Significant incidental brain magnetic resonance imaging findings in migraine headache patients: Retrospective cross-sectional study.

BACKGROUND: Migraine is one of the most common complaints encountered in neurology clinics. Accurate diagnoses of migraine are usually informed by the patient's history, and neuroimaging is only performed in cases of atypical or severe, medically intractable headache to rule out underlying pathologies. Our study aimed to identify the spectrum of brain magnetic resonance imaging (MRI) findings characteristic of chronic headache. METHODS: This retrospective study of adult patients referred to the First Scan radiology clinic in Jeddah, Saudi Arabia, for brain MRI with a known diagnosis of migraine headache was performed between April 2016 to May 2017. RESULTS: We included 275 adults (115 men; median age, 38 years, IQR 30-52) with known diagnoses of chronic migraine. Incidental MRI findings were discovered in 157 (57 %) of the scans; 23 (8.3 %) of these were clinically significant, indicating the need for an intervention. Patients aged >40 years were more likely to have an abnormal scan. There were no significant differences related to sex or duration of headaches for more than one year. CONCLUSION: The performance of brain MRI warrants consideration in patients who do not respond as expected to migraine and headache treatment. We found clinically significant MRI findings in up to 8 % of such patients. Abnormal imaging findings were the most common among patients of >40 years of age.

Brain versus orbital MRI in evaluating idiopathic intracranial hypertension.

OBJECTIVE: To evaluate the usefulness of brain MRI as compared to orbital MRI in the assessment of idiopathic intracranial hypertension (IIH). METHODS: The study was carried out at King Abdul-Aziz University Hospital, Jeddah, Kingdom of Saudi Arabia between January 2002 and December 2003. An MRI of the head and orbits was performed for 42 patients with the clinical diagnosis of IIH, and 15 normal volunteers. All cases of secondary increased intracranial pressure were eliminated. The images were evaluated for the presence of empty sella, parenchymal abnormalities, ventricular and sulcal size changes, optic disc elevation, and optic nerve sheath distention. RESULTS: The MRI of the head revealed empty sella in 29 patients and in one normal volunteer. Brain MRI did not reveal any parenchymal, ventricular or cisternal abnormalities in either group. Orbital MRI revealed optic nerve sheath distension and optic disc elevation in 36 patients, and were normal in all volunteers. CONCLUSION: Brain MRI has limited value in the evaluation of IIH. Orbital MRI is the recommended imaging modality for this entity.

Osteomalacic myopathy due to celiac disease.

Celiac disease is a gluten-sensitive enteropathy characterized by malabsorption resulting from inflammatory injury to the mucosa of the small intestine. It is well known to be associated with a variety of neurological disorders including epilepsy, myopathy, neuropathy and ataxia. The nature of this association is unclear. Although osteomalacia secondary to vitamin D deficiency is a recognized complication of celiac disease, however, severe osteomalacic myopathy as the only presentation of celiac disease is extremely rare. We present 2 interesting cases of osteomalacic myopathy secondary to celiac disease, which were treated successfully with full recovery. An important and unique observation was the brisk reflexes noticed in both patients. The mechanism behind this phenomenon is not well understood. Work-up for celiac disease is warranted in any young patient that presents with myopathy.

Idiopathic spinal cord herniation: a new theory of pathogenesis.

BACKGROUND: Idiopathic spinal cord herniation is a rare entity that has been described more frequently over the past few years. Its pathophysiology remains obscure, however. METHODS: We report a case of spinal cord herniation and review the literature extensively. In view of our review, we try to determine the clinical features of the condition and the diagnostic measures used, with emphasis on the role of magnetic resonance (MR) phase-contrast CSF study. The factors affecting the outcome of the condition are also studied including time and type of presentation, as well as the surgical procedure performed. The pathophysiological mechanisms behind spontaneous herniation are discussed, and a new hypothesis is proposed. RESULTS: Idiopathic spinal cord herniation occurs in the middle-aged adult, with a preponderance of patients being female. Brown-Séquard syndrome is the most common clinical presentation and usually progresses to spastic paraparesis. MRI typically shows a ventral kink in the thoracic cord, with MR phase-contrast imaging proving an important addition to exclude an arachnoid cyst. Better outcomes were noted in the patients treated earlier, and in those with no spasticity. Widening the dural defect seems to afford better results compared to grafting of the defect. The prognosis is favorable after correction, though a vertebral body herniation variant may be associated with worse outcome. In view of the chronology of events and imaging studies in our patient, we hypothesize that herniation occurs as an acquired phenomenon where an inflammatory process results in adherence between the spinal cord and the dura, with erosion, formation of a dural defect, and then later herniation occurring with cerebral spinal fluid (CSF) pulsations. CONCLUSIONS: Idiopathic herniation of the spinal cord should be recognized and treated early to reach a favorable outcome. It seems to be an acquired condition likely caused by an inflammatory event, the nature of which is to be determined.

Uterine lipoma.

Pure lipoma of the uterus is a rare entity and few cases have been reported. They usually develop in postmenopausal women. Clinical symptoms and physical signs are similar to those found in leiomyomas. The histogenesis of these lesions is still unclear. The diagnosis is easily made at the time of surgery or at autopsy, but before this, they may lead to many problems in the differential diagnosis with another uterine tumors. Recent papers suggest the possibility of a preoperative diagnosis made by computed tomography and magnetic resonance imaging. We report a case of a 67-year-old postmenopausal women presented with pelvic pressure and urinary symptoms. Pathological evaluation revealed pure intramural lipoma of the uterus illustrating characteristic morphological and histological findings with no evidence of sarcomata's component.

How often is low back pain or sciatica not due to lumbar disc disease?

OBJECTIVE: To determine the percentage of low back pain or sciatica referred for MRI in which the main abnormality was not disc disease. METHODS: This is a retrospective study of 634 consecutive lumbar spine MRI`s in patients with low back pain or sciatica performed over 6-month period (January to June 2002). The study was conducted at the University Hospital of King Abdul-Aziz University, Jeddah, Kingdom of Saudi Arabia. All patients were scanned on a 1.5-T MRI system. The examination included T-1 weighted sagittal images and proton density and T-2 weighted sagittal and axial images. Contrast enhanced images were obtained selectively. RESULTS: Nine patients were eliminated because they were being followed for a known diagnosis, leaving 625 patients in the study group. Of these, 11 patients (1.7%) had a new diagnosis of metastatic disease to the bony spine, 7 of which (1.1%) had a known primary and 4 of which (0.6%) had no known primary malignancy. Two patients (0.3%) had spinal tumors: one conus ependymoma and one schwannoma. Four patients had non-neoplastic causes of low back pain including syringomyelia, discitis, spondylolisthesis, and an osteoporotic compression fracture. In all, 17 of 625 patients (2.7%) had a new diagnosis of a treatable cause of low back pain or sciatica other than disc disease. CONCLUSION: In patients with low back pain or radiculopathy, 2.7% have significant pathologies other than disc disease.