Brain involvement in myotonic dystrophy: MRI features and their relationship to clinical and cognitive conditions

A prospective, case-control study was carried out on 25 patients with myotonic dystrophy (MyD) and 25 healthy subjects using brain magnetic resonance imaging (MRI). The frequency and severity of white matter hyperintense lesions (WMHL) and brain atrophy in MyD patients were compared with their clinical features and cognitive impairment using an extensive neuropsychological battery. Eighty-four per cent of MyD patients showed WMHL, compared with 16% of controls (p < 0.0001). These lesions involved all cerebral lobes, without hemispheric prevalence. Twenty-eight per cent of MyD patients also showed particular WMHL at their temporal poles. Myotonic patients had significantly more cortical atrophy than controls. No relationship between atrophy and WMHL was found on the MRI scans. The extent of brain abnormalities (WMHL or atrophy) was not correlated to age, disease duration, physical disability or severity of neuropsychological impairment. Central nervous system abnormalities revealed by MRI appear to be an almost constant feature of MyD, but they are not found to be related to clinical or cognitive parameters. Their nature is still unclear: some of them, located at the temporal poles, seem to be characteristic of the disease, while others small, diffuse WMHLs, similar to the age related alterations revealed by MRI occurring during young and adult age in MyD patients.

Stroke in a young woman due to spontaneous bilateral internal carotid dissection. A case report

The present paper reports the case of a young woman who experienced an ischemic stroke due to the spontaneous dissection and occlusion of both internal carotid arteries, with recanalisation one year after the event. It is underlined that this form is not clinically different from the unilateral form, and that it is often associated with a favourable prognosis. In addition to the characteristic angiographic findings, the paper also highlights the importance of the combined use of MR, MR angiography and echo-Doppler imaging during diagnosis and follow up.

[The current role of neuroradiology in evaluating malformation syndromes]

CT and MRI play complementary roles in the study of malformation syndromes in pediatric age: CT in particular is indispensable for adequately assessing the skeletal picture in subjects suffering from cranio-facial malformations, while MRI allows a morphological study and supplies informations on the maturation state of the white matter.

[Fryns syndrome. Description of a case]

We report on a female infant who presents a pattern of malformations including dysmorphic facies, Dandy-Walker anomaly, hypoplasia of the upper lobe of the right lung, associated with diaphragmatic elevation and slight digital anomalies. This whole clinical picture allows us to formulate the diagnosis of Fryns syndrome; this is one of the very few not lethal cases that are reported in literature.

Acute monophasic focal demyelinating diseases of the central nervous system: longitudinal clinico-neuroradiological study of two patients

We report the clinical features and laboratory-instrumental findings in two patients with acute monophasic demyelinating disease with focal clinical expression: one case of incomplete cervical transverse myelitis and one of focal supratentorial encephalitis. We describe the clinical course and evolution of the neuroradiological findings (CT and MRI) and discuss their pathological meaning and diagnostic value.

Haemodynamic changes following carotid occlusion: MRI angiography and transcranial Doppler patterns

To see the signal changes in MR angiography (MRA) when occlusions or severe stenoses of carotid arteries occur and to relate these data with the velocity values provided by transcranial Doppler sonography (TCD), 20 patients showing symptomatic or asymptomatic unilateral carotid obstructions underwent both MRA and TCD after digital angiography investigation. No MRA signal was recorded immediately downstream from the carotid occlusion. Low flow velocity values in the carotid siphon and middle cerebral artery (MCA) ipsilateral to the carotid obstruction were associated with altered MRA signals corresponding to the same vessels. Turbulence phenomena induced by reversed flow in the anterior cerebral artery induced MRA signal impairments. In carotid occlusions, there may be a relationship between the MRA patterns and the flow velocity variations detected by TCD, but the two approaches have to be applied together since they provide complementary information.

The role of MRI in the diagnosis of olivopontocerebellar atrophy

Under the term of olivopontocerebellar atrophy different nosological pictures are grouped, all characterized by showing clinical signs of deficiency of the structures of the pons and of the cerebellum. The diagnosis of olivopontocerebellar atrophy has been made, until now, by clinical criteria while typical anatomopathological changes are found at the autoptic studies. We describe three patients affected by olivopontocerebellar atrophy, of different types and at different stages of disease. In all cases MRI showed a similar and typical picture of atrophy of the olivary eminences of the medulla oblongata resulting in straightening of the angle usually present on the ventral frontier between pons and medulla oblongata. This diagnostic tool demonstrated thus to be of primary relevance yet in the early phases of the disease.