FLAIR-hyperintense Lesion in Anti-MOG-associated Encephalitis with Seizures (FLAMES)

Abstract Background Paraneoplastic neurological syndromes (PNS) are rare disorders affecting any part of the central, peripheral or autonomic nervous system that occur in association with cancer. Among cancer patients, less than 1% overall develop PNS. Anti- SOX1 antibodies positive paraneoplastic neurological disorders are rare and most often associated with small cell lung cancer (SCLC). Case presentation Herein, we report a case of a 61-year-old male presented with an unusual anti- SOX1 positive PNS. Electrodiagnostic study showed notable low amplitude motor potentials and high amplitude motor potentials of the right tibialis anterior suggesting the presence of Lambert–Eaton myasthenic syndrome (LEMS). Typical MRI and PET-CT found a hyperintense lesion with contrast enhancement in the thorax in front of 5-6 centrum of vertebrae, and thoracoscopic biopsy revealed pathological findings for SCLC. Because the diagnosis was made in time, the patient is currently receiving chemotherapy and radiotherapy for the cancer at Chinese PLA General Hospital, and the clinical symptoms improved obviously. Conclusions The comprehensive screening of onconeural antibodies in PNS-suspicious cases combined with early diagnosis and treatment of tumor are important for achieving a good outcome.

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Tacrolimus-induced neurotoxicity from bipolar disorder to status epilepticus under the therapeutic serum level: a case report

BMC Neurology ◽

10.1186/s12883-021-02479-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Bora Jin ◽

Ga Yeon Kim ◽

Sang-Myung Cheon

Keyword(s):

Adverse Events ◽

Therapeutic Range ◽

Solid Organ Transplantation ◽

Brain Magnetic Resonance Imaging ◽

Solid Organ ◽

Therapeutic Level ◽

Hyperintense Lesion ◽

Case Presentation ◽

Delta Waves ◽

Level Of Consciousness

Abstract Background Tacrolimus is a macrolide immunosuppressant widely used to prevent rejection after solid organ transplantation. In general, adverse events of tacrolimus occur more often as the concentration of tacrolimus in the blood increases. We report the case of a 39-year-old man who developed a variety of adverse events despite in the therapeutic level of tacrolimus in the blood. Case presentation A 39-year-old man underwent liver transplantation for liver cirrhosis due to alcoholic liver disease. The postoperative immunosuppressant consisted of tacrolimus (5 mg) and mycophenolate (500 mg) twice daily. Five months after taking tacrolimus, he presented with talkativeness, which gradually worsened. Brain magnetic resonance imaging performed 10 months after tacrolimus administration revealed a hyperintense lesion affecting the middle of the pontine tegmentum on T2WI. The blood concentration of tacrolimus was 7.2 ng/mL (therapeutic range 5–20 ng/mL). After 21 months, he exhibited postural tremor in both the hands. Twenty-four months after taking tacrolimus, he showed drowsy mentality, intention tremor, and dysdiadochokinesia. Electroencephalography presented generalized high-voltage rhythmic delta waves; therefore, tacrolimus was discontinued in suspicion of tacrolimus-induced neurotoxicity, and anticonvulsive treatment was started. The level of consciousness gradually improved, and the patient was able to walk independently with mild ataxia. Conclusion This case shows that tacrolimus-induced neurotoxicity can occur even at normal concentrations. Therefore, if a patient taking tacrolimus exhibits psychiatric or neurologic symptoms, neurotoxicity should be considered even when the blood tacrolimus is within the therapeutic range.

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A Septuagenarian With Progressive Hemiparesis

10.1093/med/9780197583425.003.0015 ◽

2021 ◽

pp. 48-50

Author(s):

Roman Kassa ◽

B. Mark Keegan

Keyword(s):

Multiple Sclerosis ◽

Late Onset ◽

Progressive Multiple Sclerosis ◽

Oligoclonal Bands ◽

Hyperintense Lesion ◽

Fluid Analysis ◽

Hemiparetic Gait ◽

Magnetic Resonance Imaging Mri ◽

Disease Modifying Agents ◽

The Right

A 78-year-old man with no pertinent medical history sought care for an 18-month history of progressive right lower extremity weakness, gait impairment, and falls. On neurologic examination, he had a hemiparetic gait. He had normal higher cognitive function and cranial nerve function. Motor examination showed decreased bulk over the right hand with no fasciculations, mild spasticity over the right leg, and right hemiparesis with an upper motor neuron pattern. Deep tendon reflexes were brisk throughout his limbs, and he had an extensor plantar reflex on the right side. He had impaired vibratory sense at the toes, with otherwise normal sensory and coordination examinations. Magnetic resonance imaging (MRI) of the brain showed ovoid periventricular and punctate subcortical and deep white matter T2 hyperintense foci. Some of these had corresponding T1 hypointensity. MRI of the cervical spine showed 1 eccentrically located T2 hyperintense lesion over the right lateral aspect of C2. Cerebrospinal fluid analysis showed no pleocytosis, an increased protein concentration of 66 mg/dL, and 4 unique oligoclonal bands. A diagnosis of primary progressive multiple sclerosis, very late onset, was made. With any diagnosis of late-onset multiple sclerosis, a decision about whether multiple sclerosis disease-modifying agents are indicated should be carefully considered. Our older patient had a progressive disease course, and neuroimaging studies did not reveal evidence of active disease. Based on this, a decision was made to monitor him clinically and radiologically. Management of spasticity with regular daily stretching exercises was discussed with him. A first clinical manifestation of multiple sclerosis can occur at a later-than-typical age. Most studies consider an onset at age 50 years or older to be late-onset multiple sclerosis, whereas first symptoms occurring at age 60 years or older are commonly referred to as very late–onset MS.

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Case 9.19

Mayo Clinic Body MRI Case Review ◽

10.1093/med/9780199915705.003.0241 ◽

2014 ◽

pp. 456-457

Author(s):

Christine U. Lee ◽

James F. Glockner

Keyword(s):

Lead Point ◽

Hyperintense Lesion ◽

Descending Colon

54-year-old woman with intermittent abdominal cramps, bloating, and diarrhea Coronal SSFSE images (Figure 9.19.1) demonstrate a large ovoid, T2-hyperintense lesion in the descending colon that serves as the lead point for an intussusception. Notice also a second, smaller lesion proximally in the descending colon. The lesions are hyperintense on axial T1-weighted images (...

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Case 2.25

Mayo Clinic Body MRI Case Review ◽

10.1093/med/9780199915705.003.0056 ◽

2014 ◽

pp. 110-110

Author(s):

Christine U. Lee ◽

James F. Glockner

Keyword(s):

Liver Disease ◽

Chronic Liver Disease ◽

Left Lobe ◽

Chronic Liver ◽

Diffusion Weighted Image ◽

Hyperintense Lesion ◽

Axial Diffusion ◽

Weighted Image ◽

Diffusion Weighted

60-year-old woman with chronic liver disease Axial diffusion-weighted image (b=100 s/mm2) (Figure 2.25.1) demonstrates a mildly irregular hepatic contour with parenchymal nodularity and a hyperintense lesion in the medial left lobe. The IP and OP T1-weighted 2D SPGR images (...

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A Case of Monocular Blurred Vision

Neuroimmunology ◽

10.1093/med/9780190693190.003.0001 ◽

2018 ◽

pp. 1-8

Author(s):

Aaron E. Miller ◽

Tracy M. DeAngelis ◽

Michelle Fabian ◽

Ilana Katz Sand

Keyword(s):

Demyelinating Disease ◽

Clinical Manifestations ◽

Blurred Vision ◽

Hyperintense Lesion ◽

Mcdonald Criteria ◽

Relapsing Remitting ◽

The Central Nervous System ◽

Magnetic Resonance Imaging Mri ◽

Disease Modifying Agents ◽

Middle Aged Adults

Multiple sclerosis (MS), an inflammatory demyelinating disease of the central nervous system, typically affects young to middle-aged adults. Women are affected nearly three times as often as men. The diagnosis requires the demonstration of dissemination in space (DIS) and time (DIT) in a patient with no better clinical explanation. Evidence for either DIS or DIT or both may now be obtained from MRI, in addition to clinical manifestations. The most widely used diagnostic criteria are known as the McDonald criteria, and have been revised several times, most recently in 2017. In the current criteria, DIS may be achieved by the demonstration of at least one lesion in at least two different locations: periventricular, cortical/juxtacortical, infratentorial, or spinal cord. DIT may be considered in an initial magnetic resonance imaging (MRI) if there are simultaneously at least one gadolinium-enhancing lesion and one non-enhancing T2 hyperintense lesion; or alternatively, by the demonstration of a new lesion on any MRI subsequent to the first. The course of MS is characterized as relapsing-remitting (RRMS), secondary progressive, or primary progressive. Many effective disease-modifying agents are available for RRMS, but progressive forms have been much less successfully treated.

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Primary infratentorial diffuse large b-cell lymphoma: a challenging diagnosis in an immunocompetent patient

Revista da Associação Médica Brasileira ◽

10.1590/1806-9282.65.2.136 ◽

2019 ◽

Vol 65 (2) ◽

pp. 136-140 ◽

Cited By ~ 1

Author(s):

Gabriel Laverdi Beraldo ◽

Angelo Borsarelli Carvalho Brito ◽

Márcia Torresan Delamain ◽

Carmino Antonio de Souza ◽

Carmen Silvia Passos Lima ◽

...

Keyword(s):

B Cell ◽

Cerebral Blood Volume ◽

Cell Lymphoma ◽

Brain Mri ◽

B Cell Lymphoma ◽

Immunocompetent Patient ◽

Hyperintense Lesion ◽

Large B Cell Lymphoma ◽

Cerebellar Peduncle ◽

Large B Cell

SUMMARY We describe the case of a female patient, 52 years old, with dizziness and left motor incoordination for 2 weeks. Brain MRI magnetic resonance imaging) revealed a hyperintense lesion on T2-weighted images, without restricted diffusion, in the left middle cerebellar peduncle. Spectroscopy demonstrated peak of lipids and perfusion did not show any elevation in relative cerebral blood volume (rCBV). The patient underwent an open biopsy and resection, and the diagnosis of diffuse large B-cell lymphoma (DLBCL) was established. The patient received intravenous dexamethasone with symptoms remission, followed by four cycles of methotrexate plus cytarabine. After 3 months, the patient returned with decreased consciences level and a new MRI revealed a right superior frontal gyrus lesion with features suggesting a lymphomatous lesion. The patient died five days after her relapse.

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Reversible Hyperintense Lesion after Balloon Occlusion Test

Journal of Neuroimaging ◽

10.1111/j.1552-6569.2007.00223.x ◽

2009 ◽

Vol 19 (2) ◽

pp. 174-178 ◽

Cited By ~ 1

Author(s):

Koichi Haraguchi ◽

Kiyohiro Houkin ◽

Izumi Koyanagi ◽

Tadashi Nonaka ◽

Takeo Baba

Keyword(s):

Balloon Occlusion ◽

Hyperintense Lesion ◽

Occlusion Test ◽

Balloon Occlusion Test

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Pantothenate kinase-associated neurodegeneration: Clinical aspects, diagnosis and treatments

Neurology International ◽

10.4081/ni.2018.7516 ◽

2018 ◽

Vol 10 (1) ◽

Cited By ~ 5

Author(s):

Saeed Razmeh ◽

Amir Hassan Habibi ◽

Maryam Orooji ◽

Elham Alizadeh ◽

Karim Moradiankokhdan ◽

...

Keyword(s):

Autosomal Recessive ◽

Clinical Presentation ◽

Iron Chelation ◽

Autosomal Recessive Disorder ◽

Intrathecal Baclofen ◽

Clinical Aspects ◽

Hyperintense Lesion ◽

Pantothenate Kinase ◽

Generalized Dystonia ◽

Deep Brain

Pantothenate Kinase-Associated Neurodegeneration (PKAN) is an autosomal recessive disorder characterized by a mutation in the PANK2 gene. The clinical presentation may range from only speech disorder to severe generalized dystonia, spasticity, Visual loss, dysphagia and dementia. The hallmark of this disease is eyes of the tiger sign in the medial aspect of bilateral globus pallidus on T2-weighted MRI that is a hyperintense lesion surrounded by hypointensity. Common treatments for PKAN disease include anticholinergics, botulinum toxin, Oral and Intrathecal baclofen, Iron chelation drugs and surgical procedures such as ablative pallidotomy or thalamotomy, Deep brain stimulation. There are many controversies about the pathogenesis and treatment of this disease, and in recent years interesting studies have been done on PKAN disease and other similar diseases. This review summarizes the clinical presentation, etiology, imaging modalities and treatment.

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Additional Diagnostic Value of Unenhanced Computed Tomography plus Diffusion-Weighted Imaging Combined with Routine Magnetic Resonance Imaging Findings of Early-Stage Gliblastoma

BioMed Research International ◽

10.1155/2020/1672736 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Hexiang Wang ◽

Zhenyou Liu ◽

Yong Zhang ◽

Feng Hou ◽

Weiwei Fu ◽

...

Keyword(s):

Computed Tomography ◽

Magnetic Resonance ◽

Mr Imaging ◽

Diffusion Weighted Imaging ◽

Early Stage ◽

Diagnostic Value ◽

Imaging Findings ◽

Hyperintense Lesion ◽

Unenhanced Ct ◽

Unenhanced Computed Tomography

Purpose. This study was performed to determine whether diffusion-weighted imaging (DWI) plus unenhanced computed tomography (CT) of the brain increases the diagnostic value of routine magnetic resonance (MR) imaging findings of early-stage glioblastoma. Methods. Postcontrast MR images of eight unenhanced lesions that had been pathologically diagnosed as glioblastoma were retrospectively examined. The location, margin, signal intensity, and attenuation on MR imaging and CT were assessed. Results. On MR imaging, all lesions were ill-defined, small, and isointense to hypointense on T1-weighted images and hyperintense on T2-weighted images. Four patients had perilesional edema. In seven patients, DWI showed an inhomogeneous hyperintense lesion (n = 1) or isointense lesion with a hyperintense region (n = 6). On unenhanced CT, all masses presented as a hypoattenuated lesion with a hyperattenuated region (n = 7) or isoattenuated region (n = 1). The hyperattenuated region (n = 6) or isoattenuated region (n = 1) on CT appeared on DWI as an inhomogeneous hyperintense lesion (n = 1), isointense lesion with a hyperintense region (n = 3), or ring-like peritumoral hyperintensity (n = 3). Conclusions. MR imaging was the most sensitive imaging method for depicting early-stage glioblastoma. The CT finding of a hyperattenuated or isoattenuated region combined with the DWI finding of the same region containing an inhomogeneous hyperintense lesion or isointense lesion with a hyperintense region may be a specific diagnostic sign for early-stage glioblastoma. DWI plus unenhanced CT added diagnostic value to the routine MR imaging findings of early-stage glioblastoma.

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