Search NEL Online

Case Reports 2009; 30(5): 553-557 PubMed PMID: 20035256 Citation  Keywords:  Calcinosis:diagnosis, Cerebral Cortex:pathology, Child, Female, Humans, Magnetic Resonance Imaging:standards, Male, Middle Aged, Reproducibility of Results, Tomography, X-Ray Computed,.   

BACKGROUND: Since magnetic resonance imaging (MRI) is a method of choice for establishing the correct diagnosis in a great majority of neurologic disorders, especially in detection the causes of seizures and both acute and slowly progressive neurologic disturbances, computerized tomography is becoming more frequently excluded from obligate spectrum of diagnostic protocol.

METHODS: MRI was performed on 1.5 T MR scanner in two patients, in one suffering from pseudohypoparathyroidism, and in another with Fahr disease, while CT was initially excluded from the diagnostic protocol. In third patient, 11-year-old boy with hypercalcemia, both CT and MRI were indicated because of seizure attack.

RESULTS: Completely normal appearing brain parenchyma was seen on T2W images in a patient with clinical diagnosis of pseudohypoparathyroidism while extensive intracerebral calcifications were noted after additionally performed computerized tomography of the brain. In another patient with Fahr disease and neurologic symptoms, extensive calcifications were evident on CT, while MR examination had revealed bilateral symmetric lesions of prolonged T2W signal in the basal ganglia, supratentorial white matter and cerebellum, most compatible toxic/metabolic demyelination. In the third patient, a boy with hypercalcemia, marked left parietal cortical calcification was noted on CT, while MRI, including T2 gradient-echo sequence was inconclusive.

CONCLUSIONS: MRI, without CT, can be not only confusing, but even misleading diagnostic modality for detection of not only subtle, but also extensive cerebral calcifications. The benefit of gradient-echo T2 sequence, that is usually included in MR protocol when intracranial calcifications are suspected, is also rather limited....

Read abstract  Full text PDF

Comparative Study 2009; 30(4): 487-490 PubMed PMID: 20010487 Citation  Keywords:  Adult, Binomial Distribution, Child, Electroencephalography:standards, Epilepsy:diagnosis, Humans, Magnetic Resonance Imaging:standards, Reproducibility of Results, Retrospective Studies, Risk Factors, Tomography, X-Ray Computed:standards,.   

BACKGROUND: The occurrence of the first unprovoked epileptic seizure always requires thorough examination. The risk of incorrect diagnosis is high, non-epileptic seizures represent 20-33% of newly diagnosed cases. The aim of the study is to evaluate findings of various modifications of EEG examination in the group of patients who experienced solitary unprovoked epileptic seizure and compare benefits of CT and MRI examination of the brain of these patients.

MATERIAL AND METHODS: The group involved 84 patients hospitalized at the 1st Department of Neurology , Faculty of Medicine, Comenius University in Bratislava between January 1997 and January 2007 after experiencing unprovoked epileptic seizure. It is a retrospective analysis of information from medical records and clinical documentation. For statistic comparing of benefits of various modifications of EEG examination and between CT and MRI examination of the brain binomic test of proportion was used.

RESULTS: Interictal epileptiform EEG graphoelements in native EEG was recorded only in 14.29% of patients. Statistically significantly more epileptiform graphoelements comparing EEG and EEG after sleep deprivation of the patient (SD) with one- hour recording was recorded with 24-hour 8 channels EEG monitoring after SD, EEG after SD with one- hour recording was of no significance comparing to native EEG. MRI examination of the brain was statistically more significant comparing to CT examination.

CONCLUSION: Low catchment of epileptiform EEG graphoelements in patients with solitary unprovoked seizure shows the importance of precise history in diagnostics of these patients. Though EEG is a very important examination it is an auxiliary one. We confirmed that MRI examination in patients who experienced solitary unprovoked epileptic seizure is undoubtedly the first choice method....

Read abstract  Full text PDF

Case Reports 2007; 28(3): 255-258 PubMed PMID: 17627258 Citation  Keywords:  Adult, Brain:pathology, Dandy-Walker Syndrome:pathology, Humans, Kallmann Syndrome:pathology, Male, Tomography, X-Ray Computed,.   

BACKGROUND & AIM: Dandy-Walker malformation, a rare congenital brain malformation, is described as a triad of cystic dilatation of the fourth ventricle, complete or partial agenesis of the cerebellar vermis, and an enlarged posterior fossa with elevated tentorium. We aimed to report an association of Kallmann's syndrome and Dandy-Walker malformation.

CASE: A fifteen years old boy was referred to endocrinology department due to delayed puberty. Stages of male genital development according to Marshall and Tanner, was stage G1 and P1 respectively. In the LHRH test, peak LH level was 40th min.:15.3 IU/ml. Peak growth hormone with insulin tolerance test was 14.5 microg/L. Olfactory test revealed light anosmia. With these findings the patient was accepted as isolated gonadotropin deficiency (Kalmann's syndrome). In computed tomography of the brain, cerebellar vermis was found to be hypoplastic and 4th ventricle was large and in posterior fossa broad hypodens area with cerebrospinal fluid density were seen (Dandy-Walker malformation).

CONCLUSION: We reported an association of Kallmann's syndrome and Dandy-Walker malformation. This is second reported case probably....

Read abstract  Full text PDF

Journal Article 2003; 24(5): 314-320 PubMed PMID: 14647003 Citation  Keywords:  Animals, Bone Density, Female, Mandible:diagnostic imaging, Rats, Rats, Wistar, Superior Cervical Ganglion:surgery, Sympathectomy, Tomography, X-Ray Computed, Tooth Eruption:physiology,.   

OBJECTIVE: To assess the effect of local sympathectomy on mandibular bone during tooth eruption in rats.

METHODS: The effect of a unilateral superior cervical ganglionectomy (Gx) on morphometry of ipsi- and contralateral mandible and volumetric bone density (as assessed by peripheral computed tomography) was examined 30 days after surgery.

RESULTS: Only a few mandibular morphometric parameters decreased significantly after denervation in rats subjected to a unilateral Gx and a contralateral sham-operation. Mandibular volumetric bone density decreased significantly after sympathetic denervation. In a second experiment, carried out under conditions of unilateral unimpeded eruption of incisors performed ipsilaterally or contralaterally to a unilateral Gx, a significant interaction "denervation x type of eruption" was found for most morphometric parameters. Further analysis indicated higher morphometric indexes in denervated mandibles than in the innervated ones under impeded incisor eruption conditions, and lower morphometric indexes in denervated mandibles than in the innervated ones under unimpeded incisor eruption conditions. Unimpeded eruption augmented total volumetric bone density providing the innervation was intact and caused opposite effects on cortical volumetric bone density in the presence of innervation (increase) or absence of innervation (decrease). Trabecular volumetric bone density decreased significantly after sympathetic denervation.

CONCLUSION: The results support a role of the sympathetic nervous system in the regulation of bone remodeling....

Read abstract

Case Reports 2001; 22(4): 263-269 PubMed PMID: 11524634 Citation  Keywords:  Adolescent, Adult, Child, Choristoma:diagnostic imaging, Female, Hormones:therapeutic use, Humans, Hyoid Bone, Mandibular Diseases:drug therapy, Middle Aged, Thyroid Gland, Tomography, X-Ray Computed, Tongue Diseases:diagnostic imaging,.   

OBJECTIVES: The authors describe the classification of heterotopic thyroid tissue. A survey of more than 600 literature cases is provided. Different therapy approaches for these anomalies are discussed. Data from seven subsequent cases have been added to the existing literature data. The authors present an alternative approach to the therapy of heterotopic thyroid tissue.

MATERIALS AND METHODS: The records of seven patients treated for a heterotopy of the thyroid tissue as the Department of ENT and Head and Neck Surgery of First Medical school of the Charles University of Prague since 1.1.1991 to 1.1.2001 have been analyzed.

RESULTS: The first group: No surgery. This approach was used for children. In these patients the heterotopic thyroid tissue is the only thyroid tissue they have, but its function is not damaged and there are no mechanical symptoms (no airway obstruction and dysphagia). TSH substitution-suppression therapy is necessary for this group. Cooperation and follow up by the endocrinology, otolaryngology and pediatric departments is necessary. At a later age these patients can be treated as in the second group. The second group: Surgery. All patients in this group had heterotopic thyroid tissue. The total removal of thyroid tissue has been preferred. Carcinomatous change or the development of mechanical syndrome, dysphagia or airway obstruction is possible. Total removal is the best surgical approach. Various surgical methods are described in the literature (CO2 laser, intraoral, mandibulotomy, middle hyotomy etc.). These patients are treated as after total thyroidectomy and substitution therapy with synthetic thyroid hormones is necessary. The authors describe and add seven cases to the literature data. The authors describe radical removal of aberrant and accessory tissue [corrected]....

Read abstract  Full text PDF