Evaluation of subarachnoid space and subarachnoid cisterns in children and teenagers based on computed tomography studies

Purpose: The aim of the study was to develop the normative values of linear indices to the diagnosis of changes in size of the subarachnoid space. Material and methods: Retrospective studies were conducted based on 507 head computed tomography (CT) examinations in children from 0-18 years of age. In total 381 tests were selected for correct reference values. Patients were divided into age groups. For each group, linear indices were calculated, taking into account the size of the fluid spaces in relation to the size of the skull and then the mean with standard deviation, median, as well as 10th and 90th percentile were calculated. The range between the 10th and the 90th percentiles was defined as the reference value. Results: Obtained normative values, minimum and maximum for all groups: index of basal cistern size to the size of the skull - 0.129-0.197; index of basal cistern transverse dimension to the size of the skull - 0.173-0.255; index of basal cistern sagittal dimension to the size of the skull - 0.086-0.150; index of prepontine cistern - 0.034-0.067; index of interhemispheric fissure width - 0.044-0.127; index of Sylvian fissure - 0.036-0.085; index of insular cistern width - 0.020-0.074; index of subarachnoid space - 0.017-0.081. Conclusions: The linear indices can be calculated based on images achieved during routine CT examination. The reference values allow us to determine if the size of the subarachnoid space is within the normal range for a given age group. The results from the oldest age group can also be referred to the adults. Key words: external hydrocephalus, subarachnoid space, computed tomography (CT), linear indices, infants and children

Bone dysplasia with optic atrophy, vascular malformation and seizures in a 14-year-old girl : a case report

Background: The heritable skeletal dysplasias or osteochondrodysplasias are a large heterogeneous group of disorders associated with abnormal shape, growth, or integrity of bones. Osteopetrosis is a collective term for a range of sclerosing bone diseases with various degree of defective remodeling. Increased bone density is the predominant radiologic feature. The skull is often involved with basal sclerosis and the sinuses are obliterated. The most serious consequences of the osteopetroses are seen in the nervous system. Because of perturbed remodeling of the skull bones, many aspects of the brain and cranial nerve function are endangered. Cranial nerves, blood vessels and the spinal cord may be compressed by progressive occlusion of cranial foramina. Carious, misplaced teeth, dysplastic fingernails, tendency to pathologic fractures are the other clinical manifestations. Case report: The authors present a 14-year-old girl with dysmorphic features, optic atrophy, CNS vessel malformation, pathologic fractures and seizures. The girl had a wide range of clinical and radiographic symptoms of bone dysplasias together with a giant left internal carotid artery aneurysm and epilepsy. Conclusions: On the basis of clinical and radiological features, a disease belonging to the group of skeletal dysplasias was recognized in our patient. The configuration of the presented symptoms does not allow at the moment strict classification to hitherto determined forms of dysplasia. This leads to the necessity of extending diagnostics, especially by molecular tests, and further long-lasting observations, which perhaps would allow classification of the presented syndrome to one of the known groups, or determination of a new clinical entity

Mediastinal parathyroid carcinoma: a case report

Chora w wieku 72 lat była operowana z powodu zagrażającego przełomu przytarczycowego w przebiegu pierwotnej nadczynności przytarczyc. Przedoperacyjne stężenie PTH w surowicy krwi wynosiło 808 pg/ml. Śródoperacyjnie zlokalizowano jedynie dwie przytarczyce górne — jedną prawidłową i jedną w stanie rozrostu. Pooperacyjne stężenie PTH w surowicy krwi wynosiło 726,5 pg/ml. W badaniu TK w przednim śródpiersiu stwierdzono obecność heterogennego guza. Chorą operowano ponownie. Wykonano sternotomię pośrodkową górną, usuwając zmienioną ektopowo przytarczycę. W badaniu histopatologicznym rozpoznano raka przytarczycy. Uzyskano spadek stężenia PTH do wartości 5,74 pg/ml. Badanie cytofluorometryczne wykazało diploidę przytarczyc górnych, podczas gdy rak przytarczycy miał charakter aneuploidalny. Chora została wypisana z kliniki po 27 dniach od operacji; pozostaje pod kontrolą ambulatoryjną bez cech wznowy procesu nowotworowego i jest poddana substytucji preparatami wapnia. (Endokrynol Pol 2012; 63 (2): 143–146)A 72 year-old woman with primary hyperparathyroidism was operated for parathyroid crisis. PTH serum level was 808 pg/mL. During the operation, only two superior parathyroid glands were found. One was normal, and hypertrophy was revealed in the other. After the surgical procedure, PTH serum level was 726.5 pg/mL. Helical computer tomography examination showed a heterogeneous mass in the anterior mediastinum. The tumour was removed via a sternotomy approach. Histopathological examination revealed parathyroid carcinoma. PTH level dropped to 5.74 pg/mL. Cytofluorometric examination revealed diploidy (DI = 1) in both the hypertrophic and the unchanged upper glands, whereas parathyroid cancer was aneuploid. After the initial operation, the woman was discharged from the hospital on the 27th postoperative day. One year after surgical procedures, she is well. She has to take calcium. (Pol J Endocrinol 2012; 63 (2): 143–146

What you cannot get from routine MRI of MS patient and why – The growing need for atrophy assessment and seeing beyond the plaque

Multiple sclerosis is a disease that still has not been fully understood and calls for better diagnostic procedures for the improvement of everyday patient care and drug development. Routine magnetic resonance examinations reveal demyelinating focal lesions, but they do not correlate sufficiently with the patients’ disability and cognitive impairment. For more than 100 years it has been known that demyelination affects not only white but also grey matter of the brain. Recent research has confirmed the serious consequences of grey matter pathology. Over the last several years, atrophy of the brain and especially of its grey matter has become a most promising marker of the patients’ clinical status. The paper discusses the concept and importance of atrophy assessment in relation to the standard magnetic resonance results

Malformations of cortical development in children : clinical manifestation, neuroimaging and neuropathology in selected cases

Cerebral cortical development can be divided into three steps: cellular proliferation, neuronal migration and organization. Based on known pathologic, genetic and neuroimaging features a classification for malformations of cortical development was proposed by Barkovich in 2001, and updated in 2005. Malformations of cerebral cortex development (MCCD) often demonstrate epileptic seizures and delay in psychomotor development. About 20-40% of children with epilepsy are drug-resistant and there is a large paediatric population requiring epilepsy surgery operations. In our work we performed clinical analysis of 68 children with MCCD treated in our hospital between 2000 and 2006. In our work to consider the type of MCCD we used the updated classification scheme proposed by Barkovich et al. We analyzed epilepsy, gestational and perinatal history, initial symptoms, time to establishing full diagnosis and neurodevelopmental/IQ status. In our results we found that despite similar clinical manifestation neuropathological basis could be significantly different, and vice versa: children with nearly identical neuropathological findings could have completely different neurological and radiological symptoms. Children with drug-resistant epilepsy are potential candidates for neurosurgical treatment; especially lesionectomies in such cases could be very promising in terms of epilepsy management and quality of life as well

Relationship between stroke severity, extensity of leukoaraiosis, and brain atrophy in patients with ischaemic stroke

Purpose: Leukoaraiosis (LA), according to the latest classification, is white matter hyperintensity - morphological findings of small blood vessel disease of the brain. This radiological detection of small vessels disease is important because there are no technical possibilities to assess small vessels of the brain using computed tomography (CT) or magnetic resonance imaging (MRI) angiography. Our aim was to analysis the relationship between the extension of leukoaraiosis and severity of ischaemic stroke and brain atrophy. Material and methods: We retrospectively analysed 77 head CT scans of patients admitted from the emergency room (ER) to the Radiology Department due to suspected stroke. We assessed the severity of leukoaraiosis using the van Swieten scale and brain atrophy by numerous linear measurements. Results: Statistical analysis failed to demonstrate differences between LA1 and LA2 groups with regard to stroke severity in National Institutes of Health Stroke Scale (NIHSS) (p = 0.2159). There were no differences with regard to clinical severity of stroke between the study groups divided depending on the extent of brain atrophy. There were statistically significant differences with regard to the anterior horn width of the right and left lateral ventricle, posterior horn width of the right and left lateral ventricle, distance between occipital horn of the left lateral ventricle and internal surface of the cranium and third ventricle width depending on the severity of leukoaraiosis. Conclusions: The results of our studies present an association between the degree leukoaraiosis extension and brain atrophy, but no association between central nervous system tissue atrophy of extent of leukoaraiosis and ischaemic stroke severity

Naczyniak jamisty żebra u 8-miesięcznego dziecka : opis przypadku

Background: Hemangioma cavernosum of the rib is less than 1% of all primary bone tumors. Most frequently they are found in vertebrae and in skull bones. The cases of other bones involvement are extremely rare and there are very few reports of rib hemangiomas. Case report: We report a case of hemangioma cavernosum of the left VI rib in 8-month-old male infant and describe diagnostic imaging such as radiography, ultrasound, computed tomography performed in this case. Hemangioma was excised totally. Documented 18-month postoperative course did not reveal recurrence. Conclusions: Malignant process always needs to be considered in small children who developed expanding growth of bone tumor. Hemangioma cavernosum should be considered in differential diagnosis of solid-cystic bone tumors in untypical localizations and at every age

Neurological symptoms in Schimke immuno-osseous dysplasia in a 11-year-old girl: a case report

Pozadina: Schimkeova imuno-koštana displazija (SIOD, OMIM 242900) rijetka je autosomno recesivna pleiotropna bolest uzrokova- na mutacijama u genu SMARCAL1. SIOD karakterizira trijada simptoma: progresivna bolest bubrega zbog fokalne segmentne glo- meruloskleroze (FSGS), spondiloepifizna displazija i imunodeficijencija T-stanica. Osim toga, tijekom sindroma često se bilježe hete- rogeni neurološki simptomi. Slučaj: Autori opisuju slučaj 14-godišnje djevojčice sa SIOD-om, s ponavljajućim neurološkim simptomima, poput glavobolje nalik migreni, diplopije i napadaja. Rođena je u 34. tjednu trudnoće, s hipotrofijom (1280 g) i niskim rastom (44 cm). Proteinurija nefrot- skog ranga, prvi simptom bolesti, otkrivena je u dobi od 4,5 godine. Štoviše, uočena je značajna imunodeficijencija. Konačno joj je dijagnosticirana Schimkeova imuno-koštana displazija zbog dvije patogene varijante, c.836T>C (p.F279S) i c.2542G>T (p.E848X) identificirane u genu SMARCAL1. Zaključci: Ovo izvješće opisuje klinička obilježja i nalaze neuroslika bolesnika sa SIOD-om. Također prikazuje moguću korelaciju iz- među nastalih neuroloških događaja i Schimkeove bolesti, kako bi se uzela u obzir tijekom dijagnostičkog procesa.Background: Schimke immuno-osseous dysplasia (SIOD, OMIM 242900) is a rare, autosomal recessive, pleiotropic disease caused by mutations in the SMARCAL1 gene. SIOD is characterized by a triad of symptoms, i.e., progressive kidney disease due to focal segmen- tal glomerulosclerosis (FSGS), spondyloepiphyseal dysplasia and T-cell immunodeficiency. Additionally, heterogeneous neurological symptoms are often observed in the course of the syndrome. Case: The authors describe the case of a 14-year-old girl with SIOD, who presented with recurrent neurological symptoms, such as migraine-like headaches, diplopia and seizures. She was born at 34 weeks of pregnancy with hypotrophy (1280 g) and short stature (44 cm). Nephrotic-range proteinuria, the first symptom of the disease, was detected at the age of 4 and a half years. Significant immunodeficiency was also observed. She was finally diagnosed with Schimke immuno-osseous dysplasia on account of two pat- hogenic variants, c.836T>C (p.F279S) and c.2542G>T (p.E848X) identified in the SMARCAL1 gene. Conclusions: This report describes the clinical features and neuroimaging findings of a patient with SIOD. It also presents a possible correlation between neurological events and the Schimke disease, which should be considered during the diagnostic process

Urazy układu moczowego u dzieci

Background: As shown by literature data, abdominal trauma in children is responsible for 14% of deaths, whereas in adults for 10%. Although abdominal traumas in children can be severe and lead to massive blood loss, most children die because of accompanying traumas of the thorax and head. It validates the surgical rule concerning abdominal traumas "investigate aggressively, manage conservatively". Posttraumatic injury of the urinary system is not frequent in children and its specificity (compared with adults), depends on greater susceptibility to external aggressive factors. Blunt trauma is the cause of renal parenchyma injury and acceleration/deceleration injury affects the excretory system and vessels. Extension mechanism is the cause of ureter avulsion and/or thrombus formation in stretched renal vessels - it is characteristic in children with non-accidental traumas. Bladder and urethra injuries are rare in children. During car accidents, a rupture of full bladder (seat belt injury) or bladder perforation by fractured bones of the pelvis is possible. Material/Methods: We analyzed all hospitalizations of abdominal trauma in our surgical ward in the year 2004 (70 cases). Renal injuries were found in 6 children (8.6%). Thanks to five-year clinical experience of our hospital, on the average only 1-2 cases per annum needed operation. The management of renal injuries involves first of all conservative treatment. This publication has educational character and may serve as a valuable reminder of the useful knowledge in daily cooperation between the emergency room, radiology department and surgical ward. Based on available literature from recent few years, we quote suggested renal injuries classifications and procedures.This publication contains only images from our department of radiology archives. Results/Conclusions: Clinical symptoms are often not appropriate for blunt abdominal traumas diagnosis. Owing to clinical status, which is difficult to interpret, fast and complete radiological diagnosis is necessary for proper treatment of children after abdominal trauma. Further complications of renal injuries may affect the further growth of the child

Developmental changes in ACLs and semitendinosus tendons dimensions according to age in children

Purpose: Managing anterior cruciate ligament (ACL) injuries in skeletally immature patients remains difficult. The main aim of this study was to retrospectively compile normative data on the cross-sectional area (CSA) of the semitendinosus tendon (ST) and the diameter of the ACL in children and young adults. Methods: Knee magnetic resonance imaging (MRI) examinations were performed for a 2-year period in 132 patients (83 female and 49 male patients). The mean age was 14.9 years (8-18 years). Measurements of the ST CSA were performed on axial views in greyscale by two independent researchers. The ACL diameter was measured as well. Results: The results show the CSA of the ST was related to age, and its growth was not linear. The highest growth rate of the CSA of the ST occurred at age 12–13 at the level of the femoral growth plate and at the level of the tibial plateau. The growth of the ACL diameter was linear until 18 years of age. Conclusions: ST growth (measured in CSA increments) is almost complete at the age of 13, even though the growth is not linear. ACL growth measured in diameter increments proceeds linearly from 8 to 18 years of age. MRI is a clinically useful tool for assessing hamstring tendon grafts preoperatively