- Email: [email protected]
1-37-04 Magnetic resonance findings in chronic renal failure patients with central nervous system dysfunction
S56
Neuroimaging
atypical cases similar to the new CJD variant (vCJD) described in the UK and France are known. An effort was made to divulge among neurologists, pathologists and health care authorities, the need of CJD surveillance in Argentina, vCJD characteritiics as well as 1996 WHO recommendations. Jointly with the Argentine Society of Neurology and Pathology we recently initiated CJD surveillance.
37 1l-37-01
Neuroimaging 1 Comparison of midline structure dimensions on MRI with their dimentions in formaiin fixed brains
M. Al Homsi, B. Brown, M. Reyes, M. Sarwar. Departments of Pathology and Radiology. King Faisal Specialist Hospital, Riyadh, Saudi Arabia, and Cook County Hospital, University of Illinois, Chicago, Illinois, USA Comparison of midline structure measurements on magnetic resonance (MR) midsagittal images with the measurements of the same structures on autopsied brains was conducted to determine the accuracy of those measurements on MR images. The corpus callosum, optic nerves, mammillary bodies, and superior and inferior colliculi of 199 (96 males, 103 females) patients were measured on MR midsagittal images. The male images, in comparison to female images, showed larger diameters of the optic nerves (2.65 + 0.06 mm vs. 2.43 + 0.6 mm, p < 0.005), mammillary body (4.79 + 0.09 mm vs. 4.46 + 0.09 mm, p x 0.05). superior colliculus (4.28 + 0.14 mm vs. 3.79 + 0.09 mm, p < 0.005), and inferior colliculus (4.30 + 0.09 mm vs. 3.99 + 0.10 mm, p < 0.05). Next we compared these measurements with the measurements of the same structures of formalin-fixed brains from 21 (13 males, 8 females) patients. Although we found no differences between the 13 male and 8 female patients, the measurements were constantly larger than those on the MR images in the optic nerves (2.9 + 0.1 mm vs. 2.6 + 0.2 mm, p < 0.005), mammillaty body (4.6 + 0.2 mm vs. 4.8 + 0.2 mm, p -Z 0.05), superior colliculus (4.2 + 0.2 mm vs. 4.3 + 0.2 mm, p < 0.05), and inferior colliculus (4.3 + 0.1 mm vs. 4.5 + 0.2 mm, p < 0.005), but not in corpus callosum nor the quadrigeminal plate. Gender differences in the fonalin-fixed brain measurements were not detected probably because we had too few autopsied brains. To explain the smaller measurements on MR images, we postulated that spherical structures, like the mammillary body, and rod-like structures, like the optic nerve, were imaged differently in the midsagittal plane than the flat structures, like the corpus callosum. In addition, the optic nerves and the colliculi are not true midline structures. Our study showed that measurements on MR images did not necessarily reflect the true dimensions of some brain structures.
l-37-02
Magnetic resonance angiography targeted Transcraniai DooDier sonoaraphv for the monitoring of cerebrovascuiar disorders - -
A. Auer, C. Kremser, B. Heuschneider, W. Lutz, C. Schmidauer, E. Hochmaier, S. Felber, F. Aichner. Dept. of Magnetic Resonance, Dept. of Applied Physics and Dept. of Neurology; University of Innsbruck, Austria Transcranial Doppler (TCD) Sonography and Magnetic Resonance Angiog raphy (MRA) are validated methods for the examination of cerebral vascular disorders. TCD is a real-time, cost effective bedside method. However, monitoring of flow velocities may be difficult because of limited spatial resolution and reproducibilities of insonation angles. The purpose of this study was to utilize high resolution 3D MRA data for stereotactic guidance of ultrasound. The MRA examinations were performed at a 1.5T scanner using a 3D flow compensated gradient echo sequence. A frameless fiducial marker system was used for stereotactic registration. The data sets were transferred to an infrared tracking system and superimposed to the ultrasound beam during TCD. The MRA projections of the intracranial arteries were shown on a monitor together with the ultrasound beam and the angle of insonation. Based on phantom studies and 15 volunteer examinations we found a accuracy and reproducibility for the localization of specific vessel sections, at repeated TCD examinations. We conclude that 3D MFIA, acquired as an initial diagnostic procedure in patients with intracranial vascular disorders, can be used to provide stereotactic guidance for repeated TCD bedside examinations. This facilitates a reproducible localization of specific vessel sections which is important for repeated monitoring of cerebral blood flow over longer periods of time, and thus may improve the management of stroke patients.
l-37-03
Dural sinus thrombosis: Clinical findings and value of venous MRI anaioaraohv and MRI for the diagnosis and foi6w%p’ -
U.S. Benli, U. Can, M. Abildere, H. Caner, N. Aitin6rs. Department of Neurology Bagkent University, Faculty of Medicine, Ankara, Turkey, Department of Neurosurgery Bagkent UniversiM Faculty of Medicine, Ankara, Turkey, Department of Radiologyr Bagkent Universit)! Faculty of Medicine, Ankara, Turkey The purpose of this study is to determine the value of MR angiography (MRA) as the sole procedure for the diagnosis and follow-up of dural sinus thrombosis (DST) and to review the etiologic, clinical and therapeutic aspects of this neurologic emergency. Ten patients (M: 5, F: 5) with clinical findings suggestive of DST were examined with venous MRA and MR imaging. The main symptom in adults (n = 8, r: 17-55 years) was headache. Visual symptoms, convulsions and motor signs were present in two infants. Three patients had chronic renal failure and were on hemodialysis program. One patient was diagnosed as Behget’s disease and one other was in the post partum period. The infants had congenital hearl diseases. Infection was together with DST in four patients. MRI revealed edema and white matter intensity abnonalities in 4 patients. Venous MRA detected superior sagittal sinus thrombosis in 6 patients and lateral sinus thrombosis in IO patients. All the patients were anticoagulated and given antibiotic treatment if infection also existed. In two patients, follow-up MR revealed recanalization. No mortality and morbidity was noticed in adults. Venous MRA with MRI is a noninvasive, sensitive and reliable technique for the early diagnosis and follow-up of DST.
l-37-04
Magnetic resonance findings in chronic renal failure patients with central nervous system dysfunction
U.S. Benli, M. A@ldere, Y. Ellen, N. tizdemir, H. Caner. Department of Neurology Ba.$kent Univetsiit): Faculty of Medicine, Ankara. Turkey, Department of Radiology, Bagkent University; Faculty of Medicine, Ankara, Turkey, Department of Internal Medicine and Neurosurgery, Ba$kent University, Faculty of Medicine, Ankara, Turkey The purpose of this study is to analyse the magnetic resonance imaging (MRI) findings in chronic renal failure (CRF) and to determine the correlation between laboratory findings, clinical features and MRI findings. Fourly patients (F: 17, M: 23; mean age: 49.7 years (r: 16-80)) with CRF and symptoms and signs of central netvous system (CNS) dysfunction were examined with MRI. 33 of the patients were on hemodialysis program. The most common neurologic finding was the change of the level of consciousness and headache was the most common symptom. In 20 patients (% 50), hyperintense white matter signal abnonalities (WMSA) in T2 - weighted images were detected. Cortical (n: 15) and subcortical (n: 11) atrophy was also noted. Some of the other MR findings were infarcts, hemorrhage, dural sinus thrombosis and brain abcess. The correlation between blood BUN and creatinine values and WMSA was found to be important (p > 0.05). The correlation between hypertension and WMSA was of less importance (p z 0.5). Hyponatremia was not an important factor for WMSA. Though MR findings in patients with CRF and CNS disease are nonspecific, the correlation found between BUN, creatinine levels and hypertension, and WMSA, may help to understand the etiopathogenesis of uremic encephalopathy.
1 l-37-05
1 Creutzfeidt - Jackob disease with unilateral occipital cortical abnormalities on MRI
parieto
0. Martinez, M. Martinez, J. de Sousa, P. Bonardo, J. Adamson, R. Reisin, R. Allegri, A. Taratutto, A. Thomson, MM Femandez Pardal. Servicio de Neurofogfa, Hospital Britinico de Buenos Aires, Argentina
Introduction: CreutzfeldtJackob
disease (CJD) is a lethal disorder of the central nervous system. MRI is usually normal, nevertheless, diffuse cortical atrophy can be found. Moreover, bilateral hyperintensities in basal ganglia or occipital lobes have also been reported. We present a patient with unilateral parieto occipital lobe abnormalities on imaging studies. Case report: A 73 year old right-handed woman presented with progressive mental deterioration over one month. Her neuro examination revealed transcortical aphasia, right hemianopia and a dystonic posture with myoclonic movements of the right upper limb. EEG revealed periodic sharp waves complexes of 1 Hz with maximal phase reversal over the left patietal region. CSF and brain CT were normal. MRI revealed unilateral cortical hyperintensities on T2 -weighted images confined to the left parietal and occipital lobes. A brain sterotactic biopsy showed spongiform degeneration consistent with CJD.
Neuroimaging
atypical cases similar to the new CJD variant (vCJD) described in the UK and France are known. An effort was made to divulge among neurologists, pathologists and health care authorities, the need of CJD surveillance in Argentina, vCJD characteritiics as well as 1996 WHO recommendations. Jointly with the Argentine Society of Neurology and Pathology we recently initiated CJD surveillance.
37 1l-37-01
Neuroimaging 1 Comparison of midline structure dimensions on MRI with their dimentions in formaiin fixed brains
M. Al Homsi, B. Brown, M. Reyes, M. Sarwar. Departments of Pathology and Radiology. King Faisal Specialist Hospital, Riyadh, Saudi Arabia, and Cook County Hospital, University of Illinois, Chicago, Illinois, USA Comparison of midline structure measurements on magnetic resonance (MR) midsagittal images with the measurements of the same structures on autopsied brains was conducted to determine the accuracy of those measurements on MR images. The corpus callosum, optic nerves, mammillary bodies, and superior and inferior colliculi of 199 (96 males, 103 females) patients were measured on MR midsagittal images. The male images, in comparison to female images, showed larger diameters of the optic nerves (2.65 + 0.06 mm vs. 2.43 + 0.6 mm, p < 0.005), mammillary body (4.79 + 0.09 mm vs. 4.46 + 0.09 mm, p x 0.05). superior colliculus (4.28 + 0.14 mm vs. 3.79 + 0.09 mm, p < 0.005), and inferior colliculus (4.30 + 0.09 mm vs. 3.99 + 0.10 mm, p < 0.05). Next we compared these measurements with the measurements of the same structures of formalin-fixed brains from 21 (13 males, 8 females) patients. Although we found no differences between the 13 male and 8 female patients, the measurements were constantly larger than those on the MR images in the optic nerves (2.9 + 0.1 mm vs. 2.6 + 0.2 mm, p < 0.005), mammillaty body (4.6 + 0.2 mm vs. 4.8 + 0.2 mm, p -Z 0.05), superior colliculus (4.2 + 0.2 mm vs. 4.3 + 0.2 mm, p < 0.05), and inferior colliculus (4.3 + 0.1 mm vs. 4.5 + 0.2 mm, p < 0.005), but not in corpus callosum nor the quadrigeminal plate. Gender differences in the fonalin-fixed brain measurements were not detected probably because we had too few autopsied brains. To explain the smaller measurements on MR images, we postulated that spherical structures, like the mammillary body, and rod-like structures, like the optic nerve, were imaged differently in the midsagittal plane than the flat structures, like the corpus callosum. In addition, the optic nerves and the colliculi are not true midline structures. Our study showed that measurements on MR images did not necessarily reflect the true dimensions of some brain structures.
l-37-02
Magnetic resonance angiography targeted Transcraniai DooDier sonoaraphv for the monitoring of cerebrovascuiar disorders - -
A. Auer, C. Kremser, B. Heuschneider, W. Lutz, C. Schmidauer, E. Hochmaier, S. Felber, F. Aichner. Dept. of Magnetic Resonance, Dept. of Applied Physics and Dept. of Neurology; University of Innsbruck, Austria Transcranial Doppler (TCD) Sonography and Magnetic Resonance Angiog raphy (MRA) are validated methods for the examination of cerebral vascular disorders. TCD is a real-time, cost effective bedside method. However, monitoring of flow velocities may be difficult because of limited spatial resolution and reproducibilities of insonation angles. The purpose of this study was to utilize high resolution 3D MRA data for stereotactic guidance of ultrasound. The MRA examinations were performed at a 1.5T scanner using a 3D flow compensated gradient echo sequence. A frameless fiducial marker system was used for stereotactic registration. The data sets were transferred to an infrared tracking system and superimposed to the ultrasound beam during TCD. The MRA projections of the intracranial arteries were shown on a monitor together with the ultrasound beam and the angle of insonation. Based on phantom studies and 15 volunteer examinations we found a accuracy and reproducibility for the localization of specific vessel sections, at repeated TCD examinations. We conclude that 3D MFIA, acquired as an initial diagnostic procedure in patients with intracranial vascular disorders, can be used to provide stereotactic guidance for repeated TCD bedside examinations. This facilitates a reproducible localization of specific vessel sections which is important for repeated monitoring of cerebral blood flow over longer periods of time, and thus may improve the management of stroke patients.
l-37-03
Dural sinus thrombosis: Clinical findings and value of venous MRI anaioaraohv and MRI for the diagnosis and foi6w%p’ -
U.S. Benli, U. Can, M. Abildere, H. Caner, N. Aitin6rs. Department of Neurology Bagkent University, Faculty of Medicine, Ankara, Turkey, Department of Neurosurgery Bagkent UniversiM Faculty of Medicine, Ankara, Turkey, Department of Radiologyr Bagkent Universit)! Faculty of Medicine, Ankara, Turkey The purpose of this study is to determine the value of MR angiography (MRA) as the sole procedure for the diagnosis and follow-up of dural sinus thrombosis (DST) and to review the etiologic, clinical and therapeutic aspects of this neurologic emergency. Ten patients (M: 5, F: 5) with clinical findings suggestive of DST were examined with venous MRA and MR imaging. The main symptom in adults (n = 8, r: 17-55 years) was headache. Visual symptoms, convulsions and motor signs were present in two infants. Three patients had chronic renal failure and were on hemodialysis program. One patient was diagnosed as Behget’s disease and one other was in the post partum period. The infants had congenital hearl diseases. Infection was together with DST in four patients. MRI revealed edema and white matter intensity abnonalities in 4 patients. Venous MRA detected superior sagittal sinus thrombosis in 6 patients and lateral sinus thrombosis in IO patients. All the patients were anticoagulated and given antibiotic treatment if infection also existed. In two patients, follow-up MR revealed recanalization. No mortality and morbidity was noticed in adults. Venous MRA with MRI is a noninvasive, sensitive and reliable technique for the early diagnosis and follow-up of DST.
l-37-04
Magnetic resonance findings in chronic renal failure patients with central nervous system dysfunction
U.S. Benli, M. A@ldere, Y. Ellen, N. tizdemir, H. Caner. Department of Neurology Ba.$kent Univetsiit): Faculty of Medicine, Ankara. Turkey, Department of Radiology, Bagkent University; Faculty of Medicine, Ankara, Turkey, Department of Internal Medicine and Neurosurgery, Ba$kent University, Faculty of Medicine, Ankara, Turkey The purpose of this study is to analyse the magnetic resonance imaging (MRI) findings in chronic renal failure (CRF) and to determine the correlation between laboratory findings, clinical features and MRI findings. Fourly patients (F: 17, M: 23; mean age: 49.7 years (r: 16-80)) with CRF and symptoms and signs of central netvous system (CNS) dysfunction were examined with MRI. 33 of the patients were on hemodialysis program. The most common neurologic finding was the change of the level of consciousness and headache was the most common symptom. In 20 patients (% 50), hyperintense white matter signal abnonalities (WMSA) in T2 - weighted images were detected. Cortical (n: 15) and subcortical (n: 11) atrophy was also noted. Some of the other MR findings were infarcts, hemorrhage, dural sinus thrombosis and brain abcess. The correlation between blood BUN and creatinine values and WMSA was found to be important (p > 0.05). The correlation between hypertension and WMSA was of less importance (p z 0.5). Hyponatremia was not an important factor for WMSA. Though MR findings in patients with CRF and CNS disease are nonspecific, the correlation found between BUN, creatinine levels and hypertension, and WMSA, may help to understand the etiopathogenesis of uremic encephalopathy.
1 l-37-05
1 Creutzfeidt - Jackob disease with unilateral occipital cortical abnormalities on MRI
parieto
0. Martinez, M. Martinez, J. de Sousa, P. Bonardo, J. Adamson, R. Reisin, R. Allegri, A. Taratutto, A. Thomson, MM Femandez Pardal. Servicio de Neurofogfa, Hospital Britinico de Buenos Aires, Argentina
Introduction: CreutzfeldtJackob
disease (CJD) is a lethal disorder of the central nervous system. MRI is usually normal, nevertheless, diffuse cortical atrophy can be found. Moreover, bilateral hyperintensities in basal ganglia or occipital lobes have also been reported. We present a patient with unilateral parieto occipital lobe abnormalities on imaging studies. Case report: A 73 year old right-handed woman presented with progressive mental deterioration over one month. Her neuro examination revealed transcortical aphasia, right hemianopia and a dystonic posture with myoclonic movements of the right upper limb. EEG revealed periodic sharp waves complexes of 1 Hz with maximal phase reversal over the left patietal region. CSF and brain CT were normal. MRI revealed unilateral cortical hyperintensities on T2 -weighted images confined to the left parietal and occipital lobes. A brain sterotactic biopsy showed spongiform degeneration consistent with CJD.