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ABSTRACT: Pineal cysts occur in all ages, predominantly in adults in the fourth decade of life. In series of magnetic resonance imaging (MRI) studies, the prevalence of pineal cysts ranged between 1.3% and 4.3% of patients examined for various neurologic reasons and up to 10.8% of asymptomatic healthy volunteers. The diagnosis of pineal cyst is usually established by MRI with defined radiological criteria to distinguish benign pineal cyst from tumors of this area. A recent study demonstrated the findings obtained by transcranial sonography to correspond to those obtained by MRI in the detection of both pineal gland cyst and pineal gland itself, and could be used in the future mainly as follow up examination. Pineal cysts usually have no clinical implications and remain asymptomatic for years. The most common symptoms include headache, vertigo, visual and oculomotor disturbances, and obstructive hydrocephalus. Less frequently, patients present with ataxia, motor and sensory impairment, mental and emotional disturbances, epilepsy, circadian rhythm disturbances, hypothalamic dysfunction of precocious puberty, and recently described occurrence of secondary parkinsonism. Symptomatic cysts vary in size from 7 mm to 45 mm, whereas asymptomatic cysts are usually less than 10 mm in diameter, although a relationship between the cyst size and the onset of symptoms has been proved to be irrelevant in many cases. There is agree-ment that surgical intervention should be undertaken in patients presenting with hydrocephalus, progression of neurologic symptoms, or cyst enlargement. Tissue sample of the pineal lesion can be obtained by open surgery, stereotaxy and neuroendoscopy.
Acta Clinica Croatica; Vol.48 No.3.
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ABSTRACT: Neuroimaging techniques are nonspecific for basal ganglia impairment in the majority of movement disorders, therefore the diagnosis is still based on clinical examination. Recent reports show the substantia nigra (SN) hyperechogenicity detected by transcranial sonography (TCS) to be a specific finding in Parkinson.s disease (PD). The aim of the study was to assess the possibility of TCS to help differentiate PD from essential tremor (ET) by measuring SN echogenicity. The study included 50 PD patients, 20 ET patients, and 50 healthy control subjects. The recordings were done in axial plane by a standardized protocol; SN was displayed, encircled, measured two times, and mean value was calculated and presented in cm2. In the control, PD and ET groups, bilateral combined mean SN size was 0.17 cm2 (±0.06), 0.26 cm2 (±0.06) and 0.16 cm2 (±0.04), respectively. Our data showed a significant difference in SN echogenic size between PD and control group as well as between ET and PD group (p<0.001) but not between control and ET group (p=0.240). The measurement of SN by use of TCS was found to be a valuable tool in differentiating PD from other movement disorders. Due to the portability, noninvasiveness and easy reproducibility, TCS might help in diagnosing PD, or in the differential diagnosis of vague clinical cases.
Acta Clinica Croatica; Vol.45 No.4.
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Jelena Bošnjak
Acta Clinica Croatica; Vol.44 No.4.
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Jelena Bošnjak
Acta Clinica Croatica; Vol.45 No.4.
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Jelena Bošnjak
Acta Clinica Croatica; Vol.45 No.4.
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Jelena Bošnjak
Acta Clinica Croatica; Vol.47 No.2.
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ABSTRACT: We have recently reported that transcranial sonography (TCS) is a method competitive to magnetic resonance neuroimaging (MRI) in the evaluation of pineal gland lesions. The aim of the present is study was to assess the usefulness of TCS in a larger patient sample during a two-year follow up. Twenty patients with incidental pineal gland cyst (PGC) detected by MRI scan of the brain and 40 healthy controls without any previous documented data on a disease related to pineal gland were evaluated by TCS and compared with MRI scans. There were no statistically significant differences in PGC size measured by TCS by two observers (p=0.475), PGC size measured by TCS and MRI (first observer, p=0.453; and second observer, p=0.425), size of the pineal gland measured by TCS and MRI in control group (first observer, p=0.497; and second observer, p=0.370), and pineal gland size measured by TCS by two observers in control group (p=0.473). Study results suggested TCS to be a suitable method in the evaluation of pineal gland lesions. Although its resolution cannot match the MRI resolution, its repeatability and accuracy might add to its practical value. We suggest that the repeat MRI scan of such lesions might be replaced by clinical and TCS follow up.
Acta Clinica Croatica; Vol.47 No.4.
