SUMMARY:The recently emerged novel influenza A(H1N1) virus continues to spread globally. The clinical disease generally appears mild, but unfavorable outcomes have been reported. We describe a case of a 3-year-old Italian girl infected with influenza A(H1N1) virus presenting with neurologic deterioration. CT findings were negative, but MR imaging findings were consistent with ANE. To our knowledge, this is the first case reported in Europe and the second in worldwide pediatric radiology literature.ABBREVIATIONS: ANE ϭ acute necrotizing encephalopathy; ANEC ϭ acute necrotizing encephalopathy of childhood; DTI ϭ diffusion tensor imaging; DWI ϭ diffusion-weighted imaging; HSV ϭ herpes simplex virus
Refractures of cemented vertebrae occasionally occur after vertebroplasty. It is unclear whether such fractures are procedure-related or part of the natural course of osteoporosis and neoplasy. Our aim was to identify why there is an increased risk of subsequent fracture in cemented vertebrae. We retrospectively analyzed the incidence and possible causative mechanism of refracture in patients who had received vertebroplasty for multiple levels of vertebral compression fracture and the reduction of pain after a subsequent vertebroplasty procedure. A total of 356 patients were evaluated with follow-up from June 2003 to September 2008. We identified 59 refractured patients (54 osteoporotic and four neoplastic). Refractures of cemented vertebrae after vertebroplasty occurred in 59 patients (16%: 98% osteoporotic and 2% neoplastic). Refractures occurred in 8% at the same level as the first vetebroplasty, 31% at an inferior level, 19% at a superior level, 41% at superior and inferior levels and 1% at superior and same levels. Pain was significantly reduced after retreatment in 45 patients (76%) with a moderate reduction in 14 patients (24 %). In conclusion, significant anterior vertebral height restoration increases the risk of subsequent fracture in cemented vertebrae.
In 2009 a novel swine-origin Influenza A H1N1 virus was identified in Mexico and Southern California. Since it was first recognized, neurological complications including acute necrotizing encephalopathy (ANE) have been globally documented in association with this viral infection. ANE is mostly known to occur in the paediatric population. We describe a fatal case of ANE in a previously healthy 40-year-old man infected with influenza A H1N1 virus presenting with severe neurologic decline. Computed tomography (CT) scan and magnetic resonance imaging (MRI) findings were consistent with ANE. CT and MR findings typically documented in paediatric cases of ANE - including bilateral thalamic necrosis with petechial hemorrhage - have been seldom described in adulthood.
Acute cerebellitis is an inflammatory process commonly involving both cerebellar hemispheres. Bilateral cerebellar hemispheres involvement is the most common finding. It typically occurs as a primary infectious, post-infectious or post-vaccination disorder, but is also a disease entity with heterogeneous pathogenesis including paraneoplasia. Acute cerebellitis is usually a benign, self-limiting and rarely fatal disease. Typically, cerebellar atrophy is a late consequence of the syndrome. We describe the radiological features of a case of pseudotumoural hemicerebellitis with emphasis on MRI and spectroscopy findings as non-invasive diagnostic tools to avoid unnecessary surgical procedures.
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