Primary and secondary non-traumatic intra-cerebral haemorrhage: MRI findings.

Intracranial haemorrhage (ICH) accounts for 10-30% of strokes, being the form with the worst prognosis. The causes of cerebral haemorrhage can be both primary, mainly hypertensive and amyloid angiopathy, and secondary, such as tumours or vascular lesions. Identifying the aetiology of bleeding is essential since it determines the treatment to be performed and the patient's prognosis. The main objective of this review is to review the main magnetic resonance imaging (MRI) findings of the primary and secondary causes of ICH, focusing on those radiological signs that help guide bleeding due to primary angiopathy or secondary to an underlying lesion. The indications for MRI in the event of non-traumatic intracranial haemorrhage will also be reviewed.

Hemorragia cerebral primaria y secundaria no traumática: Hallazgos en RM / Primary and secondary non-traumatic intra-cerebral haemorrhage: MRI findings

La hemorragia intracraneal (HIC) supone un 10-30% de los ictus, siendo la forma de peor pronóstico. Las causas de hemorragia cerebral pueden ser primarias, fundamentalmente la angiopatía hipertensiva y amiloide, o secundarias, como tumores o lesiones vasculares. Identificar la etiología del sangrado es importante, ya que determina el tratamiento a realizar y el pronóstico del paciente. El objetivo principal de esta revisión es repasar los principales hallazgos por resonancia magnética (RM) de las causas de HIC primarias y secundarias, deteniéndonos en aquellos signos radiológicos que ayudan a orientar hacia un sangrado por una angiopatía primaria o bien secundario a una lesión subyacente. También se revisarán las indicaciones de RM ante una hemorragia intracraneal no traumática (AU)

Intracranial hemorrhage (ICH) accounts for 10-30% of strokes, being the form with the worst prognosis. The causes of cerebral hemorrhage can be both primary, mainly hypertensive and amyloid angiopathy, and secondary, such as tumors or vascular lesions. Identifying the etiology of bleeding is essential since it determines the treatment to be performed and the patient's prognosis. The main objective of this review is to review the main magnetic resonance imaging (MRI) findings of the primary and secondary causes of ICH, focusing on those radiological signs that help guide bleeding due to primary angiopathy or secondary to an underlying lesion. The indications for MRI in the event of non-traumatic intracranial hemorrhage will also be reviewed (AU)

[«Salt and pepper¼ sign in the onset of a non-vascular pontine pathology]. / Signo de «sal y pimienta¼ como presentacion de una lesion pontina no vascular.

TITLE: Signo de «sal y pimienta¼ como presentacion de una lesion pontina no vascular.

Application of the 2010 McDonald criteria for the diagnosis of multiple sclerosis in a Spanish cohort of patients with clinically isolated syndromes.

BACKGROUND: Recently the International Panel on Diagnosis of Multiple Sclerosis (MS) has proposed new magnetic resonance imaging (MRI) criteria for the diagnosis of MS in patients with clinically isolated syndromes (CIS). We aimed to evaluate the accuracy of these new criteria for lesions dissemination in space (DIS) and time (DIT), from a single MRI scan, to predict conversion from CIS to clinically definite MS. METHODS: We studied 67 CIS patients with baseline MRI performed within the first 3 months after onset. The follow-up was of at least 24 months. The sensitivity, specificity and accuracy of Barkhof-Tintoré criteria and the new proposed MRI criteria for DIS and DIT were calculated with SPSS v.15.0. RESULTS: The mean age for clinical onset was 30 years and 64% of patients were female. The overall conversion rate was 74%. In our cohort, Barkhof-Tintoré criteria showed a sensitivity of 71.43%, a specificity of 66.67%, with an accuracy of 73.1%. New DIS criteria showed a sensitivity of 85.71%, a specificity of 64.71% and an accuracy of 80.30%. We also evaluated the new DIT criteria with a single MRI scan in 54 patients with baseline scans that included gadolinium-enhanced images. The sensitivity of the test was 52.63% with a specificity of 75.00% and an accuracy of 59.26%. CONCLUSION: New DIS criteria are simpler and more sensitive than previous criteria. The sensitivity of DIT criterion using a single MRI scan was rather low, as other previous studies showed, reflecting its stringency, but it could improve the accuracy of early MS diagnosis in that group of patients with typical CIS and gadolinium-enhancing and non-enhancing lesions on their baseline scans. These results reinforce their use in MS diagnosis.

Ectasia dural y dolor lumbar en pacientes con síndrome de Marfan / Ectasia and lumbar pain associated with marfan syndrome

Objetivo: Evaluar clínica y radiológicamente si la presencia y el volumen de la ectasia dural (ED) se asocia con dolor lumbar en pacientes con Síndrome de Marfan (SM). Material y Método: 92 pacientes diagnosticados de SM según los criterios de Gante fueron estudiados de forma prospectiva durante un año. Se les realizó una historia clínica, pruebas de imagen, incluyendo una resonancia magnética de columna lumbar volumétrica y se les entregaron 3 cuestionarios: SRS 22 (Scoliosis Research Society) y SF 36 v- 2 e Índice de discapacidad de Oswestry en función del que subdividimos la muestra en grupo I (pacientes con dolor lumbar moderado o grave) y grupo II (pacientes sin dolor lumbar). Resultados: Se realizó análisis multivariante de las variables relacionadas con el dolor lumbar, alcanzando la ED significación estadística. Estaba presente en el 75,9% de los pacientes del grupo I, y en el 49,2% del grupo II. La presencia de la ED se asocian con dolor lumbar en pacientes con SM (p= 0,016) y con la presencia de deformidad vertebral (p <0,001). Conclusiones: La presencia y el tamaño de la ED se asocian de forma significativa con dolor lumbar en el SM pero el scalloping no influye en la mayor intensidad del dolor (AU)

Objetive: Evaluate clinically and radiographically whether the presence and size of dural ectasia (ED) is associated with low back pain in patients with Marfan syndrome (MS). Material and method: 92 patients diagnosed with MS according to Ghent criteria were studied prospectively for one year. Underwent a medical history, imaging tests, including a lumbar spine MRI volumetric and 3 questionnaires were given: SRS 22 (Scoliosis Research Society) and SF 36 v-2 and Oswestry Disability Index subdivided according to the sample in group I (patients with moderate lower back pain and / or severe) and group II (patients without pain). Results: Multivariate analysis of variables related to low back pain, the ED reached statistical significance. ED was present in 75.9% of patients in group I, and 49.2% in group II. The presence of ED is associated with low back pain in patients with MS with an OR of 3.24 (1.21 to 8.68) p = 0.016 and the presence of vertebral deformity (scalloping) with an OR of 129, 83 (16.1 to 1047.74) p <0.001. Conclusion: The presence and size of ED was significantly associated with LBP in the SM but the «scalloping» does not affect the increased intensity of pain (AU)

Absceso cerebral secundario a malformación arteriovenosa pulmonar / No disponible

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[Guillain-Barre syndrome following resection of glioblastoma multiforme]. / Síndrome de Guillain-Barré tras resección de glioblastoma multiforme.

INTRODUCTION: Guillain-Barre syndrome (GBS) is an acute demyelinating polyneuropathy characterised by progressive muscular weakness and areflexia. Although the pathogenesis is uncertain, it is probably secondary to an aberrant immunological response to components of the peripheral nervous system. GBS has been linked to bacterial or viral infections, systemic diseases, neoplasias, pregnancy, traumatic injuries or organ transplant. An association with intracranial surgery has been reported, but this is exceptional. CASE REPORT: We report the case of a 67-year-old male submitted to surgical intervention due to a right-side occipital-parietal glioblastoma. The patient was well until ten days after the intervention, when he presented a rapidly progressive are flexive paraparesis with an ascending course. A spinal tap revealed cerebrospinal liquid with an elevated protein level and albuminocytologic dissociation. The electromyogram study and lumbar magnetic resonance with contrast confirmed the suspected diagnosis of GBS. After establishing treatment with immunoglobulins the patient progressed well and recovered quickly and completely from the paresis. CONCLUSIONS: GBS may appear after intracranial surgery and make it more difficult to reach a differential diagnosis with other entities. To optimise the prognosis, treatment must begin as early as possible. Intravenous immunomodulation with immunoglobulins or plasma exchange are effective in shortening the course of the disease.

Síndrome de Guillain-Barré tras resección de glioblastoma multiforme / Guillain-Barre síndrome following resection of gliobastoma multiforme

Introducción. El síndrome de Guillain-Barré (SGB) consiste en una polineuropatía desmielinizante aguda caracterizada por debilidad muscular y arreflexia progresivas. Aunque la patogénesis es incierta, probablemente es secundaria a una respuesta inmunológica aberrante frente a componentes del sistema nervioso periférico. El SGB se ha relacionado con infecciones bacterianas o virales, enfermedades sistémicas, neoplasias, embarazo, trauma o trasplante de órganos. Se ha descrito la asociación con cirugía intracraneal, pero es excepcional. Caso clínico. Se trata de un varón de 67 años intervenido de un glioblastoma parietooccipital derecho. Se encontraba previamente bien, pero diez días después de la cirugía presentó una paraparesia arrefléctica rápidamente progresiva y de curso ascendente. La punción lumbar mostró un líquido con aumento proteico y disociación albuminocitológica. El estudio de electromiografía y la resonancia magnética lumbar con contraste confirmaron la sospecha diagnóstica de SGB. Después de instaurar un tratamiento con inmunoglobulinas, el paciente experimentó una buena evolución, con rápida y completa recuperación de la paresia. Conclusiones. El SGB puede aparecer tras la cirugía intracraneal y dificultar el diagnóstico diferencial con otras entidades. Para optimizar el pronóstico, el tratamiento debe comenzar lo antes posible. La inmunomodulación intravenosa con inmunoglobulinas o recambio de plasma acorta el curso de la enfermedad de manera efectiva (AU)

Introduction. Guillain-Barre syndrome (GBS) is an acute demyelinating polyneuropathy characterised by progressive muscular weakness and areflexia. Although the pathogenesis is uncertain, it is probably secondary to an aberrant immunological response to components of the peripheral nervous system. GBS has been linked to bacterial or viral infections, systemic diseases, neoplasias, pregnancy, traumatic injuries or organ transplant. An association with intracranial surgery has been reported, but this is exceptional. Case report. We report the case of a 67-year-old male submitted to surgical intervention due to a right-side occipital-parietal glioblastoma. The patient was well until ten days after the intervention, when he presented a rapidly progressive areflexive paraparesis with an ascending course. A spinal tap revealed cerebrospinal liquid with an elevated protein level and albuminocytologic dissociation. The electromyogram study and lumbar magnetic resonance with contrast confirmed the suspected diagnosis of GBS. After establishing treatment with immunoglobulins the patient progressed well and recovered quickly and completely from the paresis. Conclusions. GBS may appear after intracranial surgery and make it more difficult to reach a differential diagnosis with other entities. To optimise the prognosis, treatment must begin as early as possible. Intravenous immunomodulation with immunoglobulins or plasma exchange are effective in shortening the course of the disease (AU)

[Cerebral astroblastoma: report of a case and literature review]. / Astroblastoma cerebral: a propósito de un caso y revisión de la literatura.

We report a new case of low grade astroblastoma of pure type and consider the definition and the clinical, neuroimaging, intraoperative and pathological characteristics of this type of uncommon intracranial tumour. We analyse the differences found in the literature concerning the immunochemistry, genetics and electron microscopy. We point out the lack of protocols for treatment of this type of intracranial tumour, and comment the various hypothesis of its origin.

Astroblastoma cerebral: a propósito de un caso y revisión de la literatura / Cerebral astroblastoma: report of a case and literature review

Se describe un nuevo caso de astroblastoma cerebral puro de bajo grado, considerándose la definición y las características clínicas, de neuroimagen, intraoperatorias y anatomopatológicas de este tipo de tumor poco frecuente. Analizamos las diferencias encontradas en la literatura respecto a los hallazgos inmunohistoquímicos, genéticos y de microscopía electrónica. Llamamos la atención sobre la ausencia de consenso en cuanto al tratamiento de este tipo de tumor. Finalmente citamos las diferentes hipótesis sobre su origen (AU)

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