Neurocisticercosis. Hallazgos radiológicos / Imaging findings in neurocysticercosis

La neurocisticercosis es una parasitosis humana causada por las larvas de la Taenia solium, que es la que con mayor frecuencia afecta el sistema nervioso central. Esta infección es endémica en prácticamente todos los países en vías de desarrollo, pero debido a la globalización y a las migraciones humanas su frecuencia ha aumentado en países desarrollados como los de Europa Occidental. Las manifestaciones clínicas más frecuentes son la epilepsia, signos neurológicos focales e hipertensión intracraneal. Los hallazgos radiológicos dependen del estadio larvario de la Taenia solium, número y localización de los parásitos (parenquimatosa, subaracnoidea e intraventricular), así como de la respuesta inmune del huésped (edema, gliosis, aracnoiditis) y del desarrollo de lesiones secundarias (arteritis, infartos o hidrocefalia). El diagnóstico de esta parasitosis debe establecerse en función de los hallazgos clínicos y radiológicos, especialmente en un contexto epidemiológico adecuado, con apoyo de la serología(AU)

Neurocysticercosis, caused by the larvae of Taenia solium, is the parasitic infection that most commonly involves the central nervous system in humans. Neurocysticercosis is endemic in practically all developing countries, and owing to globalization and immigration it is becoming more common in developed countries like those in western Europe. The most common clinical manifestations are epilepsy, focal neurologic signs, and intracranial hypertension. The imaging findings depend on the larval stage of Taenia solium, on the number and location of the parasites (parenchymal, subarachnoid, or intraventricular), as well as on the host's immune response (edema, gliosis, arachnoiditis) and on the development of secondary lesions (arteritis, infarcts, or hydrocephalus). The diagnosis of this parasitosis must be established on the basis of the clinical and radiological findings, especially in the appropriate epidemiological context, with the help of serological tests(AU)

[Imaging findings in neurocysticercosis]. / Neurocisticercosis. Hallazgos radiológicos.

Neurocysticercosis, caused by the larvae of Taenia solium, is the parasitic infection that most commonly involves the central nervous system in humans. Neurocysticercosis is endemic in practically all developing countries, and owing to globalization and immigration it is becoming more common in developed countries like those in western Europe. The most common clinical manifestations are epilepsy, focal neurologic signs, and intracranial hypertension. The imaging findings depend on the larval stage of Taenia solium, on the number and location of the parasites (parenchymal, subarachnoid, or intraventricular), as well as on the host's immune response (edema, gliosis, arachnoiditis) and on the development of secondary lesions (arteritis, infarcts, or hydrocephalus). The diagnosis of this parasitosis must be established on the basis of the clinical and radiological findings, especially in the appropriate epidemiological context, with the help of serological tests.

Hallazgos neurorradiológicos en la fase inicial del desarrollo de astrocitomas corticales de alto grado de malignidad / Neuroimaging findings in the initial phase of development of high grade cortical astrocytomas

Objetivos. Describir las características neurorradiológicas de una serie de astrocitomas corticales de alto grado de malignidad en su fase inicial de desarrollo y su patrón de crecimiento durante un corto período de tiempo. Material y métodos. Estudio observacional retrospectivo de los hallazgos neurorradiológicos de 6 pacientes que, tras una primera crisis epiléptica, mostraron lesiones focales corticales supratentoriales que fueron seguidas clínico-radiológicamente durante un corto período de tiempo, tras el cual se estableció el diagnóstico de astrocitoma de alto grado de malignidad, Resultados. En los estudios de resonancia magnética (RM) de todos los pacientes se constató una pequeña lesión cortical hiperintensa en secuencias T2 con realce leve o moderado con la administración de contraste (en 5 de ellos). En los 6 pacientes se llevó a cabo un seguimiento radiológico en los 6 primeros meses tras el examen inicial (media: 79 días), que reveló un marcado crecimiento de las lesiones. Tras esta segunda RM, los pacientes fueron sometidos a cirugía citorreductora, y se estableció el diagnóstico histológico de astrocitomas de alto grado (glioblastoma en 5 pacientes y oligoastrocitoma anaplásico en uno). Conclusión. Los astrocitomas de alto grado de malignidad de origen cortical supratentorial en estadios iniciales pueden presentarse en los estudios neurorradiológicos de forma atípica. La presencia de una lesión cortical con realce leve o moderado tras la administración de contraste en un paciente que ha presentado una primera crisis epiléptica debería incluir en su diagnóstico diferencial los astrocitomas de alto grado de malignidad (AU)

Objectives. To describe the neuroradiological characteristics of a series of high grade cortical astrocytomas in the initial phase of development and their pattern of growth during a short time period. Material and methods. This was a retrospective observational study of the neuroradiological findings in six patients diagnosed with high grade astrocytoma. All presented with a new onset epileptic seizure and focal supratentorial cortical lesions. The diagnosis was established after a short period of clinical and radiological follow-up. Results. Magnetic resonance imaging (MRI) detected a small cortical lesion that was hyperintense in T2-weighted sequences in all six patients. This lesion showed slight or moderate enhancement after the administration of a contrast agent in five patients. All six patients underwent follow-up MRI within six months of the initial MRI examination (mean 79 days). Follow-up MRI showed marked growth of the lesions in all cases, and the histological diagnosis of high grade astrocytoma (glioblastoma in five patients and anaplastic oligoastrocytoma in one) was established after surgical debulking. Conclusion. High grade astrocytomas originating in the supratentorial cortex can have an atypical neuroradiological presentation in the early stages. High grade astrocytoma should be included in the differential diagnosis of a cortical lesion that enhances slightly or moderately after the administration of contrast material in a patient with a new onset epileptic seizure (AU)

Velocidad de expansión de gliomas de alto grado. Respuesta / No disponible

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Neuroimaging findings in the initial phase of development of high grade cortical astrocytomas.

OBJECTIVES: To describe the neuroradiological characteristics of a series of high grade cortical astrocytomas in the initial phase of development and their pattern of growth during a short time period. MATERIAL AND METHODS: This was a retrospective observational study of the neuroradiological findings in six patients diagnosed with high grade astrocytoma. All presented with a new onset epileptic seizure and focal supratentorial cortical lesions. The diagnosis was established after a short period of clinical and radiological follow-up. RESULTS: Magnetic resonance imaging (MRI) detected a small cortical lesion that was hyperintense in T2-weighted sequences in all six patients. This lesion showed slight or moderate enhancement after the administration of a contrast agent in five patients. All six patients underwent follow-up MRI within six months of the initial MRI examination (mean 79 days). Follow-up MRI showed marked growth of the lesions in all cases, and the histological diagnosis of high grade astrocytoma (glioblastoma in five patients and anaplastic oligoastrocytoma in one) was established after surgical debulking. CONCLUSION: High grade astrocytomas originating in the supratentorial cortex can have an atypical neuroradiological presentation in the early stages. High grade astrocytoma should be included in the differential diagnosis of a cortical lesion that enhances slightly or moderately after the administration of contrast material in a patient with a new onset epileptic seizure.

Infarto del territorio de la arteria cerebral posterior por disección carotídea / Posterior cerebral artery territory infarcts due to carotid dissection

Introducción. Cerca del 20% de los ictus en individuosmenores de 45 años se deben a disección de las arterias cervicocefálicasy ante su sospecha la resonancia magnéticadebe considerarse como el examen de primera elección. Lacirculación fetal posterior es una variante en el desarrolloembriogénico que puede ocasionar un infarto en el territorioposterior ante una disección o estenosis carotídea.Caso clínico. Presentamos el caso de un paciente de51 años con un infarto agudo occipitotemporal izquierdo yevidencia por ecografía dúplex de una oclusión de la arteriacarótida interna y de la arteria cerebral posterior izquierda, asícomo un probable origen carotídeo de la arteria cerebral posterior.La resonancia magnética craneal confirmó los hallazgosy mostró una disección en el segmento distal de la arteria carótidainterna izquierda con presencia de trombo mural.Conclusiones. Los infartos del territorio posterior causadospor disección carotídea espontánea son una entidadrara y se han comunicado pocos casos en la bibliografía.Realizamos una revisión de la bibliografía a este respecto (AU)

Introduction. About 20% of strokes in individualsunder 45 years of age are due to cervicocephalic arterydissection. The magnetic resonance should be the firstoption in the diagnostic process when this etiology issuspected. Posterior fetal circulation is a variant in theembryogenic development that may cause posteriorterritory infarcts in carotid dissections or stenosis Case report. We report the case of a 51 year-old malepatient, with left occipitotemporal acute infarct andocclusion of the internal carotid and left posterior cerebralarteries as well as a probable carotid origin of theposterior cerebral artery. These findings were found inthe duplex doppler sonography and were confirmed inthe cranial magnetic resonance which also showed a dissectionin the distal segment of the left internal carotidartery with a mural clot.Conclusions. Posterior territory strokes due to spontaneouscarotid dissection are rare and there are fewcases reported in the literature. We have reviewed theprevious literature on this topic (AU)

[Posterior cerebral artery territory infarcts due to carotid dissection]. / Infarto del territorio de la arteria cerebral posterior por disección carotídea.

INTRODUCTION: About 20% of strokes in individuals under 45 years of age are due to cervicocephalic artery dissection. The magnetic resonance should be the first option in the diagnostic process when this etiology is suspected. Posterior fetal circulation is a variant in the embryogenic development that may cause posterior territory infarcts in carotid dissections or stenosis. CASE REPORT: We report the case of a 51 year-old male patient, with left occipitotemporal acute infarct and occlusion of the internal carotid and left posterior cerebral arteries as well as a probable carotid origin of the posterior cerebral artery. These findings were found in the duplex doppler sonography and were confirmed in the cranial magnetic resonance which also showed a dissection in the distal segment of the left internal carotid artery with a mural clot. CONCLUSIONS: Posterior territory strokes due to spontaneous carotid dissection are rare and there are few cases reported in the literature. We have reviewed the previous literature on this topic.

[Anatomic study of parapharyneal space]. / Estudio anatómico del espacio parafaríngeo.

The parapharyngeal space is considered the key space of the suprahioid neck, being essential to establish the origin and anatomic relations of the lesions of the profound neck. The descriptions of the fascial limits of the parapharyngeal space are variable in the litterature, reflecting some ambiguity in the manuals of anatomy and surgery. We have done a detailed study of this region, working on 5 cadavers, fixed in a solution of phenol and alcohol, and correlating the disection pieces with a radiologic study. The goal has been to improve our anatomic knowledge of the suprahioid neck, to be able to establish an anatomo-clinic-radiologic correlation of the lesions of this region, to be able to establish an differential diagnosis, predict possible ways of dissemination and facilitate the most proper surgical approach.

Estudio anatómico del espacio parafaríngeo / Anatomic study of parapharyneal space

El espacio parafaríngeo se considera el espacio clave del cuello suprahioideo, siendo esencial para establecer el origen y relaciones anatómicas de las lesiones que asientan en el cuello profundo. Las descripciones de los límites fasciales del espacio parafaríngeo son variables en la literatura, reflejándose cierta ambigüedad en los tratados de anatomía y de cirugía. Hemos realizado un estudio detallado de dicha región trabajando sobre 5 cabezas humanas fijadas en solución de fenol y alcohol, y correlacionando las piezas de disección con un estudio radiológico. El objetivo ha sido aumentar nuestro conocimiento anatómico del cuello suprahioideo para así poder establecer una correlación anátomo-clínico-radiológica de las lesiones que asientan en esta región y poder establecer un diagnóstico diferencial, predecir posibles rutas de diseminación y facilitar su abordaje quirúrgico más adecuado (AU)

Difusión por resonancia magnética en el diagnóstico de abscesos cerebrales / Magnetic resonance diffusion in the diagnosis of cerebral abscesses

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[Magnetic resonance in the diagnosis and treatment of multiple sclerosis]. / Resonancia magnética en el diagnóstico y manejo de la esclerosis múltiple.

Although the diagnosis of multiple sclerosis is still based on clinical criteria, confirmation by magnetic resonance imaging (MRI) is considered to be essential, thank to its high sensitivity in demonstrating the spatial dissemination of the demyelinating plaques in the brain and spinal cord. Additionally, MRI can establish an approximation of the pathological substrate of the multiple sclerosis plaques and it has proven useful for studying the natural history of the disease and monitoring the effects of new treatments. This capacity of MRI is based on its ability to estimate the degree of demyelination, gliosis, edema, inflammation and axonal damage and to detect diffuse involvement of the normal appearing white matter. The selective identification of the lesions that contribute most to the patient's disability and clinical progression, such as severe demyelination and axonal damage, improves the MRI correlation with the neurological impairment scales. However, a correct application of MRI in the study of multiple sclerosis requires standardization of the techniques and sequences used in the different clinical forms of the disease and of the systems for measuring the lesion load. In this way multiple sclerosis can serve as a true biological marker of the severity of the disease.

[Magnetic resonance in the clinical and therapeutic follow-up of multiple sclerosis]. / Resonancia magnética en el seguimiento clínico y terapéutico de la esclerosis múltiple.

Magnetic resonance is the most sensitive para-clinical method available for the diagnosis of multiple sclerosis since it shows changes in 95% of the patients with clinically definite multiple sclerosis. However, little correlation has been found, in different studies, between the parameters of magnetic resonance and the degree of neurological disability. The development and gradual application of new techniques of magnetic resonance, which permit specific detection of the lesions with the greatest degree of nerve dysfunction, permits improvement in the use of this technique for study of the natural history of the disease and thus to monitor patients given new treatments.

Resonancia magnética en el diagnóstico y manejo de la esclerosis múltiple / Magnetic resonance in the diagnosis and management of multiple sclerosis

A pesar de que la esclerosis múltiple sigue siendo un diagnóstico clínico, la resonancia magnética (RM) se considera una técnica fundamental para confirmarlo. La RM permite, además, establecer una aproximación al sustrato patológico de las placas de esclerosis múltiple y ha demostrado una gran utilidad en el estudio de la historia natural de la enfermedad y en la monitorización del posible efecto que nuevos tratamientos ejercen sobre ella. Estas posibilidades de la RM se fundamentan en su elevada sensibilidad en la demostración de diseminación espacial de las placas desmielinizantes, tanto cerebral como medular, pero también en la posibilidad de establecer una aproximación al grado de desmielinización, gliosis, edema, inflamación y daño axonal que tienen las placas, así como en la detección de la existencia de afectación difusa de la sustancia blanca de apariencia normal. Esto mejora significativamente el grado de correlación con las escalas de discapacidad neurológica, ya que permite una identificación selectiva de las lesiones que más contribuyen a la discapacidad y progresión clínica de los pacientes, como son la desmielinización grave y el daño axonal. La correcta aplicación de la RM en el estudio de la esclerosis múltiple requiere, sin embargo, una cierta estandarización de las técnicas y secuencias a aplicar en las diferentes situaciones y formas clínicas de la enfermedad, así como de los sistemas de cuantificación de la carga lesional, lo que permitiría utilizar esta técnica como un auténtico marcador biológico del grado de afectación de la enfermedad (AU)

Vertebral artery occlusion after acute cervical spine trauma.

STUDY DESIGN: A retrospective study of vertebral artery injury diagnosed during the last 6 years in our institution. OBJECTIVES: To determine the clinical and radiologic features of vertebral artery injury. SUMMARY OF BACKGROUND DATA: Extracranial occlusion of the vertebral artery associated with cervical spine fracture is uncommon and can cause serious and even fatal neurologic deficit due to back lifting and cerebellar infarction. Magnetic resonance imaging and magnetic resonance angiography are extremely helpful in the examination of acute injuries of the cervical spine. METHODS: Magnetic resonance imaging and magnetic resonance angiography were performed at the time of injury. RESULTS: The authors reviewed six patients with cervical spine fractures who were diagnosed with a unilateral occlusion of the vertebral artery by means of magnetic resonance imaging/magnetic resonance angiography. One patient had signs of vertebrobasilar insufficiency and another with complete cord lesion had cerebellar and back lifting infarctions. Surgical anterior spinal fusion was performed in five patients, and one was treated by traction and orthosis. At the time of discharge, five patients had no vertebrobasilar symptoms, and the patient who experienced vertebrobasilar territory infarctions showed no progression of the neurologic damage. CONCLUSIONS: Vertebral artery injury should be suspected in cervical trauma patients with facet joint dislocation or transverse foramen fracture. Magnetic resonance imaging/magnetic resonance angiography is a helpful test to rule out vascular injury. Vertebral artery injury affects the extracranial segment at the same level as the cervical fracture. This is a retrospective review that did not permit drawing conclusions about the effects of early surgical stabilization in the treatment of cervical spine injuries with associated vertebral artery injury; however, surgical stabilization may avoid propagation and embolization of the clot located at the site of the lesion.

Resonancia magnética en el seguimiento clínico y terapéutico de la esclerosis múltiple / Magnetic resonance in the clinical and therapeutic follow-up of multiple sclerosis

La resonancia magnética es el método paraclínico más sensible en el diagnóstico de esclerosis múltiple ya que muestra alteraciones en el 95 por ciento de pacientes con esclerosis múltiple clínicamente definida; sin embargo, la correlación obtenida en diferentes estudios entre los parámetros que ofrece la resonancia magnética y el grado de discapacidad neurológica ha sido escasa. El desarrollo y progresiva aplicación de nuevas técnicas de resonancia magnética, que permiten detectar de forma específica aquellas lesiones que traducen un mayor grado de disfunción neuronal, está permitiendo optimizar la utilización de esta técnica en el estudio de la historia natural de la enfermedad y, consiguientemente, en la monitorización de los enfermos que son sometidos a nuevos tratamientos (AU)

[The role of magnetic resonance in acute stroke]. / El papel de la resonancia magnética en el ictus agudo.

The combined use of different techniques of magnetic resonance, such as angiography by magnetic resonance, microscopic tissue diffusion, proton perfusion and spectroscopy, has meant a great advance in early diagnosis of cerebrovascular accidents. They also give relatively precise information as to the presence and extent of potentially reversible zones of border-line ischaemia, with their prognostic and therapeutic implications. Combined analysis of the different parameters which can be measured using magnetic resonance, may in the near future, permit this technique to be used for selection of patients who may benefit from the active treatment of cerebral ischaemia during the hyper-acute phase, and monitorization of the effect of this treatment.

Hyperacute spinal subdural haematoma as a complication of lumbar spinal anaesthesia: MRI.

We report two cases of hyperacute spinal subdural haematoma secondary to lumbar spinal anaesthesia, identified with MRI. Prompt diagnosis of this infrequent, potentially serious complication of spinal anaesthesia is essential, as early surgical evacuation may be needed. Suggestive MRI findings in this early phase include diffuse occupation filling of the spinal canal with poor delineation of the spinal cord on T1-weighted images, and a poorly-defined high-signal lesion with a low-signal rim on T2-weighted images.