 women and 39 men) had vestibulocochlear involvement. The most common clinical indication was dizziness (41.18%). A unilateral vascular loop was found in 43 patients (right: 21.57%, left: 20.59%) and bilateral loops were found in 59 (57.84%) patients. The most common type of vascular loop was type II (right: 69.14%; left: 58.75%). The most common origin of vascular loops was the anterior inferior cerebellar artery (right: 66.67%, left: 65.00%). No associations were observed between vascular loops and sensorineural hearing, nystagmus, or vertigo. There was an association with tinnitus. CONCLUSIONS AND SIGNIFICANCE: The presence of vascular loops is not associated with most auditory symptoms. Nevertheless, all findings on imaging studies must be reported. The interpretation of the findings of imaging studies must be correlated with the clinical symptoms after other more common causes that can explain the symptoms have been ruled out.

Correlación clínico-radiológica del asa vascular del ángulo pontocerebeloso / Vascular loop in the cerebellopontine angle: clinical-radiological correlation

Antecedentes: El tronco encefálico, situado en la fosa posterior, conecta el cerebro con la médula espinal. Debido a su ubicación, sus componentes nerviosos guardan una estrecha relación con estructuras vasculares. Objetivos: Describir una relación clínico-radiológica del asa vascular del ángulo pontocerebeloso en pacientes con síntomas indicativos de afectación vestibulococlear mediante evaluación por neuroimagen. Materiales y métodos: Se realizó un estudio retrospectivo y descriptivo. Se incluyeron todos los pacientes evaluados entre 2011 y 2017 con indicios de asa vascular del ángulo pontocerebeloso e historial clínico y estudios de diagnóstico por imagen disponibles. Resultados: 102 pacientes (63 mujeres y 39 hombres) presentaban afectación vestibulococlear. La indicación clínica más frecuente fue mareos (41,18%). Se halló asa vascular unilateral en 43 pacientes (derecho: 21,57%, izquierdo: 20,59%) y bilateral en 59 pacientes (57,84%). El tipo de asa vascular más frecuente fue el tipo II (derecho: 69,14%; izquierdo: 58,75%). El origen más frecuente fue la arteria cerebelosa anteroinferior (ACAI) (derecha: 66,67%, izquierda: 65,00%). No se observó ninguna asociación entre asas vasculares y pérdida de audición neurosensitiva, nistagmo o vértigo. Se halló una asociación con acúfenos. Conclusiones y significación: La presencia de asas vasculares no se asocia a la mayoría de los síntomas auditivos. No obstante, deben notificarse todos los hallazgos de los estudios por imagen. La interpretación de los hallazgos de los estudios por imagen debe correlacionarse con los síntomas clínicos después de excluir otras causas más frecuentes que puedan explicar la sintomatología.(AU)

Background: The brainstem, situated in the posterior fossa, connects the brain to the spinal cord. Owing to its location, the nerves of the brainstem are closely related with vascular structures. Objectives: To correlate the finding of vascular loops in the cerebellopontine angle on imaging with symptoms indicative of vestibulocochlear involvement. Materials and methods: This retrospective descriptive study included all patients evaluated between 2011 and 2017 with findings suggestive of vascular loops in the cerebellopontine angle for whom the clinical history and imaging studies were available. Results: A total of 102 patients (63 women and 39 men) had vestibulocochlear involvement. The most common clinical indication was dizziness (41.18%). A unilateral vascular loop was found in 43 patients (right: 21.57%, left: 20.59%) and bilateral loops were found in 59 (57.84%) patients. The most common type of vascular loop was type II (right: 69.14%; left: 58.75%). The most common origin of vascular loops was the anterior inferior cerebellar artery (right: 66.67%, left: 65.00%). No associations were observed between vascular loops and sensorineural hearing, nystagmus, or vertigo. There was an association with tinnitus. Conclusions and significance: The presence of vascular loops is not associated with most auditory symptoms. Nevertheless, all findings on imaging studies must be reported. The interpretation of the findings of imaging studies must be correlated with the clinical symptoms after other more common causes that can explain the symptoms have been ruled out.(AU)

Vascular loop in the cerebellopontine angle: clinical-radiological correlation. / Correlación clínico-radiológica del asa vascular del ángulo pontocerebeloso.

BACKGROUND: The brainstem, situated in the posterior fossa, connects the brain to the spinal cord. Owing to its location, the nerves of the brainstem are closely related with vascular structures. OBJECTIVES: To correlate the finding of vascular loops in the cerebellopontine angle on imaging with symptoms indicative of vestibulocochlear involvement. MATERIALS AND METHODS: This retrospective descriptive study included all patients evaluated between 2011 and 2017 with findings suggestive of vascular loops in the cerebellopontine angle for whom the clinical history and imaging studies were available. RESULTS: A total of 102 patients (63 women and 39 men) had vestibulocochlear involvement. The most common clinical indication was dizziness (41.18%). A unilateral vascular loop was found in 43 patients (right: 21.57%, left: 20.59%) and bilateral loops were found in 59 (57.84%) patients. The most common type of vascular loop was type II (right: 69.14%; left: 58.75%). The most common origin of vascular loops was the anterior inferior cerebellar artery (right: 66.67%, left: 65.00%). No associations were observed between vascular loops and sensorineural hearing, nystagmus, or vertigo. There was an association with tinnitus. CONCLUSIONS AND SIGNIFICANCE: The presence of vascular loops is not associated with most auditory symptoms. Nevertheless, all findings on imaging studies must be reported. The interpretation of the findings of imaging studies must be correlated with the clinical symptoms after other more common causes that can explain the symptoms have been ruled out.

Analysis of the pattern of functional activation of the cerebellum and its topographical correlation. / Análisis del patrón de activación funcional del cerebelo y su correlación topográfica.

OBJECTIVES: To describe the normal patterns of cerebellar activation in specific cerebral functions (motor, language, memory) and their topographical correlations in the cerebellar cortex on functional magnetic resonance imaging. MATERIALS AND METHODS: We evaluated 25 healthy subjects (8 women and 17 men; 23 right-handed and 2 left-handed; age range, 16-64 years), who did language, memory, and motor tasks while undergoing 1.5T functional magnetic resonance imaging. RESULTS: We assessed functional activity of the cerebellum associated with motor, language, and memory components, describing their relations with topographical regions of the cerebellum and their functional relations with areas in the cerebral cortex. CONCLUSIONS: Knowledge of the normal patterns of morphological characteristics and functional behavior in the cerebellum as well as their relations with the brain is important for radiologists and clinicians evaluating the cerebellum and possible pathological conditions that affect it.

Hippocampal sclerosis: volumetric evaluation of the substructures of the hippocampus by magnetic resonance imaging. / Esclerosis hipocampal: evaluación volumétrica de las subestructuras del hipocampo utilizando resonancia magnética.

OBJECTIVE: The pathological classification of hippocampal sclerosis is based on the loss of neurons in the substructures of the hippocampus. This study aimed to evaluate these substructures in patients with hippocampal sclerosis by magnetic resonance imaging and to compare the usefulness of this morphological analysis compared to that of volumetric analysis of the entire hippocampus. MATERIAL AND METHODS: We included 25 controls and 25 patients with hippocampal sclerosis whose diagnosis was extracted from the institutional epilepsy board. We used FreeSurfer to process the studies and obtain the volumetric data. We evaluated overall volume and volume by substructure: fimbria, subiculum, presubiculum, hippocampal sulcus, CA1, CA2-CA3, CA4, and dentate gyrus (DG). We considered p < 0.05 statistically significant. RESULTS: We observed statistically significant decreases in the volume of the hippocampus ipsilateral to the epileptogenic focus in 19 (76.0%) of the 25 cases. With the exception of the hippocampal sulcus, we observed a decrease in all ipsilateral hippocampal substructures in patients with right hippocampal sclerosis (CA1, p=0.0223; CA2-CA3, p=0.0066; CA4-GD, p=0.0066; fimbria, p=0.0046; presubiculum, p=0.0087; subiculum, p=0.0017) and in those with left hippocampal sclerosis (CA1, p<0.0001; CA2-CA3, p<0. 0001; CA4-GD, p<0. 0001; fimbria, p=0.0183; presubiculum, p<0. 0001; subiculum, p<0. 0001). In four patients with left hippocampal sclerosis, none of the substructures had statistically significant alterations, although a trend toward atrophy was observed, mainly in CA2-CA3 and CA4-GD. CONCLUSION: The findings suggest that it can be useful to assess the substructures of the hippocampus to improve the performance of diagnostic imaging in patients with hippocampal sclerosis.