Acute necrotizing encephalopathy (ANE) is a rapidly progressing neurologic disorder that occurs in children after common viral infections of the respiratory or gastrointestinal systems. This disease is commonly seen in East Asia. Normal healthy infants and children can get affected. The condition carries a poor prognosis with high morbidity and mortality rates. We report here a case of a 23-year-old female with ANE and describe its neuroimaging findings. Magnetic resonance imaging examination performed showed symmetric lesions involving the thalami, brainstem, and cerebellum.
BACKGROUND Clinical diagnosis of a scrotal swelling is not straightforward. It is often difficult to decide whether a palpable scrotal m ass is intratesticular or extratesticular. Moreover, the clinical examination may over look significant pathology and physical signs elicited may be improperly interpreted. The sonogram with high frequency linear transducer and colour Doppler is invaluable in evaluating scrotum and its contents. Sonography is simple to perform, rapid, non-invasive, relatively inexpensive, easily reproducible, widely available and does not expose the gonads to radiation. Aim and Objective-To evaluate various scrotal pathologies using ultrasonography and to describe the role of high resolution ultrasound and colour Doppler in their diagnosis.
Background:
Proximal “Hirayama” disease (PHD) is characterized by proximal upper extremity atrophy. It is a rare variant of Hirayama disease (HD) which involves the proximal upper limb. Recognition of PHD’s unique magnetic resonance (MR) findings is critical as the treatment options differ versus classical HD.
Case Description:
A 17-year-old male presented with gradual progressive upper extremity weakness and atrophy. On MR, PHD was demonstrated by C4-C5 kyphosis with a posterior epidural soft-tissue mass compressing the C4-C5 cord resulting in gliosis. As the patient declined surgery, he was followed for 1 year with a cervical collar during which time his deficit stabilized.
Conclusion:
PHD, characterized by proximal upper extremity weakness and atrophy, has characteristic MR findings of kyphosis associated with cord compression and ischemia/gliosis. Select patients as the one we described who decline surgery may stabilize radiographically and clinically with the protracted utilization of a cervical collar.
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