BACKGROUND AND PURPOSE: The brain stem is compactly organized with life-sustaining sensorimotor and autonomic structures that can be affected by numerous pathologies but can be difficult to resolve on conventional MR imaging. MATERIALS AND METHODS: We applied an optimized TSE T2 sequence to washed postmortem brain samples to reveal exquisite and reproducible brain stem anatomic MR imaging contrast comparable with histologic atlases. This resource-efficient approach can be performed across multiple whole-brain samples with relatively short acquisition times (2 hours per imaging plane) using clinical 3T MR imaging systems. RESULTS: We identified most brain stem structures at 7 canonical axial levels. Multiplanar or oblique planes illustrate the 3D course and spatial relationships of major brain stem white matter pathways. Measurements of the relative position, course, and cross-sectional area of these pathways across multiple samples allow estimation of pathway location in other samples or clinical subjects. Possible structurefunction asymmetries in these pathways will require further study-that is, the cross-sectional area of the left corticospinal tract in the midpons appeared 20% larger (n ϭ 13 brains, P Ͻ .10). CONCLUSIONS: Compared with traditional atlases, multiplanar MR imaging contrast has advantages for learning and retaining brain stem anatomy for clinicians and trainees. Direct TSE MR imaging sequence discrimination of brain stem anatomy can help validate other MR imaging contrasts, such as diffusion tractography, or serve as a structural template for extracting quantitative MR imaging data in future postmortem investigations. ABBREVIATIONS: ACPC ϭ anterior/posterior commissure; CST ϭ corticospinal tract; CTT ϭ central tegmental tract; ML ϭ medial lemniscus; MLF ϭ medial longitudinal fasciculus; SUDC ϭ sudden unexplained death of childhood

BACKGROUND AND PURPOSE: The basal forebrain contains multiple structures of great interest to emerging functional neurosurgery applications, yet many neuroradiologists are unfamiliar with this neuroanatomy because it is not resolved with current clinical MR imaging. MATERIALS AND METHODS: We applied an optimized TSE T2 sequence to washed whole postmortem brain samples (n ϭ 13) to demonstrate and characterize the detailed anatomy of the basal forebrain using a clinical 3T MR imaging scanner. We measured the size of selected internal myelinated pathways and measured subthalamic nucleus size, oblique orientation, and position relative to the intercommissural point. RESULTS: We identified most basal ganglia and diencephalon structures using serial axial, coronal, and sagittal planes relative to the intercommissural plane. Specific oblique image orientations demonstrated the positions and anatomic relationships for selected structures of interest to functional neurosurgery. We observed only 0.2-to 0.3-mm right-left differences in the anteroposterior and superoinferior length of the subthalamic nucleus (P ϭ .084 and .047, respectively). Individual variability for the subthalamic nucleus was greatest for angulation within the sagittal plane (range, 15°-37°), transverse dimension (range, 2-6.7 mm), and most inferior border (range, 4-7 mm below the intercommissural plane). CONCLUSIONS: Direct identification of basal forebrain structures in multiple planes using the TSE T2 sequence makes this challenging neuroanatomy more accessible to practicing neuroradiologists. This protocol can be used to better define individual variations relevant to functional neurosurgical targeting and validate/complement advanced MR imaging methods being developed for direct visualization of these structures in living patients. ABBREVIATIONS: DBS ϭ deep brain stimulation; DRT ϭ dentatorubrothalamic tract; PLIC ϭ posterior limb of the internal capsule; STN ϭ subthalamic nucleus; SUDC ϭ sudden unexplained death of childhood; Vim ϭ thalamic ventrointermedius nucleus; ZI ϭ zona incerta D eep to the cortical surface, the basal ganglia, thalamus, and subthalamus are vital basal forebrain structures involved in the regulation of autonomic, motor, sensory, limbic, and endocrine functions. 1,2 The metabolic demand of the basal forebrain exceeds the cerebral cortex in the resting state. 3 Focal pathologic functional or structural changes can have serious clinical consequences due to the compact organization of the basal forebrain. The thalamus is a complex hub receiving subcortical sensory and motor input that projects to both the cortex and striatum. 4 Thalamic infarction, demyelination, tumors, and other pathologies can cause chronic pain, 5 sensory loss in multiple modalities, amnesia, 6 dystonia, 7 and other disorders. 8,9 The subthalamus modulates basal ganglia output. 10 Ischemic and hyperglycemic injuries of the subthalamic nucleus can result in hemiballism. 11,12 The basal ganglia have complex connections to the cortical motor areas, including the...

Urinary tract infections must always be excluded as the primary infection focus in neonates with sepsis. Perinatal osteomyelitis is almost always a complication of neonatal sepsis and is associated with orthopedic sequelae. This is the first report in literature of a case of osteomyelitis complicating complex urinary duplication and urinary tract infection.

O acometimento dos nervos bulbares na síndrome de Guillain-Barré parecia-nos raro. Entretanto, nestes últimos 18 meses tivemos a oportunidade de observar 6 pacientes em que tal aconteceu, o que nos chamou a atenção para o fato e nos levou a empreender uma revisão do assunto. Nesta revisão deparamos com idéias por vêzes as mais desencontradas, quer em relação ao diagnóstico clírtico, quer no que diz respeito às formas clí-nicas, quer quanto à própria conceituação da síndrome individualizada por Guillain e Barré, quer em relação aos achados anátomo-patológicos.Predomina hoje, entretanto, o conceito de que a afecção descrita por Guillain-Barré-Strohl, com um quadro clínico definido, de evolução favorá-vel é, em última análise, conseqüência de uma reação alérgica ao nível das raízes, nervos e mesmo do neuro-eixo, em face de fatôres desencadeantes os mais variáveis. Nesse conceito é que nós nos situamos. É à luz dêsses conhecimentos que focalizamos os nossos casos e é nêles que baseamos nosso diagnóstico.É interessante enunciar êste ponto de vista, porque muitos casos de perturbações neuríticas de moléstias tóxicas ou infecciosas têm sido assinalados, em particular casos de afecções neuríticas relacionadas à difteria. Na literatura alguns dos casos de forma bulbar da polirradiculoneurite, o foram, como o de Gareiso 31 , e, em nosso próprio material clínico dois casos foram tidos como tendo sofrido difteria anteriormente, e um dêles realmente sofreu desta afecção (caso 7). Seriam êles realmente neurites tóxicas, ou seriam verdadeiras polirradiculoneurites de natureza alérgica, desencadeadas pelo próprio estado infeccioso e evoluindo de modo benigno, tal como a sín-drome de Guillain-Barré, acompanhando-se de dissociação albumino-citoló-gica no LCR?A eventualidade do comprometimento dos nervos cranianos nos casos de polirradiculoneurites generalizadas ou mesmo, a do comprometimento exclusivo dêsses nervos cranianos levou os diversos autores que têm tratado do assunto, a discutir classificações as mais variadas para formas clínicas

Objective An 8-year old female in the 3rd grade was referred for an evaluation due to concerns surrounding attention, academics, and motor skills in the context of Friedreich’s Ataxia (FA). FA is the most common genetically inherited ataxia (Delatycki et al., 2000). Neurocognitively, deficits in processing and motor speed, visuospatial reasoning, and executive function have been documented in FA (Nieto et al., 2012; Mantovan et al., 2006; Schmahmann et al., 1998). This case study expands on the limited literature on the neuropsychological profile of children with FA. Methods Patient was diagnosed with FA in 2014 following genetic testing significant for over 1,000 repeats of the Frataxin gene. She has experienced a steady decline in her gross-, fine-, and oral-motor skills. Patient requires a personal aide at school to ensure safety ambulating and manage her attention and learning challenges. Results Intellectual ability was estimated as average (WISC-V: GAI = 92). She exhibited significant deficits in reading, writing, and mathematics, clustering around an early 1st grade level (WIAT-III). She presented with attention and executive function impairments (CPT-3, TEA-Ch, NEPSY-II). Motor coordination difficulties were characteristic of FA (WRAVMA, Finger Tapper). Conclusion Patient demonstrated deficits in motor coordination, processing speed, attention, and executive function typical of FA, given its cerebellar pathology and impacted corticocerebellar pathways. The etiology of her learning challenges is unknown, as these domains are not typically impacted in FA. Future investigation of the relationship between FA and other neurocognitive domains is warranted.

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A paralisia facial periférica é produzida por causas diversas, sendo a maioria dos casos constituída pela paralisia de Bell. Por ter observado paralisia facial em otite tuberculosa julgamos oportuno relato do caso por duas razões: 1) a dificuldade para se fazer o diagnóstico etiológico correto por ocasião dos primeiros exames; 2) a raridade da etiología tuberculosa como causa de paralisia facial.