Lhermitte-Duclos disease mimicking adult-onset aqueductal stenosis

1994 ◽  
Vol 80 (6) ◽  
pp. 1095-1098 ◽  
Author(s):  
Shah N. Siddiqi ◽  
Michael G. Fehlings
Keyword(s):  
Mr Imaging ◽  
Benign Lesion ◽  
Aqueductal Stenosis ◽  
Cerebellar Hemisphere ◽  
Imaging Features ◽  
Adult Onset ◽  
Full Spectrum ◽  
Content Type ◽  
Weighted Image ◽  
Imaging Characteristics

✓ Lhermitte-Duclos disease is a rare lesion characterized by enlarged cerebellar folia containing abnormal ganglion cells. This case report describes a 51-year-old woman who was initially misdiagnosed as having adult-onset aqueductal stenosis. There were no abnormal findings on computerized tomography (CT), but subsequent magnetic resonance (MR) imaging showed a midline cerebellar lesion extending to the brain stem. This is a unique case of Lhermitte-Duclos disease arising within the cerebellar vermis. The characteristic feature of an enlarged cerebellar hemisphere is absent on CT scans; thus MR imaging is needed to confirm the diagnosis. If diagnosed late, this generally benign lesion becomes difficult to resect totally and has a poorer prognosis. Only two reports have mentioned the MR imaging characteristics of Lhermitte-Duclos disease; both described only T2-weighted images. This case illustrates the full spectrum of MR imaging features of this disease. Both T1- and T2-weighted studies showed enlarged cerebellar folia within the lesion. The T1-weighted image showed a mixed iso- and hypodense signal and the T2-weighted image a homogeneously increased signal; with gadolinium administration the lesion did not enhance. The latter feature supports the theory that this disease is a hamartoma rather than a tumor.

Hemorrhagic and nonhemorrhagic Rathke cleft cysts mimicking pituitary apoplexy

2008 ◽  
Vol 108 (1) ◽  
pp. 3-8 ◽  
Author(s):  
Mandy J. Binning ◽  
James K. Liu ◽  
John Gannon ◽  
Anne G. Osborn ◽  
William T. Couldwell
Keyword(s):  
Mr Imaging ◽  
Pituitary Tumor ◽  
Pituitary Apoplexy ◽  
Pituitary Tumors ◽  
Imaging Features ◽  
Mr Images ◽  
Acute Hemorrhage ◽  
Consistent Finding ◽  
Imaging Characteristics ◽  
Intracystic Hemorrhage

Object Rathke cleft cysts (RCCs) are infrequently symptomatic, and apoplexy is one of the most unusual presentations. Only a few cases of apoplexy associated with RCCs have been reported, and their clinical, imaging, surgical, and pathological features are poorly understood. In the cases that have been reported, intracystic hemorrhage has been a consistent finding. The authors report 6 cases of RCCs in which the presenting clinical and imaging features indicated pituitary apoplexy, both with and without intracystic hemorrhage. Methods The authors retrospectively reviewed charts and magnetic resonance (MR) imaging studies obtained in patients who underwent transsphenoidal surgery for RCC. Six patients were identified who presented with symptoms and MR imaging characteristics consistent with pituitary apoplexy but were found intraoperatively to have an RCC. All 6 patients presented with a sudden headache, 2 with visual loss, and 1 with diplopia. Review of the preoperative MR images demonstrated mixed signal intensities in the sellar masses suggestive of a hemorrhagic pituitary tumor. In all patients there was a presumed clinical diagnosis of pituitary tumor apoplexy and an imaging-documented diagnosis of hemorrhagic pituitary tumor. Results All 6 patients underwent transsphenoidal resection to treat the suspected pituitary apoplexy. Intraoperative and histopathological findings were consistent with the diagnosis of an RCC in all cases. Only 2 cases showed evidence of hemorrhage intraoperatively. In all cases, an intracystic nodule was found within the RCC at surgery, and this intracystic nodule was present on the initial MR imaging when retrospectively reviewed. The imaging characteristics of the intracystic nodules were similar to those of acute hemorrhage seen in cases of pituitary apoplexy. Conclusions The clinical and imaging features of RCCs appear similar to those of hemorrhagic pituitary tumors, making them often indistinguishable from pituitary apoplexy.

scholarly journals Pilomatrixoma, a Rare Mimicker of Male Breast Cancer

2019 ◽  
Vol 9 ◽  
pp. 46
Author(s):  
Aurela Clark ◽  
Rebecca Leddy ◽  
Laura Spruill ◽  
Abbie Cluver
Keyword(s):  
Benign Lesion ◽  
Surgical Excision ◽  
Male Breast ◽  
Skin Tumor ◽  
Imaging Features ◽  
Histologic Diagnosis ◽  
Outer Quadrant ◽  
Imaging Characteristics ◽  
Suspicious Feature

Pilomatrixoma or calcifying epithelioma of Malherbe is a benign skin tumor arising from the hair follicle; breast occurrence is considered a rarity. Clinically presenting as a palpable abnormality and with both benign and malignant mammographic and sonographic features, it can be easily misdiagnosed as a breast neoplasm. We report a very rare case of pilomatrixoma of the male breast in a 36-year-old male presenting with a firm, superficial nodule in the upper outer quadrant. Though the sonographic trifecta of imaging features (shape- margins-orientation/oval, circumscribed mass, parallel to the skin) is consistent with a benign lesion, a histologic diagnosis was warranted based on its most suspicious feature of internal pleomorphic calcifications. Pathologic diagnosis revealed the uncommon benign entity of pilomatrixoma in the male breast. Our patient was recommended for surgical excision based on current literature recommendations for management in most reports of pilomatrixoma. One alternative recommendation presented in a single report of pilomatrixoma in the breast supported follow-up imaging based on benign imaging characteristics.

Stereotactic third ventriculostomy in patients with nontumoral adolescent/adult onset aqueductal stenosis and symptomatic hydrocephalus

1991 ◽  
Vol 75 (6) ◽  
pp. 865-873 ◽  
Author(s):  
Patrick J. Kelly
Keyword(s):  
Obstructive Hydrocephalus ◽  
Aqueductal Stenosis ◽  
Primary Treatment ◽  
Target Point ◽  
Third Ventriculostomy ◽  
Computer Assisted ◽  
Adult Onset ◽  
Absorption Mechanism ◽  
Content Type ◽  
Cerebrospinal Fluid Absorption

✓ Sixteen consecutive patients with obstructive hydrocephalus due to nontumoral aqueductal stenosis of adolescent or adult onset underwent computerized tomography-guided stereotactic third ventriculostomy. Computer-assisted angiographic target-point cross-registration was used in surgical planning to reduce morbidity. The procedure was used as primary treatment in five previously unshunted patients and in 11 patients who had previously received shunts and who presented when their shunts became obstructed (five patients), became infected (five patients), or required multiple revisions (one patient). At the time of third ventriculostomy, shunt hardware was removed in patients with infected shunts and the distal element of the shunt was ligated in all patients with obstructed shunts except one, who later required repeat third ventriculostomy; the distal shunt was ligated at that time. Follow-up data (range 1 to 5 years, mean 3½ years, after surgery) showed that only one of the 16 patients had undergone a shunting procedure after the third ventriculostomy. The other 15 patients are asymptomatic and shunt-independent. In previously shunt-dependent patients, the peripheral subarachnoid space and cerebrospinal fluid absorption mechanism remained patent in spite of shunts placed earlier. Therefore, in patients with obstructive hydrocephalus due to aqueductal stenosis of adolescent or adult onset, stereotactic third ventriculostomy should be seriously considered as primary surgical management in previously unshunted patients and in shunt-dependent patients with obstructed or infected shunts.

Analysis of aqueductal cerebrospinal fluid flow after endoscopic aqueductoplasty by using cine phase-contrast magnetic resonance imaging

2000 ◽  
Vol 93 (2) ◽  
pp. 237-244 ◽  
Author(s):  
Henry W. S. Schroeder ◽  
Christiane Schweim ◽  
Klaus H. Schweim ◽  
Michael R. Gaab
Keyword(s):  
Cerebrospinal Fluid ◽  
Magnetic Resonance ◽  
Mr Imaging ◽  
Healthy Volunteers ◽  
Phase Contrast ◽  
Aqueductal Stenosis ◽  
Csf Flow ◽  
Content Type ◽  
Endoscopic Aqueductoplasty ◽  
Fine Print

Object. The purpose of this prospective study was to evaluate aqueductal cerebrospinal fluid (CSF) flow after endoscopic aqueductoplasty. In all patients, preoperative magnetic resonance (MR) imaging revealed hydrocephalus caused by aqueductal stenosis and lack of aqueductal CSF flow.Methods. In 14 healthy volunteers and in eight patients with aqueductal stenosis who had undergone endoscopic aqueductoplasty, aqueductal CSF flow was investigated using cine cardiac-gated phase-contrast MR imaging. For qualitative evaluation of CSF flow, the authors used an in-plane phase-contrast sequence in the midsagittal plane. The MR images were displayed in a closed-loop cine format. Quantitative through-plane measurements were performed in the axial plane perpendicular to the aqueduct. Evaluation revealed no significant difference in aqueductal CSF flow between healthy volunteers and patients with regard to temporal parameters, CSF peak and mean velocities, mean flow, and stroke volume. All restored aqueducts have remained patent 7 to 31 months after surgery.Conclusions. Aqueductal CSF flow after endoscopic aqueductoplasty is similar to aqueductal CSF flow in healthy volunteers. The data indicate that endoscopic aqueductoplasty seems to restore physiological aqueductal CSF flow.

scholarly journals Unusual CT and MR Imaging Characteristics of Splenic Lymphoma

2011 ◽  
Vol 2011 ◽  
pp. 1-3 ◽  
Author(s):  
Chhavi Kaushik ◽  
Nitin Relia ◽  
Kedar Jambhekar ◽  
Tarun Pandey
Keyword(s):  
Mr Imaging ◽  
English Literature ◽  
Vascular Pathology ◽  
Low Density ◽  
Imaging Features ◽  
Focal Lesions ◽  
Imaging Characteristics ◽  
Splenic Lymphoma ◽  
Proven Case ◽  
Common Malignancy

Lymphoma is the most common malignancy of the spleen. The imaging features of splenic lymphoma are nonspecific and mostly lymphomas present as a diffusely enlarged spleen. Focal lesions are described but remain of low density or intensity on CT or MRI, respectively. We describe a histologically proven case of splenic lymphoma that showed an atypical hyperdense/hyperenhancing appearance on imaging suspicious for a vascular pathology. To the best of our knowledge and based on review of English literature, such an appearance of splenic lymphoma is extremely unusual and rare.

Failure of third ventriculostomy in the treatment of aqueductal stenosis in children

1999 ◽  
Vol 90 (3) ◽  
pp. 448-454 ◽  
Author(s):  
Giuseppe Cinalli ◽  
Christian Sainte-Rose ◽  
Paul Chumas ◽  
Michel Zerah ◽  
Francis Brunelle ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Aqueductal Stenosis ◽  
Third Ventriculostomy ◽  
Content Type ◽  
Group I ◽  
Endoscopic Guidance ◽  
Group Ii ◽  
Fine Print

Object. The goal of this study was to analyze the types of failure and long-term efficacy of third ventriculostomy in children.Methods. The authors retrospectively analyzed clinical data obtained in 213 children affected by obstructive triventricular hydrocephalus who were treated by third ventriculostomy between 1973 and 1997. There were 120 boys and 93 girls. The causes of the hydrocephalus included: aqueductal stenosis in 126 cases; toxoplasmosis in 23 cases, pineal, mesencephalic, or tectal tumor in 42 cases; and other causes in 22 cases. In 94 cases, the procedure was performed using ventriculographic guidance (Group I) and in 119 cases by using endoscopic guidance (Group II). In 19 cases (12 in Group I and seven in Group II) failure was related to the surgical technique. Three deaths related to the technique were observed in Group I. For the remaining patients, Kaplan—Meier survival analysis showed a functioning third ventriculostomy rate of 72% at 6 years with a mean follow-up period of 45.5 months (range 4 days–17 years). No significant differences were found during long-term follow up between the two groups. In Group I, a significantly higher failure rate was seen in children younger than 6 months of age, but this difference was not observed in Group II. Thirty-eight patients required reoperation (21 in Group I and 17 in Group II) because of persistent or recurrent intracranial hypertension. In 29 patients shunt placement was necessary. In nine patients in whom there was radiologically confirmed obstruction of the stoma, the third ventriculostomy was repeated; this was successful in seven cases. Cine phase-contrast (PC) magnetic resonance (MR) imaging studies were performed in 15 patients in Group I at least 10 years after they had undergone third ventriculostomy (range 10–17 years, median 14.3 years); this confirmed long-term patency of the stoma in all cases.Conclusions. Third ventriculostomy effectively controls obstructive triventricular hydrocephalus in more than 70% of children and should be preferred to placement of extracranial cerebrospinal shunts in this group of patients. When performed using ventriculographic guidance, the technique has a higher mortality rate and a higher failure rate in children younger than 6 months of age and is, therefore, no longer preferred. When third ventriculostomy is performed using endoscopic guidance, the same long-term results are achieved in children younger than 6 months of age as in older children and, thus, patient age should no longer be considered as a contraindication to using the technique. Delayed failures are usually secondary to obstruction of the stoma and often can be managed by repeating the procedure. Midline sagittal T2-weighted MR imaging sequences combined with cine PC MR imaging flow measurements provide a reliable tool for diagnosis of aqueductal stenosis and for ascertaining the patency of the stoma during follow-up evaluation.

scholarly journals MR Imaging Features of Adult-Onset Neuronal Intranuclear Inclusion Disease May Be Indistinguishable from Fragile X–Associated Tremor/Ataxia Syndrome

2018 ◽  
Vol 39 (9) ◽  
pp. E100-E101 ◽  
Author(s):  
I.G. Padilha ◽  
R.H. Nunes ◽  
F.A. Scortegagna ◽  
J.L. Pedroso ◽  
V.H. Marussi ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Fragile X ◽  
Imaging Features ◽  
Adult Onset ◽  
Intranuclear Inclusion ◽  
Neuronal Intranuclear Inclusion ◽  
Ataxia Syndrome

Suprapineal recess: an alternate site for third ventriculostomy?

2004 ◽  
Vol 101 (3) ◽  
pp. 518-520 ◽  
Author(s):  
Roy Thomas Daniel ◽  
Gabriel Yin Foo Lee ◽  
Peter Lawrence Reilly
Keyword(s):  
Mr Imaging ◽  
Clinical Symptoms ◽  
Aqueductal Stenosis ◽  
Third Ventriculostomy ◽  
Content Type ◽  
Cerebrospinal Fluid Flow ◽  
Shunt Dysfunction ◽  
Symptoms And Signs ◽  
Endoscopic Ventriculostomy ◽  
Triventricular Hydrocephalus

✓ This 30-year-old woman presented with clinical symptoms and signs of intracranial hypertension and Parinaud syndrome secondary to ventriculoperitoneal shunt dysfunction. Magnetic resonance (MR) imaging revealed gross triventricular hydrocephalus with a large suprapineal recess due to aqueductal stenosis. Using an endoscopic approach, a ventriculostomy was performed within the floor of the dilated suprapineal recess. Following this procedure the patient experienced alleviation of all her neurological symptoms and signs. Postoperative MR imaging and cerebrospinal fluid flow studies demonstrated a functioning ventriculostomy. The anatomy of the suprapineal recess and its suitability for endoscopic ventriculostomy are discussed.

scholarly journals Imaging Features of Intracranial Meningiomas with Histopathological Correlation: A Relook into Old Disease

2013 ◽  
Vol 3 (1) ◽  
pp. 14-32
Author(s):  
K Gangadhar ◽  
D Santhosh ◽  
GM Fatterpekar
Keyword(s):  
Mr Imaging ◽  
Signs And Symptoms ◽  
Intracranial Meningioma ◽  
Imaging Features ◽  
Imaging Findings ◽  
Histopathological Correlation ◽  
Imaging Characteristics ◽  
Dural Tail ◽  
Atypical Meningiomas ◽  
Weighted Sequences

Background and Purpose: Imaging characteristics of meningiomas have been discussed previously in many studies; however complete imaging features involving general features, MRS and DWI of both typical and atypical meningiomas have been discussed in very few studies. CT and MR imaging findings in 46 cases of intracranial meningioma are reviewed to define specific imaging features. Methods: The present study was carried on 46 patients in the Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University during June 2009 to July 2011.The investigation was carried out by GE-VCT 64 Slice Scanner machine and Magnetic resonance imaging was contemplated using 1.5 Tesla SIEMENS-MAGNETOM AVANTO. CT and MR imaging studies were reviewed to characterize mass location, imaging characteristics, atypical features and advanced imaging features. Clinical presenting signs and symptoms were correlated with imaging findings. Results: a). Forty six cases of intra cranial meningiomas were studied prospectively in 24 women and 22men, aged 11 – 80 years. Meningiomas were stratified into typical and atypical and also depending upon intra cranial location. b). 73.91% of the cases in showed supratentorial location, rest were infratentorial (26.08%).CT/MRI revealed well defined margins in 84.78% with homogenous consistency in 73.91% of lesions. Foci of necrosis were noted in 32.60% of cases and 15.22% of cases showed calcification foci in meningioma. Sinus invasion noticed in 15.22% of cases, whereas adjacent bony reaction noticed in 30.43% of cases. c). Majority of Meningioma showed broad dural base (89.10%), adjacent white matter buckling (71.74%) and surrounding CSF cleft (52.17%). Displaced subarachnoid vessels were demonstrated in 30.43%, where as the pathognomonic dural tail was present in only 23.91% of the cases. d). All the cases of Meningioma demonstrated restriction on diffusion weighted sequences suggestive of high cellularity of the lesions. On CT angiography, neovascularity was noticed in 85.71% and tumor blush was noticed in 71.42% incidence. On MR Spectroscopy, all demonstrated choline peak and in one third cases alanine peak was discernible. Conclusion: In view of the observed evidence, it was concluded that understanding the classification, pathology and imaging appearance meningioma are essential for treatment planning. CT and MR imaging play indispensable role in the localization & characterization of these tumors, and MR have virtually yielded its position of dominance in characterizing these tumors. Nepalese Journal of Radiology / Vol.3 / No.1 / Issue 4 / Jan-June, 2013 / 14-32 DOI: http://dx.doi.org/10.3126/njr.v3i1.8713

Serial S-100 protein serum measurements related to early magnetic resonance imaging after minor head injury

1996 ◽  
Vol 85 (5) ◽  
pp. 945-948 ◽  
Author(s):  
Tor Ingebrigtsen ◽  
Bertil Romner
Keyword(s):  
Magnetic Resonance Imaging ◽  
Head Injury ◽  
Magnetic Resonance ◽  
Mr Imaging ◽  
Minor Head Injury ◽  
Cerebellar Hemisphere ◽  
Resonance Imaging ◽  
Cerebral Contusion ◽  
Content Type ◽  
S 100

✓ The authors studied 24 patients with a Glasgow Coma Scale score of 14 or 15 and normal computerized tomography scans after minor head injury. The study protocol included obtaining serial measurements of S-100 protein in serum during the first 12 hours after injury and early magnetic resonance (MR) imaging. Four patients (17%) had detectable levels of S-100 protein in serum. The S-100 protein levels were highest immediately after trauma, declining hour by hour. In two patients, MR imaging revealed intracranial contusion. Levels of S-100 protein were not detectable in serum in one patient with MR-verified cerebral contusion, but the first measurements were made late, 6 hours after trauma. The highest serum level of S-100 protein (0.9 µg/L) was seen in a 73-year-old man 2 hours after injury. Magnetic resonance imaging revealed a contusion of the left cerebellar hemisphere, and the patient suffered permanent sequelae of impaired posture and dizziness.

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