The nervus intermedius is a complex nerve that traverses the cerebellopontine angle and is associated with a wide range of pathologies for which imaging plays a crucial diagnostic role. Cerebellopontine angle masses or neurovascular compression may directly involve the nervus intermedius. Alternatively, pathologies that involve branches of the nervus intermedius may present with symptoms referable to the nervus intermedius, including sinonasal tumors, perineural tumor spread, or viral reactivation such as in Ramsay Hunt syndrome. Overlapping innervation with branches of the trigeminal, glossopharyngeal, and vagus nerves can confound diagnosis and/or lead to mislocalization, which may result in delayed diagnosis or inappropriate therapy. This review article provides an in-depth overview of nervus intermedius anatomy and physiology, and the wide spectrum of pathologies that can involve the nervus intermedius or its branches, with an emphasis on clinical relevance.Learning Objective: To understand the normal anatomy and physiology of the nervus intermedius as well as the clinical relevance and imaging findings of the neuropathologic spectrum of disease referable to the nervus intermedius and its branches: the greater superficial petrosal nerve, the chorda tympani, and the sensory auricular branch.
{"title":"Stuck in the Middle: Nervus Intermedius‐Related Neuropathologic Imaging Spectrum","authors":"S. E. Elakkad, J. Yetto, M. Landon, M. Cathey","doi":"10.3174/ng.1900006","DOIUrl":"https://doi.org/10.3174/ng.1900006","url":null,"abstract":"The nervus intermedius is a complex nerve that traverses the cerebellopontine angle and is associated with a wide range of pathologies for which imaging plays a crucial diagnostic role. Cerebellopontine angle masses or neurovascular compression may directly involve the nervus intermedius.\u0000 Alternatively, pathologies that involve branches of the nervus intermedius may present with symptoms referable to the nervus intermedius, including sinonasal tumors, perineural tumor spread, or viral reactivation such as in Ramsay Hunt syndrome. Overlapping innervation with branches of the\u0000 trigeminal, glossopharyngeal, and vagus nerves can confound diagnosis and/or lead to mislocalization, which may result in delayed diagnosis or inappropriate therapy. This review article provides an in-depth overview of nervus intermedius anatomy and physiology, and the wide spectrum of pathologies\u0000 that can involve the nervus intermedius or its branches, with an emphasis on clinical relevance.Learning Objective: To understand the normal anatomy and physiology of the nervus intermedius as well as the clinical relevance and imaging findings of the neuropathologic spectrum of disease\u0000 referable to the nervus intermedius and its branches: the greater superficial petrosal nerve, the chorda tympani, and the sensory auricular branch.","PeriodicalId":36193,"journal":{"name":"Neurographics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3174/ng.1900006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45609780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Hanna, M. Hanna, M. Rosenblum, M. Fowkes, P. Belani
Medulloblastoma is one of the most common pediatric CNS malignancies and the most common primary tumor of the posterior fossa in children. Medulloblastoma can present with leptomeningeal seeding in up to 33% of patients at presentation. Primary leptomeningeal medulloblastoma without a discrete parenchymal mass has been reported 6 times in the literature to date, in both the pediatric and adult populations. This report aims to review the literature of these rare cases and present the first case of a primary leptomeningeal medulloblastoma with a desmoplastic/nodular subtype.
{"title":"Primary Leptomeningeal Medulloblastoma: Desmoplastic/Nodular Medulloblastoma without a Discrete Parenchymal Mass","authors":"M. Hanna, M. Hanna, M. Rosenblum, M. Fowkes, P. Belani","doi":"10.3174/ng.1900015","DOIUrl":"https://doi.org/10.3174/ng.1900015","url":null,"abstract":"Medulloblastoma is one of the most common pediatric CNS malignancies and the most common primary tumor of the posterior fossa in children. Medulloblastoma can present with leptomeningeal seeding in up to 33% of patients at presentation. Primary leptomeningeal medulloblastoma without\u0000 a discrete parenchymal mass has been reported 6 times in the literature to date, in both the pediatric and adult populations. This report aims to review the literature of these rare cases and present the first case of a primary leptomeningeal medulloblastoma with a desmoplastic/nodular subtype.","PeriodicalId":36193,"journal":{"name":"Neurographics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3174/ng.1900015","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47252219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The impact of perineural invasion and perineural spread on survival and the MR imaging of this tumor spread have been well documented in the literature. What has not been addressed in the radiology literature is the mechanics that are behind perineural invasion. Perineural invasion is not the result of a passive invasion of a nerve by tumor, a common misconception. Because there are no lymphatics within a nerve, perineural invasion is not mediated by a direct lymphatic extension. Rather, perineural invasion is the result of complex molecular interactions between a nerve and an adjacent cancer. Once the cancer has entered a nerve, it can travel in the spaces between fascicles, which explains how such perineural invasion can appear at great distances from the primary tumor. This article reviews the current concepts regarding the mechanisms of perineural invasion and the relationship to peripheral nerve regeneration. Perineural invasion is diagnosed by histology, whereas perineural spread can be identified on imaging.Learning Objective: The reader will learn the intimate relationship between a tumor and its adjacent nerves that lead to perineural invasion. This process is the result of a series of molecular pathways, in part related to nerve regeneration.
{"title":"Perineural Invasion and Its Interrelationship with Neural Repair: A Review","authors":"P. Som, B. Miles, R. Bakst","doi":"10.3174/ng.1800066","DOIUrl":"https://doi.org/10.3174/ng.1800066","url":null,"abstract":"The impact of perineural invasion and perineural spread on survival and the MR imaging of this tumor spread have been well documented in the literature. What has not been addressed in the radiology literature is the mechanics that are behind perineural invasion. Perineural invasion\u0000 is not the result of a passive invasion of a nerve by tumor, a common misconception. Because there are no lymphatics within a nerve, perineural invasion is not mediated by a direct lymphatic extension. Rather, perineural invasion is the result of complex molecular interactions between a nerve\u0000 and an adjacent cancer. Once the cancer has entered a nerve, it can travel in the spaces between fascicles, which explains how such perineural invasion can appear at great distances from the primary tumor. This article reviews the current concepts regarding the mechanisms of perineural invasion\u0000 and the relationship to peripheral nerve regeneration. Perineural invasion is diagnosed by histology, whereas perineural spread can be identified on imaging.Learning Objective: The reader will learn the intimate relationship between a tumor and its adjacent nerves that lead to perineural\u0000 invasion. This process is the result of a series of molecular pathways, in part related to nerve regeneration.","PeriodicalId":36193,"journal":{"name":"Neurographics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3174/ng.1800066","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45989511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K. Khamis, Nir Giladi, C. Levine, Mikhail Kesler, Jonathan Kuten, H. Lerman, E. Even-Sapir
Movement disorders represent a common clinical feature in many different neurologic diseases. However, although the clinical features are often similar, there are many different possible etiologies of these movement disorders, which represent a valid diagnostic challenge. Management of these patients is dependent on an accurate diagnosis of the underlying etiology because the clinical course and treatment may vary significantly. 18F-Fluor-l-dopa has been used as a positron-emitting compound for PET evaluation of patients with movement disorders and parkinsonism. To emphasize the diagnostic value of combining both morphologic and functional imaging in 18F-Fluor-l-dopa PET/CT, we describe the clinical history and 18F-Fluor-l-dopa PET/CT imaging findings of 5 patients in whom the cause of movement impairment was unclear.
{"title":"The Added Value of 18F-FDOPA PET/CT in the Work-Up of Patients with Movement Disorders","authors":"K. Khamis, Nir Giladi, C. Levine, Mikhail Kesler, Jonathan Kuten, H. Lerman, E. Even-Sapir","doi":"10.3174/ng.1900004","DOIUrl":"https://doi.org/10.3174/ng.1900004","url":null,"abstract":"Movement disorders represent a common clinical feature in many different neurologic diseases. However, although the clinical features are often similar, there are many different possible etiologies of these movement disorders, which represent a valid diagnostic challenge. Management\u0000 of these patients is dependent on an accurate diagnosis of the underlying etiology because the clinical course and treatment may vary significantly. 18F-Fluor-l-dopa has been used as a positron-emitting compound for PET evaluation of patients with movement disorders and parkinsonism.\u0000 To emphasize the diagnostic value of combining both morphologic and functional imaging in 18F-Fluor-l-dopa PET/CT, we describe the clinical history and 18F-Fluor-l-dopa PET/CT imaging findings of 5 patients in whom the cause of movement impairment was unclear.","PeriodicalId":36193,"journal":{"name":"Neurographics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3174/ng.1900004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43739088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Bhatia, S. Saade-Lemus, J. Ndolo, W. Chow, E. Schwartz
Meningioangiomatosis (MA) is a rare intracranial hamartomatous lesion. We retrospectively reviewed the MRIs in 6 pediatric patients with a histopathologic diagnosis of MA. Patients with MA demonstrated a solitary lesion in the frontotemporal regions, with FLAIR hyperintensity and leptomeningeal enhancement. A solitary brain lesion in the frontotemporal lobes associated with leptomeningeal enhancement and T2/FLAIR hyperintensity should include the possibility of MA in a pediatric patient who presents with seizures or headaches.
{"title":"MR Imaging of Meningioangiomatosis in a Pediatric Population","authors":"A. Bhatia, S. Saade-Lemus, J. Ndolo, W. Chow, E. Schwartz","doi":"10.3174/ng.1900005","DOIUrl":"https://doi.org/10.3174/ng.1900005","url":null,"abstract":"Meningioangiomatosis (MA) is a rare intracranial hamartomatous lesion. We retrospectively reviewed the MRIs in 6 pediatric patients with a histopathologic diagnosis of MA. Patients with MA demonstrated a solitary lesion in the frontotemporal regions, with FLAIR hyperintensity and leptomeningeal\u0000 enhancement. A solitary brain lesion in the frontotemporal lobes associated with leptomeningeal enhancement and T2/FLAIR hyperintensity should include the possibility of MA in a pediatric patient who presents with seizures or headaches.","PeriodicalId":36193,"journal":{"name":"Neurographics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3174/ng.1900005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45724663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Bukhari, F. Alsugair, J. Bhattacharya, M. Nicolas-Jilwan
{"title":"Vein of Galen Aneurysmal Malformations: An Overview for the Diagnostic Neuroradiologist","authors":"S. Bukhari, F. Alsugair, J. Bhattacharya, M. Nicolas-Jilwan","doi":"10.3174/NG.1800053","DOIUrl":"https://doi.org/10.3174/NG.1800053","url":null,"abstract":"","PeriodicalId":36193,"journal":{"name":"Neurographics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3174/NG.1800053","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42761211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
G. Curaudeau, L. Chan, K. Hammoud, K. Buch, M. Lanfranchi
{"title":"Quite a Slippery Slope: Pictorial Review of the Radiographic Appearance of Mass Lesions and Pseudolesions of the Clivus","authors":"G. Curaudeau, L. Chan, K. Hammoud, K. Buch, M. Lanfranchi","doi":"10.3174/NG.1800054","DOIUrl":"https://doi.org/10.3174/NG.1800054","url":null,"abstract":"","PeriodicalId":36193,"journal":{"name":"Neurographics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3174/NG.1800054","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42251677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
N. Pham, B. Dahlin, M. Bobinski, A. Ozturk, G. Fananapazir
{"title":"Subclavian Steal Phenomenon Diagnosed Using TOF and Ferumoxytol-Enhanced Neck MRA: A Technical Report","authors":"N. Pham, B. Dahlin, M. Bobinski, A. Ozturk, G. Fananapazir","doi":"10.3174/NG.1800037","DOIUrl":"https://doi.org/10.3174/NG.1800037","url":null,"abstract":"","PeriodicalId":36193,"journal":{"name":"Neurographics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3174/NG.1800037","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44598467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
N. Swamy, Manoj Kumar, M. Gokden, A. Rowell, R. Samant, R. Ramakrishnaiah
{"title":"Demystifying Astroblastomas: A Case Report and Review. What Have We Learned So Far?","authors":"N. Swamy, Manoj Kumar, M. Gokden, A. Rowell, R. Samant, R. Ramakrishnaiah","doi":"10.3174/NG.1800070","DOIUrl":"https://doi.org/10.3174/NG.1800070","url":null,"abstract":"","PeriodicalId":36193,"journal":{"name":"Neurographics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3174/NG.1800070","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43982132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Ectopic Cerebellar Brain Parenchyma","authors":"R. E. Hobohm, P. Codd, M. Malinzak","doi":"10.3174/NG.1800047","DOIUrl":"https://doi.org/10.3174/NG.1800047","url":null,"abstract":"","PeriodicalId":36193,"journal":{"name":"Neurographics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3174/NG.1800047","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48518934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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