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Carpentieri-Primo P, Nahoum L, Almeida L, Nacur F, Alves Júnior SF, Ventura N. The dark side of T2: central nervous system lesions with low signal intensity on T2-weighted imaging. Radiol Bras 2024; 57:e20230085. [PMID: 38993953 PMCID: PMC11235073 DOI: 10.1590/0100-3984.2023.0085-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/22/2023] [Accepted: 09/30/2023] [Indexed: 07/13/2024] Open
Abstract
The majority of central nervous system diseases show high signal intensity on T2-weighted magnetic resonance imaging. Diseases of the central nervous system with low signal intensity are less common, which makes it a finding that helps narrow the differential diagnosis. This was a retrospective analysis of brain and spine magnetic resonance imaging examinations in which that finding was helpful in the diagnostic investigation. We selected the cases of patients examined between 2015 and 2022. All diagnoses were confirmed on the basis of the clinical-radiological correlation or the histopathological findings. We obtained images of 14 patients with the following central nervous system diseases: arteriovenous malformation; cavernous malformation; metastasis from lymphoma; medulloblastoma; embryonal tumor; metastasis from melanoma; Rathke's cleft cyst; Erdheim-Chester disease; aspergillosis; paracoccidioidomycosis; tuberculosis; syphilis; immunoglobulin G4-related disease; and metastasis from a pulmonary neuroendocrine tumor. We described lesions of different etiologies in which the T2-weighted imaging profile helped narrow the differential diagnosis and facilitated the definitive diagnosis.
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Affiliation(s)
- Pedro Carpentieri-Primo
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ,
Brazil
- Grupo Fleury, Rio de Janeiro, RJ, Brazil
| | - Luiza Nahoum
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ,
Brazil
- Grupo Fleury, Rio de Janeiro, RJ, Brazil
| | - Louise Almeida
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ,
Brazil
- Grupo Fleury, Rio de Janeiro, RJ, Brazil
| | - Fernando Nacur
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ,
Brazil
- Grupo Fleury, Rio de Janeiro, RJ, Brazil
- Instituto Estadual do Cérebro Paulo Niemeyer, Rio de
Janeiro, RJ, Brazil
| | - Sérgio Ferreira Alves Júnior
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ,
Brazil
- Grupo Fleury, Rio de Janeiro, RJ, Brazil
- Instituto Estadual do Cérebro Paulo Niemeyer, Rio de
Janeiro, RJ, Brazil
| | - Nina Ventura
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ,
Brazil
- Grupo Fleury, Rio de Janeiro, RJ, Brazil
- Instituto Estadual do Cérebro Paulo Niemeyer, Rio de
Janeiro, RJ, Brazil
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Pop MM, Bouros D, Klimko A, Florian IA, Florian IS. Intracranial epidermoid cysts: benign entities with malignant behavior: experience with 36 cases. Sci Rep 2023; 13:6474. [PMID: 37081102 PMCID: PMC10119307 DOI: 10.1038/s41598-023-33617-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 04/15/2023] [Indexed: 04/22/2023] Open
Abstract
Intracranial epidermoid cysts are benign slow-growing ectodermal inclusions that account for less than 1% of all intracranial tumors. We retrospectively reviewed 36 such cases to evaluate the demographic characteristics, clinical manifestations, anatomical distribution, surgical management, and treatment outcome of these tumors. Additionally, we sought to identify the relationship between median or paramedian cistern tumor localization and clinical parameters, such as recurrence risk, hospitalization duration, and postoperative complication rates. The most frequently observed neurological symptoms were transient headaches (77.8%), dizziness (36.1%), CN VII palsy (19.4%), CN VIII hearing difficulty (19.4%) and cerebellar signs (19.4%). The most common surgical approaches included retrosigmoid (36.1%), subfrontal (19.4%) and telovelar (19.4%) approaches; gross total resection was feasible in 83.3% of cases. The postoperative complication rate was 38.9%. Tumors were more frequently found in the paramedian cisterns (47.2%), followed by the median line cisterns (41.6%). Multivariate analysis revealed that postoperative hydrocephalus and age < 40 years were prognostic factors for tumor recurrence. Median-like tumor location was a risk factor for the presence of symptomatic hydrocephalus both preoperatively and postoperatively, increasing the likelihood of protracted hospitalization (> 10 days). Despite their benign histopathological nature, these tumors have an important clinical resonance, with a high rate of postoperative complications and a degree of recurrence amplified by younger age and hydrocephalus.
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Affiliation(s)
- Maria Mihaela Pop
- Department of Neurosurgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Clinic of Neurosurgery, Cluj County Emergency Clinical Hospital, Cluj Napoca, Romania
| | - Dragos Bouros
- Department of Neurosurgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
| | - Artsiom Klimko
- Laboratory of Molecular Neuro-Oncology, Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Ioan Alexandru Florian
- Department of Neurosurgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Clinic of Neurosurgery, Cluj County Emergency Clinical Hospital, Cluj Napoca, Romania
| | - Ioan Stefan Florian
- Department of Neurosurgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Clinic of Neurosurgery, Cluj County Emergency Clinical Hospital, Cluj Napoca, Romania
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Desita F, Ferriastuti W, Fauziah D. Unusual presentation of a neuroepithelial cyst: A case report. Radiol Case Rep 2022; 17:4384-4387. [PMID: 36188083 PMCID: PMC9520425 DOI: 10.1016/j.radcr.2022.08.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/11/2022] [Accepted: 08/14/2022] [Indexed: 11/26/2022] Open
Abstract
Neuroepithelial cysts are benign, congenital, ependymal-lined cysts that constitute an infrequent cause of neurological symptoms among intracranial cystic lesions. We present Indonesian patient who underwent brain MRI depicting neuroepithelial cysts and pathological examination confirmed. Surgery was performed and yielded a satisfying result. Awareness of the entity and specific imaging features is key to making the diagnosis of neuroepithelial cyst and commencing appropriate treatment. This report is expected to aid in the diagnosis of neuroepithelial cysts, which are rare, and reduce the occurrence of misdiagnosis.
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de Sousa Costa R, Ventura N, de Andrade Lourenção Freddi T, da Cruz LCH, Corrêa DG. The Hypoglossal nerve. Semin Ultrasound CT MR 2022; 44:104-114. [PMID: 37055141 DOI: 10.1053/j.sult.2022.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The hypoglossal nerve is the 12th cranial nerve, exiting the brainstem in the preolivary sulcus, passing through the premedullary cistern, and exiting the skull through the hypoglossal canal. This is a purely motor nerve, responsible for the innervation of all the intrinsic tongue muscles (superior longitudinal muscle, inferior longitudinal muscle, transverse muscle, and vertical muscle), 3 extrinsic tongue muscles (styloglossus, hyoglossus, and genioglossus), and the geniohyoid muscle. Magnetic resonance imaging (MRI) is the best imaging exam to evaluate patients with clinical signs of hypoglossal nerve palsy, and computed tomography may have a complementary role in the evaluation of bone lesions affecting the hypoglossal canal. A heavily T2-weighted sequence, such as fast imaging employing steady-state acquisition (FIESTA) or constructive interference steady state (CISS) is important to evaluate this nerve on MRI. There are multiple causes of hypoglossal nerve palsy, being neoplasia the most common cause, but vascular lesions, inflammatory diseases, infections, and trauma can also affect this nerve. The purpose of this article is to review the hypoglossal nerve anatomy, discuss the best imaging techniques to evaluate this nerve and demonstrate the imaging aspect of the main diseases that affect it.
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de Sousa Costa R, Ventura N, de Andrade Lourenção Freddi T, da Cruz LCH, Corrêa DG. The Glossopharyngeal, Vagus and Accessory nerves: Anatomy and Pathology. Semin Ultrasound CT MR 2022; 44:95-103. [PMID: 37055144 DOI: 10.1053/j.sult.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The glossopharyngeal, vagus, and accessory nerves are discussed in this article, given their intimate anatomical and functional associations. Abnormalities of these lower cranial nerves may be intrinsic or extrinsic due to various disease processes. This article aims to review these nerves' anatomy and demonstrates the imaging aspect of the diseases which most commonly affect them.
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Ventura N. Inherited neurometabolic diseases and the importance of imaging-based classification systems. Radiol Bras 2022; 55:VII-VIII. [PMID: 35795600 PMCID: PMC9254713 DOI: 10.1590/0100-3984.2022.55.3e2-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Nina Ventura
- Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, RJ, Brazil; Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil; Hospital Samaritano, Grupo Fleury, Rio de Janeiro, RJ, Brazil
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Ventura N. Doenças neurometabólicas hereditárias e a importância das classificações baseadas em achados de imagem. Radiol Bras 2022. [DOI: 10.1590/0100-3984.2022.55.3e2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Nina Ventura
- Instituto Estadual do Cérebro Paulo Niemeyer, Brazil; Universidade Federal do Rio de Janeiro, Brazil; Hospital Samaritano, Brazil
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Ribeiro BNDF. Magnetic resonance imaging findings in diseases affecting the cranial nerves. Radiol Bras 2022; 55:V-VI. [PMID: 35210667 PMCID: PMC8864688 DOI: 10.1590/0100-3984.2022.55.1e1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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