RESUMO
Paracoccidioidomycosis (PCM) is a infection caused by the thermodimorphic fungus Paracoccidioides spp. (P. lutzii and, mainly, P. brasiliensis). This infection predominantly affects rural male workers aged between 30 and 50 years old who deal with soil on daily activities. Clinically, the disease is classified as acute/subacute phase, which evolves rapidly, secondary to dissemination of the fungus through to the phagocytic-mononuclear system, leading to fever, weight loss, and anorexia, associated with hepatosplenomegaly and lymphadenopathy, which can be complicated with suppuration and fistulization; and chronic phase, which corresponds to 74% to 95% of symptomatic cases, with a common pulmonary involvement. Central nervous system involvement is almost always a characteristic of the chronic form. Inhalation is the most common route of primary infection, usually affecting the lungs, forming the primary complex. From the primary complex, hematogenic dissemination can occur to any organ, including the brain and spinal cord. Although PCM of the central nervous system diagnosis is usually based on histopathological analysis and the imaging features are not specific for PCM, computed tomography and magnetic resonance imaging can demonstrate evidences of granuloma, abscess, meningitis, or a combination of these lesions, contributing to a preoperative diagnosis, especially when considered in conjunction with epidemiology. In this article, we review the pathophysiology, clinical manifestations and imaging aspects of neuro-PCM.
RESUMO
The complete features of the neurological complications of coronavirus disease 2019 (COVID-19) still need to be elucidated, including associated cranial nerve involvement. In the present study we describe cranial nerve lesions seen in magnetic resonance imaging (MRI) of six cases of confirmed COVID-19, involving the olfactory bulb, optic nerve, abducens nerve, and facial nerve. Cranial nerve involvement was associated with COVID-19, but whether by direct viral invasion or autoimmunity needs to be clarified. The development of neurological symptoms after initial respiratory symptoms and the absence of the virus in the cerebrospinal fluid (CSF) suggest the possibility of autoimmunity.
Assuntos
Nervo Abducente/diagnóstico por imagem , COVID-19/diagnóstico por imagem , Doenças dos Nervos Cranianos/diagnóstico por imagem , Nervo Facial/diagnóstico por imagem , Bulbo Olfatório/diagnóstico por imagem , Nervo Óptico/diagnóstico por imagem , Nervo Abducente/imunologia , Nervo Abducente/patologia , Nervo Abducente/virologia , Adulto , Idoso , Autoimunidade , COVID-19/imunologia , COVID-19/patologia , COVID-19/virologia , Doenças dos Nervos Cranianos/imunologia , Doenças dos Nervos Cranianos/patologia , Doenças dos Nervos Cranianos/virologia , Nervo Facial/imunologia , Nervo Facial/patologia , Nervo Facial/virologia , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Neuroimagem , Bulbo Olfatório/imunologia , Bulbo Olfatório/patologia , Bulbo Olfatório/virologia , Nervo Óptico/imunologia , Nervo Óptico/patologia , Nervo Óptico/virologia , SARS-CoV-2/patogenicidadeRESUMO
Neurologic complications are being recognized as important outcomes of coronavirus disease 2019 (COVID-19). Pathogenesis is varied and incompletely understood, and may include neuroinvasion, indirect post-infectious neuroinflammation, and cerebrovascular pathologies. We present a case of COVID-19-related encephalomyeloradiculitis with clinical and magnetic resonance imaging characteristics of neuromyelitis optica spectrum disorders that was associated with anti-aquaporin-4 antibodies. Our case suggests post-infectious autoimmunity as a mechanism in at least a subset of patients with COVID-19-related neurologic disease.
Assuntos
Aquaporina 4/imunologia , Autoanticorpos/análise , Doenças Autoimunes/etiologia , COVID-19/complicações , Encefalomielite/etiologia , Radiculopatia/etiologia , Azatioprina/uso terapêutico , Encéfalo/diagnóstico por imagem , COVID-19/diagnóstico por imagem , Encefalomielite/diagnóstico por imagem , Encefalomielite/imunologia , Feminino , Humanos , Imunossupressores/uso terapêutico , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Neuromielite Óptica/diagnóstico por imagem , Neuromielite Óptica/etiologia , Troca Plasmática , Radiculopatia/diagnóstico por imagem , Radiculopatia/imunologia , Coluna Vertebral/diagnóstico por imagemRESUMO
Melanoma is a malignant neoplasm of melanin-producing cells. Melanoma usually occurs in the skin, but can also arise in any anatomical site that contains melanocytes, such as mucous membranes, the eyes, and the central nervous system (CNS). Primary CNS malignant melanoma most often develops in the leptomeninges. We report a case of a rare intramedullary melanoma of the thoracic spinal cord. A 78-year-old man was treated with surgery, radiotherapy, and immunotherapy for leptomeningeal spread. We also discuss the role of imaging methods in diagnosis and follow-up. Medullary melanoma occurs more frequently in adults. The most common presenting symptoms are the insidious onset of lower extremity weakness and paresthesia. Magnetic resonance imaging is the method of choice for evaluation. Although there are no imaging features to accurately distinguish primary malignant melanoma from other melanocytic or hemorrhagic tumors, hyperintensity on T1-weighted magnetic resonance imaging should lead to inclusion of this neoplasm in differential diagnosis of spinal cord tumors. Positron emission tomography-computed tomography is a useful auxiliary examination to evaluate the extent of local and metastatic disease. Surgical resection is the primary treatment for intramedullary melanoma. However, the efficacy of adjunctive radiotherapy and chemotherapy for primary spinal cord malignant melanoma is still controversial.
Assuntos
Neoplasias Encefálicas , Melanoma , Neoplasias Cutâneas , Neoplasias da Medula Espinal , Adulto , Idoso , Diagnóstico Diferencial , Humanos , Imageamento por Ressonância Magnética , Masculino , Melanoma/diagnóstico por imagem , Neoplasias da Medula Espinal/diagnóstico por imagem , Neoplasias da Medula Espinal/cirurgiaRESUMO
Chikungunya virus can be transmitted perinatally leading to serious neurological sequelae. We report the longitudinal evolution of the brain magnetic resonance imaging aspects of three cases of mother-to-child Chikungunya virus transmission. The first magnetic resonance imaging scan presented brain cavitations, with or without corpus callosum diffusion restriction. Follow-up scans showed reduction in the volume of cavitations, with resolution of the restricted diffusion. However, one patient presented with a normal brain magnetic resonance image, despite the delay in neurocognitive development.
Assuntos
Febre de Chikungunya/diagnóstico por imagem , Febre de Chikungunya/transmissão , Transmissão Vertical de Doenças Infecciosas , Imageamento por Ressonância Magnética/métodos , Adulto , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , GravidezRESUMO
Our purpose is to describe typical computed tomography and magnetic resonance imaging findings in encephalopathies in the emergency. The focus of this article are the most frequent toxic and acquired metabolic diseases and their preferential sites of involvement, such as hepatic encephalopathy, hypoglicemia, nonketotic hyperglycemia, osmotic demyelination, posterior reversible encephalopathy syndrome, uremia, illegal drug abuse, carbon monoxide poisoning, and hypoxic-ischemic encephalopathy. The radiologist must be able to identify the most usual patterns of lesion in computed tomography and magnetic resonance imaging in these settings.
Assuntos
Encefalopatias Metabólicas/diagnóstico por imagem , Serviço Hospitalar de Emergência , Hipóxia-Isquemia Encefálica/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Encefalopatias Metabólicas/patologia , Humanos , Hipóxia-Isquemia Encefálica/patologia , Tomografia Computadorizada por Raios X/métodosRESUMO
OBJECTIVE: To analyze and compare cerebral white matter tracts through diffusion tensor imaging in autistic and normal children. METHODS: This is a case-control study on a sample of eight male, right-handed children diagnosed with autism according to Diagnostic and Statistical Manual of Mental Disorders-4th Edition criteria, and eight healthy age- and sex-matched controls. Imaging studies were performed on a 1.5-T scanner (Symphony Maestro Class, Siemens, Erlangen, Germany). Fractional anisotropy was calculated for the frontopontine and corticospinal tracts, frontal subcortical white matter, anterior cingulate, corpus callosum, striatum, internal capsule, optic radiation, superior and inferior longitudinal fascicles, and cerebellum. Analysis of significance was based on analysis of variance test for the mean fractional anisotropy values. RESULTS: Median age of cases was 9.53 +/- 1.83 years, and of controls, 9.57 +/- 1.36 years. Diffusion tensor imaging findings included significant reduction of fractional anisotropy in the anterior corpus callosum (P= .008), right corticospinal tract (P= .044), posterior limb of right and left internal capsules (P= .003 and .049, respectively), left superior cerebellar peduncle (P= .031), and right and left middle cerebellar peduncles (P= .043 and .039, respectively) in autistic children. CONCLUSIONS: The diffusion tensor imaging findings in children with autistic disorder suggest impairment of white matter microstructure, possibly associated with reduced connectivity in corpus callosum, internal capsule, and superior and middle cerebellar peduncles.