Correlation of brain segmental volume changes with clinical parameters: a longitudinal study in multiple sclerosis patients / Correlação das alterações do volume segmentar cerebral com parâmetros clínicos: um estudo longitudinal em pacientes com esclerose múltipla

Abstract Objective To measure the cranial volume differences from 15 different parts in the follow-up of relapsing-remitting multiple sclerosis (RRMS) patients and correlate them with clinical parameters. Methods Forty-seven patients with RRMS were included in the study. Patients were grouped into two categories; low Expanded Disability Status Scale (EDSS) (< 3; group 1), and moderate-high EDSS (≥ 3; group 2). Patients were evaluated with Beck Depression Inventory (BDI), Montreal Cognitive Assessment (MOCA), Symbol Digit Modalities Test(SDMT), Fatigue Severity Scale (FSS), and calculated Annualized Relapse Rate (ARR) scores. Magnetic resonance imaging (MRI) was performed with a 1.5T MRI device (Magnetom AERA, Siemens, Erlangen, Germany) twice in a 1-year period. Volumetric analysis was performed by a free, automated, online MRI brain volumetry software. The differences in volumetric values between the two MRI scans were calculated and correlated with the demographic and clinical parameters of the patients. Results The number of attacks, disease duration, BDI, and FSS scores were higher in group 2; SDMT was higher in group 1. As expected, volumetric analyses have shown volume loss in total cerebral white matter in follow-up patients (p < 0.001). In addition, putaminal volume loss was related to a higher number of attacks. Besides, a negative relation between FSS with total amygdala volumes, a link between atrophy of globus pallidus and ARR, and BDI scores was found with the aid of network analysis. Conclusions Apart from a visual demonstration of volume loss, cranial MRI with volumetric analysis has a great potential for revealing covert links between segmental volume changes and clinical parameters.

Resumo Objetivo Medir as diferenças de dominância craniana de 15 regiões diferentes no seguimento de pacientes com esclerose múltipla recorrente-remitente (EMRR) e correlacioná-las com parâmetros clínicos. Métodos Quarenta e sete pacientes com EMRR foram incluídos no estudo. Os pacientes foram agrupados em duas categorias; EDSS baixo (< 3; grupo 1) e EDSS médio-alto (≥ 3; grupo 2). Os pacientes foram avaliados com o Inventário de Depressão de Beck (BDI, na sigla em inglês), Montreal Cognitive Assessment (MOCA, na sigla em inglês), Symbol Digit Modality Tests (SDMT, na sigla em inglês), Fatigue Severity Scale (FSS, na sigla em inglês) e taxa de ataque anual (ARR, na sigla em inglês). Duas ressonâncias magnéticas (RMs) foram feitas em um ano com um aparelho de imagem de 1,5 T MR (Magnetom AERA, Siemens, Erlangen, Alemanha). A análise de volume foi realizada com um software de medição mestre cerebral de RM gratuito e automatizado. As diferenças volumétricas entre os dois exames de RM foram calculadas e correlacionadas com os parâmetros demográficos e clínicos dos pacientes. Resultados Número de crises, duração da doença, escores BDI e FSS foram mais elevados no grupo 2; as pontuações do SDMT foram maiores no grupo 1. Como esperado, as análises volumétricas mostraram perda total de volume de substância branca no seguimento (p < 0,001). Além disso, a perda da dominância putaminal foi associada ao maior número de ataques. Além disso, uma relação negativa entre FSS e volume total da amígdala, e uma correlação entre ARR e BDI e atrofia do globo pálido foi determinada com a ajuda da análise de rede. Conclusões Além da demonstração visual da perda de volume, a RM com análise volumétrica tem grande potencial para revelar alterações segmentares dominantes e conexões ocultas entre parâmetros clínicos.

Dermoid cyst with cerebellar meningoencephalocele at different locations accompanied by posterior fossa abnormalities: case report

ABSTRACT CONTEXT: Dermoid cysts are well-defined cysts containing sebaceous glands and dermal structures. In the literature, dermoid cysts and associated closure defects have been described in the same locations. CASE REPORT: In this case, a dermoid cyst was found at the base of the mouth with a coexisting closure defect in the occipital calvarium. Additional abnormalities were also observed, including posterior myeloschisis, right cerebellar dysgenesis, vermian hypogenesis and posterior fusion of the second and third vertebrae. The finding of a dermoid cyst located at the base of the mouth is discussed here, with additional imaging findings. CONCLUSION: Dermoid cysts in the head and neck region may be accompanied by posterior fossa abnormalities.

Recurrence of retroperitoneal localized perivascular epithelioid cell tumor two years after initial diagnosis: case report

ABSTRACT CONTEXT: Perivascular epithelioid cell tumors (PEComas) are rare mesenchymal tumors. Adjuvant radiotherapy and/or chemotherapy are administered according to the patient's clinical characteristics. CASE REPORT: A 42-year-old female patient was operated to treat a retroperitoneal mass. The diagnosis was established as PEComa with benign behavior. Two years after the diagnosis, chest and abdominal computed tomography scans showed intra-abdominal recurrence and lymphangioleiomyomatosis in the lung. Treatment with everolimus was started. The disease stabilized in the third month of treatment, according to the response evaluation criteria in solid tumors. CONCLUSION: PEComas are tumors with unpredictable behavior. Therefore, these patients require long-term follow-up, even in cases of correct diagnosis and benign PEComa.

Spontaneous rupture of right gastroepiploic artery aneurysm: a rare cause of hemorrhagic shock. case report

ABSTRACT CONTEXT: Aneurysms of the gastroepiploic arteries are seen only rarely. They are usually diagnosed during autopsy or laparotomy in patients with hemodynamic instability. Although the operation to treat this condition is relatively easy, delay in making the diagnosis affects the course of the disease. Case Report: A 57-year-old woman was admitted to the emergency department with abdominal pain and unconsciousness. A computed tomography scan showed extravasation of contrast agent at the headcorpus junction of the pancreas, and the patient underwent exploratory laparotomy under general anesthesia. During laparotomy, aneurysmatic rupture of the right gastroepiploic artery was detected. Control over bleeding was achieved by ligating the right gastroepiploic artery at its origin. The aneurysm was also resected and sent for pathological examination. CONCLUSION: Especially in cases of unidentified shock, splanchnic artery aneurysms should be kept in mind. Moreover, in the light of the data in the literature, the possibility of death should be taken into account seriously and, if feasible, prophylactic aneurysmectomy should be performed.