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OBJECTIVE: Complex regional pain syndrome (CRPS) is a debilitating chronic condition characterized by severe, nociplastic pain along with various other symptoms. Neuromodulation, particularly electrical stimulation of the dorsal root ganglion (DRG), has emerged as a promising intervention for patients with CRPS unresponsive to conventional treatments. However, little is known about the anatomical characteristics of DRGs in patients with CRPS. This study aimed to assess DRG size in patients with CRPS compared with healthy controls. MATERIALS AND METHODS: A retrospective pilot study was conducted in 12 patients with unilateral lower extremity CRPS who have a history of lumbar magnetic resonance imaging, and evaluated DRG sizes bilaterally. Patients were age-, race-, and sex-matched to patients in the control group who were asymptomatic at matched spinal level. DRG sizes were evaluated by a neuroradiologist. Statistical analyses including paired t-tests were performed to compare the difference in DRG size in contralateral sides in patients with CRPS and their matched controls. RESULTS: Patients with CRPS exhibited a statistically significant reduction in DRG size on the affected side compared with the unaffected side (4.4 mm-4.8 mm, respectively). This difference was significant when compared with the difference observed in healthy controls (4.9 mm-5.0 mm, respectively). In addition, the mean DRG size difference between the affected and unaffected side showed a greater difference in DRG size in patients with CRPS (0.6 mm difference) than in control patients (0.2 mm difference). CONCLUSIONS: The findings suggest that CRPS is associated with a smaller DRG size in affected dermatomes, potentially indicating neuronal atrophy. Importantly, the study offers insights for DRG stimulation therapy especially among concerns for DRG compression after placement. This pilot study reveals a significant size difference in DRGs between affected and unaffected sides in patients with CRPS compared with controls, highlighting potential implications for treating CRPS. Further research is warranted to validate these findings and explore implications for clinical practice, including optimized neuromodulation strategies.
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Routine non-contrast material-enhanced head CT is one of the most frequently ordered studies in the emergency department. Skull base-related pathologic entities, often depicted on the first or last images of a routine head CT study, can be easily overlooked in the emergency setting if not incorporated in the interpreting radiologist's search pattern, as the findings can be incompletely imaged. Delayed diagnosis, misdiagnosis, or lack of recognition of skull base pathologic entities can negatively impact patient care. This article reviews and illustrates the essential skull base anatomy and common blind spots that are important to radiologists who interpret nonenhanced head CT images in the acute setting. The imaging characteristics of important "do not miss" lesions are emphasized and categorized by their cause and location within the skull base, and the potential differential diagnoses are discussed. An interpretation checklist to improve diagnostic accuracy is provided. ©RSNA, 2019.
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Traumatismos Craneocerebrales/diagnóstico por imagen , Base del Cráneo/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Lista de Verificación , Trastornos de la Conciencia/diagnóstico por imagen , Enfermedades de los Nervios Craneales/diagnóstico por imagen , Urgencias Médicas , Dolor Facial/diagnóstico por imagen , Cefalea/diagnóstico por imagen , Humanos , Hipertensión Intracraneal/diagnóstico por imagen , Órbita/diagnóstico por imagen , Convulsiones/diagnóstico por imagen , Base del Cráneo/anatomía & histología , Base del Cráneo/lesiones , Hueso Temporal/diagnóstico por imagen , Traumatismos del Sistema Nervioso/diagnóstico por imagen , Trastornos de la Visión/diagnóstico por imagenRESUMEN
BACKGROUND AND PURPOSE: Dental and periodontal diseases represent important but often overlooked causes of acute sinusitis. Our goal was to examine the prevalence of potential odontogenic sources of acute maxillary sinusitis according to immune status and their associations with sinusitis. MATERIALS AND METHODS: A retrospective review of maxillofacial computed tomography studies from 2013 to 2014 was performed. Each maxillary sinus and its ipsilateral dentition were evaluated for findings of acute sinusitis and dental/periodontal disease. RESULTS: Eighty-four patients (24 immunocompetent, 60 immunocompromised) had 171 maxillary sinuses that met inclusion criteria for acute maxillary sinusitis. Inspection of dentition revealed oroantral fistula in 1%, periapical lucencies in 16%, and projecting tooth root(s) in 71% of cases. Immunocompromised patients were more likely to have bilateral sinusitis than immunocompetent patients (67% vs 33%, P = 0.005). A paired case-control analysis in a subset of patients with unilateral maxillary sinusitis (n = 39) showed a higher prevalence of periapical lucency in association with sinuses that had an air fluid level-29% of sinuses with a fluid level had periapical lucency compared with 12% without sinus fluid (P = 0.033). CONCLUSIONS: Potential odontogenic sources of acute maxillary sinusitis are highly prevalent in both immunocompetent and immunocompromised patients, although the 2 patient populations demonstrate no difference in the prevalence of these potential odontogenic sources. Periapical lucencies were found to be associated with an ipsilateral sinus fluid level. Increased awareness of the importance of dental and periodontal diseases as key components of maxillofacial computed tomography interpretation would facilitate a more appropriate and timely treatment.
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Inmunocompetencia/inmunología , Huésped Inmunocomprometido/inmunología , Sinusitis Maxilar/diagnóstico por imagen , Enfermedades Periodontales/diagnóstico por imagen , Análisis de Causa Raíz/métodos , Tomografía Computarizada por Rayos X , Enfermedades Dentales/diagnóstico por imagen , Enfermedad Aguda , Huesos Faciales/diagnóstico por imagen , Humanos , Maxilar/diagnóstico por imagen , Sinusitis Maxilar/complicaciones , Sinusitis Maxilar/inmunología , Enfermedades Periodontales/complicaciones , Enfermedades Periodontales/inmunología , Estudios Retrospectivos , Enfermedades Dentales/complicaciones , Enfermedades Dentales/inmunologíaRESUMEN
Acoustic neuromas are the most common tumor in the cerebellopontine angle (CPA) but are rare in the general population. Paragangliomas are rarer still and, in a minority of cases (20%), are known to be caused by errors in the SDHD gene. Mutations in this gene are highly penetrant when inherited paternally but not maternally. We present the first reported case of a patient with a CPA tumor and a maternally inherited SDHD gene mutation.
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Neoplasias Cerebelosas/genética , Ángulo Pontocerebeloso , Análisis Mutacional de ADN , Predisposición Genética a la Enfermedad/genética , Neoplasias Primarias Múltiples/genética , Neuroma Acústico/genética , Paraganglioma/genética , Succinato Deshidrogenasa/genética , Alelos , Sustitución de Aminoácidos/genética , Secuencia de Bases , Neoplasias Cerebelosas/diagnóstico por imagen , Neoplasias Cerebelosas/cirugía , Ángulo Pontocerebeloso/diagnóstico por imagen , Ángulo Pontocerebeloso/cirugía , Deleción Cromosómica , Codón/genética , Diagnóstico Diferencial , Genotipo , Humanos , Leucina/genética , Neoplasias Primarias Múltiples/diagnóstico por imagen , Neoplasias Primarias Múltiples/cirugía , Neuroma Acústico/diagnóstico por imagen , Neuroma Acústico/cirugía , Paraganglioma/diagnóstico por imagen , Paraganglioma/cirugía , Prolina/genética , Radiografía , RadiocirugiaRESUMEN
BACKGROUND: Although neurologic manifestations often complicate the course of patients with multiple myeloma (MM), direct central nervous system invasion is rare. OBJECTIVE: To describe the neurologic symptoms and signs, imaging, cerebrospinal fluid findings, and the clinical course of patients with central nervous system myeloma invasion, all of whom had leptomeningeal myelomatosis. DESIGN AND PARTICIPANTS: Review of 23 patients with MM and leptomeningeal myelomatosis proven by malignant plasma cells in their cerebrospinal fluid. SETTING: Tertiary-care university medical center. RESULTS: Twenty-one patients had advanced-stage MM. Leptomeningeal myelomatosis was diagnosed up to 29 months (median, 13 months) after diagnosis of MM. Symptoms precipitating neurologic evaluation included manifestations of diffuse cerebral dysfunction, cranial nerve palsies, and spinal radiculopathies. Cerebrospinal fluid was abnormal in all patients, usually exhibiting pleocytosis and elevated protein content, plus positive cytologic findings. Specific magnetic resonance imaging findings suggestive of central nervous system invasion were found in 70% of the patients. These included leptomeningeal contrast enhancement and evidence of meningeal-based lesions sometimes masquerading as intraparenchymal lesions. Despite aggressive systemic and local treatment, the outcome was poor, reflecting the aggressiveness of the underlying MM. CONCLUSION: Leptomeningeal myelomatosis, although rare, should be considered in patients with MM and symptoms suggestive of widespread nervous system involvement.