Marco Nistri

Single-voxel long TE 1H-MR spectroscopy of the normal brainstem and cerebellum

To evaluate the feasibility of single voxel 1H‐MRS of the CNS structures contained in the posterior cranial fossa and to determine the distribution of the normal metabolite ratios, concentrations, and T2 relaxation times in the midbrain, pons, medulla, dentate nucleus and cerebellar vermis.

Failure of radiation therapy for brain involvement in Erdheim Chester disease.

A patient with suprasellar and brain stem involvement in Erdheim Chester disease (ECD) underwent magnetic resonance (MR) imaging and proton MR spectroscopy (1H MRS) of the ventral pons before and 1, 4 and 18 months after external whole-brain (24 Gy) radiotherapy. By revealing a decrease of the N-acetyl-aspartate/choline ratio in the pons, 1H MR spectroscopy anticipated lesions growth on MR imaging. In line with the results in four patients reported in the literature, our observation indicates that external radiation therapy is not effective for intracranial involvement in ECD.

Expanding lacunae causing triventricular hydrocephalus Report of two cases

Two patients are reported in whom the presence of triventricular hydrocephalus and aqueductal obstruction or stenosis due to multiple expanding lacunae in the mesencephalothalamic region possibly corresponds to abnormally dilated perivascular spaces. Placement of a ventriculoperitoneal cerebrospinal fluid (CSF) shunt in one patient and the performance of a third ventricle cisternotomy in the other reversed the hydrocephalic syndrome, but did not modify the complex neuroophthalmological disturbance and rubral tremor presumably related to the compressive effects of the lacunae on adjacent parenchyma. In one patient the number and size of the lacunae were increased 4 years after CSF shunt placement. A review of the literature revealed two cases in which magnetic resonance imaging demonstrated a similar, poorly understood pathological condition.

Bronchial artery embolization with detachable coils for the treatment of haemoptysis. Preliminary experience

Purpose . This paper reports our early experience in the treatment of haemoptysis with embolization of the bronchial arteries using detachable coilsMaterials and methods . Ten patients (mean age 45 years, range 23-83) with haemoptysis due to bronchoscopic biopsy of indeterminate lung nodules, lung cancer, tubercular bronchiectasis, cystic bronchiectasis or sarcoidosis underwent embolization of the bronchial arteries responsible for the bleeding using detachable coils. Patients were followed-up for a median of 14 monthsResults . In all patients the procedure halted the bronchial bleeding within 24 hours. Eight patients had no recurrence of haemoptysis. In one patient with lung cancer and another with sarcoidosis haemoptysis recurred within 1–3 months due to recruitment of additional feeding arteries and to a missed large feeding artery originating from the subclavian artery, which required a new procedureConclusions . Use of detachable coils for embolization of bronchial arteries in patients with haemoptysis is advantageous since it eliminates the risk of migration typical of other embolic materials and enables rapid and permanent vessel occlusionRiassuntoObiettivo . descrivere l’esperienza preliminare nel trattamento dell’emottisi mediante embolizzazione delle arterie bronchiali con spirali a distacco controllatoMateriali e metodi . Dieci pazienti (età media 45 anni, range 23-84) con emottisi causata da biopsia broncoscopia di noduli polmonari indeterminati, neoplasia polmonare, bronchiectasie tubercolari, bronchiectasie cistiche e sarcoidosi sono stati trattati con embolizzazione delle arterie responsabili del sanguinamento bronchiale utilizzando spirali a distacco controllato e seguiti con un follow-up medio di 14 mesiRisultati . In tutti i pazienti la procedura ha arrestato il sanguinamento bronchiale entro 24 ore. Otto pazienti non hanno avuto recidiva di emottisi. Un paziente con neoplasia polmonare ed un altro con sarcoidosi hanno presentato nuovi episodi di sanguinamento bronchiale che hanno richiesto una seconda procedura in un intervallo di tempo compreso tra 1 e 3 mesi, dovuti al reclutamento di nuovi apporti arteriosi e alla mancata embolizzazione di un apporto arterioso originante dall’arteria succlaviaConclusioni . L’impiego di spirali a distacco controllato per l’embolizzazione delle arterie bronchiali in pazienti con emottisi è vantaggioso in quanto elimina il rischio di migrazione proprio di altri materiali embolizzanti e permette una occlusione vascolare rapida e permanente

Third-nerve palsy heralding dissecting aneurysm of posterior cerebral artery: digital subtraction angiography and magnetic resonance appearance

Dissections of intracranial arteries are rare and occur most commonly in the vertebrobasilar system.1 Isolated dissecting aneurysms of the posterior cerebral artery (PCA) are very uncommon. We report a case of subarachnoid haemorrhage (SAH) heralded by a 3-month history of diplopia due to dissection of the right PCA documented with digital subtraction angiography (DSA), magnetic resonance imaging (MRI) and angiography (MRA). The patient was treated conservatively, with a good outcome. A 58-year-old male farm worker was found unconscious in the countryside and admitted to hospital. His medical history was unremarkable except for treated arterial hypertension and diplopia for 3 months. On admission, he had a Glasgow Coma Scale (GCS) score of 14 and a complete right third-nerve palsy. Vision and corneal reflexes were normal. A computed tomography scan showed diffuse SAH and intraventricular haemorrhage with hydrocephalus (fig 1A). Soon after arrival, he became less responsive and underwent temporary external ventricular drainage. DSA disclosed a fusiform dilatation of the P1–P2 segment of the right PCA with a focal “blister”, suggesting a dissecting aneurysm (fig 1B). Figure 1  Computed tomography scan at admission showing extensive subarachnoid haemorrhage (SAH) (A). Digital subtraction angiography (DSA; anteroposterior projection) showing a fusiform ectasia of the P1–P2 segment of the right posterior cerebral artery (PCA) with a …

Risonanza magnetica e H-MRS dell'encefalo in soggetti con LES ad esordio pediatrico

Systemic lupus erythematosus can produce disturbances in the CNS, characterized by seizures, headache, encephalopathy, chorea, cerebral infarction and psychosis. We used magnetic resonance and spectroscopy, in order to provide anatomical and metabolic information on the direct involvement of the CNS in LES. This study shows how these non-invasive techniques are well tolerated by children and young adults and how the levels of N-acetylaspartate correlate with the severity of the disease.

Injury of the lateral geniculate body in an amateur boxer

A 26-year-old amateur boxer noticed a visual field defect without an apparent temporal correlation with a fight. Computerized perimetry showed right inferior homonymous quadrantopsia and congruous horizontal sectoranopia. Magnetic resonance imaging revealed a CSF-filled cavity in the left lateral geniculate body, which was surrounded by a rim of signal change without hemosiderin deposits. A signal change along the course of the left optic radiation consistent with wallerian degeneration was also present. Ischemia in the territories of the perforating branches of the anterior and lateral choroidal arteries due to vascular injury might be responsible for the lateral geniculate body lesion in this patient.

La RM nelle sequele dei traumi cranici

Given the higher sensitivity of MRI and the recent advances in faster imaging techniques the purpose of the study was to obtain MRI findings in 70 patients who had suffered from a head injury with transient consciousness loss or prolonged coma at least 24 months before entering the study. Multiplanar MRI offers invaluable advantages in the identification of the precise location of the sequelae of cranial traumas. In case of hemorrhagic lesions, the information capacity of CT progressively diminishes in relation to the absorption of the edema and bleeding, whereas MRI increases its sensitivity due to the paramagnetic properties of hemoglobin by-products. MRI allows the identification of a larger amount of small lesions, particularly those located at critical sites, as corpus callosum, temporal and frontal tips cortical surface. Using Fluid Attenuated Inversion Recovery (FLAIR) pulse sequences, a better delineation of cortical and subcortical lesions is permitted, with remarkable improvement of sensitivity when compared with conventional Spin-Echo images. Finally, adopting MRI has important implications from a medico-legal standpoint.

Angioplastica e stenting intracranico nello stroke ischemico vertebrobasilare Esperienza in tre pazienti

We describe three patients with accute occlusion (case 1) and subocclusion (cases 3 and 4) of the distal portion of the vertebral artery. A satisfactory vessel recanalization was obtained in all three cases, but a good clinical outcome was only achieved in one patient while a second patient developed an apallic syndrome.

Regressione di malformazioni artero-venose cerebrali dopo parziale embolizzazione endovascolare: Descrizione di quattro casi

La storia naturale delle malformazioni arterovenose cerebrali (MAVc) è scarsamente conosciuta ed uno degli aspetti meno noti è il loro potenziale di regressione spontanea che sembra avvenire in 1-3% dei casi a seconda delle varie casistiche. Nel 70% dei casi la regressione spontanea della MAVc avviene in seguito ad un episodio emorragico intracerebrale o subaracnoideo ed, in una minoranza di casi, anche dopo intervento chirurgico. La frequenza con la quale può avvenire la regressione di una MAVc dopo embolizzazione parziale non è nota e pone dei quesiti sul modo migliore di trattare MAVc residue specialmente in sedi eloquenti. Gli Autori aggiungono la propria esperienza alla limitata casistica riportata in letteratura discutendo ed illustrando quattro casi di MAVc spontaneamente regrediti dopo parziale embolizzazione.