1/4. Anterior spinal artery stroke demonstrated by echo-planar DWI.diffusion-weighted MR (DWI) is becoming an established method for the investigation of cerebral ischemia. Its value in spinal ischemia has to be demonstrated. We report on a patient presenting with postoperative paraparesis who underwent emergency MRI of the spine with echo-planar diffusion-weighted imaging which showed an area of hyperintensity corresponding to a decrease of diffusion as measured by the apparent diffusion coefficient. On follow-up imaging spinal stroke was confirmed. In conclusion, spinal echo-planar MR imaging can demonstrate ischemic changes despite strong echo-planar artifacts. It could become an important adjunct to the management of patients with suspected spinal ischemia.- - - - - - - - - - ranking = 1keywords = cerebral (Clic here for more details about this article) |
2/4. A syndrome characteristic of tangential bullet wounds of the vertex of the skull.Six patients with tangential missile wounds of the vertex of the skull presented symptoms of limb paresis which were more marked proximally in the arms and distally in the legs where there was also sensory loss of a cortical type. Carotid cerebral angiography and operative treatment showed patency of the longitudinal sinus and injury to the medial aspects of the frontoparietal cortex. The term "longitudinal sinus syndrome" formerly applied to these cases is therefore a misnomer since the main underlying cause is cortical injury and not thrombotic occlusion of the superior longitudinal sinus, as previously suspected.- - - - - - - - - - ranking = 1keywords = cerebral (Clic here for more details about this article) |
3/4. Facet joint cysts causing cauda equina compression.Facet joint cysts are commonest at the L4-L5 level and are associated with facet joint degeneration and type III (degenerative) spondylolisthesis. It is extremely rare for facet joint cysts to cause symptomatic cauda equina compression. Three elderly patients presented to us with significant cauda equina compression caused by facet joint cysts. One presented with classic symptoms and signs of a cauda equina syndrome, a second with bilateral lower limb neurologic loss associated with uncontrolled epilepsy, and the third with bilateral leg symptoms as well as an upper limb tremor and fasciculation. The diagnosis was easily made after magnetic resonance scanning in two patients, although in one patient, it was significantly delayed because of his confounding neurologic picture. Lumbar spine surgery (decompression and cyst resection) was successful in resolving symptoms in all three, even though two patients had significant neurologic compromise before surgery. The occurrence of facet joint cysts in older patients can be associated with other degenerative neurologic conditions, and the diagnosis might not be apparent early. We suggest that in older patients who have a mixed picture of central and peripheral neurologic compromise, this diagnosis should be considered and investigation of the whole of the spine, not just the brain and spinal cord, should be undertaken.- - - - - - - - - - ranking = 0.010885695688523keywords = brain (Clic here for more details about this article) |
4/4. paraparesis associated with ruptured anterior cerebral artery territory aneurysms.BACKGROUND: paraparesis is a rare but characteristic manifestation of ruptured anterior communicating artery or anterior cerebral artery (ACA) aneurysms, but the pathogenesis remains unclear. This study investigated the neuroimaging and clinical features of patients with such paraparesis to evaluate possible causes. methods: Nine of 178 patients with ruptured anterior communicating artery or ACA aneurysms presented with paraparesis among 462 patients with subarachnoid hemorrhage (SAH) admitted between May 1996 and November 2001. diffusion-weighted magnetic resonance (MR) imaging was performed within 48 hours of the onset of SAH in 4 of these 9 patients. The clinical course and neuroimaging studies of these 4 patients were retrospectively reviewed. RESULTS: diffusion-weighted MR imaging revealed -intensity areas in the medial aspects of the bilateral frontal lobes, which were supplied by the ACAs and distal to the aneurysms, in all 4 patients. These high-intensity lesions had normal to subnormal values of apparent diffusion coefficient (ADC). Most of the high-intensity lesions recovered and did not result in the final lesions regardless of the ADC values, but some lesions with subnormal ADC values resulted in cerebral infarction. paraparesis was transient and almost completely resolved in 3 patients. CONCLUSIONS: diffusion-weighted MR imaging detected primary brain damage in the ACA territories caused by acute SAH, which was compatible with the clinical paraparesis. Primary brain damage caused by SAH may include 3 types of lesions: reversible with normal ADC value, reversible with subnormal ADC value, and irreversible with subnormal ADC value.- - - - - - - - - - ranking = 6.021771391377keywords = cerebral, brain (Clic here for more details about this article) |