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Corrêa DG, da Cruz LCH, da Rocha AJ, Pacheco FT. Imaging Aspects of Toxic and Metabolic Myelopathies. Semin Ultrasound CT MR 2023; 44:452-463. [PMID: 37555682 DOI: 10.1053/j.sult.2023.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
Metabolic and toxic myelopathies usually occurs due to several different causes. Metabolic myelopathy usually occurs due to deficiency of a nutrient, such as vitamin B12. Toxic myelopathy occurs secondary to the exposure to an external toxic agent. Although they may have a difficult diagnosis, determination of the specific cause of myelopathy is of utmost importance, because many causes are amenable to treatment. Although they have many clinical, electrophysiologic, and neuropathologic similarities, imaging may aid in the suspicion of toxic or metabolic myelopathy. The aim of this article, is to review the imaging features of the main toxic and metabolic myelopathies.
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Affiliation(s)
- Diogo Goulart Corrêa
- Department of Radiology, Clínica de Diagnóstico por Imagem (CDPI)/DASA, Rio de Janeiro, RJ, Brazil; Department of Radiology, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil.
| | | | - Antônio José da Rocha
- Department of Neuroradiology, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil; Department of Radiology, DASA, São Paulo, SP, Brazil
| | - Felipe Torres Pacheco
- Department of Neuroradiology, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil; Department of Radiology, DASA, São Paulo, SP, Brazil
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Corrêa DG, de Souza SR, Freddi TDAL, Fonseca APA, Dos Santos RQ, Hygino da Cruz LC. Imaging features of neurosyphilis. J Neuroradiol 2023; 50:241-252. [PMID: 36641134 DOI: 10.1016/j.neurad.2023.01.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 12/09/2022] [Accepted: 01/08/2023] [Indexed: 01/13/2023]
Abstract
Syphilis is an infectious disease caused by the spirochete Treponema pallidum, subspecies pallidum. Although its incidence has declined after the widespread availability of penicillin, it has recently re-emerged, especially in men who have sex with men and in people living with human immunodeficiency virus (HIV). The neurological manifestations of syphilis, generally known as neurosyphilis, may appear at any time during the infection, including the initial years after the primary infection. Neurosyphilis can be asymptomatic, only with cerebrospinal fluid abnormalities, or symptomatic, characterized by several different clinical syndromes, such as meningitis, gumma, meningovascular, brain parenchyma involvement, meningomyelitis, tabes dorsalis, and peripheral nervous system involvement. However, these syndromes may simulate several other diseases, making the diagnosis often a challenge. In addition, syphilis can also be vertically transmitted from mother to child during pregnancy, leading to neurological manifestations. Neuroimaging is essential to demonstrate abnormal brain or spinal cord findings in patients with neurosyphilis, aiding in the diagnosis, treatment, and follow-up of these patients. This article aims to review the imaging features of neurosyphilis, including the early and late stages of the infection.
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Affiliation(s)
- Diogo Goulart Corrêa
- Department of Radiology, Clínica de Diagnóstico por Imagem (CDPI)/DASA, Avenida das Américas, 4666, 302A, 303, 307, 325, 326, Barra da Tijuca, Rio de Janeiro, RJ 2640-102, Brazil; Department of Radiology, Federal Fluminense University, Rua Marquês de Paraná, 303, Centro, Niterói, RJ 24070-035, Brazil.
| | - Simone Rachid de Souza
- Department of Pathology, Federal University of Rio de Janeiro, Cidade Universitária da Universidade Federal do Rio de Janeiro, Rua Professor Rodolpho Paulo Rocco, 255, Rio de Janeiro, RJ 21941-617, Brazil
| | | | - Ana Paula Alves Fonseca
- Department of Radiology, UnitedHealth Group, São Paulo, SP, Brazil; Department of Radiology, DASA, São Paulo, SP, Brazil
| | - Roberto Queiroz Dos Santos
- Department of Radiology, Hospital dos Servidores do Estado, Rua Sacadura Cabral, 178, Saúde, Rio de Janeiro, RJ 20221-903, Brazil; Department of Radiology, Hospital das Américas, United Health Group, Avenida Jorge Curi, 550, Barra da Tijuca, Rio de Janeiro, RJ 22775-001, Brazil
| | - Luiz Celso Hygino da Cruz
- Department of Radiology, Clínica de Diagnóstico por Imagem (CDPI)/DASA, Avenida das Américas, 4666, 302A, 303, 307, 325, 326, Barra da Tijuca, Rio de Janeiro, RJ 2640-102, Brazil
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Jena A, Renjen PN, Taneja S, Gambhir A, Negi P. Integrated (18)F-fluorodeoxyglucose positron emission tomography magnetic resonance imaging ((18)F-FDG PET/MRI), a multimodality approach for comprehensive evaluation of dementia patients: A pictorial essay. Indian J Radiol Imaging 2016; 25:342-52. [PMID: 26752814 PMCID: PMC4693381 DOI: 10.4103/0971-3026.169449] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Dementia, caused by irreversible neurodegenerative disorders such as Alzheimer's disease or reversible non-degenerative conditions, is rapidly becoming one of the most alarming health problems in our aging society. This cognitive disorder associated with a multitude of clinical differentials with overlapping clinical, pathological, and imaging features is difficult to diagnose and treat, as it often presents late after significant neuronal damage has already occurred. Novel disease-modifying treatments being developed will have to be corroborated with innovative imaging biomarkers so that earlier reliable diagnosis can be made and treatment initiated upon. Along with new specific PET radiotracers, integrated PET/MRI with combined methodological advantage and simultaneously acquired structural-cum-functional information may help achieve this goal. The present pictorial essay details our experiences with PET/MRI in dementing disorders, along with reviewing recent advances and future scope.
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Affiliation(s)
- Amarnath Jena
- PET SUITE, Department of Molecular Imaging and Nuclear Medicine, Indraprastha Apollo Hospitals, New Delhi, India
| | | | - Sangeeta Taneja
- PET SUITE, Department of Molecular Imaging and Nuclear Medicine, Indraprastha Apollo Hospitals, New Delhi, India
| | - Aashish Gambhir
- PET SUITE, Department of Molecular Imaging and Nuclear Medicine, Indraprastha Apollo Hospitals, New Delhi, India
| | - Pradeep Negi
- PET SUITE, Department of Molecular Imaging and Nuclear Medicine, Indraprastha Apollo Hospitals, New Delhi, India
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Degnan AJ, Levy LM. Neuroimaging of rapidly progressive dementias, part 2: prion, inflammatory, neoplastic, and other etiologies. AJNR Am J Neuroradiol 2013; 35:424-31. [PMID: 23413251 DOI: 10.3174/ajnr.a3455] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Most dementias begin insidiously, developing slowly and generally occurring in the elderly age group. The so-called rapidly progressive dementias constitute a different, diverse collection of conditions, many of which are reversible or treatable. For this reason, accurate identification and assessment of acute and subacute forms of dementia are critical to effective treatment; neuroimaging aids greatly in narrowing the diagnosis of these conditions. This second installment of a 2-part review of rapidly progressive dementias examines the use of imaging in an assortment of other etiologies in the differential diagnosis, from prion disease and neoplastic-related conditions to rare metabolic and other conditions such as Wernicke encephalopathy. In these clinical conditions, MR imaging has the potential to narrow this broad differential diagnosis and, at times, can definitively aid in the diagnosis of certain conditions on the basis of typical imaging patterns.
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Affiliation(s)
- A J Degnan
- From the University of Pittsburgh Medical Center (A.J.D.), Pittsburgh, Pennsylvania
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Almeida KJ, Brucki SMD, Duarte MIS, Pasqualucci CAG, Rosemberg S, Nitrini R. Basal ganglia lesions in subacute sclerosing panencephalitis. Dement Neuropsychol 2012; 6:286-289. [PMID: 29213810 PMCID: PMC5619342 DOI: 10.1590/s1980-57642012dn06040014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
The parieto-occipital region of the brain is the most frequently and severely
affected in subacute sclerosing panencephalitis (SSPE). The basal ganglia,
cerebellum and corpus callosum are less commonly involved. We describe a patient
with SSPE confirmed by neuropathology based on brain magnetic resonance imaging
showing extensive basal ganglia involvement and no significant involvement of
other cortical structures. Though rarely described in SSPE, clinicians should be
aware of this involvement. SSPE should be kept in mind when changes in basal
ganglia signal are seen on brain magnetic resonance imaging with or without
involvement of other regions of the human brain to avoid erroneous etiological
diagnosis of other pathologies causing rapidly progressive dementia.
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Affiliation(s)
- Kelson James Almeida
- MD, Behavioral and Cognitive Neurology Unit and Cognitive Disorders Reference Center (CEREDIC), Department of Neurology, São Paulo SP, Brazil
| | - Sonia Maria Dozzi Brucki
- MD, Behavioral and Cognitive Neurology Unit and Cognitive Disorders Reference Center (CEREDIC), Department of Neurology, São Paulo SP, Brazil
| | | | | | - Sérgio Rosemberg
- Department of Pathology, School of Medicine of the University of São Paulo (FMUSP) São Paulo SP, Brazil
| | - Ricardo Nitrini
- MD, Behavioral and Cognitive Neurology Unit and Cognitive Disorders Reference Center (CEREDIC), Department of Neurology, São Paulo SP, Brazil
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