Abstract WMP59: Multiple Scattered Tiny Cerebral Infarctions Are Unlikely Cardiogenic

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Yi Dong ◽  
Yuan Gao ◽  
Deepak S Nair ◽  
Sarah Parker ◽  
Jan L Jahnel ◽  
...  
Keyword(s):  
Oral Anticoagulants ◽  
Previous History ◽  
B Cell Lymphoma ◽  
Median Number ◽  
Mri Imaging ◽  
Mri Findings ◽  
Presenting Symptoms ◽  
Recurrent Strokes ◽  
Moderate Chronic Kidney Disease ◽  
The Right

Background: Embolic ischemic strokes are commonly considered to be cardiogenic. In clinical practice, however,patients with a pattern of multiple tiny ischemic foci on MRI often have no cardiac source. To identifying its etiology may help selecting the right therapy to treat or prevent recurrent strokes. Methods: From 1/2010 to 12/2013, records and MRI imaging of 2984 consecutive stroke patients were reviewed. Patients with the following DWI MRI findings were included: 1) ≥3 high intensity lesions in three different arterial territories, 2) each ≤15mm in size and ≤2 sections in thickness. Other data reviewed include general demographics, clinical features and lab results. Patients with known cardiac embolism, aortic arch plaques or aneurysms and recent surgery were excluded. Images of follow-up MRI were reviewed. Results: Among 2984 cases reviewed, 71 patients had multiple tiny DWI lesions. In order to rule out artery to artery emboli, patients with lesions from the same artery territory or watershed region were excluded. Only 43 met all criteria. Their median age was 65 and 23(53.5%) were male. Extremity weakness and slurred speech were the most common presenting symptoms. The median number of DWI lesions in each brain was 13. Common disorders identified include: infection (81.4%), hyperlipidemia(58.1%), moderate chronic kidney disease(39.5%), previous history of stroke (48.8%). Four (9.3%) had large B cell lymphoma and 2 had lung cancer. The quantity of DWI lesions was related to hyperglycemia, hyperlipidemia and impaired GFR. Patients with primary hypercoagulable state more likely had multiple lesions (median 39). On discharge, 5 (11.6%) patients were prescribed dual antiplatelet therapy and 11 (25.6%) were given oral anticoagulants. Conclusions: To our knowledge, this was the first review of this type of specific DWI findings with clinical correlation. Multiple tiny or ‘Star-like’ type of lesions on DWI MRI were likely caused by infection, hyperlipidemia CKD and leukemia. They are unlikely cardiogenic and its recurrent rate was high. Recognizing the pattern of these tiny lesions will help clinicians refocus on the work up of stroke, strategies of treatment and stroke prevention strategy.

scholarly journals Levator palpabrae superioris myositis as an unusual cause of unilateral ptosis—case report

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Ahmed M. Abdrabou
Keyword(s):  
Previous History ◽  
Good Prognosis ◽  
Oculomotor Nerve Palsy ◽  
Ophthalmological Examination ◽  
Bilateral Ptosis ◽  
Mri Findings ◽  
Upper Eyelid ◽  
Unilateral Disease ◽  
The Right ◽  
Mri Study

Abstract Background Ptosis can be a manifestation of a more serious situation. Hence, the analysis of the complaint and the search for etiology are crucial in such cases. Ptosis has many causes; some of them lead to unilateral ptosis while others cause bilateral ptosis. For instance, myasthenia gravis is a cause of bilateral ptosis while oculomotor nerve palsy induces unilateral disease. Proper evaluation of the patient and identification of the cause are important to achieve accurate management and good prognosis. Case presentation A 47-year-old male patient attended the ER complaining of dropping the right eye lid of 2 days’ duration. There was no associated pain or diplopia. On examination, the extraocular muscles’ (EOM) motility was intact, normal pupil and corneal reflexes, and there was swelling of the upper eyelid. Ophthalmological examination revealed normal anterior and posterior chambers as well as the vitreous and retina. The patient had a previous history of traumatic intracranial hemorrhage that was resolved without surgical intervention. He also had diabetes mellitus and hypertension. The patient was transferred to the MRI unit to perform MRI study of the brain and orbit with MRA and IV contrast administration. MRI findings confirmed the diagnosis of LPS myositis, and the patient received medical treatment and improved. Conclusion Proper radiological diagnosis leads to accurate management and achieves rapid recovery and optimal patient care.

Reversion of Chemoresistance in Aggressive Lymphoma by Quinine. A Phase II Trial.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 4572-4572
Author(s):  
Pierre Soubeyran ◽  
Amine Masmoudi ◽  
Christele Blanc-Bisson ◽  
Isabelle Soubeyran ◽  
Ricardo Bellott ◽  
...  
Keyword(s):  
Phase Ii ◽  
Phase Ii Trial ◽  
Cell Lymphoma ◽  
Previous History ◽  
Dose Intensity ◽  
B Cell Lymphoma ◽  
Median Number ◽  
Aggressive Lymphoma ◽  
History Of ◽  
Resistance To Chemotherapy

Abstract Multidrug resistance has been one of the most studied mechanisms of cancer cell resistance to chemotherapy. Evidence of its involvement in hematological malignancies is known since many years. One well-designed phase I trial showed that about 20 to 25% of patients strictly resistant to EPOCH schedule could become responsive again by the addition of Dex-verapamil (J Clin Oncol1995; 13:1995–2004). We decided to perform a phase II trial to evaluate whether quinine could reverse resistance to chemotherapy in aggressive lymphoma. Methods: Patients included had all received at least two lines of chemotherapy including CEOP (cyclophosphamide 750mg/m2, epirubicine 60mg/m2, vincristine 1.4mg/m2 IV day 1 and prednisone 40mg/m2 orally day1 to day 7) and were demonstrated as strictly refractory to CEOP i.e. either no change or progression. Q-CEOP was administered as follows: quinine 30-mg/kg/day for two days from d0 to d1 as a continuous infusion, CEOP at the beginning of d1. Results: 15 patients have been included with the following characteristics: median age: 52 years (32–64), 66% stage III–IV, 60% elevated LDH. The median number of previous regimens was 3 (2–5). 13 patients had diffuse large B cell lymphoma including 3 with previous history of follicular lymphoma. Two had mantle cell lymphoma. Seven patients were included directly since they were initially refractory to CEOP while eight were shown refractory after two further cycles of CEOP. Epirubicin pharmacokinetics was not influenced by quinine. Mean dose intensity of epirubicin was 94%. Toxicity was mild. 4 responses were observed at the end of treatment including 2 complete and 2 partial responses (26%, IC 95%: 8–55%). Only the 2 CR patients are still alive with no evidence of disease at 35+ and 61+ months. Conclusion: These results add further arguments to confirm that MDR1 plays a significant role in resistance to chemotherapy in lymphoma. Quinine allowed unexpected long term remission in 2 responding patients.

scholarly journals Cowden Disease with Lhermitte-Duclos Disease: Case Report

2004 ◽  
Vol 31 (4) ◽  
pp. 542-549 ◽  
Author(s):  
Sujit S. Prabhu ◽  
Kenneth D. Aldape ◽  
Janet M. Bruner ◽  
Jeffrey S. Weinberg ◽  
Jeffrey S. Weinberg
Keyword(s):  
Breast Cancer ◽  
Previous History ◽  
Skin Lesions ◽  
Posterior Fossa Decompression ◽  
Cowden Disease ◽  
Lower Cranial Nerve ◽  
Presenting Symptoms ◽  
Disease Case ◽  
The Right ◽  
Cancer Multiple

Background:We report a case and review the recent literature describing 36 patients with both Lhermitte-Duclos disease (LDD) and Cowden disease (CD). Lhermitte-Duclos disease, or dysplastic gangliocytoma, is a benign hamartomatous condition involving the cerebellum. The presenting symptoms are usually headaches, gait ataxia, and symptoms of lower cranial nerve involvement. Cowden disease is a rare autosomal dominant disease that usually presents with multiple mucocutaneous lesions. Patients with CD are prone to multiple systemic malignancies, the most common of which is breast cancer. Recent studies have demonstrated an association between LDD and CD.Methods:A 44-year-old woman with a previous history of breast cancer, multiple benign skin lesions, Hashimoto's thyroiditis, and chronic headaches presented with exacerbation of her headaches during the previous year. Magnetic resonance imaging of the brain revealed a right cerebellar nonenhancing mass and an acquired tonsillar herniation.Results:The patient underwent resection of the right cerebellar mass, posterior fossa decompression, C1 and C2 laminectomies, and a duraplasty. Pathologic examination confirmed LDD. The patient recovered well after surgery, with immediate improvement of her headaches.Conclusion:The association between LDD and CD has been under-recognized and under-reported. Recognition of this association has direct clinical relevance, because diligent monitoring of individuals with LDD and CD may lead to the early detection of systemic malignancies.

scholarly journals L3 rootlet recurrent melanocytic schwannoma – case report and literature review

Folia Medica ◽  
2021 ◽  
Vol 63 (3) ◽  
pp. 448-456
Author(s):  
Georgi K. Georgiev ◽  
Ivan V. Todorov ◽  
Todor P. Shamov ◽  
Ivan V. Krushovenski ◽  
Albena D. Fakirova ◽  
...  
Keyword(s):  
Literature Review ◽  
Peripheral Nerve ◽  
Carney Complex ◽  
Mri Imaging ◽  
Mri Findings ◽  
Total Resection ◽  
Postoperative Radiation Therapy ◽  
Metastatic Recurrence ◽  
Benign Tumours ◽  
The Right

First described by Miller in 1932, melanocytic schwannoma (MS) (melanotic schwannoma, pigmented schwannoma) is a rare variation of peripheral nerve sheet tumours with ectodermal origin occurring predominantly in somatic, but also in the autonomic peripheral system with around two hundred cases in the literature. Predominantly benign tumours, MS are still imaging and pathological challenge and can be easily misdiagnosed with more aggressive peripheral nerve tumours. We report a case of melanocytic schwannoma on L3 sensory rootlet with systematic literature review of nearly 200 cases presented in intracranial, paraspinal region, thoracic, abdominal or pelvic cavities and skin. Two-thirds of cases are part of Carney complex. We present a case of a 61-year-old male with a 3-month history of low back pain, progressive numbness and stiffness in the right thigh, shin and knee, tibial and peroneal paresis causing gait disturbance and neurological claudication. MRI findings present “sand clock” type intradural extramedullary tumour formation with extension to the L3 rootlet through right L3-L4 foramen, hypointense on T2 and hyperintense on T1. Pathological diagnosis of sporadic type melanocytic schwannoma was made via immunohistological and ultrastructural analysis. Thirteen months after total resection there was clinical and MRI evidence of recurrence of the tumour. Total resection and radiosurgery was performed with a recurrence free period of 14 months.A gold standard for melanocytic schwannoma treatment is gross total surgical resection. Despite being considered benign tumours, MS have a local or metastatic recurrence of around 13%. MRI imaging in most of the cases is insufficient and only exhaustive pathological and immunohistological examination is the key to diagnosis. Need of postoperative radiation therapy is still controversial. For the first time, a criterion for postoperative adjuvant therapy was established.

scholarly journals Cerebral Infarction Associated With Thrombosed Developmental Venous Anomaly: A Case Report

2017 ◽  
pp. 14
Author(s):  
Mehdi Karimian ◽  
Afshin Borhani Haghighi
Keyword(s):  
Protein C ◽  
Rare Complication ◽  
Brain Infarction ◽  
Cranial Nerves ◽  
Previous History ◽  
Central Vein ◽  
Developmental Venous Anomaly ◽  
Venous Anomaly ◽  
Mri Findings ◽  
The Right

Introduction:Developmental venous anomaly (DVA, venous angioma) is a congenital vascular variant of cerebral venous drainage, which consists of several radial veins draining into an enlarged central vein (caput medusa appearance). This anatomical variations are usually followed by benign and asymptomatic clinical course, so it is incidentally detected at MRI, MRA, CT, angiography or autopsy performed for unrelated problems. Rarely DVAs become symptomatic and present with headache, seizures, numbness, diplopia, paresthesia, syncope and focal neurologic deficit secondary to thrombosis in drainage veins. Hemorrhagic complications occur more often than isolated ischemic events. Also, non-hemorrhagic brain infarction is a rare complication in these patients. We describe a patient with non-hemorrhagic venous infarction associated with DVA.Case report:A 57-year- old female patient was admitted to Namazi hospital with complaints of acute severe headache in the right temporo-occipital region, vertigo, left sided paresthesia and weakness. She was in good health a week prior to admission when the blurred vision appeared in her right eye. The patient had previous history of recurrent episodes of migraine-like headache that controlled by medical therapy. The family history was unremarkable. Her only medications were various oral contraceptives and propranolol. On examination, she was afebrile and alert with stable vital signs. Her pupils were equal and reactive to light. Neurological examination was normal and the cranial nerves were intact. The deep tendon reflexes were brisk and symmetric and bilateral Babinski and Hoffmann’s signs were present. On admission, her speech, memory, and intellectual performance were normal. She had weakness of the upper and lower extremities (especially on the left side) and her knees were unstable while walking. Hematology and coagulation tests (protein C, activated protein C resistance, protein S, homocysteine, anticardiolipin antibodies, antithrombin III and antinuclear anti body) were normal.The initial CT scan of the brain demonstrated no evidence of abnormal density, hydrocephalus or hemorrhagic process in the cerebral hemispheres, MRI findings revealed several radially arranged veins converging to a small enlarged vein in the right temporo-occipital lobe. Thrombosis of collector veins detected as a hypersignality on contrast enhanced MRI. Also, “caput medusa” configuration was detectable in angiography.

Popliteal artery thrombosis secondary to a tibial osteochondroma

VASA ◽  
2011 ◽  
Vol 40 (3) ◽  
pp. 251-255 ◽  
Author(s):  
Gruber-Szydlo ◽  
Poreba ◽  
Belowska-Bien ◽  
Derkacz ◽  
Badowski ◽  
...  
Keyword(s):  
Case Report ◽  
Magnetic Resonance Angiography ◽  
Popliteal Artery ◽  
Doppler Ultrasonography ◽  
Histopathological Examination ◽  
Previous History ◽  
Plain Radiography ◽  
Artery Thrombosis ◽  
History Of ◽  
The Right

Popliteal artery thrombosis may present as a complication of an osteochondroma located in the vicinity of the knee joint. This is a case report of a 26-year-old man with symptoms of the right lower extremity ischaemia without a previous history of vascular disease or trauma. Plain radiography, magnetic resonance angiography and Doppler ultrasonography documented the presence of an osteochondrous structure of the proximal tibial metaphysis, which displaced and compressed the popliteal artery, causing its occlusion due to intraluminal thrombosis..The patient was operated and histopathological examination confirmed the diagnosis of osteochondroma.

Neuroimaging of Children With Takayasu Arteritis

2021 ◽  
pp. 088307382199128
Author(s):  
Hafize Emine Sönmez ◽  
Ferhat Demir ◽  
Semanur Özdel ◽  
Şerife Gül Karadağ ◽  
Esra Bağlan ◽  
...  
Keyword(s):  
Takayasu Arteritis ◽  
Internal Carotid ◽  
Laboratory Data ◽  
Left Middle Cerebral Artery ◽  
Mri Findings ◽  
Cranial Mri ◽  
Magnetic Resonance Imaging Mri ◽  
The Right ◽  
And Diffusion ◽  
Left Middle

Objective: Takayasu arteritis is a rare granulomatous chronic vasculitis that affects the aorta and its main branches. Neurologic manifestations can accompany the disease; however, there is no study on neuroimaging in children with Takayasu arteritis. Therefore, we aimed to evaluate cranial magnetic resonance imaging (MRI) in pediatric Takayasu arteritis patients. Materials and Methods: Demographic, clinical, and laboratory data were obtained retrospectively. Results: The study included 15 pediatric Takayasu arteritis patients. All patients presented with constitutional symptoms. Additionally, 6 patients suffered from headache, 2 had syncope, 1 had loss of consciousness, and 1 had convulsion. All patients underwent cranial and diffusion MRI a median 12 months after diagnosis. Cranial MRI findings were normal in 12 patients, whereas 3 patients had abnormal findings, as follows: stenosis in the M1 and M2 segments of the left middle cerebral artery (n = 1); diffuse thinning of the right internal carotid, middle cerebral, and right vertebral and basilar artery (n = 1); as a sequela, areas of focal gliosis in both the lateral ventricular and posterior periventricular regions (n = 1). Among these 3 patients, 1 had no neurologic complaints. Conclusion: Abnormal MRI findings can be observed in pediatric Takayasu arteritis patients, even those that are asymptomatic; therefore, clinicians should carefully evaluate neurologic involvement in all pediatric Takayasu arteritis patients.

A Challenging Case of A Myeloid Sarcoma Misdiagnosed as High Grade B-Cell Lymphoma

2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S97-S97
Author(s):  
A Herrmann ◽  
B Mai ◽  
S Elzamly ◽  
A Wahed ◽  
A Nguyen ◽  
...  
Keyword(s):  
Bone Marrow ◽  
B Cell ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Myeloid Sarcoma ◽  
Proliferation Index ◽  
High Grade ◽  
Cell Markers ◽  
Thoracolumbar Region ◽  
The Right

Abstract Introduction/Objective A 46-year-old female presented with severe back pain associated with progressive bilateral lower extremity weakness and paresthesia, urinary retention, and constipation. Computed tomography revealed a retroperitoneal mass encasing the right psoas muscle, obstructing the right kidney, and extending to the thoracolumbar region resulting in severe spinal compression. An epidural tumor resection was subsequently performed at an outside hospital. Methods Histological sections showed sheets of blastoid neoplastic cells with intermediate to large nuclei, irregular membranes, fine chromatin, and prominent nucleoli. Immunohistochemical stains showed that these cells were positive for CD43, CD79a (weak, focal), BCL2, C-MYC, and PAX5 (weak, focal) and negative for CD10, CD20, CD30, ALK1, BCL6, MUM1, and Tdt. The Ki-67 proliferation index was 75-80%. With this immunophenotype, this patient was diagnosed with a high grade B-cell lymphoma and transferred to our institution for further work-up. On review of the slides, further immunohistochemical testing was requested which revealed positivity for CD117 and myeloperoxidase (MPO). Results The overall morphological and immunophenotypical features are most compatible with myeloid sarcoma (MS) with aberrant expression of B-cell markers and this patient’s diagnosis was amended. Interestingly, the patient’s bone marrow examination only showed 2% myeloblasts with left shifted granulocytosis and concurrent fluorescence in situ hybridization (FISH) studies were negative. Conclusion A literature review showed that 40-50% of MS are misdiagnosed as lymphoma. MS can frequently stain with B-cell or T-cell markers, as seen in this case, which makes it challenging for an accurate diagnosis and sub- classification. In addition, our case is interesting in that there was only extramedullary presentation without bone marrow involvement. Typically, MS develops after the diagnosis of acute myeloid leukemia (AML) with an incidence of 3–5% after AML. It can also manifest de novo in healthy patients, who then go on to develop AML months to years later. Therefore, this patient will require close follow-up.

Recurrence of Primary Breast Lymphoma Presenting as Bilateral Vitreoretinal Lymphoma

2021 ◽  
pp. 1-5
Author(s):  
Karishma Habbu ◽  
Roshan George ◽  
Miguel Materin
Keyword(s):  
Brain Mri ◽  
B Cell Lymphoma ◽  
Intrathecal Chemotherapy ◽  
Primary Breast Lymphoma ◽  
Blurred Vision ◽  
Breast Lymphoma ◽  
Central Nervous System Penetration ◽  
Vitreoretinal Lymphoma ◽  
The Right ◽  
Vitreous Biopsy

<b><i>Purpose:</i></b> This report describes a case of relapsed primary breast lymphoma (PBL) presenting as vitreoretinal lymphoma (VRL). <b><i>Methods:</i></b> We describe the clinical and hematopathologic findings in a patient with relapsed PBL involving the vitreous of both eyes. <b><i>Results:</i></b> A 59-year-old woman was treated for PBL with systemic and intrathecal chemotherapy 5 years prior to presentation. Three years later, she presented to an outside clinic with blurred vision in both eyes and bilateral vitritis. She was referred to our clinic with concern for ocular lymphoma. On presentation, the patient’s best-corrected visual acuity was 20/40 in the right eye and 20/25 in the left eye with 3+ vitreous cells in the right eye and 2+ vitreous cells in the left eye. Vitreous biopsy of the right eye revealed CD5-negative/CD10-negative B-cell lymphoma cells on flow cytometry. She had no evidence of disease on brain MRI, lumbar puncture, bone marrow biopsy, or full-body CT scans. She was treated with a regimen of rituximab, methotrexate, procarbazine, and vincristine for central nervous system penetration as well as multiple intraocular injections of methotrexate and rituximab with improvement in vision and ocular inflammation bilaterally. <b><i>Conclusion:</i></b> Relapsed PBL can present as bilateral VRL.

scholarly journals Diagnostic pitfalls: intramyocardial lymphoma metastasis mimics acute coronary syndrome in a diffuse large B cell lymphoma patient—case report

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Lilla Prenek ◽  
Klára Csupor ◽  
Péter Beszterczán ◽  
Krisztina Boros ◽  
Erika Kardos ◽  
...  
Keyword(s):  
B Cell ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Pericardial Fluid ◽  
Cardiac Tumors ◽  
Lymphoma Patient ◽  
Coronary Syndrome ◽  
Large B Cell Lymphoma ◽  
The Right ◽  
Large B Cell

Abstract Background Cardiac tumors are very uncommon compared to other cardiac diseases. Their clinical symptoms can vary from absent to non-specific. The most common symptoms are arrhythmias, blood flow obstruction due to valvular dysfunction, shortness of breath, systemic embolization, and accumulation of pericardial fluid. Hereby, we describe a very rare case of a diffuse large B cell lymphoma patient who presented with the symptoms and signs of acute coronary syndrome (ACS) but the patient’s complaints were caused by his intramyocardial lymphoma metastasis. Case presentation Forty-eight-year-old diffuse large B cell lymphoma patient was admitted to our emergency department with chest pain, effort dyspnea, and fever. The patient had normal blood pressure, blood oxygen saturation, sinus tachycardia, fever, crackles over the left lower lobe, novum incomplete right bundle branch block with Q waves and minor ST alterations, elevated C-reactive protein, high-sensitivity troponin-T, and d-dimer levels. Chest X-ray revealed consolidation on the left side and enlarged heart. Bed side transthoracic echocardiography showed inferior akinesis with pericardial fluid. Coronary angiography showed no occlusion or significant stenosis. Chest computed tomography demonstrated the progression of his lymphoma in the myocardium. He was admitted to the Department of Hematology for immediate chemotherapy and he reached complete metabolic remission, followed by allogeneic hematopoietic stem cell transplantation. Unfortunately, about 9 months later, he developed bone marrow deficiency consequently severe sepsis, septic shock, and multiple organ failure what he did not survive. Conclusions Our case demonstrates a very rare manifestation of a heart metastasis. ACS is an unusual symptom of cardiac tumors. But our patient’s intramyocardial lymphoma in the right atrium and ventricle externally compressed the right coronary artery and damaged the heart tissue, causing the patient’s symptoms which imitated ACS. Fortunately, the quick diagnostics and immediate aggressive chemotherapy provided the patient’s remission and suitability to further treatment.

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