scholarly journals Traumatic sacral dermoid cyst rupture with intracranial subarachnoid seeding of lipid particles: illustrative case

2021 ◽  
Vol 2 (24) ◽  
Keyword(s):  
Systematic Review ◽  
Dermoid Cyst ◽  
Cauda Equina ◽  
Illustrative Case ◽  
Fat Deposits ◽  
Mri Scans ◽  
Life Threatening ◽  
Magnetic Resonance Imaging Mri ◽  
Sacral Canal ◽  
Cyst Rupture

BACKGROUND Intracranial deposits of fat droplets are an unusual presentation of a spinal dermoid cyst after spontaneous rupture and are even more uncommon after trauma. Here, the authors present a case with this rare clinical presentation, along with a systematic review of the literature to guide decision making in these patients. OBSERVATIONS A 54-year-old woman with Lynch syndrome presented with severe headache and sacrococcygeal pain after a traumatic fall. Computed tomography of the head revealed multifocal intraventricular and intracisternal fat deposits, which were confirmed by magnetic resonance imaging (MRI) of the neuroaxis; in addition, a ruptured multiloculated cyst was identified within the sacral canal with proteinaceous/hemorrhagic debris, most consistent with a sacral dermoid cyst with rupture into the cerebrospinal fluid (CSF) space. An unruptured sacral cyst was later noted on numerous previous MRI scans. In our systematic review, we identified 20 similar cases, most of which favored surgical treatment. LESSONS Rupture of an intraspinal dermoid cyst must be considered when intracranial fat deposits are found in the context of cauda equina syndrome, meningism, or hydrocephalus. Complete tumor removal with close postoperative follow-up is recommended to decrease the risk of complications. CSF diversion must be prioritized if life-threatening hydrocephalus is present.

scholarly journals Dermoid Cyst of the Prepontine Cistern and Meckel's Cave: Illustrative Case and Systematic Review

2017 ◽  
Vol 79 (02) ◽  
pp. 139-150 ◽  
Author(s):  
Lawrance Chung ◽  
Carlito Lagman ◽  
Courtney Duong ◽  
Daniel Nagasawa ◽  
Alexander Tucker ◽  
...  
Keyword(s):  
Systematic Review ◽  
Dermoid Cyst ◽  
Surgical Excision ◽  
Extent Of Resection ◽  
Symptom Improvement ◽  
Illustrative Case ◽  
Recurrence Rates ◽  
Prepontine Cistern ◽  
Presenting Symptoms ◽  
Visual Disturbances

Objective Dermoid cysts are benign, congenital malformations that account for ∼0.5% of intracranial neoplasms. The authors describe a 42-year-old female with a prepontine dermoid cyst who underwent apparent gross total resection (GTR) but experienced cyst recurrence. To date, very few cases of prepontine dermoid cysts have been reported. The prevalent region where these cysts are located can be difficult to determine. In addition, the authors systematically review the literature to characterize the clinical presentation, anatomical distribution, and surgical outcomes of intracranial dermoid cysts. Design Systematic review. Setting/Participants PubMed, Web of Science, and Scopus databases. Main Outcome Measures Extent of resection, symptom improvement, and recurrence rates. Results A total of 69 patients with intracranial dermoid cysts were identified. Three (4.3%) intracranial dermoid cysts were located in the prepontine cistern. The average age of patients was 33.3 years. The most common presenting symptoms were headache (52.2%) and visual disturbances (33.3%). Intracranial dermoid cysts were distributed similarly throughout the anterior, middle, and posterior cranial fossae (29.0%, 36.2%, and 29.0%, respectively). GTR was achieved in 42.0% of cases. Thirty-four (49.3%) patients experienced symptom resolution. Recurrence rate was 5.8% at a mean follow-up of 2.1 years. Conclusions Intracranial dermoid cysts most often present as headaches and visual disturbances. Intracranial dermoid cysts were found in the anterior, middle, and posterior cranial fossae at similar frequencies but with clear predilections for the Sylvian fissure, sellar region, and cerebellar vermis. Outcomes following surgical excision of intracranial dermoid cysts are generally favorable despite moderate rates of GTR.

scholarly journals Transfer Learning Approach for Classification of Histopathology Whole Slide Images

Sensors ◽  
2021 ◽  
Vol 21 (16) ◽  
pp. 5361
Author(s):  
Shakil Ahmed ◽  
Asadullah Shaikh ◽  
Hani Alshahrani ◽  
Abdullah Alghamdi ◽  
Mesfer Alrizq ◽  
...  
Keyword(s):  
Transfer Learning ◽  
Resonance Imaging ◽  
Accurate Analysis ◽  
Mri Scans ◽  
Life Threatening ◽  
Slow Progress ◽  
Histopathology Images ◽  
Magnetic Resonance Imaging Mri ◽  
Whole Slide Images

The classification of whole slide images (WSIs) provides physicians with an accurate analysis of diseases and also helps them to treat patients effectively. The classification can be linked to further detailed analysis and diagnosis. Deep learning (DL) has made significant advances in the medical industry, including the use of magnetic resonance imaging (MRI) scans, computerized tomography (CT) scans, and electrocardiograms (ECGs) to detect life-threatening diseases, including heart disease, cancer, and brain tumors. However, more advancement in the field of pathology is needed, but the main hurdle causing the slow progress is the shortage of large-labeled datasets of histopathology images to train the models. The Kimia Path24 dataset was particularly created for the classification and retrieval of histopathology images. It contains 23,916 histopathology patches with 24 tissue texture classes. A transfer learning-based framework is proposed and evaluated on two famous DL models, Inception-V3 and VGG-16. To improve the productivity of Inception-V3 and VGG-16, we used their pre-trained weights and concatenated these with an image vector, which is used as input for the training of the same architecture. Experiments show that the proposed innovation improves the accuracy of both famous models. The patch-to-scan accuracy of VGG-16 is improved from 0.65 to 0.77, and for the Inception-V3, it is improved from 0.74 to 0.79.

scholarly journals The Value of Interhospital Transfer and Emergency MRI for Suspected Cauda Equina Syndrome: A 2-Year Retrospective Study

2008 ◽  
Vol 90 (6) ◽  
pp. 513-516 ◽  
Author(s):  
M Crocker ◽  
G Fraser ◽  
E Boyd ◽  
J Wilson ◽  
BP Chitnavis ◽  
...  
Keyword(s):  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Pain Syndrome ◽  
Working Hours ◽  
Out Of Hours ◽  
Interhospital Transfer ◽  
Mri Scans ◽  
Prolapsed Intervertebral Disc ◽  
Magnetic Resonance Imaging Mri ◽  
The Uk

INTRODUCTION The timing of surgery in cauda equina syndrome due to prolapsed intervertebral disc remains controversial. Assessment of these patients requires magnetic resonance imaging (MRI), which is of limited availability outside normal working hours in the UK. PATIENTS AND METHODS We reviewed radiological results in all patients undergoing emergency MRI within our unit for suspected cauda equina syndrome over a 2-year period, and all subjects undergoing emergency lumbar discectomy for cauda equina syndrome within the same period. Outcome measures were: proportion of positive findings in symptomatic patients and proportion of patients referred with diagnostic MRI scans undergoing emergency surgery. We also assessed outcomes of patients having surgery for cauda equina syndrome in terms of improvement of pain, sensory and sphincter disturbance. RESULTS A total of 76 patients were transferred for assessment and ‘on-call’ MRI; 27 were subsequently operated upon. Only 5 proceeded to emergency discectomy that night (prior to next scheduled list). This may be due to delays in timing – from referral to acceptance, to arrival in the department, to diagnostic scan and to theatre. With the second group of patients, 43 had emergency discectomy for cauda equina syndrome during the study period. Of these, 6 patients had an out-of-hours MRI at our hospital for assessment (one patient living locally). Most surgically treated patients experienced improvement in their pain syndrome, with approximately two-thirds experiencing improvement in sensory and sphincter disturbance. CONCLUSIONS These data support a policy of advising MRI scan for cauda equina syndrome at the earliest opportunity within the next 24 h in the referring hospital, rather than emergency transfer for diagnostic imaging which has a relatively low yield in terms of patients operated on as an emergency.

scholarly journals Acute piriformis syndrome mimicking cauda equina syndrome: illustrative case

2021 ◽  
Vol 2 (17) ◽  
Author(s):  
Jan Lodin ◽  
Štěpánka Brušáková ◽  
David Kachlík ◽  
Martin Sameš ◽  
Ivan Humhej
Keyword(s):  
Urinary Retention ◽  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Pelvic Trauma ◽  
Illustrative Case ◽  
Piriformis Syndrome ◽  
Patient History ◽  
Pelvic Region ◽  
Magnetic Resonance Imaging Mri ◽  
Motor Disturbances

BACKGROUND This report depicts a rare case of acutely developed urinary retention as well as sensory and motor disturbances caused by formation of a large hematoma within the piriformis muscle, which caused compression of nerves within the suprapiriform and infrapiriform foramina, thus imitating cauda equina syndrome. Although cases of acute lumbosacral plexopathy have been described, this case is the first time both urinary retention and sensory and motor disturbances were present. OBSERVATIONS The most useful tools for diagnosis of acute piriformis syndrome are detailed patient history, magnetic resonance imaging (MRI) of the pelvic region, and electrophysiological testing performed by an experienced electrophysiologist. As a result of diligent rehabilitation, including physiotherapy and electrostimulation, the patient was able to successfully recover, regardless of acute compression of the sacral plexus that lasted 6 days. LESSONS Clinicians should actively ask about previous pelvic trauma when taking a patient history in similar cases, especially if the patient is receiving anticoagulation treatment. If MRI of the lumbar spine does not reveal any pathologies, MRI of the pelvic region should be performed. Acute surgical decompression is crucial for preserving neurological function. In similar cases, it is possible to differentiate between spinal cord, cauda equina, and pelvic lesions using electrophysiological studies.

scholarly journals Regional medical practice variation in high-cost healthcare services

2021 ◽  
Author(s):  
Michael Berger ◽  
Thomas Czypionka
Keyword(s):  
Medical Practice ◽  
Regional Variation ◽  
Multivariate Regression ◽  
Healthcare Services ◽  
Practice Variation ◽  
District Level ◽  
Healthcare Data ◽  
Regional Medical ◽  
Mri Scans ◽  
Magnetic Resonance Imaging Mri

AbstractMagnetic resonance imaging (MRI) is a popular yet cost-intensive diagnostic measure whose strengths compared to other medical imaging technologies have led to increased application. But the benefits of aggressive testing are doubtful. The comparatively high MRI usage in Austria in combination with substantial regional variation has hence become a concern for its policy makers. We use a set of routine healthcare data on outpatient MRI service consumption of Austrian patients between Q3-2015 and Q2-2016 on the district level to investigate the extent of medical practice variation in a two-step statistical analysis combining multivariate regression models and Blinder–Oaxaca decomposition. District-level MRI exam rates per 1.000 inhabitants range from 52.38 to 128.69. Controlling for a set of regional characteristics in a multivariate regression model, we identify payer autonomy in regulating access to MRI scans as the biggest contributor to regional variation. Nevertheless, the statistical decomposition highlights that more than 70% of the regional variation remains unexplained by differences between the observable district characteristics. In the absence of epidemiological explanations, the substantial regional medical practice variation calls the efficiency of resource deployment into question.

scholarly journals A detailed analysis of anatomical plausibility of crossed and uncrossed streamline rendition of the dentato-rubro-thalamic tract (DRT(T)) in a commercial stereotactic planning system

2021 ◽  
Author(s):  
Volker A. Coenen ◽  
Bastian E. Sajonz ◽  
Peter C. Reinacher ◽  
Christoph P. Kaller ◽  
Horst Urbach ◽  
...  
Keyword(s):  
Surgical Planning ◽  
Ground Truth ◽  
Planning System ◽  
Single Subject ◽  
Fiber Structure ◽  
Native Space ◽  
Volume Of Interest ◽  
Mri Scans ◽  
Magnetic Resonance Imaging Mri ◽  
The Individual

Abstract Background An increasing number of neurosurgeons use display of the dentato-rubro-thalamic tract (DRT) based on diffusion weighted imaging (dMRI) as basis for their routine planning of stimulation or lesioning approaches in stereotactic tremor surgery. An evaluation of the anatomical validity of the display of the DRT with respect to modern stereotactic planning systems and across different tracking environments has not been performed. Methods Distinct dMRI and anatomical magnetic resonance imaging (MRI) data of high and low quality from 9 subjects were used. Six subjects had repeated MRI scans and therefore entered the analysis twice. Standardized DICOM structure templates for volume of interest definition were applied in native space for all investigations. For tracking BrainLab Elements (BrainLab, Munich, Germany), two tensor deterministic tracking (FT2), MRtrix IFOD2 (https://www.mrtrix.org), and a global tracking (GT) approach were used to compare the display of the uncrossed (DRTu) and crossed (DRTx) fiber structure after transformation into MNI space. The resulting streamlines were investigated for congruence, reproducibility, anatomical validity, and penetration of anatomical way point structures. Results In general, the DRTu can be depicted with good quality (as judged by waypoints). FT2 (surgical) and GT (neuroscientific) show high congruence. While GT shows partly reproducible results for DRTx, the crossed pathway cannot be reliably reconstructed with the other (iFOD2 and FT2) algorithms. Conclusion Since a direct anatomical comparison is difficult in the individual subjects, we chose a comparison with two research tracking environments as the best possible “ground truth.” FT2 is useful especially because of its manual editing possibilities of cutting erroneous fibers on the single subject level. An uncertainty of 2 mm as mean displacement of DRTu is expectable and should be respected when using this approach for surgical planning. Tractographic renditions of the DRTx on the single subject level seem to be still illusive.

scholarly journals Brain atrophy and clinical characteristics predicting SDMT performance in multiple sclerosis: A 10-year follow-up study

2021 ◽  
Vol 7 (1) ◽  
pp. 205521732199239
Author(s):  
Cecilie Jacobsen ◽  
Robert Zivadinov ◽  
Kjell-Morten Myhr ◽  
Turi O Dalaker ◽  
Ingvild Dalen ◽  
...  
Keyword(s):  
Clinical Data ◽  
Grey Matter Volume ◽  
Lesion Volume ◽  
Information Processing Speed ◽  
Disability Status ◽  
Mri Scans ◽  
Patients At Risk ◽  
Magnetic Resonance Imaging Mri ◽  
Specific Volumes

Objectives To identify Magnetic Resonance Imaging (MRI), clinical and demographic biomarkers predictive of worsening information processing speed (IPS) as measured by Symbol Digit Modalities Test (SDMT). Methods Demographic, clinical data and 1.5 T MRI scans were collected in 76 patients at time of inclusion, and after 5 and 10 years. Global and tissue-specific volumes were calculated at each time point. For the primary outcome of analysis, SDMT was used. Results Worsening SDMT at 5-year follow-up was predicted by baseline age, Expanded Disability Status Scale (EDSS), SDMT, whole brain volume (WBV) and T2 lesion volume (LV), explaining 30.2% of the variance of SDMT. At 10-year follow-up, age, EDSS, grey matter volume (GMV) and T1 LV explained 39.4% of the variance of SDMT change. Conclusion This longitudinal study shows that baseline MRI-markers, demographic and clinical data can help predict worsening IPS. Identification of patients at risk of IPS decline is of importance as follow-up, treatment and rehabilitation can be optimized.

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