scholarly journals Symptomatic Giant Virchow-Robin Spaces: A Rare Cause of Spastic Quadriparesis in 43-Year-old Ethiopian Patient: A Case Report

2020 ◽  
Vol 30 (5) ◽  
Author(s):  
Biniyam Ayele ◽  
Guta Zenebe ◽  
Abenet Mengesha ◽  
Yegeta Teshale
Keyword(s):  
Brain Mri ◽  
Cranial Nerves ◽  
Internal Capsule ◽  
Mass Effect ◽  
Neurological Complications ◽  
Perivascular Spaces ◽  
Anatomical Structures ◽  
Visual Blurring ◽  
Spastic Quadriparesis ◽  
Progressive Weakness

BACKGROUND: Virchow-Robin Spaces (VRS) are perivascular spaces that surround small arteries and arterioles. These normal anatomical structures are thought to be involved in the drainage of interstitial fluid and also to play an immunomodulatory role by hosting macrophages. Rarely, it becomes giant and symptomatic resulting in mass effect on adjacent neuronal structures and ventricular system causing different neurological disorders.CASE PRESENTATION: We report a 43-year-old, Ethiopian woman who presented with progressive weakness of all her extremity over the period of seven years. She had associated speech difficulty, visual blurring and pseudo-bulbar affect. Neurologic examination revealed spastic quadriparesis with increased deep tendon reflexes and up going plantar bilaterally. She had horizontal nystagmus, dysarthria and reduced bilateral visual acuity, otherwise normal cognition and cranial nerves examination. Brain MRI showed T1 hypointense, T2 hyperintense and non-enhancing multiple cystic lesions of different size, mainly in bilateral basal ganglia area with mass effect on adjacent internal capsule and lateral ventricles. Considering her clinical presentation and typical radiological features, diagnosis of symptomatic dilated Virchow-Robin spaces was made, and the patient was treated symptomatically.CONCLUSION: Commonly, dilation of Virchow-Robin spaces are not symptomatic, but giant Virchow-Robin spaces, as in our patient may result in spastic quadriparesis, causing great disability on the patient. Thus, we recommend considering symptomatic Virchow- Robin spaces as a potential differential diagnosis of progressive quadriparesis, as early neurosurgical intervention may reduce the neurological complications, such as spastic quadriparesis. 

scholarly journals Distinct pattern of microsusceptibility changes on brain magnetic resonance imaging (MRI) in critically ill patients on mechanical ventilation/oxygenation

2021 ◽  
Author(s):  
Majda M. Thurnher ◽  
Jasmina Boban ◽  
Martin Röggla ◽  
Thomas Staudinger
Keyword(s):  
Mechanical Ventilation ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Brain Mri ◽  
Brain Magnetic Resonance Imaging ◽  
Internal Capsule ◽  
Neurological Complications ◽  
Subcortical White Matter ◽  
Distinct Pattern ◽  
Magnetic Resonance Imaging Mri

AbstractPurposeOver the years, interesting SWI abnormalities in patients from intensive care units (ICU) were observed, not attributable to a specific cause and with uncertain clinical significance. Recently, multiple SWI-hypointense foci were mentioned related to neurological complications of SARS-COV-2 infection. The purpose of the study was to describe the patterns of susceptibility brain changes in critically-ill patients who underwent mechanical ventilation and/or extracorporeal membrane oxygenation (ECMO).MethodsAn institutional board-approved, retrospective study was conducted on 250 ICU patients in whom brain MRI was performed between January 2011 and May 2020. Out of 48 patients who underwent mechanical ventilation/ECMO, in fifteen patients (median age 47.7 years), the presence of SWI abnormalities was observed and described.ResultsMicrosusceptibilities were located in white-gray matter interface, in subcortical white matter (U-fibers), and surrounding subcortical nuclei in 13/14 (92,8%) patients. In 8/14 (57,1%) patients, SWI foci were seen infratentorially. The corpus callosum was affected in ten (71,4%), internal capsule in five (35,7%), and midbrain/pons in six (42,8%) patients.ConclusionWe showed distinct patterns of diffuse brain SWI susceptibilities in critically-ill patients who underwent mechanical ventilation/ECMO. The etiology of these foci remains uncertain, but the association with mechanical ventilation, prolonged respiratory failure, and hypoxemia seems probable explanations.

scholarly journals Marchiafava-Bignami Disease in a Nonalcoholic Diabetic Patient

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Sisira Yadala ◽  
Jin Jun Luo
Keyword(s):  
Corpus Callosum ◽  
Diabetic Patient ◽  
Early Stage ◽  
Brain Mri ◽  
Cranial Nerves ◽  
Internal Capsule ◽  
Sudden Onset ◽  
Functional Disturbance ◽  
Wide Range ◽  
Underlying Pathophysiology

Marchiafava-Bignami disease (MBD) is a rare neurological disorder mostly seen in alcoholic and malnourished patients with a pathognomonic hallmark of corpus callosum demyelination. MBD in nonalcoholics without malnutrition has rarely been reported. We report a case of MBD in a diabetic patient, without alcoholism or malnutrition, caused by a wide range of glycemic level fluctuations. A 38-year-old man presented with sudden onset of alteration in speech and multiple falls in three days. Neurologic examination showed dysarthria, dysmetria, and ataxia but, otherwise, normal cranial nerves, motor and sensory functions, and tendon reflexes. Brain MRI showed symmetric abnormalities in the splenium of the corpus callosum. In addition, demyelination was also observed in bilateral posterior limbs of the internal capsule and brachium ponti. His symptoms significantly improved after stabilization and normalization of his plasma glucose level and administration of multivitamins and corticosteroids. The underlying pathophysiology of the development of MBD in our case is likely to be osmotic stress from a wide range of glycemic fluctuations causing structural and functional disturbance of oligodendrocytes, which may be reversible in its early stage.

scholarly journals A rare case of central nervous system amyloidoma treated with fractionated radiotherapy

2017 ◽  
Vol 127 (2) ◽  
pp. 338-341 ◽  
Author(s):  
Teresa Meier ◽  
J. Michael Hazenfield ◽  
Saulius Girnius ◽  
Matthew Hagen ◽  
Ronald E. Warnick ◽  
...  
Keyword(s):  
Systemic Disease ◽  
Brain Mri ◽  
Internal Capsule ◽  
High Grade Glioma ◽  
Mass Effect ◽  
Facial Weakness ◽  
Fractionated Radiotherapy ◽  
Disease Therapy ◽  
Serial Brain ◽  
Multiple Episodes

A 54-year-old female presented with multiple episodes of emesis, intractable headaches, worsening balance, and slowly progressive right facial weakness. Imaging demonstrated a 3-cm mass in the left internal capsule and corona radiata region with associated edema, mass effect, and midline shift concerning for high-grade glioma, lymphoma, or brain metastasis. Stereotactic biopsy of the mass was consistent with amyloid deposition. Systemic workup for amyloidosis was negative, and the mass was thought to represent a focal tumor-like deposit of amyloid, also referred to as “amyloidoma.” In the absence of systemic disease, therapy, which can include surgery or radiotherapy, can be directed at the local process. The location of the patient's lesion was not amenable to resection; therefore, she was treated with fractionated radiotherapy of 30.6 Gy at 1.8 Gy per fraction. Serial brain MRI demonstrated stability 18 months out from therapy. To the authors' knowledge, this is the first documented case of focal fractionated radiotherapy for CNS amyloidoma. The authors concluded that radiotherapy can prevent further progression of amyloidomas in anatomical locations that prohibit resection.

scholarly journals DYSPLASTIC WHITE MATTER LESIONS IN PATIENT WITH NEUROFIBROMATOSIS 1

2015 ◽  
Vol 14 (2) ◽  
pp. 90-92
Author(s):  
P. Amaresh Reddy ◽  
◽  
Amit Agrawal ◽  
V. Umamaheshwar Reddy ◽  
P. Radharani ◽  
...  
Keyword(s):  
White Matter ◽  
Neuropsychological Functioning ◽  
Brain Mri ◽  
White Matter Lesions ◽  
Internal Capsule ◽  
Mass Effect ◽  
Neurofibromatosis 1 ◽  
Hyperintense Lesion ◽  
Malignant Lesions

Dysplastic white matter lesions/unidentified bright objects /Foci of abnormal signal intensities (FASi’s) in brain MRI are the commonest intracranial abnormality with Neurofibromatosis 1 seen in approximately 70-75% of patients. They are usually multiple, small in size and are typically located in globus pallidus, brainstem, centrum semiovale, thalamus, internal capsule, corpus callosum, and cerebellum. Although clinically silent, patients can present with reduced attention span however neuropsychological functioning of these lesions depends upon the region involved. NF1 lesions should be kept as differential for any hyperintense lesion in basal ganglia and caution is advised not to confuse these lesions with malignant lesions like gliomas as biopsies from these lesions showed benign etiology. Parental counselling regarding the prognosis is very important to alleviate unnecessary apprehension. Interval follow-up is advised for large lesions causing mass effect, showing contrast enhancement or when lesions are located in optic pathway.

scholarly journals Hematopoietic Stem Cell Transplantation-Associated Neurological Complications and Their Brain MR Imaging Findings in a Pediatric Population

Cancers ◽  
2021 ◽  
Vol 13 (12) ◽  
pp. 3090
Author(s):  
Hyewon Shin ◽  
Mi-Sun Yum ◽  
Min-Jee Kim ◽  
Jin Kyung Suh ◽  
Ho Joon Im ◽  
...  
Keyword(s):  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Malignant Disease ◽  
Brain Mri ◽  
Neurological Complications ◽  
Neurologic Complications ◽  
Hematopoietic Stem ◽  
The Poor ◽  
Poor Outcome Group ◽  
Outcome Group

Purpose: To determine the prognostic indicators for hematopoietic stem cell transplantation (HSCT)-associated neurological complications, the clinical characteristics and brain magnetic resonance imaging (MRI) lesions in pediatric HSCT recipients were reviewed. Methods: This retrospective study included 51 patients who had underwent a brain MRI due to newly developed neurological symptoms or infection signs during chemotherapy or HSCT. We reviewed the demographics, received treatments, treatment-related morbidities, laboratory findings and brain MRI findings, which were compared between good and poor neurologic outcome groups. Results: Thirty-seven patients (72.5%) fully recovered from the neurologic deficits and fourteen (27.5%) persisted or aggravated. The children with an underlying malignant disease had significantly poorer neurological outcomes (p = 0.015). The neurologic complications associated with infection were more frequent in the poor outcome group (p = 0.038). In the neuroimaging findings, the extent of the white matter lesions was significantly higher in the poor outcome group, as was that of abnormal enhancement, ventriculomegaly, cortical change, deep gray matter abnormalities and cerebellar abnormalities. Conclusion: Most children with neurologic complications and neuroimaging abnormalities during HSCT had recovered. However, children with neurologic complications associated with infectious causes, malignant disease or severe brain MRI abnormalities should be more carefully monitored during HSCT.

scholarly journals Gasperini Syndrome: A Case Report and Systematic Review and Proposing a New Definition

2020 ◽  
Vol 12 (3) ◽  
pp. 433-439
Author(s):  
Riwaj Bhagat ◽  
Siddharth Narayanan ◽  
Marwa Elnazeir ◽  
Thong Diep Pham ◽  
Robert Paul Friedland ◽  
...  
Keyword(s):  
Systematic Review ◽  
Brain Mri ◽  
Cranial Nerves ◽  
Clinical Manifestations ◽  
The Other ◽  
Neurological Deficits ◽  
Brainstem Stroke ◽  
Neurological Features ◽  
The Right ◽  
Core Features

Gasperini syndrome (GS), a rare brainstem syndrome, is featured by ipsilateral cranial nerves (CN) V–VIII dysfunction with contralateral hemibody hypoesthesia. While there have been 18 reported cases, the GS definition remains ambiguous. We report a new case and reviewed the clinical features of this syndrome from all published reports to propose a new definition. A 57-year-old man with acute brainstem stroke had right CN V–VIII and XII palsies, left body hypoesthesia and ataxia. Brain MRI showed an acute stroke in the right caudal pons and bilateral cerebellum. After a systematic review, we classified the clinical manifestations into core and associate features based on the frequencies of occurring neurological deficits. We propose that a definitive GS requires the presence of ipsilateral CN VI and VII palsies, plus one or more of the other three core features (ipsilateral CN V, VIII palsies and contralateral hemibody hemihypalgesia). Additionally, GS, similar to Wallenberg’s syndrome, represents a spectrum that can have other associated neurological features. The revised definition presented in this study may enlighten physicians with the immediate recognition of the syndrome and help improve clinical localization of the lesions and its management.

scholarly journals LINC-06. OBSERVATION ONLY IN A PATIENT WITH SUSPECTED LOW GRADE GLIOMA. SHOULD NEUROSURGERY ALWAYS BE THE FIRST STEP IN LOW AND MIDDLE INCOME COUNTRIES?

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii379-iii379
Author(s):  
Carlos Leal - Cavazos ◽  
Jose Arenas-Ruiz ◽  
Oscar Vidal-Gutierrez
Keyword(s):  
Brain Mri ◽  
Internal Capsule ◽  
Pediatric Brain Tumor ◽  
Clinical History ◽  
Low Grade ◽  
Large Tumor ◽  
Middle Income ◽  
Dismal Prognosis ◽  
Close Observation ◽  
The Right

Abstract BACKGROUND Low grade gliomas (LGGs) are the most frequent pediatric brain tumor and they comprise a variety of histologies. Complete surgery is curative but sometimes its location makes it difficult. Recent publications highlight the excellent long-term outcomes of patients with LGGs with complete and incomplete resected tumors. Current strategies are focused on reducing risks of treatment related sequelae. METHOD We describe a patient with a suspected LGG managed by close observation. We describe the case of a 6 year old female with 5 months history of focal onset seizures. During this time a brain MRI was requested and tumor was evidenced. After “tumor diagnosis” was made family visited a handful of private neurosurgeons with a uniformly dismal prognosis and high risk morbidity from procedures offered. When first seen at our Hospital, the clinical history seemed compatible with a LGG and seizures well controlled with antiepileptic drugs. Neurological examination was completely normal. MRI showed a large tumor (7x5x5 cm) hypointense on T1, hyperintense on T2, without contrast enhancement, involving the right temporal lobe white matter, insula, internal capsule, hipoccampus, thalamus and mesencephalus with middle cerebral artery encasement. Interval imaging was proposed and after 4.5 years since diagnosis the tumor has been stable and patient clinically excellent. CONCLUSION Overall survival in pediatric LGGs is excellent and risk of sequelae should always be part of multidisciplinary team considerations. In centers with significant neurosurgical morbidity, biopsy of large tumors that are compatible with LGG may not be required in selected cases.

Fish Intake and MRI Burden of Cerebrovascular Disease in Older Adults

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012916
Author(s):  
Aline Thomas ◽  
Fabrice Crivello ◽  
Bernard Mazoyer ◽  
Stephanie Debette ◽  
Christophe Tzourio ◽  
...  
Keyword(s):  
Factor Analysis ◽  
Cerebrovascular Disease ◽  
Brain Mri ◽  
Large Population ◽  
Population Based ◽  
Fish Intake ◽  
Mixed Data ◽  
Perivascular Spaces ◽  
Intracranial Volume ◽  
Cross Sectional

Background and Objective:Fish intake may prevent cerebrovascular disease (CVD), yet the mechanisms are unclear, especially regarding its impact on subclinical damage. Assuming that fish may have pleiotropic effect on cerebrovascular health, we investigated the association of fish intake with global CVD burden based on brain MRI markers.Methods:This cross-sectional analysis included participants from the Three-City Dijon population-based cohort (aged ≥65 years) without dementia, stroke, or history of hospitalized cardiovascular disease, who underwent brain MRI with automated assessment of white matter hyperintensities, visual detection of covert infarcts, and grading of dilated perivascular spaces. Fish intake was assessed through a frequency questionnaire and the primary outcome measure was defined as the first component of a factor analysis of mixed data applied to MRI markers. The association of fish intake with the CVD burden indicator was studied using linear regressions.Results:In total, 1,623 participants (mean age, 72.3 years; 63% women) were included. The first component of factor analysis (32.4% of explained variance) was associated with higher levels of all three MRI markers. Higher fish intake was associated with lower CVD burden. In a model adjusted for total intracranial volume, compared to participants consuming fish <1 per week, those consuming fish 2-3 and ≥4 times per week had a β = -0.19 (95% CI, -0.37; -0.01) and β = -0.30 (-0.57; -0.03) lower indicator of CVD burden, respectively (P trend <0.001). We found evidence of effect modification by age, so that the association of fish to CVD was stronger in younger participants (65-69 years) and not significant in participants aged ≥75 years. For comparison, in the younger age group, consuming fish 2-3 times a week was roughly equivalent (in opposite direction) to the effect of hypertension.Discussion:In this large population-based study, higher frequency of fish intake was associated with lower CVD burden, especially among participants younger than 75 years, suggesting a beneficial effect on brain vascular health before manifestation of overt brain disease.Classification of Evidence:This study provides Class II evidence that in individuals without stroke or dementia, higher fish intake is associated with lower subclinical CVD at MRI.

Gamma Knife surgery for glossopharyngeal neuralgia

2009 ◽  
Vol 110 (3) ◽  
pp. 559-563 ◽  
Author(s):  
Shoji Yomo ◽  
Yasser Arkha ◽  
Anne Donnet ◽  
Jean Régis
Keyword(s):  
Pain Relief ◽  
Gamma Knife ◽  
Cranial Nerves ◽  
Initial Response ◽  
Neurological Complications ◽  
Gamma Knife Surgery ◽  
Glossopharyngeal Neuralgia ◽  
Invasive Treatment ◽  
Neurological Effects ◽  
Lower Cranial Nerves

Gamma Knife surgery (GKS) is widely recognized as an effective, minimally invasive treatment for intractable trigeminal neuralgia, but the role of GKS in glossopharyngeal neuralgia (GPN) remains unclear. This study involved 2 patients with medically intractable GPN who were treated using GKS. One patient required 2 treatments because of a recurrence of symptoms (at maximum doses of 60 and 70 Gy), and the other patient had a single intervention (at a maximum dose of 75 Gy). The GKS target was the distal part of the glossopharyngeal nerve. Patients were investigated prospectively, treated, and then assessed periodically with respect to pain relief and neurological function. Complete pain relief was achieved initially after all 3 interventions. The first patient was pain free without medication for 2 months after the first treatment (60 Gy) and for 4 months after the second treatment (70 Gy). The second patient (treated with 75 Gy) was still pain free without medication at the last follow-up (12 months). Neither patient had any neurological complications. The initial response of GPN to low-dose GKS was favorable, but symptoms may recur. No adverse neurological effects were observed in any of the lower cranial nerves. It will be necessary to investigate the optimal radiation dose and target of GKS for achieving long-term pain relief in GPN.

scholarly journals Neuroimaging abnormalities in patients with Cowden syndrome

2018 ◽  
Vol 8 (3) ◽  
pp. 207-213 ◽  
Author(s):  
Radhika Dhamija ◽  
Steven M. Weindling ◽  
Alyx B. Porter ◽  
Leland S. Hu ◽  
Christopher P. Wood ◽  
...  
Keyword(s):  
White Matter ◽  
Brain Mri ◽  
Cowden Syndrome ◽  
Perivascular Spaces ◽  
Developmental Venous Anomaly ◽  
Cortical Malformation ◽  
Cavernous Malformations ◽  
Clinical Criteria ◽  
Signal Abnormality ◽  
Criteria For Diagnosis

BackgroundWe retrospectively reviewed the neuroimaging findings of patients with Cowden syndrome and determined their frequency in a single cohort.MethodsElectronic medical records were queried from January 1999 to January 2017 to identify patients who fit the clinical criteria for diagnosis of Cowden syndrome with or without a documentedPTENmutation. Patients with brain MRI examinations were then identified.ResultsWe retrospectively identified 44 patients with Cowden syndrome, 22 of whom had neuroimaging for review. Eleven (50%) had Lhermitte-Duclos disease, 4 (18.1%) had meningiomas, 13 (59.1%) had at least one developmental venous anomaly, 3 had cavernous malformations, 2 had evidence of dural arteriovenous fistula, 7 had increased white matter signal abnormalities relative to age (31.8%), 4 had prominent perivascular spaces, cerebellar tonsillar ectopia was present in 7 of 21 (33.3%), and 1 had cortical malformation.ConclusionsIt is important to recognize that in addition to Lhermitte-Duclos disease, other intracranial findings such as multiple venous anomalies, meningiomas, greater than expected white matter signal abnormality, prominent perivascular spaces, and cortical malformations may warrant a thorough evaluation for Cowden syndrome in the appropriate clinical setting. We further recommend that this broader spectrum of intracranial abnormalities be considered for addition to the Cowden syndrome diagnostic criteria at the time of next revision.

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