Atypical posterior reversible encephalopathy syndrome in a case of thrombotic thrombocytopenic purpura with Sjogren's syndrome.

Thrombotic thrombocytopenic purpura (TTP) is a rare hematologic disorder characterized by thrombotic microangiopathy. Neurologic symptoms are frequently seen in its presentation and the most common finding on neuroimaging of TTP is posterior reversible encephalopathy syndrome (PRES). Acute strokes, hemorrhages and atypical PRES are uncommonly seen. Our case reports the clinical and imaging details of a young male patient with TTP and Sjogren's syndrome, who made a complete recovery after aggressive plasmapheresis and immunosuppressive therapy with resolution of the imaging findings of PRES on follow up brain MR imaging. We briefly review the literature for the spectrum of imaging findings that can be seen on brain MRI with TTP.

Foreign body (toothpick) causing epiglottitis.

A 25-year-old otherwise healthy woman presented to the hospital with sore throat and dysphagia for 5 days. On her computed tomography images, thickening and edema of the right aryepiglottic fold was noted, associated with an impacted foreign body.

Rhombencephalitis in cocaine-induced nasal septal perforation and skull base erosion.

Rhombencephalitis is a rare and potentially fatal condition involving the brainstem, with infectious, autoimmune, and paraneoplastic etiologies. We present a patient presenting with left-extremity weakness and dysphonia who had brainstem imaging findings suggestive of rhombencephalitis. We suspect that the case was due to inoculation of the brainstem from nasopharyngeal adenoviral infection. Due to heavy cocaine use, extensive basiocciput erosion led to direct contact between the brainstem and the nasopharyngeal mucosa. The patient's milder clinical course might have been due to some degree of pre-existing immunity against adenovirus. Additionally, clinicians need to be aware of the proximity of the brainstem to the nasopharynx when there is basiocciput erosion, due to the potential risk of injury during instrumentation.

Cocaine abuse: Longitudinal MR imaging of lasting diffused leukoencephalopathy.

Cocaine use has been known to cause a number of adverse neurological conditions, such as cerebral ischemia and posterior reversible leukoencephalopathy. The radiologic appearance of cocaine-induced leukoencephalopathy is confounded by a common contaminant, levamisole, which is also known to cause multifocal leukoencephalopathy. However, we encountered a case of diffuse leukoencephalopathy in a patient with cocaine use that had extensive involvement of the cerebral white matter, globus pallidi as well as the cerebellum. Our case also presented with a severe clinical presentation, with the patient demonstrating minimal neurologic response after a prolonged period of critical care management. The severe clinical course and diffuse radiologic involvement of our case differs from previously reported cases of cocaine- or levamisole-induced leukoencephalopathy.

Tragus Piercing Presenting as a Novel Risk Factor with Magnetic Resonance Imaging.

Although magnetic resonance imaging (MRI) excels in a number of medical imaging utilities, one of its particular attraction is the lack of ionizing radiation. However, MRI scans are associated with their own unique safety concerns. We encountered two cases of lost tragus piercings presenting as a novel risk factor in MRI safety. The lost tragus piercings caused temporary discomfort and pain but were able to be removed without complication. Heightened awareness for this potential source of patient harm, particularly with more individuals obtaining body piercings, is necessary for appropriate patient screening.

Isolated central sulcus hemorrhage: a rare presentation most frequently associated with cerebral amyloid angiopathy.

Central sulcus hemorrhage is a rare imaging finding that can be related to cerebral amyloidosis in a normotensive non-traumatic elderly patient and present as an isolated finding or in association with other areas of involvement. We report a case presenting with an isolated central sulcus hemorrhage on computed tomography. Further imaging work-up excluded other potential causes of peripheral hemorrhages and established a putative diagnosis of cerebral amyloidosis.

Horseshoe adrenal gland in association with asplenia: presentation of six new cases and review of the literature.

BACKGROUND: Asplenia syndrome is a form of heterotaxy characterized by bilateral right-sidedness. Congenital fusion of the adrenal glands ("horseshoe adrenal gland") is a less common feature of asplenia syndrome, most instances of which have been found at autopsy. PURPOSE: To present clinical and imaging features of infants diagnosed with asplenia syndrome and horseshoe adrenal gland. MATERIALS AND METHODS: Six infants with asplenia syndrome were identified as having a horseshoe adrenal gland. Medical records and imaging studies were reviewed to determine clinical presentation, associated anomalies, and outcome. The literature was reviewed for prior reports of horseshoe adrenal gland. RESULTS: Horseshoe adrenal gland was identified in five infants by sonography and one by CT, the latter confirmed by autopsy. In all cases, the horseshoe adrenal gland was pre-aortic. Besides features of asplenia syndrome, one infant also had associated vertebral anomalies and bilateral renal agenesis. Including the current cases, of 65 reported cases of horseshoe adrenal gland 34 (52%) were associated with asplenia, 24 (37%) with neural tube defects, 19 (29%) with renal anomalies, and 2 (3%) with Cornelia de Lange syndrome. Horseshoe adrenal gland has not been reported with polysplenia syndrome. CONCLUSIONS: Horseshoe adrenal gland is a less common manifestation of asplenia that may be demonstrated by imaging. Horseshoe adrenal gland may be a differentiating feature between asplenia and polysplenia.