Lowe syndrome (the oculocerebrorenal syndrome of Lowe, OCRL) is a multisystem disorder characterized by anomalies affecting the eyes, nervous system and kidneys.1-3 The disorder was first recognized by Lowe et al. in 1952, and described as a unique syndrome with organic aciduria, decreased renal ammonia production, hydrophthalmos, and mental retardation. In 1954, renal Fanconi syndrome was recognized as being associated with Lowe syndrome and in 1965, a recessive X-linked pattern of inheritance was determined.2,4 Lowe syndrome is a very rare disease, with an estimated prevalence in the general population of 1 in 500,000. According to the Lowe Syndrome Association (LSA) in the USA, the estimated prevalence is between 1 and 10 affected males in 1,000,000 people, with 190 living in the year 2000. The Italian Association of Lowe Syndrome estimated that there were 34 Lowe syndrome patients (33 boys and one girl) living in Italy in the year 2005.2,4,5 It almost exclusively affects males.6 Physicians may not be familiar with Lowe syndrome due to its rarity.4

Meningioma is not uncommon case; however, the differentiation of high-grade from low-grade meningioma is important. The rate of recurrence of grade I meningioma is 7-20%, but in grade II meningioma is 30-40% and in grade III 50-80%. Non-invasive MRI techniques that can differentiate high-grade from low-grade meningiomas before surgery are useful for surgical planning and subsequent treatment. We present a review article and some case studies of low-grade (WHO grade I) and high-grade (WHO grade II and grade III) meningioma with conventional MRI and continue with advanced MRI; we performed diffusion weighted imaging (DWI) with apparent diffusion coefficient (ADC) value, dynamic susceptibility contrast (DSC), dynamic contrast-enhanced (DCE) magnetic resonance (MR) perfusion and 3D ASL. From these three cases show that advanced magnetic resonance imaging with ADC value, DSC, DCE, and 3D arterial spin-labelling (ASL) is an essential sequence to differentiate high-grade from low-grade meningioma.

We should be aware of the uncommon presentation during the pandemic scenario of the Coronavirus 2019 disease (COVID-19). Pneumothorax, pneumomediastinum, pneumoperitoneum, and massive emphysema subcutis are uncommon complications of COVID-19 Pneumonia. The presence of pneumomediastinum and massive emphysema subcutis were rarely reported in the literature. We present a 69-year-old man with COVID-19 Pneumonia with these complications who were managed conservatively and experienced spontaneous resolution of the complications two weeks later. He was admitted to the intensive care unit and was given a ventilator. Pneumonia, massive emphysema subcutis, pneumomediastinum, and pneumothorax are identified from chest X-ray. An Unenhanced thoraco-abdominal CT Scan revealed the presence of a small pneumoperitoneum. However, a CT scan of the abdomen and pelvis did not show any evidence of bowel perforation. It is necessary to detect these complications earlier, so the management can reduce the associated morbidity and mortality.

Background : Magnetic resonance cholangiopancreatography (MRCP) is MRI examination to visualize to visualize a disorder in part biliary or of the human bile. The artefact in the image MRCP is often happened due to the movement of respiratory system. Purpose :  This study to compare the better image quality between Breath Hold (SSTSE) and Repiratory Triggering (TSE)techinques. Methods : This study used observational analytic study with prospective approach. 16 samples were examined with two techniques SSTSE and TSE respectively in order to get 3D MRCP image. The Signal to Noise Ratio (SNR) and Contrast to Noise Ratio (CNR) is measured to evaluate the image quality. Result: The SSTSE technique only has a higher SNR in gallbladder meanwhile the TSE technique has a higher SNR in pancreatic duct. The higher CNR is got using TSE technique. Conclusion :  The TSE showed the higher SNR in pancreatic duct and the higher CNR is got with SSTSE technique. The recommendation technique for evaluating pancreatic duct is respiratory triggering.

This study aims to determine the relationship between disc height as objective data and the degree of disc degenerative Pfirrmann score assessed on MRI imaging, the imaging modality with the best current degenerative lumbal disease’s diagnosis. The measurements of disc height and Pfirrmann degenerative degree of the intervertebral disc were performed on a T2WI MRI sequence, sagittal sections of the 1-2 lumbar intervertebral discs to 5-sacral 1 (5 disc levels) using dicom MRI data using the Horos dicom viewer software. Analysis of the correlation between disc height and the degree of degeneration on MRI was performed using the Pearson correlation test. Statistical tests were performed using SPSS software (SPSS Inc., Chicago, IL, USA). The results were evaluated with a significance value of p<0.005. The results of the Pearson test in the three groups of patients, namely in the HNP L4-L5, HNP L5-S1 and HNP patient groups at both disc levels showed an inverse relationship between disc height and Pfirrmann's degenerative degree which was statistically significant, with values ​​in the L4 HNP group.

Status epileptikus (SE) merupakan kegawatan neurologis akibat kegagalan terminasi dari bangkitan dan juga hipereksitasi neuron sehingga menyebabkan bangkitan yang abnormal atau berkepanjangan. Mortalitas terkait SE terus mengalami peningkatan, terutama pada populasi geriatri. Hal ini menyebabkan SE menjadi penyakit dengan biaya pengobatan yang besar khususnya di negara-negara terbelakang dan berkembang. Pemahaman terkait elektroensefalogram (EEG) pada SE dapat membantu dalam penentuan diagnosis secara akurat dan pemberian terapi secara tepat. Penelitian ini bertujuan untuk mengetahui gambaran EEG pasien SE di Departemen Neurologi RSUD Dr. Soetomo. Penelitian dilakukan secara observasional deskriptif dengan desain studi potong lintang menggunakan data sekunder dari rekam medis pasien dengan diagnosis SE pada periode Januari 2016 – Desember 2019. Data pasien yang lengkap kemudian dilakukan analisis berdasarkan usia, jenis kelamin, etiologi, komorbid, tipe bangkitan, onset terjadinya SE, jarak waktu antara onset dengan pelaksanaan EEG, keadaan klinis, dan gambaran EEG. Hasil: Sebagian besar pasien SE dalam penelitian ini berjenis kelamin laki-laki dengan kelompok usia >1-10 tahun, diikuti kelompok usia >19-60 tahun. Etiologi SE terbanyak adalah meningoensefalitis, diikuti oleh epilepsi dan stroke. Populasi anak dan geriatri lebih rentan terhadap infeksi yang dapat menyebabkan SE, terutama di negara berkembang. Sebagian besar pasien tidak memiliki komorbid lain dan menjalani pemeriksaan EEG dalam waktu 3-<7 hari setelah bangkitan terakhir, dengan onset general sebagai onset SE yang dominan. SE konvulsif adalah jenis SE yang paling banyak dengan bangkitan general tonik-klonik sebagai manifestasi motorik terbanyak. Temuan EEG yang terbanyak adalah interiktal general diikuti oleh interiktal fokal. Sharp/spike wave dan continuous slow activity merupakan gambaran pelepasan epileptiform dan non-epileptiform terbanyak secara berurutan.

This study aims to provide the latest information regarding the accuracy of contrast and non-contrast 1.5 Tesla MRI in the diagnosis of lumbar Herniated Nucleus Pulposus (HNP) compared with surgical findings. We included studies with subjects diagnosed with lumbar HNP due to degenerative processes, preoperative 1.5 Tesla contrast, and non-contrast MRI and described the number of findings of MRI diagnostic tests (index test) on the actual conditions found during surgery (reference standard). We searched literature from 5 databases: ProQuest, Pubmed, Cochrane Library, Biomed Central, and ScienceDirect. The sensitivity and specificity of contrast and non-contrast 1.5 Tesla MRI ranged between 64-95% and 55-100% (95% CI) with the area under the curve above the threshold on the ROC curve. Two studies compared the accuracy of MRI and Computed Tomography (CT) myelography with a wider ROC curve on CT myelography than on MRI. The ROC curve which has a wide area under the curve above the threshold depicts the relationship between sensitivity and specificity, shows that contrast non-contrast 1.5 Tesla MRI has a good accuracy in HNP diagnostic.

Schwannomas are the most common peripheral nerve sheath tumors. Benign schwannomas with malignant transformation are rarely reported. Most common schwannomas occur in the head and neck region. Sciatic schwannomas are rare, as are completely cystic schwannomas. Sciatic nerve schwannomas represent less than 1% of all schwannomas. Benign tumors in the sciatic nerve consist of 60% neurofibromas and 38% schwannomas. In general, a schwannoma induces chronic symptoms. It can be misleading, sometimes mimicking degenerative spinal pathology due to disc herniation. Schwannoma involving the sciatic nerve can be asymptomatic or may present with sciatica or neurological deficits. Most schwannomas are solid or heterogeneous tumors, and completely cystic schwannomas are rare. The differential diagnoses of nondiscogenic sciatica include lumbar disc herniation, tumor, abscess, hematoma, facet syndrome, lumbar instability, sacroiliitis, piriformis syndrome, and sciatic neuritis. We report a rare case of a long completely cystic sciatic schwannoma in the left foraminal L5–S1 zone extending to the left ischial groove with chronic sciatica that was diagnosed radiologically with a combination of conventional MRI and MR neurography and confirmed histopathologically by surgical resection. The patient previously had conservative therapy, but the complaints were not reduced. Nonsurgical therapy is considered the first choice, and surgical therapy is indicated in cases that do not respond to conservative therapy, with recurrent cysts, severe pain, or neurological deficits.