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Background: Neurovascular conflict is considered one of the main causes of Trigeminal neuralgia, and 3D fast imaging employing steady-state acquisition magnetic resonance imaging (MRI) is the diagnostic imaging of choice. However, no tool is available to confirm imaging findings as the primary cause of trigeminal neuralgia because neurovascular contact is frequently found in asymptomatic individuals, according to some literature, although very little data is available till now. Therefore, we aim to determine the frequency of trigeminal neurovascular contact, involved nerve segment, culprit vessel, and characteristics of contacts in asymptomatic individuals. Knowledge about this is very crucial so that every patient may not be labeled as having neurovascular conflict as the primary cause and can be saved from unnecessary surgeries., Methods: A retrospective observational study was conducted on 105 MRI brain scans of asymptomatic individuals for trigeminal neurovascular relationships by two expert neuro-radiologists. Percentages calculated for categorical variables and for continuous variables Shapiro-Wilk test were used. The Fisher Exact test is used to assess the association between conflict and other variables. Inter-rater reliability was computed for the outcome and other variables and Cohen's kappa to evaluate the strength of agreement. All calculations were performed using STATA version 17.0., Results: Out of 105 cases, neuro-vascular contact was identified in 64 cases. The most common contacting vessel was the superior cerebellar artery. The most common nerve segment involved was the cisternal segment, followed by the Root entry zone and porous trigeminus. In about 54 cases, the vessel was abutting the nerve, while in eight cases, it was compressing and, in two cases, displacing the nerve. The superior surface of the nerve was commonly involved. The inter-rater reliability between both neuroradiologists showed significant agreement., Conclusion: Neurovascular contact is found in asymptomatic individuals, so just the presence of contact in symptomatic individuals on MRI should not be considered as only the cause of trigeminal neuralgia. It is important to identify nerve thinning and distortion, which are more reliable signs., Competing Interests: There are no conflicts of interest., (Copyright: © 2025 Surgical Neurology International.)

Purpose: The study aims to evaluate the magnetic resonance (MR) features of central nervous system (CNS) fungal infections and determine the associations between these findings and the type of fungus. Our main objective was to assess whether imaging can serve as a predictor for identifying the specific group of fungi responsible for the infection using microbiology and histopathology as a benchmark., Materials and Methods: A retrospective analysis was done on 50 patients with proven CNS fungal infections. Fungal type was determined and grouped according to microbial classifications into four subtypes: hyalohyphomycetes, mucorales, yeasts and dematiaceous molds. MR findings were compared with histopathology/microbiology and associations between fungal groups were sought., Results: A total of 37 males and 13 females with a mean age of 39.3 years were included in the study. Aspergillus spp. infection (48%) was the most common. Most patients (54%) had an underlying risk factor for the infection. Pseudo-tumoral mass-like behavior was observed with Aspergillus, and the presence of meningitis was associated with yeast infections (p < 0.001). Of the 19 abscesses, 9 (47.3%) showed a dual rim sign on susceptibility-weighted imaging (SWI), and 10 (52.6%) showed intracavitary dot-like foci of dropouts on SWI. Both findings were statistically significant with dematiaceous molds (p = 0.04 and p = 0.009, respectively)., Conclusion: Although radiological characteristics are non-specific and can overlap with each type of fungi, our study shows that certain MR features can help radiologists point towards the causative type. More specifically, dot-like foci of susceptibility point towards abscesses caused by dematiaceous molds possibly owing to melanin pigment and metal chelation properties., Competing Interests: Declarations. Ethics approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent: The requirement for obtaining written informed consent was waived by our Institutional Review Board. (IRB number 2022-7838-22486) Conflict of interest: The authors have no relevant financial or non-financial interests to disclose. Presentation: The preliminary findings of this study have been presented as an award-winning oral research presentation at Malaysian Congress of Radiology, July 2023 and as a poster presentation in European Congress of Radiology, March 2024., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: Initiated in June 2019, this collaborative effort involved 15 public and private sector hospitals in Pakistan. The primary objective was to enhance the capacity for pediatric neuro-oncology (PNO) care, supported by a My Child Matters/Foundation S grant., Methods: We aimed to establish and operate Multidisciplinary Tumor Boards (MTBs) on a national scale, covering 76% of the population (185.7 million people). In response to the COVID-19 pandemic, MTBs transitioned to videoconferencing. Fifteen hospitals with essential infrastructure participated, holding monthly sessions addressing diagnostic and treatment challenges. Patient cases were anonymized for confidentiality. Educational initiatives, originally planned as in-person events, shifted to a virtual format, enabling continued implementation and collaboration despite pandemic constraints., Results: A total of 124 meetings were conducted, addressing 545 cases. To augment knowledge, awareness, and expertise, over 40 longitudinal lectures were organized for healthcare professionals engaged in PNO care. Additionally, two symposia with international collaborators and keynote speakers were also held to raise national awareness. The project achieved significant milestones, including the development of standardized national treatment protocols for low-grade glioma, medulloblastoma, and high-grade glioma. Further protocols are currently under development. Notably, Pakistan's first pediatric neuro-oncology fellowship program was launched, producing two graduates and increasing the number of trained pediatric neuro-oncologists in the country to three., Discussion: The initiative exemplifies the potential for capacity building in PNO within low-middle income countries. Success is attributed to intra-national twinning programs, emphasizing collaborative efforts. Efforts are underway to establish a national case registry for PNO, ensuring a comprehensive and organized approach to monitoring and managing cases. This collaborative initiative, supported by the My Child Matters/Foundation S grant, showcases the success of capacity building in pediatric neuro-oncology in low-middle income countries. The establishment of treatment protocols, fellowship programs, and regional tumor boards highlights the potential for sustainable improvements in PNO care., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Mushtaq, Qureshi, Javed, Sheikh, Bakhshi, Laghari, Enam, Anwar, Hilal, Kabir, Ahmad, Goraya, Mistry, Rashid, Maaz, Munawar, Khan, Bashir, Hashmi, Saeed, Khandwala, Rehman, Dewan, Khan, Karim, Shaheen, Zia, Yasmeen, Mahmood, Memon, Kirmani, Resham, Kadri, Riaz, Hamid, Ghafoor, Imam, Mushtaq, Rana, Bouffet and Minhas.)

Background: Prominent leptomeningeal contrast enhancement (LMCE) in the brain is observed in some pediatric patients during sedation for imaging. However, based on clinical history and cerebrospinal fluid analysis, the patients are not acutely ill and do not exhibit meningeal signs. Our study determined whether sevoflurane inhalation in pediatric patients led to this pattern of 'pseudo' LMCE (pLMCE) on 3 Tesla magnetic resonance imaging (MRI)., Aim: To highlight the significance of pLMCE in pediatric patients undergoing enhanced brain MRI under sedation to avoid misinterpretation in reports., Methods: A retrospective cross-sectional evaluation of pediatric patients between 0-8 years of age was conducted. The patients underwent enhanced brain MRI under inhaled sevoflurane. The LMCE grade was determined by two radiologists, and interobserver variability of the grade was calculated using Cohen's kappa. The LMCE grade was correlated with duration of sedation, age and weight using the Spearman rho rank correlation., Results: A total of 63 patients were included. Fourteen (22.2%) cases showed mild LMCE, 48 (76.1%) cases showed moderate LMCE, and 1 case (1.6%) showed severe LMCE. We found substantial agreement between the two radiologists in detection of pLMCE on post-contrast T1 imaging (kappa value = 0.61; P < 0.001). Additionally, we found statistically significant inverse and moderate correlations between patient weight and age. There was no correlation between duration of sedation and pLMCE., Conclusion: pLMCE is relatively common on post-contrast spin echo T1-weighted MRI of pediatric patients sedated by sevoflurane due to their fragile and immature vasculature. It should not be misinterpreted for meningeal pathology. Knowing pertinent clinical history of the child is an essential prerequisite to avoid radiological overcalling and the subsequent burden of additional investigations., Competing Interests: Conflict-of-interest statement: All authors declare having no conflicts of interest with any related company, institution or individual., (©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.)

Background: Magnetic resonance imaging (MRI) is regarded as the modality of choice in diagnosis of pituitary macroadenomas. Since surgery is the first line therapy for all pituitary adenomas, simple and reproducible MRI classification based on major directions of tumour growth is an essential tool. SIPAP MRI classification for pituitary adenoma describes tumor extension in parasellar, suprasellar, infrasellar, anterior and posterior directions. We, therefore, evaluated reproducibility of SIPAP classification in reporting of pituitary adenomas., Methods: Forty-nine patients with biopsy-proven pituitary macroadenoma were graded according to SIPAP classification. Data was analyzed using Stata version 15. Interobserver variability was calculated using Cohen's Kappa. Comparison between grading before and after treatment was performed by Chi-square test. P values < 0.05 were considered statistically significant., Results: Individual tumour extensions according to SIPAP for pre- and post-operative grading showed significant difference (p-value <0.001), except for anterior extension. For suprasellar extension, 67.3 % patients had pre-operative grade-3 and 63.3 % had post-operative grade-0. For infrasellar extension, 51.0 % had pre-operative grade-2 and 71.4 % had post-operative grade-0. Anterior, posterior and parasellar extensions showed increased frequency in grade-0 in post-operative stage compared to pre-operative. Substantial inter-observer agreement was achieved for Superior, Inferior, Anterior and Posterior extent with all Kappa statistics values above 0.7 (p-value <0.001)., Conclusion: We propose incorporating simple and objective SIPAP classification in routine MR reporting for ideal pituitary tumour delineation, relationship to juxtasellar structures and tumour size, hence facilitating greater success rate in surgical and subsequent clinical management., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

High-altitude cerebral edema is a rare type of acute mountain illness characterized by consciousness disruption and truncal ataxia. Here we discuss a 40-year-old nondiabetic, nonsmoker male who went on a tour to Nanga Parbat. On returning home, the patient developed symptoms of headache, nausea, and vomiting. His symptoms worsened with time and he developed lower limb weakness and shortness of breath. Later, he underwent a computerized tomography chest scan. On the basis of CT scan findings, the doctors decided that the patient was suffering from COVID-19 Pneumonia despite having negative COVID-19 PCR tests multiple times. Later, the patient presented to our hospital with similar complaints. MRI of the brain revealed T2/fluid-attenuated inversion recovery hyperintense and T1 hypointense signals in the bilateral semioval centrum, posterior periventricular white matter, and corpus callosum genu, body, and splenium. These abnormal signals were discovered to be more evident in the corpus callosum's splenium. Moreover, susceptibility-weighted imaging revealed micro hemorrhages in the corpus callosum. This verified the diagnosis that the patient is suffering from high-altitude cerebral edema. Within 5 days, his symptoms resolved and he was discharged with full recovery., (© 2023 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Salpingo-enteric fistula is a rare disease causing infertility. It occurs when there is a connection between fallopian tube and the intestine. It can be accurately diagnosed with hysterosalpingography. Fistulas mostly occur as a consequence of obstetric complications, however, inflammatory bowel disease, pelvic malignancy, pelvic radiation therapy, iatrogenic causes, and trauma are other potential causes. The possibility of tuberculous salpingitis as a possible cause of salpingo-enteric fistula should always be considered in the developing countries where tuberculosis is endemic., (© 2022 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Introduction: Bifurcated ribs are a neuroskeletal anomaly which are incidentally discovered on chest X-ray. It is a developmental disorder where sternal end of a rib is split into two, commonly found in males, on the right side and unilaterally not associated with a vertebral defect., Presentation of Case: In this report we discuss a case of a 17-year-old girl with a left bifid rib alongside a segmental defect of the vertebra., Discussion: Bifurcated ribs usually occur in isolation or with other rib abnormalities associated with vertebral defects. Most cases are asymptomatic or found at post-mortem. Gorlin Syndrome is a condition where both these anatomical defects form a part of its criteria., Conclusion: With barely any data on significance of bifid rib with vertebral defects and no conclusive exclusion of Gorlin Syndrome, close monitoring coupled with regular follow-ups in such patients is the likely plan of treatment. In addition, genetic testing for susceptible genes should be strongly considered., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background and Purpose: This study aimed to determine the accuracy of apparent diffusion coefficient (ADC) and enhancement ratio (ER) in discriminating primary cerebral lymphomas (PCL) and glioblastomas., Materials and Methods: Circular regions of interest were randomly placed centrally within the largest solid-enhancing area of all lymphomas and glioblastomas on both post-contrast T1-weighted images and corresponding ADC maps. Regions of interest were also drawn in the contralateral hemisphere to obtain enhancement and ADC values of normal-appearing white matter. This helped us to calculate the ER and ADC ratio., Results: Mean enhancement and ADC (mm 2 /s) values for PCL were 2220.56 ± 2948.30 and 712.00 ± 137.87, respectively. Mean enhancement and ADC values for glioblastoma were 1537.07 ± 1668.33 and 1037.93 ± 280.52, respectively. Differences in ADC values, ratios and ERs were all statistically significant between the two groups ( p  < 0.05). ADC values correctly predicted 71.4% of the lesions as glioblastoma and 83.3% as PCL (area under the curve (AUC) = 0.86 on receiver operating characteristic curve analysis). ADC ratios correctly predicted 85.7% of the lesions as glioblastoma and 100% as PCL (AUC = 0.93). ERs correctly predicted 71.4% of the lesions as glioblastoma and 88.9% as PCL (AUC = 0.92). The combination of ADC ratio and ER correctly predicted 100% tumour type in both patient subgroups., Conclusions: ADC values, ADC ratios and ERs may serve as useful variables to distinguish PCL from glioblastoma. The combination of ADC ratio and ER yielded the best results in identification of both patient subgroups.

Pituitary tumour apoplexy is a rare but potentially life threatening clinical syndrome that mostly results from haemorrhage in the pre-existent tumour. Pure ischaemic subtype of apoplexy is even rarer. The presentation can be hard to differentiate clinically from bacterial meningitis. Moreover, the presence of one does not necessarily exclude the other and early diagnosis of both conditions is imperative for timely management. We report a case of ischaemic pituitary tumour apoplexy that may have precipitated in the setting of bacterial meningitis., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)