ABSTRACT
We present an illustrative case to address anterior temporal lobe atrophy with poor delineation of the temporopolar gray-white matter interface based on T2-weighted and fluid-attenuated inversion recovery (FLAIR) images in patients with temporal lobe epilepsy associated with hippocampal sclerosis (TLE-HS). A 52-year-old woman with pharmacoresistant seizures since the age of six months underwent a previous MRI scan using a suboptimal protocol which was reported as unremarkable. MRI performed according to an epilepsy protocol showed classic signs of left HS and ipsilateral temporal polar atrophy with blurring of the gray-white matter boundary on FLAIR images. She underwent a left amygdalohippocampectomy and anterior temporal resection and remains seizure-free after 24 months. Histopathological analyses showed HS and no signs of focal cortical dysplasia (FCD). Blurring and atrophy of the ipsilateral temporal pole are common in TLE-HS and often misinterpreted as FCD. This relates to delayed myelination in patients with seizures before the age of two, is more pronounced on FLAIR sequences, and gives a false impression of cortical thickening. However, the T1-weighted images show a relatively well-demarcated cortical-subcortical transition and normal cortical thickness. By contrast, the cortical thickening in FCD is observed on both T1-weighted and FLAIR images. Since FCD also occurs in temporal lobe regions, it is important to differentiate the extra-hippocampal MRI abnormalities in TLE-HS from those likely to be FCD. This case highlights the importance of evaluation based on detailed imaging, which should always be conducted considering the EEG, seizure semiology, and other clinical information.
Subject(s)
Gray Matter , Hippocampus , White Matter , Female , Gray Matter/diagnostic imaging , Gray Matter/pathology , Hippocampus/diagnostic imaging , Hippocampus/pathology , Humans , Magnetic Resonance Imaging , Middle Aged , Sclerosis , White Matter/diagnostic imaging , White Matter/pathologySubject(s)
Cerebral Cortex/diagnostic imaging , Epilepsy/diagnosis , Glioma/diagnostic imaging , Seizures/diagnosis , Anticonvulsants/therapeutic use , Brain Neoplasms/diagnostic imaging , Constriction, Pathologic/etiology , Electrodes, Implanted , Electroencephalography , Epilepsy/drug therapy , Humans , Laryngeal Diseases/etiology , Levetiracetam/therapeutic use , Magnetic Resonance Imaging , Male , Middle Aged , Seizures/drug therapyABSTRACT
Objetivo: determinar la incidencia de parto vaginal despues de una cesarea previa y evaluar la capacidad predictiva del puntaje predictor de parto vaginal descrito por Flamm en 1997. Materiales y métodos: estudio de cohorte retrospectivo de mujeres con antecedente de cesarea y embarazo de al menos 37 semanas, que consultaron al Hospital San Juan de Dios de Cali (HSJD) entre mayo 30 de 2007 y mayo 30 de 2008. Se calculo la tasa de parto vaginal y se evaluo la sensibilidad, especificidad, valores predictivos positivo (VPP) y negativo (VPN) y las razones de verosimilitud positiva (RVP) y negativa (RVN) del puntaje predictor de parto vaginal después de una cesárea cuando los valores de estos son de 4 o mas y de 8 o mas. Resultados: la proporcion de parto vaginal en este grupo fue del 20,3%. El 36% de las gestantes con puntajes entre 4 y 7 tuvieron parto vaginal y el 83% de las gestantes con 8 o mas puntos. Con un punto de corte >_ 4 puntos la sensibilidad fue de 85,7%, la especificidad 69,1%, VPP 41,3% y VPN 95%, RVP 2,8 y RVN 0,2. Si el punto de corte fue >_ 8 la sensibilidad fue de 83,3%, la especificidad 82,6%, VPP 17,9% y VPN 99,1%, RVP 4,8 y RVN 0,2. Conclusion: la frecuencia de parto vaginal posterior a cesarea es del 20%. Las gestantes con puntajes menores de 4 tuvieron una baja probabilidad de tener un parto vaginal...
Objective: determining the incidence of vaginal birth following a prior cesarean section and evaluating the predictive ability of the vaginal birth predictor score on the admission scoring system described by Flamm in 1997. Materials and methods: this was a retrospective cohort study of women having undergone a prior cesarean section and then a pregnancy lasting at least 37 weeks who had consulted at the San Juan de Dios hospital in Cali (HSJD) between May 30th 2007 and May 30th 2008. The vaginal birth rate was calculated and sensitivity, specificity, positive (PPV) and negative predictive values (NPV) were evaluated, as were positive (RVP) and negative verisimilitude ratios (RVN) regarding vaginal birth predictor score following a cesarean when their scores were 4 or more and 8 or more. Results: there were 20.3% vaginal births in this group; 36% of the pregnant women having scores between 4 and 7 had undergone vaginal birth and 83% of the expectant mothers scoring 8 or more. A >_ 4 points cut-off point gave 85.7% sensitivity, 69.1% specificity, 41.3% Positive Predictive Value (PPV) and 95% Negative Predictive Value (NPV) and 2.8 Positive likelihood ratio P LR(+) and 0.2 Negative likelihood ratio (NLR). If cut-off point were >_8, then this gave 83.3% sensitivity, 82.6% specificity, 17.9% PPV, 99.1% NPV, 4.8 RVP and 0.2 RVN. Conclusion: vaginal birth frequency following a cesarean section was 20%. Pregnant women having scores less than 4 had a low probability of having a vaginal birth...
