Alessandro Venturi

Obturator mononeuropathy caused by lipomatosis of the nerve: A case report

We report a patient who presented with the clinical features of obturator mononeuropathy. Abdomino‐pelvic computed tomography revealed a fusiform mass in the right perivesical space; magnetic resonance imaging (MRI) showed characteristic “coaxial‐cable‐like” appearance in cross‐section and “spaghetti‐like” appearance in longitudinal section, pathognomonic of lipomatosis of the nerve. Nerve lipomatosis as the cause of obturator neuropathy has not been previously reported. MRI provides definite and graphic proof of the diagnosis. Muscle Nerve, 2008

Basal Ganglia involvement in Wernicke encephalopathy: report of 2 cases.

SUMMARY: We present the neuroimaging and clinical findings in 2 nonalcoholic adult patients with WE as assessed by MR imaging. The first patient presented with gait ataxia and changes in consciousness. MR imaging disclosed bilateral lesions in the dorsal striatum and cerebellum. None of the regions typically affected in WE were involved. The second patient showed symmetric lesions in the posterior putamen associated with the alterations frequently and infrequently found WE.

Motor cortex excitability changes following a lesion in the posterior columns of the cervical spinal cord.

We used transcranial magnetic stimulation (TMS) to explore if an impairment of central sensory function produced by an isolated lesion in the cervical posterior white columns would change motor cortex excitability. Cortical silent period duration was prolonged when compared with the control subjects, while central motor conduction and motor thresholds were in the normal limits. We first demonstrate that the involvement of the ascending proprioceptive sensory pathways in spinal cord diseases may have direct consequences on the activity of intracortical inhibitory interneuronal circuits. These findings further elucidate the role of afferent inputs in motor cortex reorganisation.

MR Atypical Wernicke Encephalopathy Showing Extensive Brain Stem and Diencephalic Involvement

Wernicke encephalopathy (WE) is a serious neurological disorder caused by thiamine (vitamin B1) deficiency. We report a case of atypical and extensive location of abnormal signal lesions on magnetic resonance imaging (MRI) in a man with alcohol abuse with WE. MRI performed on the first hospital day showed signal intensity alterations extending in the whole brain stem and diencephalon; the mismatch between diffusion‐weighted images and apparent diffusion coefficient map was highly suggestive of vasogenic edema. This report further supports the view that WE may represent a spectrum of radiological entities and can have a wide spectrum of manifestations on MRI; thus, clinical features are essential to diagnose it.

Cortical silent period following TMS in a patient with supplementary sensorimotor area seizures

The cortical silent period (CSP) following transcranial magnetic stimulation (TMS) was evaluated in a patient with a dysembrioplastic neuroepithelial tumor (DNET) in the lateral portion of the right superior frontal gyrus (SFG) who suffered from supplementary sensorimotor area (SSMA) seizures. CSP duration was shortened on the affected side. Ipsilateral alterations of motor cortex excitability with TMS in epileptogenic DNET located outside the PMA argue in favour of cortico-cortical connections to primary motor cortex from SSMA. This functional connectivity should be taken into consideration to better understand the pathophysiology of ictal motor manifestations.

Transcranial magnetic stimulation shows impaired transcallosal inhibition in Marchiafava–Bignami syndrome

A case of Marchiafava–Bignami (MB) syndrome with selective callosal involvement was evaluated by clinical examination and magnetic resonance imaging (MRI) in the acute phase and 6u2003months after the onset of symptoms; at the same time, the corticospinally and transcallosally mediated effects elicited by transcranial magnetic stimulation (TMS) were investigated. The first MRI study showed the presence of extensive abnormal signal intensity throughout the entire corpus callosum. After high‐dose corticosteroid administration her symptoms rapidly resolved, in parallel with the reversion of MRI changes, except for severe cognitive impairment. Follow‐up TMS examination revealed persistent transcallosal inhibition (TI) abnormalities. This report indicates that the measurement of TI during the course of MB syndrome is useful for evaluating functional changes to the corpus callosum, including their evaluation with time and after treatment and for elucidating the pathophysiology of MB syndrome.

Transient ischaemic attacks in two cases of internal carotid artery hypoplasia.

Congenital anomalies of the internal carotid arteries (ICA) and cerebral arteries have not been frequently reported. Moreover, in the literature there is no clear association between hypoplastic carotid and cerebral vessel systems and the occurrence of cerebral ischaemia. We report two cases of unilateral hypoplasia of the ICA affecting two young patients suffering from an episode of minor stroke and from recurrent transient ischaemic attacks, respectively. Congenital variations in the configuration and size of the carotid and cerebral arteries should not always be considered benign conditions and may predispose to cerebral ischaemia in young adults.

Extramedullary Spinal Neurosarcoidosis: Report of Two Cases

Case Reports Patient 1. An 80 year-old woman was admitted to our department for a sudden onset of a sensorimotor defi cit in her right upper and lower limbs; she also complained of neck pain radiating into her right shoulder. The patient presented a sarcoidosis of the lung with hylar and mediastinal lymphadenopathy, and anterior uveitis, diagnosed in 1994. Sarcoid pathology of noncaseating granuloma with giant cells was detected in the lung biopsy specimen. She was treated with oral steroids for 1 year; for the last 10 years there had been no signs of disease. Neurological examination revealed right-sided hemiplegia and severe hypesthesia over the left side. The plantar response was extensor on the right side. Computed tomography of the brain and cervical spine was normal; magnetic resonance imaging (MRI) of the cervical spinal cord revealed a mass that was extramedullary in the right lateral aspect of the spinal canal at the level C 2 –C 3 and compressing the spinal cord ( fi g. 1 a–c). Surprisingly the plasma level of angiotensin-converting enzyme (ACE) Dear Sir, Sarcoidosis is a chronic systemic disorder of unknown etiology characterized in affected organs by an accumulation of epithelioid granulomas without caseation or staining for infectious agents and derangement of the normal tissue architecture [1] . These granulomas often incorporate multinucleated giant cells and lymphocytes. In the past decade, there has been signifi cant progress in our understanding of the immunopathogenesis of the disease, but the etiology of this enigmatic condition still eludes us. Clinical neurological involvement occurs in approximately 5% of patients. However, autopsy results suggest that subclinical involvement may be present in up to 25% of patients. Neurosarcoidosis is a great mimicker and an uncommon presentation of sarcoidosis; it is therefore a diagnostic challenge, especially when there is no prior history of systemic sarcoidosis [2–8] . A typical imaging feature is thickening and enhancement of the basilar leptomeninges of the brain. Other imaging fi ndings, such as enhancing or nonenhancing parenchymal lesions, dural and bone lesions may occur in the head and spine. Spinal sarcoidosis is a rare condition, whose natural history and therapeutic outcome are still not fully known, and extramedullary extradural mass formation is even rarer. We describe 2 additional cases Received: June 23, 2005 Accepted: October 12, 2005 Published online: January 6, 2006

Vertebral artery dissection after radiation therapy: A case report.

CADs are characterized by a low rate of recurrence, and familial occurrence is low. These observations suggest that shortlived trigger mechanisms may play an important role in the pathogenesis of CAD. We report for the first time a case of VAD in a man who received ipsilateral head-and-neck radiation therapy for a cancer of the base of the tongue, to illustrate that CAD should also be included among the radiation-induced vascular diseases.