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Bajrami A, Tamanti A, Peloso A, Ziccardi S, Guandalini M, Calderone M, Castellaro M, Pizzini FB, Montemezzi S, Marastoni D, Calabrese M. Ocrelizumab reduces cortical and deep grey matter loss compared to the S1P-receptor modulator in multiple sclerosis. J Neurol 2024; 271:2149-2158. [PMID: 38289534 PMCID: PMC11055717 DOI: 10.1007/s00415-023-12179-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/26/2023] [Accepted: 12/27/2023] [Indexed: 04/28/2024]
Abstract
INTRODUCTION Ocrelizumab (OCR) and Fingolimod (FGL) are two high-efficacy treatments in multiple sclerosis which, besides their strong anti-inflammatory activity, may limit neurodegeneration. AIM To compare the effect of OCR and FGL on clinical and MRI endpoints. METHODS 95 relapsing-remitting patients (57 OCR, 38 FGL) clinically followed for 36 months underwent a 3-Tesla MRI at baseline and after 24 months. The annualized relapse rate, EDSS, new cortical/white matter lesions and regional cortical and deep grey matter volume loss were evaluated. RESULTS OCR reduced the relapse rate from 0.48 to 0.04, FGL from 0.32 to 0.05 (both p < 0.001). Compared to FGL, OCR-group experienced fewer new white matter lesions (12% vs 32%, p = 0.005), no differences in new cortical lesions, lower deep grey matter volume loss (- 0.12% vs - 0.66%; p = 0.002, Cohen's d = 0.54), lower global cortical thickness change (- 0.45% vs - 0.70%; p = 0.036; d = 0.42) and reduced cortical thinning/volume loss in several regions of interests, including those of parietal gyrus (d-range = 0.65-0.71), frontal gyrus (d-range = 0.47-0.60), cingulate (d-range = 0.41-0.72), insula (d = 0.36), cerebellum (cortex d = 0.72, white matter d = 0.44), putamen (d = 0.35) and thalamus (d = 0.31). The effect on some regional thickness changes was confirmed in patients without focal lesions. CONCLUSIONS When compared with FGL, patients receiving OCR showed greater suppression of focal MRI lesions accumulation and lower cortical and deep grey matter volume loss.
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Affiliation(s)
- Albulena Bajrami
- Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Policlinico "G.B. Rossi" Borgo Roma Piazzale L.A. Scuro, 10, 37134, Verona, Italy
- Neurology Unit, Ospedale S. Chiara, Azienda Provinciale per i Servizi Sanitari (APSS), Largo Medaglie d'oro, 9, 38122, Trento, Italy
| | - Agnese Tamanti
- Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Policlinico "G.B. Rossi" Borgo Roma Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Angela Peloso
- Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Policlinico "G.B. Rossi" Borgo Roma Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Stefano Ziccardi
- Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Policlinico "G.B. Rossi" Borgo Roma Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Maddalena Guandalini
- Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Policlinico "G.B. Rossi" Borgo Roma Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Milena Calderone
- Radiology Unit, Cmsr Veneto Medica S.R.L., Altavilla Vicentina, via Vicenza, 204, 36077, Vicenza, Italy
| | - Marco Castellaro
- Department of Information Engineering, University of Padova, Via Giovanni Gradenigo, 6b , 35131, Padua, Italy
| | - Francesca B Pizzini
- Department of Diagnostics and Public Health, University of Verona, Policlinico "G.B. Rossi" Borgo Roma Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Stefania Montemezzi
- Department of Diagnostics and Public Health, University of Verona, Policlinico "G.B. Rossi" Borgo Roma Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Damiano Marastoni
- Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Policlinico "G.B. Rossi" Borgo Roma Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Massimiliano Calabrese
- Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Policlinico "G.B. Rossi" Borgo Roma Piazzale L.A. Scuro, 10, 37134, Verona, Italy.
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Tonelotto V, Davini A, Cardarelli L, Calderone M, Marin P. Efficacy of Fluorecare SARS-CoV-2 Spike Protein Test Kit for SARS-CoV-2 detection in nasopharyngeal samples of 121 individuals working in a manufacturing company. PLoS One 2022; 17:e0262174. [PMID: 35025944 PMCID: PMC8757945 DOI: 10.1371/journal.pone.0262174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/17/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the clinical performance of the Fluorecare SARS-CoV-2 Spike Protein Test Kit, a rapid immunochromatographic assay for SARS-CoV-2 detection. Moreover, we sought to point out the strategy adopted by a local company to lift the lockdown without leading to an increase in the number of COVID-19 cases, by performing a precise and timely health surveillance. METHODS The rapid Fluorecare SARS-CoV-2 Spike Protein Test was performed immediately after sampling following the manufacturer's instructions. RT-PCRs were performed within 24 hours of specimen collection. A total amount of 253 nasopharyngeal samples from 121 individuals were collected between March 16 and April 2, 2021 and tested. RESULTS Of 253 nasopharyngeal samples, 11 (9.1%) were positive and 242 (90.9%) were negative for SARS-CoV-2 RNA by RT-PCR assays. The rapid SARS-CoV-2 antigen detection test's mean sensitivity and specificity were 84,6% (95% CI, 54.6-98.1%) and 100% (95% CI, 98.6-100%), respectively. Two false negative test results were obtained from samples with high RT-PCR cycle threshold (Ct). CONCLUSION Our study suggested that Fluorecare SARS-CoV-2 Spike Protein Test can be introduced into daily diagnostic practice, as its mean sensitivity and specificity follow the standards recommended by WHO and IFCC Task Force. In addition, we underlined how the strategy adopted by a local company to risk assessment and health surveillance was appropriate for infection containment. This real-life scenario gave us the possibility to experience potential approaches aimed to preserve public health and work activities.
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Affiliation(s)
| | - Annamaria Davini
- C.M.S.R. Veneto Medica S.r.l., Altavilla Vicentina, Vicenza, Italy
| | - Laura Cardarelli
- Lifebrain S.r.l–Gruppo Cerba HealthCare c/o RDI—Rete Diagnostica Italiana S.r.l, Limena, Padova, Italy
| | - Milena Calderone
- C.M.S.R. Veneto Medica S.r.l., Altavilla Vicentina, Vicenza, Italy
| | - Paola Marin
- C.M.S.R. Veneto Medica S.r.l., Altavilla Vicentina, Vicenza, Italy
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Veronesi V, Calderone M, Sacco C, Donati R. Prone Position Magnetic Resonance Imaging and Transhiatal Approach to Filum Terminale Externum Sectioning in Adolescents with Occult Tethered Cord Syndrome: Report of Four Cases. Pediatr Neurosurg 2020; 55:432-438. [PMID: 33401272 DOI: 10.1159/000512471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 10/20/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Occult tethered cord syndrome (OTCS) and its surgical treatment are controversial. A previous study with lumbar magnetic resonance imaging (MRI) in the prone position had found statistically significant differences in morphological parameters between pediatric OTCS patients and a control group. Filum terminale internum (FTI) sectioning is currently the gold standard for the treatment of OTCS. CASE PRESENTATION We present four cases of adolescents with OTCS, of which three cases were associated with low-lying cerebellar tonsils (LLCT). The patients presented various symptoms of OTCS from pain to sensory disturbances to alterations in sphincter functions, but none had disorders belonging to all three categories. A T2-weighted axial MRI in the prone position supported the clinical diagnosis of OTCS. The patients were treated with minimal skin incision and filum terminale externum (FTE) sectioning through the sacral hiatus under local anesthesia. DISCUSSION We describe for the first time the association between lumbar MRI in the prone position and FTE sectioning in OTCS. The FTE sectioning has resulted in the disappearance of the pain and sensory disturbance symptoms. The results on the sphincter function are mixed. Three of our four patients with OTCS had LLCT, and all three also reported headache episodes, which, surprisingly, disappeared postoperatively. This minimally invasive surgery involves only minimal discomfort for the patient and minimizes the risks related to skin incision only. The postoperative lumbar MRI in the prone position has shown that there is no mobilization of the FTI or changes in the other preoperative morphological parameters.
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Affiliation(s)
- Vanni Veronesi
- Surgical and Major Trauma Department, Surgery of the Peripheral Nervous System, Local Health Authority of Romagna, "Degli Infermi" Faenza Hospital, Faenza, Italy,
| | | | - Carlo Sacco
- Surgical and Major Trauma Department, Surgery of the Peripheral Nervous System, Local Health Authority of Romagna, "Degli Infermi" Faenza Hospital, Faenza, Italy
| | - Roberto Donati
- Surgical and Major Trauma Department, Surgery of the Peripheral Nervous System, Local Health Authority of Romagna, "Degli Infermi" Faenza Hospital, Faenza, Italy
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Toldo I, Tangari M, Mardari R, Perissinotto E, Sartori S, Gatta M, Calderone M, Battistella PA. Headache in children with Chiari I malformation. Headache 2014; 54:899-908. [PMID: 24766291 DOI: 10.1111/head.12341] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Headache is the most common symptom of Chiari 1 malformation, a condition characterized by the herniation of cerebellar tonsils through the foramen magnum. However, the headache pattern of cases with Chiari 1 malformations is not well defined in the literature, especially in children. OBJECTIVE The aim of this retrospective chart review was to evaluate the frequency and the characteristics of headache in children with Chiari 1 malformation at initial evaluation and during follow up. METHODS Forty-five cases with tonsillar ectopia were selected among 9947 cases under 18 years of age who underwent neuroimaging between 2002 and 2010. A semistructured clinical interview (mean follow-up: 5.2 years) was conducted. Headache was classified according to the second edition of the International Classification of Headache Disorders. RESULTS Possible associations between clinical picture, in particular headache pattern, but also other signs and symptoms attributable to Chiari 1 malformation, and the extent of tonsillar ectopia were found for 3 different groups: those with borderline (<5 mm, N = 12), mild (5-9 mm, N = 27), and severe tonsillar ectopia (≥10 mm, N = 6), respectively. Twenty-four out of 33 (73%) cases with Chiari 1 malformation complained of headache, and 9/33 (27%) of those patients (5 with mild and 4 with severe tonsillar ectopia) reported headache attributed to Chiari 1 malformation. CONCLUSIONS In our studied pediatric population, the most common symptom for cases diagnosed with Chiari 1 malformation was headache, and headache attributed to Chiari 1 malformation was the most common headache pattern in patients with Chiari 1 malformation. The presence of headache attributed to Chiari 1 malformation along with 3 other signs or symptoms of Chiari 1 malformation were highly predictive of severe tonsillar ectopia.
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Affiliation(s)
- Irene Toldo
- Juvenile Headache Centre, Department of Woman and Child Health, University of Padua, Padua, Italy
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Abstract
Pleomorphic xanthoastrocytoma (PXA) is a rare astrocytic tumor that usually occurs in the superficial cerebral hemispheres of children and young adult and has a favorable prognosis. We report a case of a 14-year-old girl with a recent history of sciatica and ataxic gait. Pre- and post-contrast brain and spinal MRI revealed the presence of multiple solid lesions with a cystic component in the cerebellum and the spinal cord with a concomitant massive leptomeningeal involvement Histological and immunohistochemical findings were concordant with a final diagnosis of WHO grade II PXA. Even the biological indolent PXAs' behavior, this is the third report in the literature of such an unusual multicentric PXA with leptomeningeal dissemination.
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Affiliation(s)
- Marina Paola Gardiman
- Department of Medicine, Surgical Pathology & Cytopathology Unit, University Hospital of Padua, 35100, Padua, Italy
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Citton V, Toldo I, Balao L, Pettenazzo A, Emanuelli E, Sartori S, Calderone M, Manara R. Chiari 2 without spinal dysraphism: does it blow a hole in the pathogenesis? J Child Neurol 2012; 27:536-9. [PMID: 22378677 DOI: 10.1177/0883073811435239] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Chiari malformation type 2 is characterized by hindbrain protrusion and a constellation of supratentorial malformations. Chiari malformation type 2 is thought to be causally related to myelomeningocele due to intrauterine cerebrospinal fluid overdrainage. This relationship is so strong that it has become a rule. A 14-year-old girl affected by mental retardation, spastic triparesis, and epilepsy is presented. Brain magnetic resonance imaging disclosed a severe Chiari malformation type 2, whereas spine magnetic resonance imaging was unremarkable. The authors discuss previous literature describing rare cases of Chiari malformation type 2 without open spinal dysraphism and the relevance of concomitant, sometimes overlooked, neuroimaging findings, underlying how exceptions might be hurdles but might also eventually strengthen the rules.
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Affiliation(s)
- Valentina Citton
- Division of Neuroradiology, University Hospital of Padua, Italy.
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Bartolini L, Mardari R, Toldo I, Calderone M, Battistella PA, Laverda AM, Sartori S. Norovirus gastroenteritis and seizures: an atypical case with neuroradiological abnormalities. Neuropediatrics 2011; 42:167-9. [PMID: 21932182 DOI: 10.1055/s-0031-1286349] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
We describe an 8-year-old boy admitted because of prolonged seizures during norovirus gastroenteritis without any signs of encephalopathy. Blood tests were normal and cerebrospinal fluid examination resulted negative for both bacteria and viruses. A reverse transcriptase polymerase chain reaction revealed norovirus RNA in a stool sample. A cerebral computed tomography turned out to be normal whereas subsequent cerebral magnetic resonance imaging showed transitory signal abnormalities consistent with vasogenic edema. The post-ictal electroencephalogram revealed normal background activity with sporadic left posterior delta waves. The child was discharged after 10 days with an unremarkable physical examination. A cerebral magnetic resonance imaging and an electroencephalogram after 1 month were both negative. We report a new case of benign infantile convulsions due to norovirus gastroenteritis with neuroradiological abnormalities to the pertinent literature in order to improve knowledge about this disorder and increase the possibility of clarifying its pathogenesis.
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Affiliation(s)
- L Bartolini
- Department of Pediatrics, University Hospital of Padua, Italy.
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Faggin R, Calderone M, Denaro L, Meneghini L, d'Avella D. Long-term operative failure of endoscopic third ventriculostomy in pediatric patients: the role of cine phase-contrast MR imaging. Neurosurg Focus 2011; 30:E1. [DOI: 10.3171/2011.1.focus10303] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Although a rarely reported occurrence, late failure of endoscopic third ventriculostomy (ETV) may occur in children as a result of a variety of factors. Delay in recognition of symptoms can lead to harmful deterioration in the patient's condition. The authors undertook this study to assess the capacity of cine phase-contrast MR imaging to identify late failure in asymptomatic pediatric patients treated with ETV for hydrocephalus.
Methods
This study was a retrospective evaluation of cases involving patients who underwent ETV between January 1, 1999, and December 31, 2008, at the pediatric neurological surgery service of the University of Padua. Before 2004, patients were routinely followed up with cine MR imaging at 3, 6, and 12 months after ETV. In 2004, a protocol of annual cine MR follow-up was instituted as a result of a case of fatal late failure. The authors evaluated all cases of late failure identified through cine MR imaging and performed a statistical analysis to investigate the relationship between ETV failure and several variables, including the cause of hydrocephalus for which ETV was originally indicated.
Results
In a series of 84 patients (age range 6 days–16 years), 17 patients had early ETV failure. Of the remaining 67 patients, 5 (7%) were found to have no CSF flow through the fenestration and recurrent ventriculomegaly when assessed with cine MR imaging at 1, 2, 3, 4, and 7 years after ETV. The patient in whom ETV failure was identified 1 year postoperatively had Dandy-Walker malformation. The patients in whom ETV failure was identified 2, 3, and 4 years postoperatively all had undergone ETV for treatment of postinfective hydrocephalus. The patient in whom ETV failure was identified 7 years postoperatively had a cystic arachnopathy in the fourth ventricle after cerebellar astrocytoma removal.
Conclusions
Patients who undergo ETV for infective hydrocephalus and Dandy-Walker malformation should receive long-term follow-up, because late closure of the stoma may occur progressively and slowly. Intraoperative observation of thickened arachnoid membranes at the level of the interpeduncular cisterns at the first ETV and a progressive decreasing of CSF flow through the stoma on routine cine MR imaging should be considered unfavorable elements entailing a significant risk of deterioration.
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Affiliation(s)
| | | | | | - Luisa Meneghini
- 3Pediatric Anesthesiology, Department of Pediatrics, University of Padua, Italy
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Toldo I, Calderone M, Sartori S, Mardari R, Gatta M, Boniver C, Guerrini R, Battistella PA. Bilateral perisylvian polymicrogyria with cerebellar dysplasia and ectopic neurohypophysis. J Child Neurol 2011; 26:361-5. [PMID: 21273507 DOI: 10.1177/0883073810381447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Polymicrogyria (involving or not the sylvian scissure) with cerebellar cortical dysplasia or vermis hypoplasia has been reported in few cases. In addition, the association between ectopic neurohypophysis and other cortical malformations, including bilateral perisylvian polymicrogyria, has been documented. We describe a girl affected by focal epilepsy since the age of 2 years. Magnetic resonance imaging (MRI) at 11 and 22 years of age showed bilateral perisylvian polymicrogyria, dysplasia of the left cerebellar hemisphere, and ectopic neurohypophysis. Genetic tests, including fluorescent in situ hybridization 22q11.2 and array-comparative genomic hybridization, and pituitary hormones (at the age of 20 years) were normal. The patient is now 22 years old, and she is seizure free under therapy with lamotrigine and levetiracetam. To the best of our knowledge, this is the first description of this complex cerebral malformation. This finding confirms that bilateral perisylvian polymicrogyria can be associated with other cerebral malformations; cerebellum and neurohypophysis must be carefully evaluated in patients with polymicrogyria.
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Affiliation(s)
- Irene Toldo
- Department of Pediatrics, University Hospital of Padua, Padua, Italy.
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Abstract
Varicella zoster virus (VZV) is the only human virus known to replicate in arteries. After the acute infection, the virus persists in a noninfectious latent form in ganglia along the neuraxis, with intermittent periods of reactivation. Both primary and secondary reactivation are associated with stroke in children. These patients, regardless of the chosen treatment, have a high risk of recurrence, particularly those with worsening arterial stenosis. There are no specific therapy protocols for varicella-associated stroke in children, and the use of steroids or antiviral drugs is still controversial. We present a series of 4 children with stroke following varicella infection, with no recurrence and stable vascular stenosis at a mean follow-up of 18 months without steroid treatment. We also analyze possible correlations between anti-protein C, protein S and protein Z autoantibodies, and post-varicella arteriopathy.
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Affiliation(s)
- Luca Bartolini
- Department of Pediatrics, University Hospital of Padua, Italy
| | | | - Stefano Sartori
- Department of Pediatrics, University Hospital of Padua, Italy
| | - Milena Calderone
- Department of Neurosciences, University Hospital of Padua, Italy
| | - Paolo Simioni
- Department of Cardiologic, Thoracic and Vascular Sciences, University Hospital of Padua, Italy
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Campagna M, Opocher E, Viscardi E, Calderone M, Severino SM, Cermakova I, Perilongo G. Optic pathway glioma: long-term visual outcome in children without neurofibromatosis type-1. Pediatr Blood Cancer 2010; 55:1083-8. [PMID: 20979170 DOI: 10.1002/pbc.22748] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Little is known about the visual outcome of children affected by an optic pathway glioma (OPG). PROCEDURES We evaluated the long-term visual outcome of 32 consecutive children affected by OPG without neurofibromatosis type-1 referred to the Pediatric Department of Padua University and managed according to standardized strategies. RESULTS Eight children received chemotherapy, 10 radiotherapy, 7 both chemotherapy and radiotherapy, whereas 7 were untreated. At presentation, visual acuity (VA) was normal in 22 children (13 unilaterally and 9 bilaterally), and reduced in 10. At follow-up, VA had improved in 6 patients; it was stable in 8 and worse in 18. Visual field, assessed in 29 children, was normal in 9 and reduced in 20. The number of children with some grade of visual impairment increased from 7 to 10 during follow-up. Of the 17 children in whom the tumor became significantly smaller, VA improved in 6, was stable in 3, and worse in 8. Of the 6 children with improved VA, 5 received radiotherapy, and their papilla was normal or mildly pale. After a median follow-up of 6 years, 26 patients are alive with stable disease. CONCLUSIONS The visual prognosis of children with OPG is unsatisfactory. Older children treated with radiotherapy seem to have a better visual outcome than younger children. Severe optic pallor at diagnosis or during follow-up may be indicative of a negative prognosis.
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Affiliation(s)
- Marta Campagna
- Department of Pediatrics, University of Padua, Padua, Italy
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Sartori S, Ludwig K, Fortuna M, Marzocchi C, Calderone M, Toldo I, Salviati L, Laverda AM, Tenconi R. Dandy-Walker malformation masking the molar tooth sign: an illustrative case with magnetic resonance imaging follow-up. J Child Neurol 2010; 25:1419-22. [PMID: 20823032 DOI: 10.1177/0883073810370477] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Joubert syndrome is a disorder characterized by ataxia, developmental delay, oculomotor anomalies, and breathing irregularities, with cerebellar vermian and midbrain dysgenesis. The molar tooth sign, reflecting the midbrain dysgenesis of Joubert syndrome, is the neuroradiological hallmark and is an essential sign in the identification of this condition. Variable vermian agenesis, an expanded fourth ventricle, and a large posterior cranial fossa with a normal brainstem are typical of Dandy-Walker malformation. The authors report a case in which a Dandy-Walker malformation coexisted with Joubert syndrome, but initially prevented the ''molar tooth sign'' from being recognized because of an important cystic dilatation of the fourth ventricle. In this article, they discuss the importance of the re-examination of brain magnetic resonance features after decompression of the posterior cranial fossa in a patient with Dandy-Walker malformation and additional clinical neurological or systemic abnormalities typical of Joubert syndrome, to not miss the correct diagnosis.
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Affiliation(s)
- Stefano Sartori
- Paediatric Neurology Unit, Department of Paediatrics Salus Pueri, University of Padua, Padua, Italy.
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Opocher E, Bisogno G, Calderone M, Drigo P. Unusual neuroimaging in a young boy with cerebral X-linked adrenoleukodystrophy. Neuropediatrics 2010; 41:66-8. [PMID: 20799152 DOI: 10.1055/s-0030-1255073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We describe the case of a 7-year-old boy with cerebral X-linked adrenoleukodystrophy presenting with neurobehavioral symptoms. Attention deficit with hyperactive behavior was followed by progressive memory retrieval deficits and difficulty in writing. A detailed review of the clinical history, clinical examination and contrast-enhanced brain nuclear magnetic resonance imaging disclosed indeed an atypical cerebral form of X-linked adrenoleukodystrophy with diffuse anterior and posterior white matter involvement with a typical rim of contrast enhancement. A severe clinical deterioration occurred despite dietary treatment and hormonal replacement therapy. These rare but severe forms of atypical cerebral X-linked adrenoleukodystrophy can more often mimic attention deficit/hyperactivity disorder and should, therefore, be considered in young males with progressive neurobehavioral symptoms, particularly when possibly related to frontal white matter involvement. An accurate clinical history and examination should determine whenever a contrast-enhanced head MRI should be indicated.
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Affiliation(s)
- E Opocher
- Department of Pediatrics, University of Padua, Padova, Italy.
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14
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Manara R, Calderone M, Severino MS, Citton V, Toldo I, Laverda AM, Sartori S. Spinal cord infarction due to fibrocartilaginous embolization: the role of diffusion weighted imaging and short-tau inversion recovery sequences. J Child Neurol 2010; 25:1024-8. [PMID: 20299698 DOI: 10.1177/0883073809355822] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Fibrocartilaginous embolization is a rare cause of ischemic myelopathy caused by embolization of intersomatic disk nucleus pulposus into spinal vasculature during Valsalva-like maneuvers. Diagnostic criteria are based on patient's clinical history, magnetic resonance evidence of T2-hyperintense spinal cord lesion, and exclusion of other causes of ischemic myelopathy. These criteria do not take into account the development of magnetic resonance techniques able to enhance signal abnormalities within the neighboring intersomatic disc or vertebral body and to early characterize central nervous system lesions according to the presence of cytotoxic edema. We present 2 pediatric cases of progressive paraplegia attributed to fibrocartilaginous embolization in which short-tau inversion recovery and diffusion-weighted imaging sequences played a pivotal role showing the ischemic nature of spinal cord lesions. Due to its specificity, diffusion-weighted imaging should be included in the magnetic resonance criteria of fibrocartilaginous embolization and in standard magnetic resonance analysis when dealing with acute transverse myelopathy.
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Affiliation(s)
- Renzo Manara
- Neuroradiologic Unit, University Hospital of Padua, Padua, Italy.
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Abstract
Several studies on opiates demonstrated that selected brain areas as cerebellum and limbic system have the greatest density of opioid receptors. Recently, few cases of severe cerebellitis following methadone poisoning have been reported in children. We present the case of a 30-month-old girl who developed a delayed encephalopathy after methadone intoxication. She was admitted to our emergency department in coma, and after naloxone infusion, she completely recovered. Five days after intoxication, she developed psychomotor agitation, slurred speech, abnormal movements, and ataxia despite a negative neuroimaging finding. A repeat magnetic resonance imaging (MRI) performed 19 days after the intoxication for persistent symptoms showed signal abnormalities in the temporomesial regions, basal ganglia, and substantia nigra. To our knowledge, this is the first report of these delayed MRI findings associated with synthetic opioid intoxication.
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Affiliation(s)
- Anna Zanin
- Paediatric Emergency Unit, Paediatric Department, University of Padua, 35100 Padua, Italy.
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Gardiman MP, Fassan M, Orvieto E, D'Avella D, Denaro L, Calderone M, Severino M, Scarsello G, Viscardi E, Perilongo G. AUTHOR'S RESPONSE. Brain Pathol 2009. [DOI: 10.1111/j.1750-3639.2009.00331.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Citton V, Toldo I, Calderone M, Sartori S, Manara R. Early cortical cytotoxic edema in meningococcal meningitis. Pediatr Neurol 2009; 41:146-50. [PMID: 19589467 DOI: 10.1016/j.pediatrneurol.2009.02.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2008] [Revised: 02/02/2009] [Accepted: 02/23/2009] [Indexed: 11/30/2022]
Abstract
Meningococcal disease frequently presents neurologic sequels via vascular, metabolic, or inflammatory processes. Understanding the underlying pathogenic mechanisms may influence both treatment and outcome. We present a 2-year-old child affected by Neisseria meningitidis sepsis, who on the second day from clinical onset manifested recurrent partial motor seizures and focal neurologic signs. An early magnetic resonance angiography of the circle of Willis produced normal results, whereas magnetic resonance imaging of the brain disclosed cortical signal abnormalities consistent with cytotoxic edema, without involvement of the adjacent white matter. Six-month follow-up magnetic resonance imaging of the brain indicated faint cortical atrophy in the same regions, although the neurologic picture had resolved. The literature contains few data on early magnetic resonance parenchymal changes, and their pathogenic mechanism is controversial. Diffusion-weighted images may contribute to an understanding of the mechanisms of such brain damage.
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18
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Gardiman MP, Fassan M, Orvieto E, D'Avella D, Denaro L, Calderone M, Severino M, Scarsello G, Viscardi E, Perilongo G. Diffuse leptomeningeal glioneuronal tumors: a new entity? Brain Pathol 2009; 20:361-6. [PMID: 19486008 DOI: 10.1111/j.1750-3639.2009.00285.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
The peculiar radiological and pathological findings of four pediatric cases admitted to the University Hospital of Padua between 1990 and 2007 are described. In all cases, the contrast-enhanced head and spine magnetic resonance images revealed thickened and abnormally enhancing subarachnoid spaces particularly at the level of basal cisterns and interhemispheric fissure. Furthermore, small cystic lesions scattered throughout the brain and mainly in the cerebellum were also visible. All patients were missing a well-defined intraparenchymal mass, although during the follow-up a small intramedullary lesion appeared within the cervical spine in two and subsequently in the frontal horn of the left lateral ventricle in one of those. All patients presented an indolent long-term follow-up. Histologically, the tumors were composed by a monotonous population of cells arranged in straight lines or in small lobules. The cells were characterized by round to oval nuclei with finely granular dispersed chromatin, inconspicuous nucleoli with oligodendrocyte-like features. The morphological and immunohistochemical findings suggested in all cases a "glioneuronal commitment" of the tumors. Because of the unique similar clinical and neuroradiological characteristics, we propose this small series of tumors as a new possible distinct pathological and clinical entity.
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Affiliation(s)
- Marina Paola Gardiman
- Department of Oncological and Surgical Sciences, Division of Pathology, University Hospital of Padua, Padua, Italy.
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Sartori S, Martini G, Calderone M, Patrizi A, Gobbi G, Zulian F. Severe epilepsy preceding by four months the onset of scleroderma en coup de sabre. Clin Exp Rheumatol 2009; 27:64-67. [PMID: 19796565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Juvenile localized scleroderma (JLS) includes several subtypes including plaque morphea, linear scleroderma and the en coup de sabre type which affects face and head. The latter variety may involve the eye and the brain with various appearance and clinical complications.We describe the case of a 6-year-old boy who presented partial complex seizures, with status epilepticus, four months before the appearance of sclerodermatous skin lesions on the face. This case report raises important questions on the pathogenesis of JLS and, particularly, on the issue whether it is a mere autoimmune condition or a neuro-cutaneous disease.
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Affiliation(s)
- S Sartori
- Department of Pediatrics, University Hospital of Padova, Padova, Italy
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Affiliation(s)
- M Calderone
- Neuroradiology Unit, University of Padova, Padova, Italy
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Bisogno G, De Rossi C, Gamboa Y, Sotti G, Ferrari A, Dallorso S, Donfrancesco A, Cecchetto G, Calderone M, Gandola L, Rosolen A, Carli M. Improved survival for children with parameningeal rhabdomyosarcoma: results from the AIEOP soft tissue sarcoma committee. Pediatr Blood Cancer 2008; 50:1154-8. [PMID: 18300319 DOI: 10.1002/pbc.21527] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Parameningeal rhabdomyosarcoma (PM-RMS) is a rare, highly malignant pediatric tumor arising from locations adjacent to the meninges, from where it can spread intracranially. PROCEDURE We reviewed 109 children with non-metastatic PM-RMS enrolled in the Italian RMS79, RMS88 and RMS96 protocols over a 24-year period. All patients received intensive chemotherapy and standard or hyperfractionated and accelerated radiotherapy. Some had delayed surgery. RESULTS Five-year overall survival rose from 40% in the RMS79 to 72% in the RMS88 and RMS96 protocols (P = 0.01), where more intensive chemotherapy and hyperfractionated accelerated radiotherapy (HART) was used. Delayed surgery after initial treatment was statistically associated with a better prognosis. Unfavorable tumor characteristics for RMS arising in other sites, for example, histology, invasiveness or node involvement, did not predict outcome for PM-RMS. CONCLUSION Outcome in PM-RMS patients enrolled in three consecutive Italian protocols has progressively improved, as a result of intensive chemotherapy, delayed surgery and, possibly, HART, though improved imaging and radiotherapeutic tools may have had a role as well.
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Affiliation(s)
- Gianni Bisogno
- Division of Hematology/Oncology, Department of Pediatrics, University Hospital of Padova, Padova, Italy.
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Abstract
Astroblastoma is a rare primary brain neoplasm that accounts for 0.45-2.8% of brain gliomas. Intraventricular localization is extremely rare. The authors report a case of well-differentiated completely intraventricular astroblastoma in a 6-year-old girl and review the relevant literature. Their patient presented with a 5-week history of progressive nausea and vomiting. Magnetic resonance (MR) imaging revealed a large, well-demarcated, solid-cystic mass in the left temporooccipital ventricular horn. Macroscopic radical resection of the tumor was performed via the superior temporal sulcus. The postoperative course was uneventful and no adjuvant therapy was administered after surgery. No recurrence was detected at 9-months follow-up. Gross-total resection has the greatest impact on patient survival. In differentiated tumors, recurrence is usually local, and adjuvant therapy is recommended after repeated resection for the treatment of recurrence. In patients harboring anaplastic astroblastoma, gross-total resection and adjuvant therapy after the initial surgery seems to be the best choice. It is important to distinguish astroblastoma from ependymoma in clinical practice because of the differences in therapeutic approaches.
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Affiliation(s)
- Luca Denaro
- Department of Neuroscience, University of Padua, Pozzilli, Italy.
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Sartori S, Laverda AM, Calderone M, Carollo C, Viscardi E, Faggin R, Perilongo G. Germinoma with synchronous involvement of midline and off-midline structures associated with progressive hemiparesis and hemiatrophy in a young adult. Childs Nerv Syst 2007; 23:1341-5. [PMID: 17609967 DOI: 10.1007/s00381-007-0390-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2006] [Revised: 03/21/2007] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Cerebral germinomas, the most common and least malignant intracranial germ cell tumors, usually arise in the pineal or suprasellar region and have characteristic clinical and radiological features. Germinomas more rarely occur in the thalamus, basal ganglia, and internal capsule, causing sometimes cerebral hemiatrophy and hemiparesis. More rarely, other clinical features can be fever of unknown origin, visual disturbance, and neuropsychiatric symptoms. Cerebral hemiatrophy can precede the imaging depiction of the off-midline mass. CASE The authors present the first case of cerebral germinoma with synchronous involvement of the midline and off-midline structures, with unusual clinical and radiological presentation. DISCUSSION The literature is reviewed, and the pathogenesis, the clinical findings, the imaging, and the therapy are discussed.
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Affiliation(s)
- S Sartori
- Department of Pediatrics, University of Padua, Via Giustiniani 3, 35128 Padua, Italy
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24
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Via PD, Opocher E, Pinello ML, Calderone M, Viscardi E, Clementi M, Battistella PA, Laverda AM, Dalt LD, Perilongo G. Visual outcome of a cohort of children with neurofibromatosis type 1 and optic pathway glioma followed by a pediatric neuro-oncology program. Neuro Oncol 2007; 9:430-7. [PMID: 17704361 PMCID: PMC1994100 DOI: 10.1215/15228517-2007-031] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We evaluated the visual outcome of a cohort of children with neurofibromatosis type 1 (NF1) and optic pathway glioma (OPG) treated according to standardized therapeutic guidelines. The study population consisted of all consecutive patients with NF1 and OPG referred to a specialized pediatric neuro-oncology program between 1994 and 2004. Treatment was instituted only in cases of progressive disease or clinical deterioration. Treatment modalities were chemotherapy (based on vincristine/carboplatin) for children younger than 5 years and radiotherapy for all others. Ten boys and 10 girls (seven with a positive family history) entered the trial (median age at diagnosis of OPG, 29 months). At a median follow-up time of 78 months, seven patients had been treated with chemotherapy only, four with radiotherapy, and four with chemotherapy plus radiotherapy. Five patients were observed only. Currently, 18 are alive and two have died. Eight patients were treated for progressive visual loss in the face of stable disease, five for tumor volume increase without visual deterioration, and two for symptomatic tumor volume increase. At referral, six children had a visual acuity (VA) of < 30% in both eyes; eight children had 100% VA bilaterally. At referral, the visual field (VF) could be assessed in three children: One had VF loss in both eyes, one had VF loss in one eye, and one had normal VF. At last follow-up, eight children had VA < 20% in both eyes; only two children had 100% VA in both eyes. Among 11 children who had some visual function, three had VF loss in one eye and three in both eyes, and five had an intact VF. Contrast and color sensitivity were abnormal in seven and six patients, respectively. Thirteen children fell into the WHO hypovision category. In summary, among the 15 children treated, one had a definitive and two a mild improvement in VA. In conclusion, the visual outcome of this selected cohort of NF1 patients with OPG is unsatisfactory. A critical reappraisal of the therapeutic strategy adopted is needed.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Giorgio Perilongo
- Address correspondence to Giorgio Perilongo, Department of Pediatrics, Director of the Pediatric Neuro-oncology Program, University Hospital of Padua, Via Giustiniani 3, 35128 Padua, Italy (
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Calderone M, Rodier E, Fages J. Microencapsulation by a Solvent-Free Supercritical Fluid Process: Use of Density, Calorimetric, and Size Analysis to Quantify and Qualify the Coating. Particulate Science and Technology 2007. [DOI: 10.1080/02726350701375741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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26
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Toldo I, Calderone M, Boniver C, Dravet C, Guerrini R, Laverda AM. Hemiconvulsion-hemiplegia-epilepsy syndrome: early magnetic resonance imaging findings and neuroradiological follow-up. Brain Dev 2007; 29:109-11. [PMID: 16876973 DOI: 10.1016/j.braindev.2006.06.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2006] [Revised: 06/15/2006] [Accepted: 06/23/2006] [Indexed: 11/23/2022]
Abstract
We describe a case of hemiconvulsion-hemiplegia-epilepsy (HHE) syndrome documented by longitudinal magnetic resonance imaging (MRI). A two-year and nine-month-old boy had a prolonged hemiconvulsion during fever followed by right hemiparesis. Seven days later the imaging abnormality on T2 and diffusion-weighted images (DWI) was limited to the white matter of the left hemisphere. One month later severe gliosis and unilateral brain atrophy were already evident. MRI is useful in the early stages of prolonged seizures and T2 and DWI abnormalities appear to be well correlated with parenchymal damage that results from sustained ictal activity. The neuroradiological findings in our case and in the few HHE patients reported in the literature seem to be very characteristic and, if confirmed in larger series, could permit an early diagnosis.
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Affiliation(s)
- I Toldo
- Pediatrics Department, University of Padova, 35128 Padova, Italy
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27
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Salviati L, Trevisson E, Baldoin MC, Toldo I, Sartori S, Calderone M, Tenconi R, Laverda A. A novel deletion in the GJA12 gene causes Pelizaeus-Merzbacher-like disease. Neurogenetics 2006; 8:57-60. [PMID: 17031678 DOI: 10.1007/s10048-006-0065-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2006] [Accepted: 09/01/2006] [Indexed: 01/31/2023]
Abstract
Pelizaeus-Merzbacher disease (PMD) and Pelizaeus-Merzbacher-like disease (PMLD) are hypomyelinating disorders of the central nervous system with a very similar phenotype. PMD is an X-linked disorder caused by mutations in PLP1. PMLD is an autosomal recessive condition caused by mutations in GJA12. We report a 5-year-old girl with a complex neurological syndrome and severe hypomyelination on brain magnetic resonance imaging. She harbored a homozygous 34-bp deletion in the coding region of GJA12. There are no distinctive features for the differential diagnosis of PMD/PMLD. GJA12 should be analyzed in all patients without PLP1 mutations but should also be considered the initial genetic test in women and in patients with consanguineous parents.
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Affiliation(s)
- Leonardo Salviati
- Clinical Genetics, Department of Pediatrics, University of Padova, Via Giustiniani 3, 35128, Padua, Italy,
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Scarzello G, Buzzaccarini MS, Perilongo G, Viscardi E, Faggin R, Carollo C, Calderone M, Franchi A, Sotti G. Acute and late morbidity after limited resection and focal radiation therapy in craniopharyngiomas. J Pediatr Endocrinol Metab 2006; 19 Suppl 1:399-405. [PMID: 16700317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
Aggressive surgery of craniopharyngioma can cause severe, life-long hypothalamic and pituitary dysfunctions and possibly further impair visual function; conventional radiation therapy (RT) can affect intellectual functioning and cause secondary tumours. Because of the severe morbidity associated with aggressive surgery, many authors nowadays recommend a less radical approach followed by RT. This combined approach allows achieving 70-83% 10-year local control rates which are comparable to that achieved with aggressive surgery. The main morbidity of this conservative combined approach is represented by pituitary dysfunction secondary to RT, however, sparing severe hypothalamic disturbances. The interval between treatment and onset of the disorder is much longer than in the case of aggressive surgery and this can have a beneficial impact on quality of life, especially in children. This alternative therapeutic approach has become more appealing now that modern RT techniques allow safer delivery of the RT, particularly in childhood.
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Affiliation(s)
- G Scarzello
- Department of Radiation Therapy, University Hospital of Padua, Italy.
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Buldini B, Drigo P, Via LD, Calderone M, Laverda AM. Symmetrical thalamic calcifications in a monozygotic twin: case report and literature review. Brain Dev 2005; 27:66-9. [PMID: 15626545 DOI: 10.1016/j.braindev.2004.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2002] [Revised: 04/08/2004] [Accepted: 04/14/2004] [Indexed: 11/18/2022]
Abstract
We report the occurrence of symmetrical thalamic calcifications (STC) in one of a pair of monozygotic twins born at term without evidence of pre- or peri-natal asphyxia. STC is known to be an extremely rare condition in infants. Judging from the few cases reported in the literature, the clinical presentation is very severe: low Apgar score, no spontaneous movements, spasticity or marked hypotonia, impaired suck and swallow, facial diplegia. The prognosis is also very poor. The etiology is still a matter of debate: genetic, infectious, toxic or hypoxic-ischemic insults have been hypothesized. In our case, the presence of the lesion in one of a pair of monozygotic twins would rule out any genetic origin, nor was there any evidence of toxic or infectious disease. The only potential risk factor for fetal damage was hypoxic-ischemic insult related to the twin pregnancy.
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Affiliation(s)
- Barbara Buldini
- Department of Pediatrics, University of Padua, via Giustiniani 3, 35100 Padua, Italy
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30
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Burlina AP, Manara R, Calderone M, Catuogno S, Burlina AB. Diffusion-weighted imaging in the assessment of neurological damage in patients with methylmalonic aciduria. J Inherit Metab Dis 2003; 26:417-22. [PMID: 14518823 DOI: 10.1023/a:1025106909213] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Diffusion-weighted magnetic resonance imaging (DW-MRI) of the brain was performed in two patients with methylmalonic aciduria who presented signs and symptoms of neurological involvement without metabolic decompensation. Patient 1 presented acute metabolic stroke and patient 2 presented subacute encephalopathy. Brain DW-MRI confirmed very recent damage in patient 1, while the absence of brain lesions on brain DW-MRI indicates the development of more chronic damage in patient 2. Brain DW-MRI represents an additional and complementary tool in the assessment of brain damage in methylmalonic aciduria patients who develop neurological syndrome.
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Affiliation(s)
- A P Burlina
- Department of Neurological and Psychiatric Sciences, Azienda Ospedale, University of Padova, Italy
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Abstract
INTRODUCTION Primary fibrosarcomas of the brain are very rare tumors, so that information regarding the treatment is scarce. We report the contributions that different therapeutic options made to the treatment of a child with one of these aggressive tumors. CASE REPORT A 13-year-old boy underwent a complete resection of a left temporo-parietal mass that had been diagnosed as a fibrosarcoma by two independent pathologists. Adjuvant chemotherapy with vincristine, actinomycin-D, ifosfamide and Adriamycin was started, but after 3 months tumor relapse was evident. The boy subsequently received radiation therapy during which there was evidence of progressive tumor shrinkage. A second surgery was performed 6 months after radiotherapy and a small enhancing lesion, revealed to be gliosis, was resected. The child remains alive and well 44 months after diagnosis. CONCLUSION Our experience supports the importance of total resection followed by radiation therapy, and radiotherapy should be started as soon as possible after surgical resection, rather than administering chemotherapy first.
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Affiliation(s)
- Gianni Bisogno
- Hematology/Oncology Division, Department of Pediatrics, Via Giustiniani, 3, 35128 Padua, Italy.
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Perilongo G, Gardiman M, Bisaglia L, Rigobello L, Calderone M, Battistella A, Burnelli R, Giangaspero F. Spinal low-grade neoplasms with extensive leptomeningeal dissemination in children. Childs Nerv Syst 2002; 18:505-12. [PMID: 12382176 DOI: 10.1007/s00381-002-0626-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2002] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The aim of this study is to re-appraise paediatric leptomeningeal disseminated spinal low-grade neoplasms putting forward the hypothesis that these tumours may represent a possible distinctive clinico-pathological entity. CASE REPORT Three children affected by these rare neoplasms are reported, 2 boys and 1 girl aged 40 months, 7 and 12 years respectively. RESULTS Despite treatment, 2 died at 9 months and 9 years, while 1 has survived with stable disease at 24 months after diagnosis. Histologically, these tumours shared the generic histological appearance of low-grade neuroectodermal neoplasms, without any features that allowed them to be included in a specific classification niche. The magnetic resonance imaging of the leptomeningeal dissemination took the form of a thick, diffuse subarachnoidal enhancement involving the brain as well the spine in 2 patients; in 1 patient there was an extensive enhancement along the surface of the brain and of the spinal cord and multiple small cysts, creating the impression of a diffuse microcystic meningoencephalopathy. DISCUSSION The patients described here and the similar ones found in the literature cannot be easily placed into the present WHO system of classification for central nervous system tumours.
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Affiliation(s)
- Giorgio Perilongo
- Division of Paediatric Haematology, Paediatric Neuro-oncology Programme, Department of Paediatrics, University Hospital of Padua, Italy
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Feltrin GP, Nardin M, Marangon A, Khadivi Y, Calderone M, De Conti G. Quantitative ultrasound at the hand phalanges: comparison with quantitative computed tomography of the lumbar spine in postmenopausal women. Eur Radiol 2000; 10:826-31. [PMID: 10823642 DOI: 10.1007/s003300051013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The aim of our study was to evaluate the diagnostic effectiveness of a quantitative ultrasound technique for measuring bone tissue at the proximal phalanges of the non-dominant hand. We correlated the mean value of the amplitude-dependent speed of sound (AD-SoS) and the ultrasound bone profile score (UBPS) measured at the phalanges with bone mineral density (BMD) of the lumbar spine gauged with quantitative computed tomography (QCT). We studied a group of 177 postmenopausal women consecutively presenting for osteoporosis screening. We observed that in the whole study group both AD-SoS and UBPS correlated weakly with BMD, although with statistical significance (r = 0.54 and r = 0.45, respectively; p < 0.0001). The same parameters showed a poor correlation (r = 0.48, p < 0.0001; and r = 0.23, p = 0.017) in the group of patients which QCT has classified as osteoporotic. Finally, no correlation was found in the rest of our population. The correlation coefficients of comparison between our QUS and QCT measurements are not strong enough to allow us a prediction of one measure from the other. Therefore, we do not consider the phalangeal osteosonography a valid substitute of QCT technique for assessment of bone status in postmenopausal women.
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Affiliation(s)
- G P Feltrin
- Institute of Radiology, School of Medicine, University of Padua, Padova, Italy
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Candiani F, Meduri F, Norberto L, Calderone M. [Contrast media in ultrasonography. Venous involvement in tumors of the head of the pancreas]. Radiol Med 1998; 95:29-33. [PMID: 9687899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- F Candiani
- Istituto di Radiologia, Università degli Studi di Padova
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Tregnaghi A, De Candia A, Calderone M, Cellini L, Rossi CR, Talenti E, Blandamura S, Borsato S, Muzzio PC, Rubaltelli L. Ultrasonographic evaluation of superficial lymph node metastases in melanoma. Eur J Radiol 1997; 24:216-21. [PMID: 9232392 DOI: 10.1016/s0720-048x(96)01102-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The aims of the present work were to assess the diagnostic accuracy of ultrasonographic evaluation of superficial lymph nodes in patients with cutaneous melanoma and to describe the sonographic characteristics which permit early detection of neoplastic nodal involvement. Eighty-seven patients (89 lymph node sites) were studied for approximately a 3-year period, with a minimal surveillance time of 1 year. The ultrasonographic imaging equipment utilized were a 10 MHz scanner with a mechanical and one with 10 MHz electronic linear probe. The characteristics considered indicative of possible metastatic involvement were: round shape (short to long axis ratio > 0.5), no central hilus, nodular areas within the lymph node, sinuosity of the lymph node edges and lymph node with regular morphology and echostructure but with maximum diameter greater than 3 cm. Generally inguinal and axillary lymph nodes are larger than cervical ones. Of the 89 sites explored, 32 were considered 'suspect'. All 32 of these were subjected to cytology using ultrasound-guided, fine needle aspiration. The remaining 56 came in for a periodic control examination during a year. Thirteen of the 32 'suspect' lymph nodes proved positive at the pathologic examination. Two patients whose ultrasound diagnosis was negative developed metastases within 2 to 4 months (ultrasound false negatives). Our study indicates that there are sonographic features indicative of lymph node metastases from melanoma even in the early stages of the disease. Ultrasound scanning, therefore, is a useful diagnostic tool in the follow-up of melanoma patients, identifying which should be subjected to further testing with needle biopsy.
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Affiliation(s)
- A Tregnaghi
- Department of Radiology, University of Padua, Italy
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Tregnaghi A, De Candia A, Calderone M, Talenti E, Sartori V, Bonifatti DM, Angelini C, Fiore D, Muzzio PC. [Imaging of the thymus gland in myasthenia gravis (computerized tomography and magnetic resonance)]. Radiol Med 1995; 90:404-9. [PMID: 8552816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Since thymectomy is nearly always indicated as a possible treatment of myasthenia gravis, we examined with Magnetic Resonance (MRI) and Computed Tomography (CT) 22 patients (21-62 years old) to identify the best methodological approach. MR images were obtained with a 1.5 T superconducting unit with slice thickness ranging from 6 to 8 mm and an interslice gap of 0.6 and 0.8 mm. Spin-echo images were acquired with repetition time (TR) < 700 ms and echo time (TE) of 20 ms and T2-weighted images with TR > 1800 ms and TE of 80 ms. The sections were obtained, with cardiac gating, on transverse and sagittal planes. CT was performed with contiguous 5-mm slice thickness, after intravenous bolus injection of contrast medium. All the patients underwent surgery of anterior mediastinum and histologic diagnosis was made. Both CT and MRI correctly identified the patterns of normal thymus or hyperplasia not associated with gland enlargement, the only two cases of hyperplasia with thymic enlargement and clearly demonstrated thymomas. MRI appears to be more accurate in the evaluation of the relationship between thymus and contiguous structures. If pericardial infiltration is suspected, sagittal MR scans yield accurate information on tumor spread. We recommend MRI of anterior mediastinum to rule out the presence of a thymoma and the possible involvement of contiguous structures.
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Affiliation(s)
- A Tregnaghi
- Istituto di Radiologia, Università di Padova
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Calderone M. Dr. Mary Calderone: physicians have a vital role in sex education.. Interview by Evelyne Michaels. Can Med Assoc J 1983; 128:176. [PMID: 6848164 PMCID: PMC1874831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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