Journal of neuroimaging : official journal of the American Society of Neuroimaging
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Case Reports
Shunt-responsive dementia in sarcoid meningitis: role of magnetic resonance imaging and cisternography.
The authors report a patient with progressive cognitive and gait decline in association with sarcoid meningitis. The patient had evidence of active inflammation as determined by cerebrospinal fluid examination and was steroid dependent. Magnetic resonance imaging and radionucleotide cisternography were complementary in establishing the diagnosis of communicating hydrocephalus, and suggested that the patient would be shunt responsive.
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Because examinations of the intracranial vessels using conventional transcranial color-coded sonography (TCCS) lack spatial orientation and reproducibility, development of a three-dimensional (3-D) imaging technique is required. Three patients with middle cerebral artery (MCA) stenosis, three with suspected intracranial aneurysm, two with vascular malformation, and one healthy volunteer were investigated by 3-D TCCS using a magnetic spatial positioning sensor mounted on the transducer for simultaneous recording of the probe coordinates to create a volumetric data set. ⋯ However, it failed to detect morphological details in vascular malformations. In conclusion, 3-D TCCS is a promising technique that opens new perspectives in depicting intracranial vessels and provides volume measurement of intracranial aneurysms.
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In a prospective study, 55 patients were examined by transcranial duplex sonography (TCCS) after subarachnoid hemorrhage (SAH) to determine whether additional transcranial duplex examination on the middle cerebral artery M2 segments would aid in the examination of the MCA stem segment. The mean blood flow velocities and pulsatility index were correlated to the occurrence of delayed ischemic neurologic deficits (DIND). Out of 47 patients included, 21 did not experience any delayed deficit (group I), 15 did (group II), and in 11 the extent to which vasospasm contributed to a neurologic deficit was unclear (group III). ⋯ In 10 patients in group II, where the onset day of DIND was known exactly, Doppler data indicating ischemia before or at the time of DIND were observed in nine. In eight patients, Doppler of the MCA stem alone would have provided enough information to recognize the risk of symptomatic vasospasm; in one patient, only the M2 Doppler gave an indication of ischemic complication. Transcranial duplex sonography may provide additional information to TCD by accurate delineation of M1/M2 vasospasm and therefore may help plan cerebral angiography and neurointerventional treatment.
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Neurofibromatosis type I (NF-1) belongs to a family of diseases named phakomatoses, which are characterized by congenital malformations of ectodermal structures. Neurofibromatosis type I affects 1 in 3000 people, and has a diverse clinical presentation as well as an array of imaging findings. In this article the authors review the various neuroimaging findings present in NF-1, including abnormalities of the parenchyma, meninges, vessels, and associated neoplasms.
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An 18-year-old girl who had severe headaches in the left temporal and facial regions was found to have a small enhanced dural-based parietal convexity mass. On magnetic resonance imaging (MRI), this mass was homogeneously enhanced with "dural tail sign," and was similar to a meningioma. ⋯ A small dural mass causing severe facial pain is an unusual situation. The lack of hemosiderin in the extra-axial cavernous angioma often leads to the preoperative diagnosis of meningioma.