scholarly journals Isolated Wrist Drop Presenting as Acute Stroke: Rare Case Report with Review of Literature

2018 ◽  
Vol 09 (04) ◽  
pp. 647-649
Author(s):  
Khushbu Goel ◽  
Saraj Kumar Singh ◽  
Himanshu Agarwal ◽  
Joy Dev Mukherji ◽  
Mukesh Kumar
Keyword(s):  
Magnetic Resonance ◽  
Acute Stroke ◽  
Brain Mri ◽  
Intravenous Thrombolysis ◽  
Acute Onset ◽  
Cerebral Stroke ◽  
Rare Presentation ◽  
Rare Case Report ◽  
Magnetic Resonance Imaging Mri ◽  
Wrist Drop

ABSTRACTIsolated wrist drop is very unusual clinical presentation due to cerebral stroke. It is highly confused with peripheral neuropathy. However, timely detection of acute stroke as one of the causes of wrist drop is necessary as it changes the line of treatment and prognosis significantly. Here we are presenting a 62 year-old diabetic and hypertensive male patient who came with acute onset weakness of right hand. Initial Magnetic resonance imaging (MRI) of the brain showed hyperacute infarct in the splenium of corpus callosum. Magnetic resonance angiography (MRA) was normal. Repeat brain MRI on next day showed acute infarct at hand area of motor strip in posterior frontal region. The patient underwent intravenous thrombolysis and thereafter improved significantly. Isolated hand palsy is a rare presentation of stroke, often mistaken for peripheral lesion.

Pediatric Reversible Cerebral Vasoconstriction Syndrome: Two Unique Cases with a Review of all Reported Children

2021 ◽  
Author(s):  
Neelu Desai ◽  
Rahul Badheka ◽  
Nitin Shah ◽  
Vrajesh Udani
Keyword(s):  
Magnetic Resonance ◽  
Cerebral Arteries ◽  
Brain Mri ◽  
Brain Magnetic Resonance Imaging ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Neurological Deficits ◽  
Cerebral Vasoconstriction ◽  
Magnetic Resonance Imaging Mri ◽  
Reversible Encephalopathy ◽  
Mr Angiogram

AbstractReversible cerebral vasoconstriction syndrome (RCVS) has been well described in adults, but pediatric cases are yet under recognized. We describe two children with RCVS and review similar already published pediatric cases. The first patient was a 10-year-old girl who presented with severe headaches and seizures 3 days after blood transfusion. Brain magnetic resonance imaging (MRI) showed changes compatible with posterior reversible encephalopathy syndrome and subarachnoid hemorrhage. Magnetic resonance angiogram showed diffuse vasoconstriction of multiple cerebral arteries. The second patient was a 9-year-old boy who presented with severe thunderclap headaches. Brain MRI showed isolated intraventricular hemorrhage. Computed tomography/MR angiogram and digital subtraction angiogram were normal. A week later, he developed focal neurological deficits. Repeated MR angiogram showed diffuse vasospasm of multiple intracranial arteries. Both children recovered completely. A clinico-radiological review of previously reported childhood RCVS is provided.

scholarly journals Can we evaluate cranial aneurysms on conventional brain magnetic resonance imaging?

2016 ◽  
Vol 7 (01) ◽  
pp. 83-86 ◽  
Author(s):  
Emine Caliskan ◽  
Yeliz Pekcevik ◽  
Adnan Kaya
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Characteristic Curve ◽  
Brain Mri ◽  
Brain Magnetic Resonance Imaging ◽  
Kappa Statistics ◽  
Resonance Imaging ◽  
Vascular Structures ◽  
Magnetic Resonance Imaging Mri ◽  
Age Range

ABSTRACT Purpose: To evaluate the contribution of conventional brain magnetic resonance imaging (MRI) for the determination of intracranial aneurysms. Materials and Methods: Brain MRI and computed tomography angiography (CTA) of 45 patients (29 women and 16 men; age range, 32–80 years) with aneurysm were analyzed. A comparison was made between brain MRI and CTA based on size and presence of aneurysm. The comparisons between MRI and CTA were investigated through Bland-Altman graphics, receiver operating characteristic curve, and Kappa statistics. Results: Fifty-seven aneurysms were evaluated. Forty-five percent of 57 aneurysms on CTA were detected on conventional brain MRI. A significant correlation was found between CTA and brain MRI in the diagnosis of aneurysm (P < 0.05). In an analysis of the size measurement, a significant correlation was observed between CTA and brain MRI. Seventy-seven percent of aneurysms <4 mm was not detected and the efficiency of MRI in the detection of aneurysms <4 mm was found to be low. Conclusion: Aneurysms can also be appreciated on conventional brain MRI, and vascular structures should be reviewed carefully while analyzing brain MRI.

scholarly journals A Novel SUCLA2 Mutation Presenting as a Complex Childhood Movement Disorder

2016 ◽  
Vol 32 (2) ◽  
pp. 246-250 ◽  
Author(s):  
Caterina Garone ◽  
Juliana Gurgel-Giannetti ◽  
Simone Sanna-Cherchi ◽  
Sindu Krishna ◽  
Ali Naini ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Movement Disorder ◽  
Brain Mri ◽  
Brain Magnetic Resonance Imaging ◽  
Mitochondrial Respiratory Chain ◽  
Resonance Spectroscopy ◽  
Homozygous Mutation ◽  
Psychomotor Delay ◽  
Mtdna Depletion ◽  
Magnetic Resonance Imaging Mri

SUCLA2 defects have been associated with mitochondrial DNA (mtDNA) depletion and the triad of hypotonia, dystonia/Leigh-like syndrome, and deafness. A 9-year-old Brazilian boy of consanguineous parents presented with psychomotor delay, deafness, myopathy, ataxia, and chorea. Despite the prominent movement disorder, brain magnetic resonance imaging (MRI) was normal while 1H-magnetic resonance spectroscopy (MRS) showed lactate peaks in the cerebral cortex and lateral ventricles. Decreased biochemical activities of mitochondrial respiratory chain enzymes containing mtDNA-encoded subunits and mtDNA depletion were observed in muscle and fibroblasts. A novel homozygous mutation in SUCLA2, the first one in the ligase coenzyme A (CoA) domain of the protein, was identified. Escalating doses of CoQ10 up to 2000 mg daily were associated with improvement of muscle weakness and stabilization of the disease course. The findings indicate the importance of screening for mitochondrial dysfunction in patients with complex movement disorders without brain MRI lesions and further investigation for potential secondary CoQ10 deficiency in patients with SUCLA2 mutations.

scholarly journals Periportal hepatic involvement of non-Hodgkin lymphoma: a rare case report with magnetic resonance imaging findings

2018 ◽  
Vol 47 (2) ◽  
pp. 986-991
Author(s):  
Mehmet Beyazal
Keyword(s):  
Magnetic Resonance Imaging ◽  
Case Report ◽  
Magnetic Resonance ◽  
Resonance Imaging ◽  
Mri Findings ◽  
Non Hodgkin Lymphoma ◽  
Hepatic Involvement ◽  
Rare Case Report ◽  
Magnetic Resonance Imaging Mri ◽  
Histopathological Results

Lymphoma with hepatic involvement can present with three morphological patterns: diffuse infiltrative, nodular, and mixed infiltrative–nodular. However, lymphoma with periportal infiltrative hepatic involvement is rare. There have been a few reports of cases with this type of hepatic involvement including ultrasound or computed tomography (CT) findings. In this case report, we present CT, magnetic resonance imaging (MRI), and diffusion-weighted MRI findings together with the histopathological results for a patient with periportal hepatic lymphoma presenting with obstructive jaundice.

scholarly journals Slowly expanding/evolving lesions as a magnetic resonance imaging marker of chronic active multiple sclerosis lesions

2018 ◽  
Vol 25 (14) ◽  
pp. 1915-1925 ◽  
Author(s):  
Colm Elliott ◽  
Jerry S Wolinsky ◽  
Stephen L Hauser ◽  
Ludwig Kappos ◽  
Frederik Barkhof ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Sclerosis ◽  
Magnetic Resonance ◽  
Brain Mri ◽  
Brain Magnetic Resonance Imaging ◽  
Tissue Loss ◽  
Jacobian Determinant ◽  
Resonance Imaging ◽  
T2 Lesions ◽  
Magnetic Resonance Imaging Mri

Background: Chronic lesion activity driven by smoldering inflammation is a pathological hallmark of progressive forms of multiple sclerosis (MS). Objective: To develop a method for automatic detection of slowly expanding/evolving lesions (SELs) on conventional brain magnetic resonance imaging (MRI) and characterize such SELs in primary progressive MS (PPMS) and relapsing MS (RMS) populations. Methods: We defined SELs as contiguous regions of existing T2 lesions showing local expansion assessed by the Jacobian determinant of the deformation between reference and follow-up scans. SEL candidates were assigned a heuristic score based on concentricity and constancy of change in T2- and T1-weighted MRIs. SELs were examined in 1334 RMS patients and 555 PPMS patients. Results: Compared with RMS patients, PPMS patients had higher numbers of SELs ( p = 0.002) and higher T2 volumes of SELs ( p < 0.001). SELs were devoid of gadolinium enhancement. Compared with areas of T2 lesions not classified as SEL, SELs had significantly lower T1 intensity at baseline and larger decrease in T1 intensity over time. Conclusion: We suggest that SELs reflect chronic tissue loss in the absence of ongoing acute inflammation. SELs may represent a conventional brain MRI correlate of chronic active MS lesions and a candidate biomarker for smoldering inflammation in MS.

Stroke Mimics in a Stroke Care Pathway Based on MRI Screening

2016 ◽  
Vol 42 (3-4) ◽  
pp. 205-212 ◽  
Author(s):  
Véronique Quenardelle ◽  
Valérie Lauer-Ober ◽  
Ielyzaveta Zinchenko ◽  
Marc Bataillard ◽  
Olivier Rouyer ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Predictive Value ◽  
Time Window ◽  
Care Pathway ◽  
Brain Mri ◽  
Intravenous Thrombolysis ◽  
Stroke Care ◽  
Motor Deficit ◽  
Discharge Diagnosis ◽  
Cerebral Mri

Background: Since the use of tissue plasminogen activator for acute ischemic stroke (IS), stroke care pathways have been developed for patients with suspicion of acute stroke. The aim of this prospective observational study was to analyze the stroke mimic (SM) characteristics in patients who were part of our stroke care pathway. Methods: All consecutive patients admitted in the code stroke within a 1-year period were prospectively enrolled in this study. Patients with a sudden onset of neurological focal deficit in a time window less than 4H30 as indicated for intravenous thrombolysis, had been accepted in the pathway by a neurologist who was directly contactable by the prehospital emergency medical service 24 h per day. Patients arrived directly on the MRI site without passing by the emergency department. A clinical neurological evaluation and a brain MRI with tri-dimensional time-of-flight magnetic resonance angiography were performed. The FAST score was calculated a posteriori. The final discharge diagnosis was concluded either immediately after both neurological examination and cerebrovascular neuroimaging or after other relevant investigations. We classified the discharge diagnosis into neurovascular diseases (NVDs) and into SM. Results: There were 1,361 consecutive patients admitted for suspicion of acute stroke. Sixty-two percent (n = 840) had an NVD including IS (n = 529), transient ischemic attacks (n = 236), intracranial hemorrhages (n = 68), cerebral venous thrombosis (n = 3) and neurovascular medullar pathologies (n = 4). SM represented 38% of cases (n = 521) and the most frequent discharge diagnosis was defined as headaches (18.6%), psychological disorders (16.7%), peripheral vertigo (11.9%) and epilepsy (10.6%). The comparison between the characteristics of the NVD and those of the SM groups showed some significant differences: in the SM group, women were more represented, patients were younger and the NIHSS was lower than in the NVD group. All cardiovascular risk factors were more represented in the NVD group. Concerning the symptoms, motor deficit, speech disturbances, homonymous lateral hemianopia and head and gaze deviation were more represented in the NVD group, whereas vertigo, non-systematized visual trouble, headache, confusion, weakness, neuropsychological symptoms, seizure and chest pain were significantly more frequent in the SM group. The negative predictive value of the FAST score was 64% and the positive predictive value was 76%. Conclusions: A rate of SM up to 38% of the code stroke system confirms the difficulty to distinguish clinically a stroke from another diagnosis. In this study, using cerebral MRI in first intention was of special interest in patients with acute neurological symptoms to differentiate an NVD from an SM.

Segmentation of Brain MRI Using Wavelet Transform and Grammatical Bee Colony

2018 ◽  
Vol 27 (07) ◽  
pp. 1850108 ◽  
Author(s):  
Tapas Si ◽  
Arunava De ◽  
Anup Kumar Bhattacharjee
Keyword(s):  
Magnetic Resonance ◽  
Brain Mri ◽  
Mr Images ◽  
Bee Colony ◽  
Analysis Task ◽  
Trained Classifier ◽  
Skull Stripping ◽  
Segmented Images ◽  
Fluid Attenuated Inversion Recovery ◽  
Magnetic Resonance Imaging Mri

Multimodal Magnetic Resonance Imaging (MRI) is an imaging technique widely used in the diagnosis and treatment planning of patients. Lesion segmentation of brain MRI is one of the most important image analysis task in medical imaging. In this paper, a new method for the supervised segmentation of the lesion in brain MRI using Grammatical Bee Colony (GBC) is proposed. The segmentation process is adversely affected by the presence of noises and intensity inhomogeneities in the Magnetic Resonance (MR) images. Therefore, noises are removed from the images and intensity inhomogeneities are corrected in the pre-processing steps. A set of stationary wavelet features are extracted from the co-registered [Formula: see text]1-weighted ([Formula: see text]-[Formula: see text]), [Formula: see text]2-weighted ([Formula: see text]-[Formula: see text]) and Fluid–Attenuated Inversion Recovery (FLAIR) images after skull stripping. A classifier is evolved using the GBC to classify the tissues as healthy tissues or lesions. The GBC classifier is trained with extracted features. The trained classifier is used to segment the test Magnetic Resonance (MR) image into healthy tissues or lesion regions. Finally, the connected component labeling algorithm is used to extract the lesions from the segmented images in the post-processing step. Effectiveness of the proposed method is tested by identifying the brain lesions from a set of MR images.

scholarly journals Magnetic resonance imaging outcomes from a phase III trial of teriflunomide

2013 ◽  
Vol 19 (10) ◽  
pp. 1310-1319 ◽  
Author(s):  
Jerry S Wolinsky ◽  
Ponnada A Narayana ◽  
Flavia Nelson ◽  
Sushmita Datta ◽  
Paul O’Connor ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Disease Progression ◽  
Relapse Rate ◽  
Brain Mri ◽  
Dose Effect ◽  
Phase Iii ◽  
Lesion Volume ◽  
Resonance Imaging ◽  
Magnetic Resonance Imaging Mri

Objective: The purpose of this study was to determine the effects of oral teriflunomide on multiple sclerosis (MS) pathology inferred by magnetic resonance imaging (MRI). Methods: Patients ( n=1088) with relapsing MS were randomized to once-daily teriflunomide 7 mg or 14 mg, or placebo, for 108 weeks. MRI was recorded at baseline, 24, 48, 72 and 108 weeks. Annualized relapse rate and confirmed progression of disability (sustained ≥12 weeks) were the primary and key secondary outcomes. The principal MRI outcome was change in total lesion volume. Results: After 108 weeks, increase in total lesion volume was 67.4% ( p=0.0003) and 39.4% ( p=0.0317) lower in the 14 and 7 mg dose groups versus placebo. Other measures favoring teriflunomide were accumulated enhanced lesions, combined unique activity, T2-hyperintense and T1-hypointense component lesion volumes, white matter volume, and a composite MRI score; all were significant for teriflunomide 14 mg and most significant for 7 mg versus placebo. Conclusions: Teriflunomide provided benefits on brain MRI activity across multiple measures, with a dose effect evident on several markers. These effects were also consistent across selected subgroups of the study population. These findings complement clinical data showing significant teriflunomide-related reductions in relapse rate and disease progression, and demonstrate containment of MRI-defined disease progression.

scholarly journals Recurrent Encephalopathy During Febrile Illnesses in a 6-Year-Old Boy

2018 ◽  
Vol 5 ◽  
pp. 2333794X1878420
Author(s):  
Eliza Szuch ◽  
Jeanna Auriemma
Keyword(s):  
Influenza A ◽  
Brain Mri ◽  
Acute Onset ◽  
Inborn Errors ◽  
Maple Syrup ◽  
Pathogenic Variants ◽  
Organic Acid Profile ◽  
Urine Organic Acid ◽  
Magnetic Resonance Imaging Mri ◽  
High Index Of Suspicion

Acute onset of encephalopathy is often due to infections or intoxications, but a high index of suspicion should exist for metabolic or autoimmune causes particularly in recurrent cases. A 6-year-old previously healthy Caucasian male presented with confusion and somnolence. He had several days of fever, myalgia, headaches, and rhinorrhea and was influenza-A positive. He was noted to have new urinary incontinence, inability to follow commands, and was responsive only to noxious stimuli. His neurological examination revealed bilateral ankle clonus. Laboratory results were significant for hypoglycemia and high anion gap metabolic acidosis. Cerebrospinal fluid was unremarkable and cultures remained negative. A magnetic resonance imaging (MRI) of the brain showed diffuse gray matter restricted diffusion. His presentation was attributed to acute influenza-A encephalitis. Four months later, he presented with emesis, abdominal pain, dehydration, and hypoglycemia. He subsequently developed dysarthria and confusion. A brain MRI was similar to his previous presentation. A repeat lumbar puncture was normal. A urine organic acid profile showed elevations of ketones and branched chain ketoacids, with mild elevations of N-acetylleucine and N-acetyl isoleucine. This pattern is consistent with maple syrup urine disease (MSUD). Genetic testing revealed that he is a heterozygote for 2 pathogenic variants in the BCKDHB gene (P200X and G278S), confirming MSUD. This case highlights the importance of broadening workup to include inborn errors of metabolism in cases of unexplained encephalopathy. Providers should be aware that diseases such as MSUD can occur in intermittent forms that may not be detected until early childhood.

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