Partial epilepsy: A pictorial review of 3 TESLA magnetic resonance imaging features

Epilepsy is a disease with serious consequences for patients and society. In many cases seizures are sufficiently disabling to justify surgical evaluation. In this context, Magnetic Resonance Imaging (MRI) is one of the most valuable tools for the preoperative localization of epileptogenic foci. Because these lesions show a large variety of presentations (including subtle imaging characteristics), their analysis requires careful and systematic interpretation of MRI data. Several studies have shown that 3 Tesla (T) MRI provides a better image quality than 1.5 T MRI regarding the detection and characterization of structural lesions, indicating that high-field-strength imaging should be considered for patients with intractable epilepsy who might benefit from surgery. Likewise, advanced MRI postprocessing and quantitative analysis techniques such as thickness and volume measurements of cortical gray matter have emerged and in the near future, these techniques will routinely enable more precise evaluations of such patients. Finally, the familiarity with radiologic findings of the potential epileptogenic substrates in association with combined use of higher field strengths (3 T, 7 T, and greater) and new quantitative analytical post-processing techniques will lead to improvements regarding the clinical imaging of these patients. We present a pictorial review of the major pathologies related to partial epilepsy, highlighting the key findings of 3 T MRI.

Spinal Dural Arteriovenous Fistula: Imaging Features and Its Mimics

Spinal dural arteriovenous fistula (SDAVF) is the most common spinal vascular malformation, however it is still rare and underdiagnosed. Magnetic resonance imaging findings such as spinal cord edema and dilated and tortuous perimedullary veins play a pivotal role in the confirmation of the diagnosis. However, spinal angiography remains the gold standard in the diagnosis of SDAVF. Classic angiographic findings of SDAVF are early filling of radicular veins, delayed venous return, and an extensive network of dilated perimedullary venous plexus. A series of angiograms of SDAVF at different locations along the spinal column, and mimics of serpentine perimedullary venous plexus on MR images, are demonstrated. Thorough knowledge of SDAVF aids correct diagnosis and prevents irreversible complications.

Brainstem cavernous malformation / Cavernomas de tronco cerebral

Cavernous malformation (CM) of the central nervous system (CNS) are acquired or developmental vascular malformations that represent the 5% to 15% of all vascular malformations of the CNS. Eighty to ninety percent of CM are supratentorial, 15% infratentorial, and 5% occur in the spinal cord. The subset of brainstem malformation presents as a very difficult paradigm for treating clinicians. The widespread use of magnetic resonance imaging (MRI) has increased the recognition of this disease. Clinical presentation, pathophysiology and treatment are discussed in this article...

Os cavernomas do sistema nervoso central (SNC) são malformações vasculares do desenvolvimento ou adquiridas que representam 5% a 15% de todas as malformações vasculares do SNC. Dos cavernomas, 80% a 90% são supratentoriais, 15% são infratentoriais e 5% ocorrem na medula espinhal. As malformações do tronco encefálico se apresentam como um paradigma de decisão de tratamento muito difícil para os cirurgiões. O amplo uso das imagens por ressonância magnética aumentou o reconhecimento dessa patologia. A apresentação clínica, a fisiopatologia e o tratamento serão discutidos neste artigo...

Bilateral Carotid and Vertebral Rete Mirabile Presenting with a Prominent Anterior Spinal Artery Mimicking a Spinal Dural AV Fistula at MRI

Bilateral carotid and vertebral rete mirabile (CVRM) is a very rare condition. We report a new case of CVRM initially detected by magnetic resonance imaging (MRI) of the cervical spine. MRI demonstrated tortuous vascular signal voids limited to the anterior cerebrospinal fluid space mimicking spinal dural arteriovenous fistula. A diagnosis of CVRM was confirmed on the basis of angiographic findings of rete formation associated with bilateral aplasia of the cavernous internal carotid and vertebral arteries without abnormal arteriovenous connection.

Dural carotid cavernous sinus fistula: ocular characteristics, endovascular management and clinical outcome.

OBJECTIVE: To describe the ocular findings, endovascular treatment, and clinical outcome in patients with dural carotid cavernous sinus fistula (CCF). MATERIAL AND METHOD: A retrospective evaluation of 80 consecutive patients who underwent examination and treatment for dural CCF between January 1997 and December 2004 was performed. RESULTS: Fifty females and 30 males, with an average age of 49 years (from 6 -80 years) participated in this study. All patients had more than one clinical signs and symptoms including proptosis (84%), arterialization of conjunctival vein (93%), chemosis (42%), cranial nerve palsy (52%), elevated intraocular pressure (51%), and optic neuropathy (13%). Diminished vision was found in 43% of the patients. The degree of visual deficit ranged from 20/40 to no light perception. After angiographic evaluation, patients were classified to CCF Barrow's type B 14%, type C 15%, and type D 71%. Endovascular treatment by transvenous and/or transarterial embolization was performed in 60 patients (75%). Carotid-angular compression therapy was solely performed in 19 patients (24%) and was used as an adjunct to endovascular treatment in 30 patients (38%). The follow-up period ranged from 6 to 94 months. Clinical cure was achieved in 41 patients (51%) and improvement in 30 patients (38%). Anatomical cure was demonstrated by angiogram in 50 patients (63%). Intra-operative complications were found in three patients including ophthalmic artery occlusion and cerebral infarction. Eight patients experienced transient aggravation of symptoms including increased proptosis, elevation of intraocular pressure, choroidal detachment that required suprachoroidal drainage, and venous stasis retinopathy. Ophthalmic vein thrombosis resulting in central retinal vein occlusion was developed in three patients and finally caused severe visual deficit. There was no operative mortality. CONCLUSION: Selective management with endovascular therapy and manual compression are the effective treatment for dural CCF. However sight-threatening complications can develop after therapy due to progressive ophthalmic vein thrombosis and should be carefully monitored.

Síndrome lumbociático de etiología distinta a hernia discal / Etiology of lumbosciatic syndrome different from lumbar herniated disk

La causa más frecuente de lumbociática es la hernia de disco y la patología asociada de estenosis foraminal, espondilolistesis y entesopatía de la articulación facetaria, incluyendo quistes sinoviales. Existen una serie de condiciones que pueden presentar un cuadro clínico similar, y el problema es detectar estas causas infrecuentes en un universo muy grande de pacientes con patología discal. Esto crea una situación potencialmente peligrosa, en la cual se podría interpretar la sintomatología secundaria, por ejemplo a un tumor, como producida por una hernia discal, por otro lado asintomática. En base a una historia clínica cuidadosa y al uso racional de los exámenes complementarios, se puede sospechar aquellos casos que pudieran albergar esta patología de baja incidencia, pero de gran importancia clínica. Se revisan las causas más importantes que pueden provocar un síndrome lumbociático y que deben incluirse en el diagnóstico diferencial, como el síndrome piriforme, tumores intradurales y del nervio ciático y fístulas durales.

The most frequent etiology of sciatic pain is herniation of the nucleus pulposus and associated entesopathic diseases, including synovial cysts. There are several conditions that can present with a similar clinical picture, and the clinician is confronted with the problem of detecting this infrequent occurrences. This creates a potentially dangerous condition of thinking that an asymptomatic disc herniation is causing the symptoms that are originated higher by a tumor for example. With a careful history and judicious use of ancillary examinations, specially NMR, most of the cases can be suspected. The principal causes of non-discal sciatica are reviewed, including piriform syndrome, tumors of the spine and sciatic nerve, and dural fistulae.

Angiotac multislice con reconstrucción tridimensional en el diagnóstico de malformaciones vaculares cerebrales / 3D angioCT reconstruction for the diagnosis of cerebro vascular malformations

Objective: To presente the three-dimensional computed tomographic angiography (CTA). Material and methods: 17 patients with SAH were admitted January and July 2007. 15 patients with brain aneurysms and 2 patients with AVM’s. CTA was performed in 9 patients with brain aneurysms and 1 patient with AVM. Surgery was performed in 5 on the basis of CTA alone. CTA was used a postoperative control in 4 patients. Results: Surgical findings were compared with preoperative CTA and were considered accurate in all cases. However in postoperative CTA the presence of metallic devices (clips and stent), makes difficult the correct visualization of the nearby arteries. Conclusion: The 3D CTA is a useful diagnostic method for detection of brain vascular malformations in patients suffering SAH.

Fístulas durales intracraneales: reporte de un caso y revisión de la literatura / Dural arteriovenous fistulas: case report and review

Las fístulas arteriovenosas durales, son malformaciones consistentes en corto circuítos entre las arterias durales y extracraneales con los senos venosos durales. Son causa de consulta por acúfenos, cefalea o déficit neurológico producto de sus complicaciones, como hemorragia subaracnoídea (HSA), hematoma intracerebral (HIC) o edema vasogénico. En cuanto a su origen, este puede ser congénito o adquirido; el diagnóstico y su clasificación se realizan en base a la clínica, tomografía axial computada (TAC) y resonancia nuclear magnética (RMN), siendo el gold estándar la angiografía cerebral.

Pineal Cavernous Malformations: Report of Two Cases

Pineal hemorrhage only occurs in rare cases, and this known to have several different causes such as germ cell tumors, pineal cysts and vascular malformations, including the cavernous malformations. Pineal cavernous malformations are extremely rare: to date only fifteen cases have been reported worldwide. Although the diagnosis of pineal cavernous malformation is not easy because of the extreme rareness of this condition, the presence of this lesion can be suspected based on its typical radiological findings. Case 1. A 42-year- old man presented with a limitation in his upward gazing. Radiologic examinations showed acute hemorrhage in the pineal region. He underwent ventriculo-peritoneal (VP) shunting but the patient's condition deteriorated after the shunting surgery. We operated and totally removed the tumor and the hemorrhages via an occipital-transtentorial approach. Case 2. A 37-year-old man presented with diplopia. Radiologic examinations showed acute hemorrhage in the third ventricle. He underwent VP shunting, and after this procedure the diplopia was aggravated. We operated and totally removed the tumor and the hemorrhages via an occipital-transtentorial approach. If there is no doubt about the pineal cavernous malformation on MR imaging, we strongly recommend early surgical intervention without performing a risky biopsy. In this study, we describe our experiences for the diagnosis of cavernous malformations in the pineal region with special emphasis on the radiological aspects and the clinical course of this disease.