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- Anatomical characteristics of the styloid process in internal carotid artery dissection: Case-control studyPublication . Amorim, JM; Pereira, D; Rodrigues, MG; Beato-Coelho, J; Lopes, M; Cunha, A; Figueiredo, S; Mendes-Pinto, M; Ferreira, C; Sargento-Freitas, J; Castro, S; Pinho, JIntroduction Pathophysiology of cervical artery dissection is complex and poorly understood. In addition to well-known causative and predisposing factors, including major trauma and monogenic connective tissue disorders, morphological characteristics of the styloid process have been recently recognized as a possible risk factor for cervical internal carotid artery dissection. Aims To study the association of the anatomical characteristics of styloid process with internal carotid artery dissection. Methods Retrospective, multicenter, case-control study of patients with internal carotid artery dissection and age- and sex-matched controls. Consecutive patients with internal carotid artery dissection and controls with ischemic stroke or transient ischemic attack of any etiology excluding internal carotid artery dissection, who had performed computed tomography angiography, diagnosed between January 2010 and September 2016. Two independent observers measured styloid process length and styloid process distance to internal carotid artery. Results Sixty-two patients with internal carotid artery dissection and 70 controls were included. Interobserver agreement was good for styloid process length and styloid process-internal carotid artery distance (interclass correlation coefficient = 0.89 and 0.76, respectively). Styloid process ipsilateral to dissection was longer than left and right styloid process in controls (35.8 ± 14.4 mm versus 30.4 ± 8.9 mm and 30.3 ± 8.2 mm, p = 0.011 and p = 0.008, respectively). Styloid process-internal carotid artery distance ipsilateral to dissection was shorter than left and right distance in controls (6.3 ± 1.9 mm versus 7.2 ± 2.1 mm and 7.0 ± 2.3 mm, p = 0.003 and p = 0.026, respectively). Internal carotid artery dissection was associated with styloid process length (odds ratio = 1.04 mm-1, 95% confidence interval = 1.01-1.08, p = 0.015) and styloid process-internal carotid artery distance (OR = 0.77 mm-1, 95% confidence interval = 0.64-0.92, p = 0.004). Conclusion Longer styloid process and shorter distance between styloid process and cervical internal carotid artery are associated with cervical internal carotid artery dissection.
- Visual Cortex Plasticity Following Peripheral Damage To The Visual System: fMRI EvidencePublication . Lemos, J; Pereira, D; Castelo-Branco, MOver the last two decades, functional magnetic resonance imaging (fMRI) has become a powerful research method to investigate cortical visual plasticity. Abnormal fMRI response patterns have been occasionally detected in the visually deprived cortex of patients with bilateral retinal diseases. Controversy remains whether these observations indicate structural reorganization of the visual cortex or unmasking of previously silent cortico-cortical connections. In optic nerve diseases, there is weak evidence showing that early visual cortex seems to lack reorganization, while higher-order visual areas undergo plastic changes which may contribute to optimise visual function. There is however accumulating imaging evidence demonstrating trans-synaptic degeneration of the visual cortex in patients with disease of the anterior visual pathways. This may preclude the use of restorative treatments in these patients. Here, we review and update the body of fMRI evidence on visual cortical plasticity.
- Spontaneous Intracranial Hypotension Treated with a Targeted CT-Guided Epidural Blood PatchPublication . Correia, I; Marques, I; Ferreira, R; Cordeiro, M; Sousa, LSpontaneous intracranial hypotension (SIH) is an important cause of new daily persistent headache. It is thought to be due to spontaneous spinal cerebrospinal fluid (CSF) leaks, which probably have a multifactorial etiology. The classic manifestation of SIH is an orthostatic headache, but other neurological symptoms may be present. An epidural blood patch is thought to be the most effective treatment, but a blind infusion may be ineffective. We describe the case of a young man who developed an acute severe headache, with pain worsening when assuming an upright posture and relief gained with recumbency. No history of previous headache, recent cranial or cervical trauma, or invasive procedures was reported. Magnetic resonance imaging showed pachymeningeal enhancement and other features consistent with SIH and pointed towards a cervical CSF leak site. After failure of conservative treatment, a targeted computer tomography-guided EBP was performed, with complete recovery.
- Multiple Dural Arteriovenous Fistulas Presenting as Rapidly Progressive DementiaPublication . Mendonça, N; Santos, G; Duro, D; Machado, E; Goulão, A; Santana, IINTRODUCTION:Dural arteriovenous fistulas (DAVFs) are important causes of neurological dysfunction and are many times misdiagnosed. Particularly in older populations, DAVFs may present with a selective cognitive dysfunction. CASE REPORT: The authors describe a 70-year-old woman presenting with a rapidly progressive dementia, very similar in presentation to prion disease. Neuroimaging showed multifocal DAVFs associated with venous thrombosis and white matter changes, suggesting that impaired cerebral circulation due to venous hypertensive encephalopathy caused the patient's dementia. Prompt treatment of some of the abnormal shunts with endovascular embolization resulted in a clinically relevant improvement. Subsequent clinical improvement was achieved with anticoagulation, although no cause or predisposing factor was documented that could have led to the development of the venous thrombosis. CONCLUSIONS:Neurologists should maintain a high degree of suspicion to avoid missing the diagnosis of DAVFs that are potentially treatable lesions.
- Traumatic middle cerebral artery aneurysm secondary to a gunshot wound.Publication . Santos, G; Lima, T; Pereira, S; Macahdo, ETraumatic intracranial aneurysms are rare lesions, accounting for less than 1% of all intracranial aneurysms. Formation of these lesions after a penetrating missile wound is very unusual, and diagnosis can be difficult due to the presence of associated lesions. In this article, we report a case of a woman who developed a middle cerebral artery aneurysm after a gunshot wound, and discuss potential pitfalls found during diagnostic work-up.
- Malformações do desenvolvimento cortical em doentes com epilepsia: estudo neurorradiológico de 17 casosPublication . Carvalho, S; Brito, O; Machado, E; Santos, N; Melo Freitas, P; Bento, C; Santana, I; Sales, F; Martins, FThis article reviews Malformations of Cortical Development (MCD) diagnosed by Magnetic Resonance Imaging (MRI) in a series of patients with epilepsy. This study spans a five year period. The frequency of these malformations was 7.1%. Most of these were focal or multifocal and the most common ones were polymicrogyria (35.3% of the patients), heterotopia (29.4%), and focal cortical dysplasia (29.4%). The frontal lobes were the most frequently affected regions. The various MCD encountered reflect the wide spectrum of MCD leading to epilepsy.
- Neurorradiologia da síndroma de KallmannPublication . Melo Freitas, P; Carvalho, S; Ribeiro, F; Marnoto, D; Martins, FThe present study refers to the magnetic resonance characteristics observed in a group of three patients with clinical and laboratory evidence of Kallmann's Syndrome. This disease, also named olfactogenital dysplasia, affects the normal gonadal and olfactory development and is clinically characterized by the association of hypogonadotrophic hypogonadism and anosmia/hyposmia. The study protocol, which included the attainment of sagittal and coronal T1-weighted MPRAGE (Multiplanar Rapid Acquisition Gradient Echo) volumetric sequences, showed defective rhinocephalon development in all patients, expressed by the aplasia/hypoplasia of the olfactory bulbs/tracts and/or of the olfactory sulci. The changes observed corroborate the predictable imaging of this genetic disorder and have been mainly visible in the coronal slices obtained. The results shown are more clear evidence that magnetic resonance is an effective method to show the abnormalities in the olfactory region that are invariably found in this syndrome.
- Fístulas da tenda do cerebelo: diagnóstico e tratamentoPublication . Machado, E; Santos, N; Carvalho, S; Freitas, P; Filho, T; Machado, C; Martins, FAmong the 17 intracranial dural fistulae treated in the Department of Neuroradiology of the University Hospital of Coimbra (17 patients, 28 embolizations) between 19/10/98 and 20/11/2000, 4 cases (23%) were located on the tentorium cerebelli. Three patients were men aged 45, 53 and 56 years old. The remaining patient was an 85-year-old woman. All 4 patients were treated by embolization. One underwent post embolization surgical interruption of the draining vein. The authors analyse clinical presentation, complementary tests, therapy and outcome.
- Epidermal nevus syndrome: an unusual cerebellar involvementPublication . Pereira, S; Serra, D; Melo Freitas, P; Santiago, B; Brito, OThe epidermal nevus syndrome is characterized by several developmental anomalies associated with an epidermal nevus. In addition to the skin, other organs commonly affected include the brain, eyes and musculoskeletal system. We report here on a 24-year-old woman with this syndrome who presented with hemifacial hypertrophy, hearing abnormalities, arrhythmia and an unusual infratentorial brain involvement.
- Trombose Venosa Cerebral: Análise Retrospectiva de 49 CasosPublication . Santos, GR; André, R; Pereira, SL; Parreira, T; Machado, EIntroduction: Cerebral Venous Thrombosis (CVT) is a rare and potentially life-threatening disease, accounting for about 0.5% of stroke cases. However, it is believed to be an underdiagnosed condition. Early diagnosis requires a high degree of suspicion and appropriate use of imaging modalities. Objectives: Imagiological and clinical characterization of CVT cases diagnosed at our hospital from 2004 to 2007. Methods: This study was a retrospective, cross-sectional analysis from 2004 to 2007, using our institution database. We reviewed hospital discharge data to assess the incidence of CVT. The study population consisted of 49 patients. Retrospective review of the clinical data and imaging studies of these patients was then performed. Results: Of the 49 patients with confirmed CVT, 38 were female. Patient age varied between 16 and 75 years, with an average of 42.6 years. Thrombotic risk factors were found in 43 patients; the most frequent was dyslipidemia (n = 22) followed by oral contraceptive use (n = 18). Initial head Computerized Tomography (CT) was normal in six cases. Diagnosis was made by Magnetic Resonance (MR) in 38 cases, Cerebral CT-Venography in 10 cases and Digital Subtraction Angiography in one case. Average time from onset of symptoms to diagnosis was nine days; this was not significantly different when comparing the group diagnosed by MR with the group diagnosed by CT-Venography. Right transverse sinus was the most frequent location of thrombosis (n = 36). Only in four cases thrombosis did not involve the lateral sinuses. Conclusions: Lateral sinus thrombosis is a frequent variety of CVT, accounting for 91.8% of our cases. A negative Head CT scan does not exclude the presence of cerebral venous thrombosis; therefore appropriate imaging study should be performed whenever there's a high degree of clinical suspicion. Cerebral CT-Venography seems to be a good alternative to MR for the diagnosis of CVT.
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