Cystic angiomatous meningioma in the cerebellopontine angle mimicking hemangioblastoma

We hereby report an extremely unusual case of cystic angiomatous meningioma in the CPA region in a 58-year-old male patient. He presented with complaints of headache, repeated episodes of vomiting and increasing unsteadiness of gait. Neuroimaging showed a large multicystic left-sided tentorial tumor projecting into the cerebellum and CPA with contrast-enhancing peripheral solid rim. He underwent a left retromastoid craniectomy and total excision of the tumor. Histopathology revealed an angiomatous meningioma with predominant microvascular component and extensive cystic changes. Immunopositivity for epithelial membrane antigen (EMA), vimentin and S-100 protein proved vital in excluding a hemangioblastoma

Cystic angiomatous meningioma in the cerebellopontine angle mimicking hemangioblastoma

We hereby report an extremely unusual case of cystic angiomatous meningioma in the CPA region in a 58-year-old male patient. He presented with complaints of headache, repeated episodes of vomiting and increasing unsteadiness of gait. Neuroimaging showed a large multicystic left-sided tentorial tumor projecting into the cerebellum and CPA with contrast-enhancing peripheral solid rim. He underwent a left retromastoid craniectomy and total excision of the tumor. Histopathology revealed an angiomatous meningioma with predominant microvascular component and extensive cystic changes. Immunopositivity for epithelial membrane antigen (EMA), vimentin and S-100 protein proved vital in excluding a hemangioblastoma

Clinical radiology: Going an extra mile for patient care

Context: Clinical details help radiologists report accurately. However, the clinical aspect has taken a backseat among radiologists, who are overdependent on referral notes. This leads to inaccurate assessment, financial burden, and loss of man hours. Aims: To re-emphasize the benefits of detailed clinical evaluation and real-time monitoring of imaging in interpreting images. Settings and Design: Prospective study. Materials and Methods: A study was done in the Department of Radiodiagnosis for 10 days, including all referred patients above 18 years of age. Detailed history taking and examination was done by radiologists prior to imaging. Any additional significant clinical detail was endorsed on the referral slips. Appropriate imaging modality under given circumstances was carried out. Imaging was studied by the radiologists, near simultaneously with the acquisition. Any additional imaging needed was performed on the same day. Comprehensive reports with specific outputs were provided. Wherever apt, imaging-guided management options were offered to the patients. Results: During the study, 1024 patients with mean age of 46.3 years underwent various types of imaging, including radiography, computed tomography, magnetic resonance imaging, ultrasound scans, and fluoroscopic procedures. Additional clinical details were endorsed in referral slips in 32.4% patients, 53% of which helped in interpreting images appropriately. Primary imaging modality was changed in 3% patients. Additional imaging was done in 10.9% patients. 3.6% of patients underwent imaging-guided procedures. Conclusion: Detailed history taking and examination help radiologists in deciding appropriate imaging and better interpretation of images. This will also reduce the number of visits to the hospital and expenditure on part of patients

Dry imaging cameras

Dry imaging cameras are important hard copy devices in radiology. Using dry imaging camera, multiformat images of digital modalities in radiology are created from a sealed unit of unexposed films. The functioning of a modern dry camera, involves a blend of concurrent processes, in areas of diverse sciences like computers, mechanics, thermal, optics, electricity and radiography. Broadly, hard copy devices are classified as laser and non laser based technology. When compared with the working knowledge and technical awareness of different modalities in radiology, the understanding of a dry imaging camera is often superficial and neglected. To fill this void, this article outlines the key features of a modern dry camera and its important issues that impact radiology workflow

Clinical and radiological profile of Hirayama disease: A flexion myelopathy due to tight cervical dural canal amenable to collar therapy

Background: Hirayama disease (HD) is benign focal amyotrophy of the distal upper limbs, often misdiagnosed as motor neuron disease. Routine magnetic resonance imaging (MRI) is often reported normal. Objective: To study the clinicoradiological profile of hand wasting in young males. Materials and Methods: Patients presenting with insidious-onset hand wasting from March 2008 to May 2011 were evaluated electrophysiologically. Cervical MRI in neutral position was done in 11 patients and flexion contrast imaging was done in 10 patients. Results: All patients were males less than 25 years of age, with median age 23 years, except one patient who was 50 years old. Duration of illness was 3 months to 3 years. All (100%) had oblique amyotrophy, four (36%) cold paresis, 10 (91%) minipolymyoclonus and three (27%) had fasciculations. Regional reflexes were variably absent. Two patients (18%) had brisk reflexes of lower limbs with flexor plantars. Electromyography (EMG) showed chronic denervation in the C7-T1 myotomes. Neutral position MRI showed loss of cervical lordosis in 10/11 (91%), localized lower cervical cord atrophy in 9/11 (82%), asymmetric cord flattening in 11/11 (100%) and intramedullary hyperintensity in 2/11 (18%); flexion study showed loss of dural attachment, anterior displacement of dorsal dura, epidural flow voids in 9/10 (90%) and enhancing epidural crescent in 10/10 (100%). Clinical profile, imaging and electrophysiological findings of the patient aged 50 years will be described in detail as presentation at this age is exceptional. Collar therapy slowed progression in most cases. Conclusion: Clinical features of HD corroborated well with electrophysiological diagnosis of anterior horn cell disease of lower cervical cord. While dynamic contrast MRI is characteristic, routine studies have a high predictive value for diagnosis. Prompt diagnosis is important to institute early collar therapy