Ravi Kanth Jakkani

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.

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.

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.

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.

MRI findings in Fukuyama congenital muscular dystrophy: a rare case report.

Congenital muscular dystrophies (CMDs) are a group of phenotypically and genotypically heterogeneous muscular disorders with early infantile onset. Commonly encountered CMD’s include Walker Warburg CMD, Fukuyama CMD, muscle–eye–brain disease and merosin-deficient CMD. Most of these diseases show autosomal recessive pattern of inheritance with varying presentation of muscle weakness, hypotonia, mental retardation and ocular involvement. Fukuyama type is a unique form of CMD with high predilection for the Japanese population. MRI is the modality of choice to evaluate the brain anomalies in this disorder. Characteristic changes on cranial MRI aid in differentiating this disorder from other clinically simulating CMD’s. We report a rare case of Fukayama CMD seen in a 6-year-old boy.

Lipoma of trigeminal nerve in a patient with severe trigeminal neuralgia

A 45-year-old man presented with severe spastic, lancinating facial pain typical of intractable trigeminal neuralgia in the right mandibular area. MRI revealed an elongated lesion involving the right trigeminal nerve with signal intensity equal to that of subcutaneous fat. The homogenous T1-weighted hyperintensity (figure, A–D) and intermediate signal intensity on T2-weighted images suggested a tissue-specific diagnosis of …

MULTIFOCAL OSTEOARTICULAR TUBERCULOSIS PRESENTING AS OLIGOARTICULAR CHRONIC JUVENILE ARTHRITIS

Osteoarticular tuberculosis of the bilateral ankle joint is a rare occurrence and diagnostic dilemmas are common, as it often mimics the inflammatory arthritis. We present a rare case of bilateral ankle tuberculosis in a young male patient presenting with ankle pain in the absence of systemic and pulmonary symptoms which mimicked oligoarticular chronic juvenile arthritis. Further evaluation with MRI of ankle and chest radiograph helped in making a presumptive diagnosis of tuberculosis, which was further confirmed by obtaining granulomatous tissue on bone biopsy. Despite multifocal osteoarticular involvement, the outcome of the patient was favorable after the treatment. Osteoarticular tuberculosis must be considered in patients with chronic oligoarticular or polyarticular involvement.

MRI FINDINGS IN IDIOPATHIC GLUTEAL FIBROSIS

Gluteal fibrosis is usually secondary to intramuscular injections and rarely can be idiopathic in nature. Clinically characterized by proximal muscle weakness and in advanced cases groove can be seen in gluteal regions. It can mimic with other conditions like muscular dystrophies and poliomyelitis. MRI is a very valuable tool in diagnosing this disorder and is also helpful to exclude other conditions.