Diffuse Leptomeningeal Glioneuronal Tumor in an Adult: A Diagnostic Challenge

Here we report a rare case of diffuse leptomeningeal glioneuronal tumor (DLGNT) in a 35-year-old man, who was misdiagnosed twice as having tuberculosis meningitis and later racemose neurocysticercosis. His delayed diagnosis of DLGNT might be due to prevalence of tuberculosis in our country, similarity in magnetic resonance imaging finding of prominent leptomeningeal enhancement in different cisterns of brain, and extreme rarity of DLGNT in the adults. So, it should be differentiated clinically and radiographically from granulomatous or infectious conditions. Hence, a timely histologic diagnosis through a leptomeningeal biopsy of the brain and spinal cord in case of unusual leptomeningeal enhancement with uncertain laboratory findings is essential because cytological examination of the cerebrospinal fluid in DLGNT is known to be negative.

Structural MRI profiles and tau correlates of atrophy in autopsy-confirmed CTE

Background Chronic traumatic encephalopathy (CTE), a neurodegenerative tauopathy, cannot currently be diagnosed during life. Atrophy patterns on magnetic resonance imaging could be an effective in vivo biomarker of CTE, but have not been characterized. Mechanisms of neurodegeneration in CTE are unknown. Here, we characterized macrostructural magnetic resonance imaging features of brain donors with autopsy-confirmed CTE. The association between hyperphosphorylated tau (p-tau) and atrophy on magnetic resonance imaging was examined. Methods Magnetic resonance imaging scans were obtained by medical record requests for 55 deceased symptomatic men with autopsy-confirmed CTE and 31 men (n = 11 deceased) with normal cognition at the time of the scan, all >60 years Three neuroradiologists visually rated regional atrophy and microvascular disease (0 [none]–4 [severe]), microbleeds, and cavum septum pellucidum presence. Neuropathologists rated tau severity and atrophy at autopsy using semi-quantitative scales. Results Compared to unimpaired males, donors with CTE (45/55=stage III/IV) had greater atrophy of the orbital-frontal (mean diff.=1.29), dorsolateral frontal (mean diff.=1.31), superior frontal (mean diff.=1.05), anterior temporal (mean diff.=1.57), and medial temporal lobes (mean diff.=1.60), and larger lateral (mean diff.=1.72) and third (mean diff.=0.80) ventricles, controlling for age at scan (ps<0.05). There were no effects for posterior atrophy or microvascular disease. Donors with CTE had increased odds of a cavum septum pellucidum (OR = 6.7, p < 0.05). Among donors with CTE, greater tau severity across 14 regions corresponded to greater atrophy on magnetic resonance imaging (beta = 0.68, p < 0.01). Conclusions These findings support frontal-temporal atrophy as a magnetic resonance imaging finding of CTE and show p-tau accumulation is associated with atrophy in CTE.

Meniscal Extrusion: A Narrative Review

Background: Meniscal extrusion, referred to as an external displacement of the meniscus, is a commonly encountered but often overlooked magnetic resonance imaging finding in the knee joint. Meniscal extrusion alters the biomechanical properties of the meniscus, leading to accelerated cartilage degeneration and early osteoarthritic changes. The literature contains discrepancies about meniscal extrusion on topics ranging from definition to diagnosis. This narrative review outlines the pathogenesis, natural history, diagnosis, and treatment of meniscal extrusion. Purpose: To review the current literature on meniscal extrusion, from pathogenesis to treatment, and to provide recommendations for future research. Study Design: Narrative review. Methods: A computer-based search of the PubMed, Ovid Medline, and Cochrane Library databases was used to perform a comprehensive literature review on meniscal extrusion. A total of 81 studies was ultimately included in the review. Results: The literature review highlighted the current ambiguity in definition, difficulty in clinical diagnosis, and low level of awareness of this condition. This review covers all aspects related to meniscal extrusion and identifies many of its lesser known aspects. Conclusion: In the current literature, meniscal extrusion remains a lesser known albeit common condition because of its relatively silent nature along with lack of knowledge among orthopaedic surgeons. Further studies are warranted to provide better understanding and management of this condition.

Correlation between Clinical Tests and Magnetic Resonance Imaging Finding in Diagnosis of Chronic Ulnar-sided Wrist Pain

Background: Ulnar-sided wrist pain is a common cause of upper- extremity disability. Presentation can vary from acute traumatic injuries to chronic degenerative conditions. Carful clinical examination should be done, there are some provocative tests for some pathologies which induce pain when the patient has the specific pathology for the test. MRI of the wrist is often challenging because the components of the wrist have complex anatomy of bone and soft tissues, with ligaments and cartilage which are small sized structures measuring millimeters. MRI is a one of advanced imaging techniques that play an important role in evaluating the wrist and is a useful examination modality because of its multiplanar, multisequence capability and its excellent resolution of soft tissue structures. MRI is particularly advantageous for assessing occult bone lesions and soft tissue structures around the wrist such as cartilages, tendons, ligaments and nerves. Aim: The aim of this study is to assess the role and accuracy of clinical tests and MRI in diagnosis of chronic ulnar-sided wrist pain causes. Patients and Methods: This is a prospective study and was conducted on a 50 adult patients complaining from chronic ulnar side wrist pain. They were attended to Orthopedic Department of Tanta University Hospitals over a period of 6 months starting from November 2019 till May 2020. Results: MRI gave positive finding in most of patients (92%), while negative in about (8%) of cases, this means that there are some pathologies need more investigations to be diagnosed. Most of Clinical tests also gave a help in diagnosis of the cause of the pain especially ulnocarpal stress test, fovea sign test, ECU synergy test and piano key test which by statistics showed significant results but LT ballottement test had insignificant results so LTL pathology can't be diagnosed by clinical tests only but needs more investigations as MRI. So some pathologies can be diagnosed clinically as ECU tenosynovitis, but other pathologies need more investigations like MRI like LTL tear, also some pathologies need more investigations. Conclusion: Most of clinical tests give significant results in diagnosis of chronic ulnar-sided wrist pain except for some pathologies like LTL tear needs more investigations, also MRI has important role and gives significant results in diagnosis.

P14.89 Papillary tumor of the pineal region: three cases from a single institution

BACKGROUND Papillary tumors of the pineal region are highly unusual lesions of unknown incidence. These are neuroepithelial tumors with papillary and solid areas. There is no standardized treatment because of the difficulty to make randomized prospective trials due to its rarity. We report three patients with papillary tumor of the pineal region. MATERIAL AND METHODS Retrospective review of the clinical records of patients with papillary tumor of the pineal region at a tertiary neurological center in Buenos Aires, Argentina was done between 2/2012-04/2021. Clinical characteristics, imaging, pathology, treatment and follow-up data were obtained. RESULTS Two patients were male and one female. All three patients were adults, two in the fourth decade of life and one in the seventh. Clinical presentation included headache along with either visual symptoms, gait disturbance, or both. Imaging workup included brain and spinal magnetic resonance imaging, finding expanding lesions in the pineal region, hyperintense in FLAIR/T2 sequences, with gadolinium enhancement in T1 with contrast sequence and variable degrees of hydrocephalus. Spinal lesions were not found in these patients. Cerebrospinal fluid cytology was negative in all cases. Tumor biopsy was the initial approach in all cases. Two patients underwent an initial third ventriculostomy procedure but all were submitted to a supracerebellar infratentorial approach for major resection. Posterior treatment included chemoradiotherapy with temozolomide. One patient had a distant recurrence after seven years with and remained with stable disease for two more years, and the other two patients are under control with no recurrence after 2 and 2.5 years respectively. CONCLUSION Papillary tumors in the pineal regions are aggressively treated as recurrence is very frequent regarding previous reports (&gt; 70%). Total resection is the only predictive factor associated to better outcome, however, more information is needed in order to achieve treatment consensus.

T2/FLAIR hyperintensity in the mesial temporal lobe: challenging differential diagnosis

: T2/FLAIR hyperintensity in the mesial temporal lobe is the most common MR finding of herpes simplex encephalitis but may be observed in other infectious and non-infectious diseases. The former includes herpes human virus 6 encephalitis, Japanese encephalitis, and neurosyphilis, and the latter autoimmune encephalitis, gliomatosis cerebri, bilateral or paradoxical posterior cerebral artery infarction, status epilepticus, and hippocampal sclerosis. Thus, T2/FLAIR hyperintensity in the mesial temporal lobe is not a disease-specific magnetic resonance imaging finding, and these conditions must be differentiated to ensure proper treatment. We review diseases that are presented with T2/FLAIR hyperintensity in the mesial temporal lobe and provide a helpful flow chart based on clinical and radiologic features.