Therapeutical - imagistic correlation regarding intracerebellar hematomas

Intracerebellar hematomas are single or multiple hematic collections localized on the cerebellar parenchyma, with an evolution similar to an intracranial expansive process.If clinical examination opens the way to diagnose, the imagistics not only that can lead to an accurate diagnose in almost every case, but it also dictates the therapeutic strategy.Thus, our study is focused on establishing a link between imagistics and clinical presentation at the moment of patient's admission to hospital, patients with intracerebellar hematomas.Our study comprised a number of 57 patients, with an age ranging from 32 to 82 years, all of them admitted either to neurology or neurosurgery sections of Clinic Emergency Hospital, “N. Oblu”, Iasi, over a perioad of 7 years, it was retrospective, descriptive and longitudinal based on a selection of medical data taken from the medical history of the patients diagnosed with intracerebral hematoma. During our study the following aspects were taken into consideration: computed - tomograph imagistic aspects - hematoma's dimension, localization and associated complication -, cerebellar hematoma's treatment and progress, as well as patient's clinical presentation at the moment of admission, age, gender

The importance of CT imaging for detecting traumatic intraorbitar and maxillofacial foreign bodies

The study represents an evaluation of the ability of spiral and conventional computer tomography in the diagnoseof intraorbitar and intraocular foreign bodies.The study includes 19 patients, aged between 15 and 52 years, 10 men and 9 women, presenting intraocular or intraorbitar foreign bodies or as a result of an traumatic injuries, who addressed the Emergency Hospital N. Oblu Iasi, between September 2010 - March 2011. The CT examination was the main imaging method of investigation in addition to conventional radiographs; it was conducted on a Philips Aura single-slice unit and a Siemens SOMATOM AR.C unit in the Department of Radiology and Medical Imaging in theHospital “N. Oblu” Iasi.One patient presents an CT image of carbonite IOFB, 5 patients present metallic IOFB, the images are obtained using used incremental CT (Somatom ARC, Siemens). 2 patients present spiral CT image of a metallic penetrating intraocular foreign body, 11 patients present spiral CT image of a metallic penetrating intraocular and maxillofacial foreign body.The classical computer tomography and spiral CT are among the most effective methods of examination and management of intraocular foreign bodies, maxillofacial or intraorbital.The spiral CT realise a continuous scanning of a volume of the patients body during table movement and reduces examination time and radiation exposure

Supratentorial multiple little meningiomas with transitory stroke symptoms like: MRI case presentation

We present the case of a 45 years patient explored by MRI, who had in the last three years more than 11 episodes of left or right sensitive hemiparesis, six of them associated with transitory aphasia. She was diagnosed with transitory ischemic attacks in both carotids arteries and treated with specific drugs, although she has no vascular risk factors. The two cerebral CT exams were in normal limits. The surprise came from MRI exam images, which disclosed two little meningiomas placed on the convexity, at the level of both parietal lobes. The conclusion was that all symptoms probably were produced by them, due the hemodynamic local tumoral modifications

Unusual Posttraumatic Vascular and Cerebral Injuries in Young Patients

Blunt carotid artery injury is a relatively rare but potentially lethal injury that predominantly occurs in high-impact mechanisms such as motor-vehicle collision. Any simptoms or neurological deficits following a multiple trauma patient mandates a thorough evaluation and consideration of BCI. This is a case report on two young patients with neurologic simptoms developed after blunt trauma in the cervical region. Both patients had left internal carotid artery dissection diagnosed on a CT-angiography, followed by middle cerebral artery territory infarction. Although it can be a delayed onset with no signs of vascular demage, we believe that, by implementing a protocol with additional imaging for early detection, we can prevent a devastating outcome

Imaging of periodontal disease in patients with ischemic stroke

Objectives: Links between periodontal diseases and systemic diseases have been well documented by epidemiological studies. Cardiovascular diseases are one of the main causes of morbidity and mortality in the European countries, including Romania. One focus of interest is atherosclerosis, the underlying event of cardiovascular diseases due to its serious health impact. The aim of this study was to analyze a possible association between ischemic stroke and periodontitis by marginal bone loss assessment on panoramic radiography (PR), Dental CT or CBCT.Material and methods: 103 patients, 28 to 50 years old, with recent history of ischemic stroke or transient ischemic attack diagnosed by specialist doctors (neurologists) were selected. Several parameters were evaluated in first five days in the dental office according to the health questionnaire and the recommended blood tests (cholesterol, triglycerides, complete hemoleucogram, C-reactive protein etc.). The same examiner and also two radiologist assessed the odontal and periodontal status of each patient on the PR, Dental CT or CBCT. We analyzed irredeemable teeth, periapical lesions, interradicular lesions, 4-5mm bone loss from the enamel-cement junction (ECJ) and >6mm bone loss from the enamel-cement junction (ECJ).Results: The study group analyzed by PR, Dental CT or CBCT presented high percents of irredeemable teeth (12%), teeth with periapical lesions (>3 mm; 3%), interradicular lesions (10%), 4-5 mm proximal bone loss (11%) and >6 mm bone loss (19%) associated with different localization of ischemic stroke.Conclusions: The present study confirms the existence of correlations between endodontic infections, periodontal infections demonstrated by panoramic radiography, CT/CBCT and ischemic stroke

Diagnostic value of silver nitrate staining for nucleolar organizer regions in cerebral astrocytic tumors

AIM: to compare the AgNOR's mean number with the histological type and grade of cerebral astrocytic tumors.MATERIALS AND METHOD: 16 primary cerebral astrocytic tumors (4 diffuse astrocytomas, 4 anaplastic astrocytomas and 8 glioblastomas) stereotactic biopsied in the Department of Neurosurgery, Clinical Hospital „Prof. Dr. N. Oblu” Ia?i, and histopathologically conventional diagnosed in Department of Neuropathology of the same hospital, were retrospectively identified. Tumor specimens were submitted to a combined staining technique: one – step silver nitrate method for AgNOR protein sites (modified after Ploton et al, 1986) counterstained with periodic acid-Schiff staining for basement membrane of vascular components. The mean AgNOR values (mAgNOR) for tumoral and vascular nuclei were determined. RESULTS: The average values of mean AgNORs/nucleus (mAgNOR/nucleus) presented a linear increase with increasing grade of malignancy from 1.96 for diffuse astrocytoma (GII), 2.34 for anaplastic astrocytoma (GIII), to 3.18 for glioblastoma multiforme (GIV). mAgNOR/tumoral nucleus also showed a linear correlation with the histological tumor grade: 2.27 for diffuse astrocytomas, 2.78 for anaplastic astrocytomas, and 3.35 for glioblastomas multiforme. A distinct difference between the mean values of AgNORs/vascular nucleus was expressed: 1.52 for diffuse astrocytoma (GII), 1.90 for anaplastic astrocytoma (GIII), and 3.18 for glioblastoma multiforme (GIV). There were some overlaps between GIII and GIV astrocytic tumors regarding the mAgNOR/tumoral nucleus: maximum value in anaplastic astrocytomas (GIII) was 2.91 and minimum value in small cells glioblastomas (GIV) was 2.47. Differentiation could be achieved with mAgNORs/vascular nucleus as no extreme value overlapped: maximum value in anaplastic astrocytomas (GIII) was 1.99 and minimum value in small cells glioblastomas (GIV) was 2.54. CONCLUSION: The malignancy grade of an astrocytic tumor can accurately be establish both on histological features of the conventional stained sample and on the average number, the shape and the distribution of AgNORs within tumoral and vascular nuclei, as AgNORs determinations supplement the histological information in small biopsies

The Posttraumatic Occlusion of the Vertebral Artery: Case presentation

We investigate radiographic features of vertebral artery injury/occlusion associated with nonpenetrating cervical spine trauma and to demonstrate the importance of the CTA in high-risk cases. With the popularization of CTA (Computed Tomography Angiography) and MRA (Magnetic Resonance Angiography), vertebral artery injury has been a common complication of cervical spine trauma. The occlusion of the vertebral artery secondary to non-penetrating trauma of the cervical spine (fractures and/dislocations) can be found in approximately 20% of the cases. Vertebral artery occlusion was rarely symptomatic because of sufficient collateral blood supply through not only contralateral vertebral artery but also the circle of Willis

Posterior fossa meningiomas: Correlation between site of origin and pathology

Aim: to identify the possible correlation between demographic data of the patients, site of tumor origin, and pathological characteristics of each subgroup of the posterior fossa meningiomas as the anatomical location of these tumors is a critical determinant of the operative approach that will be chosen.Materials and Methods: We analyzed medical records of 35 patients with posterior fossa meningiomas who underwent surgery between January 2005 and December 2009 at Neurosurgery Department, Ia?i. The analysis included: age and gender of the patients, tumor location, and pathologic findings. According to the anatomical relationship with posterior fossa structures, these 35 meningiomas were classified into 5 types: cerebellar convexity, cerebellopontine angle, petroclival, foramen magnum, and unclassified tumors. According to the classification scheme of WHO 2007 (19), all cases were classified into three histopathological groups: benign, atypical, and malignant meningiomas, and every histopathological subtype was noted.Results: Posterior fossa meningiomas have a 3.33:1 female-to-male ratio with a mean age of 51.6 years. 29 patients had anatomically distinct attachment to the dura of the 4 chosen compartments of the posterior fossa (cerebellar convexity – 14.28%, cerebellopontine angle – 48.57%, petroclival – 11.42%, and foramen magnum – 8.57%) and 6 patients (17.14%) had giant tumors with broad attachment in multiple areas of the posterior fossa. Grade I meningiomas encountered in majority of cases (82.85%), whereas grade II meningiomas were diagnosed in 11.42% of the operated case, and anaplastic meningiomas (grade III) accounted only 5.71%. The most common benign histological subtypes among posterior fossa meningiomas were fibrous (37.79%) and psamomatous (24.13%). Petroclival meningiomas accounted a higher incidence then that presented in other studies (11.42% of all posterior fossa meningiomas). The mean age for female patients was older (55 years) then in other studies. There were various benign histological subtypes (psammomatous, meningothelial, and secretory) and even an atypical one that was diagnosed in a male patient. Foramen magnum meningiomas affected only females with a mean age of 52.66 years. All tumors were benign (grade I) with psammomatous subtype being the most common histological subtype (66.66%). Cerebellar convexity meningiomas presented a female to male ratios of 4:1. Female patients were older (64.25 years) then the mean age of patients with posterior fossa meningiomas. In cerebellar convexity location, all meningiomas presented only benign histology (fibrous subtype, 100%) that made us thinking to a different tumorigenesis for this tumors comparative with other locations. Cerebellopontine angle meningiomas presented a strong preponderance of female patients (5:1). Though majority of cerebellopontine angle meningiomas had grade I of malignancy, they exhibited a large variety of histological subtypes.Conclusion: In our series, posterior fossa meningiomas are clearly various tumors in their histology and demographic data. We identified a significant association between age and gender of the patients, histology of posterior fossa meningiomas, and their site of origin

Correlations between clinical, imaging and histological findings in a patient with neurofibromatosis type 1 (von Recklinghausen's disease)

Neurofibromatosis type 1 (NF1) or von Recklinghausen disease is one of the most common genetic diseases, affecting 1/4,000 individuals. It is transmitted by autosomal dominant inheritance and the gene NF1, which is responsible for the disease, is located on the long arm of chromosome 17. NF1 is characterized by varied expressions of the disease, even within the same family.We present the case of a 22-year-old patient with NF1 admitted in the Department of Neurosurgery for a two months history of diffuse intercostal nevralgias that did not respond to treatment and discuss the histopathological and immunohistochemical features of her cutaneous and spinal neurofibromas.Our case adds new data to the knowledge of the diverse biological behaviour of NF1, highlighting the fact that this condition is a complex disease even in the same individual. We report here a highly variability among neurofibromas in the same patient from a histopathological point of view. Our data are also important as they demonstrate the fact that the management of a patient with NF1, due to the various and complex manifestations of the disease, requires a multidisciplinary approach, including neurologist, neurosurgeon, ophthalmologist, plastic surgeon, derma-tologist, radiologist and pathologist

THE ROLE OF CBCT IN THE EVALUATION OF PERIODONTAL DISEASES

Scope: Diagnosis of periodontal disease is firstly based on clinical signs and symptoms, however, when bone destruction is involved, radiographic examination is the most conclusive diagnosis method to be recommended. Even if the 2D radiography is most frequently used for such a diagnosis, CBCT (Cone Beam Computed Technology) comes to complete, help and provide new data on diagnosing periodontal lesions. The present study reviews original articles and synthesis papers issued between 2004-2014 in ScienceDirect, EBSCO, PubMed. Conclusions: In periodontology, CBCT appears as superior to 2D radiographies, being especially useful in the diagnosis of branch craters, lesions, vestibular and oral bone destructions, offering to the patient highly superior benefist compared to the risks caused by exposure