F.P. Bernini

Ernia discale toracica calcifica Presentazione di un caso

Viene presentato un caso di ernia toracica calcifica mediana, localizzata a livello di T7-T8, non solo per la relativa bassa incidenza di tale patologia in sede dorsale ma anche e soprattuutto per le difficoltà incontrate in fase di diagnosi. Viene segnalato e discusso il ruolo fondamentale svolto a tale scopo dalle indagini di tomografia computerizzata e di risonanza magnetica.

Cystic Dilatation of the Cistern of the Velum Interpositum

Three peculiar cases with cystic dilatation of the “cavum Veli interpositi” have been observed. This structure contains a narrow subarachnoid space; dilatation of this cistern was rarely found in conditions interfering with normal drainage of the subarachnoidal pathways. We describe the clinical and MR findings due to this very uncommon condition; correlative anatomy and differential diagnosis are also discussed.

Radiation-Induced Optic Neuropathy A Report of Two Cases with Clinical and Radiological Study

Optic neuropathy resulting in permanent visual loss is an infrequent delayed complication of radiation therapy. Misdiagnosis of such a lesion may be due to the aspecifical clinical course, the usual tardive appearance and to a possible role of the initial pathology in visual pathways impairment. A radiation optic neuropathy must be suspected when visual disturbances appear in patients submitted to radiotherapy for sellar or skull base pathologies. Contrast-enhanced MR is the examination of choice because it will delineate the radiation-induced lesion and rule out compression of the optic nerves or optic chiasm by the tumoral pathology. The radionecrotic lesion at MR is characterized by segmental swelling with gadolinium enhancement of the visual pathways. Two patients with rapid visual loss about one year after radiotherapy are described. Corticoids and hyperbaric oxygen therapy may be useful in the treatment. The severity of this complication focuses on a strict use of radiotherapy for benign lesions of the sellar and parasellar region.

MR Imaging of the Brain in Chronic Acquired Hepatic Failure

The results of MRI of the brain in adults with non-Wilsonian chronic hepatic failure are reported. T1-weighted images demonstrated increased signal in the basal ganglia. These abnormalities are strikingly similar to those seen following manganese (Mn) intoxication. The causes of this high signal have been thought to include paramagnetic substances, especially Mn, which accumulates within the basal ganglia in liver cirrhosis, because of its increased concentration in whole blood. Mn neurotoxicity may contribute to the development of chronic hepatic encephalopathy so that therapies which prevent or reduce Mn overload may have clinical benefit.

Convexity Meningioma with an Aneurysm of the Meningeal Vascular Pedicle

Middle meningeal artery aneurysms are rare. Less infrequently post-traumatic aneurysms on meningeal vessels have been reported. Often true meningeal aneurysms are associated with tumours, Pagets disease and vascular malformations. This is the second report of a middle meningeal artery aneurysm associated with meningioma. We indicate that haemodynamic factors are important in the development of these aneurysms.

Lesioni osteodurali lombosacrali nella neurofibromatosi di von Recklinghausen

Il morbo di Recklinghausen è una facomatosi a trasmissione autosomica dominante caratterizzata dalle macchie cutanee color “caffè-latte” e dai neurofibromi. A queste manifestazioni possono associarsi lesioni tumorali del sistema nervoso ed alterazioni scheletriche. Anomalie osteodurali, specie se localizzate a livello lombosacrale, sono invece rare. Gli autori, pertanto, presentano 10 casi di Recklinghausen con anomalie osteodurali lombo-sacrali selezionati dalla classifica degli ultimi dodici anni. I pazienti di più vecchia data sono stati studiati con esame diretto e stratigrafico della colonna seguito da mielografia; quelli più recenti con TC, mielo-TC e RM. Vengono discusse le ipotesi patogenetiche delle suddette alterazioni, i quadri diagnostici e le indicazioni terapeutiche, anche alla luce della revisione della letteratura.

Extensive Oedema Surrounding Meningioma A Case Report

We report a case of intracranial meningioma surrounded by severe oedema, unusually extending to the anterior segment of the internal capsule. The possible mechanisms involved in oedema formation are discussed.

Intradiscal Gas and Disc Herniation

The development of air within the degenerated disc is secondary to the movements of the spine. Because of the negative intradiscal tension produced with hyperextension of the spine, the vacuum phenomenon increases with extension and decreases with flexion. The presence of air in the epidural space is more uncommon and may be associated with a disc herniation and even located within the herniated disc itself. We reviewed the clinical and CT findings of 750 patients. Intradiscal gas was found in 130 out of the 750 patients, 65 men and 65 women, whose age ranged from 17 to 81 years; 20 patients were under 40 years old. The gas was at a single level in 83 cases, mainly L5-S1 (43 cases) and L4-L5 (20 cases). In 22 other patients the gas collection was at a level other than disc herniation.

Degenerative Spondylolisthesis with Vacuum Facet Phenomenon

Spondylolisthesis may be associated with degenerative disease of the spine and occurs even in the absence of spondylolysis. In the presence of degenerative joint disease, the smooth pattern of spinal movement is transformed in to one that is irregular and either excessive or restricted. Consequently traction between opposing articular facets occurs, allowing a vacuum phenomenon to develop. We report CT scans demonstration of a vacuum between lumbar facets due to their separation in degenerative spondylolisthesis.

Spontaneous Intracranial Hypotension and MRI Case Reports

Postural headache due to low intracranial pressure is a well-known entity and is most commonly encountered following lumbar puncture. It may occur as a consequence of a medical condition (dehydratation, uremia, etc.) but in some cases no precipitating event is apparent and the intracranial hypotension is believed to have developed spontaneously. In such cases the underlying cause of the syndrome is rarely established and treatment is non specific. We describe three patients with spontaneous intracranial hypotension examined with MRI of the brain. Women are more commonly affected than men in the third or fourth decades of life. Schaltenbrand (1938) proposed three mechanisms by which spontaneous intracranial hypotension may be explained: diminished CSF production; CSF hyperabsorption, CSF leakage. The defect causing a CSF leak usually remains obscure. Several cases of diffuse meningeal enhancement on MRI have recently been described, probably due to meningeal hyperaemia resulting from the low CSF pressure. Subdural fluid collections have also been detected as a result of rupture of bridging veins due to the decrease in CSF volume and downward displacement of the brain. In our cases, MRI showed a diffuse dural thickening, hyperintense in T2. Spontaneous intracranial hypotension is often a self-limiting disease, responding well to bed rest and a generous intake of oral or parenteral fluid and salt.