Joanna Bladowska

Magnetic resonance spectroscopy findings as related to fatigue and cognitive performance in multiple sclerosis patients with mild disability

BACKGROUND The origin of fatigue in multiple sclerosis (MS) remains unclear. Magnetic resonance spectroscopy (MRS) provides an insight into metabolic properties of the brain. OBJECTIVES The aim of the study was to evaluate brain MRS measurements in MS patients, with regard to fatigue and cognition. METHODS The study comprised 32 MS patients and 43 controls. Fatigue was assessed using the Fatigue Severity Scale (FSS) and the Modified Fatigue Impact Scale (MFIS) and cognition - using the Brief Repeatable Battery of Neuropsychological Tests (parts of BRBNT). MRS voxels were placed in the parietal white matter (PWM) and the posterior cingulate gyrus (PCG); N-acetyl-aspartate (NAA), choline (Cho) and myoinositol (mI) to creatine (Cr) ratios were determined. Relationships were searched between MRS measurements and fatigue as well as BRBNT results. RESULTS MS patients in comparison with controls showed decreased NAA/Cr and increased mI/Cr ratios in PCG and PWM, respectively. No significant relationships between MRS parameters and fatigue measures, BRBNT results or MS-related variables were found. CONCLUSIONS The decrease of NAA and increase of mI within white and gray matters in MS patients do not show a significant relationship with cognitive performance or fatigue.

Diagnostic Imaging of the Pituitary and Parasellar Region

Pituitary (hypophysis), the secreting gland located in the sella turcica, has fascinated the scientists since ages. In 1543 the Belgian scientist Andreas Vesalius described the anatomy of pituitary gland for the first time. He believed that pituitary produces mucus, which is secreted from the brain into the nasal cavity. This is why pituitary was called the mucous gland (glandula pituitaria; pituita = mucus). Pituitary gland, also called as „master gland” plays the special role in the body. There are plenty of pathological changes with different clinical and radiological appearances of lesions located in sellar and parasellar region. The knowledge of pituitary anatomy and function, as well as of the characteristic changes in size and shape of the pituitary throughout the life and special physiologic conditions, is mandatory for the correct diagnosis and therefore these factors have to be taken into account before assessing pituitary abnormalities.

Composed Paraneoplastic Neurological Syndrome, Disseminated in Time and Space, in the Course of Non-Small Cell Neuro-Endocrine Lung Cancer

Introduction: Paraneoplastic neurological syndrome is a rare complication of different types of cancer. Non-small cell neuro-endocrine lung cancer is very rare and there are few descriptions of paraneoplastic syndrome in patients with such types of cancer. Paraneoplastic movement disorders, among them chorea, have an exceptionally rare occurrence. Clinical presentation: A 64-year-old woman presented paraneoplastic chorea with non-typical coincidence of anti-Hu and anti-GD1b antibodies. Chorea was the last sign of the disease and was comorbid with encephalitis, chronic polyradiculoneuropathy and autonomic dysfunction; the clinical symptoms were disseminated in time. A very rare type of lung cancer i.e., poorly differentiated non-small cell neuroendocrine cancer was found. Conclusions: The diversity of the clinical picture in this patient with non-small cell neuro-endocrine lung cancer can be explained by the complexity of the neurological pathomechanisms of paraneoplastic syndromes.

Acute hyperkinetic syndrome due to ephedrone abuse.

Objectives:A new form of manganese poisoning is related to the intravenous use of self-prepared methcathinone hydrochloride (ephedrone). Manganese encephalopathy typically manifests as a levodopa-resistant parkinsonism. Main Points:A 32-year-old drug-addicted man with acute gait disturbances after the ephedrone injections was presented. Choreic movements, severe postural instability, and “cock-walk” gait were observed. Magnetic resonance imaging T1 images showed high signal intensity of white matter in the basal ganglia and pituitary gland, and T2 images showed decreased signal mostly of globus pallidus with decreased N-acetylaspartate and choline levels in MR spectroscopy. Conclusions:The unusual pattern of MR imaging may explain the unusual clinical symptoms with dominant hyperkinetic syndrome.

Metastatic pulmonary calcification as a rare complication of end-stage renal disease with coexistence of pulmonary metastases from renal cell carcinoma: case report and literature review

Purpose We present a case of metastatic pulmonary calcification (MCP) in an asymptomatic patient with chronic kidney disease after renal transplantation and nephrectomy due to renal cancer. Chest computed tomography (CT) revealed bilateral, diffuse, centrilobular ground-glass opacities and heterogeneous, high-density areas distributed throughout the lungs, predominantly in the upper and middle lobes. Unusually, in our patient the metastatic calcification coexisted with pulmonary metastases from renal cell carcinoma associated with end-stage renal disease. To our knowledge, such coexistence has not been previously described. Case report CT, particularly high-resolution chest computed tomography (HRCT), plays an important role in detection and follow-up of MPC findings, which include ground-glass opacities and partially calcified nodules or consolidations, predominantly in the upper lung zones. Correct diagnosis is important because misdiagnosis may lead to improper or unnecessary treatment and/or procedures. Conclusions MPC is a rare condition that results from calcium deposition in the normal pulmonary parenchyma. MPC commonly occurs in patients with end-stage chronic kidney disease due to abnormalities in calcium and phosphate metabolism. It is worth pointing out that despite the fact that the condition is called metastatic, it is a relatively benign lung disease with a generally good long-term prognosis.

The role of diffusion and perfusion magnetic resonance imaging in differentiation of haemangioblastomas and pilocytic astrocytomas

Purpose Haemangioblastomas (HABLs) and pilocytic astrocytomas (PAs) are brain tumours presenting similar appearance and location in conventional magnetic resonance (MR) imaging. The purpose of our study was to determine whether a detailed analysis of diffusion (DWI) and perfusion (PWI) characteristics can be useful in preoperative differentiation of these tumours. Material and methods The study group consisted of biopsy proven six HABLs and six PAs, which underwent preoperative standard MR examinations including PWI and DWI. In PWI relative cerebral blood volume (rCBV) and the shape of perfusion curves (parameters of peak height – rPH and percentage of signal recovery – rPSR) were analysed. All perfusion parameters were measured for the entire tumour core (mean rCBV, mean rPH, mean rPSR) and in regions with maximal values (max rCBV, max rPH, max rPSR). In DWI parameters of apparent diffusion coefficient (ADC) from the entire tumour core (mean ADC) and in regions with minimal values (min ADC) were evaluated. Results Compared to PAs, HABLs presented significantly higher rCBV and rPH values and lower mean rPSR value. PAs showed significantly lower rCBV and rPH values and higher mean rPSR value. Mean rCBV showed no overlap in the values between HABLs and PAs, and thus it provided the highest accuracy in differentiating between them. Max rPSR, mean ADC, and min ADC did not show any significant differences. Conclusions High rCBV values and deep perfusion curves with only partial return to the baseline are characteristic features of HABLs differentiating them from PAs, which show lower rCBV values and perfusion curves overshooting the baseline. Diffusion parameters are not useful in differentiation of these tumours.

Diagnostic Difficulties in Primary Pauci-Melanotic Leptomeningeal Melanomatosis

We present a rare case of primary malignant melanoma of the central nervous system. We underline the difficulties we faced during diagnostic procedures. Finally, postmortem examination revealed the diagnosis of primary pauci-melanotic leptomeningeal melanomatosis.

Cerebral Metastases of Lung Cancer Mimicking Multiple Ischaemic Lesions – A Case Report and Review of Literature

Summary Background Restricted diffusion that is found on magnetic resonance diffusion-weighted imaging (DWI) typically indicates acute ischaemic stroke. However, restricted diffusion can also occur in other diseases, like metastatic brain tumours, which we describe in this case report. Case Report A 57-year-old male, with a diagnosis of small-cell cancer of the right lung (microcellular anaplastic carcinoma), was admitted with focal neurological symptoms. Initial brain MRI revealed multiple, disseminated lesions that were hyperintense on T2-weighted images and did not enhance after contrast administration; notably, some lesions manifested restricted diffusion on DWI images. Based on these findings, disseminated ischaemic lesions were diagnosed. On follow-up MRI that was performed after 2 weeks, we observed enlargement of the lesions; there were multiple, disseminated, sharply outlined, contrast-enhancing, oval foci with persistent restriction of diffusion. We diagnosed the lesions as disseminated brain metastases due to lung cancer. To our knowledge, this is the first description of a patient with brain metastases that were characterised by restricted diffusion and no contrast enhancement. Conclusions Multiple, disseminated brain lesions, that are characterised by restricted diffusion on DWI, typically indicate acute or hyperacute ischemic infarcts; however, they can also be due to hypercellular metastases, even if no contrast enhancement is observed. This latter possibility should be considered particularly in patients with cancer.

Chronic Lymphocytic Inflammation with Pontine Perivascular Enhancement Responsive to Steroids Syndrome: Diagnostic Challenge of the Brainstem Inflammation

resis of left limbs with pyramidal signs and exaggerated reflexes. Brain MRI showed changes typical of the chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids ( Fig. 1 ) [1] . Laboratory blood A 57-year-old man was admitted to the Neurology Department because of the 9-month history of progressive cerebellar-pyramidal syndrome with accompanied headaches. The neurological examination revealed dysarthria, dysphagia, nystagmus, gait ataxia, and the paReceived: November 14, 2016 Accepted: December 6, 2016 Published online: December 21, 2016

Cerebral venous thrombosis as a diagnostic challenge: Clinical and radiological correlation based on the retrospective analysis of own cases

BACKGROUND Cerebral venous thrombosis (CVT) is a rare condition which constitutes 0.5-1% of all strokes. The clinical and radiological picture of CVT is non-specific and can mimic other disorders. OBJECTIVES The aim of the study was to retrospectively evaluate and correlate clinical and radiological symptoms presented by patients with CVT, both in the initial and follow-up neurological and neuroimaging examinations, with a special emphasis on diagnostic difficulties. MATERIAL AND METHODS Material consisted of 11 patients with CVT (7 women, 4 men). The average age was 43.5, ranging from 23 to 69 years. Clinical symptoms, laboratory findings, risk factors and the results of neuroimaging examinations including CT, MRI and DSA were retrospectively analyzed and correlated. RESULTS All subjects developed superficial CVT and 1 also deep CVT, with no parenchymal lesions in 2 cases, non-hemorrhagic infarctions in 3 and hemorrhagic lesions in 6 subjects. The most frequent symptoms were headache, seizures and hemiparesis. The major risk factors were hormonal therapies in women and congenital thrombophilia. Factors influencing the clinical course and outcome the most were location and type of brain lesions, with hemorrhagic cortical infarctions bringing the worst prognosis and being associated with the highest rate of persistent neurological deficits, despite the rate of vessel recanalization. CONCLUSIONS In our opinion, quick diagnosis before parenchymal hemorrhagic lesions are visible on CT is of crucial importance and requires a constant alertness and good cooperation of neurologists and radiologists, especially in emergency settings.