Pontine Tegmentum Lesions Accompanying Myelitis During an Enterovirus Outbreak: Differential Diagnosis and Outcome

2020 ◽  
Vol 35 (8) ◽  
pp. 501-508
Author(s):  
Mehmet Bastemur ◽  
Rahsan Gocmen ◽  
Safak Parlak ◽  
Deniz Yuksel ◽  
Elif Acar Arslan ◽  
...  
Keyword(s):  
Brain Mri ◽  
Prognostic Significance ◽  
Mri Findings ◽  
Acute Flaccid Myelitis ◽  
Pontine Tegmentum ◽  
Etiologic Agents ◽  
Spinal Mri ◽  
Polymerase Chain ◽  
Magnetic Resonance Imaging Mri

Aim: To investigate etiology and prognostic significance of pontine tegmentum lesions accompanying a cluster of acute flaccid myelitis. Method: We retrospectively examined patients from 6 centers in Turkey who manifested encephalitis or myelitis associated with dorsal pontine lesions on magnetic resonance imaging (MRI) between July 2018 and February 2019. Results: Twenty-two patients were evaluated. Ten of 22 (45%) presented with acute paralysis and 12 of 22 (55%) with brainstem symptoms only. Reverse transcription polymerase chain reaction for enterovirus was positive in 2 patients’ respiratory tract. Other etiologic factors were detected in 10 cases. On follow-up, patients presenting with symptoms of myelitis developed motor sequalae although spinal cord lesions on MRI resolved in 5 of 9 (55%). Encephalitic symptoms, present in 17 cases, recovered in 13 (76%), and brain MRI showed complete or near-complete resolution in 11 of 14 (78%). Conclusion: Various etiologic agents can be detected in patients with pontine involvement, even in a series collected during an outbreak of EV-D68. Encephalitis has a fair outcome but clinical recovery is slow and motor sequalae are frequent in spinal involvement, irrespective of follow-up spinal MRI findings.

A case of cerebral aquaporinopathy

2010 ◽  
Vol 16 (10) ◽  
pp. 1252-1254 ◽  
Author(s):  
A. Tanaka ◽  
T. Yoshida ◽  
T. Yamada ◽  
R. Isayama ◽  
Y. Fujiwara ◽  
...  
Keyword(s):  
Area Postrema ◽  
Brain Mri ◽  
Transverse Myelitis ◽  
Brain Regions ◽  
Abnormal Signal ◽  
Spinal Mri ◽  
Magnetic Resonance Imaging Mri ◽  
Antibody Levels ◽  
Dorsal Medulla

A 35-year-old woman was hospitalized due to impaired consciousness. Magnetic resonance imaging (MRI) revealed multiple parenchymal lesions in supra and infratentorial brain regions, which were considered responsible for her declining consciousness level. She was treated with intravenous methylprednisolone. Neurological symptoms improved and she was discharged. She was readmitted 14 months later due to intractable hiccups. A follow-up brain MRI revealed an abnormal signal near the area postrema in the dorsal medulla. Serum aquaporin-4 antibody levels were positive, but there were no visual manifestations or myelitis. Spinal MRI was negative for longitudinally extended transverse myelitis throughout the clinical course.

scholarly journals Cerebral X-linked adrenoleukodystrophy: follow-up with magnetic resonance imaging

2006 ◽  
Vol 64 (4) ◽  
pp. 1033-1035 ◽  
Author(s):  
Emerson L. Gasparetto ◽  
Juliana Mecunhe Rosa ◽  
Taísa Davaus ◽  
Arnolfo de Carvalho Neto
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Brain Mri ◽  
Resonance Imaging ◽  
Mri Findings ◽  
Magnetic Resonance Imaging Mri ◽  
One Year ◽  
Occipital Lobes ◽  
The Brain

OBJECTIVE: To report a case of childhood cerebral X-linked adrenoleukodystrophy (X-ADL), emphasizing the magnetic resonance imaging (MRI) findings at initial evaluation and at the follow-up. CASE REPORT: Five year-old boy, who was asymptomatic, presented with diagnosis of X-ADL for MRI evaluation. The initial brain MRI showed a focal area of enhancement at the splenium of the corpus calosum. One year later, the follow-up MRI showed a progression of the corpus calosus lesion, as well as other lesions in the parietal and occipital lobes. CONCLUSION: The brain MRI follow-up of patients with X-ADL is important to show the progression of the lesions.

scholarly journals Short-lasting unilateral neuralgiform headache with autonomic symptoms associated with idiopathic hypertrophic pachymeningitis

2018 ◽  
Vol 1 ◽  
pp. 251581631879054
Author(s):  
J Matthijs Biesbroek ◽  
Dirk R Rutgers ◽  
Sander van Gulik ◽  
Catherina JM Frijns
Keyword(s):  
Brain Mri ◽  
Resonance Imaging ◽  
Hypertrophic Pachymeningitis ◽  
Trigeminal Autonomic Cephalalgia ◽  
Autonomic Symptoms ◽  
Meningeal Inflammation ◽  
Magnetic Resonance Imaging Mri ◽  
Multiple Episodes ◽  
Rule Out

Short-lasting unilateral neuralgiform headache with autonomic symptoms (SUNA) is a rare form of trigeminal autonomic cephalalgia. SUNA is frequently associated with a trigeminal neurovascular conflict and rarely occurs secondary to other intracranial pathology. We report a patient with SUNA that was associated with ipsilateral meningeal inflammation caused by idiopathic hypertrophic pachymeningitis (HP). During the 9-year follow-up, she experienced multiple episodes of SUNA, most of which occurred during exacerbations of the pachymeningitis. This is the third case of SUNA associated with HP reported in the literature. Based on this observation, we suggest that in patients presenting with SUNA, besides dedicated magnetic resonance imaging (MRI) of the trigeminal nerve, gadolinium-enhanced brain MRI should be performed to rule out HP.

scholarly journals Bilateral Medial Medullary Stroke: A Challenge in Early Diagnosis

2013 ◽  
Vol 2013 ◽  
pp. 1-3
Author(s):  
Amir M. Torabi
Keyword(s):  
Cervical Spine ◽  
Early Diagnosis ◽  
Brain Mri ◽  
Brain Magnetic Resonance Imaging ◽  
Mri Findings ◽  
Rare Type ◽  
Abnormal Signal ◽  
Acute Vestibular Syndrome ◽  
Spine Mr ◽  
Magnetic Resonance Imaging Mri

Bilateral medial medullary stroke is a very rare type of stroke, with catastrophic consequences. Early diagnosis is crucial. Here, I present a young patient with acute vertigo, progressive generalized weakness, dysarthria, and respiratory failure, who initially was misdiagnosed with acute vestibular syndrome. Initial brain magnetic resonance imaging (MRI) that was done in the acute phase was read as normal. Other possibilities were excluded by lumbar puncture and MRI of cervical spine. MR of C-spine showed lesion at medial medulla; therefore a second MRI of brain was requested, showed characteristic “heart appearance” shape at diffusion weighted (DWI), and confirmed bilateral medial medullary stroke. Retrospectively, a vague-defined hyperintense linear DWI signal at midline was noted in the first brain MRI. Because of the symmetric and midline pattern of this abnormal signal and similarity to an artifact, some radiologists or neurologists may miss this type of stroke. Radiologists and neurologists must recognize clinical and MRI findings of this rare type of stroke, which early treatment could make a difference in patient outcome. The abnormal DWI signal in early stages of this type of stroke may not be a typical “heart appearance” shape, and other variants such as small dot or linear DWI signal at midline must be recognized as early signs of stroke. Also, MRI of cervical spine may be helpful if there is attention to brainstem as well.

Diagnostic performance of brain MRI in pharmacovigilance of natalizumab-treated MS patients

2016 ◽  
Vol 22 (9) ◽  
pp. 1174-1183 ◽  
Author(s):  
Mike P Wattjes ◽  
Martijn T Wijburg ◽  
Anke Vennegoor ◽  
Birgit I Witte ◽  
Stefan D Roosendaal ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Diagnostic Performance ◽  
Brain Mri ◽  
Lesion Detection ◽  
Interrater Agreement ◽  
Diagnostic Study ◽  
Mri Scans ◽  
Interrater Variability ◽  
Magnetic Resonance Imaging Mri

Background: In natalizumab-treated multiple sclerosis (MS) patients, magnetic resonance imaging (MRI) is considered as a sensitive tool in detecting both MS disease activity and progressive multifocal leukoencephalopathy (PML). Objective: To investigate the performance of neuroradiologists using brain MRI in detecting new MS lesions and asymptomatic PML lesions and in differentiating between MS and PML lesions in natalizumab-treated MS patients. The secondary aim was to investigate interrater variability. Methods: In this retrospective diagnostic study, four blinded neuroradiologists assessed reference and follow-up brain MRI scans of 48 natalizumab-treated MS patients with new asymptomatic PML lesions ( n = 21) or new MS lesions ( n = 20) or no new lesions ( n = 7). Sensitivity and specificity for detection of new lesions in general (MS and PML lesions), MS and PML lesion differentiation, and PML detection were determined. Interrater agreement was calculated. Results: Overall sensitivity and specificity for the detection of new lesions, regardless of the nature of the lesions, were 77.4% and 89.3%, respectively; for PML-MS lesion differentiation, 74.2% and 84.7%, respectively; and for asymptomatic PML lesion detection, 59.5% and 91.7%, respectively. Interrater agreement for the tested categories was fair to moderate. Conclusion: The diagnostic performance of trained neuroradiologists using brain MRI in pharmacovigilance of natalizumab-treated MS patients is moderately good. Interrater agreement among trained readers is fair to moderate.

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.

The Syndrome of Spontaneous Intracranial Hypotension

Cephalalgia ◽  
1999 ◽  
Vol 19 (2) ◽  
pp. 80-87 ◽  
Author(s):  
CP O'Carroll ◽  
M Brant-Zawadzki
Keyword(s):  
Intracranial Hypotension ◽  
Spontaneous Intracranial Hypotension ◽  
Subdural Effusion ◽  
Resonance Imaging ◽  
Mri Findings ◽  
The Past ◽  
Downward Displacement ◽  
Prior Literature ◽  
Magnetic Resonance Imaging Mri

The authors report four cases of headache and other symptomatology related to the syndrome of intracranial hypotension. They were seen in a routine clinical practice over the past 3 years. The clinical features, magnetic resonance imaging (MRI) findings, and follow-up of these patients are described. Review of the prior literature on the topic is also included. All four patients presented with orthostatic headache syndrome. Three of the four demonstrated diffuse leptomeningeal thickening and enhancement on MRI studies. One subsequently developed a subdural effusion. One patient demonstrated downward displacement of the posterior fossa initially, which resolved on follow-up MRI scanning. Possible pathophysiologies of the syndrome are discussed.

scholarly journals Unusual neurological manifestations of bilateral medial medullary infarction: A case report

Open Medicine ◽  
2022 ◽  
Vol 17 (1) ◽  
pp. 119-123
Author(s):  
Ruizhi Zheng ◽  
Ting Zhang ◽  
Xianzhu Zeng ◽  
Miao Yu ◽  
Zhao Jin ◽  
...  
Keyword(s):  
Early Stage ◽  
Brain Mri ◽  
Resonance Imaging ◽  
Mri Findings ◽  
Rare Type ◽  
Acute Ischemic Stroke Patient ◽  
Medial Medullary Infarction ◽  
Functional Consequences ◽  
Magnetic Resonance Imaging Mri ◽  
Medullary Infarction

Abstract Bilateral medial medullary infarction (BMMI) is an extremely rare type of cerebrovascular accident often resulting in poor functional consequences. “Heart appearance” on diffusion-weighted imaging (DWI) of magnetic resonance imaging (MRI) is the unique presentation of BMMI. In this article, we present an acute ischemic stroke patient whose brain MRI showed the atypical “heart appearance” sign, manifested unusual bilateral central facial paralysis concurrently. For an early diagnosis of BMMI, it is essential to recognize the characteristic clinical and MRI findings of this rare type of stroke. Abnormal small dot or linear DWI signal at the midline of the brainstem should not be ignored at the early stage of stroke.

scholarly journals Intracranial meningioma in a pet rat: MRI findings

2021 ◽  
Author(s):  
C Cococcetta ◽  
F Del Signore ◽  
I Cerasoli ◽  
G Di Guardo ◽  
M Baffoni ◽  
...  
Keyword(s):  
Brain Mri ◽  
Granular Cell ◽  
Intracranial Meningioma ◽  
Granular Cell Tumour ◽  
Resonance Imaging ◽  
Mri Findings ◽  
Axial Mass ◽  
Brain Compression ◽  
Magnetic Resonance Imaging Mri ◽  
Well Differentiated

We herein report the magnetic resonance imaging (MRI) findings in a brain meningioma in a pet rat (Rattus norvegicus domestica). A 1.5-year-old pet rat was referred for depression, ataxia, tremors and bilateral nystagmus; a brain MRI was elected suspecting an intracranial neoplasia. The study was performed with a 0.25 T scanner. The MRI revealed a well-defined oval mass with a heterogeneous appearance, hyperintense in T1 and T2, and with extra-axial localisation and severe brain compression, the mass appeared strongly and diffusely contrast-enhancing. Euthanasia was elected, with the necropsy confirming the presence of a voluminous extra-axial mass. Histologically, a well-differentiated, benign meningotheliomatous meningioma was diagnosed, with the histochemical stains allowing one to exclude a granular cell tumour. To the best of our knowledge, this is the first report of MRI investigations on a pet rat intracranial meningioma.

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