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Intracranial dolichoectatic carotid and middle cerebral artery (ICDA) may cause ischemia by multiple mechanisms, including thrombosis, embolism, and occlusion of the involved arteries. We sought clinical and hemodynamic mechanisms in 8 patients with ICDA and stroke, corresponding to 0.4% of our patients with ischemic stroke, and compared these data with those for patients having ICDA without stroke. Hypertension and transient ischemic attack were the significant findings in patients with stroke compared with those without stroke. Patients with stroke were more likely to have an embolism from the stagnated vascular bed and less frequently had compression of the neighboring structure of the elongated arteries.

We report a case of aberrant hypoplastic pedicle of the fourth lumbar vertebra and ipsilateral conjoined nerve root. Ipsilateral retroisthmic laminar defect, dysplastic lamina and transverse process, enlargement of neural foramen, hypoplasia of superior and inferior articular facet were present as associated with other neural arch anomalies. The extent of these anomalies was well demonstrated by MR imaging.

The widespread use of computed tomography (CT) and magnetic resonance (MR) imaging has increased the preoperative diagnosis of dermoid tumors and detection of their complications. In particular, cases of ruptured dermoid tumors, which may manifest as emergent conditions with variable clinical pictures, have typical CT and MR imaging findings. In this report, we present a case of a spinal dermoid tumor, which ruptured into the syrinx cavity and subarachnoidal space.

Background and Purpose: Dysarthria characterized by slurring with imprecise articulation without evidence of aphasia is a frequent symptom in the acute phase of cerebral ischemia, although there is little knowledge on its anatomic specificity and spectrum of associated clinical characteristics regarding diffusion-weighted imaging (DWI). Methods: An investigation of 101 consecutive patients with sudden-onset dysarthria due to a single or multiple lesions on DWI, corresponding to 8.7% of 1,160 patients with ischemic stroke, was made. The presence of lesions of the cranial arteries was sought by magnetic resonance angiography and reviewed with a three-dimensional rotating cineangiographic method. Results: Dysarthria was mostly associated with a supratentorial lesion (63%) and with a classic lacunar stroke syndrome in 45% of patients. Lacunar lesions on DWI were found in 69 (68%) patients, while only 45 of the patients (65%) with a lacunar infarct presented a classic lacunar syndrome with dysarthria. Pure dysarthria occurred in 15% of patients, dysarthria + pure motor hemiparesis in 14%, dysarthria + ataxic hemiparesis in 11%, dysarthria + clumsy hand syndrome in 7%, dysarthria + pure sensory stroke in 3%, dysarthria + central facial paresis in 8% and lingual paresis occurred in 2%. The lesions were due to small-artery disease in 41%, large-artery disease in 15%, cardioembolism in 10% and a mixed etiology in 3%. The cause of stroke was not identified in 17 patients. Lesions on DWI were found mainly in the corona radiata (n = 18), middle cerebral artery territory, including the motor cortex and/or insular cortex (n = 13), striatocaudate nuclei (n = 11), primary motor cortex (n = 10), internal capsule (n = 7), pons (n = 25), pontobulbar junction (n = 5) and the thalamomesencephalic junction (n = 4). Isolated cerebellar infarctions (n = 6) or associated brainstem lesions (n = 6) affected mostly the superior cerebellar artery or the posterior inferior cerebellar artery territory. Conclusion: Cortical involvement was more frequent in patients with pure dysarthria than those with dysarthria and additional neurological signs, while the frequency of pontine involvement was higher in patients with additional neurological signs than those with pure dysarthria. One third of the patients with dysarthria had multiple lesions on DWI, and the most common cause of stroke was small-artery disease. Pure dysarthria, dysarthria with lingual paresis, dysarthria with clumsy hand and dysarthria with facial paresis had predictive value for lacunar lesions.

Introduction The aim of this study was to evaluate the role of diffusion-weighted imaging (DWI) in the diagnosis of viral encephalitis and its relationship with the stage of the illness. Methods We performed conventional magnetic resonance imaging ( MRI) including T1-W, T2-W and fluid attenuated inversion recovery ( FLAIR) sequences and DWI in 18 patients with viral encephalitis diagnosed on the basis of laboratory, clinical and radiologic findings. Based on the qualitative and quantitative comparison of the conventional MRI and DWI, the patients were divided into three groups. Apparent diffusion coefficient ( ADC) values of the involved and contralateral normal brain tissues were computed and compared for each group. The degree of correlation between the time (TI) from the onset of neurologic symptoms to the MR examination and ADC values was determined. Results In group I (n=11) DWI was superior to conventional MRI in detecting the encephalitic involved sites and in depicting the borders of the encephalitic lesions. In group II (n=4) DWI was similar to conventional MRI. In group III (n=3) conventional MRI was superior to DWI. Mean ADC values of affected versus contralateral normal brain tissues were 0.458+/-0.161 x 10(-3) versus 0.86 +/- 0.08 x 10(-3) in group I, 0.670 +/- 0.142 x 10(-3) versus 0.93 +/- 0.07 x 10(-3) in group II, and 1.413 +/- 0.211 x 10(-3) versus 1.05 +/- 0.06 x 10(-3) in group III. Patients in group I had significantly lower ADC values than those in group II, while patients in group III had the highest ADC values ( P< 0.05). The ADC values were significantly lower in the affected sites than in the unaffected sites of patients in groups I and II, but were significantly higher in the affected sites than in the unaffected sites of patients in group III ( P< 0.05). There was an excellent correlation between ADC values and duration of the disease (r= 0.874, P= 0.01). Conclusion DWI is superior to other conventional diagnostic MR sequences in the detection of early viral encephalitic lesions and depiction of the lesion borders and, in combination with other sequences, DWI may contribute to the determination of the disease phase. C1 Pamukkale Univ Sch Med, Dept Radiol, TR-20070 Denizli, Turkey. Ege Univ Sch Med, Dept Radiol, Izmir, Turkey. Ege Univ Sch Med, Dept Neurol, Izmir, Turkey.

Various neoplastic, vascular, and developmental causes may lead to spinal neural foraminal widening, the most common causes of spinal dumbbell lesions being schwannomas and neurofibromas. Occasionally, some other slow-growing tumors may cause neural foraminal widening. We report an exceptional case of a low-grade spinal chondrosarcoma which apparently developed from a pre-existing osteochondroma in the neural arcus of C6. The lesion passed through the C5-C6 foramen, producing a dumbbell mass.

Background and Purpose: To characterize clinically acute external (EcC) and extreme capsular (ExC) strokes in 9 patients with first-ever acute stroke. Methods: Nine patients with a lesion limited to the EcC-ExC region proven by diffusion-weighted imaging included in our registry, corresponding to 0.3% of 3,600 patients with ischemic stroke, were studied. Results: We found three main groups of clinical manifestations: (1) motor deficits in all patients (4 with faciobrachial, 2 with faciobrachiocrural, and 1 with brachiocrural, crural and facial paresis each); (2) hypesthesia in 3 patients with partial distribution concerning light touching without involvement of other sensory modalities; (3) transient speech disturbance at stroke onset in 1 patient and dysarthria in 2 patients. Small artery disease in 4 patients and artery-to-artery embolism in 3 patients probably from atherosclerotic carotid artery were the main stroke mechanism. Conclusions: Strokes restricted to the EcC-ExC region may present with complete or partial motor syndromes and dysarthria as prominent clinical presentations, but also fou rire prodromique and transient speech arrest as prodromal signs. The main etiology of stroke were microangiopathy and artery-to-artery embolism, even though no obvious cause was found in 1 patient. The prognosis was good in almost all patients.

Basilar artery dolichoectesia (BD) may cause brainstem ischemia by multiple mechanisms, including thrombosis, embolism, occlusion of deep penetrating arteries. The objective of this study was to determine and characterize clinical, imaging findings and hemodynamic mechanisms in patients with cerebrovascular event associated with BD and compare these data with those for patients with BD who did not have stroke. We studied 29 consecutive stroke, two transient ischemic attack (TIA) patients with BD who have been admitted to our stroke unit. We sought the diameter of ectasia, height of the bifurcation, lateral displacement, shape deformities, and blood flow velocity of the basilar artery (BA) by transcranial Doppler. Imaging and hemodynamic findings were compared with those found in a group of 18 patients without stroke or TIA. The main infarct localization was pons, eight (28%) with restricted single lesion, 10 (32%) with multiple lesions involving thalamus, midbrain, posterior cerebral artery (PCA) territory. Patients with BD were more probably to have had stroke fitting a clinical and imaging patterns of multiple infarcts than those with restricted infarct in territories supplied by branches of the BA (60% vs. 40%). Hypertension and atherosclerotic changes of the posterior circulation were more frequent in patients with stroke than those without (P = 0.004 and P = 0.028, respectively), whilst the incidence of other vascular risk factors were not significantly different in two groups. Patients with stroke/TIA had more often low blood flow velocity but not significant in the BA when compared with those for BD patients without cerebrovascular event (71% vs. 39%; P = 0.1). Reduced blood flow velocity in the BA was correlated significantly with distal lesions involving thalamus, midbrain and PCA territory rather than those located in the territory supplied by branches of the BA (P = 0.02). In conclusion, it seems probably that BD may cause vertebrobasilar system ischemia by multiple mechanisms, especially reduced blood flow in the BA and atheromatous changes in the vertebrobasilar system may precipitate thromboembolic stroke.

The clinical, etiological and stroke mechanisms are defined well before but the detailed clinical and etiologic mechanisms regarding to all clinical spectrum of posterior inferior cerebellar artery (PICA) infarcts were not systematically studied by diffusion-weighted imaging (DWI).Seventy-four patients with PICA territory ischemic lesion proved by DWI with decreased apparent diffusion coefficient and FLAIR (fluid attenuation inversion recovery) included in our Registry, corresponding to 2% of 3,650 patients with ischemic stroke, were studied. The presence of steno-occlusive lesions in the posterior circulation were sought by magnetic resonance angiography, and reviewed with a three-dimensional rotating cineangiographic method.We found six subgroups of PICA territory infarcts according clinico-topographical relationship: (1) 9 patients with lesion in the territory lateral branch of PICA; (2) 23 patients with an infarct in the territory of medial branch of PICA; (3) 9 patients with a lesion involving both medial and lateral branches of the PICA; (4) 9 patients with cortical infarcts at the boundary zones either between medial and lateral branches of the PICA or between PICA and m/l superior cerebellar artery (SCA); (5) 10 patients with a lesion at the deep boundary zones either between medial and lateral PICA, or between PICA and medial/lateral SCA; (6)14 patients with concomitant multiple lesions in the PICA and in other vertebrobasilar artery territories. The main cause of PICA infarcts was extracranial large-artery disease in 30 patients (41%) patients, cardioembolism and in situ branch disease in 15 patients (20%) each.Multiple PICA territory lesions on DWI were not uncommon and could be caused by multiple emboli originating from break-up of atherosclerotic plaque in the subclavian/innominate-vertebral arterial system. DWI findings of single or multiple small lesions could account for some cases with transient and subtle cerebellar symptoms which have been considered before as 'vertebrobasilar insufficiency' without morphologic lesion. Different clinical-DWI correlations allow us to determine better definition of the topographical and etiological spectrum of acute PICA territory lesions, which was previously defined by pathological and conventional MRI studies.

Purpose: To investigate the role of the CISS (constructive interference in steady state) sequence in sacral meningeal cysts. Material and Methods: Fourteen patients with sacral meningeal cysts were included. Conventional T1W and T2W sequences and the CISS sequence (TR/TE=12.25/5.90) were obtained at 1.5‐T. The 1‐mm‐thick base images and multiplanar reformatted images of the CISS sequence were studied. The sacral meningeal cysts were classified by the CISS sequence in accordance with the previously described surgical and histopathological criteria. Results: A total of 25 sacral meningeal cysts were identified in the 14 patients. The cysts and their contents were visualized by the CISS sequence, and the CISS sequence was superior to the T1W and T2W images. Fifteen of the cysts were consistent with type I lesions (extradural meningeal cysts without nerve fibers inside) and 10 cysts with type II lesions (extradural meningeal cysts with nerve fibers inside). There were no type III lesions (intradural meningeal cysts) in the sacral region. Conclusion: Previous studies have indicated that conventional MRI as well as magnetic resonance myelography are inconsistent for a classification of sacral meningeal cysts. The CISS sequence with its capability to obtain T2W thin slice acquisitions is superior in showing the nerve root fibers contained in the cysts, which is essential in the differentiation of type I and II cysts. Application of the CISS sequence is recommended in the diagnosis of sacral meningeal cysts.

Purpose: To investigate the efficacy of diffusion‐weighted imaging in patients with Wallenberg's lateral medullary syndrome. Material and Methods: Thirteen patients with Wallenberg's lateral medullary syndrome were examined with conventional and echoplanar diffusion‐weighted magnetic resonance (MR) imaging in a 1.5 T magnetic resonance unit. MR examinations were obtained in the acute or subacute stage of clinical syndrome, and diffusion‐weighted imaging (DWI) was considered to be positive for infarction when an increase in signal was seen on b=1000 s/mm2 images in the posterolateral medullary localization. Results: DWIs were positive in 12 patients in the acute or subacute stages of this clinical syndrome. A false‐negative result was obtained in only one patient examined within the first day, 10 h after onset of the symptoms. In the visual evaluation of the DWI, the contrast between normal and infarcted brainstem area was better in the high b‐value images than in the apparent diffusion coefficient map images. Conclusion: DWI is a valuable technique for examining patients presenting with the signs and symptoms of Wallenberg's syndrome and high b‐value images can provide complementary data to T2‐weighted images. However, because most of our case group were in either the acute or subacute stage, true sensitivity of the method in the hyperacute stage of the syndrome remains unclear.

Superficial siderosis of the central nervous system is a rare condition characterized by deposition of hemosiderin in the leptomeninges, subpial tissue and spinal cord. Magnetic resonance imaging provides prompt diagnosis of this entity. Three cases of cerebral superficial siderosis are presented in this study. On T2-weighted images, typical hypointense rims were observed under the brain surface. In one patient, there was also spinal superficial siderosis findings.

Our aim was to determine the value of MR angiography (MRA) in combination with MRI in the diagnosis and follow-up of craniocervical artery dissections (CCAD) and to document the effectiveness of conservative medical treatment in these patients.In seven patients, six internal carotid artery dissections and two vertebrobasilar artery dissections were studied with 2D and 3D TOF MRA and fat-saturated T1W images. MRA projection images, source images, and T1W images with fat saturation were evaluated for the presence or absence of criteria for dissection.MRA projection images showed narrowing and/or occlusion of lumen in all patients. Dissection flap was identified in 5 of the 8 dissections. Both MRA source images and T1W images with fat saturation were useful in showing the increased external diameter of the dissected vessel and the mural hematoma; although the latter proved to give better results. Almost complete resorption of hematoma and normalization of flow were achieved between 1.5 to 7 months.This study further supports the approach that MRA accompanied by T1W images with fat saturation should be the method of choice in the diagnosis and follow-up of CCAD. Fat-suppressed T1W images improve detection of the mural hematoma, especially in the late sub-acute phase and during follow-up. Conservative medical treatment may be effective, obviating the need for aggressive treatment options.

Hemiplegic migraine is defined by the occurrence of migraine during attacks of unilateral weakness. Neurologic symptoms last for 15 to 60 minutes in most cases. Attacks usually start in childhood, adolescence, or early adulthood. Diagnosis may be delayed if there is no relevant family history. A 16-year-old girl who was diagnosed with hemiplegic migraine presenting with prolonged left hemiparesis is reported. The importance of this case is that the pediatrician will also consider migraine in the differential diagnosis of a child presenting with hemiparesis even if there is no previous headache and family history. (J Child Neurol 2002;17:80-81).

In this paper, we describe two siblings with Juvenile Hyaline Fibromatosis (JHF) who were diagnosed at the age of 34 and 29 years respectively. JHF is a very congenital disease, mainly diagnosed in the first few years of life, with less than 40 published cases in literature. All the main clinical features of this syndrome, which may be summarised as multiple subcutaneous tumours, marked gingival hypertrophy, flexion contractures and osteolytic lesions were present in both of these cases. Clinical, radiological and histological differential diagnosis of JHF were made. Recent information about histopathology, treatment and prognosis of JHF was also reviewed.

We present computerized tomography (CT) and magnetic resonance imaging (MRI) findings of a costal hydatid cyst (Echinococcus multilocularis) causing spinal cord compression. The hydatid disease was proved histologically. MRI was not only very useful for determining the spinal extension of the disease by its multiplanar imaging capability, but also gave important information about the texture of the cyst, thus aiding the preoperative diagnosis.

Transcatheter arterial embolization (TAE) is alternatively employed to surgical resection in the management of hepatocellular carcinoma (HCC). TAE through the hepatic artery is sometimes insufficient since the blood supply to HCC may be from the collateral vessels as well. We report a case of HCC with abdominal wall invasion who underwent TAE through the right internal mammary artery after insufficient embolization of the tumor through the hepatic artery.

WOS: 000278603300005, PubMed ID: 22933898, Background. The aim of the study was to investigate the value of diffusion weighted MR imaging in the diagnosis of Modic type 1 change, which may be confused with the acute infectious spondylodiscitis on conventional MR imaging. Patients and methods. Twenty-seven patients with erosive intervertebral osteochondrosis, Modic type 1 and 18 patients with spondylodiscitis were included in this retrospective study. All images were acquired using on 1.5 Tesla MR units. Lumbar spinal MR imaging of 45 patients were retrieved from a digital database of a radiology record system and evaluated by one experienced radiologist. Patients with Modic type 1 change had CT slices obtained from the diseased disc space and the affected vertebrae. Results. Bone marrow adjacent to the vertebral end plate in both Modic type 1 change and acute spondylodiscitis were hypointense on T1-weighted images. On T2-weighted images corresponding levels of vertebral end-plates showed hyperintense signal intensity in both group. All the patients with spondylodiscitis and Modic type 1 change were hyperintense and hypointense on diffusion-weighted MR images, respectively. Conclusions. Our findings suggest that diffusion weighted MR imaging is an useful method in differentiating Modic type 1 changes from acute spondylodiscitis, both of which may mimic each other, either on clinical or conventional MRI findings.