Magnetic Resonance Imaging of Autoimmune Demyelinating Diseases as a Diagnostic Challenge for Radiologists: Report of Two Cases and Literature Review.

The magnetic resonance characteristics of autoimmune demyelinating diseases are complex and represent a challenge for the radiologist. In this study we presented two different cases of detected autoimmune demyelinating diseases: one case of acute disseminated encephalomyelitis and one case of neuromyelitis optica, respectively. Expected and unexpected findings of magnetic resonance imaging examination for autoimmune demyelinating diseases were reported in order to provide a valuable approach for diagnosis. In particular, we highlight, review and discuss the presence of several uncommon imaging findings which could lead to a misinterpretation. The integration of magnetic resonance imaging findings with clinical and laboratory data is necessary to provide a valuable diagnosis.

Intracranial capillary hemangioma: a description of four cases.

OBJECTIVE: Capillary hemangiomas are benign vascular lesions involving the skin and soft tissues that commonly occur at birth or an early age. Intracranial capillary hemangiomas are extremely rare; only 14 cases have been reported the literature. CASE DESCRIPTION: We describe four patients with capillary hemangiomas. In two of these patients the lesions arose from the cavernous sinus. In the third patient, a large capillary hemangioma arising from the middle cranial fossa extended into the infratemporal fossa. The fourth patient had a left hemorrhagic temporoparietal capillary hemangioma. RESULTS: The first two patients underwent a partial resection, followed by radiotherapy. Local tumor control was achieved in both cases, as shown by the follow-up magnetic resonance imaging. In the third patient the lesion was subtotally removed after embolization. Radiotherapy, performed one year after surgery because of recurrence, allowed tumor control. In the fourth patient surgical removal was total and no adjuvant radiotherapy was required after surgery; follow-up magnetic resonance imaging did not show any recurrence at the one-year follow-up. CONCLUSION: Surgery is an option for symptomatic intracranial capillary hemangiomas. However, because partial removal is associated with a high recurrence rate, capillary hemangiomas that cannot be removed radically should be treated with radiotherapy, which offers the possibility of controlling lesion size and preventing tumor recurrence.

[Non-recurrent inferior laryngeal nerves and sympathetic-inferior laryngeal anastomotic branches: 6 years' personal experience]. / Il nervo laringeo inferiore non ricorrente e le anastomosi con il simpatico cervicale. La nostra esperienza di 6 anni.

The incidence and possible association of inferior laryngeal nerve and sympathetic anastomotic branch anomalies were evaluated in this study. Non-recurrent inferior laryngeal nerves stem from vascular anomalies involving the right subclavian artery and aortic arches during embryological development. These anomalies usually have no functional consequences (except for occasional dysphagia), but are potentially dangerous during thyroid surgery, occurring in about 1% of cases. Sympathetic-inferior laryngeal anastomotic branches are described in about 1.5% of cases, and may be confused with non-recurrent inferior laryngeal nerves. 1473 patients submitted to total thyroidectomy for benign disease over the period 2001-2006 were evaluated. Four non-recurrent inferior laryngeal nerves (incidence: 0.27%) and 11 sympathetic-inferior laryingeal anastomotic branches (incidence: 0.74%) were observed. Out of a total of 25 definitive inferior laryngeal nerve lesions, 1 occurred in a case of non-recurrent inferior laryngeal nerve. Awareness of the anatomical anomalies described and accurate surgical technique, including a constant search for the inferior laryngeal nerve, are the requirements for identification of non-recurrent inferior laryngeal nerves and sympathetic-inferior laryngeal anastomotic branches. During the pre-operative workup, ultrasonographic study of the right subclavian artery may be advisable in order to rule out alterations of its origin and course.

Extradural arteriovenous fistulas involving the vertebral artery in neurofibromatosis Type 1.

Spinal extradural arteriovenous fistulas (AVFs) are rare lesions that may be associated with neurofibromatosis Type 1 (NF1). In these patients, the shunt typically occurs between the V(2) segment of the vertebral artery and the epidural venous plexus. Previously, reported cases have been treated either by using endovascular embolization or, sporadically, by open surgery. In surgical reports, proximal deafferentation or manipulation of the venous portion of the shunt--including suture, resection, or open embolization of the epidural ectasia--was attempted with variable results. The authors report on a case of a young patient with NF1 who underwent emergency surgical disconnection of a cervical extradural AVF after previously unsuccessful endovascular and surgical therapy. The lesion drained into a giant intrathecal varix, causing severe myelopathy. After surgery, the patient recovered almost completely. This experience clarified the surgical anatomy of these malformations and showed that, when surgery is necessary, the optimal treatment providing complete and permanent cure of this condition is direct closure of the epidural shunt pedicle.

BOLD signal and vessel dynamics: a hierarchical cluster analysis.

The aim of the present study was to analyze blood oxygenation level-dependent (BOLD) signal variation during an apnea-based task in order to assess the capability of a functional magnetic resonance imaging (fMRI) procedure to estimate cerebral vascular dynamic effects. We measured BOLD contrast by hierarchical cluster analysis in healthy subjects undergoing an fMRI experiment, in which the task paradigm was one phase of inspirational apnea (IA). By processing the time courses of the fMRI experiment, analysis was performed only on a subclass of all the possible signal patterns; basically, root mean square and absolute variation differences have been calculated. Considering the baseline value obtained by computing the mean value of the initial rest period as reference, particular voxels showed relative important variations during the IA task and during the recovery phase following the IA. We focused our interest on the signal response of voxels that would correspond mainly to white and gray matter regions and that also may be affected by the proximity of large venous vessels. The results are presented as maps of space-temporal distribution of time series variations with two levels of hierarchical clustering among voxels with low to high initial response. Furthermore, we have presented a clustering of the signal response delay, conducting to a partition and identification of specified brain sites.