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Aphasia is an acquired language disorder due to a cerebral lesion; it is characterized by errors in production, denomination, or comprehension of language. Although most aphasias are mixed, from a practical point of view they are classified into different types according to their main clinical features: Broca's aphasia, Wernicke's aphasia, conduction aphasia, transcortical aphasia, and alexia with or without agraphia. We present the clinical findings for the main subtypes of aphasia, illustrating them with imaging cases, and we provide an up-to-date review of the language network with images from functional magnetic resonance imaging and tractography.

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INTRODUCTION: The development of structural magnetic resonance scanning and new methods of analysis has made it possible to explore, in a hitherto unknown way, the neuroanatomical bases of attention deficit hyperactivity disorder (ADHD). Yet, little is known about the relation between the clinical symptoms and the neuropsychological dysfunctions characterising ADHD and the neuroanatomical alterations that are observed. AIM: To explore the relation between neuroanatomy, clinical features and neuropsychology in ADHD. DEVELOPMENT: At group level, there are a number of marked differences between the brain of children, adolescents and adults with ADHD and the brain of subjects with a typical development. These differences are observed cross-sectionally and longitudinally in all the measurements, both in the grey matter and in the white matter. Although still scarce, there is an increasing body of evidence showing that these differences are related with the core symptoms of the disorder and with the degree of clinical dysfunction. They also appear to be associated with cognitive functioning (mainly attention and inhibitory control). CONCLUSIONS: The relation among the different levels of analysis in the study of ADHD bring research closer to the clinical features and allows a better understanding and management of the disorder. Although progress is undoubtedly being made in this field, there are still many questions that need exploring in greater depth. There is a need for a better understanding of the association between the neuroanatomical measurements and each dimension of the symptoms, and their relationship with other neuropsychological processes that are also involved in the disorder.

TITLE: Neuroanatomia del trastorno por deficit de atencion/hiperactividad: correlatos neuropsicologicos y clinicos.Introduccion. El desarrollo de la resonancia magnetica estructural y de nuevos metodos de analisis ha permitido examinar, como nunca antes, las bases neuroanatomicas del trastorno por deficit de atencion/hiperactividad (TDAH). No obstante, poco se sabe todavia sobre la relacion de los sintomas clinicos y las disfunciones neuropsicologicas caracteristicas del TDAH con las alteraciones neuroanatomicas observadas. Objetivo. Explorar la relacion entre neuroanatomia, clinica y neuropsicologia en el TDAH. Desarrollo. A nivel de grupo, existen diferencias marcadas entre el cerebro de niños adolescentes y adultos con TDAH y el cerebro de personas con desarrollo tipico. Estas diferencias se observan transversal y longitudinalmente en todas las medidas, tanto de la sustancia gris como de la sustancia blanca. Aunque todavia escasa, cada vez existe mayor evidencia que señala que estas diferencias se relacionan con los sintomas nucleares del trastorno y con el grado de disfuncion clinica. Tambien parecen asociarse con el funcionamiento cognitivo (principalmente, atencion y control inhibitorio). Conclusiones. La relacion entre los distintos niveles de analisis de estudio del TDAH acerca la investigacion a la clinica y permite comprender y tratar mejor el trastorno. Aunque el avance en este campo es innegable, todavia son muchas las cuestiones que hay que explorar y profundizar en mayor detalle. Se requiere comprender mejor la asociacion entre las medidas neuroanatomicas y cada dimension sintomatologica, y la relacion con otros procesos neuropsicologicos tambien implicados en el trastorno.

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Presentamos el caso de un paciente de 9 años con trastorno de Tourette y de la lectura con antecedente de un proceso infeccioso grave durante el período neonatal tardío. La resonancia magnética cerebral demostró una cavidad encefalomalácica parietal izquierda, y un estudio con tensor de difusión y tractografía mostraron una llamativa disrupción del haz de sustancia blanca que une la región parietal izquierda con la frontal homolateral, con afectación del fascículo longitudinal superior y del fascículo arcuato izquierdos. Aunque los trastornos descritos son fundamentalmente neuropsiquiátricos hereditarios, pueden existir casos secundarios a alteraciones cerebrales como la que nos ocupa en el presente niño. La introducción de ésta y otras técnicas modernas de neuroimagen en pacientes con trastornos neuropsiquiátricos (o riesgo de padecerlos) podrían tener un gran valor diagnóstico y pronóstico en el futuro (AU)

We present the case of a nine-year-old boy with Tourette syndrome and reading disorder with a history of a severe infectious process in the late neonatal period. Brain MRI showed a left parietal malacotic cavity and diffusion tensor imaging and tractography showed a striking disruption of the white matter bundle that joins the left parietal region with the ipsilateral frontal region with involvement of the left superior longitudinal fasciculus and of the left arcuate fasciculus. Although Tourette syndrome and reading disorder are fundamentally hereditary neuropsychiatric disorders, they can also occur secondary to cerebral alterations like those existing in this boy. The introduction of modern neuroimaging techniques in patients with neuropsychiatric disorders (or the risk of developing them) can be very useful in the diagnosis and prognosis in the future (AU)

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Objetivo: Valorar la asociación entre disfunción del tendón tibial posterior (DTTP), las lesiones de diversas estructuras del tobillo diagnosticadas por RM, y los signos radiológicos del pie plano. Material y método: Realizamos un estudio retrospectivo comparando 29 pacientes con DTTP, todos examinados por RM (21 de ellos con un estudio radiológico en carga) y un grupo control de 28 pacientes elegidos aleatoriamente entre aquellos estudiados por otras afecciones del tobillo mediante RM y estudio radiológico en carga. En los estudios de RM revisamos la existencia de espolón calcáneo, pico talar, fascitis plantar, edema óseo calcáneo, tendinopatía del Aquiles, lesión del ligamento Spring, afección del seno del tarso y coalición tarsiana. En los estudios radiológicos en carga se valoraron el ángulo de Costa-Bertani y los signos radiológicos de pie plano. Analizamos las diferencias entre los grupos en los hallazgos con RM y presencia de pie plano mediante el test exacto de Fisher y del ángulo de Costa-Bertani mediante el análisis de lavarianza. Resultados: La presencia de espolón calcáneo, pico talar, afección del seno del tarso y del ligamento Spring fue más frecuente en el grupo con DTTP, de forma estadísticamente significativa (p < 0,05). También existieron diferencias significativas en la presencia del pie plano radiológico y valores anómalos en el ángulo de Costa-Bertani, más frecuentes (p < 0,001) en el grupo con DTTP. Conclusión: Corroboramos la asociación entre la lesión de estas estructuras diagnosticada por RM y los signos del pie plano radiológico con DTTP. Conocer esta asociación puede ser de utilidad para establecer un diagnóstico preciso (AU)

Objective: To evaluate the association of posterior tibial tendon dysfunction and lesions of diverse ankle structures diagnosed at MRI with radiologic signs of flat foot. Material and methods: We retrospectively compared 29 patients that had posterior tibial tendon dysfunction (all 29 studied with MRI and 21 also studied with weight-bearing plain-film X-rays) with a control group of 28 patients randomly selected from among all patients who underwent MRI and weight-bearing plain-film X-rays for other ankle problems. In the MRI studies, we analyzed whether a calcaneal spur, talar beak, plantar fasciitis, calcaneal bone edema, Achilles’ tendinopathy, spring ligament injury, tarsal sinus disease, and tarsal coalition were present. In the weight-bearing plain-film X-rays, we analyzed the angle of Costa-Bertani and radiologic signs of flat foot. To analyze the differences between groups, we used Fisher’s exact test for the MRI findings and for the presence of flat foot and analysis of variance for the angle of Costa-Bertani. Results: Calcaneal spurs, talar beaks, tarsal sinus disease, and spring ligament injury were significantly more common in the group with posterior tibial tendon dysfunction (P<.05). Radiologic signs of flat foot and anomalous values for the angle of Costa-Bertani were also significantly more common in the group with posterior tibial tendon dysfunction (P<.001). Conclusion: We corroborate the association between posterior tibial tendon dysfunction and lesions to the structures analyzed and radiologic signs of flat foot. Knowledge of this association can be useful in reaching an accurate diagnosis (AU)

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We present the case of a nine-year-old boy with Tourette syndrome and reading disorder with a history of a severe infectious process in the late neonatal period. Brain MRI showed a left parietal malacotic cavity and diffusion tensor imaging and tractography showed a striking disruption of the white matter bundle that joins the left parietal region with the ipsilateral frontal region with involvement of the left superior longitudinal fasciculus and of the left arcuate fasciculus. Although Tourette syndrome and reading disorder are fundamentally hereditary neuropsychiatric disorders, they can also occur secondary to cerebral alterations like those existing in this boy. The introduction of modern neuroimaging techniques in patients with neuropsychiatric disorders (or the risk of developing them) can be very useful in the diagnosis and prognosis in the future.

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OBJECTIVE: To evaluate the association of posterior tibial tendon dysfunction and lesions of diverse ankle structures diagnosed at MRI with radiologic signs of flat foot. MATERIAL AND METHODS: We retrospectively compared 29 patients that had posterior tibial tendon dysfunction (all 29 studied with MRI and 21 also studied with weight-bearing plain-film X-rays) with a control group of 28 patients randomly selected from among all patients who underwent MRI and weight-bearing plain-film X-rays for other ankle problems. In the MRI studies, we analyzed whether a calcaneal spur, talar beak, plantar fasciitis, calcaneal bone edema, Achilles' tendinopathy, spring ligament injury, tarsal sinus disease, and tarsal coalition were present. In the weight-bearing plain-film X-rays, we analyzed the angle of Costa-Bertani and radiologic signs of flat foot. To analyze the differences between groups, we used Fisher's exact test for the MRI findings and for the presence of flat foot and analysis of variance for the angle of Costa-Bertani. RESULTS: Calcaneal spurs, talar beaks, tarsal sinus disease, and spring ligament injury were significantly more common in the group with posterior tibial tendon dysfunction (P<.05). Radiologic signs of flat foot and anomalous values for the angle of Costa-Bertani were also significantly more common in the group with posterior tibial tendon dysfunction (P<.001). CONCLUSION: We corroborate the association between posterior tibial tendon dysfunction and lesions to the structures analyzed and radiologic signs of flat foot. Knowledge of this association can be useful in reaching an accurate diagnosis.

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Objetivo. Describir, con estudios funcionales de activación y tractografía en una RM de 3 Teslas (3 T), las áreas corticales y vías subcorticales implicadas en el lenguaje, y mostrar la buena correlación de estos estudios funcionales con la estimulación directa cortical y subcortical intraoperatoria. Material y métodos. Presentamos una serie de 14 pacientes con lesiones focales cerebrales junto a áreas elocuentes. Todos los pacientes se evaluaron neuropsicológicamente antes y después de la cirugía, se estudiaron con RM con secuencias estructurales, de perfusión, espectroscopia, resonancia magnética funcional y del lenguaje y tractografía 3D, y se sometieron a un mapeo cortical de estimulación cortical y subcortical y resección de la lesión. Se hizo un control posquirúrgico a las 24 h. Resultados. La correlación funcional motora y del haz corticoespinal con el mapeo intraoperatorio cortical y subcortical motor fue completa. Las áreas elocuentes del lenguaje expresivo y del lenguaje receptivo presentaron una alta correlación con el mapeo cortical intraoperatorio en todos los casos menos 2, un glioma infiltrativo de alto grado y un glioma de bajo grado frontal. La tractografía 3D identificó los fascículos arcuato, frontoparietal, subcalloso, frontooccipital inferior y las radiaciones ópticas, lo que permitió marcar los límites de la resección. La correlación con el mapeo subcortical en la disposición anatómica de los fascículos con respecto a las lesiones, fue completa. Conclusión. La máxima resección tumoral sin déficits asociados es el mejor tratamiento posible ante un tumor cerebral, lo que resalta la necesidad de estudios funcionales de alta calidad en la planificación prequirúrgica (AU)

Objective: To describe the detection of cortical areas and subcortical pathways involved in language observed in MRI activation studies and tractography in a 3 T MRI scanner and to corre- late the findings of these functional studies with direct intraoperative cortical and subcortical stimulation. Material and methods: We present a series of 14 patients with focal brain tumors adjacent to eloquent brain areas. All patients underwent neuropsychological evaluation before and after surgery. All patients underwent MRI examination including structural sequences, perfusion imaging, spectroscopy, functional imaging to determine activation of motor and language areas, and 3D tractography. All patients underwent cortical mapping through cortical and subcortical stimulation during the operation to resect the tumor. Postoperative follow-up studies were done 24 hours after surgery. Results: The correlation of motor function and of the corticospinal tract determined by functional MRI and tractography with intraoperative mapping of cortical and subcortical motor areas was complete. The eloquent brain areas of language expression and reception were strongly correlated with intraoperative cortical mapping in all but two cases (a high grade infiltrating glioma and a low grade glioma located in the frontal lobe). 3D tractography identified the arcuate fasciculus, the lateral part of the superior longitudinal fasciculus, the subcallosal fasciculus, the inferior fronto-occipital fasciculus, and the optic radiations, which made it possible to mark the limits of the resection. The correlation with the subcortical mapping of the anatomic arrangement of the fasciculi with respect to the lesions was complete. Conclusion: The best treatment for brain tumors is maximum resection without associated deficits, so high quality functional studies are necessary for preoperative planning (AU)

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El síndrome neurocutáneo descrito con el acrónimo PHACE describe la presencia de un hemangioma facial segmentario que asocia, entre otras, anomalías de la fosa posterior, anomalías arteriales cerebrovasculares, afectación cardiaca/coartación de aorta y alteración ocular. La presencia añadida de defectos del desarrollo ventral se denomina como PHACES. Nuestro propósito es describir un caso de síndrome PHACES con resonancia magnética cerebral pre y posnatal y afectación de la arteria cerebelosa posteroinferior derecha. El caso presentado es excepcional dado que se trata del primero publicado con iconografía pre y posnatal y debido a que presenta una alteración vascular única que amplía el espectro de anomalías arteriales intracraneales posibles en este síndrome (AU)

The neurocutaneous syndrome known by the acronym PHACE consists of the association of a segmental facial hemangioma with, among other entities, posterior fossa anomalies, cerebrovascular anomalies, cardiac involvement/aortic coarctation, and eye abnormalities. When ventral developmental defects are also present, the syndrome is referred to as PHACES. We report the prenatal and postnatal MRI findings in a case of PHACES with involvement of the right posteroinferior cerebellar artery. This case is exceptional because, to our knowledge, it is the first to report the findings at both prenatal and postnatal MRI and because of the unique vascular anomaly that widens the spectrum of possible intracranial arterial anomalies in this syndrome (AU)

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OBJECTIVE: To describe the detection of cortical areas and subcortical pathways involved in language observed in MRI activation studies and tractography in a 3T MRI scanner and to correlate the findings of these functional studies with direct intraoperative cortical and subcortical stimulation. MATERIAL AND METHODS: We present a series of 14 patients with focal brain tumors adjacent to eloquent brain areas. All patients underwent neuropsychological evaluation before and after surgery. All patients underwent MRI examination including structural sequences, perfusion imaging, spectroscopy, functional imaging to determine activation of motor and language areas, and 3D tractography. All patients underwent cortical mapping through cortical and subcortical stimulation during the operation to resect the tumor. Postoperative follow-up studies were done 24 hours after surgery. RESULTS: The correlation of motor function and of the corticospinal tract determined by functional MRI and tractography with intraoperative mapping of cortical and subcortical motor areas was complete. The eloquent brain areas of language expression and reception were strongly correlated with intraoperative cortical mapping in all but two cases (a high grade infiltrating glioma and a low grade glioma located in the frontal lobe). 3D tractography identified the arcuate fasciculus, the lateral part of the superior longitudinal fasciculus, the subcallosal fasciculus, the inferior fronto-occipital fasciculus, and the optic radiations, which made it possible to mark the limits of the resection. The correlation with the subcortical mapping of the anatomic arrangement of the fasciculi with respect to the lesions was complete. CONCLUSION: The best treatment for brain tumors is maximum resection without associated deficits, so high quality functional studies are necessary for preoperative planning.

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The neurocutaneous syndrome known by the acronym PHACE consists of the association of a segmental facial hemangioma with, among other entities, posterior fossa anomalies, cerebrovascular anomalies, cardiac involvement/aortic coarctation, and eye abnormalities. When ventral developmental defects are also present, the syndrome is referred to as PHACES. We report the prenatal and postnatal MRI findings in a case of PHACES with involvement of the right posteroinferior cerebellar artery. This case is exceptional because, to our knowledge, it is the first to report the findings at both prenatal and postnatal MRI and because of the unique vascular anomaly that widens the spectrum of possible intracranial arterial anomalies in this syndrome.

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La esclerosis tuberosa es un trastorno multisistémico, de herencia autosómica dominante, que afecta a diversos órganos, como el cerebro, la piel, los riñones, los ojos y el corazón. Exponemos 3 casos clínicos diagnosticados prenatalmente tras el hallazgo incidental de uno o más rabdomiomas cardiacos en las ecografías de control, y lesiones cerebrales halladas posteriormente mediante resonancia magnética (RM) fetal. Esta técnica tiene un gran valor como prueba complementaria en el diagnóstico, pronóstico y consejo genético de la esclerosis tuberosa. Analizamos los casos de 3 mujeres gestantes en cuyas ecografías sistemáticas fetales se detectó la presencia de uno o más rabdomiomas cardiacos. Se realizó una RM fetal que mostraba nódulos subependimarios periventriculares ,y se confirmó el diagnóstico de esclerosis tuberosa. Dos de las 3 ecografías fetales no mostraban nódulos subependimarios cerebrales(ni otra alteración objetivable de esclerosis tuberosa en el sistema nervioso central) una semana antes de la realización de la RM. Dado que cada vez es más frecuente la petición de valoración de consejo genético y pronóstico por parte del servicio de ginecología-obstetricia a los pediatras, nos parece importante dar a conocer que la presencia de tan sólo un rabdomioma cardiaco conlleva necesariamente la recomendación de realizar una RM fetal, dado que la ecografía resulta insuficiente para la detección de las anomalías cerebrales que pueden acompañar a dicho hallazgo(AU)

Tuberous sclerosis is a multisystemic syndrome that affects diverse organs like brain, skin, kidneys, eyes and heart. We expose three clinical cases of tuberous sclerosis diagnosed prenatally after the incidental discovery of at less one cardiac rhabdomyoma in the routine ultrasound examination and cerebral lesions found later on by fetal magnetic resonance imaging. This technique has great impact on diagnosis, prognosis and genetic counseling of tuberous sclerosis. We analyze three women whose pregnancy had been initially uncomplicated. In their routine ultrasound examination one or more cardiac rhabdomyoma are detected. Magnetic fetal resonance is carried out and they show subependymal nodules establishing the clinical diagnosis of tuberous sclerosis. Two of the three fetal ultrasound examination didn’t show brain subependymal nodules (neither another feature of tuberous sclerosis in the nervous central system) one week before the realization of the fetal magnetic resonance imaging. Pregnant women with a fetus likely affected with a disease are frequently referred for diagnosis, prognosis and genetic counseling by obstetrics and gynecology specialists to the pediatricians. For that reason, is important to give to know that the presence of only one cardiac rhabdomyoma should continue of the recommendation of the realization of a magnetic fetal resonance, since fetal ultrasound examination is less accurate in the detection of the cerebral anomalies that can be associated with this finding(AU)

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La cerebelitis aguda consiste en una enfermedad de comienzo súbito, habitualmente de curso limitado y benigno. Nuestro propósito es describir un caso clínico con hallazgo reversibles en la resonancia magnética (RM) potenciada en difusión en un niño con una cerebelitis aguda postvaricelosa. Varón de 5 años, que presentó varicela 15 días antes de ser ingresado, que acude por fiebre, rigidez cervical y disartria. En el examen neurológico destacaban signos de afectación cerebelosa. Se realiza RM potenciada en difusión, apareciendo alteraciones en dicha secuencia, pero no en aquellas potenciadas en T1, T2 o FLAIR. El enfermo mejoró rápidamente y la RM era normal al mes de alta. La cerebelitis aguda puede, ocasionalmente, ser diagnosticada únicamente mediante la RM potenciada en difusión, por lo que esta técnica debe ser añadida a las secuencias convencionales en aquellos casos en los que se sospeche dicho trastorno (AU)

Acute cerebellitis consists of a sudden onset illness, which normally follows a limited course and is of a benign nature. Our purpose is to describe a clinical case with reversible lesions in MR diffusion-weighted imaging (DWI) findings in a child that has post-varicella acute cerebellitis. Five year old male that developed chickenpox 15 days before being admitted with fever, cervical rigidity and dysarthria. During the neurological examination cerebellar affection signs were found. When DWI was performed, hyperintensity of cerebellar hemispheres appeared, but not in T1, T2 and FLAIR sequences. The patient showed rapid improvement and the MR was normal a month after discharge. Acute cerebellitis may sometimes be diagnosed only on DWI, hence this technique should be added to conventional MR in suspected cases (AU)

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El divertículo uretral adquirido es una lesión relativamente frecuente en la mujer. Suelen ser asintomáticos pero pueden complicarse, siendo la infección y la formación de cálculos las complicaciones más frecuentes. La degeneración maligna con desarrollo de una tumoración maligna en el divertículo es una complicación rara que debe ser tenida en cuenta. Son pocos los casos descritos en la literatura de desarrollo de neoplasias malignas a partir de divertículos uretrales. Presentamos a continuación un caso de una mujer que fue diagnosticada de una tumoración maligna en un divertículo uretral. Revisamos los hallazgos de imagen de los divertículos uretrales y sus complicaciones (AU)

Acquired urethral diverticula are relatively common in women. They are usually asymptomatic but they can lead to complications; infection and stones are the most common complications. Malignant degeneration with the development of a malignant tumor in the diverticulum is a rare complication that must be taken into account. Few cases of malignant tumors in urethral diverticula have been reported. We present the case of a woman diagnosed with a malignant tumor in a urethral diverticulum. We review the imaging findings for urethral diverticula and the complications that can arise in this condition (AU)

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Acquired urethral diverticula are relatively common in women. They are usually asymptomatic but they can lead to complications; infection and stones are the most common complications. Malignant degeneration with the development of a malignant tumor in the diverticulum is a rare complication that must be taken into account. Few cases of malignant tumors in urethral diverticula have been reported. We present the case of a woman diagnosed with a malignant tumor in a urethral diverticulum. We review the imaging findings for urethral diverticula and the complications that can arise in this condition.

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La hernia medular idiopática es una entidad rara, causante de mielopatía progresiva. Es el resultado de una hernia de la médula espinal a través de un defecto de la duramadre, de etiología no conocida. La forma de presentación clínica más habitual es como un síndrome de Brown-Séquard. La importancia de un diagnóstico radiológico precoz radica en que es causa reversible de mielopatía, ya que el defecto dural es corregible quirúrgicamente con una alta tasa de recuperación funcional. La resonancia magnética es la técnica de imagen de elección para el diagnóstico. A continuación se presentan 2 casos de hernia medular idiopática donde se muestran los hallazgos radiológicos que nos permiten reconocer y diagnosticar esta entidad (AU)

Idiopathic spinal cord hernia, in which the reason that spinal cord protrudes through a defect in the dura mater is unknown, is a rare cause of progressive myelopathy. The most common clinical presentation is Brown-Séquard syndrome. Spinal cord herniation is a reversible cause of myelopathy: surgery to correct the defect in the dura mater has a high rate of functional recovery. Thus, early imaging detection is crucial. Magnetic resonance imaging is the technique of choice for the diagnosis. We present two cases of idiopathic spinal cord herniation and show the imaging findings that make it possible to recognize and diagnose this condition (AU)

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Idiopathic spinal cord hernia, in which the reason that spinal cord protrudes through a defect in the dura mater is unknown, is a rare cause of progressive myelopathy. The most common clinical presentation is Brown-Séquard syndrome. Spinal cord herniation is a reversible cause of myelopathy: surgery to correct the defect in the dura mater has a high rate of functional recovery. Thus, early imaging detection is crucial. Magnetic resonance imaging is the technique of choice for the diagnosis. We present two cases of idiopathic spinal cord herniation and show the imaging findings that make it possible to recognize and diagnose this condition.

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Median arcuate ligament syndrome is a disorder resulting from compression of the origin of the celiac trunk by the arcuate ligament, a fibrous arch that connects the right and left diaphragmatic crura. This is a controversial entity because the clinical manifestations are often nonspecific and isolated compression of the celiac trunk is relatively common in asymptomatic individuals. We report two cases of median arcuate ligament syndrome and review the radiographic features necessary for the imaging workup of this entity.

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