Arteriovenous malformation associated with moyamoya disease: Case report

A rare case of arteriovenous malformation associated with moyamoya disease is reported. In this case, an interesting angiographic change was obtained during the follow-up period. The feeding artery from the internal carotid artery gradually disappeared as the moyamoya disease progressed, and a new feeding artery appeared from the external carotid artery.     

Spinal dysraphism with anorectal malformation: lumbosacral magnetic resonance imaging evaluation of 120 patients

Purpose

We evaluated the prevalence of spinal dysraphism (SD) in patients with anorectal malformation (ARM) by magnetic resonance imaging (MRI).

Methods

From January 2002 to March 2009, 120 patients with ARM who underwent anorectal reconstruction were evaluated for SD with sacral plain film, spinal ultrasonography (US), and lumbosacral MRI. We adopted Krickenbeck international classification of ARM.

Results

Spinal dysraphism was present in 41 (34.2%) of 120 patients with ARM, 3 (13.0%) of 23 patients with perineal fistula, 7 (29.2%) of 24 patients with vestibular fistula, 4 (36.4%) of 11 patients with rectovesical fistula, 18 (40.9%) of 44 patients with rectourethral fistula, and 9 (60.0%) of 15 patients with cloacal anomaly (P = .04). Among 41 patients having SD detected by MR, 26 patients (26/41; 63.4%) underwent detethering surgery for tethered spinal cord. The mean sacral ratio (SR) in patients who underwent detethering surgery (0.54 ± 0.19) was significantly lower than in patients who did not undergo detethering surgery (0.69 ± 0.13; P < .001). The optimal cutoff for the SR value predicting SD requiring detethering surgery was 0.605, with sensitivity of 65.4% and specificity of 77.7%.

Conclusions

Spinal dysraphism is common in patients with ARM, and its prevalence is higher in patients with complex ARM. Spinal anomalies can occur even with benign types of ARM and, therefore, that all patients should be screened. Magnetic resonance imaging is useful in detecting occult SD that may be missed by conventional radiologic evaluation, physical examination, and spinal US. We further recommend a lumbosacral MRI examination in those whose SR is lower than 0.6.     

A split cord malformation with paresis of the unilateral lower limb: case report

BACKGROUND

We report a rare case of split cord malformation.

CASE DESCRIPTION

A female neonate presented with split cord malformation (SCM) manifesting as right lower limb paresis. Myelomeningocele and meningocele were found in the lumbosacral region at birth. Magnetic resonance imaging (MRI) demonstrated division of the spinal cord into two hemicords below the T5 level. The right hemicord formed a hemimyelomeningocele and the left hemicord terminated in the low-lying conus. Three-dimensional computed tomography (3D CT) showed extensive vertebral body abnormalities. The hemimyelomeningocele was repaired 1 day after birth, and septectomy and the repair of the meningocele were performed when the patient was 1 year old. The patient has been followed up as an outpatient, and has residual right lower limb paresis.

CONCLUSION

SCM can be associated with multiple spinal abnormalities. MRI and 3D-CT are useful for identifying such abnormalities and planning the surgical treatment.     

Spinal synovial cyst: Case report using magnetic resonance imaging

The case of a 65-year-old woman who developed a spinal synovial cyst at the L4-5 disk space is reported. Her clinical signs and symptoms are presented. A comparison among her preoperative myelogram, computed tomography scan, and magnetic resonance imaging showed magnetic resonance imaging to be more accurate in detailing both the intraoperative and pathological findings.     

Magnetic resonance imaging of vertebral osteoblastoma: A report of two cases

Two patients with vertebral osteoblastoma evaluated with computed tomography and magnetic resonance imaging are presented. A literature review revealed that cases of osteoblastoma originating within the vertebral body are exceedingly rare.     

Magnetic resonance imaging and the nonoperative treatment of spinal epidural abscess

This report describes three patients with spinal epidural abscess diagnosed by magnetic resonance imaging and treated nonoperatively. Prior to treatment, one patient was neurologically intact, one patient demonstrated a moderate neurological deficit, and one patient was severely paraparetic with loss of bladder and bowel control. Following identification of the pathogenic organism, antibiotic therapy was continued until the patients demonstrated clinical improvement and radiological resolution of the abscess. All patients remained stable or improved neurologically. Analysis of 33 previously reported patients treated with antibiotics suggests that nonoperative treatment may be a reasonable alternative therapy under certain clinical conditions. These include (1) identification of the pathogenic organism, (2) a stable neurological condition, (3) access to magnetic resonance imaging or computed tomography for potentially rapid reevaluation, and (4) appropriate neurosurgical consultation and nursing care. Nonoperative treatment may also be considered as a reasonable alternative for patients who have severe concurrent medical illness.     

Midsagittal tissue bridges are associated with walking ability in incomplete spinal cord injury: A magnetic resonance imaging case series

Context: Following spinal cord injury (SCI), early prediction of future walking ability is difficult, due to factors such as spinal shock, sedation, impending surgery, and secondary long bone fracture. Accurate, objective biomarkers used in the acute stage of SCI would inform individualized patient management and enhance both patient/family expectations and treatment outcomes. Using magnetic resonance imaging (MRI) and specifically a midsagittal T2-weighted image, the amount of tissue bridging (measured as spared spinal cord tissue) shows potential to serve as such a biomarker. Ten participants with incomplete SCI received MRI of the spinal cord. Using the midsagittal T2-weighted image, anterior and posterior tissue bridges were calculated as the distance from cerebrospinal fluid to the damage. Then, the midsagittal tissue bridge ratio was calculated as the sum of anterior and posterior tissue bridges divided by the spinal cord diameter. Each participant also performed a 6-minute walk test, where the total distance walked was measured within six minutes.

Findings: The midsagittal tissue bridge ratio measure demonstrated a high level of inter-rater reliability (ICC?=?0.90). Midsagittal tissue bridge ratios were significantly related to distance walked in six minutes (R?=?0.68, P?=?0.03).

Conclusion/clinical relevance: We uniquely demonstrated that midsagittal tissue bridge ratios were correlated walking ability. These preliminary findings suggest potential for this measure to be considered a prognostic biomarker of residual walking ability following SCI.     

Familial cavernous malformations: Diagnostic potential of magnetic resonance imaging

Three patients from the same family underwent operations for neurological symptoms related to vascular lesions that proved on pathological examination to be cavernous malformations. Two of these lesions were intracranial and one was in the thoracic spine. Five other family members have also had neurological symptoms; three of these five were studied with cerebral magnetic resonance imaging and computed tomography. The vascular malformations seen on computed tomography scans were more clearly delineated by magnetic resonance images, and in one case, magnetic resonance images identified intracerebral vascular pathology not demonstrated by computed tomography. Magnetic resonance images in two neurologically normal family members showed no abnormalities. We conclude that in this family, magnetic resonance imaging was superior to computed tomography in identifying and delineating vascular malformations of the central nervous system.     

Association of vascular compression in trigeminal neuralgia versus other “facial pain syndromes” by magnetic resonance imaging

Magnetic resonance imaging was performed in 13 patients with trigeminal neuralgia and 18 control patients with facial pain of other types. Among trigeminal neuralgia patients, eight (62%) had vessels seen abutting, or immediately adjacent to, the trigeminal nerve on the side of their symptoms. Only three control patients (17%) had such vessels. The proportion of patients having a trigeminal region vessel associated with their symptoms was significantly higher in patients with trigeminal neuralgia than in controls (p = 0.0086). These findings provide evidence supporting the theory that trigeminal neuralgia is associated with vascular compression of the fifth cranial nerve.     

功能性磁共振成像技术在脊髓功能研究中的应用

正磁共振成像(MRI)具有软组织分辨率高、多方位任意切层、多参数成像等优点,在临床工作中备受欢迎。但其单一地呈现组织形态学变化的现状已经不能满足目前疾病诊断的需求,功能性磁共振成像(f MRI)应运而生。f MRI是在普通MRI的基础上,着重反映某一特定神经组织功能状态的成像技术,最早被广泛应用于脑组织疾病研究~([1-2])。早期因脊髓周围的解剖结构和运动伪影等问题而使脊髓f MRI的发展受到一定的限制。目前随着技术的改进     

Intramedullary and extramedullary schwannoma of the cervical spinal cord—Case report

Intramedullary schwannomas and neurofibromas are rare tumors. Only two cases have been reported as having both an intramedullary and extramedullary component.

We have managed the case of a 15-year-old girl with a schwannoma that appeared to track along the sensory nerve root into the spinal cord. The clinical presentation in this case was that of motor weakness and atrophy, sensory abnormalities, and, late in the course, pain.

Magnetic resonance imaging with gadolinium enhancement was better than myelography and computed tomography at delineating the intramedullary extent of the tumor. The tumor was removed microsurgically at two operative sittings. Reports of this unusual pathology are reviewed.     

Congenital contracture of the quadriceps muscle: a case report with magnetic resonance imaging

Introduction Case report of a rare form of congenital contracture of the quadriceps muscle. Congenital contracture of the quadriceps muscle is encountered very rarely in daily orthopaedic practice. A few cases have been reported, but unfortunately these did not detail the MRI findings of congenital contracture.Materials and methods A 34-year-old woman presented with difficulty in sitting with full flexion of the bilateral knee joints. She had no history of intramuscular injection, and her brother had a similar abnormality. A physical and radiographical review of the case was conducted.Results A palpable corded induration was detected in the quadriceps muscle which prevented further flexion of the bilateral knee joints. Magnetic resonance imaging of both thighs demonstrated marked atrophy of the rectus femoris muscle and dark signal intensity of the muscle on both T1-weighted and T2-weighted images. It was suggested that the muscles had been replaced by fibrosis.Conclusion This appears to be the first report to include MRI findings of congenital contracture. Clinical awareness of congenital contracture with unique clinical symptoms and radiographic findings may aid the correct diagnosis.     

Cerebral vasculitis in Henoch-Schönlein purpura: a case report with sequential magnetic resonance imaging

Neurological complications are rare during the course of Henoch-Schönlein purpura (HSP). We report a 5-year-old girl with HSP who presented with seizures. Sequential magnetic resonance imaging and electroencephalography showed bilateral multifocal cerebral lesions initially, which gradually and completely resolved with clinical improvement. These lesions were compatible with the radiological pattern of the non-hemorrhagic vasculitic involvement of cerebral parenchyma.     

Acute calcific tendinitis of the gluteus medius: a case report with serial magnetic resonance imaging findings

A case of calcific tendinitis of the gluteus medius is presented. Calcification was evident in the soft tissue adjacent to the greater trochanter on plain radiographs. On the initial magnetic resonance images (MRI), inflammatory edematous change was detected not only in the gluteus medius but also in the bone marrow of the greater trochanter, corresponding to the painful area. Three months later, calcification disappeared on plain radiographs and the femur showed normal signal intensity on MRI. Initial MRI excluded other diseases including infection and bone tumor, and serial MRI confirmed that the change in extraosseous and intraosseous findings were in accordance with self-limiting clinical symptoms.     

肛门直肠畸形术后排粪失禁患儿盆腔磁共振成像表现及其临床意义

目的通过肛门直肠畸形术后排粪失禁患儿的盆腔MRI表现,了解盆底肌的形态,直肠、肛管的形态和位置,以及脊髓和骶骨的发育,为分析排粪失禁的原因及制订治疗方案提供客观依据。方法回顾性分析2009年9月至2011年12月间山东大学第二医院收治的34例肛门直肠畸形术后排粪失禁患儿的临床和影像资料,其中男2l例,女13例,年龄3,14岁。应用1．5TMR扫描仪,常规行轴位、冠状位及矢状位扫描,观察肛门括约肌、耻骨直肠肌和提肛肌、直肠、肛管的形态,以及脊髓、骶骨的发育情况。结果MRI检查提示：肛门外括约肌发育不良18例,耻骨直肠肌发育不良23例,肛提肌发育不良27例;直肠位置异常6例,直肠扩张12例,肛直角增大11例;肛管周围脂肪组织5例;合并神经管闭合不全2例,Currarino综合征2例,骶骨发育不全11例,直肠尿道瘘2例。以上影像学结果均经临床最终证实。结论MRI可清楚显示肛门外括约肌、耻骨直肠肌和肛提肌的形态,以及直肠和肛管的形态和位置,同时还可显示脊髓和骶骨的发育情况,是评价肛门直肠畸形术后排粪失禁患儿非常有价值的检查方法。     

Sequential changes of ascending myelopathy after spinal cord injury on magnetic resonance imaging: a case report of neurologic deterioration from paraplegia to tetraplegia

Background contextMarked neurologic deterioration within a few days of traumatic spinal cord injury, known as subacute posttraumatic ascending myelopathy, is rare. Although several hypotheses regarding the pathogenesis of this condition have been proposed, the details remain elusive.PurposeTo report a case of ascending myelopathy in which a series of magnetic resonance images (MRIs) taken through the course of the illness helped follow the course of the disease and discuss possible pathogenesis.Study designCase report and review of the literature.Patient sampleA 75-year-old woman involved in a motor vehicle collision sustained a fracture dislocation of T7–T8 with complete paraplegia below T8.MethodsNeurologic examination and radiologic imaging taken by various means.ResultsPosterior surgical stabilization was performed 18 hours after the injury. Both the surgical and postsurgical courses were uneventful. Four days after the injury, however, the patient reported feeling a tingling sensation in the right-hand fingers and gradually suffered from motor weakness of the upper extremities, deteriorating within a few hours to complete tetraplegia and ventilator dependence. Subsequent cervicothoracic MRI showed abrupt cord swelling with abnormal areas of signal intensity in the cervical and upper thoracic spinal cord during the interval between the onset of tingling and the development of motor paralysis in the arms. On the 20th postsurgical day, an area of hypointensity within the region of high intensity was observed on T2-weighted MRIs, indicating intramedullary spinal cord hemorrhage.ConclusionsOur MRI findings suggest that systemically increased intraspinal pressure resulting from the impairment of spinal venous drainage is involved in the pathogenesis of ascending myelopathy. Although ascending myelopathy is often thought to be partly reversible, persisting increase of the intraspinal pressure may result in intramedullary hemorrhage and irreversible neurologic deficit.     

Intraoral vascular malformation and airway management: A case report and review of the literature

A patient with a large airway venous malformation underwent anesthesia for a tooth extraction. The procedure was uneventful until extubation, immediately after which complete airway obstruction resulted. After unsuccessful attempts to relieve the problem, the patient's trachea was reintubated. Laryngoscopy showed that the venous malformation in the airway had enlarged and was responsible for the airway obstruction. Another attempt at extubation after corrective maneuvers was again unsuccessful. A tracheostomy was required, which was eventually removed after a complete recovery. Anesthesiologists must be concerned with any airway vascular abnormality. Most abnormalities involving the airway are either hemangiomas or venous malformations. The anesthesiologist must diagnose the problem correctly because even minor manipulation of a venous malformation may result in exsanguination, or the malformation may become engorged and compromise the airway.     

Identifying the optimal inlet for antegrade tibial intramedullary nailing via magnetic resonance imaging

IntroductionTibial shaft fractures treated with antegrade rigid tibial intramedullary nailing has been supported worldwide. However, the optimal inlet for nailing is still controversial. Practically, varied inlets may significantly affect the tibial alignment. This retrospective study intended to utilize magnetic resonance imaging (MRI) to investigate the optimal inlet for antegrade tibial nailing.MethodsMRIs of 100 consecutive adult patients (50 men and 50 women, average 27 years) were used in this study. All patients had MRIs for meniscus or knee ligament injuries. There were no fractures or prior bony anomalies. The center of the tibial width (TW) at the level of the tibial tubercle (TT) was considered the optimal inlet and was positioned on the axial view of the MRIs. Various related anatomic landmarks were investigated concomitantly. All parameters were compared statistically.ResultsThe medial edge of the patellar tendon (PT) was 55% from the lateral end of the TW. The apex of the TT was 38% from the lateral end of the TW. The lateral edge of the PT was 19% from the lateral end of the TW. The TT was 2.5 cm distal to the tibial articular surface. The PT width was 2.3 cm. Except for the TW, the distance from the TT to the articular surface, and PT width between genders (p < 0.001), all other parameters showed no statistical significance (p > 0.05).ConclusionsThe optimal inlet for antegrade rigid tibial intramedullary nailing may be at a site 3 mm laterally to the medial edge of the PT. There are normally no differences for the nail inlet between men and women. The PT splitting approach for nail insertion may require modification.     

Chiari malformation: CSF flow dynamics in the craniocervical junction and syrinx

Summary Background. A CSF flow study in patients with Chiari malformation (ChM) who undergo craniocervical junction decompression (CCJD). Methods. Using spatial modulation of magnetization (SPAMM), cerebrospinal fluid (CSF) flow velocities were measured at the prepontine (PP), anterior cervical (AC), and posterior cervical (PC) subarachnoid spaces (SAS) in healthy subjects (n = 11) and patients with Chiari malformation (ChM) before and/or after CCJD (n = 15). In the syringes, the intrasyrigeal pulsatile CSF motion was estimated qualitatively as present or absent. Findings. In normal subjects, the mean CSF velocities were 2.4 ± 0.2 cm/s (PP), 2.8 ± 0.3 cm/s (AC), and 2.4 ± 0.2 cm/s (PC). Velocities were significantly lower than normal in patients with ChM prior to CCJD, reduced by 38%, 25%, and 79% in the 3 regions, respectively (P<0.001). Post-CCJD, velocities were 20% (PP), 100% (AC), and 40% (PC) greater than preoperatively (P<0.001). Conclusions. In ChM, the posterior cervical CSF flow velocity was low, increased minimally after CCJD and, by itself, had limited predictive value. Post-CCJD, an increase of the sum of anterior and posterior cervical CSF flow velocities by more than 20% consistently preceded or coincided with marked headache improvement. After CCJD, the finding that the intrasyringeal CSF pulsatile motion had become absent was an earlier and more sensitive predictor of motor or sensory improvement than a reduction in syrinx’s size. SPAMM can be used to assess whether CCJD has restored CSF flow, predict outcome and provide pathophysiological insights in ChM and syringomyelia.