Hourglass-Like Constriction of the Brachial Plexus in the Posterior Cord: A Case Report

Neurosurgery ◽  
2017 ◽  
Vol 82 (1) ◽  
pp. E1-E5 ◽  
Author(s):  
Yasunobu Nakagawa ◽  
Hitoshi Hirata
Keyword(s):  
Brachial Plexus ◽  
Treatment Options ◽  
Surgical Approaches ◽  
Mri Findings ◽  
Surgical Interventions ◽  
Residual Symptoms ◽  
Arm Pain ◽  
Preoperative Magnetic Resonance ◽  
Magnetic Resonance Imaging Mri ◽  
Short Tau Inversion Recovery

Abstract BACKGROUND AND IMPORTANCE Hourglass-like constrictions are fascicular conditions confirmed definitively by interfascicular neurolysis. Certain peripheral nerves have vulnerable areas such as around the elbow in the posterior interosseous nerve. We report the first hourglass-like constriction in the brachial plexus supplying the radial innervated forearm musculature. Preoperative magnetic resonance imaging (MRI) findings of the brachial plexus were consistent with neuralgic amyotrophy (NA). CLINICAL PRESENTATION A 9-yr-old boy experienced worsening left arm pain and difficulty in elevating the shoulder. Sequentially, severe palsy emerged when extending the wrist, thumb, and fingers. Based on the clinical picture, we diagnosed him with NA. The oblique coronal T2-weighted short-tau inversion recovery images showed mildly diffuse enlargement and hyperintensity of the brachial plexus. He showed few signs of improvement and interfascicular neurolysis was performed 11 mo after the onset. One of the fascicles in the posterior cord had developed an hourglass-like constriction. Electrical stimulation confirmed that the fascicle supplied forearm muscles. His wrist and finger extension had almost recovered at the 12-mo postoperative visit. CONCLUSION Hourglass-like constrictions can occur in the brachial plexus. Although surgical approaches for the constrictions are still controversial, several reports demonstrated their effectiveness. Meanwhile, concerning NA treatment, evidence on the surgical intervention is lacking. Brachial plexus MRI might help in discerning the lesion and planning treatment options including surgical interventions. Hourglass-like constrictions are a possible etiology for certain NA patients with residual symptoms or paresis.

Pharmacological treatment of hepatocellular carcinoma with cavoatrial tumor thrombus – case series and literature review

2019 ◽  
Vol 57 (04) ◽  
pp. 501-507 ◽  
Author(s):  
Tianzuo Zhan ◽  
Janina Sollors ◽  
Niels Steinebrunner ◽  
Hans Schlitt ◽  
Christian Stroszczynski ◽  
...  
Keyword(s):  
Tumor Thrombus ◽  
Systemic Treatment ◽  
Treatment Options ◽  
Survival Rates ◽  
Vena Cava ◽  
Case Series ◽  
Surgical Approaches ◽  
Surgical Interventions ◽  
Advanced Hcc ◽  
Multimodal Therapy Concept

AbstractHepatocellular carcinomas (HCC) that extend into the vena cava and the right atrium have a poor prognosis. Surgical approaches including partial hepatectomy and thrombectomy are the most frequently reported treatment options. However, most patients with advanced HCC are not eligible for complex surgical interventions due to reduced liver function, comorbidities, and metastases. At the same time, systemic treatment options of HCC have expanded in recent years. Here, we report 3 cases of patients with advanced HCC who developed a cavoatrial tumor thrombus (CATT) after initial surgical or interventional therapy. The patients were consequently treated with sorafenib or nivolumab. In all cases, the tumor responded to systemic treatment with disease stabilization or partial regression. Overall survival after diagnosis of CATT was 3 and 17 months for sorafenib and 7 + months for nivolumab. Compared to survival rates of alternative treatment options, systemic therapies demonstrated comparable outcomes. In summary, pharmacotherapy is an efficient and well worth option to treat patients with HCC and CATT and should be an integral part of a multimodal therapy concept.

scholarly journals A case of chronic progressive Lyme encephalitis as a manifestation of late Lyme neuroborreliosis

2014 ◽  
Vol 6 (4) ◽  
Author(s):  
Vivek Verma ◽  
Matthew Roman ◽  
Disha Shah ◽  
Marina Zaretskaya ◽  
Mohamed H. Yassin
Keyword(s):  
White Matter ◽  
Short Term Memory ◽  
Treatment Options ◽  
Chronic Fatigue ◽  
Short Term ◽  
Mri Findings ◽  
White Matter Changes ◽  
Neurological Improvement ◽  
Magnetic Resonance Imaging Mri

A 54-year-old female living in Europe presented with gait ataxia, dizziness, and bilateral hearing loss. Magnetic resonance imaging (MRI) revealed non-specific white matter changes. The patient’s condition gradually deteriorated over two years without diagnosis. The patient continued to decline cognitively and neurologically with worsening ataxia and upper motor neuron signs. Repeat MRI showed worsening white matter changes. Lumbar puncture, not previously done, showed positive Lyme testing. Treatment with intravenous ceftriaxone resulted in marked neurological improvement. Four years after symptom, the patient has short-term memory deficits and chronic fatigue, but is otherwise neurologically, cognitively, and functionally intact. Follow up MRI findings remain largely unchanged. Because cases of intraparenchymal or encephalopathic neuroborreliosis in America are lacking, so are treatment options. We present a rare case and discuss our experience with antibiotic treatment. This case lends evidence to define optimal treatment of this disease, imperative for hastening neurological recovery.

scholarly journals Spontaneous Intracranial Hypotension: Case Series of Rare Clinical Presentations

2011 ◽  
Vol 38 (1) ◽  
pp. 54-58 ◽  
Author(s):  
N. Chaudhary ◽  
P. Cooper ◽  
S.P. Lownie ◽  
W. Ng ◽  
N. Duggal
Keyword(s):  
Intracranial Hypotension ◽  
Fluid Pressure ◽  
Spontaneous Intracranial Hypotension ◽  
Case Series ◽  
Mri Findings ◽  
Surgical Interventions ◽  
Clinical Presentations ◽  
Lateral Decubitus ◽  
Magnetic Resonance Imaging Mri ◽  
Diffuse Pachymeningeal Enhancement

Abstract:Background:Spontaneous intracranial hypotension (SIH) is an increasingly described entity, with over 70 cases reported in the literature. The classic triad includes orthostatic headache, diffuse pachymeningeal enhancement on magnetic resonance imaging (MRI) with gadolinium, and low cerebrospinal fluid pressure (CSF) in the lateral decubitus (<60 mm H2O) and sitting positions.Method:We present four rare clinical presentations of SIH, two of which have not been previously described in the literature, to the best of our knowledge.Results:Patient 1 presented with dyspnea, dysphagia, bilateral ptosis, diplopia and seizures. Patient 2 presented with a paradoxical positional pattern of orthostatic hypotension. In Patient 3, bilateral subdural hematomas (SDH) were encountered; while in Patient 4, a recurrent unilateral SDH requiring multiple surgical interventions was demonstrated.Conclusion:Although uncommon clinical presentations, all four cases of intracranial hypotension were spontaneous, demonstrated diagnostic MRI findings, and responded favorably to blood patches or saline injections.

Articular Cartilage Repair in the Knee: Postoperative Imaging

2020 ◽  
Vol 34 (01) ◽  
pp. 002-010
Author(s):  
Brian W. Yang ◽  
Christopher M. Brusalis ◽  
Peter D. Fabricant ◽  
Harry G. Greditzer
Keyword(s):  
Clinical Outcomes ◽  
Cartilage Repair ◽  
Clinical Decision Making ◽  
Treatment Options ◽  
Clinical Decision ◽  
Mri Findings ◽  
Postoperative Imaging ◽  
Patient Reported ◽  
Magnetic Resonance Imaging Mri

AbstractDiagnostic and therapeutic advancements have improved clinical outcomes for patients with focal chondral injuries of the knee. An increased number and complexity of surgical treatment options have, in turn, resulted in a commensurate proliferation of patients requiring postoperative evaluation and management. In addition to patient-reported clinical outcomes, magnetic resonance imaging (MRI) offers clinicians with noninvasive, objective data to assist with postoperative clinical decision making. However, successful MRI interpretation in this setting is clinically challenging; it relies upon an understanding of the evolving and procedure-specific nature of normal postoperative imaging. Moreover, further research is required to better elucidate the correlation between MRI findings and long-term clinical outcomes. This article focuses on how specific morphologic features identified on MRI can be utilized to evaluate patients following the most commonly performed cartilage repair surgeries of the knee.

scholarly journals Surgical treatment of adult traumatic brachial plexus injuries: an overview

2011 ◽  
Vol 69 (3) ◽  
pp. 528-535 ◽  
Author(s):  
Mario G. Siqueira ◽  
Roberto S. Martins
Keyword(s):  
Surgical Treatment ◽  
Brachial Plexus ◽  
Hand Function ◽  
Treatment Options ◽  
Elbow Flexion ◽  
Optimal Care ◽  
Surgical Interventions ◽  
Traumatic Injuries ◽  
Microsurgical Technique ◽  
Shoulder Stability

Traumatic injuries to the brachial plexus in adults are severely debilitating. They generally affect young individuals. A thorough understanding of the anatomy, clinical evaluation, imaging and electrodiagnostic assessments, treatment options and proper timing of surgical interventions will enable nerve surgeons to offer optimal care to patients. Advances in microsurgical technique have improved the outcome for many of these patients. The treatment options offer patients with brachial plexus injuries the possibility of achieving elbow flexion, shoulder stability with limited abduction and the hope of limited but potentially useful hand function.

scholarly journals Diagnostic Accuracy of Preoperative Conventional MRI for Patients With Ectopic Pregnancy

2021 ◽  
Vol 105 (1-3) ◽  
pp. 449-454
Author(s):  
Toshimichi Onuma ◽  
Kimihisa Tajima ◽  
Kumiko Sato ◽  
Katsushige Hattori ◽  
Shin Fukuda ◽  
...  
Keyword(s):  
Ectopic Pregnancy ◽  
Predictive Value ◽  
Correct Diagnosis ◽  
Tubal Pregnancy ◽  
Mri Findings ◽  
Tubal Ectopic Pregnancy ◽  
Conventional Mri ◽  
Mri Diagnosis ◽  
Preoperative Magnetic Resonance ◽  
Magnetic Resonance Imaging Mri

Objective To assess the utility of preoperative magnetic resonance imaging (MRI) in the diagnosis of tubal pregnancy. Summary of background data Most cases of ectopic pregnancy are tubal pregnancies. Preoperative accurate diagnosis including the location of the tubal pregnancy is important. Method We performed a retrospective single-center cohort study evaluating patients who underwent surgery for ectopic pregnancy from April 2004 to March 2016 and who underwent preoperative MRI. Sixty patients were enrolled in the study. Chorion confirmed at the tubal pregnancy site detected by MRI was defined as a correct diagnosis. Results Mean estimated gestational age at the time of MRI according to the last menstrual period was 7 weeks (median: 5 weeks; range: 3–10 weeks). Ectopic pregnancy was diagnosed by MRI in 57 cases, and all cases were either left or right tubal pregnancy. In 52 cases, the actual position matched the MRI findings. In 5 cases, the location of tubal ectopic pregnancy was different from that diagnosed by MRI, or no tubal pregnancy was observed intraoperatively. In 2 cases, no ectopic pregnancy site was observed on MRI, but tubal pregnancy was confirmed by surgery. In one case, an ectopic pregnancy site was not found, and the tube showed normal findings on MRI. The sensitivity of MRI diagnosis was 96.2%, specificity was 16.7%, positive predictive value was 91.1%, and negative predictive value was 33.3%. Conclusion In cases of ectopic pregnancy treated surgically, the sensitivity of MRI diagnosis, including identification of the location of ectopic pregnancy, is high.

Epidural blood patch for spontaneous intracranial hypotension (SIH): a report of two cases

2020 ◽  
Vol 50 (4) ◽  
pp. 369-373
Author(s):  
Ganesh Arumugam ◽  
Sudha Ram ◽  
Bhaskar Naidu P ◽  
Selvakumar Kumaravelu
Keyword(s):  
Intracranial Hypotension ◽  
Epidural Blood Patch ◽  
Treatment Options ◽  
Spontaneous Intracranial Hypotension ◽  
Cerebrospinal Fluid Leak ◽  
Mri Findings ◽  
Meningeal Enhancement ◽  
Blood Patch ◽  
Magnetic Resonance Imaging Mri ◽  
Persistent Headache

One of the latest diagnoses that need to be considered when evaluating patients with persistent headache is spontaneous (postural) intracranial hypotension (SIH). The diagnosis can be clinched by magnetic resonance imaging (MRI) findings of subdural collections, meningeal enhancement and tonsillar descent. Cerebrospinal fluid leak has been postulated as the cause, and both medical and surgical treatment options have been documented. The treatment of choice is, however, an epidural blood patch. Here we discuss two cases of SIH treated successfully with epidural blood patch.

Top-Ten Tips for Imaging the Brachial Plexus with Ultrasound and MRI

2019 ◽  
Vol 23 (04) ◽  
pp. 405-418 ◽  
Author(s):  
James F. Griffith ◽  
Radhesh Krishna Lalam
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Brachial Plexus ◽  
Muscle Denervation ◽  
Resonance Imaging ◽  
Neural Injury ◽  
Clinical Indications ◽  
Magnetic Resonance Imaging Mri ◽  
High Level ◽  
Extensive Involvement

AbstractWhen it comes to examining the brachial plexus, ultrasound (US) and magnetic resonance imaging (MRI) are complementary investigations. US is well placed for screening most extraforaminal pathologies, whereas MRI is more sensitive and accurate for specific clinical indications. For example, MRI is probably the preferred technique for assessment of trauma because it enables a thorough evaluation of both the intraspinal and extraspinal elements, although US can depict extraforaminal neural injury with a high level of accuracy. Conversely, US is probably the preferred technique for examination of neurologic amyotrophy because a more extensive involvement beyond the brachial plexus is the norm, although MRI is more sensitive than US for evaluating muscle denervation associated with this entity. With this synergy in mind, this review highlights the tips for examining the brachial plexus with US and MRI.

Accuracy of Rotator Cuff Tears and Tendinosis Diagnoses on Shoulder Ultrasound Performed by a Short-experienced Operator

2018 ◽  
Vol 1 ◽  
pp. 9
Author(s):  
Harshad Arvind Vanjare ◽  
Jyoti Panwar
Keyword(s):  
Rotator Cuff ◽  
Negative Predictive Value ◽  
Rotator Cuff Tear ◽  
Predictive Value ◽  
Rotator Cuff Tears ◽  
Mri Findings ◽  
Cuff Tear ◽  
Experienced Operator ◽  
Magnetic Resonance Imaging Mri ◽  
Sensitivity Specificity

Objective The objective of the study was to assess the accuracy of ultrasound examination for the diagnosis of rotator cuff tear and tendinosis performed by a short experienced operator, compared to magnetic resonance imaging (MRI) results. Method A total of 70 subjects suspected to have rotator cuff tear or tendinosis and planned for shoulder MRI were included in the study. Shoulder ultrasound was performed either before or after the MRI scan on the same day. Ultrasound operator had a short experience in performing an ultrasound of the shoulder. Ultrasound findings were correlated to MRI findings. Results Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for the diagnosis of tendinosis were 58%, 84%, 63%, 80%, and 75%, respectively, and it was 68%, 91%, 73%, 88%, and 85%, respectively, for the diagnosis of rotator cuff tear. Conclusions Sensitivity for diagnosing rotator cuff tear or tendinosis was moderate but had a higher negative predictive value. Thus, the ultrasound operator with a short experience in performing shoulder ultrasound had moderate sensitivity in diagnosing tendinosis or tears; however, could exclude them with confidence.

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