Neurofunctional correlates of attention rehabilitation in Parkinson's disease: an explorative study

The effectiveness of cognitive rehabilitation (CR) in Parkinson’s disease (PD) is in its relative infancy, and nowadays there is insufficient information to support evidence-based clinical protocols. This study is aimed at testing a validated therapeutic strategy characterized by intensive computer-based attention-training program tailored to attention deficits. We further investigated the presence of synaptic plasticity by means of functional magnetic resonance imaging (fMRI). Using a randomized controlled study, we enrolled eight PD patients who underwent a CR program (Experimental group) and seven clinically/demographically-matched PD patients who underwent a placebo intervention (Contro…

Magnetic resonance findings in scuba diving-related spinal cord decompression sickness

Scuba diving is associated with risk of severe decompression sickness (DCS type II), which results from rapid reduction of the environmental pressure sufficient to cause the formation into tissue or blood of inert gas bubbles previously loaded within tissues as a soluble phase. DCS type II constitutes a unique subset of ischemic insults to the central nervous system (CNS) with primarily involvement of the spinal cord. Ten patients with diving-related barotrauma underwent neurologic examination. Two of them presented progressive sensory and motor loss in the extremities at admission and were presumed affected by spinal cord DCS. Magnetic resonance imaging (MRI) demonstrated abnormalities in …

Percutaneous Pedicle-Lengthening Osteotomy in Minimal Invasive Spinal Surgery to Treat Degenerative Lumbar Spinal Stenosis: A Single-Center Preliminary Experience

Background Lumbar spinal stenosis (LSS) is a narrowing of the spinal canal due to spinal degeneration, and its main clinical symptom is neurogenic claudication. Surgical treatment is pursued for patients who do not improve with conservative care. Patients with symptomatic LSS who also have significant medical comorbidities, although clearly in need of intervention, are unattractive candidates for traditional open lumbar decompressive procedures. Thus it is important to explore minimally invasive surgical techniques to treat select patients with LSS. Methods This retrospective case series evaluated the clinical and radiographic outcomes of a new minimally invasive procedure to treat LSS: pe…

MRI findings and evoked potentials in patients with myotonic dystrophy versus facioscapulohumeral dystrophy

Evoked potentials recordings have been applied to many neurological disorders, localizing the lesions in the central nervous system (CNS) pathways. Facioscapulohumeral muscular dystrophy (FSHD) is a slowly progressive degenerative disease involving the muscles of the face and shoulders. On the contrary, myotonic distrophy (MD), the most frequent and severe myotonic disease, is caracterized by myotonia (delay of relaxation after voluntary contraction), muscular atrophy and dystrophic changes in non-muscular tissues. In the present investigation, patients with clinically and electromyographically verified FSHD and MD were examined using somatosensory evoked potentials (SEP) and brainstem aud…

Transfusional Hemochromatosis: Quantitative Relation of MR Imaging Pituitary Signal Intensity Reduction to Hypogonadotropic Hypogonadism

To assess the relationship between magnetic resonance (MR) imaging pituitary signal intensity reduction in patients with transfusional hemochromatosis and the clinical manifestation of hypogonadotropic hypogonadism.Pituitary MR imaging at 0.5 T was performed in 38 consecutive patients affected by secondary hemochromatosis and in 20 healthy volunteers. Serum ferritin levels were estimated in the affected population. Twenty (53%) of the 38 patients had hypogonadotropic hypogonadism diagnosed. Pituitary-to-fat signal intensity ratios were calculated from coronal gradient-echo (GRE) T2*-weighted MR images. The relationship between the quantitative reduction of the pituitary-to-fat signal intens…

Familial Cavernous Angioma: MRI Study of three Generation in two Italian Families and Literature Review

According to recent magnetic resonance imaging studies, cavernous angioma (CA) seems to involve the central nervous system in 0.5%-1% of the population 1 - in a similar percentage to a large autopsy series 2.The incidence of familial CA is unknown 3: the first paper in the literature concerning familial CA was published in 1936 5: recently however, thank to the widespread use of MR, at least 13 families have been described.We report MR findings in two Italian families with familial CA.In conclusion, familial CA should be included in the differential diagnosis of patients with intracranial haemorrhage, seizures or cerebrovascular disease.

Multiple sclerosis: prevalence of the ‘central vein’ sign in white matter lesions on gadolinium-enhanced susceptibility-weighted images

Aims To evaluate prospectively whether an intravenous gadolinium injection could improve the detection of the central vein sign on susceptibility-weighted imaging sequences obtained with a 1.5 T magnetic resonance scanner in patients with multiple sclerosis compared to unenhanced susceptibility-weighted images. Materials and methods This prospective, institution review board-approved study included 19 patients affected by multiple sclerosis (six men; 13 women; mean age 40.8 years, range 20–74 years). Patients had the relapsing–remitting clinical subtype in 95% of cases, and only one (5%) patient had the primary progressive clinical subtype of multiple sclerosis. T2-weighted images, fluid-at…

Sindrome da leuconecefalopatia posteriore reversibile (RPLS): aspetti neuroradiologici

Tinnitus e ipertensione neurogena da conflitto neurovascolare: descrizione di un caso

The term neurovascular conflict (NVC) has been introduced to describe the anatomic situation where a nerve makes contact with a blood vessel, artery or vein, at the exit zone from the brain’s trunk. The NVC between the VIII nerve and a blood vessel is clinically associated with tinnitus, vertigo (disabling positional vertigo, DPV), and unilateral sensorineural hearing loss. The blood vessels which most frequently make contact with the VIII nerve are the anterior-inferior cerebellar artery, then the posterior-inferior cerebellar artery and the basilar artery. The authors present an unusual case in which both vertebral arteries (one of which crosses the midline) create a NVC with left acousti…

Accuracy of SWI sequences compared to T2*-weighted gradient echo sequences in the detection of cerebral cavernous malformations in the familial form

Purpose The purpose of this study was to assess the accuracy of susceptibility-weighted imaging (SWI), compared with T2*-weighted gradient echo (GRE) imaging in assessing cerebral cavernous malformations. Materials and methods We retrospectively evaluated 21 patients with a familial form of cavernous malformation. Magnetic resonance (MR) protocol included non-enhanced and contrast-enhanced fast-spin echo (FSE) T1-weighted sequences, FSE T2-weighted sequences, fluid-attenuated inversion-recovery (FLAIR), GRE T2*-weighted and SWI sequences. Images were reviewed in consensus by two expert neuroradiologists to assess the location, number, size and conspicuity of the lesions on T2*-weighted GRE …

Late-onset Sheehan's syndrome presenting with rhabdomyolysis and hyponatremia: a case report.

Abstract Introduction Hyponatremia associated with rhabdomyolysis is a rare event and a correct diagnostic approach is required to rule out this or other diseases as a primary cause and to avoid other complications resulting from a lack of appropriate treatment. Case presentation A 64-year-old Caucasian woman presented to our facility with worsening fatigue, slurred speech, nausea and vomiting, and high serum levels of creatine kinase and myoglobin together with hyponatremia. Normal arterial blood gas analysis results, normal serum potassium levels, increased urine sodium levels, urine specific gravity of >1003N/m3 and low urine volume suggested an endocrine etiology. Her low cortisol an…

Ruolo dell’imaging di Risonanza Magnetica nella valutazione del controllo della risposta al trattamento radiochirurgico delle metastasi encefaliche

Reversible MRI abnormalities in an unusual paediatric presentation of Wernicke's encephalopathy

Background. We report an unusual paediatric presentation of acute Wernicke's encephalopathy in a 12-year-old boy affected by chronic gastrointestinal disease. MRI demonstrated, in addition to the typical diencephalic and mesencephalic signal abnormalities on T2-weighted images, enhancement of the mammillary bodies and the floor of the hypothalamus. Materials and methods. Following parenteral administration of thiamine for 4 days, the patient recovered from his neurological deficits and on follow-up enhanced MRI 1 month later, no signal abnormalities were found nor was there diencephalic or mesencephalic atrophy, as is usual in the chronic phase of the disease. Results. MRI provides crucial …

Imaging processing for CT angiography of the cervicocranial arteries: evaluation of reformatting technique.

Purpose. The aim of this study was to compare computed tomography angiography (CTA) sliding-thin-slab (STS) multiplanar reformatting (MPR), STS maximum intensity projection (MIP) and three-dimensional (3D) volume rendering (VR) reformatting techniques in the evaluation of cervicocranial arteries. Materials and methods. Twenty patients examined with multislice CT were included in this study. CTA images were reformatted as STS-MIP, STS-MPR and 3DVR in orthogonal planes and in the oblique-coronal plane. Images were evaluated in consensus by two radiologists, with a third radiologist to resolve discordances in grading image quality parameters. The Spearman correlation analysis was performed to …

Accumulo di ferro a livello ipofisario in pazienti affetti da beta-talassemia major: Aspetti RM

Gli autori si propongono di valutare le modificazioni del segnale RM a livello ipofisario nella emosiderosi secondaria in pazienti affetti da beta-talassemia major. Lo studio è stato condotto prospetticamente su un gruppo di 20 pazienti in regime alto-trasfusionale e trattamento ferro-chelante e su 10 volontari sani come gruppo di controllo. Gli esami RM sono stati condotti con apparecchiatura a magnete superconduttivo a 0,5T con sequenze SE TI-dipendenti e GRE TE*-dipendenti. Il sovraccarico di ferro è stato valutato mediante il dosaggio della ferritina sierica. è stata effettuata una valutazione quantitativa delle immagini RM SE T1- e GRE T2*-dipendenti attraverso la misurazione, mediant…

Hypogonadotrophic Pituitary Insufficiency in Transfusional Hemochromatosis Complicating Thalassemia Major: MR Imaging

To identify pituitary iron overload in patients with transfusion-dependent thalassemia major causing secondary hypogonadism, we prospectively evaluated signal intensity abnormalities of the anterior lobe of the pituitary gland of 30 patients comparing spin-echo, gradient-echo imaging and pituitary T2 relaxation times measurement. We found that pituitary iron overload can best be assessed by MR imaging using gradient-echo T2*-weighted technique to establish signal reduction in the anterior lobe of the pituitary gland. This finding is correlated to increasing serum ferritin level — a parameter that reflects the severity of iron overload, and is more evident in patients with secondary hypogon…

Comparison of Single-Echo T2-weighted Fast Spin-Echo and Conventional Spin-Echo MR Sequences

We compared single-echo T2-weighted fast spin-echo (FSE) magnetic resonance imaging and conventional spin-echo (CSE) T2-weighted imaging in the detection of brain lesions of multiple sclerosis (MS). 16 patients with clinically definite MS underwent brain imaging at 0.5 T with T2-weighted single-echo fast spin-echo (FSE) and conventional spin-echo (CSE) sequences. Image analysis was performed by three of the investigators who worked together to reduce interobserver variability. Statistical analysis was performed using Student's t test to assess the difference in the contrast-to-noise (C/N) ratio of MS lesions between CSE and FSE sequences. The Wilcoxon signed rank test was used to evaluate …

Value of serial magnetic resonance imaging in the assessment of brain metastases volume control during stereotactic radiosurgery

AIM To evaluate brain metastases volume control capabilities of stereotactic radiosurgery (SRS) through serial magnetic resonance (MR) imaging follow-up. METHODS MR examinations of 54 brain metastases in 31 patients before and after SRS were reviewed. Patients were included in this study if they had a pre-treatment MR examination and serial follow-up MR examinations at 6 wk, 9 wk, 12 wk, and 12 mo after SRS. The metastasis volume change was categorized at each follow-up as increased (> 20% of the initial volume), stable (± 20% of the initial volume) or decreased (< 20% of the initial volume). RESULTS A local tumor control with a significant (P < 0.05) volume decrease was observed in 25 meta…

Magnetic resonance imaging in the assessment of brain involvement in alcoholic and nonalcoholic Wernicke's encephalopathy

AIM To present the typical and atypical magnetic resonance (MR) imaging findings of alcoholic and non-alcoholic Wernicke’s encephalopathy. METHODS This study included 7 patients with Wernicke’s encephalopathy (2 men, 5 women; mean age, 52.3 years) that underwent brain MR examination between January 2012 and March 2016 in a single institution. Three patients were alcoholics and 4 patients were non-alcoholics. MR protocol included a T2-weighted sequence, a fluid attenuation inversion recovery (FLAIR) sequence, a diffusion-weighted sequence (b = 0 and 1000 s/mm2), and a contrast-enhanced MR sequence. All MR images were retrospectively reviewed at baseline and follow-up by two radiologists. RES…