Serial brain MRI findings in a rare survivor of rabies encephalitis

Rabies is a neurotropic viral illness, almost always fatal, that is equally dreaded by healthcare practitioners and patients due to the dismal prognosis and limited treatment options once symptoms set in. There are hardly any reports on MRI changes in the brain in survivors of rabies encephalitis. We present the clinical course and the imaging findings on serial MRI examinations in a rare patient who survived rabies infection. Initial brain MRI done 8 days after onset of symptoms revealed bilaterally symmetrical non-enhancing areas of T1 and T2 hyperintensity in the basal ganglia, thalami, mid brain, and pons along with T2 hyperintensity and restricted diffusion in fronto-parietal cortical grey matter and left hippocampus. Subsequent MRI scans at 2 months and 5 months revealed progressive brain atrophy, leukoencephalopathy, and gliosis.

Sonographic Measurement of Visceral Fat Thickness as a Correlate of Existing Metabolic Syndrome- A Cross-sectional Study

Introduction: Metabolic syndrome is a well-known disease of multiple risk factors that has at its core, insulin resistance accompanying abnormal adipose deposition and function. Multiple studies demonstrate a potential relationship between Visceral Fat Thickness (VFT) and metabolic syndrome. Ultrasound provides a radiation free low-cost alternative, which is high reproducible in the quantification of visceral fat and can act as an effective screening modality. The simplicity of the method combined with its objectiveness makes it advantageous for accurate measurement of VFT. Aim: To correlate of sonographic measurement of VFT with existing metabolic syndrome. Materials and Methods: This cross-sectional study was conducted on all patients that underwent ultrasound at the study center between August 2016 to August 2019 and were clinically suspected of suffering from metabolic syndrome at the Endocrinology Outpatient Department (OPD). Collation of data into three categories based on VFT (<7 cm, 7 to 10 cm and >10 cm) was done. The patients in each category underwent further testing and metabolic syndrome was either ruled out or diagnosed. Results: The study cohort comprised of 2022 patients. The VFT ranged between 4 and 16 with a mean value of 10.8 and standard deviation of 2.8. The percentage of patients with metabolic syndrome increased in proportion to the increased VFT. VFT >10 cm was found to have specificity and Positive Predictive Value (PPV) 92.52% and 92.53% respectively while VFT <7 cm was found to have a sensitivity and Negative Predictive Value (NPV) of 95.11% and 95.10%, respectively. Conclusion: Ultrasound seems to be the best screening tool for the assessment of intra-abdominal fat deposition as the number of VFT subjects with metabolic syndrome in Category 1 was higher.

Neurocutaneous Melanosis with Bilateral Temporal Lobe Lesions without Leptomeningeal Enhancement: A Distinct Entity or Subtype

Neurocutaneous melanosis (NCM) is a rare congenital disorder. Most of the cases described in literature for this entity have involvement of the leptomeninges and other structures of brain such as brain stem, temporal lobes, and spinal meninges and no involvement of leptomeninges and presence of lesions in bilateral temporal lobes. NCM without the involvement of leptomeninges should be considered a distinct entity as the prognosis is favorable as compared to cases with leptomeningeal involvement who develop early hydrocephalus and multiple cranial nerve palsies.

Incorporation of Whole Spine Screening in Magnetic Resonance Imaging Protocols for Low Back Pain: A Valuable Addition

STUDY DESIGN

A retrospective review of lumbar magnetic resonance imaging (MRI) studies conducted at the Department of Radiodiagnosis & Imaging of a Tertiary Care Armed Forces Hospital between May 2014 and May 2016.

PURPOSE

To assess the advantages of incorporating sagittal screening of the whole spine in protocols for conventional lumbar spine MRI for patients presenting with low back pain.

OVERVIEW OF LITERATURE

Advances in MRI have resulted in faster examinations, particularly for patients with low back pain. The additional detection of incidental abnormalities on MRI helps to improve patient outcomes by providing a swifter definitive diagnosis. Because low back pain is extremely common, any change to the diagnostic and treatment approach has a significant impact on health care resources.

METHODS

We documented all additional incidental findings detected on sagittal screenings of the spine that were of clinical significance and would otherwise have been undiagnosed.

RESULTS

A total of 1,837 patients who met our inclusion criteria underwent MRI of the lumbar spine. The mean age of the study population was 45.7 years; 66.8% were men and 33.2% women. Approximately 26.7% of the patients were diagnosed with incidental findings. These included determining the level of indeterminate vertebrae, incidental findings of space-occupying lesions of the cervicothoracic spine, myelomalacic changes, and compression fractures at cervicothoracic levels.

CONCLUSIONS

We propose that T2-weighted sagittal screening of the whole spine be included as a routine sequence when imaging the lumbosacral spine for suspected degenerative pathology of the intervertebral discs.

Ultrasound Guided Percutaneous Injection of Thrombin: Effective Technique for Treatment of Iatrogenic Femoral Pseudoaneurysms

INTRODUCTION

Arterial pseudoaneurysms are well known iatrogenic complication of percutaneous angiographic or interventional vascular procedures. In the past, the definitive treatment option was open surgical repair which is a relatively invasive procedure. In the last few years, Ultrasound (US) guided percutaneous thrombin injection has been gaining popularity as definitive treatment of pseudoaneurysms.

AIM

To evaluate efficacy and safety of US guided percutaneous injection of thrombin for treatment of iatrogenic femoral pseudoanurysms at a tertiary care interventional radiological and cardiology centre.

MATERIALS AND METHODS

A retrospective analysis was conducted on 38 consecutive patients, diagnosed to have iatrogenic femoral artery pseudoaneurysms by Doppler study, in the period from Jan 2013 to Jun 2016. All these patients were treated by US guided percutaneous injection of thrombin solution inside the pseudoaneurysm sac till contents became echogenic and flow inside the pseudoaneurysm stopped completely. One month further follow up in all these patients was done.

RESULTS

The dose of thrombin injected varied from 200-1000 IU (mean 300 IU). Immediate thrombosis was seen in all the pseusdoaneurysms. Follow up at 24-48 hours showed complete thrombosis and regression of pseudoaneurysm in all the patients except one in whom a small residual sac was seen which thrombosed completely on second thrombin injection. Further follow up at one month showed regression of aneurysms in all the cases. No significant post procedural clinically significant complications were seen in any of the patients.

CONCLUSION

US guided percutaneous thrombin injection is a highly successful and safe procedure for the treatment of iatrogenic femoral pseudoaneurysms.

A study of coronary artery variants and anomalies observed at a tertiary care armed forces hospital using 64-slice MDCT

BACKGROUND

Isolated coronary artery anomalies are usually clinically silent and mostly detected incidentally during angiography or autopsy. However, few of them may be implicated in cases of sudden cardiac death even in the absence of additional heart abnormalities. Prior knowledge of such variants and anomalies is necessary for planning various interventional procedures. Multiple detector computed tomography coronary angiography has proved a very useful non-invasive modality in this field given its superiority over conventional coronary angiography in providing detailed coronary artery anatomy.

METHODS

A retrospective review of the coronary CT angiography studies was carried out at our center between August 2014 and December 2015 with the purpose of describing the coronary artery variants and anomalies that we came across in our cohort.

RESULTS

In our cohort, about 77% (n=391) of the patients had a right dominant system while left dominant and co-dominant systems were seen in 12% (n=61) and 11% (n=56) respectively. Coronary CT angiography was successful in visualizing smaller branches, such as the conus artery (96.25%, n=489), the sinus node artery (83.07%, n=422), and the septal branches (95.27%, n=484). Coronary anomalies were observed in the 10.04% of our population (n=51). Eleven anomalies of origin and course were found.

CONCLUSION

Coronary CT angiography gives us a good understanding of the variations and anomalies of the anatomy of the coronary arteries. This can be of immense help to the clinician planning interventional procedures.