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Neuroradiology/ neuropatholgy Clinical Conference

Janica Walden, Michael Solle, Neuroradiology. Neuroradiology/ neuropatholgy Clinical Conference. Case 1: History. 1-2008: 26 male with ventriculomegaly & symptoms concerning for hydrocephalus with papilledema & headaches. Case 1: Head CT. Case 1: MRI (FLAIR). Case 1: MRI (CISS).

sebastian-mckenzie
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Neuroradiology/ neuropatholgy Clinical Conference

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  1. Janica Walden, Michael Solle, Neuroradiology Neuroradiology/neuropatholgy Clinical Conference

  2. Case 1: History • 1-2008: • 26 male with ventriculomegaly & symptoms concerning for hydrocephalus with papilledema & headaches.

  3. Case 1: Head CT

  4. Case 1: MRI (FLAIR)

  5. Case 1: MRI (CISS)

  6. Case 1: Surgery • Multiple cysts were visualized & removed from lateral & 3rd ventricles.

  7. Case 1: Pathology • Light Microscope: • Sections showed fragments of degenerating wall of a cysticercal cyst. Wall shows a small amount of calcification. • Diagnosis: Cysticercosis

  8. Neurocystircercosis • Cysticercosis is the most common parasitic infection in immunocompetent patients: • incidence is not increased in patients with AIDS, • Cysticercosis is generally acquired by ingesting fruits or vegetables contaminated with eggs (Taeniasolium,. • ingesting larvae (undercooked pork) results in intestinal teniasis. • Most common cause of acquired seizures. • Gray-white junction- hematogenous spread (?) • Intraventricular lesions (20-50%). • Subarachnoid space lesions (racemose type- cluster of grapes) (less than 10%).

  9. Neurocystircercosis • Vesicular stage: • cyst-like lesion w/mural nodule (larva with full bladder & scolex, generally no contrast enhancement). • Colloidal stage: • cyst dies & produces inflammatory reaction (incomplete ring-enhancing lesion w/edema). • Occasionally, multiple lesions are in the colloidal stage & produce an encephalitis-like picture. • Granular stage: • dead organism produces classic ring-enhancing lesion. • Nodular stage: • final stage in which lesion calcifies.

  10. Case 2: • History: • 27 male with HIV, lumbar puncture was done… & india ink stained positive for cryptococcus.

  11. Case 2: Intial study

  12. Case 2: 1st Follow up study

  13. -Operation • A single burr hole was made. Dura was opened & underlying pia was cauterized. Following this, using stereotaxy, a biopsy needle was advanced. Once the target was achieved, mild aspiration yielded gross purulence. Multiple specimens were obtained.

  14. Case 2: 2nd Follow up study, post op • Patient non-compliant with medications.

  15. Case 2: 3rd Follow up study • Improved compliance.

  16. Case 2: 4th Follow up study, further improvement

  17. IRIS (immune reconstitution syndrome) • HIV pts initiated on retroviral therapy. • Restored immune system now reacting/over-reacting (?) to intact pathogens and/or residual antigens. • Paradoxical worsening of a known condition, or appearance of a new condition following initiation of therapy.

  18. IRIS • Most commonly involved include CMV, mycobacterium, varicella zoster, herpes, PCP, & cryptococcus . • Clinical presentation involves recurrence of symptoms related to a latent TB infection, or cryptococcal meningitis.

  19. References: • www.aidsrestherapy.com/content/4/1/9 • http://en.wikipedia.org/wiki/Immune_reconstitution_inflammatory_syndrome

  20. Case 3

  21. Case 3

  22. Case 3

  23. Operation & pathology: • Right frontal sinus mass pedunculated off of the posterior table of frontal sinus, which was noted to be dehiscent. Most consistent with an encephalocele. • Fragments of central-nervous-system tissue, consistent with encephalocele/heterotopia.

  24. Case 4: History • 3 year old girl with presented with left leg weakness & limp x 3 weeks. • Fell 3 weeks prior & had been limping ever since. • 2 days prior to presentation she began not using her left hand.

  25. Arterial spin label cerebral blood flow map.

  26. Case 4: Pathology • Sections show a proliferation of neoplasticastrocytes. • Moderate nuclear atypia & mitotic figures. No necrosis, histologic findings consistent with anaplastic astrocytoma. • Neoplastic cells diffusely stained for GFAP. • Many nuclei of neoplastic cells stained positive for p53. • A Ki-67 immunostain reveals a labeling index of 12% in area sampled.

  27. Case 5 • 74 year old male with diabetes & hypertension presented with weakness/extreme fatigue, weight loss & CN V & VI palsies.

  28. CT

  29. Findings • Enhancing soft tissue mass at left petrous apex & left posterolateral wall of the left cavernous sinus. • Measures 1.8 cm x 1.2 cm. • Extends along cavernous sinus, erodes through sphenoid sinus wall. • Extends along cisternal portion of V & into brainstem. • Narrowing of adjacent left petrous internal carotid artery.

  30. Pathology • Acutely inflamed necrotic debris with fungal hyphae and giant cells present.

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