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Yahaya SNB, Khan AHKY, Sankala HA. A Case of Cobra Bite Complicated with Basilar Artery Occlusion. J Emerg Trauma Shock 2023; 16:185-188. [PMID: 38292282 PMCID: PMC10824211 DOI: 10.4103/jets.jets_23_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/29/2023] [Accepted: 04/17/2023] [Indexed: 02/01/2024] Open
Abstract
Snakebite is one of the most common complaints related to wilderness medicine. Venomous snakebite manifestation is divided into local and systemic envenomation. For the Elapidae group, the most feared complication is respiratory muscle paralysis due to neurotransmitter malfunction at the neuromuscular junction level which leads to respiratory insufficiency. However, there is a lack of evidence or case report incidence to suggest that it can potentially associate with the development of stroke disorder. We present a rare case of massive posterior circulation infarct in a middle-aged gentleman following a cobra bite. He was brought to our center few hours later following the bite and antivenom was administered. He improved shortly after receiving it. However, he had an abrupt drop in his conscious level several hours later. Noncontrast-enhanced computed tomography (NCCT) brain was performed immediately, but stroke disorder was excluded prematurely. Repeated NCCT imaging which was done 12 h apart showed massive posterior circulation infarction with hydrocephalus. He succumbed to death 3 days later. Given its rarity, the evolution of his clinical condition warrants clinician's early suspicion of potential stroke-related complications that can occur following a cobra bite.
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Affiliation(s)
| | - Abdul Hanif Khan Yusof Khan
- Department of Neurology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
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Poon R, Badawy MK. Radiation dose and risk to the lens of the eye during CT examinations of the brain. J Med Imaging Radiat Oncol 2019; 63:786-794. [DOI: 10.1111/1754-9485.12950] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 08/11/2019] [Accepted: 08/19/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Rebekah Poon
- Department of Medical Imaging and Radiation Sciences School of Primary and Allied Health Care Faculty of Medicine, Nursing and Health Sciences Monash University Clayton Victoria Australia
| | - Mohamed K Badawy
- Department of Medical Imaging and Radiation Sciences School of Primary and Allied Health Care Faculty of Medicine, Nursing and Health Sciences Monash University Clayton Victoria Australia
- Monash Imaging Monash Health Clayton Victoria Australia
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Mormina E, Petracca M, Bommarito G, Piaggio N, Cocozza S, Inglese M. Cerebellum and neurodegenerative diseases: Beyond conventional magnetic resonance imaging. World J Radiol 2017; 9:371-388. [PMID: 29104740 PMCID: PMC5661166 DOI: 10.4329/wjr.v9.i10.371] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 07/18/2017] [Accepted: 08/02/2017] [Indexed: 02/06/2023] Open
Abstract
The cerebellum plays a key role in movement control and in cognition and cerebellar involvement is described in several neurodegenerative diseases. While conventional magnetic resonance imaging (MRI) is widely used for brain and cerebellar morphologic evaluation, advanced MRI techniques allow the investigation of cerebellar microstructural and functional characteristics. Volumetry, voxel-based morphometry, diffusion MRI based fiber tractography, resting state and task related functional MRI, perfusion, and proton MR spectroscopy are among the most common techniques applied to the study of cerebellum. In the present review, after providing a brief description of each technique’s advantages and limitations, we focus on their application to the study of cerebellar injury in major neurodegenerative diseases, such as multiple sclerosis, Parkinson’s and Alzheimer’s disease and hereditary ataxia. A brief introduction to the pathological substrate of cerebellar involvement is provided for each disease, followed by the review of MRI studies exploring structural and functional cerebellar abnormalities and by a discussion of the clinical relevance of MRI measures of cerebellar damage in terms of both clinical status and cognitive performance.
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Affiliation(s)
- Enricomaria Mormina
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
- Neuroradiology Unit, Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, 98100 Messina, Italy
| | - Maria Petracca
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80138 Naples, Italy
| | - Giulia Bommarito
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy
| | - Niccolò Piaggio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy
- Department of Neuroradiology, San Martino Hospital, 16132 Genoa, Italy
| | - Sirio Cocozza
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80138 Naples, Italy
| | - Matilde Inglese
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy
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Kaditis DG, Zintzaras E, Sali D, Kotoulas G, Papadimitriou A, Hadjigeorgiou GM. Conjugate eye deviation as predictor of acute cortical and subcortical ischemic brain lesions. Clin Neurol Neurosurg 2016; 143:80-5. [PMID: 26903074 DOI: 10.1016/j.clineuro.2016.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 02/02/2016] [Accepted: 02/07/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Non-enhanced computed tomography (NECT) of the brain is used to exclude intracranial hemorrhage in patients who are considered for treatment with tissue plasminogen activator due to stroke symptoms. However, early infarct signs on NECT have low sensitivity for ischemic stroke. It was hypothesized that horizontal conjugate eye deviation (average ocular gaze deviation-OGD >14°) on NECT predicts ischemic brain injury on a second detailed examination. PATIENTS AND METHODS Patients who underwent brain NECT within three hours after the onset of stroke symptoms and subsequently had brain CT scan with intravenous contrast or MRI were potential participants. OGD was measured from the cross-sectional image including both globes at their maximum diameter. RESULTS 73 subjects were studied (mean age 64.2±20.8 years) with a median interval (interquartile range) of 56 h (22-109.3 h) between NECT and the second examination. On NECT, 24 of 73 (32.9%) subjects had OGD >14°. Of 32 individuals with acute ischemic injury on the second examination, 19 (59.4%) had OGD >14° on NECT. OGD >14° was associated with increased risk of ischemic injury: OR=10.5 (95% confidence interval 3.33-33.9); P=0.002. OGD >14° had significantly higher sensitivity and negative predictive value than early infarct signs on NECT (59.4% vs. 21.9% and 73.5% vs. 59.7%, respectively; P<0.05), and similar specificity and positive predictive value (87.8% vs. 90.2% and 79.2% vs. 63.6%; P>0.05). CONCLUSION In the presence of stroke symptoms, average OGD >14° on the initial brain NECT is early predictor of ischemic brain injury.
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Affiliation(s)
- Dimitrios G Kaditis
- Department of Neurology, University of Thessaly School of Medicine and Larissa University Hospital, Larissa, Greece.
| | - Elias Zintzaras
- Department of Biomathematics, University of Thessaly School of Medicine and Larissa University Hospital, Larissa,Greece
| | - Dimitra Sali
- Department of Neurology, Euroclinic Hospital, Athens, Greece
| | | | - Alexandros Papadimitriou
- Department of Neurology, University of Thessaly School of Medicine and Larissa University Hospital, Larissa, Greece
| | - Georgios M Hadjigeorgiou
- Department of Neurology, University of Thessaly School of Medicine and Larissa University Hospital, Larissa, Greece
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Yamashiro T, Miyara T, Honda O, Kamiya A, Tanaka Y, Murayama S. 320-Row wide volume CT significantly reduces density heterogeneity observed in the descending aorta: Comparisons with 64-row helical CT. Comput Med Imaging Graph 2014; 38:15-21. [DOI: 10.1016/j.compmedimag.2013.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 10/07/2013] [Indexed: 11/29/2022]
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Machida H, Takeuchi H, Tanaka I, Fukui R, Shen Y, Ueno E, Suzuki S, Lin XZ. Improved delineation of arteries in the posterior fossa of the brain by model-based iterative reconstruction in volume-rendered 3D CT angiography. AJNR Am J Neuroradiol 2013; 34:971-5. [PMID: 23292530 DOI: 10.3174/ajnr.a3320] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Improved CTA delineation of arteries and unruptured aneurysms is clinically desired in the posterior fossa. We present a novel model-based iterative reconstruction that models system statistics and optics to improve CT image quality. We investigated the utility of MBIR for improving delineation of arteries in the posterior fossa on 3D brain CTA. MATERIALS AND METHODS Using filtered back-projection with a standard kernel and MBIR, we reconstructed axial images of 0.625-mm thickness of 28 consecutive patients (14 men; mean age, 58.6 ± 14.6 years) who underwent 64-detector brain CTA. We placed regions of interest on the axial images, measured the mean CT value in the basilar artery and the value and SD in the pons and bilateral cerebellar hemispheres, and calculated the contrast-to-noise ratio of the brain arteries in the posterior fossa. Using volume-rendered CTA and a 4-point scale, 2 radiologists independently graded delineation of the BA, bilateral vertebral artery, superior cerebellar artery, and anterior and posterior inferior cerebellar arteries. We compared the results between FBP and MBIR by using paired t and Wilcoxon signed-rank tests. RESULTS Compared with FBP, MBIR significantly improved the contrast-to-noise ratio (P < .0001) and subjective delineation of all arteries in the posterior fossa except the BA (VA, SCA, AICA, and PICA; P < .05 for all). The mean visual score by MBIR was 3.0 or higher for all those arteries except the AICA assessed by reader 1 (2.6 ± 0.7). CONCLUSIONS With 3D brain CTA, contrast-to-noise ratio and arterial delineation of the VA, SCA, AICA, and PICA in the posterior fossa are better with MBIR than FBP.
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Affiliation(s)
- H Machida
- Department of Radiology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.
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Connell L, Koerte IK, Laubender RP, Morhard D, Linn J, Becker HC, Reiser M, Brueckmann H, Ertl-Wagner B. Hyperdense basilar artery sign—a reliable sign of basilar artery occlusion. Neuroradiology 2011; 54:321-7. [DOI: 10.1007/s00234-011-0887-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Accepted: 04/29/2011] [Indexed: 10/18/2022]
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Comparison of image quality and lens dose in helical and sequentially acquired head CT. Clin Radiol 2010; 65:868-73. [DOI: 10.1016/j.crad.2010.02.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Revised: 02/11/2010] [Accepted: 02/17/2010] [Indexed: 11/23/2022]
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Kampondeni S, Birbeck GL, Oostveen RJ, Hammond C, Potchen MJ. Alternative oblique head CT scanning technique reduces bone artifact and improves interpretability of brainstem anatomy. Neurol Int 2010; 2:e14. [PMID: 21577337 PMCID: PMC3093213 DOI: 10.4081/ni.2010.e14] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Revised: 06/07/2010] [Accepted: 06/09/2010] [Indexed: 11/28/2022] Open
Abstract
Brainstem pathology due to infections, infarcts and tumors are common in developing countries, but neuroimaging technology in these resource-poor settings is often limited to single slice, and occasionally spiral, CT. Unlike multislice CT and MRI, single slice and spiral CT are compromised by bone artifacts in the posterior fossa due to the dense petrous bones, often making imaging of the brainstem non-diagnostic. With appropriate head positioning, the petrous ridges can be avoided with 40° sagittal oblique scans parallel to either petrous ridge. We describe an alternative sagittal oblique scanning technique that significantly reduces brainstem CT artifacts thereby improving clarity of anatomy. With Institutional Ethical approval, 13 adult patients were enrolled (5 males; 39%). All patients had routine axial brain CT and sagittal oblique scans with no lesions found. Images were read by 2 readers who gave a score for amount of artefact and clarity of structures in the posterior fossa. The mean artifact score was higher for routine axial images compared to sagittal oblique (2.92 vs. 1.23; P<0.0001). The mean anatomical certainty scores for the brainstem were significantly better in the sagittal oblique views compared to routine axial (1.23 vs. 2.77; P<0.0001). No difference was found between the two techniques with respect to the fourth ventricle or the cerebellum (axial vs. sag oblique: 1.15 vs. 1.27; P=0.37). When using single slice CT, the sagittal oblique scanning technique is valuable in improving clarity of anatomy in the brainstem if axial images are non-diagnostic due to bone artifacts.
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Affiliation(s)
- Sam Kampondeni
- Michigan State University, Department of Radiology, East Lansing, MI, USA
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Matsubara K, Koshida K, Suzuki M, Shimono T, Yamamoto T, Matsui O. Effective dose evaluation of multidetector CT examinations: influence of the ICRP recommendation in 2007. Eur Radiol 2009; 19:2855-61. [DOI: 10.1007/s00330-009-1497-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2009] [Revised: 05/28/2009] [Accepted: 06/04/2009] [Indexed: 11/24/2022]
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