scholarly journals Intracranial arachnoid cysts: Review of natural history and proposed treatment algorithm

2021 ◽  
Vol 12 ◽  
pp. 621
Author(s):  
John Carbone ◽  
Ananthababu Pattavilakom Sadasivan
Keyword(s):  
Incidental Finding ◽  
Treatment Algorithm ◽  
Arachnoid Cysts ◽  
Princess Alexandra Hospital ◽  
Mesh Terms ◽  
Asymptomatic Patients ◽  
Benign Nature ◽  
Cyst Growth

Background: With a prevalence of 1.4%, intracranial arachnoid cysts are a frequent incidental finding on MRI and CT. Whilst most cysts are benign in the long-term, clinical practice, and imaging frequency does not necessarily reflect this. Methods: A literature review was conducted searching the Medline database with MESH terms. This literature was condensed into an article, edited by a consultant neurosurgeon. This was further condensed, presented to the neurosurgery department at Princess Alexandra Hospital for final feedback and editing. Results: This review advises that asymptomatic patients with typical cysts have a low risk of cyst growth and development of new symptomatology, thus do not require surveillance or intervention. The minority of symptomatic patients or those with cysts in sensitive areas may require referral to a neurosurgeon for clinical follow-up or intervention. Conclusion: Greater than 94% of patients are asymptomatic, practitioners can be confident in reassuring patients of the benign nature of a potentially worrying finding. Recognizing the small number of symptomatic patients and those with cysts in areas sensitive to causing hydrocephalus is where GP decision making in conjunction with specialty input is of highest yield.

scholarly journals Congenital kinking of aorta – A rare aortic arch anomaly

2021 ◽  
Vol 33 (4) ◽  
pp. 38-42
Author(s):  
Suad Rashid Al Amer ◽  
Vimalarani Arulselvam ◽  
Rajesh Jayakumar ◽  
Abhinav Agarwal ◽  
Neale Nicola Kalis
Keyword(s):  
Aortic Arch ◽  
Surgical Repair ◽  
Incidental Finding ◽  
Aneurysmal Dilatation ◽  
Diagnostic Modality ◽  
Ligamentum Arteriosum ◽  
Aortic Arch Anomaly ◽  
Asymptomatic Patients

Congenital kinking of aorta or pseudocoarctation is a rare anomaly of the aortic arch with elongation and kinking of aorta at the level of ligamentum arteriosum. This anomaly is not a true coarctation as there is no significant hemodynamic obstruction or pressure gradient across the lesion. We report two cases with this anomaly diagnosed during the evaluation for incidental finding of murmur. Both patients had flow gradient across the kinked segment of aorta by echocardiography but did not require any intervention. Long term complication is aneurysmal dilatation and rupture beyond the kinked segment. Computed tomography of the aorta is a simple noninvasive diagnostic modality for the definitive diagnosis. Surgical repair should be performed for all symptomatic individuals. Regular periodic follow up is mandatory for all asymptomatic patients.

scholarly journals Clinical Features of Iris Cysts in Long-Term Follow-Up

2021 ◽  
Vol 10 (2) ◽  
pp. 189
Author(s):  
Joanna Konopińska ◽  
Łukasz Lisowski ◽  
Zofia Mariak ◽  
Iwona Obuchowska
Keyword(s):  
Visual Acuity ◽  
Ultrasound Biomicroscopy ◽  
Anatomical Location ◽  
Long Term Follow Up ◽  
Temporal Quadrant ◽  
The Mean ◽  
Multiple Cysts ◽  
Cyst Growth

This study evaluated the characteristics and clinical course of patients with iris cysts in the long-term follow-up (24–48 months). We retrospectively analyzed the medical records of 39 patients with iris cysts (27 women and 12 men). Age, visual acuity, intraocular pressure (IOP), slit-lamp evaluation, and ultrasound biomicroscopy images were assessed. The mean age at diagnosis was 40.6 ± 17.48 years. Thirty (76.9%) cysts were peripheral, five (12.8%) were located at the pupillary margin, two (5.1%) were midzonal, and two (5.1%) were multichamber cysts extending from the periphery to the pupillary margin. A total of 23 (59%) cysts were in the lower temporal quadrant, 11 (28.2%) were in the lower nasal quadrant, and 5 (12.8%) were in the upper nasal quadrant. Cyst size was positively correlated with patient age (rs = 0.38, p = 0.003) and negatively correlated with visual acuity (rs = −0.42, p = 0.014). Cyst growth was not observed. The only complication was an increase in IOP in three (7.7%) patients with multiple cysts. The anatomical location of the cysts cannot differentiate them from solid tumors. The vast majority of cysts are asymptomatic, do not increase in size, and do not require treatment during long-term follow-up.

scholarly journals Index event of cerebral amyloid angiopathy (CAA) determines long-term prognosis and recurrent events (retrospective analysis and clinical follow-up)

2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Andrea Wagner ◽  
Christiane Groetsch ◽  
Sibylle Wilfling ◽  
Karl-Michael Schebesch ◽  
Mustafa Kilic ◽  
...  
Keyword(s):  
Cerebral Amyloid Angiopathy ◽  
Recurrent Events ◽  
Clinical Presentation ◽  
Secondary Prophylaxis ◽  
Amyloid Angiopathy ◽  
Index Event ◽  
Asymptomatic Patients ◽  
Cerebral Amyloid

Abstract Background The modified Boston criteria (mBC) define the probability for the diagnosis of cerebral amyloid angiopathy (CAA). Its initial clinical presentation differs from asymptomatic cerebral microbleedings (cMBs), acute ischemic stroke (AIS), cortical hemosiderosis (cSS), to lobar ICH (lICH). Methods Retrospective analyses and clinical follow-ups of individuals with at least mBC “possible” CAA from 2005 to 2018. Results 149 patients were classified in subgroups due to the index event: lICH (n = 91), AIS (n = 32), > 3 cMBs only (n = 16) and cSS (n = 10). Patients in the lICH subgroup had a significantly higher percentage of single new lICHs compared to other groups, whereas patients in the AIS-group had a significantly higher percentage of multiple new AIS. cMBs as index event predisposed for AIS during follow up (p < 0.0016). Patients of the cMBs- or cSS-group showed significantly more TFNEs (transient focal-neurological episodes) and lower numbers of asymptomatic patients (for epilepsy and TFNEs) at the index event than patients with lICH or AIS (p < 0.0013). At long-term follow-up, the cMBs- and cSS-group were characterized by more TFNEs and fewer asymptomatic patients. Conclusions A new classification system of CAA should add subgroups according to the initial clinical presentation to the mBCs allowing individual prognosis, acute treatment and secondary prophylaxis.

Percutaneous endoscopic treatment of suprasellar arachnoid cysts: ventriculocystostomy or ventriculocystocisternostomy?

1996 ◽  
Vol 84 (4) ◽  
pp. 696-701 ◽  
Author(s):  
Philippe Decq ◽  
Pierre Brugières ◽  
Caroline Le Guerinel ◽  
Michel Djindjian ◽  
Yves Kéravel ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Flow Dynamics ◽  
The Other ◽  
Arachnoid Cysts ◽  
Csf Flow ◽  
Content Type ◽  
Secondary Closure ◽  
Fine Print

✓ The use of an endoscope in the treatment of suprasellar arachnoid cysts provides an opening of the upper and lower cyst walls, thereby allowing the surgeon to perform a ventriculocystostomy (VC) or a ventriculocystocysternostomy (VCC). To discover which procedure is appropriate, magnetic resonance (MR)—imaged cerebrospinal fluid (CSF) flow dynamics in two patients were analyzed, one having undergone a VC and the other a VCC using a rigid endoscope. Magnetic resonance imaging studies were performed before and after treatment, with long-term follow-up periods (18 months and 2 years). The two patients were reoperated on during the follow-up period because of slight headache recurrence in one case and MR—imaged CSF flow dynamics modifications in the other. In each case surgery confirmed the CSF flow dynamics modifications appearing on MR imaging. In both cases, long-term MR imaging follow-up studies showed a secondary closing of the upper wall orifice. After VCC, however, the lower communication between the cyst and the cisterns remained functional. The secondary closure of the upper orifice may be explained as follows: when opened, the upper wall becomes unnecessary and tends to return to a normal shape, leading to a secondary closure. The patent sylvian aqueduct aids this phenomenon, as observed after ventriculostomy when the aqueduct is secondarily functional. The simplicity of the VCC performed using endoscopic control, which is the only procedure to allow the opening in the cyst's lower wall to remain patent, leads the authors to advocate this technique in the treatment of suprasellar arachnoid cysts.

scholarly journals Long-Term Prognosis of Plantar Fasciitis: A 5- to 15-Year Follow-up Study of 174 Patients With Ultrasound Examination

2018 ◽  
Vol 6 (3) ◽  
pp. 232596711875798 ◽  
Author(s):  
Liselotte Hansen ◽  
Thøger Persson Krogh ◽  
Torkell Ellingsen ◽  
Lars Bolvig ◽  
Ulrich Fredberg
Keyword(s):  
Plantar Fasciitis ◽  
Corticosteroid Injection ◽  
Physical Work ◽  
Fat Pad ◽  
Heel Spur ◽  
Asymptomatic Patients ◽  
The Mean ◽  
Long Term Prognosis

Background: Plantar fasciitis (PF) affects 7% to 10% of the population. The long-term prognosis is unknown. Purpose: Our study had 4 aims: (1) to assess the long-term prognosis of PF, (2) to evaluate whether baseline characteristics (sex, body mass index, age, smoking status, physical work, exercise-induced symptoms, bilateral heel pain, fascia thickness, and presence of a heel spur) could predict long-term outcomes, (3) to assess the long-term ultrasound (US) development in the fascia, and (4) to assess whether US-guided corticosteroid injections induce atrophy of the heel fat pad. Study Design: Cohort study; Level of evidence, 3. Methods: From 2001 to 2011 (baseline), 269 patients were diagnosed with PF based on symptoms and US. At follow-up (2016), all patients were invited to an interview regarding their medical history and for clinical and US re-examinations. Kaplan-Meier survival estimates were used to estimate the long-term prognosis, and a multiple Cox regression analysis was used for the prediction model. Results: In all, 174 patients (91 women, 83 men) participated in the study. All were interviewed, and 137 underwent a US examination. The mean follow-up was 9.7 years from the onset of symptoms and 8.9 years from baseline. At follow-up, 54% of patients were asymptomatic (mean duration of symptoms, 725 days), and 46% still had symptoms. The risk of having PF was 80.5% after 1 year, 50.0% after 5 years, 45.6% after 10 years, and 44.0% after 15 years from the onset of symptoms. The risk was significantly greater for women ( P < .01) and patients with bilateral pain ( P < .01). Fascia thickness decreased significantly in both the asymptomatic and symptomatic groups ( P < .01) from 6.9 mm and 6.7 mm, respectively, to 4.3 mm in both groups. Fascia thickness ( P = .49) and presence of a heel spur ( P = .88) at baseline had no impact on prognosis. At follow-up, fascia thickness and echogenicity had normalized in only 24% of the asymptomatic group. The mean fat pad thickness was 9.0 mm in patients who had received a US-guided corticosteroid injection and 9.4 mm in those who had not been given an injection ( P = .66). Conclusion: The risk of having PF in this study was 45.6% at a mean 10 years after the onset of symptoms. The asymptomatic patients had PF for a mean 725 days. The prognosis was significantly worse for women and patients with bilateral pain. Fascia thickness decreased over time regardless of symptoms and had no impact on prognosis, and neither did the presence of a heel spur. Only 24% of asymptomatic patients had a normal fascia on US at long-term follow-up. A US-guided corticosteroid injection did not cause atrophy of the heel fat pad. Our observational study did not allow us to determine the efficacy of different treatment strategies.

scholarly journals Impact of optimal follow-up of monoclonal gammopathy of undetermined significance on early diagnosis and prevention of myeloma-related complications

Blood ◽  
2010 ◽  
Vol 116 (12) ◽  
pp. 2019-2025 ◽  
Author(s):  
Giada Bianchi ◽  
Robert A. Kyle ◽  
Colin L. Colby ◽  
Dirk R. Larson ◽  
Shaji Kumar ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Laboratory Testing ◽  
Monoclonal Gammopathy ◽  
Incidental Finding ◽  
Optimal Frequency ◽  
Future Studies ◽  
Risk Of Progression ◽  
Undetermined Significance

Abstract Monoclonal gammopathy of undetermined significance (MGUS) is associated with a long-term risk of progression to multiple myeloma (MM) or related malignancy. To prevent serious myeloma-related complications, lifelong annual follow-up has been recommended, but its value is unknown. We reviewed all patients from southeastern Minnesota seen at Mayo Clinic between 1973 and 2004 with MGUS who subsequently progressed to MM. Of 116 patients, 69% had optimal follow-up of MGUS. Among these, abnormalities on serial follow-up laboratory testing led to the diagnosis of MM in 16%, whereas MM was diagnosed only after serious MM-related complications in 45%. In the remaining, workup of less serious symptoms (25%), incidental finding during workup of unrelated medical conditions (11%), and unknown (3%) were the mechanisms leading to MM diagnosis. High-risk MGUS patients (≥ 1.5 g/dL and/or non-IgG MGUS) were more likely to be optimally followed (81% vs 64%), and be diagnosed with MM secondary to serial follow-up testing (21% vs 7%). This retrospective study suggests that routine annual follow-up of MGUS may not be required in low-risk MGUS. Future studies are needed to replicate and expand our findings and to determine the optimal frequency of monitoring in higher-risk MGUS patients.

Stent-assisted coil embolization of aneurysms with small parent vessels: safety and efficacy analysis

2015 ◽  
Vol 8 (6) ◽  
pp. 581-585 ◽  
Author(s):  
Anna Luisa Kühn ◽  
Samuel Y Hou ◽  
Ajit S Puri ◽  
Christine F Silva ◽  
Matthew J Gounis ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Incidental Finding ◽  
Vascular Risk ◽  
Thromboembolic Complications ◽  
Anterior Circulation ◽  
Stent Occlusion ◽  
Efficacy Analysis ◽  
Wide Neck

BackgroundStent-assisted coil embolization (SACE) is a viable therapeutic approach for wide-neck intracranial aneurysms. However, it can be technically challenging in small cerebral vessels (≤2 mm).ObjectiveTo present our experience with stents approved for SACE in aneurysms with small parent arteries.MethodsAll patients who underwent stent-assisted aneurysm treatment with either a Neuroform or an Enterprise stent device at our institution between June 2006 and October 2012 were identified. Additionally, we evaluated each patient's vascular risk factors, aneurysm characteristics (ruptured vs non-ruptured, incidental finding, recanalized) and follow-up angiography data.ResultsA total of 41 patients with 44 aneurysms met our criteria, including 31 women and 10 men. Most of the aneurysms were located in the anterior circulation (75%). Stent placement in vessels 1.2–2 mm in diameter was successful in 93.2%. Thromboembolic complications occurred in 6 cases and vessel straightening was seen in 1 case only. Initial nearly complete to complete aneurysm obliteration was achieved in 88.6%. Six-month follow-up angiography showed coil compaction in three cases, one asymptomatic in-stent stenosis and stent occlusion. Twelve to 20-months’ follow-up showed stable coil compaction in two patients compared with previous follow-up, and aneurysm recanalization in two patients. Twenty-four to 36-months’ follow-up showed further coil compaction in one of these patients and aneurysm recanalization in a previous case of stable coil compaction on mid-term follow-up.ConclusionsOur results suggest that SACE of aneurysms with small parent vessels is feasible in selected cases and shows good long-term patency rates of parent arteries.

Nachsorge bei Krebs: ausgewählte solide Tumore und hämatologische Neoplasien

2018 ◽  
Vol 143 (05) ◽  
pp. 334-342
Author(s):  
Malte Rörden ◽  
Clemens Hinterleitner ◽  
Janina Metzger ◽  
Lothar Kanz
Keyword(s):  
Treatment Success ◽  
Individual Risk ◽  
Hämatologische Neoplasien ◽  
Asymptomatic Patients ◽  
Oncological Patients ◽  
After Care ◽  
Follow Up Care ◽  
Individual Risk Factors

AbstractMore and more follow-up care gets important in the treatment of oncological patients. In addition to detection of recurrent and secondary diseases, the focus should be put particularly on identifying and medicating sequelae associated with therapy. Anamnesis and clinical examination remain at the centre of follow-up treatment. Further contents of follow-up care are based on the disease situation, previous therapies and individual risk factors. For most entities there is no recommendation for routine radiological diagnosis in asymptomatic patients. However, imaging measures are indicated especially when symptoms require clarification. The increasing rate of oral long-term and permanent therapies implies new tasks in after-care. Here, potential side effects have to be registered specifically. Furthermore, treatment success should be monitored regularly.

scholarly journals Intramedullary Arachnoid Cyst of the Cervical Spine: Case Report and Literature Review

2017 ◽  
Vol 36 (04) ◽  
pp. 256-259 ◽  
Author(s):  
Saleh Baeesa ◽  
Abdalrahman Aljameely
Keyword(s):  
Spinal Cord ◽  
Cervical Spine ◽  
Arachnoid Cyst ◽  
Arachnoid Cysts ◽  
Magnetic Resonance Imaging Scan ◽  
Resonance Imaging ◽  
Benign Lesions ◽  
Clinical And Radiological Results

AbstractIntramedullary arachnoid cysts of the spinal cord are extremely rare benign lesions of unclear pathogenesis. To our knowledge, only 21 cases were reported in the literature, 10 of which involved the cervical spine. We report the case of a 47-year-old female who presented with a symptomatic spinal intramedullary arachnoid cyst (SIAC). Magnetic resonance imaging scan of the cervical spine demonstrated an intramedullary arachnoid cyst at C3-C5 level. The patient had a cervical laminectomy and cysto-subarachnoid shunt with rapid and excellent clinical recovery and no recurrence at 2-year follow-up.Intramedullary arachnoid cysts should be considered in the differential diagnosis of intramedullary cystic lesions of the spinal cord. Their pathogenesis and natural history are not well defined in the literature. However, a cysto-subarachnoid shunt can be performed with excellent long-term clinical and radiological results.

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