Full moon mesencephalon sign: a transient cytotoxic lesion in a hemodialysis patient with newly diagnosed atrial fibrillation and severe stenosis of the right vertebral artery.

IF 2.7 4区 医学 Q2 CLINICAL NEUROLOGY
Neurological Sciences Pub Date : 2025-04-01 Epub Date: 2024-12-11 DOI:10.1007/s10072-024-07926-6
Celeste Sassi, Sylvia Habermann, Marcelo Alejandro Coria, Albert Grüger, Vasilis Kola, Hans-Michael Schmitt
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引用次数: 0

Abstract

Brain cytotoxic edema is a neuroradiological sign secondary to variegate diseases ranging from migraine to fulminant Listeria rhombencephalitis. The tempestive identification of its underlying cause is vital for an effective treatment as any delay may be fatal. However, the lack of distinctive imaging biomarkers and the paucity of reports pose a significant challenge in its diagnosis and frequently lead to a misdiagnosis particularly with the more common acute ischemic stroke. Importantly, due to its rarity, mesencephalon midline cytotoxic lesion is likely to remain an underdiagnosed clinical phenomenon, especially if follow up MRI is not performed. Here we report a case of a central, midline, symmetric midbrain cytotoxic edema in a haemodialysis patient with diverse chronic progressive severe cardiovascular risk factors and a newly diagnosed atrial fibrillation. We expand the spectrum of neuroradiological hallmarks associated to terminal renal failure and report a full moon-like mesencephalon midline transient restricted diffusion as a reliable imaging biomarker for the prompt and accurate diagnosis of midbrain cytotoxic edema with the enormous potential of rapidly identifying and effectively treating its causative factors and timely reverse the associated symptomatic.

满月中脑征象:一过性细胞毒性病变在血液透析患者新诊断心房颤动和右椎动脉严重狭窄。
脑细胞毒性水肿是一种继发于从偏头痛到暴发性李斯特菌菱形脑炎等多种疾病的神经放射学征象。快速确定其根本原因对于有效治疗至关重要,因为任何延误都可能是致命的。然而,缺乏独特的成像生物标志物和报告的缺乏对其诊断构成了重大挑战,并经常导致误诊,特别是更常见的急性缺血性中风。重要的是,由于其罕见性,中脑中线细胞毒性病变可能仍然是一种未被诊断的临床现象,特别是如果没有进行MRI随访。在这里,我们报告一例中央,中线,对称的中脑细胞毒性水肿在血液透析患者多种慢性进行性严重心血管危险因素和新诊断的心房颤动。我们扩大了与终末期肾衰竭相关的神经放射学特征的范围,并报道了满月样中脑中线瞬时限制性弥散作为快速准确诊断中脑细胞毒性水肿的可靠成像生物标志物,具有快速识别和有效治疗其病因并及时逆转相关症状的巨大潜力。
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来源期刊
Neurological Sciences
Neurological Sciences 医学-临床神经学
CiteScore
6.10
自引率
3.00%
发文量
743
审稿时长
4 months
期刊介绍: Neurological Sciences is intended to provide a medium for the communication of results and ideas in the field of neuroscience. The journal welcomes contributions in both the basic and clinical aspects of the neurosciences. The official language of the journal is English. Reports are published in the form of original articles, short communications, editorials, reviews and letters to the editor. Original articles present the results of experimental or clinical studies in the neurosciences, while short communications are succinct reports permitting the rapid publication of novel results. Original contributions may be submitted for the special sections History of Neurology, Health Care and Neurological Digressions - a forum for cultural topics related to the neurosciences. The journal also publishes correspondence book reviews, meeting reports and announcements.
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