5 avril 2013 5 05 /04 /avril /2013 23:00

 

 Etude IRM de

 l ' HIPPOCAMPE de

l 'ALZHEIMER INCIPIENS


  PROTEINE TAU  TAUOPATHIES             PHOSPHORYLATION

http://irmresonance.over-blog.com/article-4895859.html

 

 

http://www.uku.fi/neuro/37the.htm


DETECTION IRM  

 

http://www.futura-sciences.com/news-alzheimer-avancee-detection-maladie-grace-irm_5791.php

 


 

 

 ALZHEIMER 

 Diagnostics différentiels .

 http://www.alzheimer-montpellier.org/dgdff.html


 

 Anatomie Hippocampe  coupe SAGITTALE      http://perso.wanadoo.fr/adna/hippocampus.gif

     

 


 

  coupe sagittale  :

http://www.inrp.fr/Acces/biotic/neuro/plasticite/images/hippocampe-dans-cerveau.jpg

 

 

  http://www.inrp.fr/Acces/biotic/neuro/plasticite/


 

 

 

 

 

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1 juin 2012 5 01 /06 /juin /2012 19:37

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6. Céphalées et migraines

Les céphalées constituent une des causes les plus fréquentes de consultation en pédiatrie [5]. Dans la grande majorité des cas, il s’agit de migraines et de céphalées psychogènes chez les enfants d’âge scolaire et les adolescents.

 

 


L’imagerie est rarement utile en l’absence d’élément clinique d’appel faisant suspecter des céphalées lésionnelles [14].
- douleurs permanentes ou augmentant en fréquence ou en intensité
- douleurs nocturnes ou aux changements de position, à la défécation, à l’effort
- changement de comportement et/ou du caractère, épilepsie ou anomalies à l’examen neurologique.
L’IRM est plus performante que le scanner pour rechercher des malformations vasculaires non rompues, une malformation de Chiari 1, voire une dissection carotidienne ou vertébrale.
En pratique quotidienne, le scanner sans injection de produit de contraste, est le plus souvent suffisant pour éliminer une pathologie tumorale ou une hémorragie méningée.

7. Les symptomatologies médullaires aiguës

Il s’agit de la seule urgence véritable en IRM, à la recherche d’une compression médullaire.
En l’absence de tumeur intracanalaire, il faut penser à une maladie inflammatoire cérébro médullaire et, dans ce cadre, pratiquer (non nécessairement en urgence) une étude complète de la moelle avec des séquences STIR, à la recherche de plaques ou d’anomalies de signal intramédullaires (myélite transverse, plaques de SEP). Dans ce cadre, il est indispensable de pratiquer au moins une séquence FLAIR sur l’encéphale à la recherche de plaques sus ou soustentorielles infracliniques.

8. Le torticolis persistant

Lorsque les radiographies du rachis cervical de face et de profil sont normales (absence de malformation vertébrale, de vertébra plana…), il est indispensable de pratiquer une IRM cérébrale afin de vérifier, non pas tant l’absence d’une tumeur de la fosse postérieure qui peut être éliminée sur un scanner, mais surtout l’absence de malformation de Chiari.

 

 Dans cette hypothèse, la présence d’une symptomatologie d’effort est très évocatrice du diagnostic : il peut s’agir de céphalées d’effort, voire de radiculalgie d’effort.

Table 1 : Traumatismes crâniens de l’adulte.
Classification clnique selon DJ Masters et al [19]

Groupe 1 (risques faibles)

• patients asymptomatiques
• céphalées
• sensation de vertiges
• hématome, blessure, contusion ou abrasion du scalp
• absence de signe des groupes 2 et 3


Groupe 2 (risques modérés)

• vomissements
• modification de la conscience
• céphalées croissantes
• crise comitiale
• histoire peu fiable
• prise de substance
• lésions faciales sévères
• signes de fracture basilaire
• fractures avec dépression ou pénétrante


Groupe 3 (risques élevés)

• altération du niveau de conscience
• diminution progressive de l'état de conscience
• signes neurologiques focaux
• plaie pénétrante
• embarrure
• polytraumatisme (au moins deux lésions)

Tableau 2 :
Indication de l'imagerie dans les traumatismes craniens du nourrisson et de l'enfant

Pas de radio de crâne
(sauf maltraitance)
Scanographie en cas de
  • vomissements répétés ou
après intervalle libre
  • signes neurologique focaux
  • convulsions
  • troubles de la conscience
initiaux ou secondaires
  • suspicion de maltraitance
  • embarrure, lésion
pénétrante et plaie sévère de
la face
  • polytraumatisme

 

Tableau 3
Critères du diagnostic des neurofibromatoses de type 1 [25]

Le diagnostic de NF est établi sur la présence d’au moins 2 des critères suivants :
- au moins 6 taches café au lait de plus de 5mm de diamètre chez les individus prépubères et de plus de 15mm chez des individus pubères,
- au moins 2 neurofibromes ou un neurofibrome plexiforme,
- des lentigines axillaires ou inguinales,
- un gliome des voies optiques,
- au moins 2 nodules de Lisch,
- une lésion osseuse caractéristique comme une dysplasie sphénoïde, un amincissement de la corticale des os longs avec ou sans pseudarthrose,
- un parent du premier degré atteint de NF suivant les critères précédents.

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19 février 2012 7 19 /02 /février /2012 08:16

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COURS IRM DIFFUSION CEREBRALE

JUSSIEU

SEQUENCE DE DIFFUSION

 

 

 

 

 

 

 

http://www.chups.jussieu.fr/polys/radiologie/jrad/index.htm

 

 

 

 

 

 

 

 

 

http://www.chups.jussieu.fr/polys/radiologie/jrad/index.htm

 

 

 

 

 

 

 

 

-

Repost 0
16 octobre 2010 6 16 /10 /octobre /2010 21:49
Repost 0
27 août 2010 5 27 /08 /août /2010 23:00

 

 

ATLAS MRI BRAIN
of UNIVERSITY of ANGERS / FRANCE



 

 

http://www.med.univ-angers.fr/discipline/radiologie/Intlatlas/CadresAtlas.html

 

 

 

Repost 0
27 juillet 2010 2 27 /07 /juillet /2010 13:41

 

 

This month’s case courtesy of Ali Chahlavi M.D. and Peter Rasmussen M.D., from the Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, OH.

History of Present Illness: A 63 year-old right handed Caucasian male with a history of hyperlipidemia, emphysema, and borderline hypertension presents with sudden onset of right hemiparesis, right facial droop, and global aphasia. After about 30 minutes, the patient’s symptoms improved to full motor strength in all 4 extremities, although the right hemiparesis and the aphasia re-occurred intermittently, depending on his blood pressure. The aphasia consisted of fluent speech, poor comprehension, poor naming and normal repetition. The patient had a fluctuating neurologic exam that was extremely dependent on the systolic blood pressure. IV fluids and pressor agents were required to maintain his blood pressure greater than 160 systolic. If the systolic blood pressure dipped below 140, he would develop global aphasia and right-sided hemiparesis.

Studies: A Doppler ultrasound of his cervical carotid arteries showed a 60-70% right internal carotid artery (ICA) stenosis and an occlusion of left ICA at its origin. The MRI demonstrated a watershed infarct within the left anterior cerebral artery (ACA) and middle cerebral artery (MCA) distribution (Figure 1). The MRA confirmed this with no flow signal in the left ICA with collateral filling of left ACA and left MCA, and moderate to severe stenosis within the proximal right ICA.

Figure 1. MRI

The following day, a three-vessel angiogram was performed (Figure 2). It showed occlusion of the left internal carotid artery at its origin (2a) and 50-55% stenosis of the proximal right ICA (2b). The left internal carotid artery was supplied by the left ophthalmic artery and, from the right ICA via the anterior communicating artery (2c). There was no significant supply from the posterior circulation (2d).

Figure 2. Angiogram
(a) (b) (c) (d)

A Diamox SPECT (single photon emission computed tomography) scan showed decreased perfusion in the left MCA distribution with a 20% reduction in perfusion after the administration of Diamox (acetazolamide) (Figure 3)

Figure 3. Diamox SPECT

HOSPITAL COURSE: To improve perfusion, the patient underwent angioplasty with stenting of the right ICA, with residual stenosis of 30% [Figure 4A (Pre-stent) & B(Post-Stent)]. A repeat Diamox SPECT scan showed improved perfusion in the left MCA distribution, but there was still reduced cerebral vascular reserve (20% reduction with Diamox challenge). Furthermore, the patient continued to have recurrent symptoms when the systolic blood pressure was less than 140 mmHg.

Figure 4. Angioplasty
(a) (b)

OUTCOME: The patient underwent a left superficial temporal artery to middle cerebral artery (STA-MCA) bypass without complication. Postoperatively, a head CT showed mild edema in the left MCA territory that resolved with follow-up imaging but no new infarcts. There was no recurrence of ischemic symptoms when his blood pressure was normalized. On the day of discharge, the patient had fluent speech, good repetition and comprehension, and mild word finding difficulty; his motor strength was 5-/5 on the right side, and sensory function was normal. At 6 week follow-up, the patient had full motor power, good fine motor control of his right hand and very subtle word-finding difficulty. The arterial graft was clinically patent.

 
1. What further diagnostic studies are needed?
 
2. What are the options for medical management of this patient?
 
3. What is the best surgical option?
 
4. Would you offer surgery to this patient?
 
5. Please provide any comments or suggestions regarding management of this case:
1. Was the patient started on anti-platelet agents? 2. Was a stent considered? 3. It would be nice to have the option to enlarge the images by clicking on them. Alexander Mason Cleveland Ohio
thereis no indication for the first operation.
Would a left carotid endarterectomy with the goal of resolving the total occlusion (getting good back-flow) be a reasonable alternative first approach? It may or may not accomplish the necessary restoration of flow, although a bypass, as it was done, can do it too ... Shahram Makoui
I believe that the authors did a great treatment. The result is excellent. Thanks Kudret Tureyen M.D. University of Wisconsin Department of Neurosurgery K4/886 Clinical Science Centre 600 Highland Avenue Madison WI, 53792 Tel: 608/265-8121 Fax: 608/263-1728 e-mail: k.tureyen@neurosurg.wisc.edu
Would also consider Endarterectomy of R ICA
Would recommend post-op: 1)Spect cerebral perfusion 2) cerebral angiogram
 
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History of Present . showed watershed infarct within the left anterior cerebral artery (ACA) and middle cerebral artery (MCA) distribution (Figure 1). The MRA confirmed this with no flow signal in the left ICA with collateral filling of left ACA and left MCA, and moderate to severe stenosis within the proximal right ICA.

Figure 1. MRI

The following day, a three-vessel angiogram was performed (Figure 2). It showed occlusion of the left internal carotid artery at its origin (2a) and 50-55% stenosis of the proximal right ICA (2b). The left internal carotid artery was supplied by the left ophthalmic artery and, from the right ICA via the anterior communicating artery (2c). There was no significant supply from the posterior circulation (2d).

the administration of Diamox (acetazolamide) (Figure 3)

, but there was still reduced cerebral vascular reserve (20% reduction with Diamox challenge). Furthermore, the patient continued to have recurrent symptoms when the systolic blood pressure was less than 140 mmHg.

Figure 4. Angioplasty
(a) (b)

OUTCOME: The patient underwent a left superficial temporal artery to middle cerebral artery (STA-MCA) bypass without of his right hand and very subtle word-finding difficulty. The arterial graft was clinically patent.

 
1. What further diagnostic studies are needed?
 
 
2. What are the options for medical management of this patient?
 
 
3. What is the best surgical option?
 
 
4. Would you offer surgery to this patient?
 
 
5. Please provide any comments or suggestions regarding management of this case:
1. Was the patient started on anti-platelet agents? 2. Was a stent considered? 3. It would be nice to have the option to enlarge the images by clicking on them. Alexander Mason Cleveland Ohio
thereis no indication for the first operation.
2)
 
Monthly Message

Case of the Month Archive

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Contact Us | Jobs | Site Map | Disclaimer | Privacy Policy | Credits
Copyright © 2006 Congress of Neurological Surgeons

Repost 0
8 juillet 2010 4 08 /07 /juillet /2010 09:18
Repost 0
3 juillet 2010 6 03 /07 /juillet /2010 19:23

GOLDMINER RSNA

PACHYMENINGITE  EPAISSISSEMENT DURE-MERE DURA MATER

 

 

http://radiographics.rsna.org/content/25/4/1075/F6.expansion

 

 

 

 

 

 

http://radiographics.rsna.org/content/25/4/1075/F6.expansion

 

 

 

 

 

Repost 0
8 juin 2010 2 08 /06 /juin /2010 06:47

GRANULOME A CHOLESTERINE ANGLE PONTO CEREBELLEUX IRM

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Repost 0
6 juin 2010 7 06 /06 /juin /2010 06:44

KYSTE ARACHNOIDIEN

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