BACKGROUND CONTEXT: Current literature suggests that degenerated or damaged vertebral endplates are a significant cause of chronic low back pain (LBP) that is not adequately addressed by standard care. Prior 2-year data from the treatment arm of a sham-controlled randomized controlled trial (RCT) showed maintenance of clinical improvements at 2 years following radiofrequency (RF) ablation of the basivertebral nerve (BVN).

Balloons may not be required to treat all patients with carotid stenosis. A stent alone was feasible in 79% of patients, and 79% of patients were alive and free from ipsilateral stroke or restenosis at 1 year. Restenosis rates with this approach are higher than with conventional angioplasty and stent insertion. Carotid arteries with very severe stenoses (> 90%) and circumferential calcification may be more successfully treated with angioplasty combined with stent placement.

Object The mean level of the conus medullaris (CM) has been estimated to lie opposite the L1/2 disc space in several previous studies using ultrasound, CT myelography, and magnetic resonance (MR) imaging, but these studies have been limited in examining only the lumbar spine and including patients being evaluated for back pain and sciatica (creating a selection bias). Moreover, significant variability was found in the termination of the CM, with a small subset of subjects having a CM as low as the mid-body of L4. The authors sought to determine the normal level of the CM and its variability. Methods Children with brain or spinal cord tumors who underwent whole-spine surveillance MR imaging were identified retrospectively. The level of the CM was identified in each subject by counting down from C1. Vertebral anomalies, such as lumbarized S1, sacralized L5, or fewer rib-bearing segments, and the presence of fatty filum were noted. Results Findings regarding the level of termination of the CM were tightly grouped; the average was at the lower third of L1 and the mode of the distribution was at the L1/2 disc space, with very little variation. No CM ended below the mid-body of L2. The level of the CM was not significantly different among individuals with lumbarized or sacralized vertebrae or 11 rib-bearing segments. Conclusions The CM terminates most commonly at the L1–2 disc space and in the absence of tethering, the CM virtually never ends below the mid-body of L2. A CM that appears more caudal on neuroimages should be considered tethered.

A good or excellent clinical outcome can be obtained in most patients treated using endovascular coil embolization of intracranial aneurysms. Note, however, that a significant number of patients treated using traditional platinum coils will harbor unstable aneurysm remnants or require repeated treatment.

Furuncular myiasis caused by Dermatobia hominis is endemic throughout Central and South America. However, because of widespread travel, furuncular myiasis has become more common in North America. Misdiagnosis and mismanagement can occur owing to limited awareness of the condition outside endemic areas. We report a case of furuncular myiasis in an immigrant from El Salvador with magnetic resonance imaging findings. The case is unique because neuroimaging was obtained upon the clinical suspicion of calvarial osteomyelitis. Parasitic infestation should be included in the differential diagnosis of a new skin lesion in patients who have traveled to endemic areas.

AimTo identify the effective magnetic resonance angiography (MRA) technique to monitor intracranial aneurysms treated with stent-assisted coiling.Materials and MethodsRetrospective analysis of various MRA techniques was performed in 42 patients. Three neuroradiologists independently compared non-contrast time of flight (ncTOF) MRA of the head, contrast-enhanced time of flight (cTOF) MRA of the head and dynamic contrast-enhanced MRA (CEMRA) of the head and neck or of the head. Digital subtraction angiography (DSA) was available for comparison in 32 cases. Inter-rater agreement (kappa statistic) was assessed.ResultsArtifactual in-stent severe stenosis or flow gap was identified by ncTOF MRA in 23 of 42 cases (55%) and by cTOF MRA in 23 of 38 cases (60%). DSA excluded in-stent stenosis or occlusion in all 32 cases. No difference was noted between ncTOF and cTOF in the demonstration of neck remnants or residual aneurysms in three cases each. CEMRA of the head and neck or of the head was rated superior to ncTOF and cTOF MRA by all three investigators in seven out of eight cases. In one case, all three techniques demonstrated signifcant artifacts due to double stent placement during coiling. The kappa statistic revealed 0.8 agreement between investigators.ConclusionsIn the assessment of stent-assisted coiling of intracranial aneurysm, both ncTOF and cTOF MRA show similar results. CEMRA tends to show better flow signals in stent and residual aneurysm.

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Developmental venous anomaly (DVA), formally known as venous angioma, is a congenital anatomic variant of the venous drainage of the brain. Although they typically have a benign clinical course and a low symptomatic rate, thrombosis of a drainage vein may occur, leading to potentially debilitating complications. We report a unique case of spontaneous thrombosis of a posterior fossa developmental venous anomaly with cerebellar infarct in a 61-year-old man who presented with acute onset cerebellar ataxia. DVA thrombosis was well-depicted on CT and MR studies. Patient was put on anticoagulant therapy and complete recanalization was seen on follow-up imaging.