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Diffusion-weighted MR of the brain: methodology and clinical application.

Clinical diffusion magnetic resonance (MR) imaging in humans started in the last decade with the demonstration of the capabilities of this technique of depicting the anatomy of the white matter fibre tracts in the brain. Two main approaches in terms of reconstruction and evaluation of the images obtained with application of diffusion sensitising gradients to an echo planar imaging sequence are possible. The first approach consists of reconstruction of images in which the effect of white matter anisotropy is averaged -- known as the isotropic or diffusion weighted images, which are usually eval

Pearls and oy-sters: tuberculous meningitis: not a diagnosis of exclusion.

A 21-year-old man presented to his local emergency department with 5 days of headache, which was dull, occipital, bilateral, nonthrobbing, and progressively worsening. It was associated with mild fever, photophobia, and neck pain and stiffness. He had no history of headache, chronic illness, recent vaccinations, cutaneous rash, cough, diarrhea, arthralgia, or myalgia. He was from Ecuador and had been living in the United States for less than 1 year. He had been incarcerated while in Ecuador. Sublingual temperature on admission was 102.6°F. Other vital signs were within normal limits. On physic

Vertebroplasty and delayed subdural cauda equina hematoma: Review of literature and case report.

Vertebroplasy is considered an alternative and effective treatment of painful oncologic spine disease. Major complications are very rare, but with high morbidity and occur in less than 1% of patients who undergo vertebroplasty. Spinal subdural hematoma (SDH) is an extremely rare complication, usual developing within 12 h to 24 h after the procedure. We report the case of a tardive SDH in an oncologic patient who underwent VP for Myxoid Liposarcoma metastasis. Trying to explain the pathogenesis, we support the hypothesis that both venous congestion of the vertebral venous plexus of the vertebra

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… Both patients improved after the second surgical procedure, but reported back pain after a few months, with an MRI showing spinal arachnoiditis, controlled with steroids and anti-inflammatory drug therapy. … Although some authors have suggested that thin and delicate extra-arachnoid vessels on the inner surface of dura can give rise to SDH, it is confined to specific cases occurring in association with a subarachnoid hemorrhage of traumatic origin[ 34 ]. …

Miscellaneous Spinal Cord Diseases

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Disorders of the Spinal Cord

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Scoping Review of Treatment Strategies for Holmes Tremor: Pharmacological and Surgical Interventions.

BACKGROUND: Holmes tremor is a rare neurological condition, first described in 1904, characterized by a low-frequency tremor that manifests at rest, posture, and action. Despite its recognition for over a century, effective treatment strategies for Holmes tremor remain elusive due to its rarity and challenges in conducting robust studies. METHODS: Given that the existent medical literature on Holmes tremor is based on reports and case series, we conducted a survey using the keywords "Holmes tremor" and "Rubral tremor" to analyze the therapeutic approaches utilized, as well as their success ra

Multiple myeloma presenting as an intramedullary spinal cord tumor: a case report and review of the literature.

BackgroundExtramedullary disease in multiple myeloma often portends a worse diagnosis. In approximately 1% of cases, multiple myeloma may metastasize to the central nervous system as either leptomeningeal involvement or an intracranial, intraparenchymal lesion. Spinal cord metastases, however, are exceedingly rare. We present a case of spinal cord multiple myeloma as well as a literature review of reported cases.Case presentationA 66-year-old African American man with multiple myeloma presented with acute midthoracic pain and lower extremity paresis and paresthesia. Magnetic resonance imaging

Cerebrospinal Fluid sCD27 в качестве биомаркера неевроинфламационной болезни: систематический обзор и мета-анализ.

Нейровоспалительные заболевания центральной нервной системы (ЦНС) создают значительные диагностические проблемы из-за переплетения клинических характеристик и отсутствия конкретных биомаркеров, способных надежно обнаруживать воспаление CNS. Растворимый CD27 (SCD27) — маркер адаптивной иммунной активации, выпущенный на CD27-CD70 SCD27 стал многообещающим биомаркером цереброспиновой жидкости (CSF), однако его клиническая полезность остается неясной. Цель этого систематического обзора и метаанализа заключалась в уточнении диагностического значения CSF SCD27 в нейронных условиях. Мы систематически

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… Treatment status not further specifies | sCD27 mean: In case group overall: ‐LI + (6): 126.44 ‐LI – (24): 68.05 NIND: no exact value, in article written below cutoff value (350) Panackal et al. ( 2017 ) | Cryptococcal spinal arachnoiditis*: 6 *IND in this review | HC: 11 | All patients were treated with … “Spinal Arachnoiditis as a Complication of Cryptococcal Meningoencephalitis in Non‐HIV Previously Healthy Adults.” Clinical Infectious Diseases 64, no. 3: 275–283. 10.1093/cid/ciw739. R Core Team . 2024. R: A Language and Environment for Statistical Computing (4.4.2). …

Leptomeningeal Disease as an Initial Presenting Manifestation in Breast Cancer.

Leptomeningeal disease (LMD) occurs in less than 5% of breast cancer patients. Rarely, patients present with LMD at diagnosis. We report a case of a 59-year-old female who presented with lower back pain, radicular neuropathy with lower extremity weakness, and was found to have diffuse LMD. Workup was initiated to evaluate the etiology of LMD and later involved iliac bone biopsy showed metastatic adenocarcinoma consistent with breast carcinoma. Patient received radiation therapy followed by abemaciclib with letrozole and responded well with the treatment.

Treatment of Leptomeningeal Carcinomatosis in a Patient with Metastatic Pancreatic Cancer: A Case Report and Review of the Literature.

Pancreatic cancer is the fourth leading cause of cancer-related death with a median survival of 3-11 months when metastatic. We present a patient with metastatic pancreatic cancer and an exceptional response to initial systemic chemotherapy with FOLFIRINOX (fluorouracil, leucovorin, irinotecan, and oxaliplatin). Despite evidence of disease control on body imaging, he developed symptomatic leptomeningeal disease and brain metastases 29 months into treatment. He received aggressive treatment with capecitabine and irinotecan, intrathecal topotecan, and eventually bevacizumab. He did well for 36 w

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… Arachnoiditis, a more significant side effect, did not affect patients in the 0.2- or 0.4-mg groups [ 11 ]. … Without a direct comparison of intrathecal agents available in the setting of an extraordinarily rare presentation of pancreatic cancer metastasis to the leptomeninges, we chose topotecan over methotrexate because topotecan has better long-term tolerability and is associated with a lower rate of arachnoiditis …

Aggressive Central Nervous System Relapse after Autologous Stem Cell Transplant in Multiple Myeloma: Case Reports and Literature Review.

Extramedullary disease is an aggressive presentation at diagnosis and relapse for multiple myeloma (MM) patients. Central nervous system (CNS) is a very rare manifestation of the extramedullary disease, accounting for less than 1% of MM on diagnosis and relapse. Neurological symptoms are unspecific and usually attributed to other causes. We present two patients with CNS-MM at relapse after autologous stem cell transplant highlighting the importance of clinical suspicion and interdisciplinarity at diagnostic workup as well as the need for intensive therapeutic options on such rare and aggressiv

The utility of stereotactic biopsy of intracranial lesions in the diagnosis of leukemia complicated by central nervous system lesions.

BACKGROUND: Leukemia complicated by central nervous system (CNS) lesions (LCNSL) includes leukemia involving the CNS (CNSL) and CNS secondary lesions related to leukemia treatment (e.g., CNS infections, leukoencephalopathy, inflammatory demyelination, and vascular diseases). The clinical manifestations and imaging characteristics of different types of LCL are similar, increasing the possibility of misdiagnosis. This study aimed to enhance our understanding and management of LCL. METHODS: We retrospectively collected clinical data from 22 patients with LCL and analyzed their magnetic resonance

[Operative neurosurgery: personal view and historical backgrounds (3). Anterior circulation--pterional approach].

Under the title of anterior circulation aneurysms and the pterional approach, followings are presented and emphasized along with mentioning their historical development in our present performance status. Pterional approach: head positioning with Mayfield-Kees fixation apparatus using one pin around the processus matoideus and the other 2 pins on the contralateral side behind the hair line the head turned 30 degrees and reclined chin-up l5-20 grade. Skin incision beginning just in front of the tragus ending up at the midline hair line in a curvilinear fashion always including the superficial te

Геномическая аттестация в Biobank Cohort предлагает роль C8B и MFG-E8 в патогенезе Тригеминальной Невралгии.

Тригеминальная нейронгия (TN) — серьезная болевая болезнь, вызванная неопределенной патофизиологией и неясным генетическим фоном. Хотя недавние исследования свидетельствуют о том, что генетические факторы играют более важную роль в патогенезе ТН, на сегодняшний день было предложено несколько потенциальных генов. Цель настоящего исследования состояла в том, чтобы выявить независимые генетические варианты генов белкового кодирования, связанных с ТН. Мы сосредоточились на генах, ранее связанных с TN, на основе результатов four Протеомные исследования, проведенные нашей исследовательской группой.

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… TNF-β, reported to be elevated in the CSF of TN patients (Ericson et al. 2019 ), contributes to the development of tertiary lymphoid organs, potentially reflecting the observed arachnoiditis associated with the trigeminal nerve in TN. … Notably, tertiary lymphoid organs produce MFG-E8 (Krautler et al. 2012 ), and elevated MFG-E8 levels could potentially reflect such arachnoiditis. …

Leptomeningeal carcinomatosis in gastric cancer: A Review.

Gastric cancer is the fifth most common cancer worldwide and leptomeningeal carcinomatosis (LM) occurs in 0.06% of gastric cancers. As such, trials are difficult to power and quantitative analyses difficult to standardize. We composed a review and analysis of 47 recent cases to be used as a comprehensive resource for an oncologist faced with managing this highly morbid, rapidly fatal disease. Gold-standard of diagnosis of LM is through cerebral spinal fluid (CSF) cytology; MRI is the preferred imaging modality to identify LM. However, repeated lumbar punctures and imaging studies are often req

Imaging for Plasma Cell Dyscrasias: What, When, and How?

Imaging plays a vital role in the diagnosis, response assessment, and follow-up of patients with plasma cell bone disease. The radiologic diagnostic paradigm has thus far evolved with developing technology and availability of better imaging platforms; however, the skewed availability of these imaging modalities in developed vis-à-vis the developing countries along with the lack of uniformity in reporting has led to a consensus on the imaging criteria for diagnosing and response assessment in plasma cell dyscrasia. Therefore, it is imperative for not only the radiologists but also the treating

Targeting endoplasmic reticulum stress-induced lymphatic dysfunction for mitigating bisphosphonate-related osteonecrosis.

BACKGROUND: Bisphosphonates (BPs) are the first-line treatment to stop bone resorption in diseases, including osteoporosis, Paget's disease, multiple myeloma and bone metastases of cancer. However, BPs-related osteonecrosis of the jaw (BRONJ), characterized by local inflammation and jawbone necrosis, is a severe intractable complication. The cumulative inflammatory burden often accompanies impaired lymphatic drainage, but its specific impact on BRONJ and the underlying mechanisms remain unclear. METHODS: The mouse BRONJ model was established to assess the integrity and drainage function of ly

Агрессивная внутричерепная менингиома, связанная с множественным склерозом.

Менингиомы являются наиболее распространенными первичными опухолями центральной нервной системы (КНС) и часто требуют радиационной терапии (RT), которая может привести к возникновению таких осложнений, как вызванное радиацией обезвоживание. В настоящем исследовании описывается случай с 40-летним пациентом мужского пола, у которого появились демиелионирующие повреждения после РТ в случае менингиомы первого класса ВОЗ, в конечном счете диагностированной с помощью MS. Это состояние имеет клинические и радиологические особенности с множественным склерозом, в том числе повреждения олигодендроцитов,

Intracranial meningiomas, the VEGF-A pathway, and peritumoral brain oedema.

Meningiomas are the second-most common intracranial tumours in adults. They are derived from the arachnoid cells, and although approximately 90% of meningiomas are benign, more than half of all meningiomas develop peritumoral brain oedema (PTBE), which increases morbidity. The PTBE can be treated with steroid therapy, but this treatment is not specific, is not always effective, and involves long-term side-effects. Meningiomas are treated with radiation therapy, stereotactic radio-surgery or surgical resection. At the moment surgical resection is the only definite treatment, and the removal of

Neurology

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