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Torticollis in children must always instigate a search for trauma. Many other etiologies can be found. The authors report a case of postmedicinal atlantoaxial rotatory pseudoluxation (AARP) occurring in a child. This child had fallen down in the morning with head trauma followed by headache. Clinically, a stiff neck with an irreducible right rotation of his neck, and an osteotendinous hyperreflexia were noted. There was a C1-C2 rotatory dislocation with no traumatic lesion on the cervical CT scan. After a few hours, the torticollis spontaneously reduced and then reappeared on the left side. This clinical fluctuation and the absorption of metoclopramide (Primperan) started in the morning for acute gastroenteritis provided the diagnosis of AARP. This entity was confirmed by the good clinical and radiological follow-up and was caused by the substantial ligament laxity of the craniovertebral junction encountered in children. The analysis of medical imaging and the systematic search for a medicinal cause helped make the right diagnosis.

Resume L’imagerie en tenseur de diffusion est une technique permettant l’analyse de la microstructure et de l’organisation du tissu cerebral. La connectivite des fibres de la substance blanche peut egalement etre appreciee par la tractographie. Le but de cet article est de presenter les notions theoriques de base de l’imagerie en tenseur de diffusion et de la tractographie, ainsi que leurs limites actuelles.

Cerebrospinal fluid (CSF) fistulae can produce leakage through a defect in the bony skull and meninges into the contiguous air-filled cavities at the base of the skull. The major risk is central nervous system infection. When abundant clear rhinorrhea or otorrhea is present, the diagnosis is obvious and imaging is used to localize the fistula. Computed tomography (CT) with millimetric slices and magnetic resonance imaging (MRI) are the most effective diagnostic tools. CT cisternography, an invasive procedure, should only be used when the diagnosis remains uncertain following CT scan and MRI. When CSF leakage is sparse or intermittent, the diagnosis can be made by measuring beta-2 transferrine in the escaping fluid. CT scan followed by MRI are also useful for making the diagnosis and locating the fistula when exterior leakage is absent. CT scan alone is effective for assessing isolated otorrhea. If the diagnosis remains uncertain after all these studies have been used, the patient should be closely followed clinically and isotopic study or surgery should be considered.

All patients with aneurysms treated with Guglielmi detachable coils (GDC) are undergo angiography to assess long-term stability of aneurysm exclusion or to show recurrence of the aneurysm sac, which may require further treatment. We prospectively compared the plain-film appearance of the coil-mass, 3D time-of-flight MR angiography (TOF MRA) and digital subtraction angiography (DSA) for the detection of aneurysm recanalisation during follow-up. We studied 60 patients with 74 intracranial aneurysms treated with Guglielmi detachable coils. We used the unsubtracted image of the angiograms performed at the completion of any embolisation procedure and at follow-up as the plain radiographs. Recanalisation was considered if loosening, compaction or reorientation of the coil mass was apparent. TOF MRA was performed to assess the presence and size of a neck remnant. DSA was regarded as the definitive investigation. Comparison of the techniques showed good agreement as regards aneurysm recanalisation. MRA was more accurate than plain radiography and could replace DSA for long term follow- up. The initial follow-up examination should, however, include both modalities. In cases of contraindications or limitations to MRA, the interval between follow-up angiographic examinations could be increased if there is no change in the plain-film coil-mass appearances.

We report a rare case of post intubation cricoarytenoid arthritis. A 18-year-old man admitted to emergency was easely intubated for 14 days for a non neck injury. Sixty-six days after intubation, he consulted for severe odynophagia with dyspnoea. Nasofibroscopic examination revealed a right arytenoid granuloma with oedema and inflammation, and bilateral arytenoid immobility. There was evidence on the CT scan of cricoarytenoid arthritis with fluid accumulation. Antibiotic treatment and two punctures for drainage allowed healing. There were cricoid and arytenoid calcifications. The patient recovered total and stable laryngeal mobility and function. This case is unusual, with features unlike those previously reported: intubation being the probable cause, the unusual clinical presentation with painless cricoid palpation, and the contrast between imaging findings during follow-up and the evolution under treatment. Indeed, there was an apparent discrepancy between the favourable clinical course and the CT-images revealing calcifications.

La connaissance de l’anatomie des reseaux veineux rachidien et cerebral et de leurs voies de drainage est necessaire pour la comprehension de l’hemodynamique des flux veineux cerebro-spinaux et pour la pratique therapeutique, que la voie d’abord soit endovasculaire ou chirurgicale.

Objectifs Un patient de 54 ans est pris en charge pour une decouverte de cancer prostatique secondairement a des troubles fonctionnels urinaires. Il a comme principal antecedent une HTA et une appendicectomie. Le toucher rectal retrouve un lobe gauche indure, le taux de PSA est a 294 ng/mL et les biopsies ont mis en evidence un adenocarcinome prostatique Gleason 8, envahissant largement le lobe gauche avec un engainement des filets nerveux et 2/6 biopsies positives au niveau du lobe droit. Lors du bilan d’extension par TEP/TDM a la 18F-Choline, il a ete mis en evidence un foyer d’accumulation pathologique intracrânien frontal gauche posant l’hypothese d’une possible origine metastatique ou d’une tumeur primitive cerebrale. Materiels et methodes Le bilan d’imagerie locoregionale et d’extension a comporte une IRM pelvienne, une TEP/TDM au 18FNA puis une TEP/TDM 18F-Choline en raison de l’existence d’une adenopathie suspecte iliaque externe gauche a l’IRM. L’IRM prostatique retrouve une lesion peripherique gauche de 32 mm, un score de Likert a 5, avec irregularite capsulaire postero-laterale gauche et un rehaussement des vesicules seminales associe a une adenopathie iliaque externe gauche hautement suspecte. La TEP/TDM corps entier au 18FNA n’a pas revele de dissemination osseuse ni d’anomalie de la voute crânienne. Resultats La TEP/TDM 18F-Choline a confirme l’atteinte intraprostatique avec extension ganglionnaire pelvienne et lombo-aortique etendue en mediastinal posterieur. Par ailleurs, mise en evidence d’un foyer intracerebral hyperfixant suspect necessitant une exploration complementaire par IRM. L’IRM cerebrale (sequence T1, diffusion, perfusion, FLAIR FatSat, T2) a mis en evidence un processus tissulaire extra-axial en lieu et place du foyer accumulant la 18F-choline, hypervasculaire. L’analyse spectroscopique est globalement peu remaniee pour un meningiome (habituellement hausse typique du pic de choline), mais reste toutefois compatible avec ce diagnostic. Le TDM cerebral realise a l’issue, afin d’apprecier l’extension osseuse, n’a pas revele d’anomalie pathologique au contact de ce meningiome. Conclusions Compte tenu de la realisation d’acquisitions tardives incluant la voute crânienne en TEP/TDM en 18F-Choline, il semble important de savoir reconnaitre ce diagnostic differentiel, bien que peu decrit dans la litterature. De plus, il s’agit de tumeurs a metabolisme cellulaire eleve et hormono-sensibles pouvant evoluer sous traitement anti-androgenique entrainant d’eventuels symptomes neurologiques.

La presence d’une nouvelle prise de contraste a l’IRM apres irradiation d’une tumeur maligne pose le probleme du diagnostic differentiel entre recurrence tumorale et radionecrose. De nombreux criteres ont ete proposes dans la litterature reposant sur des criteres morphologiques, fonctionnels ou metabolique. Le but de cette communication est de presenter les meilleurs outils actuels pour differentier des lesions de radionecrose d’une recidive ou poursuite evolutive de tumeur cerebrale maligne. Pour les gliomes, la morphologie ne permet pas de guider le diagnostic et l’utilisation des techniques de perfusion et/ou de spectroscopie est necessaire. Dans le suivi des metastases irradiees, une augmentation de volume transitoire et moderee des lesions est possible avec un bon pronostic. Les caracteristiques morphologiques lesionnelles (volume, ratio T2/T1 gadolinium) et l’analyse de la perfusion fournissent des outils utiles pour approcher le diagnostic de radionecrose.

International audience; Purpose : Age-related fMRI changes have not been extensively studied for language, whereas important adaptive mechanisms have been seen in other cognitive fields. This study examined age-related changes in fMRI activation during language tasks and, in particular, their dynamic course.Patients and methods fMRI was performed on 22 young and 21 old healthy right-handed subjects during a silent category word-generation task. Activation and dynamics of BOLD signals were studied separately during the first and second portions of each 30-s block.Results : Activation of the left frontal lobe was initially similar in young and old participants; however, it decreased after 30s in the old participants. On the other hand, additional areas were initially involved only in old subjects and especially in the default mode network.Conclusion :This study showed age-related differences in the dynamics of fMRI activation during a silent word-generation task, suggesting a different pattern of language function with aging.

Brain magnetic resonance imaging frequently identifies signal abnormalities in the white matter and cerebral cortex in the elderly. They are related to a degenerative disease of the small vessels that may be of ischemic (leukoaraiosis, lacunae and infarct) or hemorrhagic (microbleeds and hematomas) origin. These lesions are part of the aging process, and compounded by vascular risk factors. They increase the occurrence frequency and severity of ischemic or hemorrhagic stroke. Their importance is also associated with the presence of cognitive and/or affective symptoms, and their impact on the occurrence and evolution of dementia remains to be evaluated. The visible consequences of this microangiopathy on MRI probably represent the focal mark of a widespread cerebrovascular disease in the brain parenchyma.

Torticollis in children must always instigate a search for trauma. Many other etiologies can be found. The authors report a case of postmedicinal atlantoaxial rotatory pseudoluxation (AARP) occurring in a child. This child had fallen down in the morning with head trauma followed by headache. Clinically, a stiff neck with an irreducible right rotation of his neck, and an osteotendinous hyperreflexia were noted. There was a C1-C2 rotatory dislocation with no traumatic lesion on the cervical CT scan. After a few hours, the torticollis spontaneously reduced and then reappeared on the left side. This clinical fluctuation and the absorption of metoclopramide (Primpéran) started in the morning for acute gastroenteritis provided the diagnosis of AARP. This entity was confirmed by the good clinical and radiological follow-up and was caused by the substantial ligament laxity of the craniovertebral junction encountered in children. The analysis of medical imaging and the systematic search for a medicinal cause helped make the right diagnosis.

Cerebrospinal fluid (CSF) fistulae can produce leakage through a defect in the bony skull and meninges into the contiguous air-filled cavities at the base of the skull. The major risk is central nervous system infection. When abundant clear rhinorrhea or otorrhea is present, the diagnosis is obvious and imaging is used to localize the fistula. Computed tomography (CT) with millimetric slices and magnetic resonance imaging (MRI) are the most effective diagnostic tools. CT cisternography, an invasive procedure, should only be used when the diagnosis remains uncertain following CT scan and MRI. When CSF leakage is sparse or intermittent, the diagnosis can be made by measuring beta-2 transferrine in the escaping fluid. CT scan followed by MRI are also useful for making the diagnosis and locating the fistula when exterior leakage is absent. CT scan alone is effective for assessing isolated otorrhea. If the diagnosis remains uncertain after all these studies have been used, the patient should be closely followed clinically and isotopic study or surgery should be considered.

Objectifs pedagogiques Connaitre les grandes categories de la classification des anomalies vasculaires superficielles. Connaitre le bilan radiologique approprie a chaque groupe de la classification. Connaitre les grandes orientations therapeutiques avec une approche specifique a chaque groupe de cette classification. Messages a retenir Le diagnostic des anomalies vasculaires est avant tout clinique. L’attitude pratique decoule de la classification. Il faut distinguer les tumeurs regressives (hemangiomes) des malformations vasculaires portant sur les capillaires, les veines, les arteres ou les vaisseaux lymphatiques (non regressives). Les malformations arterioveineuses et les malformations complexes necessitent une prise en charge multidisciplinaire en raison de leur dangerosite.

Objectifs Montrer l’interet du dacryoscanner pour le diagnostic positif, la localisation et la caracterisation de l’obstruction des voies lacrymales lors du bilan pre-therapeutique. Materiels et methodes Travail realise a partir de dacryoscanners obtenus chez des patients adresses par le service d’ophtalmologie pour epiphora. Resultats Les bases anatomiques et la technique du dacryoscanner sont rappelees. Les pathologies observees sont decrites (pathologie inflammatoire, dacryocele, pathologie malformative) ainsi que les differentes possibilites therapeutiques. Les aspects scanographiques de ces pathologies et leur correlation avec les constatations chirurgicales sont precises. Conclusion Le dacryoscanner est un outil performant pour diagnostiquer la cause et le niveau d’obstruction des voies lacrymales a l’origine d’un epiphora. Il fournit des renseignements importants pour guider un traitement chirurgical.