Jyoti Sureka

MRI findings in acute hyperammonemic encephalopathy resulting from decompensated chronic liver disease

Hyperammonemic encephalopathy is a type of metabolic encephalopathy with diversified etiology. Hyperammonemia is the end result of several metabolic disorders such as congenital deficiencies of urea cycle enzymes, hepatic encephalopathy, Reye’s syndrome and other toxic encephalopathies. Non-specific clinical presentation poses a great challenge in early diagnosis of this entity. Irrespective of the underlying etiology, hyperammonemia causes a distinctive pattern of brain parenchymal injury. The cingulate gyrus and insular cortex are more vulnerable to this type of toxic insult. Characteristic magnetic resonance imaging findings in combination with laboratory parameters can help to differentiate this entity from other metabolic encephalopathy and thus aiding in early diagnosis and treatment.

Magnetic resonance imaging findings in a fatal case of Salmonella typhi-associated encephalopathy: a case report and literature review.

We describe MRI findings in a fatal case of culture proven Salmonella typhi-associated encephalopathy. MRI findings included symmetrical diffuse abnormal signal in centrum semiovale, periventricular and deep white matter, splenium of corpus callosum and cerebellar deep white matter with central area of restricted diffusion. There was no contrast enhancement, significant edema or mass effect. Previous literature is also reviewed for imaging findings in Salmonella associated encephalopathy.

An unusual case of a giant aneurysm of an aberrant systemic artery supplying a pulmonary sequestration.

A 39-year old gentleman presented with cough and haemoptysis for 5 years. A chest radiograph showed a large left retrocardiac opacity (Fig. 1). A contrast enhanced computerised tomography of the thorax showed a hypertrophied aberrant systemic artery from the descending thoracic aorta, leading to a large saccular, partially thrombosed aneurysm in the left lower lobe (Fig. 2). The patient underwent thoracotomy and diagnosis of a bronchopulmonary sequestration with the aneurysm of the supplying artery was confirmed.

Intraneural ganglion cysts of obturator nerve causing obturator neuropathy

A 26-year-old gentleman presented with thigh pain and progressive adductor muscles weakness. A magnetic resonance imaging of the pelvis revealed multiple small cysts along the course of right obturator nerve extending along the articular branch to communicate the ipsilateral anteromedial hip joint (Fig. 1a, b). Atrophy and denervation hyperintensity of ipsilateral adductor brevis and magnus muscles were also noted (Fig. 2a, b). Intra-neural obturator ganglion cysts, although very rare [1], do exist and clinically symptoms often mimic with hip or lumbosacral disc disease which causes delay in diagnosis [1, 2]. These are benign mucoid containing cysts within the epineurium of the nerves compressing the nerve fascicles towards the periphery [3]. An effort must be made to identify and

Spondyloarthropathy occurring in long standing idiopathic hypoparathyroidism

Idiopathic hypoparathyroidism can rarely present with extensive spondyloarthropathic changes that closely resemble ankylosing spondylitis, diffuse idiopathic skeletal hyperostosis, or fluorosis. Clinical presentation of the patient, typical laboratory parameters, and radiological findings aid in their differential diagnosis. Extensive spondyloarthropathy with normal sacroiliac joints in patients with neuromuscular symptoms like tetany, paresthesia, and hypocalcemia should raise the possibility of this entity.

MRI findings in cranial eumycetoma

Cranial eumycetoma (CE) due to direct inoculation of Madurella grisea into the scalp is extremely rare. We describe a case of CE caused by direct inoculation of M. grisea with the characteristic MRI findings of the “dot-in-circle” sign and a conglomeration of multiple, extremely hypointense “dots.”

Congenital distal tibiofibular synostosis

Congenital distal tibiofibular synostosis is a very rare anomaly. The cases of congenital tibiofibular synostosis reported in the literature so far have been confined to the proximal tibiofibular joint. We present an unusual case of tibiofibular synostosis that involves the distal part of the tibia and fibula based on characteristic X-ray, CT, and MRI findings.

MR IMAGING OF SUPRASCAPULAR NEUROPATHIES

Suprascapular neuropathy has become increasingly recognized entity which is often overlooked and mistaken for other causes of shoulder pain and dysfunction like rotator cuff injury, shoulder impingement syndrome, cervical spondylosis and brachial plexopathy. It can be caused by a variety of anatomic and pathologic entities as the nerve courses from the brachial plexus through the suprascapular and spinoglenoid notches to innervate the supraspinatus and infraspinatus muscles. Because of the widespread availability of high-field MRI scanners now it is possible to detect the subtle perineural pathology, thereby excluding the other common causes of shoulder pain. There are scattered case reports and reviews describing suprascapular nerve (SSN) abnormalities using MRI. This article comprehensively reviews different pathologic abnormalities involving the SSN and illustrates their MR features, clinical presentation, correlation with electrophysiologic studies and surgical findings based on a review of 24 cases. We found the different clinical entities which includes trauma and a spectrum of nontraumatic etiology such as idiopathic, mass lesions compressing the nerve, intrinsic lesion like intraneural ganglion cysts of SSN, repetitive overuse, viral neuritis and chemotherapy induced neuropathy.

Subacute sclerosing panencephalitis resembling Rasmussen’s encephalitis on magnetic resonance imaging

Subacute sclerosing panencephalitis (SSPE) is a rare, slowly progressing but invariably fatal disease that is related to a prior measles virus infection and most commonly affects paediatric patients. Magnetic resonance (MR) imaging is the modality of choice for determining such changes in white matter. SSPE typically demonstrates bilateral but asymmetric periventricular and subcortical white matter involvement. We herein report a rare case of unilateral white matter involvement in a 13-year-old boy with SSPE that closely simulated Rasmussens encephalitis. To the best of our knowledge, this is the first report of an atypical presentation on MR imaging in which SSPE was a rare cause of unilateral brain parenchymal involvement in a patient with intractable seizures.

Appendix in Inguinal Hernia—Amyand’s Hernia

Inguinal hernia containing vermiform appendix as its content is termed as Amyand’s hernia. Though an unusual condition, however it is important for the radiologists as well as the surgeons to be aware of this entity especially if the herniated appendix is inflamed so as to avoid delay in treatment and decrease the associated morbidity and mortality.