Neuroradiology
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The origin of the vertebral artery may be difficult to show on sonography or conventional angiography. Our aim was to evaluate the accuracy of CT angiography (CTA) in detecting arteriosclerotic changes in the first segment (V1) of the vertebral artery. We performed CTA and intra-arterial digital subtraction angiography (DSA) on 24 patients with vertebrobasilar insufficiency. ⋯ CTA revealed 4 stenoses in cases in which angiography proved inadequate, 11 zones of calcification and 5 cases of luminal reduction due to calcified plaques undetected on DSA. In the V1 segment DSA and CTA showed 3 stenoses, 9 cases of kinking, 1 of coiling and 4 stenoses due to kinking. CTA also demonstrated 4 additional stenoses, 2 cases of kinking and 3 stenoses due to kinking.
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Case Reports
Dural caroticocavernous fistula with both ophthalmic arteries arising from middle meningeal arteries.
A 60-year-old woman presented with a dural caroticocavernous fistula (CCF) in whom both by ophthalmic arteries arose from the middle meningeal arteries instead of from the internal carotid arteries. Transarterial embolisation of the CCF was contraindicated because of the risk of blindness. Transvenous coil embolisation was therefore performed. Bilateral origin of the ophthalmic artery from the middle meningeal artery is extremely rare.
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In brain lesions, the target sign has been defined as a central nidus of calcification or central enhancement surrounded by a ring of enhancement. It has been considered a pathognomonic finding of central nervous system (CNS) tuberculoma. The purpose of this report is to demonstrate that the target sign related to central enhancement is a nonspecific finding and may lead to erroneous diagnosis of CNS tuberculoma.
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We studied 21 cases of pathologically confirmed tumefactive demyelinating lesions and reviewed the spectrum of tumefactive demyelinating lesions in the literature. Radiological features and clinical data were reviewed to characterize the lesions as consistent with a known demyelinating disease, most notably multiple sclerosis. Atypical clinical or radiological features (other than tumefaction) were noted. ⋯ No case strongly suggestive of variants or related diseases, such as Schilder's disease or Balo's concentric sclerosis, were found. There was one case suggestive of acute disseminated encephalomyelitis. Features which help distinguish the lesions from tumour are discussed.
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Case Reports
Contrast-enhanced MRI of intrasellar arachnoid cysts: relationship between the pituitary gland and cyst.
We recently encountered two large intrasellar arachnoid cysts extending to the suprasellar region. The intensity of the cyst contents was identical to that of the cerebrospinal fluid on both T1- and T2- weighted MRI. On contrast-enhanced MRI, the pituitary gland was compressed posteroinferiorly and flattened in the sella turcica. In this report of rare intrasellar arachnoid cysts the discussion is focused on dislocation of the pituitary gland.