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1.
Artigo em Inglês | MEDLINE | ID: mdl-36657949

RESUMO

BACKGROUND AND PURPOSE: There is limited discussion in current literature about the normal imaging appearance of the round window. The purpose of this study was to assess the prevalence and imaging characteristics of gadolinium enhancement in the round window niche on MR imaging to the internal auditory canal. MATERIALS AND METHODS: The presence or absence and laterality of enhancement in the round window niche on MR imaging was retrospectively reviewed in 95 patients from 1 institution. All studies included high-resolution (≤0.5-mm section thickness) pre- and postgadolinium 3D FSE T1 with fat-saturation and postgadolinium 3D FLAIR image sequences. T1 and T2 acquisitions were viewed as coregistered overlays to confirm that enhancement was lateral to the round window membrane within the round window niche. CT was reviewed when available to assess the presence and laterality of soft tissue in the round window niche. RESULTS: Ninety-five patients with internal auditory canal MRIs were included. Enhancement was present in the round window of 15 of 95 patients (15.8%). Of the 27 patients who underwent CT, 4 (14.8%) had concordant soft tissue on CT and MR imaging enhancement in the round window niche. One patient had MR imaging enhancement within the round window niche without a corresponding abnormality on CT. The absence of soft tissue on CT and the corresponding lack of MR imaging enhancement were present in 22 (81.5%) patients. CONCLUSIONS: Enhancement can be visualized within the round window niche on MR imaging as an incidental finding. This enhancement probably represents postinflammatory granulation tissue and does not require further intervention. However, the potential for this enhancement to be misdiagnosed as a pathologic process can be a pitfall in MR imaging.

2.
Artigo em Inglês | MEDLINE | ID: mdl-36456084

RESUMO

The Monro-Kellie doctrine is a well-accepted principle of intracranial hemodynamics. It has undergone few consequential revisions since it was established. Its principle is straightforward: The combined volume of neuronal tissue, blood, and CSF is constant. To maintain homeostatic intracranial pressure, any increase or decrease in one of these elements leads to a reciprocal and opposite change in the others. The Monro-Kellie doctrine assumes a rigid, unadaptable calvaria. Recent studies have disproven this assumption. The skull expands and grows in response to pathologic changes in intracranial pressure. In this review, we outline what is known about calvarial changes in the setting of pressure dysregulation and suggest a revision to the Monro-Kellie doctrine that includes an adaptable skull as a fourth component.

3.
AJNR Am J Neuroradiol ; 43(10): 1539-1543, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36574327

RESUMO

CSF leaks, including CSF-venous fistulas, which cause spontaneous intracranial hypotension, remain difficult to diagnose, even on digital subtraction myelography and CT myelography. Dual-energy CT technology has been used to improve diagnostic utility within multiple organ systems. The capability of dual-energy CT to create virtual monoenergetic images can be leveraged to increase conspicuity of contrast in CSF-venous fistulas and direct epidural CSF leakage to improve the diagnostic utility of CT myelography. Six cases (in 5 patients) are shown in which virtual monoenergetic images demonstrate a leak location that was either occult or poorly visible on high- or low-kilovolt series. This clinical report describes the novel application of dual-energy CT for the detection of subtle CSF leaks including CSF-venous fistulas.


Assuntos
Fístula , Hipotensão Intracraniana , Humanos , Mielografia/métodos , Vazamento de Líquido Cefalorraquidiano/diagnóstico por imagem , Vazamento de Líquido Cefalorraquidiano/complicações , Hipotensão Intracraniana/etiologia , Tomografia Computadorizada por Raios X/métodos , Fístula/complicações
4.
Artigo em Inglês | MEDLINE | ID: mdl-36007946

RESUMO

BACKGROUND AND PURPOSE: The normal appearance of the vestibular aqueduct on postcontrast MR images has not been adequately described in the literature. This study set out to characterize the expected appearance of the vestibular aqueduct, with particular emphasis on the enhancement of the structure on both 3D FSE T1 and 3D-FLAIR sequences. MATERIALS AND METHODS: All MR imaging examinations of the internal auditory canals performed between March 1, 2021, and May 20, 2021, were retrospectively reviewed. All studies included high-resolution (≤0.5-mm section thickness) pre- and postgadolinium 3D FSE T1 with fat-saturated and postgadolinium 3D-FLAIR sequences. Two neuroradiologists independently reviewed the MR images of the vestibular aqueduct for the presence or absence of enhancement on both T1 and FLAIR images and compared the relative intensity of enhancement between sequences. The presence or absence of an enlarged vestibular aqueduct was also noted. RESULTS: Ninety-five patients made up the patient cohort, of whom 5 did not have postcontrast FLAIR images available (50 women [55.6%]). On both sides, enhancement was significantly more commonly seen on postgadolinium FLAIR (76/180, 42.2%) than on T1 fat-saturated images (41/190, 21.6%) (P < .001). The intensity of enhancement was significantly greater on postgadolinium FLAIR images than on T1 fat-saturated images (38.9% versus 3.7%, respectively; P < .001). CONCLUSIONS: Enhancement within the vestibular aqueduct is an expected finding on MR imaging and is both more common and more intense on postgadolinium 3D-FLAIR than on T1 fat-saturated sequences. Such enhancement should not be confused with pathology on MR imaging unless other suspicious findings are present.

5.
AJNR Am J Neuroradiol ; 43(7): 978-983, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35772803

RESUMO

BACKGROUND AND PURPOSE: Diagnosing spontaneous intracranial hypotension and associated CSF leaks can be challenging, and additional supportive imaging findings would be useful to direct further evaluation. This retrospective study evaluated whether there was a difference in the prevalence of calvarial hyperostosis in a cohort of patients with spontaneous intracranial hypotension compared with an age- and sex-matched control population. MATERIALS AND METHODS: Cross-sectional imaging (CT of the head or brain MR imaging examinations) for 166 patients with spontaneous intracranial hypotension and 321 matched controls was assessed by neuroradiologists blinded to the patient's clinical status. The readers qualitatively evaluated the presence of diffuse or layered calvarial hyperostosis and measured calvarial thickness in the axial and coronal planes. RESULTS: A significant difference in the frequency of layered hyperostosis (31.9%, 53/166 subjects versus 5.0%, 16/321 controls, P < .001, OR = 11.58) as well as the frequency of overall (layered and diffuse) hyperostosis (38.6%, 64/166 subjects versus 13.2%, 42/321 controls, P < .001, OR = 4.66) was observed between groups. There was no significant difference in the frequency of diffuse hyperostosis between groups (6.6%, 11/166 subjects versus 8.2%, 26/321 controls, P = .465). A significant difference was also found between groups for calvarial thickness measured in the axial (P < .001) and coronal (P < .001) planes. CONCLUSIONS: Layered calvarial hyperostosis is more prevalent in spontaneous intracranial hypotension compared with the general population and can be used as an additional noninvasive brain imaging marker of spontaneous intracranial hypotension and an underlying spinal CSF leak.


Assuntos
Hiperostose , Hipotensão Intracraniana , Estudos de Casos e Controles , Vazamento de Líquido Cefalorraquidiano , Anormalidades Craniofaciais , Humanos , Hiperostose/diagnóstico por imagem , Hipotensão Intracraniana/complicações , Hipotensão Intracraniana/diagnóstico por imagem , Hipotensão Intracraniana/epidemiologia , Imageamento por Ressonância Magnética/métodos , Mielografia/métodos , Estudos Retrospectivos
6.
AJNR Am J Neuroradiol ; 43(1): 117-124, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34887246

RESUMO

BACKGROUND AND PURPOSE: Percutaneous CT-guided core needle biopsies of head and neck lesions can be safely performed with vigilant planning. This largest-to-date single-center retrospective study evaluates multiple approaches with consideration of special techniques and examines the histopathologic yield. MATERIALS AND METHODS: Retrospective review of CT-guided core biopsies of head and neck lesions from January 1, 2010, to October 30, 2020, was performed. We recorded the following: patient demographics, sedation details, biopsy needle type and size, lesion location and size, approach, patient positioning, preprocedural intravenous contrast, proceduralists' years of experience, complications, and pathology results. RESULTS: One hundred eighty-four CT-guided core biopsies were evaluated. The initial diagnostic yield was 93% (171/184). However, of 43/184 (23%) originally "negative for malignancy" biopsies, 4 were eventually positive for malignancy via rebiopsy/excision, resulting in a 2% false-negative rate and an adjusted total diagnostic yield of 167/184 (91%). Biopsies were performed by 16 neuroradiologists with variable experience. The diagnostic yield was essentially the same: 91% (64/70) for proceduralists with ≤3 years' experience, and 90% (103/114) with >3 years' experience. The diagnostic yield was 93% (155/166) for lesions of >10 mm. The diagnostic yield per biopsy needle gauge was the following: 20 ga, 81% (13/16); 18 ga, 93% (70/75); 16 ga, 90% (64/71); and 14 ga, 91% (20/22). There were 4 asymptomatic hematomas, with none requiring intervention. CONCLUSIONS: Percutaneous CT-guided core needle biopsies are safe procedures for superficial and deep head and neck lesions with a high diagnostic yield. Careful planning and special techniques may increase the number of lesions accessible percutaneously while minimizing the risk of complications.


Assuntos
Biópsia Guiada por Imagem , Tomografia Computadorizada por Raios X , Biópsia com Agulha de Grande Calibre/efeitos adversos , Biópsia com Agulha de Grande Calibre/métodos , Humanos , Biópsia Guiada por Imagem/métodos , Pescoço , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos
7.
Indian J Radiol Imaging ; 31(3): 751-753, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34790330

RESUMO

Hypertrophic cardiomyopathy is a relatively common inherited cardiac disorder, with echocardiography still being the initial imaging method for its diagnosis. Cardiac fibroma is a primary neoplasm that most commonly presents in childhood. We present a patient who was investigated for typical cardiac symptoms who went on to have cardiac magnetic resonance imaging and was found to have both of these conditions.

8.
FASEB J ; 35(8): e21765, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34318967

RESUMO

The bioactive lipid intermediate palmitoyl CoA (PCoA) can inhibit mitochondrial ADP/ATP transport, though the physiological relevance of this regulation remains unclear. We questioned whether myocardial ischemia provides a pathological setting in which PCoA regulation of ADP/ATP transport would be beneficial, and secondly, whether the chronically elevated lipid content within the diabetic heart could make mitochondria less sensitive to the effects of PCoA. PCoA acutely decreased ADP-stimulated state 3 respiration and increased the apparent Km for ADP twofold. The half maximal inhibitory concentration (IC50 ) of PCoA in control mitochondria was 22 µM. This inhibitory effect of PCoA on respiration was blunted in diabetic mitochondria, with no significant difference in the Km for ADP in the presence of PCoA, and an increase in the IC50 to 32 µM PCoA. The competitive inhibition by PCoA was localised to the phosphorylation apparatus, particularly the ADP/ATP carrier (AAC). During ischemia, the AAC imports ATP into the mitochondria, where it is hydrolysed by reversal of the ATP synthase, regenerating the membrane potential. Addition of PCoA dose-dependently prevented this wasteful ATP hydrolysis for membrane repolarisation during ischemia, however, this beneficial effect was blunted in diabetic mitochondria. Finally, using 31 P-magnetic resonance spectroscopy we demonstrated that diabetic hearts lose ATP more rapidly during ischemia, with a threefold higher ATP decay rate compared with control hearts. In conclusion, PCoA plays a role in protecting mitochondrial energetics during ischemia, by preventing wasteful ATP hydrolysis. However, this beneficial effect is blunted in diabetes, contributing to the impaired energy metabolism seen during myocardial ischemia in the diabetic heart.


Assuntos
Diabetes Mellitus Tipo 2/metabolismo , Isquemia , Mitocôndrias Cardíacas/metabolismo , Miocárdio , Palmitoil Coenzima A , Trifosfato de Adenosina/metabolismo , Animais , Respiração Celular , Metabolismo Energético , Isquemia/metabolismo , Isquemia/patologia , Masculino , Miocárdio/metabolismo , Miocárdio/patologia , Consumo de Oxigênio , Palmitoil Coenzima A/farmacologia , Palmitoil Coenzima A/fisiologia , Ratos , Ratos Wistar
9.
10.
AJNR Am J Neuroradiol ; 42(2): 228-232, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33303524

RESUMO

Optic nerve choristomas are rare entities in which a developmental focus of histologically normal tissue is abnormally located within or along a segment of the optic nerve. Although benign, choristomas may demonstrate slow growth, ultimately resulting in visual field deficits due to compression of the adjacent nerve in the few cases reported in the anterior fossa. Choristomas may have cystic components, though this has not been described in such lesions along the optic nerve. Here, a predominantly cystic optic nerve choristoma is described, with radiologic features mimicking those of an anterior cranial fossa neurenteric cyst. The case highlights the radiology-pathology correlates of choristomas and reviews the surgical approach and management of patients with such lesions.


Assuntos
Coristoma/diagnóstico , Coristoma/patologia , Defeitos do Tubo Neural/diagnóstico , Nervo Óptico/patologia , Glândulas Salivares , Coristoma/cirurgia , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade
11.
Skin Health Dis ; 1(4): e74, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-35663770

RESUMO

Background: Acute generalized exanthematous pustulosis (AGEP) is a severe pustular drug eruption with rare reports of haemodynamic instability. Objective: To describe the clinical characteristics, management, and outcomes of patients with AGEP-associated haemodynamic instability. Methods: This retrospective case series identified adult patients diagnosed with AGEP who had haemodynamic instability from November 2012 to February 2020 that were seen at two academic teaching hospitals with roles as a burn centre and tertiary referral centre at the University of Texas Southwestern Medical Center in Dallas, TX USA. Patients with a discharge diagnosis of AGEP that had haemodynamic instability during their eruption were included. Patients with a history of psoriasis, presentations thought to be a flare of generalized pustular psoriasis, or concurrent infection during eruption were excluded. AGEP with haemodynamic instability was characterized by degree of hypotension, dermatologic phenotype at time of dermatologic consultation, and management approach. Results: This study included 19 patients with AGEP-associated haemodynamic instability (mean age, 52 years; age range, 29-76 years; 11 (58%) female). Patients were classified on a spectrum of haemodynamic instability; three had sustained hypotension, 10 had hypotension with organ dysfunction, and six had shock. Patients with AGEP-associated haemodynamic instability had a range of dermatologic phenotypes at initial consultation: subtle exanthematous eruption with minimal pustules, typical eruption with pustules and flexural predominance, and severe eruption with features of Stevens-Johnson syndrome. Both topical and systemic corticosteroids were used for treatment of several patients. Of the patients that required vasopressors and received systemic steroids, the majority were off vasopressors within 24 h of steroid initiation. Conclusion: Approximately 22% of patients presenting with AGEP to a tertiary referral center had haemodynamic instability. Clinicians should be aware that dermatologic phenotype of AGEP at presentation does not correlate with development of haemodynamic instability.

12.
J Exp Biol ; 224(20)2021 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-34581406

RESUMO

Sound and vibration are generated by mechanical disturbances within the environment, and the ability to detect and localize these acoustic cues is generally important for survival, as suggested by the early emergence of inherently directional otolithic ears in vertebrate evolutionary history. However, fossil evidence indicates that the water-adapted ear of early terrestrial tetrapods lacked specialized peripheral structures to transduce sound pressure (e.g. tympana). Therefore, early terrestrial hearing should have required nontympanic (or extratympanic) mechanisms for sound detection and localization. Here, we used atympanate salamanders to investigate the efficacy of extratympanic pathways to support directional hearing in air. We assessed peripheral encoding of directional acoustic information using directionally masked auditory brainstem response recordings. We used laser Doppler vibrometry to measure the velocity of sound pressure-induced head vibrations as a key extratympanic mechanism for aerial sound reception in atympanate species. We found that sound generates head vibrations that vary with the angle of the incident sound. This extratympanic pathway for hearing supports a figure-eight pattern of directional auditory sensitivity to airborne sound in the absence of a pressure-transducing tympanic ear.


Assuntos
Condução Óssea , Localização de Som , Animais , Sinais (Psicologia) , Orelha Média , Audição , Urodelos , Vibração
13.
J Exp Biol ; 223(Pt 24)2020 12 21.
Artigo em Inglês | MEDLINE | ID: mdl-33161383

RESUMO

The tympanic middle ear is an adaptive sensory novelty that evolved multiple times in all the major terrestrial tetrapod groups to overcome the impedance mismatch generated when aerial sound encounters the air-skin boundary. Many extant tetrapod species have lost their tympanic middle ears, yet they retain the ability to detect airborne sound. In the absence of a functional tympanic ear, extratympanic hearing may occur via the resonant qualities of air-filled body cavities, sensitivity to seismic vibration, and/or bone conduction pathways to transmit sound from the environment to the ear. We used auditory brainstem response recording and laser vibrometry to assess the contributions of these extratympanic pathways for airborne sound in atympanic salamanders. We measured auditory sensitivity thresholds in eight species and observed sensitivity to low-frequency sound and vibration from 0.05-1.2 kHz and 0.02-1.2 kHz, respectively. We determined that sensitivity to airborne sound is not facilitated by the vibrational responsiveness of the lungs or mouth cavity. We further observed that, although seismic sensitivity probably contributes to sound detection under naturalistic scenarios, airborne sound stimuli presented under experimental conditions did not produce vibrations detectable to the salamander ear. Instead, threshold-level sound pressure is sufficient to generate translational movements in the salamander head, and these sound-induced head vibrations are detectable by the acoustic sensors of the inner ear. This extratympanic hearing mechanism mediates low-frequency sensitivity in vertebrate ears that are unspecialized for the detection of aerial sound pressure, and may represent a common mechanism for terrestrial hearing across atympanic tetrapods.


Assuntos
Condução Óssea , Urodelos , Animais , Limiar Auditivo , Orelha Média , Audição , Vibração
14.
AJNR Am J Neuroradiol ; 41(12): 2176-2187, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33093137

RESUMO

Paraneoplastic syndromes are systemic reactions to neoplasms mediated by immunologic or hormonal mechanisms. The most well-recognized paraneoplastic neurologic syndrome, both clinically and on imaging, is limbic encephalitis. However, numerous additional clinically described syndromes affect the brain, spinal cord, and peripheral nerves. Many of these syndromes can have imaging findings that, though less well described, are important in making the correct diagnosis. Moreover, imaging in these syndromes frequently mimics more common pathology, which can be a diagnostic challenge for radiologists. Our goal is to review the imaging findings of paraneoplastic neurologic syndromes, including less well-known entities and atypical presentations of common entities. Specifically, we discuss limbic encephalitis, paraneoplastic cerebellar degeneration, paraneoplastic brain stem encephalitis, cranial neuropathy, myelitis, and polyneuropathy. We also demonstrate common diagnostic pitfalls that can be encountered when imaging these patients.


Assuntos
Neuroimagem/métodos , Síndromes Paraneoplásicas do Sistema Nervoso/diagnóstico por imagem , Humanos , Pessoa de Meia-Idade , Síndromes Paraneoplásicas do Sistema Nervoso/patologia
15.
AJNR Am J Neuroradiol ; 41(10): 1953-1957, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32883671

RESUMO

BACKGROUND AND PURPOSE: Digital subtraction myelography performed with the patient in the lateral decubitus position has the potential for increased sensitivity over prone-position myelography in the detection of spinal CSF-venous fistulas, a well-established cause of spontaneous intracranial hypotension. We report on the safety of performing routine, consecutive-day right and left lateral decubitus digital subtraction myelography in these patients. MATERIALS AND METHODS: In this retrospective case series, all patients undergoing consecutive-day lateral decubitus digital subtraction myelography for suspected spinal CSF leak between September 2018 and September 2019 were identified. Chart review was performed to identify any immediate or delayed adverse effects associated with the procedures. Procedural parameters were also analyzed due to inherent variations associated with the positive-pressure myelography technique that was used. RESULTS: A total of 60 patients underwent 68 pairs of consecutive-day lateral decubitus digital subtraction myelographic examinations during the study period. No major adverse effects were recorded. Various minor adverse effects were observed, including pain requiring analgesics (27.2%), nausea/vomiting requiring antiemetics (8.1%), and transient neurologic effects such as syncope, vertigo, altered mental status, and autonomic dysfunction (5.1%). Minor transient neurologic effects were correlated with increasing volumes of intrathecal saline injectate used for thecal sac prepressurization. CONCLUSIONS: In patients with spontaneous intracranial hypotension and suspected spontaneous spinal CSF leak, consecutive-day lateral decubitus digital subtraction myelography demonstrates an acceptable risk profile without evidence of neurotoxic effects from cumulative intrathecal contrast doses. Higher intrathecal saline injectate volumes may correlate with an increased incidence of minor transient periprocedural neurologic effects.


Assuntos
Vazamento de Líquido Cefalorraquidiano/complicações , Vazamento de Líquido Cefalorraquidiano/diagnóstico por imagem , Hipotensão Intracraniana/etiologia , Mielografia/métodos , Posicionamento do Paciente/métodos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
16.
AJNR Am J Neuroradiol ; 41(10): 1958-1962, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32855185

RESUMO

BACKGROUND AND PURPOSE: Inadvertent subdural contrast injections can occur during any myelogram. Currently, there are no guidelines defining when residual subdural iodinated contrast will be cleared and no longer interfere with subsequent procedure and imaging. We investigated the time to resolution of subdural contrast using a 2-day lateral decubitus digital subtraction myelogram and associated CT myelogram data in patients undergoing evaluation for spontaneous intracranial hypotension. MATERIALS AND METHODS: Retrospective review of 63 patients with lateral decubitus digital subtraction myelograms from September 4, 2018, to October 1, 2019, was performed. Patients with 2-day lateral decubitus digital subtraction myelograms on 2 consecutive days, with or without a same-day CT myelogram on day 1 and with a same-day CT myelogram on day 2, were included. Patients with next-day CT covering at least the abdomen and pelvis after either-day injection were also included. In cases of subdural injection, next-day CT scans were evaluated for residual subdural contrast. RESULTS: Of 49 included patients, 5 had subdural injection on day 1, with the second-day CT myelogram available for review. One of these 5 patients had subdural injections on 2 different days and subsequently had chest/abdomen/pelvis CTA a day after the second subdural injection. In all 6 cases of subdural injections, there was complete resolution of subdural contrast on the next-day CT, with the shortest time to resolution of approximately 20.5 hours (range, 20.5-28.5 hours). CONCLUSIONS: Our study suggests that resolution of inadvertently injected subdural contrast occurs within 1 day, and the myelogram can be reattempted as early as the next day.


Assuntos
Meios de Contraste/administração & dosagem , Hipotensão Intracraniana/diagnóstico por imagem , Mielografia/métodos , Espaço Subdural , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos
17.
AJNR Am J Neuroradiol ; 41(10): 1786-1790, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32819895

RESUMO

Chordomas are rare primary bone malignancies derived from notochord remnants. The tumors often are slow-growing and often present with indolent, nonspecific symptoms. Nevertheless, chordomas are locally aggressive and highly prone to local recurrence, necessitating precise planning before biopsy and/or surgical resection. Familiarity with the imaging features of chordomas is, therefore, essential. This case highlights the typical imaging and pathologic features of a spinal chordoma as well as the surgical approach and the patient's subsequent outcome.


Assuntos
Cordoma/patologia , Neoplasias da Coluna Vertebral/patologia , Idoso , Dor nas Costas/etiologia , Cordoma/complicações , Cordoma/cirurgia , Humanos , Vértebras Lombares/patologia , Masculino , Recidiva Local de Neoplasia/patologia , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/cirurgia , Corpo Vertebral/patologia
18.
AJNR Am J Neuroradiol ; 41(8): 1339-1347, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32646948

RESUMO

Spontaneous intracranial hypotension is a condition characterized by low CSF volume secondary to leakage through a dural defect with no identifiable cause. Patients classically present with orthostatic headaches, but this symptom is not specific to spontaneous intracranial hypotension, and initial misdiagnosis is common. The most prominent features of spontaneous intracranial hypotension on intracranial MR imaging include "brain sag" and diffuse pachymeningeal enhancement, but these characteristics can be seen in several other conditions. Understanding the clinical and imaging features of spontaneous intracranial hypotension and its mimickers will lead to more prompt and accurate diagnoses. Here we discuss conditions that mimic the radiologic and clinical presentation of spontaneous intracranial hypotension as well as other disorders that CSF leaks can imitate.


Assuntos
Hipotensão Intracraniana/diagnóstico por imagem , Diagnóstico Diferencial , Feminino , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino
19.
AJNR Am J Neuroradiol ; 41(4): 573-578, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32217553

RESUMO

Polymorphous low-grade neuroepithelial tumors of the young (PLNTYs) are recently described CNS tumors. Classically, PLNTYs are epileptogenic and are a subtype of a heterogeneous group of low-grade neuroepithelial tumors that cause refractory epilepsy, such as angiocentric gliomas, oligodendrogliomas, gangliogliomas, and pleomorphic xanthoastrocytomas. Although they are a relatively new entity, a number of imaging and histologic characteristics of PLNTYs are already known. We present the imaging and pathologic findings of such a tumor as well as the surgical approach and clinical management.


Assuntos
Neoplasias Encefálicas/patologia , Neoplasias Neuroepiteliomatosas/patologia , Adulto , Neoplasias Encefálicas/cirurgia , Calcinose , Feminino , Humanos , Neoplasias Neuroepiteliomatosas/cirurgia , Procedimentos Neurocirúrgicos
20.
AJNR Am J Neuroradiol ; 41(1): 21-28, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31857327

RESUMO

Digital subtraction myelography is a valuable diagnostic technique to detect the exact location of CSF leaks in the spine to facilitate appropriate diagnosis and treatment of spontaneous spinal CSF leaks. Digital subtraction myelography is an excellent diagnostic tool for assessment of various types of CSF leaks, and lateral decubitus digital subtraction myelography is increasingly being used to diagnose CSF-venous fistulas. Lateral decubitus digital subtraction myelography differs from typical CT and fluoroscopy-guided myelograms in many ways, including equipment, supplies, and injection and image-acquisition techniques. Operators should be familiar with techniques, common pitfalls, and artifacts to improve diagnostic yield and prevent nondiagnostic examinations.


Assuntos
Vazamento de Líquido Cefalorraquidiano/diagnóstico por imagem , Mielografia/métodos , Feminino , Humanos , Masculino
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