ABSTRACT
The prevalence of tuberculosis (TB) has increased in developing and developed countries as a consequence of the AIDS epidemic, immigration, social deprivation, and inadequate TB control and screening programs. Spinal TB may be osseous or nonosseous. Classic findings of multiple contiguous vertebral body involvement, gibbus formation, and subligamentous spread with paravertebral abscesses are optimally evaluated with MR imaging. Nonspondylitic spinal TB is less well described in the literature, may develop in the absence of TB meningitis, and is often associated with meningovascular cord ischemia. Radiologists should be familiar with the spectrum of imaging findings, allowing early diagnosis and treatment of this serious condition.
Subject(s)
Magnetic Resonance Imaging , Tomography, X-Ray Computed , Tuberculosis, Spinal/diagnosis , Tuberculosis, Spinal/pathology , Adult , Child , Humans , Spine/diagnostic imaging , Spine/pathology , Tuberculosis, Spinal/diagnostic imagingABSTRACT
INTRODUCTION: Hemiconvulsion-hemiplegia-epilepsy (HHE) syndrome is a recognized sequel of febrile partial status in children younger than 4 years. OBJECTIVE: To describe the clinical features, neuroradiology and outcome in 8 South African children with HHE syndrome. METHOD: A retrospective descriptive study of 8 consecutive cases of HHE syndrome presenting to tertiary hospitals in the Western Cape over a 2 year period. RESULTS: The median age of onset of convulsive status was 16 months (range: 9-36 months). Gender distribution was equal. The duration of the initial episode of status exceeded 2 h in all children. All children were reported to have been developmentally normal prior to the onset of the first seizure and none previously suffered seizures or had a family history of febrile seizures and epilepsy. In 7 of the 8 cases the initial seizure was not associated with fever or preceding illness. Imaging demonstrated cerebral hemiatrophy in all and additional crossed cerebellar atrophy in 2 children. Moderate to severe intellectual disability ensued in the majority of children. The severity of the intellectual disability correlated with the degree of the motor deficit and occurred irrespective of the cerebral hemisphere involved. CONCLUSION: In contrast to developed countries, HHE syndrome is still prevalent in South Africa. The neurological morbidity in South African children is significant and highlights the need for improved emergency care of status epilepticus.
Subject(s)
Epilepsy/physiopathology , Hemiplegia/physiopathology , Seizures/physiopathology , Atrophy , Brain/pathology , Child Development , Child, Preschool , Cognition/physiology , Developing Countries , Diagnosis, Differential , Epilepsy/diagnostic imaging , Epilepsy/therapy , Female , Hemiplegia/diagnostic imaging , Hemiplegia/therapy , Humans , Infant , Intellectual Disability/etiology , Intellectual Disability/psychology , Intelligence Tests , Magnetic Resonance Imaging , Male , Movement/physiology , Retrospective Studies , Seizures/diagnostic imaging , Seizures/therapy , Seizures, Febrile/complications , South Africa , Syndrome , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
BACKGROUND: Tuberculous meningitis (TBM) is closely associated with miliary tuberculosis and a pathogenetic relationship is suspected, although it has been proposed that the two processes are unrelated. OBJECTIVE: To describe miliary tuberculosis of the central nervous system (CNS) on MRI in children with TBM. MATERIALS AND METHODS: A retrospective descriptive study of 32 paediatric TBM patients referred for MRI. The presence of miliary nodules in the CNS was recorded. Lesions were categorized according to their distribution, enhancement pattern, size and signal characteristics. RESULTS: A miliary distribution of nodules was present in 88% of patients. All patients with a miliary distribution had leptomeningeal nodules and 18% of these patients had deep parenchymal nodules in addition. At least one tuberculoma with central T2 hypointensity was identified in 39% of patients. CONCLUSION: The high prevalence of miliary leptomeningeal nodules in the CNS of children with TBM is significant because it points to a pathogenetic relationship that has long been suspected on epidemiological grounds. Our findings challenge the concept that miliary tuberculosis is only an incidental finding in TBM patients and suggest that it plays an integral part in the pathogenesis.
Subject(s)
Central Nervous System/pathology , Magnetic Resonance Imaging/methods , Tuberculosis, Meningeal/diagnosis , Tuberculosis, Meningeal/epidemiology , Tuberculosis, Miliary/epidemiology , Tuberculosis, Miliary/pathology , Adolescent , Brain/pathology , Child , Child, Preschool , Comorbidity , Contrast Media , Female , Gadolinium DTPA , Humans , Image Enhancement/methods , Infant , Male , Observer Variation , Prevalence , Retrospective Studies , Tuberculosis, Miliary/diagnosisABSTRACT
The endolymphatic sac tumour (ELST) is an adenomatous neoplasm of the papillary pattern originating from the endolymphatic sac's epithelium. We describe the computed tomography and magnetic resonance imaging features of a rare grade IV tumour with extensive skull base, cerebello-pontine and nasopharyngeal spread as well as involvement of the left temporomandibular joint. Papillary ELST may easily be misinterpreted on histopathological and even on immunohistochemical examination with other papillary lesions. Thus the radiological imaging features and localization in conjunction with histopathological features and clinical presentation play a paramount role in making the correct diagnosis.
