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Background: Neonates often show involuntary movements peri-operatively which are difficult to diagnose. Neonatal Shivering albeit very rare, may confuse the anaesthesiologist by presenting as Seizures. Case : A Neonate was scheduled for the repair of Lumbar Meningomyelocele in our Operating Room. At the end of an uneventful Surgery, we noticed jittery movements during recovery from Anaesthesia. Differentiating these movements from Neonatal Shivering, Motor Automatisms and Physiological New-born Behaviour was a challenge. The immediate venous blood gas analysis was within normal limits and no apparent cause could be found. Suspecting accidental Hypothermia, Immediate rewarming was initiated and after Consulting Paediatric Neurology intravenous Levetiracetam was given. There were no further similar episodes. Conclusion : Shivering-like episodes in Neonates during the peri-operative period need to be carefully evaluated to allay parental anxiety, avoid inappropriate treatment and prevent any further complications
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Background: Claustrophobia associated with MRI scan is a well-recognized problem all over the world. The unpleasant psychological experience during MRI can lead to premature cancellation of the study resulting in non-interpretable data. In addition, performing future studies on the claustrophobic patient may not be possible leading to non-utilization of an important diagnostic modality. This study was conducted with the aim to determine a cheap and short intervention which can be applicable to small radiology set up as well.Methods: A prospective study was conducted at a tertiary care hospital from October 2016 to December 2016. Accompanying someone was the first strategy used to coped MR imaging claustrophobia followed by placebo (multivitamin), listening Quran and closed eye (blindfold). All those patients who failed to respond in these strategies were finally labeled as an unsuccessful candidate. Listening of Quran was selected as one of the tools as all the patients were Muslims in present study.Results: Among 84 claustrophobic patients, a closed eye was the most successful strategy found effective in (13) 81.2%, followed by placebo 66.7% patients, listening Quran (7) 30.4%, accompanying someone (15) 17.85% while 4% patients remained claustrophobic after application of all strategies. Significant association of accompanying someone and placebo was observed with education (p-value 0.037) and age of the patients (0.016) respectively.Conclusions: In general, placebo, being accompanied by someone and blindfold were found to be the most effective strategies to cope with MRI related claustrophobia. However, the success of these strategies is also dependent on certain factors like age, education status and socioeconomic status of the patients.
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OBJECTIVE: To evaluate 3-dimensional magnetic resonance imaging (MRI) of Kambin’s safe zone to calculate maximum cannula diameter permissible for safe percutaneous endoscopic lumbar discectomy.METHODS: Fifty 3D MRIs of 19 males and 31 females (mean, 47 years) were analysed. Oblique, axial and sagittal views were used for image analysis. Three authors calculated the inscribed circle (cannula diameter) individually, within the neural (original) and bony Kambin’s triangle in oblique views, disc heights on sagittal views and root to facet distances at upper and lower end plate levels on axial views and their averages were taken.RESULTS: The mean root to facet distances at upper end plate level measured on axial sections increased from 3.42±3.01 mm at L12 level to 4.57±2.49 mm at L5S1 level. The mean root to facet distances at lower end plate level measured on axial sections also increased from 6.07±1.13 mm at L12 level to 12.9±2.83 mm at L5S1 level. Mean maximum cannula diameter permissible through the neural Kambin’s triangle increased from 5.67±1.38 mm at L12 level to 9.7±3.82 mm at L5S1 level. The mean maximum cannula diameter permissible through the bony Kambin’s triangle also increased from 4.03±1.08 mm at L12 level to 6.11±1 mm at L5S1 level. Only 2% of the 427 bony Kambin’s triangles could accommodate a cannula diameter of 8mm. The base of the bony Kambin’s triangle taken in oblique view (3D MRI) was significantly higher than the root to facet distance at lower end plate level taken in axial view.CONCLUSION: The largest mean diameter of endoscopic cannula passable through “bony” Kambin’s triangle was distinctively smaller than the largest mean diameter of endoscopic cannula passable through “neural” Kambin’s triangle at all levels. Although proximity of exiting root to the facet joint is always taken into consideration before PELD procedure, our 3D MRI based anatomical study is the first to provide actual maximum cannula dimensions permissible in this region.
Subject(s)
Female , Humans , Male , Anatomy, Regional , Catheters , Diskectomy , Endoscopy , Intervertebral Disc , Lumbosacral Region , Magnetic Resonance Imaging , Zygapophyseal JointABSTRACT
OBJECTIVE: To evaluate 3-dimensional magnetic resonance imaging (MRI) of Kambin’s safe zone to calculate maximum cannula diameter permissible for safe percutaneous endoscopic lumbar discectomy. METHODS: Fifty 3D MRIs of 19 males and 31 females (mean, 47 years) were analysed. Oblique, axial and sagittal views were used for image analysis. Three authors calculated the inscribed circle (cannula diameter) individually, within the neural (original) and bony Kambin’s triangle in oblique views, disc heights on sagittal views and root to facet distances at upper and lower end plate levels on axial views and their averages were taken. RESULTS: The mean root to facet distances at upper end plate level measured on axial sections increased from 3.42±3.01 mm at L12 level to 4.57±2.49 mm at L5S1 level. The mean root to facet distances at lower end plate level measured on axial sections also increased from 6.07±1.13 mm at L12 level to 12.9±2.83 mm at L5S1 level. Mean maximum cannula diameter permissible through the neural Kambin’s triangle increased from 5.67±1.38 mm at L12 level to 9.7±3.82 mm at L5S1 level. The mean maximum cannula diameter permissible through the bony Kambin’s triangle also increased from 4.03±1.08 mm at L12 level to 6.11±1 mm at L5S1 level. Only 2% of the 427 bony Kambin’s triangles could accommodate a cannula diameter of 8mm. The base of the bony Kambin’s triangle taken in oblique view (3D MRI) was significantly higher than the root to facet distance at lower end plate level taken in axial view. CONCLUSION: The largest mean diameter of endoscopic cannula passable through “bony” Kambin’s triangle was distinctively smaller than the largest mean diameter of endoscopic cannula passable through “neural” Kambin’s triangle at all levels. Although proximity of exiting root to the facet joint is always taken into consideration before PELD procedure, our 3D MRI based anatomical study is the first to provide actual maximum cannula dimensions permissible in this region.
Subject(s)
Female , Humans , Male , Anatomy, Regional , Catheters , Diskectomy , Endoscopy , Intervertebral Disc , Lumbosacral Region , Magnetic Resonance Imaging , Zygapophyseal JointABSTRACT
Objective To explore the advantages of Argus method by comparing the accuracy and timeliness of Argus and artificial methods for measuring femoral head necrosis area in MRI scanning.Methods Totally 17 patients (31 hips) were measured with Argus and artificial methods respectively for the necrosis area, and then the measuring results and time were compared, and the correlation was investigated between the results and the patients' pain degree, along with that between the results and the extent of femoral head collapse.Results The necrosis area ratios determined by Argus and artificial methods were (33.5±4.08)%and (34.6±4.06)%respectively, with no statistical difference between the ratios (P>0.05). The time consumed by artificial method was (21.3 ±3.62)min, significantly longer than (7.89 ±1.03)min by Argus method, with P<0.001. Regression analysis proved that the necrosis areas were positively correlated with the patients' pain degree, and the correlation coefficient by Argus method was 0.807 8, more than 0.740 9 by artificial method. The femoral heads of 11 cases(16 hips) collapsed in the follow-up period, the necrosis areas were positively correlated with the patients collapse level, but the correlation coefficient by Argus method was 0.783 8, more than 0.726 7 by artificial method.Conclusion Argus method gains high accuracy and timeliness when used in MRI scanning of femoral head necrosis area, and thus is worth popularizing clinically.
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Introducción: para el trastorno de déficit de atención e hiperactividad (TDAH), se utilizan los criterios del DSM-IV. Debido a que han surgido diversas pruebas como el electroencefalograma, tomografía y resonancia, surge un particular interés en determinar la utilidad y precisión diagnóstica de estas pruebas para el diagnóstico del TDAH. Objetivo: identificar, sintetizar y evaluar la mejor evidencia disponible sobre la utilidad del electroencefalograma, tomografía computarizada y resonancia magnética como método diagnóstico en TDAH en la población entre 6 y 19 años. Métodos: se realizó una revisión sistemática de estudios de pruebas diagnósticas que evaluaron la validez, confiabilidad y efectividad de la realización del electroencefalograma, tomografía y resonancia magnética en el diagnóstico del TDAH en población entre 6 y 19 años, usando la base de datos de PubMed, LILACS, Cochrane, DARE y National Guideline Clearinghouse, publicados hasta febrero de 2012, en inglés y español. Los artículos que cumplieron los criterios de inclusión, evaluados por dos investigadores en forma independiente, se les evaluó su calidad metodológica según patrones estándar para estudios de revisión y de pruebas diagnósticas. Resultados: de los 115 estudios obtenidos, se incluyeron ocho estudios, entre ellos dos revisiones sistemáticas de mediana calidad y adicionalmente un artículo primario de pruebas diagnósticas, de buena calidad. También se incorporaron cinco guías clínicas basadas en evidencias que abordan este tema. Conclusiones: la evidencia científica disponible sobre la validez, confiabilidad y efectividad del electroencefalograma, la tomografía computarizada y la resonancia magnética, no recomiendan su uso como herramienta de diagnóstico del TDAH; las guías de práctica clínica no la recomiendan. El uso de dichas pruebas se recomienda para la valoración integral del individuo con este trastorno.
Introduction: Attention deficit and hyperactivity disorder (ADHD) is generally diagnosed based on the criteria of DSM-IV. Because several diagnostic tests have appeared such as electroencephalography (EEG), CT scan and magnetic resonance imaging (MRI), there is a particular interest in determining the usefulness and diagnostic accuracy of these tests for the diagnosis of ADHD. Purpose: To identify, synthesize and evaluate the best available evidence on the usefulness of EEG, CT and MRI as a diagnostic tool in ADHD in the 6-19 year-old population. Methods: A systematic review of studies on diagnostic tests that assessed the validity, reliability and effectiveness of the implementation of EEG, CT and MRI in the diagnosis of ADHD in the 6-19 year-old population was conducted. Searches were done in PubMed/MEDLINE, LILACS, Cochrane, DARE and National Guideline Clearinghouse databases, until February 2012, in English and Spanish. The articles that met the inclusion criteria were independently assessed by two investigators for methodological quality using standard checklists for review articles and diagnostic test articles. Results: Of the 115 studies found, eight studies were included, among which two medium-quality systematic reviews and a good-quality primary article on diagnostic tests. Additionally, five evidence-based clinical guidelines that address this issue were also included. Conclusions: The available evidence on the validity, reliability and effectiveness of the electroencephalogram, computed tomography and magnetic resonance imaging, does not recommend their use as diagnostic tools for ADHD. Clinical practice guidelines do not recommend their use either. These tests are recommended for the assessment of the individual patient with the disorder.
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Humans , Male , Adolescent , Female , Child , Electroencephalography , Magnetic Resonance Imaging , Tomography, X-Ray Computed , Attention Deficit Disorder with Hyperactivity/diagnosis , Evidence-Based Medicine , Reproducibility of ResultsABSTRACT
PURPOSE: Hippocampal sclerosis is known to strongly correlate with medical intractability of temporal lobe epilepsy. However, the informations about this have been biased due to improper selection of the sampling obtained from severe cases of tertiary epilepsy center and surgical epilepsy field. We tried to investigate the influence of hippocampal sclerosis on the pharmacoresistance in temporal lobe epilepsy by group comparison study. METHODS: The fifty patients with complex partial seizures of temporal lobe origin, and temporal spike on EEG and/or hippocampal sclerosis on brain MRI were selected. Follow-up period of them were more than 2 years. The patients who had a seizure or seizures during the last 1-year period and had already been in adequate doses of two or more antiepileptic drugs were considered to be poorly controlled epileptics. RESULTS: Five of 17 patients without hippocampal sclerosis (29. 4%) and 24 of 33 patients with hippocampal sclerosis (72.7%) were poorly controlled by medication and the difference was significant (p=0.003, chi-square). Other factors, including sex, age of onset, febrile convulsion, secondary generalization, familial history of epilepsy, duration of disease, and delay of initial therapy had no significant effects on medical response (p>0.05). The only independent predictor of intractable epilepsy after multiple logistic regression analysis was also hippocampal sclerosis (p=0.005). CONCLUSION: Medical response in temporal lobe epilepsy was significantly associated with hippocampal sclerosis. Hippocampal sclerosis on brain MRI itself may be a crucial factor determining pharmacoresistance of temporal lobe epilepsy.
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Humans , Age of Onset , Anticonvulsants , Bias , Brain , Drug Resistance , Electroencephalography , Epilepsy , Epilepsy, Complex Partial , Epilepsy, Temporal Lobe , Follow-Up Studies , Generalization, Psychological , Hippocampus , Logistic Models , Magnetic Resonance Imaging , Sclerosis , Seizures , Seizures, Febrile , Temporal LobeABSTRACT
OBJECTIVE: This study is aimed to evaluate the chemonucleolytic effect of medical ozone by investigating the change of the signal intensity on magnetic resonance imaging (MRI) scan after injection of medical ozone into the lumbar intervertebral disc of the rabbit. METHODS: A series of 21 intradiscal injections of 1ml of medical ozone(30microgram of ozone per ml of oxygen) was performed in 7 young adult rabbits. Two control series, which 20 intradiscal injections of 0.1ml of iodine contrast medium in 7 young adult rabbits and 21 intradiscal injections of 0.05ml of chymopapain in 7 young adult rabbits, were performed. T2 weighted MRI scan was performed pre-operatively and at 4 weeks after injection. RESULTS: T2-weighted MRI scan of intervertebral disc spaces demonstrated significantly decreased signal intensities in the series (n=21) of intradiscal injections of medical ozone at 4 weeks after injection, as compared with the control series of intradiscal injections of 0.1ml of iodine contrast medium. T2-weighted MRI scan of intervertebral disc spaces demonstrated significantly decreased signal intensities in the series(n=21) of intradiscal injections of chymopapain at 4 weeks after injection. Any neurologic deficit or complication was not found in all groups. CONCLUSION: Intradiscal injections of medical ozone into the lumbar intervertebral disc of the rabbits are proven to have chemonucleolytic effects.
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Humans , Rabbits , Young Adult , Chymopapain , Intervertebral Disc Chemolysis , Intervertebral Disc , Iodine , Magnetic Resonance Imaging , Neurologic Manifestations , OzoneABSTRACT
Objective To research paramagnetic contrast media(PCM)dose,injection speed and imaging time etc in low field MRI.Methods 406 patients with lesions spreading all over the body received Gadolinium-DTPA-enhanced scan by bolus injection with the dose of 0.1～0.15 mmol/kg within 60 seconds,and the effects of contrast-enhanced were observed.Results Among 406 patients lesions,337 cases(83%)were enhanced,9 undiscovered lesions displayed enhancement on the precontrast views,5 cases were discovered new lesions in delaying enhancement scan.Conclusion It is safe to apply the above mentioned dose and injection speed in clinic.The side-effects is small,and the development effect is good.It is especially important for lesions involving the structure of the blood brain barrier(BBB).
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Lymphocytic infundibuloneurohypophysitis was known as a cause of idiopathic central diabetes insipidus. Until recent time, it is characterized into two groups. One has thickening of the pitutitary stalk, enlargement of the neurohypophysis and loss of hyperintense signal of the normal neurohypophysis, the other has only loss of hyperintense signal but not morphological change. A 51-year-old man presented with a one month history of polydipsia and polyuria. The interpretation of water deprivation test was compatible with complete central diabetes insipidus. Endocrinologic examination of the adenohypophysis hormones and its triple stimulation test were normal apart from thyroid stimulating hormone (TSH), which showed low response despite thyrotropin releasing hormone (TRH). Sellar MRI scan disclosed an loss of hyperintense singnal of normal neurohypophysis and about 10 mm-sized nodular mass lesion on neurohypophysis. However, thickness of the pituitary stalk was normal. Pathologic examination demonstrated diffuse infiltration of lymphocytes and plasma cells. No adenomas, menigitis, sarcoidosis or granulomas were present. We supposed that this case was an atypical type of lymphocytic infundibuloneurohypophysitis, which did not belong to any other part of two groups described above.
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Humans , Middle Aged , Adenoma , Diabetes Insipidus, Neurogenic , Granuloma , Lymphocytes , Magnetic Resonance Imaging , Pituitary Gland , Pituitary Gland, Anterior , Pituitary Gland, Posterior , Plasma Cells , Polydipsia , Polyuria , Sarcoidosis , Thyrotropin , Thyrotropin-Releasing Hormone , Water DeprivationABSTRACT
BACKGROUND: Hemifacial spasm (HS) has been attributed frequently to vascular compression of facial nerve root exit zone from brainstem. A recent brain CT scan study showed that patients with HS had narrower posterior fossa than normal controls. However, cause relationship between narrowed posterior fossa and vascular tortuosity is unknown. METHODS: In 25 patients with HS and 29 controls, using temporal bone MRI, we measured petrous angle (PA) and pons diameter index (PDI) to define correlation between severity of posterior fossa narrowing and compression to brainstem. We compared severity of narrowing of posterior fossa between patients with and without tortuous arteries in posterior fossa. We also compared degree of narrowing of posterior fossa and clinical severity of HS. RESULTS: The mean (+/-standard deviation) of PA of 24 patients with HS (115.5 +/-6.0 degree) was significantly smaller than that of controls ( 118.6 +/- 4.8 degree). The mean (+/-standard deviation) of PDI of patients with HS (82.5 +/-4.7%) was significantly greater than that of controls (77.3 +/-3.7%). However, there was no correlation between PA and PDI in patients with HS. There was no correlation between degree of narrowing of posterior fossa and clinical severity of HS. CONCLUSIONS: Patients with HS have narrower posterior fossa as compared with controls. However, narrow posterior fossa does not seem to be a single important factor causing deformity of brainstem or tortuous arteries in posterior fossa.