The recurrent laryngeal nerve must be carefully dissected and totally exposed during thyroid surgery in order to best preserve its function. Moreover, the thyroid surgeon must be aware of the existence of anatomical variations, which are not as rare as one may think.
The authors report the imaging findings in a patient with a long history of alcoholism, who presented with delirium and recurrent left hemiparesis meeting the criteria of subacute encephalopathy with seizures in alcoholics (SESA) syndrome. MRI revealed fully reversible signal intensities (T2, diffusion-weighted imaging with a decreased apparent coefficient) throughout the right hemisphere. This case suggests that the MRI characteristics of SESA syndrome resemble those of status epilepticus.
A 24-year-old woman presented with sudden right-sided weakness and aphasia. Brain MRI was performed 5 hours after symptoms onset. On diffusion-weighted imaging (DWI), the lesion showed a marked increase in signal intensity and an approximatively 70% mean apparent diffusion coefficient (ADC) decline as compared with the contralateral hemispheric white matter ( figure). The patient met diagnostic criteria for multiple sclerosis and other etiologies were excluded.ADC decline in acute multiple sclerosis lesions, suggesting a diagnosis of ischemic stroke, has been previously reported.1,2 However, the decline in ADC values (22% to 40% decrease) was not as pronounced as our observation. Thus this fourth case of reduced ADC in acute demyelinating lesion indicates that the ADC drop may be important and close to that observed in the core of an acute brain infarction.
We report the case of an 11-year-old, male, competitive hockey player with a complete rupture of the subscapularis insertion but no avulsion fracture of the lesser tuberosity. Ultrasound and MRI were performed before surgical repair with suture anchors. The boy regained a normal range of movement after 4 weeks of immobilization and 2 months of rehabilitation. This unique case (with the absence of lesser tuberosity avulsion) is compared with the 16 other cases of paediatric subscapularis avulsion fracture reported in the literature.
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