W e read with great interest the article by Toledano-Massiah et al 1 entitled, "Unusual Brain MRI Pattern in 2 Patients with COVID-19 Acute Respiratory Distress Syndrome." The authors reported 2 patients hospitalized in their intensive care unit with confirmed coronavirus disease 2019 (COVID-19) in whom brain MR imaging had shown an unusual DWI pattern with nodular and ring-shaped lesions involving the periventricular and deep white matter. Based on the recent literature, the authors discussed the probable mechanism of action for Severe Acute Respiratory Syndrome coronavirus disease 2 (SARS-CoV-2) neurologic invasion. We treated 2 hospitalized patients who share some similarities with the reported unusual brain MR imaging pattern. Patient 1 was a previously healthy 49-year-old man whose CT revealed interstitial pneumonia and with real-time polymerase chain reaction (RT-PCR) was positive for SARS-CoV-2. Endotracheal intubation and mechanical ventilation with prolonged sedation were required because of severe respiratory failure. He presented with delayed recovery of consciousness after protracted sedation. Patient 2 was a previously healthy 9-year-old child with a family history of COVID-19 who had difficulty walking and speaking, right hemiparesis, and impaired ocular motor function. There were no respiratory symptoms. The serologic test for COVID-19 was positive. Brain MR imaging was performed on day 30 from hospitalization for patient 1 (day 5 after the sedation) (Fig 1) and on day 7 for patient 2 (day 37 after the first symptoms) (Fig 2). At that time, patient 1 showed progressive clinical and laboratory improvement of COVID-19, and patient 2 remained without respiratory symptoms with blood RT-PCR negative for SARS-CoV-2. The CSF RT-PCR for SARS-CoV-2 was negative for patient 1 and not available for patient 2.

This study supports previous results and demonstrates the utility of amplitude-integrated electroencephalography for monitoring brain function and predicting early outcome in the studied groups of infants at high risk for brain injury.

A 42-year-old man presented with a 3-year history of headache. Neurologic examination was unremarkable. Brain MRI showed multiple peripheral cerebellar nodules, some containing fat (figure). Biopsy revealed neurocytic cancer cells scattered with mature fat tissue. The approach was conservative with serial imaging follow-up. Cerebellar liponeurocytoma is a rare tumor classified as grade II by the World Health Organization, 1 now considered a clinicopathologic entity distinct from medulloblastoma.1 It is almost always solitary and almost always cerebellar. The clear multifocality of the MRI findings makes this case unusual. 2Thiago Luiz

Central nervous system infections remain an important cause of morbidity and mortality worldwide. Meningitis is the most common manifestation. Pathogens vary based on the location of the infection, geography, vaccination status, age, surgical intervention, and immune status. They are conside red medical emergencies requiring immediate diagnosis and therapy, and crucial steps are needed to achieve a good clinical outcome. Lumbar puncture is the fi rst step in their evaluation, and imaging of the brain is often indicated in patients with neurologic defi cits, altered immunity, or decreased level of consciousness.

A 49-year-old woman presented with progressive ascending quadriparesis associated with paresthesias and recent wide-based gait. Cognitive impairment associated with reduced vibration and proprioception sense was observed. Brain MRI documented the presence of extensive white matter demyelination (Figure 1). Megaloblastic anemia, low B12 level and chronic gastritis were confirmed (Figure 2

ResumoO osteolipoma é uma rara variante benigna do lipoma e constitui menos de 1% de todos os lipomas, se apresentando como uma massa indolor bem circunscrita. É um tumor conhecido por ocorrer em várias regiões, comumente intraósseas ou adjacente ao tecido ósseo, cuja patogênese ainda não está clara. Os exames de imagem são úteis em sua avaliação e, principalmente, no planejamento cirúrgico, que consiste na exérese tumoral. Contudo, o diagnóstico definitivo do osteolipoma é realizado pelo exame histopatológico. Apesar de benigno, o osteolipoma pode comprimir estruturas ao seu redor, levando a importante sintomatologia como neste caso relatado em que está em contato com o plexo braquial.

CNS WM tracts are mainly composed of axons, and when these structures undergo apoptosis or lose their integrity, neurodegeneration may occur. Secondary neuronal degeneration can be classified as axonal degeneration and involves only the first neuron in a pathway (Wallerian degeneration of the corticospinal tract being its prototype) or be classified as transaxonal degeneration and involve more than a single neuron in a common pathway, usually a closed neuronal circuit, in specific tracts, such as the dentate-rubro-olivary tract, tracts of the limbic system, corticopontocerebellar tract, cranial nerve tracts, and nigrostriatal pathway. This study aimed to review the anatomy of the main CNS tracts susceptible to secondary neuronal degeneration and to illustrate, through different imaging modalities, the findings associated with this poorly explored and understood process involved in the pathophysiologic substrate of numerous neurologic diseases.Learning Objective: Recognize the anatomy of the main CNS tracts susceptible to secondary neuronal degeneration and identify its main imaging findings in different imaging modalities.

Idiopathic intracranial hypertension (IIH) is a disease characterized by an increase in the opening pressure of the cerebrospinal fluid (CSF) associated with symptoms of elevated intracranial pressure (ICP). The condition is more prevalent in women and typically managed clinically. Surgical treatment is reserved for select refractory cases. The well-established surgical procedures for the management of IIH are CSF shunting and fenestration of the optic nerve sheath. These procedures, however, are associated with high rates of complication and recurrence.More recently, venous sinus angioplasty with stents has been employed in cases with documented narrowing of the sigmoid-transverse sinuses. This technique is associated with a significant reduction in the venous pressure gradient at the stenosis site, alleviating the symptoms of intracranial hypertension.We report a case of a previously healthy 12-year-old patient who presented with 10-day history of headaches, blurring of vision, nausea and vomiting, which evolved with worsening of the visual acuity and papilledema. Imaging scans disclosed stenosis of the right transverse and sigmoid sinuses. The patient underwent stenting of the stenotic venous segments and showed good evolution, with significant clinical improvement within 24 hours of the procedure.