RESUMEN
We report two patients with bacterial brain abscesses whose etiological diagnosis was correctly proposed by association of diffusion weighted images (DWI) and magnetic resonance spectroscopy (MRS) with conventional MRI. Both patients presented ring enhancing lesions with evidences of restricted diffusion. On MRS, the abscess caused by aerobic bacteria presented lactate and aminoacids peaks and the abscess caused by anaerobic facultative bacteria showed also acetate and succinate peaks. These results are in agreement with an unique previous study that related MRS pattern with bacterial etiology. Conventional MRI, associated with DWI and MRS is effective in diagnosing bacterial abscess and promising in exploring its etiology.
Asunto(s)
Absceso Encefálico/diagnóstico , Imagen de Difusión por Resonancia Magnética , Espectroscopía de Resonancia Magnética , Infecciones Estreptocócicas/diagnóstico , Adolescente , Absceso Encefálico/microbiología , Humanos , Masculino , Persona de Mediana Edad , Infecciones Estreptocócicas/microbiología , Streptococcus milleri (Grupo)/aislamiento & purificación , Streptococcus pneumoniae/aislamiento & purificaciónAsunto(s)
Duramadre/patología , Linfoma de Células B de la Zona Marginal/patología , Neoplasias Meníngeas/patología , Femenino , Humanos , Linfoma de Células B de la Zona Marginal/diagnóstico por imagen , Neoplasias Meníngeas/diagnóstico por imagen , Persona de Mediana Edad , Tomografía Computarizada por Rayos XRESUMEN
We report a patient with longstanding Behçet disease who presented sudden onset of headache and facial paresis. The magnetic resonance imaging (MRI) showed a mass in the right thalamus, extending to the lentiform nucleus, subthalamic area, right cerebral peduncle and deep subcortical white matter. Stereotactic brain biopsy disclosed gliosis with no signs of malignancy. The diagnosis of a pseudotumoral form of neuro-Behçet disease was done and she was treated with pulse methylpredinisolone and intravenous cyclophosphamide. After 8 weeks she had improved and a new MRI showed disappearance of the tumor-like lesion. The differential diagnosis, especially with central nervous system tumor is emphasized.
Asunto(s)
Síndrome de Behçet/diagnóstico , Encefalopatías/diagnóstico , Adulto , Síndrome de Behçet/tratamiento farmacológico , Encefalopatías/tratamiento farmacológico , Neoplasias Encefálicas/diagnóstico , Neoplasias del Sistema Nervioso Central/diagnóstico , Ciclofosfamida/administración & dosificación , Diagnóstico Diferencial , Quimioterapia Combinada , Femenino , Estudios de Seguimiento , Cefalea/fisiopatología , Humanos , Inmunosupresores/administración & dosificación , Inyecciones Intravenosas , Imagen por Resonancia Magnética , Mesencéfalo/patología , Metilprednisolona/administración & dosificación , Quimioterapia por Pulso , Técnicas Estereotáxicas , Tálamo/patología , Factores de Tiempo , Resultado del TratamientoRESUMEN
We report two patients with bacterial brain abscesses whose etiological diagnosis was correctly proposed by association of diffusion weighted images (DWI) and magnetic resonance spectroscopy (MRS) with conventional MRI. Both patients presented ring enhancing lesions with evidences of restricted diffusion. On MRS, the abscess caused by aerobic bacteria presented lactate and aminoacids peaks and the abscess caused by anaerobic facultative bacteria showed also acetate and succinate peaks. These results are in agreement with an unique previous study that related MRS pattern with bacterial etiology. Conventional MRI, associated with DWI and MRS is effective in diagnosing bacterial abscess and promising in exploring its etiology.
Apresentamos dois pacientes com abscessos bacterianos cerebrais cujos diagnósticos etiológicos foram corretamente auxiliados pela associação de difusão e espectroscopia à ressonância magnética convencional. Ambos apresentavam lesões com captação anelar de contraste e evidências de restrição à difusão de moléculas de água. Na espectroscopia, o abscesso causado por bactéria aeróbia apresentou picos de lactato e aminoácidos, enquanto o abscesso causado por bactéria anaeróbia facultativa mostrou, além destes, picos de acetato e succinato. Tais resultados concordam com um único estudo prévio que relacionou o padrão de espectroscopia nos abscessos com sua etiologia bacteriana. A ressonância magnética convencional, associada à difusão e à espectroscopia é uma técnica eficiente no diagnóstico de abscessos bacterianos e promissora em explorar suas etiologias.
Asunto(s)
Adolescente , Humanos , Masculino , Persona de Mediana Edad , Absceso Encefálico/diagnóstico , Imagen de Difusión por Resonancia Magnética , Espectroscopía de Resonancia Magnética , Infecciones Estreptocócicas/diagnóstico , Absceso Encefálico/microbiología , Infecciones Estreptocócicas/microbiología , Streptococcus milleri (Grupo)/aislamiento & purificación , Streptococcus pneumoniae/aislamiento & purificaciónRESUMEN
O granuloma reparador de células gigantes é lesão óssea rara, correspondendo a cerca de 7 por cento de todos os tumores ósseos benignos da mandíbula, com maior incidência no sexo feminino. Embora seja considerada resposta a um trauma, este antecedente nem sempre está presente. O aspecto radiológico característico é de lesão lítica, uni ou multiloculada, com afilamento da cortical, podendo apresentar calcificações no seu interior. Neste trabalho relatamos os aspectos clínicos e radiológicos de cinco casos de granuloma reparador de células gigantes envolvendo a mandíbula e o maxilar, e as principais características que permitem o diagnóstico diferencial com outras lesões fibro-ósseas que acometem a face
Giant cell reparative granuloma is an uncommon bone lesion accounting for slightly less than 7% of all benign tumors of the jaw and affecting predominantly females. It probably represents a reparative reaction to a traumatic injury, although history of trauma is not always confirmed. The characteristic radiological feature is a uni- or multilocular lytic bone defect eroding the bone cortical and occasionally presenting with calcifications within the lesion. We report the most important clinical and radiological features observed in five patients with giant cell reparative granuloma involving the mandible and the maxillae and discuss the main aspects for the differential diagnosis with other fibro-osseous lesions that affect the facial bones.
Asunto(s)
Humanos , Femenino , Niño , Adulto , Persona de Mediana Edad , Enfermedades Maxilomandibulares/diagnóstico , Granuloma de Células Gigantes/diagnóstico , Granuloma de Células Gigantes/patología , Enfermedades Mandibulares , Enfermedades Maxilares , Neoplasias Maxilares , Diagnóstico por Imagen , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: To describe the role of magnetic resonance imaging (MRI) in the evaluation of patients with chronic and recurrent aseptic meningitis.METHOD: A retrospective study of five patients with aseptic meningoencefalitis diagnosed by clinical and CSF findings. CT scans showed without no relevant findings. RESULTS: MRI showed small multifocal lesions hyperintense on T2 weighted images and FLAIR, with mild or no gadolinium enhancement, mainly in periventricular and subcortical regions. Meningoencephalitis preceded the diagnosis of the underlying disease in four patients (Behçet's disease or systemic lupus erythematosus). After the introduction of adequate treatment for the rheumatic disease, they did not present further symptoms of aseptic meningoencephalitis. CONCLUSION: Aseptic meningoencephalitis can be an early presentation of an autoimmune disease. It is important to emphasize the role of MRI in the diagnosis and follow-up of these patients.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Enfermedades del Tejido Conjuntivo/diagnóstico , Meningitis Aséptica/diagnóstico , Meningoencefalitis/diagnóstico , Síndrome de Behçet/complicaciones , Síndrome de Behçet/diagnóstico , Síndrome de Behçet/tratamiento farmacológico , Enfermedad Crónica , Enfermedades del Tejido Conjuntivo/complicaciones , Enfermedades del Tejido Conjuntivo/tratamiento farmacológico , Estudios de Seguimiento , Lupus Eritematoso Sistémico/complicaciones , Lupus Eritematoso Sistémico/diagnóstico , Lupus Eritematoso Sistémico/tratamiento farmacológico , Imagen por Resonancia Magnética , Meningitis Aséptica/líquido cefalorraquídeo , Meningitis Aséptica/tratamiento farmacológico , Meningitis Aséptica/etiología , Meningoencefalitis/líquido cefalorraquídeo , Meningoencefalitis/tratamiento farmacológico , Meningoencefalitis/etiología , Recurrencia , Estudios RetrospectivosRESUMEN
The purpose of this paper, which was conducted on 175 children with hemiparetic cerebral palsy (H-CP), was to verify the etiological risk period for this disease. Etiological risk factors (ERF) were detected through anamnesis: 23 percent in the prenatal period, 18 percent in the perinatal period and 59 percent of the patients the period was undefined (ERF in the prenatal and perinatal period was 41 percent and no ERF was 18 percent of the cases. The computerized tomographic scan (CT) and MRI were performed on all the patients, who were then classified according to their etiopathogenic data: CT1= normal (18 percent); CT 2= unilateral ventricular enlargement (25 percent); CT 3= cortical/ subcortical cavities (28 percent); CT4= hemispheric atrophy and other findings (14 percent); CT 5= malformations (15 percent). CT 5 was associated with physical malformations beyond the central nervous system and with prenatal ERF's , while CT 2 was associated with the perinatal ERF's, mainly in premature births. Magnetic resonance imaging was performed on 57 patients and demonstrated a good degree of concordance with the CT. Etiology remained undefined in only 37 percent of the cases after neuroimaging was related to ERF. A high perinatal RF frequency (59 percent) was observed and emphasized the need for special care during this period