Spigelian hernia (SH), a protrusion of intra-abdominal contents through a defect in the semilunar line (Spigelian fascia) of the abdominal wall, is extremely rare in the pediatric population. Fewer than 100 cases of pediatric SH have been reported in the literature since the first description in 1939. Pediatric SH is often congenital and may present with non-specific symptoms, making diagnosis challenging. Notably, about one-quarter to one-third of reported pediatric cases are associated with ipsilateral undescended testis, an association sometimes termed the "Spigelian-cryptorchidism syndrome". To systematically review all reported cases of Spigelian hernia in children and identify its diagnostic and surgical features. A comprehensive literature search was performed (1939 through 2023) using PubMed and other databases for all publications on Spigelian (semilunar line) hernias in children. Both English and non-English articles were included. Case reports, case series, and relevant reviews were analyzed. Data extracted included patient demographics, hernia side/location, clinical features, imaging and intraoperative findings, coexisting conditions (particularly cryptorchidism), management (open vs laparoscopic repair), and outcomes. A total of approximately 90 pediatric SH cases from 44 publications were identified. The median age at presentation was around 3-4 years (range: Neonate to 17 years). Slight male predominance was observed, although SH also occurs in females. About 30% of cases involved an ipsilateral undescended testis within the hernia sac or in the Spigelian region. Rare associations with other anomalies were noted, including concurrent inguinal hernias, umbilical hernia, and even complex syndromic presentations (for example, limb defects, neuroblastoma) in a few cases. Clinical presentation often included a reducible lump or intermittent bulge along the lateral aspect of the lower abdomen, sometimes misdiagnosed as an inguinal hernia. Recurrent localized abdominal pain was a frequent symptom, and some infants presented with acute intestinal obstruction from incarcerated SH. Diagnosis was most commonly established by ultrasound, which is considered the gold standard imaging modality for SH in children due to its ability to detect fascial defects and herniated tissue dynamically. A subset of cases (approximately 10%) were attributed to blunt abdominal trauma (for example, bicycle handlebar injury), causing an acquired SH. Management: All reported pediatric SHs were treated surgically, given the high risk of incarceration. Open hernia repair through a small transverse incision over the defect was the traditional approach, and no recurrences have been reported after adequate fascial closure. Over the last decade, laparoscopic repair has become the method of choice, especially for cases combined with an undescended testis, allowing simultaneous orchiopexy. Laparoscopic techniques have been successful in safely reducing the hernia and closing the defect, with excellent outcomes and minimal morbidity. Spigelian hernia in children is a rare but clinically important entity that should be considered in cases of unexplained recurrent abdominal pain, lateral abdominal wall swelling, or cryptorchidism. Early recognition using high-resolution ultrasound and prompt surgical intervention are critical to prevent life-threatening incarceration. Congenital defect of the Spigelian fascia underlies most pediatric cases, and the frequent association with ipsilateral undescended testis suggests a developmental interplay. Surgical repair has excellent outcomes. Increased awareness of pediatric SH among clinicians is necessary to ensure timely diagnosis and treatment, thereby avoiding complications and improving patient outcomes.

Endovascular therapy (EVT) has proven benefit for patients with anterior circulation large vessel occlusion (LVO) strokes with moderate-to-severe deficits, but its value in patients presenting 6-24 hours after onset with mild symptoms (NIH Stroke Scale score ≤5) remains unclear. This journal club article examines a retrospective analysis of CLEAR registry data comparing EVT with medical management in this patient subgroup. The authors used multivariable regression and sensitivity analyses to adjust for baseline differences but found no significant association between EVT and improved functional outcomes. Key takeaways for trainees include critical appraisal of nonrandomized data, interpretation of nonsignificant results, and understanding the role of adjusted models and sensitivity analyses in observational research. Limitations of this study include its retrospective, nonrandomized design and potential for selection bias. Until randomized trial data from ENDOLOW and MOSTE become available, treatment decisions should be individualized, incorporating imaging findings and clinical context.

Shared neural network dysfunctions in treatment-resistant major depression and alcohol use disorder: Resting-state fMRI evidence and implications for neuromodulation.

Methotrexate (MTX) is one of the most commonly used therapeutic agents for rheumatologic inflammatory diseases and is generally considered a safe medication. Its negative effects on bone mineral density and the occurrence of fractures were first described as side effects of high-dose MTX in pediatric cancer patients. MTX-associated osteopathy in adults receiving moderate or low doses of MTX (up to 25mg/week) for rheumatic musculoskeletal disorders remains a controversial topic. The pathogenesis and clinical significance of MTX-associated osteopathy are still incompletely understood. Clinically, it presents as atraumatic stress fractures of the distal or proximal tibia and the calcaneus, most often in elderly women with longstanding rheumatic musculoskeletal diseases, particularly rheumatoid arthritis (RA) and reduced bone mineral density. Its characteristic hallmark remains the imaging finding of band- or meander-shaped fractures along the growth plate, which are commonly multiple. The diagnosis is challenging and requires the exclusion of other causes of lower limb pain. Moreover, overlapping risk factors for insufficiency fractures are common and should be carefully investigated. The diagnosis must be made with caution, as the clinical consequences are discontinuation of MTX. In this paper, we describe four female patients with RA who presented with stress, meander-shaped fractures of the calcaneus and tibia (two with multiple fractures), showing rapid clinical improvement after MTX discontinuation, which can be attributed to MTX-associated osteopathy. Additionally, we performed a systematic review of this condition, focusing on its most common clinical and radiological features, as well as the effects of MTX on bone mineral density and fracture risk.

Abstract Background Hepatopulmonary fusion (HPF) is a rare anomaly seen in cases of right-sided congenital diaphragmatic hernia (CDH). Regarding the prenatal findings and diagnosis of HPF, this is the third case as per our literature search. Case presentation We present the prenatal and postnatal imaging findings in a case of HPF and also discuss the relevant literature review. A fetus with right-sided CDH was diagnosed at 22 weeks by antenatal ultrasound, followed by MRI. Postnatally, contrast-enhanced CT was performed. Intraoperatively, HPF complicated with abnormal vascular connections between the liver and lung was detected. Partial separation of lungs and liver was performed. On retrospective review subtle features indicative of hepatopulmonary fusion was noted in the antenatal MRI scan and ultrasound as well as postnatal CECT, which could have aided in the early diagnosis and proper preoperative planning. Conclusion Early prenatal diagnosis of CDH HPF would help in changing the treatment approach. This would reduce the high morbidity and mortality associated with HPF. Hence, it is important to create awareness about prenatal diagnosis of HPF.

Beyond patient history, clinical examination and psychophysical gustatory testing, no standardized guidelines exist for the diagnosis of unclear taste disorders, especially regarding imaging. We therefore aimed to investigate the frequency of use of magnetic resonance imaging (MRI), the findings, and the cost and benefits in a large cohort of patients with taste disorders presenting at a tertiary referral centre over a period of 10 years. We retrospectively reviewed clinical records of all patients with gustatory disorders presenting at our tertiary smell and taste clinic between 2010 and 2019 who received an MRI. A board-certified neuroradiologist, specialized in head and neck imaging, reviewed all MRIs. MRI findings were classified according to their relevance to the taste disorder. A cost-benefit analysis was performed. Of the 125 patients with taste complaints, 70 underwent MRI. Imaging data were retrievable for 65 patients, representing 52% of the total cohort. Pathological findings were observed in 54 patients; 46 had incidentalomas not related to the initial complaint. Findings potentially related to the gustatory complaint (treatable in 6 cases, not treatable in 2 cases) were seen in only 8 MR scans. The imaging findings matched the clinical findings in only 4 cases, and these were therefore classified as clearly related to the complaint. The total cost of all the MRIs performed was 55,034.89 CHF. The estimated costs per finding attributable to a taste disorder were 13,758.72 CHF. In this selected cohort of patients with isolated taste disorders, MRI rarely revealed findings clearly attributable to the complaint. While incidentalomas were frequent, clinically relevant abnormalities were uncommon. These results suggest that MRI should be reserved for select cases, and its routine use critically evaluated. Further prospective studies are needed to better define when MRI is warranted in the diagnosis of unclear isolated taste disorders.

Fetal macrocephaly (HC Z-score ≥ +2) is a common reason for referral for neurosonography. While most cases are benign and asymptomatic, syndromic macrocephaly poses a significant risk of abnormal neurodevelopment. This study aimed to describe the sonographic and genetic features of fetuses at the highest risk of syndromic macrocephaly. We retrospectively analyzed 19 fetuses with either HC Z-scores ≥+2.5 or those with ≥+2 and associated anomalies, evaluated between January 2015 and October 2024. Assessments included fetal neurosonography, anomaly scans, MRI, and genetic work-up. Outcomes and postnatal/postmortem data were reviewed. Mean gestational age at the time of diagnosis was 29.6weeks (range 23-35.4weeks). Seventeen fetuses (89%) had associated anomalies: large for gestational age (12/19), callosal abnormalities (11/19), malformation of cortical development (13/19), and facial dysmorphism (11/19) were diagnosed. Genetic investigation results (CMA) were available for 17 of the 19 patients. Overall, 14 of the 17 patients had abnormal genetic findings, mostly involving mTOR pathway genes. High Z-scores and additional imaging findings strongly correlate with genetic abnormalities, most often mTOR-related. These results support the integration of exome sequencing into prenatal evaluation of fetal macrocephaly.

This study aims to assess the clinical value of computed tomographic angiography (CTA) and three-dimensional reconstruction techniques in the repair of facial skin defects. A total of 40 patients with facial trauma or scars underwent free flap transplantation. CTA and 3D reconstruction were used preoperatively in 23 patients to measure blood vessel diameter, location, direction, and branching, as well as the relationship between the vessels, skin flap, and surrounding tissues. Superficial temporoparietal, facial, thoracic, dorsal, and scapular arteriovenous vessels were analyzed. The flap harvesting time, overall operation time, and incidence of flap-related complications such as blood supply disorders or reoperation were recorded. The preoperative imaging findings were consistent with the intraoperative vascular anatomy in all cases, with no statistically significant differences observed. Additionally, no cases of reoperation, blood supply disorders, or flap necrosis occurred. CTA and 3D reconstruction accurately reflect key vascular characteristics, providing a reliable digital anatomical guide for surgery.

Hypernatremia is a condition that can lead to severe neurological symptoms, including flaccid paralysis, cognitive impairment, encephalopathy, and coma. Osmotic demyelination syndrome (ODS), which encompasses central pontine myelinolysis and extrapontine myelinolysis (EPM), is a known complication of the rapid correction of sodium levels. Limited data exist on the occurrence of ODS in post-partum women, particularly those with hypernatremia. Here, we present a case of a post-partum lady who presented in an unconscious and agitated state with hypernatremia and was found to have imaging characteristics consistent with hypernatremic demyelination. Despite a moderately elevated sodium level, she exhibited typical symptoms and imaging findings of EPM. While previously reported cases often involve patients with significantly higher sodium levels, this case highlights the importance of maintaining a low threshold for suspicion of ODS, particularly in post-partum women with hypernatremia, to prevent catastrophic consequences.

Bone infarctions are arelatively understudied subgroup of osteonecroses in the literature. As frequently incidental, yet distinct imaging findings, they must be interpreted in the context of predisposed patient groups, relevant risk factors, differential diagnoses, and potential complications. To present the interrelationship of pathophysiology with imaging, as well as the clinical courses, histopathological correlates, and diagnostic challenges. Literature research over the past three decades on epidemiology, pathophysiology, risk factors, and the clinical spectrum with pertinent implications for imaging (plain radiography, computed tomography [CT], magnetic resonance imaging [MRI]). Bone infarctions manifest in the meta-/diaphyses of long bones and are frequently multifocal. Robust epidemiological data are lacking. Clinically, they present with acute, painful courses in systemic diseases or as oligosymptomatic incidental imaging findings. Imaging reflects the pathophysiology. Plain radiography is in general sufficient for diagnosis in late stages, whereas MRI provides the highest diagnostic accuracy. Although often an "Aunt Minnie" in imaging, bone infarctions should be understood as asystemic condition. Differentiation from acute osteomyelitis and the rare risk of malignant transformation represent major clinical and diagnostic challenges.

Skull base osteomyelitis (SBO) and nasopharyngeal carcinoma (NPca) are challenging to differentiate due to overlapping clinical and radiological features. This study aimed to develop and validate a multi-parametric magnetic resonance imaging (MRI)-based radiomics model with high sensitivity, enabling reliable diagnosis of SBO in adult patients presenting with equivocal imaging findings. This was a retrospective, multicenter study using institutional data. The training cohort, comprising 63 adult patients from two classes (31 SBO, 32 NPca) with MRI data, was used for model development and optimization. An external test set (n = 30; 12 SBO, 18 NPca) obtained from two different clinical centers was used for model performance analysis and generalizability. Lesion segmentation was performed using a manual volumetric technique on three axial MRI sequences (pre-contrast T1-weighted, fat-suppressed T2-weighted, and post-contrast fat-suppressed T1-weighted). Hand-crafted radiomic features (n = 2,553) were extracted using the Pyradiomics library. A multi-step process was used to select the final features, including reproducibility analysis using an interclass correlation coefficient threshold of 0.9, pairwise Spearman correlation analysis with a threshold of 0.8 to reduce redundancy, and least absolute shrinkage and selection operator regression. The final set of five features were used to train six machine learning models. The models were internally validated using 5-fold cross-validation, and performance was confirmed using the unseen external test set. Traditional statistical tests, including the Mann-Whitney U test and chi-squared test, were used to compare baseline characteristics, with a P value of <0.05 considered significant. Among the evaluated classifiers, the random forest model demonstrated the best diagnostic performance, yielding the highest area under the curve (AUC) value in the 5-fold cross-validation analysis. In the external test set, the semantic model demonstrated the best diagnostic performance, achieving an AUC of 0.940 [95% confidence interval (CI): 0.857-1.00], followed by the radiomics model (AUC: 0.903, 95% CI: 0.784-1). The apparent diffusion coefficient (ADC)-based model demonstrated limited discriminative ability (AUC: 0.694, 95% CI: 0.497-0.892). The difference between the semantic and radiomics models did not reach statistical significance (P = 0.644), whereas both significantly outperformed the ADC model (P < 0.05). Radiomics achieved high and consistent performance in distinguishing SBO from advanced NPca. Although expert-based semantic assessment performed slightly better, radiomics provides an objective alternative. ADC-based methods showed limited generalizability due to inter-center variability. Our study confirms the importance of expert radiologist assessment while demonstrating that radiomics offers a comparably effective and objective decision-support tool. Its ability to provide a consistent, quantitative output is particularly valuable for standardizing the diagnostic approach and empowering less experienced radiologists to make more confident assessments.

External neck trauma represents a potentially life-threatening clinical scenario. Blunt and penetrating injuries are the primary etiologies and may result in laryngeal injuries with concurrent tracheal involvement. High-impact or high-energy laryngotracheal trauma arises from diverse mechanisms; therefore, injury reporting must account for varied patterns and incorporate any synchronous tracheal injury, thereby establishing a more effective framework for managing complex external airway trauma. Data from seven patients experiencing high intensity extreme laryngotracheal trauma were retrospectively analyzed, focusing on injury mechanisms, clinical presentations, site and grade of injury, imaging findings, management approaches and outcomes. In parallel, a PRISMA-guided search of PubMed, Embase, Scopus, and Web of Science (January 1980-April 2025) identified English-language case series reporting ≥5 patients. Data on injury mechanisms, Schaefer-Fuhrman grade, management, and outcomes were extracted. Seven cases of severe laryngotracheal trauma with varying mechanisms are presented, including closed glottis barotrauma, penetrating and blunt neck injury, accidental strangulation, prolonged labor and rough manipulation of a vertex presentation, clothesline injury and postintubation injury. The obstetric patient did not survive, while other patients underwent prompt airway stabilization with favorable functional outcomes. The systematic review incorporated 11 studies: blunt trauma predominated (65-75 %), severe injuries (Schaefer grades III-V) accounted for one-half of cases, and overall mortality was 2 %. Tracheal extension, including cricotracheal separation was predominantly reported after high-impact blunt trauma in several studies. The current classification system for external laryngeal trauma does not adequately capture the severity or anatomical complexities of high-impact laryngotracheal injuries. Our experience, supported by pooled literature data, underscores the limitations of laryngeal-only grading. Incorporating both the mechanism and extent of injury is essential to improve clinical decision-making, guide treatment strategies, and ultimately enhance patient outcomes and prognosis.

The claustrum sign, marked by increased MRI signal intensity of the claustrum, is an increasingly recognized imaging finding associated with new-onset refractory status epilepticus (NORSE), and may be associated with a more refractory disease course and worse outcomes. We present a 42-year old male patient who developed NORSE refractory to several treatments including immunotherapy, with MRI demonstrating the claustrum sign early in his disease course. We aim to highlight this sign as an important feature of NORSE, which could alert clinicians to the diagnosis, prompting more extensive workup and aggressive treatment earlier on.

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) often presents as acute ischemic stroke involving cerebral perforators. This study compared the clinical and imaging characteristics and stroke recurrence between patients with CADASIL and those with sporadic small vessel occlusion. We retrospectively analyzed 70 patients with CADASIL and 70 age- and sex-matched patients with sporadic small vessel occlusion, all of whom experienced acute ischemic stroke. Clinical characteristics and imaging findings were compared, and factors associated with stroke recurrence over a 10-year follow-up period were assessed using Cox proportional hazards models. Patients with sporadic small vessel occlusion had more vascular risk factors, whereas patients with CADASIL had more extensive small vessel disease. Acute ischemic stroke lesions in CADASIL were more commonly located in the anterior circulation (78.6% versus 59.4%) and frequently involved the subcortex (28.6% versus 4.3%), centrum semiovale (25.7% versus 0%), and splenium (15.7% versus 0%). In contrast, lesions were less common in the basal ganglia (11.4% versus 32.9%) and brainstem (8.6% versus 24.3%). Multiple simultaneous lesions were more frequent in CADASIL (35.7% versus 7.1%). The 10-year stroke recurrence rate in CADASIL was 50%, with a hazard ratio (HR) of 7.12 (95% CI, 2.99-16.94; P<0.001). In multivariable Cox regression, CADASIL was the strongest independent predictor of recurrence (adjusted HR, 15.692 [95% CI, 4.452-49.166]; P<0.001), along with older age, hypertension, elevated initial diastolic blood pressure, periventricular white matter hyperintensities (grade 2), and multiple lesion involvement. Patients with CADASIL patients with acute ischemic stroke have distinct imaging patterns and a significantly higher recurrence risk compared with those with sporadic small vessel occlusion.

Anterior clinoidal meningiomas (ACMs) are complex skull base tumors that may pose significant surgical challenges due to their proximity to critical neurovascular structures. While tumor size is often assumed to correlate with worse outcomes, comparative data between giant (≥5 cm) and non-giant (<5 cm) ACMs remain limited. Objective: To compare clinical presentation, radiological features, surgical strategy, and functional outcomes between giant and non-giant ACMs. A retrospective analysis of 47 patients who underwent surgical resection of ACMs between 2014 and 2023. Patients were stratified into non-giant (<5 cm, n = 36) and giant (≥5 cm, n = 11) groups. Variables included demographics, imaging findings, Al-Mefty classification, vascular encasement, extent of resection, postoperative complications, and long-term outcomes. The primary surgical approach was pterional craniotomy with frequent extradural clinoidectomy. Visual impairment was more frequent in non-giant ACMs (36.1%) compared to giant (18.1%). Vascular encasement, particularly of the internal carotid artery, was significantly higher in the giant group (91% vs 53%; p = 0.009). Cavernous sinus involvement was paradoxically more common in non-giant tumors (25% vs 18.1%). Gross total resection (Simpson grade I-II) was achieved in 78% of non-giant and 73% of giant tumors. Visual improvement occurred in 11.1% of patients, and all new postoperative visual deficits recovered during follow-up. Mean follow-up was 34.2 ± 30.3 months (non-giant) and 26.7 ± 34.7 months (giant). Most patients achieved a favorable functional outcome (mRS ≤ 1). Giant ACMs are associated with greater vascular encasement and longer operative time, but not necessarily worse visual or functional outcomes. Tumor size alone is not a reliable predictor of cavernous sinus invasion or postoperative vision. These findings support the need for individualized surgical strategies based on anatomy rather than size alone.

Background Cervical disc herniation at the C2-3 level, resulting in cervical spondylotic myelopathy (CSM), is an uncommon clinical entity. The diagnostic and therapeutic complexity escalates when this pathology coexists with non-contiguous multilevel cervical disc degenerative disease (CDDD). Due to the segmental variability in pathological features, the clinical manifestations of such cases are highly heterogeneous, thereby necessitating a highly individualized treatment strategy. Hybrid surgery (HS), which integrates cervical disc arthroplasty (CDA) and anterior cervical discectomy and fusion (ACDF), offers a tailored approach for the management of multilevel degenerative cervical pathology. The unique anatomical features and surgical technical challenges at the C2-3 level impose significant constraints on treatment options. This article presents a case of non-contiguous three-level hybrid surgery involving CDA at C2-3 and ACDF at C4-5 and C5-6, and discusses the feasibility of this technique for upper cervical disc pathology. Case presentation A 62-year-old female was admitted with a 6-month history of neck and right upper limb pain, numbness, and gait instability, which had been unresponsive to conservative management. DR revealed loss of the normal cervical lordosis. CT showed no significant osteophyte formation or bony canal stenosis. MRI demonstrated a large disc extrusion at C2-3 causing spinal cord compression, and disc herniations at C4-5 and C5-6 with nerve root impingement. Based on clinical and imaging findings, a diagnosis of multilevel cervical spondylopathy (C2-3, C4-5, and C5-6 disc herniation) was established. The patient underwent anterior cervical discectomy followed by artificial disc arthroplasty (CDA) at C2-3, and anterior cervical discectomy and fusion (ACDF) at C4-5 and C5-6, successfully completing a non-contiguous three-level hybrid surgical procedure. Results Postoperative symptoms were significantly alleviated. At the 12-month follow-up, pain and gait disturbance had largely returned to normal. MRI confirmed adequate decompression of neural compression, DR demonstrated satisfactory range of motion (ROM) at C2-3, and CT revealed satisfactory bone healing at the fused segments. Conclusion CDA serves as an effective alternative for C2-3 disc pathology, achieving neural decompression while preserving segmental mobility. The HS provides a valuable surgical option for the precise treatment of non-contiguous multilevel degenerative disease.

Imaging findings in Klippel-feil Syndrome with Unilateral Renal Agenesis and Ectopic Pelvic Kidney

Defying Deprivation: Neurosurgical Outcomes and 75% 6-Month Survival in 96 Primary Brain Tumor Cases Amid Yemen's Humanitarian Crisis.

Imaging findings for differentiating and predicting prognosis in undifferentiated pleomorphic sarcoma and myxofibrosarcoma.

Pediatric frontal lobe epilepsy (FLE): Semiological distinctions from adult-onset FLE.