ABSTRACT
BACKGROUND: Craniocerebral invasive Aspergillosis of sino-nasal origin has been reported with a very high mortality due to a peculiarly fulminant clinical course. Early diagnosis based on clinical radiological imaging may have an impact on final clinical outcome. This retrospective study focuses on characteristic MR imaging features of Aspergillosis (of sinonasal origin) in immunocompetent patients. METHODS: Medical records of patients were reviewed retrospectively during the period from 1991 to 2003 in the two tertiary care hospitals. All the patients had radiological evidence of disease in the paranasal sinuses with or without intracranial extension. Immunocompetence of patients was assessed on clinical and radiological data. MRI scans (n=20) were reviewed by both clinical neurosurgeons and neuroradiologists separately. MRI was done on 1.5 tesla scanners and both T2-weighted and T1 weighted sequences were obtained followed gadolinium enhanced images. Patients were categorized into three types based on their anatomical location on MRI scans; type-1 being intracerebral, type-2 as intracranial extradural and type-3 invading orbit and/or skull base only. All these patient had the epicenter of disease in the nose and/or paranasal sinuses as evident on MR imaging. All patients underwent standard surgical intervention followed by antifungal therapy. Clinical outcome was assessed on Glasgow outcome scale with mean duration of clinical follow up of 13.9 months. FINDINGS: Mean age of patents (n=20) was 31.1 years with male preponderance (3:1). MRI scans showed evidence of disease in paranasal sinuses including mucosal thickening (n=11) and complete filling of sinuses (n=9). T2-weighted images showed extremely hypo-intense fungal mass (n=19) while T1-weighted images had iso-intense signals (n=18). Gadolinium-enhanced images showed bright homogenous contrast enhancement (n=18) and peripheral ring enhancement pattern (n=2). All patients underwent appropriated surgical procedures depending upon anatomical location followed by standard antifungal therapy. Tissue diagnoses were established by histopathology (n=20) and culture growth (n=5). Overall mortality remained 15 percent. INTERPRETATION: Craniocerebral Aspergillosis of sinonasal origin has typical MR imaging features. These features include a mass lesion producing hypo-to-iso-intense signals on T1-weighted, extremely low signals (hypo-intense) on T2-weighted images, with bright homogenous enhancement on post-gadolinium T1-weighted imaging. These features in the clinical background may be helpful in early diagnosis and management of Aspergillosis of sino-nasal origin in immunocompetent hosts. Prospective clinical study is required to make firm clinical therapeutic recommendations.
Subject(s)
Brain/microbiology , Brain/pathology , Meningitis, Fungal/diagnosis , Neuroaspergillosis/diagnosis , Skull Base/microbiology , Skull Base/pathology , Adolescent , Adult , Aged , Antifungal Agents/administration & dosage , Brain/physiopathology , Disease Progression , Female , Humans , Immunocompetence/immunology , Magnetic Resonance Imaging , Male , Meningitis, Fungal/physiopathology , Meningitis, Fungal/therapy , Middle Aged , Nasal Cavity/microbiology , Nasal Cavity/pathology , Nasal Cavity/physiopathology , Neuroaspergillosis/physiopathology , Neuroaspergillosis/therapy , Neurosurgical Procedures , Orbit/microbiology , Orbit/pathology , Orbit/physiopathology , Paranasal Sinus Diseases/complications , Paranasal Sinus Diseases/microbiology , Paranasal Sinus Diseases/physiopathology , Paranasal Sinuses/microbiology , Paranasal Sinuses/pathology , Paranasal Sinuses/physiopathology , Retrospective Studies , Skull Base/physiopathology , Survival Rate , Treatment OutcomeABSTRACT
Syringomyelia may complicate cervical spondylotic myelopathy (CSM). We describe a case of CSM with instability at C3/4 and a cervicothoracic syrinx which was demonstrated using magnetic resonance imaging. Decompression and stabilization, without drainage of the syrinx, were adequate surgical treatment.
Subject(s)
Cervical Vertebrae/physiopathology , Muscular Atrophy, Spinal/complications , Spinal Osteophytosis/complications , Syringomyelia/complications , Aged , Cervical Vertebrae/surgery , Decompression , Female , Humans , Magnetic Resonance Imaging , Muscular Atrophy, Spinal/physiopathology , Spinal Osteophytosis/physiopathology , Spinal Osteophytosis/surgery , Syringomyelia/surgeryABSTRACT
A postsurgical pseudomeningocoele (PSPM) forms when cerebrospinal fluid extravasates through a dura-arachnoidal tear and becomes encysted within the wound. Patients may become symptomatic with wound swelling, headache and radiculopathy. A uniform method of repairing PSPMs is described which includes separation of the dura from the arachnoid, dural repair under operating microscope control, and the use of overlapped local flaps to reinforce the dura and obliterate the PSPM sac. Four recent cases are presented which were successfully treated using this method.
Subject(s)
Lumbar Vertebrae/surgery , Meningocele/etiology , Postoperative Complications , Adult , Aged , Arachnoid/surgery , Diagnosis, Differential , Dura Mater/surgery , Female , Humans , Intervertebral Disc Displacement/diagnostic imaging , Intervertebral Disc Displacement/surgery , Laminectomy , Lumbar Vertebrae/diagnostic imaging , Male , Meningocele/diagnosis , Meningocele/diagnostic imaging , Middle Aged , Tomography, X-Ray ComputedABSTRACT
Two patients with Wegener's granulomatosis and spontaneous subarachnoid haemorrhage are presented in whom four vessel angiograms were normal. The diagnosis of Wegener's granulomatosis should be considered in patients with subarachnoid haemorrhage and negative four vessel angiography. The presence of antibodies to a neutrophil cytoplasmic antigen may be of diagnostic value.