T1 hyperintensity in the spinal cord: A diagnostic marker of amyotrophic lateral sclerosis?

Amyotrophic Lateral Sclerosis (ALS) is a rare, devastating motor neuron disease characterized by the degeneration of upper and lower motor neurons causing muscular weakness, paralysis, and eventual death. MRI plays a supportive role in the diagnosis; its primary role is to exclude other clinical mimics. Some of the imaging features associated with ALS include hypointense signal along the motor cortices on susceptibility or T2*-weighted imaging and hyperintensity along the corticospinal tracts (CST) within the cerebral hemispheres, brainstem, and spinal cord on the T2 weighted imaging. In this report, we discuss the value of T1 hyperintensity along the CST, especially in the spinal cord.

Hemorrhagic PRES: A Rare Neurological Manifestation of COVID -19 Infection.

As of August 2021, the COVID -19 pandemic has affected approximately 200 million cases worldwide. Most of the reported medical literature about the COVID-19 infection discusses its respiratory and haematological manifestations, with limited information about its neurological complications. Encephalitis, meningitis, acute disseminated encephalomyelitis, stroke and encephalopathy have been reported in patients with COVID-19 infection. Symptomatology of CNS involvement includes dizziness, headache, impaired consciousness, acute cerebrovascular disease, ataxia, and seizures. Encephalopathy is encountered commonly in patients with severe disease, multi-organ dysfunction and elevated inflammatory markers. Acute cerebrovascular disease is another major manifestation of COVID -19 infection and is mainly due to occlusion of large vessels, hypercoagulability and a pro-inflammatory state. In this report, we discuss the diagnosis and outcome of a 30-year-old patient detected with Posterior Reversible Encephalopathy Syndrome (PRES) as a complication of COVID-19 infection. We hope this report will provide physicians with a useful framework for understanding pathophysiology and imaging findings of PRES in COVID-19 infection.

Rhino-orbito-cerebral Mucormycosis: Pictorial Review.

Mucormycosis (MCR) is a fulminant, potentially lethal, opportunistic fungal infection. Diabetes, immunocompromised states and elevated serum iron levels are the most important risk factors for contracting MCR infection. Recently, MCR co-infections have been observed in patients with COVID-19 disease owing to a complex interplay of metabolic factors and corticosteroid therapy. Rhino-orbito-cerebral mucormycosis (ROCM) is the most common clinical form of MCR infection and refers to infection of the nasal cavities, paranasal sinuses, neck spaces, orbits and intracranial structures. Sinonasal inoculation is typically the primary site of infection; the necrotising and angioinvasive properties of the fungus facilitate its spread into adjacent structures. In this review, we discuss the pertinent mycology and risk factors of MCR infection. The review also aims to acquaint the reader with the cross-sectional imaging appearances of ROCM and its complications. All the cases discussed in this pictorial essay are microbiologically and/or histopathologically proven cases of ROCM with concomitant COVID-19 infection.

Sciatica: An Extremely Rare Complication of the Perianal Abscess.

BACKGROUND: Sciatica has been classically described as pain in the back and hip with radiation in the leg along the distribution of the sciatic nerve, secondary to compression or irritation of the sciatic nerve. Spinal abnormality being the most common etiology, is one of the most common indications for MRI of the lumbosacral spine. Here we describe imaging findings secondary to a supralevator perianal abscess causing irritation of the sciatic nerve, which was diagnosed on MRI of the lumbosacral spine. CASE REPORT: A 47-year-old male patient presented to the emergency department with severe acute pain in the right hip and right leg which was aggravated by limb movement. Clinically, a possibility of sciatica was suggested and MRI of the lumbosacral spine was ordered. The MRI did not reveal any abnormality in the lumbosacral spine; however, on STIR coronal images, a right perianal abscess with air pockets was seen. The perianal abscess was extending above the levator ani muscle with and was seen tracking along the sciatic nerve, explaining pain along the distribution of the sciatic nerve. The abscess was surgically drained, followed by an antibiotic course. The patient was symptomatically better post-surgery. Post-operative scan done 3 days later revealed significant resolution of the infra- and supralevator perianal abscess. The patient was discharged from hospital on post-operative day 3 on oral antibiotics for 7 days. On 15th post-operative day, the patient was clinically completely asymptomatic with good healing of the perianal surgical wound. CONCLUSIONS: Extra-spinal causes are rare and most often overlooked in patients with sciatica. While assessing patients with sciatica, extra-spinal causes for the radiation of pain along the distribution of the sciatic nerve should always be looked for if abnormalities in the MRI of the lumbar spine are not found. Inclusion of STIR sequences in the imaging of the lumbosacral spine, more often than not, helps to identify the extra-spinal cause of sciatica when MRI of the lumbosacral spine does not reveal any abnormality.

Sonographic diagnosis of ectopic pregnancy 2 years after total hysterectomy.

We report a case of a 35-year-old multigravida with a chief complaint of 8 days of mild pain in the lower abdomen with history of vaginal hysterectomy 2 years prior. Ultrasonography and MRI showed a gestational sac-like structure with a fetal pole in the pelvis. Urine pregnancy test was positive with increased beta-HCG levels. Diagnosis of ectopic pregnancy was made. Surgical exploration and subsequent histopathology confirmed the sonographic findings.

Rudimentary third lower limb in association with spinal dysraphism: Two cases.

Spinal dysraphism is a common congenital anomaly with many associated variants. One of the rarest associated findings is a full grown or rudimentary third limb, collectively called Tripagus. We present two cases of spinal dysraphism with rudimentary third limb arising from the ilium.