Cerebral aneurysms associated with seizures but without clinical signs of rupture: seemingly distinctive MR imaging findings in two patients.
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Adult↗
Biomedical subjects
J M Provenzale
Publications and source records attributed to J M Provenzale.
Patients with antiphospholipid antibodies: CT and MR findings of the brain.
OBJECTIVE: The purpose of this study was to determine the spectrum of neuroradiologic findings in patients with antiphospholipid antibodies (APA) and to compare findings in systemic lupus erythematosus (SLE) and non-SLE patients. MATERIALS AND METHODS: We identified 110 patients with APA who underwent CT or MR imaging, of whom 59 (54%) had abnormal studies. Of these 59 patients, abnormalities were categorized as large infarcts, cortical infarcts, lacunar infarcts, hyperintense white matter foci on T2-weighted images, or dural sinus thrombosis. White matter foci were designated as small (< 5mm) or large (> 5 mm). RESULTS: Large infarcts were the most common abnormality, seen in 24 of 110 (22%) patients, followed in frequency by hyperintense white matter foci, seen in 19 of 110 (17%) patients. Ninety-five percent of patients with hyperintense white matter foci had at least one large lesion, and 76% had five or more small foci, three or more large foci, or both. Small cortical infarcts and lacunar infarcts were seen in 11 of 110 (10%) and 10 of 110 (9%) patients, respectively. Dural sinus thrombosis was seen in five patients. The frequency of abnormalities was high in both the SLE (57%) and the non-SLE (41%) groups. Large infarcts were more common in the non-SLE group (26%) than in the SLE group (5%). Although hyperintense white matter foci and cortical infarcts were more common in SLE patients, the differences were not statistically significant. CONCLUSION: Infarcts of various sizes and hyperintense white matter foci are the most common abnormalities seen on CT and MR imaging in patients with APA. We found no significant differences in frequencies of abnormalities seen between non-SLE and SLE patients.
Adult↗
Spinal angiolipomas: MR features.
PURPOSE: To determine the MR features of spinal angiolipomas and to compare these findings with their histologic appearance. METHODS: The MR examinations of three patients with surgically proved angiolipomas were reviewed for tumor location and extent, signal characteristics, and pattern of contrast enhancement, and were then compared with the histologic findings. RESULTS: Four tumors were found in the three patients, all located in the posterior epidural compartment, averaging about 2.5 vertebral bodies in length. On noncontrast T1-weighted images, all lesions were inhomogeneous and hypointense relative to epidural fat. Inhomogeneous enhancement was seen in three lesions on postcontrast T1-weighted images obtained with fat-saturation techniques. Angiolipomas were least conspicuous on T2-weighted images. A high vascular content correlated with the presence of large hypointense regions on T1-weighted images. CONCLUSION: Spinal angiolipomas are typically hyperintense on noncontrast T-1-weighted images relative to other tumors. Angiolipomas that contain large hypointense foci on noncontrast T1-weighted images can be expected to have a high degree of vascularity.
Adult↗
Wegener granulomatosis: CT and MR findings.
PURPOSE: To demonstrate the spectrum of CT and MR imaging findings in patients with Wegener granulomatosis and to determine how often these findings could be attributed to either direct extension from paranasal or orbital disease sites, remote granulomas, or central nervous system (CNS) vasculitis. METHODS: We retrospectively reviewed the CT or MR studies of 15 patients with Wegener granulomatosis. RESULTS: Abnormal findings were seen in 7 patients (5 examined with MR imaging, 2 with CT). Findings included dural thickening and contrast enhancement (3 patients), infarcts (2 patients), regions of hyperintense signal on T2-weighted MR images (2 patients), and abnormal MR signal in the brain stem (2 patients). Three patients with imaging findings of dural enhancement and thickening were thought to have remote granulomatous lesions involving the dura. No patients had extension from sites external to the CNS or clinical findings suggestive of CNS vasculitis. CONCLUSION: The spectrum of CT and MR findings in Wegener granulomatosis includes dural thickening and enhancements cerebral infarction, and MR signal abnormalities in the brain stem and white matter. Presumed remote granulomatous lesions were the most common causes of CNS findings in this study. Complications related to non-CNS disease (eg, hypertension, endocarditis) also appear to have played a role in some patients.
Adult↗
Reversible leukoencephalopathy associated with graft-versus-host disease: MR findings.
Ten weeks after undergoing bone marrow transplantation for metastatic lymphoma of the parotid gland, a 9-year-old girl became disoriented and had tremor and myoclonus in the context of graft-versus-host disease (GVHD). MR images showed abnormal signal primarily within the brain stem and deep white matter, which resolved almost completely after treatment. The findings are consistent with brain involvement by GVHD.
Adrenal Cortex Hormones↗
Adrenal hemorrhage in patients with primary antiphospholipid syndrome: imaging findings.
OBJECTIVE: The primary antiphospholipid syndrome consists of recurrent thromboses, early stroke, recurrent fetal loss, and livedo reticularis in patients with antiphospholipid antibodies and without systemic lupus erythematosus. The purpose of this study was to analyze the imaging findings in patients who had this syndrome as well as adrenal hemorrhage. MATERIALS AND METHODS: The medical records and reports of radiologic examinations of 228 patients with elevated titers of lupus anticoagulant or anticardiolipin antibodies from January 1992 to April 1994 were examined for indications of adrenal hemorrhage. Four patients (two men and two women 38-78 years old) were identified as having adrenal hemorrhage. The abdominal CT and MR imaging findings for three patients and autopsy data for the fourth patient were analyzed. RESULTS: Adrenal hemorrhage was seen in all three patients who underwent abdominal CT and in one patient who underwent MR imaging. Adrenal hemorrhage was bilateral in three patients. Extension of hemorrhage into the perinephric space was present in two patients. Associated clinical findings probably attributable to the presence of antiphospholipid antibodies included amaurosis fugax (two patients), deep venous thrombosis (three patients), and transient ischemic attacks or stroke (two patients). CONCLUSION: Antiphospholipid antibodies appear to be a risk factor for adrenal hemorrhage. The presence of these antibodies should be suspected in patients who have adrenal hemorrhage as well as recurrent thromboses and early stroke.
Abdomen↗
Anatomic distribution of venous thrombosis in patients with antiphospholipid antibody: imaging findings.
OBJECTIVE: Antiphospholipid antibodies are immunoglobulins that cross-react with phospholipid within cell membranes. These antibodies have been associated with a hypercoagulable state manifested by early stroke, frequent arterial and venous thromboses, recurrent fetal loss, thrombocytopenia, and livedo reticularis (antiphospholipid syndrome). The purpose of this study was to determine the anatomic distribution of venous thrombosis in patients with antiphospholipid antibodies as seen on imaging examinations. MATERIALS AND METHODS: We retrospectively reviewed the laboratory results of patients tested for antiphospholipid antibodies at a tertiary referral center during the period January 1992 to April 1994. This review revealed 228 patients with antiphospholipid antibodies. We excluded patients with systemic lupus erythematosus or any other medical condition associated with a hypercoagulable state and patients over 65 years old. Thirty-one of the remaining 73 patients had undergone imaging studies of the CNS or non-CNS venous system. Radiologic studies (contrast angiography or venography, MR angiography or venography, or Doppler sonography) were examined for the presence of venous thrombosis. Nineteen patients--11 men and eight women, 18-62 years old (average age, 38 years)--with venous thromboses were identified. RESULTS: Twelve patients had non-CNS thrombosis alone, three had CNS thrombosis alone, and four had both CNS and non-CNS thromboses. Locations of non-CNS thromboses included deep veins of the legs (nine occurrences), pulmonary vessels (five), and large veins in the thorax or abdomen (six). Three of these patients had documented thromboses at other sites. Twelve patients had recurrent thrombotic events (six with multiple recurrences), including five with arterial thromboses and two with both venous and arterial thromboses and stroke. Among patients with CNS involvement, five had documented thromboses (four dural sinus, one arterial) and two had arterial distribution strokes demonstrated by CT. Two patients with only non-CNS thromboses had either seizures or migraines. CONCLUSION: Deep veins of the leg were the most common site of venous thrombosis. The thoracic and abdominal venous system and the dural sinuses--unusual sites of thrombosis in the general population--are other common sites. Antiphospholipid antibodies should be suspected when thromboses are found in these locations in the absence of other known risk factors, or when found in combination with arterial thromboses or CNS ischemic disease in young or middle-aged patients.
Adolescent↗
Dissection of the internal carotid and vertebral arteries: imaging features.
Dissection of either the internal carotid artery or the vertebral artery (cervicocephalic arterial dissection) was once considered uncommon. However, in the past few decades, it has been increasingly recognized as a cause of stroke in young and middle-aged adults. Dissection causes only 0.4-2.5% of all strokes in the general population but causes 5-20% of strokes among young patients. Anticoagulant therapy is usually started immediately after the dissection is diagnosed. The clinical and radiologic features are important to recognize so that anticoagulation therapy can be started promptly, thereby minimizing the risks of infarction, permanent neurologic disability, and death.
Aortic Dissection↗
Neuroradiologic findings in fucosidosis, a rare lysosomal storage disease.
Fucosidosis is a rare lysosomal storage disorder with the clinical features of mental retardation, cardiomegaly, dysostosis multiplex, progressive neurologic deterioration, and early death. The neuroradiologic findings in two patients are reported, and include abnormalities within the globus pallidus (both patients) and periventricular white matter (one patient).
Biopsy↗
MR of the brain in mitochondrial myopathy.
PURPOSE: To determine the spectrum of MR findings in patients with mitochondrial myopathy and correlate them with central nervous system symptoms and signs. METHODS: We performed a prospective evaluation of the MR findings of eight patients with mitochondrial myopathy (three with Kearns-Sayre syndrome and five with chronic progressive external ophthalmoplegia), six of whom had central nervous system symptoms or signs (ataxia, sensorineural hearing loss, or cognitive dysfunction). RESULTS: All six patients with neurologic symptoms or signs had multiple abnormal MR findings, whereas patients without neurologic symptoms had either normal MR findings (one patient) or the solitary finding of cortical atrophy (one patient). Abnormal MR findings consisted of cerebral cortical atrophy (seven patients), cerebellar atrophy (six patients), and hyperintense signal abnormalities on T2-weighted images within the cerebral white matter (three patients), cerebellar white matter (one patient), basal ganglia (three patients), brain stem (one patient), and thalamus (one patient). In two patients, the cerebral white matter signal abnormalities were primarily peripheral and involved the arcuate fibers. All patients with ataxia had abnormal cerebellar findings on MR imaging, but there was poor correlation between other neurologic features and MR findings. CONCLUSIONS: Cerebral and cerebellar atrophy are the most common MR findings in Kearns-Sayre syndrome and chronic progressive external ophthalmoplegia. White matter and deep gray nuclei abnormalities, presumed to result from the diffuse spongiform encephalopathy reported in these patients, can also be seen. Patients with abnormal neurologic findings typically have multiple abnormalities on MR imaging, which frequently do not correlate with specific symptoms.
Adult↗
Radiologic-pathologic correlation. Bilateral retinoblastoma with coexistent pinealoblastoma (trilateral retinoblastoma).
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Brain Neoplasms↗
Antiphospholipid antibodies in patients without systemic lupus erythematosus: neuroradiologic findings.
PURPOSE: To study neuroradiologic findings in patients with hypercoagulability due to antiphospholipid antibodies (APAs). MATERIALS AND METHODS: Retrospective review of abnormal angiographic, computed tomographic, and magnetic resonance imaging findings was performed over a 14-month period in patients with APAs, no diagnosis of systemic lupus erythematosus, age less than 65 years, and no other cause of a hypercoagulable state. RESULTS: Fourteen patients (age range, 22-62 years) with APAs had abnormal results at neuroradiologic examination. Abnormal findings on cross-sectional imaging studies included large-artery (n = 3), lacunar (n = 5), and venous infarctions (n = 2); cortical atrophy (n = 5); white matter abnormalities (n = 3); and dural sinus thrombosis (n = 4). Abnormal angiographic findings included large-artery occlusions (n = 2), arterial narrowing that simulated vasculitis (n = 2), and transverse sinus thrombosis (n = 1). CONCLUSION: Presence of APAs should be suspected when no cause is apparent for either (a) an ischemic cerebrovascular event in young and middle-aged adults or (b) dural sinus or cerebral venous thrombosis (c) in patients with recurrent systemic arterial or venous thromboses, especially women with recurrent miscarriages.
Adult↗
MR diagnosis of Creutzfeldt-Jakob disease: significance of high signal intensity of the basal ganglia.
OBJECTIVE: Creutzfeldt-Jakob disease is a rare dementing illness that usually affects older adults. Currently, neuroradiologic examinations play a minor role in the diagnosis of Creutzfeldt-Jakob disease. Several single case reports have noted a distinctive finding of hyperintense signal abnormalities in the basal ganglia on T2-weighted MR images of patients with Creutzfeldt-Jakob disease. In order to assess the diagnostic utility of this finding, we studied the imaging features of four patients with Creutzfeldt-Jakob disease in whom this MR finding was present. MATERIALS AND METHODS: Two neuroradiologists retrospectively reviewed the MR images of four patients who had pathologically proved Creutzfeldt-Jakob disease and signal abnormalities in the basal ganglia on T2-weighted MR images. The patients' clinical findings were also analyzed. RESULTS: The four patients had MR examinations between 6 months and 1 year after the onset of symptoms. In all four cases, the hyperintense signal abnormalities in the basal ganglia on T2-weighted images were diffuse and bilaterally symmetric. The T1-weighted images were normal. A CT scan was obtained on a single patient and was normal. CONCLUSION: Although a lack of signal abnormality in the basal ganglia on MR imaging cannot be used to rule out a diagnosis of Creutzfeldt-Jakob disease, our experience and review of published reports suggest that in the proper clinical setting, bilaterally symmetric, diffuse hyperintense abnormalities in the basal ganglia on T2-weighted images may be a specific sign of Creutzfeldt-Jakob disease.
Adult↗
Lupus-related myelitis: serial MR findings.
PURPOSE: To correlate the MR findings in transverse myelitis secondary to systemic lupus erythematosus with clinical findings during disease exacerbation and remission. METHODS: Four patients (ages 33 to 47 years) with episodes of transverse myelitis secondary to systemic lupus erythematosus were identified. Three patients had recurrent transverse myelitis episodes (one patient with two recurrences), for a total of eight episodes. MR examinations (six after contrast administration) were performed during each transverse myelitis episode, as well as during four periods of remission (in three patients) after therapy with steroids and/or immunosuppressive agents. MR examinations were reviewed for the presence of spinal cord enlargement, intramedullary signal abnormality, and contrast enhancement. RESULTS: Prolongation of T1 or T2 signal (or both) was seen in eight episodes (100%). Spinal cord enlargement was seen in six (75%) of eight transverse myelitis episodes, although it was mild during two episodes. Contrast enhancement was seen in three of six transverse myelitis episodes (dense, inhomogeneous enhancement during two episodes in one patient, and a small focus of enhancement in one patient). During periods of remission, spinal cord diameter returned to normal, and no contrast enhancement was seen, although abnormal signal was present in three examinations performed within 2 months of a transverse myelitis episode. CONCLUSION: Spinal cord widening and signal abnormalities are common MR findings during episodes of transverse myelitis related to systemic lupus erythematosus, and contrast enhancement is less frequently seen. Improvement or resolution of these findings correlates with clinical improvement.
Adrenal Cortex Hormones↗
Hemiballismus.
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AIDS-Related Opportunistic Infections↗
Treatment modalities in Guillain-Barré syndrome.
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Animals↗
Anorexia nervosa--thinness as illness.
Anorexia nervosa appears to be on the rise, perhaps in part due to the cultural ideal of a thin figure. The anorectic is typically a highly motivated, over-compliant adolescent girl or young woman who has had problems with self-image and social interactions. Her behavior is an attempt to exert control and self-direction, usually through the regulation of food intake. Weight loss is the most common symptom of the disease and, when extreme, can be life-threatening. Although anorexia nervosa is usually considered a psychologic disorder, strong evidence for biologic relationships exists. Therapy includes both medical treatment and some form of psychotherapy. However, while acute problems often respond to medical intervention, many aspects of the anorectic condition are relatively refractory and some patients continue to have problems for much of their lives.
Adolescent↗
Dural sinus thrombosis and venous infarction associated with antiphospholipid antibodies: MR findings.
OBJECTIVE: Our goal was to describe the neuroradiologic findings in hemorrhagic venous infarction related to a hypercoagulable state caused by antiphospholipid antibodies (aPA). MATERIALS AND METHODS: Magnetic resonance imaging was performed on two patients with superior sagittal thrombosis related to the presence of aPA. RESULTS: A parenchymal region of hyperintense signal due to hemorrhagic venous infarction was demonstrated in both patients, along with abnormal signal within the thrombosed superior sagittal sinus. CONCLUSION: Hemorrhagic venous infarction may result from the hypercoagulable state related to aPA. The presence of these antibodies should be considered in the setting of otherwise unexplained dural sinus thrombosis and/or venous infarction.
Adult↗