A posttraumatic AVF reduces parenchymal perfusion in the affected region. CE-US examination may help in monitoring fistulas during the active phase and following spontaneous closure.
The treatment of posttraumatic aneurysms of peripheral arteries using covered stents is increasingly commonplace. We present the case of a 10-year-old girl with a pseudoaneurysm of the subclavian artery complicated by an arteriobronchial fistula with hemorrhaging into the bronchial tree and distal subclavian artery occlusion. Despite the lack of artery patency, endovascular stent graft implantation was successful. Pseudoaneurysm exclusion and involution was achieved, together with a patent implant and maintained collateral circulation patency.
IntroductionThe aim of our study was to determine the possibility of using a new functional technique: a T1-dependent sequence with administration of blood pool contrast agent (BPCA), in patients with brain tumors before and after surgical treatment. We also aimed to compare our results with those obtained using the fMRI technique, based on Blood Oxygenation Level-Dependent (BOLD) contrast.MethodsFor each of our 14 oncologic patients (four before and ten after neurosurgical intervention), we obtained: a T1-3D GRE sequence (TR = 2.6 ms/TE = 1.1 ms/FA = 10°) after intravenous administration of BPCA (0.03 mmol/kg), as well as a T2*EPI sequence (TR = 3 s/TE = 50 ms/FA = 90°). Movement and/or tactile block type paradigms were carried out during both functional runs. SPM5 software was used for analysis.ResultsFor both functional techniques, maximum activations were localized in the same areas. There were no significant differences observed in the t values calculated for activations located in the primary motor cortex between groups of pre- and post-intervention patients (in the same functional technique). The mean values for T2* EPI examinations were 10.84 and 9.36, respectively. The mean t values for the T1 technique were lower, especially for the post-intervention patients (5.83 and 3.9, respectively).ConclusionsThe T1 technique can be used to detect functional areas in patients with brain tumors, pre-, and post-surgical intervention. This technique enables the evaluation of cortical centers that suffer from susceptibility artifacts when using the T2* BOLD technique. Activations found using both techniques have the same localization, with lower values for the T1 technique.
Background
Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is an autoimmune disorder which often presents with neuropsychiatric symptoms. A large proportion of cases are associated with an identifiable tumor, most commonly ovarian teratoma. However, recent literature has also described an overlap of anti-NMDAR encephalitis and demyelinating syndromes. Cases have been reported of anti-NMDAR encephalitis in patients with ADEM, optic neuritis, myelitis and multiple sclerosis. This link is considered rare, however has important clinical implications as treatments and prognosis may differ.
Case presentation
A 33-year-old female with a history of multiple sclerosis presented with new-onset neuropsychiatric symptoms. After substance-induced psychosis was ruled out, she was admitted to the medical ward for work up of psychosis secondary to multiple sclerosis. However, the consultation-liaison psychiatry service noted atypical symptoms which were concerning for autoimmune encephalitis. Admission to a psychiatric inpatient ward was deferred. Anti-NMDAR encephalitis was diagnosed with CSF analysis demonstrating lymphocytic pleocytosis and anti-NMDAR antibodies. In addition to first-line treatment of encephalitis with steroids, second-line immunotherapies were also implemented given the patient’s underlining demyelinating syndrome. The patient’s neurologic and psychiatric symptoms began to improve.
Conclusions
There is literature to demonstrate a possible connection between anti-NMDAR encephalitis and demyelinating syndromes. As such, autoimmune encephalitis should be considered in patients with multiple sclerosis presenting with atypical symptoms. Determining the correct diagnosis is crucial to inform the appropriate treatment protocol, and to improve prognosis.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.