Neuroradiology
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We report the case of a newborn child with maple syrup urine disease (MSUD), diagnosed at 10 days of life. Diffusion-weighted echoplanar MRI showed marked hyperintensity of the cerebellar white matter, the brainstem, the cerebral peduncles, the thalami, the dorsal limb of the internal capsule and the centrum semiovale, while conventional dual-echo sequence evidenced only a weak diffuse T2 hyperintensity in the cerebellar white matter and in the dorsal brainstem. ⋯ Therefore, in agreement with current hypotheses on MSUD pathogenesis, MSUD oedema proves to be a cytotoxic oedema. Diffusion-weighted MRI may be a valuable tool, more sensitive than conventional spin-echo techniques, to assess the extent and progression of cytotoxicity in MSUD, as well as the effectiveness of the therapeutic interventions.
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We report the MRI findings in a girl aged 3 years and 10 months who developed a spinal subdural haematoma after posterior fossa open surgery for cerebellar malignant rhabdoid tumour. Emergency surgery was performed immediately because of increased intracranial pressure. ⋯ Spinal subdural haematoma is rare, and only few cases have been reported, especially in children. This report suggests that "silent" (without clinical symptoms) postoperative spinal acute subdural haemorrhage can occur after posterior fossa surgery.
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Detection of a venous angioma at the root entry zone is important for surgical planning, so that the neurosurgeon will be aware that both veins and arteries may require microvascular decompression. In selected cases, alternative treatment may be indicated to avoid the potential surgical complication of a venous infarct. ⋯ When associated with a venous angioma at the root entry zone, trigeminal neuralgia usually presents at a younger age [4, 5, 6]. We review the imaging examinations and clinical data of five patients with trigeminal neuralgia who had a venous angioma adjacent to the root entry zone of the trigeminal nerve, and discuss how the imaging findings affected their management.
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Central neurocytoma is classically considered as an intraventricular benign tumour, largely based on data from small retrospective series and single case reports. We report on a 16-year-old girl who suffered from a large parietooccipital tumour that was diagnosed histologically as central neurocytoma. The features of CT, MRI and proton MR spectroscopy studies are discussed. ⋯ As well as elevated choline (Cho), the tumour spectrum showed strongly decreased N-acetylaspartate (NAA). NAA is assumed to be produced in mature neurons, and we therefore expected to find high amounts of NAA in this well-differentiated tumour, which was histologically composed of mature neuronal tissue. This observation leads to the conclusion that even the highly differentiated cells of neurocytomas are too immature to produce NAA.
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MR imaging was found to be the most sensitive modality for the detection of spinal cord abnormalities in the acutely injured spine. Although it is reported that traumatic pneumomyelogram indicates a base-of-skull or middle cranial fossa fracture and is almost certainly associated with intracranial subarachnoid air, early MR imaging may demonstrate subarachnoid air in penetrating trauma of the spinal cord without head injury. We report two cervical-spine stab-wound cases, one of which had subarachnoid air on early MR findings.