RESUMEN
BACKGROUND: Differentiating sellar region meningiomas from pituitary adenomas on standard magnetic resonance imaging (MRI) sequences can be difficult. Arterial spin labeling (ASL) is a noninvasive technique of magnetic resonance perfusion imaging. The range of applications of ASL in neurosurgery has increased, and the information provided can be unique and complementary to other MRI sequences. Here we investigate the utility of ASL MRI in differentiating between sellar region meningiomas and pituitary adenomas. METHODS: This was a retrospective comparison of quantitative assessments on absolute and normalized tumor blood flow in histologically proven meningiomas versus pituitary adenomas. RESULTS: A total of 15 patients with sellar region lesions were identified, including 9 meningiomas and 6 pituitary adenomas. Mean absolute tumor blood flow and normalized tumor blood flow were significantly higher in meningiomas (131 mL/100 g/min and 2.22) than adenomas (47 mL/100 g/min and 0.92; P < 0.05). CONCLUSIONS: ASL MRI is a useful adjunct sequence in differentiating sellar region meningiomas, which exhibit high perfusion, from pituitary adenomas, which exhibit relatively low perfusion.
Asunto(s)
Adenoma/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Neoplasias Meníngeas/diagnóstico por imagen , Meningioma/diagnóstico por imagen , Neoplasias Hipofisarias/diagnóstico por imagen , Adenoma/patología , Adulto , Anciano , Anciano de 80 o más Años , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Neoplasias Meníngeas/patología , Meningioma/patología , Persona de Mediana Edad , Neoplasias Hipofisarias/patología , Estudios Retrospectivos , Marcadores de SpinRESUMEN
A 37-year-old man, amateur rugby player sustained a hyperextension injury to his lower thoracic spine during a scrum collapse. The patient developed extreme hyperpathia in the T10-12 dermatome, and parasthesia from T12 to S1 in the left lower limb. Medical Research Council grade 5 power was regained rapidly within minutes of the accident, and the hyperpathia resolved within a week. MRI showed contusion of the spinal cord at T10 level but no associated osseoligamentous injury. Six months later, parasthesia and subjective weakness remained in the left lower limb. To our knowledge, this is the first description of a lower thoracic spinal cord injury without radiographic abnormality following an isolated low-energy injury in a skeletally mature patient.
Asunto(s)
Traumatismos en Atletas , Fútbol Americano , Traumatismos de la Médula Espinal/patología , Médula Espinal/patología , Traumatismos Vertebrales/patología , Columna Vertebral , Tórax , Adulto , Traumatismos en Atletas/complicaciones , Traumatismos en Atletas/diagnóstico por imagen , Contusiones/etiología , Humanos , Extremidad Inferior , Imagen por Resonancia Magnética , Masculino , Debilidad Muscular/etiología , Radiografía , Sensación , Médula Espinal/anomalías , Médula Espinal/diagnóstico por imagen , Traumatismos de la Médula Espinal/diagnóstico por imagen , Traumatismos Vertebrales/diagnóstico por imagenRESUMEN
We report a 37-year-old man with a primary intracranial oligodendroglioma presenting later with symptomatic multiple cerebrospinal fluid (CSF) intradural drop spinal metastases. This patient initially presented in 2006 with complex partial seizures. Initial histology demonstrated World Health Organization (WHO) grade 2 oligodendroglioma. The patient had further generalised seizures 7 months after initial tumour resection. MRI at that time confirmed tumour recurrence. The patient underwent a repeat craniotomy. Histology showed anaplastic transformation to a WHO grade 3 oligodendroglioma. About 30 months after his initial presentation, the patient developed a focal neurological deficit in the left leg with associated retention of urine. MRI of the neuraxis demonstrated widespread leptomeningeal metastatic drop deposits within the spinal canal. We discuss the mechanisms involved in tumour dissemination throughout the CSF. We also review the relevant literature regarding this phenomenon.
Asunto(s)
Neoplasias Encefálicas/patología , Duramadre/patología , Vértebras Lumbares/patología , Carcinomatosis Meníngea/secundario , Neoplasias Meníngeas/secundario , Oligodendroglioma/secundario , Polirradiculopatía/patología , Adulto , Antineoplásicos/uso terapéutico , Aracnoides/patología , Aracnoides/fisiopatología , Cauda Equina/patología , Cauda Equina/fisiopatología , Craneotomía , Duramadre/fisiopatología , Resultado Fatal , Lóbulo Frontal/patología , Lóbulo Frontal/fisiopatología , Hemiplejía/etiología , Hemiplejía/fisiopatología , Humanos , Vértebras Lumbares/fisiopatología , Imagen por Resonancia Magnética , Masculino , Carcinomatosis Meníngea/complicaciones , Carcinomatosis Meníngea/fisiopatología , Neoplasias Meníngeas/complicaciones , Neoplasias Meníngeas/fisiopatología , Oligodendroglioma/complicaciones , Oligodendroglioma/fisiopatología , Cuidados Paliativos , Polirradiculopatía/etiología , Polirradiculopatía/fisiopatología , Radioterapia , Convulsiones/etiología , Neoplasias de la Médula Espinal/secundario , Insuficiencia del Tratamiento , Vejiga Urinaria Neurogénica/etiologíaAsunto(s)
Neoplasias Encefálicas/patología , Glioma/patología , Tálamo/patología , Ácido Aspártico/análogos & derivados , Ácido Aspártico/análisis , Colina/análisis , Creatina/análisis , Femenino , Humanos , Imagen por Resonancia Magnética/métodos , Espectroscopía de Resonancia Magnética/métodos , Persona de Mediana EdadRESUMEN
OBJECTIVE: Tumors of the hypothalamic-pineal region may present with a wide variety of symptoms, including disturbed eating. We present a case where such a tumor was misdiagnosed as anorexia nervosa. METHOD: We describe a case of pineal germinoma invading the hypothalamus, which was initially diagnosed as anorexia nervosa. RESULTS: Clinical features included weight loss, vomiting, pyrexia, hypernatraemia, and visual disturbance and the typical psychopathology of anorexia nervosa was absent. CONCLUSION: Organic disorder should always be considered before making a diagnosis of anorexia nervosa, particularly if the presentation is atypical.