Danielle Hernalsteen

Recurrent seizure and sustained encephalopathy associated with dimethylsulfoxide-preserved stem cell infusion

We report the case of a patient who received two infusions of dimethylsulfoxide (DMSO) cryopreserved autologous peripheral blood progenitor cells (PBPCs) after myeloablative chemotherapy for a relapsing lymphoma. A 49-year-old man presented an episode of tonic-clonic seizure over a few minutes after the start of each infusion and developed a profound and sustained but reversible encephalopathy with coma after the second infusion. The patients neurological condition correlated well with the electrophysiological findings (electroencephalogram and multimodality evoked potentials) and, to a lesser extent, with the radiological abnormalities (magnetic resonance imaging). Severe but reversible neurological complications may occur with the infusion of PBPCs cryopreserved with DMSO.

Pituitary stalk hemangioblastoma: The fourth case report and review of the literature

Supratentorial hemangioblastomas (HBL) have been rarely described in the literature. Herein we report the fourth case of pituitary stalk HBL diagnosed concurrently with cerebellar HBLs in a 51-year-old woman with von Hippel-Lindau disease. Complete resection of the lesion was achieved using left frontopterional craniotomy and no recurrence was observed after 8 years of follow-up. The clinical presentation, radiological features, pathological findings, and the management of this particular case are discussed in the light of the available literature. To our knowledge, this case is the only pituitary stalk HBL with total resection, and a long follow-up fully documented.

Comparison of Five MR Sequences for the Detection of Acute Intracranial Hemorrhage

Purpose: To evaluate the respective value of 5 MR sequences to distinguish between stroke patients with and without acute intracerebral hemorrhage (ICH). Methods: MR images obtained ≤6 h after stroke onset of 86 patients (43 ICH, 43 non-ICH) were reviewed by 3 observers who looked for signs of acute ICH on each image set [T1 and T2 gradient echo (GRE), FLAIR, T2-EPI and DWI], presented separately. Results: For the identification of ICH, intraobserver and interobserver concordance were at least ĸ = 0.95 for all sequences. Of all interpretations, 7 (0.4%) were erroneous, with sensitivity and specificity of FLAIR, T2-EPI and DWI reaching 100%; GRE sensitivity and specificity were 100% and 95–97.5%, respectively; T1 sensitivity and specificity were 97.3–100% and 97.4–100%, respectively. All 4 patients misclassified on one pulse sequence were correctly classified on all the other sequences. Conclusion: In the setting of acute stroke, each of the 5 studied sequences enables ICH and non-ICH patients to be distinguished with high sensitivity and specificity.

Gliomatosis cerebri, imaging findings of 12 cases.

BACKGROUND AND PURPOSE We report 12 cases of Gliomatosis cerebri (GC), a rare brain neoplasm, to define its semeiologic criteria. Literature was reviewed to clarify its physiopathology. PATIENTS AND METHODS From 1997 to 2008, 12 histologically proven cases with GC were retrospectively reviewed. Of the 12 patients, nine were male. The mean age was of 54 years. Were performed CT-Scan (n=6), MRI (n=12), diffusion and perfusion weighted images (n=12 and n=4), MR Spectroscopy (n=3), a FDG and a Methionin PET-Scan (n=2 and n=3 respectively). RESULTS Primary diagnosis was missed in six cases. Most frequent clinical signs were seizure and mental changes. Imaging criteria were: area of high signal intensity on FLAIR and T2-weighted images, involving three or more contiguous lobes with conserved architecture. Frequently a bilateral widespread invasion with involvment of the corpus callosum or the anterior white commissure or both was observed. At diagnosis and in the classical form (type I) of GC, no significant contrast enhancement and decreased rCBV were observed. Focal enhancement and increased rCBV were observed in the focal mass in type II GC. MR Spectroscopy showed an increase of the Cho/Cr ratio and a decrease in the NAA/Cr one. FDG PET showed in type I a decreased avidity for the FDG whereas in type II a increased avidity was observed. MET-PET showed an increased avidity for the tracer in a GC type II and a slight avidity in a GC type I. CONCLUSION GC is a rare brain entity. Primary diagnosis is often missed. The imaging findings of GC I, a WHO grade III tumor, should be known and include classical MRI but also PWI, MRS and scintigraphic findings.

Reversible splenial lesion syndrome in cerebral malaria.

A 71-year-old Caucasian man living in Congo was investigated by serial magnetic resonance imaging (MRI) after having presented cerebral malaria due to Plasmodium falciparum. The clinical picture was characterized initially by coma and seizures. The patient developed multiple organ failure. There was, at 4 months follow-up only, a minimal neurological improvement consistent with minimally conscious state. The first cerebral MRI on day 17 showed a lesion of the splenium of corpus callosum with high signal intensity on DWI and FLAIR sequence and reduced ADC, and small cortical infarcts in the internal occipital regions. Follow-up MRI obtained 36 days later showed a complete resolution of splenial lesion, though without clinical improvement. Cerebral malaria should be added to the list of possible causes of reversible lesion of the splenium of corpus callosum.

Moelle épinière tumorale et pseudo-tumorale

Swelling of the spinal cord and/or enhancement after intravenous gadolinium administration are not always specific features of intramedullary tumour. These may also be seen in association with several diseases of inflammatory, infectious, granulomatous or vascular origin. A tumour is characterized by its sagittal location, axial topography: central, lateral or exophytic, its size and size of the spinal canal, macroscopic components: calcium, fat, methemoglobin, melanin, hemosiderin, vascular pedicle, cystic component, enhancement after intravenous gadolinium administration, effect on the spinal cord tracts and edema. Characteristics: astrocytoma is lateral and infiltrative, ependymoma is central with white matter tract displacement and hemosiderin cap, hemangioblastoma is postero-lateral and shows enhancement with a vascular pedicle, metastases arc very edematous or leptomeningeal in location.

Long-term (6-year) follow-up of untreated multiple aggressive vertebral haemangiomas in an adolescent

Received: 23 June 2004 Accepted: 26 June 2004 Published online: 27 July 2004 Springer-Verlag 2004 Sir, We had the privilege of presenting, 6 years ago, the case of a 13year-old girl with multiple bone haemangiomas of the spine, two of them showing extra-osseous extension within the spinal canal at the level of T12 and of L4 (Fig. 1) [1]. She had the first case of aggressive bone haemangioma to be reported in childhood. Very few cases of multiple locations of aggressive bone haemangiomas have been reported to date, and only in adults [2]. Since the initial examination, the patient and her parents have repeatedly refused any therapeutic intervention. We performed follow-up spinal MRI of the patient in June 2004; she is now aged 19. In comparison with the initial examination in October 1998, we observed significant shrinkage of the two aggressive haemangiomas, mainly that located at L4, with a subsequent decrease in the degree of impingement on the thecal sac (Fig. 1). Additional intrinsic changes were present with an increase in the fatty component of both the intraand extra-osseous parts of the lesions. One noteworthy feature was that the fatty involution of the abnormal haemangiomatous tissue involved not only the intra-osseous part of the lesion, but also the extra-osseous component within the spinal canal (Fig. 1). Pediatr Radiol (2004) 34: 831–832 DOI 10.1007/s00247-004-1290-9 LETTER TO THE EDITOR

Diffusion et pathologie infectieuse

Resume L’imagerie de diffusion seule ne permet pas de detecter les lesions infectieuses plus tot et plus precisement que les sequences conventionnelles. Diffusion et cartographie ADC doivent etre utilisees avec les sequences T2, FLAIR, Tl sans et avec gadolinium, en prenant en compte les donnees cliniques, la localisation anatomique des lesions et les delais d’evolution de la maladie. Imagerie de diffusion et ADC ne traduisent qu’un etat physique de la matiere. Empyemes et abces cerebraux ont souvent un aspect tres evocateur avec un signal intense en imagerie de diffusion et un ADC reduit. Ceci permet de differencier les abces des tumeurs necrotiques. Mais des metastases peuvent prendre le masque d’un abces et inversement un abces detecte tardivement le masque d’une tumeur necrotique avec un ADC eleve. En cas de meningite, l’image de diffusion et la cartographie ADC varient selon la gravite des lesions : avec tous les intermediaires entre aspect normal du LCR et signal intense avec reduction d’ADC. Les lesions d’encephalite se presentent souvent comme des lesions ischemiques, les 2 mecanismes etant parfois en jeu dans certaines affections telle l’encephalite herpetique. Le lymphome peut prendre le masque d’une plage encephalitique avec un signal eleve en diffusion et meme un ADC reduit.