The neuroradiology journal
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This study assessed the impact and modification of intradiscal, intraforaminal, epidural and intramuscular swine injection of a new material, Discogel(®)- radiopaque gelified ethanol- recently introduced for the mini-invasive treatment of herniated disc. Discogel(®) is a sterile viscous solution containing ethyl alcohol, cellulose derivative product, added to a radio-opaque element, tungsten. The pig was sedated and under fluoroscopy guidance a needle was positioned within disc L1-L2 followed by intradiscal, intraforaminal, epidural and intramuscular injection of 1 ml of Discogel. ⋯ No alteration was found where discogel was injected, and the nucleus pulposus, disc, chondromixoid and root ganglium were normal. After intradiscal, intraforaminal, epidural and intramuscular injection of Discogel(®) no morpho-structural changes in nuclear tissue and annulus were found. Further studies on pigs with immunohistochemical analysis after treatment will confirm the morphological alterations induced by discogel and its action.
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The clinical findings of intracranial vascular malformations are strictly related to their morphologic, angioarchitectural and hemodynamic characteristics. An overall study of these features is the first step to understand the different classifications for arteriovenous malformations, dural arteriovenous fistulas and carotid-cavernous fistulas. This evaluation will also suggest the correct timing of endovascular treatment and which part of the lesion should be the target of the therapy. ⋯ The correlation between clinical findings, angiographic features and classifications is even stronger for cranial dural arteriovenous fistulas, in which cortical venous drainage is typical of "aggressive" fistulas and is usually absent in the "benign" type. Similarly, carotid-cavernous fistulas can be differentiated at angiography into high or low flow lesions according to the flow rate of the shunt, and into direct or indirect fistulas, according to the origin of arterial feeders. This paper focuses on the existing relation between the hemodynamics of brain arteriovenous malformations, cranial dural arteriovenous fistulas, carotid-cavernous fistulas, and their most frequent clinical findings, through an analysis of the most widely used different classification systems.
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Spinal dural arteriovenous fistulae are the most common type of spinal vascular malformations (AVMs). They have been classified into four types: dural AVM (type I), glomus AVM (type II), juvenile AVM (type III), and intradural direct arteriovenous fistula (type IV). ⋯ It is located in the extradural space involving a bone at the area of the dilated venous sac to which all the feeders converge to the margin. We describe the case of a 14-year-old girl with cervical epidural hematoma caused by a spinal epidural arteriovenous fistula.
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Pneumorrhachis (PR), the presence of air in the spinal canal, is a rare but suggestive radiographic finding, associated to different aetiologies and possible pathways of air entry into the spinal canal. It can be divided into primary and secondary PR, descriptively classified into extra- or intradural PR and aetiologically subsumed into iatrogenic, traumatic and non traumatic PR. Pneumoencephalus (PE), lack of air in the skull, is the equivalent intracranial phenomenon, associated mostly with traumatic or iatrogenic aetiology. Non traumatic PR and PE, especially when concurrent, are an uncommon radiological finding.
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Central pontine myelinolysis (CPM) and extrapontine myelinolysis (EPM) are disorders frequently associated with serum osmotic imbalance. The prognosis is very variable from complete regression of clinical symptomatology to signs of significant quadruparesis, a vegetative state and death. We report the case of a 25-year-old man with a diagnosis of osmotic demyelination syndrome. ⋯ Our case is suggestive in the rare MRI appearance of myelinolysis in addition to CLN and coagulative necrosis in the basal ganglia following the rapid correction of serum osmolarity. We suggest that this finding is prognostically very unfavourable. In the reported patient clinically initial neurological deficit progressed to a vegetative state within one month.