SUMMARY:We describe 2 patients with unusual white matter cystic dilations, which could correspond to widening of the perivascular spaces. They underwent morphologic MR imaging with tractography, functional MR imaging (fMRI), and neuropsychological evaluation. fMRI examination showed no functional reorganization of cortical areas. Tractography showed an apparent decrease of white matter tract vectors into the regions of concern. Findings of the neuropsychological examination were normal. It seems that even an extensive cystic dilation of white matter does not deteriorate brain function.A n extreme widening of Virchow-Robin spaces is a rare entity, because fewer than 10 cases have been reported in the literature. [1][2][3][4][5][6] We report 2 patients showing unilateral intraparenchymal extensive cystic dilations suspected of corresponding to perivascular spaces. These abnormalities were fortuitously discovered on CT. Both patients underwent a morphologic and functional MR imaging evaluation (tractography, fMRI) associated with a neuropsychological examination. Case Reports Patient 1A 45-year-old man, because of benign head trauma, underwent a nonenhanced CT scan, which revealed a left frontal hypoattenuated lesion. The clinical neurologic and neuropsychological examination findings were normal.A morphologic MR imaging examination was performed and showed extensive cystic dilations into the left superior (F1) and inferior (F2) frontal gyri, a portion of the left precentral gyrus, the anterior left cingulate gyrus, and the corpus callosum ( Fig 1A, -B).An fMRI of the right-and left-handed motor tasks (block paradigm, finger tapping, T2* echo-planar imaging [EPI], TR ϭ 2500 ms, TE ϭ 30 ms, matrix ϭ 64 ϫ 64, FOV ϭ 25 cm, 130 frames, image preprocessing [ie, section timing, realigning, coregistering]) and statistical analyses (P Ͻ .001) were performed by using SPM2 (Wellcome Department of Cognitive Neurology, Queen's College, London; http://www.fil.ion.ucl.ac.uk/spm), and a diffusion tensor imaging acquisition (TR ϭ 7000 ms, TE ϭ 78.6 ms, b ϭ 1000 s/mm 2 , 15 directions, matrix ϭ 128 ϫ 128, FOV ϭ 26 cm, section thickness ϭ 3 mm) with fiber tracking (Fibertrack; FuncTool software, Version 3.1.22, GE Healthcare, Milwaukee, Wis) was performed. fMRI ( Fig 1C, -D) showed a cortical activation in the left motor supplementary area in Broadmann areas 4 and 6 after right-handed finger tapping. After the left-handed movement, the activations were identical and symmetric to the right side. Tractography (Fig 1E) showed a decrease of white matter fibers in the pathologic areas compared with the healthy side. Patient 2A 57-year-old woman presenting with stability disorders underwent a nonenhanced CT scan, which revealed a left temporoparietal hypoattenuated lesion. The clinical neurologic and neuropsychological examination findings were normal.A morphologic MR imaging was performed and showed extensive cystic dilations into the left superior and inferior parietal lobules and in the posterior part of the left middle (T2) and inferi...
Segmental omental infarction (OI) is a rare cause of abdominal pain in children. It generally occurs in the right lower and upper quadrants of the abdomen and only a few cases of other locations have been described in adults. We report a unique paediatric case of OI with an unusual left-sided location extending into the pelvis in a 6-year-old non-obese girl. The diagnosis was suspected on US and CT based on imaging patterns previously described in adults and children. Laparoscopic resection should be balanced with nonsurgical management.
With only 25 mL of iodinated contrast medium focused on the arterial phase, 64-detector CT angiography allowed satisfactory diagnostic and therapeutic management of nontraumatic SAH.
Context: Ischemia of the cervical spinal cord is a rare complication of spontaneous vertebral artery dissection (VAD) and usually involves the ventral portion. We describe a less evocative clinical presentation and images of unilateral posterior spinal cord infarction due to spontaneous VAD in order to facilitate early diagnosis. Findings: A previously fit 30-year-old man presented with persistent headaches and proximal motor deficit of the right arm. He was diagnosed with spontaneous dissection of both vertebral arteries, with occlusion of the right one, and the right carotid artery. Neurological examination also revealed a right C2-C3 tactile sensory loss, with unilateral proprioceptive deficit below. Brain images revealed small bilateral cerebellar infarcts which could not be responsible for the clinical symptoms. Magnetic resonance imaging of the spinal cord showed a right posterior cervical spinal cord infarction. The patient achieved nearly complete recovery after several weeks of anticoagulation and rehabilitation. Conclusion and clinical relevance: Infarction of the caudal portion of the cervical spinal cord, especially unilateral, caused by spontaneous VAD, has rarely been described and is certainly under-diagnosed due to less suggestive symptoms, like unilateral and mainly sensory deficit. Nevertheless, early diagnosis of this condition is important to guide patient management and rehabilitation.
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