SÍNDROME DEL ESPACIO CUADRILÁTERO: ¿INFRECUENTE O INSOSPECHADO?  Quadrilateral space syndrome: infrequent or unsuspected?

Introducción: El síndrome del espacio cuadrilátero (QSS) es un cuadro clínico causado por la compresión nerviosa y/o vascular a nivel del espacio axilar lateral. La prevalencia de este síndrome se desconoce y se cree que es baja, sin embargo, formas de presentación incompleta podrían llevar a que el mismo sea subdiagnosticado. Objetivo: Describir un protocolo diagnóstico utilizado en una serie de casos consecutivos de pacientes con omalgia inespecífica y sospecha de QSS. Materiales y Métodos: De manera prospectiva se evaluaron 10 pacientes con omalgia agravada con la rotación externa forzada, uno de ellos con síntomas bilaterales. Se realizó electromiografía (EMG) de deltoides y redondo menor bilaterales, con estudios de conducción nerviosa. Los valores se compararon con el hombro sano, y con un grupo control. El diagnóstico se confirmó mediante resonancia magnética nuclear (RMN). Resultados: El EMG mostró en todos los casos atrapamiento con compromiso axonal de la rama para el redondo menor, con preservación de la inervación del deltoides. La RMN mostró en los 11 hombros afectados atrofia selectiva del redondo menor. Conclusión: El QSS en sus formas incompletas suele ser subdiagnosticado, siendo necesario mantener un alto índice de sospecha clínica frente a un cuadro de omalgia inespecífica. Palabras Claves: espacio cuadrilátero, omalgia, electromiografía, redondo menor, nervio axilar. Introduction: The quadrilateral space syndrome (QSS) has clinical features caused by a nervous and /or vascular compression at the lateral axillary space. The prevalence of this syndrome is unknown but it is believed to be low. Nevertheless, some cases with an incomplete clinical presentation might be misdiagnosed. Purpose: To describe a diagnostic protocol used in a series of consecutive cases of patients with non-specific omalgia and suspected QSS. Materials and Methods: Ten patients of both genders suffering shoulder pain aggravated by forced external rotation were prospectively evaluated. One of them had bilateral symptoms. Evaluation included clinical examination, electromyography (EMG) and nerve conduction studies of the deltoid and teres minor bilaterally. The results were compared with an age-matched control group. Diagnosis was confirmed by magnetic resonance imaging (MRI). Results: The EMG showed in all the cases a selective entrapment of the branch for the teres minor, with preservation of the innervation of the deltoid. The RMN showed in the 11 affected shoulders selective atrophy of the teres minor. Conclusion: Incomplete presentations of the QSS are usually underdiagnosed, making it necessary to maintain a high index of clinical suspicion in front of any non-specific omalgia case. Key words: quadrilateral space, omalgia, electromyography, teres minor, axillary nerve.

Download Full-text

Ligaments of the os trigonum: an anatomical study

Surgical and Radiologic Anatomy ◽

10.1007/s00276-021-02694-w ◽

2021 ◽

Author(s):

Paweł Szaro ◽

Khaldun Ghali Gataa ◽

Mateusz Polaczek

Keyword(s):

Posterior Part ◽

Anatomical Study ◽

Control Group ◽

Flexor Hallucis Longus ◽

Resonance Imaging ◽

Os Trigonum ◽

Posterior Process ◽

Magnetic Resonance Imaging Mri ◽

Experimental Group ◽

Posterior Talofibular Ligament

Abstract Purpose The aim of the study was to examine the ligaments of the os trigonum. Methods The ankle joint magnetic resonance imaging (MRI) of 104 patients with the os trigonum (experimental group) and 104 patients without the os trigonum (control group) were re-reviewed. The connections of the os trigonum and posterior talofibular ligament (PTFL), the fibulotalocalcaneal ligament (FTCL), the paratenon of the Achilles tendon, the posterior talocalcaneal ligament (PTCL), the osteofibrous tunnel of the flexor hallucis longus (OF-FHL) and the flexor retinaculum (FR) were studied. Results The os trigonum is connected to structures. The posterior part of the PTFL inserted on the os trigonum in 85.6% of patients, whereas in all patients in the control group, the posterior part of the PTFL inserted on the posterior talar process (p < 0.05). The connection of the PTCL was seen in 94.2% of patients in the experimental group, while it was seen in 90.4% of patients in the control group (p > 0.05). The connection to the FTCL in the experimental group was 89.4%, while in the control group, it was 91.3% (p > 0.05). The communication with the paratenon was seen more often in the control group compared to that in the experimental group (31.7% vs. 63.8%, p < 0.001). The FTCL was prolonged medially into the FR in 85.6% of patients in the experimental group and in 87.5% of patients in the control group (p > 0.05). The flexor hallucis longus (FHL) run at the level of articulation between the os trigonum 63.5% and the posterior process of the talus 25% and less often on the os trigonum 11.5%. Conclusion The os trigonum is connected with all posterior ankle structures and more connections than previously reported.

Download Full-text

Extended Cranial Ultrasound Views in Infants with Acute Brain Stem/Infratentorial Lesions: Diagnosis of a Progressive Midline Glioma in a 6-Week-Old Infant

Journal of Child Science ◽

10.1055/s-0041-1736157 ◽

2021 ◽

Vol 11 (01) ◽

pp. e262-e264

Author(s):

Matthias Lange ◽

Bernd Mitzlaff ◽

Florian Beske ◽

Holger Koester ◽

Wiebke Aumann ◽

...

Keyword(s):

Clinical Presentation ◽

World Health ◽

Cranial Ultrasound ◽

Anterior Fontanel ◽

Resonance Imaging ◽

Who Grade ◽

Magnetic Resonance Imaging Mri ◽

Health Organization ◽

Mastoid Fontanelle ◽

Diffuse Midline Glioma

AbstractCentral nervous system (CNS) tumors are the most common solid tumors in children and adolescents. However, in neonates and children aged younger than a year, they are very rare. Clinical presentation in neonates is often subtle and nonspecific. When neurological symptoms are apparent at this age, cranial ultrasound (CUS) is often done as the initial evaluation, with a standard approach through the anterior fontanel (AF), followed by further imaging, such as magnetic resonance imaging (MRI), if necessary. We report the first neonatal case of a rapidly progressive diffuse midline glioma positive for histone H3 K27M mutation (World Health Organization [WHO] grade IV) in which using extended (transmastoid) CUS studies through the mastoid fontanelle (MF) in the second month of life defined the lesion in the brainstem.

Download Full-text

Analysis of Combined Treatment of Embolic Stroke in Rat with r-tPA and a GPIIb/IIIa Inhibitor

Journal of Cerebral Blood Flow & Metabolism ◽

10.1038/sj.jcbfm.9600010 ◽

2005 ◽

Vol 25 (1) ◽

pp. 87-97 ◽

Cited By ~ 23

Author(s):

Guangliang Ding ◽

Quan Jiang ◽

Li Zhang ◽

Zheng Gang Zhang ◽

Lian Li ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Thrombolytic Therapy ◽

Combination Treatment ◽

Infarct Volume ◽

Embolic Stroke ◽

Control Group ◽

Resonance Imaging ◽

Cerebral Microvessels ◽

Magnetic Resonance Imaging Mri

Suppression of platelet activation improves the efficacy of thrombolytic therapy for stroke. Thus, combination treatment with recombinant tissue plasminogen activator (r-tPA) and 7E3 F(ab′)2, a GPIIb/IIIa inhibitor that binds the platelet to fibrin, may improve the efficacy of thrombolytic therapy in embolic stroke. Magnetic resonance imaging (MRI) was used to monitor treatment response in rats subjected to embolic middle cerebral artery (MCA) occlusion (MCAo). Animals were randomized into treated ( n = 12) and control ( n = 10) groups and received intravenous combination therapy or saline, respectively, 4 hours after MCAo. Magnetic resonance imaging (MRI) measurements performed 1 hour after MCAo showed no difference between groups. However, an increased incidence (50%) of MCA recanalization was found in the treated group at 24 hours compared with 20% in the control group. The area of low cerebral blood flow at 24 and 48 hours was significantly smaller in the combination treatment group, and the lesion size, as indicated from the T2 and T1 maps, differed significantly between groups. Fluorescence microscopy measurements of cerebral microvessels perfused with fluorescein isothiocyanate-dextran and measurements of infarct volume revealed that the combination treatment significantly increased microvascular patency and reduced infarct volume, respectively, compared with the control rats. The efficacy of combination treatment 4 hours after ischemia is reflected by MRI indices of tissue perfusion, MCA recanalization, and reduction of lesion volume. The treatment also reduced secondary microvascular perfusion deficits.

Download Full-text

ACROMEGALY UNVEILED DURING A NASAL RECONSTRUCTION SURGERY: A CASE REPORT

10.36106/0620326 ◽

2021 ◽

pp. 66-68

Author(s):

Kiran Shah ◽

Ishant Bhanarkar ◽

Vasavdatta Sharma ◽

Durvesh Bhangale ◽

Vinod Pawara ◽

...

Keyword(s):

Clinical Presentation ◽

Delayed Diagnosis ◽

Somatic Growth ◽

Care Physician ◽

Nasal Reconstruction ◽

Thyroid Function Tests ◽

Resonance Imaging ◽

Magnetic Resonance Imaging Mri ◽

New Diagnosis ◽

Gh Excess

Acromegaly is a condition of excessive somatic growth and distorted proportion due to hypersecretion of growth hormone(GH) and insulin-like growth factor 1 (IGF-1). Insidious clinical manifestation of GH excess as a result of GH-secreting pituitary adenoma renders acromegaly a disease with typically delayed diagnosis. We report a 29-year old male planned to undergo reconstruction of the nose. The patient was referred for medical tness. Given the clinical features consistent with acromegaly the patient was evaluated further for diagnosis. Laboratory investigation showed raised IGF-1and non-suppressed GH post 75gms glucose, amid normal cortisol, corticotropin(ACTH), prolactin, testosterone, and thyroid function tests. He did not have dysglycemia. Magnetic resonance imaging (MRI) of the pituitary revealed a pituitary macroadenoma consistent with acromegaly. This case highlights the notable absence of recognizing the clinical presentation of acromegaly in this patient by his medical care physician and surgeons, and therefore the importance of thorough history taking, attention, and observation in making a new diagnosis that has the potential to alter a patient's health care and alleviate impending complications, morbidity and/or mortality

Download Full-text

Serial MR Imaging of Adult-Onset Rasmussen's Encephalitis

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100120815 ◽

2011 ◽

Vol 38 (1) ◽

pp. 141-142 ◽

Cited By ~ 3

Author(s):

Myriam Irislimane ◽

François Guilbert ◽

Jean-Maxime Leroux ◽

Lionel Carmant ◽

Dang Khoa Nguyen

Keyword(s):

Clinical Presentation ◽

Subcortical White Matter ◽

Adult Onset ◽

Resonance Imaging ◽

Rasmussen’S Encephalitis ◽

Arm Muscles ◽

Cerebral Biopsy ◽

Magnetic Resonance Imaging Mri ◽

The Right ◽

Progressive Dysphagia

A 52-year-old woman was referred for a progressive neurological condition which started a year before with continuous irregular twitching of the right facial and arm muscles as well as the tongue and palate, followed by progressive dysphagia, right hemiparesis, ataxia, dysphasia and dysarthria. Though magnetic resonance imaging (MRI) at clinical presentation and a year after were both normal (Figure A1), Rasmussen's encephalitis (RE) was strongly suspected and treatment with corticosteroids and immunoglobulins were begun. A third MRI, two years after onset, revealed mild T2 hyperintense subcortical white matter changes over the left perisylvian region (Figure A) which confirmed our initial suspicion of RE as she now met clinical, electrophysiological and morphological criterias for RE. While waiting for a cerebral biopsy after unsatisfactory response from antiepileptic drugs, corticosteroids and immunoglobulins, her condition markedly worsened less than three years after onset with the sudden occurrence of status epilepticus requiring intubation and continuous infusions of midazolam and propofol.

Download Full-text

Carcinomatous encephalitis as clinical presentation of occult lung adenocarcinoma: case report

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2007000500022 ◽

2007 ◽

Vol 65 (3b) ◽

pp. 841-844 ◽

Cited By ~ 5

Author(s):

Henrique Barbosa Ribeiro ◽

Tadeu Ferreira de Paiva Jr ◽

Gustavo Pignatari Rosas Mamprin ◽

Milton Luiz Gorzoni ◽

Antônio José da Rocha ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Computed Tomography ◽

Clinical Presentation ◽

Clinical Manifestations ◽

Mass Effect ◽

Pulmonary Adenocarcinoma ◽

Rare Entity ◽

Resonance Imaging ◽

Clinical Imaging ◽

Magnetic Resonance Imaging Mri

Carcinomatous encephalitis is a rare entity, originally described by Madow and Alpers in 1951, which is characterized by tumoral spreading perivascular, without mass effect. Clinical manifestations such as hemiparesis, seizures, ataxia, speech difficulties, cerebrospinal fluid findings as well as computed tomography are nonspecific. This leads the physician to pursue more frequent diseases that could explain those manifestations - toxic, metabolic, and/or infectious encephalopathy. A magnetic resonance imaging (MRI) with gadolinium, the method of choice, presumes the diagnosis. Previous reports of this unusual form of metastatic disease have described patients with prior diagnosis of pulmonary adenocarcinoma. We present the case of carcinomatous encephalitis in a 76-years-old woman as the primary manifestation of occult pulmonary adenocarcinoma with its clinical, imaging, and anatomopathological findings.

Download Full-text

Optimal Cut-Off Value of the Superior Articular Process Area as a Morphological Parameter to Predict Lumbar Foraminal Stenosis

Pain Research and Management ◽

10.1155/2017/7914836 ◽

2017 ◽

Vol 2017 ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

Tae-Ha Lim ◽

Soo Il Choi ◽

Hyung Rae Cho ◽

Keum Nae Kang ◽

Chang Joon Rhyu ◽

...

Keyword(s):

Facet Joint ◽

Control Group ◽

Foraminal Stenosis ◽

Morphological Parameter ◽

Resonance Imaging ◽

Cross Sectional ◽

Lumbar Foraminal Stenosis ◽

Articular Process ◽

Magnetic Resonance Imaging Mri ◽

Bone Margin

Background. We devised a new morphological parameter called the superior articular process area (SAPA) to evaluate the connection between lumbar foraminal stenosis (LFS) and the superior articular process. Objective. We hypothesized that the SAPA is an important morphologic parameter in the diagnosis of LFS. Methods. All patients over 60 years of age were included. Data regarding the SAPA were collected from 137 patients with LFS. A total of 167 control subjects underwent lumbar magnetic resonance imaging (MRI) as part of a routine medical examination. We analyzed the cross-sectional area of the bone margin of the superior articular process at the level of L4-L5 facet joint in the axial plane. Results. The average SAPA was 96.3±13.6 mm2 in the control group and 128.1±17.2 mm2 in the LFS group. The LFS group was found to have significantly higher levels of SAPA (p<0.001) in comparison to the control group. In the LFS group, the optimal cut-off value was 112.1 mm2, with 84.4% sensitivity, 83.9% specificity, and AUC of 0.94 (95% CI: 0.91–0.96). Conclusions. Higher SAPA values were associated with a higher possibility of LFS. These results are important in the evaluation of patients with LFS.

Download Full-text

Successful pregnancy after natalizumab-associated progressive multifocal leukoencephalopathy in a patient with multiple sclerosis

Multiple Sclerosis Journal ◽

10.1177/1352458516678475 ◽

2016 ◽

Vol 23 (3) ◽

pp. 483-486 ◽

Cited By ~ 3

Author(s):

Kalliopi Pitarokoili ◽

Kerstin Hellwig ◽

Carsten Lukas ◽

Ralf Gold

Keyword(s):

Multiple Sclerosis ◽

Progressive Multifocal Leukoencephalopathy ◽

Clinical Presentation ◽

Dimethyl Fumarate ◽

Resonance Imaging ◽

Successful Pregnancy ◽

Uncomplicated Pregnancy ◽

Pregnancy And Delivery ◽

Magnetic Resonance Imaging Mri ◽

Inflammatory Syndrome

We report the case of a post-progressive multifocal leukoencephalopathy (PML), multiple sclerosis (MS) patient with an uncomplicated pregnancy and delivery. A 28-year-old woman on natalizumab (total of 49 infusions) was diagnosed with PML due to typical magnetic resonance imaging (MRI) and clinical presentation. John Cunningham virus (JCV) was detected in the cerebrospinal fluid (CSF) during the immune reconstitution inflammatory syndrome (IRIS). Nine months after PML onset, JCV negativity in the CSF was observed. MS was stabilised with dimethyl fumarate (DMF), and 18 months later, a desired pregnancy was reported, resulting in the birth of a healthy boy. Our report gives new hope regarding family planning for post-PML patients.

Download Full-text

Retroperitoneal lymphangiectasia: a great clinical masquerade

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20200267 ◽

2020 ◽

Vol 8 (2) ◽

pp. 748

Author(s):

Siddhant Uttam Manwar ◽

Manisha Vishnu Joshi ◽

Devdas Sudhakar Shetty ◽

Upendra Diwakar Bhalerao

Keyword(s):

Clinical Presentation ◽

Imaging Findings ◽

Resonance Imaging ◽

Colour Doppler ◽

Cross Sectional ◽

Cross Sectional Imaging ◽

Anatomical Extent ◽

Sectional Imaging ◽

Magnetic Resonance Imaging Mri ◽

Ct And Mri

Retroperitoneal lymphangiectasia is a very rare lymphatic disorder characterized by abnormal proliferation of lymphatics. We present series of 3 cases of retroperitoneal lymphangiectasia which are diagnosed in our institute with the help of Ultrasonography (USG), Computed Tomography (CT) and Magnetic resonance imaging (MRI) of abdomen and pelvis with unusual clinical presentation. We include clinical features and imaging findings of this disorder with its pathogenesis and diagnosis. Two of the cases were clinically masquerading as hernia and one case was mimicking varicocele. Thorough clinical examination and USG, colour Doppler, CT and MRI are extremely helpful imaging investigation that aid in differentiating these lesions from hernia/ varicocele and the cross sectional imaging like CT and MRI can depict the anatomical extent of the disease.

Download Full-text

CIDP Masquerading as Mononeuritis Multiplex: The Value of MR Neurography

Neurology and Neurobiology ◽

10.31487/j.nnb.2021.02.01 ◽

2021 ◽

pp. 1-4

Author(s):

James Holt ◽

Selina Robertson ◽

Simon McCrory ◽

James Holt

Keyword(s):

Clinical Presentation ◽

Lower Limbs ◽

Sensory Impairment ◽

Resonance Imaging ◽

Mononeuritis Multiplex ◽

Diagnostic Challenge ◽

Mr Neurography ◽

Neurophysiological Studies ◽

Magnetic Resonance Imaging Mri ◽

Learning Points

Background: We present two patients with the Lewis-Sumner variant of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), charting the diagnostic challenge posed by their clinical presentation and electrodiagnostic findings. The learning points center on the use of magnetic resonance imaging (MRI) in establishing a definitive diagnosis when clinical and neurophysiology data do not otherwise add up. Cases: The first patient presented with slowly progressive asymmetric distal weakness of the lower limbs with wasting, weakness, areflexia and numbness on examination. The second patient experienced stepwise asymmetric hand/forearm weakness with deformity and areflexia, plus mild distal sensory impairment. Neurophysiological studies for both patients were initially most suggestive of mononeuritis multiplex, with no evidence of demyelination. Conclusion: The possibility of asymmetric or multifocal CIDP, the Lewis-Sumner variant, should not be forgotten in suspected mononeuritis multiplex and the value of MRI in such cases is discussed.

Download Full-text