The neuroradiology journal
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Case Reports
Subpial Hematoma and Extravasation in the Interhemispheric Fissure with Subarachnoid Hemorrhage.
A recent report on computed tomography (CT) findings of contrast extravasation in subarachnoid hemorrhage (SAH) with Sylvian hematoma suggests that the occurrence of the hematoma is secondary to bleeding in the subpial space. Our patient was in his sixties and was admitted to the hospital because of loss of consciousness (Glasgow Coma Scale E4V1M4). ⋯ This case indicates that the occurrence of subpial hematoma such as Sylvian hematoma can be a secondary event following subpial bleeding from damaged small vessels elsewhere in the cranium. Instead of four-dimensional (4D) CT, the dual-phase CTA technique may help detect minor extravasations with usual helical CT scanner.
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Brain atrophy and physical disability in primary progressive multiple sclerosis: A volumetric study.
Grey matter atrophy has been shown in primary progressive multiple sclerosis (PPMS), but its association with physical incapacity is unclear. We submitted 19 patients with PPMS to a neurological evaluation and brain magnetic resonance imaging (MRI) with volumetric analysis using FreeSurfer. We found no relation between the Expanded Disability Status Scale or disease duration and the grey matter or white matter structures analysed. Lesion load was negatively correlated with cortical and subcortical grey matter volumes, but not with total white matter volume. We concluded that physical disability in PPMS is not directly related to brain atrophy and that focal inflammatory white matter lesions may contribute to progressive neuronal degeneration. ⋯ Physical disability in PPMS is not directly related to brain volume loss. Grey matter atrophy correlates with lesion load in patients with PPMS, indicating that focal inflammatory white matter lesions may contribute to progressive neuronal degeneration.
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Functional imaging modalities, such as functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI), are rapidly changing the scope and practice of neuroradiology. While these modalities have long been used in research, they are increasingly being used in clinical practice to enable reliable identification of eloquent cortex and white matter tracts in order to guide treatment planning and to serve as a diagnostic supplement when traditional imaging fails. ⋯ While fMRI is limited to visualization of gray matter, DTI permits visualization of white matter tracts through diffusion restriction along different axes. We will discuss the physical, statistical and physiological principles underlying these functional imaging modalities and explore new promising clinical applications.
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Randomized Controlled Trial
MRI DWI/ADC signal predicts shrinkage of lumbar disc herniation after O2-O3 discolysis.
Evaluate the discal morpho-structural changes as a predictive sign in the clinical outcome after ozone therapy in lumbar disc herniation using the T2-shine through effect in diffusion-weighted imaging (DWI). ⋯ T2-shine through effect in DWI is present before morphological disc reduction and moreover could be considered as a predictive sign of response to oxygen-ozone treatment.
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Case Reports
Reversible and Asymptomatic Gyral and Subarachnoid Contrast Enhancement after Carotid Stenting.
The presence of sulcal hyperdensity in patients after endovascular procedures is not necessarily attributable to hemorrhage. It may frequently indicate the absolute or concomitant extravasation of contrast material into the subarachnoid spaces. This case report describes the clinical case of an 84-year-old patient with 90% stenosis of the right internal carotid who presented with a diffuse gyral and sulcal hyperdensity in the right temporal-occipital and frontal lobes at routine post-carotid stenting (CAS) brain CT scan. ⋯ A 24-hour follow-up brain CT demonstrated the complete resolution of the hyperdensity, confirming the diagnosis. In this patient we considered the concomitant presence of gyral and sulcal hyperdensity as the consequence of reversible damage to the blood-brain barrier (BBB) determining a transitory extravasation of contrast material. Asymptomatic gyral and subarachnoid contrast enhancement following CAS is generally indicative of benign and transitory damage to the BBB and is not to be misinterpreted as hemorrhage.