Magnesium deposition in brain of pregnant patients administered intramuscular magnesium sulphate

We present three cases of T1 hyperintense signal in the MRI scans of the brains of pregnant patients who were administered magnesium sulphate intramuscularly for control of hypertension during eclampsia. The increase in signal is symmetric and is seen in the globus pallidi of these patients. We postulate it to be secondary to deposition of magnesium in the brain parenchyma. The signal intensity was found to be directly varying according to the level of magnesium in the blood. It decreased over a period of time coming to normalcy after approximately 6months. To the best of our knowledge, this is the first case report which has documented this finding. It has to be determined whether deposition of magnesium in the brain parenchyma could have implications in the use of magnesium sulphate in pregnant patients.

Intracranial lesions with high signal intensity on T1-weighted MR images - review of pathologies

In the article we present pathological intracranial substances and lesions, which produce high signal intensity on T1-weighted MR images. Six groups of substances are discussed: 1. Gadolinium – based contrast agents, 2.hemoglobin degradation products (intra- and extra-cellular methemoglobin), 3. lipid-containing lesions (lipoma, dermoid cyst, implanted fatty materials, laminar cortical necrosis), 4. substances with high concentration of proteins (colloid cyst, craniopharyngioma, Rathke’s cleft cyst, ectopic posterior pituitary gland), 5. melanin (metastatic melanoma), 6. lesions containing mineral substances such as: calcium (calcifications, Fahr’s disease), copper (Wilson’s disease) and manganese (hepatic encephalopathy, manganese intoxication in intravenous drug abusers). Appropriate interpretation of signal intensity as well as analysis of location of lesions and clinical symptoms enables planning of further diagnostics and, in many cases, establishing the final diagnosis based on MR examination.

β-Propeller protein-associated neurodegeneration: a new X-linked dominant disorder with brain iron accumulation

Neurodegenerative disorders with high iron in the basal ganglia encompass an expanding collection of single gene disorders collectively known as neurodegeneration with brain iron accumulation. These disorders can largely be distinguished from one another by their associated clinical and neuroimaging features. The aim of this study was to define the phenotype that is associated with mutations in WDR45, a new causative gene for neurodegeneration with brain iron accumulation located on the X chromosome. The study subjects consisted of WDR45 mutation-positive individuals identified after screening a large international cohort of patients with idiopathic neurodegeneration with brain iron accumulation. Their records were reviewed, including longitudinal clinical, laboratory and imaging data. Twenty-three mutation-positive subjects were identified (20 females). The natural history of their disease was remarkably uniform: global developmental delay in childhood and further regression in early adulthood with progressive dystonia, parkinsonism and dementia. Common early comorbidities included seizures, spasticity and disordered sleep. The symptoms of parkinsonism improved with l-DOPA; however, nearly all patients experienced early motor fluctuations that quickly progressed to disabling dyskinesias, warranting discontinuation of l-DOPA. Brain magnetic resonance imaging showed iron in the substantia nigra and globus pallidus, with a 'halo' of T1 hyperintense signal in the substantia nigra. All patients harboured de novo mutations in WDR45, encoding a beta-propeller protein postulated to play a role in autophagy. Beta-propeller protein-associated neurodegeneration, the only X-linked disorder of neurodegeneration with brain iron accumulation, is associated with de novo mutations in WDR45 and is recognizable by a unique combination of clinical, natural history and neuroimaging features.

Primary leptomeningeal melanoma in an adolescent: Case report and review of the literature

A previously healthy 16-year-old male patient came to the emergency department with a six-week history of left posterior hip pain following a head-on ATV collision. After failing conservative therapy, he was found to have weakness and atrophy of the left lower extremity on exam. MRI demonstrated an epidural mass that was hyperintense on T1 and hypointense on T2. Biopsy of the mass revealed a melanocytic lesion; further lesions were identified in the lungs, which biopsy proved to be malignant melanoma. Dermoscopy of the entire body, anoscopy, and retinal exam were negative for melanoma; a whole-body PET scan did not reveal any further lesions or evidence of a primary lesion. Given the lack of a primary lesion, this was thought to be a primary leptomeningeal melanoma. Primary melanomatous tumors of the spine are rare entities, with fewer than 40 cases described in the literature. This case was unique due to the patient's very young age and the presence of metastases on presentation.

Postoperative imaging of vestibular schwannomas

Symptomatic vestibular schwannomas can be treated with resection (translabyrinthine, retrosigmoid [suboccipital], or middle cranial fossa approaches) or stereotactic radiosurgery. When appropriate, auditory brainstem stimulators can also be implanted in patients with current or impending hearing loss due to bilateral vestibular schwannomas. Imaging plays a prominent role in determining management following these procedures. In this article, the expected postoperative imaging appearances are depicted. The radiological features of complications are also reviewed, including recurrent tumor, fat graft necrosis, CSF leakage, infection, hydrocephalus, cerebral infarction, venous sinus thrombosis, hemorrhage, and temporal lobe and cerebellar contusions.