The Visualization and Frequency of Cerebral Cavernous Angioma on Magnetic Resonance.

Background: Cavernous angiomas (CAs) are abnormal, congenital, vascular malformations, which often grow in size over the course of life. Conservative treatment, microsurgical resection, and stereotactic radiosurgery are the three main options for treatment of CA. Radiological studies play a key role in diagnosis, with magnetic resonance (MR) being the method of choice. Objective: The aim of this study was to establish the prevalence of cavernous angiomas, the size, appearance, that is, the type of CAs and to determine visualization of cavernous angiomas by magnetic resonance. Methods: The study included all patients who underwent an MR of the brain in the period from January 2011 to the end of December 2017 at the Radiology Clinic of Tuzla University Clinical Centre, and in whom MR examination verified one or more CAs. Results: The prevalence of cavernous angioma in the study was 0.57%, and men and women were equally represented. The number of cavernous angiomas per patient was between 1 and 79 ; the average diameter was 11mm, and the most common type at ≥ 3mm was equivalent to Type II, whilst the largest number of cavernous angiomas, regardless of the size and visualization on individual sequences, were equivalent to Type IV. No significant difference was found in sensitivity between spin echo sequence and T2W gradient echo sequence in the group comprised of cavernous angiomas ≥ 3mm, whilst in the group comprised of punctiform cavernomas < 3mm, T2W* was a significantly more sensitive sequence than spin echo, that is, spin echo sequence had significantly lower sensitivity in the detection of punctiform CAs. Conclusion: The prevalence of CAs was in line with the results of other studies. T2W* sequence is significantly more sensitive in comparison with spin echo only in the detection of punctiform CAs, and is important in the detection of multiple familiar CAs.

Symmetry, asymmetry and hypoplasia of the intracranial internal carotid artery on magnetic resonance angiography.

OBJECTIVE: The aim of this study was to determine the prevalence of symmetry, asymmetry and hypoplasia of the intracranial internal carotid artery (ICA), and the possible presence of other variants of the ICA by magnetic resonance angiography (MRA). SUBJECTS AND METHODS: This prospective-retrospective study included 1000 subjects who underwent consecutively MRA of the cerebral arteries. 3D-time of flight angiograms were performed according to the standard protocol. We measured the diameter of the ICA and the diameter of the A1 segment of the anterior cerebral artery (ACA). The symmetry, asymmetry and hypoplasia of the ICA, as well hypoplasia of the A1 segment of the ACA were analysed using the vascular asymmetry coefficient. RESULTS: The right and left ICA were symmetrical in 93.9% examinees, and asymmetrical in 6%, while ICA hypoplasia was found in only one patient (0.1%). Other variants of the ICA were not found. There was no significant difference in the prevalence of individual variations between male and female patients, and no significant frequency difference was found between anatomical variations in terms of the right and left ICA. In 38.3% patients with asymmetrical ICAs, aplasia or hypoplasia of the A1 segment of the ACA was found on the side of the ICA with a reduced diameter. CONCLUSION: Congenital hypoplasia of ICAs is a very rare abnormality, while asymmetry of ICAs is more common. After evaluating severe asymmetry of intracranial ICAs by MRA, MRA of the neck is recommended, especially in patients with a complete anterior part of the circle of Willis.

Tumor marker CA 15-3 in breast cancer patients.

OBJECTIVE: The aim of this study was to determine whether there is a correlation between the serum concentration of the tumor marker CA 15-3 and breast cancer, which has not been proven by the existence of regional and distant metastases, and breast cancer with the presence of regional and distant metastases. PATIENTS AND METHODS: The study was a retrospective-prospective study, and was conducted on 100 women aged 40-70 years of age in the period of January 2007 until June 2011, in whom, after surgery, breast cancer was histologically verified, where before the surgery serum tumor marker CA 15-3 levels were established. The serum tumor marker CA 15-3 concentrations are determined in all patients after radiological diagnosis of suspected breast cancer (radiological findings concluded as BI RADS 4 and 5). The study excluded patients with liver cirrhosis, liver cancer and lung cancer. The study group consisted of patients with metastatic breast cancer, and the control group of patients with breast cancer comprised those shown to be without verified metastatic disease. To calculate the correlation, Spearman's correlation coefficient was used. A difference in p values of less than 0.05 (p<0.05) was considered statistically significant. RESULTS: The serum tumor marker CA 15-3 was elevated in all patients with proven remote or clubbing metastasis in 35.5% of patients with metastasis spreading to regional lymph nodes. CONCLUSION: There is a significant correlation between serum concentrations of the tumor marker CA 15-3 and the presence of metastasis, and serum concentrations of tumor markers and the dissemination of the underlying disease.

Anton's Syndrome due to Bilateral Ischemic Occipital Lobe Strokes.

We present a case of a patient with Anton's syndrome (i.e., visual anosognosia with confabulations), who developed bilateral occipital lobe infarct. Bilateral occipital brain damage results in blindness, and patients start to confabulate to fill in the missing sensory input. In addition, the patient occasionally becomes agitated and talks to himself, which indicates that, besides Anton's syndrome, he might have had Charles Bonnet syndrome, characterized by both visual loss and hallucinations. Anton syndrome, is not so frequent condition and is most commonly caused by ischemic stroke. In this particular case, the patient had successive bilateral occipital ischemia as a result of massive stenoses of head and neck arteries.

Wegener's granulomatosis of the paranasal sinuses with orbital and central nervous system involvement-diagnostic imaging.

Wegener's granulomatosis (WG) is a systemic vasculitis that can affect any organic system, but primarily involves the upper and lower respiratory tracts and the kidneys. WG relatively frequently affects the nervous system (in 30-50%), usually in the form of peripheral or cranial neuropathy. Involvement of the brain is reported in a very small percentage of patients (2%-8%). Three major mechanisms have been described as the cause of central nervous system (CNS) disease in WG: contiguous invasion of granuloma from extracranial sites, remote intracranial granuloma and CNS vasculitis. CNS involvement caused by contiguous invasion of granuloma from extracranial sites is the rarest. We report the case of a 37-year-old man with WG, manifested as a pulmonary and paranasal sinuses disease, with orbital and CNS involvement, caused by contiguous invasion from the paranasal sinuses. In this report, the rich spectrum of findings achieved by computed tomography and magnetic resonance are demonstrated. The importance of computed tomography in bony destruction PNS findings, and the importance of MR imaging in evaluation of the direct intracranial spread from nasal, paranasal and orbital disease are also emphasized.