941/4545. Giant intraparenchymal neurocysticercosis: unusual MRI findings. We report a case of surgically proven giant neurocysticercosis (NCC). MR imaging revealed an unusually large solitary parenchymal cystic lesion showing signal intensity similar to CSF on all pulse sequences, with internal septations and a small nodule in the anterior aspect of this lesion compatible with this diagnosis. Identification of a scolex in a cystic lesion with CSF intensity plays a key role in the diagnosis of NCC. The presence of internal septations is an atypical feature. ( info) |
| We report two rare cases of primary intracranial plasma cell granuloma. The tumors probably arose from the dura and involved the cerebral parenchyma. These patients presented with clinical features of raised intracranial pressure and there was focal neurological deficit. The management issues are discussed. ( info) |
943/4545. New solitary cysticercus granulomas causing recurrent symptoms in patients with resolved solitary granulomas. recurrence of symptoms in a patient with a resolved solitary cerebral cysticercus granuloma (SCCG) is uncommon. Recurrent seizures in these patients are generally attributed to an epileptogenic scar or calcific residue of the granuloma. We report two patients with recurrent seizures and one patient with headache; all three patients were previously diagnosed to have SCCG and had complete resolution of the granuloma on follow-up imaging. Computed tomography (CT) at the time of recurrent symptoms showed a SCCG at a site different from the initial lesion, but in the same cerebral hemisphere in all the three patients. Since a new lesion can cause recurrent symptoms in patients with a resolved SCCG, repeat imaging should be performed in all these patients. We also postulate that recurrent cysticercal lesions in patients who have previously had a SCCG, tend to be solitary. ( info) |
944/4545. The pattern of proton magnetic resonance spectroscopy in non-neoplastic encephalic lesions. The purpose of this article is show the role of proton magnetic resonance spectroscopy (MRS), associated with magnetic resonance images, in the study of non-neoplastic disorders, helping in diagnosis and better characterization of the nature of the lesion. Herein, we analyzed single voxel proton spectroscopy in eight different non-neoplastic lesions, displayed in six categories (infectious, ischaemic, demyelinating, inflammatory, malformation of development and phacomatosis). The presence or the ratios of signal intensities brain tissue metabolites observed with this technique (N-acetyl aspartate, choline, creatine, lactate and lipids) helped in their differentiation with neoplastic lesions and helped in correct diagnosis. In infectious diseases, signals of acetate, succinate and amino acids were also important. In conclusion, proton MRS is a noninvasive method, very useful as an additional technique to define the nature of non-neoplastic encephalic lesions. ( info) |
945/4545. Resection of dominant opercular gliosis in refractory partial epilepsy. Report of two cases. Frontal opercular gliosis in the dominant hemisphere caused medically refractory partial epilepsy in two patients. Both patients were aphasic during their seizures, but otherwise had normal speech. Magnetic resonance images showed well-demarcated lesions resembling tumors in each patient; on heavily T2-weighted images, the lesions were hyperintense compared with normal brain. Cortical mapping with subdural grids localized speech to the area of the lesions; therefore, the resections were performed under local anesthesia and speech was tested throughout the procedure. Postoperatively, both patients were seizure-free and had no new neurological deficits. Well-demarcated lesions, even in the dominant operculum, can be safely removed in patients with medically refractory partial epilepsy. ( info) |
946/4545. Intracranial aspergillosis in a non-immunocompromised patient treated for muscle-invasive bladder cancer. We report a case of intracerebral aspergillosis in a patient undergoing radical cystectomy for the treatment of muscle-invasive bladder cancer who did not reveal any deterioration of the immune system. aspergillus fumigatus is an ubiquitously present, airborne fungus that tends to infect the upper respiratory tract. However, the latter was not observed in the patient presented. Complications in the form of an involvement of the central nervous system are very rarely recognized as a result of an Aspergillus infection and primarily occur in patients who are not immunologically competent. To our knowledge, we present the first case of intracerebral invasive aspergillosis in an otherwise healthy patient diagnosed with an urological malignancy. ( info) |
947/4545. Neuro-Behcet's disease with chorea after remission of intestinal Behcet's disease. Neuro-Behcet's disease shows various neuropsychiatric symptoms, but chorea has rarely been reported. We report a case of neuro-Behcet's disease in a 67-year-old woman with depression and chorea that occurred 22 years after the onset of intestinal Behcet's disease. brain magnetic resonance imaging (MRI) using a fluid-attenuated inversion-recovery (FLAIR) sequence demonstrated lesions more clearly than did T2-weighted MRI. Some of the lesions appeared as small ring-like foci, i.e. low-intensity spots rimmed with remarkable hyperintense signals, in the periventricular white matter and basal ganglia. A review of the literature revealed that the onset of chorea in cases of Behcet's disease varied from the time of onset of Behcet's disease to 31 years after onset of the disease. Psychiatric manifestations have often been associated with neuro-Behcet's disease. In the present patient, treatment with prednisolone resolved the chorea, suggesting that the chorea was caused by an autoimmune mechanism. It seems likely that the long-term development of vasculitis in patients with Behcet's disease results in the formation of these particular brain lesions on FLAIR MR images. chorea should be taken into consideration as one of the manifestations of Behcet's disease, even many years after remission of the disease. ( info) |
| A Japanese woman presenting with neurologic symptoms was presumptively diagnosed with neurocysticercosis based on imaging findings. Hooklets in the scolex of the resected lesion were not confirmed through histopathological observation. However, the illness was confirmed by mitochondrial dna analysis to be a solitary neurocysticercosis case caused by the Asian genotype of taenia solium. ( info) |
949/4545. Areas MT/V5 and their transcallosal connectivity in cortical dysplasia by fMRI. A patient with unilateral focal cortical dysplasia with a significant impairment of visual motion perception within the contralateral hemifield was examined with fMRI. During hemifield visual motion stimulation primary visual cortex areas were activated contralaterally and deactivated ipsilaterally to the stimulated hemifield. Transcallosal visuo-visual interaction was further evident as bilateral activation in temporo-occipital areas that best correspond to the motion sensitive areas MT/V5. MT/V5 was displaced anteriorly, superiorly, and medially within the dysplastic hemisphere and separated into two distinct activation clusters. During visual motion stimulation the parieto-insular vestibular cortex showed signal decreases that agree with the concept of inhibitory visuo-vestibular interaction. Thus, fMRI is a suitable tool for detecting preserved function and transcallosal connections in patients with focal cortical dysplasia. ( info) |
| Whether karyotyping is indicated in a fetus with choroid plexus cysts who is otherwise structurally normal is still controversial. Many authors have suggested basing the decision on cyst size, bilaterality, persistence with advancing gestational age, and association with other anomalies. We report a case of large bilateral choroid plexus cysts in a fetus with trisomy 21 who had no evidence of congenital anomalies or ultrasonographic signs of down syndrome. Cyst sizes diminished by half over a 3-week period of follow-up. It appears that diminishing size alone should not be considered sufficient reassurance about the normality of the fetal karyotype. A similar case has been previously reported, and it is conceivable that choroid plexus cysts are associated not only with trisomy 18 but also with trisomy 21. ( info) |