A case of McLeod phenotype of neuroacanthocytosis brain MR features and literature review.

Huntington's disease and neuroacanthocytosis may present similar clinical and MRI features. It is important to differentiate these findings since treatment and prognosis vary vastly between them. The aim of this article is to familiarize radiologists with the differentiating features of Huntington's disease and various diseases comprising neuroacanthocytosis. A 40-year-old Indian man with extrapyramidal symptoms was referred for MRI. The clinical diagnosis was Huntington's disease, but there were a few atypical clinical features such as a history of biting the tongue, tics, marked hyporeflexia and lower limb muscle wasting. MR showed atrophy of the caudate nucleus and putamen with iron deposition in the basal ganglia, which can be seen in Huntington's disease and in neuroacanthocytosis. An increased blood acanthocyte level was subsequently confirmed. Further work-up revealed increased serum creatine phosphokinase levels, normal serum lipoprotein levels and depressed K cell antigen activity on serological studies, confirming the diagnosis of McLeod syndrome. McLeod syndrome is one of the distinct phenotypes of neuroacanthocytosis. Neuroacanthocytosis is a group of disorders with increased serum acanthocyte counts and neurological involvement. Various causes of neuroacanthocytosis are discussed. It is important to consider the possibility of neuroacanthocytosis when features typical of Huntington's disease are encountered on imaging.

Single prediction equation for bioelectrical impedance analysis in adults aged 22-59 years.

The purpose of this study was to validate a single bioelectrical impedance analysis (BIA) equation in healthy Indian subjects aged 22-59 years with a body mass index (BMI) between 16.8 and 47.3 kg m⁻². Healthy subjects (34 men and 30 women) were measured by two methods: bone mineral content (BMC) was measured by a commercial body composition analyser and bioelectrical impedance at various frequencies was measured by a newly developed bioelectrical impedance measurement system. As correlations were high and prediction error was low, a single equation was developed using all subjects as follows: BMC = -3.5268 + (0.0279  x  h) + (0.0145  x  w) + (184  x  (h²/Z(body50)))-(1.08  x  (w x  h²/Z(body6.25)))-(0.0032  x  (age))-(0.103  x  (sex); men = 1, women = 0). BMC measured from commercial instrument InBody720 was 2.552 ±â€Š0.457 kg. BMC predicted by equation was 2.554 ±â€Š0.447 kg (R = 0.976, adjusted R²â€Š= 0.948, standard error of estimate = 0.104 kg, total error = 0.09987 kg). The results of this study show that the newly developed multi-frequency bioelectrical impedance measurement system with the single prediction BIA equation can be used in screening the subjects suspected with osteoporosis and for follow-up study of the patient under the therapy for osteoporosis. For validation of commercial instrument InBody720, BMC of 22 healthy subjects was measured by InBody720 and dual-energy X-ray absorptiometry. High correlation (R = 0.9531) and low error (total error = 0.0913 kg) was found between these two methods.

Adductor insertion avulsion syndrome with stress fracture of femoral shaft: MRI findings.

Chronic vague hip pain may be caused by stress-related injury in the proximal or mid-femoral diaphysis. This has been described as an entity called adductor insertion avulsion syndrome, or thigh splints. In the appropriate clinical setting, the radiologist interpreting the magnetic resonance imaging must be aware of this condition as its imaging findings are subtle. The diagnosis will help the clinician plan the appropriate management. Magnetic resonance imaging can also depict the complications such as stress fracture.

Caudal regression syndrome with sacral rib: MRI features.

Caudal regression syndrome (CRS) involves improper and incomplete development of distal spinal segments. Sacral rib is an unusual entity, where an accessory rib arises from the sacral vertebral segments. Very few cases have been described in the English literature. We present the case of a 3-year-old girl presenting with urinary and bowel incontinence and difficulties in walking with left-sided sacral rib, terminal cord syrinx, and caudal regression syndrome, involving sacrococcygeal segments, diagnosed on MRI. The association is not well illustrated in previous reports.

Spontaneous intracranial hypotension: a study of six cases with MR findings and literature review.

Spontaneous intracranial hypotension is clinically characterized by orthostatic headache and other symptoms caused by low cerebrospinal fluid pressure due to leakage of cerebrospinal fluid from dural punctures or other medical causes. The other symptoms are mainly due to traction of the cranial and spinal nerves owing to descent of the brain caused by low cerebrospinal fluid pressure. Magnetic resonance imaging is very useful in the diagnosis because of its characteristic findings. We describe the MRI findings in six cases that had variable clinical presentation.

MR spectroscopy-aided differentiation: "giant" extra-axial tuberculoma masquerading as meningioma.

Tuberculosis is common in the developing world and in developed nations secondary to increasing immunocompromise in the population. It commonly causes meningitis and parenchymal tuberculomas. We present a case of an unusual masslike "giant" extra-axial tuberculoma during pregnancy. Unusual morphology and size at imaging made meningioma a close differential. MR spectroscopy served to complement MR imaging, providing diagnostic confirmation and depicted findings characteristic of a tuberculoma.

Magnetic resonance spectroscopic diagnosis of acute alcohol ingestion with hidden history.

Parenchymal changes within the brain in chronic alcoholics are well known, and specific MRI and MR spectroscopy findings have been described. However, recent alcohol ingestion goes undetected on routine MRI because of lack of specific parenchymal changes in the acute setting. Magnetic resonance spectroscopy can detect the presence of ethanol as a metabolite in the brain accurately and can provide valuable information regarding acute ingestion of alcohol. This may be useful especially in cases where history of alcohol ingestion is withheld.

Bilateral optic pathway glioma with intracranial calcification: magnetic resonance imaging and magnetic resonance spectroscopy findings.

Optic nerve glioma is the most common primary neoplasm of the optic nerve in childhood. It can extend intracranially along the optic pathway (optic pathway glioma). The lesion tends to present with decreased visual acuity in the affected eye, but can cause additional symptoms when it is large. Local involvement within the orbit can be characterized using CT, but MRI is superior in showing the intracranial extent of the lesion. Intracranial calcification in optic pathway glioma is rare. We present a rare case of optic pathway glioma with calcification in the intracranial component. Also, we describe MR spectroscopy (MRS) findings in this case.

Intracranial metastasis from prostatic adenocarcinoma simulating a meningioma.

We report an unusual case of extra-axial metastatic adenocarcinoma of the prostate that closely simulated a frontal, parasagittal, dural-based meningioma. Such tumours, which satisfy several criteria for a diagnosis of meningioma, but which have proved instead to be metastatic adenocarcinoma of the prostate, form the focus of our report.

Multiple hemangiomas involving the vertebral column.

Hemangiomas are benign, slow-growing skeletal and soft tissue tumors that commonly involve the bony spine. When found in the spine, they are usually asymptomatic, but can sometimes be associated with local pain and/or neurological deficits. We report the case of a middle-aged Indian male with multiple hemangiomas involving almost all the vertebrae contiguously from C2 to S1 vertebral levels. These were discovered incidentally when a magnetic resonance scan was performed for backache. To the best of our knowledge, such extensive involvement of the spine has not been reported previously.

Ultrafast MRI in the prenatal diagnosis of Bourneville's tuberous sclerosis.

The purpose of this report is to highlight the utility of prenatal MRI as an adjunctive imaging modality in the diagnosis and prognosis of Tuberous Sclerosis (TS) (Bourneville's disease). We report a case of TS detected in utero at 30 weeks gestation. A routine ultrasonography at 26 weeks in a 28-year-old primigravida was followed by an ultrafast MRI examination at 30 weeks gestation. Ultrasound raised the possibility of TS based on the detection of multiple cardiac rhabdomyomas. Fetal MRI, subsequently performed, showed the presence of cortical tubers and subependymal nodules establishing the diagnosis. Fetal MRI in the appropriate clinical setting can be potentially invaluable and can have important prognostic implications.

Magnetic resonance volumetric analysis of hippocampi in children in the age group of 6-to-12 years: a pilot study.

Atrophy of the mesial temporal structures, especially the hippocampus, has been implicated in temporal lobe epilepsy. However, to date, there is very scant data regarding normal volumes of the hippocampus in the pediatric population. This is a pilot study to estimate the normal volumetric data for the Indian pediatric population between 6 and 12 years of age. We have also tried to understand whether age and gender have an effect on the hippocampal volumes in this age group. The study group comprised 20 children, 6-12-years old without history of epilepsy or other neurological deficits. There were nine boys and 11 girls. All scans were performed on a 1.5T GE echo speed scanner. 3D fast SPGR sequence was prescribed in the coronal plane. The images were post-processed on an Advantage Windows 3.1 workstation. Using an automated program, the same observer calculated the hippocampal area, in cubic centimeters, clockwise and anticlockwise. The clockwise/anticlockwise data were subjected to correlation analysis for detecting intra-observer agreement. The mean and SD for left and right hippocampal volumes were estimated. The lower and upper limits for normal hippocampal volumes were determined using 95% (+/- 2SD) limits on either side of the mean. In order to understand the effect of age on various hippocampal volumes we performed regression analysis. Mann-Whitney's test was used to test the significance of differences for gender variations. Correlation analysis established that there was intra-observer agreement. In the Indian pediatric population we have found the mean right hippocampal volume (RHV) to be 2.75 cm(3) and mean left hippocampal volume (LHV) to be 2.49 cm(3). Mean hippocampal volume was found to be 2.67 cm(3) (SD = 0.42). The upper and lower limits for hippocampal volumes were 3.51 cm(3) and 1.83 cm(3), respectively, based on 95% (+/- 2SD) limits on either side of the mean. There was no effect of age or gender on the hippocampal volumes. In the Indian pediatric population we determined hippocampal volumes in a small series of healthy children. We found that hippocampal volumes < or =1.83 cm(3) (< or =2SD) can be considered to be abnormal. These findings can be used as normative data to evaluate cases of hippocampal sclerosis in the Indian population.

Co-existing spinal cord and brain cavernous angiomas.

Cavernous angioma of spinal cord is an extremely rare vascular malformation. The association with brain cavernous angioma is even uncommon. There should be a high index of suspicion for a spinal cord lesion whenever a brain cavernous angioma is diagnosed, in cases with appropriate suggestive spinal symptoms. We present a case of cavernous angioma of the brain involving the genu of the corpus callosum, co-existing with spinal cord hemangioma. Involvement of the corpus callosum by a cavernous angioma is also uncommon. Intraventricular extension of this lesion was also detected.

Extensive gliomas of visual tract in a patient of neurofibromatosis-I.

Although bilateral optic nerve gliomas are commonly found in patients with neurofibromatosis I, extensive gliomas involving the entire visual tracts, bilaterally are relatively rare. Usually the optic radiations are spared. We report a case of a 2-year-old child with extensive disease of bilateral visual pathways with involvement of the hypothalamus manifesting as obesity.