Lumbar epidural vein thrombosis mimicking disc herniation: A report of 3 cases.

Epidural vein thrombosis is a rare cause of lumbosciatica than can clinically and radiologically mimic other causes of nerve root compression such as disc herniation. We describe 3 unusual cases of spinal epidural plexus vein thrombosis illustrating the difficulty in preoperative diagnosis of this entity. Misinterpretation of imaging findings can lead to an erroneous diagnosis and inappropriate treatment. Knowledge of certain radiologic findings will increase the likelihood of recognizing epidural vein thrombosis.

Neurofibromas plexiformes voluminosos de cuello en la neurofibromatosis tipo 1 / Voluminous plexiform neurofibromas of the neck region in neurofibromatosis 1

Objetivo. Presentar las características clínicas, de imagen y evolutivas de una serie de pacientes con neurofibromatosis tipo 1 que desarrollaron durante la infancia neurofibromas plexiformes voluminosos en el cuello (NFPVC). Pacientes y métodos. Nueve pacientes (cinco mujeres y cuatro varones) con edades entre 3 y 15 años en el momento del diagnóstico de los tumores, que podían extenderse también a la fosa posterior y a la zona torácica superior. El diagnóstico estuvo basado fundamentalmente en la clínica, la imagen y la histología. Resultados. Un tumor era intralaríngeo y causaba problemas respiratorios. Los otros ocho casos tenían su origen en varias raíces espinales de uno o de ambos lados y podían crecer también hacia el interior de la fosa posterior y de la región torácica en algunos pacientes, y desplazaban a las estructuras anatómicas vecinas, especialmente en tres casos, todos niñas, en las que el tumor creció hasta alcanzar gran volumen, especialmente por un lado, parándose el crecimiento entre los 11 y 12 años y no volviendo a crecer más tarde. Conclusiones. Los NFPVC son tumores histológicamente benignos. La extirpación es necesaria cuando están localizados en la laringe por los problemas respiratorios que causan, pero no en los de las otras regiones, pese a que el voluminoso tamaño que alcanzan en algunos casos puede causar exagerados desplazamientos de las estructuras vecinas. El estudio de nuestra serie parece indicar que al menos los tumores extralaríngeos sólo crecen hasta los 11-12 años. Puede ser recomendable retrasar la cirugía tanto como sea posible si no existe sintomatología aguda que la haga necesaria (AU)

Aim. To present the clinic, imaging and evolutive characteristics of a series of patients with neurofibromatosis 1 with voluminous plexiform neurofibromas in the neck (VPNFN) during childhood. Patients and methods. Nine patients (five females and four males) who were diagnosed as VPNFN at ages between 3 and 15 years. The VPNFN widespread to the posterior fossa or the upper thoracic region in some cases. The diagnosis was based on the clinical, imaging and histological findings. Results. One of the tumors was intralaryngeal and caused respiratory difficulties. The other eight patients had the origin of the tumor in several spinal roots of one or both sides and could growth to the posterior fossa and to the upper thoracic region in some cases with displacement of the surrounding organs, especially in three patients, all girls, in whom the tumor reached a voluminous size on one side, that was observed only until 10 to 11 years when the growth ceased. Conclusions. The VPNFN are histologically benign tumors. Those located in the larynx must be removed because of therespiratory problems, but it is not necessary in cases with other locations despite the voluminous size that can reach in some patients with great displacement of the surrounding organs. The analysis of the results of our series may demonstrate that al least the extralaryngeal tumors only grow to 11-12 years of age. This possibility may make recommendable to retard the surgical treatment as much as possible in cases that it is not necessary (AU)

[Voluminous plexiform neurofibromas of the neck region in neurofibromatosis 1]. / Neurofibromas plexiformes voluminosos de cuello en la neurofibromatosis tipo 1.

AIM. To present the clinic, imaging and evolutive characteristics of a series of patients with neurofibromatosis 1 with voluminous plexiform neurofibromas in the neck (VPNFN) during childhood. PATIENTS AND METHODS. Nine patients (five females and four males) who were diagnosed as VPNFN at ages between 3 and 15 years. The VPNFN widespread to the posterior fossa or the upper thoracic region in some cases. The diagnosis was based on the clinical, imaging and histological findings. RESULTS. One of the tumors was intralaryngeal and caused respiratory difficulties. The other eight patients had the origin of the tumor in several spinal roots of one or both sides and could growth to the posterior fossa and to the upper thoracic region in some cases with displacement of the surrounding organs, especially in three patients, all girls, in whom the tumor reached a voluminous size on one side, that was observed only until 10 to 11 years when the growth ceased. CONCLUSIONS. The VPNFN are histologically benign tumors. Those located in the larynx must be removed because of the respiratory problems, but it is not necessary in cases with other locations despite the voluminous size that can reach in some patients with great displacement of the surrounding organs. The analysis of the results of our series may demonstrate that al least the extralaryngeal tumors only grow to 11-12 years of age. This possibility may make recommendable to retard the surgical treatment as much as possible in cases that it is not necessary.

TITLE: Neurofibromas plexiformes voluminosos de cuello en la neurofibromatosis tipo 1.Objetivo. Presentar las caracteristicas clinicas, de imagen y evolutivas de una serie de pacientes con neurofibromatosis tipo 1 que desarrollaron durante la infancia neurofibromas plexiformes voluminosos en el cuello (NFPVC). Pacientes y metodos. Nueve pacientes (cinco mujeres y cuatro varones) con edades entre 3 y 15 años en el momento del diagnostico de los tumores, que podian extenderse tambien a la fosa posterior y a la zona toracica superior. El diagnostico estuvo basado fundamentalmente en la clinica, la imagen y la histologia. Resultados. Un tumor era intralaringeo y causaba problemas respiratorios. Los otros ocho casos tenian su origen en varias raices espinales de uno o de ambos lados y podian crecer tambien hacia el interior de la fosa posterior y de la region toracica en algunos pacientes, y desplazaban a las estructuras anatomicas vecinas, especialmente en tres casos, todos niñas, en las que el tumor crecio hasta alcanzar gran volumen, especialmente por un lado, parandose el crecimiento entre los 11 y 12 años y no volviendo a crecer mas tarde. Conclusiones. Los NFPVC son tumores histologicamente benignos. La extirpacion es necesaria cuando estan localizados en la laringe por los problemas respiratorios que causan, pero no en los de las otras regiones, pese a que el voluminoso tamaño que alcanzan en algunos casos puede causar exagerados desplazamientos de las estructuras vecinas. El estudio de nuestra serie parece indicar que al menos los tumores extralaringeos solo crecen hasta los 11-12 años. Puede ser recomendable retrasar la cirugia tanto como sea posible si no existe sintomatologia aguda que la haga necesaria.

Cortical thickness in fetal alcohol syndrome and attention deficit disorder.

Fetal alcohol syndrome represents the classic and most severe manifestation of epigenetic changes induced by exposure to alcohol during pregnancy. Often these patients develop attention deficit hyperactivity disorder. We analyzed cortical thickness in 20 children and adolescents with fetal alcohol syndrome and attention deficit hyperactivity disorder (group 1), in 20 patients without fetal alcohol syndrome (group 2), and in 20 control cases. The first group revealed total cortical thickness significantly superior to those of the other two groups. In per-lobe analyses of cortical thickness, group 1 demonstrated greater cortical thickness in the frontal, occipital, and right temporal and left frontal lobes compared with the second group, and in both temporal lobes and the right frontal lobe compared with the control group. This study demonstrated greater cortical thickness in patients with attention deficit hyperactivity disorder and heavy prenatal exposure to alcohol, probably as an expression of immature or abnormal brain development.

Involución espontánea de tumores frontales en un paciente con neurofibromatosis tipo 1 / Spontaneous involution of frontal tumors in a patient with neurofibromatosis type 1

Objetivo. Presentar un paciente con neurofibromatosis tipo 1 (NF1) que tenía tumores cerebrales –no localizados en las vías ópticas– que involucionaron espontáneamente. Caso clínico. Niña con NF1 que mostró imágenes tumorales frontales, una en cada lado, rodeadas de una zona edematosa, cuando tenía 29 meses en el estudio rutinario de resonancia magnética (RM). El estudio por RM espectroscópica a esa edad mostró alteraciones que podrían corresponder a astrocitoma tipo 2. Los tumores frontales se mantuvieron sin cambios de tamaño en los controles de RM durante los primeros tres años y medio de vida pero, a los 6 años, había desaparecido el localizado en lóbulo frontal derecho y había disminuido en un 90% el del lado izquierdo. Los nervios ópticos no mostraban tumores durante los tres primeros años, pero éstos aparecían perfectamente desarrollados a los 6 años. Conclusión. La involución de tumores intracraneales asociados a NF1, localizados en el parénquima cerebral (no en las vías ópticas), es infrecuente, pero se observa en algunos pacientes. Los tumores de vías ópticas pueden desarrollarse entre los 3 y los 6 años de edad (AU)

Aim. To present a patient with neurofibromatosis type 1 (NF1) who had cerebral tumors (in a non-optic pathway location) that regressed spontaneously. Case report. A girl with NF1 and cerebral tumors, probably astrocytomas, with similar neuroimaging characteristics, was studied by magnetic resonance (MR) and MR spectroscopy between 29 months and 6- years of age. The frontal tumors (one on each hemisphere) did not change size in the MR studies done during the first three and a half years of life, but, at six years, the right frontal lobe tumor had apparently disappeared and the left frontal lobe tumor had decreased in a 90% of its original size. During the first three and half years of life, MR images did not demonstrate any optic tumor. However, such a tumor appeared well developed when the MR study was performed at six years of age. Conclusion. Involution of cerebral tumors associated with NF1, unrelated to optic pathway, is rare, but has been observed in some patients. Optic pathway tumors can develop in patients with NF1 between three and six years of age (AU)

[Spontaneous involution of frontal tumors in a patient with neurofibromatosis type 1]. / Involución espontánea de tumores frontales en un paciente con neurofibromatosis tipo 1.

AIM: To present a patient with neurofibromatosis type 1 (NF1) who had cerebral tumors (in a non-optic pathway location) that regressed spontaneously. CASE REPORT: A girl with NF1 and cerebral tumors, probably astrocytomas, with similar neuroimaging characteristics, was studied by magnetic resonance (MR) and MR spectroscopy between 29 months and 6- years of age. The frontal tumors (one on each hemisphere) did not change size in the MR studies done during the first three and a half years of life, but, at six years, the right frontal lobe tumor had apparently disappeared and the left frontal lobe tumor had decreased in a 90% of its original size. During the first three and half years of life, MR images did not demonstrate any optic tumor. However, such a tumor appeared well developed when the MR study was performed at six years of age. CONCLUSION: Involution of cerebral tumors associated with NF1, unrelated to optic pathway, is rare, but has been observed in some patients. Optic pathway tumors can develop in patients with NF1 between three and six years of age.

Neuroimagen en el trastorno por déficit de atención/hiperactividad / Neuroimaging in attention deficit hyperactivity disorder

Introducción. Los avances en neuroimagen en la última década han aportado numerosos hallazgos en el trastorno por déficit de atención/hiperactividad (TDAH). El rápido desarrollo tecnológico, junto con el de la genética y la investigación neuroquímica, sugiere una disfunción del circuito frontoestriatal que involucra a la corteza prefrontal y a su relación con los núcleos de la base, tálamo y cerebelo como base fisiopatológica de este trastorno. Por otro lado, es posible que, en un futuro, la neuroimagen pueda ser complementaria a la evaluación clínica, favoreciendo diagnósticos más precisos, identificando los subtipos e incluso la modalidad de tratamiento y su monitorización. Objetivo y desarrollo. Realizar un examen de la bibliografía más significativa acerca de la neuroimagen y el TDAH y exponer la utilidad y los inconvenientes de las diferentes modalidades de técnicas de neuroimagen aplicables de cara a un mejor y más profundo conocimiento del TDAH en el futuro. Conclusiones. Aunque el desarrollo de la neuroimagen en el TDAH es prometedor, actualmente su utilidad diagnóstica es muy limitada. Una de las mayores dificultades al respecto se basa en la heterogeneidad clínica, genética y fisiopatológica del trastorno, por lo que, ante la inexistencia de un marcador específico, se hace imperativa, de cara a los próximos estudios, la búsqueda varios marcadores que tengan un adecuado valor en el diagnóstico, pronóstico y/o tratamiento de los diferentes subtipos de TDAH (AU)

Introduction. Advances in neuroimaging in the last decade have allowed a number of new findings about attention deficit hyperactivity disorder (ADHD) to be obtained. Quickly developing technology, together with the progress being made in genetics and neurochemical research, suggests a dysfunction of the fronto striatal circuit that involves the prefrontal cortex and its relationship with the basal, thalamic and cerebellar nuclei as the pathophysiological foundation of this disorder. On the other hand, neuroimaging in the future may complement clinical evaluation, which will favour more accurate diagnoses and allow the subtypes and even the mode of treatment and its monitoring to be identified. Aims and development. The aim of this study was to review the more significant literature on neuroimaging and ADHD and to discuss the usefulness and drawbacks of the different modes of neuroimaging techniques that can be applied with a view to gaining an improved and deeper knowledge of ADHD in the future. Conclusions. Although the development of neuroimaging in ADHD is a promising area, at the present time its diagnostic value is very restricted. One of the greatest difficulties in this respect concerns the clinical, genetic and pathophysiological heterogeneity of the disorder. Hence, given the inexistence of a specific marker, future studies will have to search for several markers that have a suitable value in the diagnosis, prognosis and/or treatment of the different subtypes of ADHD (AU)