Cerebral perfusion in posterior reversible encephalopathy syndrome measured with arterial spin labeling MRI.

Background And Purpose: The pathophysiologic basis of posterior reversible encephalopathy syndrome (PRES) remains controversial. Hypertension (HTN)-induced autoregulatory failure with subsequent hyperperfusion is the leading hypothesis, whereas alternative theories suggest vasoconstriction-induced hypoperfusion as the underlying mechanism. Studies using contrast-based CT and MR perfusion imaging have yielded contradictory results supporting both ideas.

Isolated lateral collateral ligament complex injury in rock climbing and Brazilian Jiu-jitsu.

We report two occurrences of high-grade tears of the lateral collateral ligament complex (LCLC), consisting of the anterolateral ligament (ALL) and fibular collateral ligament (FCL). One injury occurred in a rock climber and the other in a martial artist. Increasing awareness of isolated injuries of the LCLC will allow for appropriate diagnosis and management.

Radiation-induced cavernous malformations of the cauda equina mimicking carcinomatous or infectious meningitis. A case report.

The authors present a case of multiple radiation-induced cavernous malformations of the cauda equina in a patient with a remote history of testicular cancer and extended field radiation therapy. Magnetic resonance imaging (MRI) demonstrated multiple nodular areas of enhancement coating the nerve roots of the cauda equina, mimicking an aggressive leptomeningeal process such as carcinomatous or infectious meningitis. Biopsy of one of these lesions revealed ectatic vascular channels devoid of intervening neuroglial tissue consistent with cavernous malformation.

Multifocal intravascular papillary endothelial hyperplasia in the retroperitoneum and spine: a case report and review of the literature.

The authors present a unique case of intravascular papillary endothelial hyperplasia (IPEH) localized in the renal hilum, retroperitoneum, and spine in a patient with Wegener granulomatosis. IPEH rarely occurs in the abdomen or spine with few cases reported in the literature. No case has been reported of IPEH involving both the retroperitoneum and spine.

Utilization of glutamate/creatine ratios for proton spectroscopic diagnosis of meningiomas.

Introduction: Our purpose was to determine the potential of metabolites other than alanine to diagnose intracranial meningiomas on proton magnetic resonance spectroscopy (MRS).

Methods: Using a 1.5-T MR system the lesions were initially identified on FLAIR, and T1- and T2-weighted images.

Diffusion-weighted magnetic resonance imaging versus computed tomography in the diagnosis of acute ischemic stroke.

Current treatment protocols using reperfusion therapy for acute ischemic stroke rely on non-contrast computed tomography (NCCT), with most indications including the absence of acute hemorrhage or large volume of infarction in the presence of clinical signs and symptoms. This predictably results in a significant incidence of the administration of reperfusion therapy to patients with "stroke mimics," such as migraine headache or Todd's paralysis after a seizure. Diffusion-weighted imaging (DWI) is a technique based on magnetic resonance imaging (MRI) that may be more sensitive and specific for acute cerebral ischemia than NCCT.

Diffusion-weighted imaging distinguishes recurrent epidermoid neoplasm from postoperative arachnoid cyst in the lumbosacral spine.

Diffusion-weighted imaging can be used to distinguish epidermoid tumor from arachnoid cyst in the intracranial compartment. We report the use of diffusion-weighted imaging in a postoperative spine to successfully distinguish a recurrent epidermoid tumor from arachnoid cyst in a noninvasive manner. Our case illustrates the value of this readily available sequence presently not generally used in the clinical evaluation of spinal pathology.

Proton magnetic resonance spectroscopy of mesial temporal sclerosis: Analysis of voxel shape and position to improve diagnostic accuracy.

Objective: To determine if change in voxel shape and position improves the lateralization of magnetic resonance (MR) spectroscopy to the side of the MR imaging and/or electroencephalography (EEG) abnormality in mesial temporal sclerosis.

Methods: In 10 patients with unilateral mesial temporal sclerosis and 5 controls, MR spectroscopy was performed. Long echo time single-voxel spectroscopy was obtained in the right and left hippocampus.

Treatment of ischemic stroke complicating cardiac catheterization with systemic thrombolytic therapy.

Ischemic stroke is a rare but serious complication of cardiac catheterization. We report a case in which systemic thrombolytic therapy was successfully utilized in treating a patient with a cerebellar stroke, leading to obtundation during elective cardiac catheterization. Underlying bilateral vertebrobasilar disease with thrombotic embolization to the basilar artery was postulated to be the pathophysiological basis for the stroke and subsequent success of thrombolytic treatment in this patient.

Stereolithographic vascular replicas from CT scans: choosing treatment strategies, teaching, and research from live patient scan data.

Our goal was to develop a system that would allow us to recreate live patient arterial pathology by using an industrial technique known as stereolithography (or rapid prototyping). In industry, drawings rendered into dicom files can be exported to a computer programmed to drive various industrial tools. Those tools then make a 3D structure shown by the original drawings.

Aneurysmal pressure changes with nondetachable balloon placement and fluid infusion: rationale for liquid embolization.

Background And Purpose: To improve the safety and efficacy of liquid embolization, we evaluated changes in pressures in experimental aneurysms.

Methods: We created three replicas of a lateral sidewall aneurysm and placed them in a physiologic flow circuit. A 3 x 10-mm nondetachable balloon was positioned in the parent vessel across the aneurysmal neck.

Lymphocytic vasculitis mimicking aggressive multifocal cerebral neoplasm: mr imaging and MR spectroscopic appearance.

We present a case of multifocal enhancing lesions confined to the right cerebral hemisphere that mimicked diffuse neoplasm. MR spectroscopy revealed not only minimal elevation of the choline peak, but also marked elevation of the glutamate and glutamine peaks, findings that are more suggestive of an inflammatory process. Biopsy showed lymphocytic vasculitis, a rare variant of primary angiitis of the CNS.

Intracranial meningeal disease: comparison of contrast-enhanced MR imaging with fluid-attenuated inversion recovery and fat-suppressed T1-weighted sequences.

Background And Purpose: Contrast-enhanced fluid-attenuated inversion recovery (FLAIR) imaging has been reported to have higher sensitivity for detecting leptomeningeal disease compared with contrast-enhanced T1-weighted MR imaging. The purpose of this study was to compare contrast-enhanced T1-weighted MR images with fat suppression to contrast-enhanced FLAIR images to determine which sequence was superior for depicting meningeal disease.

Methods: We reviewed MR images of 24 patients (35 studies) with a variety of meningeal diseases.

Role of proton magnetic resonance spectroscopy in the diagnosis of gliomatosis cerebri: a unique pattern of normal choline but elevated Myo-inositol metabolite levels.

A patient with histologically proven gliomatosis cerebri presented with a normal choline level but a markedly abnormal elevated myo-inositol level on magnetic resonance (MR) spectroscopy. We describe the case presentation, imaging findings (in particular, the unique MR spectroscopic pattern), and their significance regarding the diagnosis of this relatively rare neoplasm.

Intramedullary spinal cord metastasis of lung adenocarcinoma presenting as Brown-Sequard syndrome.

Background: It is extremely rare for cancer to present first as an intramedullary spinal cord metastasis. Furthermore, because it is unlikely for spinal cord neoplasm to present acutely, an acute presentation may signify metastatic disease and should be considered in the initial differential diagnosis.

Methods: The authors present a case of a 59-year-old man presenting with Brown-Sequard syndrome and in whom metastatic lung adenocarcinoma to the spinal cord was subsequently discovered.

Aneurysm flow dynamics: alterations of slipstream flow for neuroendovascular treatment with liquid embolic agents.

Background And Purpose: The main issue with use of a liquid embolic agent is one of safety. To determine and improve the efficacy of potential neuroendovascular treatment regimens, particularly the use of liquid embolic agents, we evaluated the changes in aneurysm flow dynamics resulting from alterations of parent vessel flow.

Methods: We created silicone replicas of a laboratory-created aneurysm model and a basilar artery aneurysm cast from a human cadaver.

Intramedullary spinal cord astrolipoma: case report.

Objective And Importance: Reported is a case of a thoracic intramedullary astrocytoma with a lipomatous component, a so-called astrolipoma. This is the only known case of a single intraspinal astrolipoma in an otherwise healthy patient.

Clinical Presentation: The patient was a 36-year-old woman with dorsal thoracic pain of more than 1 month's duration, mild lower extremity weakness, and incomplete sensory loss to the T10 level.

Transient focal leptomeningeal enhancement in Sturge-Weber syndrome.

The authors describe a 36-year-old man with Sturge-Weber syndrome who presented with focal seizures and subsequently developed a temporary post-ictal hemianopia. Magnetic resonance imaging of the brain demonstrated focal leptomeningeal enhancement, which subsequently resolved.

Reproducibility analysis of a new objective method for measuring arteriovenous malformation nidus size at angiography.

Background And Purpose: Currently, no specific method exists to measure arteriovenous malformation (AVM) nidus size, a requirement in assessing the success of treatment. Additionally, the commonly used evaluation provides only a linear one-dimensional measurement of this three-dimensional entity. The purpose of this study was to devise an improved method for measuring AVM nidus size, an irregularly shaped radiologic entity, that provides objective and reproducible results.

Epidural blood patch in a patient with an arachnoid cyst.

Arachnoid cysts are relatively common occurrences, with the majority being asymptomatic. The safety of an epidural blood patch in a patient with an arachnoid cyst has not been reported. Our patient had a known thoracic arachnoid cyst and required epidural blood patch for a postdural puncture headache.