Journal of neuroimaging : official journal of the American Society of Neuroimaging
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A 41-year-old male presented with an acute onset of headache, confusion, seizures, and unilateral focal neurological deficit 25 years after receiving whole-brain radiation therapy to treat a cerebellar medulloblastoma. Brain magnetic resonance imaging (MRI) demonstrated a thick unilateral parieto-occipital cortical contrast enhancement. ⋯ Here, we describe the brain MR spectroscopy findings of SMART, showing a decrease in N-acetyl-aspartate and increased levels of creatine and choline, corresponding with neuronal destruction or transient neuronal impairment with mild nonspecific gliosis. The absence of a lactate peak suggests that mitochondrial dysfunction, vasospasm or ischemic mechanisms were not involved.
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Brainstem intracranial dural arteriovenous fistulas are extremely rare and can mimic a glioma at the time of presentation. ⋯ A careful radiological study looking for dilated vessels around the brainstem is necessary in the workup of an infiltrating brainstem lesion, in order to rule out intracranial dural arteriovenous fistula.
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We evaluated the relationship between middle cerebral artery (MCA) residual contrast stagnation on immediate postprocedural noncontrast CT scan and intraparenchymal hemorrhage (IPH) after endovascular treatment in acute ischemic stroke patients. ⋯ On immediate postprocedural noncontrast CT scan of stroke patients with acute MCA M1 occlusion after endovascular treatment, higher residual contrast stagnation in the affected MCA, compared to contralateral artery, is associated with an increased risk of IPH.
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With conventional magnetic resonance imaging (MRI), 20-30% of patients with temporal lobe epilepsy (TLE) have negative pathological MRI findings. Further investigations of the role of magnetic resonance spectroscopy (MRS) in the pre-surgical evaluation of patients with MRI-negative TLE are important to avoid intracranial EEG recording and to better understand the mechanism of the epileptogenic process. This study aimed to compare the measurements of N-acetylaspartate (NAA), creatine (Cr), and choline (Cho) in the hippocampi of MRI-negative TLE patients and normal subjects. ⋯ In MRI-negative TLE, significant reductions in the NAA/Cr and NAA/(Cr+Cho) ratios ipsilateral to the seizure side may help lateralize and localize the epileptogenic zone.