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N Anzalone

Publications and source records attributed to N Anzalone.

17 recordsLinked to original sources
PubMed2004

Neuroradiologic differential diagnosis of cerebral intraparenchymal hemorrhage.

Cerebral intraparenchymal hematoma (IH) is one of the most common causes of sudden onset of focal neurologic deficit. This is particularly true in the acute phase, in which IH appears hyperdense compared to the cerebral tissue. By three to four weeks, it becomes isodense with the cerebral gray matter and hypodense within 2 to 6 months. After contrast media administration, IH shows a peripheral ring of enhancement owing to the breakdown of the blood brain barrier. On magnetic resonance imaging (MRI), the appearance of IH depends upon the paramagnetic effects of the different derivates of hemoglobin and both the magnetic field strength and type of sequences used. In the hyperacute phase, IH appears hyperintense on T2 and hypointense on T1 owing to the presence of oxyhemoglobin. In the acute phase, IH is hypointense on T2 and iso-hypointense on T1 as a consequence of the presence of deoxyhemoglobin, which is converted into methemoglobin by 3 to 5 days. Methemoglobin has a strong paramagnetic effect, so in this phase IH becomes hyperintense on T1 and hypointense on T2. After 2 weeks, methemoglobin is converted in hemosiderin, responsible of the ring of hypointensity surrounding the lesion on T2WI. When an IH has been diagnosed, someone should think about the origin of bleeding. Among the different differential diagnosis, one should think about the possible origin, taking into account some parameters, such as: anamnestic data, site of the lesion, number of lesions, appearance on CT and MRI, and presence of perilesional edema. Computed tomography is a reliable and very fast tool for the diagnosis of IH, but MRI is able to provide additional information about the spontaneous or secondary nature of the hematoma, thus allowing a better characterization of the hemorrhagic lesion.

Brain Edema↗
PubMed2002

Primary brain CD30+ ALK1+ anaplastic large cell lymphoma ('ALKoma'): the first case with a combination of 'not common' variants.

BACKGROUND: Primary central nervous system lymphomas (PCNSLs) are rare tumors, mostly represented by diffuse large B cells. PCNSLs with a T phenotype are less frequently reported; even rarer are anaplastic large cell lymphomas (ALCLs). PCNSL ALCLs are commonly represented, like their systemic counterpart, by a variably prevalent amount of large pleomorphic tumor cells ('hallmark cells'), and this feature enhances their recognition. Patient and methods We report the first case of primary brain CD30+ ALK-1+ ALCL with a T-cell phenotype, showing the combination of both the 'lymphohistiocytic' and the 'small cell' variants of the disease. A few elements consistent with 'hallmark cells' were recognizable. However, these cells were never prominent, increasing diagnostic difficulties. Immunohistochemistry results were critical for the correct interpretation. Our findings also differ from the majority of PCNSL ALCLs for the absence of tumor necrosis and the lack of prominent mitotic activity. The neuroimaging picture was not specific. A comparison with literature data concerning the clinical/instrumental features shows a very frequent meningeal involvement in PCNSL ALCLs, in contrast to the majority of PCNSLs. CONCLUSION: The occurrence of such a rare form of ALCL may widen the spectrum of differential diagnoses in PCNSL and their recognition may allow a rapid diagnosis, thus encouraging adequate treatment, which should take into account the high rate of meningeal involvement observed in these cases.

Adult↗
PubMed2000

Three-dimensional time-of-flight MR angiography in the evaluation of intracranial aneurysms treated with Guglielmi detachable coils.

BACKGROUND AND PURPOSE: Intravascular treatment of intracranial aneurysms is a relatively new therapeutic technique and long-term controlled angiographic trials are needed to assess persistence of aneurysm occlusion. Our purpose was to evaluate the effectiveness of 3D time-of-flight (3D-TOF) MR angiography as a noninvasive screening tool in the follow-up of cerebral aneurysms treated with Guglielmi detachable coils (GDCs). METHODS: Forty-nine patients with 50 intracranial aneurysms previously treated with GDCs were studied with both DSA and 3D-TOF MR angiography. In 14 cases, a second follow-up examination was performed, for a total of 64 aneurysms evaluated. In 25 aneurysms, both pre- and postcontrast MR angiographic studies were obtained. RESULTS: In seven of 64 aneurysms, the MR angiographic studies were considered to be unreliable owing to the presence of artifacts that obscured part of the parent artery and did not allow an accurate evaluation of the aneurysm neck. These seven aneurysms, however, all were shown to be completely occluded at digital subtraction angiography (DSA). In the remaining 57 aneurysms, DSA revealed complete occlusion in 39 and the presence of residual patency in 18, whereas MR angiography showed complete occlusion in 38 and residual patency in 19. Enhanced MR angiography proved to be useful in evaluating residual patency in large and giant aneurysms and in better depicting the distal branch arteries. CONCLUSION: Although artifacts related to the presence of coils are evident on a considerable number of imaging studies, our findings indicate that MR angiography is useful in the evaluation of residual patency of cerebral aneurysms treated with GDCs and may eventually prove valuable in the follow-up of those cases in which a good initial correlation with DSA was demonstrated.

Angiography, Digital Subtraction↗
PubMed1998

Intracranial vascular malformations.

Many efforts and much research have been dedicated to the field of non-invasive angiographic techniques in the past few years. Thanks first to magnetic resonance angiography (MRA) and subsequently to computed tomographic angiography (CTA), very interesting results have been obtained in the diagnosis of cerebrovascular diseases. Neck vessels are most successfully evaluated by both MRA and CTA, and the need for digital subtraction angiography (DSA) examinations in patients at risk for vascular occlusions has significantly decreased. The role and the diagnostic accuracy of these non-invasive modalities in intracranial vascular pathology is still under investigation, and several studies have been and are being performed. Both techniques have a better spatial resolution and sensitivity in detecting cerebrovascular malformations than DSA. In the diagnosis of cerebral aneurysms, both MRA and CTA - due to their high sensitivity - have become screening techniques in the population at risk for subarachnoid hemorrhage, these techniques may become basic diagnostic modalities in treatment planning. The results are less satisfying in the evaluation of brain arteriovenous malformations and in the different steps of pre- and post-therapeutic evaluation.

Angiography, Digital Subtraction↗
PubMed1995

Acute subarachnoid haemorrhage: 3D time-of-flight MR angiography versus intra-arterial digital angiography.

To evaluate the efficacy and reliability of 3D time-of-flight MR angiography (TOF MRA) as a noninvasive procedure, 27 patients with acute subarachnoid haemorrhage (SAH) were studied with MRA immediately before or after intra-arterial digital subtraction angiography (DSA).3DTOF MRA was performed with an axial slab of 60 mm centered on the circle of Willis and isotropic voxels. DSA showed 22 aneurysms and 1 dural arteriovenous fistula in 21 patients; the aneurysms ranged in size from 2 to 8mm. MRA failed to show 2 small aneurysms, at the origin of the posterior and anterior communicating arteries. The 3D display of the intracranial vessels obtained with maximum intensity projection (MIP) or targetted MIP sometimes rendered the aneurysms better than DSA. However, due to its high spatial resolution, DSA more clearly defined the overall anatomy of the walls of the normal and abnormal vessels.

Acute Disease↗
PubMed1993

Three dimensional time-of-flight magnetic resonance angiography in carotid artery surgery: a comparison with digital subtraction angiography.

Three dimensional time-of-flight magnetic resonance angiography (MRA) and intra-arterial digital subtraction angiography (DSA), considered the gold-standard technique, were compared for pre- and postoperative evaluation of the carotid bifurcation. Images of suitable quality of 194 bifurcations were available with both techniques. Percentage stenosis was graded into 5 groups: A = 0-29%, B = 30-59%, C = 60-89%, D = 90-99%, E = 100% (occlusion). Preoperative MRA (126 bifurcations) overgraded the stenosis in 14 cases and undergraded it in 11. The two techniques agreed in 101 cases and the extent of misgrading was never more than one category. Regression analysis showed a good correlation between the two methods. Severe ulceration was better identified by DSA. As far as the surgical indication was concerned, MRA had a sensitivity of 92.6% and a specificity of 98.3%. In 68 operated cases, postoperative MRA and intraoperative completion angiography showed a satisfactory endarterectomy with no residual stenosis in any of the cases. In conclusion, MRA seems an accurate modality for imaging of carotid bifurcations. Significant limitations still exist for an adequate demonstration of intracranial circulation.

Adult↗
PubMed1991

Analysis of diagnostic procedure costs for cerebrovascular disease admission to a highly specialized hospital.

Length of stay and hospital costs for cerebrovascular disease admissions depend on several hospital-, patient- and disease-related factors. To determine the incidence of each of these factors we studied 240 admissions for cerebrovascular diseases in a neurology division and in two medical divisions of a highly specialized hospital. Statistical analysis of the data collected from the case records revealed the effect of several factors. Some increased only the length of stay (severe neurological sequels on discharge; stay in general medicine, diagnosis of hemorrhage, arterial hypertension). Others increased investigation costs (length of stay, marital status), and costs were higher in a specialists ward. Length of stay was shorter where the nurse/bed ratio was higher. Old age and male sex were associated with a lower cost of diagnostic procedures.

Adult↗
PubMed1991

Are sensorimotor strokes lacunar strokes? A case-control study of lacunar and non-lacunar infarcts.

To determine whether sensorimotor strokes should be considered as lacunar syndromes 34 consecutive patients with first-ever ischaemic sensorimotor stroke were evaluated and compared with 103 patients with non-lacunar infarcts and another 88 patients with lacunar infarcts. Potential thromboembolic sources were more frequent in patients with non-lacunar infarcts (p = 0.003, versus sensorimotor strokes). Although the overall prevalence of hypodense lesions at CT scan was not significantly different among the three groups, lacunar lesions were found in 47.1% of sensorimotor strokes, compared with 6.8% of non-lacunar infarcts (p less than 0.0001). In a mean follow up period of 28.7 months, the incidence of stroke and myocardial infarction among sensorimotor strokes was similar to that of patients with lacunar infarct, but significantly lower than in non-lacunar infarcts (p less than 0.05). These results demonstrate important differences between sensorimotor and non-lacunar infarcts, but quite similar findings in sensorimotor and lacunar strokes, and thus support the theory that sensorimotor strokes are commonly due to lacunar lesions.

Adult↗
PubMed1990

Variable angiographic findings in patients with stroke and neurosyphilis.

We describe four patients with cerebral infarction and active neurosyphilis who had variable angiographic findings. Patients 1 and 2 had evidence of arteritis and an atheromatous ulcerated stenosis of the extracranial carotid artery, respectively. The third and fourth patients had symptoms of lacunar infarction, but cerebral angiography was normal in patient 3, whereas patient 4 had evidence of concomitant atheromatous and arteritic lesions. Neither age nor presence of cerebrovascular risk factors was of aid in predicting angiographic features. The concomitance of cerebral infarction and active neurosyphilis does not imply a cause-and-effect relation, since atherosclerotic lesions may coexist with arteritis or may even represent the only angiographic feature. Our findings underscore the importance of angiography to confirm the diagnosis in cases of suspected syphilitic arteritis.

Adult↗
PubMed1989

Non ischaemic causes of lacunar syndromes: prevalence and clinical findings.

To evaluate the prevalence of lacunar syndromes due to non ischaemic causes 97 consecutive patients with recent (less than 72 hours) onset of a recognised lacunar syndrome were studied. Investigations showed that nine cases were due to non ischaemic pathologies (four primary intracerebral haemorrhages, one rupture of a mycotic aneurysm, one cerebral abscess, one subdural haematoma, one glioblastoma, one multiple sclerosis). Clinical features did not allow a separation of non ischaemic from ischaemic patients; however, hypertension was significantly more frequent in the latter group, and its positive predictive value in identifying ischaemic patients was 96.6%. Lacunar syndromes due to non ischaemic causes are not rare; since CT scan allowed appropriate treatment in two patients and demonstrated contraindications to antithrombotic therapy in five others, its early use appears warranted in patients with acute lacunar syndromes, particularly if normotensive.

Adult↗
PubMed1989

A case-control study of transient global amnesia.

To evaluate risk factors and prognosis of transient global amnesia (TGA), three groups of 30 subjects each affected respectively by: (1) first-ever TGA; (2) first-ever transient ischaemic attack (TIA); (3) depressive neurosis, were compared. Prevalence of cerebrovascular risk factors was similar in patients with TGA and TIA, but significantly lower in the third group. CT showed more hypodense lesions in TIA patients than in those with TGA. In a mean follow-up of 36 months, five TGA patients experienced a TIA and three others had recurrence of TGA, but none suffered stroke or myocardial infarction. In the TIA group, four had recurrence of TIA, two suffered a stroke and two others a myocardial infarction, whereas none had TGA attacks. None of the patients of the third group had any ischaemic event during follow-up. The similar prevalence of risk factors, but the different prognosis between TGA and TIA patients, suggest that TGA is an ischaemic event, probably not triggered by thromboembolism but by a different, possibly vasospastic, mechanism.

Adult↗
PubMed1988

Lacunar infarction in a puerpera with mitral valve prolapse.

We report the case of a 20-year-old woman who presented with pure motor hemiparesis due to a deep hemispheric infarction after delivery of twins followed by marked blood loss and anemia. Echocardiography revealed mitral valve prolapse, which was regarded as the main determinant of her stroke, since detailed clinical and instrumental evaluation disclosed no other apparent causes. Careful analysis of predisposing factors is warranted in lacunar strokes, particularly if they occur in young patients.

Adult↗
PubMedDate not supplied

[Hypercoagulation and recurrence of cerebral infarct].

We measured plasma levels of fibrinopeptide A (FPA) and beta-thromboglobulin (BTG) in 27 patients, two months after first stroke. FPA, a sensitive index of "in vivo" hypercoagulability, was significantly higher in stroke patients than in 40 age- and sex-matched controls, and in patients with cerebral infarction who experienced recurrence within 5 years than in those who remained asymptomatic. On the contrary, FPA levels had no prognostic significance among patients with hemorrhagic stroke. Also BTG, an index of platelet activation, was higher in patients than in controls, but it was not associated with stroke recurrence. In a multivariate analysis of hemostatic and clinical variables, only FPA levels greater than 4 ng/ml were significantly related to cerebral reinfarction. These results support the role of hypercoagulability in the recurrence of ischemic stroke and allow identification of patients at high risk of cerebral reinfarction, providing a rationale for clinical trials of anticoagulant therapy in this subgroup.

Adult↗