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1.
Neurology ; 93(24): e2237-e2246, 2019 12 10.
Artigo em Inglês | MEDLINE | ID: mdl-31719134

RESUMO

OBJECTIVE: To determine the frequency of high-convexity tight sulci (HCTS) in a population-based sample and whether the presence of HCTS and related features influenced participants' cognitive status and classification within the new Alzheimer-biomarker framework. METHODS: We analyzed 684 participants ≥50 years of age who were enrolled in the prospective population-based Mayo Clinic Study of Aging and underwent structural MRI, amyloid PET imaging, and tau PET imaging. A fully automated machine-learning algorithm that had been developed previously in house was used to detect neuroimaging features of HCTS. On the basis of PET and MRI measures, participants were classified as having normal (A-) or abnormal (A+) amyloid, normal (T-) or abnormal (T+) tau, and normal (N-) or abnormal (N+) neurodegeneration. The neuropsychological battery assessed domain-specific and global cognitive scores. Gait speed also was assessed. Analyses were adjusted for age and sex. RESULTS: Of 684 participants, 45 (6.6%) were classified with HCTS according to the automated algorithm. Patients with HCTS were older than patients without HCTS (mean [SD] 78.0 [8.3] vs 71.9 [10.8] years; p < 0.001). More were cognitively impaired after age and sex adjustment (27% vs 9%; p = 0.005). Amyloid PET status was similar with and without HCTS, but tau PET standard uptake value ratio (SUVR) was lower for those with HCTS after age and sex adjustment (p < 0.001). Despite a lower tau SUVR, patients with HCTS had lower Alzheimer disease (AD) signature cortical thickness. With the amyloid-tau-neurodegeneration framework, HCTS was overrepresented in the T-(N)+ group, regardless of amyloid status. CONCLUSION: The HCTS pattern represents a definable subgroup of non-AD pathophysiology (i.e., T-[N]+) that is associated with cognitive impairment. HCTS may confound clinical and biomarker interpretation in AD clinical trials.


Assuntos
Doença de Alzheimer/diagnóstico por imagem , Disfunção Cognitiva/etiologia , Hidrocefalia/diagnóstico por imagem , Neuroimagem/métodos , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/complicações , Doença de Alzheimer/patologia , Cognição/fisiologia , Feminino , Humanos , Hidrocefalia/complicações , Hidrocefalia/patologia , Interpretação de Imagem Assistida por Computador/métodos , Aprendizado de Máquina , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons/métodos , Espaço Subaracnóideo/patologia
2.
World Neurosurg ; 132: 173-176, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31491571

RESUMO

BACKGROUND: Epidermoid cysts of the spinal cord may rupture, resulting in keratin dissemination in the subarachnoid space, in the ventricles, and along the central canal of the spinal cord causing meningitis, myelopathic changes, or hydrocephalus. CASE DESCRIPTION: A 53-year-old woman with no past medical history presented with a 2-week history of headache located in the occipital region associated with neck pain. Brain magnetic resonance imaging demonstrated multiple fat droplets scattered throughout the subarachnoid and intraventricular spaces with significant edema of the right posterior temporoparietal lobes with trapping of the right temporal horn of the lateral ventricle and atrium. An intracranial lesion could not be observed in the study. The spinal region was suspected as the possible culprit, and spinal imaging showed a large cystic lesion at the level of the conus medullaris. The patient underwent neuronavigation endoscopic exploration of the right lateral ventricle with flushing of the keratin particles followed by a posterior lumbar decompression with resection of the epidermoid cyst. Pathology was consistent with an epidermoid cyst. Successful recovery with improvement in symptoms was quickly observed. CONCLUSIONS: When an epidermoid cyst is suspected but no intracranial lesion is found, the intraspinal area should be studied. Rupture of a spinal epidermoid cyst may cause meningitis and inflammation producing obstructive hydrocephalus. We present this rare entity and describe the diagnostic and surgical techniques used.


Assuntos
Cisto Epidérmico/complicações , Hidrocefalia/etiologia , Hidrocefalia/cirurgia , Meningite/etiologia , Procedimentos Neurocirúrgicos/métodos , Doenças da Coluna Vertebral/complicações , Ventrículos Cerebrais/metabolismo , Ventrículos Cerebrais/patologia , Descompressão Cirúrgica , Endoscopia , Feminino , Humanos , Queratinas/metabolismo , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Neuronavegação , Ruptura , Espaço Subaracnóideo/metabolismo , Espaço Subaracnóideo/patologia , Resultado do Tratamento
3.
Pan Afr Med J ; 33: 98, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31489076

RESUMO

Tarlov cyst or perineural cyst is a local dilation of the subarachnoid space formed within the nerve root and filled with cerebrospinal fluid. There is no consensus on the best treatment of syntomatic sacral perinervous cysts. Many methods have been used to treat these symptomatic lesions, with variable results. We report a case series including 20 patients undergoing surgery for sacral Tarlov cyst. Our results were satisfactory; 80% of patients improved without neurological worsening in the post-operative period. Our surgical technique (sacral laminectomy+cyst puncture+establishment of dural sheat) described for the first time in this study seems to have been effective in the 20 cases reported in our study.


Assuntos
Laminectomia/métodos , Sacro/cirurgia , Cistos de Tarlov/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sacro/patologia , Espaço Subaracnóideo/patologia , Cistos de Tarlov/diagnóstico
4.
Neuroradiol J ; 32(5): 382-385, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31159654

RESUMO

BACKGROUND AND PURPOSE: Cervical spine tapering affects cerebrospinal fluid dynamics. Cervical spine taper ratios derived from anteroposterior diameters reportedly differ between patients with syringomyelia and controls. We attempted to verify the differences in diameter and to show differences in cross-sectional area between syringomyelia and controls. METHODS: Cervical spine magnetic resonance images in syringomyelia patients (idiopathic or Chiari I related) and control patients were examined. In each subject, the anteroposterior diameter of the spinal canal was measured at each cervical level, and C1-C4, C4-C7, and C1-C7 taper ratios were calculated. Differences in taper ratio between groups were tested for statistical significance with the t-test. Cross-sectional areas of the spinal canal were measured at each cervical spinal level, and tapering was calculated. RESULTS: Eighteen patients with idiopathic syringomyelia, 28 with Chiari I, and 29 controls were studied. Chiari and syringomyelia patients had significantly steeper diameter-based taper ratios than controls. The dural sac areas tapered proportionally with the diameter-based taper ratio in all groups. CONCLUSIONS: Cervical spine anteroposterior diameter tapering and dural sac cross-sectional areas tapering differ between syringomyelia patients and controls.


Assuntos
Espaço Subaracnóideo/cirurgia , Siringomielia/cirurgia , Adolescente , Adulto , Idoso , Malformação de Arnold-Chiari/patologia , Malformação de Arnold-Chiari/cirurgia , Estudos de Casos e Controles , Vértebras Cervicais , Criança , Pré-Escolar , Dura-Máter/patologia , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Espaço Subaracnóideo/patologia , Siringomielia/patologia , Adulto Jovem
5.
J Neurol Surg A Cent Eur Neurosurg ; 80(3): 228-232, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30708387

RESUMO

BACKGROUND: Intracranial chondromas are extremely rare and represent only 0.2% of all intracranial primary neoplasms. The histologic appearance lacks nuclear atypism and mitoses, and it usually shows low growth potential, although these benign features do not necessarily imply a good prognosis. CASE DESCRIPTION: A 44-year-old man was referred to our institution with a subarachnoid hemorrhage (SAH). He had a history of SAH 5 years previously that was diagnosed as unknown etiology at another hospital. Head magnetic resonance imaging showed a large tumor located in the prepontine cistern and extending up to the interpeduncular cistern, and the tumor was irregularly enhanced with contrast medium. Retrospective analysis of the original computed tomography of 5 years earlier identified a small contrast enhancing defect behind the dorsum sellae. Tumor removal was planned to prevent repeated SAH and control the apparently growing tumor. An extended transsphenoidal approach was performed. The pituitary gland was dissected from the bottom of the sellar floor and transposed forward to the prechiasmatic cistern with preservation of the pituitary stalk and its blood supply, and subtotal removal of the tumor was achieved. Postoperative diabetes insipidus disappeared within a few days, and the patient was discharged without neurologic or endocrinologic deficits. Histologic examination established the diagnosis as chondroma without a sarcomatous component. Follow-up examination 3 months after surgery showed a re-enlargement of the residual tumor, and gamma knife surgery was performed. CONCLUSIONS: Intracranial chondroma sometimes manifests as intracranial hemorrhage and grows comparatively rapidly in a short period despite the benign histologic features. A long and careful follow-up period is essential.


Assuntos
Neoplasias Encefálicas/cirurgia , Encéfalo/cirurgia , Condroma/cirurgia , Hemorragia Subaracnóidea/cirurgia , Adulto , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/patologia , Condroma/complicações , Condroma/diagnóstico por imagem , Condroma/patologia , Humanos , Imagem por Ressonância Magnética , Masculino , Período Pós-Operatório , Estudos Retrospectivos , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/etiologia , Hemorragia Subaracnóidea/patologia , Espaço Subaracnóideo/diagnóstico por imagem , Espaço Subaracnóideo/patologia , Espaço Subaracnóideo/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
6.
Neurosurgery ; 84(2): 457-468, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-29618081

RESUMO

BACKGROUND: The origin of syrinx fluid is controversial. OBJECTIVE: To elucidate the mechanisms of syringomyelia associated with cerebrospinal fluid pathway obstruction and with intramedullary tumors, contrast transport from the spinal subarachnoid space (SAS) to syrinx was evaluated in syringomyelia patients. METHODS: We prospectively studied patients with syringomyelia: 22 with Chiari I malformation and 16 with SAS obstruction-related syringomyelia before and 1 wk after surgery, and 9 with tumor-related syringomyelia before surgery only. Computed tomography-myelography quantified dye transport into the syrinx before and 0.5, 2, 4, 6, 8, 10, and 22 h after contrast injection by measuring contrast density in Hounsfield units (HU). RESULTS: Before surgery, more contrast passed into the syrinx in Chiari I malformation-related syringomyelia and spinal obstruction-related syringomyelia than in tumor-related syringomyelia, as measured by (1) maximum syrinx HU, (2) area under the syrinx concentration-time curve (HU AUC), (3) ratio of syrinx HU to subarachnoid cerebrospinal fluid (CSF; SAS) HU, and (4) AUC syrinx/AUC SAS. More contrast (AUC) accumulated in the syrinx and subarachnoid space before than after surgery. CONCLUSION: Transparenchymal bulk flow of CSF from the subarachnoid space to syrinx occurs in Chiari I malformation-related syringomyelia and spinal obstruction-related syringomyelia. Before surgery, more subarachnoid contrast entered syringes associated with CSF pathway obstruction than with tumor, consistent with syrinx fluid originating from the subarachnoid space in Chiari I malformation and spinal obstruction-related syringomyelia and not from the subarachnoid space in tumor-related syringomyelia. Decompressive surgery opened subarachnoid CSF pathways and reduced contrast entry into syringes associated with CSF pathway obstruction.


Assuntos
Líquido Cefalorraquidiano/diagnóstico por imagem , Siringomielia/líquido cefalorraquidiano , Siringomielia/diagnóstico por imagem , Siringomielia/patologia , Adulto , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Espaço Subaracnóideo/diagnóstico por imagem , Espaço Subaracnóideo/patologia
7.
AJNR Am J Neuroradiol ; 40(1): 74-79, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30523139

RESUMO

BACKGROUND AND PURPOSE: Several studies have evaluated the use of MR imaging markers for the prediction of outcome after shunt surgery in idiopathic normal pressure hydrocephalus with conflicting results. Our aim was to investigate the predictive value of a number of earlier proposed morphologic MR imaging markers in a large group of patients with idiopathic normal pressure hydrocephalus. MATERIALS AND METHODS: One hundred sixty-eight patients (mean age, 70 ± 9.3 years) with idiopathic normal pressure hydrocephalus, subjected to standardized quantification of clinical symptoms before and after shunt surgery, were included in the study. Outcome was calculated using a composite score. Preoperative T1, FLAIR, and flow-sensitive images were analyzed regarding the presence of 13 different morphologic MR imaging markers. RESULTS: The median Evans index was 0.41 (interquartile range, 0.37-0.44). All patients had an aqueductal flow void sign present and white matter hyperintensities. The median callosal angle was 68.8° (interquartile range, 57.7°-80.8°). Dilated Sylvian fissures were found in 69%; focally dilated sulci, in 25%; and widening of the interhemispheric fissure, in 55%. Obliteration of the sulci at the convexity was found in 36%, and 36% of patients were characterized as having disproportionately enlarged subarachnoid space hydrocephalus. Sixty-eight percent of patients improved after surgery. None of the investigated MR imaging markers were significant predictors of improvement after shunt surgery. CONCLUSIONS: Disproportionately enlarged subarachnoid space hydrocephalus, a small callosal angle, and the other MR imaging markers evaluated in this study should not be used to exclude patients from shunt surgery. These markers, though they may be indicative of idiopathic normal pressure hydrocephalus, do not seem to be a part of the mechanisms connected to the reversibility of the syndrome.


Assuntos
Derivações do Líquido Cefalorraquidiano/métodos , Hidrocefalia de Pressão Normal/diagnóstico por imagem , Hidrocefalia de Pressão Normal/patologia , Hidrocefalia de Pressão Normal/cirurgia , Seleção de Pacientes , Idoso , Corpo Caloso/diagnóstico por imagem , Corpo Caloso/patologia , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Espaço Subaracnóideo/diagnóstico por imagem , Espaço Subaracnóideo/patologia
8.
Magn Reson Med Sci ; 18(3): 194-199, 2019 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-30416181

RESUMO

PURPOSE: Since the first report on the deposition of gadolinium in the brain parenchyma after repeated intravenous administrations of gadolinium-based contrast agent GBCA (IV-GBCA), the mechanisms of penetration and retention are still remaining a hot topic of discussion and a target of investigation. We routinely obtain endolymphatic hydrops (EH) images at 4 h after IV administration of a single dose (SD) of GBCA (IV-SD-GBCA) using heavily T2-weighted three-dimensional fluid-attenuated inversion recovery imaging (hT2W-3D-FLAIR). Occasionally, we have encountered cases, which indicate high-signal intensity (SI) in the cerebrospinal fluid (CSF) surrounding the vein of Labbe. The purpose of the present study was to investigate the degree of contrast enhancement of the CSF surrounding the vein of Labbe on hT2W-3D-FLAIR after IV-SD-GBCA in comparison with other CSF spaces. MATERIALS AND METHODS: In 25 patients with a suspicion of EH, a magnetic resonance cisternography (MRC) and an hT2W-3D-FLAIR were obtained at 4 h after IV-SD-GBCA. The perivascular space (PVS) in the basal ganglia, CSF spaces in the ambient cistern (CSF-Amb), the CSF surrounding the superficial middle cerebral vein (CSF-SMCV), and the CSF surrounding the vein of Labbe (CSF-VL) were segmented on MRC. The PVS and CSF regions were co-registered onto the hT2W-3D-FLAIR and the SI of the PVS and CSF spaces were measured. The SI ratio (SIR) of the post-contrast hT2W-3D-FLAIR to the pre-contrast hT2W-3D-FLAIR was measured. Significant differences were evaluated using Steel-Dwass's test for multiple comparisons. RESULTS: The SIR of the CSF-VL was significantly higher than that of the PVS (P = 0.008), the CSF-Amb (P = 0.021), and the CSF-SMCV (P = 0.023). CONCLUSION: The strong contrast enhancement of CSF space around the vein of Labbe was confirmed on hT2W-3D-FLAIR at 4 h after IV-GBCA compared to the PVS and the other CSF spaces.


Assuntos
Gânglios da Base/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Veias Cerebrais/diagnóstico por imagem , Líquido Cefalorraquidiano/diagnóstico por imagem , Hidropisia Endolinfática/diagnóstico por imagem , Espaço Subaracnóideo/diagnóstico por imagem , Administração Intravenosa , Adulto , Idoso , Gânglios da Base/patologia , Veias Cerebrais/patologia , Meios de Contraste/administração & dosagem , Hidropisia Endolinfática/patologia , Feminino , Gadolínio DTPA/administração & dosagem , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Espaço Subaracnóideo/patologia
10.
AJNR Am J Neuroradiol ; 39(11): 2022-2026, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30361433

RESUMO

BACKGROUND AND PURPOSE: The DESH (disproportionately enlarged subarachnoid-space hydrocephalus) pattern of "tight high-convexity and medial subarachnoid spaces, and enlarged Sylvian fissures with ventriculomegaly" is used to determine which patients undergo an operation for adult hydrocephalus at many centers. Our aim was to review adult hydrocephalus cases when DESH has not been a criterion for an operation to determine the prevalence of DESH among the cohort and compare the surgical outcomes in the presence or absence of DESH. MATERIALS AND METHODS: A retrospective cohort study was conducted at a single institution (Johns Hopkins Hospital) to include patients surgically treated for adult hydrocephalus between 2003 and 2014 drawn from a data base of patients who had undergone standardized hydrocephalus protocol MR imaging. Preoperative imaging was reviewed by 2 blinded neuroradiologists to characterize the presence of DESH. Preoperative and postoperative clinical symptomatology was recorded. Frequencies were compared using the Fisher exact test, and nonparametric means were compared using the Mann-Whitney U Test. RESULTS: One hundred thirty-three subjects were identified and included (96 DESH absent, 37 DESH present). Shunting led to significant improvement in gait and urinary and cognitive symptoms for the overall cohort and for patients with and without DESH (P < .05). The Fisher exact test did not demonstrate any significant differences in either gait or urinary or cognitive symptom improvement between patients with or without DESH (P > .05). CONCLUSIONS: The current study demonstrated symptom improvement in patients with adult hydrocephalus following shunting, with no significant differences between subjects with and without DESH. Thus, shunt insertion for patients with adult hydrocephalus should not rely solely on the presence of preoperative DESH findings.


Assuntos
Derivações do Líquido Cefalorraquidiano/métodos , Hidrocefalia de Pressão Normal/patologia , Hidrocefalia de Pressão Normal/cirurgia , Espaço Subaracnóideo/patologia , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Hidrocefalia de Pressão Normal/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Espaço Subaracnóideo/diagnóstico por imagem , Resultado do Tratamento
11.
J Neurosurg Spine ; 29(6): 720-724, 2018 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-30192219

RESUMO

The authors report on a 47-year-old woman with a symptomatic thoracic spinal arachnoid cyst (SAC) who underwent a novel procedure that involves direct puncture of the SAC to visualize, diagnose, and potentially treat these rare spinal lesions. The method described utilizes 3D fluoroscopy to gain access to the SAC, followed by injection of myelographic contrast into the cyst. A characteristic "jellyfish sign" was observed that represents the containment of the contrast within the superior aspect of the cyst and a clear block of cranial flow of contrast, resulting in an undulating pattern of movement of contrast within the cyst. Following balloon fenestration of the cyst, unimpeded flow of contrast was visualized cranially throughout the thoracic subarachnoid space. The patient was discharged the following day in good condition, and subsequently experienced 1 year free from symptoms. This is the first reported case of a successful direct puncture of an SAC with balloon fenestration, and the first noted real-time fluoroscopic "behavior" of CSF within an arachnoid cyst.


Assuntos
Cistos Aracnóideos/cirurgia , Punções , Doenças da Medula Espinal/cirurgia , Medula Espinal/cirurgia , Espaço Subaracnóideo/patologia , Cistos Aracnóideos/diagnóstico por imagem , Feminino , Fluoroscopia/métodos , Humanos , Imagem por Ressonância Magnética/métodos , Pessoa de Meia-Idade , Neuroimagem/métodos , Procedimentos Neurocirúrgicos/métodos , Punções/métodos , Medula Espinal/patologia , Doenças da Medula Espinal/diagnóstico por imagem
12.
Acta Neurochir (Wien) ; 160(7): 1439-1449, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29802560

RESUMO

BACKGROUND: Glioependymal cysts (GECs) are benign intracranial cysts that have been rarely reported in the literature. The exact pathogenesis of these developmental anomalies is controversial. Moreover, the terminology used to name GECs and other intracranial cysts is confusing because they are undistinguishably reported under a variety of names. The available information in the literature about GECs is scarce, and for this reason, a detailed description about these uncommon lesions is necessary. METHODS: An illustrative case is presented; in addition, a PubMed and Scopus search adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed to include studies reporting patients with GECs. Different information was analyzed in these patients to describe the characteristics of this condition. In addition, different sources of literature were analyzed to complete the description of this clinical entity. RESULTS: The literature review yielded 26 cases of patients with intracranial GECs showing a diversity of clinical manifestations. All studies were case reports or small case series. Different characteristics of GECs are described. Moreover, the authors suggest an updated classification of intracranial benign cysts. CONCLUSIONS: The data collected from this review shows that GECs are rare and very often are erroneously named. They are congenital benign lesions with a neuroectodermal origin that share many radiological characteristics with a variety of intracranial benign cysts. The definite diagnosis of GECs is confirmed by the presence of a glial layer in the cyst wall at histological examination. The appropriate surgical technique should be selected according to the location of the cyst and its proximity to the ventricles or subarachnoid space.


Assuntos
Encefalopatias/diagnóstico por imagem , Cistos/diagnóstico por imagem , Neuroglia/patologia , Idoso , Encefalopatias/patologia , Ventrículos Cerebrais/diagnóstico por imagem , Ventrículos Cerebrais/patologia , Cistos/patologia , Feminino , Humanos , Espaço Subaracnóideo/diagnóstico por imagem , Espaço Subaracnóideo/patologia
13.
Neurocrit Care ; 29(2): 203-213, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29619661

RESUMO

BACKGROUND: This study aims to determine the relationship between pupillary reactivity, midline shift and basal cistern effacement on brain computed tomography (CT) in moderate-to-severe traumatic brain injury (TBI). All are important diagnostic and prognostic measures, but their relationship is unclear. METHODS: A total of 204 patients with moderate-to-severe TBI, documented pupillary reactivity, and archived neuroimaging were included. Extent of midline shift and basal cistern effacement were extracted from admission brain CT. Mean midline shift was calculated for each ordinal category of pupillary reactivity and basal cistern effacement. Sequential Chi-square analysis was used to calculate a threshold midline shift for pupillary abnormalities and basal cistern effacement. Univariable and multiple logistic regression analyses were performed. RESULTS: Pupils were bilaterally reactive in 163 patients, unilaterally reactive in 24, and bilaterally unreactive in 17, with mean midline shift (mm) of 1.96, 3.75, and 2.56, respectively (p = 0.14). Basal cisterns were normal in 118 patients, compressed in 45, and absent in 41, with mean midline shift (mm) of 0.64, 2.97, and 5.93, respectively (p < 0.001). Sequential Chi-square analysis identified a threshold for abnormal pupils at a midline shift of 7-7.25 mm (p = 0.032), compressed basal cisterns at 2 mm (p < 0.001), and completely effaced basal cisterns at 7.5 mm (p < 0.001). Logistic regression revealed no association between midline shift and pupillary reactivity. With effaced basal cisterns, the odds ratio for normal pupils was 0.22 (95% CI 0.08-0.56; p = 0.0016) and for at least one unreactive pupil was 0.061 (95% CI 0.012-0.24; p < 0.001). Basal cistern effacement strongly predicted midline shift (OR 1.27; 95% CI 1.17-1.40; p < 0.001). CONCLUSIONS: Basal cistern effacement alone is associated with pupillary reactivity and is closely associated with midline shift. It may represent a uniquely useful neuroimaging marker to guide intervention in traumatic brain injury.


Assuntos
Lesões Encefálicas Traumáticas/diagnóstico , Lesões Encefálicas Traumáticas/patologia , Lesões Encefálicas Traumáticas/fisiopatologia , Reflexo Pupilar/fisiologia , Espaço Subaracnóideo/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Admissão do Paciente , Estudos Retrospectivos , Índice de Gravidade de Doença , Espaço Subaracnóideo/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto Jovem
14.
World Neurosurg ; 112: 201-204, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29382614

RESUMO

BACKGROUND: Perivascular spaces (PVS), also known as Virchow-Robin spaces, are pial-lined, interstitial fluid-filled structures in the brain that accompany cerebral vessels as they penetrate the cerebral substance. In healthy individuals, a PVS diameter of <2 mm is considered normal and can typically be seen within the white matter on magnetic resonance imaging (MRI). When PVS dilate, they are considered benign lesions and are associated with aging and other risk factors. These dilated PVS can cause neurologic symptoms, depending on their size and location. Symptomatic, massive enlargement of PVS are referred to as "giant" or "tumefactive" PVS; these are extremely rare and require neurosurgical intervention. CASE DESCRIPTION: We present a rare case of giant tumefactive PVS (GTPVS) associated with hydrocephalus in a female patient who presented with progressive headache for 6 months. The patient was found to have giant tumefactive dilatation of PVS involving the right midbrain, with extension to the pons and thalamus, and with supratentorial moderate hydrocephalus. She was treated with cerebrospinal fluid diversion alone. CONCLUSIONS: PVS are found on MRI in healthy people; rarely, they may dilate and cause neurologic symptoms. GTPVS are rare and can be misdiagnosed as central nervous system tumors; however, their imaging characteristics facilitate diagnosis. It has been postulated that these expanding PVS are due to defects in the drainage of interstitial fluid, where it enters into the ventricular system, and they are not the result of increased intraventricular pressure. We hypothesize that this may have been the case for the patient in our study, as the GTPVS collapsed following the insertion of a ventriculoperitoneal shunt. However, more recent literature provides evidence to support the idea that hydrocephalus is the consequence, and not the cause, of aqueduct compression by the lesion.


Assuntos
Hidrocefalia/diagnóstico por imagem , Espaço Subaracnóideo/diagnóstico por imagem , Adulto , Dilatação Patológica/diagnóstico por imagem , Dilatação Patológica/patologia , Feminino , Humanos , Hidrocefalia/patologia , Hidrocefalia/cirurgia , Imagem por Ressonância Magnética , Espaço Subaracnóideo/patologia , Espaço Subaracnóideo/cirurgia , Resultado do Tratamento , Derivação Ventriculoperitoneal
16.
J Neurosurg Pediatr ; 21(1): 31-37, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29099352

RESUMO

OBJECTIVE Children who have subdural hematomas (SDHs) with no or minimal neurological symptoms (SDH-mild symptoms) often present a forensic challenge. Nonabusive causes of SDH, including birth-related SDH, benign enlargement of the subarachnoid spaces (BESS), and other proposed causes have been offered as etiologies. These alternative causes do not provide explanations for concomitant suspicious injuries (CSIs). If SDH with mild symptoms in young children are frequently caused by these alternative causes, children with SDH-mild symptoms should be more likely to have no other CSIs than those who have SDH with severe symptoms (SDH-severe symptoms). Additionally, if SDH with mild symptoms is caused by something other than abuse, the location and distribution of the SDH may be different than an SDH caused by abuse. The objectives of this study were to determine the prevalence of other CSIs in patients who present with SDH-mild symptoms and to compare that prevalence to patients with SDH-severe symptoms. Additionally, this study sought to compare the locations and distributions of SDH between the two groups. Finally, given the data supporting BESS as a potential cause of SDH in young children, the authors sought to evaluate the associations of BESS with SDH-mild symptoms and with other CSIs. METHODS The authors performed a 5-year retrospective case-control study of patients younger than 2 years of age with SDH evaluated by a Child Abuse Pediatrics program. Patients were classified as having SDH-mild symptoms (cases) or SDH-severe symptoms (controls). The two groups were compared for the prevalence of other CSIs. Additionally, the locations and distribution of SDH were compared between the two groups. The presence of BESS was evaluated for associations with symptoms and other CSIs. RESULTS Of 149 patients, 43 presented with SDH-mild symptoms and 106 with SDH-severe symptoms. Patients with SDH-mild symptoms were less likely to have other CSIs (odds ratio [OR] 0.2, 95% confidence interval [CI] 0.08-0.5) and less likely to have severe retinal hemorrhages (OR 0.08, 95% CI 0.03-0.3). However, 60.5% of patients with SDH-mild symptoms had other CSIs. There was no difference between the groups regarding the location and distribution of SDH. Of the entire study cohort, 34 (22.8%) had BESS, and BESS was present in 17 (39.5%) of the SDH-mild symptoms group and 17 (16%) of the SDH-severe symptoms group (OR 3.4, 95% CI 1.5-7.6). The presence of BESS was significantly associated with a lower chance of other CSIs (OR 0.1, 95% CI 0.05-0.3). However, 17 patients had BESS and other CSIs. Of these 17, 6 had BESS and SDH-mild symptoms. CONCLUSIONS The high occurrence of other CSIs in patients with SDH-mild symptoms and a similar high occurrence in patients with BESS (including those with SDH-mild symptoms) indicate that such children benefit from a full evaluation for abuse.


Assuntos
Maus-Tratos Infantis/diagnóstico , Traumatismos Craniocerebrais/etiologia , Hematoma Subdural/etiologia , Espaço Subaracnóideo/patologia , Estudos de Casos e Controles , Traumatismos Craniocerebrais/patologia , Feminino , Hematoma Subdural/patologia , Humanos , Lactente , Imagem por Ressonância Magnética , Masculino , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
17.
Brain ; 140(10): 2691-2705, 2017 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-28969373

RESUMO

The glymphatic system has in previous studies been shown as fundamental to clearance of waste metabolites from the brain interstitial space, and is proposed to be instrumental in normal ageing and brain pathology such as Alzheimer's disease and brain trauma. Assessment of glymphatic function using magnetic resonance imaging with intrathecal contrast agent as a cerebrospinal fluid tracer has so far been limited to rodents. We aimed to image cerebrospinal fluid flow characteristics and glymphatic function in humans, and applied the methodology in a prospective study of 15 idiopathic normal pressure hydrocephalus patients (mean age 71.3 ± 8.1 years, three female and 12 male) and eight reference subjects (mean age 41.1 + 13.0 years, six female and two male) with suspected cerebrospinal fluid leakage (seven) and intracranial cyst (one). The imaging protocol included T1-weighted magnetic resonance imaging with equal sequence parameters before and at multiple time points through 24 h after intrathecal injection of the contrast agent gadobutrol at the lumbar level. All study subjects were kept in the supine position between examinations during the first day. Gadobutrol enhancement was measured at all imaging time points from regions of interest placed at predefined locations in brain parenchyma, the subarachnoid and intraventricular space, and inside the sagittal sinus. Parameters demonstrating gadobutrol enhancement and clearance in different locations were compared between idiopathic normal pressure hydrocephalus and reference subjects. A characteristic flow pattern in idiopathic normal hydrocephalus was ventricular reflux of gadobutrol from the subarachnoid space followed by transependymal gadobutrol migration. At the brain surfaces, gadobutrol propagated antegradely along large leptomeningeal arteries in all study subjects, and preceded glymphatic enhancement in adjacent brain tissue, indicating a pivotal role of intracranial pulsations for glymphatic function. In idiopathic normal pressure hydrocephalus, we found delayed enhancement (P < 0.05) and decreased clearance of gadobutrol (P < 0.05) at the Sylvian fissure. Parenchymal (glymphatic) enhancement peaked overnight in both study groups, possibly indicating a crucial role of sleep, and was larger in normal pressure hydrocephalus patients (P < 0.05 at inferior frontal gyrus). We interpret decreased gadobutrol clearance from the subarachnoid space, along with persisting enhancement in brain parenchyma, as signs of reduced glymphatic clearance in idiopathic normal hydrocephalus, and hypothesize that reduced glymphatic function is instrumental for dementia in this disease. The study shows promise for glymphatic magnetic resonance imaging as a method to assess human brain metabolic function and renders a potential for contrast enhanced brain extravascular space imaging.


Assuntos
Hidrocefalia de Pressão Normal/diagnóstico por imagem , Imagem por Ressonância Magnética , Espaço Subaracnóideo/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Meios de Contraste/farmacocinética , Feminino , Humanos , Hidrocefalia de Pressão Normal/líquido cefalorraquidiano , Processamento de Imagem Assistida por Computador , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Compostos Organometálicos/farmacocinética , Estudos Prospectivos , Espaço Subaracnóideo/patologia , Fatores de Tempo
18.
J Med Case Rep ; 11(1): 231, 2017 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-28823247

RESUMO

BACKGROUND: Ectopic cerebellar tissue located distantly from the normal cerebellum is very rare, and its pathophysiology remains to be elucidated. CASE PRESENTATION: We report an extremely rare case of intraosseous ectopic cerebellum detected incidentally at suboccipital craniotomy in a 46-year-old Japanese woman with hemifacial spasm. She had a small bone defect in the occipital bone, which contained a tiny area of soft tissue surrounded by cerebrospinal fluid connecting to the normal subarachnoid space through a dural opening. Histopathology demonstrated cerebellar cortex tissue consisting of molecular and granular cell layers. CONCLUSIONS: This is the first report of glioneuronal ectopia within the skull bone separated from normal brain tissue, and it is important to distinguish this entity from other osteolytic lesions.


Assuntos
Córtex Cerebral/patologia , Neoplasias do Ventrículo Cerebral/patologia , Coristoma/patologia , Espasmo Hemifacial/cirurgia , Osso Occipital/patologia , Espaço Subaracnóideo/patologia , Tomografia Computadorizada por Raios X , Coristoma/complicações , Craniotomia , Feminino , Espasmo Hemifacial/fisiopatologia , Humanos , Achados Incidentais , Pessoa de Meia-Idade , Resultado do Tratamento
19.
World Neurosurg ; 108: 54-61, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28843754

RESUMO

BACKGROUND: Intradural epidermoid tumors of the spinal cord are commonly associated with spinal cord dysraphism or invasive procedures. We report the particular relationships between spinal subarachnoid compartments and thoracic intradural-extramedullary epidermoid tumor, highlighting the relevant anatomic changes that may influence microsurgery. METHODS: A 40-year-old woman from compressive myelopathy owing to a thoracic epidermoid tumor extending from T3 to T4 and not associated with spina bifida, trauma, previous surgery, or lumbar spinal puncture underwent microsurgical excision. Accurate tumor membrane dissection, respecting spinal arachnoidal compartments, was performed. Reposition of a laminoplasty plateau helped in restoring thoracic spine anatomic integrity. RESULTS: Safe gross total tumor resection was achieved. Complete neurologic recovery as well as absence of recurrent tumor was documented at 4-year follow-up. A literature review revealed only 2 other cases of "isolated" thoracic spine epidermoid tumor. However, description of the relationship between tumor membranes and spinal subarachnoid compartments was not available in either case. CONCLUSIONS: A thorough knowledge of spinal subarachnoid space anatomy is helpful to distinguish between tumor membranes and arachnoidal planes and to achieve a safe and complete resection to avoid recurrences.


Assuntos
Cisto Epidérmico/cirurgia , Microcirurgia , Procedimentos Neurocirúrgicos , Neoplasias da Medula Espinal/cirurgia , Espaço Subaracnóideo/patologia , Espaço Subaracnóideo/cirurgia , Adulto , Diagnóstico Diferencial , Cisto Epidérmico/complicações , Cisto Epidérmico/diagnóstico por imagem , Cisto Epidérmico/patologia , Feminino , Humanos , Laminectomia , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/cirurgia , Neoplasias da Medula Espinal/complicações , Neoplasias da Medula Espinal/diagnóstico por imagem , Neoplasias da Medula Espinal/patologia , Espaço Subaracnóideo/diagnóstico por imagem , Vértebras Torácicas/cirurgia
20.
Neuropathology ; 37(6): 502-508, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28836300

RESUMO

To clarify the frequency of CAA in the brain parenchyma and subarachnoid space (SAS), we counted sections of blood vessels showing positive staining for Aß in the SAS, cerebral cortex (CC) and cerebral white matter (WM) using paraffin-embedded sections of the frontal, temporal and occipital lobes. The specimens had been taken for routine neuropathological examination from the brains of 105 Japanese patients (aged 40-95 years) selected from among 200 consecutive patients autopsied between 1989 and 2015 at our hospital. We examined the anatomical ratios of blood-vessel sections in the SAS relative to the CC in three selected CAA cases, and those of Aß-positive blood-vessel sections in CAA cases. CAA was found in 53 of the 105 cases (50.5%), and the youngest patient affected was a 51-year-old man. The incidence of CAA increased with age. The anatomical ratio of blood vessel sections in the SAS relative to the CC was 1/3.70-1/4.37 (mean: 1/3.94). The ordinary CAA group, in which CAA was seen in both the SAS and CC, included 41 cases (77.4%). In 37 of these cases, the SAS/CC ratio of Aß-positive blood vessels was 1/0.05-1/0.66 (mean: 1/0.26), and in the other four cases the ratio was 1/1-1/1.5. In the ordinary CAA group, the SAS/CC ratio of Aß-positive blood vessels was smaller than the anatomical ratio. The meningeal CAA group, in which CAA was found only in the SAS, included 12 cases (22.6%). These patients ranged in age from their fifties to their nineties. There was no case in which CAA was limited only to the CC. We concluded that CAA initially develops in the meningeal blood vessels, and not in the cortical blood vessels. CAA in the WM was seen in 10 cases, not only in nine cases that were severe, but also in a mild case.


Assuntos
Vasos Sanguíneos/patologia , Encéfalo/patologia , Angiopatia Amiloide Cerebral/patologia , Meninges/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Espaço Subaracnóideo/patologia
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