Acute abducens nerve palsy with acute disseminated encephalomyelitis-like presentation following COVID-19 vaccination

We report two adult cases of abducens nerve palsy presenting immediately (within weeks) after they received the first dose of Covishield vaccination. Magnetic resonance imaging (MRI) of the brain obtained after the onset of diplopia demonstrated demyelinating changes. The patients had associated systemic symptoms. Post-vaccination demyelination typically known as acute disseminated encephalomyelitis (ADEM) associated with several vaccines is more common in children. Although the mechanism of the nerve palsy remains unclear, it is suspected to be related to the post-vaccine neuroinflammatory syndrome. Cranial nerve palsies and ADEM-like presentations may represent part of the neurologic spectrum following COVID-vaccination in adults, and ophthalmologists should be aware of these sequelae. Although cases of sixth nerve palsy following COVID vaccination are already reported, associated MRI changes have not been reported from India.

Intracranial ruptured dermoid cyst presenting as dysarthria: A case report

Intracranial dermoid cysts are tumors which are rare and are derived from ectopic epithelial cells. These dermoid cysts are slow-growing and are benign; they can cause morbidity by compressing the neurovascular structures. They also do rupture rarely into the subarachnoid space. Dermoid cystic tumors arise from the inclusion of ectodermal committed cells at the time of neural tube closure during the third to fifth week of embryogenesis. These lesions are slow growing due to the active production of hair and oils from the internal dermal elements. This is a case of a ruptured intracranial dermoid presenting as slurring of speech caused by the fat droplets.

Analysis of MRI findings of recurrent supurative colangitis complicated by intrahepatic cholangiocarcinoma / 中国生化药物杂志

Objective To investigate the MRI findings of recurrent supurative colangitis complicated by intrahepatic cholangiocarcinoma and clinical diagnostic value.Methods 264 patients with recurrent suppurative cholangitis who were admitted into the hospital during June 2010 to July 2014 were selected as the research objects.All of the patients were given magnetic resonance imaging(MRI)and surgical pathological examination or biopsy.The Resultsof surgical pathological examination certified that there 43 patients(52 lesions)complicated by intrahepatic cholangiocarcinoma.The results of pathological examination were taken as the golden standard to evaluate the accuracy, specificity and sensitivity of MRI in the clinical diagnosis of recurrent supurative colangitis complicated by intrahepatic cholangiocarcinoma.The MRI findings were analuzed.ResultsAmong the 264 patients with recurrent supurative cholangitis in this group, there were 43 patients(52 lesions)with complicated intrahepatic cholangiocarcinoma confirmed by surgical pathological examination or biopsy, accounting for 16.3% of total number of subjects;MRI results showed that 218 cases were true negative, 41 cases true positive, 2 cases false negative and 3 cases false positive.The diagnostic sensitivity was 95.3%(41/43), specificity 98.6%(218/221)and the accuracy 98.1%(259/264).Conclusion MRI in the diagnosis of recurrent supurative cholangitis complicated by intrahepatic cholangiocarcinoma is of higher accuracy, sensitivity and specificity.MRI findings are obvious.It is worthy of clinical promotion.

Does spinal stenosis correlate with MRI findings and pain, psychologic factor and quality of life? / 대한마취과학회지

BACKGROUND: To investigate and analyze MRI findings in relation to visual analogue scale (VAS), Oswestry Disability Index (ODI), psychological-factor, sleep-quality, and Short-Form Health Survey (SF-36) scores among patients with central lumbar spinal stenosis (LSS) for the purpose of elucidating a correlation. METHODS: From July 2013 to May 2014, 117 consecutive patients with central LSS were included in this study. All of the MRIs were evaluated by one of the authors, and the evaluated items were the dural sac cross-sectional area (DSCSA), the number of stenotic levels, and the presence and levels of spondylolisthesis. The ODI, VAS, 36-item SF-36, Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and Pittsburgh Sleep Quality Index (PSQI) questionnaires were used to evaluate the participants. RESULTS: There are no correlations between the ODI, VAS, BDI, BAI, PSQI, and SF-36 scores and the minimum DSCSA; however, a significant correlation was found between the ODI scores and multilevel LSS. The BDI, BAI, and PSQI scores are higher for multilevel LSS compared with single-level LSS, but the difference of this mean value is not statistically significant. CONCLUSIONS: A significant correlation was shown between those patients with multilevel LSS and the ODI scores; however, significant correlations were not found between the MRI findings and the psychological factors pertaining to sleep and life qualities.

Short-term Follow up after Meniscus Allograft Transplantation with Clinical Results and MRI Findings

PURPOSE: We investigated the clinical results and MRI findings follow up after meniscal transplantation using fresh frozen meniscal allograft. MATERIAL AND METHODS: From Dec. 1999 to Dec. 2001, we evaluated 17 patients (12 cases: male, 5 cases: female) after meniscal transplantation using fresh frozen meniscal allograft. The patients performed the lateral meniscal transplantation were 12cases, the medial were 5cases. The average age was 32 years old (ranging from 19 to 50 years old), and was follow up period 18 months (ranging from 12 to 26 months). Among them we studied MRI findings in 16 patients and the postop-period was 16.9 months (ranging from 5 to 26 months). We analyzed the clinical data by applying KASS(knee assessment scoring system) & Lysholm knee score, and rehabilitation ability using of Tegner activity scale. It investigated the retrogressive changes of joint effusion, misfortune degree of meniscal location, intensity, tear and degenerative change which was made from the MRI. RESULTS: The follow up mean KASS score and Lysholm score were 84.3 (ranging from 61 to 94), and 81.1 (ranging from 63 to 90). Among the 17 patients, 15 patients showed good results. But painful swellings were 2 cases and intermitent locking symtom was 1 case. The MRI findings were 14 cases increasing signal intensity, 2 cases peripheral displacement, 2 cases partial meniscal tear and some degree effusions of 13 cases. CONCLUSION: The meniscal transplantation using fresh frozen allogrft came to be thought with the surgical method which improved the function of knee joint after operating it brought a successful result from the MRI.

Analysis of MRI Findings of Adolescent Lumbar Disc Herniation (Comparision with Adult Lumbar Disc Herniation Findings) / 대한척추외과학회지

STUDY DESIGN: We compared the MRI and X-ray findings of adolescent lumbar disc herniation with that of adult. OBJECTIVES: Purpose of study was to assess the different pathologic findings of adolescent lumbar disc herniation from adult in MRI and to predict the causes indirectly. SUMMARY OF LITERATURE REVEIWS: There are many debates about the causes of adolescent lumbar disc herniation, because disc herniation occurs before the degenerative changes of aging process of intervertebral disc. Trauma, structural anomalies and degenerative changes have been suggested as a cause MATERIALS AND METHODS: We reviewed 29 adolescents and 36 adults with surgically proven lumbar disc herniation. Type of herniation, direction of herniation, severity of herniation, disc height, decrease of signal intensity, annular tear, facet asymmetry in MRI and associated spinal structural anomalies in plain X-ray were assessed. All of involved segments and operated segments were seperately analysed. Results were compared between two groups. RESULTS: In adolescent group, definite degenerative changes such as decrease of signal intensity and annular tear of operated segments were found. Multiple levels were involved in adolescent as same with adult group.. All the findings showed no significant differences between two groups, but signal intensity of nucleus pulposus was severely decreased in adult group. In adolescent group, incidence of male and incidence of Schmorl's node were high which suggested that herniated disc has deep relationship with trauma. Facet asymmetry was more frequent in adolescent. CONCLUSION: Pathologic premature degeneration presented already in adolescent disc herniation, and multiple level involvement suggested that underlying diathesis contributes to development of disc herniation, but degeneration of nucleus pulposus was severe in adult group. Trauma and facet asymmetry seem to be other factors in development of disc herniation.

Reversible MRI Findings in Metronidazole-induced Cerebellar Dysfunction

Metronidazole is widely used for the treatment of trichomoniasis, giardiasis, amebiasis, and anaerobic infections. It pro-duces a number of neurological side effects including peripheral neuropathy, encephalopathy, cerebellar dysfunction, and seizures. A 66-year-old male patient was admitted to our department because of a tingling sensation in both toes as well as ataxia with dizziness which had developed five prior to admission. He had had been diagnosed with hepatoma and had an operation in 1993. One month before admission, he felt a febrile sensation and was diagnosed as having abdominal abscess by an ultrasonography, and took about 30g of metronidazole until visiting our emergency room. A nerve conduc-tion test revealed sensorimotor polyneuropathy in the four extremities. A brain MRI showed symmetrically increased signal intensities without enhancement in the supratentorial white matter and the dentate nucleus of the cerebellum. After stopping metronidazole, his neurological symptoms began to improve and on the following MRI taken seven weeks later, the symmetrically increased signal intensities in the dentate nucleus of the cerebellum were nearly disappeared.

Reversible MRI Findings in Metronidazole-induced Cerebellar Dysfunction

Metronidazole is widely used for the treatment of trichomoniasis, giardiasis, amebiasis, and anaerobic infections. It pro-duces a number of neurological side effects including peripheral neuropathy, encephalopathy, cerebellar dysfunction, and seizures. A 66-year-old male patient was admitted to our department because of a tingling sensation in both toes as well as ataxia with dizziness which had developed five prior to admission. He had had been diagnosed with hepatoma and had an operation in 1993. One month before admission, he felt a febrile sensation and was diagnosed as having abdominal abscess by an ultrasonography, and took about 30g of metronidazole until visiting our emergency room. A nerve conduc-tion test revealed sensorimotor polyneuropathy in the four extremities. A brain MRI showed symmetrically increased signal intensities without enhancement in the supratentorial white matter and the dentate nucleus of the cerebellum. After stopping metronidazole, his neurological symptoms began to improve and on the following MRI taken seven weeks later, the symmetrically increased signal intensities in the dentate nucleus of the cerebellum were nearly disappeared.

MRI and Electrophysiological findings in a case of Tabes Dorsalis

By doing MRI of spinal cord and elctrophysiological studies we were going to correlate MRI and electrophysiologi-cal findings with the known pathology of tabes dorsalis. A 45 year old male patient developed gait ataxia with a tin-gling sense in hands and feet in september of 1996. Neurological examination revealed impaired position sense in his great toes and thumbs with profound instability in the Romberg test, and areflexias in his knee and ankle jerks. Serum VDRL and TPHA test results were positive. CSF revealed pleocytosis(WBC : 16/cubic mm), elevated protein level, and reactive VDRL and FTA-ABS tests. Spinal MRI showed high signal intensity in the posterior part of the entire length of the cervical cord without enhancement with Gadolinium. Follow-up spinal MRI of the cervical area, which was taken two years after penicillin treatment did not show any interval change and spinal MRI of thoracolumbar area also showed similar finding to that of the cervical cord. Nerve conduction studies before and after the penicillin trea-ment showed normal findings except absent H-reflexes. However, the somatosensory evoked potentials with posterior tibial nerve stimulation did not show any abnormalities, which were incompatible with previous report and the known pathologic abnormality. Normal somatosensory evoked potentials suggests using any other pathways than the posterior column in conducting somatosensory evoked potentials.

Brain Magnetic Resonance Imaging Findings in Children with Cerebral Palsy: Compared between Preterm and Term Groups / 대한소아신경학회지

PURPOSE: We used MRI to retrospectively analyze the brain of patients suffering from cerebral palsy. Our aim is to determine MRI's role in the assessment of brain damage, the relationship of gestational age. METHODS: A total of 66 patients (29 preterm group and 37 term group), who visited Kang-Dong Sacred Heart Hospital from January, 1994 to July, 1998, were enrolled in this study. RESULTS: Among the 29 in the preterm group, 13 patients showed MR images of hypoxic ischemic injury in which periventricular leukomalacia (PVL) and multifocal ischemic necrosis in 12 (41.3%) and 1 (3.4%) respectively. Neuronal migration disorders were 6 (20.8%), other congenital malformations 5 (17%) and normal MR images 5 (17%) in this preterm group. Among the 37 in the term group, 22 patients showed MR images of hypoxic ischemic injury in which selective neuronal necrosis were 11 (29.7%), PVL 4 (10.8%), focal and multifocal ischemic necrosis 4 (10.8%) and status marmoratus 3 (8.1%). Neuronal migration disorders were 4 (10.8%), other congenital malformations 5 (13.5%) and normal MR images 6 (16.2%) in the term group. CONCLUSION: MRI provided useful information in a majority of children with cerebral palsy. Hypoxic ischemic injury was significantly different in preterm and term groups. PVL was frequent in the preterm group and selective neuronal necrosis was statistically common in the term group.

The correlation between the findings on MRI of spinal disorders and physical signs. The meaning of physical signs in clinical acupuncture therapy / 全日本鍼灸学会雑誌

Recently, magnetic resonance imaging (MRI) has brought significant advancements in the diagnosis of spinal disorders. But there is much debate about the abnormalities detected by MRI clinically. In this study, we try to clarify the correlation between spinal abnormalities detected by MRI and physical signs in 45 patients with neck, shoulder, and low back pain. Physical signs were segmental sensory disturbance, amyotrophy, and radicular pain, and the abnormalities of MRI were bulging, protrution, extrution, and osteophytes. MRI showed a symptomatic change, that is a false positive (abnormality of MRI<SUP>*</SUP> (+), physical sign<SUP>**</SUP> (-)), in 26 of the 45 patients (57.7%), a true positive (+, <SUP>**</SUP>+) in 15 of 45 patients (31.1%), a true negative (<SUP>*</SUP>+, <SUP>**</SUP>-) in the remaining 5 patients (11.1%).<BR>These results suggested that the physical signs are more important than the abnormalities of MRI in patients with neck, shoulder and low back pain. We think that the acupuncture therapist should carry out a more detailed physical examination of the patients clinically.

A Clinical Analysis of the Carpal Tunnel Syndrome Patients Who Were Surgically Treated

The carpal tunnel syndrome is well known, studied and easily treatable disease as one of the entities of peripheral neuroentrapment disease. This report is based on last ten year of our experience since the January of 1987 by observing 31 hands of 21 surgically treated patients with carpal tunnel syndrome. The age range of patients was from 29 to 61 years old(average 48.70. The peak age group was six decade. Both hands were affected predominantly followed by right and left hand, 18(58%), 9(29%) and 4(13%) respectively. Tingling sensation and pain were presented in all hands followed by Tinel's sign in 21 hands(67.7%), Phalen's sign in 19 hands(61.2%) and thenar muscle atrophy in 9(29%). The postoperative results were excellent in 64.7% of patients, good 23.5%, fair 5.9% and poor 5.9%. There were no postoperative complication. From these results we stress that carpal tunnel syndrome can be treated well by surgery.

Analysis of Inconclusive Diagnostic lesions in Stereotactic Biopsy: Review of Cases in 5 Years

While stereotactic biopsy increases the accuracy of obtaining appropriate tissue for precise diagnosis, inconclusive diagnostic lesions can still be observed frequently. We present a review of 43 patients with inconclusive diagnostic samples in stereotactic biopsy between June 1989 and June 1994. inconclusive diagnostic lesions were found in 43 patients(17.9%); the biopsy of these patients showed reactive gliosis in 22, foam cell infiltration and/or demyelination with coagulation necrosis in 8, chronic inflammatory cell infiltration with necrosis, fibrosis in 6, no evidence of tumor in 5, and ganglioglial lesion in 2. The final diagnosis was based on histological findings of permanent paraffin sections after rebiopsy or open surgery, close follow-up CT/MRI scan findings, clinical features and/or history, and serological studies;neoplasm 16, infarction/leukodystrophy 8, infection/inflammation 4, granuloma 1, and no confirmative diagnosis 4, In conclusion, rebiopsy or open surgery is recommended if the lesion is suspected to be a neoplasm, and the patient is closely observed with repeated radiological studies if the lesion is suspected to be benign. This study provides evidence that in some cases an accurate histopathological diagnosis can not be made with stereotactic biopsy and therefore, further investigations are needed in such inconclusive cases.