RESUMEN
BACKGROUND: The efficiency of traditional anthropometric measurements such as body mass index (BMI) or waist circumference (Waist C) used to replace biomedical imaging for assessing visceral adipose tissue (VAT) is still highly controversial in youth. HYPOTHESIS AND OBJECTIVES: We evaluated the most accurate model predicting VAT in overweight/obese youth, using various anthropometric measurements and their correlation with different body fat compartments, especially by testing, for the first time in youth, the hypothesis that subtracting the anthropometric measurement the most highly correlated with subcutaneous abdominal adipose tissue (SAAT) and less correlated possible with VAT from an anthropometric abdominal measurement highly correlated with visceral and total abdominal adipose tissue (TAAT), predicts VAT with higher accuracy. SUBJECTS AND METHODS: VAT and SAAT data resulted from magnetic resonance imaging (MRI) analysis performed on 181 boys and girls (7-17 y) from Diabetes & Endocrinology Care Paediatrics Clinic in Luxembourg. Height, weight, abdominal diameters, waist, hip, and thigh circumferences were measured with a view to developing the anthropometric VAT predictive algorithms. RESULTS: In girls, subtracting proximal thigh circumference (Proximal Thigh C), the most closely correlated anthropometric measurement with SAAT, from Waist C, the most closely correlated anthropometric measurement with VAT was instrumental in improving VAT prediction, in comparison with the most accurate single VAT anthropometric surrogate. [Formula: see text] Residual analysis showed a negligible estimation error (5 cm2 ). In boys, Waist C was the best VAT predictor. CONCLUSIONS: Subtraction of abdominal subcutaneous fat is important to predict VAT in overweight/obese girls.
Asunto(s)
Adiposidad , Grasa Intraabdominal/diagnóstico por imagen , Modelos Biológicos , Sobrepeso/diagnóstico por imagen , Obesidad Infantil/diagnóstico por imagen , Grasa Subcutánea Abdominal/diagnóstico por imagen , Adolescente , Algoritmos , Índice de Masa Corporal , Tamaño Corporal , Niño , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador , Luxemburgo , Imagen por Resonancia Magnética , Masculino , Reproducibilidad de los Resultados , Caracteres Sexuales , Muslo , Circunferencia de la CinturaRESUMEN
We present a case of intraparenchymal radioinduced cyst of the brain observed in our department. It is a rare and relatively benign pathology which is usually treated conservatively or by surgery. We emphasize long-term imaging follow up in patients treated by radiosurgery, which can lead to the demonstration of multiple adverse events such as tumefactive cyst formation.
Asunto(s)
Encefalopatías/etiología , Quistes/etiología , Complicaciones Posoperatorias/diagnóstico , Radiocirugia/efectos adversos , Adulto , Encefalopatías/diagnóstico , Encefalopatías/terapia , Quistes/diagnóstico , Quistes/terapia , Humanos , Malformaciones Arteriovenosas Intracraneales/cirugía , Imagen por Resonancia Magnética , Masculino , Tomografía Computarizada por Rayos XRESUMEN
AF might be a life threatening disease. Patients have been under oral antithrombotic treatment in order to avoid thrombotic events. Although this treatment proved to be effective in the last decades there was always the inconvenience of a regular blood control. In the last months NOACs have been flooding the market promising to be as effective as their older concurrents in certain circumstances and highlighting the fact that the control of INR has become obsolete. However, as there is no specific antidote up to date, NOACs might present a life threatening event in case of an intracerebral haemorrhage. The brain surgeons might find themselves in a difficult situation when they have to decide whether to operate on a patient with a compromised haemostasis or not. We present four patients who were treated with NOACs for AF. Three of them were admitted with intracerebral haemorrhage in our neurosurgical unit from January to October 2013. The fourth patient bled one week after stopping his treatment with NOAC. Furthermore we take a closer look to the existing literature and try to portray the issue from a neurosurgical point of view.
Asunto(s)
Anticoagulantes/efectos adversos , Fibrilación Atrial/tratamiento farmacológico , Hemorragia Cerebral/inducido químicamente , Hemorragia Cerebral/terapia , Anciano , Bencimidazoles/efectos adversos , Hemorragia Cerebral/cirugía , Dabigatrán , Femenino , Humanos , Hipertensión/tratamiento farmacológico , Masculino , Morfolinas/efectos adversos , Rivaroxabán , Tiofenos/efectos adversos , beta-Alanina/efectos adversos , beta-Alanina/análogos & derivadosRESUMEN
BACKGROUND: Toxoplasmosis is the most frequent opportunistic infection of the central nervous system among individuals with the acquired immunodeficiency syndrome. Radiographic modalities include brain CT, MRI and PET scan. The differential diagnosis are usually: primary CNS lymphoma, cerebral metastasis, Progressive multifocal leukoencephalopathy, cytomegalovirus. It indicates severe immunodeficiency and, if it remains untreated, it may lead to death. CASE DESCRIPTION: A 65 year old immunodeficiency woman with a Non Hodgkin Lymphoma treated with Chemotherapy. She had been suffering from vomiting, headache and vertigo. Treatment she received Dafalgan, Betaserc, neupogen and nexiam. CONCLUSION: This case illustrates that a brain biopsy is compulsory before starting any treatment.
Asunto(s)
Antineoplásicos/uso terapéutico , Huésped Inmunocomprometido , Neoplasias Infratentoriales/diagnóstico , Neoplasias Infratentoriales/parasitología , Linfoma no Hodgkin/tratamiento farmacológico , Toxoplasmosis/complicaciones , Anciano , Biopsia , Diagnóstico Diferencial , Femenino , Cefalea/parasitología , Humanos , Imagen por Resonancia Magnética , Tomografía de Emisión de Positrones , Tomografía Computarizada por Rayos X , Vértigo/parasitología , Vómitos/parasitologíaRESUMEN
BACKGROUND: Posterior reversible encephalopathy syndrome (PRES) affects predominantly the parietal and occipital lobes. Frequent clinical features are epileptic seizure, altered mental status and visual disturbances. CLINICAL PRESENTATION: We present the first case of a patient with pericarditis and mitral valve insufficiency, who developed PRES after application of a glycerolnitrate patch day three post-operatively and whose neurological deficits improved within 2 days after withdrawal of patch therapy. CONCLUSION: The precise pathomechanism of PRES is unknown. The lower sympathetic innervation of the posterior circulation may be one explanation for its particular vulnerability to vasodilatation caused by glycerolnitrate.
Asunto(s)
Ceguera Cortical/inducido químicamente , Infarto Encefálico/inducido químicamente , Nitroglicerina/efectos adversos , Síndrome de Leucoencefalopatía Posterior/inducido químicamente , Ceguera Cortical/diagnóstico por imagen , Ceguera Cortical/fisiopatología , Infarto Encefálico/diagnóstico por imagen , Infarto Encefálico/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Nitroglicerina/administración & dosificación , Síndrome de Leucoencefalopatía Posterior/diagnóstico por imagen , Síndrome de Leucoencefalopatía Posterior/fisiopatología , Cuidados Posoperatorios/efectos adversos , RadiografíaRESUMEN
The purpose was to determine whether a strong decrease in apparent diffusion coefficient (ADC) within epidermoid cysts (ECs) is actually responsible for their bright signal intensity on diffusion-weighted (DW) trace images. We studied six patients with surgically proven ECs in whom ADC calculation from T2-weighted DW-EPI-SE data were performed within the ECs and within the deep white matter and cerebrospinal fluid (CSF) as references. All ECs displayed highest signal intensity on the DW trace images. ADC values ranged from 1,280 to 807 x 10(-6) mm(2)/s within cysts (with a mean value of 1,070), from 849 to 698 x 10(-6) mm(2)/s within white matter (with a mean value of 764) and from 3,370 to 2,980 x 10(-6) mm(2)/s within CSF (with a mean value of 3,185). ECs exhibited slightly higher ADC values than white matter, and not the strongly decreased ones which would have been expected if diffusion-weighting were the prominent mechanism for bright signal intensity of the ECs on DW images. However, the EC ADC values are much lower than those of the CSF. Other mechanisms must therefore be involved, i.e. the T2 shine-through effect. Reduced ADC is not the only explanation of the EC bright signal intensity on the DW trace images.
Asunto(s)
Encefalopatías/diagnóstico , Quiste Epidérmico/diagnóstico , Imagen por Resonancia Magnética , HumanosRESUMEN
The simultaneous occurrence of multiple sclerosis and a primary brain neoplasm is exceptional: only 32 cases have been reported in the literature. We report the case of a 30-year-old woman with multiple sclerosis proven for 10 years who developed a grade II astrocytoma revealed by MRI. At the pathology examination, there was no cellular continuity with areas of demyelinized white matter. Unlike the hypothesis put forward in certain publications describing this association that argue for an induction link between these two entities, our case did not demonstrate any spatial or temporal relationship suggestive a common cause.
Asunto(s)
Neoplasias Encefálicas/complicaciones , Glioma/complicaciones , Esclerosis Múltiple/complicaciones , Lóbulo Temporal , Adulto , Femenino , HumanosRESUMEN
A double-blind clinical trial of mitoxantrone versus methylprednisolone was performed in 49 patients with relapsing, secondary multiple sclerosis. Patients were randomized to receive 13 infusions of mitoxantrone 12 mg/m2 (n = 28), or 13 infusions of 1 g of methylprednisolone (n = 21), over 32 months. Twenty-four patients completed the trial. There were no statistical differences between the two groups of patients at study entry. A significant improvement in the Expanded Disability Scale Score (EDSS) was observed in the mitoxantrone group after one year of treatment (p < 0.0022). The total number of relapses, the mean number of relapses/patient/year, and the total number of gadolinium-enhanced lesions on bi-annual MRI scans were significantly decreased in the mitoxantrone group throughout the study period. Nausea, vomiting, and alopecia were more frequent in the mitoxantrone-treated patients. Mitoxantrone has a role in the treatment of MS patients with frequent exacerbations and rapid disease progression.
Asunto(s)
Inmunosupresores/uso terapéutico , Metilprednisolona/uso terapéutico , Mitoxantrona/uso terapéutico , Esclerosis Múltiple/tratamiento farmacológico , Adulto , Alopecia/inducido químicamente , Medios de Contraste , Método Doble Ciego , Femenino , Estudios de Seguimiento , Gadolinio , Humanos , Inmunosupresores/efectos adversos , Recuento de Linfocitos , Imagen por Resonancia Magnética , Masculino , Azul de Metileno/uso terapéutico , Metilprednisolona/efectos adversos , Mitoxantrona/efectos adversos , Esclerosis Múltiple/patología , Náusea/inducido químicamente , Náusea/prevención & control , Pacientes Desistentes del Tratamiento , Flebitis/inducido químicamente , Flebitis/complicaciones , Embolia Pulmonar/etiología , Pirrolidinas/uso terapéutico , Recurrencia , Índice de Severidad de la Enfermedad , Resultado del Tratamiento , Vómitos/inducido químicamente , Vómitos/prevención & controlRESUMEN
Laser-induced fluorescence (LIF) spectroscopy is introduced as an in situ diagnostic for phenol and intermediate products in an aqueous solution degraded by corona discharges. The complications that are inherent in applying LIF as a diagnostic for aqueous solutions are experimentally examined. The LIF intensities of phenol and the intermediate products are measured as a function of time. The absolute phenol concentration is determined. We confirm the applicability of LIF spectroscopy for monitoring phenol concentration during degradation.
RESUMEN
BACKGROUND: Ectopic pituitary adenomas are rare. Only 29 cases are reported in the literature. The clivus was involved in some cases but sella turcica was occasionally involved. CLINICAL PRESENTATION: Headache was the first symptom of a 47-year-old woman. Radiological examination diagnosed a clivus tumour. No connection with the pituitary gland was observed. Pre-operative diagnosis was metastasis of an unknown cancer. INTERVENTION: By a transphenoidal approach, we removed a haemorrhagic tumour. No connection between the normal pituitary gland and the tumour was observed. Neuropathological analysis showed a prolactinoma. CONCLUSION: We report a rare case of an ectopic prolactinoma in the clivus unrelated to the pituitary gland. Only one other case has been reported in the literature.
Asunto(s)
Coristoma/cirugía , Fosa Craneal Posterior/cirugía , Neoplasias Hipofisarias/cirugía , Prolactinoma/cirugía , Femenino , Humanos , Imagen por Resonancia Magnética , Microcirugia , Persona de Mediana Edad , Neoplasias Hipofisarias/diagnóstico , Prolactinoma/diagnósticoRESUMEN
Wilson's disease rarely starts after the third decade and may present with misleading psychiatric signs. We observed a 39-year-old white male who developed hysterical behaviour followed by frank delusional psychosis. Secondary neurological symptoms like astasia and dyarthria were misinterpreted as drug-induced. Despite a treatment with D-penicillamine and zinc sulfate there was further deterioration with anarthria and pseudo-compulsive stereotypies. These latter signs cleared after five months, whereas astasia and abasia remained the same and MRI imaging showed further deterioration characterized by marked bilateral putaminal cavitation. SPECT imaging could not predict the clinical evolution. Our case emphasizes that Wilson's disease can have variable initial presentations, and confirms the relationship between pseudo-compulsive stereotypies and bilateral lenticular lesions, as already described in other diseases of the basal ganglia.
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Degeneración Hepatolenticular/diagnóstico , Trastornos del Movimiento/etiología , Adulto , Conducta Compulsiva , Degeneración Hepatolenticular/diagnóstico por imagen , Degeneración Hepatolenticular/psicología , Humanos , Imagen por Resonancia Magnética , Masculino , Trastornos del Movimiento/psicología , Estereotipo , Tomografía Computarizada de Emisión de Fotón ÚnicoRESUMEN
Hypomelanosis of Ito is a rare sporadic neurocutaneous disorder. CNS abnormalities are observed in more than 50% of the cases. A case of hypomelanosis in a 2 year old girl is reported. MRI is unusual in the fact that it shows symmetrical abnormalities: non-obstructive hydrocephalus, mega cisterna magna and multiple white matter lesions.
Asunto(s)
Encéfalo/anomalías , Imagen por Resonancia Magnética , Trastornos de la Pigmentación/patología , Encéfalo/patología , Encefalopatías/diagnóstico , Preescolar , Cisterna Magna/anomalías , Cisterna Magna/patología , Epilepsia Generalizada/diagnóstico , Femenino , Gliosis/diagnóstico , Gliosis/patología , Humanos , Hidrocefalia/diagnóstico , Hidrocefalia/patología , Vaina de MielinaRESUMEN
Radiation-induced myelopathy is often a diagnosis of exclusion. In addition to the classic criteria needed to support the diagnosis, the presence of another radiation-induced lesion, such as aseptic vertebral necrosis, is useful to confirm the cause of the spinal cord lesion.
Asunto(s)
Osteorradionecrosis/diagnóstico , Traumatismos por Radiación/diagnóstico , Enfermedades de la Médula Espinal/diagnóstico , Vértebras Torácicas , Anciano , Humanos , Imagen por Resonancia Magnética , Masculino , Neoplasias del Mediastino/radioterapia , Osteorradionecrosis/etiología , Traumatismos por Radiación/etiología , Radioterapia/efectos adversos , Enfermedades de la Médula Espinal/etiología , Enfermedades de la Columna Vertebral/diagnóstico , Enfermedades de la Columna Vertebral/etiología , Vértebras Torácicas/patologíaRESUMEN
We report one case of histologically proved Lhermitte-Duclos disease. Suspected on the basis of CT and angiography, the pre-operative diagnosis has been confirmed by the characteristic features of the lesion on MRI: a unilateral posterior fossa mass, hyperintense on proton density and T2-weighted images, hypointense on T1-weighted images, non enhancing after Gd administration. The gyral pattern was preserved, but a specific thickening of cerebellar folia was demonstrated. Despite a good post-operative short term prognosis, recurrence may occur. With a better depiction of lesion limits, MRI could improve the surgical approach and reduce the risk of subtotal excision.
Asunto(s)
Neoplasias Cerebelosas/diagnóstico , Ganglioneuroma/diagnóstico , Imagen por Resonancia Magnética , Adulto , Neoplasias Cerebelosas/patología , Medios de Contraste , Gadolinio , Gadolinio DTPA , Ganglioneuroma/patología , Humanos , Masculino , Compuestos Organometálicos , Ácido Pentético/análogos & derivadosRESUMEN
Sequential radiographic and magnetic resonance (MR) imaging examinations were performed in nine patients with an intravertebral vacuum cleft indicative of avascular necrosis. Progressive changes in the content of the cleft occurred within an hour after the patients were placed in a supine position. Initially, the cleft showed a gaslike pattern during extension of the spine, with a radiolucent band on radiographs and a signal void on MR images. Later, the vacuum phenomenon disappeared on radiographs, and a fluidlike high-signal-intensity pattern appeared on T2- or T2*-weighted MR images, suggestive of a slow fluid inflow within the intravertebral cleft. Because the recognition of a vacuum cleft in a collapsed vertebral body helps avoid confusion with malignancy or infection, it is important to search for this in examinations performed immediately after supine positioning.
Asunto(s)
Disco Intervertebral/patología , Enfermedades de la Columna Vertebral/diagnóstico , Columna Vertebral/patología , Anciano , Femenino , Humanos , Disco Intervertebral/diagnóstico por imagen , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Osteonecrosis/diagnóstico , Osteonecrosis/diagnóstico por imagen , Radiografía , Enfermedades de la Columna Vertebral/diagnóstico por imagen , Columna Vertebral/diagnóstico por imagen , Posición Supina , Factores de TiempoRESUMEN
Sixteen paragangliomas of the neck were reviewed. Lesions were found in the carotid body (n = 12), vagal nerve (n = 3) and larynx (n = 1). While paragangliomas were often misdiagnosed clinically, CT scanning defined the extent of the disease. MR was able to accurately characterize the tumors as highly vascular. Multiplanar imaging, exquisite tissue contrast and anatomic detail allowed better display of the relationship between these neoplasms and surrounding carotid sheath vessels and intracranial structures. MR constitutes the imaging modality of choice in carotid body tumor. Arteriography is necessary for definite diagnosis and presurgical embolization.
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Tumor del Cuerpo Carotídeo/diagnóstico por imagen , Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Paraganglioma Extraadrenal/diagnóstico por imagen , Adulto , Angiografía , Tumor del Cuerpo Carotídeo/irrigación sanguínea , Tumor del Cuerpo Carotídeo/terapia , Embolización Terapéutica , Neoplasias de Cabeza y Cuello/irrigación sanguínea , Neoplasias de Cabeza y Cuello/terapia , Humanos , Persona de Mediana Edad , Paraganglioma Extraadrenal/irrigación sanguínea , Paraganglioma Extraadrenal/terapia , Tomografía Computarizada por Rayos XRESUMEN
A 48-year-old woman was referred from Zaire with suspected rabies encephalitis. Survival was 34 days after the onset of symptoms and the diagnosis of rabies was ultimately proven after brain autopsy. Serial neurophysiological investigations, including EEG and multimodality evoked potentials and radiological examinations (cerebral magnetic resonance imaging and computed tomodensitometry) were performed. Whereas the clinical findings and EEG were compatible with brain death at the end of the course, this diagnosis could be definitely ruled out by multimodality evoked potentials, magnetic resonance imaging and autopsy. The validity of multimodality evoked potentials is discussed in this particular setting.
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Muerte Encefálica/fisiopatología , Encefalitis/fisiopatología , Rabia/fisiopatología , Encéfalo/patología , Encéfalo/fisiopatología , Muerte Encefálica/patología , Diagnóstico Diferencial , Electroencefalografía , Encefalitis/patología , Potenciales Evocados/fisiología , Femenino , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Rabia/patologíaRESUMEN
Two cases of arachnoid cyst in the lumbar region are described. One is intradural, acquired, and associated to severe arachnoiditis while the other is extradural in location and probably congenital. The interest of myelography, CT myelography, and MRI for the diagnosis is discussed.
Asunto(s)
Quistes Aracnoideos/diagnóstico , Diagnóstico por Imagen , Adulto , Quistes Aracnoideos/congénito , Quistes Aracnoideos/etiología , Aracnoiditis/complicaciones , Femenino , Humanos , Región Lumbosacra , Imagen por Resonancia Magnética , Persona de Mediana Edad , Mielografía , Tomografía Computarizada por Rayos XRESUMEN
A 27-year-old woman presented with right spinal accessory juxtabulbar schwannoma, associated with hydrocephalus. The only specific clinical symptom was long-standing weakness of the right trapezius. C.T. scan evoked a cerebellar tumor, whilst the jugular foramen appeared normal. Vertebral angiography was not decisive. M.R.I. suggested an extra-axial tumor. Post-operative evolution was entirely favourable. Schwannomas of the 9th, 10th and 11th cranial nerves are generally located at the level of the jugular foramen but can also be observed along the extracranial path of these nerves. An intracranial paramedial, or so-called "intracisternal" localization is rare and is best diagnosed by magnetic resonance imaging.
Asunto(s)
Nervio Accesorio , Neoplasias de los Nervios Craneales/diagnóstico , Neurilemoma/diagnóstico , Adulto , Encéfalo/diagnóstico por imagen , Neoplasias de los Nervios Craneales/complicaciones , Femenino , Humanos , Imagen por Resonancia Magnética , Neurilemoma/complicaciones , Tomografía Computarizada por Rayos X , Arteria Vertebral/diagnóstico por imagenRESUMEN
Neurological complications of myeloma are multiple and various. Cranial and intracranial locations have been rarely reported. They can be classified into three clinical groups: (1) cranial nerve palsies secondary to single or multiple lesions in the base of the skull, (2) intraorbital tumors, (3) intracranial tumors, either cranial myeloma extending intracranially or pure intracranial tumor (dural and/or cerebral). In our case, macroscopic and microscopic examination of the brain showed dural and cerebral involvement, confirmed by immunohistochemical studies. The radiological features are discussed (CT scan, MRI, angiography). To our knowledge, a single report of intracranial plasmacytoma documented by MRI has been reported in the literature.