A Woman With Headaches and a Tumefactive Brain Lesion

2021 ◽  
pp. 202-203
Author(s):  
Andrew McKeon
Keyword(s):  
Corpus Callosum ◽  
Clinical Decision Making ◽  
Demyelinating Disease ◽  
Brain Lesion ◽  
Brain Magnetic Resonance Imaging ◽  
Corticosteroid Treatment ◽  
Mass Effect ◽  
Clinical Decision ◽  
Contrast Imaging ◽  
Language Deficit

A 65-year-old woman sought care for a 6-month history of confusion and emotional disturbance that was initially ascribed to stress. She then had development of headaches over several weeks, which prompted brain magnetic resonance imaging with contrast. Imaging showed a mass emanating bilaterally from the splenium of the corpus callosum with heterogeneous T1 postgadolinium enhancement. Neurologic examination indicated left homonymous hemianopia, but she was otherwise normal. She had neither alexia nor other language deficit that may appear with a splenial corpus callosum lesion. A biopsy of the brain mass was performed. Histologic analysis of the biopsy specimen revealed glioblastoma multiforme. Corticosteroid treatment was prescribed, which relieved her headache. Radiation therapy and chemotherapy (temozolomide) were recommended. No further follow-up information was available. In neurologic clinical practice, a large corpus callosum–based lesion is sometimes encountered. The localization of such lesions is not specific for any one diagnosis, but radiologic characteristics can aid clinical decision making. Although the radiologic appearance of a lesion spreading out into both hemispheres from the corpus callosum can indicate butterfly glioma, the differential diagnosis also includes tumefactive demyelinating disease and lymphoma, which can also have a callosal localization and produce mass effect.

scholarly journals Vici syndrome in an Egyptian infant: case report and differential diagnosis of inherited hypopigmented disorders

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Marwa Abd Elmaksoud ◽  
Aya Attya Abeesh ◽  
Catarina Pereira ◽  
Marwa El-Saeed El-Deeb
Keyword(s):  
Differential Diagnosis ◽  
Corpus Callosum ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Phenotype Correlation ◽  
Multisystem Disease ◽  
Case Presentation ◽  
Correlation Studies ◽  
Clinical Description ◽  
Infant Case

Abstract Background Vici syndrome is a severe inherited multisystem disease caused by mutations in the EPG5 gene. The diagnosis depends on the constellation of cardinal features of agenesis of the corpus callosum, cataracts, oculocutaneous hypopigmentation, cardiomyopathy, and a combined immunodeficiency followed by confirmation by genetic testing. We report an Egyptian infant with Vici syndrome carrying a homozygous splice site variant (c.1252+1G>T; NM_020964.2) in the EPG5 gene, detailed clinical description, outcome, and differential diagnosis of inherited hypopigmentation disorders associated with neurological manifestations. Case presentation The infant initially presented with oculocutaneous hypopigmentation, agenesis of the corpus callosum, and immunodeficiency. A few months later, a diagnosis of dilated cardiomyopathy was made. Family history revealed 2 deceased siblings phenotypically matching our index infant. He died at the age of 15 months with acute respiratory failure. Conclusion The accurate diagnosis of such rare diseases with genetic confirmation is vital for proper clinical decision-making, genetic counseling of the affected families, and future genotype-phenotype correlation studies.

Decompressive aspiration in myelinoclastic diffuse sclerosis or Schilder disease

2002 ◽  
Vol 97 (6) ◽  
pp. 1447-1449 ◽  
Author(s):  
Farideh Nejat ◽  
Behzad Eftekhar
Keyword(s):  
White Matter ◽  
Intracranial Hypertension ◽  
Demyelinating Disease ◽  
Corticosteroid Treatment ◽  
Mass Effect ◽  
Subcortical White Matter ◽  
Brain Images ◽  
Content Type ◽  
Fine Print ◽  
Diffuse Sclerosis

✓ This 9-year-old girl with rapidly progressive cerebral demyelinating disease presented with hemiplegia and intracranial hypertension. Brain images revealed four lesions with mass effect in the subcortical white matter of both hemispheres. Demyelination was found on pathological studies of these lesions. The patient experienced some recovery with corticosteroid treatment but improved completely with decompressive aspiration of the largest lesion.

scholarly journals Operationalization of the learned non-use phenomenon - A Delphi study

2020 ◽  
Author(s):  
Theresa Hirsch ◽  
Maria Barthel ◽  
Pauline Aarts ◽  
Yi-An Chen ◽  
Susanna Freivogel ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Delphi Study ◽  
Clinical Decision Making ◽  
Negative Reinforcement ◽  
Brain Lesion ◽  
Clinical Decision ◽  
Diagnostic Process ◽  
Sources Of Information ◽  
Wide Range

AbstractThe discrepancy between residual functional capacity and reduced use of the contralesional hand, frequently observed after a brain lesion, has been termed Learned Non-Use (LNU) and is thought to depend on the interaction of neuronal mechanisms during recovery and learning-dependent mechanisms such as negative reinforcement. Despite the generally accepted existence of the LNU phenomenon among clinicians and researchers, no unequivocal and transdisciplinary definition exists to date. Furthermore, although therapeutic approaches are implemented in clinical practice to explicitly target LNU, no standardized diagnostic routine is described in the current literature.Based on a structured group communication following the Delphi method among clinical and scientific experts in the field of LNU, knowledge from both, the work with patient populations and with animal models, was synthesized and integrated to reach consensus regarding a transdisciplinary definition of the LNU phenomenon. Furthermore, the mode and strategy of the diagnostic process, as well as the sources of information and outcome parameters relevant for the clinical decision making, were described with a wide range showing the current lack of a consistent universal diagnostic approach. Building on these results, the need for the development of a structured diagnostic procedure and its implementation into clinical practice is emphasized. Moreover, it exists a striking gap between the prevailing hypotheses regarding the mechanisms underlying the LNU phenomenon and the actual evidence. Therefore, basic research is needed to bridge between bedside and bench and eventually improve clinical decision making and further development of interventional strategies beyond the field of stroke rehabilitation.

scholarly journals A Web Based Dynamic MANA Nomogram for Predicting the Malignant Cerebral Edema in patients with large hemispheric infarction

2020 ◽  
Author(s):  
Wenzhe Sun ◽  
Guo Li ◽  
Yang Song ◽  
Zhou Zhu ◽  
Zhaoxia Yang ◽  
...  
Keyword(s):  
Cerebral Edema ◽  
Clinical Decision Making ◽  
Mass Effect ◽  
Clinical Decision ◽  
Chinese Patients ◽  
Midline Shift ◽  
Patient Death ◽  
Exact Probability ◽  
Decompressive Hemicraniectomy ◽  
Hemispheric Infarction

Abstract Background: For large hemispheric infarction (LHI), malignant cerebral edema (MCE) is a life-threatening complication with a mortality rate approaching 80%. Establishing a convenient prediction model of MCE after LHI is vital for the rapid identification of high-risk patients as well as for a better understanding of the potential mechanism underlying MCE.Methods: 142 consecutive patients with LHI within 24h of onset between January 1, 2016 and August 31, 2019 were retrospectively reviewed. MCE was defined as patient death or received decompressive hemicraniectomy (DHC) with obvious mass effect (≥ 5mm midline shift or Basal cistern effacement). Binary logistic regression was performed to identify independent predictors of MCE. Independent prognostic factors were incorporated to build a dynamic nomogram for MCE prediction.Results: After adjusting for confounders, four independent factors were identified, including previously known atrial fibrillation (KAF), midline shift (MLS), National Institutes of Health Stroke Scale (NIHSS) and anterior cerebral artery (ACA) territory involvement. To facilitate the nomogram use for clinicians, we used the “Dynnom” package to build a dynamic MANA (acronym for MLS, ACA territory involvement, NIHSS and KAF) nomogram on web (http://www.MANA-nom.com) to calculate the exact probability of developing MCE. The MANA nomogram’s C-statistic was up to 0.887 ± 0.041 and the AUC-ROC value in this cohort was 0.887 (95%CI, 0.828~0.934).Conclusions: Independent MCE predictors included KAF, MLS, NIHSS, and ACA territory involvement. The dynamic MANA nomogram is a convenient, practical and effective clinical decision-making tool for predicting MCE after LHI in Chinese patients.

Cardiac masses and tumours

2015 ◽  
pp. 549-562
Author(s):  
Peter Buser ◽  
Thomas Buck ◽  
Björn Plicht
Keyword(s):  
Tissue Characterization ◽  
Clinical Decision Making ◽  
Imaging Modality ◽  
High Sensitivity ◽  
Clinical Decision ◽  
Tissue Doppler ◽  
Doppler Imaging ◽  
Contrast Imaging ◽  
Cardiac Tumours ◽  
Cardiac Masses

Cardiac tumours represent a rare but important cause of morbidity and mortality in clinical cardiology and are often challenging in diagnostic cardiac imaging. There is a broad spectrum of differential diagnosis for cardiac masses. This chapter is mainly focused on the diagnosis of primary and secondary cardiac tumours and intra-cardiac thrombi. Diagnostic imaging of cardiac tumours provides important clinical decision-making information, such as origin, size, extension, morphology, and mobility of the tumour, involvement of cardiac chambers, valves, myocardium and pericardium, invasiveness, vascularization, and tissue characterization. Echocardiography is usually the first imaging modality providing high sensitivity in detecting cardiac masses, particularly by transoesophageal approach, and detailed analysis of mass characteristics by the use of different imaging modalities, including 3D imaging, tissue Doppler imaging, and contrast imaging.

scholarly journals Neuroimaging findings in pediatric sports-related concussion

2015 ◽  
Vol 16 (3) ◽  
pp. 241-247 ◽  
Author(s):  
Michael J. Ellis ◽  
Jeff Leiter ◽  
Thomas Hall ◽  
Patrick J. McDonald ◽  
Scott Sawyer ◽  
...  
Keyword(s):  
Decision Making ◽  
Arachnoid Cyst ◽  
Clinical Decision Making ◽  
Demyelinating Disease ◽  
Skull Fracture ◽  
Clinical Decision ◽  
Return To Play ◽  
Mri Findings ◽  
Imaging Results ◽  
The Impact

OBJECT The goal in this review was to summarize the results of clinical neuroimaging studies performed in patients with sports-related concussion (SRC) who were referred to a multidisciplinar ypediatric concussion program. METHODS The authors conducted a retrospective review of medical records and neuroimaging findings for all patients referred to a multidisciplinary pediatric concussion program between September 2013 and July 2014. Inclusion criteria were as follows: 1) age ≤ 19 years; and 2) physician-diagnosed SRC. All patients underwent evaluation and follow-up by the same neurosurgeon. The 2 outcomes examined in this review were the frequency of neuroimaging studies performed in this population (including CT and MRI) and the findings of those studies. Clinical indications for neuroimaging and the impact of neuroimaging findings on clinical decision making were summarized where available. This investigation was approved by the local institutional ethics review board. RESULTS A total of 151 patients (mean age 14 years, 59% female) were included this study. Overall, 36 patients (24%) underwent neuroimaging studies, the results of which were normal in 78% of cases. Sixteen percent of patients underwent CT imaging; results were normal in 79% of cases. Abnormal CT findings included the following: arachnoid cyst (1 patient), skull fracture (2 patients), suspected intracranial hemorrhage (1 patient), and suspected hemorrhage into an arachnoid cyst (1 patient). Eleven percent of patients underwent MRI; results were normal in 75% of cases. Abnormal MRI findings included the following: intraparenchymal hemorrhage and sylvian fissure arachnoid cyst (1 patient); nonhemorrhagic contusion (1 patient); demyelinating disease (1 patient); and posterior fossa arachnoid cyst, cerebellar volume loss, and nonspecific white matter changes (1 patient). CONCLUSIONS Results of clinical neuroimaging studies are normal in the majority of pediatric patients with SRC. However, in selected cases neuroimaging can provide information that impacts decision making about return to play and retirement from the sport.

Primary demyelinating disease simulating glioma of the corpus callosum

1981 ◽  
Vol 55 (4) ◽  
pp. 620-624 ◽  
Author(s):  
Kenneth G. Rieth ◽  
Giovanni Di Chiro ◽  
Laurence D. Cromwell ◽  
Paul E. McKeever ◽  
Paul L. Kornblith ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Corpus Callosum ◽  
Demyelinating Disease ◽  
Mass Effect ◽  
Periventricular White Matter ◽  
Content Type ◽  
The Central Nervous System ◽  
The Brain ◽  
Fine Print

✓ Computerized tomography (CT) has made it easier to distinguish tumoral from nontumoral diseases of the central nervous system. In the presence of mass effect, however, this distinction may be difficult or impossible to make. Primary demyelinating disease may occasionally present as a focal cerebral mass. The authors report three cases of primary demyelinating disease of the brain involving the corpus callosum and periventricular white matter and associated with mass effect, which proved difficult to differentiate from infiltrating “butterfly” gliomas.

Demyelinating Disease of Corpus Callosum Presenting as Glioma on Magnetic Resonance Scan: A Case Documented with Pathological Findings

Neurosurgery ◽  
1987 ◽  
Vol 21 (2) ◽  
pp. 247-250 ◽  
Author(s):  
Uma P. Kalyan-Raman ◽  
Dennis J. Garwacki ◽  
Patrick W Elwood
Keyword(s):  
Magnetic Resonance ◽  
Corpus Callosum ◽  
Demyelinating Disease ◽  
Brain Mri ◽  
Mass Effect ◽  
Demyelinating Diseases ◽  
Pathological Findings ◽  
Demyelinating Disorder ◽  
First Case ◽  
Magnetic Resonance Imaging Mri

Abstract Magnetic resonance imaging (MRI) has improved the diagnosis of several pathological entities of the brain. MRI especially has been credited with distinguishing demyelinating diseases of the central nervous system from other diseases. The presence of a mass effect in a demyelinating disorder, however, makes difficult the distinction between tumor and a demyelinating disease. We report a case of a demyelinating disorder simulating an infiltrating glioma of the corpus callosum on MRI scan, resulting in surgical intervention. To our knowledge, this is the first case to be reported with MRI and documented pathological findings.

scholarly journals A Web Based Dynamic MANA Nomogram for Predicting the Malignant Cerebral Edema 

2020 ◽  
Author(s):  
Wenzhe Sun ◽  
Guo Li ◽  
Yang Song ◽  
Zhou Zhu ◽  
Zhaoxia Yang ◽  
...  
Keyword(s):  
Cerebral Edema ◽  
Clinical Decision Making ◽  
Binary Logistic Regression ◽  
Mass Effect ◽  
Clinical Decision ◽  
Rapid Identification ◽  
Chinese Patients ◽  
Midline Shift ◽  
Patient Death ◽  
Exact Probability

Abstract Background: For large hemispheric infarction (LHI), malignant cerebral edema (MCE) is a life-threatening complication with mortality approaching 80%. Establishing a convenient prediction model of MCE after LHI is vital for rapid identification of high-risk patients and understanding of the potential mechanism of MCE.Methods: 142 consecutive patients with LHI within 24h of onset from January 1, 2016 to August 31, 2019 were retrospectively collected. MCE was defined as patient death or received DHC with obvious mass effect (≥ 5mm midline shift or Basal cistern effacement). Binary logistic regression was performed to evaluated the independent predictors of MCE. Independent prognostic factors were incorporated to build dynamic MANA nomogram to predict MCE.Results: After adjustment for confounders, four independent factors were identified, including previously known atrial fibrillation (KAF), midline shift (MLS), National Institutes of Health Stroke Scale (NIHSS) and anterior cerebral artery (ACA) territory involvement. Furthermore, to facilitate the use of the nomogram for clinicians, we use “Dynnom” package to build dynamic MANA (acronym for MLS, ACA territory involvement, NIHSS and KAF) nomogram on web page (http://www.MANA-nom.com) to calculate the exact probability of developing MCE. The c-statistic of MANA nomogram was up to 0.887 ± 0.041 and AUC-ROC value in this cohort was 0.887 (95%CI, 0.828~0.934).Conclusions: Independent predictors of MCE included KAF, MLS, NIHSS, and ACA territory involvement. The dynamic MANA nomogram is a convenient, practical and effective clinical decision-making tool for predicting MCE after LHI in Chinese patients.

scholarly journals Cryptogenic cervical intramedullary abscess with rapidly progressive myelopathy: illustrative case

2021 ◽  
Vol 1 (4) ◽  
Author(s):  
Nebras M. Warsi ◽  
Ann Wilson ◽  
Armaan K. Malhotra ◽  
Jerry C. Ku ◽  
Ahmed A. Najjar ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Decision Making ◽  
Demyelinating Disease ◽  
Clinical Decision ◽  
Illustrative Case ◽  
Dermal Sinus ◽  
Progressive Myelopathy ◽  
Intramedullary Abscess ◽  
Infectious Risk ◽  
First Case

BACKGROUNDThe purpose of the present case report is to highlight the presentation, workup, clinical decision making, and operative intervention for a 68-year-old woman who developed rapidly progressive myelopathy secondary to idiopathic cervical intramedullary abscess.OBSERVATIONSThe patient underwent laminectomy and aspiration/biopsy of the lesion. Intraoperatively, division of the posterior median sulcus released a large volume of purulent material growing the oral pathogens Eikenella corrodens and Gemella morbillorum. Broad-spectrum antibiotics were initiated postoperatively. At the 6-month follow-up, the patient had almost completely recovered with some persistent hand dysesthesia. Complete infectious workup, including full dental assessment and an echocardiogram, failed to reveal the source of her infection.LESSONSThe authors report the first case of cryptogenic spinal intramedullary abscess secondary to Eikenella spp. and Gemella spp. coinfection. Intramedullary abscesses are exceptionally rare and most commonly develop in children with dermal sinus malformations or in the context of immunosuppression. In adults without risk factors, they can readily be mistaken for more common pathologies in this age group, such as intramedullary neoplasms or demyelinating disease. Prompt diagnosis and management based on rapidly progressive myelopathy, assessment of infectious risk factors and/or symptoms, and targeted imaging are critical to avoid potentially devastating neurological sequelae.

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