Ophthalmoplegic migraine: an unresolved problem.
Explore the source record for details and available documents.
Adult↗
Biomedical subjects
J Casselman
Publications and source records attributed to J Casselman.
Orbital imaging: Part 1. Normal anatomy.
Advanced imaging techniques enable the radiologist to detect an increasing number of structures within the orbit not previously identifiable. We describe the imaging techniques and orbital anatomy with an emphasis on radiologically identifiable structures. In a second review of orbital pathology we present pathological processes that may involve these structures.
Facial Bones↗
Eosinophilic fungal rhinosinusitis (EFRS): a distinct CT/MRI-entity? A European experience.
OBJECTIVE: To determine the value of radiological features in the diagnosis of Eosinophilic Fungal Rhinosinusitis (EFRS). STUDY DESIGN: Retrospective review of the radiological materials of 65 patients with documented Eosinophilic Fungal Rhinosinusitis treated at the same institution. METHODS: Evaluation by the ENT surgeon and the head and neck radiologist. RESULTS: EFRS was more common in female patients in this series. Fifty-four (83%) patients were above 30 years of age, with a peak of 18 patients (27.7%) in the seventh decade. All the patients except one (98.5%) showed bilateral mucosal thickening on unenhanced CT scans. Thirty-eight patients (58%) showed increased intrasinus attenuation on unenhanced CT scans. Thirty-seven patients (57%) showed opacification of at least one sinus; 25 (38%) showed osteitis; 11 (17%) had erosion of the sinus wall and only one patient showed minor expansion of an involved sinus. In 6 patients, typical hyperattenuation patterns on CT scans, together with distinctive MRI images, were highly suggestive of EFRS. CONCLUSION: Our data show that hyperattenuation on CT images with bone window settings suggests the presence of EFRS. This hyperattenuation is more clearly seen with soft-tissue window settings. When necessary, adjunctive MRI can provide information which might be highly predictive for the diagnosis of EFRS. However, non-specific imaging findings of chronic rhinosinusitis (CRS) should also be seen as possible EFRS pathology.
Adult↗
Varicella zoster virus: beyond facial paralysis.
J. Ramsay Hunt's hypothesis that herpes zoster oticus results from a reactivation of the herpes zoster virus in the geniculate ganglion, has been supported by the demonstration of varicella zoster viral DNA in the geniculate ganglion of the side with facial paralysis in patients with Ramsay Hunt syndrome, with the use of the polymerase chain reaction. Similarly, DNA of the varicella zoster virus has been identified in the spiral and vestibular ganglion as well. We report on three patients with cochleovestibular symptoms as the first manifestations of Ramsay Hunt syndrome. A 64-year old woman and a 72-year old man presented with vertigo and an auricular herpetiform eruption. Only the woman developed later on a mild facial paralysis. A 58-year old man presented with an acute cochleovestibular syndrome, serologically proven to be a varicella zoster viral reactivation, which was followed three weeks later by the typical cutaneous recrudescence. We believe that these cases result from reactivation of latent varicella zoster virus in the spiral and/or vestibular ganglion. As the varicella zoster virus is dormant in the non-neuronal satellite cells, the facial symptoms in our patients as well as the high incidence of cochleovestibular symptoms in classical Ramsay Hunt syndrome can be explained by viral transmission across the nerves inside the internal auditory canal. Therefore, we think there are grounds to recommend a prompt treatment with an antiviral and a corticosteroid agent, not only in case of an acute facial paralysis but also when confronted with an acute cochleovestibular syndrome.
Acyclovir↗
Cochlear implants in aplasia and hypoplasia of the cochleovestibular nerve.
OBJECTIVE: To report on the outcome of four patients with aplasia or hypoplasia of the cochleovestibular nerve who have received a cochlear implant. STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral center. PATIENTS: Four patients with: 1) type I aplasia; 2) type IIa aplasia; 3) type IIa hypoplasia; and 4) type IIb aplasia received a cochlear implant. All patients had corner audiograms even with hearing aids. INTERVENTION: Three patients received a LAURA multichannel implant, and one patient received a Nucleus 24 implant. MAIN OUTCOME MEASURE: Auditory performance, educational setting. RESULTS: The patients with type I and type IIb aplasia did not have auditive perception with their implant and became non-users. Both are now in a total communication educational setting. The patients with type IIa aplasia and hypoplasia had moderate audiological results with the implant with audiometrical thresholds of approximately 40-60 dB HL (pure tone average), moderate phoneme discrimination, and poor word discrimination. One child is in a total communication educational setting and the other in an oral educational setting, but the preferred mode of communication remains total communication for both. Both appear to benefit from the implant nonetheless. CONCLUSION: Patients with aplasia/hypoplasia of the cochleovestibular nerve should be counseled with caution with respect to cochlear implantation, but particular circumstances may justify the intervention. At present these circumstances seem to be a type IIa aplasia or hypoplasia in which the end organ (cochlea or common cavity) still connects to a neural structure on MRI.
Auditory Perception↗
Follow-up of breast lesions detected by MRI not biopsied due to absent enhancement of contrast medium.
Our objective was to follow-up patients in whom scheduled MR-guided vacuum biopsies for suspicious lesions were aborted due to absent enhancement of contrast medium. Thirty-seven of 291 scheduled MR-guided vacuum biopsies were aborted. Six cases were lost to follow-up. Two could be unequivocally identified and were nevertheless biopsied. In 25 of 29 patients absent enhancement was confirmed on subsequent studies without compression. Varying hormonal or inflammatory changes between initial MRI and MR-guided vacuum biopsy most probably explain the findings. Enhancement re-appeared on short-term follow-up <6 months without compression in 4 of the 29 patients. Too strong compression during MR-guided vacuum biopsy explains the absence of enhancement in these patients. Of note, on histology, three of these cases proved malignant. We conclude that short-term follow-up without compression is necessary and recommended for all lesions not visible during scheduled MR-guided vacuum biopsy.
Artifacts↗
Multicenter study for the evaluation of a dedicated biopsy device for MR-guided vacuum biopsy of the breast.
The purpose of this multicenter study was to determine the accuracy and clinical value of a dedicated breast biopsy system which allows for MR-guided vacuum biopsy (VB) of contrast-enhancing lesions. In five European centers, MR-guided 11-gauge VB was performed on 341 lesions. In 7 cases VB was unsuccessful. This was immediately realized on postinterventional images or direct follow-up combined with histopathology-imaging correlation; thus, a false-negative diagnosis was avoided. Histology of 334 successful biopsies yielded 84 (25%) malignancies, 17 (5%) atypical ductal hyperplasias, and 233 (70%) benign entities. Verification of malignant or borderline lesions included reexcision of the biopsy cavity. Benign histologic biopsy results were verified by retrospective correlation with the pre- and postinterventional MRI and by subsequent follow-up. Our results indicate that MR-guided VB, in combination with the dedicated biopsy coil, offers the possibility to accurately diagnose even very small lesions that can only be visualized or localized by MRI.
Biopsy↗
Lymph node metastases from head and neck squamous cell carcinoma: MR imaging with ultrasmall superparamagnetic iron oxide particles (Sinerem MR) -- results of a phase-III multicenter clinical trial.
The aim of this study was to compare the clinical usefulness of ultrasmall superparamagnetic iron oxide (USPIO) MR contrast media (Sinerem, Guerbet Laboratories, Aulnay-sous-Bois, France) with precontrast MRI in the diagnosis of metastatic lymph nodes in patients with head and neck squamous cell carcinoma, using histology as gold standard. Eighty-one previously untreated patients were enrolled in a multicenter phase-III clinical trial. All patients had a noncontrast MR, a Sinerem MR, and surgery within a period of 15 days. The MR exams were analyzed both on site and by two independent radiologists (centralized readers). Correlation between histology and imaging was done per lymph node groups, and per individual lymph nodes when the short axis was > or = 10 mm. For individual lymph nodes, Sinerem MR showed a high sensitivity (> or = 88%) and specificity (> or = 77%). For lymph node groups, the sensitivity was > or = 59% and specificity > or = 81%. False-positive results were partially due to inflammatory nodes; false-negative results from the presence of undetected micrometastases. Errors of interpretation were also related to motion and/or susceptibility artifacts and problems of zone assignment. Sinerem MR had a negative predictive value (NPV) > or = 90% and a positive predictive value (PPV) > or = 51%. The specificity and PPV of Sinerem MR were better than those of precontrast MR. Precontrast MR showed an unexpectedly high sensitivity and NPV which were not increased with Sinerem MR. The potential contribution of Sinerem MR still remains limited by technical problems regarding motion and susceptibility artifacts and spatial resolution. It is also noteworthy that logistical problems, which could reduce the practical value of Sinerem MR, will be minimized in the future since Sinerem MR alone performed as good as the combination of precontrast and Sinerem MR.
Adult↗
International investigation of breast MRI: results of a multicentre study (11 sites) concerning diagnostic parameters for contrast-enhanced MRI based on 519 histopathologically correlated lesions.
A multicentre study was undertaken to provide fundamentals for improved standardization and optimized interpretation guidelines of dynamic contrast-enhanced MRI. Only patients scheduled for biopsy of a clinical or imaging abnormality were included. They underwent standardized dynamic MRI on Siemens 1.0 (163 valid lesions > or = 5 mm) or 1.5 T (395 valid lesions > or = 5 mm) using 3D fast low-angle shot (FLASH; 87 s) before and five times after standardized bolus of 0.2 mmol Gd-DTPA/kg. One-Tesla and 1.5 T data were analysed separately using a discriminant analysis. Only histologically correlated lesions entered the statistical evaluation. Histopathology and imaging were correlated in retrospect and in open. The best results were achieved by combining up to five wash-in or wash-out parameters. Different weighting of false-negative vs false-positive calls allowed formulation of a statistically based interpretation scheme yielding optimized rules for the highest possible sensitivity (specificity 30%), for moderate (50%) or high (64-71%) specificity. The sensitivities obtained at the above specificity levels were better at 1.0 T (98, 97, or 96%) than at 1.5 T (96, 93, 86%). Using a widely available standardized MR technique definition of statistically founded interpretation rules is possible. Choice of an optimum interpretation rule may vary with the clinical question. Prospective testing remains necessary. Differences of 1.0 and 1.5 T are not statistically significant but may be due to pulse sequences.
Adult↗
Prognostic value of magnetic resonance imaging findings in hearing preservation surgery for vestibular schwannoma.
OBJECTIVE: The purpose of this study was to determine whether three magnetic resonance imaging (MRI) findings (tumor size, extension to the fundus, intralabyrinthine signal intensity) have a predictive value to hearing preservation in vestibular schwannoma surgery. STUDY DESIGN: A retrospective study was conducted of preoperative high-resolution MR images in a series of consecutive hearing preservation attempts for vestibular schwannomas. PATIENTS: Twenty-six consecutive records of patients with an acoustic tumor removed via a retrosigmoid transcanal approach were analyzed, and the MR images were reviewed blindly and compared with postoperative hearing. SETTING: The study took place in a tertiary referral center. Imaging Techniques: The MR sequences used in this study were unenhanced and gadolinium-enhanced T1-weighted spin-echo images and gradient echo images (3DFT-CISS). MAIN OUTCOME MEASURES: The predictive value of three MRI signs was analyzed: tumor size, lateral extension of the tumor (with and without obliteration of the fundus), and the maintenance of, or decrease in, the intralabyrinthine signal intensity on the affected side in comparison with the signal intensity on the opposite normal side as seen on 3DFT-CISS images. RESULTS: The tumor size in ears in which hearing was preserved averaged 15 mm and was 17 mm in those cases where hearing was not preserved. Hearing was preserved in 50% of ears when the tumor did not extend to the fundus but in only 33% when the fundus was obliterated by tumor. A "normal" intralabyrinthine signal on CISS images (being an isointense signal when compared with the contralateral unaffected ear) was followed by hearing preservation in 82% of ears, whereas in cases where the intralabyrinthine signal was low, hearing was preserved in only 20%. This correlation was statistically significant (p < 0.05). CONCLUSION: The intralabyrinthine signal intensity on 3DFT-CISS gradient-echo images is a valuable additional tool for determining candidacy for hearing preservation surgery. In two cases with preoperative decrease in signal intensity of the intralabyrinthine fluids, control MRI after surgery showed spontaneous recovery of normal intralabyrinthine signal intensity. The authors hypothesize that vascular compression in the internal auditory canal by the tumor is responsible for the observed intralabyrinthine signal decrease.
Adult↗
Symmetrical ethmoidal metastases from ductal carcinoma of the breast, suggesting transcribrosal spread.
Symmetrical ethmoidal metastases from ductal carcinoma of the breast, suggesting transcribrosal spread. While half of breast cancers develop metastases, the appearance of metastatic disease in paranasal sinuses from this origin is very rare. Eighteen other cases were found in the literature, dating from 1939 till now. A case of metastatic breastcancer presenting as a subacute therapy-resistant pansinusitis is described. The perfect symmetry was misleading. Bilateral ethmoidal biopsies were compatible with metastases from a ductal adenocarcinoma. Further investigation revealed meningeal carcinomatosis in the supra-orbital region and locoregional recurrence in the mastectomy scar and axilla. Comparing these 19 cases in chronological order, it was noticed that symptoms at time of diagnosis shift from those of space occupying lesions to those suggestive for sinusitis. This shift could be explained by earlier diagnosis. High index of suspicion is the key to diagnosis. Earlier diagnosis does not result in longer survival since in most cases patients have already widespread disease and die within one year. Most authors mention the role of the vertebral venous plexus in hematogeneous spreading of tumor cells. Another pathway of hematogenous spread is via (occult) lung metastases. This case prompts the hypothesis of transcribrosal spread from meningeal involvement.
Aged↗
Orbital edema resulting from Haller's cell pathology: 3 case reports and review of literature.
Sinuspathology must be considered when rapid onset of unilateral orbital edema is found in the absence of ophtalmologic signs. Urgent medical treatment is necessary in these patients when headache, fever, facial pain and vision problems are present. However, symptoms may be more subtle. Three female patients with unilateral orbital edema and facial pain are presented. Inflammation of an ipsilateral Haller's cell should be considered as one of the potential causes of unilateral orbital edema and it can be the only cause. To our knowledge this is the first report of Haller's cell disease resulting in an orbital complication.
Adult↗
[Malignant adrenal gland tumors. A case report and an overview of the literature].
Explore the source record for details and available documents.
Adrenal Gland Neoplasms↗
Audiological findings in large vestibular aqueduct syndrome.
An enlarged vestibular aqueduct is a congenital disorder causing early onset and progressive hearing loss in children. This paper presents the audiological findings at first presentation and the audiological evolution in 10 consecutive cases presenting with hearing loss and showing a large vestibular aqueduct on imaging. The reported onset of the hearing loss is within the first few years of life. Most of the cases (80%) showed bilateral involvement. The sex ratio was 1. Patients presented on average at age 5 with a median hearing loss of 62 dB at the speech frequencies. The hearing loss was essentially asymmetrical with an interaural difference, of 33 dB and it was a mixed type of hearing loss in 90% of the cases. The authors claim that the conductive component of this hearing loss is a pure cochlear conductive loss which may be pathognomonic for the disease. The presence of a conductive component in a child is easily misinterpreted as a middle ear ventilation problem or in case of good ventilation as an ossicular problem (type otosclerosis). In addition and in contrast to most literature data, the authors did not find evidence for stabilization of the hearing loss but they found a steady decrease of the hearing at an average rate of 4 dB/year.
Audiometry↗
Suprascapular nerve entrapment at the spinoglenoid notch due to a ganglion cyst.
Explore the source record for details and available documents.
Humans↗
[Requirements for accreditation or retention of accreditation].
Explore the source record for details and available documents.
Accreditation↗
Brain and spinal cord MRI in motor neuron disease.
Explore the source record for details and available documents.
Corpus Callosum↗
[Benign multilocular cystic nephroma].
A case of benign multilocular cystic nephroma in a young female is presented. The radiological features (urography, ultrasonography, computed tomography and angiography) are not specific for this diagnosis. The differential diagnosis includes a cystic Wilms' tumor in children and a cystic renal cell carcinoma in adults. The final diagnosis is obtained by histological examination of the resected specimen.
Adult↗