Ivy Sign on Fluid-Attenuated Inversion Recovery Images in Moyamoya Disease: Correlation with Clinical Severity and Old Brain Lesions

PURPOSE: Leptomeningeal collateral, in moyamoya disease (MMD), appears as an ivy sign on fluid-attenuated inversion-recovery (FLAIR) images. There has been little investigation into the relationship between presentation of ivy signs and old brain lesions. We aimed to evaluate clinical significance of ivy signs and whether they correlate with old brain lesions and the severity of clinical symptoms in patients with MMD. MATERIALS AND METHODS: FLAIR images of 83 patients were reviewed. Each cerebral hemisphere was divided into 4 regions and each region was scored based on the prominence of the ivy sign. Total ivy score (TIS) was defined as the sum of the scores from the eight regions and dominant hemispheric ivy sign (DHI) was determined by comparing the ivy scores from each hemisphere. According to the degree of ischemic symptoms, patients were classified into four subgroups: 1) nonspecific symptoms without motor weakness, 2) single transient ischemic attack (TIA), 3) recurrent TIA, or 4) complete stroke. RESULTS: TIS was significantly different as follows: 4.86+/-2.55 in patients with nonspecific symptoms, 5.89+/-3.10 in patients with single TIA, 9.60+/-3.98 in patients with recurrent TIA and 8.37+/-3.39 in patients with complete stroke (p=0.003). TIS associated with old lesions was significantly higher than those not associated with old lesions (9.35+/-4.22 vs. 7.49+/-3.37, p=0.032). We found a significant correlation between DHI and motor symptoms (p=0.001). CONCLUSION: Because TIS has a strong tendency with severity of ischemic motor symptom and the presence of old lesions, the ivy sign may be useful in predicting severity of disease progression.

Neurotuberculosis. Hallazgos intracraneanos en RM / Neurotuberculosis. Intracranial MRI findings

Objetivos. Mostrar nuestra casuística de pacientes con diagnóstico de tuberculosis intracraneana y describir los diferentes tipos de lesiones documentadas en Resonancia Magnética (RM) que caracterizan a esta entidad. Materiales y Métodos. Para el presente trabajo fueron seleccionados, de forma retrospectiva, 20 pacientes con hallazgos positivos de tuberculosis intracraneana. Doce eran de sexo masculino y 8 de sexo femenino, conun rango etario de 8 meses a 49 años de edad (edad media: 21 años). El diagnóstico clínico fue realizado con punción lumbar y cultivo de LCR. Once pacientes presentaron serología positiva para VIH. Las RM fueron realizadas en resonadores de 0.5T y 1.5T, complementadas en dos casos con Tomografía Computada (TC) de cerebro. A dos pacientes se les realizó difusión (DWI) y a un paciente espectroscopía. Resultados. Del total de pacientes (n=20), 14 presentaron compromiso subaracnoideo en la convexidad y 13 compromiso subaracnoideo cisternal basal (afectación leptomeníngea). En 13 se observaron tuberculomas y 11 presentaron angeítis de grandes vasos; mientras que 7 tuvieron angeítis de pequeños vasos, 7 hidrocefalia, 6 infartos parenquimatosos y 1 afectación paquimeníngea. Quince pacientes tenían lesiones combinadas.Conclusión. La localización más frecuente de neurotuberculosis en esta serie fue meníngea con compromiso leptomeníngeo (14 pacientes con afectación subaracnoidea, seguido de afectación cisternal en 13 pacientes) y sólo en un caso fue paquimeníngea. La manifestación parenquimatosa más frecuente fue el tuberculoma (granulomas tuberculosos) con 13 casos. De estos, 5 presentaron un patrón miliar y sólo uno comportamiento pseudotumoral...

Astrocitoma pilocítico juvenil con realce leptomeníngeo inusual: reporte de un caso / Astrocitoma pilocítico juvenil com realce leptomeníngeo infreqüente: reporte de um caso / Juvenile pilocytic astrocytoma with unusual leptomeningeal enhancement: a case report

Se reporta el caso de un niño de cinco años de edad con un astrocitoma pilocítico juvenil que exhibe un inusual realce leptomeníngeo, resaltando los hallazgos radiológicos. Neurocirujanos y radiólogos deben sospechar esta entidad al encontrar tumores intraparenquimatosos con realce leptomeníngeo en pacientes jóvenes...

A case of a 5-year-old boy with a juvenile pilocytic astrocytoma that shows an unusual leptomeningeal enhancement is presented. The course of the illness and radiological and surgical findings are presented. Neurosurgeons and radiologists must suspect this pathological entity when they treat young patients with intraparenchymal tumors with marked leptomeningeal enhancement...

Reporta-se o caso de um menino de cinco anos de idade com um astrocitoma pilocítico juvenil que mostra um infreqüente realce leptomeníngeo, ressaltando os achados radiológicos. Neurocirurgiões e radiologistas devem suspeitar esta entidade ao encontrar tumores intraparenquimatosos com realce leptomeníngeo em pacientes jovens...

The effects of intrathecal administration of betamethasone over the dogs' spinal cord and meninges

PURPOSE: To determinate the potential clinical and histological changes due the injection of betamethasone, when administered into the canine intrathecal space. METHODS: Twenty one animals were included in a random and blind manner in the study. After general anesthesia, intrathecal puncture was performed and 1 ml of the random solution was injected. The G1 dogs received 0.9 percent saline solution, the G2 dogs received 1.75 mg betamethasone and the G3 dogs received 3.5 mg of betamethasone. The animals were clinically evaluated for 21 days and then sacrificed. The lumbar and sacral portions of the spinal cord were removed for light microscopy histological analyses. RESULTS: No clinical changes were observed in any of the animals included in this study. No histological changes were observed in G1 animals. Inflammatory infiltration was observed in two dogs, one in G2, another in G3. Hemorrhage and necrosis were also seen in the G2 dog which inflammatory infiltration was detected. In other two dogs, one from G2 and another from G3, there was discreet fibrosis and thickness of the arachnoid layer which was focal in one and diffuse in the other. CONCLUSION: Intrathecal administration of betamethasone caused histological changes in the spinal cord and meninges in some of the dogs involved in this study.

OBJETIVO: Determinar possíveis alterações clínicas e histológicas determinadas pela administração da betametasona no espaço subaracnóideo de cães. MÉTODOS: Vinte e um cães foram incluídos no estudo de forma aleatória e encoberta. Depois de anestesiados, os cães foram submetidos a punção subaracóidea com injeção de 1 ml da solução sorteada. Os animais receberam solução salina 0,9 por cento em G1, betametasona na dose de 1,75 mg em G2 e betametasona na dose de 3,5 mg em G3. Todos os animais foram mantidos em observação clínica por 21 dias, sendo posteriormente sacrificados. Porções da medula espinhal e sacral foram removidas para análise histológica por microscopia óptica. RESULTADOS: Não foram detectadas alterações clínicas em quaisquer dos animais incluídos no estudo. Da mesma forma, nenhum animal do G1 apresentou alterações histológicas. Infiltração inflamatória foi observada em dois cães, um do G2 e outro e G3. No cão do G2 onde a infiltração inflamatória foi observada ocorreu, conjuntamente, hemorragia e necrose. Em dois cães, um de G2 e outro de G3, observou-se discreta fibrose e espessamento da aracnóide, sendo focal em um e difusa no outro. CONCLUSÃO: A administração subaracnóidea de betametasona determinou alterações histológicas em medula e meninges de alguns dos cães envolvidos no estudo.

Sacral extradural meningeal cyst

Sacral extradural meningeal cysts are a rare condition; we describe a case of sacral extradural cyst in a 61-year-old lady. The clinical, radiological and histopathological characteristics of the lesion and a review of previous reports are discussed. The final diagnosis of spinal extradural cyst is difficult to make, while intraoperative inspection combined with radiological and histopathoIogical examination is essential

Linfoma leptomeníngeo en un niño con infección por el virus de la inmunodeficiencia humana / Leptomeningeal lymphoma in a child infected with the human immunodeficiency virus

El linfoma primario del sistema nervioso central en pacientes pediátricos VIH positivos es poco frecuente. Se presenta un paciente, de siete años de edad, de sexo masculino, con síndrome de inmunodeficiencia adquirida, que desarrolló un linfoma decélulas B con localización leptomeníngea. El niño inició el cuadro con síntomas de alteración del sensorio, hipertensión endocraneana y amaurosis bilateral. El diagnóstico se efectuó por biopsia cerebral, inmunofenotipo de las células B del líquido cefalorraquídeo, además de PCR positiva para virus de Epstein Barr en el líquido. Realizó tratamiento con quimioterapia intratecal y sistémica. Mejoraron los síntomas durante quince meses y luego recidivó en la región talámica. Cumplió radioterapia craneo espinal y falleció cuatro meses después de la recidiva. En este artículo se realiza una revisión de la bibliografía sobre esta enfermedad, señalando el carácter excepcional de este paciente por tratarse de un linfoma localizado en forma exclusiva en el sistema nervioso central y, más precisamente, en la leptomeninges

Atretic fronto-ethmoidal encephalocele

This case report describes a 4 months old infant with a lump on forehead since birth. The lump turned out to be an atretic encephalocele. Herniation of brain matter through scalp suture lines during intrauterine life is a rare happening. Congenital and environmental factors have been implicated

A hypothesis of epiarachnoidal growth of vestibular schwannoma at the cerebello-pontine angle: surgical importance.

AIMS: The purpose of this study is to clarify the rearrangement of the arachnoid membrane on the vestibular schwannoma during its growth in relation to adjacent neurovascular structures for a better understanding of dissecting plane of arachnoid during surgery. METHODS: Arachnoid membrane over the tumour was investigated during surgery with suboccipital transmeatal approach in twenty-six tumours. All microsurgical procedures were recorded with a video and reviewed. The tumour growth was classified into five stages depending upon the tumour diameter in the cerebello-pontine (CP) angle: Stage 1; purely intracanalicular (2 cases), Stage 2; less than 5 mm (2 cases), Stage 3; > or = 5 and <15 mm (8 cases), Stage 4; > or = 15 and <25 mm (9 cases) and Stage 5; > or = 25 mm (5 cases). Rearrangement of the arachnoid on the tumour was conceptualised throughout all stages. RESULTS: All tumours of Stage 1 and 2 were entirely located in the subarachnoid space of the cerebello-pontine cistern without arachnoidal rearrangement, while all tumours of Stages 3 to 5 were enveloped, in the CP angle, with invaginated arachnoid membrane consisting of cerebello-pontine cistern except two surfaces; the medial pole and the tumour surface under the facial and cochlear nerves near the porus. CONCLUSION: The tumour originates subarachnoidally within the internal auditory meatus (IAM) and grows epiarachnoidally in the CP angle. Rearrangement of the arachnoid begins with its adhesion on the medial pole of the tumour along the porus, resulting in the arachnoidal invagination into the cerebello-pontine cistern with further growing of the tumour.

Diffuse cerebrospinal gliomatosis with extensive leptomeningeal spread

A case of diffuse cerebrospinal gliomatosis with extensive leptomeningeal spread is presented. The patient, an 18-year-old girl, was admitted due to progressive weakness and paresthesia of both legs, following rapid neuropsychiatric deterioration. An initial magnetic resonance imaging (MRI) study of the T-spine showed diffuse high signal intensities from T9 to T12 spinal cords on a T2 sagittal image and diffuse cord bulging at T1WI. This suggested an inflammatory lesion such as tuberculosis or fungal meningoencephalitis. A limited autopsy was performed. A microscopic examination revealed multifocal GFAP-positive astrocytic proliferations that were low grade astrocytoma in the cerebral leptomeninges, parietal, occipital and temporal lobes and anaplastic astrocytoma in the spinal cord and spinal leptomeninges. The high proliferative indices of the spinal lesion and aneuploidy correspond to a diagnosis of malignant astrocytoma and a rapid fatal clinical course.

Hematopoyesis extramedular intracraneal (HEIC) en una paciente con mielofibrosis / MR findings in intracraneal extremedullary hematopoiesis due to myelofibrosis

Presentamos un caso de hematopoyesis extramedular intracraneal (HEIC) en una paciente con mielofibrosis diagnosticado por resonancia magnética. Se trata de una mujer de 55 años que consulta por cefaleas y crisis convulsivas. Se le realiza RM de encéfalo observándose engrosamiento meníngeo lineal a nivel de la convexidad cerebral y uno nodular parietal izquierdo, con refuerzo intenso y homogéneo con el gadolinio. A pesar de ser una entidad poco frecuente, la HEIC es un diagnóstico a tener en cuenta en pacientes con engrosamientos maníngeos focales o difusos que padecen hemodiscrasias y dishematopoyesis

Estudo da paracoccidioidomicose encefálica por tomografia computadorizada / Brain paracoccidioidomycosis evaluation by computed tomography

Neste trabalho foram analisadas, retrospectivamente, as tomografias computadorizadas de 11 pacientes acometidos por paracoccidioidomicose encefálica, com ênfase nas características dos granulomas e no comportamento evolutivo das lesöes tratadas. Foram também descritas as alteraçöes tomográficas do acometimento meníngeo da micose, com pequeninos nódulos corticais e com impregnaçäo leptomeníngea pelo meio de contraste, aspectos estes näo-relatados na literatura consultada. Pode-se realizar controle evolutivo em seis dos pacientes, sendo que em um deles o controle tomográfico foi feito durante sete anos. Na forma granulomatosa parenquimatosa, o aspecto mais comum foi de lesöes nodulares isodensas, com interior hipodenso, impregnandose perifericamente pelo meio de contraste. O aspecto mais freqüentemente observado foi de lesöes múltiplas, predominando no compartimento supratentorial, em especial nos lobos do telencéfalo. Com o tratamento, as lesöes tenderam a involuir e a se tornar calcificadas, bem como perderam a capacidade de se impregnar pelo meio de contraste

Hidrocefalia crónica obstructiva por histoplasmosis meningo-cerebral / Chronic obstructive hydrocephalus due to meningeal and cerebral histoplasmosis

El presente caso describe un caso de histoplasmosis del sistema nervioso central con hidrocefalia obstructiva, que ha estado presente durante 8 años sin mayores secuelas o evidencias clínicas de infección activa en otros órganos, en un huésped inmunocompatible. La punción lumbar y el análisis del líquido cefalorraquídeo (LCR) revelaron un elevado nivel de proteínas, linfocitosis e hipoglucorraquia. Los títulos de fijación de complementos séricos y del LCR para histoplasma fueron positivos. La tomografía computada (TC) demostró que existía hidrocefalia y dos lesiones periventriculares con un marcado refuerzo con contraste. Se inició el tratamiento con altas dosis de ketoconazol y a continuación se administró fluconazol con una mejoría parcial del estado clínico y los valores de LCR. Finalmente se le practicó al paciente un tratamiento con anfotericina mostrando una completa remisión clínica, pero sin curación con valores variables en los controles de seguimiento a largo plazo de los títulos de complemento sérico y del LCR. En la actualidad, el paciente permanece asintomático y está tratado con itraconazol oral

Meningitis por Salmonella revision de casos clinicos / Meningitis by salmonella: review of clinical cases

La miningitis por Salmonella es poco frecuente, los factores de riesgo so: edad deterioro inmunológico y condiciones socio-economicas e higiénicas, asociados a un incremento significativode la morbimortalidad. En el presente estudio se señala la casuística del Departamento De Pediatria del Hospital Militar "Dr Carlos Arvelo" , así mismo se revisa la literatura correspondiente