A 40 years old female has been suffering from cluster headache for the last 20 years. For the last 1.5 years it has been transformed from an episodic form to a chronic one. The patient reports an episodes of vertigo, for which she carried out otorhinolaryngology examination and brain NMR. On NMR was detected a periventricular lesion of about 1.2 cm, without mass effect. This lesion was probably present also 4 years ago, when the patient underwent another NMR.
7-year-old boy with prodrome of right-sided and right face weakness, gait ataxia, and intermittent headaches. Head computed tomography demonstrated a tumor at the brainstem/posterior fossa, and then MRI confirmed a diffuse intrinsic pontine glioma (a typical brainstem glioma). Following initiation of dexamethasone (Decadron, steroid for vasogenic edema), the child has started experimental treatment with the medicine nimotuzumab to be followed with conventional radiotherapy.
45-year-old male who presented with acute onset of flaccid paraparesis more pronounced on the left, sensation of current shocks in both legs and sensory level from the umbilicus downwards. The symptoms have reached their pick within less than a day. On examination the left lower limb was plegic and the right lower limb was partially weak. EMG was interpreted as demyelinating sensorimotor neuropathy. MRI showed hyperintense signals at the dorsal terminal segment of the marrow consistent with myelitis.
A 66 year old man that was diagnosed with prostate cancer underwent radical prostatectomy 2 years ago. Pathology result of the surgical specimen revealed poorly differentiated prostate carcinoma with positive surgical margins. He was treated with antiandrogens and adjuvant radiation therapy. Since the beginning of the last year and under hormonal monotherapy with Casodex his PSA levels doubled. PET CT of the abdomen and the pelvis revealed hepatic lesion.
A 23 year old female was diagnosed 7 years ago with multiple sclerosis. The patient had 4 acute attacks 7 years ago, and since then she has been treated by Avonex. The patient had no attacks since then, feel healthy and lead a normal healthy life as a busy university student. She enjoys sports several times a week, and there are no problems regarding her physical and mental function. Neurologically, the only reminiscence of her illness is a positive Babinsky sign in the left leg and a temporal blindness in the left eye.
21-year-old female with an acute onset of a unilateral sixth cranial nerve deficit. Brain MRI showed at least a dozen white matter lesions, one of them contrast-enhancing. Sensory evoked potentials showed a bilateral increase in latency. Multiple sclerosis was diagnosed, and the patient was treated by corticosteroids, followed by improvement of symptoms. The first follow-up revealed no focal neurological signs with a history of a transitory unilateral lower limb hyposthenia. On the second visit, a horizonto-rotatory nystagmus and irregular paraesthesia in the right toes are documented.
23-year-old female had episodes of hemiparesis, dysmetria and parenthesis underwent MRI that showed a demyelization process. After she was hospitalized with Left Retro-Bulbar Optic Neuritis, she started treatment with weekly injections of AVONEX (Interferon beta-1a). Now she is in good general health and asks about stopping the Anovex treatment. The expert answers that she shouldn't stop the treatment , because the purpose of the medications is to prevent exacerbations, that may leave neurologic residual dysfunction.
21-year-old female with an acute onset of a unilateral sixth cranial nerve deficit. Brain MRI showed at least a dozen white matter lesions, one of them contrast-enhancing. Sensory evoked potentials showed a bilateral increase in latency. Multiple sclerosis was diagnosed, and the patient was treated by corticosteroids, followed by improvement of symptoms. The first follow-up revealed no focal neurological signs with a history of a transitory unilateral lower limb hyposthenia. On the second visit, a horizonto-rotatory nystagmus and irregular paraesthesia in the right toes are documented.
31 years old healthy man, a month ago, during a soccer match, had a trauma of the right shoulder and was diagnosed with right glenohumeral luxation.
The Emergency Room orthopedist reduced luxation, and during the first days of the event, the patient treated pain, of modest importance and bearable. At present, the day pain has completely disappeared reappearing a bit at night and affecting mainly the forearm.
5-year-old boy with diagnosis of neurofibromatosis type 1 underwent ophthalmological evaluation that showed picture of slight reduction in visual acuity of the right eye and severe hypovision of the left eye with slight reduction of the bilateral visual field. MRI showed presence of a big expansive lesion and of right temporopolar arachnoid cyst. The treating doctors recommended an urgent surgery in order to reduce the cerebral hypertension.
5-year-old boy with diagnosis of neurofibromatosis type 1 underwent ophthalmological evaluation that showed reduction in visual acuity and reduction of the bilateral visual field. MRI showed presence of a big expansive lesion and of temporopolar arachnoid cyst. The treating doctors recommended an urgent surgery in order to reduce the cerebral hypertension. In the expert's opinion, after having seen the images, the arachnoid cyst has not changed that much, and probably has little impact or effect, and therefore meanwhile no surgery is warranted.
47-year-old female with a diagnosis of Multiple Sclerosis ,who suffers from progressive tetraparesis, more pronounced in the lower extremities. Her treatment included mitoxantrone and Interferon-beta treatment, both were discontinued because of side effects. Her movement difficulties, due to the left lower limb rigidity, are increasing progressively.
39-year-old male experienced in 1994 intense lower back pain after lifting weights, with spontaneous resolution. In 2006, he again experienced lower back pain radiating into both thighs. A lumbar MRI showed degenerative changes and EMG test showed L5 nerve root irritation. His physical examination demonstrated increased reflexes and a concern for cervical stenosis was entertained. Further cervical MRI and lumbar studies showed arthritic changes, and the thoracic MRI showed evidence of spinal cord compression. The surgeon suggested posterior thoracic laminectomy.
38-year-old female started to suffer pain in her right foot on without a notable trauma. She was examined by several orthopeadic doctors and she got different opinions. The first diagnosed medium sprain of right foot and slight tumefaction on forefoot, and suggested her paracetamol administration that was with no benefit. The second specialist diagnosed sesamoiditis and right plantar fasciitis with 3rd degree cavus-valgus feet and recommended Depomedrol + Lidocaine, Pennsaid drops and NSAIDs. As part of the examinations she underwent an MR with and without Gadolinium.
