Subject(s)
Humans , Male , Aged, 80 and over , Magnetic Resonance Imaging/methods , Encephalomyelitis/diagnostic imaging , Brain Stem/pathology , Brain Stem/diagnostic imaging , Chronic Disease , Adrenal Cortex Hormones/therapeutic use , Diagnosis, Differential , Encephalomyelitis/pathology , Encephalomyelitis/drug therapy , Glymphatic System/diagnostic imagingABSTRACT
OBJECTIVES: Approximately one-third of candidates for epilepsy surgery have no visible abnormalities on conventional magnetic resonance imaging. This is extremely discouraging, as these patients have a less favorable prognosis. We aimed to evaluate the utility of quantitative magnetic resonance imaging in patients with drug-resistant neocortical focal epilepsy and negative imaging. METHODS: A prospective study including 46 patients evaluated through individualized postprocessing of five quantitative measures: cortical thickness, white and gray matter junction signal, relaxation rate, magnetization transfer ratio, and mean diffusivity. Scalp video-electroencephalography was used to suggest the epileptogenic zone. A volumetric fluid-attenuated inversion recovery sequence was performed to aid visual inspection. A critical assessment of follow-up was also conducted throughout the study. RESULTS: In the subgroup classified as having an epileptogenic zone, individualized postprocessing detected abnormalities within the region of electroclinical origin in 9.7% to 31.0% of patients. Abnormalities outside the epileptogenic zone were more frequent, up to 51.7%. In five patients initially included with negative imaging, an epileptogenic structural abnormality was identified when a new visual magnetic resonance imaging inspection was guided by information gleaned from postprocessing. In three patients, epileptogenic lesions were detected after visual evaluation with volumetric fluid-attenuated sequence guided by video electroencephalography. CONCLUSION: Although quantitative magnetic resonance imaging analyses may suggest hidden structural lesions, caution is warranted because of the apparent low specificity of these findings for the epileptogenic zone. Conversely, these methods can be used to prevent visible lesions from being ignored, even in referral centers. In parallel, we need to highlight the positive contribution of the volumetric fluid-attenuated sequence.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Young Adult , Magnetic Resonance Imaging/methods , Drug Resistant Epilepsy/diagnostic imaging , Brain Mapping , Prospective Studies , Diagnosis, Computer-Assisted/methods , Electroencephalography/methods , Multimodal ImagingABSTRACT
Summary Currently Latin America is undergoing a major epidemic of Zika virus, which is transmitted by Aedes mosquitoes. Concern for Zika virus infection has been increasing as it is suspected of causing brain defects in newborns such as microcephaly and, more recently, potential neurological and autoimmune complications including Guillian-Barré syndrome and acute disseminated encephalomyelitis. We describe a case of virus infection in a 25-year-old woman during the first trimester of her pregnancy, confirmed by laboratory tests only for the detection of viral particles in maternal urine, with imaging studies demonstrating the progression of cranial and encephalic changes in the fetus and later in the newborn, such as head circumference reduction, cerebral calcifications and ventriculomegaly.
Resumo Atualmente, a América Latina está passando por uma grande epidemia de Zika vírus, transmitido por mosquitos Aedes. A preocupação pela infecção pelo Zika vírus vem aumentando, uma vez que é suspeita de causar defeitos cerebrais em recém-nascidos, como a microcefalia e, mais recentemente, potenciais complicações neurológicas e autoimunes, como síndrome de Guillian-Barré e encefalomielite disseminada aguda. Descrevemos um caso de infecção pelo vírus em uma mulher de 25 anos durante o primeiro trimestre de gestação, confirmado dentre os exames laboratoriais apenas pela detecção de partículas virais na urina materna, com estudos de imagens demonstrando a evolução das alterações cranianas e encefálicas no feto e no recém-nascido, como redução do perímetro cefálico, calcificações cerebrais e ventriculomegalia.
Subject(s)
Humans , Animals , Female , Pregnancy , Infant, Newborn , Adult , Pregnancy Complications, Infectious/urine , Zika Virus/isolation & purification , Zika Virus Infection/urine , Microcephaly/diagnostic imaging , Pregnancy Complications, Infectious/virology , Pregnancy Trimester, First , Prenatal Diagnosis , Brazil , Tomography, X-Ray Computed , Magnetic Resonance Angiography , Zika Virus Infection/complications , Zika Virus Infection/congenital , Microcephaly/virologyABSTRACT
Apresentamos o caso de paciente do gênero feminino, 35 anos, atendida com queixa de dores esporá- dicas no flanco esquerdo por 5 anos. Negou comorbidades. Exames laboratoriais sem anormalidades. Ultrassonografias prévias do aparelho urinário (sem o uso de Doppler colorido) descreveram possível cisto simples póstero-inferiormente a pelve renal esquerda. Em ultrassonografia recente observou-se, nessa topografia, volumosa formação ovalada, acentuadamente hipoecóica, com discreto fluxo de permeio. Tomografia computadorizada e ressonância magnética abdominais subsequentes caracterizaram massa retroperitoneal junto ao hilo do rim esquerdo, associada à redução dimensional renal e hidronefrose ipsilaterais. Diagnóstico histológico pós-exérese tumoral: schwannoma celular (somente padrão histológico Antoni A). (AU)
We present the case of a female patient, 35 years old, who had a complaint of sporadic left flank pain for 5 years. She said she had no comorbidities. The results of the laboratory tests did not show abnormalities. Previous ultrasonography of the urinary tract (without the use of color Doppler) described a possible single cyst postero-inferiorly to the left renal pelvis. In recent ultrasound we observed that topography massive oval formation markedly hypoechoic with discrete intermingled flow. Subsequent abdominal computed tomography and magnetic resonance imaging characterized retroperitoneal mass along the hilum of the left kidney, associated with renal dimensional reduction and ipsilateral hydronephrosis. Histological diagnosis after tumor excision: cell schwannoma (Antoni A histological standard only) (AU)
Subject(s)
Adult , Schwann Cells , Cysts , Renal Insufficiency, Chronic , NeurilemmomaABSTRACT
Abstract Objective: To identify and classify the radiographic patterns of megaesophagus in Chagas disease, as seen on esophagograms and chest X-rays. Materials and Methods: This was a prospective study of 35 patients diagnosed with esophageal disease via manometry. The changes found on esophagograms were stratified according to Rezende's classification, divided into four categories (grades I through IV) determined by the degree of dilatation and impairement of esophageal motility. We subsequently correlated that ranking with the chest X-ray findings: gastric air bubble; air-fluid level; and mediastinal widening. Results: Among the 35 patients, the esophageal disease was classified as grade I in 9 (25.7%), grade II in 3 (8.6%), grade III in 19 (54.3%), and grade IV in 4 (11.4%). None of the patients with grade I esophageal disease showed changes on chest X-rays. In two of the three patients with grade II disease, there was no gastric air-bubble, although there were no other findings in any of the grade II patients. Of the 19 patients with grade III disease, 15 had abnormal findings on X-rays. All four patients with grade IV disease showed abnormalities. Conclusion: The use of Rezende's classification is feasible, encompassing findings ranging from the subtle changes that characterize the initial phases of esophageal disease to the complete akinesia seen in dolicomegaesophagus. Chest X-ray findings are more common in patients with advanced stages of the disease and indicate the degree of esophageal involvement in Chagas disease.
Resumo Objetivo: Identificar e classificar as alterações radiológicas no megaesôfago chagásico no esofagograma e na radiografia simples de tórax. Materiais e Métodos: Foram estudados 35 pacientes com diagnóstico de esofagopatia na manometria. As alterações encontradas no esofagograma foram estratificadas segundo a classificação de Rezende, dividida em quatro categorias, determinadas pelo grau de dilatação e alteração da motilidade do esôfago. Também foi realizada correlação desta classificação com os achados na radiografia de tórax: presença ou ausência de bolha gástrica, nível líquido e alargamento do mediastino. Resultados: A distribuição encontrada, segundo a classificação de Rezende, foi: grau I - 25,7% (9/35); grau II - 8,6% (3/35); grau III - 54,3% (19/35); grau IV - 11,4% (4/35). Nenhum paciente grau I apresentou alterações na radiografia simples. No grau II, o único achado foi a ausência da bolha gástrica (2/3). No grau III, 15 dos 19 pacientes apresentaram achados anormais na radiografia. Já no grau IV, em todos os quatro pacientes identificaram-se anormalidades no exame simples. Conclusão: A classificação de Rezende é praticável, encontrando-se desde achados sutis caracterizando os graus iniciais até a completa acinesia do dolicomegaesôfago. Os achados na radiografia de tórax são mais frequentes em pacientes com estágios avançados da doença e podem fazer aventar o grau da esofagopatia chagásica.
ABSTRACT
Epilepsy is a disease with serious consequences for patients and society. In many cases seizures are sufficiently disabling to justify surgical evaluation. In this context, Magnetic Resonance Imaging (MRI) is one of the most valuable tools for the preoperative localization of epileptogenic foci. Because these lesions show a large variety of presentations (including subtle imaging characteristics), their analysis requires careful and systematic interpretation of MRI data. Several studies have shown that 3 Tesla (T) MRI provides a better image quality than 1.5 T MRI regarding the detection and characterization of structural lesions, indicating that high-field-strength imaging should be considered for patients with intractable epilepsy who might benefit from surgery. Likewise, advanced MRI postprocessing and quantitative analysis techniques such as thickness and volume measurements of cortical gray matter have emerged and in the near future, these techniques will routinely enable more precise evaluations of such patients. Finally, the familiarity with radiologic findings of the potential epileptogenic substrates in association with combined use of higher field strengths (3 T, 7 T, and greater) and new quantitative analytical post-processing techniques will lead to improvements regarding the clinical imaging of these patients. We present a pictorial review of the major pathologies related to partial epilepsy, highlighting the key findings of 3 T MRI.
Subject(s)
Humans , Epilepsies, Partial/diagnosis , Magnetic Resonance Imaging/methods , Brain Neoplasms/diagnosis , Brain Neoplasms/pathology , Central Nervous System Vascular Malformations/diagnosis , Central Nervous System Vascular Malformations/pathology , Epilepsies, Partial/pathology , Gliosis/diagnosis , Gliosis/pathology , Malformations of Cortical Development/diagnosis , Malformations of Cortical Development/pathology , Sclerosis , Tuberous Sclerosis/diagnosis , Tuberous Sclerosis/pathologyABSTRACT
OBJETIVO: Demonstrar, através dos métodos de imagem (raios-X, tomografia computadorizada (TC), ressonância magnética (RM) e ultra-sonografia (US)), as fases da doença de depósito de cristais de hidroxiapatita nas articulações, principalmente no ombro, apresentando da fase silenciosa até a migração intra-óssea das calcificações e o controle radiológico com remissão completa após tratamento fisioterápico. MATERIAL E MÉTODO: Foram avaliadas 27 articulações (25 ombros, um quadril e um cotovelo) de pacientes seguidos com controle radiográfico, sendo os extremamente sintomáticos e os refratários ao tratamento encaminhados a RM ou US. RESULTADOS: Com o tratamento houve remissão completa das calcificações em 15 articulações - 14 no ombro e uma no cotovelo. Em duas articulações houve migração da calcificação para o interior do osso, em uma para a bursa subdeltóidea, em uma para a bainha do cabo longo do bíceps, em uma para o recesso subcoracóide e em uma para o interior do músculo infraespinal. Em dois casos a RM e a TC demonstraram o alto grau de processo inflamatório desencadeado pela doença. CONCLUSAO: A doença de depósito de cristais de hidroxiapatita acomete várias articulações, podendo ser assintomática até extremamente sintomática. Os métodos de imagem demonstram todas as fases, inclusive a fase migratória. Geralmente, a radiografia é suficiente para o diagnóstico e seguimento. A RM e a TC possibilitam o diagnóstico mais acurado da fase ativa da doença. Nosso trabalho demonstrou remissão em 55 por cento dos casos com tratamento fisioterápico - iontoforese.