Head Magnetic Resonance Imaging Research Articles

Intravascular Large B-Cell Lymphoma (IVLBCL) Presenting with CNS Involvement in Patient with Chronic Lymphocytic Leukemia

Background: Intravascular lymphoma (IVL) is a rare, often fatal disease characterized by intraluminal proliferation of lymphoid cells within blood vessels. Intravascular Large B-Cell Lymphoma (IVLBCL) is frequently found in different organs, but the skin and central nervous system (CNS) are the most affected ones. Routine radiological examination and additional diagnostic tools, such as high-resolution, three-dimensional (3D) FLAIR sequence, T2-weighted (T2W) and T1-weighted (T1W) contrast-enhanced magnetic resonance imaging (MRI), MRI diffusion and perfusion imaging studies are useful to confirm the diagnosis in cases where it is not easy to perform histopathological examinations [1]. 1.2. Case Report: We present a clinical case of a 63-year-old female patient who presented with progressive cognitive deficit as mild motor aphasia, acalculia, agraphia, dyslexia and mild ideomotor apraxia without any signs of other organ involvement. It was known that the patient had 5-year anamnesis of chronic lymphocytic leukemia, stage II and splanchnic venous thrombosis 2 months ago. Blood biochemical analysis without any significant change, except leukocytosis in full blood count (leukocytes 15,2 x 10*9/L, where neutrophils were in normal range, but lymphocytes were increased). Head magnetic resonance imaging (MRI) showed pathological signal areas on the left parietal lobe with hypointense signal on contrast-enhanced T1-weighted, hyperintense signal on contrast-enhanced T2-weighted and FLAIR-weighted MRI images with restricted diffusion and slightly lower ADC value. Magnetic resonance perfusion imaging studies did not show an increase in cerebral blood flow or in cerebral blood volume. In this case, the patient’s diagnosis was made based on typical radiological features. 1.3. Conclusions: Intravascular large B-cell lymphoma is a rare subtype of extra nodal large B-cell lymphoma with an aggressive clinical course. The diagnosis is challenging, as it presents without any obvious tumour mass or lymphadenopathy. [2] As the clinical presentation is variable without specific characteristics, mostly biopsy or even autopsy confirms the definite diagnosis. But in some cases, the diagnosis can be made by typical radiological findings in the restricted availability of brain biopsy.

PS-R06-3: A CASE OF CEREBRAL INFARCTION IN AN ELDERLY HYPERTENSIVE PATIENT WITH 24-HOUR STRICT BLOOD PRESSURE CONTROL

Introduction: In elderly patients, hypertension is a major risk factor of stroke. Therefore, strict blood pressure (BP) control provides most effective for the prevention of stroke incidence. Here, we report the case of stroke occurred under strict BP control in an elderly patient. Case: A 80-year-old Japanese women with the treatment of hypertension and dyslipidemia was admitted to our hospital with suddenly vertigo. Before admission, her BP control was controlled, which her ambulatory BP monitoring performed three months prior to admission showed that 24-hour, daytime and nighttime BP were 107/61 mmHg, 112/64 mmHg and 94/53 mmHg, respectively, and diurnal BP variation showed dipper pattern. On admission, her electrocardiography showed sinus rhythm, and her head magnetic resonance imaging showed the bilateral cerebellum infarction, which is the area dominated by posterior inferior cerebellar artery. The D-dimer level was 1.2 μg/ml. Transesophageal echocardiography was performed to search for an embolic source of stroke and revealed a patent foramen ovale (PFO). Leg vein echocardiography showed the thrombus in the bilateral soleus veins. Based on the above results, we diagnosed a paradoxical cerebral embolism caused by deep vein thrombosis of the lower extremities and PFO. Conclusion: The patient had achieved strict BP control assessed by ABPM prior to the onset of the stroke and was considered to be at low risk of stroke. Paradoxical cerebral embolism is a common cause of stroke in younger patients, however, physicians should be also noted as a cause of cerebral infarction even in the elderly patients.

Morphometric Analysis of Age and Genderrelated Variations of Corpus Callosum by using Magnetic Resonance Imaging: A Cross-sectional Study

Introduction: The Corpus Callosum (CC) is the largest commissural bundle connecting the two cerebral hemispheres which is involved in learning, memory, thinking, three-dimensional visual ability, executive functions as well as behavioural patterns. Exact morphometric dimensions are a prerequisite before surgical interventions and stereotactic approaches to the foramen of Munro and also in cases of callosectomy for intractable epilepsy as inconsistencies exist regarding gender and age related changes of CC. Also, most published studies are from the western world and very few studies are from South-east Asia and India. Aim: To study the morphometry of CC and possible age, gender related variations using Magnetic Resonance Imaging (MRI) in the North Indian population. Materials and Methods: An observational, cross-sectional study was done in Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India from January 2019 to October 2019. A total of 200 head MRI scans, using PACS (Picture Archiving and Communication System) System Viewer software were evaluated. In all the scans, length, height, minimum and maximum thickness of CC were studied. The data were statistically analysed using STATA Software for age and gender-related differences. Student’s t-test, one-way Analysis of Variance (ANOVA), linear regression and Pearson correlation coefficient were applied. Results: The study showed decrease in thickness of body, rostrum and splenium with age, linked to generalised degeneration of cortical neurons or atrophy of white matter with advancing age. Also, there was increase in length with age, possibly due to age mediated structural dilatation in lateral ventricles. Statistically significant sexual dimorphism was observed as a larger CC length in males (74.24±4.26 mm) than females (72.67±4.16 mm) (p-value<0.001) and larger brain length in males (171.75±5.51 mm) as compared to females (163.70±5.75 mm) (p-value<0.001). Males also showed greater splenial thickness (10.15±1.79 mm) in comparison to females (9.68±1.51 mm) (p-value<0.001) which may represent the importance of distribution of fibres of visual cortex in males due to larger occipital lobe. Conclusion: The present study documented morphometry of normal CC in different gender and age groups and observed sexual dimorphism, especially greater CC length and splenial thickness in males than females. With age increase in the length and decrease in thickness of CC was seen.

A case report of epileptic seizures caused by Rosai Dorfman disease followed by a literature review

Rosai Dorfman disease is a rare benign histiocytoproliferative disorder that occurs in the intracranial area, which occurrs typically in lymph nodes. Extrapnodal Rosai Dorfman disease rarely develops in the central nervous system and is often a focal lesion based on the dura. Based on imaging and clinical symptoms, RDD may be misdiagnosed as meningioma, and some lesions can also occur in the brain parenchyma. In the case of benign disease, the final diagnosis is made by pathological tissue diagnosis. For chronic diseases, progression may be chronic or remitting and relapsing. A 54-years-old man was hospitalized after experiencing paroxic convulsions and being unconsciousness. A head magnetic resonance imaging demonstrates a strip of lesions in the right parietal lobe. No obvious abnormality is found in the laboratory data. We diagnosed meningioma of right parietal lobe and secondary epilepsy, and prescribed oral sodium valproate to treat him. The lesion is located in the right parietal lobe on neuroimaging prior to surgery, which was taken for immunohistochemical examination. If it is found that immunohistochemistry reveals histiocytes are positive for CD68, S-100, but negative for CD1a, it is identified as RDD. For patients who are seizure-free following surgery, symptomatic management is used. Following parietal lesion resection, patients are seizure-free during the follow-up period (44 months). Basing on studying and summarizing relevant literatures, RDD is described in the report in terms of its diagnosis, pathology, treatment, and clinical outcome, in order to improve the diagnosis and identification of intracranial RDD by physicians.

Relationship between neutrophil count in cerebrospinal fluid and cerebral infarct appearance in head MRI on tuberculous meningitis patients

ObjectivesTo determine the relationship between neutrophils count in cerebrospinal fluid and cerebral infarction in head magnetic resonance imaging (MRI) on patients with tuberculous meningitis MethodsA diagnostic study was done on patients with tuberculous meningitis (TBM) who underwent head MRI examination and cerebrospinal fluid analysis at Dr. Hasan Sadikin General Hospital from January 2015 to September 2016. TBM was diagnosed by Mycobacterium tuberculosis isolation from cerebrospinal fluid. Cut-off value of neutrophil count was determined using receiver operating characteristics (ROC) curve. Conformity test was done using Kappa test. ResultsThirty seven subjects were recruited in this study. Higher neutrophil count in CSF was observed on subjects with cerebral infarction (p < 0.05). Cut-off value of neutrophil count in CSF was determined as > 41 %. There was a moderate conformity between higher neutrophil count in CSF and cerebral infarction appearance in MRI (p < 0.05, Kappa score 0.529). ConclusionHigher neutrophil count was associated with the appearance of cerebral infarct in head MRI on adult patients with tuberculous meningitis.

Normal size of benign upper neck nodes on MRI: parotid, submandibular, occipital, facial, retroauricular and level IIb nodal groups

Nodal size is an important imaging criterion for differentiating benign from malignant nodes in the head and neck cancer staging. This study evaluated the size of normal nodes in less well-documented nodal groups in the upper head and neck on magnetic resonance imaging (MRI). Analysis was performed on 289 upper head and neck MRIs of patients without head and neck cancer. The short axial diameters (SAD) of the largest node in the parotid, submandibular, occipital, facial, retroauricular and Level IIb of the upper internal jugular nodal groups were documented and compared to the commonly used threshold of ≥ 10mm for diagnosis of a malignant node. Normal nodes in the parotid, occipital, retroauricular and Level IIb groups were small with a mean SAD ranging from 3.8 to 4.4mm, nodes in the submandibular group were larger with a mean SAD of 5.5mm and facial nodes were not identified. A size ≥ 10mm was found in 0.8% of submandibular nodes. Less than 10% of the other nodal group had a SAD of ≥ 6mm and none of them had a SAD ≥ 8mm. To identify malignant neck nodes in these groups there is scope to reduce the size threshold of ≥ 10mm to improve sensitivity without substantial loss of specificity.

Horizontal diplopia with right abducens palsy and gaze evoked nystagmus due to pontine lesion in human immunodeficiency virus related cerebral toxoplasmosis

AbstractPurpose: This case report will discuss about the diagnostic approach in a rare case of horizontal diplopia with Human Immunodeficiency Virus (HIV) related Cerebral Toxoplasmosis.Methods: The diagnosis was based on history taking, ophthalmologic examinations, vestibular‐ocular reflex (VOR) test, convergence test, nystagmus test, cerebellar function test, serological findings and magnetic resonance imaging (MRI) of head and orbita.Results: A 30 years old man with the main complaint binocular horizontal diplopia since 2 months ago, accompanied by headache, disorder of coordination, balance, speech and also impaired of memory and concentration. There was history of head injury and promiscuity. Visual acuity of both eyes 6/6 with best corrected visual acuity. There were abduction deficit on right eye, abducting nystagmus on left eye, no vestibular‐ocular reflex, no convergence insufficiency and no dysfunction of cerebellar. Immunoglobulin‐G antibodies Toxoplasma &gt;650.0 IU/ml, Cluster Determinant 4 (CD4) T cell 55 cells/μl, and HIV reactive in serological findings. MRI of head and orbita revealed a lesion on pontine tegmentum. Patient was diagnosed with horizontal diplopia with right abducens palsy and gaze evoked nystagmus due to pontine lesion in HIV related cerebral toxoplasmosis.Conclusions: History taking and ophthalmologic examinations are important steps to establish the diagnosis. VOR test can determine the lesion in supranuclear, nuclear or infranuclear. Serological tests and MRI of head and orbita may be helpful in confirming the diagnosis and finding the cause of binocular horizontal diplopia.

Detection of myelin oligodendrocyte glycoprotein antibody in pediatric patient with acute disseminated encephalomyelitis: a case report

Introduction: Acute Disseminated Encephalomyelitis (ADEM) is an immunity-mediated central nervous system demyelinating disorder. Myelin Oligodendrocyte Glycoprotein (MOG) examination provides information about a patient's ADEM development status. A positive MOG antibody can signify a first episode or incomplete recovery. This review aims to report a case of a pediatric patient with acute disseminated encephalomyelitis with positive MOG antibody. Case Presentation: We present a 5-year-old girl with symptoms of low-grade fever, encephalopathy, blurred vision, numb and tingling sensations on hands and feet, weakness, unable to walk. Head MRI (Magnetic Resonance Imaging) examination reveals lesions in the bilateral thalamus and white matter of the left parietal lobe. There was also a bilateral thickening of the optic nerves. Blood laboratory examination was relatively normal, and the MOG antibody test was positive. The patient was then treated with corticosteroids for 1 year and had 2 recurrent episodes of attacks. MOG test evaluation was still also positive 6 months after the first attack. After Intravenous immunoglobulin (IVIG) treatment was given, resulting in excellent clinical response and no recurrent attack since then. Conclusions: ADEM cases have a good prognosis and good recovery. IVIG administration, with the help of other supportive therapy, improves recovery in treating pediatric ADEM.

Congenital systemic chondrodysplasia in a white lion (Panthera leo)

AbstractThe death of a 6‐month‐old, male, white lion with micrognathia and short, thick limbs in a zoo prompted postmortem whole‐body computed tomography and head magnetic resonance imaging to be performed. Computed tomography revealed malformation of all bones. The metaphyses of the long bones were enlarged and showed fraying and cupping. Moreover, magnetic resonance imaging revealed abnormal bone tissue with reduced bone density, severe bilateral compression of the spinal cord from the stomach up to the level of the atlas and herniation of the cerebellar vermis. Histopathological examination revealed that the metaphyses of all long bones were enlarged and replaced with cartilage; however, the structure of the joints was maintained. This report presents the first case of congenital systemic chondrodysplasia identified by postmortem examination and imaging in a lion.

Magnetic resonance imaging-guided surgical strategies for treating trigeminal neuralgia without vascular compression

ObjectiveTo describe the surgical strategy, curative effect and postoperative complications of trigeminal neuralgia (TN) without vascular compression using head magnetic resonance imaging (MRI). MethodsWe retrospectively enrolled 184 patients with TN who were admitted to the Department of Neurosurgery of Zhoukou Central Hospital from January 2018 to March 2021 and had complete clinical data. Preoperative MRI reveled that 35 patients (19.0%) had no vascular compression. Among them, 16 (45.7%) had simple venous compression during surgery, 9 (25.7%) had venous compression and arachnoid adhesion during surgery, 5 (14.3%) had arachnoid adhesion during surgery, 3 (8.6%) had no venous compression or arachnoid adhesion during surgery, and 2 (5.7%) had simple artery compression during surgery. During the operation, the corresponding surgical strategies for the various types of venous compression were developed. Postoperative efficacy was assessed using the Barrow Neurological Institute pain intensity and facial numbness scores. ResultsAccording to the four types of compression identified during the operation, which did not reveal obvious vascular compression on preoperative head MRI, appropriate decompression methods were found to effectively relieve or eliminate pain (97.1%), and the postoperative effect was relatively satisfactory. There was no recurrence after 1–2 years of follow-up. After operation, two patients (5.7%) experienced occasional pain, one patient (2.9%) reported minor pain, and two patients (5.7%) reported numbness on the affected side of the face. Furthermore, one patient had aseptic meningitis (2.9%) and one patient (2.9%) had transient tinnitus or hearing loss on the affected side. ConclusionFor patients with (TN) without vascular compression on head MRI prior to surgery, different surgical strategies can be implemented based on microvascular decompression and adequate trigeminal nerve decompression findings. Our results showed that these strategies could achieve satisfactory postoperative results without increasing postoperative complications.

ODP341 Pachydermia lesions identified on imaging in a cohort of acromegaly patients

Abstract Introduction Pachydermia is a clinical term derived from the former taxonomic order of mammals pachydermata, and it corresponds to a benign thickening and furrowing of the skin. It is classically associated with pachydermoperiostosis, but it can emerge in another conditions, including in acromegaly. These lesions may be distributed throughout the body. When they are mainly located to the scalp and forehead, resembling cerebral gyri, they receive the designation of cutis verticis gyrata (CVG). These are seldomly reported in acromegaly patients. Therefore, with this study we aimed to assess the prevalence of these pachydermia lesions in the patients with acromegaly followed at our center. Materials and methods We retrospectively reviewed the head magnetic resonance imaging (MRI) of 42 patients with acromegaly followed at our center. We inspected the composition, thickness and shape of the scalp, and those cases with more than 1 unequivocal furrow on the skin/connective tissue of the scalp region visible on the MRI were considered as a patient displaying pachydermia lesions. Demographic data and IGF-I levels at diagnosis were also registered. Results Six out of the 42 (14%) acromegaly patients displayed pachydermia lesions identifiable on MRI. Of the 6 patients, 4 had pachydermia lesions in the parietal area, while the occipital and the temporo-occipital regions were each involved in 1 patient. The mean age of these six patients were 51±10yr, and there were 4 males and 2 females. Their serum IGF-1 levels at the diagnosis of acromegaly were 1125±326ng/mL (minimum and maximum IGF-1 levels were respectively 517 and 1358), and 5 of the six patients were identified with a pituitary macroadenoma at diagnosis, while only one patient had a microadenoma. Discussion Pachydermia lesions are uncommonly reported in patients with acromegaly, although their prevalence might be significant in this setting, particularly in male patients, as demonstrated in this study. Pachydermia lesions may be depicted on imaging studies, thus clinical examination together with careful inspection of the scalp and skin on radiological studies may be important to identify such lesions, which in turn may contribute for an earlier diagnosis of acromegaly or facilitate the investigation of other etiologies. Presentation: No date and time listed

PMON84 A Unique Case of Diabetes Insipidus Revealing Hodgkin's lymphoma

Abstract Introduction While diabetes insipidus rarely presents as a symptom of non-Hodgkin's lymphoma, it is very rarely a revealing symptom of Hodgkin's lymphoma. We present a case of this unique association. Case presentation We report a case of a 25-year-old previously healthy male with no significant past medical history who presented with complaints of polydipsia, polyuria, and nocturia. A water deprivation test confirmed central diabetes insipidus. He started therapy with oral desmopressin and had clinical improvement. Magnetic resonance imaging (MRI) of his head showed thickened infundibulum and a lack of posterior pituitary bright spot, consistent with infundibulo-neurohypophysitis. There were no obvious masses within the anterior or posterior lobe, nor were suprasellar soft tissue masses noted. Diabetes mellitus (DM), autoimmune diseases, and infectious diseases were excluded. A chest x-ray revealed a superior mediastinal mass and a CT scan confirmed multiple mediastinal lymphadenopathies. A biopsy of pre-tracheal lymph node revealed nodular sclerosing Hodgkin's lymphoma. The patient received six cycles of chemotherapy with Adriamycin, Bleomycin, Vinblastine and Dacarbazine (ABVD) and achieved a complete remission. A follow up MRI head scan showed a decreasing in the thickness of infundibulum along with non-visualization of the posterior pituitary bright spot. Finally, his symptoms resolved with DDAVP therapy. Conclusions Diabetes insipidus involving the pituitary gland of Hodgkin's lymphoma is an extremely rare presentation of endocrine deficiency and malignancy. The literature describes only a few such cases. Clinicians should be aware diabetes insipidus might rarely present as a symptom of Hodgkin's lymphoma without obvious metastatic involvement of the neurohypophysial system. Continuing to report anecdotal experiences in managing similar complex scenarios is essential and remains the only reference for clinicians who handle patients with a similar presentation. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

Rhinocerebral Mucormycosis in Patients with Diabetes Mellitus After a New Coronavirus Infection (COVID-19): СT and MRI Patterns Data

Objective: to study the computed tomography (CT) and magnetic resonance imaging (MRI) manifestations of rhinocerebral mucormycosis (RCM) in patients with diabetes mellitus and new coronavirus infection, to develop attentive attitude of radiologists for early detection of this pathology, rapid surgery and followup examinations.Material and methods. Totally 53 head (facial skull, soft facial tissues and brain) CT and MRI studies were performed in 13 patients with RCM. The number of CT and MRI studies varied from 1 to 9 per one patient, depending on the severity of his condition and clinical indications; the follow-up period was 1–4 months. All patients received surgical aid; diagnosis was verified by microscopy of surgical samples of excised necrotic tissues. A detailed descriptive analysis of pathological changes on CT and MRI characterizing RCM was carried out. The sequence of pathological signs manifestations was described, the prevalence of the lesion was estimated for planning the scope of surgical intervention. A comparative analysis of the identified RCM signs with the literature data was performed.Results. Lesions of the nasal cavity and paranasal sinuses in RCM were found in 100% of our observations, with approximately equal single and bilateral lesions of 54% and 46%, respectively. Lesions of the perimaxillar fatty tissue and pterygoid fossa were determined in 77% of patients, unilateral orbital lesions – in 23%, superior orbital vein and cavernous sinus thrombosis – in 31%, facial soft tissue lesion – in 15.5%, intracranial spread through the perineural spaces – in 7.7%, internal carotid artery arteritis – in 15.5%. Brain substance and meninges involvement in the pathological process was observed in the form of cerebritis in 23% of patients and meningitis in 46%. The formation of brain abscess was noted in follow up examinations in 15.5% of patients, skull bones osteomyelitis was diagnosed in 46%. The mortality rate was 15%. In cases of long-term observation, the manifestations of pathological changes started from the nasal cavity, then spreaded in the perimaxillary adipose tissue and orbit, and were followed by the development of intracranial complications.Conclusion. The accumulated experience in identifying the combination of CT and MRI signs and patterns of RCM combined with clinical and anamnestic data allows to increase the alertness of clinicians and radiologists for earlier diagnosis and selection of the optimal volume of surgical intervention.

The current status of nanotechnological approaches to therapy and drug delivery in otolaryngology: A contemporary review.

To summarize the current standing of nanomedicine-based technology, particularly nanoparticles (NPs), for drug delivery and diagnostic mechanisms in otolaryngology and the otolaryngology subspecialties. Literature searches were performed using PubMed and Ovid MEDLINE from 2010 to 2022. The search focused on original articles describing developments and applications of nanotechnology and drug delivery in otology, neurotology, cranial base surgery, head and neck oncology, laryngology, bronchoesophagology, and rhinology. Keyword searches and cross-referencing were also performed. No statistical analysis was performed. The PubMed search yielded 29 articles, and two Ovid MEDLINE searches both yielded 7 and 26 articles, respectively. Cross-referencing and keyword searches in PubMed and Google Scholar yielded numerous articles. The results indicate that currently, NPs are the most thoroughly studied nanotechnology for drug delivery and therapy in otolaryngology. Organic NPs have been utilized for drug delivery in otology and head and neck oncology due to their high biocompatibility. Inorganic NPs have similarly been utilized for drug delivery. However, inorganic NPs seem to be studied less extensively in these fields, likely due to an increased risk for heavy metal toxicity. Due to their magnetic properties, inorganic NPs have been utilized for magnetic-guided delivery in otology and thermoradiation and magnetic resonance imaging in head and neck oncology. Applications of nanotechnology to the fields of laryngology, bronchoesophagology, and rhinology have been studied less compared with otology and head and neck oncology. However, researchers have primarily employed NPs and other nanotechnologies such as nanofibers and nanoclusters for drug elution at mucosal surfaces to reduce airway and nasal inflammation. Nanomedicine offers potential benefits in the treatment of patients in the field of otolaryngology due to enhanced control over drug release, cell-specific targeting, and the potential to reduce drug toxicity. Future work is needed to ensure the safety of these therapies to integrate this field of research into human therapies.

Identifying stroke diagnosis-related features from medical imaging reports to improve clinical decision-making support

BackgroundMedical imaging reports play an important role in communication of diagnostic information between radiologists and clinicians. Head magnetic resonance imaging (MRI) reports can provide evidence that is widely used in the diagnosis and treatment of ischaemic stroke. The high-signal regions of diffusion-weighted imaging (DWI) images in MRI reports are key evidence. Correctly identifying high-signal regions of DWI images is helpful for the treatment of ischaemic stroke patients. Since most of the multiple signals recorded in head MRI reports appear in the same part, it is challenging to identify high-signal regions of DWI images from MRI reports.MethodsWe developed a deep learning model to automatically identify high-signal regions of DWI images from head MRI reports. We proposed a fine-grained entity typing model based on machine reading comprehension that transformed the traditional two-step fine-grained entity typing task into a question-answering task.ResultsTo prove the validity of the model proposed, we compared it with the fine-grained entity typing model, of which the F1 measure was 5.9% and 3.2% higher than the F1 measures of the models based on LSTM and BERT, respectively.ConclusionIn this study, we explore the automatic identification of high-signal regions of DWI images from the description part of a head MRI report. We transformed the identification of high-signal regions of DWI images to an FET task and proposed an MRC-FET model. Compared with the traditional two-step FET method, the model we proposed not only simplifies the task but also has better performance. The comparable result shows that the work in this study can contribute to improving the clinical decision support system.

Clinical characteristics in 26 children with congenital tuberculosis in Central Southern China: a retrospective study

ABSTRACT Background Congenital tuberculosis (CTB) is relatively rare and most patients are described in case reports. Aim To investigate the clinical characteristics of CTB in 26 children. Methods A retrospective analysis of 26 children with CTB from January 2013 to December 2021 in Changsha Central Hospital in Central Southern China was undertaken. Results The median age at onset was 25 days (17–33) and within 4 weeks of age in approximately 73% of cases. Of 24 mothers (including two mothers of twins), 18 (75.0%) were asymptomatic during pregnancy, and four were diagnosed with tuberculosis prenatally. The numbers of tuberculous meningitis, tuberculous encephalitis and liver TB were 17 (65.4%), five (19.2%) and four (15.4%), respectively. The main symptoms were fever (n = 18, 69.2%) and cough (n = 16, 61.5%). Positive rates of T-SPOT.TB, acid-fast bacilli smear, culture of Mycobacterium tuberculosis and GeneXpert MTB/RIF test were, respectively, 84.2% (16/19), 42.3% (11/26), 43.5% (10/23) and 83.3% (5/6). Radiograph or computed tomography demonstrated typical pulmonary tuberculous lesions in all cases and the head magnetic resonance imaging (MRI) showed marked meningeal enhancement or parenchymal lesions in seven cases (26.9%). One case had drug-resistant TB. During follow-up, nine cases had varying degrees of liver injury, and one had delayed growth and development. Eight died and 18 recovered satisfactorily. Conclusion Maternal TB status during pregnancy, the epidemiological history, T-SPOT.TB and other TB-related aetiological tests and imaging are important for the early diagnosis and treatment of CTB, and are associated with a favourable outcome. Abbreviations AFB: acid-fast bacilli; Amk: amikacin; Cs: cycloserine; CT: computed tomography; E: ethambutol; GeneXpert MTB/RIF: GeneXpert Mycobacterium tuberculosis and rifampicin resistance; H: isoniazid; IVF-ET: in-vitro fertilization-embryo transfer; Lzd: linezolid; Mfx: moxifloxacin; MTB: Mycobacterium tuberculosis; mNGS: next generation sequencing; MTB-DNA: Mycobacterium tuberculosis-deoxyribonucleic acid; Pto: protionamide; R: rifampicin; TB: tuberculosis; T-SPOT.TB: spot test of mycobacterium TB infection T-lymphocytes; Z: pyrazinamide.

Traumatic Brain Injury, Bulging Eyeball, and Skin Lumps

A 43-year-old man was admitted to the emergency department for motor vehicle collision. First clinical impression was traumatic injury of the right eye with bare light perception. A physical examination revealed multiple nodular skin lesions on the head and neck. Head magnetic resonance imaging and computed tomography scans showed intracerebral hemorrhage, trans-orbital brain herniation, and right sphenoid wing dysplasia. A diagnosis of neurofibromatosis type 1 was made. Sphenoid wing dysplasia (also known as bare orbit sign) in neurofibromatosis type 1 was a contributing factor to the trans-orbital herniation, but also helped reduce intracranial pressure after traumatic brain injury in this rare case. Mannitol was administered, and no neurosurgical intervention was needed for traumatic brain injury. Canthorrhaphy of the right eye was performed to preserve patient's right eyeball. At 1-month follow-up, patient's right eyeball was preserved, and vision improved as well.

Study on the Predictive Value of Thromboelastography in Early Neurological Deterioration in Patients with Primary Acute Cerebral Infarction.

Objective To investigate the predictive value of thromboelastography for the occurrence of early neurological deterioration (END) in patients with primary acute cerebral infarction (ACI). Methods 150 patients who were hospitalized in the department of neurology of our hospital from September 2020 to September 2021 and were clearly diagnosed with primary ACI by head CT and head magnetic resonance imaging (MRI) were selected and divided into END and non-END groups according to the change in National Institute of Health Stroke Scale (NIHSS) score within 72 h of admission. The general baseline data and laboratory indexes of the first examination at admission were compared between the two groups, and the factors that may affect the occurrence of END were determined by univariate analysis and multivariate logistic regression analysis, and the predictive value of thromboelastography on the occurrence of END after ACI was analyzed by applying the receiver operating characteristic (ROC) curve. Results Time to onset, baseline NIHSS score, percentage of diabetes, white blood cell (WBC) levels, C-reactive protein (CRP), and apolipoprotein B (Apo B) levels were higher in the END group than in the non-END group (P < 0.05); coagulation reaction time (RT) (3.97 ± 1.16 vs. 5.49 ± 1.03) and kinetic time (KT) (1.32 ± 0.67 vs. 1.82 ± 0.58) were lower in the END group than in the non-END group (P < 0.05). Inthe END group (P < 0.05) diabetes, baseline NHISS score, CRP level, Apo B level, and RT were independent risk factors for the development of END in patients with ACI (P < 0.05). The AUC of RT to predict the occurrence of END in patients with ACI was 0.855 (95% CI: 0784 to 0925, P = 0.001), with a sensitivity of 81.70% and specificity of 78.00% when the optimal cut-off value was 0.597. Conclusion NIHSS score at admission, CRP, apolipoprotein B, RT shortening, and diabetes mellitus were independent risk factors for the development of END in ACI patients; RT shortening in TEG was predictive of END in ACI patients.

Head MRI imaging profile of meningioma according to WHO 2016 grading

Magnetic resonance imaging (MRI) of meningiomas is essential in predicting their histopathological grade. Meningiomas are the second most common central nervous system neoplasm in adults, usually benign, originating from arachnoid cap cells and categorized according to the WHO classification as benign (grade I), atypical (grade II), and anaplastic (grade III). The study aims to determine the head MRI imaging profile in preoperative meningioma patients confirmed by pathologic results according to WHO 2016 grading. A retrospective study was conducted from January 2017 to March 2022 with 30 samples of meningioma patients who underwent surgery. Preoperative head MRI and pathologic examination were done and tumor location, border, edge, and size were confirmed with pathology results according to WHO 2016 grading. Most patients were 41-50 years old, female (100%), mostly WHO grade I histopathology with transitional type. The most common locations were convexity meningiomas, with the most MRI characteristics of well-defined borders, regular edges, size 0-3 cm, with hypointense T1, hyperintense T2, hyperintense T2 FLAIR, restricted diffusion on DWI, type 2 DCE, homogeneous enhancement pattern, and the most feeding arteries originated from the meningeal artery.

Impact of extended pre-scan written instructions on motion artifacts during head magnetic resonance imaging.

This study aimed to assess the effect of extending pre-scan written instructions to patients undergoing head magnetic resonance imaging (MRI) examinations on motion artifacts. A controlled study was conducted in King Fahad Hospital at the Department of Radiology. A total of 100 patients were involved: 50 received only routine oral hospital instructions (control group), and another 50 received pre-scan extended written instructions besides routine oral hospital instructions (intervention group). The head MRI images were assessed regarding motion artifacts. Informed consent was obtained from all patients included in the study. The incidence of motion artifacts was significantly less in the intervention group than in the control group, 10% and 58%, respectively (p-value=0.001). The motion artifacts decreased significantly in the intervention group compared to the control group. Extending written information before an MRI scan could significantly reduce motion artifacts and improve image quality.