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- A distinct neuromelanin magnetic resonance imaging pattern in parkinsonian multiple system atrophyPublication . Simões, Rita Moiron; Castro Caldas, Ana; Grilo, Joana; Correia, Daisy; Guerreiro, Carla; Pita Lobo, Patrícia; Valadas, Anabela; Fabbri, Marguerita; Correia Guedes, Leonor; Coelho, Miguel; Rosa, Mário Miguel; Ferreira, Joaquim J; Reimão, SofiaBackground: Parkinsonian variant of multiple system atrophy is a neurodegenerative disorder frequently misdiagnosed as Parkinson's disease. No early imaging biomarkers currently differentiate these disorders. Methods: Simple visual imaging analysis of the substantia nigra and locus coeruleus in neuromelanin-sensitive magnetic resonance imaging and nigrosome 1 in susceptibility-weighted sequences was performed in thirty patients with parkinsonian variant of multiple system atrophy fulfilling possible/probable second consensus diagnostic criteria. The neuromelanin visual pattern was compared to patients with Parkinson's disease with the same disease duration (n = 10) and healthy controls (n = 10). Substantia nigra semi-automated neuromelanin area/signal intensity was compared to the visual data. Results: Groups were similar in age, sex, disease duration, and levodopa equivalent dose. Hoehn & Yahr stage was higher in parkinsonian multiple system atrophy patients, 69% of whom had normal neuromelanin size/signal, significantly different from Parkinson's disease patients, and similar to controls. Nigrosome 1 signal was lost in 74% of parkinsonian multiple system atrophy patients. Semi-automated neuromelanin substantia nigra signal, but not area, measurements were able to differentiate groups. Conclusions: In patients with parkinsonism, simple visual magnetic resonance imaging analysis showing normal neuromelanin substantia nigra and locus coeruleus, combined with nigrosome 1 loss, allowed the distinction of the parkinsonian variant of multiple system atrophy from Parkinson's disease and healthy controls. This easy and widely available method was superior to semi-automated measurements in identifying specific imaging changes in substantia nigra and locus coeruleus.
- Radiologic clue to cavernous sinus hemangioma diagnosisPublication . Esteves, Cristiano; Berhanu, David; Guerreiro, CarlaWe describe a case of a 57-year-old woman presenting initially with diplopia who later developed retro-orbital and retroauricular pain. Examination showed right abducens nerve palsy and subsequent right trigeminal nerve hyperesthesia. Neuroimaging revealed a well-defined mass confined to the right cavernous sinus, with high T2 signal intensity and homogeneous enhancement on postgadolinium T1-weighted images. A meningioma was initially considered as the most likely diagnosis. The lesion grew over months, extending into the Meckel's cave and the pituitary fossa. Dynamic T1-weighted images revealed striking and progressive centripetal enhancement, leading to a revised diagnosis of cavernous sinus hemangioma (CSH). CSH is a rare benign extra-axial tumor, which is highly vascularized, and is frequently misdiagnosed as meningioma or schwannoma. The combination of very high T2 signal intensity and progressive centripetal contrast enhancement highly suggest CSH diagnosis. Given the significant risk of bleeding and mortality associated with surgical intervention, it is crucial to recognize CSH preoperatively to plan a meticulous surgical approach.
- Magnetic resonance imaging and Ménière’s disease : unavoidable alliancePublication . Sousa, Rita; Raposo, Francisco; Guerreiro, Carla; Berhanu, David; Eça, Tiago; Campos, J.; Luís, LeonelMénière’s disease (MD) is a clinical syndrome characterized by recurrent episodes of spontaneous vertigo, unilateral fluctuating sensorineural hearing loss, tinnitus, and aural fullness. Endolymphatic hydrops is recognized as the pathophysiological substrate of the disease, having been demonstrated in anatomical pathological studies and more recently by magnetic resonance imaging (MRI). The current criteria of the disease, however, remain symptom based and do not include the demonstration of endolymphatic hydrops. The authors review MRI techniques and diagnostic criteria of endolymphatic hydrops and the role of MRI in MD is discussed.
- A standardized MR Imaging protocol for ParkinsonismPublication . Reimão, Sofia; Guerreiro, Carla; Seppi, Klaus; Ferreira, Joaquim J; Poewe, WernerDespite well-established Parkinson’s disease (PD) diagnostic criteria, diagnosis can still be challenging, with a high rate of misdiagnosis in atypical cases, especially in early disease stages. The majority of misdiagnoses are related to the differential diagnosis of PD with atypical parkinsonian disorders (APD), such as multiple system atrophy–parkinsonian type (MSA-P), progressive supranuclear palsy (PSP), or corticobasal degeneration, as well as essential tremor (ET) and other forms of parkinsonism (drug-induced, vascular, functional).
- Immunotherapy in lung cancer brain metastasesPublication . Paisana, Eunice; Cascao, Rita; Alvoeiro, Magda; Félix, Francisco; Martins, Guilherme; Guerreiro, Carla; Roque, Rafael; Cruz, Rafael Moiteiro Da; Pacheco, Teresa; Amado, Ana Cristina; Ferro, Filipa; Lopes Machado, Andrea; Vilariça, Ana Sofia; Hasmucrai, Direndra; Alves, Paula; Faria, ClaudiaBrain metastases (BM) occur frequently in lung cancer, particularly in non-small cell lung cancer (NSCLC) patients and remain a significant cause of morbidity and mortality. Standard therapies have limited efficacy due to poor crossing of the blood-brain barrier and the distinct features between BM and the primary tumor. This review explores the immune landscape of brain metastatic disease, emerging immunotherapeutic strategies, and promising biomarkers in NSCLC patients.