MRI Findings in Childhood PRES: What is Different than the Adults?

PURPOSE: Posterior reversible encephalopathy syndrome (PRES) is a clinical scenario with convulsion, vision abnormalities, altered mental status, and headaches in the presence of an underlying etiology, and the diagnosis can be made by support of radiological studies. In this study, we evaluated the magnetic resonance imaging (MRI) findings of PRES in children and compared our findings with that of the known features in adults, and reviewed the possible pathophysiological reasons that may cause the difference. MATERIALS AND METHODS: A total of 29 children (13 male, 16 female, aged 1-17 years, mean age: 10 years) diagnosed as having PRES were retrospectively reviewed. Clinical records were analyzed for the clinical symptoms and the underlying etiology. MR images were evaluated for the distribution of lesions, contrast enhancement, diffusion restriction, and hemorrhage. RESULTS: Presenting symptoms and underlying etiologies were variable. Frontal lobe (66 %) edema was almost as common as parietal and occipital involvement. Cerebellar involvement was present in almost half of the patients (48 %), which was more frequent than in the adult patients. Contrast enhancement is another finding that was found to be more common in children than in the adults (39 %). Four patients had diffusion restriction (15 %) and four patients had hemorrhage (%15), which are almost the same frequency as in the adults. CONCLUSION: The increased incidence of cerebellar involvement may show that the posterior circulation in children is more vulnerable than the adults. The contrast enhancement in children, which is seen more commonly than in the adults, may show that the pathophysiology in children may be more commonly related to blood-brain barrier breakdown, which can support the theory of the toxic endothelial injury.

[Hemicentral retinal artery occlusion associated with moyamoya syndrome]. / Hemizentralarterienverschluss bei Moyamoya-Syndrom.

Moyamoya syndrome is a rare cerebrovascular disorder characterized by bilateral progressive supraclinoidal stenosis or occlusion of the internal carotid artery and development of collateral vessels in the lenticulostriate region. The syndrome manifests itself in association with another disease or other clinical symptoms. We present the case of a 12-year-old girl with hemicentral retinal artery occlusion due to moyamoya syndrome associated with clinical and laboratory findings of presumed systemic lupus erythematosus.

Lumbar myxopapillary ependymoma mimicking neurofibroma.

OBJECTIVE: To report a case of lumbar myxopapillary ependymoma in whom neuroradiological and surgical findings strongly suggested neurofibroma. CLINICAL PRESENTATION: The patient presented with a 2 year history of progressive monoparesthesia and monoparesia of his right leg. He reported having minimal fecal and urinary incontinence. INTERVENTION: Total resection of the tumor was achieved by total L1-L2 laminectomies. There was no attachment to the spinal cord and dura. CONCLUSION: In spite of contemporary sophisticated neuroradiological facilities, we may still have diagnostic difficulties in some spinal tumors.

A case of incidentally detected Castleman's disease with retroperitoneal paravertebral localization.

Castleman's disease, or angiofollicular lymph node hyperplasia, is a fairly rare benign tumor of lymphoid origin. The expected localization is mediastinum and rarely retroperitoneum. An asymptomatic case is reported with multimodality imaging and postoperative findings. The lesion was detected incidentally on routine chest radiogram. Surgical exploration revealed a retroperitoneal mass and the mass was resected successfully through a thoracoabdominal flank incision. Castleman's disease should be included in the list of differential diagnosis of retroperitoneal masses which are mostly malignant tumors.

Giant posterior fossa teratoma.

In this study we report a rare case of a giant midline posterior fossa teratoma; its clinical presentation, radiological appearance, treatment and outcome, with an extensive review of the literature.

A comparison of transrectal ultrasonography and endorectal magnetic resonance imaging in the local staging of prostatic carcinoma.

OBJECTIVE: To compare the staging accuracy of transrectal ultrasonography (TRUS) and endorectal magnetic resonance imaging (eMRI) for organ-confined prostatic carcinoma. PATIENTS AND METHODS: Twenty-five patients with clinically confined prostatic adenocarcinoma were evaluated to be candidates for radical prostatectomy. All underwent TRUS and eMRI before surgery. Imaging findings evaluated prospectively in each patient were extracapsular extension (ECE), seminal vesicle invasion (SVI) and the site of involvement. The results of the imaging techniques were compared with the histopathological findings. As two patients with metastatic lymph nodes (detected on frozen-section examination during surgery) were spared radical prostatectomy, the final evaluation included 23 patients. RESULTS: Endorectal coil MRI was more sensitive than TRUS for detecting both ECE, SVI and the site of ECE involvement in organ-confined prostatic carcinoma. TRUS was more accurate than eMRI for detecting the site of SVI involvement. However, the overall staging accuracy rates for both imaging modalities were equal. CONCLUSIONS: Neither TRUS nor eMRI was significantly better than the other for determining the local extent of prostatic carcinoma. Therefore, TRUS should be the study of choice until MRI technology improves sufficiently in the preoperative staging of localized prostate cancer.

Double spinal cord injury in a patient with ankylosing spondylitis.

Ankylosing spondylitis patients are more prone to spinal fractures and these fractures commonly result in mobile nonunion. We report a patient with a 30-year history of ankylosing spondylitis who sustained double spinal cord injuries following minor trauma. The first injury occurred at the lumbar level due to pseudoarthrosis of an old fracture, and the second at the thoracic level following cardiopulmonary arrest and an episode of hypotension. The possible mechanisms of the injuries are discussed and maintaining normal blood pressure in these patients is emphasized.

Calcific myonecrosis.

Calcific myonecrosis is a rare and late sequela of compartment syndrome, which becomes symptomatic years after the initial trauma. We diagnosed this condition in a 64-year old man, 42 years after he sustained a shot-gun wound to the right lower leg. Total excision of a peripherally calcified, cystic mass, continuous with the anterior tibial muscle belly resulted in complete resolution of symptoms. Consideration of the diagnosis is warranted in patients with a history of major injury who develop a soft tissue mass in the traumatized compartment. The treatment of choice is marginal excision.

Interesting radiologic findings in suprasellar mass lesions. Report of three cases.

The authors report three quite rare lesions of the sellar/parasellar region. They are namely; pituitary abscess, cystic macroadenoma and osteochondroma. In none of the cases, the preoperative diagnostic priority was not same as the final histopathologic diagnosis. The radiologic findings of these pathologies are discussed with emphasis on differential diagnosis.

Intracranial calcification in children on computed tomography.

Pathological intracranial calcifications detected on computed tomography of 83 children during a six-year period were reviewed. The common causes in our series were tuberous sclerosis and intracranial tumors. Other conditions associated with calcification were Sturge-Weber syndrome, neurofibromatosis, Cockayne's syndrome, hypoparathyroidism, arteriovenous malformations, vein of Galen aneurysm, encephalomalacia, cerebral infarcts, subdural hematoma, cerebral infections, birth asphyxia and dihydropteridine reductase deficiency. In two cases (2%), calcifications were idiopathic. The distribution and location of the calcifications in these conditions are discussed.