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1.
Acta Neurol Taiwan ; 28(2): 57-58, 2019 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-31867708

RESUMO

ation. No significant past medical history except for pharmacologically controlled mild hypertension. During the neurological examination the patient appeared alert, oriented and showed no deficit of strength, sensitivity and coordination. An expressive temporary aphasia was confirmed and Transient Ischemic Attacks (TIA) was suspected. Cranial Computed Tomography Angiography (CTA) showed hypoplasia of left Internal Carotid Artery (ICA) with a focal duplication in the intracavernous segment (Figure 1, arrowhead). Circle of Willis appears to be regular, with the left middle cerebral artery supported by the vertebrobasilar system through the left posterior communicating artery of increased caliber, and by the contralateral ICA via anterior communicating artery. Consequently, patient underwent Digital Subtraction Angiography (DSA) lateral view that confirmed the segmental duplication of the left intracavernous ICA (Figure 2, arrowhead). Vessels had a lightly winding course within the cavernous sinus and the intracranial branches downstream of their confluence presented a slight delay in visualization. After few hours her symptoms completely regressed and, in agreement with clinical and imaging data, diagnosis of TIA was made. The transient ischemic event was, in fact, most likely caused by low flow to the left cerebral hemisphere due to hypoplasia of the ICA and aforementioned abnormalities of its intracavernous tract that caused alteration and reduction of intracranial flow distribution. Medical treatment with anti-platelet drugs was started and patient was discharged with a clinical, laboratory and imaging follow-up program. Duplications of ICA in the intracranial tract are very rare(1,2). Most of the cases are localized in the supraclinoid segment. To our knowledge this is the first case described in literature of true duplication of ICA in the intracavernous tract. Patients with congenital variants or acquired pathology of ICA are mostly asymptomatic, but when symptoms appear, patients must be investigated(1-3). CTA is considered the first line non-invasive diagnostic method for intracranial vascular anatomy. At present, medical treatment remains the choice in patients with no-complicated duplications of ICA in the intracranial tract.


Assuntos
Artéria Carótida Interna , Angiografia Digital , Artéria Carótida Interna/diagnóstico por imagem , Angiografia Cerebral , Angiografia por Tomografia Computadorizada , Feminino , Humanos
2.
Clin Imaging ; 60(1): 109-122, 2019 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-31865214

RESUMO

Diagnosis of extramedullary spinal diseases is often complex, firstly requiring a good anatomic knowledge for a precise localization of pathologies. The spinal canal, a tubular space delimited by vertebral bodies and neural arches, contains the spinal cord, nerve roots and cauda equina. Neural structures are surrounded and supported, from outer to inner, by meninges: dura, arachnoid and pia mater; meningeal layers divide extramedullary spaces in epidural, subdural and subarachnoid. Extramedullary diseases may be broadly classified in degenerative, neoplastic, traumatic, infective or miscellaneous. Imaging (MRI, CT) plays a fundamental role in the identification of pathologies, providing elements of differential diagnosis and accurate informations (location, extension, tissue characteristics) to guide further management. MRI is the best imaging modality technique to investigate extramedullary spaces and their diseases; however, CT may be useful in cases of bone involvement. The purposes of this article are to depict extramedullary anatomy, describe the most important extramedullary diseases following physiopathological and space-to-space criteria, illustrate imaging features of extramedullary pathologies, and underline imaging clues for differential diagnosis.

3.
World Neurosurg ; 129: 186-187, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31426251

RESUMO

Extraventricular neurocytoma (EVN) is an exceedingly rare brain tumor. The radiologic and histologic features of EVN are insidious, and only a few reports and clinical cases describe the characteristics of the tumor, which may show different presentations. We report a case of atypical EVN in a 23-year-old man; Computed Tomography and Magnetic Resonance Imaging features of the mass are described, and differential diagnosis are illustrated. In light of the high variability of imaging presentation, the definitive diagnosis of EVN remains histologic. Although some cases have already been reported in the literature, we believe that the description of our case could be useful to increase the knowledge of this insidious tumor, which has gained recognition only over the past 2 decades and should be included in the differential diagnosis in young patients who present brain tumors.


Assuntos
Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/patologia , Neurocitoma/diagnóstico por imagem , Neurocitoma/patologia , Diagnóstico Diferencial , Lobo Frontal/diagnóstico por imagem , Lobo Frontal/patologia , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Neuroimagem/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto Jovem
4.
World Neurosurg ; 131: 194-195, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31437518

RESUMO

We present a case of post-traumatic intracranial dislocation of an unfractured mandibular condyle in a 17-year old female patient associated with multiple skull base fractures. Computed tomography (CT) findings are illustrated, and also postoperative CT is described. The article underlines the pivotal role of CT in the early diagnosis and in the investigation of additional brain lesions and complications.


Assuntos
Luxações Articulares/diagnóstico por imagem , Luxações Articulares/etiologia , Côndilo Mandibular/diagnóstico por imagem , Base do Crânio/diagnóstico por imagem , Base do Crânio/lesões , Fraturas Cranianas/diagnóstico por imagem , Acidentes de Trânsito , Adolescente , Diagnóstico Diferencial , Diagnóstico Precoce , Feminino , Humanos , Luxações Articulares/complicações , Fraturas Cranianas/complicações , Tomografia Computadorizada por Raios X
5.
Insights Imaging ; 10(1): 33, 2019 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-30877408

RESUMO

The human body has 12 pairs of cranial nerves that control motor and sensory functions of the head and neck. The anatomy of cranial nerves is complex and its knowledge is crucial to detect pathological alterations in case of nervous disorders. Therefore, it is necessary to know the most frequent pathologies that may involve cranial nerves and recognize their typical characteristics of imaging. Cranial nerve dysfunctions may be the result of pathological processes of the cranial nerve itself or be related to tumors, inflammation, infectious processes, or traumatic injuries of adjacent structures. Magnetic resonance imaging (MRI) is considered the gold standard in the study of the cranial nerves. Computed tomography (CT) allows, usually, an indirect view of the nerve and is useful to demonstrate the intraosseous segments of cranial nerves, the foramina through which they exit skull base and their pathologic changes. The article is a complete pictorial overview of the imaging of cranial nerves, with anatomic and pathologic descriptions and great attention to illustrative depiction. We believe that it could be a useful guide for radiologists and neuroradiologists to review the anatomy and the most important pathologies that involve cranial nerves and their differential diagnosis.

7.
Acta Neurol Taiwan ; 28(4): 126-130, 2019 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-32026456

RESUMO

We report two cases of patients who presented to the Emergency Room (ER) with a history of recurrent epistaxis. Conservative treatment was provided to both patients and the most common causes of bleeding were excluded. Patients underwent radiological examinations that revealed the presence of an Intracavernous Carotid Artery Aneurysm (ICAA) extending into the sphenoid sinus through the erosion of postero-lateral bony wall. Aneurysms rupture caused massive nasal bleeding. The purpose of our case report is to illustrate as a very common symptom like epistaxis, in a small number of cases can be underestimated: rare and severe causes of nasal bleeding, as ICAA, should therefore always be considered in the differential diagnosis.


Assuntos
Doenças das Artérias Carótidas , Epistaxe , Aneurisma Intracraniano , Artéria Carótida Interna , Diagnóstico Diferencial , Humanos
8.
Endocr Pathol ; 29(3): 289-293, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29675587

RESUMO

Grade 3 neuroendocrine tumor (NET G3) is a rare new entity that has recently been introduced in the classification of neuroendocrine neoplasms of the pancreas. It is a well-differentiated form, with a high proliferative activity (Ki67 > 20%), and it represents a category whose prognosis is intermediate between NET G2 and poorly differentiated neuroendocrine carcinoma (NEC G3). In sites other than the pancreas, this new category is by far less coded. Herein is reported a case of NET G3 of the stomach, the 13th described in literature. The patient was a 71-year-old man with a mass in the gastric fundus. Histological examination revealed a neuroendocrine tumor that was mostly composed by areas with conventional well-differentiated features and intermediate proliferative rate (< 20 mitoses/10 HPFs and 7% Ki67); part of the tumor was characterized by increased nuclear atypia, a confluent growth pattern, intermediate mitotic activity, and high Ki67 value (25%). The tumor was studied immunohistochemically and molecularly, and the only alteration that came out was MEN1 gene mutation (Lau584SerfsTer5) in both the high- and low-grade components. According to the actual classification of gastric neuroendocrine neoplasms, this case is labeled as NEC G3 but it should be named NET G3, with a much better prognosis than the former. Overall, both morphological pattern and the Ki67 value should be mentioned in the histological report in cases of high-grade neuroendocrine neoplasms because of its clinical significance in defining the prognosis and for new potential therapeutic approaches.


Assuntos
Tumores Neuroendócrinos/patologia , Neoplasias Gástricas/patologia , Idoso , Humanos , Masculino , Gradação de Tumores
9.
Neurol Sci ; 38(10): 1771-1777, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28726048

RESUMO

BACKGROUND: Intravenous tPA is the standard treatment for acute ischemic stroke within 4.5 hours of symptom onset. Neuroradiological selection is currently based upon non-contrast- brain CT scan (NCCT). AIMS: To verify, in an "expert-opinion setting", the possible usefulness of CT perfusion (CTP) in decision-making toward i.v. thrombolysis. PATIENTS AND METHOD: One hundred and three consecutive patients with acute ischemic stroke who underwent NCCT and CTP were re-evaluated by an expert in cerebrovascular disease, to verify if adding CTP information would have changed expert's opinion. RESULTS: After CTP, a definitive decision was made for 20 more patients, changing the proportion of patients candidate to i.v. tPA from 44% to 51%, and reducing uncertainty from 29% to 10%. CTP results were useful inmilder stroke (p = 0.01). CONCLUSIONS: In a "real world" setting, CT perfusion could be useful for clinical decision, in particular for milder stroke.


Assuntos
Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/terapia , Angiografia Cerebral , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/terapia , Tomografia Computadorizada por Raios X , Adulto , Idoso , Idoso de 80 Anos ou mais , Encéfalo/diagnóstico por imagem , Angiografia Cerebral/métodos , Tomada de Decisão Clínica , Meios de Contraste , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos Testes , Estudos Retrospectivos , Método Simples-Cego , Terapia Trombolítica , Tomografia Computadorizada por Raios X/métodos , Adulto Jovem
10.
Parkinsons Dis ; 2015: 180940, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26171275

RESUMO

In Parkinson's disease (PD) degeneration of mesocortical dopaminergic projections may determine cognitive and behavioral symptoms. Choice reaction time task is related to attention, working memory, and goal-directed behavior. Such paradigm involves frontal cortical circuits receiving mesocortical dopamine which are affected early in PD. The aim of this study is to characterize the role of dopamine on the cognitive processes that precede movement in a reaction time paradigm in PD. We enrolled 16 newly diagnosed and untreated patients with PD without cognitive impairment or depression and 10 control subjects with essential tremor. They performed multiple-choice reaction time task with the right upper limb and brain (18)F-DOPA PET/CT scan. A significant inverse correlation was highlighted between average reaction time and (18)F-DOPA uptake in the left lateral orbitofrontal cortex. No correlations were found between reaction time and PD disease severity or between reaction time and (18)F-DOPA uptake in controls. Our study shows that in PD, but not in controls, reaction time is inversely related to the levels of dopamine in the left lateral orbitofrontal cortex. This novel finding underlines the role of dopamine in the lateral orbitofrontal cortex in the early stages of PD, supporting a relation between the compensatory cortical dopamine and movement preparation.

11.
Eur J Nucl Med Mol Imaging ; 42(7): 1062-70, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25820675

RESUMO

PURPOSE: The role of mesocortical dopaminergic pathways in the cognitive function of patients with early Parkinson's disease (PD) needs to be further clarified. METHODS: The study groups comprised 15 drug-naive patients with de novo PD and 10 patients with essential tremor (controls) who underwent (18)F-DOPA PET (static acquisition, normalization on mean cerebellar counts) and an extended neuropsychological test battery. Factor analysis with varimax rotation was applied to the neuropsychological test scores, to yield five factors from 16 original scores, which explained 82 % of the total variance. Correlations between cognitive factors and (18)F-DOPA uptake were assessed with SPM8, taking age and gender as nuisance variables. RESULTS: (18)F-DOPA uptake was significantly lower in PD patients than in controls in the bilateral striatum, mainly in the more affected (right) hemisphere, and in a small right temporal region. Significant positive correlations were found only in PD patients between the executive factor and (18)F-DOPA uptake in the bilateral anterior cingulate cortex (ACC) and the middle frontal gyrus, between the verbal fluency factor and (18)F-DOPA uptake in left BA 46 and the bilateral striatum, and between the visuospatial factor and (18)F-DOPA uptake in the left ACC and bilateral striatum. No correlations were found between (18)F-DOPA uptake and either the verbal memory factor or the abstraction-working memory factor. CONCLUSION: These data clarify the role of the mesocortical dopaminergic pathways in cognitive function in early PD, highlighting the medial frontal lobe, anterior cingulate, and left BA 46 as the main sites of cortical correlation with executive and language functions.


Assuntos
Córtex Cerebral/diagnóstico por imagem , Cognição , Di-Hidroxifenilalanina/análogos & derivados , Doença de Parkinson/diagnóstico por imagem , Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos , Idoso , Estudos de Casos e Controles , Córtex Cerebral/patologia , Neurônios Dopaminérgicos/diagnóstico por imagem , Função Executiva , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/diagnóstico , Comportamento Verbal
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