R. V. Phadke

Problems in distinguishing spinal tuberculosis from neoplasia on MRI.

We reviewed MRI studies of 60 patients presenting with extradural compressive myeloradiculopathy secondary to vertebral disease to assess the imaging features which may help in differentiating tuberculous from neoplastic disease. Spinecho T1-, proton density- and T2-weighted images were available for all patients and fast low-angle shot images with a low flip angle for 21 patients. Contrast-enhanced images were available for 28 patients. There were 41 patients with tuberculosis and 19 patients with neoplastic disease (metastases 11, lymphoma 6, plasmacytoma 1, and giant cell tumour 1). Discovertebral disease with or without involvement of the posterior arch was a feature not only of tuberculous spondylitis (30 patients) but also of metastases (6). The remaining 11 patients with tuberculosis had “atypical” involvement (vertebral body with or without posterior arch in 8 and posterior arch alone in 3) described as typical of neoplasms. This “atypical” involvement was seen in metastases (5), lymphoma (6) and the 2 primary bone tumours. The presence of an abscess helped in differentiating tuberculosis from neoplasia in 22 of the 41 patients with tuberculosis and was absent in all with neoplasms. The presence of bone fragments in 16 patients (8 with and 8 without an abscess) was found to be specific for tuberculosis. In the absence of an abscess or bone fragments, image-guided biopsy is essential to establish the diagnosis.

Migraine-like visual hallucinations in occipital lesions of cysticercosis.

Four Indian patients with occipital lesions of cysticercosis presented with visual hallucinations. Neuro-ophthalmic and systemic examinations were normal in all cases except for one patient who had a partial homonymous hemianopia. Electroencephalography was normal in all cases. Neuroimaging revealed ring-enhancing lesions in the occipital lobe typical of neurocysticercosis. In endemic regions like India, neurocysticercosis should be suspected in patients presenting with visual hallucinations, even when there are no other clinical findings.

Spinal segmental maldevelopment with a dermal sinus

Abstract Segmental spinal dysgenesis is a rare form of spinal dysraphism. We report a case of segmental hypoplasia of the spinal cord extending from T6 to L1 vertebral levels, with a dorsal dermal sinus, diagnosed by spinal sonography and MRI and confirmed at surgery. The probable pathogenesis is suggested.

Double traumatic caroticocavernous fistula and its treatment by detachable balloons

SummaryA case with two separate fistulous caroticocavernous communications on the same side and their successful endovascular management with preservation of the carotid artery are reported.

Treatment of Recurrent Posterior and Bulbar Urethral Strictures with Expandable Metallic Stents

PURPOSEnThe role of expandable metallic Z stents (non-mesh) in the treatment of recurrent posterior and bulbar urethral strictures was evaluated.nnnPATIENTS AND METHODSnSeven men with recurrent posterior/bulbar urethral strictures underwent balloon angioplasty followed by insertion of two stents in tandem. Retrograde urethrography, micturating cystourethrography, and urodynamic evaluation of these patients was done initially.nnnRESULTSnSuccessful dilation and placement of stents was possible in all cases. In one patient slight proximal migration of the stent occurred; terminal dysuria in this patient necessitated stent extraction. In two other patients near total occlusion of the stent by an exuberant fibrous reaction occurred and this open urethroplasty in the other. Immediate postprocedure urethrography and urodynamic evaluation showed significant improvement. Five patients continue to show a satisfactory clinical urodynamic response. The follow-up period in this patient group ranged from 5 months to 1 year.nnnCONCLUSIONnShort-term response (5 months to 1 year) in patients with posterior/bulbar urethral strictures treated with Z stents appears promising. However, the efficacy of the procedure on a long-term basis requires further follow-up and evaluation.

Anterior spinal artery aneurysm in aortic stenosis of different etiology: Report of three cases

Isolated aneurysms of spinal arteries are rare. Spinal artery aneurysms are commonly found in association with spinal cord arteriovenous malformation and coarctation of aorta and rarely with aortic arch interruption and Klippel-Trenaunay syndrome. Spinal angiograms are the gold standard for diagnosing these spinal artery aneurysms but with the advances in computed tomography technology these aneurysms can also be very well demonstrated in computed tomography angiograms. We describe three cases of anterior spinal artery aneurysm, those are flow related aneurysms, associated with coarctation of aorta and with Takayasu arteritis.

A case report of rim enhancing lesion at the orbital apex

ABSTRACT We report a case of partial third nerve palsy resulting from a cystic lesion located at the orbital apex. Imaging was suggestive of cystic schwanomma but histopathology of the lesion confirmed epidermoid cyst, which is a rare tumour of the orbit.

Inferior petrosal sinus route microcatheterization study and embolization for primary orbital varix.

Purpose Primary orbital varix is a rare lesion but difficult to treat. Our main aim was to demonstrate the varices and their central venous communication and to explore the feasibility of embolization of these lesions. Method In four patients with clinical suspicion of varix, in whom MRI showed retro-global vascular channels, microcatheter digital subtraction angiography (DSA) of the varices was performed using femoral venous access. Embolization was carried out in two patients. Results In all four patients orbital varices could be accessed with a microcatheter through inferior petrosal sinus and ophthalmic vein (superior or inferior) route. Microcatheter angiography showed opacification of varices and demonstrated their central venous communication. Two patients were treated with coil embolization. Complete resolution of symptoms was seen in one patient and partial relief in the other. Conclusion The study presents microcatheterization of orbital varices via the inferior petrosal sinus–cavernous sinus–ophthalmic vein route with injections into distal ophthalmic veins for demonstration of these variceal sacs and their central venous connection. Coiling to disconnect the venous communication should be the primary goal of embolization.

Curious case of corpus callosal hematoma in a normotensive post-partum female patient: a case report of reversible post-partum angiopathy with clinico-radiological correlation

The occurrence of ischemic stroke in postpartum period is uncommon. PCA is a reversible, non-relapsing clinicradiological syndrome which is characterized by onset of acute headache, focal neurologic deficits and reversible cerebral segmental vasoconstriction. Angiography demonstrates areas of multifocal and segmental narrowing in medium and large sized cerebral arteries, appearance akin to vasculitis. The process is usually selflimiting, with resolution of vasoconstriction within 4-12 weeks of onset along with complete resolution of symptoms. However due to its association with intraparenchymal hemorrhage and infarction, PCA carry a significant risk of morbidity and mortality.

Role of MR spectroscopy in diagnosis of intracranial neuroenteric cyst

IntroductionNeuroenteric cysts are rare benign endodermal lesions of the central nervous system that result from incomplete resorption of neuroenteric canal and mostly found in cervical and upper thoracic spinal canal. Intracranial neuroenteric cysts are extra axial and commonly located anteriorly in the posterior cranial fossa. MRI demonstrates variable intensity within the lesion on T1, T2W, and DWI sequences.MethodsThree cases of posterior fossa non-enhancing cystic lesions of variable signal intensity underwent MRI with MR spectroscopy, where MR spectroscopy demonstrated dominant peak at 2 ppm, mimicking normal Nacetyl aspartate (NAA).ConclusionMR spectroscopy in addition to conventional MRI may help in differentiating intracranial neuroenteric cyst from its close differentials.