L'invecchiamento del rachide

Le modificazioni del rachide nell'invecchiamento sono note da tempo e vengono spesso raccolte sotto la definizione globale di artrosi vertebrale. La complessità e la molteplicità delle articolazioni intervertebrali ed intersegmentarie della colonna vertebrale, tuttavia, impongono una analisi più dettagliata dei singoli fenomeni che contribuiscono alla instaurazione di quelle modificazioni anatomo-patologiche proprie del complesso degenerativo rachideo senile.

Gli Autori procedono alla suddetta analisi, integrando i dati noti dalla Radiologia tradizionale e dalla TC con le acquisizioni più recenti della RM e con le basi patologiche macroscopiche e submacroscopiche rilevabili in letteratura. Tra i vari gruppi di patologia, quella che risulta più ricca di corrispondenze verificabili tra dati neuro-radiologici ed anatomici è quella riguardante l'unità funzionale disco-somatica, con particolare riguardo per l'osteocondrosi intervertebrale.

Attraverso l'approfondimento della patologia delle articolazioni cartilaginee, sinoviali e fibrose della colonna vertebrale, si tenta inoltre di fornire un quadro generale, finalistico, delle varie alterazioni vertebrali che sembra condurre verso una visione «protettiva» dell'artrosi vertebrale rispetto a danni più gravi, privilegiando in età senile la funzione statica rachidea rispetto a quella dinamica. Diventa a questo punto chiaro il perchè della difficoltà di tracciare una chiara linea distintiva tra alterazioni «parafisiologiche» dell'invecchiamento del rachide e alterazioni chiaramente patologiche.

Multiple Cerebral Aneurysms Associated with Atrial Myxoma

Cardiac myxoma is a tumor of mesenchymal origin accounting for half of all primary cardiac neoplasms. Intracranial involvement by atrial myxoma is a rare cause of neurologic deficit. When the myxoma arises in the left atrium, systemic emboli from a cardiac myxoma can lead to infarction, cerebral hemorrhage and aneurysm formation. In the light of the potentially preventable nature of these lesions, the diagnosis of myxomatous aneurysms should be considered in any patient with neurologic symptoms and a history of cardiac myxoma. Because aneurysms are often stable over several years, conservative management with careful clinical and radiological follow-up with MRI and angiography seems sensible. We describe a case in which MR imaging and angiography were used to diagnose multiple cerebral aneurysms caused by left atrial myxoma.

Recurrent Intraventricular Hemorrhages Caused by an AVM Detected by Angiography with Initially Normal Angiogram

Primary intraventricular haemorrhage (PIVH) is an uncommon type of non-traumatic cerebral haemorrhage limited to the ventricular system arising in adults and children, with diverse aetiology and variable course. Vascular malformations account for 34% of PIVH, whereas no cause is found in 21–47%. When a primary intraventricular haemorrhage is detected in a young patient an underlying lesion such as an arteriovenous malformation (AVM) must be ruled out. The diagnosis may be suspected when there is sudden onset of headache, nausea and vomiting with or without a reduced level of consciousness. Nevertheless, even if clinical features suggest the diagnosis of PIVH, cerebral computed tomography (CT) scan is required for confirmation, and magnetic resonance imaging (MRI) and catheter angiography are necessary to establish the aetiology. We describe a case of isolated recurrent intraventricular haemorrhages caused by AVM detected by diagnostic intracranial angiography with no abnormality demonstrated on angiography four years earlier.

CT-Cisternography in Post-Surgical CSF Rhinorrhea

Cerebrospinal fluid (CSF) rhinorrhea is a dangerous problem. CSF rhinorrhea implies an abnormal communication between the subarachnoid space and the nasal cavity, with subsequent leakage of CSF through the anterior nasal apertures. requiring surgical repair. Imaging techniques have evolved from conventional cranial radiography to polytomography, thin-section computed tomography (CT) and intrathecal water-soluble iodinated contrast agent-enhanced CT cisternography. We present two cases of post-surgical CSF rhinorrhea in which the best diagnostic findings were obtained by CT cisternography.

Traumatic carotid cavernous fistula: failure of endovascular treatment with two stent-grafts

SUMMARY

We describe an unconventional endovascular approach in a young patient with large highflow traumatic carotid cavernous fistula that could not be treated by detachable balloon procedure. Two coronary stent-grafts were used to close the large tear of internal carotid artery. After the failure of stenting procedure, the fistula was successfully treated by trapping with two detachable balloons.

Olfactory groove meningioma and multiple aneurysms. Case report

We report a case of a patient with olfactory groove meningioma associated with multiple aneurysms. The association between intracranial aneurysms and meningiomas is infrequent and perhaps it is due to chance alone; many theories have been formulated to explain it. In the cases with both lesions, meningiomas are more frequently located at level of the convexity while aneurysms are more often located at level of the anterior cerebral-anterior communicating artery complex or at level of the middle cerebral artery.