C. Di Biasi

Spinal subarachnoid hematomas: Our experience and literature review

SummaryStudy design. Spinal subarachnoid hematomas are unusual and difficult to diagnose and the outcome of treatment is influenced by the lesions that frequently accompany them.Objectives. To clarify the neuroradiological diagnostic aspects of spinal subarachnoid hematoma as well as the results of treatment.Background. Only recently has subarachnoid hematoma been clearly distinguished from more common subarachnoid hemorrhage and its characteristics have still not been dealt with in detail.Methods. A total of 69 cases (3 personal case, 66 published cases) were revised in terms of etiology, diagnostic imaging and the results of both surgical and conservative treatment.Results. The most common causes of spinal subarachnoid hematoma are coagulopathies (either pharmacologically-induced or resulting from systemic diseases) (40.5%), lumbar puncture for diagnostic or anesthesiological purposes (44.9%) and traumatic injuries (15.9%): these factors may be present singly or variously combined. They may be spontaneous (17.3%) or, in rare cases, associated with aortic coarctation or degenerative vascular diseases. Overall mortality is 25.7%. In the 50 cases in whom long-term follow-up was possible, the outcome of treatment, which is almost exclusively always surgical, was good in 93.5% of 31 patients in whom neurological status on admission was satisfactory and in 15.8% of 19 cases with severe neurological deficits.Conclusions. MRI and CT are not usually diagnostic because they are not able to differentiate between a subarachnoid lesion and a subdural one. However, diagnosis may be possible when these investigations detect the CSF or the contrast medium surrounding the hematoma. Although the risks of producing spinal subarachnoid hematoma as a result of LP are remote, this is, in fact, the primary cause in patients with coagulopathies. The results of treatment depend on the patient’s initial neurological condition, the severity of any concomitant pathologies, the position of the hematoma and the eventual association of a subdural hematoma.

Magnetic resonance imaging of the parotid glands and lip biopsy in the evaluation of xerostomia in Sjögren's syndrome

Magnetic Resonance Imaging (MRI) of the parotid glands was performed in 23 patients with dry mouth. Each patient underwent lip salivary gland (LSG) biopsy and complete clinical and immunological assessment. MRI showed a quite specific nodular pattern in the parotid glands of patients with Sjögrens syndrome (SS), especially those with severe histologic abnormalities in LSG. However no significant correlation could be detected between MRI score and both LSG biopsy class and immunological abnormalities. MRI of the parotid glands can be regarded as a useful noninvasive procedure with high positive predictive value for the evaluation of the salivary component in SS.

Influence of obstetric complication severity on brain morphology in schizophrenia: an MR study

IntroductionThe purpose of this study was to determine if a causal relationship exists between obstetric complications (OCs) severity and linear magnetic resonance (MR) measurements of brain atrophy in patients with schizophrenia.Materials and methodsLinear measurements of ventricular enlargement (bifrontal span, Evans ratio, and bicaudate ratio) and hippocampal atrophy (interuncal distance) were completed on MR images obtained in 47 patients with schizophrenia. Regression analysis was used to look at association with OCs severity, assessed by the “Midwife protocol” of Parnas and colleagues. The relationship between MR measurements and phenomenologic variables such as age at onset, illness duration, and exposure to antipsychotic medications was explored. The relationship between MR measurements, OCs severity, and symptom presentation was also investigated.ResultsOCs severity was significantly associated with MR measurements of ventricular enlargement (bifrontal span, Evans ratio). As the severity of OCs increased, bifrontal span and Evans ratio increased. This effect was independent of age at onset, illness duration, or even antipsychotic treatment. Interestingly, bifrontal span, Evans ratio, and OCs severity score all showed a significant positive correlation with hallucinatory symptomatology.ConclusionAlthough confirmatory studies are needed, our findings would support the idea that environmental factors, in this case severe OCs, might partly contribute to ventricular abnormalities in schizophrenia.

Accuracy of transcranial ultrasound in the detection of mild white matter lesions in newborns

Cranial Ultrasound (cUS) may not be sensitive enough to detect subtle white matter (WM) injuries. Our study compared serial cUS with MRI at term equivalent age (TEA) to determine if it is possible to identify an ultrasound representation of subtle diffuse WM injuries such as punctate lesions (PWMLs) and diffuse excessive high signal intensity (DEHSI). Fifty-six very preterm infants were scanned sequentially from birth to TEA, an MRI was performed at TEA. Each echodensity found on cUS was classified as absent, transient (≤7 days), or prolonged (>7 days). A transient periventricular echodensity was detected in seven infants (12.5%), and a prolonged echodensity in 15 (26.8%). MRI examinations were performed in all 56 infants. No altered signal intensity was found in 18 infants (32.1%). DEHSI was detected in 14 infants (25%), and PWMLs were detected in eight babies (14.3%). Both abnormalities were found in 16 infants (28.6%). The positive predictive values of the prolonged echodensity for DEHSI and PWMLs were 86.7% and 46.7% respectively. However, a significant statistical correspondence (p=0.002, Odds Ratio 11.9) was found comparing DEHSI with cUS abnormal echodensities. Serial cUS during the neonatal period in preterm infants is essential and cannot be replaced with MRI at TEA. MRI seems to be more reliable in detecting mild or moderate WM abnormalities. However, serial cUS performed by an experienced neonatologist can provide valuable information on early WM changes such as prolonged echodensities that could potentially lead to a diffuse injury.

Chiari type 1 malformation in Neurofibromatosis type 1: experience of a center and review of the literature.

OBJECTIVE To evaluate the possible correlation and the true incidence between Neurofibromatosis type 1 and Arnold-Chiari malformation type I. MATERIALS AND METHODS We reviewed all clinical charts, neurological consultations and MRI scans of 428 NF1 patients followed by 1994 to 2014 in our Department. NF1 patients in our clinic are seen usually every year by both the dermatologist and the neurologist. All patients also undergo a brain and spinal cord with the same 1.5 Tesla MRI scan. RESULTS We found a diagnosis of Arnold Chiari malformation type I in 9 of the 428 NF1 cases (2%). CONCLUSION This frequency is higher than that expected on the basis of a chance association. Therefore we underline the importance of serial MRI studies in patients with NF1 to assess the presence of cranio-cervical anomalies. Future studies should try to better understand what are the pathogenetic mechanisms underlying this close association.

Aspetti TC-RM delle cisti aracnoidee sopratentoriali associate ad ematoma subdurale cronico

Le cisti aracnoidee (CA) sono patologie congenite da aberrato sviluppo delle meningi spinali , e nella maggior parte dei casi risultano completamente asintomatiche, tanto da venir spesso riconosciute casualmente in corso di esami radiografici condotti per altri scopi diagnostici . Da studi ultrastrutturali, esse risultano confinate tra gli strati del foglietto aracnoideo esterno, e contengono liquido simil-liquorale . È stata dimostrata la loro possibile comunicazione con lo spazio subaracnoideo, attraverso la quale una CA può eventualmente aumentare di volume e diventare clinicamente sintomatica . Nei pazienti portatori di una CA è stata verificata una maggior incidenza di ematomi subdurali cronici 8 sebbene ad oggi la precisa causalità di questa associazione rimanga poco chiara. In diversi lavori sono state chiariti i caratteri radiologici di queste lesioni da sole e associate ad ematoma subdurale cronico . In diversi casi segnalati in letteratura, le indagini TC e RM hanno rivelato un segnale intracistico come da avvenuta emorragia . Il miglior trattamento delle cisti aracnoidee associate ad ematoma subdurale cronico non è stato ancora stabilito definitivamente, e ultimamente alcuni autori suggeriscono di procedere all’evacuazione dell’ematoma senza aggredire chirurgicamente la cisti .

Disgenesia callosa: Analisi RM di 34 casi e correlazioni con altre malformazioni associate

Di 576 pazienti pediatrici studiati con RM, ne sono stati selezionati 82 con patologia malformativa cerebro-midollare, 34 dci quali presentavano patologia malformativa del corpo calloso (CC). In particolare sono stati osservati 20 casi di ipogenesia, 7 casi di agenesia e 7 di ipoplasia. In 22 casi (65%) vi erano altre malformazioni associate ed in 12 (35%) la malformazione callosa era singola. Le anomalie associate con maggiore frequenza sono state le malformazioni di Chiari e le anomalie della migrazione neuronale. I nostri dati sono in accordo a quanto descritto in letteratura e confermano la notevole frequenza con cui questa struttura «pacchetto» di connessione interemisferica è interessata nelle malformazioni cerebromidollari; la RM può essere utile per distinguere le forme disgenetiche da quelle in cui il danno si è stabilito successivamente.