Ring enhanced aneurysm due to vasa vasorum of aneurysm wall mimicking a metastatic brain tumor

Background: A spherical intracranial mass can be occasionally misdiagnosed due to the lack of typical radiographic features. Completely thrombosed intracranial aneurysms (CTIA) are uncommon, but a possible differential diagnosis must be considered to guarantee the best surgical approach for these lesions. Case Description: Here, we report an extremely rare case of a right frontal mass mimicking a brain tumor, in which the surgery unveiled a CTIA of the right middle cerebral artery (MCA). A 56-year-old woman presented with right hemiparesis and mild headache. Magnetic resonance imaging (MRI) revealed a right frontal mass with peripheral edema. The lesion enhanced on initial and follow-up MRI of the brain. Subsequent vascular studies and metastatic workup were negative. A temporal craniotomy with neuronavigation (Brain Lab AG, Germany) was performed and an intraoperative diagnosis of a thrombosed aneurysm along the branch of the MCA was established. The aneurysm was successfully trapped and resected. The patient did not exhibit any postoperative neurological deficits. Conclusion: This is the rare report of a ring enhanced completely thrombosed aneurysm due to vasa vasorum which is misdiagnosed as metastatic brain tumor. In case of an intracranial ring enhanced mass with signs of intralesional hemorrhage and peripheral edema, CTIA should be considered as a possible differential diagnosis.

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Peri-Aneurysmal Brain Edema in Native and Treated Aneurysms: The Role of Thrombosis

Neurointervention ◽

10.5469/neuroint.2020.00255 ◽

2020 ◽

Author(s):

Valeria Onofrj ◽

Donatella Tampieri ◽

Alessandro Cianfoni ◽

Elisa Ventura

Keyword(s):

Vessel Wall ◽

Vasogenic Edema ◽

Cerebral Aneurysms ◽

Evaluation Process ◽

Endovascular Embolization ◽

Vasa Vasorum ◽

Aneurysm Wall ◽

Magnetic Resonance Imaging Mri ◽

Inflammatory Changes

Cerebral peri-aneurysmal edema (PE) is typically associated with giant partially-thrombosed aneurysms and less frequently with smaller aneurysms treated with endovascular embolization. An understanding of the pathophysiologic mechanism of PE is still limited. We report 3 cases of cerebral aneurysms associated with PE. We describe 2 cases of giant partially thrombosed aneurysms surrounded by vasogenic edema with apposition of an intramural and juxtamural thrombus. Our third case is a smaller aneurysm inciting vasogenic edema several years after coil embolization. Vessel-wall magnetic resonance imaging (MRI) showed avid wall enhancement and an enhancing thrombus embedded within the coils, reflecting inflammation of the aneurysm wall and proliferation of the vasa vasorum. Thrombosis within the aneurysmal sac and walls, both in native and treated aneurysms, may promote inflammatory changes and sustain the occurrence of PE. Vessel-wall MRI has a potential role in the evaluation process of this subgroup of aneurysms.

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Deep Learning-Based Classification and Voxel-Based Visualization of Frontotemporal Dementia and Alzheimer’s Disease

Frontiers in Neuroscience ◽

10.3389/fnins.2020.626154 ◽

2021 ◽

Vol 14 ◽

Author(s):

Jingjing Hu ◽

Zhao Qing ◽

Renyuan Liu ◽

Xin Zhang ◽

Pin Lv ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Differential Diagnosis ◽

Deep Learning ◽

Frontotemporal Dementia ◽

Image Data ◽

Rapid Acquisition ◽

Magnetic Resonance Imaging Mri ◽

The One ◽

The Right

Frontotemporal dementia (FTD) and Alzheimer’s disease (AD) have overlapping symptoms, and accurate differential diagnosis is important for targeted intervention and treatment. Previous studies suggest that the deep learning (DL) techniques have the potential to solve the differential diagnosis problem of FTD, AD and normal controls (NCs), but its performance is still unclear. In addition, existing DL-assisted diagnostic studies still rely on hypothesis-based expert-level preprocessing. On the one hand, it imposes high requirements on clinicians and data themselves; On the other hand, it hinders the backtracking of classification results to the original image data, resulting in the classification results cannot be interpreted intuitively. In the current study, a large cohort of 3D T1-weighted structural magnetic resonance imaging (MRI) volumes (n = 4,099) was collected from two publicly available databases, i.e., the ADNI and the NIFD. We trained a DL-based network directly based on raw T1 images to classify FTD, AD and corresponding NCs. And we evaluated the convergence speed, differential diagnosis ability, robustness and generalizability under nine scenarios. The proposed network yielded an accuracy of 91.83% based on the most common T1-weighted sequence [magnetization-prepared rapid acquisition with gradient echo (MPRAGE)]. The knowledge learned by the DL network through multiple classification tasks can also be used to solve subproblems, and the knowledge is generalizable and not limited to a specified dataset. Furthermore, we applied a gradient visualization algorithm based on guided backpropagation to calculate the contribution graph, which tells us intuitively why the DL-based networks make each decision. The regions making valuable contributions to FTD were more widespread in the right frontal white matter regions, while the left temporal, bilateral inferior frontal and parahippocampal regions were contributors to the classification of AD. Our results demonstrated that DL-based networks have the ability to solve the enigma of differential diagnosis of diseases without any hypothesis-based preprocessing. Moreover, they may mine the potential patterns that may be different from human clinicians, which may provide new insight into the understanding of FTD and AD.

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Brain Tumor in Differential Diagnosis of Seizures in Puerperium: Case Report

The Open Neurology Journal ◽

10.2174/1874205x01913010067 ◽

2019 ◽

Vol 13 (1) ◽

pp. 67-71

Author(s):

Luíza Guazzelli Pezzali ◽

Gabriela Francoes Rostirolla ◽

Carina Bauer Luiz ◽

Lúcio Brandão Gomes ◽

Raquel Camara Rivero ◽

...

Keyword(s):

Differential Diagnosis ◽

Brain Tumor ◽

Cesarean Section ◽

Neurological Deficits ◽

Cerebral Function ◽

Clonic Seizures ◽

Reversible Encephalopathy ◽

Expansive Lesion ◽

The Brain

Convulsive crisis is a transient disturbance of cerebral function, and the etiology of which may be manifold. Its clarification is essential for establishing adequate therapy and seizure control. In the pregnancy-puerperal cycle, eclampsia is the most common cause of it, but brain tumor, epilepsy and other disorders are part of the differential diagnosis. We report a case of seizure triggered by tumor in a primigest, 22 years old, at 38 weeks’ gestation with premature rupture of membranes. Cesarean section was performed due to non-reassuring fetal condition. On the second day of puerperium, she presented recurrent episodes of generalized tonic-clonic seizures and elevated blood pressure. She received magnesium sulfate for 24 hours and persisted with severe headache. Magnetic resonance imaging of the brain showed an expansive lesion in the left frontoparietal region. The patient underwent intracranial microsurgery on the eighth day after cesarean section, with complete resection of the lesion and anatomopathological diagnosis of schwannoma. She went through good postoperative evolution, without neurological deficits, and stayed on phenobarbital, with no seizures until 6 months of follow-up. From the case we conclude that although the first diagnosis in pregnant or puerperal women with seizures should be eclampsia, there are other causes, such as brain tumor and Posterior Reversible Encephalopathy Syndrome (PRES). Careful evaluation is required, especially in refractory cases and not responding to usual treatment.

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Voluminous Myoepithelioma of the Minor Salivary Glands Involving the Base of the Tongue

Case Reports in Otolaryngology ◽

10.1155/2016/3785979 ◽

2016 ◽

Vol 2016 ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

Mario Policarpo ◽

Valentina Longoni ◽

Pietro Garofalo ◽

Paolo Spina ◽

Francesco Pia

Keyword(s):

Differential Diagnosis ◽

Salivary Glands ◽

Malignant Neoplasm ◽

Needle Aspiration ◽

Hyperintense Lesion ◽

Rare Tumour ◽

Weighted Magnetic Resonance Imaging ◽

Magnetic Resonance Imaging Mri ◽

The Right ◽

Histology And Immunohistochemistry

Myoepithelioma is an extremely rare tumour subtype and diagnosis is based on a wide variation of cellular morphology. FNAC specimens do not always suffice for a definitive differential diagnosis which depends on histology and immunohistochemistry of the lesion.Case Presentation. A 54-year-old female came to our attention with dysphagia and dyslalia of 6-month standing. Ear, Nose, and Throat (ENT) examination revealed a voluminous mass on the right portion of the base of her tongue, where postcontrast T2-weighted Magnetic Resonance Imaging (MRI) evidenced a hyperintense lesion. The fine-needle aspiration specimen taken for cytology was not diagnostic, as a differential diagnosis between myoepithelioma and a malignant neoplasm of the salivary glands necessitates parameters that cytology alone cannot provide. Therefore, the whole lesion was excised by diode laser through a transoral approach. Histology and immunohistochemistry of the completely excised lesion confirmed a myoepithelioma.

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Interhemispheric Contralateral Transfalcine Approach for Subparacentral Arteriovenous Malformation: 3-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opab198 ◽

2021 ◽

Author(s):

Matías Baldoncini ◽

Alvaro Campero ◽

Sabino Luzzi ◽

Juan F Villalonga

Keyword(s):

Right Hemisphere ◽

Vascular Lesion ◽

Neurological Deficits ◽

3 Dimensional ◽

Postoperative Mri ◽

Drainage Vein ◽

History Of ◽

Magnetic Resonance Imaging Mri ◽

Superior Longitudinal Sinus ◽

The Right

Abstract Neurovascular procedures along the interhemispheric fissure harbor unique features differentiating them from those arteriovenous malformations (AVMs) located at the lateral surface of the brain.1-4 The aim of this 3-dimensional operative video is to present a microsurgical resection of an AVM in a subparacentral location, operated through an interhemispheric contralateral transfalcine approach.1,3,5 This is a case of a 29-yr-old female, with headaches and history of seizures. The patient presented an interhemispheric bleeding 6 mo before the surgery. The magnetic resonance imaging (MRI) showed a vascular lesion located on the medial surface of the right hemisphere at the confluence between the cingulate sulcus and its ascending sulcus. In the cerebral angiography, a right medial AVM was observed, receiving afference from the right anterior cerebral artery and draining to the superior longitudinal sinus. The patient signed an informed consent for the procedure and agreed with the use of her images and surgical video for research and academic purposes. The patient was in a supine position, and a left interhemispheric contralateral transfalcine approach was performed,1-3 a circumferential dissection of the nidus, and, finally, the AVM was resected in one piece. The patient evolved without neurological deficits after the surgery. The postoperative MRI and angiography showed a complete resection of the AVM. In the case presented, to avoid exposing the drainage vein first and to use the gravity of the exposure, the contralateral transfalcine interhemispheric approach was used,1,2 which finally accomplished the proposed objectives.

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Delayed Stroke following Blunt Neck Trauma: A Case Illustration with Recommendations for Diagnosis and Treatment

Case Reports in Emergency Medicine ◽

10.1155/2017/3931985 ◽

2017 ◽

Vol 2017 ◽

pp. 1-4

Author(s):

Best Anyama ◽

Daniela Treitl ◽

Jeffery Wessell ◽

Rachele Solomon ◽

Andrew A. Rosenthal

Keyword(s):

Neck Injury ◽

Neurological Deficits ◽

Blunt Cerebrovascular Injury ◽

Rare Injury ◽

Basketball Game ◽

Ct Angiogram ◽

Blunt Neck Trauma ◽

Magnetic Resonance Imaging Mri ◽

The Right ◽

The Brain

Blunt cerebrovascular injury (BCVI) to the carotid artery is a relatively rare injury that is difficult to identify even with imaging. Any symptoms or neurological deficits following blunt neck injury mandate evaluation and consideration of BCVI. In an effort to highlight this issue, we report the case of a 31-year-old male patient who presented with left-sided weakness consistent with transient ischemic attack (TIA) and concussion. The patient’s symptoms occurred within 24 hours of a blunt neck injury sustained by a knee strike during a basketball game. An initial computerized tomography (CT) scan of the brain was normal; a CT angiogram (CTA) of the neck and carotids did not reveal obstruction, dissection, stenosis, or abnormalities of the carotid or vertebral vessels and the patient was subsequently discharged. A magnetic resonance imaging (MRI) of the brain obtained four days after the initial injury demonstrated an acute infarct in the right middle cerebral artery (MCA) territory. Thus, despite initial negative imaging, neurological deficits must be aggressively pursued in order to prevent stroke in BCVI cases.

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Internet of things mathematical approach for detecting brain tumor

International Journal of Engineering & Technology ◽

10.14419/ijet.v7i4.16283 ◽

2018 ◽

Vol 7 (4) ◽

pp. 2779

Author(s):

Noor Kareem Jumaa ◽

Auday A.H Mohamad ◽

Sameer Hameed Majeed

Keyword(s):

Brain Tumor ◽

Internet Of Things ◽

Support Vector ◽

Medical Field ◽

Brain Functions ◽

Svm Algorithm ◽

Magnetic Resonance Imaging Mri ◽

The Right ◽

Computerized System ◽

Program Version

Brain is highly important organ which makes us able to walk, breath, and all other activities; without brain lives can’t do all of that. The importance of brain functions made it critical to make any not precisely measured medical action. Currently; computer vision is very important in medical field, where it helps specialists to precisely diagnose and take the right decision before making surgeries. This article worked on accommodating the technology of internet of things (IoT) for serving brain medicine specialist in the field of identifying the need of making surgeries depending on magnetic resonance imaging (MRI) images. Support Vector Machine (SVM) algorithm is used to detect brain tumor and segment it from MRI morphological images. Putting SVM on IoT Thingspeak platform will help brain specialist to diagnose MRI images that are received from MRI computerized system online. The obtained results are compared with same algorithm implemented locally with assist of Matlab program version R2017a.

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Lacrimal ductal cyst of the medial orbit: a case report

BMC Ophthalmology ◽

10.1186/s12886-020-01636-1 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Yu Zhang ◽

Changhong Zeng ◽

Ningshao Chen ◽

Chunling Liu

Keyword(s):

Differential Diagnosis ◽

Lacrimal Gland ◽

Ocular Motility ◽

Body Sensation ◽

Clinical Presentations ◽

Orbital Masses ◽

Gland Tissue ◽

Magnetic Resonance Imaging Mri ◽

Painless Mass ◽

The Right

Abstract Background The lacrimal ductal cyst (dacryops) is an uncommon clinical entity. It occurs anywhere that lacrimal gland tissue is present but most often appears as an expanding mass in the region of the lacrimal gland. The presence involving the medial part of the orbit is rare, ectopic location can be misleading in the differential diagnosis of orbital masses. The authors report a 53-year-old man who presented with dacryops occurred in an unusual location with significant clinical presentations. Case presentation A 53-year-old man had a painless mass located in the right superomedial orbit accompanied with foreign body sensation and lachrymation for two months, which had rapidly grown within 10 days. Decrease of visual acuity, high intraocular pressure (IOP) and limitation of extraocular movements in the right eye were present. The result of visual evoked potential (VEP) test suggested the impaired function of the optic nerve. Magnetic resonance imaging (MRI) studies revealed the presence of an isolated cystic lesion. The mass was completely removed via a transcutaneous approach, histopathologic findings were consistent with the lacrimal ductal cyst. The ocular motility and high IOP returned to normal. There had been no post-operative complications or signs of recurrence over five months follow-up. Conclusion Lacrimal ductal cysts can present in the medial orbit, clinicians should include this entity in the differential diagnosis of orbital masses and be aware of its variable presentations such as high IOP in this case. We comment on the fact that many reported cases of ectopic dacryops may be an extension of normal lacrimal gland tissue.

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Abnormal MRI in a patient with ‘headache with neurological deficits and CSF lymphocytosis (HaNDL)’

Cephalalgia ◽

10.1111/j.1468-2982.2009.01950.x ◽

2009 ◽

Vol 30 (5) ◽

pp. 615-619 ◽

Cited By ~ 22

Author(s):

A Yilmaz ◽

H Kaleagasi ◽

O Dogu ◽

E Kara ◽

A Ozge

Keyword(s):

Cerebrospinal Fluid ◽

Grey Matter ◽

Brain Regions ◽

Neurological Deficits ◽

Hemiplegic Migraine ◽

Headache Episode ◽

Magnetic Resonance Imaging Mri ◽

The Right ◽

Similar Imaging

A 27-year-old woman was admitted to the Emergency Department with right upper-extremity numbness and mild weakness followed by a bifrontal throbbing headache for 30 min, which was similar to a headache lasting for 12 h that had occurred 3 days ago. Laboratory tests were unremarkable except for cerebrospinal fluid (CSF) lymphocytic pleocytosis. On the following day, a headache episode with left hemiparesis and hemihypoaesthesia, left hemifield visio-spatial inattention, anosagnosia and confusion recurred. The headache was diagnosed as headache and neurological deficits with cerebrospinal fluid lymphocytosis (HaNDL) syndrome according to the criteria of the second edition of the International Classification of Headache Disorders. Simultaneously performed magnetic resonance imaging (MRI) revealed swelling of the grey matter, CSF enhancement in the sulci of the right temporal and occipital regions and hypoperfusion of the same brain regions. During the following 10 days two more similar episodes recurred and during the ensuing 12 months the patient remained headache free. Neuroimaging findings of the HaNDL syndrome are always thought as virtually normal. MRI abnormalities in our patient have not been reported in HaNDL syndrome previously, although they have been reported in hemiplegic migraine patients before. The findings in our case suggest that hemiplegic migraine and HaNDL syndrome may share a common pathophysiological pathway resulting in similar imaging findings and neurological symptoms.

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