Hungarian Radiology

[Jugulotympanic glomus tumor - 7-year follow up of a rare disease]

SEBŐ Nóra, LÁZÁR István, SZÍGYÁRTÓ Mária, SÍPOS Gyula

OCTOBER 20, 2007

Hungarian Radiology - 2007;81(05-06)

[INTRODUCTION - The jugulotympanic glomus tumor is rare pathology with slow progression and its treatment is difficult. We present the imaging and clinical findings of a case obtained during 7 year follow up period. CASE REPORT - A 77-year-old female patient was admitted in 2000 with slowly progressing swelling of the neck. A palpable soft, non-painful resistance was noted at the main neck vessel region. Angiography revealed a jugulo-tympanic glomus tumor and embolization of the feeders from the external carotid artery was also performed. The size of the tumor is decreased but a clinically silent floating thrombus appeared in the internal jugular vein. It was treated with LMWH. Three years later external carotid artery transsection and denudation was performed. Slow progression of the tumor toward the subclavian vein was detected without intracranial invasion, in 2004. Repeated angiography was performed in 2005, but embolization was not possible due to technical reasons. Irradiation was considered to diminsh clinical symptoms, however due to the old age of the patients and the risk of bleeding, the treatment was not performed. Symptomatic therapy has been applied. CONCLUSION - Jugulo-tympanic glomus tumor is one of the non-chromaffin paragangliomas. The clinical symptomps are dominated by the paresis of IX.-X.-XI. nerves. Semimalignant disease and metastases are rare. The course is mostly influenced by compression syndromes and intracranial spread. The therapy is mostly microsurgical but preoperative embolization is frequently done to decrease blood loss. Surgical therapy is recommended with prior embolization of the feeders in order to decrease the blood supply of the mass. If surgery cannot be carried out irradiation therapy is needed. Unfortunately, all of these procedures are seldom curatives because of natural course of the disorder and the high frequency of recurrencies.]

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[Computed tomography brain perfusion in the management of acute stroke]

BAGI Róbert, SZABÓ Tünde, MONOKI Erzsébet

[INTRODUCTION - The multidetector CT-technology made the application of perfusion CT-examination in the diagnosis of vascular brain damages possible in recently. The purpose of this study was to introduce the method and to assess the importance of computed tomography brain perfusion in emergency patient care and early diagnosis of brain ischemia. PATIENTS AND METHODS - We perform brain perfusion examinations with a 2 slice multidetector computer tomography (General Electric Highspeed NX/i, 2004) in our hospital. We examined the results of native and perfusion CT of 27 patients who underwent CT brain perfusion examination during emergency patient care in our department between 2004 January and 2006 December. We also examined if the patients got systemic thrombolysation and the patients’ condition after therapy. RESULTS - The perfusion software can make quantitative colour maps of parameters (CBF, CBV, MTT) and can visualize mean value and percentil decrease of measuring parameters. There were 18 positive and 8 negative CTbrain perfusion examinations in the examined period. One examination was technically unvaluable. CONCLUSION - By measuring blood flow's decrease the CT-brain perfusion examination can separate the reversible and irreversible damage of brain parenchyma. The examination protocol of brain vascular damages are native CT-scan, postcontrast perfusion CT-examination and CTangiography by the recommendation of international literature. Despite the multidetector CT-s and CT-perfusion technic is available for years, the CT-brain perfusion examination is not a routine process in the emergency patient care in our country.]

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[Prenatal detection of campomelic dysplasia by sonography]

NAGY Gábor, VRECZENÁR László

[INTRODUCTION - The campomelic dysplasia is a disorder characterized by short and bowed lower limbs resulting in dwarfism. CASE REPORT - In the case of a 21-year-old primipara woman the second screening ultrasonography raised the suspicion of short and bowed lower limbs of the fetus, at the 19th week of the pregnancy. Repeated examinations proved the presence of short and bowed femurs and tibias and abnormal echogenecity of the bones. The upper limbs were almost normal in length. During the 19th week of pregnancy, after a genetic analysis in agreement of the parents the pregnancy was interrupted without any complication. Photography and Xray of the fetus confirmed the diagnosis. CONCLUSION - Fetal ultrasonography should include exact size measurement and observation of the shape of the long bones, making possible the early detection of limb anomalies. The anomaly being proven by positive genetic analysis the pregnancy can be interrupted at the parents' request.]

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[INTRODUCTION - 95 MR angiographic examinations of the supraortic arteries were performed at the Rethy Pal Hospital, Bekescsaba between February 2003 and May 2005. The aim of this publication is to analyse the clinical benefit of contrast-enhanced MR angiography compared to duplex ultrasound and to evaluate the role of TOF MR angiography in the diagnostics of the carotid arteries. We compared the results of contrast-enhanced MR angiography, TOF MR angiography and duplex ultrasound. MATERIAL AND METHOD - 95 patients were examined by CE MR angiography following carotid duplex US in 59 cases and TOF MR angiography in 88 cases. Duplex US was done using LOGIQ 400 PRO system, MR angiography were performed by 1.5 T Siemens Magnetom Symphony unit. RESULTS - Stenosis of the internal carotid artery was confirmed in 67 cases and stenosis of the common carotid artery was seen in 10 cases. Bilateral ICA stenoses were detected in 17 patients and bilateral CCA stenoses could be revealed in 3 cases. The ICA stenosis was mild in 22 (33%), moderate in 18 (27%), and serious in 27 cases (40%). Occlusion was seen in 10 cases (15%). CE MR angiography showed stenosis at the origin of the CCA in 5 patients, at the origin of the vertebral and the subclavian artery in 10-10 cases that could not be detected by duplex ultrasound. Subclavian artery stenosis was seen in 15 patients, 7 of them presented subclavian steal syndrome. 13 patients had vertebral artery stenosis, 7 of them bilateral. 13 of the 20 VA stenoses were mild, 4 were found to be moderate and 3 were serious. In four patients the vertebral arteries were occluded. In six questionable cases MR angiography solved the problem. Reversed flow could be detected in 5 cases with duplex ultrasound suggestive of subclavian steal syndrome, which was later confirmed by TOF and CE MR angiography. TOF MR angiography showed stenosis on reconstructed images, which was not confirmed by neither duplex US or CE MR angiography. Paraganglioma was detected in one patient. CONCLUSION - In case of calcified plaques and abnormal arterial-course CE MR angiography contributes significantly to the detection of the stenosis. In cases with moderate and serious stenosis duplex ultrasound and MR angiography provided similar results. In case of occlusions the results of the two modalities were the same. The contrast-enhanced MR angiography gives the possibility to show the aortic origin of the supraaortic arteries in contrast to the duplex US and TOF MR angiography. To establish the diagnosis of subclavian steal syndrome the directional sensitivity of TOF MR angiography and duplex US is helpful adjunct to CE MR angiography.]

Clinical Neuroscience

The etiology and age-related properties of patients with delirium in coronary intensive care unit and its effects on inhospital and follow up prognosis

ALTAY Servet, GÜRDOGAN Muhammet, KAYA Caglar, KARDAS Fatih, ZEYBEY Utku, CAKIR Burcu, EBIK Mustafa, DEMIR Melik

Delirium is a syndrome frequently encountered in intensive care and associated with a poor prognosis. Intensive care delirium is mostly based on general and palliative intensive care data in the literature. In this study, we aimed to investigate the incidence of delirium in coronary intensive care unit (CICU), related factors, its relationship with inhospital and follow up prognosis, incidence of age-related delirium and its effect on outcomes. This study was conducted with patients hospitalized in CICU of a tertiary university hospital between 01 August 2017 and 01 August 2018. Files of all patients were examined in details, and demographic, clinic and laboratory parameters were recorded. Patients confirmed with psychiatry consultation were included in the groups of patients who developed delirium. Patients were divided into groups with and without delirium developed, and baseline features, inhospital and follow up prognoses were investigated. In addition, patients were divided into four groups as <65 years old, 65-75 yo, 75-84 yo and> 85 yo, and the incidence of delirium, related factors and prognoses were compared among these groups. A total of 1108 patients (mean age: 64.4 ± 13.9 years; 66% men) who were followed in the intensive care unit with variable indications were included in the study. Of all patients 11.1% developed delirium in the CICU. Patients who developed delirium were older, comorbidities were more frequent, and these patients showed increased inflammation findings, and significant increase in inhospital mortality compared to those who did not develop delirium (p<0.05). At median 9-month follow up period, rehospitalization, reinfarction, cognitive dysfunction, initiation of psychiatric therapy and mortality were significantly higher in the delirium group (p<0.05). When patients who developed delirium were divided into four groups by age and analyzed, incidence of delirium and mortality rate in delirium group were significantly increased by age (p<0.05). Development of delirium in coronary intensive care unit is associated with increased inhospital and follow up morbidity and mortality. Delirium is more commonly seen in geriatric patients and those with comorbidity, and is associated with a poorer prognosis. High-risk patients should be more carefully monitored for the risk of delirium.

Clinical Neuroscience

Alexithymia is associated with cognitive impairment in patients with Parkinson’s disease

SENGUL Yildizhan, KOCAK Müge, CORAKCI Zeynep, SENGUL Serdar Hakan, USTUN Ismet

Cognitive dysfunction (CD) is a common non-motor symptom of Parkinson’s disease (PD). Alexithy­mia is a still poorly understood neuropsychiatric feature of PD. Cognitive impairment (especially visuospatial dysfunction and executive dysfunction) and alexithymia share com­mon pathology of neuroanatomical structures. We hypo­thesized that there must be a correlation between CD and alexithymia levels considering this relationship of neuroanatomy. Objective – The aim of this study was to evaluate the association between alexithymia and neurocognitive function in patients with PD. Thirty-five patients with PD were included in this study. The Toronto Alexithymia Scale–20 (TAS-20), Geriatric Depression Inventory (GDI) and a detailed neuropsychological evaluation were performed. Higher TAS-20 scores were negatively correlated with Wechsler Adult Intelligence Scale (WAIS) similarities test score (r =-0.71, p value 0.02), clock drawing test (CDT) scores (r=-0.72, p=0.02) and verbal fluency (VF) (r=-0.77, p<0.01). Difficulty identifying feelings subscale score was negatively correlated with CDT scores (r=-0.74, p=0.02), VF scores (r=-0.66, p=0.04), visual memory immediate recall (r=-0.74, p=0.01). VF scores were also correlated with difficulty describing feelings (DDF) scores (r=-0.66, p=0.04). There was a reverse relationship bet­ween WAIS similarities and DDF scores (r=-0.70, p=0.02), and externally oriented-thinking (r=-0.77,p<0.01). Executive function Z score was correlated with the mean TAS-20 score (r=-62, p=0.03) and DDF subscale score (r=-0.70, p=0.01) Alexithymia was found to be associated with poorer performance on visuospatial and executive function test results. We also found that alexithymia was significantly correlated with depressive symptoms. Presence of alexithymia should therefore warn the clinicians for co-existing CD.

Clinical Neuroscience

Delirium due to the use of topical cyclopentolate hydrochloride

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Introduction - Our aim is to present a rare case where a child had delirium manifestation after instillation of cyclopentolate. Case presentation - A 7-year old patient was seen in our outpatient clinic, and cyclopentolate was dropped three times at 10 minutes intervals in both eyes. The patient suddenly developed behavioral disorders along with gait disturbance, and complained of visual hallucinations 20-25 minutes after the last drop. The patient was transferred to intensive care unit and 0.02 mg/kg IV. physostigmine was administered. The patient improved after minutes of onset of physostigmine, and was discharged with total recovery after 30 minutes. Conclusion - Delirium is a rare systemic side effect of cyclopentolate. The specific antidote is physostigmine, which can be used in severely agitated patients who are not responding to other therapies.