Benefits of Brain Magnetic Resonance Imaging Over Computed Tomography in Children Requiring Emergency Evaluation of Ventriculoperitoneal Shunt Malfunction

The artery of Percheron is a solitary trunk representing an uncommon anatomic variant that provides bilateral arterial supply to the paramedian thalami and the rostral midbrain. Occlusion of this artery results in bilateral thalamic and mesencephalic infarctions. The clinical diagnosis is difficult because the complex anatomy causes large clinical variability. We report a case of a comatose patient with normal early head-computed tomography and magnetic resonance imaging. A bilateral paramedian thalamic infarct due to an occlusion of the artery of Percheron was revealed two days later by a new head computed tomography. To our knowledge, this is the first report in the literature of a symptomatic patient presenting an acute Percheron stroke with normal early brain magnetic resonance imaging. Our case indicates that a normal initial magnetic resonance imaging cannot formally eliminate the diagnosis of acute stroke of the artery of Percheron. We discuss the causes of noncontributive brain magnetic resonance imaging at the onset of this acute Percheron stroke and the alternative diagnosis and therapy methods.

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Acute Pancreatitis and Posterior Reversible Encephalopathy Syndrome: A Case Report

Acta Médica Portuguesa ◽

10.20344/amp.7368 ◽

2016 ◽

Vol 29 (9) ◽

pp. 567 ◽

Cited By ~ 3

Author(s):

Vítor Magno Pereira ◽

Luís Marote Correia ◽

Tiago Rodrigues ◽

Gorete Serrão Faria

Keyword(s):

Magnetic Resonance Imaging ◽

Computed Tomography ◽

Emergency Department ◽

Magnetic Resonance ◽

Posterior Reversible Encephalopathy Syndrome ◽

Epigastric Pain ◽

Brain Magnetic Resonance Imaging ◽

Resonance Imaging ◽

Posterior Reversible Encephalopathy ◽

Reversible Encephalopathy

The posterior reversible encephalopathy syndrome is a neurological syndrome characterized by headache, confusion, visual disturbances and seizures associated with identifiable areas of cerebral edema on imaging studies. The authors report the case of a man, 33 years-old, leukodermic with a history of chronic alcohol and tobacco consumption, who is admitted to the emergency department for epigastric pain radiating to the back and vomiting with about six hours of evolution and an intense holocranial headache for two hours. His physical examination was remarkable for a blood pressure of 190/100 mmHg and tenderness in epigastrium. His analytical results revealed emphasis on amylase 193 U/L and lipase 934 U/L. During the observation in the emergency department,he presented a generalized tonic-clonic seizure. Abdominal ultrasonography was performed and suggestive of pancreatitis withoutgallstones signals. Head computed tomography showed subarachnoid haemorrhage and a small right frontal cortical haemorrhage. The brain magnetic resonance imaging done one week after admission showed areas of a bilateral and symmetrical T2 / FLAIR hyperintensities in the subcortical white matter of the parietal and superior frontal regions, suggesting a diagnosis of posterior reversible encephalopathy syndrome. Abdominal computed tomography (10 days after admission) demonstrated a thickened pancreas in connection with inflammation and two small hypodense foci in the anterior part of the pancreas body, translating small foci of necrosis. The investigation of a thrombophilic defect revealed a heterozygous G20210A prothrombin gene mutation. The patient was discharged without neurological sequelae and asymptomatic. The follow-up brain magnetic resonance imaging confirmed the reversal of the lesions, confirming the diagnosis.

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Pure ground glass nodular adenocarcinomas: Are preoperative positron emission tomography/computed tomography and brain magnetic resonance imaging useful or necessary?

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2015.06.024 ◽

2015 ◽

Vol 150 (3) ◽

pp. 514-520 ◽

Cited By ~ 13

Author(s):

Hyoun Cho ◽

Ho Yun Lee ◽

Jhingook Kim ◽

Hong Kwan Kim ◽

Joon Young Choi ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Computed Tomography ◽

Positron Emission Tomography ◽

Magnetic Resonance ◽

Brain Magnetic Resonance Imaging ◽

Emission Tomography ◽

Ground Glass ◽

Resonance Imaging ◽

Positron Emission

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The Use of Transcutaneous Thermal Convection Analysis to Assess Shunt Function in the Pediatric Population

Operative Neurosurgery ◽

10.1227/neu.0b013e31823cf18d ◽

2011 ◽

Vol 70 (suppl_2) ◽

pp. ons181-ons183 ◽

Cited By ~ 2

Author(s):

Arthur E. Marlin ◽

Sarah J. Gaskill

Keyword(s):

Magnetic Resonance Imaging ◽

Computed Tomography ◽

Magnetic Resonance ◽

Thermal Convection ◽

Clinical Symptoms ◽

Pediatric Population ◽

Shunt Malfunction ◽

Resonance Imaging ◽

Shunt Series

ABSTRACT BACKGROUND: The diagnosis of shunt malfunction is largely made by subjective clinical history and assessment in association with neurodiagnostic imaging. OBJECTIVE: To evaluate the use of a transcutaneous thermal convection device for the diagnosis of shunt malfunction. METHODS: We present the results of a trial of a commercially available device under an Institutional Review Board--approved protocol. All patients had neurodiagnostic studies that defined their shunt function at the time of transcutaneous thermal convection measurement. Thirty-seven shunts were studied in 35 patients. To be included, patients had to be between 0 to 18 years of age, had to be due within a 3-month period for routine follow-up evaluations, and had to have neurodiagnostic imaging (computed tomography or magnetic resonance imaging) as part of this visit and a shunt series. All patients were seen in routine follow-up, and none had clinical symptoms of shunt malfunction. RESULTS: Three patients had fractured shunts. The remaining 32 patients had functioning shunts as determined by clinical criteria, computed tomography or magnetic resonance imaging scans, and, when appropriate, a shunt series. In these remaining patients, flow was initially confirmed in only 40%. After some filtering of the data, this was increased to 51%. Although these results are disappointing, they outline the current issues with the technique and the state of its utility and point to the need for further refinement. CONCLUSION: Our current research suggests that cerebrospinal fluid flow as detected by thermoconvection analysis is not a reliable indicator of shunt function in the pediatric population.

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