Spinal changes in patients with ankylosing spondylitis on MRI: case series

Magnetic Resonance Imaging appearances are described in three cases of Ankylosing Spondylitis (AS). The different appearances of AS on magnetic resonance imaging are described and their significance in relation to the pathology of this condition is discussed. MRI is increasingly used to detect changes in the spine of patients with AS. Spinal changes associated with spondyloarthritis are florid anterior spondylitis (Romanus lesion), florid discitis (Andersson lesion), ankylosis, insufficiency fractures of the ankylosed spine, syndesmophytes, arthritis of the apophyseal and costovertebral joints and enthesitis of the interspinal ligaments

Cerebral toxoplasmosis in a patient with acquired immunodeficiency syndrome

Cerebral toxoplasmosis commonly affects patients with advanced HIV immunodeficiency. Toxoplasmosis in patients who are immunocompromised can be severe and debilitating in patients with Central Nervous System (CNS) involvement and the condition may be fatal. We report the case of a 40-year-old man who was a known case of HIV and presented with cerebral toxoplasmosis. His Magnetic Resonance Imaging (MRI) scan showed multiple ring enhancing lesions with extensive surrounding oedema in supratentorial as well as infratentorial region. Lesions were mainly located in the periventricular region as well as at the grey-white matter junction and showed enhancement in the periphery as well as a tiny nodular enhancement in the centre. Patient was started on Septran DS, empirically for toxoplasmosis and steroids to reduce intracranial pressure. On follow up MRI scan after 10 days there was a reduction in size, number and enhancement of the masses with decrease in the surrounding oedema. Patient was clinically stable, oriented and his fever settled. He was discharged from hospital on same medication and advised to continue regular follow-up

Posterior reversible encephalopathy syndrome: a case series in patients with eclampsia

Posterior Reversible Encephalopathy Syndrome (PRES) refers to a clinicoradiologic entity with characteristic features on neuro-imaging and non-specific symptoms comprising headache, confusion, visual disturbances and seizures. The lesions in PRES are thought to be due to vasogenic oedema, predominantly in the posterior cerebral hemispheres, and are reversible with appropriate management. We report 3 cases of acute PRES who had eclampsia and presented with recurrent episodes of seizures and hypertension. Their MRI scan showed diffuse abnormal signal intensities involving predominantly deep white matter of the occipital lobes. Based on the findings the most probable diagnosis of PRES was suggested. They were started on antihypertensive drugs. On follow-up examination after 5-7 weeks, the patients showed marked improvement clinically and on neuro-imaging following which they were discharged in stable condition

Diffusion weighted image (DWI) findings in methanol intoxication

Methanol is a toxic substance with extremely devastating effects upon exposure. The case described suffered from such kind of poisoning. MRI brain demonstrated necrosis bilaterally in the Putamen areas which is a classic hallmark finding. Additional Diffusion weighted imaging showed abnormal signal bilaterally in the putamen areas along with Diffusion positive bilateral lesions (possibly infarctions) in both the frontal and occipital lobes that were not evident on MRI with or without contrast

Cerebral nocardiosis

Localized and multisystem nocardiosis is an opportunistic disease that occurs commonly in immunocompromised patients. Rarely, it is also seen in immunocompetent individuals. The most common disease sites include lung, skin and central nervous system. We report a case of 73 years old man who is a known case of rheumatoid arthritis for more than 15 years and was on Methotrexate and Prednisolone. Now presented with generalized tonic clonic seizures. His Magnetic Resonace Imaging (MRI) scan showed a ring enhancing lesion with mild surrounding oedema in right posterior parietal cortex. Based on the finding, the most probable diagnosis of cerebral abscess was suggested. Patient underwent right sided craniotomy with aspiration of abscess. Serum Gram staining showed branching Gram-positive rods, and serum culture showed colonies of Nocardia Asteroides. He was started on Sulfamethoxazole-Trimethoprim. On follow-up examination, the patient showed marked improvement clinically and was discharged in stable condition on long term antibiotic therapy. This case highlights the importance of including nocardia on the differential diagnosis especially in patients who present with abnormal MRI scan findings that mimic tuberculoma or neoplastic disease. Clinical awareness of this condition could expedite the diagnostic process and help improve morbidity and mortality

Central nervous system involvement in multiple myeloma

Involvement of the central nervous system by multiple myeloma (MM) is considered to be extremely rare. Magnetic Resonauce Imaging (MRI) is the imaging modality of choice to detect and differentiate myeloma at unusual sites. We present the case of a sixty-year-old man who was a known case of MM. In this case report MRI findings of central nervous system in myeloma lesions are reported. The purpose is to increase the awareness of the clinical presentation, neuroradiological findings and follow-up of multiple myeloma with intracranial growth. There are only a few reported cases found concerning MM with intracranial involvement in the literature. To the best of our knowledge, there is no such published literature available locally

Application and advantage of functional magnetic resonance imaging and blood oxygen level dependant (BOLD) imaging modality

The objective of the study was to introduce the availability of bold imaging facility at Aga Khan University Hospital Karachi for the first time in Pakistan and also to review the practical application and advantages of functional magnetic resonance imaging (fMRI) and blood oxygen level dependant (BOLD) Imaging Procedures. The study was conducted at Aga Khan University Hospital, Karachi from August 2008 to November 2008 .Three patients were selected that had presented with intracranial space occupying lesions. They underwent Functional Magnetic Resonance Imaging (fMRI). The findings of the images were important to describe and localize the eloquent brain areas and their relationship to the underlying pathology. In conclusion this study reflected the significance of the Blood Oxygen Level Dependant (BOLD) imaging modality that can help in improved outcome of patients presenting with intracranial space occupying lesions

Assessment of menisci and ligamentous injuries of the knee on magnetic resonance imaging: correlation with arthroscopy

OBJECTIVE: To evaluate the validity of MRI, in the assessment of the meniscal and cruciate ligamenteous injuries of the knee joint and comparison with arthroscopic findings. METHODS: A one year prospective cross-sectional study from January 2006 to January 2007, was performed on 50 patients (32 males & 18 females) with knee injury presenting at the orthopedic unit of AKUH. The patients were referred to radiology department for MRI evaluation and arthroscopy. RESULTS: The sensitivity, specificity and accuracy for MRI of the menisci and ligaments were as follows: medial meniscus resulted in 100% sensitivity, 69.27% specificity, 90% PPV, 100% NPV and 92% accuracy: lateral meniscus resulted in 87.5% sensitivity, 88.23% specificity, 77% PPV, 93% NPV and 88% accuracy: anterior cruciate ligament resulted in 86.67% sensitivity, 91.43% specificity, 81% PPV, 94% NPV and 88% accuracy; posterior cruciate ligament resulted in 100% sensitivity, 95.83% specificity,50% PPV, 100 NPV and 96% accuracy. CONCLUSION: Magnetic resonance imaging is a good, accurate and non invasive modality for the assessment of menisci and ligamenteous injuries. It can be used as a first line investigation in patients with soft tissue trauma to knee

Utility of MRI in assessment of pituitary iron overload

Beta thalassemia is highly prevalent in Pakistan with a carrier rate of 5-8%. The main complication of beta thalassemia major is iron overload, especially in reticuloendothelial system, heart, joints and endocrine glands. Pituitary siderosis leads to hypogonadotropic hypogonadism and growth hormone deficiency. Measures of plasma ferritin levels and hepatic iron level are used for assessing body iron overload but these are limited for various reasons particularly in case of pituitary siderosis. Magnetic Resonance Imaging (MRI) is a reliable, non invasive and easily available utility for assessing tissue siderosis. We assessed a 20 year old female beta thalassemic diagnosed with hypogonadotropic hypogonadism and pituitary siderosis using routine spin echo (SE) T1 and T2 weighted sequences of MRI and special Gradient Recalled Echo (GRE) sequence of MRI. We found MRI signal intensity to be decreased on all three sequences but most so on GRE suggesting its greatest sensitivity to pituitary iron deposition. MRI signal hypo-intensity due to paramagnetic effects of iron has been validated for liver siderosis but is still under investigation for pituitary siderosis. Our findings suggest that MRI especially GRE sequence can be used in conjunction with laboratory data to evaluate pituitary siderosis and to prevent further pituitary dysfunction