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1.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 50(5): 765-767, 2019 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-31762249

RESUMO

A healthy 52-year-old woman presented with 10-days history of back pain. Neurologic testing failed to detect any functional deficits in the upper and lower extremities, and the patient had a full range of cervical spine motion without associated pain. Spinal CT and MRI revealed a well-circumscribed intradural mass located at conus medullaris. The operation of L1 hemilaminectomy was performed, and pathological examination discovered dilatation of sweat ducts and suggested the diagnosis of ectopic sweat duct ectasia. IHC staining in epithelia immunophenotype showed: pan-cytokeratin (PCK)(+), epithelia membrane antigen (EMA)(+), P63(+), cytokeratin 5/6 (CK5/6)(+), gross cystic disease fluid protein 15 (GCDFP15)(-). Intraspinal ectopic sweat duct ectasia is extremely rare, which has not been reported in the literature to date.


Assuntos
Dor nas Costas/etiologia , Medula Espinal/diagnóstico por imagem , Glândulas Sudoríparas/patologia , Dilatação Patológica , Feminino , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade
2.
Medicine (Baltimore) ; 98(36): e16887, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31490372

RESUMO

RATIONALE: Multiple syphilitic gummas involving both the brain and spinal cord are quite rare. Central nervous system (CNS) syphilitic gummas are commonly misdiagnosed as CNS tumors, and clinical suspicion and diagnosis of a syphilitic gumma by physicians are vital to avoiding unnecessary surgeries. Our case emphasizes the importance of routine serologic syphilis tests and standard therapy with penicillin in patients with a CNS mass. PATIENT CONCERNS: A 22-year-old previously healthy man presented with a 9-day history of progressive right lower limb weakness. DIAGNOSIS: The diagnosis of gummatous neurosyphilis was based on positive serological, cerebrospinal fluid tests for syphilis and magnetic resonance imaging (MRI) findings, which revealed the presence of multiple dural-based enhancing masses with marked edema. INTERVENTIONS: Therapy consisting of intravenous penicillin G at 24 million units daily divided into 6 doses were given for a total of 21 days, along with 3 weekly intramuscular injections of benzathine penicillin G (2.4 million units) to ensure that the syphilitic lesions in the CNS were adequately treated. OUTCOMES: Complete resolution of the lesions was observed on MRI over a 3-month period. LESSONS: The importance of routine serologic syphilis tests and standard therapy with penicillin in patients with central CNS mass lesions is noted to avoiding unnecessary surgeries.


Assuntos
Neurossífilis/diagnóstico , Antibacterianos/uso terapêutico , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Diagnóstico Diferencial , Soronegatividade para HIV , Humanos , Imagem por Ressonância Magnética , Masculino , Neurossífilis/diagnóstico por imagem , Neurossífilis/tratamento farmacológico , Penicilina G/uso terapêutico , Medula Espinal/diagnóstico por imagem , Medula Espinal/patologia , Adulto Jovem
3.
Clin Nucl Med ; 44(10): 804-805, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31306210

RESUMO

Falx cerebri ossification is an incidental finding. Mostly it is easy to diagnose, but can be challenging in few cases, and should be distinguished from calcified meningioma, hematoma, and meningeal infiltration. We report a case of a 46-year-old woman with breast cancer complaining of back pain. F-NaF PET/CT images show focal increase uptake at facet joints of L5/S1 vertebrae and both knees joints, suggesting degenerative disease. There is normal variant F-NaF uptake noted in the ossification at the falx cerebri. Recognition of normal and abnormal extraosseous F-NaF uptake is important for correct interpretation to avoid unnecessary further investigations.


Assuntos
Radioisótopos de Flúor , Osteogênese , Fluoreto de Sódio/metabolismo , Medula Espinal/fisiologia , Transporte Biológico , Feminino , Humanos , Achados Incidentais , Pessoa de Meia-Idade , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Medula Espinal/diagnóstico por imagem , Medula Espinal/metabolismo
5.
Mayo Clin Proc ; 94(5): 875-881, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31054607

RESUMO

Acute flaccid myelitis (AFM) is characterized by flaccid paralysis of one or more limbs, often following a viral illness, with magnetic resonance imaging findings consistent with inflammation of the spinal cord gray matter. It is unclear whether all patients with AFM will have full recovery of neurologic function. Since 2014, there have been several clusters of AFM in the United States, with a 3-fold increase in reported AFM cases recorded in 2018 compared with the previous year. Epidemiological evidence supports a temporal association between respiratory enteroviral illness, particularly with enteroviruses D68 and A71, and clustering of AFM cases. However, causality has yet to be established. Treatment of AFM is primarily supportive. Adjunctive therapies such as intravenous immunoglobulin, corticosteroids, plasmapheresis, and fluoxetine have not been found to improve long-term outcomes. Further research is urgently needed to characterize and optimize management of this emerging, yet poorly understood, condition.


Assuntos
Infecções por Enterovirus/epidemiologia , Hipotonia Muscular/etiologia , Mielite/etiologia , Doença Aguda , Enterovirus Humano D , Infecções por Enterovirus/líquido cefalorraquidiano , Infecções por Enterovirus/diagnóstico , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Hipotonia Muscular/virologia , Mielite/virologia , Paralisia , Medula Espinal/diagnóstico por imagem , Estados Unidos/epidemiologia
6.
Medicina (Kaunas) ; 55(5)2019 May 23.
Artigo em Inglês | MEDLINE | ID: mdl-31126152

RESUMO

Varicella-zoster virus (VZV) is a human neurotropic herpes virus that causes chickenpox in children. After becoming latent in dorsal root ganglia, it can reactivate to cause dermatological manifestations, the most common one being shingles or herpes zoster. Severe neurologic dysfunctions can occur in immunocompromised patients such as encephalitis, meningitis, myelitis and neuropathy. Longitudinal extensive transverse myelitis (LETM) is an unusual neurological complication mainly described in immunocompromised patients, with very few cases described in immunocompetent ones. We hereby report a case of VZV-induced LETM in an immunocompetent older adult-a situation rarely described in the literature. LETM is a rare complication of VZV and its pathogenesis; therapeutic interventions and prognosis are far from being fully clarified. However, a prompt diagnosis is needed to allow a rapid initialization of treatment and ensure a better outcome. Although the therapeutic lines are not clear, immunosuppressive agents may have their place in cases of unsuccessful results and/or relapses following acyclovir coupled with a well conducted methylprednisolone therapy. Further studies are highly needed to improve the current understanding of the disease course and mechanisms, and to optimize therapeutic strategies.


Assuntos
Hospedeiro Imunocomprometido/imunologia , Mielite Transversa/complicações , Idoso , Herpesvirus Humano 3 , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Mielite Transversa/diagnóstico por imagem , Mielite Transversa/virologia , Recidiva , Medula Espinal/diagnóstico por imagem , Medula Espinal/virologia
7.
J Vet Sci ; 20(2): e7, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30944530

RESUMO

The magnetic resonance (MR) features of spinal epidural hemorrhage depending with the passage of time have a meaning in veterinary medicine. The aim of this study is to propose the characteristic MR image of spinal epidural hemorrhage using a lower field permanent magnet scanner in dogs. A total of 8 clinically normal beagle dogs, weighing about 9 kg, were allocated. After a baseline MR examination, spinal epidural hemorrhage was created. MR scanning was executed on days 1, 2, 3, 4, 5, 10, 15, 20, 25, and 30 using 0.25 Tesla low field MR. Transverse MR images were attained for image examination. T2W, T1W, fluid-attenuated inversion recovery (FLAIR), short tau inversion recovery (STIR), and T2*-GRE sequences were used. Images were compared subjectively for signal transition assessment. Spinal epidural hemorrhage models were produced positively in 8 dogs at the T12 to L2 region. Initially, the spinal cord and epidural lesions were hyper-intense on T2W and T1W images. On T2W, FLAIR and STIR images, the spinal cord lesion was steadily hyperintense. No significant and consistent hypointense signal indicating hemorrhage was seen on T2*-GRE images. This study result suggests that relatively consistent hyperinstensity on T2 and FLAIR is observed for 30 days, meanwhile T2*-GRE imaging is less useful in hemorrhage detection.


Assuntos
Doenças do Cão/diagnóstico por imagem , Hematoma Epidural Espinal/veterinária , Imagem por Ressonância Magnética/veterinária , Animais , Doenças do Cão/patologia , Cães , Feminino , Hematoma Epidural Espinal/diagnóstico por imagem , Hematoma Epidural Espinal/patologia , Medula Espinal/diagnóstico por imagem , Medula Espinal/patologia , Fatores de Tempo
8.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 30(2): 60-68, mar.-abr. 2019. ilus, graf, tab
Artigo em Espanhol | IBECS | ID: ibc-182003

RESUMO

Introducción: Hemos analizado la descompresión obtenida mediante corpectomía dorsal o dorsolumbar medida a través del ángulo de Cobb y el área del canal medular antes y después de la cirugía. Además, se ha comparado la evolución de la técnica entre los primeros 5 años del estudio y los 5 posteriores. Material y método: Se realizó un estudio retrospectivo de los pacientes operados entre 2005-2015 en nuestro centro mediante abordajes anteriores y posteriores. Resultados: Se intervinieron 24 pacientes y observamos una mejoría significativa entre los valores preoperatorios y postoperatorios en el análisis morfométrico (corrección de 4,18° de cifosis y un aumento del área del canal medular de 130,8mm2 con una significación de p<0,001 en ambos casos) y mejoría clínica (45,8% de los pacientes presentaron mejoría en la escala ASIA y una mejoría media de 13 puntos en el Karnofsky, p<0,001). Sin embargo, no se observa correlación entre los parámetros clínicos y morfométricos. También hemos observado que en los últimos 5 años del estudio los abordajes posteriores se utilizaron con mayor frecuencia y con buenos resultados. Conclusiones: La corpectomía dorsal permite una descompresión espinal significativa, con mejoría de la función neurológica sin que se correlacione con las mediciones de la descompresión. Gracias a las mejoras técnicas, las técnicas mínimamente invasivas (abordajes posteriores y técnicas MISS) permiten unos buenos resultados funcionales que son similares a los obtenidos con técnicas anteriores


Introduction: We analysed the decompression obtained by dorsal or dorsolumbar corpectomy measured by Cobb angle and the spinal area prior to and after surgery and compared the evolution of the technique over the last five years of the study. Material and method: A retrospective review of patients operated between 2005 and 2015 through anterior or posterior approaches was performed. Results: 24 patients were studied and a significant improvement was observed between the preoperative and postoperative morphometrical measurement (4.18° correction of the kyphosis and an increase of 130.8mm2 in the spinal canal, p<.001 in both cases) and in clinical parameters (45.8% of patients improved in ASIA, and Karnofsky showed 13 points of improvement, p<.001 in both cases). However, there was no correlation between clinical and morphological parameters. We also observed that in the last five years of the study posterior approaches were more frequently used with good results. Conclusions: Dorsal corpectomy allows significant spinal decompression, with neurological improvement but this does not correlate with the measurement of decompression. Thanks to technical improvements, less invasive techniques (posterior approaches and MISS) allow good clinical results, which are similar to those obtained by anterior techniques


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Descompressão/métodos , Medula Espinal/diagnóstico por imagem , Medula Espinal/cirurgia , Compressão da Medula Espinal/diagnóstico por imagem , Estudos Retrospectivos , Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/cirurgia , Avaliação de Estado de Karnofsky , Compressão da Medula Espinal/cirurgia
9.
Acta Medica (Hradec Kralove) ; 62(1): 39-42, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30931896

RESUMO

Spinal epidermoid cysts are benign tumors. Syringomyelia secondary to intramedullary tumors are frequently observed. However, the association between syringomyelia and spinal intradural extramedullary epidermoid cyst in the conus medullaris region is extremely rare. We present the case of a 3-year-old male who was admitted with paraparesis and urinary retention. Magnetic resonance imaging (MRI) of the spine demonstrated intradural extramedullary lesion, compatible with epidermoid cyst, that at the conus medullaris level and a large syringomyelia extending from T4 to L1 vertebrae. Total microsurgical excision of the cyst was performed. No additional drainage was carried out for the syringomyelic cavity. Histopathological examination verified the diagnosis of the epidermoid cyst. Total excision of the cyst and disappearance of the syringomyelia were observed on MRI at 15 days postoperatively. We have clarified the etiology, clinical, histopathological and radiological features, differential diagnosis, and treatment modalities of spinal epidermoid cysts. In addition, we have discussed the possible mechanisms of syringomyelia formation in spinal intradural lesions.


Assuntos
Cisto Epidérmico/cirurgia , Paraparesia/patologia , Doenças da Medula Espinal/cirurgia , Medula Espinal/patologia , Siringomielia/patologia , Retenção Urinária/patologia , Pré-Escolar , Cisto Epidérmico/complicações , Cisto Epidérmico/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Paraparesia/diagnóstico por imagem , Paraparesia/etiologia , Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/complicações , Doenças da Medula Espinal/patologia , Siringomielia/diagnóstico por imagem , Resultado do Tratamento , Retenção Urinária/diagnóstico por imagem , Retenção Urinária/etiologia
10.
Fluids Barriers CNS ; 16(1): 10, 2019 Apr 04.
Artigo em Inglês | MEDLINE | ID: mdl-30947716

RESUMO

BACKGROUND: Respiration-induced pressure changes represent a powerful driving force of CSF dynamics as previously demonstrated using flow-sensitive real-time magnetic resonance imaging (MRI). The purpose of the present study was to elucidate the sensitivity of CSF flow along the spinal canal to forced thoracic versus abdominal respiration. METHODS: Eighteen subjects without known illness were studied using real-time phase-contrast flow MRI at 3 T in the aqueduct and along the spinal canal at levels C3, Th1, Th8 and L3. Subjects performed a protocol of forced breathing comprising four cycles of 2.5 s inspiration and 2.5 s expiration. RESULTS: The quantitative results for spinal CSF flow rates and volumes confirm previous findings of an upward movement during forced inspiration and reversed downward flow during subsequent exhalation-for both breathing types. However, the effects were more pronounced for abdominal than for thoracic breathing, in particular at spinal levels Th8 and L3. In general, CSF net flow volumes were very similar for both breathing conditions pointing upwards in all locations. CONCLUSIONS: Spinal CSF dynamics are sensitive to varying respiratory performances. The different CSF flow volumes in response to deep thoracic versus abdominal breathing reflect instantaneous adjustments of intrathoracic and intraabdominal pressure, respectively. Real-time MRI access to CSF flow in response to defined respiration patterns will be of clinical importance for patients with disturbed CSF circulation like hydrocephalus, pseudotumor cerebri and others.


Assuntos
Líquido Cefalorraquidiano , Hidrodinâmica , Respiração , Medula Espinal/fisiologia , Abdome , Adolescente , Adulto , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pressão , Medula Espinal/diagnóstico por imagem , Tórax , Adulto Jovem
11.
Ann Clin Lab Sci ; 49(2): 265-270, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31028074

RESUMO

BACKGROUND: Spinal neurosyphilis manifesting as a solitary syphilitic gumma is exceedingly rare. There are non-specific imaging findings and challenges in the diagnosis of spinal syphilitic gumma, which could be easily misdiagnosed as tumor lesions and require surgical resection or biopsy. CLINICAL PRESENTATION: We report the case of a 45-year-old female patient who was diagnosed with Spinal syphilitic gumma. Our case is the first reported case of spinal cord syphilitic gumma with intradural-extramedullary and intramedullary involvement. CONCLUSION: Spinal syphilitic gumma exhibits diverse clinical manifestations, lacks specific imaging features, accompanied by the patient's history deliberately concealed. Since clinicians do not have sufficient knowledge about such rare cases, misdiagnosis and missed diagnosis will be likely. When there is clinical suspicion for spinal syphilitic gumma, clinicians should pay close attention to relevant medical history, carry out a comprehensive physical examination and specific serological tests and cerebrospinal fluid (CSF) analysis. In summary, in cases with stable neurologic conditions, a trial administration of intravenous penicillin with follow-up imaging may be the optimal treatment option, and in cases with rapid progression or acute exacerbation, a surgical resection together with systemic antibiotic treatment for syphilis after surgery may be the best treatment strategy.


Assuntos
Síndrome de Brown-Séquard/complicações , Neurossífilis/complicações , Medula Espinal/patologia , Adulto , Idoso , Síndrome de Brown-Séquard/diagnóstico por imagem , Feminino , Humanos , Inflamação/patologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neurossífilis/diagnóstico por imagem , Medula Espinal/diagnóstico por imagem , Resultado do Tratamento
12.
World Neurosurg ; 122: e655-e666, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30992117

RESUMO

BACKGROUND: Underestimation of the spinal cord's volume or position during spine stereotactic radiosurgery can lead to severe myelopathy, whereas overestimation can lead to tumor underdosage. Spinal cord delineation is commonly achieved by registering a magnetic resonance imaging (MRI) study with a computed tomography (CT) simulation scan or by performing myelography during CT simulation (myelosim). We compared treatment planning outcomes for these 2 techniques. METHODS: Twenty-three cases of spine stereotactic radiosurgery were analyzed that had both a myelosim and corresponding MRI study for registration. The spinal cord was contoured on both imaging data sets by 2 independent blinded physicians, and Dice similarity coefficients were calculated to compare their spatial overlap. Two treatment plans (16 Gy and 18 Gy) were created using the MRI and CT contours (92 plans total). Dosimetric parameters were extracted and compared by modality to assess tumor coverage and spinal cord dose. RESULTS: No differences were found in the partial spinal cord volumes contoured on MRI versus myelosim (4.71 ± 1.09 vs. 4.55 ± 1.03 cm3; P = 0.34) despite imperfect spatial agreement (mean Dice similarity coefficient, 0.68 ± 0.05). When the registered MRI contours were used for treatment planning, significantly worse tumor coverage and greater spinal cord doses were found compared with myelosim planning. For the 18-Gy plans, 10 of 23 MRI cases (43%) exceeded the spinal cord or cauda dose constraints when using myelosim as the reference standard. CONCLUSIONS: Significant spatial, rather than volumetric, differences were found between the MRI- and myelosim-defined spinal cord structures. Tumor coverage was compromised with MRI-based planning, and the high spinal cord doses were a concern. Future work is necessary to compare thin-cut, volumetric MRI registration or MRI simulation with myelosim.


Assuntos
Imagem por Ressonância Magnética/normas , Radiocirurgia/normas , Medula Espinal/diagnóstico por imagem , Medula Espinal/cirurgia , Tomografia Computadorizada por Raios X/normas , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Imagem por Ressonância Magnética/métodos , Masculino , Radiocirurgia/métodos , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/cirurgia , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia , Tomografia Computadorizada por Raios X/métodos
13.
J Nippon Med Sch ; 86(1): 48-54, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30918157

RESUMO

Intracranial dural arteriovenous fistula (DAVF) with perimedullary venous drainage may cause brainstem swelling and represent a diagnostic challenge. A 66-year-old man presented to the emergency room with recurrent vertigo, minimal truncal ataxia with a wide-based gait, and a slightly impaired tandem gait. Brain magnetic resonance imaging (MRI) revealed a hyperintense lesion in the left pontomedullary area on T2-weighted images (T2WIs) with partial gadolinium enhancement, but without increased signals on diffusion-weighted images. Abnormal serpentine flow void vessels surrounding the medulla and upper cervical spinal cord were initially overlooked but discovered later. An angiogram revealed DAVF with feeders from the right occipital artery and the meningeal branch of the right distal vertebral artery with drainage into the anterior medullary venous system and the perimedullary veins. The patient underwent a successful transarterial endovascular embolization and improved gradually. A brain MRI at 3-month follow-up revealed a residual hyperintense signal on the T2WIs in the left lower medulla. Six cases of patients exhibiting DAVF with isolated unilateral brainstem swelling from the literature were reviewed. Isolated unilateral brainstem swelling due to intracranial DAVF with perimedullary venous drainage is extremely rare and might mimic a tumor on MRI. Abnormal serpentine flow void vessels on the surface of the brainstem or spinal cord are crucial diagnostic clues.


Assuntos
Neoplasias Encefálicas/diagnóstico por imagem , Tronco Encefálico/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Diagnóstico Diferencial , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Bulbo/diagnóstico por imagem , Idoso , Tronco Encefálico/irrigação sanguínea , Tronco Encefálico/patologia , Vértebras Cervicais , Imagem de Difusão por Ressonância Magnética , Embolização Terapêutica , Procedimentos Endovasculares/métodos , Seguimentos , Humanos , Malformações Arteriovenosas Intracranianas/patologia , Malformações Arteriovenosas Intracranianas/cirurgia , Angiografia por Ressonância Magnética , Masculino , Bulbo/irrigação sanguínea , Bulbo/patologia , Medula Espinal/irrigação sanguínea , Medula Espinal/diagnóstico por imagem , Medula Espinal/patologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
14.
J Neurooncol ; 143(1): 101-106, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30879172

RESUMO

PURPOSE: We explored the use of intraventricular 131I-Omburtamab targeting B7-H3 in patients with ETMR. METHODS: Patients were enrolled in an IRB approved, phase 1, 3 + 3 dose escalation trial. Patients with CNS disease expressing the antibody target antigen B7-H3 were eligible. We report on a cohort of three patients with ETMR who were enrolled on the study. Three symptomatic children (ages 14 months, 3 and 3.5 years) had large parietal masses confirmed to be B7-H3-reactive ETMR. Patients received 2 mCi 131I-Omburtamab as a tracer followed by one or two therapeutic 131I-Omburtamab injections. Dosimetry was based on serial CSF, blood samplings and region of interest (ROI) on nuclear scans. Brain and spine MRIs and CSF cytology were done at baseline, 5 weeks after 131I-Omburtamab, and approximately every 3 months thereafter. Acute toxicities and survival were noted. RESULTS: Patients received surgery, focal radiation, and high dose chemotherapy. Patients 1 and 2 received 131I-Omburtamab (80 and 53 mCi, respectively). Patient 3 had a local recurrence prior to 131I-Omburtamab treated with surgery, external beam radiation, chemotherapy, then 131I-Omburtamab (36 mCi). 131I-Omburtamab was well-tolerated. Mean dose delivered by 131I-Omburtamab was 68.4 cGy/mCi to CSF and 1.95 cGy/mCi to blood. Mean ROI doses were 230.4 (ventricular) and 58.2 (spinal) cGy/mCi. Patients 1 and 2 remain in remission 6.8 years and 2.3 years after diagnosis, respectively; patient 3 died of progressive disease 7 months after therapy (2 years after diagnosis). CONCLUSIONS: 131I-Omburtamab appears safe with favorable dosimetry therapeutic index. When used as consolidation following surgery and chemoradiation therapy, 131I-Omburtamab may have therapeutic benefit for patients with ETMR.


Assuntos
Anticorpos Monoclonais Murinos/uso terapêutico , Anticorpos Monoclonais/uso terapêutico , Neoplasias do Sistema Nervoso Central/radioterapia , Radioisótopos do Iodo/uso terapêutico , Neoplasias Embrionárias de Células Germinativas/radioterapia , Anticorpos Monoclonais/líquido cefalorraquidiano , Anticorpos Monoclonais Murinos/líquido cefalorraquidiano , Encéfalo/diagnóstico por imagem , Neoplasias do Sistema Nervoso Central/líquido cefalorraquidiano , Neoplasias do Sistema Nervoso Central/diagnóstico por imagem , Pré-Escolar , Evolução Fatal , Feminino , Humanos , Lactente , Injeções Intraventriculares , Radioisótopos do Iodo/líquido cefalorraquidiano , Masculino , Neoplasias Embrionárias de Células Germinativas/líquido cefalorraquidiano , Neoplasias Embrionárias de Células Germinativas/diagnóstico por imagem , Radioimunoterapia , Radiometria , Medula Espinal/diagnóstico por imagem
15.
Nat Methods ; 16(4): 341-350, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30858600

RESUMO

Brain atlases enable the mapping of labeled cells and projections from different brains onto a standard coordinate system. We address two issues in the construction and use of atlases. First, expert neuroanatomists ascertain the fine-scale pattern of brain tissue, the 'texture' formed by cellular organization, to define cytoarchitectural borders. We automate the processes of localizing landmark structures and alignment of brains to a reference atlas using machine learning and training data derived from expert annotations. Second, we construct an atlas that is active; that is, augmented with each use. We show that the alignment of new brains to a reference atlas can continuously refine the coordinate system and associated variance. We apply this approach to the adult murine brainstem and achieve a precise alignment of projections in cytoarchitecturally ill-defined regions across brains from different animals.


Assuntos
Mapeamento Encefálico/métodos , Encéfalo/diagnóstico por imagem , Biologia Computacional/métodos , Processamento de Imagem Assistida por Computador/métodos , Algoritmos , Animais , Encéfalo/anatomia & histologia , Tronco Encefálico/diagnóstico por imagem , Aprendizado de Máquina , Imagem por Ressonância Magnética , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Neurônios Motores , Neuroanatomia , Neurônios , Probabilidade , Medula Espinal/diagnóstico por imagem
16.
Fluids Barriers CNS ; 16(1): 7, 2019 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-30909935

RESUMO

BACKGROUND: Fluid homeostasis in the central nervous system (CNS) is essential for normal neurological function. Cerebrospinal fluid (CSF) in the subarachnoid space and interstitial fluid circulation in the CNS parenchyma clears metabolites and neurotransmitters and removes pathogens and excess proteins. A thorough understanding of the normal physiology is required in order to understand CNS fluid disorders, including post-traumatic syringomyelia. The aim of this project was to compare fluid transport, using quantitative imaging of tracers, in the spinal cord from animals with normal and obstructed spinal subarachnoid spaces. METHODS: A modified extradural constriction model was used to obstruct CSF flow in the subarachnoid space at the cervicothoracic junction (C7-T1) in Sprague-Dawley rats. Alexa-Fluor 647 Ovalbumin conjugate was injected into the cisterna magna at either 1 or 6 weeks post-surgery. Macroscopic and microscopic fluorescent imaging were performed in animals sacrificed at 10 or 20 min post-injection. Tracer fluorescence intensity was compared at cervical and thoracic spinal cord levels between control and constriction animals at each post-surgery and post-injection time point. The distribution of tracer around arterioles, venules and capillaries was also compared. RESULTS: Macroscopically, the fluorescence intensity of CSF tracer was significantly greater in spinal cords from animals with a constricted subarachnoid space compared to controls, except at 1 week post-surgery and 10 min post-injection. CSF tracer fluorescence intensity from microscopic images was significantly higher in the white matter of constriction animals 1 week post surgery and 10 min post-injection. At 6 weeks post-constriction surgery, fluorescence intensity in both gray and white matter was significantly increased in animals sacrificed 10 min post-injection. At 20 min post-injection this difference was significant only in the white matter and was less prominent. CSF tracer was found predominantly in the perivascular spaces of arterioles and venules, as well as the basement membrane of capillaries, highlighting the importance of perivascular pathways in the transport of fluid and solutes in the spinal cord. CONCLUSIONS: The presence of a subarachnoid space obstruction may lead to an increase in fluid flow within the spinal cord tissue, presenting as increased flow in the perivascular spaces of arterioles and venules, and the basement membranes of capillaries. Increased fluid retention in the spinal cord in the presence of an obstructed subarachnoid space may be a critical step in the development of post-traumatic syringomyelia.


Assuntos
Líquido Cefalorraquidiano , Constrição Patológica/fisiopatologia , Hidrodinâmica , Espaço Subaracnóideo/fisiopatologia , Siringomielia/fisiopatologia , Animais , Constrição Patológica/diagnóstico por imagem , Modelos Animais de Doenças , Corantes Fluorescentes , Masculino , Microscopia de Fluorescência , Imagem Óptica , Ratos Sprague-Dawley , Medula Espinal/irrigação sanguínea , Medula Espinal/diagnóstico por imagem , Medula Espinal/fisiopatologia , Espaço Subaracnóideo/diagnóstico por imagem , Siringomielia/diagnóstico por imagem
17.
BMJ Case Rep ; 12(2)2019 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-30819681

RESUMO

Spinal arachnoid cysts (SAC) are rare in isolation and the exact aetiology is still debated. Primary (congenital) cysts are caused by structural abnormalities in the arachnoid layer and largely affect the thoracic region. Secondary cysts are induced by a multitude of factors, infection, trauma or iatrogenic response, and can affect any level of the spinal cord. While subarachnoid haemorrhage (SAH) is a relatively common condition with significant repercussions, it is extremely uncommonly associated with SAC. When present, it may develop in the months and years after the original bleed, giving rise to new neurological symptoms. Prompt treatment is needed to halt or reverse the worsening of symptoms and questions are still being asked about how best to approach this condition. A 42-year-old man presented with chronic back pain, severe worsening ataxia and numbness below the umbilicus, 7 months after treatment for a World Federation of Neurosurgical Societies grade five (WFNS V) SAH. Imaging revealed a SAC extending from T12 to L4 and causing thecal compression. This was treated with a L3 laminectomy andmarsupialisation. An improvement in neurological function was observed at 6 months. Aetiology of the SAC and its association with SAH are discussed and a review of the relevant literature is provided.


Assuntos
Cistos Aracnóideos/complicações , Cistos Aracnóideos/diagnóstico por imagem , Paraparesia/etiologia , Doenças da Medula Espinal/complicações , Doenças da Medula Espinal/diagnóstico por imagem , Hemorragia Subaracnóidea/etiologia , Adulto , Cistos Aracnóideos/cirurgia , Dor nas Costas/etiologia , Humanos , Laminectomia , Imagem por Ressonância Magnética/métodos , Masculino , Medula Espinal/diagnóstico por imagem , Medula Espinal/cirurgia , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/cirurgia , Doenças da Medula Espinal/cirurgia , Resultado do Tratamento
18.
J Vet Med Sci ; 81(5): 747-749, 2019 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-30867352

RESUMO

A 9-year-old castrated male cat presented with sudden onset of paralysis in four limbs. Magnetic resonance imaging revealed an intramedullary lesion at C3, and lesions in the vermis and right hemisphere of the cerebellum, which were hyperintense on T2-weighted imaging. The cat was euthanized, and postmortem examination was performed. Grossly, transverse sectioning of the spinal cord revealed areas of malacia within the gray matter extending from C2 to C3. Histologically, the ventral spinal artery, the spinal intramedullary arteries and the arterioles of arachnoid in the cerebellum contained fibrocartilaginous emboli confirmed by metachromatic staining with toluidine blue. To our knowledge, this is the first report of fibrocartilaginous embolism involving both the cerebellum and cervical spinal cord in a cat.


Assuntos
Doenças das Cartilagens/veterinária , Doenças do Gato/diagnóstico por imagem , Cerebelo/diagnóstico por imagem , Embolia/veterinária , Medula Espinal/diagnóstico por imagem , Animais , Doenças das Cartilagens/diagnóstico por imagem , Doenças das Cartilagens/patologia , Doenças do Gato/patologia , Gatos , Cerebelo/patologia , Embolia/diagnóstico por imagem , Embolia/patologia , Imagem por Ressonância Magnética/veterinária , Masculino , Paralisia/etiologia , Paralisia/veterinária , Medula Espinal/patologia
19.
Mult Scler Relat Disord ; 30: 247-251, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30849681

RESUMO

BACKGROUND: Efficacy and safety profiles of alemtuzumab for relapsing-remitting multiple sclerosis (RRMS) mainly come from Western countries and have not been reported in Asian populations. The aim of this study was to report the efficacy and safety of alemtuzumab for RRMS patients in a Korean population. METHODS: We retrospectively reviewed RRMS patients treated with alemtuzumab. Study outcomes included annualized relapse rate (ARR), expanded disability status scale (EDSS) score, 6-month confirmed disability worsening (CDW), confirmed disability improvement (CDI), MRI lesion activity (new/enlarging T2 hyperintense and gadolinium-enhancing T1 lesions), no evidence of disease activity (NEDA), and adverse events. RESULTS: Nineteen patients were identified and mean follow-up was 1.5 years after alemtuzumab initiation. Mean ARR fell from 1.20 pre-treatment to 0.30 post-treatment (p < 0.001). Mean EDSS score remained stable, with a change from baseline of -0.08 at 1 year. After treatment, 16 patients (84.2%) had freedom from 6-month CDW, 3 (15.8%) had 6-month CDI, 11 (57.9%) had freedom from new/enlarging T2 hyperintense lesions, 13 (68.4%) had freedom from gadolinium-enhancing lesions, and 10 (52.6%) had NEDA. Four patients (21.1%) developed relapses after alemtuzumab therapy. CONCLUSION: Alemtuzumab efficacy and safety were similar to that reported previously in Western populations. Severe relapses can occur after alemtuzumab administration.


Assuntos
Alemtuzumab/uso terapêutico , Antineoplásicos Imunológicos/uso terapêutico , Esclerose Múltipla/tratamento farmacológico , Adulto , Encéfalo/diagnóstico por imagem , Avaliação da Deficiência , Feminino , Seguimentos , Humanos , Imagem por Ressonância Magnética , Masculino , Esclerose Múltipla/diagnóstico por imagem , República da Coreia , Estudos Retrospectivos , Medula Espinal/diagnóstico por imagem
20.
Radiol Clin North Am ; 57(2): 257-279, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30709470

RESUMO

Myelopathy refers to any pathologic process that involves the spinal cord, and can be caused by a variety of different diseases. MR imaging is the primary modality for evaluating the patient presenting with myelopathy. The first step must be the exclusion of spinal cord compression. Although the MR features of many causes of myelopathy overlap, careful attention to the time course of presentation, knowledge of common and uncommon causes of myelopathy, and identification of specific imaging patterns and features can help narrow the differential diagnosis or establish a definitive diagnosis.


Assuntos
Imagem por Ressonância Magnética/métodos , Doenças da Medula Espinal/diagnóstico por imagem , Doença Aguda , Doença Crônica , Diagnóstico Diferencial , Humanos , Medula Espinal/diagnóstico por imagem , Medula Espinal/patologia
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