Prevalence and natural history of arachnoid cysts in adults

2013 ◽  
Vol 118 (2) ◽  
pp. 222-231 ◽  
Author(s):  
Wajd N. Al-Holou ◽  
Samuel Terman ◽  
Craig Kilburg ◽  
Hugh J. L. Garton ◽  
Karin M. Muraszko ◽  
...  
Keyword(s):  
Natural History ◽  
Brain Mri ◽  
Arachnoid Cysts ◽  
Consecutive Series ◽  
Middle Fossa ◽  
Presenting Symptoms ◽  
History Analysis ◽  
Number Of Patients ◽  
History Of

Object Arachnoid cysts are a frequent finding on intracranial imaging. The prevalence and natural history of these cysts in adults are not well defined. Methods We retrospectively reviewed the electronic medical records of a consecutive series of adults who underwent brain MRI over a 12-year interval to identify those with arachnoid cysts. The MRI studies were reviewed to confirm the diagnosis. For those patients with arachnoid cysts, we evaluated presenting symptoms, cyst size, and cyst location. Patients with more than 6 months' clinical and imaging follow-up were included in a natural history analysis. Results A total of 48,417 patients underwent brain MRI over the study period. Arachnoid cysts were identified in 661 patients (1.4%). Men had a higher prevalence than women (p < 0.0001). Multiple arachnoid cysts occurred in 30 patients. The most common locations were middle fossa (34%), retrocerebellar (33%), and convexity (14%). Middle fossa cysts were predominantly left-sided (70%, p < 0.001). Thirty-five patients were considered symptomatic and 24 underwent surgical treatment. Sellar and suprasellar cysts were more likely to be considered symptomatic (p < 0.0001). Middle fossa cysts were less likely to be considered symptomatic (p = 0.01. The criteria for natural history analysis were met in 203 patients with a total of 213 cysts. After a mean follow-up of 3.8 ± 2.8 years (for this subgroup), 5 cysts (2.3%) increased in size and 2 cysts decreased in size (0.9%). Only 2 patients developed new or worsening symptoms over the follow-up period. Conclusions Arachnoid cysts are a common incidental finding on intracranial imaging in all age groups. Although arachnoid cysts are symptomatic in a small number of patients, they are associated with a benign natural history for those presenting without symptoms.

Prevalence and natural history of arachnoid cysts in children

2010 ◽  
Vol 5 (6) ◽  
pp. 578-585 ◽  
Author(s):  
Wajd N. Al-Holou ◽  
Andrew Y. Yew ◽  
Zackary E. Boomsaad ◽  
Hugh J. L. Garton ◽  
Karin M. Muraszko ◽  
...  
Keyword(s):  
Natural History ◽  
Mr Imaging ◽  
Incidental Finding ◽  
Arachnoid Cysts ◽  
Consecutive Series ◽  
Imaging Characteristics ◽  
History Analysis ◽  
History Of ◽  
Over Time

Object Arachnoid cysts are a frequent finding on intracranial imaging in children. The prevalence and natural history of these cysts are not well defined. The authors studied a large consecutive series of children undergoing MR imaging to better define both the MR imaging–demonstrated prevalence and behavior of these lesions over time. Methods The authors reviewed a consecutive series of 11,738 patients who were 18 years of age or younger and had undergone brain MR imaging at a single institution during an 11-year period. In the patients in whom intracranial arachnoid cysts were identified, clinical and demographic information was recorded and imaging characteristics, such as cyst size and location, were evaluated. Prevalence data were analyzed using univariate and multivariate logistic regression, linear regression, and ANOVA. All patients with sufficient data (repeat MR imaging studies as well as repeated clinical evaluation over at least 5 months) for a natural history analysis were identified. This group was assessed for any change in symptoms or imaging appearance during the follow-up interval. Results Three hundred nine arachnoid cysts (2.6% prevalence rate) were identified. There was an increased prevalence of arachnoid cysts in males (p < 0.000001). One hundred eleven patients met all criteria for inclusion in the natural history analysis. After a mean follow-up of 3.5 years, 11 arachnoid cysts increased in size, 13 decreased, and 87 remained stable. A younger age at presentation was significantly associated with cyst enlargement (p = 0.001) and the need for surgery (p = 0.05). No patient older than 4 years of age at the time of initial diagnosis had cyst enlargement, demonstrated new symptoms, or underwent surgical treatment. Conclusions Arachnoid cysts are a common incidental finding on intracranial imaging in pediatric patients. An older age at the time of presentation is associated with a lack of clinical or imaging changes over time.

scholarly journals Filum terminale lipomas: imaging prevalence, natural history, and conus position

2014 ◽  
Vol 13 (5) ◽  
pp. 559-567 ◽  
Author(s):  
Michael J. Cools ◽  
Wajd N. Al-Holou ◽  
William R. Stetler ◽  
Thomas J. Wilson ◽  
Karin M. Muraszko ◽  
...  
Keyword(s):  
Natural History ◽  
Incidental Finding ◽  
Tethered Cord ◽  
Filum Terminale ◽  
Presenting Symptoms ◽  
Asymptomatic Patients ◽  
History Analysis ◽  
History Of ◽  
Clinical Records

Object Filum terminale lipomas (FTLs) are being identified with increasing frequency due to the increasing utilization of MRI. Although an FTL may be associated with tethered cord syndrome (TCS), in many cases FTLs are diagnosed incidentally in patients without any symptoms of TCS. The natural history of FTLs is not well defined. Methods The authors searched the clinical and imaging records at a single institution over a 14-year interval to identify patients with FTLs. For patients with an FTL, the clinical records were reviewed for indication for imaging, presenting symptoms, perceived need for surgery, and clinical outcome. A natural history analysis was performed using all patients with more than 6 months of clinical follow-up. Results A total of 436 patients with FTL were identified. There were 217 males and 219 females. Of these patients, 282 (65%) were adults and 154 (35%) were children. Symptoms of TCS were present in 22 patients (5%). Fifty-two patients underwent surgery for FTL (12%). Sixty-four patients (15%) had a low-lying conus and 21 (5%) had a syrinx. The natural history analysis included 249 patients with a mean follow-up time of 3.5 years. In the follow-up period, only 1 patient developed new symptoms. Conclusions Filum terminale lipomas are a common incidental finding on spinal MRI, and most patients present without associated symptoms. The untreated natural history is generally benign for asymptomatic patients.

Natural history of brain capillary vascular malformations in hereditary hemorrhagic telangiectasia patients

2016 ◽  
Vol 9 (1) ◽  
pp. 26-28 ◽  
Author(s):  
Waleed Brinjikji ◽  
Vivek N Iyer ◽  
Giuseppe Lanzino ◽  
Kent R Thielen ◽  
Christopher P Wood
Keyword(s):  
Natural History ◽  
Hereditary Hemorrhagic Telangiectasia ◽  
Vascular Malformations ◽  
Neurological Deficits ◽  
Secondary Outcome ◽  
Consecutive Series ◽  
Focal Neurological Deficit ◽  
Brain Capillary ◽  
History Of

Background and purposeBrain capillary vascular malformations (CVMs) are known to occur with relatively high frequency in hereditary hemorrhagic telangiectasia (HHT) patients. These lesions are thought to have a benign natural history but this has not been systematically studied. The purpose of our study was to examine the natural history of CVMs in a consecutive series of HHT patients.Materials and methodsConsecutive patients with untreated CVMs receiving serial imaging were included. Baseline data including demographics, HHT gene mutations, and Curacao diagnostic criteria were collected. The primary outcome was rupture on follow-up. A secondary outcome was new focal neurological deficit or seizure related to the lesion.Results22 patients with 42 CVMs were included. Mean age was 45.9±16.9 years. 18 patients (81.8%) were women and 4 (18.2%) were men. 19 patients (86.4%) had definite HHT and 3 patients (13.6%) had probable HHT. Mean follow-up was 4.6±3.7 years. There were a total of 100.2 patient years of follow-up and 222.5 lesion years. No lesions ruptured on follow-up and no patient had focal neurological deficits or seizures related to the lesions.ConclusionsOur study found that CVMs in HHT patients have a benign natural history as no patients had hemorrhage or other symptoms related to these lesions. These findings should be confirmed in additional multicenter longitudinal studies.

Progressive Telomere Shortening Is Part of the Natural History of Chronic Lymphocytic Leukemia (CLL) and Impacts Clinical Outcome

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 2845-2845
Author(s):  
Elisa Bernocco ◽  
Davide Rossi ◽  
Elisa Genuardi ◽  
Chiara Lobetti-Bodoni ◽  
Roberto Passera ◽  
...  
Keyword(s):  
Natural History ◽  
Conflicts Of Interest ◽  
Lymphocytic Leukemia ◽  
Kinetic Evaluation ◽  
Mutational Status ◽  
Number Of Patients ◽  
History Of ◽  
Telomere Loss ◽  
Over Time

Abstract Abstract 2845 Introduction: Telomere length (TL) at diagnosis has been established as an independent outcome predictor in CLL (Rossi et al Leukemia 2009). However data on TL dynamics over time are scant and anedoctal. Aim of this study was to evaluate telomere dynamics in the natural history of CLL. This issue has been here addressed on a series of 88 CLL patients (pts). Methods: 25 pts were assessed for TL at diagnosis and at relapse and 63 pts had two determinations during the “watch and wait” (WW) phase. The series was fully characterized in terms of Binet stage, ALC, CD38, ZAP-70, IGHV mutational status (IGHV-MS), stereotyped receptors, cytogenetics and detailed clinical history. LDH, B2-microglobulin, p53 mutations and CD49d were available in more than 70% of pts. Treatment-free survival (TFS) analysis was performed exclusively in pts undergoing kinetic evaluation during the WW phase. This population had a median follow-up of 73 months and a median TFS of 130 months. TL was analyzed as previously described (Rossi et al Leukemia 2009; Ladetto et al Blood 2004). Median time between TL determinations was 44 months (range 12–231). Telomere loss was calculated in terms of both absolute loss (AL) and yearly loss (YL). Continuous variables were compared by the Mann-Whitney test, while TFS by the stratified Kaplan-Meyer method. Results: Telomeres were shorter at follow-up compared to baseline with a median loss of 651bp (range +493bp, −5874bp; p<0.001) (Fig 1A). AL and YL were greater in cases with higher baseline TL while those with short telomeres at diagnosis had only modest additional erosion (p=ns for pts in the 25th lowest percentile) (Fig 1B). Telomere loss over time was noticeable both in pts assessed at diagnosis and at relapse as well as in those assessed during the WW phase, but clearly inferior in the former subgroup (YL of −61bp, p<0.05 and −210bp, p<0.01, respectively), possibly due to the higher number of patients with short telomeres. AL and YL did not correlate with any available clinical or biological parameter, with the exception of a positive association with IGHV-MS (p<0.05). Pts with baseline TL shorter than the validated cut-off value of 5000bp (Rossi et al Leukemia 2009) were associated to an inferior TFS (median TFS 41 months vs 182 months; p<0.0001) as expected. Moreover also Binet status and IGVH-MS were predictive for TFS in this series. Surprisingly, also an YL above the median value (-210bp) appeared to be predictive for an inferior TFS (median TFS 82 months vs 182 months; p<0.05) (Fig 1C), despite being more common in pts with longer telomeres and VH-mutated IgH genes. Following stratification of pts according to baseline TL (< or > 5000bp), YL was predictive for TFS in both pts subgroups (Fig 1D i.e. baseline TL >5000bp; YL ≥ −210bp vs YL <-210bp: TFS 88 months vs not reached p<0.01. Figure 1E i.e. baseline TL <5000bp; YL ≥-210bp vs TL <210bp: median TFS 36 months vs 50 months, p<0.01). Conclusions: The results of the first systematic analysis on TL dynamics in CLL indicate the following: i) progressive telomere erosion occurs as part of the natural history of CLL; ii) telomere loss is more pronounced when baseline TL is higher; iii) accelerated telomeric loss associates to an inferior TFS. The results described in the present analysis corroborate basic studies suggesting that telomere disruption represents a critical step associated to CLL progression. Disclosures: No relevant conflicts of interest to declare.

Prevalence and natural history of pineal cysts in adults

2011 ◽  
Vol 115 (6) ◽  
pp. 1106-1114 ◽  
Author(s):  
Wajd N. Al-Holou ◽  
Samuel W. Terman ◽  
Craig Kilburg ◽  
Hugh J. L. Garton ◽  
Karin M. Muraszko ◽  
...  
Keyword(s):  
Natural History ◽  
Mr Imaging ◽  
Demographic Data ◽  
Patient Characteristics ◽  
Initial Study ◽  
Pineal Cyst ◽  
History Analysis ◽  
History Of ◽  
Study Population

Object We reviewed our experience with pineal cysts to define the natural history and clinical relevance of this common intracranial finding. Methods The study population consisted of 48,417 consecutive patients who underwent brain MR imaging at a single institution over a 12-year interval and who were over 18 years of age at the time of imaging. Patient characteristics, including demographic data and other intracranial diagnoses, were collected from cases involving patients with a pineal cyst. We then identified all patients with pineal cysts who had been clinically evaluated at our institution and who had at least 6 months of clinical and imaging follow-up. All inclusion criteria for the natural history analysis were met in 151 patients. Results Pineal cysts measuring 5 mm or larger in greatest dimension were found in 478 patients (1.0%). Of these, 162 patients were male and 316 were female. On follow-up MR imaging of 151 patients with pineal cyst at a mean interval of 3.4 years from the initial study, 124 pineal cysts remained stable, 4 increased in size, and 23 decreased in size. Cysts that were larger at the time of initial diagnosis were more likely to decrease in size over the follow-up interval (p = 0.004). Patient sex, patient age at diagnosis, and the presence of septations within the cyst were not significantly associated with cyst change on follow-up. Conclusions Follow-up imaging and neurosurgical evaluation are not mandatory for adults with asymptomatic pineal cysts.

Natural history and imaging prevalence of cavernous malformations in children and young adults

2012 ◽  
Vol 9 (2) ◽  
pp. 198-205 ◽  
Author(s):  
Wajd N. Al-Holou ◽  
Thomas M. O'Lynnger ◽  
Aditya S. Pandey ◽  
Joseph J. Gemmete ◽  
B. Gregory Thompson ◽  
...  
Keyword(s):  
Young Adults ◽  
Natural History ◽  
Mr Imaging ◽  
Group Versus ◽  
Cavernous Malformations ◽  
Age Related ◽  
History Analysis ◽  
History Of ◽  
Children And Young Adults

Object This study was undertaken to define the age-related prevalence of cavernous malformations (CMs) in children and young adults undergoing intracranial imaging. In addition, the authors aim to clarify the natural history of CMs in young people, especially in those with incidentally discovered lesions. Methods To identify those patients with CMs, the authors retrospectively reviewed the electronic medical records of 14,936 consecutive patients 25 years of age or younger who had undergone brain MR imaging. In patients with a CM, clinical and imaging data were collected. Patients with untreated cavernomas who had more than 6 months of clinical and MR imaging follow-up were included in a natural history analysis. The natural history analysis included 110 CMs in 56 patients with a 3.5-year mean clinical follow-up interval (199 patient-years and 361 cavernoma-years). Results In 92 patients (0.6%), 164 CMs were identified. The imaging prevalence of cavernomas increased with advancing age (p = 0.002). Multiple CMs occurred in 28 patients (30%), and 8 patients (9%) had a family history of multiple CMs. Fifty patients (54%) presented with symptoms related to the cavernoma, of whom 30 presented with hemorrhage (33%). Of the 164 cavernomas identified, 103 (63%) were considered incidental, asymptomatic lesions. Larger size was associated with acute symptomatic presentation (p = 0.0001). During the follow-up interval, 6 patients with 8 cavernomas developed 11 symptomatic hemorrhages after initial identification. Five of the patients who had a hemorrhage during the follow-up interval had initially presented with hemorrhage, while only 1 had presented incidentally. The hemorrhage rate for all patients in the natural history group was 1.6% per patient-year and 0.9% per cavernoma-year. The hemorrhage rate was 8.0% per patient-year in the symptomatic group versus 0.2% in the incidental group. Symptomatic hemorrhage after long-term follow-up was associated with initial acute presentation (p = 0.02). Conclusions The imaging prevalence of CM increases with advancing age during childhood. Patients presenting without hemorrhage have a significantly lower risk of bleeding compared with those who present with acute neurological symptoms. Comparing this series of children to prior analyses of CM natural history in adults, the authors' data do not suggest a higher bleeding risk in younger patients.

Natural history of helicobacter pylori infection from infancy to adulthood: A 21-year follow-up cohort study

2001 ◽  
Vol 120 (5) ◽  
pp. A128-A128 ◽  
Author(s):  
H MALATY ◽  
D GRAHAM ◽  
A ELKASABANY ◽  
S REDDY ◽  
S SRINIVASAN ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Cohort Study ◽  
Natural History ◽  
Helicobacter Pylori Infection ◽  
History Of

The natural history of pituitary apoplexy: long term follow-up study

2019 ◽  
Author(s):  
Ayesha Shaikh ◽  
Natasha Shrikrishnapalasuriyar ◽  
Giselle Sharaf ◽  
David Price ◽  
Maneesh Udiawar ◽  
...  
Keyword(s):  
Natural History ◽  
Pituitary Apoplexy ◽  
Follow Up Study ◽  
Long Term Follow Up ◽  
History Of

The natural history of benign thyroid nodules: 10 years follow-up

2020 ◽  
Author(s):  
Valeria Ramundo ◽  
Giorgio Grani ◽  
Rocco Bruno ◽  
Giuseppe Costante ◽  
Domenico Meringolo ◽  
...  
Keyword(s):  
Natural History ◽  
Thyroid Nodules ◽  
History Of ◽  
Benign Thyroid Nodules ◽  
Benign Thyroid

Unruptured intracranial aneurysms in children: 18 years’ experience in a tertiary care pediatric institution

2019 ◽  
Vol 24 (2) ◽  
pp. 184-189 ◽  
Author(s):  
Daniel-Alexandre Bisson ◽  
Peter Dirks ◽  
Afsaneh Amirabadi ◽  
Manohar M. Shroff ◽  
Timo Krings ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Natural History ◽  
Internal Carotid Artery ◽  
Intracranial Aneurysms ◽  
Internal Carotid ◽  
Tertiary Care ◽  
Unruptured Intracranial Aneurysms ◽  
History Of ◽  
Mean Size

OBJECTIVEThere are little data in the literature on the characteristics and natural history of unruptured intracranial aneurysms in children. The authors analyzed their experience with unruptured intracranial aneurysms in the pediatric population at their tertiary care pediatric institution over the last 18 years. The first objective was to assess the imaging characteristics and natural history of these aneurysms in order to help guide management strategies in the future. A second objective was to evaluate the frequency of an underlying condition when an incidental intracranial aneurysm was detected in a child.METHODSThe authors conducted a Research Ethics Board–approved retrospective review of incidental intracranial aneurysms in patients younger than 18 years of age who had been treated at their institution in the period from 1998 to 2016. Clinical (age, sex, syndrome) and radiological (aneurysm location, type, size, thrombus, mass effect) data were recorded. Follow-up imaging was assessed for temporal changes.RESULTSSixty intracranial aneurysms occurred in 51 patients (36 males, 15 females) with a mean age of 10.5 ± 0.5 years (range 9 months–17 years). Forty-five patients (88.2%) had a single aneurysm, while 2 and 3 aneurysms were found in 3 patients each (5.8%). Syndromic association was found in 22 patients (43.1%), most frequently sickle cell disease (10/22 [45.5%]). Aneurysms were saccular in 43 cases (71.7%; mean size 5.0 ± 5.7 mm) and fusiform in the remaining 17 (28.3%; mean size 6.5 ± 2.7 mm). Thirty-one aneurysms (51.7%) arose from the internal carotid artery (right/left 1.4), most commonly in the cavernous segment (10/31 [32.3%]). Mean size change over the entire follow-up of 109 patient-years was a decrease of 0.6 ± 4.2 mm (range −30.0 to +4.0 mm, rate −0.12 ± 9.9 mm/yr). Interval growth (2.0 ± 1.0 mm) was seen in 8 aneurysms (13.3%; 4 saccular, 4 fusiform). An interval decrease in size (8.3 ± 10.7 mm) was seen in 6 aneurysms (10%). There was an inverse relationship between aneurysm size and growth rate (r = −0.82, p < 0.00001). One aneurysm was treated endovascularly with internal carotid artery sacrifice.CONCLUSIONSUnruptured pediatric intracranial aneurysms are most frequently single but can occur in multiples in a syndromic setting. None of the cases from the study period showed clinical or imaging signs of rupture. Growth over time, although unusual and slow, can occur in a proportion of these patients, who should be identified for short-term imaging surveillance.

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