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Intracranial dermoid cysts generally occurring along the midline are rare. They are benign, congenital, slow-growing cystic lesions located inside the skull. They account for<1% of all primary intracranial tumors and are more common in females in the first three decades of life. Many intracranial dermoid cysts are asymptomatic and are found by chance when brain imaging is carried out for other reasons. Clinical presentation usually relates to compression of adjacent structures or spontaneous rupture of the cyst. The signs and symptoms may range from headaches, seizures to cerebral ischemia. On CT imaging these lesions usually appear as well-defined lobulated midline masses with low attenuation and hyperintense on T1-weighted MRI imaging. We hereby report a case of an 18-year-old female presented with history of seizures involving right upper limb which spread to other limbs associated with frothing and tongue bite- 3 episodes since 2 months. She also had cleft lip. On examination CT images showed hypodense lesion in intrahemispheric region in frontal lobe and MRI image with contrast showed hyperintense T2W, hypointense T1W/FLAIR lesion. A diagnosis of an intracranial dermoid cyst in the intrahemispheric region of frontal lobe was made and the patient was advised a surgical excision of the cyst.
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Objective:To investigate the association between plaque vulnerability characteristics and infarction sub-types in patients with acute unilateral anterior circulation cerebral infarction due to intracranial atherosclerotic disease.Methods:A total of 58 eligible patients who underwent intracranial high-resolution magnetic resonance imaging (HRMRI) were finally enrolled in the retrospective study from December 2018 to December 2020. In the current study, all patients were classified into the group with artery-to-artery (A-to-A) embolic infarction ( n=32) and the group without ( n=26), according to infarction sub-types on diffusion-weighted imaging. Baseline information, the presence/absence of hyperintense plaque, irregular plaque surface, remodeling pattern and quadrant distribution by HRMRI were collected and evaluated. Multivariate Logistic regression analysis was performed to determine the relationship between plaque vulnerability and infarction sub-types. Furthermore, the analysis of interaction between hyperintense plaque and positive remodeling in response to A-to-A embolism was visualized by Sankey diagram. Results:The presence of hyperintense plaque ( OR=3.90, 95% CI 1.21-12.59, P=0.023) and arterial remodeling patterns (positive remodeling vs intermediate state, OR=4.32, 95% CI 0.86-21.49, P for trend=0.027) were the strong independent predictors for A-to-A embolism. Importantly, a significantly positive synergy between the remodeling pattern and hyperintense plaque in response to infarction sub-types was found by Sankey diagram ( Wald=10.044, P for interaction=0.007). Similarly, in receiver operating characteristic curve analysis, the discrimination of hyperintense plaque combined with positive remodeling for A-to-A embolism was significantly superior to that of either biomarker alone (area under the curve=0.710, 95% CI 0.576-0.845, P=0.006). Conclusion:A synergistic effect between positive remodeling and hyperintense plaque can promote plaque vulnerability, suggesting a potential target sub-population may benefit from stroke prevention with intensive antithrombotic therapy, although this must be confirmed in future.
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Resumen: El síndrome de interrupción del tallo pituitario es una anomalía congénita que se caracteriza por la demostración neurorradiológica de un tallo pituitario ausente, interrumpido o hipoplásico, adenohipófisis aplásica/hipoplásica y neurohipófisis ectópica. Este síndrome se ha relacionado con formas severas de hipopituitarismo congénito, asociado a múltiples deficiencias de hormonas pituitarias. Los signos y los síntomas perinatales que presentan los pacientes incluyen hipoglucemia hasta en un 61%, ictericia en un 38%, micropene en un 77% y colestasis en un 19%, las convulsiones neonatales se dieron en el 75% de los niños. Durante la infancia suelen tener talla baja y disminución en la velocidad del crecimiento, así mismo pueden presentar retardo en la expresión de los caracteres sexuales secundarios (1). En nuestro caso clínico se trata de un paciente adolescente el cual tenía como manifestaciones clínicas principales, retardo en los caracteres sexuales secundarios, los hallazgos principales que se encontraron en la resonancia magnética nuclear, incluyeron ausencia del tallo hipofisario, neurohipófisis ectópica, localizada adyacente al túber cinereum y adenohipofisis hipoplásica.
Abstract: Pituitary stalk disruption syndrome is a congenital anomaly characterized by neuroradiologic demonstration of an absent, interrupted, or hypoplastic pituitary stalk, aplastic/ hypoplastic adenohypophysis, and ectopic neurohypophysis. This syndrome has been related to severe forms of congenital hypopituitarism, associated with multiple deficiencies of pitu- itary hormones. Perinatal signs and symptoms presented by patients include hypoglycemia in up to 61%, jaundice in 38%, micropenis in 77% and cholestasis in 19%, neonatal seizures occurred in 75% of children. During childhood, they tend to have short stature and a decrease in growth speed, as well as a delay in the expression of secondary sexual characteristics. In our clinical case, an adolescent patient was presented whose main clinical manifestations were delayed secondary sexual characteristics, the main findings were found in nuclear magnetic resonance, including absence of the pituitary stalk, ectopic neurohypophysis, located adjacent to the tuber cinereum and hypoplastic adenohypophys.
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Objective To investigate the correlation between white matter hyperintensities (WMH)and hyperintense vessel sign (HVS) on fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging(MRI)in old adults and to explore the risk factors and pathogeneses of WMH.Methods We retrospectively collected imaging and clinical data of patients who had received both head and neck CTA and brain MRI within one month at our hospital from 2013 to 2016.The Fazekas visual scale was used to evaluate periventricular white matter hyperintensity(PWMH)and deep white matter hyperintensity(DWMH)in each brain hemisphere.According to the presence or absence of HVS in a cerebra[hemisphere,patients were assigned into an HVS-positive group or an HVS-negative group.Clinical data,PWMH,and DWMH differences were compared between the two groups.Results A total of 271 patients(542 cerebral hemispheres)were included in this study.HVS-positive imaging occurred in 79(14.6％)cerebral hemispheres and negative imaging was observed in 463 (85.4％) cerebral hemispheres.There was a significant difference between the HVS-positive and negative groups in the ipsilateral CIA stenosis(x2 =126.840,P＜0.01).The incidence of ipsilateral severe carotid artery stenosis in the HVS-positive group was 62.0％ (49/79),which was significantly higher than 9.9％ (46/463)in the HVS-negative group.The incidence of moderate-severe DWMH was 65.8％(52/79) in the HVS-positive group,which was higher than 34.8％ (161/463)in the negative group(x2 =34.962,P ＜20.01).Nevertheless,the incidences of moderate-severe PWMH in the two groups were 65.8％ (52/79) and 55.5％ (257/463),respectively,without a significant difference between them (x2 =6.944,P =0.074).After adjusting for age,gender,ipsilateral ICA stenosis,hypertension,diabetes,etc.multivariate analysis suggested that HVS-positive imaging was still an independent risk factor for DWMH(OR =2.653,95％CI:1.489-4.726,P =0.001).Conclusions HVS-positive imaging is an independent risk factor for DWMH in the elderly,but no clear correlation with PWMH is found.It suggests that hypoperfusion is a possible mechanism for the development of DWMH in the elderly.
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Objective To explore the prognostic effect of hyperintense vessel sign (hyperintense vessel sign,HVS) in fluid-attenuated inversion recovery (FLAIR) on endovascular recanalization of acute ischemic stroke.Methods The clinical and imaging data of the patients with acute middle cerebral artery (MCA) occlusion treated by endovascular therapy from January 2013 to october 2015 were analyzed retrospectively.The inclusion criteria:(1)＜8 h after symptom onset;(2) The preoperative MRI included conventional non-enhanced MR,FLAIR,diffusion-weighted imaging (DWI),magnetic resonance angiography (MRA) and DWI-ASPECTS (Alberta Stroke Program Early CT Score) ≥7;(3) acute MCA occlusion verified by conventional angiography and recanalizations (TICI score of 2b and 3) were obtained after endovascular therapy;(4) postoperative similar MR examinations were performed within one week.The patients were divided into group A (HVS score＜5) and B (HVS score≥5).The clinical outcomes and radiological characteristics were compared between two groups.Results There were 15 patients in group A and 33 patients in group B.No significant differences were noted in onset-to-MRI interval (4.8±0.7 h vs 4.6± 0.6 h),MRI-to-recanalization interval (2.1 ±0.5 h vs 2.2±0.5 h) and preoperative DWI-ASPECTS score (7.8± 0.9 score vs 8.2± 1.0 score) between the two groups (all P＞0.05).Significant differences were noted in NIHSS score at admission (14.6±2.6 score vs 10.1±2.2 score),grade of collateral circulation (1.6±0.3 score vs 2.4± 0.4 score),postoperative DWI-ASPECTS score (5.6±0.8 score vs 7.3±0.9 score),postoperative extension of DWI-ASPECTS score (2.2±0.4 score vs 0.9±0.2 score),the incidence of cerebral hemorrhage transformation (26.7％ vs 12.1％) and mRS score at 3 months (3.2±0.5 score vs 2.3±0.4) score between the two groups (all P＜0.05).Conclusion HVS score is clearly associated with collateral circulation and high HVS score indicates better functional outcomes than low HVS score.
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Objective To investigate the significance of MRI T2 fluid-attenuated inversion recovery hyperintense vessel sign (FLAIR HVS)in clinical prognosis evaluation of the patients with acute middle cerebral artery irnfarction.Methods The data in 57 inpatients with acute middle cerebral artery infarction in our hospital from Aug.2013 to Aug.2015 were retrospectively analyzed.All cases were performed the intact MRI examination(ineluding FLAIR,DWI and MRA)and CTA.The infarct volume with DWI,national institute of health stroke scale(NIHSS)score and modified Rankin Scale(mRS)score on 30 d after discharge were performed the comparative analysis.Results Fifty-seven cases of middle cerebral artery occlusion were divided into the distal HVSgroup and non-distal HVS group(8 cases in proximal HVS group,21 cases in HVS negative group).The infarction volume of DWI sequence,NIHSS scores at admissiom and discharge and mRS score on 30 d after discharge in the distal HVS group were superior to those in the non-distal HVS group(P＜0.05).Conclusion MRI-T2 FLAIR sequence HVS has certain reference value in the prognosis evaluation in the patients with middle cerebral artery occlusion.
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A 68-year-old woman with poorly controlled diabetes mellitus presented to the emergency department with choreoathetoid movements affecting the upper and lower left limbs. Computed tomography of the brain did not show any intracranial abnormalities. However, subsequent magnetic resonance (MR) imaging of the brain revealed an increased T1 signal in the right basal ganglia, raising the suspicion of nonketotic hyperglycaemic chorea-hemiballismus. Management consisted of adjusting her insulin dose to achieve good glycaemic control. The patient subsequently recovered and was discharged after eight days. There are many causes of basal ganglia T1 hyperintensity, including hyperglycaemia in patients with poorly controlled diabetes mellitus. This case emphasises the importance of MR imaging in the early diagnosis of hyperglycaemia as a cause of chorea-hemiballismus, to enable early treatment and a better clinical outcome.
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Aged , Female , Humans , Brain , Diagnostic Imaging , Chorea , Diagnosis , Diagnosis, Differential , Dyskinesias , Diagnosis , Hyperglycemia , Diagnosis , Magnetic Resonance Imaging , Methods , Tomography, X-Ray Computed , MethodsABSTRACT
OBJECTIVE: Hyperintense acute reperfusion marker (HARM) without diffusion abnormalities is occasionally found in patients with an acute stroke. This study was to determine the prevalence and clinical implications of HARM without diffusion abnormalities. MATERIALS AND METHODS: There was a retrospective review of magnetic resonance images 578 patients with acute strokes and identified those who did not have acute infarction lesions, as mapped by diffusion-weighted imaging (DWI). These patients were classified into an imaging-negative stroke and HARM without diffusion abnormalities groups, based on the DWI findings and postcontrast fluid attenuated inversion recovery images. The National Institutes of Health Stroke Scale (NIHSS) scores at admission, 1 day, and 7 days after the event, as well as clinical data and risk factors, were compared between the imaging-negative stroke and HARM without diffusion abnormalities groups. RESULTS: Seventy-seven acute stroke patients without any DWI abnormalities were found. There were 63 patients with an imaging-negative stroke (accounting for 10.9% of 578) and 13 patients with HARM without diffusion abnormalities (accounting for 2.4% of 578). The NIHSS scores at admission were higher in HARM without diffusion abnormalities group than in the imaging-negative stroke group (median, 4.5 vs. 1.0; p < 0.001), but the scores at 7 days after the event were not significantly different between the two groups (median, 0 vs. 0; p = 1). The patients with HARM without diffusion abnormalities were significantly older, compared with patients with an imaging-negative stroke (mean, 73.1 years vs. 55.9 years; p < 0.001). CONCLUSION: Patients with HARM without diffusion abnormalities are older and have similarly favorable short-term neurological outcomes, compared with the patients with imaging-negative stroke.
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Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Blood-Brain Barrier/pathology , Contrast Media , Diffusion Magnetic Resonance Imaging/methods , Image Enhancement/methods , Retrospective Studies , Risk Factors , Stroke/cerebrospinal fluid , Treatment Outcome , United StatesABSTRACT
Objective To investigate the significance of change of fluid-attenuated inversion recovery(FLAIR) hyperintense vessel sign(HVS) after endovascular recanalization in acute ischemic stroke. Methods The clinical and imaging data of the patients with acute middle cerebral artery(MCA) occlusion treated by mechanical thrombectomy with Solitaire AB from January 2013 to october 2014 were analyzed retrospectively. The inclusion criteria: (1) The preoperative MRI included conventional non-enhanced MR, diffusion-weighted imaging (DWI), magnetic resonance angiography(MRA) and perfusion-weighted imaging (PWI), and HVS was observed on preoperative FLAIR images; (2) acute MCA occlusion verified by conventional angiography;(3) postoperative similar MR images examination was performed within 48 hours. The relationships among postoperative changes in the HVS, DWI and Thrombolysis In Cerebral Ischemia (TICI) scale (1—3) were assessed. Results After endovascular therapy, HVS of the 11 cases were showed to be disappeared(n = 9) and decreased (n = 2). All the 9 patients with disappeared HVS achieved high grade flow (TICI 3), and minor decrease of ischemic area on DWI in 1 case, minor progression in 6, and significant progression in 2. However, of the 2 patients with decreased HVS, one achieved relatively low grade flow (TICI 2a) and the other was found to be relatively high grade flow (TICI 2b), but severe MCA stenosis. DWI demonstrated significant progression in both two cases. Conclusion Our data indicate that endovascular recanalization of acute MCA occlusion was effective for decreasing HVS. Postoperative decrease and disappear in HVS can be considered as a marker for hemodynamic improvement.
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No abstract available.
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Humans , Cerebral Infarction , Constriction, Pathologic , Magnetic Resonance Imaging , Middle Cerebral ArteryABSTRACT
Purpose To evaluate the correlation between T2-FLAIR hyperintense vessel sign (HVS) and the stenotic degree of internal carotid artery (ICA) and assess the HVS changes after the carotid endarterectomy (CEA). Materials and Methods Fifty-one patients with CEA were retrospectively enrolled. The stenosis of the bilateral ICA were as:≥90%, and<90%. The distribution of HVS locations was classified as three regions:sylvian fissure, sulci of temporo-occipital lobe and other areas. The presence and the location of HVS were counted. The extrension of HVS on T2-FLAIR were graded as:I:the presence of HVS was<1/3 of the MCA territory, II:the presence of HVS was≥1/3 of the MCA territory.χ2-test was performed for correlation between HVS and ICA stenosis. The difference of HVS and stenosis of ICA and their effects on CEA was accessed. Results HVS was significantly higher in the ICA stenosis more than 90%group than in the less than 90% group (χ2=23.584, P<0.001). The frequencies of HVS were 12, 34 and 15 in sylvian fissure, sulci of temporo-occipital lobe and other area, respectively. The proportion of grade II HVS was higher in the ≥ 90% group than in the<90% group (χ2=8.395, P<0.05). After CEA, HVS on 29 affected hemispheres were showed to be disappeared (n=24) or remained (n=5) in the treated side. Conclusion The presence and the grade of HVS were correlated with the stenotic degree of ICA. In the patients with ICA stenosis, HVS was most frequently found in the sulci of temporal lobe and occipital lobe, and seldom found in sylvian fissure. HVS disappeared after CEA indicating that HVS can be considered as a marker for CEA treatment.
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We previously demonstrated correlation between parasympathetic dysfunction and brain white matter lesions in chronic chagasic patients. OBJECTIVE: To correlate serum functional circulating antibodies with beta adrenergic (Ab-β), muscarinic (Ab-M) or muscarinic and beta adrenergic (Ab-Mβ) activity, the autonomic system function and brain lesions in chronic chagasic patients. METHOD: In fifteen consecutive chagasic patients, the autonomic nervous system was evaluated and brain magnetic resonance imaging (MRI) was performed. The sera of all patients were tested to the presence of circulating functional antibodies. RESULTS: Sera from 11 of 15 chronic chagasic patients had some activity (Ab-β: 7; Ab-M: 1; Ab-Mβ: 3); however, there was no significant correlation between the presence of antibodies and the autonomic system function or the presence of hyperintensities in MRI. CONCLUSION: The mechanism involved in the genesis of hyperintense lesions seen in brain MRI of chronic chagasic patients is still unresolved, although apparently related to parasympathetic dysfunction.
A correlação entre disfunção parassimpática e lesões de substância branca cerebral em pacientes chagásicos já foi previamente demonstrada. OBJETIVO: Correlacionar a presença de anticorpos circulantes funcionais com atividade beta-adrenérgica (Ab-β), muscarínica (Ab-M) ou muscarínica e beta adrenérgica (Ab-Mβ), a presença de disautonomia e lesões de substância branca cerebral em pacientes chagásicos crônicos. MÉTODO: Em quinze pacientes chagásicos consecutivos, foram realizados a avaliação do sistema nervoso autônomo e ressonância magnética (RM) do crânio. O soro dos pacientes foi testado para a presença de anticorpos funcionais circulantes. RESULTADOS: O soro de 11 dos 15 pacientes chagásicos apresentou alguma atividade (Ab-β: 7; Ab-M: 1; Ab-Mβ: 3); porém não houve correlação significativa entre a presença de anticorpos circulantes e disautonomia ou de hiperintensidades à RM. CONCLUSÃO: O mecanismo envolvido na gênese das lesões hiperintensas à RM do crânio dos pacientes chagásicos crônicos não está esclarecida ainda, apesar de aparentemente relacionada à disfunção parassimpática.
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Animals , Female , Humans , Male , Middle Aged , Rabbits , Autonomic Nervous System Diseases , Autoantibodies/blood , Brain , Chagas Disease , Receptors, Adrenergic, beta/immunology , Receptors, Muscarinic/immunology , Autonomic Nervous System Diseases/immunology , Autonomic Nervous System Diseases/pathology , Autonomic Nervous System Diseases/physiopathology , Brain/immunology , Brain/pathology , Chronic Disease , Chagas Disease/immunology , Chagas Disease/pathology , Chagas Disease/physiopathology , Prospective Studies , Trypanosoma cruziABSTRACT
BACKGROUND: Idiopathic Central Diabetes Insipidus in children or adolescents requires a frequent follow-up regimen using serial brain MRI and CSF examinations especially if an isolated pituitary stalk thickening or loss of a hyperintense signal in the posterior pituitary lobe is observed. Although a detailed description has not been made in adults who had Idiopathic Central Diabetes Insipidus, the clinical course of a Central Diabetes Insipidus in children or in adolescents can not be applied to adults because a follow-up study is so invasive and expensive. In this report, we evaluated the clinical course of Idiopathic Central Diabetes Insipidus in adults. METHODS: The diagnosis of Idiopathic Central Diabetes Insipidus was based on the presenting clinical symptoms, the water deprivation test, biochemical studies and a brain MRI. We measured the urine specific gravity, urine and plasma osmolarity, electrolytes, and daily urine amount and we also performed an anterior pituitary evaluation. Patients had contrast-enhanced MRI and biochemical studies every 4 to 12 months. RESULTS: The patients included 8 females and 4 males. Their ages ranged from 20 to 76 years and their mean age was 45+/-17 years. Tumor markers in the CSF were not detected any of the patients. An anterior pituitary evaluation showed that four patients had hyperprolactinemia, and five patients had impaired secretory responses of Growth Hormone to an insulin induced hypoglycemia. Nine of the 12 patients had thickening of the pituitary stalk, seven had lacked the hyperintense signal of a normal neurohypophysis. The abnormalities of MRI disappeared in 3 patients by the 4th, 27th and 36th month follow up periods, respectively. The follow up duration was between 8 months and 11 years 3 months and the mean follow up duration period was 50.6+/-45.5 months. Clinical symptoms were corrected by DDAVP administration. Other symptoms were absent. CONCLUSION: In our study, of Idiopathic Central Diabetes Insipidus in adults there were no observed germinomas or other disease that were observed. Therefore this disorder may have a benign course.