29 research outputs found
Utilidad de las secuencias potenciadas en susceptibilidad paramagnética (SWI) para diferenciar crisis somestésicas de accidentes isquémicos transitorios en un paciente con angiopatía amiloide cerebral
Background. Cerebral amyloid angiopathy (CAA) is
characterized by the deposit of β-amyloid on the walls
of small and medium-sized arteries of the cerebral cortex
and leptomeninges causing cerebral bleeding. Clinical
presentations may include transient neurological
events for which differential diagnosis can be difficult.
Case report. We report a subject with a medical history
of recent stroke who presented somesthetic seizures
mimicking transient ischemic attacks owing to CAA
microbleeding. Antiplatelet treatment was reduced and
after lamotrigine was commenced the episodes disappeared.
Susceptibility-weighted magnetic resonance
imaging was very helpful for diagnosis (SWI-MRI).
Conclusions. CAA microbleeding can be manifested in
the form of seizures mimicking focal transient sensitive
neurological deficits that can be erroneously attributed
to cerebral ischemia. The present case report suggests
that, despite the presence of a past medical history of
strokes, neurologists should consider CAA microbleeding
as a possible cause of pseudo-transient ischemic
attacks. High-resolution neuroimaging including SWIMRI
imaging can be helpful in identifying cortical microbleedings.
In this way, the start or increase of antiplatelet
treatment can be avoided, and the risk of potentially
fatal complications minimize
Hallazgos neurorradiológicos de la Acidosis Glutárica tipo I
Glutaric aciduria type I is a rare disorder of organic acid metabolism caused by
deficiency of glutaryl-CoA dehydrogenase, a mitochondrial enzyme. Improper
degeneration of amino acids: tryptophan, lysine, and hydroxylysine, results in
increased levels of glutaric acid, which typically becomes clinically manifest as
an acute dystonic crisis in young children. Accumulation of glutaric acid causes
neurotoxicity in the basal ganglia and fronto-temporal cortex which can lead to
progressive dystonia, hypotonia, permanently impaired speech and seizures.
Because dietary and drug therapy may alter the natural history of the disease,
early diagnosis of such patients is critical. We report the magnetic resonance
(MR) imaging findings in a 16 year-old girl with this disorder who presented with
a chronic dystonic syndrome and previously diagnosed of brain paralysis. MR
imaging demonstrated bilateral involvement of the putamina and periventricular
white matter, and bilateral temporal atrophy and widened Silvian fissure
Infratentorial hygroma secondary to decompressive craniectomy after cerebellar infarction
We present a case of expansive CSF collection in the cerebellar convexity. The patient was a 74 years old lady who one month before had suffered a cerebellar infarct complicated with acute hydrocephalus. She had good evolution after decompressive craniectomy without shunting. Fifteen days after surgery, the patient started with new positional vertigo, nausea and vomiting and a wound CSF fistula that needed ventriculoperitoneal shunt (medium pressure) because conservative treatment failed. After shunting, the fistula closed, but the patient symptoms worsened. The MRI showed normal ventricular size with a cerebellar hygroma, extending to the posterior interhemispheric fissure. The collection had no blood signal and expanded during observation. A catheter was implanted in the collection and connected to the shunt. The patient became asymptomatic after surgery, and the hygromas had disappeared in control CT at one month. This case shows an infrequent problem of CSF circulation at posterior fossa that resulted in vertigo of central origin. A higroma-ventricle-peritoneal shunt solved the symptoms of the patient
Reversible cerebral vasoconstriction syndrome induced by adrenaline
Reversible cerebral vasoconstriction syndrome (RCVS) is
characterized by acute severe thunderclap headaches and evidence of multifocal,
segmental, reversible vasoconstrictions of the cerebral arteries. Several
precipitating factors have been identified and reported, including the use of
recreational substances or sympathomimetic drugs and the postpartum state. Case
description: Here we present the case of a woman who developed RCVS after the
administration of adrenaline (epinephrine) in the setting of an anaphylactic
reaction during antibiotic allergy testing. Discussion: To our knowledge, this is
the first reported case of RCVS following the administration of exogenous
adrenaline. This case contributes to the understanding of the physiopathological
mechanisms underlying reversible cerebral vasoconstrictio
RM en el diagnóstico y control evolutivo de la degeneración combinada subaguda. A propósito de un caso
A deficit of vitamin B12, generally resulting from pernicious anaemia, can give rise to disorders of the spinal cord, brain, optic and peripheral nerves. The principal neurological syndrome is subacute combined degeneration of the spinal cord (SCD), which can cause progressive motor and/or sensitive alterations, instability and incontinency, due to the demyelination of the posterior horn of the spinal cord. The identification by magnetic resonance (MR) of signal hyperintensity in T2 weighted sequences at the level of the posterior horns of the spinal and/or cervical cord can be of great use in diagnosising the patient with SCD, above all when the symptoms are mild or nonspecific, and the patient does not have haematological or gastrointestinal alterations. Besides, the evolution of the altered signal of the posterior horns in MR can be of use in evaluating the efficacy of treatment, since their normalization is related to clinical improvemen
Functional bold MRI: advantages of the 3 T vs. the 1.5 T
We quantitatively evaluate the benefits of a higher field strength for functional
brain MRI (fMRI) based on the blood oxygenation level-dependent contrast. The 3-T
fMRI shows a higher sensitivity for the motor and somatosensory stimulation and
more specific localization in the grey substance. The 3-T fMRI detects additional
areas of activation with the motor paradigm
The impact of silent vascular brain burden in cognitive impairment in Parkinson's disease
White matter hyperintensities (WMHs) detected by magnetic
resonance imaging (MRI) of the brain are associated with dementia and cognitive
impairment in the general population and in Alzheimer's disease. Their effect in
cognitive decline and dementia associated with Parkinson's disease (PD) is still
unclear. METHODS: We studied the relationship between WMHs and cognitive state in
111 patients with PD classified as cognitively normal (n = 39), with a mild
cognitive impairment (MCI) (n = 46) or dementia (n = 26), in a cross-sectional
and follow-up study. Cognitive state was evaluated with a comprehensive
neuropsychological battery, and WMHs were identified in FLAIR and T2-weighted
MRI. The burden of WMHs was rated using the Scheltens scale. RESULTS: No
differences in WMHs were found between the three groups in the cross-sectional
study. A negative correlation was observed between semantic fluency and the
subscore for WMHs in the frontal lobe. Of the 36 non-demented patients
re-evaluated after a mean follow-up of 30 months, three patients converted into
MCI and 5 into dementia. Progression of periventricular WMHs was associated with
an increased conversion to dementia. A marginal association between the increase
in total WMHs burden and worsening in the Mini Mental State Examination was
encountered. CONCLUSIONS: White matter hyperintensities do not influence the
cognitive status of patients with PD. Frontal WMHs have a negative impact on
semantic fluency. Brain vascular burden may have an effect on cognitive
impairment in patients with PD as WMHs increase overtime might increase the risk
of conversion to dementia. This finding needs further confirmation in larger
prospective studies
Surgery guided by 5-aminolevulinic fluorescence in glioblastoma: volumetric analysis of extent of resection in singlecenter experience
We analyzed the efficacy and applicability of surgery guided by 5-aminolevulinic
acid (ALA) fluorescence in consecutive patients with glioblastoma multiforme
(GBM). Thirty-six patients with GBM were operated on using ALA fluorescence.
Resections were performed using the fluorescent light to assess the right plane
of dissection. In each case, biopsies with different fluorescent quality were
taken from the tumor center, from the edges, and from the surrounding tissue.
These samples were analyzed separately with hematoxylin-eosin examination and
immunostaining against Ki67. Tumor volume was quantified with pre- and
postoperative volumetric magnetic resonance imaging. Strong fluorescence
identified solid tumor with 100% positive predictive value. Invaded tissue beyond
the solid tumor mass was identified by vague fluorescence with 97% positive
predictive value and 66% negative predictive value, measured against
hematoxylin-eosin examination. All the contrast-enhancing volume was resected in
83.3% of the patients, all patients had resection over 98% of the volume and mean
volume resected was 99.8%. One month after surgery there was no mortality, and
new or increased neurological morbidity was 8.2%. The fluorescence induced by
5-aminolevulinic can help to achieve near total resection of enhancing tumor
volume in most surgical cases of GBM. It is possible during surgery to obtain
separate samples of the infiltrating cells from the tumor borde
CT and MRI of Hepatic Abscess in Patients with Chronic Granulomatous Disease
We describe the spectrum of radiologic appearances of hepatic
abscesses in patients with chronic granulomatous disease (CGD), a hereditary
immunodeficiency presenting in childhood that occurs at a rate of 1 in
200,000-250,000 live births and predisposes patients to infection with
catalase-positive organisms. CONCLUSION: Hepatic abscesses in patients with CGD
show an atypical radiologic appearance compared with sporadic hepatic abscesses,
and they are characterized by homogeneous enhancement and multiseptal
enhancement. In the appropriate clinical setting, the appearance of an enhancing
mass should suggest the possibility of a CGD-related hepatic absces