[Show abstract][Hide abstract] ABSTRACT: Acute disseminated encephalomyelitis in adulthood occurs in most cases after a viral infection. Acute disseminated encephalomyelitis associated with bacterial meningitis, however, is quite rare.
An 82-year-old Japanese woman presented with a fever and somnolence. Increased neutrophil count and protein content, and decreased glucose levels in her cerebrospinal fluid initially suggested bacterial meningitis. Brain magnetic resonance imaging on admission showed bilateral symmetrical lesions in her brainstem and her cerebellum. She was diagnosed with acute disseminated encephalomyelitis following bacterial meningitis. Even though appropriate antibiotic and steroid treatment improved her symptoms, she developed transverse myelitis and lumbosacral polyradiculitis on day 9.
Parainfectious encephalomyeloradiculitis, a variant of acute disseminated encephalomyelitis, is a unique neurological syndrome that may be caused by bacterial infection in the central nervous system.
Journal of Medical Case Reports 12/2015; 9(1). DOI:10.1186/s13256-014-0508-1
[Show abstract][Hide abstract] ABSTRACT: Introduction:
Fenestration, early bifurcation, and duplication of the posterior cerebral artery (PCA) and the so-called hyperplastic anterior choroidal artery (AChA), considered a variation of the PCA, are rare. We evaluated the prevalence and characteristic features of these PCA variations on magnetic resonance (MR) angiography.
We reviewed intracranial MR angiographic images of 2402 patients examined using a 3-tesla scanner. Images from the skull base to the intracranial region were obtained using the standard time-of-flight technique. We excluded images of 52 patients with insufficient image quality or occlusion of the PCA(s) and retrospectively evaluated the images of 2350 patients using a picture archiving and communication system.
We observed PCA fenestration in eight (0.34 %) patients, most at the P1 segment and P1-P2 junction and all small in size, early bifurcation at the P1-P2 junction or proximal P2A segment in eight (0.34 %) patients, complete duplication in one patient, and hyperplastic AChA in 13 (0.55 %) patients. Eleven of the 13 hyperplastic AChAs supplied only the territory of the temporal branch of the PCA, and the remaining two supplied the entire territory of the PCA.
We observed PCA variations in 30 (1.28 %) patients. We believe the name "hyperplastic AChA" inaccurately describes variations of the PCA in which the AChA supplies part of or all of the territory of the PCA and propose "accessory PCA" to describe an AChA that supplies part of the territory of the PCA or "replaced PCA" to describe that vessel that supplies the territory all branches of the PCA.
[Show abstract][Hide abstract] ABSTRACT: We report a case in which the temporal branch of the posterior cerebral artery (PCA) arose from the posterior communicating artery (PCoA) and was diagnosed by magnetic resonance (MR) angiography. The PCoA arose from its normal point on the supraclinoid internal carotid artery and fused with the PCA at its normal point of the P1-P2 junction. We believe this is the first report of such a variation. Careful review of MR angiographic images is important to detect rare arterial variations, and partial maximum-intensity-projection images aid their identification on MR angiography.
[Show abstract][Hide abstract] ABSTRACT: A 48-year-old man experienced lateral medullary infarction resulting from spontaneous vertebral artery (VA) dissection. Minimal fusiform dilatation was noted on basi-parallel anatomic scanning-magnetic resonance imaging; therefore, the patient was treated conservatively. Eight months later, he experienced deterioration of dysphagia and the onset of gait ataxia. Repeated imaging studies showed enlargement of the VA aneurysm with bulbar compression. Parent artery occlusion on the proximal side of the VA affected by the dissection relieved the patient's symptoms. Although the majority of dissected lesions stabilize within a few months, studies with longer observation periods and more frequent neuroimaging examinations are required.
Internal Medicine 03/2015; 54(4):427-9. DOI:10.2169/internalmedicine.54.3347 · 0.90 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We present an extremely rare case of an aberrant course of the petrous internal carotid artery (ICA) associated with the ipsilateral occipital artery arising from the cervical ICA, a combination not previously reported by magnetic resonance (MR) angiography. The patient was a 53-year-old woman with no symptoms related to the anomalous ICA. Source images and partial maximum-intensity-projection images of MR angiography are useful in diagnosing these variations. Source images and curved multiplanar reconstruction images of computed tomography angiography are important for the accurate evaluation of reduced arterial diameter and the relationship between the anomalous artery and petrous bone.
[Show abstract][Hide abstract] ABSTRACT: Extremely rarely, the ophthalmic artery (OphA) arises from the A1 segment of the anterior cerebral artery (ACA). Discovery of this anomalous OphA during angiography or surgery has been reported in several patients. We report a case in which an OphA of ACA origin was diagnosed by magnetic resonance (MR) angiography and confirmed by selective cerebral angiography. To our knowledge, this is the first report of this variation with MR angiography. Careful observation of MR angiographic images is important for detecting rare arterial variations. Partial maximum-intensity-projection images are useful in identifying tiny anomalous arteries on MR angiography.
[Show abstract][Hide abstract] ABSTRACT: We report two cases of an extremely long left posterior communicating artery (PCoA) diagnosed by magnetic resonance (MR) angiography. The PCoA arose from the normal point of the supraclinoid internal carotid artery and fused with the posterior cerebral artery (PCA) at its posterior ambient segment, forming an extremely long PCoA and extremely long precommunicating segment of the PCA. To our knowledge, this is the first report of such variation. Careful observation of MR angiographic images is important for detecting rare arterial variations. To identify these anomalous arteries on MR angiography, partial maximum-intensity-projection images are useful.
[Show abstract][Hide abstract] ABSTRACT: Moyamoya disease is a rare progressive cerebrovascular steno-occlusive disease associated with different variations of the cerebral arteries. We evaluated the types and prevalence of such variations among patients with moyamoya disease. In our institution during the past seven years, we diagnosed 72 patients (24 male, 48 female; aged 6 to 75 years, mean, 42 years) with moyamoya disease by magnetic resonance (MR) angiography using either a 3-Tesla or one of two 1.5-T imagers and a standard time-of-flight technique without contrast media. An experienced neuroradiologist retrospectively reviewed the images. There were 15 cerebral arterial variations in 13 of 72 patients with moyamoya disease (18.1%), including four basilar artery fenestrations, three ophthalmic arteries arising from the middle meningeal artery, two intracranial vertebral artery fenestrations, two persistent first cervical intersegmental arteries, two persistent trigeminal arteries, one extracranial origin of the posterior inferior cerebellar artery, and one persistent stapedial artery. Although our number of patients was small, moyamoya disease was frequently associated with variations of the cerebral arteries, especially fenestrations in the vertebrobasilar system and persistent trigeminal artery.
[Show abstract][Hide abstract] ABSTRACT: Dear Sir,I read with great interest the article by Wakao et al. . With this study, the authors confirm with 3D CTA the vertebral artery variations at the C1-C2 level that we described as diagnosed by MRA .Nevertheless, we wish to draw the attention of your readers about a possible misinterpretation of the anatomy in figures 1C and 5. The authors state that in these figures, the posterior inferior cerebellar artery (PICA) arises from C1/2. However, my interpretation of the images of both figures is that the PICA does not arise from level C1/2 but is arising from the foramen magnum level, i.e., above C1. In true C1/2 origin of the PICA, the origin of this vessel has to be clearly under the level of C1 (Fig. 1) .Fig. 1Schematic illustration of posterior inferior cerebellar artery (PICA) of C1/2 origin (left lateral projection). Arrows indicate anomalously originated left PICA from the C1/2 level (V3)It might be that in the patients represented in figures 1C and 5, the origin of t ...
[Show abstract][Hide abstract] ABSTRACT: The several types of agenesis of the internal carotid artery (ICA) are classified based on the aplastic segment of the ICA and types of collateral circulation. On magnetic resonance angiography, we incidentally found an extremely rare case in which the patient had 2 types of collateral circulation-anastomosis between the paraclinoid and supraclinoid segments of the contralateral ICA and anastomosis between the tip of the basilar artery and the posterior communicating artery. This is the first report of a case of ICA agenesis with 2 such types of collateral circulation.
[Show abstract][Hide abstract] ABSTRACT: A 58-year-old woman developed agraphia and mild right hemiparesis approximately one month after undergoing coil embolization of an unruptured left internal carotid artery aneurysm. MRI performed on day 39 post-coil embolization showed multiple lesions in the white matter with signal hyperintensity on T2-weighted and FLAIR images in the left middle cerebral artery territory. The patient's cerebrospinal fluid exhibited an elevated protein level at 46 mg/dL; however, no other findings suggested another underlying disease. Corticosteroids were administered, and, by day 50 post-coil embolization, the clinical findings and abnormal features on MRI had improved. The patient was therefore diagnosed with contrast-induced encephalopathy after coil embolization.
Internal Medicine 09/2014; 53(18):2133-8. DOI:10.2169/internalmedicine.53.2380 · 0.90 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Anastomosis of the carotid-anterior cerebral artery (ACA) is a rare anomalous vessel that arises from the internal carotid artery (ICA) at the level of the ophthalmic artery and takes an infraoptic and prechiasmatic path to anastomose with the ACA. It has known right-sided predominance. We report the case of an 83-year-old man with a left carotid-ACA anastomosis that was diagnosed by magnetic resonance (MR) angiography from the neck to the head during investigation of transient left hemiplegia. The right ICA was occluded at its origin. Our literature search revealed only six reported cases of left carotid-ACA anastomoses. We believe ours is the first case diagnosed by MR angiography.
[Show abstract][Hide abstract] ABSTRACT: A 46-year-old man presented with right hemiparesis. Cranial magnetic resonance (MR) imaging revealed both an acute cerebral infarction in the territory of the left anterior cerebral artery (ACA) and a thin subarachnoid hemorrhage in the left superior frontal sulcus. MR angiography revealed stenosis at the A2 segment of the left ACA. MR cisternography was, therefore, performed on day 12 after admission using sagittal, 3-dimensional, heavily T2-weighted images. Fusiform dilatation of the outer contour was confirmed by MR cisternography at the region of narrowing identified by MR angiography. This case indicates that the combination of MR cisternography and angiography can be useful for detecting ACA dissection.
Journal of stroke and cerebrovascular diseases: the official journal of National Stroke Association 07/2014; 23(6). DOI:10.1016/j.jstrokecerebrovasdis.2013.12.005 · 1.67 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of our study was to investigate the effects of subclinical brain lesions and cognitive function on gait performance with or without concurrent cognitive task in community-dwelling elderly subjects. Participants without dementia (92 men and 109 women with a mean age of 67.8 years) underwent brain magnetic resonance imaging, neuropsychologic tests, and gait measurements. Impaired gait velocity of the Timed Up and Go test was associated with deep white matter lesions (odds ratio [OR], 2.338; 95% confidence interval [CI], 1.120-4.880) and diabetes mellitus (OR, 2.725; 95% CI, 1.120-6.630) after adjusted for age, sex, education, and cognitive function tests. Impaired gait velocity of dual task walking was associated with age and the score of Rivermead Behavioral Memory Test (OR, .899/1 point higher; 95% CI, .813-.994), whereas deep white matter lesions were not significantly associated with dual task walking. The present study showed that gait represents not only physical functioning but also subclinical cognitive dysfunction particularly memory impairment in healthy elderly subjects.
Journal of stroke and cerebrovascular diseases: the official journal of National Stroke Association 06/2014; 23(7). DOI:10.1016/j.jstrokecerebrovasdis.2014.05.008 · 1.67 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A 40-year-old man visited to our hospital due to progressive right hemiparesis. Magnetic resonance imaging demonstrated a heterogeneous contrast-enhanced lesion in the left basal ganglia with compression of the ventricles. A brain biopsy did not demonstrate central nervous system (CNS) lymphoma, although acute demyelination was observed. Despite the administration of steroids, the lesion increased in size, and the patient died three months after admission. An autopsy disclosed perivascular and parenchymal infiltration of lymphoma cells. An immunohistochemical analysis showed that the lesion was a cytotoxic T-cell lymphoma. This case indicates that the development of primary CNS lymphoma of this immunophenotype may be preceded by demyelination with subsequent rapid progression, thus requiring a careful evaluation and meticulous diagnosis.
Internal Medicine 06/2014; 53(11):1197-200. DOI:10.2169/internalmedicine.53.1902 · 0.90 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Recently, magnetic resonance imaging (MRI) abnormalities of the pulvinar in patients with epilepsy have received greater attention, but their occurrence and features have not been fully elucidated. Therefore, we investigated the clinical and radiological features of patients with epilepsy who presented MRI abnormalities of the pulvinar.
We retrospectively investigated 225 consecutive patients who came to our institute because of seizures and underwent an MRI within 24h. The patients who exhibited pulvinar MRI abnormalities, their profile, seizure type, efficacy of medication, and chronological changes of MRI findings were examined.
Out of the 225 patients who underwent MRI within 24h of seizure, 17 exhibited MRI abnormalities of the pulvinar. All of these 17 patients presented status epilepticus. Bilateral pulvinar diffusion-weighted imaging (DWI) hyperintensity was observed in 3 patients and unilateral pulvinar DWI hyperintensity in the other 14. Out of these 14 patients, 7 exhibited DWI hyperintensity in the ipsilateral cerebral cortex, and 10 patients presented an old lesion due to stroke or trauma.
Our results demonstrated that the involvement of the pulvinar in status epilepticus is more frequent than expected and consisted of unilateral or bilateral DWI hyperintensities that may completely normalize. These pulvinar MRI abnormalities possibly reflect the epileptogenic hyperexcitation of different cortical areas through their connections with the pulvinar.
Journal of Neuroradiology 01/2014; 41(4). DOI:10.1016/j.neurad.2013.09.003 · 1.75 Impact Factor