Asymptomatic natalizumab-associated PML manifestations on MRI show a rather localised disease, frequently located in the frontal lobes, affecting the cortical grey matter and adjacent juxtacortical white matter. Awareness of this lesion pattern facilitates an earlier diagnosis of natalizumab-associated PML in an asymptomatic stage associated with a more favourable prognosis.
The addition of a bolus chaser to 80 mL of contrast material results in a slightly higher attenuation. Decreasing the volume of contrast material from 80 to 60 mL results in a significantly lower attenuation.
Neuromyelitis optica (NMO) is a rare autoimmune disease affecting the optic nerves and spinal cord. In the majority of NMO patients anti-aquaporin-4 antibodies (AQP4-IgG) are detected. Here we assessed a nationwide incidence of AQP4-IgG-seropositive NMO spectrum disorders (NMOSD) in the Netherlands based on results of one central laboratory. Data were collected since the introduction of the highly sensitive cell-based assay for six consecutive years. Samples from 2795 individual patients have been received; of them 94 (3.4%) were seropositive. Based on the Dutch population with 16.6 million inhabitants, the mean incidence of AQP4-IgG-seropositive NMOSD was calculated at 0.09 per 100,000 people.
An uncommon cause of cerebral ischemia in the territory of the posterior cerebral artery (PCA) is the combination of a fetal origin of the PCA and atherosclerotic disease in the internal carotid artery. This study compared the accuracy of CTA with DSA in the assessment of a fetal origin of the PCA. Patients in whom an intracranial DSA and CTA had been performed were reviewed. A fetal origin was defined as a normal-sized patent posterior communicating artery (PCoA) with hypoplasia or aplasia of the ipsilateral P1 segment. One hundred PCAs in 51 patients were analyzed. A fetal origin was present in ten vessels (10%, eight patients). CTA revealed all of them. CTA considered an additional three vessels as having a fetal origin, while DSA revealed a PCoA with the same diameter as the P1 segment of the PCA. Sensitivity and specificity of CTA in the assessment of a fetal origin could be estimated at 100 and 97%, respectively. Positive and negative predictive values were 77 and 100%, respectively. CTA can be considered a valid diagnostic tool for the assessment of a fetal origin of the PCA in patients with a cerebral ischemic event in the territory of the PCA.
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