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There is abnormal This is a disease of childhood purchase avapro american express treatment diabetes elderly, previously referred to by the enhancement involving the pia-arachnoid (small black arrows) lin- term eosinophilic granuloma (of bone) buy cheap avapro 300mg online diabetesorg. Although this can be inflammatory in nature (due to infection or sion generic avapro 150 mg line diabetes mellitus or diabetes insipidus, and is treated by excision. On the axial image a small, well-defined calvarial (diploic space) lesion is visualized near the vertex. On the coronal post-contrast image the lesion demonstrates promi- nent enhancement, and is noted to be slightly expansile in nature. Multiple focal, mildly expansile, lesions of the diploic space (arrows) are noted. Enhancement is pres- are the most common benign intracranial tumor (15% of all ent post-contrast, which is critical for differential diagnosis as well as intracranial tumors in adults), and the most common extra- identification of lesions in patients with less prominent disease. Morphologically, meningiomas are usually globular in shape and well demarcated, often with a broad dural at- This developmental skeletal disease occurs in both mono- tachment. Much less common is the en plaque variant, with stotic and polyostotic forms, with craniofacial involvement primary extension along the dura and without parenchymal seen in 10 to 25% and 50%, respectively, of cases. Meningioma Common locations for meningiomas include the falx Meningiomas are common “incidental” findings (unex- (Fig. The dural base and extra-axial location (with displacement of the adjacent gyrus) are readily evident. Less common, yet character- can be seen displaced or “buckled” away from the lesion istic, additional locations include the olfactory groove, cer- (confirming the extra-axial location). It is important to consider the differential diag- typically homogeneous and intense (Fig. Post-con- nosis for lesions in the suprasellar region, which includes trast, a dural tail (linear enhancing thickening of the me- pituitary macroadenoma, craniopharyngioma, optic nerve ninges extending away from the tumor) is common, seen in glioma, aneurysm, metastasis, chordoma, and hypothalamic about half of cases. However, this finding is not specific for a glioma, although all—with the possible exception of metas- meningioma and can be seen with other extra-axial lesions. A Although meningiomas are usually homogeneous lesions, meningioma is the most common tumor of the atrium of necrotic areas, cysts, and hemorrhage can be seen. The typical imaging appearance of a meningioma is that An en plaque meningioma is a subtype that grows along of a well-circumscribed, extra-axial mass lesion with a flat the planes of the leptomeninges, in distinction to the typi- dural interface. Marked hyperostosis of adjacent bone is not uncommon, Meningiomas are relatively isointense to brain on pre- often disproportionate with tumor size. On a T1-weighted diagnosis, both for an en plaque and a globular meningi- scan with good gray–white matter contrast, the gray matter oma, includes a dural-based metastasis. On the coronal T2-weighted scan, a homo- geneous soft tissue mass is seen within the right cavernous sinus, displacing the pitu- itary (and infundibulum) to the left. On the axial post-contrast scan, there is intense homogeneous enhancement, with convex outward bowing of the margin of the right cavernous sinus (consistent with a mass therein), encasement of the right internal carotid artery (seen also on the coronal scan), and a suggestion of extension of the lesion along the dural margin posteriorly (confirmed on scans not shown). There is diffuse abnormal increased signal in- tensity on T2-weighted images within the peri- ventricular and supraventricular white matter, in this elderly patient who received whole brain ra- diation more than a year previous to the current exam. The abnormality extends from immediate periventricular in location toward the more pe- ripheral white matter. Hemangiopericytoma Clinically, radiation white matter changes are most often seen in patients given palliative whole brain radiation for Hemangiopericytomas arise from embryonic vascular metastatic disease. In this population, the early changes elements (angioblasts), as do hemangioblastomas. These can be somewhat subtle and restricted to the more imme- tumors have a higher cellularity, are extremely vascular, diate periventricular white matter. They have a high this involvement will progress both in terms of the degree rate of recurrence following resection. Mass effect and associated vasogenic edema are Radiation necrosis occurs in up to 25% of cases after con- common, as are signs of prominent vascularity such as flow ventional therapy. Vasogenic edema is ferentiating between these two entities is further compli- seen early following treatment, due to damage to capil- cated by the common existence of a mixture of tumor and lary endothelium, with limited clinical consequences. The extent of involvement, and specifically the degree with which more peripheral white matter is involved, depends on many factors, including in particular radia- ■ Nonneoplastic Cysts tion dose. The involvement of the white matter will be scalloped laterally, and in severe disease can extend to the Arachnoid Cyst cortical gray matter (but sparing the subcortical U-fibers). In terms of time of onset from treatment varies, and can be seen etiology, they can be congenital, inflammatory, or post- within the first year following a single radiation treatment. Restricted diffusion (high signal inten- persistent gliosis but without enhancement. In the of an arachnoid cyst is characteristic, a consideration of middle cranial fossa, arachnoid cysts can be accompanied two other entities that show some similarity on imaging by hypogenesis of the temporal lobe. However, these lesions with the subarachnoid space can be dem- epidermoids are distinctive in having marked high signal onstrated, with filling by intrathecal contrast on delayed intensity on diffusion weighted scans. With an arachnoid cyst there may be simply displacement of adjacent brain, or, as in this instance, also loss of brain sub- stance. In the second patient, a single axial T2-weighted image above the level of the ventricular system demonstrates a moder- ate in size convexity arachnoid cyst. Note the mass effect associated with this lesion, and in particular the remodeling (and thin- ning) of the adjacent calvarium. In the third patient, axial T2- and sagittal T1-weighted images depict a posterior fossa arachnoid cyst, with the remodeling of adjacent bone and the mild mass effect on the cerebellum (the latter best seen on the sagittal image) differentiating this lesion from a prominent cisterna magna. They occur in the midline, with a supra- Epidermoid Cyst sellar location most common, followed by the posterior These are rare, benign congenital lesions, resulting from fossa. Dermoid cysts can also originate in the spine, and incomplete cleavage of neural from cutaneous ectoderm at then present clinically due to rupture, with fat globules the time of neural tube closure, with retention of ectopic seen distributed throughout the subarachnoid space of ectodermal cells in the neural groove. There is significant morbidity and grow slowly by desquamation of epithelial cells from the mortality associated with rupture. These lesions symptoms include meningeal signs, seizure, and vaso- are thought of as pliable, extending into and conforming spasm. A scan with fat satura- tion for an epidermoid cyst is the cerebellopontine angle. There Here it is the third most common lesion after vestibular may be mild enhancement of the capsule with primary schwannoma and meningioma. Col- tion of the lesion and demonstration of the characteristic loid cysts are of congenital origin, and enlarge slowly. Another differentiating feature until adulthood, but when symptomatic can cause hydro- between these two lesions is that an epidermoid encases cephalus (due to obstruction of the foramina of Monro), nerves and vessels. With fat saturation, this is small round lesions are noted within the superior part of the lateral suppressed, confirming the lesions to be fat. Other scattered fat ventricles, each demonstrating a subtle chemical shift artifact (arti- globules were noted in this patient in the ventricular system and factual high signal intensity anterior rim). The ventricular system proximal to the level of obstruction will be dilated, with the dilated portion more round in appearance (“ballooned”). The sulci and cisterns will be effaced, and the corpus callosum thinned: the latter in cases where the lateral ventricles are both enlarged. Obstructive Hydrocephalus, Extraventricular In this entity, also known as communicating hydrocepha- lus, there is obstruction distal to the outlet foramina of the fourth ventricle. The lateral and third ventricles, and in most cases the fourth ventricle, will be enlarged without evidence of a specific (proximal) lesion causing obstruc- tion.

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The frst child ing to children who could not grow normally during pregnancy and initially enjoys all the attention and resources generic avapro 300 mg diabetes type 2 zwanger worden, whereas the second require special care discount avapro online mastercard diabetes in dogs and skin conditions. The effect of birth order on psychological development purchase 150mg avapro diabetes type 2 with microalbuminuria, intellectual capabilities, and personality traits is well known, but it affects physical health as well. Statistically, isolation of the effect of birth order is not criminating power than birth weight percentile for perinatal deaths. Difference in late fetal death families, where the risk increases with each additional birth. It is rate in association with determinants of small for gestational age therefore necessary to exercise care when studying birth order as an fetuses: Population based cohort study. Association of birth order with cardiovascular disease risk fac- percentile to express infant weight in research and clinical practice: A tors in young adulthood: A study of one million Swedish men. Myrskylä M, Silventoinen K, Jelenkovic A, Tynelius P, Rasmussen biserial correlation, see point-biserial correlation F. The association between height and birth order: Evidence from 652,518 Swedish men. Maternal age at child birth, birth order, and suicide When two variables are considered together, this is called a bivariate at a young age: A sibling comparison. This helps us to know the probability that the two backward elimination 55 butterfy effect variables together take given values. For example, the joint distribu- where one variable (birth order) is discrete and the other (birth tion of albumin and globulin levels will indicate the chance that a weight) is continuous. In this case, the distribution of all boys (irre- random person has, say, albumin between 4 and 5 g/dL and globulin spective of birth order) is the (marginal) distribution of birth weight between 7 and 8 g/dL. B variable over all possible values of the other, called the marginal The concept of joint distribution, conditional distribution, and distribution. This can also tell us the distribution of one variable marginal distribution can be extended to a multivariate setup when for specifc values of the other, called the conditional distribution. Simultaneous study of two variables helps to explore or determine the extent and nature of the relationship between them. For example, bivariate Gaussian distribution we all know how age and height are intimately related in children, and A bivariate Gaussian distribution, better known as bivariate normal that the relationship is nonlinear. In this case, both variables are con- distribution, is a special type of bivariate distribution that follows tinuous, but one or both of them can be discrete. At with ungrouped data), the bottom two axes depict systolic (x) and the extreme of this is a binary bivariate setup, such as the relationship diastolic levels (y), and the vertical axis depicts the number of sub- between antecedent present/absent and outcome present/absent (see jects. In this case, you will see the same The number of subjects with different values of the two variables shape no matter which side the plot is viewed from. The peak is such that kur- and systolic levels are given in intervals for convenience, but that is tosis is 0. Similarly, there is a distribution of diastolic level for each in a bivariate Gaussian distribution, the shape is not exactly sym- interval of systolic level. Similarly, the last row is the marginal distribution of systolic level in these 600 women. In many applications, the term marginal is black-box approach ignored, and the distribution among total subjects is simply called the distribution of the concerned variable. Using computer programs without properly understanding the As mentioned earlier, we can have a bivariate distribution when underlying procedure is sometimes called a black-box approach. Distribution of birth weight of Users generally know what goes in and what comes out of a com- boys born at different birth orders will be a bivariate distribution puter package, but few understand what happens in between. As statistical methods are becoming increasingly complex by the day, use of a black-box approach is inevitably increasing. Many health professionals and some statisticians fnd the intricate math- ematics behind these methods too complex to understand, and resort immediately to the use of computer software to get a solution to their problems. Most statistical software packages are not yet intelligent enough to check the underlying assumptions and appropriateness of the method for the problem at hand. Even if software packages are Martin Bland intelligent for the specifed method, users sometimes are not fully aware of how to use them. Further diffculties arise in proper inter- The Bland–Altman method of agreement is for fnding whether pretation of the computer output, particularly since statistical soft- the two measurements taken on the same subjects agree or not. Some researchers use this investigates the presence or otherwise of an x = y relationship for this output in their report without full appreciation of the implica- each individual. This is different from regression since regression is not the results and conclusions are based on proper reading of the for averages. Thus, some research reports remain of doubtful other methods of assessing agreement are discussed under that topic. Differences A black-box approach can be used for any calculation for which will arise, and the question is whether the differences are within a computer package is available, but it is frequently used for pre- the tolerance range or not. Kuhn and Johnson ferences d = (x − y) in the values obtained by the two methods or [1] have given an example of a model to “[i]dentify patients who observers under comparison are examined. If these differences are will be admitted to a hospital within the next year, using historical randomly distributed around 0 and none of the differences is large, data,” to illustrate how challenging unfolding a black-box algorithm the agreement is considered good. Statisticians’ Modifcations have now appeared that allow it to be used when the vital role in big data and predictive modeling. Depending upon which is labeled x and which y, an upward Bland–Altman method of agreement, see also trend indicates that x is generally more than y, and a downward trend, that y is more than x. If x is a gold standard against which y values are agreement assessment (overall) to be assessed for agreement, plot (y − x) versus x [3]. The Bland–Altman method is the most widely used method of A commonsense approach is to consider agreement as reasonably assessing agreement between the same quantitative measurement good if, say, 95% of these differences fall within the prespecifed clini- taken on the same subjects by two methods, two sites, two observers, cally tolerable range and the other 5% are also not too far. The paper describing this was originally published in a statis- note that when the two methods or two observers are actually measur- tical journal (The Statistician) in 1983 [1], and it was repeated in ing the same variable, then the difference d is mostly the measurement a revised form for a medical audience in The Lancet [2] in 1986 error. Such errors are known to follow a Gaussian (normal) distribu- with a reverse sequence of authorship. From then on, this paper has tion irrespective of the distribution of the original measurements. The literature 160 describes them as the limits of agreement, but they are actually limits Y = X 150 B of disagreement because they delineate the extent of disagreement. If these limits are within clinical tolerance in the sense that a difference of that magnitude does not alter the management of the subjects, then 140 one method could be replaced by the other. The mean difference d is 130 the bias between the two sets of measurements, and sd measures the magnitude of random error. This well-known artifact 90 100 110 120 130 140 150 160 incidentally also highlights the limitation of the limits-of-disagreement Korotkoff (mmHg) approach. To detect this kind of fallacy, plot the differences against the mean of paired values. This Despite the means being nearly equal and the correlation coeffcient trend can immediately reveal this kind of systematic bias. Secondly, the high, the limits of disagreement show that a difference of nearly 13 method considers absolute difference and does not work well when the mmHg can arise between the two readings on either side (average of difference between two measurements under investigation is in propor- pulse oximetry readings can give either less or more than the Korotkoff tion to the values—a larger difference for large values.

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Cervicomedullary kinking purchase avapro mastercard diabetes y alcohol consecuencias, overlapping of the medulla and cervical cord order avapro 300mg diabetes type 2 wiki, may occur cheap avapro online diabetes in dogs side effects of insulin. There may be an enlarged foramen magnum and upper cervical canal, accompanied by a smaller C1 ring, with resultant compression of dis- placed brainstem, tonsils, and vermis at this level. Callosal dysgenesis (usually partial agenesis of the corpus callosum) is seen in 75%. The frontal horns may have a characteristic inferior pointing seen on coronal images. There is often hypoplasia or fenestration of the falx, with interdigi- tation of cerebral gyri. In a Chiari I malformation, the cerebellar ton- sils are pointed (arrows), and extend more inferiorly than normal, 5 mm below the level of the foramen magnum. Additional features involve the forebrain (the cerebral hemispheres, basal gan- glia, and thalamic structures). Phase contrast images at peak flow By definition, there will be a small posterior fossa with velocity in both the cranial and caudal directions are also illustrated. The tentorial incisura may Flow is depicted as white or black, depending on direction, and is be widened, allowing the cerebellum to extensive supe- seen both anterior to the pons and anterior to the cord, establishing riorly, a “towering cerebellum. An additional concordant finding of the cerebellum will have a vertical orientation. This hindbrain dysgenesis has many character- (5), low insertion of the tentorium (6), a towering appearance to the istic features, not all of which will be present in the same patient. Imaging in the sagittal plane is essential for ence of the sinuses/torcula high in position. There is a spec- there is a large posterior fossa cyst that communicates with trum of severity of findings, and thus the additional use, in the fourth ventricle anteriorly. The third defining feature the past, of the terms Dandy-Walker continuum and Dandy- is vermian and cerebellar hemisphere hypoplasia, which Walker variant. On sagit- been suggested more recently, specifically including mega tal images, the residual vermis may be rotated superiorly cisterna magna as the entity with the mildest findings. There is dilatation of the fourth ventricle (which communicates with a posterior fossa cyst), hypoplasia of the inferior ver- mis, rotation of the vermis superiorly, and elevation of the torcula. The primary differential terior to the cerebellum, without mass effect, and with diagnostic consideration is tuberous sclerosis, specifically the cerebellar hemispheres, vermis and fourth ventricle the subependymal nodules therein. These are common, and considered onstrate calcification, with the cortical involvement in tu- to be incidental findings. The primary differential diag- berous sclerosis an additional differentiating feature. Like all arachnoid cysts, however, a discrete of cortical formation, with arrested neuronal migration. Retrocerebellar arachnoid cysts surface, a small number of shallow sulci, and decreased are most common along the midline. Histo- rior fossa and position of the tentorium and straight sinus logically there is a four-layered cortex (as opposed to the are usually normal, with the cerebellar vermis and hemi- normal six layers). Abnormalities of the brain on Lissencephaly type 2, also known as cobblestone lissen- the side of involvement are common and include a thick- cephaly, is a distinct, separate entity from lissencephaly ened cortex and abnormal white matter signal intensity. In type 2, there is a nodular or “pebbly” appearance In heterotopic gray matter, there are displaced masses to the brain surface, with broadened gyri and loss of sulci of gray matter, found anywhere from the embryologic site (thus the term lissencephaly). There are commonly associ- of development (periventricular) to the final destination ated ocular anomalies, with this entity usually occurring after cell migration (cortical). The brain is tion is that of small focal regions of gray matter adjacent small and the cerebral white matter reduced in volume. Important for diagno- In polymicrogyria, an abnormality involving late neuro- sis is that these small focal lesions are isointense to gray nal migration, there are multiple small gyri along the brain surface (Fig. The resultant imaging appearance is that of a focal region of brain with an irregular cortical surface, a thick layer of gray matter (cortex), and subtle irregularity at the gray–white matter interface. There will be a decreased number of gyri, with the visible gyri being broad, thick, and relatively smooth. Anomalous venous drain- age, often a large draining vein located in a deep sulcus, is common in regions of dysplastic cortex. On histology, in polymicrogyria, there is a derangement of the normal six-layered cortex. Schizencephaly is characterized by the presence of a gray matter lined cleft, which extends from the cortex to the ventricular system. There is a spectrum of appearance, in terms of separation of the gray matter lined walls, from closed to open lip (Fig. A dimple in the wall of the ventricle can be an important clue for recognition of the closed lip form (Fig. In the first there is near complete agenesis of the corpus callo- smooth brain surface are seen in the fourth patient, with agyria, who sum, with radially oriented gyri adjacent to the lateral ventricles. Many also demonstrates the characteristic “cell-sparse” layer (small black posterior fossa malformations are associated with callosal agenesis, arrows) underlying the cortex. The fifth patient demonstrates pachy- and in this patient a large retrocerebellar cyst is also present. In the gyria, with a section (white arrows) of smooth thickened cortical gray second patient, the lateral ventricles demonstrate a parallel orienta- matter with shallow sulci. The sixth patient has a focal area in the fron- tion, a sign in the axial plane of callosal agenesis. Semilobar holopros- tal lobe of polymicrogyria (small black arrows), with many very small encephaly is illustrated in the third patient, with the interhemispheric gyri producing a cobblestoning appearance. The term porencephaly has also been used more communicate with the ventricle but is not lined by gray generally to include any non-neoplastic cavity within the matter. Porencephaly is caused by a vascular accident dur- brain, not specifically in utero in etiology, including vascu- ing the third trimester of fetal development, and as such lar insult, trauma, infection, and surgery. As well, there is only a hint of the defect on the right (“closed lip” schizencephaly), with a small ventricular dimple seen (small white arrow). There is an additional small named segment, the The corpus callosum develops in the fetus between the rostrum, which is a continuation of the genu, and proj- 8th and 20th weeks, in an anterior to posterior fashion. Total agen- esis of the corpus callosum is due to an early insult, with partial agenesis due to a later insult during gestation. With total agenesis, axons that normally cross the midline in- stead run along the medial borders of the lateral ventri- cles, parallel to the interhemispheric fissure, forming the bundles of Probst (Fig. The lateral ventricles will be more widely separated than normal, and their orientation parallel. On a coronal image, there will be a crescent shape to the lateral ventricles, in particular the front horns, with the bundles of Probst lying medially. Along the midline, as seen in the sagittal plane, there will be a radial orientation to the gyri adjacent to the body of the lateral ventricles. The term callosal dysgenesis includes both partial and complete absence of the corpus callosum. On the left, a ventricular dimple (black arrow)—the ependymal margin of the con- Holoprosencephaly is a congenital malformation of the tralateral cleft—is demonstrated, together with part of a gray matter brain, characterized by failure of cleavage and differen- lined cleft, in this patient with bilateral “closed lip” schizencephaly.

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According to some authors avapro 150mg with amex type 1 diabetes symptoms yahoo answers, radio- and chemotherapy leads to gradual restoration of the height of phosphoric spectrum 1 purchase avapro 150 mg on-line diabetes type 2 drugs. In the normal brain discount 150 mg avapro otc diabetic vs hypertensive retinopathy, the highest central creatinine defciency syndrome (Bianchi et al. However, cur- ence of lipid predecessors like phosphoryl Cho, phosphoryl rent work on the use of echo-planar pulse sequences for fast 31 ethanolamine and Lip. Workstations and digital diagnostic a diagnostic conclusion without the patient present. The old flm technologies of data presentation and Use of remote graphic stations for postprocessing is prompt- storage of flms are gradually become obsolete. The need for ed by the necessity of 3D image construction, including the additional computer processing for obtaining more detailed combined models of sof tissues of a head, skull, brain and information on the pathology in question is arising more of- its vascular system for neurosurgery intervention modelling ten (Rodionov et al. However, operative memory is limited and blood fow parameters, parametrical maps construction), and is not intended for the long-term data storage necessary in other such parameters, requires mathematical processing. In accessible via network for search and viewing, and if neces- modern medical clinics, imaging results are ofen stored on sary, for new data processing. The digital storage of medical data is more preferably in comparison with flm archives. Films could be stored for about 10 years in cases of strict compliance with all storage rules, while digital archives could exist indefnitely. Images are accessible for repeated calculations and analysis, which is es- pecially important in neuroradiology, due to frequent neces- sity of dynamic observation for the patient during long peri- ods. Taking into account the high cost of flm and signifcant expenses for service of photographic developing apparatus, it is no surprise that digital technologies of storage, transfer and representation of the medical information are increasingly coming into practice all over the world. The Neuroradiology Department of the Burdenko Neu- rosurgical Institute of Russian Academy of Medical Science developed a system to organise the information radiological system for obtaining, storage, transfer and postprocessing of diagnostic medical images. Moreover, it in- cludes several graphic stations for viewing and postprocessing of medical images. The surgeon, according to the 3D image, chooses accessible reference points (for example, a tip of a nose, teeth, curves of an auricle) on a surface of the pa- tient’s head. Tis frame, in the form of a partial arch, does not close the operational feld and does not limit the surgeon in his or her actions. It is necessary to note that, for the past 10 years, the optimal application for frameless navigation is the surgery the quantity amount of diagnostic examinations performed of basal and small convex located tumours (Fig. Tis has led to development of modern navigating systems that enable surgeons to navigate quickly and precisely in the 3D space of a surgical incision during operation, with a 1- to 2-mm precision. Such systems allow surgeons to perform in- tervention with minimal injury to the surrounding tissues. Such systems use so-called frameless technology, unlike classical stereotaxis, which uses a frame-based navigating method. Navigation is based on “binding” of space coordi- nates to certain reference points that have static positions in geonavigating systems, e. Classical medical stereotactic devices use for these purposes a special frame fastened tightly to a patient’s skull before the opera- tion. All further calculations are based on the mutual relation between intracranial structures and the reference points of a frame and its geometrical centre. Navigation of the surgical tool is made with the help of relatively large facilities such as various arches and guides fastened to a frame. Such technical decisions in classical stereotaxis limits the neurosurgeon’s ac- tions in an incision and allows the carrying out of only simple manipulations (biopsy, implantation of electrode, catheter, cyst lancing). Hourani R et al (2006) Proton magnetic resonance spectroscop- invasive magnetic resonance imaging of human cerebral blood ic imaging to diferentiate between non-neoplastic lesions and fow. Karsmar G et al (1991) P-31 spectroscopy study of response of Medicine Publishers, Moscow, p 167 (in Russian) superfcial human tumors to therapy. Konovalov A, Kornienko V (1985) Computed tomography in Neurology 61:648–654 neurosurgical clinic. Braun K et al (1999) Cerebral metabolism in experimental hy- 290 (in Russian) drocephalus: an in vivo 1H and 31P magnetic resonance spec- 19. Kornienko V, Pronin I, Fadeeva L et al (2000) Difusion weight- and single brain metastasis by peak height and percentage of ed imaging in study of brain tumours and peritumoural edema. Kornienko V, Pronin I, Golanov A et al (2004) Neuroimaging J Neuroradiol 28:1078–1084 of primary lymphomas of brain. Chai J-W et al (2007) Characterisation of focal brain lesions by Russian) gradient-echo arterial spine-tagging perfusion imaging. Hesseltine S et al (2007) Application of difusion tensor imaging aging using spin echoes. Holshouser B et al (2006) Prospective longitudinal proton mag- the difusion tensor. Radiographics 25:53–68 Neuroradiology: History and New Research Technologies 27 28. The basic text- coregistration: a feature-based approach to align difusion ten- book of the European Magnetic Resonance Forum. Rodionov P, Serkov S, Fadeeva L (2002) Modern sofware in normal adult human brain and brain tumours. Sen P-N, Basser P-J (2005) A model for difusion in white matter Imaging 15:291–313 in the brain. Stadlbauer A et al (2007) Changes in fbre integrity, difusivity, ponent apparent difusion coefcients in human brain. Pouratian N, Sheth S, Bookheimer S et al (2003) Applications immature oligodendrocytes in vitro. J Neurochem 59:55–61 and limitations of perfusion-dependent functional brain map- 52. Neurosurg Focus 15:1 perfusion measurements in patients with symptomatic unilater- 39. Pronin I, Kornienko V, Podoprigora A et al (2002) Complex al carotid artery stenosis. Eur Neuropsychopharmacol 12:517–526 Chapter 2Chapter 2 Congenital Malformations 2 of the Brain and Skull in collaboration with V. In healthy children aged 5–15 years, the cerebellar tonsil are located a bit lower than in children aged 5 years and younger (and in adults). Hence, cerebellar tonsil displacement up to 5 mm below the foramen magnum in chil- dren aged 5–15 years should not be regarded abnormal (Alt- man et al. This malformation is more frequently isolated, but con- Congenital brain malformations occur as a result of embryo- comitants hydrocephalus and hydromyelia, craniocervical genesis impairment and present as an anatomic defect or de- dysgenesia, platibasia, basilar impression, occipitalisation of structive brain lesion (Arendt 1968; Barkovich 2000; DeMyer the atlas and Klippel-Feil malformation are not infrequent in 1971; Glenn and Barkovich 2006; Harwood-Nash et al. It is very dif- clinical features: occipital headaches, cranial nerve palsies, fcult to make a diagnosis of congenital brain malformation, and dissociated anaesthesia in limbs (due to hydromyelia).

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