WED 170 The utility of brain FDG-PET in a patient with natalizumab associated PML-IRIS

2018 ◽  
Vol 89 (10) ◽  
pp. A21.3-A21
Author(s):  
Baheerathan Aravindhan ◽  
Kalam Sabrina ◽  
Grote Helen ◽  
Mcnamara Cillian ◽  
Rane Neil ◽  
...  
Keyword(s):  
Fdg Pet ◽  
Demyelinating Disease ◽  
Jc Virus ◽  
Middle Cerebellar Peduncle ◽  
Signal Abnormality ◽  
Dna Repeat ◽  
Concurrent Use ◽  
Cerebellar Peduncle ◽  
The Right ◽  
Relapsing Remitting Multiple Sclerosis

Natalizumab, a highly effective disease modifying drug used in relapsing remitting multiple sclerosis (RRMS), is associated with progressive multifocal leukoencephalopathy (PML), a fatal intracerebral demyelinating disease caused by the JC virus that can be worsened with concurrent use of steorids. Stopping natalizumab in the context of PML can cause immune reconstitution inflammatory syndrome (IRIS) that can be treated with steroids. IRIS can be indistinguishable from PML on MRI - thus causing a clinical conundrum.We describe a woman with RRMS on Natalizumab who developed dysarthria and right-sided hemiparesis. MRI demonstrated non-enhancing peridentate white matter signal abnormality in the right middle cerebellar peduncle (RMCP). Cerebrospinal fluid JC virus DNA was >1 million copies/ml. PML was diagnosed and Natalizumab withdrawn. Four weeks later she developed bulbar weakness and left-sided hemiparesis despite falling JC virus DNA. Repeat MRI demonstrated new extensive pontine changes consistent with PML-IRIS.FDG-PET imaging confirmed focal areas of hypometabolism at the original site of PML and multiple areas of hypermetabolism in the left pons and middle cerebellar peduncle, suggestive of IRIS. Her clinical deterioration was attributed to IRIS and Prednisolone was commenced.In this case FDG-PET scanning helped distinguish between PML and IRIS, guiding patient management.

scholarly journals Developmentally anomalous cerebellar encephalocele arising within the cerebellopontine angle and extending into the adjacent skull base in a pediatric patient

2021 ◽  
Author(s):  
Forrest A. Hamrick ◽  
Michael Karsy ◽  
Carol S. Bruggers ◽  
Angelica R. Putnam ◽  
Gary L. Hedlund ◽  
...  
Keyword(s):  
Skull Base ◽  
Pediatric Patient ◽  
Cerebellopontine Angle ◽  
Resonance Imaging ◽  
Middle Cerebellar Peduncle ◽  
Cerebellar Tissue ◽  
Cerebellar Peduncle ◽  
Histopathologic Analysis ◽  
The Right ◽  
Internal Acoustic Canal

AbstractLesions of the cerebellopontine angle (CPA) in young children are rare, with the most common being arachnoid cysts and epidermoid inclusion cysts. The authors report a case of an encephalocele containing heterotopic cerebellar tissue arising from the right middle cerebellar peduncle and filling the right internal acoustic canal in a 2-year-old female patient. Her initial presentation included a focal left 6th nerve palsy. Magnetic resonance imaging was suggestive of a high-grade tumor of the right CPA. The lesion was removed via a retrosigmoid approach, and histopathologic analysis revealed heterotopic atrophic cerebellar tissue. This report is the first description of a heterotopic cerebellar encephalocele within the CPA and temporal skull base of a pediatric patient.

scholarly journals Retrosigmoid Approach for Resection of Cerebellar Peduncle Cavernoma

2018 ◽  
Vol 79 (S 05) ◽  
pp. S420-S421
Author(s):  
Hussam Abou-Al-Shaar ◽  
Gmaan Alzhrani ◽  
Yair Gozal ◽  
William Couldwell
Keyword(s):  
Acute Onset ◽  
Middle Cerebellar Peduncle ◽  
Postoperative Mri ◽  
History Of ◽  
Horizontal Gaze ◽  
Cerebellar Peduncle ◽  
Magnetic Resonance Imaging Mri ◽  
Residual Blood ◽  
The Right

The case described in this video involved a 38-year-old man, who presented with a 4-week history of worsening acute-onset headache, nausea, double vision, and vertigo. On examination, he had impaired tandem gait and diplopia on right horizontal gaze. A computed tomography (CT) scan revealed a hyperdense lesion of the right cerebellopontine angle. Magnetic resonance imaging (MRI) revealed a nonenhancing middle cerebellar peduncle lesion that was isointense on T2-weighed imaging and hypointense on FLAIR imaging (Fig. 1A–B). The differential diagnoses for this lesion included cavernous malformation, thrombosed aneurysm, and neurocysticercosis. CT angiography was done preoperatively to rule out cerebral aneurysm. Surgical resection of the lesion was recommended to relieve his symptoms, to prevent further deterioration/bleeding, and to obtain a pathological diagnosis. The patient underwent a right retrosigmoid craniotomy for resection of the right middle cerebellar peduncle cavernoma (Fig. 2). The patient tolerated the procedure well with no new postoperative neurological deficit. Postoperative MRI depicted gross total resection of the lesion and expected residual blood in the resection cavity (Fig. 1C–D). The patient was discharged home on postoperative day 4. At his last follow-up appointment, 1 month after surgery, he reported complete resolution of his preoperative symptoms, including diplopia. The patient gave consent for publication.The link to the video can be found at: https://youtu.be/TRieS9DXbV4.

scholarly journals Transaxonal degenerations of cerebellar connections: the value of anatomical knowledge

2020 ◽  
Vol 78 (5) ◽  
pp. 301-306
Author(s):  
Mariana Trombetta de Lima RAEDER ◽  
Eduardo Pontes REIS ◽  
Brunno Machado CAMPOS ◽  
Igor Aloísio Garcez ZAMILUTE ◽  
Marcondes Cavalcante FRANÇA JÚNIOR ◽  
...  
Keyword(s):  
Dentate Nucleus ◽  
Demyelinating Disease ◽  
Clinical Manifestations ◽  
Imaging Findings ◽  
Middle Cerebellar Peduncle ◽  
Imaging Characteristics ◽  
Central Tegmental Tract ◽  
Clinical Correlations ◽  
Cerebellar Peduncle ◽  
T2 Hyperintensity

ABSTRACT Transaxonal degenerations result from neuronal death or the interruption of synaptic connections among neuronal structures. These degenerations are not common but may be recognized by conventional magnetic resonance imaging. Objective: The learning objectives of this review include recognition of the imaging characteristics of transaxonal degenerations involving cerebellar connections, the identification of potential encephalic lesions that can lead to these degenerations and correlation of the clinical manifestations with imaging findings that reflect this involvement. Methods: In this report, we review the neuroanatomical knowledge that provides a basis for identifying potential lesions that can result in these degenerations involving cerebellar structures. Results: Hypertrophic olivary degeneration results from an injury that interrupts any of the components of the Guillain-Mollaret triangle. In this work, we describe cases of lesions in the dentate nucleus and central tegmental tract. The crossed cerebellar diaschisis presents specific imaging findings and clinical correlations associated with its acute and chronic phases. The Wallerian degeneration of the middle cerebellar peduncle is illustrated by fiber injury of the pontine cerebellar tracts. A T2-hyperintensity in the dentate nucleus due to a thalamic acute lesion (in ventral lateral nuclei) is also described. Each condition described here is documented by MRI images and is accompanied by teaching points and an anatomical review of the pathways involved. Conclusion: Neurologists and radiologists need to become familiar with the diagnosis of these conditions since their presentations are peculiar and often subtle, and can easily be misdiagnosed as ischemic events, degenerative disease, demyelinating disease or even tumors.

Microsurgical Resection of a Middle Cerebellar Peduncle Cavernous Malformation: 3-Dimensional Operative Video

2019 ◽  
Vol 19 (2) ◽  
pp. E170-E171
Author(s):  
Marcio S Rassi ◽  
Guilherme H W Ceccato ◽  
Emerson Schindler ◽  
Felipe G Fagundes ◽  
Matias N P Beiras ◽  
...  
Keyword(s):  
Cavernous Malformation ◽  
Neurophysiological Monitoring ◽  
En Bloc ◽  
Complete Excision ◽  
Middle Cerebellar Peduncle ◽  
Cavernous Malformations ◽  
Initial Symptoms ◽  
Telovelar Approach ◽  
Cerebellar Peduncle ◽  
The Right

Abstract Brainstem cavernous malformations are frequently surrounded by vital structures, which often makes surgical treatment a challenging task even to the most skilled surgeon. Accordingly, microsurgical excision is preferably offered to symptomatic patients and superficial lesions.1-3 We present the case of a 41-yr-old male presenting with progressive dizziness and diplopia. Neurological examination showed horizontal nystagmus, dysmetria, and unbalance. Preoperative magnetic resonance imaging (MRI) suggested a cavernous malformation in the right middle cerebellar peduncle. A telovelar approach was employed with the guidance of intraoperative neurophysiological monitoring. An exophytic lesion was identified in the right middle cerebellar peduncle and a clear cleavage plane was obtained allowing circumferential dissection around the capsule. The lesion was removed en bloc. Postoperative MRI confirmed a complete excision of the malformation. The patient presented an improvement in his initial symptoms, with no new neurological deficit. Cavernous malformations related with the fourth ventricle can be successfully resected through a telovelar approach in select cases, especially when exophytic, where the surgeon might take advantage of the path created by the lesion. Informed consent was obtained from the patient for the procedure and publication of this operative video. Anatomic images were a courtesy of the Rhoton Collection, American Association of Neurological Surgeons (AANS)/Neurosurgical Research and Education Foundation (NREF).

scholarly journals RONC-26. A CASE OF RADIATION NECROSIS OF THE CEREBELLUM 16 YEARS AFTER CHEMORADIOTHERAPY FOR MEDULLOBLASTOMA

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii460-iii460
Author(s):  
Mayuko Miyata ◽  
Masahiro Nonaka ◽  
Akio Asai
Keyword(s):  
Radiation Necrosis ◽  
Tumor Resection ◽  
Pathological Examination ◽  
Secondary Cancer ◽  
Brain Necrosis ◽  
Cerebellar Medulloblastoma ◽  
Cerebellar Peduncle ◽  
The Right ◽  
The Brain

Abstract BACKGROUND If new lesions are observed during follow-up of the malignant tumor after treatment, it is difficult to distinguish whether the tumor is a recurrent lesion, secondary cancer, or radiation necrosis of the brain. We have encountered a patient with symptomatic radiation necrosis of the cerebellum 16 years after treatment of medulloblastoma. CASE PRESENTATION: A 24-year-old man who had received a tumor resection and chemoradiotherapy for cerebellar medulloblastoma at the age of 8 presented with dizziness. For the past 16 years, there was no recurrence of the tumor. He subsequently underwent MRI scan, and T1-Gd image showed enhanced lesion in the right cerebellar peduncle. Cerebrospinal fluid cytology analysis was negative for tumor. We suspected tumor reccurence or secondary cancer, and performed lesion biopsy. The result of the pathological examination was radiation necrosis of the cerebellum. DISCUSSION: The interval of radiation necrosis of the brain and radiotherapy can vary from months to more than 10 years. So, whenever a new lesion is identified, radiation brain necrosis must be envisioned. According to guidelines in Japan, there is no absolute examination for discriminating tumor recurrence from radiation brain necrosis and diagnosis by biopsy may be required. CONCLUSION We experienced a case of symptomatic radiation necrosis of the cerebellum 16 years after treatment. In patients showing new lesion after long periods of time, the possibility of radiation necrosis to be considered.

scholarly journals Radiation-Induced Metabolic Shifts in the Hepatic Parenchyma: Findings from 18F-FDG PET Imaging and Tissue NMR Metabolomics in a Mouse Model for Hepatocellular Carcinoma

Molecules ◽  
2021 ◽  
Vol 26 (9) ◽  
pp. 2573
Author(s):  
Yi-Hsiu Chung ◽  
Cheng-Kun Tsai ◽  
Ching-Fang Yu ◽  
Wan-Ling Wang ◽  
Chung-Lin Yang ◽  
...  
Keyword(s):  
Fdg Pet ◽  
Liver Parenchyma ◽  
Metabolic Alterations ◽  
Nmr Metabolomics ◽  
Post Irradiation ◽  
The Third ◽  
Radiation Induced ◽  
18F Fdg ◽  
The Right ◽  
Over Time

Purpose: By taking advantage of 18F-FDG PET imaging and tissue nuclear magnetic resonance (NMR) metabolomics, we examined the dynamic metabolic alterations induced by liver irradiation in a mouse model for hepatocellular carcinoma (HCC). Methods: After orthotopic implantation with the mouse liver cancer BNL cells in the right hepatic lobe, animals were divided into two experimental groups. The first received irradiation (RT) at 15 Gy, while the second (no-RT) did not. Intergroup comparisons over time were performed, in terms of 18F-FDG PET findings, NMR metabolomics results, and the expression of genes involved in inflammation and glucose metabolism. Results: As of day one post-irradiation, mice in the RT group showed an increased 18F-FDG uptake in the right liver parenchyma compared with the no-RT group. However, the difference reached statistical significance only on the third post-irradiation day. NMR metabolomics revealed that glucose concentrations peaked on day one post-irradiation both, in the right and left lobes—the latter reflecting a bystander effect. Increased pyruvate and glutamate levels were also evident in the right liver on the third post-irradiation day. The expression levels of the glucose-6-phosphatase (G6PC) and fructose-1, 6-bisphosphatase 1 (FBP1) genes were down-regulated on the first and third post-irradiation days, respectively. Therefore, liver irradiation was associated with a metabolic shift from an impaired gluconeogenesis to an enhanced glycolysis from the first to the third post-irradiation day. Conclusion: Radiation-induced metabolic alterations in the liver parenchyma occur as early as the first post-irradiation day and show dynamic changes over time.

scholarly journals Regulation of CTLA-4 and PD-L1 Expression in Relapsing-Remitting Multiple Sclerosis Patients after Treatment with Fingolimod, IFNβ-1α, Glatiramer Acetate, and Dimethyl Fumarate Drugs

2021 ◽  
Vol 11 (8) ◽  
pp. 721
Author(s):  
Afshin Derakhshani ◽  
Zahra Asadzadeh ◽  
Hossein Safarpour ◽  
Patrizia Leone ◽  
Mahdi Abdoli Shadbad ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Mononuclear Cells ◽  
Demyelinating Disease ◽  
Immune Checkpoints ◽  
Peripheral Blood Mononuclear ◽  
Relapsing Remitting ◽  
Remitting Multiple Sclerosis ◽  
Multiple Sclerosis Patients ◽  
Relapsing Remitting Multiple Sclerosis ◽  
The Impact

Multiple sclerosis (MS) is a chronic demyelinating disease of the central nervous system (CNS) that is characterized by inflammation which typically results in significant impairment in most patients. Immune checkpoints act as co-stimulatory and co-inhibitory molecules and play a fundamental role in keeping the equilibrium of the immune system. Cytotoxic T-lymphocyte antigen-4 (CTLA-4) and Programmed death-ligand 1 (PD-L1), as inhibitory immune checkpoints, participate in terminating the development of numerous autoimmune diseases, including MS. We assessed the CTLA-4 and PD-L1 gene expression in the different cell types of peripheral blood mononuclear cells of MS patients using single-cell RNA-seq data. Additionally, this study outlines how CTLA-4 and PD-L1 expression was altered in the PBMC samples of relapsing-remitting multiple sclerosis (RRMS) patients compared to the healthy group. Finally, it investigates the impact of various MS-related treatments in the CTLA-4 and PD-L1 expression to restrain autoreactive T cells and stop the development of MS autoimmunity.

Isolated Bilateral Middle Cerebellar Peduncle Infarcts

2013 ◽  
Vol 22 (8) ◽  
pp. e645-e646 ◽  
Author(s):  
Seby John ◽  
Mohamed Hegazy ◽  
Esteban Cheng Ching ◽  
Irene Katzan
Keyword(s):  
Middle Cerebellar Peduncle ◽  
Cerebellar Peduncle
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