Cerebrum-cervical arterial dissection in adults during sports and recreation / Dissecção arterial cérebro-cervical em adultos durante prática de esportes e recreação

Dissection of cervical arteries constitutes a medical emergency. Although relatively rarely, activities classified as sports and recreation may be a cause of arterial dissection independently of neck or head trauma. The purpose of the present paper was to present a series of cases of cerebrum-cervical arterial dissection in individuals during or soon after the practice of these sports activities. Methods Retrospective data on patients with arterial dissection related to sports and recreation. Results Forty-one cases were identified. The most frequently affected vessel was the vertebral artery. A large variety of activities had a temporal relationship to arterial dissection, and jogging was the most frequent of these. This is the largest case series in the literature. Conclusion Arterial dissection may be a complication from practicing sports.

A dissecção das artérias cervicais é uma emergência médica. Embora de forma relativamente rara, certas atividades descritas como esportes e recreação podem ser a causa de dissecção arterial independentemente de trauma de crânio ou cervical. O propósito do presente estudo é apresentar uma série de casos de dissecção de artérias cérebro-cervicais em indivíduos durante ou logo após a prática destas atividades desportivas. Métodos Dados retrospectivos de pacientes com dissecção arterial relacionada à prática de esportes e recreação. Resultados Quarenta e um casos foram identificados. A artéria mais frequentemente afetada foi a vertebral. Uma grande variedade de atividades teve relação temporal com a dissecção arterial, sendo a corrida a mais frequente delas. Esta é a maior série de casos da literatura. Conclusão Dissecção arterial pode ser uma complicação da prática de esportes.

Cerebrum-cervical arterial dissection in adults during sports and recreation.

UNLABELLED: Dissection of cervical arteries constitutes a medical emergency. Although relatively rarely, activities classified as sports and recreation may be a cause of arterial dissection independently of neck or head trauma. The purpose of the present paper was to present a series of cases of cerebrum-cervical arterial dissection in individuals during or soon after the practice of these sports activities. METHODS: Retrospective data on patients with arterial dissection related to sports and recreation. RESULTS: Forty-one cases were identified. The most frequently affected vessel was the vertebral artery. A large variety of activities had a temporal relationship to arterial dissection, and jogging was the most frequent of these. This is the largest case series in the literature. CONCLUSION: Arterial dissection may be a complication from practicing sports.

Asymmetric cortical degenerative syndromes: an integrated approach to clinical and imaging review.

BACKGROUND: The term asymmetric cortical degenerative syndromes (ACDSs) refers to any brain afflictions that result in selective atrophy, particularly with an asymmetric pattern. Regardless of the etiology, the resulting compromised profile reflects the affected topography, which correlates with the clinical findings, more than any specific neuropathologic entity. REVIEW SUMMARY: ACDS can represent a diagnostic challenge, because of an overlap of clinical manifestations, especially in the early stages. Magnetic resonance techniques are useful to understand nuclear medicine studies and to confirm areas of focal atrophy by providing anatomic details and allowing an accurate correlation with several different clinical settings. CONCLUSIONS: This article demonstrates a practical neuroradiologic approach for ACDS, including optimized imaging analysis (magnetic resonance and nuclear medicine studies), which correlates their patterns with clinical and pathologic findings of the most relevant disorders.

Pyramidal tract degeneration in multiple system atrophy: the relevance of magnetization transfer imaging.

The clinical features of multiple system atrophy (MSA) include four domains: autonomic failure/urinary dysfunction, Parkinsonism, cerebellar ataxia, and corticospinal tract dysfunction. Although the diagnosis of definite MSA requires pathological confirmation, magnetic resonance imaging (MRI) studies have been shown to contribute to the diagnosis of MSA. Although pyramidal tract dysfunction is frequent in MSA patients, signs of pyramidal tract involvement are controversially demonstrated by MRI. We evaluated the pyramidal involvement in 10 patients (7 women) with clinically probable MSA, detecting the presence of spasticity, hyperreflexia, and Babinski sign, as well as demonstrating degeneration of the pyramidal tract and primary motor cortex by MRI in all of them. Our article also discusses key radiological features of this syndrome. In MSA, pyramidal tract involvement seems to be more frequent than previously thought, and the clinicoradiological correlation between pyramidal tract dysfunction and degeneration may contribute to the understanding of the clinical hallmarks of MSA. MRI may also add information regarding the differential diagnosis of this syndrome.

Focal transient lesion in the splenium of the corpus callosum in three non-epileptic patients.

INTRODUCTION: We analyzed the imaging features of transient focal lesions in the splenium of the corpus callosum (SCC) in non-epileptic patients receiving antiepileptic drugs (AEDs). METHODS: We identified signal abnormalities in the SCC in three non-epileptic patients, all of them receiving AEDs. We examined two of these patients with multiplanar magnetic resonance (MR) imaging using 1.0-T equipment including fluid-attenuated inversion recovery (FLAIR), T2-weighted (TSE) and T1-weighted (SE) sequences before and after injection of contrast agent. The third patient was studied using 1.5-T equipment with the same sequences. Additionally, a T1 SE sequence with a magnetization transfer contrast pulse off resonance (T1 SE/MTC), diffusion-weighted imaging (EPI-DWI) and apparent diffusion coefficient (ADC) maps were obtained. RESULTS: We observed an identical pattern of imaging abnormalities in all patients characterized by round lesions, hyperintense on FLAIR and hypointense on T1 SE images, located in the central portion of the SCC. One lesion showed homogeneous gadolinium enhancement and perilesional vasogenic edema. This particular lesion showed restricted diffusion confirmed on the ADC map. This pattern was considered consistent with focal demyelination. Follow-up MR examinations showed complete disappearance or a clear reduction in lesion size. All patients had been treated with AEDs, but they did not show any clinical signs of toxicity, interhemispheric symptoms, or abnormal neurological findings (including seizures). CONCLUSION: We believe that our MR findings might be interpreted as transient lesions related to AED toxicity. They presumably resulted from focal demyelination in the central portion of the SCC.

Comparison of magnetic resonance imaging sequences with computed tomography to detect low-grade subarachnoid hemorrhage: Role of fluid-attenuated inversion recovery sequence.

OBJECTIVES: To compare computed tomography (CT) with magnetic resonance imaging (MRI) for the presumptive diagnosis and localization of acute and subacute low-grade subarachnoid hemorrhage (SAH). METHODS: We consecutively enrolled 45 patients clinically suspected of low-grade SAH, comparing them with a control group. We obtained axial nonenhanced CT scans as well as fluid-attenuated inversion recovery (FLAIR) and T2-weighted gradient echo (T2*) MRI sequences at 1.0 T. Two neuroradiologists scrutinized the presence of blood at 26 different regions in the intracranial subarachnoid space (SAS). RESULTS: Three of 45 patients had normal CT and MRI scans, and SAH was excluded by lumbar puncture. We demonstrated SAH on CT scans in 28 of 42 (66.6%) patients, T2* sequences in 15 of 42 (35.7%) patients, and FLAIR sequences in 42 of 42 (100%) patients. Fluid-attenuated inversion recovery sequences were superior to CT in 16 of the 26 evaluated regions. CONCLUSIONS: The FLAIR sequence was superior for presumptive diagnosis and localization of acute and subacute low-grade SAH, representing a potential tool in this setting.

Comparative analysis of MR sequences to detect structural brain lesions in tuberous sclerosis.

BACKGROUND: Tuberous sclerosis (TS) is a neurocutaneous genetically inherited disease with variable penetrance characterized by dysplasias and hamartomas affecting multiple organs. MR is the imaging method of choice to demonstrate structural brain lesions in TS. OBJECTIVE: To compare MR sequences and determine which is most useful for the demonstration of each type of brain lesion in TS patients. MATERIALS AND METHODS: We reviewed MR scans of 18 TS patients for the presence of cortical tubers, white matter lesions (radial bands), subependymal nodules, and subependymal giant cell astrocytoma (SGCA) on the following sequences: (1) T1-weighted spin-echo (T1 SE) images before and after gadolinium (Gd) injection; (2) nonenhanced T1 SE sequence with an additional magnetization transfer contrast medium pulse on resonance (T1 SE/MTC); and (3) fluid-attenuated inversion recovery (FLAIR) sequence. RESULTS: Cortical tubers were found in significantly (P<0.05) larger numbers and more conspicuously in FLAIR and T1 SE/MTC sequences. The T1 SE/MTC sequence was far superior to other methods in detecting white matter lesions (P<0.01). There was no significant difference between the T1 SE/MTC and T1 SE (before and after Gd injection) sequences in the detection of subependymal nodules; FLAIR sequence showed less sensitivity than the others in identifying the nodules. T1 SE sequences after Gd injection demonstrated better the limits of the SGCA. CONCLUSION: We demonstrated the importance of appropriate MRI sequences for diagnosis of the most frequent brain lesions in TS. Our study reinforces the fact that each sequence has a particular application according to the type of TS lesion. Gd injection might be useful in detecting SGCA; however, the parameters of size and location are also important for a presumptive diagnosis of these tumors.

Optic nerve infiltration by acute lymphoblastic leukemia: MRI contribution.

We describe the clinical presentation and imaging features of a patient with acute lymphoblastic leukemia (ALL) that was complicated by optic nerve infiltration. The clinical and diagnostic characteristics of this complication must be recognized so that optimal therapy can be started to prevent blindness. MR imaging is useful in early detection and should be performed in any leukemic patient with ocular complaints, even during remission.