A multinodular and vacuolating neuronal tumor (MVNT) is a rare non-malign central nervous system tumor. The cerebral cortex of young to middle-aged adults is affected and seizures and focal neurological deficits could reveal it. Despite being considered a low-grade tumor, MVNT can be challenging to diagnose and manage due to its histopathological similarities to other neuronal tumors. The limited number of reported cases makes it difficult to establish definitive guidelines for treatment and follow-up. Given the relatively recent discovery of MVNT, there is a need for further research to better understand its pathogenesis, optimal treatment and long-term strategies. Furthermore, studying MVNT can contribute to the broader understanding of brain tumor biology and the intricacies of tumor heterogeneity. This paper explores the challenges and perspectives surrounding MVNT to improve clinical decision-making and patient outcomes. Based on the present narrative review, advancements in diagnostic technologies have shown promise in addressing the challenges associated with diagnosing MVNTs. Liquid biopsy is an innovative and non-invasive diagnostic tool that analyzes biomarkers to provide information about tumors, and radiomics is a method that extracts quantitative data from medical images to provide detailed insights into tumor characteristics. Such innovative diagnostic technologies are important because they have the potential to significantly improve the current diagnostic landscape for MVNTs, allowing for earlier detection, accurate classification, and personalized treatment strategies.
The primary objective of this narrative review is to evaluate the most frequently recommended structural and functional imaging methods in managing epilepsy cases as effectively as possible from a neurologist’s perspective. This review examines the background of current practice, from the beginnings of neuroimaging by computer tomography to the newly introduced methods and their combination, which helps diagnose and monitor these patients. The neuroimaging investigations required for the presurgical evaluation of patients with epilepsy are presented, and recommendations for specific MRI protocols are provided. The clinical use of functional imaging methods is also considered, and correlations between clinical aspects and specific imaging methods are explored, based on the retrieved data in the literature. In conclusion, this review emphasizes using functional and structural imaging methods, guided by clinical evidence, for better therapeutic management in patients with epilepsy.
Gliosarcoma is a rare and aggressive variant of glioblastoma, characterized by both a malignant glial component and a mesenchymal sarcomatous component. Gliosarcomas have genetic alterations with glioblastomas, including TP53, PTEN mutations, and EGFR amplification, but may also exhibit additional changes related to epithelial-mesenchymal transition pathways. Management is similar to glioblastoma, involving safe, maximal surgical resection followed by radiotherapy and chemotherapy with temozolomide, but the prognosis remains poor, with a median survival of 6-14 months. Both Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) play crucial roles in the detection, characterization, and treatment planning of gliosarcoma. While MRI is the gold standard, CT remains valuable in certain situations. Light microscopy is essential for definitive diagnosis, allowing pathologists to examine cellular morphology and tissue architecture. It is essential for distinguishing gliosarcoma from other high- grade gliomas and for guiding treatment decisions. In addition, two-photon excited fluorescence (TPEF) microscopy is an advanced optical imaging technique that enables real-time, high-resolution visualization of tumor tissue without the need for staining or contrast agents and enhances visualization of collagen structure and vascularization, key factors in gliosarcoma assessment. The study of radiological and histopathological (light microscopy) features in primary gliosarcomas of the brain is a priority to achieve an early diagnosis that can be translated into better outcomes. Here, we describe the radiological and histopathological features observed in multiple cases of gliosarcoma in current practice.
Background: Late-delayed complications after radiotherapy (RT) results from an imbalance between cell lesions and the protective capacities of the CNS. Temozolomide (TMZ) after RT may represent a potent radiosensitizing regimen. Although radionecrosis (RN) of the anterior visual pathway has been documented, in our opinion this is the first report of reversible visual field loss associated with occipital lobe radionecrosis. Case observation: We report a patient who suffered a left lateral homonymous hemianopia one year after radiochemotherapy (RCT) for an infiltrative low grade fibrillary astrocytoma. The visual field deficit was completely reversible after one month. Visual field defects have been described after the use of conventional external beam therapy for lesions near the anterior visual pathway. The cortex is relatively spared after RT. Conclusions: Given the new scientific data, we suppose that neuroplasticity may play a role in the reversibility of visual field deficit. At this time there is no proven treatment of radionecrosis. Homonymous hemianopia caused by occipital lesions are attributable to vascular disease and tumors, but take into account radiation effects. The risk of neurogenic visual loss must be factored into the decision to irradiate the whole brain.
Epilepsy is one of the world's oldest diseases. Social stigma, misunderstanding and thus, discrimination have surrounded patients and their families from the beginnings until nowadays. Approximatively up to 80% of epilepsy cases worldwide are found in developing regions. The risk of premature death is two to three times higher than for the general population. There is contradictory evidences concerning the question of whether to inform patients about the possibility of sudden unexpected death in epilepsy (SUDEP). Actual guidelines states that individuals with epilepsy and their families or careers should be given access to information on SUDEP. We have information about how, when and what to say to the patients and families about SUDEP. But it's a delicate subject, and some patients do not want to know that they are at risk for this.
A male from rural area, S.M., aged 77 years, was admitted in our department for discontinuous headache. His medical history was irrelevant. He has been experiencing intermittent right parietal-occipital headaches during the last 3 months. Neurologic exam revealed a slight right limb ataxia. Initial laboratory findings revealed a white blood cell count of 6500/mm3 with 75% polymorphonuclear leukocytes, 15% lymphocytes and 8% monocytes. His serum glucose was 90 mg/dL. Non Gadolinium CT scan shows rounded, inhomogenous spontaneous hyperdense area (40-45 UH) between 5-12 mm diameter, localized frontal, temporal, occipital and cerebellar bilaterally. The question was whether the lesions were metastasis or parasitic infection? Cerebral MRI showed unenhanced,well lesions defined,multiple lesions between3-17 mm, with iso- • Active parenchymal stage: the scolex within acyst hyperintensityT1, T2, and FLAIR, spreadout may appear as a hyperdense dot periventriculary, subcortically, infrontal, temporal, • Calcified stage: when the parasite dies, parietal lobes andsubtentorially, right and left nodularparenchymal calcifications are seen. cerebellum(figure 2). After serological testsfrom blood and CSF the diagnosticof neurocysticercosis was certified(an enzyme-linked immunosorbentassay of the CSF was positivefor immunoglobulin G cysticercosisantibody, with 1.32 optical densityunits (OD) (positive result > 0.50OD); his serum IgG cysticercosis antibodywas positive with 5.12 OD). CT findings are depending on the stageof evolution: • Vesicular stage (viable larva): hypodense, nonenhancinglesions • Colloidal stage (larval degeneration): hypodense/isodense lesions with peripheral enhancementand edema • Nodular-granular stage: nodular-enhancinglesions • Cysticercotic encephalitis: diffuse edema,collapsed ventricles, and multiple enhancingparenchymal Our patient has multiple lesions in differentphases of evolution (active and calcified). DISCUSSIONS Neurocysticercosis is a parasitic brain infection,caused by larval cysts of the tapeworm Taenia soliumby accidental ingestion of eggs. It is the most common parasitic disease of the nervous system and it is themain cause of acquired epilepsy mainly in developingcountries. Once in the human intestine, Taenia eggsevolve to oncospheres 1 Carol Davila Central Emergency Military Hospital, Bucharest 2 Carol Davila University of Medicine and Pharmacy, Faculty of Medicine, Bucharest 40
