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

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.

Download Full-text

Bilateral Medial Medullary Stroke: A Challenge in Early Diagnosis

Case Reports in Neurological Medicine ◽

10.1155/2013/274373 ◽

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.

Download Full-text

Intracranial meningioma in a pet rat: MRI findings

Veterinární Medicína ◽

10.17221/191/2020-vetmed ◽

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.

Download Full-text

Evaluation of Brain Magnetic Resonance Imaging (MRI) Findings of Neonates with Clinical Seizure Admitted to Yazd Shahid Sadoughi Hospital and its Effect on Diagnostic and Therapeutic Interventions of Newborns from 2015-2016

Journal of Shahid Sadoughi University of Medical Sciences ◽

10.18502/ssu.v28i9.4777 ◽

2020 ◽

Author(s):

Razieh Fallah ◽

Mohammad Javad Asadi ◽

Reza Nafisi Moghadam ◽

Mohammad Hossein Ahrar Yazdi

Keyword(s):

Magnetic Resonance Imaging ◽

Brain Mri ◽

Brain Magnetic Resonance Imaging ◽

Common Type ◽

Therapeutic Interventions ◽

Resonance Imaging ◽

Mri Findings ◽

Clinical Seizure ◽

Magnetic Resonance Imaging Mri ◽

Abnormal Brain

Introduction: In neonatal period, brain magnetic resonance imaging (MRI) is the best neuroimaging to find etiology of seizure. The aim of this study was to evaluate brain MRI findings of neonates with clinical seizure and its effect on diagnostic and therapeutic interventions of newborn. Methods: In a retrospective study, medical records and brain MRI findings of neonates with clinical seizure admitted to Neonatal Intensive Care Unit or Pediatric Ward of Shahid Sadoughi Hospital, Yazd, Iran from September 2018 and before were evaluated. The data were analyzed using SPSS version 16 software , the required indicators and tables were prepared and Fisher exact test and Chi-square test were used to determine the relationship between qualitative variables and independent t-test was used to compare the means in the two groups Results: Twenty-five girls and 38 boys were studied. The cause of seizures was found in 94% and the most common cause of congenital hypoxia was in 22 infants (35%). The most common type of seizure was tonic in 23 infants (36.5%) and the most common type of generalized seizure was in 47 infants (75%). Brain MRI was abnormal in 19 neonates (30%). Based on the MRI results, there was a change in therapeutic interventions (brain surgery) in four infants (6.3%) and in diagnostic interventions (metabolic tests) in 19 infants (30%). Abnormal brain MRI was more frequent in neonates by cesarean section (46%) than normal vaginal delivery (19%), (p= 0.01) and also neonates with partial seizure (37.5%) had an abnormal MRI than generalized seizure (21%), (p= 0.03). Mean of hospitalization days was longer in neonates with abnormal brain MRI (12.32±2.76 days) than neonates with normal MRI (8.57±2.82 days) (P = 0.02). Conclusion: Based on the results of this study, brain MRI might be useful in finding intracranial pathology that causes seizure in neonates by cesarean section to detect birth asphyxia and in newborns with partial seizure.

Download Full-text

SUNCT/SUNA and neurovascular compression: New cases and critical literature review

Cephalalgia ◽

10.1177/0333102413494273 ◽

2013 ◽

Vol 33 (16) ◽

pp. 1337-1348 ◽

Cited By ~ 49

Author(s):

Valentina Favoni ◽

Daniela Grimaldi ◽

Giulia Pierangeli ◽

Pietro Cortelli ◽

Sabina Cevoli

Keyword(s):

Brain Mri ◽

Brain Magnetic Resonance Imaging ◽

Primary Headache ◽

Neurovascular Compression ◽

Resonance Imaging ◽

Mri Findings ◽

Cranial Autonomic Symptoms ◽

Magnetic Resonance Imaging Mri ◽

Critical Literature

Background Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache with cranial autonomic symptoms (SUNA) are primary headache syndromes. A growing body of literature has focused on brain magnetic resonance imaging (MRI) evidence of neurovascular compression in these syndromes. Objective The objective of this article is to assess whether SUNCT is a subset of SUNA or whether the two are separate syndromes and clarify the role of neurovascular compression. Method We describe three new SUNCT cases with MRI findings of neurovascular compression and critically review published SUNCT/SUNA cases. Results We identified 222 published SUNCT/SUNA cases. Our three patients with neurovascular compression added to the 34 cases previously described (16.9%). SUNCT and SUNA share the same clinical features and therapeutic options. At present, there is no available abortive treatment for attacks. Lamotrigine was effective in 64% of patients; topiramate and gabapentin in about one-third of cases. Of the 34 cases with neurovascular compression, seven responded to drug therapies, 16 patients underwent microvascular decompression of the trigeminal nerve (MVD) with effectiveness in 75%. Conclusions We suggest that SUNCT and SUNA should be considered clinical phenotypes of the same syndrome. Brain MRI should always be performed with a dedicated view to exclude neurovascular compression. The high percentage of remission after MVD supports the pathogenetic role of neurovascular compression.

Download Full-text

“Heart Appearance” Infarction of the Pons: A Case Report

Case Reports in Radiology ◽

10.1155/2012/690903 ◽

2012 ◽

Vol 2012 ◽

pp. 1-2 ◽

Cited By ~ 1

Author(s):

Keisuke Ishizawa ◽

Mikiko Ninomiya ◽

Yoshihiko Nakazato ◽

Toshimasa Yamamoto ◽

Nobuo Araki

Keyword(s):

Magnetic Resonance ◽

Basilar Artery ◽

Brain Mri ◽

Diffusion Weighted Image ◽

Term Care ◽

Apparent Diffusion ◽

Medial Medullary Infarction ◽

Magnetic Resonance Imaging Mri ◽

Medullary Infarction

“Heart appearance” on magnetic resonance imaging (MRI) is a unique presentation of bilateral medial medullary infarction. In contrast, “heart appearance” infarction of the pons has rarely been featured in the medical literature. In this paper, we present a case of “heart appearance” infarction of the pons with its MRI and magnetic resonance angiography (MRA) findings. The patient was an 87-year-old male who manifested with weakness in the four extremities. Later, bulbar palsy and tetraplegia became apparent, and he eventually was trapped in locked-in syndrome. Brain MRI disclosed a “heart appearance” lesion in the pons, which was high on diffusion-weighted image MRI and low on apparent diffusion coefficient map MRI. Brain MRA demonstrated that the basilar artery remained intact. A diagnosis of fresh, bilateral pontine infarction with a “heart appearance” was made. After the treatment he was transferred to another hospital for long-term care. This case suggests that bilateral ischemic involvement of the pons is possible even in the context of an intact basilar artery.

Download Full-text

Magnetic Resonance Imaging of Bacterial Meningoencephalitis in a Foal

Case Reports in Veterinary Medicine ◽

10.1155/2012/402714 ◽

2012 ◽

Vol 2012 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Judit Viu ◽

Lara Armengou ◽

Cristian de la Fuente ◽

Carla Cesarini ◽

Sònia Añor ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Brain Mri ◽

Mass Effect ◽

Resonance Imaging ◽

Mri Findings ◽

Cortical Areas ◽

Fluid Analysis ◽

Mri Features ◽

Magnetic Resonance Imaging Mri

Magnetic resonance imaging (MRI) in equidae suffering meningoencephalitis (ME) has not been described. The objective of this paper is to describe brain MRI findings in a foal with bacterial ME. A five-month-old, 200 kg bwt Arabian filly was referred with a history of abnormal mental status and locomotion. The filly was recumbent and obtunded, and pupillary light reflexes were sluggish, and oculocephalic movements were normally present. Ophthalmic examination revealed bilateral optic neuritis. Hematology revealed leukocytosis and neutrophilia. Cerebrospinal fluid analysis showed neutrophilic pleocytosis with intracellular bacteria. On brain MRI, there were multifocal cortical areas of mild hyperintensity on T2-weighted images (T2WI) affecting both hemispheres. The lesions had ill-delineated margins, and there was loss of differentiation between gray and white matter. Diffuse hyperintensity was also identified in the left cerebellar cortex on T2WI. Neither mass effect nor cerebral midline shift were identified. On FLAIR images, the lesions were also hyperintense and, in some areas, they seemed to coalescence to form diffuse cortical areas of hyperintensity. The MRI findings described were similar to the MRI features described in cases of humans and small animals with ME. Brain MRI can be a useful diagnostic tool in foals and small-sized equidae with intracranial disease.

Download Full-text

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

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2006000600030 ◽

2006 ◽

Vol 64 (4) ◽

pp. 1033-1035 ◽

Cited By ~ 2

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.

Download Full-text

Identifying Clinical Clues in Children With Global Developmental Delay / Intellectual Disability With Abnormal Brain Magnetic Resonance Imaging (MRI)

Journal of Child Neurology ◽

10.1177/0883073820977330 ◽

2020 ◽

pp. 088307382097733

Author(s):

Abdullah Alamri ◽

Yaser I. Aljadhai ◽

Abdullah Alrashed ◽

Bandar Alfheed ◽

Roba Abdelmoaty ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Intellectual Disability ◽

Magnetic Resonance ◽

Developmental Delay ◽

Brain Mri ◽

Brain Magnetic Resonance Imaging ◽

Global Developmental Delay ◽

Resonance Imaging ◽

Mri Findings ◽

Magnetic Resonance Imaging Mri

Global developmental delay / intellectual disability are common pediatric conditions. Brain magnetic resonance imaging (MRI), although an important diagnostic tool in the evaluation of these patients, often requires general anesthesia. Recent literature suggests that unnecessary general anesthesia exposure should be avoided in early years because of possible long-term negative neurodevelopmental sequelae. This study sought to identify clinical clues associated with brain MRI abnormalities in children with global developmental delay / intellectual disability in an attempt to provide guidance to physicians on selecting patients who would benefit from an MRI. Retrospective chart review analysis was conducted for patients presenting to a pediatric neurology tertiary care center between 2014 and 2017 for a first clinic evaluation for global developmental delay / intellectual disability. Detailed clinical history and physical examination findings were analyzed and correlated with brain MRI findings. The majority (218/327, 67%) of children referred for evaluation of global developmental delay / intellectual disability underwent complete clinical and radiologic evaluations. Mean age was 37.9 months (±32.5 standard deviation) and 116 were males (53%). Motor deficits were predominant in most subjects (122/218, 56%). Abnormal MRI findings were observed in 153 children (70%), with the most prevalent abnormalities noted within the white matter (104/153, 68%), corpus callosum (77/153, 50%), and the hippocampus (50/153, 33%). Abnormal MRI findings were prevalent in children with predominant motor delay (84, 69%) and cognitive disability (3, 100%) as well as those with visual and hearing impairment ( P < .05). The presence of facial dysmorphisms (57/71, P = .02); cranial nerve abnormalities (79/100; P = .007) and abnormal reflexes (16, P = .01) on examination also correlated significantly with increased MRI abnormalities.

Download Full-text

Findings of Brain Magnetic Resonance Imaging in Girls with Central Precocious Puberty Compared with Girls with Chronic or Recurrent Headache

Journal of Clinical Medicine ◽

10.3390/jcm10102206 ◽

2021 ◽

Vol 10 (10) ◽

pp. 2206

Author(s):

Shin-Hee Kim ◽

Moon Bae Ahn ◽

Won Kyoung Cho ◽

Kyoung Soon Cho ◽

Min Ho Jung ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Precocious Puberty ◽

Brain Mri ◽

Brain Magnetic Resonance Imaging ◽

Central Precocious Puberty ◽

Resonance Imaging ◽

Mri Findings ◽

Magnetic Resonance Imaging Mri ◽

Few Data

In the present study, the results of brain magnetic resonance imaging (MRI) in girls with central precocious puberty (CPP) were compared those in with girls evaluated for headaches. A total of 295 girls with CPP who underwent sellar MRI were enrolled. A total of 205 age-matched girls with chronic or recurrent headaches without neurological abnormality who had brain MRI were included as controls. The positive MRI findings were categorized as incidental non-hypothalamic–pituitary (H–P), incidental H–P, or pathological. Positive MRI findings were observed in 39 girls (13.2%) with CPP; 8 (2.7%) were classified as incidental non-H–P lesions, 30 (10.2%) as incidental H–P lesions, and 1 (0.3%) as a pathological lesion (tuber cinereum hamartoma). The prevalence of positive MRI findings in girls with CPP did not differ from girls with headaches (13.2% vs. 12.2%, p = 0.74). The prevalence of incidental H–P lesions in girls with CPP <6 years of age, 6–6.9 years of age, and 7–7.9 years of age was 21.2%, 13.5%, and 9.6%, respectively (p = 0.21). Known pathological lesions were detected in only one (3.0%) girl with CPP aged <6 years and in no girls with CPP aged 6–7.9 years. Microadenomas were detected in no girls with CPP aged <6 years and in 5 (1.9%) girls with CPP aged of 6–7.9 years. Our findings call into question the routine use of brain MRI in girls with CPP, especially in girls 6 years or older. Current guidelines recommend a follow-up MRI in cases of microadenoma, but few data exist to support this recommendation for children.

Download Full-text

Computed Tomography and Magnetic Resonance Imaging-aided Diagnosis of Primary Essential Cutis Verticis Gyrata: A Case Report with 5-year Follow-up and Review of the Literature

Current Medical Imaging Formerly Current Medical Imaging Reviews ◽

10.2174/1573405614666181005113448 ◽

2019 ◽

Vol 15 (9) ◽

pp. 906-910

Author(s):

Hongzhang Zhu ◽

Shi-Ting Feng ◽

Xingqi Zhang ◽

Zunfu Ke ◽

Ruixi Zeng ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Three Dimensional ◽

Stable Condition ◽

Resonance Imaging ◽

Mri Findings ◽

Cutis Verticis Gyrata ◽

Essential Form ◽

History Of ◽

Magnetic Resonance Imaging Mri

Background: Cutis Verticis Gyrata (CVG) is a rare skin disease caused by overgrowth of the scalp, presenting as cerebriform folds and wrinkles. CVG can be classified into two forms: primary (essential and non-essential) and secondary. The primary non-essential form is often associated with neurological and ophthalmological abnormalities, while the primary essential form occurs without associated comorbidities. Discussion: We report on a rare case of primary essential CVG with a 4-year history of normal-colored scalp skin mass in the parietal-occipital region without symptom in a 34-year-old male patient, retrospectively summarizing his pathological and Computer Tomography (CT) and magnetic resonance imaging (MRI) findings. The major clinical observations on the CT and MR sectional images include a thickened dermis and excessive growth of the scalp, forming the characteristic scalp folds. With the help of CT and MRI Three-dimensional (3D) reconstruction techniques, the characteristic skin changes could be displayed intuitively, providing more evidence for a diagnosis of CVG. At the 5-year followup, there were no obvious changes in the lesion. Conclusion: Based on our observations, we propose that not all patients with primary essential CVG need surgical intervention, and continuous clinical observation should be an appropriate therapy for those in stable condition.

Download Full-text