scholarly journals Serial magnetic resonance imaging findings during severe attacks of familial hemiplegic migraine type 2: a case report

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
David Fear ◽  
Misha Patel ◽  
Ramin Zand

Abstract Background Hemiplegic migraines represent a heterogeneous disorder with various presentations. Hemiplegic migraines are classified as sporadic or familial based on the presence of family history, but both subtypes have an underlying genetic etiology. Mutations in the ATP1A2 gene are responsible for Familial Hemiplegic type 2 (FHM2) or the sporadic hemiplegic migraine (SHM) counterpart if there is no family history of the disorder. Manifestations include migraine with aura and hemiparesis along with a variety of other symptoms likely dependent upon the specific mutation(s) present. Case presentation We report the case of an adult man who presented with headache, aphasia, and right-sided weakness. Workup for stroke and various infectious agents was unremarkable during the patient’s extended hospital stay. We emphasize the changes in the Magnetic Resonance Imaging (MRI) over time and the delay from onset of symptoms to MRI changes in Isotropic Diffusion Map (commonly referred to as Diffusion Weighted Imaging (DWI)) as well as Apparent Diffusion Coefficient (ADC). Conclusions We provide a brief review of imaging findings correlated with signs/symptoms and specific mutations in the ATP1A2 gene reported in the literature. Description of the various mutations and consequential presentations may assist neurologists in identifying cases of Hemiplegic Migraine, which may include transient changes in ADC and DWI imaging throughout the course of an attack.

2012 ◽  
Vol 18 (11) ◽  
pp. 1585-1591 ◽  
Author(s):  
Delphine Wybrecht ◽  
Françoise Reuter ◽  
Wafaa Zaaraoui ◽  
Anthony Faivre ◽  
Lydie Crespy ◽  
...  

Background: The ability of conventional magnetic resonance imaging (MRI) to predict subsequent physical disability and cognitive deterioration after a clinically isolated syndrome (CIS) is weak. Objectives: We aimed to investigate whether conventional MRI changes over 1 year could predict cognitive and physical disability 5 years later in CIS. We performed analyses using a global approach (T2 lesion load, number of T2 lesions), but also a topographic approach. Methods: This study included 38 patients with a CIS. At inclusion, 10 out of 38 patients fulfilled the 2010 revised McDonald’s criteria for the diagnosis of multiple sclerosis. Expanded Disability Status Scale (EDSS) evaluation was performed at baseline, year 1 and year 5, and cognitive evaluation at baseline and year 5. T2-weighted MRI was performed at baseline and year 1. We used voxelwise analysis to analyse the predictive value of lesions location for subsequent disability. Results: Using the global approach, no correlation was found between MRI and clinical data. The occurrence or growth of new lesions in the brainstem was correlated with EDSS changes over the 5 years of follow-up. The occurrence or growth of new lesions in cerebellum, thalami, corpus callosum and frontal lobes over 1 year was correlated with cognitive impairment at 5 years. Conclusion: The assessment of lesion location at the first stage of multiple sclerosis may be of value to predict future clinical disability.


Cephalalgia ◽  
2004 ◽  
Vol 24 (7) ◽  
pp. 533-539 ◽  
Author(s):  
S Oberndorfer ◽  
C Wöber ◽  
C Nasel ◽  
S Asenbaum ◽  
H Lahrmann ◽  
...  

Familial hemiplegic migraine (FHM) is a rare inherited autosomal dominant disorder. Migraine aura may last up to several weeks and then resolve without sequel. We report a 21-year-old male with FHM since the age of 3 years. Diffusion-weighted magnetic resonance imaging (DWI), perfusion-MR imaging (P-MRI) and [99mTc] hexamethyl-propyleneamine-oxime-single photon emission tomography (HMPAO-SPECT) were performed on day 2, when he was somnolent with right-sided hemiplegia, on day 9 when a mild hemiparesis was still present and on day 24 after recovery. The right central region showed normal findings in DWI, whereas P-MRI and SPECT revealed hyperperfusion on day 2, less marked on day 9, and normal findings on day 24. In conclusion, this case report indicates for the first time, by means of SPECT, P-MRI and DWI studies, that even extremely long-lasting migraine aura is not associated with cerebral ischaemia. Therefore, it supports the revised International Headache Society criteria where the term ‘persistent’ aura is proposed.


Author(s):  
Sebnem Karasu ◽  
Atilla Hikmet Cilengir ◽  
Irfan Ocal ◽  
Serpil Aydogmus

Background: Vaginal adenosis is a rare clinicopathological entity which refers to the presence of glandular endometrial tissue in the vaginal wall. Case report: A gravida 46-year-old woman was presented to the gynecology department with symptoms of chronic pelvic pain. Maternal Diethylstilbestrol (DES) usage has been proven effective in the development of vaginal adenosis. It can also be idiopathic. Its sonographic or magnetic resonance imaging (MRI) findings have not been described in English literature previously. Conclusion: Here, we report the clinical, transperineal ultrasonographic (US) and MRI findings of a pathologically proven case of vaginal adenosis.


2016 ◽  
Vol 38 (01) ◽  
pp. 056-059
Author(s):  
Carlos Pereira

AbstractThe Kernohan-Woltman notch phenomenon is a paradoxical neurological manifestation consisting of a motor deficit ipsilateral to a primary brain injury. It has been observed in patients with brain tumors and with supratentorial hematomas. It is considered a false localizing neurological sign. Magnetic resonance imaging (MRI) scan has been the test of choice. The recognition of this phenomenon is important to prevent a surgical procedure on the opposite side of the lesion. The present case report describes a case of chronic subdural hematoma with a probable finding of the Kernohan-Woltman phenomenon, and it discusses its pathophysiology, imaging findings, treatment, and prognosis.


2021 ◽  
Vol 104 (5) ◽  
pp. 872-885

Fungal infections of the central nervous system (CNS) are usually identified in immunocompromised patients but rare in immunocompetent hosts. The clinical and imaging manifestations are mainly influenced by types of fungal pathogen and immune status of the patients. The CNS fungal infections can develop through hematogenous dissemination from primary site of infection, cerebrospinal fluid seeding, or direct extension from adjacent sources of infection. Fungal infections can result in meningitis, meningoencephalitis, cerebritis, granuloma, or abscess formation, which imaging findings are often non-specific and difficult to distinguish from bacterial or tuberculous infection, non-infectious inflammatory disease, or even intracranial neoplasm. Vascular complications including vasculitis, cerebral infarction, or mycotic aneurysm are commonly present due to angioinvasion of fungal hyphae. In addition, some characteristic imaging features of fungal infections can be identified by computed tomography (CT) or magnetic resonance imaging (MRI), such as intracavitary projections in fungal abscesses and gelatinous pseudocysts in cryptococcosis that could help suggest the diagnosis. Recognizing the imaging findings of common intracranial fungal infections combined with appropriate clinical setting is crucial for allowing early diagnosis and leading to early specific treatment. The present article reviewed common imaging findings of CNS fungal infections and distinct imaging features of specific pathogens. Keywords: Fungal infection, Brain abscess, Cryptococcosis, Central nervous system (CNS), Computed tomography (CT), Diffusion weighted imaging (DWI), Magnetic resonance imaging (MRI)


2010 ◽  
Vol 25 (4) ◽  
pp. 497-499 ◽  
Author(s):  
Anita Choudhary ◽  
Suvasini Sharma ◽  
Naveen Sankhyan ◽  
Sheffali Gulati ◽  
Veena Kalra ◽  
...  

2017 ◽  
Vol 2017 ◽  
pp. 1-3 ◽  
Author(s):  
Mohankumar Kurukumbi ◽  
Allison Jacobs

Peri-ictal magnetic resonance imaging (MRI) findings following seizure activity are a recognized phenomenon that is not well understood (Cole, 2004). Transient changes are not usually expected to be present in postictal MRI studies because of their rarity. Here, we present a unique case of peri-ictal MRI findings located in the occipital lobe, present in a 34-year-old female with recurrent occipital seizures occurring twice in four years. MRI changes completely resolved after both episodes with no residual focal damage. The peri-ictal occipital changes on MRI in this patient are unique because they have been captured on more than one occasion. Peri-ictal MRI findings are a known phenomenon with unknown pathophysiology, although attempts have been made to understand these findings. Though the MRI findings and presentation appear to be stroke-like or PRES-like, seizures should be kept in the differential for better treatment outcomes.


2016 ◽  
Vol 50 (3) ◽  
pp. 151-155 ◽  
Author(s):  
Anindita Sinha ◽  
Mandeep Dhillon ◽  
Mahesh Prakash

ABSTRACT Magnetic resonance imaging (MRI) is often modality of choice to evaluate the sports related injuries involving knee joint. It is important for the clinicians to identify the common injuries pattern seen on MRI for quick management. How to cite this article Prakash M, Sinha A, Dhillon M, Khandelwal N. Pictorial Magnetic Resonance Imaging Findings in Common Sports Injuries of Knee. J Postgrad Med Edu Res 2016;50(3):151-155.


2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e16798-e16798
Author(s):  
Joshua P. Raff ◽  
Charles Noyer ◽  
Nicole Boxer ◽  
Sara Sadan ◽  
Dan Costin ◽  
...  

e16798 Background: There are no accepted guidelines for testing individuals at elevated risk for developing pancreatic duct adenocarcinoma (PC). We initiated a prospective screening and surveillance program for individuals at elevated risk for PC. Methods: Eligibility for the Pancreatic Cancer Early Detection Protocol (PCEDP) was based on germ line status and/or family history of PC, provided that the imparted risk was either five times that of the general population or 7.5% lifetime risk for developing PC. Testing was continued alternating between Endoscopic Ultrasound (EUS) and Magnetic Resonance Imaging (MRI) of the abdomen. Objectives were was to analyze the number, type, and location of pancreatic conditions found and their associations with genetic or family history; and to evaluate the outcomes and/or complications that may have resulted from our testing. Results: From April 2014 through October 2019 we received 238 queries, out of which 75 individuals (31%) enrolled in the PCEDP. Eligibility was based upon individual’s germ line only (45%), family history only (32%), and both (23%). Germ line mutations were observed in 34 (BRCA2), 9 (BRCA1), 4 (ATM), 3 (PALB2), and 3 (CDKN2A) individuals. Median age at consent was 57, 60% were female,and88%, 4%, 3%, and 1% self-identified as Caucasian, African American, Hispanic, and Asian, respectively. 133 EUS procedures and 83 MRIs have been performed. No serious adverse events occurred. Standard Insurance approved and paid for the vast majority of tests. Four individuals withdrew (5%) and three (4%) were lost to follow up. Ten individuals (13%) were found to have abnormal findings in the pancreas and therefore met an endpoint of the study, including seven anechoic cysts and three suspected intraductal papillary mucinous neoplasms (IPMN). All individuals with endpoints were recommended to continue surveillance with EUS. Eight of the ten endpoints were found on baseline EUS, one one from baseline MRI, and one was found on the 3rd EUS. One of the individuals with a 2.5cm IPMN seen on baseline EUS underwent a subsequent distal pancreatectomy, with pathology revealing high grade dysplasia. Conclusions: Screening and surveillance for PC using EUS alternating with MRI was feasible and well tolerated in our population of individuals with an elevated risk. Baseline EUS was successful in detecting 10/75 = 13% of enrollees with some abnormal pancreatic finding, including one requiring intervention with a high grade pre-malignant IPMN.


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