RESUMO
Epilepsy is a common neurological condition with varied etiological causes, with temporal lobe epilepsy being the most common. Among the varied etiologies of temporal lobe epilepsy, mesial temporal sclerosis is an important one and it presents as intractable epilepsy. However, we describe here a case of intractable temporal lobe epilepsy with a rather rare etiology, calcifying pseudo neoplasm of neuraxis (CAPNON) syndrome. CAPNON is a rare benign lesion that can occur anywhere in the central nervous system. The thought process till date is to excise any intracranial space occupying lesion to relieve pressure and for a better prognosis, which is not questionable. However, we feel in case of CAPNON, wait and watch protocol can be used to a better effect with radiological and clinical follow-up. Above all surgical excision was primarily done due to imaging confusion over CAPNON and this article comes up with few key findings to clinch the radiological diagnosis of CAPNON.
RESUMO
A 12-year-old female presented with complaints of progressive visual impairment in both her eyes. On clinical examination, she was short for her age and her ophthalmoscopic examination revealed bilateral optic atrophy. Computed tomography of the patient revealed multiple expansile lytic lesions of mandible suggesting cherubism. The optic atrophy was confirmed on magnetic resonance imaging, which additionally revealed bilateral retrocerebellar arachnoid cysts. This association of cherubism with optic atrophy and short stature was grouped as orphan disease by National Institutes of Health and only one case was reported in the literature so far.
RESUMO
OBJECTIVE: This study was to assess the usefulness of newer three-dimensional (3D)-T1 sampling perfection with application optimized contrast using different flip-angle evolutions (SPACE) and 3D-T2 fluid-attenuated inversion recovery (FLAIR) sequences in evaluation of meningeal abnormalities. METHODS: 78 patients who presented with high suspicion of meningeal abnormalities were evaluated using post-contrast 3D-T2-FLAIR, 3D-T1 magnetization-prepared rapid gradient-echo (MPRAGE) and 3D-T1-SPACE sequences. The images were evaluated independently by two radiologists for cortical gyral, sulcal space, basal cisterns and dural enhancement. The diagnoses were confirmed by further investigations including histopathology. RESULTS: Post-contrast 3D-T1-SPACE and 3D-T2-FLAIR images yielded significantly more information than MPRAGE images (p < 0.05 for both SPACE and FLAIR images) in detection of meningeal abnormalities. SPACE images best demonstrated abnormalities in dural and sulcal spaces, whereas FLAIR was useful for basal cisterns enhancement. Both SPACE and FLAIR performed equally well in detection of gyral enhancement. In all 10 patients, where both SPACE and T2-FLAIR images failed to demonstrate any abnormality, further analysis was also negative. CONCLUSION: The 3D-T1-SPACE sequence best demonstrated abnormalities in dural and sulcal spaces, whereas FLAIR was useful for abnormalities in basal cisterns. Both SPACE and FLAIR performed holds good for detection of gyral enhancement. Post-contrast SPACE and FLAIR sequences are superior to the MPRAGE sequence for evaluation of meningeal abnormalities and when used in combination have the maximum sensitivity for leptomeningeal abnormalities. The negative-predictive value is nearly 100%, where no leptomeningeal abnormality was detected on these sequences. Advances in knowledge: Post-contrast 3D-T1-SPACE and 3D-T2-FLAIR images are more useful than 3D-T1-MPRAGE images in evaluation of meningeal abnormalities.
