Bilateral lateral ventricular subependymoma with extensive multiplicity presenting with hemorrhage

This 48-year-old-man who had undergone right thyroid lobectomy for undifferentiated thyroid carcinoma nine years earlier developed generalized seizures. His cerebrospinal fluid was xanthochromic with elevation of total protein. Computed tomography (CT) showed mixed-density bilateral ventricular masses. Magnetic resonance imaging (MRI) revealed multiple nodules in both lateral ventricles; they were heterogeneously enhanced by gadolinium. Diffuse hyperintensity in the right medial temporal lobe and bilateral subependymal area was noted on fluid-attenuated inversion recovery images. Susceptibility-weighted imaging showed low intensity in the masses and cerebellar sulci suggesting hemorrhage and hemosiderin deposition. The preoperative diagnosis was disseminated malignant tumor with recurring hemorrhage. Histological examination of biopsy specimens showed clusters of cells with small uniform nuclei embedded in a dense fibrillary matrix of glial cells and microcystic degeneration. Pseudo-rosettes indicating ependymoma were absent. Microhemorrhages and hemosiderin deposits were noted. Immunohistochemically, the background fibrillary matrix and neoplastic cells were positive for glial fibrillary acidic protein. Mutated isocitrate dehydrogenase-1 was negative. The MIB-1 index was 1.5%. The tumor was pathologically diagnosed as subependymoma containing microhemorrhages and hemosiderin deposits. The extensive multiplicity and hemorrhage encountered in this case have rarely been reported in patients with subependymoma.

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Two cases of possible neuro-Sweet disease with meningoencephalitis as the initial manifestation

Neurology International ◽

10.4081/ni.2012.e5 ◽

2012 ◽

Vol 4 (1) ◽

pp. 5 ◽

Cited By ~ 10

Author(s):

Go Makimoto ◽

Yasuhiro Manabe ◽

Chizuru Yamakawa ◽

Daiki Fujii ◽

Yasuko Ikeda-Sakai ◽

...

Keyword(s):

High Intensity ◽

Skin Lesions ◽

Pulse Therapy ◽

Initial Manifestation ◽

Diffusion Weighted Images ◽

Fluid Analysis ◽

Fluid Attenuated Inversion Recovery ◽

Left Caudate ◽

Magnetic Resonance Imaging Mri ◽

The Right

We report 2 cases that were considered to be neuro-Sweet disease. They initially manifested with meningoencephalitis and no skin lesions, and rapidly improved with corticosteroid therapy. In both cases, patients complained of meningitic symptoms such as fever and headache, and HLA-B54 and -Cw1 turned out to be positive over the clinical course. Cerebrospinal fluid analysis showed increased levels of lymphocytes and protein. In case #1, fluid-attenuated inversion recovery (FLAIR), magnetic resonance imaging (MRI) and diffusion-weighted images (DWI) showed high-intensity signals in the right dorsal medulla oblongata, bilateral dorsal midbrain, and left thalamus. In case #2, FLAIR and DWI showed high-intensity signals in the bilateral cerebellar cortex and left caudate nucleus. Symptoms and MRI images were markedly improved in both cases after corticosteroid pulse therapy. According to published diagnostic criteria, these 2 cases were considered possible neuro-Sweet disease. These cases suggest that the combination of meningoencephalitis and HLA specificity is important to consider the possibility of neuro-Sweet disease, even without skin lesions.

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Identifying Changepoints in Biomarkers During the Preclinical Phase of AD

10.1101/508820 ◽

2018 ◽

Author(s):

Laurent Younes ◽

Marilyn Albert ◽

Abhay Moghekar ◽

Anja Soldan ◽

Corinne Pettigrew ◽

...

Keyword(s):

Symptom Onset ◽

Medial Temporal Lobe ◽

Cognitive Testing ◽

Mri Findings ◽

Single Measure ◽

Cognitively Normal ◽

Preclinical Phase ◽

Normal Individuals ◽

Magnetic Resonance Imaging Mri ◽

The Right

Objective: Several models have been proposed for the evolution of Alzheimer's disease (AD) biomarkers. The aim of this study was to identify changepoints in a range of biomarkers during the preclinical phase of AD. Methods: We examined nine measures based on cerebrospinal fluid (CSF), magnetic resonance imaging (MRI) and cognitive testing, obtained from 306 cognitively normal individuals, a subset of whom subsequently progressed to the symptomatic phase of AD. A changepoint model was used to determine which of the measures had a significant change in slope in relation to clinical symptom onset. Results: All nine measures had significant changepoints, all of which preceded symptom onset, however the timing of these changepoints varied considerably. A single measure, CSF-tau, had an early changepoint (40 years prior to symptom onset). A group of measures, including the remaining CSF measures (CSF-Abeta and phosphorylated tau) and all cognitive tests had changepoints 10-15 years prior to symptom onset. A second group is formed by medial temporal lobe shape composite measures, with a five-year time difference between the right and left side (respectively nine and three years prior to symptom onset). Conclusions: These findings highlight the long period of time prior to symptom onset during which AD pathology is accumulating in the brain. There are several significant findings, including the early changes in cognition and the laterality of the MRI findings. Additional work is needed to clarify their significance.

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White-matter markers for psychosis in a prospective ultra-high-risk cohort

Psychological Medicine ◽

10.1017/s0033291709991711 ◽

2009 ◽

Vol 40 (8) ◽

pp. 1297-1304 ◽

Cited By ~ 94

Author(s):

O. J. N. Bloemen ◽

M. B. de Koning ◽

N. Schmitz ◽

D. H. Nieman ◽

H. E. Becker ◽

...

Keyword(s):

White Matter ◽

High Risk ◽

Temporal Lobe ◽

Medial Temporal Lobe ◽

Healthy Controls ◽

Syndrome Scale ◽

Ultra High Risk ◽

Mri Scans ◽

Magnetic Resonance Imaging Mri ◽

The Right

BackgroundSubjects at ‘ultra high risk’ (UHR) for developing psychosis have differences in white matter (WM) compared with healthy controls. WM integrity has not yet been investigated in UHR subjects in relation to the development of subsequent psychosis. Hence, we investigated a prospective cohort of UHR subjects comparing whole brain fractional anisotropy (FA) of those later developing psychosis (UHR-P) to those who did not (UHR-NP).MethodWe recruited 37 subjects fulfilling UHR criteria and 10 healthy controls. Baseline 3 Tesla magnetic resonance imaging (MRI) scans and Positive and Negative Syndrome Scale (PANSS) ratings were obtained. UHR subjects were assessed at 9, 18 and 24 months for development of frank psychosis. We compared baseline FA of UHR-P to controls and UHR-NP subjects. Furthermore, we related clinical data to MRI outcome in the patient population.ResultsOf the 37 UHR subjects, 10 had transition to psychosis. UHR-P subjects showed significantly lower FA values than control subjects in medial frontal lobes bilaterally. UHR-P subjects had lower FA values than UHR-NP subjects, lateral to the right putamen and in the left superior temporal lobe. UHR-P subjects showed higher FA values, compared with UHR-NP, in the left medial temporal lobe. In UHR-P, positive PANSS negatively correlated to FA in the left middle temporal lobe. In the total UHR group positive PANSS negatively correlated to FA in the right superior temporal lobe.ConclusionsUHR subjects who later develop psychosis have differences in WM integrity, compared with UHR subjects who do not develop psychosis and to healthy controls, in brain areas associated with schizophrenia.

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Neuroimaging Insights Into Early Stages of HIV-Progressive Multifocal Leukoencephalopathy: A Case Report

Journal of Central Nervous System Disease ◽

10.1177/1179573520939339 ◽

2020 ◽

Vol 12 ◽

pp. 117957352093933

Author(s):

Natalia Gonzalez Caldito ◽

J Scott Loeb ◽

Darin T Okuda

Keyword(s):

Progressive Multifocal Leukoencephalopathy ◽

Early Recognition ◽

Brain Mri ◽

Disease Evolution ◽

Early Stages ◽

Mri Features ◽

Fluid Attenuated Inversion Recovery ◽

Magnetic Resonance Imaging Mri ◽

Punctate Pattern ◽

The Right

This report aims to enhance the understanding of early longitudinal neuroimaging features of progressive multifocal leukoencephalopathy (PML) in human immunodeficiency virus (HIV). Neuroimaging has become crucial in the diagnosis and early recognition of PML. Recognition of magnetic resonance imaging (MRI) features in the early stages of PML is paramount to avoid misdiagnosis and facilitate the delivery of treatments aimed at reducing disease progression. A 49-year-old white man with HIV presented with 4-month progressive left-sided weakness. Neurological examination revealed mild cognitive impairment, left-sided hemiparesis, and somatosense impairment to all modalities. Brain MRI revealed a punctate pattern with innumerable T2-FLAIR (fluid attenuated inversion recovery) hyperintensities in the cortex, brainstem, cerebellum, subcortical, and periventricular areas. Susceptibility-weighted imaging (SWI) revealed hypointensities involving subcortical U-fibers and cortical architecture. A comprehensive diagnostic evaluation was inconclusive. John Cunningham virus (JCV) PCR in cerebrospinal fluid (CSF) was indeterminate. He was started on antiretroviral therapy. Repeat brain MRI performed 1.5 months later, in the setting of further neurological decline, demonstrated progression of the T2-hyperintensities into a large confluent white matter lesion in the right frontoparietal lobe. Despite an indeterminate JCV PCR, the appearance and characteristic progression of the lesions in successive imaging in the setting of severe immunosuppression, with extensive negative infectious workup, was indicative of PML. This clinical experience illustrates unique neuroimaging features of HIV-PML in early stages and its progression over time. It especially highlights the relevance of the SWI sequence in the diagnosis and features observed with disease evolution. Short-term imaging follow-up may assist with the recognition of MRI features consistent with the biology of the infection.

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Detection of aneurysmal subarachnoid hemorrhage 3 months after initial bleeding: evaluation of T2* and FLAIR MR sequences at 3 T in comparison with initial non-enhanced CT as a gold standard

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2015-011819 ◽

2015 ◽

Vol 8 (8) ◽

pp. 813-818 ◽

Cited By ~ 4

Author(s):

Sébastien Mulé ◽

Sébastien Soize ◽

Azzedine Benaissa ◽

Christophe Portefaix ◽

Laurent Pierot

Keyword(s):

Subarachnoid Hemorrhage ◽

Gold Standard ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Predictive Values ◽

Hemosiderin Deposition ◽

Enhanced Ct ◽

Fluid Attenuated Inversion Recovery ◽

Interhemispheric Fissure ◽

Hemosiderin Deposits ◽

Mr Sequences

ObjectiveTo investigate the ability of T2* and fluid-attenuated inversion recovery (FLAIR) MR sequences to detect hemosiderin deposition 3 months after aneurysmal subarachnoid hemorrhage (SAH) in comparison with early non-enhanced CT (NECT) as a gold standard.Materials and methodsFrom September 2008 through May 2013, patients with aneurysmal SAH were included if a NECT less than 24 h after the onset of symptoms showed a SAH, and MRI, including T2* and FLAIR sequences, was performed 3 months later. All aneurysms were treated endovascularly. NECT and MR sequences were blindly analyzed for the presence of SAH (NECT) or hemosiderin deposition (MRI). When positive, details of the spatial distribution of SAH or hemosiderin deposits were noted. Sensitivities were calculated for each patient. Sensitivities, specificities, and positive predictive values (PPVs) were calculated for each location.ResultsForty-nine patients (mean age 52.9 years) were included. Bleeding-related patterns were identified in 43 patients (87.8%) on T2* and 10 patients (20.4%) on FLAIR. T2* was highly predictive of the location of the initial hemorrhage, especially in the Sylvian cisterns (PPVs 95% and 100%) and the anterior interhemispheric fissure (PPV 90%).ConclusionsThe T2* sequence can detect and localize a previous SAH a few months after aneurysmal bleeding.

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Dysembryoplastic Neuroepithelial Tumor: A Rare Brain Tumor with Excellent Seizure Control after Surgical Resection

Indian Journal of Neurosurgery ◽

10.1055/s-0040-1713561 ◽

2020 ◽

Author(s):

Rajnish Kumar Arora ◽

Pranshu Bhargava ◽

Poonam Arora ◽

Prashant Joshi ◽

Garga Basu ◽

...

Keyword(s):

Surgical Resection ◽

Medial Temporal Lobe ◽

Seizure Control ◽

Intractable Epilepsy ◽

Mass Effect ◽

Sudden Onset ◽

Dysembryoplastic Neuroepithelial Tumor ◽

Focal Neurological Deficit ◽

Fluid Attenuated Inversion Recovery ◽

The Right

Abstract Introduction Dysembryoplastic neuroepithelial tumor (DNET) is a rare cause of intractable epilepsy, which has excellent results in terms of seizure control after surgical resection. We present one such case, because of its rarity, to highlight the effect of tumor removal on seizure control, particularly DNET. Materials and Methods/Case Summary A 9-year-old male patient presented with sudden onset of partial seizures for the past 6 months. There were five episodes. In each episode, the patient engaged in irrelevant talk, followed by deviation of mouth to left and twitching movements. The episode lasted 5 minutes and there was no loss of consciousness. There was no aura or tongue bite, and in one of the episodes, the patient lost consciousness. There was no other significant positive history. On examination, the child was consciously alert, without focal neurological deficit or features of meningitis. There was no papilledema. The patient was on phenytoin sodium, phenobarbitone and clobazam. Magnetic resonance imaging (MRI) of brain was done with and without contrast. MRI revealed a lesion approximately 4.1 × 3.6 × 3.2 cm in the right medial temporal lobe. It was hypointense to brain on T1 and fluid-attenuated inversion recovery (FLAIR), and hyperintense on T2-weighted images. Diffusion restriction was present and there was minimal contrast uptake. There was no evidence of mass effect or midline shift After discussing the risks and benefits with parents, the patient underwent preanesthetic checkup, and was taken up for craniotomy and excision of tumor. Gross total excision was done. The child was started orally on day 1 postoperatively and ambulated. There were no further seizure episodes. The patient was continued on phenytoin and clobazam, and phenobarbitone was tapered gradually. At 6 months, the child was seizure-free. Conclusions DNET are rare tumors occurring early in life and presenting with intractable seizures. Surgical resection offers a good and safe chance for long-term seizure control.

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Early Motor Fluctuations in a Patient with Striatonigral Degeneration

Case Reports in Neurology ◽

10.1159/000453254 ◽

2016 ◽

Vol 8 (3) ◽

pp. 243-250

Author(s):

Fumihito Yoshii ◽

Yusuke Moriya ◽

Tomohide Ohnuki ◽

Wakoh Takahashi ◽

Masafuchi Ryo

Keyword(s):

Marked Decrease ◽

Emission Tomography ◽

Resonance Imaging ◽

Striatonigral Degeneration ◽

Recovery Sequence ◽

Positron Emission ◽

Fluid Attenuated Inversion Recovery ◽

Wearing Off ◽

Magnetic Resonance Imaging Mri ◽

The Right

We report a 44-year-old female with striatonigral degeneration (SND) who showed wearing-off oscillations after 4 months of levodopa treatment. The patient presented with asymmetric left-side dominant rigidity, and levodopa was effective at first. However, she began to show wearing-off oscillations of motor symptoms, which gradually worsened thereafter. Fluid-attenuated inversion recovery sequence magnetic resonance imaging (MRI) showed linear lateral putamen hyperintensities, and positron emission tomography (PET) studies using 18F-fluorodopa (FD) and 11C-N-methylspiperon (NMSP) showed a marked decrease of radioactivity in the right putamen, especially in the posterior putamen. The results of MRI and 2 PET studies with FD and NMSP were well consistent with the diagnosis of SND.

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Neuroimaging of Children With Takayasu Arteritis

Journal of Child Neurology ◽

10.1177/0883073821991287 ◽

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.

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Musculoskeletal Soft-Tissue Sarcoma: Quality Assessment of Initial MRI Reports Shows Frequent Deviation from ESSR Guidelines

Diagnostics ◽

10.3390/diagnostics11040695 ◽

2021 ◽

Vol 11 (4) ◽

pp. 695

Author(s):

Sebastian Weiss ◽

Alexander Korthaus ◽

Nora Baumann ◽

Jin Yamamura ◽

Alexander S. Spiro ◽

...

Keyword(s):

Soft Tissue ◽

Soft Tissue Sarcomas ◽

Quality Criteria ◽

Final Diagnosis ◽

Tissue Mass ◽

Musculoskeletal Radiology ◽

Radiology Reports ◽

Patients At Risk ◽

Magnetic Resonance Imaging Mri ◽

The Masses

Soft-tissue sarcomas (STS) are a rare subtype of soft-tissue mass and are frequently misinterpreted as benign lesions. Magnetic resonance imaging (MRI) is the primary recommended type of diagnostics. To assess the quality of primary radiology reports, we investigated whether recommended MRI report elements were included in compliance with European Society of Musculoskeletal Radiology (ESSR) guidelines. A total of 1107 patients were evaluated retrospectively, and 126 radiological reports on patients with malignant STS were assessed for ESSR quality criteria. One or more required sequences or planes were missing in 67% of the reports. In all 126 cases, the report recognized the mass as anomalous (100%). Sixty-eight percent of the reports mentioned signs of malignancy. The majority of reports (n = 109, 87%) articulated a suspected diagnosis, 32 of which showed a mismatch with the final diagnosis (25%). Thirty-two percent of the reports had a misinterpretation of the masses as benign. Benign misinterpretations were more common in masses smaller than 5 cm (65% vs. 27%). Thirty percent of the reports suggested tissue biopsy and 6% recommended referral to a sarcoma center. MRI reports showed frequent deviations from ESSR guidelines, and protocol guidelines were not routinely met. Deviations from standard protocol and reporting guidelines could put patients at risk for inadequate therapy.

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Juxtacortical susceptibility changes in progressive multifocal leukoencephalopathy at the gray–white matter junction correlates with iron-enriched macrophages

Multiple Sclerosis Journal ◽

10.1177/1352458521999651 ◽

2021 ◽

pp. 135245852199965

Author(s):

Kedar R Mahajan ◽

Moein Amin ◽

Matthew Poturalski ◽

Jonathan Lee ◽

Danielle Herman ◽

...

Keyword(s):

White Matter ◽

Progressive Multifocal Leukoencephalopathy ◽

Central Nervous System Lymphoma ◽

Susceptibility Weighted Imaging ◽

Resonance Imaging ◽

Gradient Echo ◽

Total N ◽

Mri Brain ◽

Fluid Attenuated Inversion Recovery ◽

Magnetic Resonance Imaging Mri

Objective: Describe magnetic resonance imaging (MRI) susceptibility changes in progressive multifocal leukoencephalopathy (PML) and identify neuropathological correlates. Methods: PML cases and matched controls with primary central nervous system lymphoma (PCNSL) were retrospectively identified. MRI brain at 3 T and 7 T were reviewed. MRI-pathology correlations in fixed brain autopsy tissue were conducted in three subjects with confirmed PML. Results: With PML ( n = 26 total, n = 5 multiple sclerosis natalizumab-associated), juxtacortical changes on susceptibility-weighted imaging (SWI) or gradient echo (GRE) sequences were noted in 3/3 cases on 7 T MRI and 14/22 cases (63.6%) on 1.5 T or 8/22 (36.4%) 3 T MRI. Similar findings were only noted in 3/25 (12.0%) of PCNSL patients (odds ratio (OR) 12.83, 95% confidence interval (CI), 2.9–56.7, p < 0.001) on 1.5 or 3 T MRI. On susceptibility sequences available prior to diagnosis of PML, 7 (87.5%) had changes present on average 2.7 ± 1.8 months (mean ± SD) prior to diagnosis. Postmortem 7 T MRI showed SWI changes corresponded to areas of increased iron density along the gray–white matter (GM-WM) junction predominantly in macrophages. Conclusion: Susceptibility changes in PML along the GM-WM junction can precede noticeable fluid-attenuated inversion recovery (FLAIR) changes and correlates with iron accumulation in macrophages.

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