No abstract

Introduction:Amyotrophic lateral sclerosis (ALS) is a fatal and most common motor neuron disease, caused by progressive loss of motor neurons. Diffusion tensor imaging (DTI) and magnetic resonance spectroscopic (MRS) studies detect pathological changes in neuronal fibers in vivo. We evaluated the role of DTI and MRS in early course of the disease, which may prove beneficial in the early diagnosis and better management.Materials and Methods:Twenty-one patients with ALS and 13 age-matched controls received 1.5T DTI and three-dimensional multi-voxel MRS. Fractional anisotropy (FA), apparent diffusion coefficient, N-acetyl aspartate (NAA)/Creatine (Cr), and NAA/Choline (Ch) ratios were analyzed in various regions of the brain and compared with healthy controls. ALS patients were classified as definite, possible, and probable category, and patients were also studied in limb versus bulbar onset.Results:Decreased FA and increase mean diffusivity values in regions of corticospinal tract (CST) and corpus callosum (CC) was consistent finding in definite and probable disease category (P < 0.05). In possible disease, CC involvement was not significant. NAA/Cr and NAA/Ch ratios were lower in CC and regions of CST. However, in possible disease, CC involvement was not significant, while regions of CST were showing significant reduction in NAA/Cr and NAA/Ch ratios (P < 0.05).Conclusion:DTI and MRS detect changes associated with ALS even in the early phase of the disease. Bulbar onset and limb onset ALS patients show different pattern of involvement. Extramotor involvement suggested by CC involvement is a feature seen in bulbar onset patient and can suggest poor outcome in such patients. The present findings may be helpful for designing further studies in the direction of more early diagnosis of disease and its management.

No abstract

An aberrant splenic artery arising from the superior mesenteric artery, also known as the splenomesenteric trunk, is a rare anatomical variant seen in less than 1% of the population and is more common in females. Aneurysms of the splenic artery originating anomalously from the superior mesenteric artery are extremely rare; only 35 cases of aneurysm of an aberrant splenic artery have been described so far in the English medical literature. We report an extremely rare case of aneurysm of aberrant splenic artery in a 28-year-old man in whom the lesion was detected during routine abdominal scanning and confirmed on computed tomography angiography. Aneurysms of an anomalous splenic artery originating from the superior mesenteric artery are extremely rare; however, they are clinically important because possible rupture could be catastrophic. Exploring these variations is important especially if surgical intervention is contemplated. This could greatly affect the surgical planning and avoid injuries to major arteries and organs intraoperatively. Keywords Aberrant splenic artery, aneurysm, mesenteric arteryAberrant splenic artery arising from superior mesenteric artery (SMA), also known as splenomesenterictrunk, is an anatomical variant seen in less than 1% of population, present more commonly in females 1 ; it's possible embryological basis being interruption of ventral longitudinal anastomosis. Aneurysms of the aberrant splenic artery are seen in a proximial position near the origin of splenic artery from SMA; compared to common location of splenic artery aneurysms in distal-half of splenic artery in patients with orthotopic splenic arteries.2 Proximal anatomical origin coupled with retro-pancreatic location further complicates their management.2,3 Treatment options include surgical resection, laparoscopic techniques and endovascular therapy 4 ; endovascular treatment is safe and minimally invasive with rapid recovery. 3,4A 28-year-old man presented with generalised weakness. Routine ultrasound abdomen revealed anechoic area, in continuation with SMA, showing swirling arterial flow on colour Doppler. Another vessel was arising from this dilatation, coursing towards the spleen. Computed tomography angiography revealed (Figure 1) a 31 Â 27 Â 19 mm saccular aneurysm 18 mm distal to SMA (SMA was normal at its origin). The aneurysm arose off the superior lateral margin of SMA, projecting anterio-laterally, towards right, having a narrow neck which measured 2.4 mm. Enlarged and tortuous splenic artery originated directly from this aneurysm. A hypoplastic celiac artery gave origin to left gastric and common hepatic arteries. Rest of the visceral arteries were normal. There was no history of pancreatitis, trauma or alcohol intake. Considering the large size of the aneurysm, stenting and/or embolisation was advised; however, the patient refused any intervention. He was discharged with the advice of close follow-up.Aneurysms of an aberrant splenic artery are extremely rare, with only 35 such cases been described so far ...