Arachnoid Granulations Mimicking Multiple Osteolytic Bone Lesions in the Occipital Bone

Evaluation of anterior and middle cranial fossa intraosseous arachnoid granulations with 3D T2-SPACE sequence

OBJECTIVES

Arachnoid granulations (AG) can be located anywhere outside the dural sinuses. Their presence is thought to be associated with idiopathic intracranial hypertension (IIH) and cerebrospinal fluid (CSF) leaks. It was aimed to evaluate the intraosseous AGs located in the middle and anterior cranial fosses in detail with three-dimensional T2-SPACE (Sampling Perfection with Application optimized Contrasts using different flip angle Evolution-Siemens) imaging and to investigate their clinical significance.

MATERIALS AND METHODS

Sixty-five intraosseous AG of 46 patients were included in this retrospective study. The highest diameter, bone indentation degree (in the inner tabula, diploe distance, reaching and exceeding the outer tabula), content (CSF/+parenchyma) of each AG were evaluated by 2 experienced radiologists. In addition, the presence of other MRI findings supporting IIH was examined.

RESULTS

Additional signs of IIH were detected in 25 patients, and they were statistically significantly more common in the middle cranial fossa. Parenchymal herniation (in four patients) was more common in the young population.

CONCLUSIONS

Intraosseous AGs can be evaluated in detail with T2-SPACE imaging. Determining intraosseous AG is very important both as an indicator of IIH and in terms of its content. T2-SPACE imaging is superior to CT and conventional sequences in this regard.

Diagnosing neurocysticercosis in skeletonized human remains of forensic importance

Neurocysticercosis is endemic in many parts of the underdeveloped and developing countries, with continuous presence in developed countries due to the influx of migrants from regions where the diseases are endemic. Neuroimaging, anatomic pathological techniques, immunodiagnostic tests, clinical examination and epidemiologic considerations will easily provide the diagnosis. However, physicians in developed countries are perhaps progressively missing the diagnosis, and need to re-acquaint themselves with the condition and acquire a high suspicion index. The authors present a medicolegal case where the forensic team made a conclusion of neurocysticercosis (among other diagnoses), following post mortem examination of a largely skeletonized and mummified human remains. Characteristic changes were observed in the calvarium of the decedent at autopsy. Review of the antemortem medical records revealed that Computed Tomography (CT) scan had 12 years earlier, suggested diagnostic features in a Hispanic migrant, but the attending surgeons failed to consider the possibility of the condition. Physicians should pay attention to suggestive clinical findings especially when attending to individuals coming from endemic parts of the world. Cysticercosis remains endemic and a misdiagnosis can potentially attract medical malpractice suits. Forensic pathologists should also consider the possibility of uncommon clinical disorders, even in skeletonized remains. Perhaps an earlier diagnosis might have altered the outcome in the decedent.