Hemiplegic migraine during pregnancy: unusual magnetic resonance appearance with SPECT scan correlation.

OBJECTIVE: This article discusses the pathophysiology and implications for treatment of hemiplegic migraine within a case study presentation. BACKGROUND: We evaluated a 31-year-old white woman for hemiplegia in her 36th week of pregnancy. She initially presented with severe headache, dysarthria, lethargy, and left-sided numbness and weakness. Hemiplegic migraine remains a diagnosis made by exclusion; neurologic examination of these patients is localizing, but nonspecific. DESIGN: Magnetic resonance imaging and single photon emission computed tomography scanning were performed on this patient during an exacerbation of headache associated with dense hemiplegia. RESULTS: Magnetic resonance imaging showed a superficial cerebral hemispheric signal abnormality with enhancement. Single photon emission computed tomography scanning confirmed hyperperfusion of that hemisphere. CONCLUSIONS: We believe the imaging evidence in our patient suggests that hemiplegia was caused and sustained by hyperperfusion. This case lends supportive evidence to a primarily vasodilatory mechanism and hyperperfusion as an etiology of the paralysis in such headaches and perhaps migraine with aura.

Primary angiitis of the central nervous system: unusual MR appearance.

The MR findings of a biopsy-proved case of primary angiitis of the central nervous system are described and compared with previously reported cases. Multiple punctate and linear areas of gadopentetate dimeglumine enhancement were present in the brain stem and white matter and appear to correspond to the inflammatory reaction of the small perforating vessels and perivascular tissues seen in the pathologic specimen.

Epidural abscess of the cervical spine: MR findings in five cases.

Cervical epidural abscess is an uncommon infectious process of the spinal epidural space. Although this disorder is often unsuspected clinically, the patient's signs and symptoms may suggest other diagnoses that frequently lead to an MR examination. We retrospectively reviewed the MR examinations of five patients with surgically proved cervical epidural abscess in order to assist in the diagnosis of this clinically elusive disorder. Each epidural abscess was evaluated for MR signal intensity, location, extent, delineation, and enhancement pattern. We assessed the spinal cord for compression and signal intensity and analyzed the vertebrae, intervertebral disks, and paraspinal soft tissue. Compared with the spinal cord, the abscess was isointense or hypointense on T1-weighted spin-echo images and hyperintense on T2-weighted images. The abscess was hyperintense or isointense relative to the cord on T2* gradient-echo images. Enhancement of the abscess occurred in the two patients given an IV injection of gadopentetate dimeglumine. The epidural abscess was located anteriorly in three patients, posteriorly in one, and was circumferential in one. The abscess extended from two to nine vertebral bodies in length. In each case, the abscess caused some degree of spinal cord compression, and one patient had bright signal intensity within the cord on T2-weighted images. Three patients had MR changes of accompanying osteomyelitis and paravertebral abscess. MR imaging is useful in diagnosing cervical epidural abscess and in evaluating associated abnormality of the spinal cord, vertebral bodies, intervertebral disks, and paraspinal soft tissue.

CT and MR appearance of cervical acrylic struts.

A patient sustained trauma to the cervical spine and underwent surgical fusion that included the use of methyl methacrylate struts. The CT and MR appearances of these acrylic struts are described.