G. Wilms

Localized 1H NMR spectroscopy in fifty cases of newly diagnosed intracranial tumors

Fifty patients with newly diagnosed, untreated intracranial tumors were examined with 1H nuclear magnetic resonance single-volume spectroscopy (MRS) using a 1.5 T whole-body MR system. Prior to the MRS, contrast enhanced MR and/or CT imaging studies were carried out. Histological verification was obtained in all patients except one. All tumor spectra revealed distinct abnormalities as compared with the normal brain spectra. Although most meningiomas showed a rather characteristic spectral pattern, generally features specific for the various tumor types were not observed. For instance, though a strong lactic acid signal was seen in most malignant tumors, this signal was also evident in five benign neoplasms.

Solitary fibrous tumour of the orbit

Solitary fibrous tumour, originally called localized fibrous mesothelioma, is a rare and usually benign spindle cell neoplasm typically occurring in the pleural cavity, usually in the form of a pedunculated mass. Originally solitary fibrous tumour was thought to be of mesothelial origin, but immunohistochemical or ultrastructural evidence is lacking for this hypothesis. A (myo)fibroblastic origin is much more likely. This tumour has been described in extrapleural sites, including the pericadium, (retro)peritoneum, lung, liver, upper respiratory tract and mediastinum. Only very recently an orbital localization has been described in eight cases. We report a well documented orbital solitary fibrous tumour and discuss its differential diagnosis from other orbital spindle cell neoplasms as well as the characteristic features on the imaging procedures, in particular the angiographic features which have apparently not been reported before.

Sciatica caused by a dilated epidural vein: MR findings

Abstract. We report the MR imaging findings in a 41-year-old woman presenting with sudden low back pain and sciatica. At surgery a dilated epidural vein was found compressing the nerve root. The MR findings may suggest the diagnosis. Magnetic resonance imaging of a dilated epidural vein or varix causing sciatica has not been reported until now.

Transcatheter embolization of hepatic arteriovenous fistulas in Rendu-Osler-Weber disease: a case report and review of the literature

Abstract. A patient with hereditary hemorrhagic telangiectasia and diffuse intrahepatic arteriovenous fistulas developed secondary high-output ventricular failure and pulmonary hypertension. A serial staged hepatic arterial coil embolization was performed with long-term resultant haemodynamic and clinical improvement. The methods of this procedure and related complications are discussed.

Repositioning and Leaving In Situ the Central Venous Catheter During Percutaneous Treatment of Associated Superior Vena Cava Syndrome: A Report of Eight Cases

AbstractPurpose: To describe a combined procedure of repositioning and leaving in situ a central venous catheter followed by immediate percutaneous treatment of associated superior vena cava syndrome (SVCS). Methods: Eight patients are presented who have central venous catheter-associated SVCS (n=6 Hickman catheters, n=2 Port-a-cath) caused by central vein stenosis (n=4) or concomitant thrombosis (n=4). With the use of a vascular snare introduced via the transcubital or transjugular approach, the tip of the central venous catheter could be engaged, and repositioned after deployment of a stent in the innominate or superior vena cava. Results: In all patients it was technically feasible to reposition the central venous catheter and treat the SVCS at the same time. In one patient flipping of the Hickman catheter in its original position provoked dislocation of the released Palmaz stent, which could be positioned in the right common iliac vein. Conclusion: Repositioning of a central venous catheter just before and after stent deployment in SVCS is technically feasible and a better alternative than preprocedural removal of the vascular access.

Lymphocytic infundibulohypophysitis presenting in the postpartum period: Case report

BACKGROUND Lymphocytic adenohypophysitis is a well-known autoimmune disorder affecting the anterior pituitary gland. Posterior pituitary gland function can be impaired by a similar autoimmune disorder called lymphocytic infundibulohypophysitis. Only very few cases have been reported. CLINICAL PRESENTATION We present a patient with central diabetes insipidus in the postpartum period. On radiologic and endocrine evidence lymphocytic involvement of the pituitary stalk and infundibulum was suspected. INTERVENTION A diagnostic pterional craniotomy was performed. The diagnosis of lymphocytic infundibulohypophysitis was confirmed by biopsy. CONCLUSION We present a case of lymphocytic infundibulohypophysitis. In view of its autoimmune pathophysiology the occurrence of this disorder in the postpartum period is not surprising, even though it has not been reported before. This rare disorder should be distinguished from the more common lymphocytic adenohypophysitis.

Benign isolated arteritis of the central nervous system

We present a case of benign isolated arteritis of the CNS. The clinical and angiographic features of this rare disease are discussed and compared with similar cases published in the recent literature. The importance of the angiographic pattern in the diagnosis of this treatable disease is stressed.

Posterior fossa dermoid cyst associated with dermal fistula: report of 2 cases and review of the literature

Two cases of dermoid cysts of the posterior fossa in association with a dermal fistula and with different clinical presentations are reported. The patient in case 1 is a 14-month-old girl with a history of recurrent bacterial meningitis. Case 2, a 7-year-old girl, presented with a skin “granuloma” at the inion. Both cases, and a review of the literature, demonstrate the need for a thorough exploration of the cranial and spinal midline skin areas in every newborn and argue for widespread use of nuclear magnetic resonance imaging whenever a suspected midline lesion is found.

Digital intraarterial subtraction technique of the extracerebral vascular system

We report the results from intraarterial digital subtraction angiography (IA DSA) of the extracerebral vessels with aortic arch injection of contrast medium via femoro-arterial puncture, instead of the more widely used intravenous digital subtraction angiography (IV DSA). Intraarterial DSA is performed using a lower contrast dose and rate, making this study less invasive and costly than the conventional arteriographic study of the aortic arch. Intraarterial DSA provides better resolution than IV DSA. The diagnostic accuracy is almost equivalent to conventional angiography and is largely superior to photographic subtraction angiography with intravenous injection of contrast media.

Lhermitte–Duclos disease: a tumour or not a tumour

We have read with interest the review article that was recently published (1). The authors emphasized the non-neoplastic histopathological findings and the benign behaviour of Lhermitte–Duclos disease (LDD). LDD, first reported in 1920, consists of a diffuse hypertrophy of the cerebellar cortex (2). Today the lesion is classified as a WHO grade 1 tumour and dysplastic gangliocytoma is often used as a synonym (3). In the literature it remains controversial whether the disease represents a tumour or a malformation (1, 4). We have examined a 12-year-old girl with a leftsided LDD. Partial resection was carried out and confirmed this diagnosis. There was no contrast enhancement at all on the preoperative images (Fig. 1A,B). A post-operative scan on day 7 showed the expected post-operative changes at the site of resection. But in addition there was enhancement of the residual LDD, which was located at some distance of the surgical site (Fig. 1C). This enhancement is remarkable in that it was not present prior to surgery and that it cannot be explained by the well-known reactional inflammatory post-operative changes. We suggest that the enhancement of LDD in this case may have been due to folial hyperaemia or extravasation of contrast in the cortex following the manipulation during surgery. Similar enhancement, in the absence of a blood–brain barrier damage, has previously been described in patients with subarachnoid haemorrhage and cerebral contusions (5, 6). The disappearance of the folial enhancement in our patient on the follow-up scan 5 months later supports this hypothesis. Tumoral tissue that does not enhance on imaging before surgery never enhances in the early post-operative phase. Therefore we believe that the enhancement in our patient represented contusion of dysplastic tissue and this is another argument in favour of LDD being a malformation rather than a tumour.