N 1991, Allen, et al., 2 described three pediatric patients with brain tumors in whom spontaneous... more N 1991, Allen, et al., 2 described three pediatric patients with brain tumors in whom spontaneous intracerebral hemorrhages developed in sites other than the primary tumor site, several years after undergoing craniospinal radiation therapy. All three hemorrhages required surgical evacuation. Histological examination revealed microscopic anomalous blood vessels in two of the three surgical specimens. In 1994, Ciricillo, et al., 8 reported seven cases of intracerebral cavernomas in pediatric patients whose tumors had been previously irradiated for primary malignancies, one of which hemorrhaged and required surgical intervention. They postulated that cranial irradiation in children may induce the formation of cavernomas. Subsequently, numerous cases of intracerebral hemorrhages and cavernomas in children after central nervous system irradiation have been reported. 1,3-5,7,9,10,12-15,17,19 Although these lesions are consistent radiographically and clinically with cavernomas, the diagnosis has not been proven through analysis of biopsy specimens in every case for obvious reasons. In cases of ce
To demonstrate whether the magnetic resonance imaging (MRI) localization of the abnormal enhancem... more To demonstrate whether the magnetic resonance imaging (MRI) localization of the abnormal enhancement of the optic nerve can be related to the pain or pattern of visual field loss associated with acute optic neuritis. Retrospective observational series and MRI review from a referral neuro-ophthalmology service. Seventy-three women and 23 men with acute optic neuritis who had high resolution gadolinium-enhanced fat-suppressed MRI within twenty days of the onset of visual loss. The presence of eye or other fifth cranial nerve (V(1)) pain, and pain with eye movement ipsilateral to the affected optic nerve or no eye pain was recorded. The neuroradiologist reviewed the MRI, masked to the affected eye, and recorded the length and segment (orbital, canalicular, intracranial, or combination of segments) of abnormal optic nerve enhancement. The presenting visual field defects were characterized as diffuse, central, arcuate, nasal or temporal. The types of pain and patterns of field loss were correlated with the segments of optic nerve enhancement in the affected eye. Five patients had nerves that did not enhance and were excluded from the outcome analysis. In the 91 patients with abnormal enhancement, 70 experienced eye/V(1) pain, 67 had pain with eye movement and 17 patients had no pain. Enhancement of the orbital optic nerve occurred in 66 patients, 93.9% who had eye/V(1) pain and 92.4% who had pain with eye movement. In the 25 patients with enhancement of the canalicular, intracranial or both segments, without orbital involvement, 32% had eye/V(1) pain and 24% had pain with eye movement. No pain occurred in 3% with enhancement of the orbital segment and in 60% with enhancement of the other optic nerve segments. The length of enhancement moderately correlated with eye/V(1) pain (r = 0.49, P = 0.01) and pain with eye movement (r = 0.37, P = 0.01). Patients with enhancement longer than 10 mm had pain five times (P = 0.004) more frequent than did those with enhancement <or=10 mm. There was no significant specific pattern of field loss associated with a particular location of enhancement, except temporal field loss occurred in 25% of intracranial lesions (P = 0.04). When optic neuritis involved the orbital segment of the optic nerve, eye or other V(1) distribution pain (94.3% vs. 32%) and pain with eye movement (91.4% vs. 24%) were significantly more frequent. In contrast, pain was absent 20 times more often when the orbital segment was not involved (60% vs. 3%). Except for temporal field loss in eyes with intracranial nerve lesions, no pattern of visual field loss appeared to correlate with the location or length of abnormal optic nerve enhancement.
Intracranial and intraspinal ependymomas are uncommon tumors of the central nervous system. These... more Intracranial and intraspinal ependymomas are uncommon tumors of the central nervous system. These tumors have a variety of imaging characteristics, some of which are fairly specific for ependymoma. We discuss the MRI features of ependymomas for each of the typical locations within the neuraxis, and provide MR imaging examples.
N 1991, Allen, et al., 2 described three pediatric patients with brain tumors in whom spontaneous... more N 1991, Allen, et al., 2 described three pediatric patients with brain tumors in whom spontaneous intracerebral hemorrhages developed in sites other than the primary tumor site, several years after undergoing craniospinal radiation therapy. All three hemorrhages required surgical evacuation. Histological examination revealed microscopic anomalous blood vessels in two of the three surgical specimens. In 1994, Ciricillo, et al., 8 reported seven cases of intracerebral cavernomas in pediatric patients whose tumors had been previously irradiated for primary malignancies, one of which hemorrhaged and required surgical intervention. They postulated that cranial irradiation in children may induce the formation of cavernomas. Subsequently, numerous cases of intracerebral hemorrhages and cavernomas in children after central nervous system irradiation have been reported. 1,3-5,7,9,10,12-15,17,19 Although these lesions are consistent radiographically and clinically with cavernomas, the diagnosis has not been proven through analysis of biopsy specimens in every case for obvious reasons. In cases of ce
Background We hypothesize that fractional anisotropy (FA) of the Ascending Reticular Activating S... more Background We hypothesize that fractional anisotropy (FA) of the Ascending Reticular Activating System (ARAS) can be used to predict the state of consciousness of patients suffering intracerebral hemorrhage. To test this hypothesis, we performed a pilot analysis of the ARAS correlating NIH Stroke Score with quantitative assessment of the ARAS on DTI imaging. Methods 21 patients with spontaneous ICH admitted to the Mount Sinai Health System between October 2017 and February 2018 were evaluated with NIHSS and MRI-DTI at 24–48 hours and 7–10 days using a 1.5 T scanner. DTI and tractography were performed with the READY view software, quantifying mean FA (mFA) and density with a ROI in the ventromedial mesencephalon. We divided patients into 2 subgroups: ‘conscious’ (NIHSS=0–15) and ‘unconscious’ (NIHSS=16–42). Results Pearson’s correlation coefficient demonstrated that quantitative DTI metrics (mFA and density) negatively correlate with the NIHSS at 7–10 days. The biserial correlation test demonstrated a significant association between mFA and NIHSS subgroups at 7–10 days. We assessed the probability for each patient of being in the subgroups given mFA using multivariate logistic regression model. Using a decision tree analysis, the mFA cut-off threshold between the two subgroups is 0.3765 (sensitivity 93.3%, specificity 83.3%, ROC AUC=0.86). Conclusions The mFA measured by quantitative DTI at 7–10 days after onset of intracerebral hemorrhage strongly predicts NIHSS. Patients with lower mFA values in the ARAS are far more likely to be unconscious.Abstract O-025 Figure 1Abstract O-025 Figure 2 Disclosures J. Scaggiante: None. N. Dangayach: None. X. Zhang: None. J. Mocco: 2; C; Rebound Therapeutics, Consulting Agreement, Consultant, Synchron, Consultant, Cerebrotech, Consulting Agreement, Consultant. 4; C; Synchron, Ownership Interest (Stock, options, shareholder), NeuroTechnology Investors, Ownership Interest (Stock, options, shareholder), The Stroke Project, Ownership Interest (Stock, options, shareholder), Endostream, Ownership Interest (Stock, options, shareholder), Apama, Ownership Interest (Stock, options, shareholder), NeurVana, Ownership Interest (Stock, options, shareholder). D. Lefton: None. C. Kellner: 2; C; Penumbra, Inc, Consulting Agreement.
Although cases of pituitary adenomas containing amyloid deposits have been described in the liter... more Although cases of pituitary adenomas containing amyloid deposits have been described in the literature, to our knowledge this is the first report to describe MR imaging characteristics of a pituitary adenoma containing almost entirely amyloid tissue.
Four pediatric patients were sent to our institution with the diagnosis of soft-tissue/malignant ... more Four pediatric patients were sent to our institution with the diagnosis of soft-tissue/malignant bone tumor. In all cases an MRI was the initial study performed for neck or back pain. All were surgically proven to have an osteoid osteoma/osteoblastoma (OO) as a final diagnosis. The MRI findings are reviewed. Four patients, three boys and one girl, ranging in age from 5 to 17 years, presented with symptoms of neck or back pain for 2 months to 2 years. Two had neurological findings. All patients underwent MRI. All MRIs demonstrated decreased T1 signal and increased T2 signal in the soft tissues and bone surrounding the lesions consistent with edema. Enhancement was observed in the adjacent soft tissues and in the lesion nidus retrospectively. Investigating neck or back pain with an initial MRI may lead to misleading diagnoses unless the radiologist is aware of the typical MRI appearance of vertebral osteoid osteoma.
BACKGROUND AND PURPOSE: Coronavirus disease 2019 (COVID-19) is an active worldwide pandemic with ... more BACKGROUND AND PURPOSE: Coronavirus disease 2019 (COVID-19) is an active worldwide pandemic with diverse complications. Stroke as a presentation has not been strongly associated with COVID-19. The authors aimed to retrospectively review a link between COVID-19 and acute stroke. MATERIALS AND METHODS: We conducted a retrospective case-control study of 41 cases and 82 control subjects matched by age, sex, and risk factors. Cases were patients who underwent stroke alert imaging with confirmed acute stroke on imaging between March 16 and April 5, 2020, at 6 hospitals across New York City. Control subjects were those who underwent stroke alertimaging during the same timeframe without imaging evidence of acute infarction. Data pertaining to diagnosis of COVID-19 infection, patient demographics, and risk factors were collected. A univariate analysis was performed to assess the covariate effect of risk factors and COVID-19 status on stroke imaging with positive findings.
Critical Reviews in Diagnostic Imaging, Jul 1, 2000
A variety of histologic subtypes of tumor may affect the thalamus and the hypothalamus in the ped... more A variety of histologic subtypes of tumor may affect the thalamus and the hypothalamus in the pediatric population. These tumors have radiologic features that are useful in predicting pathology. We discuss the radiologic findings of childhood thalamic and hypothalamic tumors and provide imaging examples.
OBJECTIVE Patients with partial or complete bilateral vertebral artery occlusion often present wi... more OBJECTIVE Patients with partial or complete bilateral vertebral artery occlusion often present with signs and symptoms of transient ischemic attacks or infarction. Advances in phase contrast magnetic resonance imaging have led to noninvasive assessment of volumetric blood flow rates and direction that help in the workup and management of these patients. CLINICAL PRESENTATION We present the case of a patient with symptoms of vertebrobasilar insufficiency without previous transient ischemic attacks or stroke. Quantitative magnetic resonance angiography (QMRA) demonstrated bilateral vertebral artery occlusion with reversal of flow in the basilar and vertebral arteries to the level of the posterior inferior cerebellar arteries bilaterally. A prominent right posterior communicating artery filled the basilar artery and proximal vertebral arteries. INTERVENTION The presence of reversal and diminished flow in the basilar and vertebral arteries suggested that occipital artery-to-posterior inferior cerebellar artery bypass would improve posterior circulation, relieve symptoms, and reduce the risk of infarction. Postoperative QMRA and angiography confirmed revascularization, and QMRA confirmed correction of blood flow direction. CONCLUSION This case illustrates the potential of QMRA as part of a comprehensive cerebrovascular assessment, operative planning, and follow-up of patients with vertebrobasilar insufficiency.
BACKGROUND AND PURPOSE: Pseudomeningocele is a well-known MR imaging finding in Erb palsy. Our ai... more BACKGROUND AND PURPOSE: Pseudomeningocele is a well-known MR imaging finding in Erb palsy. Our aim was to evaluate the prevalence and imaging features of PST, a lesser known but, in our experience, more common finding in Erb palsy. MATERIALS AND METHODS: This retrospective study consisted of 37 subjects with Erb palsy from birth trauma. MR imaging examinations of the brachial plexus were evaluated independently by 2 neuroradiologists for the presence and signal-intensity characteristics/configuration of PST. Other findings included pseudomeningocele and posterior humeral head subluxation. The Blyth-Still-Casella procedure was used to construct an exact 95% CI for the percentage of patients seen to be positive for a specific imaging or anatomic feature by at least 1 observer and for the percentage positive according to both readers. RESULTS: The percentage of subjects found to have PST by both readers was 95% (35/37) (95% CI, 86.2%-99.9%). The PST was typically isointense to muscle on T1-and hyperintense on T2-weighted images. The most common morphology of the PST was a round or oval mass, though other morphologies were observed. Pseudomeningocele and posterior humeral head subluxation were reported in 40% (15/37) and 81% (30/37) of subjects, respectively. CONCLUSIONS: PST was the most common MR imaging finding in our series of subjects with Erb palsy and was observed more frequently than currently used imaging features. Although the morphology of PST is somewhat variable, several distinct patterns were observed, possibly reflecting different histologic compositions. ABBREVIATIONS: A ϭ anterior scalene muscle; CI ϭ confidence interval; HHS ϭ humeral head subluxation; M ϭ middle scalene muscle; PS ϭ pseudomeningocele; PST ϭ periscalene soft tissue
The prevalence of human immune-deficiency virus (HIV) infection around the world, coupled with in... more The prevalence of human immune-deficiency virus (HIV) infection around the world, coupled with increasing population movement, make it likely that many physicians will treat HIV-infected patients. New treatment protocols for the specific manifestations of acquired immune-deficiency syndrome (AIDS) make distinguishing the different neurological diseases of great importance. The pattern of disease in children differs from those of adults both in its distribution and etiology. This article encapsulates the salient aspects relating to the imaging of the brain in HIV-positive children, paying particular attention to recent advances and the different features of the various pathological conditions affecting the HIV-infected brain in children.
Coronavirus disease 2019 (COVID-19) is a global pandemic, and it is increasingly important that p... more Coronavirus disease 2019 (COVID-19) is a global pandemic, and it is increasingly important that physicians recognize and understand its atypical presentations. Neurological symptoms such as anosmia, altered mental status, headache, and myalgias may arise due to direct injury to the nervous system or by indirectly precipitating coagulopathies. We present the first COVID-19 related cases of carotid artery thrombosis and acute PRES-like leukoencephalopathy with multifocal hemorrhage.
The frequency of disc degeneration (DD) in the distal mobile segments will increase over time fol... more The frequency of disc degeneration (DD) in the distal mobile segments will increase over time following surgery for adolescent idiopathic scoliosis (AIS). Retrospective review of a prospective AIS registry. Durability of surgical outcomes is essential for maintenance of quality of life as well as for family decision making and for assessment of the value of a healthcare intervention. We assessed DD, its risk factors, and association with health-related quality of life 10 years after AIS surgery. Five radiographic indicators of DD, previously validated, were evaluated preoperatively and 1 month, 2, 5, and 10 years postoperatively by a radiologist in operative AIS patients. A composite radiographic score (CRS; range 0-10) was calculated using the sum of each of the DD indicators. The severity of CRS in relation to the time point after surgery and various risk factors were assessed using linear regression or Pearson χ test. CRS ≥3 was chosen to indicate significant DD. Association of CRS with SRS-22 outcome was evaluated by linear regression. 193 consecutive patients (mean age at surgery 14.4 years; 86% female) were assessed. Surgical approach included 102 posterior and 91 anterior fusions. Contributors to maximum CRS at 10 years were Schmorl's nodes (7.3% of patients), osteophytes (40.4%), sclerosis (29%), and irregular endplate (8.3%). CRS ≥3 occurred in 1.6%, 0.54%, 3.7%, 6.8%, and 7.3% of patients at the various time points (r=0.83, p=.0313), respectively. More than 50% of DD occurred at the second (35.5%) and third (20%) disc caudal to the LIV. LIV of L4 compared with more cephalad LIV had the highest risk of developing significant DD (27.3%; p=.0267). It was found that disc wedging subjacent to the LIV (≥5°) and LIV translation (≥2 cm) lead to a sixfold increase in significant DD (odds ratio=6.71 and 6.13, respectively). Severity of DD was not associated with the number of levels fused (p=.2131), the surgical approach (p=.8245), or the construct type (p=.2922). No significant association was established between 10-year CRS and SRS-22 scores. In the first study of its kind, we found that only 7.3% of patients had significant DD 10 years after surgical correction of AIS. Rates of DD increased over time. Our data provide evidence to support recommendations to save as many caudal motion segments as possible, to avoid fusing to L4, and maintain the LIV tilt angle below 5° and LIV translation less than 2 cm.
... Gelatine Based Bone Wax To the Editor: We have read with interest the paper by Magyar et al... more ... Gelatine Based Bone Wax To the Editor: We have read with interest the paper by Magyar et al1 on a new alkylene oxide copolymer bone hemostatic material (Ostene) and we congratulate the authors for conducting a throughout study on a new water soluble bone hemostat. ...
LEARNING OBJECTIVES 1) Review the pathophysiology of stroke in children and young adults, 2) Exam... more LEARNING OBJECTIVES 1) Review the pathophysiology of stroke in children and young adults, 2) Examine the CT and MRI/MRA imaging features of stroke and 3) Learn various etiologies of stroke in children and young adults ABSTRACT Stroke is the third leading cause of death after heart disease and cancer and a leading cause of long term disability in older patients. The purpose of this exhibit is to heighten awareness that stroke also occurs in infants, children and young adults. We reviewed fifty three cases from three major institutions over the last seven years that illustrate the imaging and clinical features of stroke in these populations. There are twenty-six cases of stroke in infants (0-11 months) from hypoxic/ischemic events, protein C/S deficiency, infection, thrombocytosis, sinus thrombosis, post immunization and gestational Diabetes Mellitus, twenty-two cases of stroke in children (1-14 years old) from sickle-cell disease (including Moya-Moya), maternal cocaine use, fibromusc...
N 1991, Allen, et al., 2 described three pediatric patients with brain tumors in whom spontaneous... more N 1991, Allen, et al., 2 described three pediatric patients with brain tumors in whom spontaneous intracerebral hemorrhages developed in sites other than the primary tumor site, several years after undergoing craniospinal radiation therapy. All three hemorrhages required surgical evacuation. Histological examination revealed microscopic anomalous blood vessels in two of the three surgical specimens. In 1994, Ciricillo, et al., 8 reported seven cases of intracerebral cavernomas in pediatric patients whose tumors had been previously irradiated for primary malignancies, one of which hemorrhaged and required surgical intervention. They postulated that cranial irradiation in children may induce the formation of cavernomas. Subsequently, numerous cases of intracerebral hemorrhages and cavernomas in children after central nervous system irradiation have been reported. 1,3-5,7,9,10,12-15,17,19 Although these lesions are consistent radiographically and clinically with cavernomas, the diagnosis has not been proven through analysis of biopsy specimens in every case for obvious reasons. In cases of ce
To demonstrate whether the magnetic resonance imaging (MRI) localization of the abnormal enhancem... more To demonstrate whether the magnetic resonance imaging (MRI) localization of the abnormal enhancement of the optic nerve can be related to the pain or pattern of visual field loss associated with acute optic neuritis. Retrospective observational series and MRI review from a referral neuro-ophthalmology service. Seventy-three women and 23 men with acute optic neuritis who had high resolution gadolinium-enhanced fat-suppressed MRI within twenty days of the onset of visual loss. The presence of eye or other fifth cranial nerve (V(1)) pain, and pain with eye movement ipsilateral to the affected optic nerve or no eye pain was recorded. The neuroradiologist reviewed the MRI, masked to the affected eye, and recorded the length and segment (orbital, canalicular, intracranial, or combination of segments) of abnormal optic nerve enhancement. The presenting visual field defects were characterized as diffuse, central, arcuate, nasal or temporal. The types of pain and patterns of field loss were correlated with the segments of optic nerve enhancement in the affected eye. Five patients had nerves that did not enhance and were excluded from the outcome analysis. In the 91 patients with abnormal enhancement, 70 experienced eye/V(1) pain, 67 had pain with eye movement and 17 patients had no pain. Enhancement of the orbital optic nerve occurred in 66 patients, 93.9% who had eye/V(1) pain and 92.4% who had pain with eye movement. In the 25 patients with enhancement of the canalicular, intracranial or both segments, without orbital involvement, 32% had eye/V(1) pain and 24% had pain with eye movement. No pain occurred in 3% with enhancement of the orbital segment and in 60% with enhancement of the other optic nerve segments. The length of enhancement moderately correlated with eye/V(1) pain (r = 0.49, P = 0.01) and pain with eye movement (r = 0.37, P = 0.01). Patients with enhancement longer than 10 mm had pain five times (P = 0.004) more frequent than did those with enhancement <or=10 mm. There was no significant specific pattern of field loss associated with a particular location of enhancement, except temporal field loss occurred in 25% of intracranial lesions (P = 0.04). When optic neuritis involved the orbital segment of the optic nerve, eye or other V(1) distribution pain (94.3% vs. 32%) and pain with eye movement (91.4% vs. 24%) were significantly more frequent. In contrast, pain was absent 20 times more often when the orbital segment was not involved (60% vs. 3%). Except for temporal field loss in eyes with intracranial nerve lesions, no pattern of visual field loss appeared to correlate with the location or length of abnormal optic nerve enhancement.
Intracranial and intraspinal ependymomas are uncommon tumors of the central nervous system. These... more Intracranial and intraspinal ependymomas are uncommon tumors of the central nervous system. These tumors have a variety of imaging characteristics, some of which are fairly specific for ependymoma. We discuss the MRI features of ependymomas for each of the typical locations within the neuraxis, and provide MR imaging examples.
N 1991, Allen, et al., 2 described three pediatric patients with brain tumors in whom spontaneous... more N 1991, Allen, et al., 2 described three pediatric patients with brain tumors in whom spontaneous intracerebral hemorrhages developed in sites other than the primary tumor site, several years after undergoing craniospinal radiation therapy. All three hemorrhages required surgical evacuation. Histological examination revealed microscopic anomalous blood vessels in two of the three surgical specimens. In 1994, Ciricillo, et al., 8 reported seven cases of intracerebral cavernomas in pediatric patients whose tumors had been previously irradiated for primary malignancies, one of which hemorrhaged and required surgical intervention. They postulated that cranial irradiation in children may induce the formation of cavernomas. Subsequently, numerous cases of intracerebral hemorrhages and cavernomas in children after central nervous system irradiation have been reported. 1,3-5,7,9,10,12-15,17,19 Although these lesions are consistent radiographically and clinically with cavernomas, the diagnosis has not been proven through analysis of biopsy specimens in every case for obvious reasons. In cases of ce
Background We hypothesize that fractional anisotropy (FA) of the Ascending Reticular Activating S... more Background We hypothesize that fractional anisotropy (FA) of the Ascending Reticular Activating System (ARAS) can be used to predict the state of consciousness of patients suffering intracerebral hemorrhage. To test this hypothesis, we performed a pilot analysis of the ARAS correlating NIH Stroke Score with quantitative assessment of the ARAS on DTI imaging. Methods 21 patients with spontaneous ICH admitted to the Mount Sinai Health System between October 2017 and February 2018 were evaluated with NIHSS and MRI-DTI at 24–48 hours and 7–10 days using a 1.5 T scanner. DTI and tractography were performed with the READY view software, quantifying mean FA (mFA) and density with a ROI in the ventromedial mesencephalon. We divided patients into 2 subgroups: ‘conscious’ (NIHSS=0–15) and ‘unconscious’ (NIHSS=16–42). Results Pearson’s correlation coefficient demonstrated that quantitative DTI metrics (mFA and density) negatively correlate with the NIHSS at 7–10 days. The biserial correlation test demonstrated a significant association between mFA and NIHSS subgroups at 7–10 days. We assessed the probability for each patient of being in the subgroups given mFA using multivariate logistic regression model. Using a decision tree analysis, the mFA cut-off threshold between the two subgroups is 0.3765 (sensitivity 93.3%, specificity 83.3%, ROC AUC=0.86). Conclusions The mFA measured by quantitative DTI at 7–10 days after onset of intracerebral hemorrhage strongly predicts NIHSS. Patients with lower mFA values in the ARAS are far more likely to be unconscious.Abstract O-025 Figure 1Abstract O-025 Figure 2 Disclosures J. Scaggiante: None. N. Dangayach: None. X. Zhang: None. J. Mocco: 2; C; Rebound Therapeutics, Consulting Agreement, Consultant, Synchron, Consultant, Cerebrotech, Consulting Agreement, Consultant. 4; C; Synchron, Ownership Interest (Stock, options, shareholder), NeuroTechnology Investors, Ownership Interest (Stock, options, shareholder), The Stroke Project, Ownership Interest (Stock, options, shareholder), Endostream, Ownership Interest (Stock, options, shareholder), Apama, Ownership Interest (Stock, options, shareholder), NeurVana, Ownership Interest (Stock, options, shareholder). D. Lefton: None. C. Kellner: 2; C; Penumbra, Inc, Consulting Agreement.
Although cases of pituitary adenomas containing amyloid deposits have been described in the liter... more Although cases of pituitary adenomas containing amyloid deposits have been described in the literature, to our knowledge this is the first report to describe MR imaging characteristics of a pituitary adenoma containing almost entirely amyloid tissue.
Four pediatric patients were sent to our institution with the diagnosis of soft-tissue/malignant ... more Four pediatric patients were sent to our institution with the diagnosis of soft-tissue/malignant bone tumor. In all cases an MRI was the initial study performed for neck or back pain. All were surgically proven to have an osteoid osteoma/osteoblastoma (OO) as a final diagnosis. The MRI findings are reviewed. Four patients, three boys and one girl, ranging in age from 5 to 17 years, presented with symptoms of neck or back pain for 2 months to 2 years. Two had neurological findings. All patients underwent MRI. All MRIs demonstrated decreased T1 signal and increased T2 signal in the soft tissues and bone surrounding the lesions consistent with edema. Enhancement was observed in the adjacent soft tissues and in the lesion nidus retrospectively. Investigating neck or back pain with an initial MRI may lead to misleading diagnoses unless the radiologist is aware of the typical MRI appearance of vertebral osteoid osteoma.
BACKGROUND AND PURPOSE: Coronavirus disease 2019 (COVID-19) is an active worldwide pandemic with ... more BACKGROUND AND PURPOSE: Coronavirus disease 2019 (COVID-19) is an active worldwide pandemic with diverse complications. Stroke as a presentation has not been strongly associated with COVID-19. The authors aimed to retrospectively review a link between COVID-19 and acute stroke. MATERIALS AND METHODS: We conducted a retrospective case-control study of 41 cases and 82 control subjects matched by age, sex, and risk factors. Cases were patients who underwent stroke alert imaging with confirmed acute stroke on imaging between March 16 and April 5, 2020, at 6 hospitals across New York City. Control subjects were those who underwent stroke alertimaging during the same timeframe without imaging evidence of acute infarction. Data pertaining to diagnosis of COVID-19 infection, patient demographics, and risk factors were collected. A univariate analysis was performed to assess the covariate effect of risk factors and COVID-19 status on stroke imaging with positive findings.
Critical Reviews in Diagnostic Imaging, Jul 1, 2000
A variety of histologic subtypes of tumor may affect the thalamus and the hypothalamus in the ped... more A variety of histologic subtypes of tumor may affect the thalamus and the hypothalamus in the pediatric population. These tumors have radiologic features that are useful in predicting pathology. We discuss the radiologic findings of childhood thalamic and hypothalamic tumors and provide imaging examples.
OBJECTIVE Patients with partial or complete bilateral vertebral artery occlusion often present wi... more OBJECTIVE Patients with partial or complete bilateral vertebral artery occlusion often present with signs and symptoms of transient ischemic attacks or infarction. Advances in phase contrast magnetic resonance imaging have led to noninvasive assessment of volumetric blood flow rates and direction that help in the workup and management of these patients. CLINICAL PRESENTATION We present the case of a patient with symptoms of vertebrobasilar insufficiency without previous transient ischemic attacks or stroke. Quantitative magnetic resonance angiography (QMRA) demonstrated bilateral vertebral artery occlusion with reversal of flow in the basilar and vertebral arteries to the level of the posterior inferior cerebellar arteries bilaterally. A prominent right posterior communicating artery filled the basilar artery and proximal vertebral arteries. INTERVENTION The presence of reversal and diminished flow in the basilar and vertebral arteries suggested that occipital artery-to-posterior inferior cerebellar artery bypass would improve posterior circulation, relieve symptoms, and reduce the risk of infarction. Postoperative QMRA and angiography confirmed revascularization, and QMRA confirmed correction of blood flow direction. CONCLUSION This case illustrates the potential of QMRA as part of a comprehensive cerebrovascular assessment, operative planning, and follow-up of patients with vertebrobasilar insufficiency.
BACKGROUND AND PURPOSE: Pseudomeningocele is a well-known MR imaging finding in Erb palsy. Our ai... more BACKGROUND AND PURPOSE: Pseudomeningocele is a well-known MR imaging finding in Erb palsy. Our aim was to evaluate the prevalence and imaging features of PST, a lesser known but, in our experience, more common finding in Erb palsy. MATERIALS AND METHODS: This retrospective study consisted of 37 subjects with Erb palsy from birth trauma. MR imaging examinations of the brachial plexus were evaluated independently by 2 neuroradiologists for the presence and signal-intensity characteristics/configuration of PST. Other findings included pseudomeningocele and posterior humeral head subluxation. The Blyth-Still-Casella procedure was used to construct an exact 95% CI for the percentage of patients seen to be positive for a specific imaging or anatomic feature by at least 1 observer and for the percentage positive according to both readers. RESULTS: The percentage of subjects found to have PST by both readers was 95% (35/37) (95% CI, 86.2%-99.9%). The PST was typically isointense to muscle on T1-and hyperintense on T2-weighted images. The most common morphology of the PST was a round or oval mass, though other morphologies were observed. Pseudomeningocele and posterior humeral head subluxation were reported in 40% (15/37) and 81% (30/37) of subjects, respectively. CONCLUSIONS: PST was the most common MR imaging finding in our series of subjects with Erb palsy and was observed more frequently than currently used imaging features. Although the morphology of PST is somewhat variable, several distinct patterns were observed, possibly reflecting different histologic compositions. ABBREVIATIONS: A ϭ anterior scalene muscle; CI ϭ confidence interval; HHS ϭ humeral head subluxation; M ϭ middle scalene muscle; PS ϭ pseudomeningocele; PST ϭ periscalene soft tissue
The prevalence of human immune-deficiency virus (HIV) infection around the world, coupled with in... more The prevalence of human immune-deficiency virus (HIV) infection around the world, coupled with increasing population movement, make it likely that many physicians will treat HIV-infected patients. New treatment protocols for the specific manifestations of acquired immune-deficiency syndrome (AIDS) make distinguishing the different neurological diseases of great importance. The pattern of disease in children differs from those of adults both in its distribution and etiology. This article encapsulates the salient aspects relating to the imaging of the brain in HIV-positive children, paying particular attention to recent advances and the different features of the various pathological conditions affecting the HIV-infected brain in children.
Coronavirus disease 2019 (COVID-19) is a global pandemic, and it is increasingly important that p... more Coronavirus disease 2019 (COVID-19) is a global pandemic, and it is increasingly important that physicians recognize and understand its atypical presentations. Neurological symptoms such as anosmia, altered mental status, headache, and myalgias may arise due to direct injury to the nervous system or by indirectly precipitating coagulopathies. We present the first COVID-19 related cases of carotid artery thrombosis and acute PRES-like leukoencephalopathy with multifocal hemorrhage.
The frequency of disc degeneration (DD) in the distal mobile segments will increase over time fol... more The frequency of disc degeneration (DD) in the distal mobile segments will increase over time following surgery for adolescent idiopathic scoliosis (AIS). Retrospective review of a prospective AIS registry. Durability of surgical outcomes is essential for maintenance of quality of life as well as for family decision making and for assessment of the value of a healthcare intervention. We assessed DD, its risk factors, and association with health-related quality of life 10 years after AIS surgery. Five radiographic indicators of DD, previously validated, were evaluated preoperatively and 1 month, 2, 5, and 10 years postoperatively by a radiologist in operative AIS patients. A composite radiographic score (CRS; range 0-10) was calculated using the sum of each of the DD indicators. The severity of CRS in relation to the time point after surgery and various risk factors were assessed using linear regression or Pearson χ test. CRS ≥3 was chosen to indicate significant DD. Association of CRS with SRS-22 outcome was evaluated by linear regression. 193 consecutive patients (mean age at surgery 14.4 years; 86% female) were assessed. Surgical approach included 102 posterior and 91 anterior fusions. Contributors to maximum CRS at 10 years were Schmorl's nodes (7.3% of patients), osteophytes (40.4%), sclerosis (29%), and irregular endplate (8.3%). CRS ≥3 occurred in 1.6%, 0.54%, 3.7%, 6.8%, and 7.3% of patients at the various time points (r=0.83, p=.0313), respectively. More than 50% of DD occurred at the second (35.5%) and third (20%) disc caudal to the LIV. LIV of L4 compared with more cephalad LIV had the highest risk of developing significant DD (27.3%; p=.0267). It was found that disc wedging subjacent to the LIV (≥5°) and LIV translation (≥2 cm) lead to a sixfold increase in significant DD (odds ratio=6.71 and 6.13, respectively). Severity of DD was not associated with the number of levels fused (p=.2131), the surgical approach (p=.8245), or the construct type (p=.2922). No significant association was established between 10-year CRS and SRS-22 scores. In the first study of its kind, we found that only 7.3% of patients had significant DD 10 years after surgical correction of AIS. Rates of DD increased over time. Our data provide evidence to support recommendations to save as many caudal motion segments as possible, to avoid fusing to L4, and maintain the LIV tilt angle below 5° and LIV translation less than 2 cm.
... Gelatine Based Bone Wax To the Editor: We have read with interest the paper by Magyar et al... more ... Gelatine Based Bone Wax To the Editor: We have read with interest the paper by Magyar et al1 on a new alkylene oxide copolymer bone hemostatic material (Ostene) and we congratulate the authors for conducting a throughout study on a new water soluble bone hemostat. ...
LEARNING OBJECTIVES 1) Review the pathophysiology of stroke in children and young adults, 2) Exam... more LEARNING OBJECTIVES 1) Review the pathophysiology of stroke in children and young adults, 2) Examine the CT and MRI/MRA imaging features of stroke and 3) Learn various etiologies of stroke in children and young adults ABSTRACT Stroke is the third leading cause of death after heart disease and cancer and a leading cause of long term disability in older patients. The purpose of this exhibit is to heighten awareness that stroke also occurs in infants, children and young adults. We reviewed fifty three cases from three major institutions over the last seven years that illustrate the imaging and clinical features of stroke in these populations. There are twenty-six cases of stroke in infants (0-11 months) from hypoxic/ischemic events, protein C/S deficiency, infection, thrombocytosis, sinus thrombosis, post immunization and gestational Diabetes Mellitus, twenty-two cases of stroke in children (1-14 years old) from sickle-cell disease (including Moya-Moya), maternal cocaine use, fibromusc...
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