Apport de l'IRM multimodale dans la prise en charge des tumeurs encéphaliques chez l'adulte à Abidjan / Contribution of multimodal MRI in the management of brain tumors in adults in Abidjan

Dans le monde, le nombre de nouveaux cas de tumeurs encéphaliques était de 14 millions en 2014 avec environ 8 millions de personnes décédées. Objectif: déterminer l'efficacité diagnostique de l'IRM multimodale dans la prise en charge des tumeurs encéphaliques dans notre contexte. Matériels et Méthodes: Etude rétrospective à visée descriptive, multicentrique sur une période de 2 ans allant de février 2017 à mars 2019, dans 2 services de radiologie et 2 services de Neurochirurgie, à Abidjan. Nous nous sommes intéressés àtous les patients ayant réalisé une IRM multimodale pour suspicion d'un processus tumoral encéphalique, et qui ont eu une exérèse chirurgicale suivie d'un examen anatomopathologique de la pièce opératoire. Les examens d'IRM multimodale encéphaliques ont été réalisés selon un protocole standard sur des appareils de 1,5 Tesla, et lus par des radiologues séniors. Nous avons confronté les résultats anatomopathologiques aux diagnostics posés à l'imagerie IRM multimodale.Résultats: Ont été retenu 18 dossiers. On notait une prédominance masculine avec un sex-ratio de 1,57. L'âge moyen était de 42,8 ans avec des extrêmes de 20ans et 61ans et un écart type de 10,75.La corrélation diagnostique entre l'examen anatomopathologique et l'IRM a été de6 sur 7 cas, 4 sur 5 cas, 2 sur 2 cas, 2 sur 2 cas et 1 sur 1 cas respectivement pour le méningiome, le gliome, les métastases, l'adénome hypophysaire, le lymphome cérébral primitif.Conclusion:Les tumeurs encéphaliques dans notre étude, étaient variéeset concernaient la population jeune. Les motifs d'erreur diagnostique étaient essentiellement en rapport avec la variété de présentations des tumeurs à l'IRM et l'expérience récente de nos radiologues sur l'utilisation efficace des séquences avancées.

Worldwide, the number of new cases of brain tumors was 14 million in 2014 with approximately 8 million people dying.Objective: determine the diagnostic effectiveness of multimodal MRI in the management of brain tumors in our context.Methods: Retrospective study with a descriptive aim, multicenter over a period of 2 years from February 2017 to March 2019, in 2 radiology departments and 2 neurosurgery departments, in Abidjan. We were interested in all patients who had a multimodal MRI for suspicion of a brain tumor process, and who had a surgical excision followed by an pathological examination of the surgical specimen. The multimodal brain MRI examinations were carried out according to a standard protocol on 1.5 Tesla devices, and read by seniorradiologists. We compared the pathological results with the diagnoses made on multimodal MRI imaging.Results:18 files were retained. There was a male predominance with a sex ratio of 1.57. The average age was 42.8 years with extremes of 20 and 61 years and a standard deviation of 10.75. The diagnostic correlation between the pathological examination and MRI was 6 out of 7 cases, 4 out of 5 cases, 2 out of 2 cases, 2 out of 2 cases and 1 out of 1 case respectively for meningioma, glioma, metastases, pituitary adenoma, primary cerebral lymphoma.Conclusion: The brain tumors in our study were varied and concerned the young population. The reasons for diagnostic error were mainly related to the variety of tumor presentations on MRI and the recent experience of our radiologists on the effective use of advanced sequences.

Metronidazole: A culprit to balance and speech

In a country like India, oral metronidazole is the commonly prescribed drug of choice for entities such as amebiasis and visceral abscesses. Oral such cases, it is usually well tolerated and safe but can cause serious neurological adverse events. Peripheral neuropathy commonly encounters in practice but central nervous system toxicity is also well documented as it crosses the blood–brain barrier easily. Neurological toxicity of metronidazole may be due to prolonged administration, high doses, or high cumulative doses. Magnetic resonance imaging (MRI) of brain is the modality of choice to evaluate brain involvement. In the brain, the splenium of the corpus callosum, dentate nucleus of the cerebellum, and posterior pons involvement are commonly seen and diagnostic. Here, we have an interesting case report of a patient who was on oral metronidazole treatment for his large liver abscess, presenting with a complaint of neurological symptoms of unsteady gait, vertigo, dysdiadochokinesia, and difficulty in speech. Moreover, thus suspected as metronidazole drug toxicity and further investigated for the same, and MRI typically shows cerebellar and posterior corpus callosal involvement

Case Report: Arterial Spin Labeling Perfusion MRI Contribution for Clinical Implementation of Brain Disease

@#Currently, ASL is widely used as an additional breakthrough sequence in MRI due to acquiring reliable results. The case report aims to prove the efficacy and effectiveness of a quantitative method of ASL sequence through the calculation of the cerebral blood flow (CBF) on CBF maps in different cases. ASL sequence has been done on four patients with different cases. Then, the authors put 2 regions of interest (ROI) for measurement in normal and different regions on CBF maps and then calculated the average value result from CBF maps. ASL has been proven as a reliable and breakthrough sequence in MRI for detecting brain disease with a non-invasive method through the calculation of CBF value. ASL should be used as an additional protocol in brain examinations because it allows radiologists to assess the significance of CBF values using a quantitative method that is more reliable and non-invasiv

An Uncommon Presentation of a Common Etiology : Tubercular Cerebral Abscess in Pulmonary TB

A patient, recently diagnosed with Pulmonary Tuberculosis and on ATT for the last 1 month, was initially admitted in a primary care setup with severe headache and altered consciousness for 5 days and then referred to our institute for further management. Extensive investigations and imaging led to the conclusion that the patient had a massive Tubercular Brain Abscess (TBA) in the background of Pulmonary TB

Seizures in a child with tuberculomas: case report

Central tuberculomas, occurring because of the haematogenous spread of' M. tuberculosis, can present variably with the symptoms ranging from headache, decreased level of consciousness, neck stiffness to altered mental status, seizures and focal deficits. Diagnostic investigations include but are not limited to CSF analysis, MRI Brain, CT head, and AFB smear, mycobacterial cultures or CBNAAT of the CSF sample. Magnetic resonance spectroscopy can help distinguishing the tuberculoma from its differentials by showing a peculiar lipid peak. Treatment with the antituberculosis drugs over a prolonged period of time along with dexamethasone usually shows significant clinical improvement. Authors present to you the case report of an 8 year old boy who presented to the pediatric emergency with generalized tonic clonic seizures and was subsequently detected with the tuberculoma with the help of MRI Brain and CBNAAT (cartridge based nucleic acid amplification test) of CSF sample. The objective of this case report is to discuss the symptoms, pathogenesis, detection and management of tuberculomas, which are still quite common in the developing countries and if left untreated are associated with high morbidity and mortality.

Starry sky appearance of tuberculoma

CNS tuberculosis accounts for only 10% of all cases of tuberculosis, carries a high mortality and morbidity. Tuberculoma of the brain is an important clinical entity. The main challenge in the management of brain tuberculoma is its diagnosis. Hereby, referring case of a 12 years old male child who presented with clinical picture of tuberculosis but radiologically NCC, hence posing a diagnostic dilemma as clinically it was in the favor of tuberculosis whereas radiologically inclination was towards neurocysticercosis. Based on clinical manifestations it was suggestive of meningitis, CSF picture was suggestive of hypoglycorrhachia. CT chest showed miliary pattern and neuroimaging showing multiple ring enhancing lesions. High index of clinical suspicion is required to make a diagnosis and evaluation with reports.

A novel approach for pre-surgical evaluation of facial morphometry in children using magnetic resonance imaging scans of the brain: a feasibility analysis / Un enfoque novedoso para la evaluación prequirúrgica de la morfometría facial en niños mediante imágenes por resonancia magnética de cerebro: un análisis de viabilidad

Pre-surgical evaluation of facial morphometry is frequently warranted for children with facial dysmorphism. Though many methods utilized previously for such purposes, data is scarce on using magnetic resonance (MRI) brain images for such purposes. The purpose of this study was to appraise the feasibility of utilizing MRI brain scans done in epilepsy imaging protocol to assess facial morphometry. Measurements of the face; orbit, mouth, and nose of children aged 1 to 7 years were obtained using T1 sagittal, T2 axial and three dimensional (3D) MRI images of the brain (n=20). Ability to obtain facial measurements, inter and intra-observer variability calculated. The mean age of the studied children was 4±2 years, of which 40% (n=8) were boys, and 60% (n=12) were girls. Obtaining facial measurements were reliable with high intra-observer (α=0.757 to 0.999) and inter-observer agreements (α=0.823 to 0.997). The landmarks of the cranium, upper face, and upper nose could be identified (100%) in both two dimensional (2D) and 3D images when such landmarks were contained in the imaging field of view (FOV). Landmarks of lower nose, (subalar width = 0%) or mouth (0%) were not contained in the FOV of 2D images, but contained in 3D images (100%). Both 2D and 3D images did not allow assessment of lower face or the mandible as such landmarks were not contained in the FOV.We conclude thatBrain MRIs performed to evaluate cerebral pathology can be executed to assess facial measurements, provided the FOV of the scan is adjusted to include all significant landmarks.

La evaluación prequirúrgica de la morfometría facial con frecuencia se justifica para niños con dismorfismo facial. Aunque muchos métodos se utilizaron anteriormente para tales fines, los datos son escasos sobre el uso de imágenes cerebrales por resonancia magnética (MRI) para tales fines. El propósito de este estudio fue evaluar la viabilidad de utilizar resonancias magnéticas cerebrales realizadas en el protocolo de imágenes de epilepsia para evaluar la morfometría facial.Medidas de la cara, la órbita, la boca y la nariz de niños de 1 a 7 años se obtuvieron mediante imágenes de resonancia magnética cerebral T1 sagital, axial T2 y tridimensional (3D) del cerebro (n = 20). Se obtuvieron las medidas faciales, y fue calculada la variabilidad inter e intraobservador.La edad de los niños estudiados fue de 4 ± 2 años, de los cuales el 40% (n = 8) hombre y el 60% (n = 12) mujer. La obtención de medidas faciales fue confiable con altos acuerdos intraobservador (α = 0,757 a 0,999) e interobservador (α = 0,823 a 0,997). Los puntos de referencia del cráneo, la cara superior y la nariz superior se pudieron identificar (100%) tanto en imágenes bidimensionales (2D) como en 3D cuando dichos puntos de referencia estaban contenidos en el campo de visión de la imagen (FOV). Los puntos de referencia de la parte inferior de la nariz (ancho subalar = 0%) o la boca (0%) no estaban contenidos en el campo de visión de las imágenes 2D, sino que estaban contenidos en las imágenes 3D (100%). Tanto las imágenes 2D como las 3D no permitieron la evaluación de la parte inferior de la cara o la mandíbula, ya que tales puntos de referencia no estaban contenidos en el campo de visión.Concluimos que las resonancias magnéticas cerebrales realizadas para evaluar la patología cerebral se pueden usar para evaluar las medidas faciales, siempre que el campo de visión de la exploración se ajuste para incluir todos los puntos de referencia importantes.

Pulse Sequence Single Shot Fast Spin Echo for Reducing Motion Artefact on MRI of the Brain

Abstract@# This research was motivated by the increase of brain MRI examinations in emergency medicine. In an emergency, patients are often uncooperative, and they raise motion artefact on the image. Therefore, fast scanning techniques such as pulse Sequence Single Shot Fast Spin Echo (SS-FSE) is required to reduce the artefact. This study was conducted to determine the effectiveness of using SS-FSE technique to minimize motion artefact. Methods: This study was an observational analytic with prospective methods. Scanning was conducted to 16 normal patients (volunteers). Two neuro radiologists retrospectively and independently reviewed all images. Observations used standard diagnostic of brain MR Image by evaluating the anatomical and morphological structure. Results: Based on the results of the analysis of each organ that was assessed, it was obtained that the average of the image for overall organs on the brain; 76% looks sharp, 21% looks moderate (minimum blurred), and 3% looks blurred. Conclusion: SS-FSE technique affects reducing motion artefact due to object movement in MRI brain. The overall image SS-FSE produced has good image quality.

A Rare Case Of Space Occupying Lesion Of Brainstem In An Elderly Male Patient

An elderly male patient aged 65 presented to us with history of swaying towards left side of the body since 1 month with normal higher mental functions and neurological examination suggestive of cerebellar ataxia. MRI Brain plus contrast was suggestive of an irregular, ill-defined heterogeneous enhancing lesion with few necrotic areas within and few foci of blooming on FFE (Fast Field Echo imaging technique) with significant perilesional oedema involving right thalamus and brainstem showing Choline peak on MR Spectroscopy.

A study on idiopathic intracranial hypertension

Background: IIH is defined as an elevated intracranial pressure but no clinical, laboratory or radiological evidence of hydrocephalus, infection, tumor or vascular abnormality. Aim: To study the clinical and radiological profile of Idiopathic Intracranial Hypertension (IIH). Materials and methods: Total 31 IIH cases were studied. Patients were subjected to Fundoscopy, CT/MRI brain and CSF analysis. Results: Females were predominant and Headache was the most common presenting symptom. All patients had papilledema. Mean CSF pressure was 318.1 mm of H2O. MRI findings included prominent subarachnoid space, vertical tortuosity of optic nerves, flattening of posterior sclera. Conclusion: IIH predominantly affects women with headache being the most common symptom. Medical management and Life style medication is mostly useful. Surgical management is imperative in patients with impending vision loss.

Parkinsonism and brain mri findings in a relapsed culture-proven Salmonella typhi infection: a case report in Malaysia

Typhoid fever is a systemic infection caused by Salmonella typhi, which may be associated with extra-intestinal complications. Neurological manifestations, particularly Parkinsonism, are rarely reported. We report a 17-year-old patient with relapsed culture-proven Salmonella typhi infection who developed septic shock and subsequently Parkinsonism. Lumbar puncture revealed acellular cerebrospinal fluid with raised protein level. Magnetic resonance imaging revealed cerebral petechial haemorrhages resulted from small vessels vasculitis. His symptoms resolved spontaneously after 3 months.

Hypoglycemic Brain Injury: A Case Report.

Diverse neurologic manifestations of hypoglycemia have been reported. Hypoglycemia can cause various neurologic symptoms including profound memory loss, transient motor deficits, a persistent vegetative state and death in 2-4% of cases. Brain magnetic resonance imaging (MRI) is a useful technique to evaluate hypoglycemic brain damage. We describe herein characteristic brain MR diffusion imaging features in a diabetic patient who had severe hypoglycemia.