janica walden michael solle neuroradiology
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Neuroradiology/ neuropatholgy Clinical Conference

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Janica Walden, Michael Solle, Neuroradiology. Neuroradiology/ neuropatholgy Clinical Conference. Case 1: History. 1-2008: 26 male with ventriculomegaly & symptoms concerning for hydrocephalus with papilledema & headaches. Case 1: Head CT. Case 1: MRI (FLAIR). Case 1: MRI (CISS).

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Presentation Transcript
case 1 history
Case 1: History
  • 1-2008:
    • 26 male with ventriculomegaly & symptoms concerning for hydrocephalus with papilledema & headaches.
case 1 surgery
Case 1: Surgery
  • Multiple cysts were visualized & removed from lateral & 3rd ventricles.
case 1 pathology
Case 1: Pathology
  • Light Microscope:
      • Sections showed fragments of degenerating wall of a cysticercal cyst. Wall shows a small amount of calcification.
  • Diagnosis: Cysticercosis
neurocystircercosis
Neurocystircercosis
  • Cysticercosis is the most common parasitic infection in immunocompetent patients:
    • incidence is not increased in patients with AIDS,
    • Cysticercosis is generally acquired by ingesting fruits or vegetables contaminated with eggs (Taeniasolium,.
    • ingesting larvae (undercooked pork) results in intestinal teniasis.
  • Most common cause of acquired seizures.
  • Gray-white junction- hematogenous spread (?)
  • Intraventricular lesions (20-50%).
  • Subarachnoid space lesions (racemose type- cluster of grapes) (less than 10%).
neurocystircercosis1
Neurocystircercosis
  • Vesicular stage:
    • cyst-like lesion w/mural nodule (larva with full bladder & scolex, generally no contrast enhancement).
  • Colloidal stage:
    • cyst dies & produces inflammatory reaction (incomplete ring-enhancing lesion w/edema).
    • Occasionally, multiple lesions are in the colloidal stage & produce an encephalitis-like picture.
  • Granular stage:
    • dead organism produces classic ring-enhancing lesion.
  • Nodular stage:
    • final stage in which lesion calcifies.
case 2
Case 2:
  • History:
    • 27 male with HIV, lumbar puncture was done… & india ink stained positive for cryptococcus.
operation
-Operation
  • A single burr hole was made. Dura was opened & underlying pia was cauterized. Following this, using stereotaxy, a biopsy needle was advanced. Once the target was achieved, mild aspiration yielded gross purulence. Multiple specimens were obtained.
case 2 2 nd follow up study post op
Case 2: 2nd Follow up study, post op
  • Patient non-compliant with medications.
case 2 3 rd follow up study
Case 2: 3rd Follow up study
  • Improved compliance.
iris immune reconstitution syndrome
IRIS (immune reconstitution syndrome)
  • HIV pts initiated on retroviral therapy.
  • Restored immune system now reacting/over-reacting (?) to intact pathogens and/or residual antigens.
  • Paradoxical worsening of a known condition, or appearance of a new condition following initiation of therapy.
slide18
IRIS
  • Most commonly involved include CMV, mycobacterium, varicella zoster, herpes, PCP, & cryptococcus .
  • Clinical presentation involves recurrence of symptoms related to a latent TB infection, or cryptococcal meningitis.
references
References:
  • www.aidsrestherapy.com/content/4/1/9
  • http://en.wikipedia.org/wiki/Immune_reconstitution_inflammatory_syndrome
operation pathology
Operation & pathology:
  • Right frontal sinus mass pedunculated off of the posterior table of frontal sinus, which was noted to be dehiscent. Most consistent with an encephalocele.
  • Fragments of central-nervous-system tissue, consistent with encephalocele/heterotopia.
case 4 history
Case 4: History
  • 3 year old girl with presented with left leg weakness & limp x 3 weeks.
  • Fell 3 weeks prior & had been limping ever since.
  • 2 days prior to presentation she began not using her left hand.
case 4 pathology
Case 4: Pathology
  • Sections show a proliferation of neoplasticastrocytes.
    • Moderate nuclear atypia & mitotic figures. No necrosis, histologic findings consistent with anaplastic astrocytoma.
  • Neoplastic cells diffusely stained for GFAP.
  • Many nuclei of neoplastic cells stained positive for p53.
  • A Ki-67 immunostain reveals a labeling index of 12% in area sampled.
case 5
Case 5
  • 74 year old male with diabetes & hypertension presented with weakness/extreme fatigue, weight loss & CN V & VI palsies.
findings
Findings
  • Enhancing soft tissue mass at left petrous apex & left posterolateral wall of the left cavernous sinus.
    • Measures 1.8 cm x 1.2 cm.
    • Extends along cavernous sinus, erodes through sphenoid sinus wall.
    • Extends along cisternal portion of V & into brainstem.
  • Narrowing of adjacent left petrous internal carotid artery.
pathology
Pathology
  • Acutely inflamed necrotic debris with fungal hyphae and giant cells present.
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