Typical Magnetic Resonance Imaging Changes Research Articles

Pathognomonic neuroradiological signs in Wilson's disease – Truth or myth?

IntroductionWilson's disease (WD) is a treatable genetic disorder caused by impaired copper metabolism. Early diagnosis and correct anti-copper treatment are crucial for therapeutic success. Brain magnetic resonance imaging (MRI) is used both for diagnosis and treatment monitoring. Several neuroradiological signs have been proposed to be pathognomonic for WD; however, their frequency and significance are not established. The frequency and significance of these brain MRI signs were analyzed in a large cohort of WD patients. MethodsWe retrospectively analyzed 100 newly diagnosed, treatment-naive WD patients. Brain MRI was performed and the frequency of typical MRI changes was analyzed with demographic, clinical and laboratory characteristics of WD. ResultsPotentially pathognomonic brain MRI signs for WD occurred in 24% patients and in 43% (24/55) patients with neurological WD. Signs detected included the “face of the giant panda” in 15% of all patients (27.3% of neurological cases), “miniature panda” in 12% (21.8% of neurological cases), “split thalamus” in 7% (12.7% of neurological cases), and “bright claustrum” and “whorl” signs in 1 patients each. Signs were observed only in patients with neurological symptoms and were significantly associated with early age of onset/diagnosis, more severe neurological presentation and lower ceruloplasmin level (all p < 0.05). ConclusionsPotentially brain MRI pathognomonic signs occurred relatively rarely across all patients, most often in patients with early onset and severe neurological symptoms, and this knowledge may improve WD diagnosis. However, as these signs are also found in brain MRI in other disorders, they may not be truly pathognomonic of WD.

Nature of pathological changes on magnetic resonance imaging of the CNS in patients with focal forms of acute tick-borne encephalitis

Introduction. Tick-borne encephalitis (TBE) is a widespread natural focal viral neuroinfection in Russia and the Sverdlovsk region. The high level of morbidity, leading to disability, and the annual registration of focal forms and lethal cases determine the relevance of the search for early differential diagnostic criteria for acute tickborne encephalitis (TBE). A promising direction in the early diagnosis of TBE is acquired by magnetic resonance imaging (MRI).The aim of the study was to study the features of the MRI picture in patients with focal forms of TBE.Material and methods. The study included 38 patients with focal forms of OKE who were treated in the neurological department of Sverdlonsk regional clinical hospital № 1 since 2009 to 2019.Results. In the acute period of focal forms of TBE, pathological changes of an inflammatory nature during MRI of the CNS were more often detected in the cerebral hemispheres (mainly in the white matter) in 40.4 % and subcortical structures in 36.8 %, in the brainstem in 16.7 %, less often in 6.1 % – in the region of the cerebellum and spinal cord. Bilateral nature and combined lesions of the CNS structures were detected 2 times more often. Discussion A detailed analysis of the localization and nature of MRI changes in the CNS in patients with severe focal forms of the disease, in contrast to single descriptions of the MRI picture of TBE according to the literature, made it possible to identify combined lesions of the frontal and parietal lobes characteristic of TBE in combination with pathological changes in the region of the thalamus and basal ganglia.Conclusion. Identification of typical MRI changes in the CNS in patients with a clinical picture of viral encephalitis in the spring-summer period contributes to the early diagnosis of a severe course of TBE.

Balo's concentric sclerosis: a clinical case

This paper describes a case of Balo's concentric sclerosis, a rare demyelinating disease of the central nervous system (CNS), which is currently classified as multiple sclerosis. In recent years, there has been a more favorable clinical course of Balo's sclerosis. The significant polymorphism of clinical manifestations of the disease, its neuroimaging pattern, and laboratory tests cause difficulties diagnosing this pathology. Its differentiation with CNS tumors presents a particular challenge. So it also happens in the described clinical case, when computed tomography revealed the signs of space-occupying lesion, the histological pattern of concentric focus biopsy specimen indicated the presence of protoplasmic astrocytoma. However, immunohistochemical analyses of the biopsy specimen, immunological examination of cerebrospinal fluid, as well as the typical magnetic resonance imaging changes of Balo's sclerosis could suggest the demyelinating nature of the pathological process. The article shows that immunohistochemical techniques for examining a brain biopsy specimen and immunological assays of blood and cerebrospinal fluid are of great diagnostic value.

An investigation into the relationship between vigabatrin, movement disorders, and brain magnetic resonance imaging abnormalities in children with infantile spasms.

We aimed to investigate the relationship between movement disorders, changes on brain magnetic resonance imaging (MRI), and vigabatrin therapy in children with infantile spasms. Retrospective review and brain MRI analysis of children enrolled in the International Collaborative Infantile Spasms Study (ICISS) who developed a movement disorder on vigabatrin therapy. Comparisons were made with controls within ICISS who had no movement disorder. Ten of 124 infants had a movement disorder and in eight it had developed on vigabatrin therapy. Two had a movement disorder that resolved on dose-reduction of vigabatrin, one had improvement on withdrawing vigabatrin, two had resolution without any dose change, and in three it persisted despite vigabatrin withdrawal. The typical brain MRI changes associated with vigabatrin therapy were noted in two infants. Ten control infants were identified. Typical MRI changes noted with vigabatrin were noted in three controls. It is possible that in two out of eight cases, vigabatrin was associated with the development of a movement disorder. In six out of eight cases a causal relationship was less plausible. The majority of infants treated with vigabatrin did not develop a movement disorder. MRI changes associated with vigabatrin do not appear to be specifically related to the movement disorder.

The worm that turned

When a patient presents with acute myelopathy in the developed world, helminthic infection is not routinely considered in the differential diagnosis. We report the case of a 34-year-old South African male who presented with acute urinary retention and lower leg paraesthesiae. Subsequently, myeloradiculopathy secondary to Schistosoma mansoni was diagnosed on the basis of typical magnetic resonance imaging changes in the conus medullaris and positive stool microscopy. Prior to this presentation the patient had lived in urban western South Africa and more recently in New Zealand, without exposure to infected water for 22 years. His symptoms and signs resolved following treatment with praziquantel and methylprednisolone. Spinal schistosomiasis is a rare but serious cause of myelopathy and should be considered in any patient who has ever visited or lived in an endemic area.

Cerebral magnetic resonance imaging in eclampsia: a series of 12 cases

The object of this study was to assess the ability of magnetic resonance imaging (MRI) to detect the cerebral abnormalities associated with eclampsia and therefore to establish its place in our management of the condition. This study was of particular relevance to our institution because eclampsia is common in our patient population. This was a prospective study in which 13 patients with an initial diagnosis of eclampsia received MRI brain scans. Of 12 patients with a final diagnosis of eclampsia, seven (58.3%) showed the typical MRI changes of eclampsia, namely cerebral hyperintensities representing focal areas of oedema. In five patients (41.6%) the scans were normal. The rate of abnormality detection was surprisingly low. We conclude that the reason for this was the time delay in obtaining the scans. The cerebral changes in eclampsia can be rapidly reversible. Future studies must aim to perform MRI within 48 hours of seizure activity. MRI is more sensitive than computed tomography scanning but has no practical advantages over computed tomography except where the diagnosis is in doubt.