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1.
Br J Radiol ; 93(1106): 20190398, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-31825670

RESUMO

OBJECTIVE: CT is the mainstay imaging modality for assessing change in ventricular volume in patients with ventricular shunts or external ventricular drains (EVDs). We evaluated the performance of a novel fully automated CT registration and subtraction method to improve reader accuracy and confidence compared with standard CT. METHODS: In a retrospective evaluation of 49 ventricular shunt or EVD patients who underwent sequential head CT scans with an automated CT registration tool (CT CoPilot), three readers were assessed on their ability to discern change in ventricular volume between scans using standard axial CT images versus reformats and subtraction images generated by the registration tool. The inter-rater reliability among the readers was calculated using an intraclass correlation coefficient (ICC). Bland-Altman tests were performed to determine reader performance compared to semi-quantitative assessment using the bifrontal horn and third ventricular width. McNemar's test was used to determine whether the use of the registration tool increased the reader's level of confidence. RESULTS: Inter-rater reliability was higher when using the output of the registration tool (single measure ICC of 0.909 with versus 0.755 without the tool). Agreement between the readers' assessment of ventricular volume change and the semi-quantitative assessment improved with the registration tool (limits of agreement 4.1 vs 4.3). Furthermore, the tool improved reader confidence in determining increased or decreased ventricular volume (p < 0.001). CONCLUSION: Automated CT registration and subtraction improves the reader's ability to detect change in ventricular volume between sequential scans in patients with ventricular shunts or EVDs. ADVANCES IN KNOWLEDGE: Our automated CT registration and subtraction method may serve as a promising generalizable tool for accurate assessment of change in ventricular volume, which can significantly affect clinical management.


Assuntos
Tomografia Computadorizada por Raios X/métodos , Derivação Ventriculoperitoneal , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Automação , Ventrículos Cerebrais/diagnóstico por imagem , Drenagem/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ventriculostomia/métodos , Adulto Jovem
2.
World Neurosurg ; 135: 228-232, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31863895

RESUMO

BACKGROUND: Tension pneumoventricle is an extremely rare, but treatable, neurosurgical emergency. The prompt and accurate diagnosis of tension pneumoventricle requires vigilance for the detection of clinical signs, which should also be corroborated by the imaging findings. We have reported on the pathophysiology of tension pneumoventricle and its management. CASE DESCRIPTION: A 66-year-old woman had presented with a Rathke cleft cyst. The patient underwent transsphenoidal surgery (TSS), with no clinical cerebrospinal fluid leakage observed peri- or postoperatively. However, she developed an altered mental status 8 hours after surgery, and a computed tomography scan showed evidence of a tension pneumoventricle. The patient underwent emergent external ventricular drainage insertion and exploratory endoscopic TSS. A 1-way valve was observed during TSS, and the sella floor was packed with a fat graft for 1-way valve obliteration. The patient recovered well without neurologic deficits. No radiologic regrowth was noted at the 48-month follow-up examination. CONCLUSIONS: Tension pneumoventricle is an extremely rare, but life-threatening, complication of TSS. The development of tension pneumoventricle should be kept in mind even when the surgery has proceeded very smoothly. Sellar reconstruction will, theoretically, prevent this extremely rare complication but might increase the recurrence rate of Rathke cleft cysts. The related symptoms and signs should be recognized. Prompt recognition and treatment of this condition can be life-saving, and the long-term outcomes have generally been favorable if the condition has been recognized early.


Assuntos
Cistos do Sistema Nervoso Central/cirurgia , Ventrículos Cerebrais/cirurgia , Recidiva Local de Neoplasia/cirurgia , Neuroendoscopia , Pneumocefalia/cirurgia , Complicações Pós-Operatórias/cirurgia , Sela Túrcica/cirurgia , Idoso , Ventrículos Cerebrais/diagnóstico por imagem , Feminino , Escala de Coma de Glasgow , Humanos , Imagem por Ressonância Magnética , Pneumocefalia/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Osso Esfenoide , Tomografia Computadorizada por Raios X , Ventriculostomia
3.
Lakartidningen ; 1162019 Oct 08.
Artigo em Sueco | MEDLINE | ID: mdl-31593285

RESUMO

The recently documented high survival of extremely preterm infants in Sweden is related to a high degree of centralization of pre- and postnatal care and to recently issued national consensus guidelines providing recommendations for perinatal care at 22-24 gestational weeks. The prevalence of major neonatal morbidity remains high and exceeded 60 % in a recent study of extremely preterm infants born at < 27 gestational weeks delivered in Sweden in 2014-2016 and surviving to 1 year of age. Damage to immature organ systems inflicted during the neonatal period causes varying degrees of functional impairment with lasting effects in the growing child. There is an urgent need for evidence-based novel interventions aiming to prevent neonatal morbidity with a subsequent improvement of long-term outcome.


Assuntos
Lactente Extremamente Prematuro , Doenças do Prematuro , Nascimento Prematuro , Displasia Broncopulmonar/epidemiologia , Displasia Broncopulmonar/fisiopatologia , Displasia Broncopulmonar/prevenção & controle , Serviços Centralizados no Hospital , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/epidemiologia , Hemorragia Cerebral/fisiopatologia , Hemorragia Cerebral/prevenção & controle , Ventrículos Cerebrais/irrigação sanguínea , Ventrículos Cerebrais/diagnóstico por imagem , Enterocolite Necrosante/epidemiologia , Enterocolite Necrosante/fisiopatologia , Enterocolite Necrosante/prevenção & controle , Feminino , Humanos , Fenômenos Fisiológicos da Nutrição do Lactente , Recém-Nascido , Doenças do Prematuro/epidemiologia , Doenças do Prematuro/fisiopatologia , Doenças do Prematuro/prevenção & controle , Assistência Perinatal/organização & administração , Gravidez , Nascimento Prematuro/mortalidade , Retinopatia da Prematuridade/sangue , Retinopatia da Prematuridade/epidemiologia , Retinopatia da Prematuridade/fisiopatologia , Retinopatia da Prematuridade/prevenção & controle , Taxa de Sobrevida , Suécia/epidemiologia
4.
Neurology ; 93(18): e1699-e1706, 2019 10 29.
Artigo em Inglês | MEDLINE | ID: mdl-31578297

RESUMO

OBJECTIVE: To characterize the time course of ventricular volume expansion in genetic frontotemporal dementia (FTD) and identify the onset time and rates of ventricular expansion in presymptomatic FTD mutation carriers. METHODS: Participants included patients with a mutation in MAPT, PGRN, or C9orf72, or first-degree relatives of mutation carriers from the GENFI study with MRI scans at study baseline and at 1 year follow-up. Ventricular volumes were obtained from MRI scans using FreeSurfer, with manual editing of segmentation and comparison to fully automated segmentation to establish reliability. Linear mixed models were used to identify differences in ventricular volume and in expansion rates as a function of time to expected disease onset between presymptomatic carriers and noncarriers. RESULTS: A total of 123 participants met the inclusion criteria and were included in the analysis (18 symptomatic carriers, 46 presymptomatic mutation carriers, and 56 noncarriers). Ventricular volume differences were observed 4 years prior to symptom disease onset for presymptomatic carriers compared to noncarriers. Annualized rates of ventricular volume expansion were greater in presymptomatic carriers relative to noncarriers. Importantly, time-intensive manually edited and fully automated ventricular volume resulted in similar findings. CONCLUSIONS: Ventricular volume differences are detectable in presymptomatic genetic FTD. Concordance of results from time-intensive manual editing and fully automatic segmentation approaches support its value as a measure of disease onset and progression in future studies in both presymptomatic and symptomatic genetic FTD.


Assuntos
Ventrículos Cerebrais/diagnóstico por imagem , Demência Frontotemporal/diagnóstico por imagem , Sintomas Prodrômicos , Adulto , Idoso , Proteína C9orf72/genética , Ventrículos Cerebrais/patologia , Feminino , Demência Frontotemporal/genética , Demência Frontotemporal/patologia , Heterozigoto , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Progranulinas/genética , Proteínas tau/genética
5.
World Neurosurg ; 132: e783-e794, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31415888

RESUMO

BACKGROUND: Numerous lesions are found in the ventricular atrium (VA). Access is gained through many white matter tracts with great relevance and specific neurologic functions. It is important to understand the configuration of the most relevant structures surrounding this zone and, thus, select the safest entry zone on the lateral cerebral surface. OBJECTIVE: We studied the white matter layers traversed in the lateral transcortical parietal approach through the intraparietal sulcus (IPS), adding a transillumination technique. With this knowledge, we selected the safest highway to improve this particular approach. METHODS: An in-depth study of the white matter tracts was performed on 24 cerebral hemispheres (12 human whole brains). The Klingler technique and microsurgical dissection techniques were used under ×6 to ×40 magnification. The transillumination technique (torch illuminating the ventricular cavity) was used to expose the layers surrounding the VA and, thus, guide the dissection. RESULTS: Taking the IPS on the cerebral surface as a reference, we identified the following white matter layers ordered from the surface to the ependyma: U fibers, superior longitudinal fascicle, arcuate fascicle, vertical occipital fascicle, sagittal stratum with the optic radiations, and tapetum fibers. The transillumination technique allowed for the easier identification of the white matter deep periventricular layers. CONCLUSIONS: Knowledge of the main fascicles in the path and neighborhood of the VA allowed us to understand how certain neurologic functions can be affected by lesions at this level and to select the most appropriate way to avoid damaging relevant fascicles.


Assuntos
Ventrículos Cerebrais/diagnóstico por imagem , Ventrículos Cerebrais/cirurgia , Procedimentos Neurocirúrgicos/métodos , Transiluminação/métodos , Substância Branca/diagnóstico por imagem , Substância Branca/cirurgia , Cadáver , Humanos , Imageamento Tridimensional , Fibras Nervosas , Lobo Parietal/diagnóstico por imagem , Lobo Parietal/cirurgia
6.
Neurology ; 93(9): e879-e888, 2019 08 27.
Artigo em Inglês | MEDLINE | ID: mdl-31371565

RESUMO

OBJECTIVE: To describe the relationship between intraventricular hemorrhage (IVH) expansion and long-term outcome and to use this relationship to select and validate clinically relevant thresholds of IVH expansion in 2 separate intracerebral hemorrhage (ICH) populations. METHODS: We used fractional polynomial analysis to test linear and nonlinear models of 24-hour IVH volume change and clinical outcome with data from the Predicting Hematoma Growth and Outcome in Intracerebral Hemorrhage Using Contrast Bolus CT (PREDICT)-ICH study. The primary outcome was poor clinical outcome (modified Rankin Scale [mRS] score 4-6) at 90 days. We derived dichotomous thresholds from the selected model and calculated diagnostic accuracy measures. We validated all thresholds in an independent single-center ICH cohort (Massachusetts General Hospital). RESULTS: Of the 256 patients from PREDICT, 127 (49.6%) had an mRS score of 4 to 6. Twenty-four-hour IVH volume change and poor outcome fit a nonlinear relationship, in which minimal increases in IVH were associated with a high probability of an mRS score of 4 to 6. IVH expansion ≥1 mL (n = 53, sensitivity 33%, specificity 92%, adjusted odds ratio [aOR] 2.68, 95% confidence interval [CI] 1.11-6.46) and development of any new IVH (n = 74, sensitivity 43%, specificity 85%, aOR 2.53, 95% CI 1.22-5.26) strongly predicted poor outcome at 90 days. The dichotomous thresholds reproduced well in a validation cohort of 169 patients. CONCLUSION: IVH expansion as small as 1 mL or any new IVH is strongly predictive of poor outcome. These findings may assist clinicians with bedside prognostication and could be incorporated into definitions of hematoma expansion to inform future ICH treatment trials.


Assuntos
Hemorragia Cerebral/diagnóstico , Ventrículos Cerebrais/irrigação sanguínea , /estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Hemorragia Cerebral/diagnóstico por imagem , Ventrículos Cerebrais/diagnóstico por imagem , Estudos de Coortes , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Dinâmica não Linear , Tomografia Computadorizada por Raios X
7.
World Neurosurg ; 130: 493-498, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31295607

RESUMO

BACKGROUND: Symptomatic slit ventricle is one of the most challenging complications of shunt surgery in children. Clinical signs and symptoms may appear with a wide range of intracranial pressure (ICP) values. We report the case of a 10-year-old girl, who did not present the classic clinical features of extremely elevated ICP, which was proven by multiple invasive ICP recordings, performed during shunt revisions. CASE DESCRIPTION: At the age of 6 months, the patient presented squeal for many hours, accompanied with sunset eyes, bulging anterior fontanel, and dilated ventricles of all 4 ventricles on computed tomography scan. Acute ventriculoperitoneal shunt insertion was performed with adjustable valve. During the following 9 years, she was regularly seen and medically treated for intermittent headache, with nausea and vomiting. From 9 years of age, she was hospitalized for severe (10/10 on the visual analog scale), unbearable headache, agitation, and screaming on multiple occasions. Altogether, we had to revise the shunt system 5 times throughout 1 year. Radiologic imaging always showed narrow ventricles. Ophthalmologic examination of the fundus never revealed signs of raised ICP. Perioperative monitoring of the ICP with intraparenchymal sensor showed unexpected high values of 40-45 mm Hg. However, repetitive shunt revisions were successful only temporarily because the symptoms always returned. Only bilateral shunting of the ventricular system was able to eliminate the symptoms permanently. CONCLUSIONS: Images of slit ventricle can be associated either with low or extremely high ICP needing urgent surgical consideration, including ICP monitoring. Bilateral shunt insertion can be effective treatment for slit ventricle syndrome.


Assuntos
Ventrículos Cerebrais/cirurgia , Síndrome do Ventrículo Colabado/diagnóstico , Síndrome do Ventrículo Colabado/cirurgia , Derivação Ventriculoperitoneal/efeitos adversos , Ventrículos Cerebrais/diagnóstico por imagem , Ventrículos Cerebrais/patologia , Criança , Feminino , Humanos , Pressão Intracraniana , Reoperação , Síndrome do Ventrículo Colabado/complicações , Resultado do Tratamento
9.
Int J Comput Assist Radiol Surg ; 14(11): 1923-1932, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31350705

RESUMO

PURPOSE: Hydrocephalus is a clinically significant condition which can have devastating consequences if left untreated. Currently available methods for quantifying this condition using CT imaging are unreliable and prone to error. The purpose of this study is to investigate the clinical utility of using convolutional neural networks to calculate ventricular volume and explore limitations. METHODS: A two-dimensional convolutional neural network was designed to perform fully automated ventricular segmentation on CT images. A total of 300 head CTs were collected and used in this exploration. Two hundred were used to train the network, 50 were used for validation, and 50 were used for testing. RESULTS: Dice scores for the left lateral, right lateral, and third ventricle segmentations were 0.92, 0.92, and 0.79, respectively; the coefficients of determination were r2 = 0.991, r2 = 0.994, and r2 = 0.976; the average volume differences between manual and automated segmentation were 0.821 ml, 0.587 ml, and 0.099 ml. CONCLUSION: Two-dimensional convolutional neural network architectures can be used to accurately segment and quantify intracranial ventricle volume. While further refinements are necessary, it is likely these networks could be used as a clinical tool to quantify hydrocephalus accurately and efficiently.


Assuntos
Ventrículos Cerebrais/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Humanos , Tamanho do Órgão , Estudos Retrospectivos
10.
Rinsho Shinkeigaku ; 59(8): 509-514, 2019 Aug 29.
Artigo em Japonês | MEDLINE | ID: mdl-31341125

RESUMO

This is a case of a 71 years old man. Hemichorea appeared in the left half of his body in the middle of November, 2014. Minute hyperintense areas in the white matter near the posterior horn of the right lateral ventricle and in the right parasagittal frontal cortex was shown in MRI diffusion weighted image. Severe stenosis was seen in the right internal carotid artery, and reduction in cerebral blood flow of the right cerebral hemisphere including the basal ganglia was shown in single photon emission computed tomography (SPECT). After having carotid endarterectomy of the right internal carotid artery in January, 2015, hemichorea disappeared, and the cerebral blood flow of the right cerebral hemisphere improved. It is known that hemichorea is caused by the infarction of the basal ganglia. In recent years, some hemichorea cases are reported around East Asia caused by internal carotid artery stenosis with reduction in cerebral blood flow.


Assuntos
Artéria Carótida Interna/cirurgia , Estenose das Carótidas/complicações , Estenose das Carótidas/cirurgia , Coreia/etiologia , Endarterectomia das Carótidas , Idoso , Artéria Carótida Interna/diagnóstico por imagem , Ventrículos Cerebrais/irrigação sanguínea , Ventrículos Cerebrais/diagnóstico por imagem , Circulação Cerebrovascular , Cérebro/irrigação sanguínea , Cérebro/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética , Lobo Frontal/irrigação sanguínea , Lobo Frontal/diagnóstico por imagem , Humanos , Masculino , Tomografia Computadorizada de Emissão de Fóton Único , Resultado do Tratamento
11.
Stroke ; 50(7): 1688-1695, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31177984

RESUMO

Background and Purpose- We investigated the prognostic significance of spontaneous intracerebral hemorrhage location in presence of severe intraventricular hemorrhage. Methods- We analyzed diagnostic computed tomography scans from 467/500 (excluding primary intraventricular hemorrhage) subjects from the CLEAR (Clot Lysis: Evaluating Accelerated Resolution of Intraventricular Hemorrhage) III trial. We measured intracerebral hemorrhage engagement with specific anatomic regions, and estimated association of each region with blinded assessment of dichotomized poor stroke outcomes: mortality, modified Rankin Scale score of 4 to 6, National Institutes of Health Stroke Scale score of >4, stroke impact scale score of <60, Barthel Index <86, and EuroQol visual analogue scale score of <50 and <70 at days 30 and 180, respectively, using logistic regression models. Results- Frequency of anatomic region involvement consisted of thalamus (332 lesions, 71.1% of subjects), caudate (219, 46.9%), posterior limb internal capsule (188, 40.3%), globus pallidus/putamen (127, 27.2%), anterior limb internal capsule (108, 23.1%), and lobar (29, 6.2%). Thalamic location was independently associated with mortality (days 30 and 180) and with poor outcomes on most stroke scales at day 180 on adjusted analysis. Posterior limb internal capsule and globus pallidus/putamen involvement was associated with increased odds of worse disability at days 30 and 180. Anterior limb internal capsule and caudate locations were associated with decreased mortality on days 30 and 180. Anterior limb internal capsule lesions were associated with decreased long-term morbidity. Conclusions- Acute intracerebral hemorrhage lesion topography provides important insights into anatomic correlates of mortality and functional outcomes even in severe intraventricular hemorrhage causing obstructive hydrocephalus. Models accounting for intracerebral hemorrhage location in addition to volumes may improve outcome prediction and permit stratification of benefit from aggressive acute interventions. Clinical Trial Registration- URL: https://www.clinicaltrials.gov . Unique identifier: NCT00784134.


Assuntos
Hemorragia Cerebral/diagnóstico por imagem , Ventrículos Cerebrais/diagnóstico por imagem , Idoso , Gânglios da Base/diagnóstico por imagem , Hemorragia Cerebral/mortalidade , Hemorragia Cerebral/terapia , Estudos de Coortes , Feminino , Escala de Coma de Glasgow , Globo Pálido/diagnóstico por imagem , Humanos , Hidrocefalia/etiologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Tálamo/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento
12.
Eur J Paediatr Neurol ; 23(4): 571-580, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31147106

RESUMO

PURPOSE: Regular measurement of ventricular size is important in children with hydrocephalus. After closure of the fontanelle this is currently addressed by repetitive cranial MRI or CT imaging, coming along with risks of anaesthesia or radiation. As the third ventricle is accessible via the temporal bone window using ultrasound, determination of its diameter might be an easy and radiation-free alternative to assess the ventricular system. An essential precondition is that changes of the third ventricle diameter (TVD) mirror changes of the whole ventricular system. This study compares changes of TVD with changes of ventricular indices before and after initial treatment of hydrocephalus and during the following evolution. METHODS: MRT/CT images from 117 children with hydrocephalus were evaluated at time of diagnosis, after initial therapy and during follow-up with functional shunts. Measurements included axial TVD and three standard linear measures of the lateral ventricles (Evans Index - EI, fronto-occipital horn ratio - FOHR Index, and Cella Media Index - CMI). Furthermore, a correlation within subjects was calculated in 8 patients over the entire available follow-up. RESULTS: Relative changes of TVD were significantly correlated to relative changes of all ventricular indices (r = 0.48, r = 0.68 and r = 0.701 for EI, FOHR and CMI, respectively, p < 0.01). The correlation within subjects was outstanding for EI (r = 0.988), FOHR (r = 0.99) and CMI (r = 0.99). CONCLUSION: TVD showed a significant correlation with all three linear indices at the time of diagnosis and during follow-up changes independently of age, aetiology and ventricular width. TVD and its changes are therefore a reliable surrogate of changes in ventricular size in pediatric hydrocephalus undergoing treatment.


Assuntos
Hidrocefalia/diagnóstico , Hidrocefalia/patologia , Terceiro Ventrículo/patologia , Adolescente , Ventrículos Cerebrais/diagnóstico por imagem , Ventrículos Cerebrais/patologia , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Imagem por Ressonância Magnética/métodos , Masculino , Estudos Retrospectivos , Terceiro Ventrículo/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos
13.
Int. j. morphol ; 37(2): 554-560, June 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1002258

RESUMO

The aim of this study was to determine the normal values of brain ventricles and indices in healthy subjects in our population using magnetic resonance imaging (MRI) and to reveal sex and age related differences. The MRI of two hundred-sixty-five healthy individuals aged between eighteen and eighty-seven years were examined and the midsagittal and axial images were used for measurements. The measurements were performed from MRI on a Workstation. The following mean values of brain ventricles and indices were observed; frontal horn width (FHW) (33.14 mm); third (3rd) ventricle width (TVW) (3.37 mm); fourth ventricle anteroposterior width (FVWAP) (9.93 mm); fourth ventricle transverse width (FVWT) (12.40 mm); and the maximum transverse inner diameter of the skull (TIDS) (128.75 mm) in females. The same dimensions were 34.85 mm, 3.91 mm, 10.26 mm, 12.81 mm, and 134.68 mm in males, respectively. There were statistically significantly differences in the frontal horn width, third (3rd) ventricle width, and the maximum transverse inner diameter of the skull values in between sexes. The mean values of Evans' index which obtanied with maximum width between the frontal horns of the lateral ventricles divided by the maximum transverse inner diameter of the skull were found as 0.280 ±0.172 in females; whereas the same dimensions were calculated 0.276±0.161 in males. These values were lower in healthy male subjects than females, however; there were no found significantly difference between groups. Present findings obtained from MRI are necessary anatomical baseline data for interpreting pathological changes, planning surgery, and determining presence and progress of some neurological diseases.


El objetivo de este estudio fue determinar los valores normales de los ventrículos e índices cerebrales en sujetos sanos en nuestra población mediante el uso de imágenes de resonancia magnética (RM) y revelar las diferencias relacionadas con el sexo y la edad. Se examinó la resonancia magnética de 265 individuos sanos de entre 18 y 87 años, y se utilizaron las imágenes en sentido medio y sagital para las mediciones. Las mediciones se realizaron a partir de IRM en una estación de trabajo. Se observaron los siguientes valores medios de ventrículos e índices cerebrales: longitud del asta frontal (FHW) (33,14 mm); longitud del tercer ventrículo (TVW) (3,37 mm); longitud anteroposterior del cuarto ventrículo (FVWAP) (9,93 mm); longitud transversal del cuarto ventrículo (FVWT) (12,40 mm); y el diámetro transversal máximo del cráneo (SID) (128,75 mm) en las hembras. Las mismas dimensiones fueron 34,85 mm, 3,91 mm, 10,26 mm, 12,81 mm y 134,68 mm en machos, respectivamente. Hubo diferencias estadísticamente significativas en el ancho del asta frontal, el ancho del tercer ventrículo y el diámetro interno transversal máximo de los valores del cráneo entre los sexos. Los valores medios del índice de Evans que obtuvieron el ancho máximo entre los cuernos frontales de los ventrículos laterales dividido por el diámetro interno transversal máximo del cráneo se encontraron en 0,280 ± 0,172 en las mujeres; mientras que las mismas dimensiones se calcularon en hombres (0,276 ± 0,161). Sin embargo, estos valores fueron más bajos en hombres sanos que en mujeres; no se encontraron diferencias significativas entre los grupos. Los hallazgos actuales obtenidos de IRM son datos anatómicos de referencia necesarios para interpretar los cambios patológicos, planificar la cirugía y determinar la presencia y el progreso de algunas enfermedades neurológicas.


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Imagem por Ressonância Magnética , Ventrículos Cerebrais/anatomia & histologia , Ventrículos Cerebrais/diagnóstico por imagem , Fatores Etários , Caracteres Sexuais
14.
Prog. obstet. ginecol. (Ed. impr.) ; 62(3): 286-291, mayo-jun. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-185011

RESUMO

Objetivo: presentación de un caso recurrente de una patología fetal poco frecuente y revisión de posibles etiologías de la misma. Material y métodos: estudio descriptivo de caso único de hemorragia fetal intracraneal no asociada a prematuridad con recurrencia en siguiente gestación. Resultados: presentamos el caso de una gestante cuya sospecha se estableció en la semana 27 de gestación mediante control ecográfico seriado y con antecedente de feto con hemorragia fetal intracraneal de IV grado. Presentamos igualmente la evolución de ambos hijos ya que decidió continuar con la gestación. Conclusiones: La hemorragia fetal intracraneal es una entidad cuya incidencia es desconocida y cuya etiología generalmente no se conoce. Además la recurrencia es muy improbable. Con un mayor conocimiento de las etiologías probables sería posible una mejor prevención y asesoramiento a los progenitores


Objective: Report on a recurrent case relating to a rare fetal pathology and review of its etiologies. Material and methods: a descriptive study of a case of intracranial fetal hemorrhage not associated with prematurity and with recurrence in the following gestation. Results: we report the case of a pregnant woman, in which we suspected a recurrence of fetal intracranial hemorrhage at week 27 of gestation by means of serial ultrasound monitoring, and with a history of fetus with intracranial IV grade fetal hemorrhage. We also present the evolution of both children, since the parents decided to continue with the pregnancy. Conclusions: Intracranial fetal hemorrhage is an unknown entity and of which etiology is not generally known. In addition, recurrence is very unlikely. With a greater knowledge of probable etiologies, prevention and advice to parents would be better


Assuntos
Humanos , Feminino , Gravidez , Adulto , Hemorragia Cerebral/diagnóstico por imagem , Ventrículos Cerebrais/diagnóstico por imagem , Hidrocefalia/diagnóstico por imagem , Diagnóstico Pré-Natal/métodos , Ultrassonografia Pré-Natal/métodos , Fatores de Risco , Aconselhamento Genético/métodos
15.
Neurol Med Chir (Tokyo) ; 59(7): 271-280, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31068544

RESUMO

It is known that the cerebrospinal fluid (CSF) pulsation flow sign in the lateral ventricles directly above the foramen of Monro (CPF-M) on axial fluid attenuated inversion recovery (FLAIR) is a normal physiological finding as an artifact of FLAIR. In this study, whether CPF-M can be used as a neuroradiological finding related to pathological conditions in patients with acute aneurysmal subarachnoid hemorrhage (aSAH) was investigated. CPF-M-related clinical features were retrospectively evaluated in 147 aSAH patients who underwent adequate serial MRI examinations without massive intraventricular hemorrhage (IVH) of the lateral ventricle within 48 h of ictus. The frequency of the CPF-M in the control group was 32% (57/178), 33% (40/123), and 38% (45/117) for the normal control, chronic cerebral infarction, and deep white matter lesion (WML) groups, respectively. In aSAH patients, the overall prevalence of the CPF-M was 57% (84/147), significantly higher than in the three control groups. Multivariate analysis showed that age <70 years, lower IVH Hijdra score of the fourth ventricle, absence of T1-FLAIR mismatch, deep WMLs, old infarction, diffuse brain swelling, symptomatic delayed cerebral ischemia (DCI), shunt-dependent chronic hydrocephalus (SDCH), and favorable outcome were significantly associated with the CPF-M. Although limited to SAH patients without massive IVH of the lateral ventricles, one can conclude that, in acute aSAH, the presence of CPF-M on admission MRI suggests that the circulatory dynamics of the CSF from the basal cistern to the ventricles are approximately normal. Thus, this finding may appear to offer an indicator of a good outcome without DCI and SDCH.


Assuntos
Ventrículos Cerebrais/diagnóstico por imagem , Ventrículos Cerebrais/fisiopatologia , Líquido Cefalorraquidiano/fisiologia , Fluxo Pulsátil/fisiologia , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Hemorragia Subaracnóidea/cirurgia , Resultado do Tratamento
16.
J Vet Intern Med ; 33(3): 1368-1375, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30957934

RESUMO

BACKGROUND: One of the remaining questions in treating dogs with internal hydrocephalus is the association between the decrease of ventricular volume and re-expansion of cerebral parenchyma with clinical improvement. HYPOTHESIS: A decrease in ventricular volume and re-expansion of brain tissue occur after ventriculoperitoneal shunting (VPS). Clinical improvement defined by resolution of ≥1 clinical signs is associated with decreased size of cerebral ventricles and that the extent of change in ventricular size is associated with clinical improvement. ANIMALS: Forty-five client-owned dogs with newly diagnosed communicating internal hydrocephalus. METHODS: Ventricular volume, brain volume, and clinical status of dogs that underwent VPS were measured before and 3 months after surgery. Multiple logistic regression analysis was performed to assess the influence of decrease in ventricular size in addition to the covariates "age of the animal" and "duration of clinical signs before surgery" on improvement of clinical signs. RESULTS: Decreased volume of cerebral ventricles was associated with resolution of ≥1 preoperative clinical sign (P < .003). The covariates "age of the animal" and "duration of clinical signs" were not associated with improvement of clinical signs. The percentage decrease in ventricular size was associated with resolution of ataxia (P = .008) and obtundation (P = .011). CONCLUSION AND CLINICAL IMPORTANCE: The decrease in ventricular volume and increase in brain parenchyma after VPS are associated with improvement in clinical signs.


Assuntos
Ventrículos Cerebrais/cirurgia , Doenças do Cão/cirurgia , Hidrocefalia/veterinária , Derivação Ventriculoperitoneal/veterinária , Animais , Ataxia/veterinária , Encéfalo/diagnóstico por imagem , Ventrículos Cerebrais/diagnóstico por imagem , Cães , Feminino , Hidrocefalia/cirurgia , Imagem por Ressonância Magnética/veterinária , Masculino , Estupor/veterinária
17.
World Neurosurg ; 127: e979-e985, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30965165

RESUMO

OBJECTIVES: To investigate the risk factors in the development of pneumonia and its impact on outcome after primary intraventricular hemorrhage (PIVH). METHODS: This is a single-center retrospective study including consecutive patients with PIVH admitted to West China Hospital from 2010 to 2016. Pneumonia was defined according to the modified Centers for Disease Control and Prevention criteria within 7 days after PIVH onset. Poor outcome (modified Rankin score ≥3) and mortality at discharge and at 90 days were analyzed. RESULTS: Among the included 174 patients, pneumonia occurred in 13 (7.5%) patients. Patients with pneumonia had lower Glasgow Coma Scale (GCS) score (P = 0.001) and greater Graeb score (P = 0.001) at admission, presented more often with acute hydrocephalus (P = 0.04) and greater rates with stroke history (P = 0.002), and harbored greater admission blood glucose (P = 0.01) and absolute neutrophil counts (P = 0.02). In a multivariable analysis, only GCS score and stroke history were independent predictors of pneumonia after PIVH. The patients with pneumonia had longer duration of hospital stay (P = 0.002) and poorer outcome (P = 0.02) at 90 days. However, after adjustment for confounders, pneumonia after PIVH was not an independent predictor of poor outcome at 90 days. CONCLUSIONS: GCS score and stroke history were independent predictors of pneumonia development after PIVH. Pneumonia after PIVH was associated with longer duration of hospital stay and poorer outcome at 90 days.


Assuntos
Hemorragia Cerebral/complicações , Hemorragia Cerebral/diagnóstico por imagem , Escala de Coma de Glasgow/tendências , Tempo de Internação/tendências , Pneumonia/diagnóstico por imagem , Pneumonia/etiologia , Adulto , Idoso , Ventrículos Cerebrais/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
18.
Neuroimage Clin ; 22: 101787, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30991622

RESUMO

Preterm infants are at high risk for brain injury during the perinatal period. Intraventricular hemorrhage and periventricular leukomalacia, the two most common patterns of brain injury in prematurely-born children, are associated with poor neurodevelopmental outcomes. The hippocampus is known to be critical for learning and memory; however, it remains unknown how these forms of brain injury affect hippocampal growth and how the resulting alterations in hippocampal development relate to childhood outcomes. To investigate these relationships, hippocampal segmentations were performed on term equivalent MRI scans from 55 full-term infants, 85 very preterm infants (born ≤32 weeks gestation) with no to mild brain injury and 73 very preterm infants with brain injury (e.g., grade III/IV intraventricular hemorrhage, post-hemorrhagic hydrocephalus, cystic periventricular leukomalacia). Infants then underwent standardized neurodevelopmental testing using the Bayley Scales of Infant and Toddler Development, 3rd edition at age 2 years, corrected for prematurity. To delineate the effects of brain injury on early hippocampal development, hippocampal volumes were compared across groups and associations between neonatal volumes and neurodevelopmental outcomes at age 2 years were explored. Very preterm infants with brain injury had smaller hippocampal volumes at term equivalent age compared to term and very preterm infants with no to mild injury, with the smallest hippocampi among those with grade III/IV intraventricular hemorrhage and post-hemorrhagic hydrocephalus. Further, larger ventricle size was associated with smaller hippocampal size. Smaller hippocampal volumes were related to worse motor performance at age 2 years across all groups. In addition, smaller hippocampal volumes in infants with brain injury were correlated with impaired cognitive scores at age 2 years, a relationship specific to this group. Consistent with our preclinical findings, these findings demonstrate that perinatal brain injury is associated with hippocampal size in preterm infants, with smaller volumes related to domain-specific neurodevelopmental impairments in this high-risk clinical population.


Assuntos
Hemorragia Cerebral Intraventricular/complicações , Ventrículos Cerebrais/patologia , Hipocampo/crescimento & desenvolvimento , Hipocampo/patologia , Hidrocefalia/complicações , Lactente Extremamente Prematuro , Leucomalácia Periventricular/complicações , Imagem por Ressonância Magnética , Ventrículos Cerebrais/diagnóstico por imagem , Pré-Escolar , Feminino , Hipocampo/diagnóstico por imagem , Humanos , Recém-Nascido , Estudos Longitudinais , Masculino
19.
BMJ Case Rep ; 12(4)2019 Apr 24.
Artigo em Inglês | MEDLINE | ID: mdl-31023733

RESUMO

Neurocysticercosis (NCC) is the most common helmintic disease affecting the central nervous system and a major cause of adult-onset epilepsy in the developing world. 1 We describe a case of intraventricular NCC associated with hydrocephalus in a 28-year-old woman, Peruvian native, admitted to the emergency department for subacute headache and nausea. The cranial CT scan done showed asymmetric enlargement of the lateral ventricles which on cranial MRI was revealed to be due to an intraventricular cyst. An intraventricular endoscope was used to remove the cyst at the foramina of Monro, and therefore treat the obstructive hydrocephalus. NCC-a known cause of hydrocephalus in many Latin American countries-should be among the differential diagnosis in a patient with history of travel or residency in these countries. Treatment of choice for obstructive hydrocephalus caused by NCC is cyst removal with neuroendoscopy.


Assuntos
Cefaleia/cirurgia , Neurocisticercose/patologia , Cuidados Semi-Intensivos/métodos , Adulto , Ventrículos Cerebrais/diagnóstico por imagem , Líquido Cefalorraquidiano/citologia , Líquido Cefalorraquidiano/parasitologia , Diagnóstico Diferencial , Epilepsia/etiologia , Feminino , Cefaleia/diagnóstico , Cefaleia/etiologia , Humanos , Hidrocefalia/diagnóstico por imagem , Hidrocefalia/etiologia , Ventrículos Laterais/diagnóstico por imagem , América Latina/etnologia , Imagem por Ressonância Magnética/métodos , Neurocisticercose/complicações , Neurocisticercose/parasitologia , Neurocisticercose/cirurgia , Neuroendoscopia/métodos , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
20.
Neurol Med Chir (Tokyo) ; 59(4): 133-146, 2019 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-30814424

RESUMO

The "cerebrospinal fluid (CSF) circulation theory" of CSF flowing unidirectionally and circulating through the ventricles and subarachnoid space in a downward or upward fashion has been widely recognized. In this review, observations of CSF motion using different magnetic resonance imaging (MRI) techniques are described, findings that are shared among these techniques are extracted, and CSF motion, as we currently understand it based on the results from the quantitative analysis of CSF motion, is discussed, along with a discussion of slower water molecule motion in the perivascular, paravascular, and brain parenchyma. Today, a shared consensus regarding CSF motion is being formed, as follows: CSF motion is not a circulatory flow, but a combination of various directions of flow in the ventricles and subarachnoid space, and the acceleration of CSF motion differs depending on the CSF space. It is now necessary to revise the currently held concept that CSF flows unidirectionally. Currently, water molecule motion in the order of centimeters per second can be detected with various MRI techniques. Thus, we need new MRI techniques with high-velocity sensitivity, such as in the order of 10 µm/s, to determine water molecule movement in the vessel wall, paravascular space, and brain parenchyma. In this paper, the authors review the previous and current concepts of CSF motion in the central nervous system using various MRI techniques.


Assuntos
Ventrículos Cerebrais/diagnóstico por imagem , Líquido Cefalorraquidiano/fisiologia , Hidrodinâmica , Imagem por Ressonância Magnética , Espaço Subaracnóideo/diagnóstico por imagem , Ventrículos Cerebrais/fisiopatologia , Humanos , Espaço Subaracnóideo/fisiopatologia
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