Enhancement of the subarachnoid space after intravenous administration of gadolinium contrast agent is not common. Enhancement usually occurs in pathological conditions that increase the permeability ...of the blood–cerebrospinal fluid barrier, most notably in meningitis. We herein describe possible subarachnoid enhancement in patients with no apparent effect on the meninges. These patients had clinical signs of Meniere’s disease and underwent specific magnetic resonance imaging of the inner ear to possibly visualize endolymphatic hydrops. The endolymphatic space can be noninvasively imaged by intravenous administration of contrast agent, usually at a double dose, 4 hours before the scanning process. During this time, the contrast agent penetrates not only the perilymph but also the subarachnoid space, where the highest concentration occurs after 4 hours according to some studies.
Brain abscess caused by
Listeria monocytogenes
(LM) is a rare, yet serious condition with high mortality if not recognized and treated timely. We present a series of three cases of LM brain abscesses ...and describe their characteristic radiological appearances which can be considered very typical. LM abscesses frequently present as markedly irregular formations, revealing characteristic worm-like tubular pattern of chaotic curvilinear arrangement. Knowledge of this imaging pattern can be very helpful in early recognition of LM abscesses whose initial differential diagnosis can often be misleading initially.
A high multiple sclerosis activity while on alemtuzumab is rather uncommon compared to moderate-efficacy drugs. The purpose of this case report is to present a case of a 37-year-old female patient ...with bronchial asthma and no other medical history, whose disease activity required switching from dimethyl fumarate to fingolimod, then to alemtuzumab and finally to ocrelizumab.
In our patient, two severe attacks were observed and treated after administration of the first pulse of alemtuzumab. After six months of therapy, patient's immunological profile showed the expected decrease in CD4+ and CD8+ T-cells and, markedly increased values of CD19+ B-cells. Surprisingly memory B-cells, which typically repopulate very slowly following alemtuzumab treatment, were above baseline levels. Regular administration of ocrelizumab based on a standardised scheme, after the alemtuzumab therapy failure, resulted in the stabilisation of the patient's condition both clinically and radiologically.
Thus, when the alemtuzumab treatment is unsuccessful, the authors recommend testing T- and B-cell levels and proceeding with an early switch to ocrelizumab if high B-cell counts are found.
Abstract Objective To evaluate the prevalence of spoke-wheel pattern and typical symptoms of focal nodular hyperplasia (FNH) by means of dynamic contrast-enhanced ultrasonography (CEUS) in relation ...to lesion size. Methods Twenty-eight patients were included in the trial, in whom, based on the CEUS, we raised suspicion of hypervascularized liver lesion; there were 30 lesions altogether. The final diagnosis of FNH was verified by means of CT, MRI or lesion biopsy. Majority of patients (26) were females, compared to 2 male, with average age of 33.3 years. Average lesion size was 45.6 mm. Besides the ultrasound examination, we used also “blood pool” ultrasound contrast agent of second generation, sulphur hexafluoride (BR1); we evaluated enhancement of the lesion until the late stage—within 5 min from application. Results In lesions larger than 3 cm ( n = 20), stellate vascular enhancement was found in 19 cases (95.0%) early in arterial phase. As for lesions smaller than 3 cm ( n = 10), spoke-wheel pattern was observed only in 3 cases (30%) and lesions smaller than 2 cm practically did not show this phenomenon at all ( n = 1; 17%). Generally, symptom of spoke-wheel pattern was observed in 22 cases, i.e. in 73.3%. In total, central scar was present in 63.3% ( n = 19) of cases. In lesions larger than 3 cm, it was present in 85.0% ( n = 17), in lesions smaller than 3 cm in 20% ( n = 2). Conclusion Contrast-enhanced ultrasonography can be the final diagnostic method for FNH larger than 3 cm which has typical spoke-wheel vessel structure on CEUS. If this phenomenon is not present and the central scar is not visible, specific diagnosis of FNH cannot be based solely on CEUS findings.
Minimally invasive oxygen-ozone (O
-O
) therapy utilizing the biochemical effects of O
-O
mixture is commonly used in the treatment of musculoskeletal pain. The literature dealing with O
-O
therapy ...of spinal pain focuses mainly on the lumbosacral region. The aim of this review is to evaluate the efficacy of O
-O
therapy in musculoskeletal pain in the neck region. The Medline (PubMed), SCOPUS, Web of Science, and Google Scholar databases were searched for clinical studies, using the free text terms: ozone, neck, cervical, spine, pain, disc, hernia, nucleolysis, paravertebral, treatment, and various combinations of them. In total, seven studies (two randomized controlled trials and five observational studies) were found. These studies dealt with the intradiscal or intramuscular paravertebral application of O
-O
mixture in patients with myofascial pain syndrome, cervical disc hernias, and chronic neck pain. All these studies proved a significant decrease in neck pain (evaluated by Visual Analog Scale or Numerical Rating Scale), and most of them showed improvement in functional status (measured by Oswestry Disability Index or Neck Disability Index). In addition, other pain assessment scales and function and quality of life measures (DN4 questionnaire, pain pressure threshold, cervical lateral flexion range of motion, Japanese Orthopedic Association scale, 12- and 36-Item Short Form Surveys, modified MacNab criteria, and analgesic drug intake reduction) were used. Changes in these measurements also mostly supported the efficacy of O
-O
treatment. No significant complications of the treatment were reported. The available evidence is sparse, but despite this, the O
-O
treatment of musculoskeletal neck pain can be considered potentially beneficial and relatively safe.
Spontaneous spinal epidural hematoma (SSEH) is a very rare clinical entity with potential diagnostic difficulties and which can result in severe neurological deficit. The etiology of this rare ...condition is largely not known, but with potential predisposition in patients on anticoagulation medication. This includes the novel anticoagulants with direct inhibition of the factor Xa mechanism (DOACs). These medications are supposed to have more predictable pharmacokinetics with fewer severe haemorrhagic adverse events in comparison with standard warfarin therapy. However, in the last few years, an increasing number of case reports have been published of haemorrhage into the central nervous system. We present a case of non-traumatic spinal epidural hematoma in the lumbar region in a patient on chronic apixaban therapy. To the best of our knowledge, it is the first described SSEH in the lumbar region associated with apixaban therapy.
Abstract
Background
The objective of this prospective randomized monocentric study is to compare the speed and quality of interbody fusion of implanted porous Al
2
O
3
(aluminium oxide) cages with ...PEEK (polyetheretherketone) cages in ACDF (anterior cervical discectomy and fusion).
Materials and methods
A total of 111 patients were enrolled in the study, which was carried out between 2015 and 2021. The 18-month follow-up (FU) was completed in 68 patients with an Al
2
O
3
cage and 35 patients with a PEEK cage in one-level ACDF. Initially, the first evidence (initialization) of fusion was evaluated on computed tomography. Subsequently, interbody fusion was evaluated according to the fusion quality scale, fusion rate and incidence of subsidence.
Results
Signs of incipient fusion at 3 months were detected in 22% of cases with the Al
2
O
3
cage and 37.1% with the PEEK cage. At 12-month FU, the fusion rate was 88.2% for Al
2
O
3
and 97.1% for PEEK cages, and at the final FU at 18 months, 92.6% and 100%, respectively. The incidence of subsidence was observed to be 11.8% and 22.9% of cases with Al
2
O
3
and PEEK cages, respectively.
Conclusions
Porous Al
2
O
3
cages demonstrated a lower speed and quality of fusion in comparison with PEEK cages. However, the fusion rate of Al
2
O
3
cages was within the range of published results for various cages. The incidence of subsidence of Al
2
O
3
cages was lower compared to published results. We consider the porous Al
2
O
3
cage as safe for a stand-alone disc replacement in ACDF.
The aim of our study was to evaluate duplex ultrasonography (DUS) and magnetic resonance angiography (MRA) in detection of haemodynamically significant renal artery stenosis (RAS).
The study included ...patients with high clinical suspicion of renovascular hypertension (RVH). The imaging of renal arteries was performed by DUS, MRA and digital subtraction angiography (DSA). Significant RAS was defined as maximum systolic velocity > or =180 cm/sec (DUS) or as 60% reduction of the endoluminal arterial diameter (MRA, DSA). The results of DUS and MRA were assessed in respect to the results of DSA.
Arterial supply of 186 kidneys in 94 patients was evaluated. DSA revealed significant RAS in 61 kidneys evaluated. DUS was not able to examine arterial supply in 18 kidneys of 13 patients. In the detection of significant RAS, DUS was characterized by sensitivity and specificity of 85% and 84%. MRA achieved satisfactory imaging quality in all but one kidney evaluated. The sensitivity and specificity of MRA in the detection of significant RAS was 93% and 93%, respectively.
In patients with high clinical probability of RVH, MRA proved to be more reliable and superior in both sensitivity and specificity to DUS in the detection of significant RAS.
For the treatment of chronic unilateral radicular syndrome, there are various methods including three minimally invasive computed tomography (CT)-guided methods, namely, pulsed radiofrequency (PRF), ...transforaminal oxygen ozone therapy (TFOOT), and transforaminal epidural steroid injection (TFESI). Despite this, it is still unclear which of these methods is the best in terms of pain reduction and disability improvement. Therefore, the purpose of this study was to evaluate the short and long-term effectiveness of these methods by measuring pain relief using the visual analogue scale (VAS) and improvement in disability (per the Oswestry disability index (ODI)) in patients with chronic unilateral radicular syndrome at L5 or S1 that do not respond to conservative treatment.
After screening 692 patients, we enrolled 178 subjects, each of whom underwent one of the above CT-guided procedures. The PRF settings were as follows: pulse width = 20 ms, f = 2 Hz, U = 45 V, Z ˂ 500 Ω, and interval = 2 × 120 s. For TFOOT, an injection of 4-5 mL of an O
-O
mixture (24 μg/mL) was administered. For the TFESI, 1 mL of a corticosteroid (betamethasone dipropionate), 3 mL of an anaesthetic (bupivacaine hydrochloride), and a 0.5 mL mixture of a non-ionic contrast agent (Iomeron 300) were administered. Pain intensity was assessed with a questionnaire.
The data from 178 patients (PRF, n = 57; TFOOT, n = 69; TFESI, n = 52) who submitted correctly completed questionnaires in the third month of the follow-up period were used for statistical analysis. The median pre-treatment visual analogue scale (VAS) score in all groups was six points. Immediately after treatment, the largest decrease in the median VAS score was observed in the TFESI group, with a score of 3.5 points (a decrease of 41.7%). In the PRF and TFOOT groups, the median VAS score decreased to 4 and 5 points (decreases of 33% and 16.7%, respectively). The difference in the early (immediately after) post-treatment VAS score between the TFESI and TFOOT groups was statistically significant (
= 0.0152). At the third and sixth months after treatment, the median VAS score was five points in all groups, without a statistically significant difference (
> 0.05). Additionally, there were no significant differences in the Oswestry disability index (ODI) values among the groups at any of the follow-up visits. Finally, there were no significant effects of age or body mass index (BMI) on both treatment outcomes (maximum absolute value of Spearman's rank correlation coefficient = 0.193).
Although the three methods are equally efficient in reducing pain over the entire follow-up, we observed that TFESI (a corticosteroid with a local anaesthetic) proved to be the most effective method for early post-treatment pain relief.
Chronic lumbosacral radicular pain (CLRP) as a possible adverse consequence of lumbar spine surgery represents a serious medical challenge. Pulsed radiofrequency of dorsal root ganglion (PRF-DRG) ...treatment is known to be effective in alleviating CLRP. This retrospective study compares the efficacy of a single CT-guided PRF-DRG procedure in the treatment of unilateral CLRP between patients without (non-PSS) and with (PSS) previous lumbar spine surgery. Non-PSS and PSS groups included 30 and 20 patients, respectively. Outcomes (pain intensity and disability) were evaluated by means of the visual analog scale (VAS) and Oswestry disability index (ODI) immediately after the procedure (VAS), as well as three and six months after the procedure, respectively. Non-PSS group showed a significant (
˂ 0.001) decrease of VAS (median) at all follow-up intervals (from 6 to 4; 4; 4.5 points, respectively). The PSS group showed a significant yet transient VAS (median) decrease (from 6 to 5 points) immediately after the procedure only (
< 0.001). The decrease of VAS was more pronounced in the non-PSS group after three and six months (
= 0.0054 and 0.011, respectively) in intergroup comparison. A relative decrease of VAS ≥ 50% during follow-up was achieved in 40%; 43.3%; 26.7% (non-PSS), and 25%; 5%; 0% (PSS) of patients. ODI (median) significantly decreased in the non-PSS group (from 21.5 to 18 points) at three and six months (
= 0.014 and 0.021, respectively). In conclusion, previous lumbar spine surgery decreases the therapeutic efficacy of PRF-DRG procedure in CLRP patients.
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