Differential Diagnosis between Neoplastic and Non-Neoplastic Brain Lesions in Radiology / Diagnóstico diferencial entre lesões cerebrais neoplásicas e não neoplásicas em radiologia

Introduction The observation of multiple lesions in a skull computed tomography (CT) scan is always cause for concern because of the frequent possibility of neoplastic etiology, although granulomatous, infectious, vascular, iatrogenic, demielinating, trauma, parasitic diseases, and strokes can produce a similar aspect on radiology. A wide range of non-neoplastic conditions can mimic a brain tumor, both clinically and radiologically, representing a potential pitfall for physicians involved in patient care. The study's goal is to alert specialists to the possibility of other neoplastic and nonneoplastic etiologies in the differential diagnosis of hypodense lesions in non-contrast. Methods We performed a literature review using PubMed, Medline, Science Direct, Embase, Clinical Trials, Ebsco, and Scielo. Articles were selected in the period of 1986 to 2015. Discussion Knowledge of various etiologies when with multiple lesions appear on computed tomography allows specialists to guide the diagnosis to appropriate treatment, avoiding the irradiation of non-neoplastic lesions and unnecessary surgeries. The most common lesions were the neoplasm (74% to 86%), especially gliomas, followed by infections (8% to 15%), and infarcts (0.6% to 6%), which represent nonneoplastic lesions. Conclusion Given the relatively high percentage of wrong neuroradiology diagnoses, most cases may require histological diagnosis, because even magnetic resonance imaging (MRI) renders difculties in distinguishing such lesions.

Introdução Observação de múltiplas lesões na tomograa computadorizada de crânio (TC) é sempre motivo de preocupação por causa da possibilidade frequente de etiologia neoplásica, embora as doenças granulomatosas, infecciosas, vascular, iatrogênica, desmielinizante, trauma, e parasitárias podem produzir aspecto semelhante na radiologia. Uma ampla gama de condições não neoplásicas pode mimetizar um tumor cerebral, tanto clínica, quanto radiologicamente, representando uma armadilha potencial para os médicos envolvidos no cuidado ao paciente. O objetivo do estudo é alertar a possibilidade de outras etiologias neoplásicas e não neoplásicas no diagnóstico diferencial de lesões hipodensas em TC sem contraste. Métodos Revisão da literatura utilizando PubMed, MEDLINE, Google Scholar, Ensaios Clínicos, EBSCO, Scielo, Tópicos em radiologia. Foram selecionados por período 1986- 2015. Discussão O conhecimento de várias etiologias, quando confrontado com múltiplas lesões na tomograa computadorizada permite o direcionamento do diagnóstico para o tratamento adequado, evitando a irradiação de lesões não neoplásicas e cirurgias desnecessárias. As lesões mais frequentes são neoplasias (74% a 86%), especialmente gliomas, seguido de infecções (8% a 15%) e infartos (0,6% a 6%), que representam lesões não neoplásicas. Conclusão Como um possível resultado da percentagem relativamente elevada de diagnósticos errados neurorradiológicos, o diagnóstico histológico faz necessário, porque mesmo Ressonância pode ser difícil na diferenciação de tais lesões.

[Comparative evaluation of effectiveness of the combined immunocorrection in patients suffering severe craniocerebral trauma].

Comparative estimation of clinical efficacy of various immunocorrection schemes for the immune state correction was conducted in 106 patients in conditions ofsevere craniocerebral trauma (SCCT), combined application of immunofan and intravenous laser irradiation of blood (IVLIB). In 32 patients (I group) a standard intensive therapy (SITH) was conducted: in 21 (II group)--immunofan was applied additionally; in 25 (III group)--in addition to SITH IVLIB was conducted; in 28 (IV group)--immunofan solution was infused and sessions of IVLIB (3 - 4 sessions a day) on a background of SITH were conducted. The immunity indices were analyzed on the 1 - 2, 5 - 6-th and 9 -10-th days after trauma. Estimation of the combined therapy efficacy have shown, that in SCCT she renders a significant immunocorrecting effect on the 5 - 6-th days already, on the 9 - 10-th days the immune state parameters were really normalized, reduction of the complications rate by 26% and of lethality by 8.6% was noted.

Computerised tomographic patterns in patients with head injury at the university of Benin teaching hospital

Background: Head injuries rank high among morbidities due to trauma. Computerised tomography is an important modality in the investigation of these cases. However; literature on this subject in the south-south geopolitical zone of Nigeria is sparse. This study therefore aimed to document the computerized tomographic features of patients with head injury managed at the University of Benin Teaching Hospital (UBTH). Materials and Methods: A prospective study involving patients with head injury referred for CT scan from the Accident and Emergency Unit of UBTH over a 12-month period. A total of 100 patients were studied; using non-enhanced cranial CT scans. Findings were recorded and data analysis using SPSS done. Results: The age group 21-30 years was most frequently involved. Sex preponderance was 4.3:1 (male: female). Twenty-six patients had normal CT scans. The most common abnormal finding was intracerebral hemorrhage 35 cases (33). This was followed by skull fractures; 23 cases (31); subdural hemorrhage; 16 cases (21); cerebral edema; 11 cases (15). Others included mass effect; nine cases (12). Conclusion: CT plays a very significant role in management of head injuries; as demonstrated in this study; by making such diagnoses that guided eventual patient management. Intracerebral hemorrhage was the most common abnormal finding in this report. Regular use of CT in moderate to severe cases of head injury is advocated

Prise en charge neurochirurgicale des traumatismes crâniens à Parakou, Bénin : apport de la radiographie standard

Objectif : Rapporter l'apport de la radiographie standard du crâne dans la prise en charge chirurgicale des traumatismes crânio-encéphaliques (TCE) au bénin. Méthodes : Etude descriptive réalisée à l'unité de neurochirurgie du CHD-Borgou au nord-est du Bénin. Elle concernait 29 cas de TCE tous opérés entre Avril 2008 et Juin 2009 sur des critères cliniques et radiographiques. Résultats : L'âge moyen des patients était de 23,46 ± 14,28 ans avec une prédominance masculine (93,10%). Neuf patients (31%) présentaient un TCE grave, 15 (51,8%) un TCE modéré et 5 (17,2%) un TCE léger. La radiographie du crâne objectivait une embarrure chez 17 (58,6%) patients, une fracture de la voûte chez 7 (24,2%) et aucune lésion dans 5(17,2%) cas. IL a été réalisé une réparation de plaie crânio-cérébrale 3(10,3%) cas, une évacuation d'hématome extra dural 4(13,8%) cas, une trépanation exploratrice 5 (17,2%) cas et un redressement d'embarrure 17 (58,6%) cas auquel était associé 3 évacuations d'hématome extra dural, 3 réparations de brèche ostéoméningée et 4 débridements et duroplasties. Conclusion : La radiographie du crâne ne peut pallier au défaut de scanner cérébral en cas de TCE. Elle peut néanmoins apporter de précieuses informations permettant une prise en charge chirurgicale

Decreasing the apoptotic threshold of tumor cells through protein kinase C inhibition and sphingomyelinase activation increases tumor killing by ionizing radiation.

Approximately 30% of cancer deaths result from the failure to control local and regional tumors. The goal of radiotherapy is to maximize local and regional tumor cell killing while minimizing normal tissue destruction. Attempts to enhance radiation-mediated tumor cell killing using halogenated pyrimidines, antimetabolites, and other DNA-damaging agents or sensitizers of hypoxic tumor cells have met with only modest clinical success. In an unique strategy to modify tumor radiosensitivity, we used an inhibitor of the protein kinase C group A and B isoforms, chelerythrine chloride (chelerythrine), to enhance the killing effects of ionizing radiation (IR). Protein kinase C activity plays a central role in cellular proliferation, differentiation, and apoptosis. Chelerythrine increases sphingomyelinase activity and enhances IR-mediated cell killing through induction of apoptotic tumor cell death in a radioresistant tumor model both in vitro and in vivo. Although previous reports have suggested that IR-mediated apoptosis correlates with tumor volume reduction, we demonstrate for the first time that lowering the apoptotic threshold increases tumor cell killing in vivo.