Signal intensity of basal ganglions in T2 magnetic resonance imaging in multiple sclerosis

Although multiple sclerosis is a disease affecting white matter of brain and spinal cord, but involvement of basal ganglions in some studies demonstrated a decrease in T2 sequence signals. This study was done to assess signal intensity of basal ganglions in T2 magnetic resonance imaging [MRI] in multiple sclerosis. This case - control study was done on 30 multiple sclerosis patients and 30 controls in Imam Reza hospital, Kermanshah, Iran, during 2010. MRI images of multiple sclerosis of patients and control group were matched according to age and sex. The basal ganglia signals were identified based on involvement areas, number of plaques, and brain atrophy in T2 and flair sequences. Data were analyzed using SPSS-16, Chi-Square, Fisher exact test and independent t-tests. Among the case group, 10 patients [33.3%] demonstrated low signals in right thalamus and 14 patients [46.7%] in left thalamus, which was statistically significant compared with control group [P<0.001]. The presence of plaques in right and left globus pallidus was observed in 4 [13.3%] and 7 patients [23.3%] respectively. The presence of plaques in right and left thalamus was observed in 10 patients [33.3%] and 14 patients [46.7%] respectively, which was significant compared with control group [P<0.001]. The presence of brain atrophy was observed in 18 patients [60%] in case groups and in one patient [3.3%] in control group [P<0.001]. This study indicated that reduction of T2 signals in thalamus is a valuable finding in multiple sclerosis patients and it may facilitate the diagnosis of multiple sclerosis

[Descriptive investigation of causes of thunderclap headache in patients at Imam-Reza Hospital in Kermanshah from 2009 to 2011]

Headache is one of the most frequent causes of patient attendance in emergency rooms. One important type of headache is known as thunderclap headache which reaches its peak in approximately one minute. It has several different causes. The aim of this study was to evaluate the demographic and clinical characteristics and causes of this type of headache in the patients referring to Imam-Reza hospital in Kermanshah. In this descriptive analytic study, we reviewed the records of all the patients with thunderclap headache in Imam-Reza Hospital from April 2009 to April 2011. Demographic data, paraclinical investigations and final diagnoses were analyzed with SPSS software. This study included 48 patients, 28 female and 20 male patients with a mean age of 50.7 years. The most common accompanying complaints were nausea and vomiting. Brain imaging was performed for all patients. The most frequent cause of headache was subarachnoid hemorrhage. Cerebral venous thrombosis and intracerebral hemorrhage were the next common causes. Our findings revealed that the most frequent cause of thunderclap headache in our study population was subarachnoid hemorrhage. The second most frequent cause was cerebral venous thrombosis, and the least frequent causes were idiopathic intracranial hypertension and tension headache. A significant percentage of the causes of thunderclap headache can be life-threatening

[Report of a rare manifestation of cerebral venous thrombosis]

Straight sinus thrombosis can lead to bilateral thalamus infarct, and if it is not diagnosed on time, death of the patient will ensue. Bilateral thalamus infarct usually presents by loss of consciousness, memory disorders, vertical gaze palsy and psychological disturbances. Our patient was a 28-year old female who had history of fasting for 2 months and prolonged use of contraceptive pills, who referred to emergency department with loss of consciousness, weakness, and a history of severe headache, nausea, vomiting and hypophonic speech from 4 days ago. 10 hours prior to admission she developed disturbances of consciousness. Non contrast computed tomography scan of brain revealed a hyper dense area within the straight sinus and a hyper dense area in the body and posterior horn of right lateral ventricle which was indicative of hemorrhage. MRI and MRV revealed extensive thrombosis in the straight sinus which had led to acute bilateral ischemia in thalami. Anticoagulants, acetazolemide and phenytoin started for the patient for 5 weeks. When she regained her consciousness completely and there was no lateralizing sign, she was discharged from the hospital. Cerebral venous thrombosis can present with protean clinical manifestations in different age groups which may lead to misdiagnosis. Considering history, thinking of this diagnosis and availability of appropriate Para clinical facilities can decrease diagnostic errors

Diagnostic value of T2-weighted gradient-echo for diagnosis of cerebral venous thrombosis

The role of MRI has been increased for diagnosis of cerebral venous thrombosis during recent years. In this study the efficacy of T2 Gradient echo for diagnosing cerebral thrombosis has been assessed. This study was a descriptive-analytical study, which was focused on diagnostic values. Diagnostic value T2 GRE sequence of MRI is being evaluated and compared with common sequences of T1, T2, and FLAIR. Then, via Golden Standard of MR Venography, different sequences of MRI have been compared. Gathered data had been entered in SPSS software and through using descriptive statistical methods and data frequency, different sequence sensitivities were computed. Twenty one patients, including three males [14.3%] and 18 females [85.7%] with the average age of 36.00 +/- 10.13 participated in this study, and they have had a total number of 55 numbers of thrombosis. The most common clinical symptom, predisposing factor, involved sinus, and common underlying disorder was headache [95.2%], taking OCP [52.4%], superior sagittal sinus [71.4%], and infraction [47.6%] respectively. The sensitivity rates of T1, T2, and T2GRE sequence for diagnosis of acute thrombosis were 30%, 0, and 90% respectively, and for Early Sub-Acute cases they were 92.9%, 92.9%, and 100% respectively. T2 GRE sequence can be used as a quick diagnostic tool for diagnosing CVT before applying MR venography in patients. Using this sequence can be very effective, especially when it is critical to diagnose the disease quickly

[Incidence rate of cerebral venous thrombosis and its related factors in Kermanshah city in 2009-2010]

Cerebral venous thrombosis [CVT] is a rare disorder. Incidence of CVT in developing countries is not clear. This study was conducted to determine the incidence rate of cerebral venous thrombosis, its symptoms and some of its predisposing factors in Kermanshah city. This was a descriptive study. The sample size included 21 cases. Diagnosis of cases of CVT was based on MRI sequences T1, T2, FLAIR and approved by the gold standard MR venography over 12 months. The data were introduced into SPSS software and analyzed by means of descriptive statistics and the frequency of data was calculated. This study included 21 patients; three males [14.3%] and 18 females [85.7%] with a mean age of 36.00 +/- 10.13 years who had a total number of 55 thromboses. The most prevalent clinical symptoms, predisposing factor, associated disorder, and sinus involved, included headache [95.2%], OCP consumption [52.4%], infarction [47.6%] and superior sagital sinus [71.4%] respectively. This study showed that the incidence of cerebral venous thrombosis in Kermanshah is relatively higher in comparison to the statistics mentioned in other studies, so further studies for more evaluation of contributing factors in this disease are recommended