scholarly journals A Case for Conservative Management: Characterizing the Natural History of Radiographically Diagnosed Rathke Cleft Cysts

2015 ◽  
Vol 100 (10) ◽  
pp. 3943-3948 ◽  
Author(s):  
Silas A. Culver ◽  
Yuval Grober ◽  
David A. Ornan ◽  
James T. Patrie ◽  
Edward H. Oldfield ◽  
...  
Keyword(s):  
Conservative Management ◽  
Medical Center ◽  
Brain Magnetic Resonance Imaging ◽  
Visual Disturbance ◽  
Pressure Effects ◽  
Pituitary Hormone ◽  
Rathke Cleft Cyst ◽  
Adjacent Structures ◽  
Mri Scans ◽  
Magnetic Resonance Imaging Mri

Context: Rathke cleft cysts (RCCs) are benign embryonic remnants of the Rathke's pouch found in 13% to 33% of the general population. When symptomatic, they manifest themselves by compressing adjacent structures, causing pressure effects such as headache, visual disturbance, or pituitary hormone deficits. Most RCCs are asymptomatic, and their management remains controversial. Surgical resection has generally been indicated to treat symptomatic RCCs but carries the risk of complications. Objective: Our objective was to better characterize the outcomes for patients with presumed RCCs undergoing conservative management. Design: This was a retrospective cohort study. Setting: The setting was a pituitary program at a university medical center. Participants: The participants were 75 patients with radiographically diagnosed RCCs. Methods: All brain magnetic resonance imaging (MRI) scans performed at the University of Virginia from 2006 through 2013 were searched for the words “Rathke cleft cyst,” and pituitary clinic notes from 2007 to 2012 were reviewed for patients identified as probably having an RCC. Images for all patients were reviewed by the interpreting neuroradiologist, and those patients with at least 2 MRI scans were included. The dimensions of each cyst were assessed by the same neuroradiologist, and the volume of each cyst was analyzed as a function of the time from the first image obtained. Results: A total of 75 patients (4–76 years old) met our inclusion criteria. The length of follow-up was 1 to 126 months (median 24 months). In 43 patients (57%) no detectable change in the size of their cysts was seen, in 21 patients (28%) cysts increased in size, and in 11 patients (15%) cysts decreased in size. The predicted mean cyst growth rate was not significantly different from 0. Conclusion: The increasingly prevalent use of brain imaging modalities such as MRI has resulted in an increase in the incidental discovery of pituitary lesions. Our study demonstrates that the majority of radiologically diagnosed RCCs remain unchanged or decrease in size over time. These results suggest that, in the absence of pressure symptoms, it is reasonable to manage patients with RCCs conservatively.

scholarly journals White Matter Hyperintensities Predict Cognitive Decline: A Community-Based Study

2019 ◽  
Vol 46 (04) ◽  
pp. 383-388 ◽  
Author(s):  
Xuemei Qi ◽  
Huidong Tang ◽  
Qi Luo ◽  
Bei Ding ◽  
Jie Chen ◽  
...  
Keyword(s):  
White Matter ◽  
Cognitive Decline ◽  
White Matter Hyperintensities ◽  
Smoking Status ◽  
Brain Magnetic Resonance Imaging ◽  
The Elderly ◽  
Brain Regions ◽  
Cholinergic Pathways ◽  
Mri Scans ◽  
Magnetic Resonance Imaging Mri

ABSTRACT:Introduction: White matter hyperintensities (WMHs) were commonly seen in brain magnetic resonance imaging (MRI) of the elderly. Many studies found that WMHs were associated with cognitive decline and dementia. However, the association between WMHs in different brain regions and cognitive decline remains debated. Methods: We explored the association of the severity of WMHs and cognitive decline in 115 non-demented elderly (≥50 years old) sampled from the Wuliqiao Community located in urban area of Shanghai. MRI scans were done during 2009–2011 at the beginning of the study. Severity of WMHs in different brain regions was scored by Improved Scheltens Scale and Cholinergic Pathways Hyperintensities Scale (CHIPS). Cognitive function was evaluated by Mini-Mental State Examination (MMSE) every 2 to 4 years during 2009–2018. Results: After adjusting for confounding factors including age, gender, education level, smoking status, alcohol consumption, depression, hypertension, diabetes, hyperlipidemia, brain infarcts, brain atrophy, apoE4 status, and baseline MMSE score, periventricular and subcortical WMH lesions as well as WMHs in cholinergic pathways were significantly associated with annual MMSE decline ( p < 0.05), in which the severity of periventricular WMHs predicted a faster MMSE decline (–0.187 points/year, 95% confidence interval: –0.349, –0.026, p = 0.024). Conclusions: The severity of WMHs at baseline was associated with cognitive decline in the non-demented elderly over time. Interventions on WMH lesions may offer some benefits for cognitive deterioration.

Should frequent MRI monitoring be performed in natalizumab-treated MS patients? A contribution to a recent debate

2019 ◽  
Vol 26 (10) ◽  
pp. 1227-1236 ◽  
Author(s):  
Cristina Scarpazza ◽  
Alessio Signori ◽  
Mirco Cosottini ◽  
Maria Pia Sormani ◽  
Simonetta Gerevini ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Small Volume ◽  
Brain Magnetic Resonance Imaging ◽  
Available N ◽  
Disability Status ◽  
Mri Scans ◽  
Recent Debate ◽  
Magnetic Resonance Imaging Mri ◽  
Mri Surveillance ◽  
The Impact

Background: Brain magnetic resonance imaging (MRI) is the most effective surveillance tool for the detection of asymptomatic progressive multifocal leukoencephalopathy (PML). However, the optimal frequency for routine MRI surveillance is under-investigated. Objective: To understand whether, upon their first MRI appearance, PML lesions present a difference in volume when comparing patients who frequently underwent MRI surveillance (3/4 months) with those who were assessed at longer intervals (6/12 months) and to understand the impact of the volume of lesions on clinical outcome. Methods: The data of patients included in the Italian PML cohort were retrospectively analysed. Patients who had all the pre-diagnostic MRI scans available ( n = 37) were included. The volume of PML lesion was calculated by manually outlining the PML lesion. Results: Compared with patients who underwent MRI examination at least every 4 months, patients who were assessed less frequently had a lesion of significantly higher volume (median: 2567 (883–3583) vs. 664 mm3 (392–963) p = 0.006) and suffered a higher rate of disability (median: 2.25 expanded disability status scale points (–2.5 to 8) vs. 0.5 (–1 to 2.5) p = 0.004). Conclusion: The positive clinical outcome of patients undergoing frequent MRI surveillance and the small volume of the PML lesion upon first appearance justify a frequent surveillance using MRI in patients at high risk of PML.

Neurologic Examination Findings Associated With Small Cerebellar Volumes After Prematurity

2019 ◽  
Vol 34 (10) ◽  
pp. 586-592
Author(s):  
Emily W.Y. Tam ◽  
Vann Chau ◽  
Raphaël Lavoie ◽  
M. Mallar Chakravarty ◽  
Ting Guo ◽  
...  
Keyword(s):  
Brain Magnetic Resonance Imaging ◽  
Postural Instability ◽  
White Matter Injury ◽  
Neurologic Examination ◽  
Equivalent Age ◽  
Cerebellar Volume ◽  
Mri Scans ◽  
Magnetic Resonance Imaging Mri ◽  
Deformation Based Morphometry

To help clinicians understand what to expect from small cerebellar volumes after prematurity, this study aims to characterize the specific impacts of small cerebellar volumes on the infant neurologic examination. A prospective cohort of preterm newborns (<32 weeks’ gestational age) had brain magnetic resonance imaging (MRI) studies at term-equivalent age. Cerebellar volumes were compared with neurologic examination findings in follow-up, adjusting for severity of intraventricular hemorrhage, white matter injury, and cerebellar hemorrhage. Deformation-based analyses delineated regional morphometric differences in the cerebellum associated with these findings. Of 119 infants with MRI scans, 109 (92%) had follow-up at 19.0±1.7 months corrected age. Smaller cerebellar volume at term was associated with increased odds of truncal hypotonia, postural instability on standing, and patellar hyperreflexia ( P < .03). Small cerebellar volume defined as <19 cm3 by 40 weeks was associated with 7.5-fold increased odds of truncal hypotonia ( P < .001), 8.9-fold odds postural instability ( P < .001), and 9.7-fold odds of patellar hyperreflexia ( P < .001). Voxel-based deformation-based morphometry showed postural instability associated with paravermian regions. Small cerebellar volume is associated with specific abnormalities on neurologic examination by 18 months of age, including truncal tone, reflexes, and postural stability.

The contribution of assessing cognitive impairment in radiologically-isolated syndrome (RIS): a single case report follow-up study

2014 ◽  
Vol 20 (14) ◽  
pp. 1912-1915 ◽  
Author(s):  
L D’Anna ◽  
S Lorenzut ◽  
A Perelli ◽  
B Zanchettin ◽  
M Valente ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Single Case ◽  
Brain Magnetic Resonance Imaging ◽  
Single Case Report ◽  
Radiologically Isolated Syndrome ◽  
Therapeutic Decisions ◽  
Mri Scans ◽  
Incidental Discovery ◽  
Magnetic Resonance Imaging Mri

Radiologically-isolated syndrome (RIS) is a recently-defined entity, described as the incidental discovery of lesions suggestive of multiple sclerosis (MS) on brain magnetic resonance imaging (MRI) scans demonstrating dissemination in space (DIS) without symptom expression and with a normal neurological examination. Recent studies demonstrate that RIS patients present similar features of cognitive impairment as MS patients. We describe a case of a RIS patient in whom investigating cognitive functions was a useful tool for diagnostic and therapeutic decisions.

MRI white matter lesions in pediatric migraine

Cephalalgia ◽  
2013 ◽  
Vol 33 (11) ◽  
pp. 906-913 ◽  
Author(s):  
Tal Eidlitz-Markus ◽  
Avraham Zeharia ◽  
Yishay Haimi-Cohen ◽  
Osnat Konen
Keyword(s):  
White Matter ◽  
Pediatric Patients ◽  
Medical Center ◽  
Brain Mri ◽  
Brain Magnetic Resonance Imaging ◽  
White Matter Lesions ◽  
Pediatric Migraine ◽  
Laboratory Examinations ◽  
Magnetic Resonance Imaging Mri ◽  
Headache Clinic

Objectives: Studies have reported an association between migraine and white matter hyperintensities on T2-weighted brain magnetic resonance imaging (MRI) in adults. The aim of the present study was to evaluate white matter MRI brain findings in pediatric patients with migraine. Methods: The medical files and imaging scans of all 194 patients who underwent brain MRI at the headache clinic of a tertiary medical center in 2008–2011 were reviewed. Results: Mean age was 10.9 ± 3.5 years. Migraine was diagnosed in 131 patients and other disorders in 63. In the migraine group, findings on physical and laboratory examinations were within normal range. White matter lesions were identified on MRI scan in 14 children with migraine (10.6%) and none of the children with other disorders ( p = 0.006). In 13/14 patients, the lesions were focal with a variable distribution; in the remaining patient, confluent periventricular hyperintensities were documented. Conclusions: In a headache clinic of a tertiary pediatric medical center, white matter lesions are found in about 10% of pediatric patients with migraine.

scholarly journals A standardised pathway for the surveillance of stable vestibular schwannoma

2018 ◽  
Vol 100 (3) ◽  
pp. 216-220 ◽  
Author(s):  
J Shapey ◽  
K Barkas ◽  
S Connor ◽  
A Hitchings ◽  
H Cheetham ◽  
...  
Keyword(s):  
Cost Analysis ◽  
Vestibular Schwannoma ◽  
Conservative Management ◽  
Growth Patterns ◽  
Imaging Protocol ◽  
Surveillance Programme ◽  
Maximal Diameter ◽  
Mri Scans ◽  
Magnetic Resonance Imaging Mri ◽  
The Cost

Introduction Conservative management of patients with a stable vestibular schwannoma (VS) places a significant burden on National Health Service (NHS) resources and yet patients’ surveillance management is often inconsistent. Our unit has developed a standardised pathway to guide surveillance imaging of patients with stable VS. In this article, we provide the basis for our imaging protocol by reviewing the measurement, natural history and growth patterns of VS, and we present a cost analysis of implementing the pathway both regionally and nationally. Methods Patients with an extrameatal VS measuring ≤20mm in maximal diameter receive magnetic resonance imaging (MRI) six months after their index imaging, followed by three annual MRI scans, two two-year interval MRI scans, a single three-year interval MRI scan and then five-yearly MRI scans to be continued lifelong. Patients with purely intrameatal tumours follow the same protocol but the initial six-month imaging is omitted. A cost analysis of the new pathway was modelled on our unit’s retrospective data for 2015 and extrapolated to reflect the cost of VS surveillance nationally. Results Based on an estimation that imaging surveillance would last approximately 25 years (+/- 10 years), the cost of implementing our regional surveillance programme would be £151,011 per year (for 99 new referrals per year) and it would cost the NHS £1,982,968 per year if implemented nationally. Conclusions A standardised surveillance pathway promotes safe practice in the conservative management of VS. The estimated cost of a national surveillance programme compares favourably with other tumour surveillance initiatives, and would enable the NHS to provide a safe and economical service to patients with VS.

scholarly journals Primary multiple cerebral hydatid disease in a young patient with surgically-treated intracerebral haemorrhage

2021 ◽  
pp. 71-74
Author(s):  
Anwar N. Hafedh ◽  
Awfa A. Aktham ◽  
Zahraa F. Al-Sharshahi ◽  
Ahmed Ibrahim Al-Jorani ◽  
Sama Albairamani ◽  
...  
Keyword(s):  
Hydatid Disease ◽  
Intracerebral Haemorrhage ◽  
Right Hemisphere ◽  
Brain Magnetic Resonance Imaging ◽  
Future Research ◽  
New Findings ◽  
Mri Scans ◽  
Magnetic Resonance Imaging Mri ◽  
One Year ◽  
The Right

Introduction:  Cerebral hydatid disease (CHD) is rare and the multiple-cystic variety is even rarer. In this paper, we report a case of multiple CHD and explore a possible link with a preceding spontaneous intracerebral haemorrhage (ICH).   Case presentation: A 27-year old gentleman with a history of surgically-evacuated, spontaneous ICH presented with severe headache, left-sided weakness - Medical Research Council (MRC) grade II - and recurrent tonic-clonic seizures, while on a full dose of anti-epileptic medication. Brain magnetic resonance imaging (MRI) scans showed multiple intra-axial cystic lesions in the right hemisphere. The cysts were removed intact using Dowling’s technique through a large temporoparietal craniotomy. The surgery went uneventful and the patient recovered as expected. Post-operatively, a prophylactic course of albendazole (200 mg) was prescribed. On his one-year follow-up visit, the patient was symptom-free and his weakness had improved (left upper limb: MRC grade IV and full power of the left lower limb). The computed tomography (CT) scan showed no new findings.   Conclusion: Primary cerebral hydatid disease is rare and the multiple-cyst variety is even rare. In this case, a peculiar association with a surgically-treated ICH was explored with possible theories to suggest future research directions.

Glatiramer acetate after induction therapy with mitoxantrone in relapsing multiple sclerosis

2008 ◽  
Vol 14 (5) ◽  
pp. 663-670 ◽  
Author(s):  
T Vollmer ◽  
H Panitch ◽  
A Bar-Or ◽  
J Dunn ◽  
MS Freedman ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Glatiramer Acetate ◽  
Induction Therapy ◽  
Brain Magnetic Resonance Imaging ◽  
Short Term ◽  
Disability Status ◽  
Mri Scans ◽  
Magnetic Resonance Imaging Mri ◽  
Multiple Sclerosis Patients ◽  
Relapsing Multiple Sclerosis

Forty relapsing multiple sclerosis patients with 1–15 gadolinium (Gd)-enhancing lesions on screening brain magnetic resonance imaging (MRI) and Expanded Disability Status Scale (EDSS) scores 0–6.5 were randomized to receive short-term induction therapy with mitoxantrone (three monthly 12 mg/m2 infusions) followed by 12 months of daily glatiramer acetate (GA) therapy 20 mg/day subcutaneously for a total of 15 months (M-GA, n = 21) or daily GA 20 mg/day for 15 months (GA, n = 19). MRI scans were performed at months 6, 9, 12 and 15. The primary measure of outcome was the incidence of adverse events; secondary measures included number of Gd-enhanced lesions, confirmed relapses and EDSS changes. Except age, baseline demographic characteristics were well matched in both treatment arms. Both treatments were safe and well tolerated. M-GA induction produced an 89% greater reduction (relative risk (RR) = 0.11, 95% confidence interval (CI): 0.04–0.36, p = 0.0001) in the number of Gd-enhancing lesions at months 6 and 9 and a 70% reduction (RR = 0.30, 95% CI: 0.11–0.86, p = 0.0147) at months 12 and 15 versus GA alone. Mean relapse rates were 0.16 and 0.32 in the M-GA and GA groups, respectively. Short-term immunosuppression with mitoxantrone followed by daily GA for up to 15 months was found to be safe and effective, with an early and sustained decrease in MRI disease activity.

scholarly journals A triad of cluster-like headaches with delayed development of a macroscopic prolactinoma: A case report

2020 ◽  
Vol 3 ◽  
pp. 251581632091103
Author(s):  
Stephanie A Ihezie ◽  
Manisha Chandalia ◽  
Mark J Burish
Keyword(s):  
Magnetic Resonance Imaging ◽  
Case Report ◽  
Brain Mri ◽  
Brain Magnetic Resonance Imaging ◽  
Pituitary Hormone ◽  
Supporting Evidence ◽  
Resonance Imaging ◽  
Headache Onset ◽  
Magnetic Resonance Imaging Mri ◽  
Pituitary Lesion

Pituitary hormone testing is recommended in refractory cluster headache (CH), but supporting evidence is limited. We present a patient with cluster-like headaches and a negative brain magnetic resonance imaging (MRI) 1 year after headache onset. He failed multiple medication trials. Three years after headache onset, additional workup showed abnormal pituitary labs including hyperprolactinemia and a brain MRI with a 15 × 15 × 14 mm3 enhancing pituitary lesion. With cabergoline 0.25 mg twice weekly, the patient has been headache-free for over 2 years. This case supports the recommendations for pituitary testing in refractory CH, even if imaging is initially negative for a pituitary tumor.

The influence of slice orientation on brain MRI lesion load measurement in multiple sclerosis

1997 ◽  
Vol 3 (6) ◽  
pp. 382-384
Author(s):  
M. Rovaris ◽  
MP Sormanis ◽  
MA Rocca ◽  
G. Comi ◽  
M. Filippi
Keyword(s):  
Multiple Sclerosis ◽  
Spin Echo ◽  
Brain Mri ◽  
Brain Magnetic Resonance Imaging ◽  
Lesion Load ◽  
Conventional Mri ◽  
Slice Orientation ◽  
Mri Scans ◽  
The Mean ◽  
Magnetic Resonance Imaging Mri

This study aimed at evaluating the influence of a different slice orientation on brain magnetic resonance imaging (MRI) lesion load in multiple sclerosis (MS). Fifteen MS patients were scanned obtaining both axial and sagittal conventional spin echo (24 slices; TR 2400, TE 30/80) brain MRI. The total lesion load (TLL) was assessed twice for each scan, using a semi-automated local thresholding technique and the same marked hardcopies. The mean TLL was 22734 mm3 for axial and 22003 mm3 for sagittal scans. The mean intra-observer coefficient of variation (COV) was 4.65% for the axial acquisitions and 4.52% for the sagittal acquisitions. This difference was not statistically significant (one-way ANOVA, P> 0.1). The lesion load was significantly higher from axial MRI as compared to the intra-observer variability (two-way ANOVA, P =0.01), but the fluctuations around this average difference between axial and sagittal scan TLL were significantly large (test for interaction, P < 0.00I). Our data indicate that the use of sagittal conventional MRI scans does not seem to be worthwhile for the quantitative assessment of lesion load in MS patients.

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