Neuroradiological and pathomorphological features of epilepsy associated brain tumors

Brain tumors are the second most common etiology in pediatric patients with focal seizures undergoing surgery for drug-resistant epilepsy. These neoplasms have a number of distinctive features from those found in adult patients, one of which is a wide polymorphism of structural architectonics during neuroradiological examination. Given the tremendous biological stability of these tumors, not in all cases of pre-surgical examination it is possible to verify the presence of a neoplastic process in the structure of the epileptogenic substrate using routine neuroimaging methods. In some complex diagnostic cases, a multimodal imaging approach and in-depth complex examination are required for reliable diagnosis and success of the results of epileptic surgery.

Cervical Spinal Meningeal Melanocytoma Presenting as Intracranial Superficial Siderosis

Meningeal melanocytoma is a rare pigmented tumor of the leptomeningeal melanocytes. This rare entity results in diagnostic difficulty in imaging unless clinical and histopathology correlation is performed. In this case report, we describe a case of meningeal melanocytoma of the cervical region presenting with superficial siderosis. Extensive neuroradiological examination is necessary to locate the source of the bleeding in such patients. Usually, the patient will be cured by the complete surgical excision of the lesion.

Epileptic seizures due to multiple cerebral cavernomatosis

Background. Cavernous angiomas are angiographically occult vascular malformations that are present in 0.4?0.9 % of people, and represent around 5% of all cerebrovascular malformations. They can be single or multiple, and sporadic or familial. The presence of multiple lesions is more frequent in familial cavernomatosis. Ten to 30 % are associated with familial clustering. Case report. We presented the case of a 43-year-old man, admitted to the Emergency Department due to unprovoked seizure during the wide awake and everyday activities. Neurological examination was with no focal signs. A 32-channel standard digital EEG was without any significant changes of normal baseline activity. After sleep deprivation EEG showed multifocal, bilateral and asymmetric polyspikes and sharpwaves activity. Hyperventilation induced generalized epileptiform discharges. MRI scan demonstrated multiple small cavernous angiomas. Neuropsychological testing demonstrated a delayed memory impairment. Neurosurgery treatment was not recommended, and the therapy with valproate 1 250 mg/day had an excellent efficacy with no singnificant adverse effects. Conclusion. This patient considered as a rare case with multiple cavernomatosis highlights the importance of neuroradiological examination in adult patients with the first epileptic seizure but with no focal neurological signs. .

Aspetti neuroradiologici della sindrome adreno-genitale

We describe the results of a study on 21 patients with adrenogenital syndrome without neurological symptoms who underwent neurological examination, neurophysiological tests and MR scan. Only five patients (23.8%) had a negative neuroradiological examination, whereas 14 (66.3%) presented focal or diffuse white matter hyperintensity, ten (47.6%) had supratentorial cortical atrophy and seven (33.3%) inferior ectopia of the cerebellar tonsils. The frequency of white matter changes was not a chance finding and the lesions are speculated to be demyelinating. This hypothesis is interesting because the gene responsible for a deficit of the 21 beta-hydroxylase enzyme implicated in adrenogenital syndrome is near to the TNF gene implicated in the origin of multiple sclerosis. The possible causes of supratentorial atrophy and tonsillar ectopia are also discussed.

Lateral Approach for Resection of the C3 Corpus: Technical Case Report

OBJECTIVE AND IMPORTANCE The C3 level is the transition zone between the upper and lower cervical spine. Because of its high position and anatomic relationships to significant structures, exposing C3 is challenging, and the surgical approach is controversial. CLINICAL PRESENTATION A 16-year-old girl was admitted to our institution with a 3-year history of neck pain and progressive quadriparesis. Neuroradiological examination revealed severe spinal cord compression from kyphosis at the C3 level. TECHNIQUE We used the lateral approach to resect the C3 corpus and realign the cervical spine. Resecting the transverse processes of C2–C4 and mobilizing the V2 segment of the vertebral artery adequately exposed C3 for resection. Bilateral occipitocervical fusion was performed in a second procedure, and no postoperative complications occurred. The patient's neurological status improved drastically after surgery, and she has had no craniocervical instability during the follow-up period. CONCLUSION The lateral approach to the C3 corpus offers the greatest degree of cord decompression and easy access to the lesion in a wide and sterile operative field. We describe the surgical technique of this approach as an alternative to the anterior transmucosal or anterolateral retropharyngeal approach.

Towards a Functional Definition of Lumbar Vertebral Instability

We attempted to define lumbar vertebral instability by investigating its characteristic biomechanical anomalies. The computed tomography “morphological” variations described, obtained with axial loading, are constant, reproducible, can be transformed into animations and are functionally significant. Ninety patients (47 men, 43 women; age range 21–80 years, mean 51 years) with a clinical diagnosis of vertebral instability underwent conventional non invasive neurophysiologic, radiological and neuroradiological examination. They also underwent axial loaded computed tomography (ALCT), the images of which were processed to obtain animations (cine-ALCT). Elementary and complex dynamic modifications (EDMs and CDMs) characterising “morphological” variations in the components of functional spinal units (FSUs) under load and their interactions are described case by case, and were found to match the respective individual clinical signs and symptoms well. Investigation by ALCT and cine-ALCT makes it possible to build a reliable and methodologically valid identikit of anomalous paraphysiological and sometimes clearly pathological functioning of this segment of the human spine, i. e. lumbar vertebral instability.

Are Brain-Damaged Patients Inappropriately Labeled as Malingering Using the 21-Item Test and the WMS—R Logical Memory Forced Choice Recognition Test?

This study examined the false positive hit rate of the 21-item Test and the WMS–R Logical Memory Forced Choice Recognition Test and compared the relationship between the measures in classifying biased responding/malingering. Of 40 patients referred for comprehensive neuropsychological evaluation, 18 were classified as brain-damaged based on independent neurological or neuroradiological examination. The remaining 22 patients could not be so classified on neurological or neuroradiological evidence and thus served as a medical control group. Findings indicated the brain-damaged group performed more poorly than did the control group across measures, and both groups, on the average, performed markedly better than that required to suggest biased responding. Also, taking both tests together, no individual patient was classified as malingering.

Hydrocephalus associated with intramedullary low-grade gliomas

✓ Over the past 15 years, eight children affected by intramedullary low-grade gliomas associated with hydrocephalus were treated at l'Hôpital des Enfants Malades. In all cases the diagnosis of hydrocephalus was made prior to that of the spinal tumor. Neuroradiological examination of all patients revealed contrast enhancement of the intracranial subarachnoid spaces. In six cases this was progressive, suggesting subarachnoid spread of the tumor, which was confirmed in two cases by histological examination. The authors analyzed 38 cases of intramedullary low-grade glioma associated with hydrocephalus that were reported in the literature. Fifteen of the cases had intracranial leptomeningeal seeding. Several hypotheses have been proposed to explain this unusual association, such as 1) increase in cerebrospinal fluid (CSF) viscosity because of elevated fluid protein content; 2) obliteration of the cisterna magna due to a rostral extension of the tumor; and 3) blockage of the spinal subarachnoid pathways of CSF resorption. Two other theories seem of particular interest. Bamford and Labadie suggested that the abnormal presence of fibrinogen in the CSF and its transformation into fibrin at the level of the basal cisterns and Pacchioni's granulation may alter CSF hydrodynamics. This mechanism alone is sufficient to induce hydrocephalus of the communicating type. In addition, as suggested by Maurice-Williams and Lucey, the resulting leptomeningeal fibrosis might predispose secondary implantation of neoplastic elements in the subarachnoid spaces of the intracranial compartment.