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Tyler-Kabara and Michael B. No reports exist demonstrating this via magnetic resonance angiography MRA. As invasive and noninvasive imaging have become more widespread, vascular abnormalities are diagnosed with higher frequencies.

Understanding of such variants is important for the diagnosis and treatment of vascular disease, particularly via endovascular approaches [9].

We report a year-old girl with no right CCA. The visual deficit reversed to the pre-operative severity grade after endovascular obliteration of the pseudoaneurysm with preservation of the parent vessel.

The etiology and pathophysiology of pseudoaneurysm development and of visual recovery in the present case are discussed.

It consists of fibers running in the central tegmental tract from the red nucleus to the ipsilateral inferior olivary nucleus, from here to the contralateral dentate nucleus through the inferior cerebellar peduncle and from there via the dentatorubral tract running in the superior cerebellar peduncle back to the ipsilateral red nucleus Figure 1.

This neuronal circuit acts as an inhibitory system on cortical generated impulses by comparing them with their performance in the peripheral motor effector organs.

Lesions including parts of the Guillain-Mollaret triangle may result in a rare, but characteristic hypertrophic degeneration of the inferior olivary nucleus [2].

A cranial computed tomography done in a district hospital showed a cystic lesion within the right frontal lobe. The neurologic as well as the physical examinations upon admission to our hospital were normal.

Mild leukocytosis with Brain magnetic resonance imaging MRI confirmed the cystic lesion in the frontal lobe and revealed ring enhancement on T1-weighted T1w images after administration of gadolinium Figure 1d.

Open microsurgical resection of the lesion was performed via a frontal approach. The content of the cyst was drained, and the wall of the cyst was resected.

Macroscopically, the lesion had a grayish-glassy appearance compatible with gliomatous tissue. Elger The possibility of discovering incidental findings is a serious ethical and juridical issue in human neuroimaging research.

There is consensus among neuroscientists and neuroradiologists that appropriately handling incidental findings requires ethical guidelines.

The Bonn Neuroethics Working Group is organizing a comprehensive process among neuroscientists from German-speaking countries with the aim of identifying the points of consent and preparing a proposal for future guidelines.

The aim of the editorial of Hentschel and von Kummer on behalf of the DGNR was to enhance the quality of the discussion and provide a solid basis for the sincere criticism of the guideline as proposed so far.

When writing and publishing this editorial, the revision of the guideline by Heinemann et al. We agree with our colleagues in Bonn in now concentrating on the next version and working on the guideline for brain imaging research based on essential ethical and juridical concepts and distinctions that will become an internationally recognized standard regarding the detection and interpretation of incidental imaging findings in brain research.

To achieve a common base for the evaluation of tumors, a possible dissemination and responses to treatment or the natural course of a CNS central nervous system tumor, all imaging studies of patients included in these studies are reviewed by the national Reference Center for Neuroradiology.

The center also serves as a common database for the collection of imaging examinations of rare brain tumors and as consulting institution mainly for tumorous lesions of the brain and spinal cord.

The large numbers of various CNS tumors also enable broad-based scientific evaluations on different aspects of imaging. The aims and patient populations of the different studies are described and the typical morphology and the differential diagnostic aspects of the individual tumors as well as the main principles of oncologic staging procedures in pediatric brain tumors are presented.

Common problems occurring during the review evaluation are discussed and a common imaging proposition for the European brain tumor studies is presented.

Present and future aims are the improvement in the treatment of children with brain tumors and the implementation of new imaging techniques in the common imaging protocols to facilitate the resolution of problems with conventional imaging like persisting residual tumors or the identification of possibly treatment-related lesions.

The authors hypothesized that using a short echo time TE should not only reduce susceptibility artifacts but also increase the overall signal-to-noise ratio and allow to retrieve a blood oxygenation level-dependent BOLD signal in regions normally affected by these artifacts.

Material and Methods: Two sequences with TEs of 60 and 32 ms were compared using a 1. In an olfactory stimulation paradigm, activations in piriform cortex were compared.

Concomitant to this, geometric distortions and signal dropout artifacts were decreased at orbitofrontal and temporomesial brain areas in both paradigms.

Changes in cortical activation were significant in the right, but not in the left piriform cortex. Conclusion: Although a shorter TE reduces signal dropouts due to susceptibility artifacts, this shorter TE is not sufficient to recover the BOLD signal from regions affected by susceptibility artifacts such as the piriform cortex.

In einem olfaktorischen Paradigma wurden Aktivierungen im piriformen Kortex verglichen. Schild and Andreas O. Gerstner Abstract Purpose: To evaluate the usefulness and safety of cone-beam computed tomography CBCT dacryocystography in detecting lesions, identifying coexisting soft-tissue changes and determining treatment options in patients with epiphora.

Patients and Methods: Unilateral digital subtraction dacryocystography and CBCT dacryocystography were carried out on 45 patients. Stenoses and occlusions were identified and coexisting changes such as septal deviation and dacryoliths were noted.

The diameter of the bony lacrimal duct of affected and unaffected side was measured and related to the clinically evident epiphora.

An attempt was made to base the subsequent therapeutic planning on the CBCT dacryocystographic findings. Additionally, the radiation dose levels for CBCT dacryocystography in comparison to those of multislice computed tomography MSCT were evaluated in a standardized head-neck Rando-Alderson phantom.

The minimal bony diameter of the side with epiphora was significantly decreased compared to the unaffected side.

Coexisting soft-tissue changes did not correlate significantly with the clinical sign of epiphora. Eight patients showed no underlying reason for the epiphora and were treated conservatively.

A total of eleven patients received interventional therapy for their stenosis and 23 patients had to be treated surgically.

A further three patients received medical treatment for infection, before surgery and interventional therapy, respectively, were carried out.

Conclusion: CBCT dacryocystography is a safe and time-efficient modality for assessing the nasolacrimal duct system in patients with epiphora.

CBCT dacryocystography provides detailed images of the nasolacrimal drainage system, surrounding soft tissue, and bony structures in one diagnostic tour.

It allows clear measurement of the bony nasolacrimal duct and displays information beyond that of the drainage lumen, improving the planning of therapeutic interventional and surgical procedures.

Bei 34 der 45 Patienten konnten ein oder mehrere Zusatzbefunde erhoben werden. Die statistische Analyse der Zusatzbefunde ergab jedoch keinen signifikanten Zusammenhang zwischen dem Vorliegen eines oder mehrerer dieser Zusatzbefunde und dem Auftreten von Epiphora.

After hospitalization, a computed tomography CT study was done and reported as normal. The discharge home followed after symptomatic treatment for 5 days.

Now, a subarachnoid hemorrhage with an intracerebral bleeding of the left frontal lobe was diagnosed in another hospital.

This was suspicious for an aneurysm of the anterior communicating artery. It was treated with coiling and, in addition, an installation of an external cerebrospinal fluid CSF drainage was necessary because of a hydrocephalus with development of a temporary CSF leakage.

The patient appealed to the fact-finding board for medical liability questions because of the misdiagnosis of the first treating hospital.

The board found the adjustment of damages of the patient to be valid and recommended an extrajudicial regulation.

Jetzt wurde in einer anderen Klinik mittels CT eine Subarachnoidalblutung mit intrazerebraler Blutung frontal links bei Verdacht auf ein Aneurysma der Arteria communicans anterior diagnostiziert.

Clinically, they are rare tumors mostly appearing with signs of increased intracranial pressure caused by occlusive hydrocephalus.

They typically present as hyper- to isodense non-contrast-enhancing masses on computed tomography CT. Hypo-dense colloid cysts are regarded as uncommon.

The description of the signal intensity of colloid cysts on magnetic resonance imaging MRI varies widely. They are described as hypointense, isointense or hyperintense on T1-weighted images.

Even on T2 images they may appear with very low to high signal intensity. In conclusion, one may say that colloid cysts are commonly homogeneously hyperintense to brain on T1-weighted and hyperintense on T2-weighted images, but MRI signal characteristics are variable.

On fluid-attenuated inversion-recovery FLAIR images, the signal is not suppressed and they usually show no enhancement.

The missing contrast enhancement is considered a more important differential criterion. In addition, she suffered from an endocrine disorder with type 2 diabetes and a panhypopituitarism.

Upon admission to our hospital the patient presented with slowed psychomotricity and neuropsychological deficits. Apart from gait ataxia the neurologic examination was normal.

The ophthalmologic examination was normal. Magnetic resonance imaging MRI showed a contrast-enhancing lesion in both hypothalami with suprasellar extension.

A histopathologic diagnosis could be established after stereotactic biopsy of the lesion. Their classification depends on the differentiation of shunting versus nonshunting lesions, the latter being the spinal cord cavernomas.

In the shunting lesions, the next step in the proposed classification scheme is related to the feeding artery which can subdivide the dural vascular shunts from the pial vascular malformations: while those shunts that are fed by radiculomeningeal arteries i.

Depending on the type of transition between artery and vein, the latter pial AVMs can be further subdivided into glomerular plexiform or nidus-type AVMs with a network of intervening vessels in between the artery and vein and the fistulous pial AVMs.

The proposed classification is therefore based on a stepwise analysis of the shunt including its arterial anatomy, its nidus architecture and its flow-volume evaluation.

The major advantage of this approach is that it leads to a subclassification with direct implications on the choice of treatment, thereby constituting a simple and practical approach to evaluate these rare diseases.

It occurs in all age groups, but affects predominately young and middle-aged females. The symptoms of CVST are highly variable, thus, diagnosis is often made with a considerable delay.

This review first presents a short summary of the epidemiology, risk factors, clinical signs, and prognosis of CVST. Der Schwerpunkt der Arbeit liegt auf der neuroradiologischen Diagnose der Erkrankung.

CT was used as gold standard. CSF flow artifacts occurred predominantly in the third and fourth ventricles. Der CT-Befund wurde als Goldstandard herangezogen.

Despite the nonspecific and variable clinical presentation of these patients, they show typical radiologic findings.

Previous studies evaluated typical radiologic findings with symmetric infratentorial hyperintense signal changes and similar alteration in the posterior limb of the internal capsule, the splenium of corpus callosum, the medial lemniscus and the lateral brainstem.

In context with the reviewed literature, a series of another three cases with toxic leukoencephalopathy after heroin abuse other than vapor inhalation is presented.

Patients and Methods: All three patients underwent magnet resonance imaging MRI including additional diffusion- weighted imaging and apparent diffusion coefficient maps.

Clinical and laboratory findings were recorded. Results: MRI of all three patients revealed similar symmetric supratentorial hyperintense signal changes involving the frontal, parietal, occipital and temporal lobes.

The cortex was spared and the subcortical U fibers were partially involved. Further, the brainstem and the cerebellar white matter were not affected.

Conclusion: Toxic leukoencephalopathy without involvement of the cerebellum and brainstem is a rare complication of heroin abuse. The pattern of heroin-induced toxic leukoencephalopathy on MRI might not only be related to an unknown adulterant, but also to the mode of drug administration.

Der Kortex war komplett und die subkortikalen U-Fasern waren partiell ausgespart. Schlussfolgerung: Die toxische Leukoenzephalopathie ohne Einbezug des Cerebellums und des Hirnstamms ist eine seltene Komplikation bei Heroinabusus.

The authors present their initial experience with a self-expanding stent for use in intracranial vascular reconstruction, permitting immediate recanalization of acute thromboembolic occlusions of the anterior circulation.

Treatment comprised systemic and intraarterial thrombolysis, mechanical thrombectomy, and stent placement. Neither distal emboli nor any procedure-related complications were encountered.

One patient developed symptomatic intracerebral hemorrhage and two patients needed decompressive craniectomy after treatment. The use of antiplatelet therapy after treatment may, however, increase the risk of reperfusion intracerebral hemorrhage.

Ergebnisse: Sechs Patienten wurden eingeschlossen. Distale Emboli und prozedurale Komplikationen traten nicht auf. Im Verlauf erlitt ein Patient eine symptomatische intrazerebrale Blutung, zwei weitere Patienten mussten zur Druckentlastung kraniektomiert werden.

In dieser Serie zeigt sich eine hohe Effizienz mit Reperfusion bei allen Patienten. After interdisciplinary consultation, combined treatment with endovascular embolization and subsequent stereotactic irradiation was recommended.

Once the patient had survived the acute phase with application of external drainage and later implantation of a shunt system, he was left with an organic brain syndrome.

His lawyer brought suit against the clinic for improper treatment and inadequate information. The court rejected the suit as without foundation, basing its reasoning essentially on the statements of the neuroradiologic expert.

Kategorie Correspondence DOI They can present either with unusual imaging appearance in the form of unusual signals or in uncommon locations.

Epidermoid cyst and abscess are among those lesions which are usually hypointense on T1-weighted imaging T1-WI but rarely can be hyperintense on T1-WI and can mimic each other in different pulse sequences including diffusion-weighted imaging DWI.

When they are present in an uncommon location, they can be confused with each other, especially when one is situated in a location considered more characteristic of the other.

Here, we describe this potential confusing scenario in the form of two cases. Taschner Clinical Case A year-old farmer presented with complex partial seizures and headache for 9 months.

An initial magnetic resonance imaging MRI exam revealed an infiltrating lesion within the left frontotemporal region and the right temporal lobe Figure 1.

A stereotactic brain biopsy in September yielded unspecific findings with diffuse hypercellularity and reactive changes.

Therefore, no therapy was initiated. The patient was readmitted in May , after he had suffered a generalized seizure.

Upon admission he was comatose with a fixed and dilated left pupil. Emergency intubation was performed, a ventricular drainage was placed, and steroids and osmotherapy were given because of increased intracranial pressure ICP and signs of uncal herniation.

A second MRI was performed revealing an increase of the space-occupying effect as well as a new lesion within the left-sided inferior temporal gyrus Figure 2.

Hattingen, S. Blasel, M. Nichtweiss, F. Zanella and S. Weidauer Abstract The spectrum of pathologic processes affecting the midbrain features some differences to other brain areas.

The midbrain is exposed to traumatic alterations due to its position between the tentorial edges, and some neurodegenerative and metabolic-toxic diseases may typically involve the midbrain.

Primary midbrain tumors are also infrequent and often show a benign clinical course. Apart from multiple sclerosis other inflammatory autoimmune processes and some infectious agents predominantly affect the brainstem including the midbrain.

This review discusses the different pathologic processes of the midbrain, i. Obschon regelhaft eine mesenzephale Beteiligung beim Basilarisspitzensyndrom vorliegt, sind isolierte Mittelhirninfarkte selten.

Flacke, H. Tschampa, D. Hadizadeh, S. Greschus, H. Clusmann, R. Kristof and H. Urbach Abstract Background and Purpose: Streak artifacts caused by aneurysm clips and coils impede image quality in multidetector computed tomography MDCT.

The authors propose a technique to minimize these artifacts by gated data reconstruction and shifting the reconstruction window.

Patients and Methods: Intracranial CT angiograms were acquired in the follow-up of six patients with clipped and coiled intracranial aneurysms, respectively.

Data acquisition was gated via an external pacemaker cable-connected to the scanner. Results: Artifact orientation could be rotated by shifting the reconstruction window and interesting vessel segments visualized without disturbing streak artifacts.

This allowed to assess the posterior communicating artery origin in two cases and a middle cerebral artery aneurysm remnant in another case, respectively.

However, due to a higher noise interesting vessel segments were not adjustable in another three patients. Conclusion: Gated MDCT is a promising technique to reduce the amount and to change the position of artifacts induced by clips or coils.

Wir stellen eine neue Methode zur Artefaktreduktion vor durch Verwendung einer getriggerten Datenakquisition und durch Verschiebung des Rekonstruktionsintervalls.

Material und Methodik: Sechs Patienten mit geclippten bzw. After endovascular therapy by coiling, a hemiparesis was observed following extubation.

Disturbance of speech and disorientation added later. An infarct of the lenticular nucleus was found. The angiography showed an occlusion of a frontal opercular branch of the left middle cerebral artery.

The fact-finding board for medical liability should investigate, if the infarct with continuous neurological deficits is explained by improper treatment and if the following management of complication was adequate.

A neuroradiologic opinion was requested. Based on that, the board came to the result that no incorrect medical treatment was done.

Im Computertomogramm stellte sich ein frischer Linsenkerninfarkt dar. Die Angiographie zeigte einen Verschluss eines frontalen operkularen Astes der A.

Es wurde ein neuroradiologisches Gutachten angefordert. Urbach, A. Grote, P. Niehusmann, L. Roesseler and K. Kuchelmeister Introduction The choroid plexus of the 4th ventricle is a T-like, doubled-layered, secretory epithelium attached to the inferior roof and extending into the lateral recesses and foramina of Luschka.

It often calcifies or appears lobulated or cystic. In its normal state, the choroid plexus state shows a papillary or villous architecture supported by a ramifying thin fibrovascular stroma.

We report on a year-old patient with a choroid plexus adenoma in the 4th ventricle and discuss differential diagnoses.

Fischer, C. Schul, P. Lanzer and H. Cervical spondylosis and osteophyte formation affecting the foramina transversaria have been associated primarily with vertebrobasilar insufficiency.

Diagnostic work-up of patients presenting with a suspected cerebral artery dissection includes diffusion-weighted imaging, magnetic resonance imaging MRI , magnetic resonance angiography MRA , and, in most cases, a selective digital subtraction angiography DSA.

Recommended treatment includes therapeutic anticoagulation to prevent thrombus formation and endovascular revascularization to restore patency [3].

Recurrent stenosis due to intimal hyperplasia or other mechanisms remains a major concern. Here, we report a case of vertebral artery dissection and recurrent in-stent stenoses due to external vessel compression caused by an adjacent vertebral osteophyte.

Dorn, A. Milkereit, P. Berlit and T. Liebig Introduction Local or regional inflammatory disease in the head and neck region is a common and usually benign condition.

We present three cases of ischemic brain infarctions that occurred due to transmural involvement of the internal carotid artery ICA as a complication of sinusitis and otitis and discuss endovascular treatment options.

Rossitti Introduction This communication concerns a case of severe intracerebral hematoma and intraventricular hemorrhage in a young man, with continuous hemorrhage shown on angiography that was controlled by transarterial occlusion of a bleeding thalamoperforating artery.

The pathophysiology of continuous intracranial bleeding in this particular case is discussed. Moske-Eick, C. Taschner, S. Krauss, J.

Kirschner, V. Rottenburger, J. Prinz Clinical Case In October , a year-old previously healthy boy was referred to our hospital with paresthesia of the left leg for several weeks and new onset of mild proximal weakness of the right arm and leg.

There was no history of trauma or previous infection. On clinical examination, the child presented discrete hemiparesis with increased deep tendon reflexes and a positive Babinski sign on the right side.

Analysis of the cerebrospinal fluid showed no abnormal findings. The initial postoperative course was uneventful. A combined therapy of local irradiation and temozolomide chemotherapy was started [1].

Four weeks after the termination of radiotherapy, the patient showed clinical progression with tetraparesis and neurological bladder dysfunction.

Fesl, M. Demmel, J. Albrecht, R. Kopietz, V. Schoepf, A. Kleemann, O. Pollatos, A. Anzinger, T. Schreder, H. Brueckmann and M. Material and Methods: Twenty-nine healthy subjects participated in three functional magnetic resonance imaging fMRI sessions each.

The sessions differed regarding emotional states, which were induced by standardized pleasant positive condition, POS , unpleasant negative condition, NEG , or neutral neutral condition, NEU pictures taken from the International Affective Picture System IAPS while the subjects performed a finger-tapping task right index-to-thumb opposition.

After each session, the subjects had to rate their actual mood and the pleasantness of the presented pictures. Furthermore, their state anxiety was assessed.

Behavioral data were evaluated with SPSS. Functional imaging data were processed using statistical parametric mapping SPM2 and were analyzed for main effects of emotional stimulation using an analysis of variance ANOVA.

The local maximum of interest was analyzed by a signal change analysis. Results: Compared to the neutral emotional state, the positive and the negative emotional states caused a reduction of signal intensity changes within the primary sensorimotor hand area during simple finger tapping.

The behavioral data indicated that the unpleasant pictures had a stronger effect on the emotional state than the pleasant images. Conclusion: This study showed that the emotional state of a test person is indeed influencing fMRI results and that well-balanced subjects in a neutral mood achieve the best fMRI results.

Becker Abstract Report of a year-old woman who had sudden vision problems and homonymous hemianopia on the left. A cranial computed tomography CCT was carried out in a radiologic practice.

A native homogeneous, smooth-edged hyperdense intracerebral mass of about 5. Following intravenous administration of contrast medium, a patchy increase in density of about 1 cm was seen.

The mass had only a thin hypodense rim. The patient was informed that she had a tumor. Three days later, magnetic resonance imaging was to be done for further evaluation.

After the patient had returned home, she had headaches, nausea and vomiting in the evening. At night, she was admitted to a hospital as emergency case.

With further increase of intracranial pressure, a craniotomy was done and a hemorrhage was removed. Histologically, a bleeding of a cavernous hemangioma was found.

The patient appealed to the fact-finding board for medical liability questions because she had not been admitted to a hospital immediately after the CCT.

Therefore, surgery was done delayed. The board found that the behavior of the radiologist was wrong. However, it cannot be proven that this medical malpractice is of importance for the existing postoperative complaints.

Dabei fand sich eine nativ homogene, glatt berandete hyperdense intrazerebrale Raumforderung von ca. Nur ein kleiner Anteil von ca.

Es bestand nur ein schmaler hypodenser Randsaum. Der Patientin wurde mitgeteilt, dass sie einen Tumor habe. Nachts erfolgte die Notfallaufnahme in eine Klinik.

Die Schlichtungsstelle kam zu dem Ergebnis, dass das Verhalten des Radiologen fehlerhaft war. As an manager he has assorted equals, and some superiors; but in guidance, from fancy experi- ence and a peculiar care in discovering the occult causes of disorder, he has certainly a opponent.

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