MRI of Cranial Nerve Enhancement

Saremi, Farhood; Helmy, Mohammad; Farzin, Sahar; Zee, Chi Shing; Go, John L.

doi:10.2214/ajr.04.1518

Cited by 96 publications

(77 citation statements)

References 12 publications

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“…Cranial neuropathies may also be secondary to neoplastic seeding of the meninges by solid tumors, leptomeningeal carcinomatosis or lymphomatous and leukemic infiltrates [1,7,28].…”

Section: Secondary Neoplastic Conditionsmentioning

confidence: 99%

“…Although lymphoma and leukemia are the most common neoplasms to seed the CSF, only in a small proportion of cases do they invade the meninges and incite an inflammatory reaction that can be seen in neuroimaging studies [28]. Lymphomatous deposits along cranial nerves are seldom seen and may be the first and only sign of recurrent disease (Fig.…”

Section: Secondary Neoplastic Conditionsmentioning

confidence: 99%

“…Leptomeningeal carcinomatosis is secondary, in increasing order of frequency, to carcinomas of the breast, lung and melanoma [7,28]. In the pediatric population, neuroblastoma is the most common neoplasm seeding the subarachnoid space [7,28].…”

Section: Secondary Neoplastic Conditionsmentioning

confidence: 99%

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Imaging the cranial nerves: part II: primary and secondary neoplastic conditions and neurovascular conflicts

Borges

Casselman²

2007

Eur Radiol

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There have been unprecedented improvements in cross-sectional imaging in the last decades. The emergence of volumetric CT, higher field MR scanners and higher resolution MR sequences is largely responsible for the increasing diagnostic yield of imaging in patients presenting with cranial nerve deficits. The introduction of parallel MR imaging in combination with small surface coils allows the depiction of submillimetric nerves and nerve branches, and volumetric CT and MR imaging is able to provide high quality multiplanar and curved reconstructions that can follow the often complex course of cranial nerves. Seeking the cause of a cranial nerve deficit is a common indication for imaging, and it is not uncommon that radiologists are the first specialists to see a patient with a cranial neuropathy. To increase the diagnostic yield of imaging, high-resolution studies with smaller fields of view are required. To keep imaging studies within a reasonable time frame, it is mandatory to tailor the study according to neuro-topographic testing. This review article focuses on the contribution of current imaging techniques in the depiction of primary and secondary neoplastic conditions affecting the cranial nerves as well as on neurovascular conflicts, an increasingly recognized cause of cranial neuralgias.

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“…Cranial neuropathies may also be secondary to neoplastic seeding of the meninges by solid tumors, leptomeningeal carcinomatosis or lymphomatous and leukemic infiltrates [1,7,28].…”

Section: Secondary Neoplastic Conditionsmentioning

confidence: 99%

Section: Secondary Neoplastic Conditionsmentioning

confidence: 99%

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Imaging the cranial nerves: part II: primary and secondary neoplastic conditions and neurovascular conflicts

Borges

Casselman²

2007

Eur Radiol

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“…30 Once the diameter of the nerves has increased, the perineurial fat tissue (particularly that at the foraminal openings) tends to decrease.…”

Section: Diagnosticsmentioning

confidence: 99%

Cancer around the brain

Grisold

2014

Neuro-Oncology Practice

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Background Neuro-oncologists are familiar with primary brain tumors, intracerebral metastases meningeal carcinomatosis and extracerebral intracranial tumors as meningeoma. For these conditions, and also some other rare tumor entities several treatment options exist. Cancer can also involve structures around the brain as the dura, the base of the skull, the cavities of the skull and tissue around the bony skull, the skin, the tissue of the neck. and either compress, invade or spread in the central or peripheral nervous system. Methods A systematic literature research was conducted determining symptoms and signs, tumor sites of nerve invasion, tumor types, diagnostic techniques, mechanisms of nerve invasion, and important differential diagnosis. Additional cases from own experience were added for illustration. Results The mechanisms of tumor invasion of cranial nerves is heterogenous and not only involves several types of invasion, but also spread along the cranial nerves in antero- and retrograde fashion and even spread into different nerve territories via anastomosis. In addition the concept of angiosomas may have an influence on the spread of metastases. Conclusion In addition to the well described tumor spread in meningeal carcinomatosis and base of the skull metastases, dural spread, lesions of the bony skull, the cavities of the skull and skin of the face and tissue of the neck region need to be considered, and have an impact on therapeutic decisions.

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“…[3][4][5] Among leukodystrophies, cranial nerve involvement has been documented in infantile Krabbe disease. 6,7 Proposed mechanisms for the abnormal nerve root enhancement have included altered vascular permeability with breakdown of the blood-nerve barrier as a result of perivascular inflammation or infiltration 8 and enhancement in areas of active myelin breakdown.…”

mentioning

confidence: 99%

Multiple Cranial Nerve Enhancement: A New MR Imaging Finding in Metachromatic Leukodystrophy

Maia¹,

Rocha²,

Silva³

et al. 2007

American Journal of Neuroradiology

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Metachromatic leukodystrophy (MLD) is a set of several disorders caused by deficient lysosomal activity. This deficiency results in accumulation of a metachromatic lipid material, galactosylceramide sulfatide, leading to the breakdown of the myelin sheath in both central and peripheral nervous systems, initially sparing the subcortical "U" fibers.1,2 Several MR imaging features of MLD have been described, but to the best of our knowledge, cranial nerve involvement demonstrated by MR imaging was never mentioned in this setting. An undernourished 2-year-old girl was hospitalized as a result of uncontrollable vomiting and retarded neuropsychomotor development. Deep tendon reflexes were abolished in the 4 limbs, and the plantar reflex showed bilateral extension response. The routine laboratory tests, cranial nerve examination, and funduscopy were unremarkable. Electroneuromyography showed signs of predominantly sensory peripheral neuropathy in the lower limbs, with a demyelinating pattern that involved all 4 of the limbs, and an ultrastructural examination of the sural nerve was carried out, which showed abnormalities consistent with MLD. The disease was confirmed by a severe decrease of arylsulfatase A activity in leukocytes (1.0 nmol/h/mg of protein; reference range, 5-20 nmol/h/mg).The baseline MR imaging scan showed bilateral and symmetrical involvement of the posterior periventricular white matter and splenium of the corpus callosum, sparing the U fibers. Gadolinium (Gd)-enhanced T1-weighted images showed bilateral and symmetrical abnormal enhancement of several cranial nerves, including the optic, oculomotor, trigeminal, abducens, facial, and vestibulocochlear nerves. The follow-up scan (Fig 1) demonstrated diffuse and symmetrical demyelination in the periventricular white matter and centrum semiovale, with numerous hypointense linear structures in a radiating ("tigroid") pattern, with involvement of the internal capsules, corticospinal tracts, cerebral peduncles, and cerebellar white matter. There was no evidence of leptomeningeal or parenchymal enhancement. There was no evidence of nerve hypertrophy. There was a considerable worsening of the neurologic deficits characterized by spastic tetraplegia without any contact with the environment.Cranial nerve Gd enhancement can be seen in a variety of entities, including neoplastic, infectious, demyelinating, and idiopathic diseases.3-5 Among leukodystrophies, cranial nerve involvement has been documented in infantile Krabbe disease. 6,7 Proposed mechanisms for the abnormal nerve root enhancement have included altered vascular permeability with breakdown of the blood-nerve barrier as a result of perivascular inflammation or infiltration 8 and enhancement in areas of active myelin breakdown. 6 We presume that multiple cranial nerve enhancement in MLD is secondary to the accumulation of the metachromatic lipid material and to the disruption of the myelin sheath, similar to the process that affects peripheral nerves. A future investigation with a larger series is requi...

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MRI of Cranial Nerve Enhancement

Abstract: MRI with contrast enhancement is a valuable tool for detecting and characterizing disease of the cranial nerves. Abnormal cranial nerve enhancement on MRI may sometimes be the first or only indication of an underlying disease process.

Cited by 96 publications

References 12 publications

Imaging the cranial nerves: part II: primary and secondary neoplastic conditions and neurovascular conflicts

Imaging the cranial nerves: part II: primary and secondary neoplastic conditions and neurovascular conflicts

Cancer around the brain

Multiple Cranial Nerve Enhancement: A New MR Imaging Finding in Metachromatic Leukodystrophy

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