Neuroimaging clinics of North America
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The classic multiple sclerosis variants including Devic's neuromyelitis optica (NMO), Balo's concentric Sclerosis, Schilder's disease, and Marburg MS are both interesting and instructive from a disease pathophysiology perspective. Although rare, the variants are important as they often arise in the differential diagnosis for severe, acute demyelinating disease, including MS and acute disseminated encephalomyelitis. In the case of NMO, an originally unsuspected and entirely new pathophysiology based on water channels has been described, only after the recent original description of the more specific diagnostic test for NMO based on serum immunoglobulin.
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While well-differentiated thyroid cancer is generally thought to be a treatable cancer with excellent outcomes, some patients suffer from recurrent disease. Risk factors for recurrent disease include primary disease greater than 4 cm, incomplete resection, multiple positive lymph nodes in the central compartment, and lateral neck disease with multiple positive lymph nodes in multiple levels or pathologic extracapsular extension. These factors can help stratify the thyroid cancer population in to low-, medium-, and high-risk patients. ⋯ High-risk patients are best monitored with stimulated thyroglobulin, ultrasound of the head and neck, and low-dose iodine 131 uptake scans at the 6- to 12-month mark. The treatment of locoregional recurrent thyroid cancer is surgical resection with the overall goal of complete tumor removal while maintaining function and decreasing risks. The use of adjuvant therapy is dependent on the presence / absence of high risk pathologic features.
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Neuroimaging Clin. N. Am. · May 2008
ReviewMRI of the cranial nerves--more than meets the eye: technical considerations and advanced anatomy.
Magnetic resonance (MR) imaging is the method of choice to evaluate the cranial nerves. Although the skull base foramina can be seen on CT, the nerves themselves can only be visualized in detail on MR. To see the different segments of nerves I to XII, the right sequences must be used. ⋯ In this article, MR principles for imaging of the cranial nerves are discussed. The basic anatomy of the cranial nerves and the cranial nerve nuclei as well as their central connections are discussed and illustrated briefly. The emphasis is on less known or more advanced extra-axial anatomy, illustrated with high-resolution MR images.
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We discuss the arterial supply of the cranial nerves from their exit out of the brain stem to their exit from the skull base. Four distinct groups can be differentiated from an embryologic and phylogenetic standpoint. Understanding the arterial supply to the cranial nerves and the potential anastomoses is paramount in the endovascular treatment of dural AV shunts and highly vascularized tumors of the skull base to avoid neurologic deficits.
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Acute disseminated encephalomyelitis (ADEM) is a monophasic demyelinating disease of the central nervous system typically affecting the gray and the white matter of the brain and spinal cord in multiple locations. In the acute stages, ADEM is characterized histologically by perivenous edema, demyelination, and infiltration with macrophages and lymphocytes, with relative axonal sparing, whereas the late course of the disease is characterized by perivascular gliosis.