scholarly journals SMART Syndrome: A Case Report

2022 ◽  
Author(s):  
Saliha Bozkurt ◽  
Berna Toprak ◽  
Hasan Çağrı Yıldırım ◽  
Şafak Parlak ◽  
Deniz Can Güven ◽  
...  
Keyword(s):  
Late Complication ◽  
Treatment Protocol ◽  
Cerebrovascular Diseases ◽  
Mri Findings ◽  
Diffusion Restriction ◽  
Brain Radiotherapy ◽  
Appropriate Treatment ◽  
New Findings ◽  
The Right ◽  
Reversible Encephalopathy

Abstract Introduction: Stroke-like migraine attacks after radiation therapy (SMART) syndrome, is a late complication of brain radiotherapy. (1) Symptoms are commonly subacute in onset and involve migraine type of headache, seizures, focal neurologic deficits.(2) . MRI findings are usually unilateral and posterior predominant cortical-subcortical hyperintensity, swelling and prominent gyriform (cortical and leptomeningeal) gadolinum enhancement in the areas of brain that underwent irradiation with or without diffusion restriction.(1) There is no standard treatment protocol of SMART syndrome. Antiepileptics and corticosteroids are commonly used drugs.Case Report: A 65 years old woman diagnosed with breast cancer with brain metastases and treated with more than 50 Gy brain radiotherapy. A couple of months later patient presented with acute right sided weakness and numbness, episodic myoclonic jerking of the right arm and leg and gait instability. MRI and magnetic resonance angiography of the brain with gadolinium revealed left parietooccipital cortical diffusion restriction and accompanying dilatation of the left posterior cerebral artery as new findings. Computed tomography perfusion revealed increased perfussion in the affected area. The patient was diagnosed with SMART syndrome.Management & Outcome: The patient was treated with dexamethasone (16 mg/day) and anticonvulsant therapy. Myoclonic seizures had almost completely remitted. However, her cognitive impairment persisted, then the patient arrested because of aspiration a month later.Discussion: Besides confirming SMART syndrome, diagnostic investigations is also important to exclude other etiologies. Posterior reversible encephalopathy syndrome, post-ictal changes, meningoencephalitis and cerebrovascular diseases are radiological differential diagnosis which should be considered.(3) Proper and early diagnosis of SMART syndrome is significant to refrain unneccessary aggressive approaches and for appropriate treatment to prevent sequela lesions.

Neuroimaging of Children With Takayasu Arteritis

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.

scholarly journals Levator palpabrae superioris myositis as an unusual cause of unilateral ptosis—case report

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Ahmed M. Abdrabou
Keyword(s):  
Previous History ◽  
Good Prognosis ◽  
Oculomotor Nerve Palsy ◽  
Ophthalmological Examination ◽  
Bilateral Ptosis ◽  
Mri Findings ◽  
Upper Eyelid ◽  
Unilateral Disease ◽  
The Right ◽  
Mri Study

Abstract Background Ptosis can be a manifestation of a more serious situation. Hence, the analysis of the complaint and the search for etiology are crucial in such cases. Ptosis has many causes; some of them lead to unilateral ptosis while others cause bilateral ptosis. For instance, myasthenia gravis is a cause of bilateral ptosis while oculomotor nerve palsy induces unilateral disease. Proper evaluation of the patient and identification of the cause are important to achieve accurate management and good prognosis. Case presentation A 47-year-old male patient attended the ER complaining of dropping the right eye lid of 2 days’ duration. There was no associated pain or diplopia. On examination, the extraocular muscles’ (EOM) motility was intact, normal pupil and corneal reflexes, and there was swelling of the upper eyelid. Ophthalmological examination revealed normal anterior and posterior chambers as well as the vitreous and retina. The patient had a previous history of traumatic intracranial hemorrhage that was resolved without surgical intervention. He also had diabetes mellitus and hypertension. The patient was transferred to the MRI unit to perform MRI study of the brain and orbit with MRA and IV contrast administration. MRI findings confirmed the diagnosis of LPS myositis, and the patient received medical treatment and improved. Conclusion Proper radiological diagnosis leads to accurate management and achieves rapid recovery and optimal patient care.

scholarly journals Longer T2relaxation time is a marker of hypothalamic gliosis in mice with diet-induced obesity

2013 ◽  
Vol 304 (11) ◽  
pp. E1245-E1250 ◽  
Author(s):  
Donghoon Lee ◽  
Joshua P. Thaler ◽  
Kathryn E. Berkseth ◽  
Susan J. Melhorn ◽  
Michael W. Schwartz ◽  
...  
Keyword(s):  
Relaxation Time ◽  
High Field ◽  
Relaxation Times ◽  
Quantitative Mri ◽  
Human Studies ◽  
Mri Findings ◽  
Diet Induced Obesity ◽  
Magnetic Resonance Imaging Mri ◽  
The Right ◽  
Mr Brain

A hallmark of brain injury from infection, vascular, neurodegenerative, and other disorders is the development of gliosis, which can be detected by magnetic resonance imaging (MRI). In rodent models of diet-induced obesity (DIO), high-fat diet (HFD) consumption rapidly induces inflammation and gliosis in energy-regulating regions of the mediobasal hypothalamus (MBH), and recently we reported MRI findings suggestive of MBH gliosis in obese humans. Thus, noninvasive imaging may obviate the need to assess MBH gliosis using histopathological end points, an obvious limitation to human studies. To investigate whether quantitative MRI is a valid tool with which to measure MBH gliosis, we performed analyses, including measurement of T2relaxation time from high-field MR brain imaging of mice fed HFD and chow-fed controls. Mean bilateral T2relaxation time was prolonged significantly in the MBH, but not in the thalamus or cortex, of HFD-fed mice compared with chow-fed controls. Histological analysis confirmed evidence of increased astrocytosis and microglial accumulation in the MBH of HFD-fed mice compared with controls, and T2relaxation times in the right MBH correlated positively with mean intensity of glial fibrillary acidic protein staining (a marker of astrocytes) in HFD-fed animals. Our findings indicate that T2relaxation time obtained from high-field MRI is a useful noninvasive measurement of HFD-induced gliosis in the mouse hypothalamus with potential for translation to human studies.

Improvement of the prosthodontic treatment protocol in patients with TMD via functional diagnosis

2021 ◽  
Vol 26 (2) ◽  
pp. 144-149
Author(s):  
L. V. Dubova ◽  
S. S. Prisyazhnykh ◽  
N. V. Romankova ◽  
D. I. Tagiltsev ◽  
G. V. Maksimov
Keyword(s):  
Treatment Protocol ◽  
Cone Beam ◽  
Control Group ◽  
Central Position ◽  
Optimal Position ◽  
Electrical Nerve Stimulation ◽  
Functional Diagnosis ◽  
Stabilization Splint ◽  
Lower Jaw ◽  
The Right

Relevance. The purpose of the research is to improve the functional diagnosis protocol in prosthodontic treatment of patients with TMD.Materials and methods. The optimal position of the mandible was determined for each patient by two methods: 1) TENS (transcutaneous electrical nerve stimulation) and 2) TENS + kinesiography. Then, the cone-beam computed tomography (CBCT) data were analyzed to determine the most physiological position of the condyles.Results. The analysis of the CT scans of patients without TMD (control group) showed that the right and left condyles occupy an anterior or central symmetrical position relative to the glenoid fossa. In the first and second methods, the condyles occupy an anterior or central position, which is the most optimal position of the lower jaw for the manufacturing of an occlusal stabilization splint. The statistical coefficients allowed us to determine that the second method was more accurate, since the obtained values were lower than those of the first method.Conclusion. Based on the results of this study, we can conclude that the improvement of the protocol, namely a new method for determining the optimal position of the mandible is more time-consuming, but more accurate and allows increasing the effectiveness at all stages of treatment of patients with this pathology.

scholarly journals Posterior reversible encephalopathy syndrome: A case report

2015 ◽  
Vol 72 (8) ◽  
pp. 735-739
Author(s):  
Dejan Kostic ◽  
Biljana Brkic-Georgievski ◽  
Aleksandar Jovanovski ◽  
Smiljana Kostic ◽  
Drazen Ivetic ◽  
...  
Keyword(s):  
Case Report ◽  
White Matter ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Impaired Consciousness ◽  
Posterior Reversible Encephalopathy ◽  
Neurological Signs ◽  
Appropriate Treatment ◽  
History Of ◽  
Reversible Encephalopathy ◽  
The Brain

Posterior reversible encephalopathy syndrome (PRES) is characterized by the following symptoms: seizures, impaired consciousness and/or vision, vomiting, nausea, and focal neurological signs. Diagnostic imaging includes examination by magnetic resonance (MR) and computed tomography (CT), where brain edema is visualized bi-laterally and symmetrically, predominantly posteriorly, parietally, and occipitally. Case report. We presented a 73-year-old patient with the years-long medical history of hipertension and renal insufficiency, who developed PRES with the symptomatology of the rear cranium. CT and MR verified changes in the white matter involving all lobes on both sides of the brain. After a two-week treatment (antihypertensive, hypolipemic and rehydration therapy) clinical improvement with no complications occurred, with complete resolution of changes in the white matter observed on CT and MR. Conclusion. PRES is a reversible syndrome in which the symptoms withdraw after several days to several weeks if early diagnosis is made and appropriate treatment started without delay.

scholarly journals Mucinous cystadenomas of the liver

2013 ◽  
Vol 141 (3-4) ◽  
pp. 173-177
Author(s):  
Radoje Colovic ◽  
Nikica Grubor ◽  
Miodrag Jovanovic ◽  
Marjan Micev ◽  
Natasa Colovic ◽  
...  
Keyword(s):  
Frozen Section ◽  
Benign Tumors ◽  
Appropriate Treatment ◽  
Head Of The Pancreas ◽  
Malignant Alteration ◽  
Mucinous Cystadenomas ◽  
The Right ◽  
Healthy Liver ◽  
Single Lesion ◽  
Partial Excision

Introduction. Biliary cystadenomas of the liver are rare benign tumors prone to malignant alteration so that a total excision is recommended. Objective. The aim of the paper is to present our experience in treatment and to evaluate whether a simple ablation represents the appropriate treatment. Methods. Over a 10?year period 25 patients (24 women) of the average age of 58 years suffering from cystadenomas of the liver, 18 in the right, 4 in the left and 3 in both lobes of the liver were operated. Twenty?three patients had a single lesion, while two patients had 3 and 6 lesions, respectively. Pain was present in 20, occasional vomiting in 4, discomfort in 2 and a sense of fullness in 2 patients. Three patients were jaundiced, 1 due to cystadenoma of the liver, 2 due to concomitant tumors of the head of the pancreas, while 5 patients had concomitant diseases. Results. A total ablation was performed in 22 patients, left lateral bisegmentectomy in 1 and partial excision in 2 patients. Six additional procedures were performed. Five cystadenomas of the liver had ?ovarian like? stroma, all in women. A focal malignant alteration was found in 2 patients aged 66 and 79 years, respectively. Recurrence was registered in 1 female patient in whom a partial excision had been done. Two patients with concomitant malignancy and 1 patient who developed malignant histiocytosis six months after surgery, died after 1, 2 and 3 years, respectively. Conclusion. Biliary cystadenomas of the liver may be misdiagnosed as simple liver cysts, so that ?frozen section? histology is highly recommended. In most cases the tumor may be successfully treated by ablation up to the healthy liver tissue. Major liver resections are rarely necessary.

scholarly journals Koji je administrativni status rimskog naselja na Ilidži? / What was the administrative status of the Roman settlement in Ilidža?

2018 ◽  
pp. 149-178
Author(s):  
Amra Šačić Beća
Keyword(s):  
Roman Empire ◽  
Urban Centers ◽  
Literary Sources ◽  
New Findings ◽  
Administrative Development ◽  
Administrative Unit ◽  
Urban Complex ◽  
Definition Of ◽  
The Right ◽  
Res Publica

Medicinal sulfuric springs at present-day Ilidža helped to create Roman thermae that gave the Roman municipium the name Aquae. Systematic archaeological examinations conducted by Carl Patch and Esad Pašalić suggest that this Roman  settlement in Ilidža had existed without interruptions from the 1st  to the 4th  century. Based on the comparison of literary sources and the results of archaeologic research and epigraphic inscriptions, this paper will determine the genesis of administrative development of this Roman administrative unit whose administration included the upper course of the Bosna river and the Sarajevo area. This is an attempt at answering the following question: «Can we speak of Aquae in the context of Roman  citizens at all?” Another important question is what methodology should we use to  treat the expression res publica Aquae S(...?) that was carved on the base of Diocletian’s statue discovered in Ilidža. BiH scholarship has so far based its understanding  of this term on Mócsy’s definition of the noun phrase res publica in the context  of “pseudo-municipal” status. The results of analysis of inscriptions found on epigraphic monuments that will be presented in this paper suggest that one should  step away from understanding the phrase res publica as an administrative category. Finally, we should point out that the objective of this paper is to present the territorial and administrative development of Aquae, as it is an exact example of the  Roman municipalization model in the provincial interior. This interior was usually geographically very distant from the most important economic and urban centers  of the Roman Empire that has also left an impact on its cultural and historical development. Systematic archaeological research on the right bank of the Željeznica river  in 2016 and 2017 has revealed several stratigraphic layers which include, among others, the ancient period. These new findings have been discovered more to the  east compared to the previous findings, indicating that the urban complex of Aquae  had been expanding toward the Sarajevo area.

Noninvasive Localization of Language Cortex in an Awake 4-Year-Old Child with Rasmussen Encephalitis: A Case Report

2019 ◽  
Vol 18 (5) ◽  
pp. E175-E180
Author(s):  
Shalini Narayana ◽  
Luke M Embury ◽  
Namrata Shah ◽  
Sarah Weatherspoon ◽  
Asim F Choudhri ◽  
...  
Keyword(s):  
Young Children ◽  
Young Patients ◽  
Definitive Treatment ◽  
Rasmussen Encephalitis ◽  
Mri Findings ◽  
Left Frontal Lobe ◽  
Epilepsia Partialis Continua ◽  
Language Functions ◽  
Mapping Tool ◽  
The Right

Abstract BACKGROUND AND IMPORTANCE Presurgical mapping of eloquent cortex in young patients undergoing neurosurgery is critical for timely intervention, surgical planning, and minimizing postoperative deficits. However, invasive direct cortical stimulation has limited success in young children and noninvasive modalities, such as magnetoencephalography and functional MRI, require sedation, often precluding localization of critical language cortices. Transcranial magnetic stimulation (TMS), a noninvasive brain stimulation technique, is well suited to evaluate language areas in young children because it does not require the patient to remain still during mapping. CLINICAL PRESENTATION A 4-yr and 11-mo-old female patient diagnosed with epilepsia partialis continua of the right arm and face and right-sided weakness was evaluated at our institution. MRI findings and clinical examination led to the diagnosis of Rasmussen encephalitis involving left frontal lobe and insula. Language cortices were successfully identified in both hemispheres using TMS. The TMS findings aided in discussing with the family the risks of postsurgical deficits of left functional hemispherectomy, the definitive treatment for Rasmussen encephalitis. Postoperatively, the patient had intact speech and was seizure free. CONCLUSION We illustrate the feasibility and utility of TMS as a noninvasive functional mapping tool in this young child. The preoperative demonstration of bilateral language organization indicated a greater likelihood of preserved language functions postsurgery. We demonstrate that TMS is a safe and noninvasive tool to map language cortices in young children with serious epilepsy syndromes.

Posterior Reversible Encephalopathy (PRES) in a Child with Severe Dengue

2019 ◽  
Vol 66 (3) ◽  
pp. 322-326
Author(s):  
Yogini Sawant ◽  
Suresh Birajdar ◽  
Hiren Doshi ◽  
Pooja Soni ◽  
Deepak Patkar ◽  
...  
Keyword(s):  
Pediatric Population ◽  
White Blood Cells ◽  
Neurological Complications ◽  
Severe Dengue ◽  
Mri Findings ◽  
Posterior Reversible Encephalopathy ◽  
Magnetic Resonance Imaging Mri ◽  
Mri Changes ◽  
Reversible Encephalopathy ◽  
Csf Examination

Abstract Among neurological complications associated with dengue, posterior reversible encephalopathy syndrome (PRES) has not been reported in pediatric population. We report a 10-year-old girl with severe dengue who developed PRES. The patient presented with hemorrhagic shock that required fluid resuscitation and inotropic support. She developed seizures with encephalopathy 2 days after recovering from the shock. Cerebrospinal fluid (CSF) examination was negative for dengue (no white blood cells in CSF with negative polymerase chain reaction for dengue). Her clinical features and magnetic resonance imaging (MRI) findings showed typical changes associated with posterior encephalopathy that reverted after resolution of hypertension. Repeat MRI after a month was normal. PRES should be considered as a possible differential diagnoses of dengue associated encephalopathy, especially in cases with normal CSF examination and characteristic MRI changes.

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