Orbital neuromuscular choristoma of the ophthalmic nerve

Introduction: Neuromuscular choristoma (NC) is a rare tumor composed of striated muscle fibers admixed with nerve fibers that often affects large peripheral nerve trunks in children. To the best of our knowledge, this is the first reported case in the literature of a NC of the ophthalmic nerve in an adult. Case description: A 27-year-old woman presented with a 20-day history of left periorbital headache radiating to the frontotemporal region, with associated tearing, nausea, and vomiting. The examination was normal, except for hypoesthesia in the distribution of the first trigeminal nerve branch (V1). Cranial computerized tomography showed a lesion in the left orbit and cavernous sinus with widening of the superior orbital fissure. On magnetic resonance imaging, the lesion was well-defined with fusiform morphology and showed a central cystic component and peripheral enhancement. An extradural approach was performed with subtotal tumor resection. Biopsy showed proliferation of striated muscle cells admixed with nerve fascicles and Schwann cells. A pathological diagnosis of NC of V1 was determined. Six months after surgery, left hypotropia with limitation of supraduction was observed, as well as hypoesthesia and paralysis of the left forehead with ipsilateral eyebrow ptosis. The rest of the examination remained within normal limits. Conclusion: NC should be considered in the differential diagnosis of a young patient with periorbital headache and hypoesthesia in the V1 region.

To study the correlation of serum S-100 protein level with the severity of stroke and its prognostic implication

Objective: This study investigated correlation between mortality, stroke subtype and stroke severity with serum S-100 protein level prior to the treatment of the patients admitted to the emergency department and diagnosed with a stroke. Methods: Pretreatment sample were collected from the patients (n = 142) to determine S-100 protein level, age and sex-matched healthy individuals (n = 40) served as control. All patients had cranial computerized tomography scan/magnetic resonance imaging in the first 24 h. The neurological evaluation was made with the National Institute of Health Stroke Scale (NIHSS) in the acute stage. Results: Compared with controls, S-100 protein level were significantly higher in the stroke groups. In stroke groups, S-100 protein level was more significantly higher in the ischemic group than hemorrhage and transient ischemic attack group and highest in expired patients. Conclusion: Serum S-100 protein measurement can be used as an early marker of brain damage. There is a role of S-100 protein as a co-predictor of outcome in patients with acute stroke.

Study of the positivity of spontaneous and directed diagnosis of leukoaraiosis in the elderly by cranial computerized tomography, and its correlation with cognitive defi cit and cardiovascular risk factors

OBJECTIVE: To evaluate the prevalence of leukoaraiosis (LA) and its correlation with vascular risk factors and the cognitive performance of elderly patients. METHOD: 78 patients were randomly selected and submitted to clinic-laboratorial evaluation for vascular risk factors. Two cognitive tests were performed. All patients were submitted to cranial computerized tomography (CT), which was analyzed in two situations: the spontaneous and the directed way. RESULTS: There was no statistically significant difference between the prevalence of spontaneous and the directed diagnoses of LA (20.5 and 18%, respectively). The presence of LA was not significantly correlated with cognitive impairment. Only age was positively associated with LA. CONCLUSION: Cranial CT is a trustworthy method for the diagnosis of LA. Only age showed a positive association. No clinical implications were found, concerning the cognitive performance of the patients.

A portable diagnostic workstation based on a Webpad: implementation and evaluation

A wireless hand-held Webpad device was used to review a sample set of cranial computerized tomography (CT) studies to assess its diagnostic capabilities and its feasibility as a portable diagnostic workstation for radiology. The data-set consisted of 30 head CT studies of emergency cases. Two neuroradiologists and a senior radiologist participated in the evaluation of the portable workstation. They used a Web-based viewer that we developed, which provided all the major functionalities required for radiological image review. The reported radiological findings and diagnoses were compared with a gold standard, comprising a set of diagnoses previously formulated by a consensus panel of radiologists who had reviewed the original studies. The diagnoses made using the Webpad were correct (no major discrepancies) in 82 out of 90 interpretations (91%), which is comparable to the accuracy reported in image review with a conventional radiological workstation. The average total working time per diagnosis was 5 min 25 s (range 2–12 min). The simplicity of use of the system and its low cost make it suitable for distributing radiological studies within hospital facilities.