Kawasaki Disease Complicated with Cerebral Vasculitis and Severe Encephalitis.

We report a case of a 7-year-old boy with Kawasaki disease (KD) complicated with cerebral vasculitis and encephalitis. The patient was admitted with signs of encephalopathy, seizures, and coma. The diagnosis of KD was made on the 2nd day of hospitalization based on the clinical features (fever >5 days, maculopapular rash, nonpurulent conjunctivitis, fissured lips, and cervical adenopathy). Brain magnetic resonance imaging findings suggested cerebral vasculitis. Treatment with intravenous immunoglobulin was followed by mild improvement. After a single dose of immunoglobulin, pulse methylprednisolone therapy was started resulting in gradual improvement of consciousness and eventual complete motor and cognitive function recovery with regression of brain magnetic resonance lesions. KD can present with marked neurological symptomatology. Therefore, it should be considered in the differential diagnosis of encephalitis and encephalopathy etiologies in children.

Partial rhombencephalosynapsis: prenatal MR imaging diagnosis and postnatal follow up.

We present a case of partial rhombencephalosynapsis, diagnosed by magnetic resonance imaging (MRI), in fetus aged 27 gestational weeks, in a dizygotic twin pregnancy. The distinctive MRI features of this cerebellar malformation (segmental hypogenesis of the cerebellar vermis, partial fusion of the cerebellar hemispheres and dentate nuclei) without associated cerebral abnormalities were confirmed by 32-weeks prenatal and 3-months postnatal MRI studies. At the age of 12 months the affected twin had a slight delay in psychomotor development, mild hypotonia with normal cognitive development. To the authors' best knowledge, this is the first report of a fetal case with isolated partial rhombencephalosynapsis. Its MRI features enlarges the narrow spectrum of uncommon variants of rhombencephalosynapsis, and allow an accurate differentiation from other vermian and cerebellar anomalies with less favorable postnatal outcome.

Gender differences in brain areas involved in silent counting by means of fMRI.

BACKGROUND: Pattern of brain asymmetries varies with handedness, gender, age, and with variety of genetic and social factors. Large-scale neuroimaging analyses can optimize the detection of asymmetric features and confirm the factors that might modulate pattern of brain asymmetries. We attempted to evaluate eventual differences between genders in hemodynamic responses to a simple language task. METHODS: 12 healthy right-handed volunteers (age 24-46), 6 men and 6 women underwent fMRI scanning while performing the simple cognitive - language processing task - silent number counting in Serbian. RESULTS: Group analysis of hemodynamic responses shows activation in expected brain language areas of inferior frontal gyrus (IFG) and superior temporal gyrus (STG) in both hemispheres. In the male group, aside from dedicated language areas in IFG and STG, activation was noted in right frontal region and interhemispheric supplementary motor area. On the other hand, in the female group, besides activation in dedicated language areas, activation was noted, in right hippocampus, limbic brain and cerebellum bilaterally. CONCLUSIONS: Our results on differences in silent counting by means of fMRI suggest that those differences may be based on different brain pattern activation in men and women. The relation between performance, strategies and regional brain activation should be the topic of further studies when considering not only gender differences in language processing but also differences that may be attributed to the variations in the task details, stimuli, and the stimulus presentation methods.

[Dynamic magnetic resonance imaging of the cerebrospinal fluid flow within the cerebral aqueduct by different FISP 2D sequences].

BACKGROUND/AIM: A vast majority of current radiogical techniques, such as computerized tomography (CT) and magnetic resonance imaging (MRI) have great potencial of vizualization and delineation of cerebrospinal fuid spaces morphology within cerebral aqueduct. The aim of this study was to determine the possibilities of two differently acquired FISP (Fast Imaging with Steady State Precession) 2D MR sequences in the estimation of the pulsatile cerebrospinal fluid (CSF) flow intensity through the normal cerebral aqueduct. METHODS: Sixty eight volunteers underwent brain MRI on 1.5T MR imager with additionally performed ECG retrospectively gated FISP 2D sequences (first one, as the part of the standard software package, with following technical parameters: TR 40, TE 12, FA 17, Matrix: 192 x 256, Acq 1, and the second one, experimentally developed by our investigation team: TR 30, TE 12, FA 70, Matrix: 192 x 256, Acq 1) respectively at two fixed slice positions--midsagittal and perpendicular to cerebral aqueduct, displayed and evaluated by multiplegated images in a closed-loop cinematographic (CINE) format. RESULTS: Normal brain morphology with preserved patency of the cerebral aqueduct in all of 68 healthy volunteers was demonstrated on MRI examination. Cerebrospinal fluid flow within the cerebral aqueduct was distinguishable on both CINE MRI studies in midsagittal plane, but the estimation of intraaqueductal CSF flow in perpendicular plane was possible on CINE MRI studies acquired with experimentally improved FISP 2D (TR 30, FA 70) sequence only. CONCLUSION: Due to the changes of technical parameters CINE MRI study acquired with FISP 2D (TR 30, FA 70) in perpendicular plane demonstrated significantly higher capability in the estimation of the CSF pulsation intensity within the cerebral aqueduct.