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Shamavu GK, Mahmud FA, Maren MB, Arias Ortiz YE, Mseza B, Tsongo FK, Vahwere BM, Egesa WI. The "White Cerebellum Sign", a Striking Computed Tomography Scan Finding in a Critically Ill Infant: A Case Report. Int Med Case Rep J 2023; 16:693-697. [PMID: 37854708 PMCID: PMC10581014 DOI: 10.2147/imcrj.s422778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/11/2023] [Indexed: 10/20/2023] Open
Abstract
The "white cerebellum sign" is a striking neuroradiological finding, resulting from diffuse hypodense brain lesions in both cerebral hemispheres while sparing the cerebellum. This indicates widespread ischemic damage or expanded cerebral edema associated with the loss of white-gray matter differentiation. It is commonly reported in pediatric cases with severe neurological conditions, usually resulting in a poor prognosis. We present a case of a three-month-old female infant who was managed for confirmed acute bacterial meningitis complicated by status epilepticus, where the Computed tomography scan (CT scan) showed the "white cerebellum sign" in relation to diffuse cerebral hypoxic-ischemic lesions. However, the patient had a favorable outcome following treatment. This case underscores the importance of early recognition in cases presenting with the "white cerebellum sign". It highlights the potential for a positive prognosis even in severe neurological conditions when appropriate interventions are promptly administered.
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Affiliation(s)
- Gabriel Kakuru Shamavu
- Faculty of Clinical Medicine and Dentistry, Department of Pediatrics, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda
| | - Fatima Abdullha Mahmud
- Faculty of Clinical Medicine and Dentistry, Department of Pediatrics, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda
| | - Melvis Bernis Maren
- Faculty of Clinical Medicine and Dentistry, Department of Pediatrics, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda
| | - Yamile Enedina Arias Ortiz
- Faculty of Clinical Medicine and Dentistry, Department of Pediatrics, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda
| | - Banga Mseza
- Faculty of Clinical Medicine and Dentistry, Department of Pediatrics, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda
| | - Fidel Kasereka Tsongo
- Faculty of Clinical Medicine and Dentistry, Department of Radiology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Bienfait Mumbere Vahwere
- Faculty of Clinical Medicine and Dentistry, Department of Surgery, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda
| | - Walufu Ivan Egesa
- Faculty of Clinical Medicine and Dentistry, Department of Pediatrics, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda
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2
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Mehta TI, Arun A, Heiberger C, Cognetti D, Ray TR, Amans MR, Fargen K, Huisman TAGM, Hui F. Venous Pathologies and Interventions of the Head. Semin Neurol 2023; 43:439-453. [PMID: 37562454 DOI: 10.1055/s-0043-1771512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
Intracranial venous pathologies are a historically underrecognized group of disorders that can have a devastating impact on patients. Despite advancements in peripheral venous disorders and arterial neurointerventions, intracranial venous pathologies have received comparatively little attention. Understanding the anatomy, physiology, clinical relevance, and treatment options of intracranial venous pathologies is fundamental to evolving therapies and research priorities. This article provides an overview of major intracranial venous pathologies, the respective pathophysiologies, and treatment options.
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Affiliation(s)
- Tej Ishaan Mehta
- The United States Air Force Medical Corps, Falls Church, Virginia
- Department of Radiology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Anirudh Arun
- Department of Radiology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Caleb Heiberger
- Department of Radiology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - David Cognetti
- Department of Otolaryngology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Tyler R Ray
- Department of Mechanical Engineering, University of Hawai'i at Mānoa, Honolulu, Hawaii
- Department of Cellular and Molecular Biology, John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, Hawaii
| | - Matthew R Amans
- Department of Radiology, University of California San Francisco, San Francisco, California
- Department of Neurosurgery, University of California San Francisco, San Francisco, California
| | - Kyle Fargen
- Department of Neurosurgery, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
| | - Thierry A G M Huisman
- Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Ferdinand Hui
- Department of Radiology, The Queen's Medical Center, Honolulu, Hawaii
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3
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Matsuo T, Fujimoto S, Komori T, Nakata Y. Case report: The origin of transmantle-like features. FRONTIERS IN RADIOLOGY 2022; 2:927764. [PMID: 37492659 PMCID: PMC10365096 DOI: 10.3389/fradi.2022.927764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/08/2022] [Indexed: 07/27/2023]
Abstract
The transmantle sign is considered to be a magnetic resonance imaging feature specific to patients with type II focal cortical dysplasia; however, this sign can be difficult to distinguish from other pathologies, such as a radial-oriented white matter band in tuberous sclerosis. Here, we report a case showing a high-intensity area on T2-weighted and fluid-attenuated inversion recovery images extending from the ventricle to the cortex associated with atypical histopathological findings containing corpora amylacea. This case demonstrates that some instances of transmantle signs may be due to corpora amylacea accumulation.
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Affiliation(s)
- Takeshi Matsuo
- Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, Fuchu, Japan
| | - So Fujimoto
- Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, Fuchu, Japan
| | - Takashi Komori
- Department of Laboratory Medicine and Pathology, Tokyo Metropolitan Neurological Hospital, Fuchu, Japan
| | - Yasuhiro Nakata
- Department of Neuroradiology, Tokyo Metropolitan Neurological Hospital, Fuchu, Japan
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4
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Etemadifar M, Ashourizadeh H, Nouri H, Kargaran PK, Salari M, Rayani M, Aghababaee A, Abhari AP. MRI signs of CNS demyelinating diseases. Mult Scler Relat Disord 2020; 47:102665. [PMID: 33310421 DOI: 10.1016/j.msard.2020.102665] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 11/25/2020] [Accepted: 11/28/2020] [Indexed: 11/27/2022]
Abstract
The differential diagnosis of the central nervous system (CNS) demyelinating diseases can be greatly facilitated by visualization and appreciation of pathognomonic radiological signs, visualized on magnetic resonance imaging (MRI) sequences. Given the distinct therapeutic approaches for each of these diseases, a decisive and reliable diagnosis in patients presenting with demyelination-associated symptoms is of crucial value. Multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) are major examples of such conditions, each possessing a number of MRI signs, closely associated with the disorder. This pictorial review aims to describe seventeen pathognomonic MRI signs associated with several CNS demyelinating disorders including MS, NMOSD, myelin oligodendrocyte glycoprotein-associated disease, Baló's concentric sclerosis, metachromatic leukodystrophy, progressive multifocal leukoencephalopathy, and neurosarcoidosis.
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Affiliation(s)
- Masoud Etemadifar
- Department of Neurosurgery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Helia Ashourizadeh
- Functional Neurosurgery Research Center, Shohada Tajrish Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hosein Nouri
- Alzahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran; Network of Immunity in Infection, Malignancy, and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Isfahan, Iran.
| | - Parisa K Kargaran
- Departments of Cardiovascular Medicine, Center for Regenerative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Mehri Salari
- Department of Neurological Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Milad Rayani
- Alzahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Aghababaee
- Alzahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amir Parsa Abhari
- Alzahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran; Network of Immunity in Infection, Malignancy, and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Isfahan, Iran
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5
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Sharma M, Sood D, Chauhan NS, Manjuswamy RH, Kapila PT. Pictorial Essay: Classic Signs in Pediatric Neuroradiology. Curr Pediatr Rev 2020; 16:6-16. [PMID: 31526350 DOI: 10.2174/1573396315666190916141023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 07/09/2019] [Accepted: 07/10/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND A number of metaphorical imaging signs have been described in the radiology literature. OBJECTIVE These signs not only make the learning process easier but also increase diagnostic confidence. For this reason, these signs are quite popular among radiologists. CONCLUSION In this article, we have demonstrated classic signs described in pediatric neuroradiology with appropriate examples and illustrations.
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Affiliation(s)
- Madhurima Sharma
- Department of Radiology, Dr. Rajendra Prasad Government Medical College Kangra at Tanda, Kangra, Himachal Pradesh, Pin: 176001, India
| | - Dinesh Sood
- Department of Radiology, Dr. Rajendra Prasad Government Medical College Kangra at Tanda, Kangra, Himachal Pradesh, Pin: 176001, India
| | - Narvir S Chauhan
- Department of Radiology, Dr. Rajendra Prasad Government Medical College Kangra at Tanda, Kangra, Himachal Pradesh, Pin: 176001, India
| | - Rajanna H Manjuswamy
- Department of Radiology, Dr. Rajendra Prasad Government Medical College Kangra at Tanda, Kangra, Himachal Pradesh, Pin: 176001, India
| | - Preeti T Kapila
- Department of Radiology, Dr. Rajendra Prasad Government Medical College Kangra at Tanda, Kangra, Himachal Pradesh, Pin: 176001, India
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Baby N, Gilvaz P, Kuriakose AM. White Cerebellum Sign: A Poor Prognostic Sign. Pediatr Neurol 2019; 101:86-87. [PMID: 31043329 DOI: 10.1016/j.pediatrneurol.2019.03.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 03/27/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Neena Baby
- Department of Neurology, Jubilee Mission Medical College Hospital and Research Institute, Thrissur, Kerala, India.
| | - Percival Gilvaz
- Department of Neurology, Jubilee Mission Medical College Hospital and Research Institute, Thrissur, Kerala, India
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Lim M, Kheok SW, Lim KC, Venkatanarasimha N, Small JE, Chen RC. Subdural haematoma mimics. Clin Radiol 2019; 74:663-675. [PMID: 31109715 DOI: 10.1016/j.crad.2019.04.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 04/09/2019] [Indexed: 11/30/2022]
Abstract
A subdural haematoma (SDH) is a frequently encountered pathology seen on an emergency room computed tomography (CT) head scan. An extra-axial crescentic density along the convexity of the brain or within the interhemispheric fissure is generally thought to represent a SDH; however, SDH mimics are known to occur in nature, and can be broadly classified under the subcategories of normal anatomy, artefacts, tumour, inflammation, infection, ischaemia, trauma, and iatrogenic. Understanding the typical characteristics of a SDH, knowledge of normal anatomy, close inspection of the morphology of the subdural process, changes to the adjacent structures, and rigorous attention to clinical details may reveal subtle clues that distinguish a true SDH from a mimic. This is crucial in appropriately directing clinical management. This review amalgamates most of the rare subdural processes that have been reported to mimic SDH, and discusses the imaging and clinical features that help to differentiate between them. This topic is highly valuable for radiology trainees, general radiologists, and emergency room physicians, and may serve as a refresher for the practising neuroradiologist.
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Affiliation(s)
- M Lim
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore.
| | - S W Kheok
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
| | - K C Lim
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
| | - N Venkatanarasimha
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
| | - J E Small
- Neuroradiology, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - R C Chen
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
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Alshoabi S, Alnajmani R, Shamsuddin M, Gameraddin M. Early signs of middle cerebral artery infarction on multidetector computed tomography: Review of 20 cases. Brain Circ 2019; 5:27-31. [PMID: 31001598 PMCID: PMC6458774 DOI: 10.4103/bc.bc_28_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 12/28/2018] [Accepted: 01/28/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This study intended to assess the occurrence of early signs of middle cerebral artery (MCA) on multidetector computed tomography (MDCT) in correlation with duration of the clinical features of stroke. PATIENTS AND METHODS This retrospective study analyzed the electronic records of 20 patients with MCA infarction. The detected signs studied according to the onset of the clinical features of stroke to the time of CT imaging. RESULTS Out of 20 patients with MCA infarction included in this study, the results revealed a significant relationship between the presence of insular ribbon sign and/or subtle hypodensity and hyperacute infarction (P < 0.001 and 0.003, respectively). Results revealed significant relationship between the occurrence of hypodense area, effacement of the cortical sulci, and compression of the ipsilateral lateral ventricle with acute infarction (6-72 h), (P = 0.006, 0.007, and 0.002) (odds ratio = 0.047, 0.050 and 0.028) and (95% confidence interval = 0.004-0.552, 0.004-0.597 and 0.002-0.367) respectively. CONCLUSION MDCT can detect nearly half of MCA infarctions in the first 6 h. Insular ribbon sign and subtle hypodensity were the most significant findings in the first 6 h of stroke. Hypodense area was a significant sign after 6 h. Diabetes mellitus and ischemic heart disease were the most common risk factors. Hemiparesis was the most common clinical finding in MCA infarction.
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Affiliation(s)
- Sultan Alshoabi
- Department of Diagnostic Radiologic Technology, College of Applied Medical Sciences, Taibah University, Almadinah Almunawarah, Medina, Saudi Arabia
| | - Ramzi Alnajmani
- Department of Radiology and Medical Imaging, 22 Mayo Hospital, Hodeidah, Republic of Yemen
| | | | - Moawia Gameraddin
- Department of Diagnostic Radiologic Technology, College of Applied Medical Sciences, Taibah University, Almadinah Almunawarah, Medina, Saudi Arabia
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van Keulen S, Nishio N, Fakurnejad S, Birkeland A, Martin BA, Lu G, Zhou Q, Chirita SU, Forouzanfar T, Colevas AD, van den Berg NS, Rosenthal EL. The Clinical Application of Fluorescence-Guided Surgery in Head and Neck Cancer. J Nucl Med 2019; 60:758-763. [PMID: 30733319 PMCID: PMC6581234 DOI: 10.2967/jnumed.118.222810] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 12/29/2018] [Indexed: 01/17/2023] Open
Abstract
Although surgical resection has been the primary treatment modality of solid tumors for decades, surgeons still rely on visual cues and palpation to delineate healthy from cancerous tissue. This may contribute to the high rate (up to 30%) of positive margins in head and neck cancer resections. Margin status in these patients is the most important prognostic factor for overall survival. In addition, second primary lesions may be present at the time of surgery. Although often unnoticed by the medical team, these lesions can have significant survival ramifications. We hypothesize that real-time fluorescence imaging can enhance intraoperative decision making by aiding the surgeon in detecting close or positive margins and visualizing unanticipated regions of primary disease. The purpose of this study was to assess the clinical utility of real-time fluorescence imaging for intraoperative decision making. Methods: Head and neck cancer patients (n = 14) scheduled for curative resection were enrolled in a clinical trial evaluating panitumumab-IRDye800CW for surgical guidance (NCT02415881). Open-field fluorescence imaging was performed throughout the surgical procedure. The fluorescence signal was quantified as signal-to-background ratios to characterize the fluorescence contrast of regions of interest relative to background. Results: Fluorescence imaging was able to improve surgical decision making in 3 cases (21.4%): identification of a close margin (n = 1) and unanticipated regions of primary disease (n = 2). Conclusion: This study demonstrates the clinical applications of fluorescence imaging on intraoperative decision making. This information is required for designing phase III clinical trials using this technique. Furthermore, this study is the first to demonstrate this application for intraoperative decision making during resection of primary tumors.
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Affiliation(s)
- Stan van Keulen
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University School of Medicine, Stanford, California.,Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - Naoki Nishio
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University School of Medicine, Stanford, California
| | - Shayan Fakurnejad
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University School of Medicine, Stanford, California
| | - Andrew Birkeland
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University School of Medicine, Stanford, California
| | - Brock A Martin
- Department of Clinical Pathology, Stanford University School of Medicine, Stanford, California
| | - Guolan Lu
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University School of Medicine, Stanford, California
| | - Quan Zhou
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University School of Medicine, Stanford, California
| | - Stefania U Chirita
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University School of Medicine, Stanford, California.,Cancer Clinical Trials Office, Stanford Cancer Center, Stanford University School of Medicine, Stanford, California; and
| | - Tymour Forouzanfar
- Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - A Dimitrios Colevas
- Division of Medical Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Nynke S van den Berg
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University School of Medicine, Stanford, California
| | - Eben L Rosenthal
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University School of Medicine, Stanford, California
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Nguyen BK, Patel NM, Arianpour K, Svider PF, Folbe AJ, Hsueh WD, Eloy JA. Characteristics and management of sinonasal paragangliomas: a systematic review. Int Forum Allergy Rhinol 2018; 9:413-426. [DOI: 10.1002/alr.22261] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 10/08/2018] [Accepted: 10/28/2018] [Indexed: 12/21/2022]
Affiliation(s)
- Brandon K. Nguyen
- Department of Otolaryngology–Head and Neck SurgeryWayne State University School of Medicine Detroit MI
- Department of OtolaryngologyWilliam Beaumont Hospital Royal Oak MI
| | - Nirali M. Patel
- Department of Otolaryngology–Head and Neck SurgeryRutgers New Jersey Medical School Newark NJ
| | - Khashayar Arianpour
- Department of Otolaryngology–Head and Neck SurgeryWayne State University School of Medicine Detroit MI
- Department of OtolaryngologyWilliam Beaumont Hospital Royal Oak MI
| | - Peter F. Svider
- Department of Otolaryngology–Head and Neck SurgeryRutgers New Jersey Medical School Newark NJ
| | - Adam J. Folbe
- Department of OtolaryngologyWilliam Beaumont Hospital Royal Oak MI
- Barbara Ann Karmanos Cancer Institute Detroit MI
| | - Wayne D. Hsueh
- Department of Otolaryngology–Head and Neck SurgeryRutgers New Jersey Medical School Newark NJ
- Center for Skull Base and Pituitary Surgery, Neurological Institute of New JerseyRutgers New Jersey Medical School Newark NJ
| | - Jean Anderson Eloy
- Department of Otolaryngology–Head and Neck SurgeryRutgers New Jersey Medical School Newark NJ
- Center for Skull Base and Pituitary Surgery, Neurological Institute of New JerseyRutgers New Jersey Medical School Newark NJ
- Department of Ophthalmology and Visual ScienceRutgers New Jersey Medical School Newark NJ
- Department of Neurological Surgery, Neurological Institute of New JerseyRutgers New Jersey Medical School Newark NJ
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11
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Kizilca Ö, Öztek A, Kesimal U, Şenol U. Signs in Neuroradiology: A Pictorial Review. Korean J Radiol 2017; 18:992-1004. [PMID: 29089832 PMCID: PMC5639165 DOI: 10.3348/kjr.2017.18.6.992] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Accepted: 02/02/2017] [Indexed: 01/08/2023] Open
Abstract
One of the major problems radiologists face in everyday practice is to decide the correct diagnosis, or at least narrow down the list of possibilities. In this context, indicative evidences (signs) are useful to recognize pathologies, and also to narrow the list of differential diagnoses. Despite classically being described for a single disease, or a closely related family of disorders, most indications are not restricted exclusively to their traditional definition. Therefore, using signs for prognosis requires knowledge of the mechanism of their appearance, and which pathologies they are observed in. In this study, we demonstrate some of the more common and useful neuroradiologic signs with relevant images, and discuss their use in differential diagnosis.
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Affiliation(s)
- Özgür Kizilca
- Department of Radiology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Alp Öztek
- Department of Radiology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Uğur Kesimal
- Department of Radiology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Utku Şenol
- Department of Radiology, Akdeniz University Faculty of Medicine, Antalya, Turkey
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12
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Imaging in Juvenile Nasopharyngeal Angiofibroma: Clinical Significance of Ramharan and Chopstick Sign. Indian J Otolaryngol Head Neck Surg 2017; 69:81-87. [PMID: 28239585 DOI: 10.1007/s12070-016-1039-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 12/16/2016] [Indexed: 10/20/2022] Open
Abstract
Imaging plays an important role in the diagnosis, staging and prognosis of JNA. Certain radiological changes as seen on CECT were observed to be consistent in our case series. This study analysed preoperative and postoperative CECT of large series of JNA patients to evaluate the sites and pattern of spread of tumor. We evaluated the clinical significance of pterygoid wedge in preoperative and postoperative imaging and thus elucidating two new radiological signs. Retrospective analysis of the pre operative and post operative imaging data of 242 patients with JNA. The findings in the scan were clinically correlated with the endoscopic intraoperative findings. Preoperative evaluation of the pterygoid wedge revealed widening on the involved side in 99.1% of our cases which is 1.8 times greater compared to the uninvolved side. The possibility of residual/recurrent tumor was found to be significantly higher in those where the pterygoid wedge was not removed by drilling (p < 0.001) Drilling of the pterygoid wedge intra operatively, reduced the rate of residual/recurrence from 31.9 to 3.07%. Widening of the pterygoid wedge seen in the preoperative CECT, referred as RAM HARAN sign occurs in JNA. It has a significant diagnostic value as a radiological sign in JNA. Drilling of the pterygoid wedge intraoperatively reduces the rate of recurrence of JNA. Appearance of the two pterygoid plates on postoperative CECT, as two parallel lines, referred as Chopstick sign, has a remarkable prognostic value as a radiological sign in JNA.
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13
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Bozdogan E, Kocaturk O, Altiparmak IH, Karakas E. Hyperdense Middle Cerebral Artery Sign Together with Pulmonary Thromboembolism. Pol J Radiol 2016; 81:247-9. [PMID: 27279927 PMCID: PMC4880310 DOI: 10.12659/pjr.896442] [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: 10/27/2015] [Accepted: 11/05/2015] [Indexed: 11/23/2022] Open
Abstract
Background Hyperdense middle cerebral artery sign is an appearance of the middle cerebral artery on non-contrast-enhanced computed tomography. Embolic occlusion of the pulmonary arterial system is referred to as pulmonary embolism. When pulmonary embolism coexists with a patent foramen ovale, increased pressure in the right atrium may result in widening of the foramen and consequently, cause serious conditions due to paradoxical embolus. Coexistence of hyperdense middle cerebral artery sign and pulmonary thromboembolism is very rare in the literature. Case Report We presented a 60-year-old female patient who had both hyperdense middle cerebral artery sign and pulmonary thromboembolism. Conclusions To our knowledge, togetherness of hyperdense MCA sign and pulmonary thromboembolism is extremely rare in the literature. In our case, we found both pulmonary embolism due to DVT and paradoxical embolism due to existing patent foramen ovale.
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Affiliation(s)
- Erol Bozdogan
- Department of Radiology, Harran University Medical School, Sanliurfa, Turkey
| | - Ozcan Kocaturk
- Department of Neurology, Harran University Medical School, Sanliurfa, Turkey
| | | | - Ekrem Karakas
- Department of Radiology, Harran University Medical School, Sanliurfa, Turkey
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14
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Lisch and the Importance of His Nodules. W INDIAN MED J 2015; 63:799-802. [PMID: 25867571 DOI: 10.7727/wimj.2013.323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 01/20/2014] [Indexed: 11/18/2022]
Abstract
Neurofibromatosis 1 is the commonest neurocutaneous autosomal dominant disorder with full penetrance, although expression may not be complete by the age of five years. Lisch nodules, however, are predominantly visible in children usually after the age of six years. Therefore, it is important to appreciate that their absence before this age does not pre-empt the diagnosis. A child being treated for hypertension of unknown aetiology with cafe au lait lesions presented to the ophthalmologist with blurred vision. Clinical examination revealed Lisch nodules which confirmed the suspicion of neurofibromatosis 1 as per National Institutes of Health criteria. The aim of this report is to highlight the importance of regular ophthalmic screening, both in suspected and confirmed cases, as these patients have long-term sequelae.
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15
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Bare orbit sign: classical sign in cranio-orbital-temporal neurofibromatosis 1. Indian J Pediatr 2015; 82:203-4. [PMID: 25179240 DOI: 10.1007/s12098-014-1564-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 08/12/2014] [Indexed: 10/24/2022]
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Atalar MH, Salk I, Egilmez H. Classical signs and appearances in pediatric neuroradiology: a pictorial review. Pol J Radiol 2014; 79:479-89. [PMID: 25538798 PMCID: PMC4274733 DOI: 10.12659/pjr.891107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 07/17/2014] [Indexed: 11/15/2022] Open
Abstract
Radiological practice includes classification of illnesses with similar characteristics through recognizable signs. In this report, twenty-eight important and frequently seen neuroradiological signs in childhood are presented and described using X-rays, computed tomography (CT), magnetic resonance (MR) images, illustrations and photographs.
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Affiliation(s)
- Mehmet Haydar Atalar
- Department of Radiology, Cumhuriyet University, School of Medicine, Sivas, Turkey
| | - Ismail Salk
- Department of Radiology, Cumhuriyet University, School of Medicine, Sivas, Turkey
| | - Hulusi Egilmez
- Department of Radiology, Cumhuriyet University, School of Medicine, Sivas, Turkey
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Amaral LLF, Gaddikeri S, Chapman PR, Roy R, Gaddikeri RS, Marussi VH, Bag AK. Neurodegeneration with Brain Iron Accumulation: Clinicoradiological Approach to Diagnosis. J Neuroimaging 2014; 25:539-51. [PMID: 25545045 DOI: 10.1111/jon.12195] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 07/30/2014] [Accepted: 08/16/2014] [Indexed: 11/28/2022] Open
Abstract
Discovery of genetic abnormalities associated with neurodegeneration with brain iron accumulation (NBIA) has led to use of a genetic-based NBIA classification schema. Most NBIA subtypes demonstrate characteristic imaging abnormalities. While clinical diagnosis of NBIA is difficult, analysis of both clinical findings and characteristic imaging abnormalities allows accurate diagnosis of most of the NBIA subtypes. This article reviews recent updates in the genetic, clinical, and imaging findings of NBIA subtypes and provides a practical step-by-step clinicoradiological algorithm toward clinical diagnosis of different NBIA subtypes.
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Affiliation(s)
- Lázaro L F Amaral
- Department of Radiology, Medimagem - Hospital da Beneficência Portuguesa, São Paulo, Brazil.,Department of Radiology, Santa Casa de Misericordia of Sao Paulo, Brazil
| | | | - Philip R Chapman
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL
| | - Rasmoni Roy
- Department of Neurology, University of Tennessee Health Sciences Center, Memphis, TN
| | | | - Victor Hugo Marussi
- Department of Radiology, Medimagem - Hospital da Beneficência Portuguesa, São Paulo, Brazil
| | - Asim K Bag
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL
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18
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Affiliation(s)
- Gwinyai Masukume
- Department of Obstetrics and Gynecology, Mpilo Central Hospital, Bulawayo, Zimbabwe.
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Abstract
Imaging signs form an important part of the language of radiology, but are not represented in established lexicons. We sought to incorporate imaging signs into RSNA's RadLex® ontology of radiology terms. Names of imaging signs and their definitions were culled from books, journal articles, dictionaries, and biomedical web sites. Imaging signs were added into RadLex as subclasses of the term "imaging sign," which was defined in RadLex as a subclass of "imaging observation." A total of 743 unique imaging signs were added to RadLex with their 392 synonyms to yield a total of 1,135 new terms. All included definitions and related RadLex terms, including imaging modality, anatomy, and disorder, when appropriate. The information will allow RadLex users to identify imaging signs by modality (e.g., ultrasound signs) and to find all signs related to specific pathophysiology. The addition of imaging signs to RadLex augments its use to index the radiology literature, create and interpret clinical radiology reports, and retrieve relevant cases and images.
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Affiliation(s)
- Matthew W. Shore
- Department of Radiology, Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI 53226 USA
| | - Daniel L. Rubin
- Department of Radiology, Stanford University Medical School, Stanford, CA USA
| | - Charles E. Kahn
- Department of Radiology, Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI 53226 USA
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