Amalia Paonessa - Academia.edu (original) (raw)

Papers by Amalia Paonessa

Research paper thumbnail of CT-Cisternography in Post-Surgical CSF Rhinorrhea

The Neuroradiology Journal, 2007

Cerebrospinal fluid (CSF) rhinorrhea is a dangerous problem. CSF rhinorrhea implies an abnormal c... more Cerebrospinal fluid (CSF) rhinorrhea is a dangerous problem. CSF rhinorrhea implies an abnormal communication between the subarachnoid space and the nasal cavity, with subsequent leakage of CSF through the anterior nasal apertures. requiring surgical repair. Imaging techniques have evolved from conventional cranial radiography to polytomography, thin-section computed tomography (CT) and intrathecal water-soluble iodinated contrast agent-enhanced CT cisternography. We present two cases of post-surgical CSF rhinorrhea in which the best diagnostic findings were obtained by CT cisternography.

Research paper thumbnail of Radiological strategy in acute stroke in children

European Journal of Radiology, 2010

The aim of the study was to estimate the preponderance of patterns of pediatric stroke, ischemic ... more The aim of the study was to estimate the preponderance of patterns of pediatric stroke, ischemic or hemorrhagic, their etiologies and the correct diagnostic protocol for acute management. Forty-one consecutive pediatric patients (age range 5-16 years) with an acute stroke observed in acute phase during a 10-year period, were retrospectively evaluated. Twenty-three patients underwent magnetic resonance imaging (MRI), 3 cases were studied by computed tomography (CT) without MRI, and 15 underwent both CT and MRI studies. In 9 cases, intra-arterial digital subtraction angiography (IADSA) was performed after non-invasive preliminary assessment. Seventeen hemorrhagic (41%) and 24 ischemic (59%) strokes were found. Among hemorrhagic forms, 5 cases were due to arteriovenous malformation (AVM), 7 to cavernoma, and 2 to aneurysm. Among ischemic forms, 2 were due to sickle-cell disease, 1 to hyperomocysteinemia, 1 to moyamoya syndrome, 1 to pseudoxantoma elasticum, 3 to prothrombotic state, 1 to Fabry's disease, 1 concomitant with CO intoxication, 5 to venous sinus thrombosis, and 4 to cardio-embolic state. Etiology remains unknown in 8 cases (20.5%). This study shows a moderate prevalence of ischemic over hemorrhagic strokes. Moreover, personal experience suggests that MRI is always more informative than CT and in selected cases should be the first-choice examination in the acute phase.

Research paper thumbnail of PreoperativeEvaluationofConsistency withDiffusion-weightedMR

Research paper thumbnail of Spontaneous Disappearance of Juxta-Sylvian Cyst: MRI Study and Clinical Evaluations

The Neuroradiology Journal, 2005

Several cystic lesions may involve the temporal lobe including arachnoid, choroidal fissure and j... more Several cystic lesions may involve the temporal lobe including arachnoid, choroidal fissure and juxta-sylvian cysts. We reported a case of appearance, increase and spontaneous disappearance of a juxta-sylvian cyst in a young girl with headache studied by MRI between 1990 and 2003. In agreement with previous reports, the sudden disappearance, without a history of trauma, could be the result of an osmotic effect that shifted CSF inside the cyst, leading to an increase in osmotic pressure and rupture of the cyst wall.

Research paper thumbnail of doi:10.4061/2011/172168 Review Article Pediatric Stroke: Clinical Findings and Radiological Approach

License, which permits unrestricted use, distribution, and reproduction in any medium, provided t... more License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This paper focuses on radiological approach in pediatric stroke including both ischemic stroke (Arterial Ischemic Stroke and Cerebral Sinovenous Thrombosis) and hemorrhagic stroke. Etiopathology and main clinical findings are examined as well. Magnetic Resonance Imaging could be considered as the first-choice diagnostic exam, offering a complete diagnostic set of information both in the discrimination between ischemic/hemorrhagic stroke and in the identification of underlying causes. In addition, Magnetic Resonance vascular techniques supply further information about cerebral arterial and venous circulation. Computed Tomography, for its limits and radiation exposure, should be used only when Magnetic Resonance is not available and on unstable patients. 1.

Research paper thumbnail of Degenerative Disease of the Spine

Neuroimaging Clinics of North America, 2007

Research paper thumbnail of Pediatric Stroke: Clinical Findings and Radiological Approach

Stroke Research and Treatment, 2011

This paper focuses on radiological approach in pediatric stroke including both ischemic stroke (A... more This paper focuses on radiological approach in pediatric stroke including both ischemic stroke (Arterial Ischemic Stroke and Cerebral Sinovenous Thrombosis) and hemorrhagic stroke. Etiopathology and main clinical findings are examined as well. Magnetic Resonance Imaging could be considered as the first-choice diagnostic exam, offering a complete diagnostic set of information both in the discrimination between ischemic/hemorrhagic stroke and in the identification of underlying causes. In addition, Magnetic Resonance vascular techniques supply further information about cerebral arterial and venous circulation. Computed Tomography, for its limits and radiation exposure, should be used only when Magnetic Resonance is not available and on unstable patients.

Research paper thumbnail of Cavernous angioma of the corpus callosum causing recurrent intraventricular hemorrhages

European Journal of Radiology Extra

Primary intraventricular hemorrhage (PIVH) is an uncommon type of non-traumatic cerebral hemorrha... more Primary intraventricular hemorrhage (PIVH) is an uncommon type of non-traumatic cerebral hemorrhage, limited to the ventricular system, very rare in adults and in children, with diverse aetiology and variable course.The aetiology is varied, and it should be emphasized that vascular malformations cause 34% of PIVH, and in 21–47% no cause is found.When a primary intraventricular hemorrhage is detected in a young patient it is mandatory to rule out an underlying lesion such as arteriovenous malformations (AVMs).The diagnosis may be suspected when there is sudden onset of headache, nausea and vomiting with or without reduced level of consciousness.Nevertheless, even if clinical features can suggest the diagnosis of PIVH, cerebral computed tomography (CT) scan is required for confirmation, and magnetic resonance (MR) imaging and/or catheter angiography are necessary for diagnosis of aetiology.A rare case of PIVH is represented by intraventricular cavernous angioma.We report a case of iso...

Research paper thumbnail of Reversible focal splenial lesions

Neuroradiology, 2007

Reversible focal lesions in the splenium of the corpus callosum (SCC) have recently been reported... more Reversible focal lesions in the splenium of the corpus callosum (SCC) have recently been reported.They are circumscribed and located in the median aspect of the SCC. On MRI, they are hyperintense on T2-W and isohypointense on T1-W sequences, with no contrast enhancement. On DWI, SCC lesions are hyperintense with low ADC values, reflecting restricted diffusion due to cytotoxic edema. The common element is the disappearance of imaging abnormalities with time, including normalization of DWI. Clinical improvement is often reported. The most established and frequent causes of reversible focal lesions of the SCC are viral encephalitis, antiepileptic drug toxicity/withdrawal and hypoglycemic encephalopathy. Many other causes have been reported, including traumatic axonal injury. The similar clinical and imaging features suggest a common mechanism induced by different pathological events leading to the same results. Edema and diffusion restriction in focal reversible lesions of the SCC have been attributed to excitotoxic mechanisms that can result from different mechanisms; no unifying relation-ship has been found to explain all the pathologies associated with SCC lesions. In our opinion, the similar imaging, clinical and prognostic aspects of these lesions depend on a high vulnerability of the SCC to excitotoxic edema and are less dependent on the underling pathology. In this review, the relevant literature concerning reversible focal lesions in the SCC is analyzed and hypotheses about their pathogenesis are proposed.

Research paper thumbnail of Are bilateral cavernous hemangiomas of the orbit rare entities? The role of MRI in a retrospective study

European Journal of Radiology, 2008

Cavernous hemangioma is a benign orbital extraocular vascular lesion consisting of large dilated ... more Cavernous hemangioma is a benign orbital extraocular vascular lesion consisting of large dilated venous channels with fibrous, well-delineated capsule and hemosiderin deposition. Cavernous hemangioma is considered to be almost always unilateral and bilateral cases have been rarely described. The aim of our study is to evaluate imaging characteristics of cavernous hemangioma and evaluate the prevalence of bilateral cases. We studied 14 patients with cavernous hemangioma of the orbit with surgical confirmation. MRI was performed on a 1.5-T unit before and after contrast agent administration. Each MR examination had been retrospectively evaluated in order to define signal patterns, dimensions, location and other main imaging characteristics. In 3 out of the 14 cases studied (21.4%) bilateral cavernous hemangiomas were found. Thirteen masses appeared isointense on T1, two were hypointense, and two heterogeneous. On T2, 12 were hyperintense, 3 were heterogeneous, 1 isointense, and 1 hypointense. Contrast enhancement was inhomogeneous in 5, homogeneous and intense in 12 cases. The size ranged from 3mm up to 21 mm (average 14.57). In four patients also CT scan without contrast administration of the orbits was performed. Bilateral cavernous hemangioma appears to be more frequent than as predicted by the literature. In our opinion the main reason of this incongruence is related to technological advances. Our results could also be related to carelessness of radiologists to inspect the other orbit for possible concomitant lesions, and thus invites to major attention in exploring both orbits for eventual bilateral lesions.

Research paper thumbnail of Radiological strategy in acute stroke in children

European Journal of Radiology, 2010

The aim of the study was to estimate the preponderance of patterns of pediatric stroke, ischemic ... more The aim of the study was to estimate the preponderance of patterns of pediatric stroke, ischemic or hemorrhagic, their etiologies and the correct diagnostic protocol for acute management. Forty-one consecutive pediatric patients (age range 5-16 years) with an acute stroke observed in acute phase during a 10-year period, were retrospectively evaluated. Twenty-three patients underwent magnetic resonance imaging (MRI), 3 cases were studied by computed tomography (CT) without MRI, and 15 underwent both CT and MRI studies. In 9 cases, intra-arterial digital subtraction angiography (IADSA) was performed after non-invasive preliminary assessment. Seventeen hemorrhagic (41%) and 24 ischemic (59%) strokes were found. Among hemorrhagic forms, 5 cases were due to arteriovenous malformation (AVM), 7 to cavernoma, and 2 to aneurysm. Among ischemic forms, 2 were due to sickle-cell disease, 1 to hyperomocysteinemia, 1 to moyamoya syndrome, 1 to pseudoxantoma elasticum, 3 to prothrombotic state, 1 to Fabry's disease, 1 concomitant with CO intoxication, 5 to venous sinus thrombosis, and 4 to cardio-embolic state. Etiology remains unknown in 8 cases (20.5%). This study shows a moderate prevalence of ischemic over hemorrhagic strokes. Moreover, personal experience suggests that MRI is always more informative than CT and in selected cases should be the first-choice examination in the acute phase.

Research paper thumbnail of CT-Cisternography in Post-Surgical CSF Rhinorrhea

The Neuroradiology Journal, 2007

Cerebrospinal fluid (CSF) rhinorrhea is a dangerous problem. CSF rhinorrhea implies an abnormal c... more Cerebrospinal fluid (CSF) rhinorrhea is a dangerous problem. CSF rhinorrhea implies an abnormal communication between the subarachnoid space and the nasal cavity, with subsequent leakage of CSF through the anterior nasal apertures. requiring surgical repair. Imaging techniques have evolved from conventional cranial radiography to polytomography, thin-section computed tomography (CT) and intrathecal water-soluble iodinated contrast agent-enhanced CT cisternography. We present two cases of post-surgical CSF rhinorrhea in which the best diagnostic findings were obtained by CT cisternography.

Research paper thumbnail of Radiological strategy in acute stroke in children

European Journal of Radiology, 2010

The aim of the study was to estimate the preponderance of patterns of pediatric stroke, ischemic ... more The aim of the study was to estimate the preponderance of patterns of pediatric stroke, ischemic or hemorrhagic, their etiologies and the correct diagnostic protocol for acute management. Forty-one consecutive pediatric patients (age range 5-16 years) with an acute stroke observed in acute phase during a 10-year period, were retrospectively evaluated. Twenty-three patients underwent magnetic resonance imaging (MRI), 3 cases were studied by computed tomography (CT) without MRI, and 15 underwent both CT and MRI studies. In 9 cases, intra-arterial digital subtraction angiography (IADSA) was performed after non-invasive preliminary assessment. Seventeen hemorrhagic (41%) and 24 ischemic (59%) strokes were found. Among hemorrhagic forms, 5 cases were due to arteriovenous malformation (AVM), 7 to cavernoma, and 2 to aneurysm. Among ischemic forms, 2 were due to sickle-cell disease, 1 to hyperomocysteinemia, 1 to moyamoya syndrome, 1 to pseudoxantoma elasticum, 3 to prothrombotic state, 1 to Fabry's disease, 1 concomitant with CO intoxication, 5 to venous sinus thrombosis, and 4 to cardio-embolic state. Etiology remains unknown in 8 cases (20.5%). This study shows a moderate prevalence of ischemic over hemorrhagic strokes. Moreover, personal experience suggests that MRI is always more informative than CT and in selected cases should be the first-choice examination in the acute phase.

Research paper thumbnail of PreoperativeEvaluationofConsistency withDiffusion-weightedMR

Research paper thumbnail of Spontaneous Disappearance of Juxta-Sylvian Cyst: MRI Study and Clinical Evaluations

The Neuroradiology Journal, 2005

Several cystic lesions may involve the temporal lobe including arachnoid, choroidal fissure and j... more Several cystic lesions may involve the temporal lobe including arachnoid, choroidal fissure and juxta-sylvian cysts. We reported a case of appearance, increase and spontaneous disappearance of a juxta-sylvian cyst in a young girl with headache studied by MRI between 1990 and 2003. In agreement with previous reports, the sudden disappearance, without a history of trauma, could be the result of an osmotic effect that shifted CSF inside the cyst, leading to an increase in osmotic pressure and rupture of the cyst wall.

Research paper thumbnail of doi:10.4061/2011/172168 Review Article Pediatric Stroke: Clinical Findings and Radiological Approach

License, which permits unrestricted use, distribution, and reproduction in any medium, provided t... more License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This paper focuses on radiological approach in pediatric stroke including both ischemic stroke (Arterial Ischemic Stroke and Cerebral Sinovenous Thrombosis) and hemorrhagic stroke. Etiopathology and main clinical findings are examined as well. Magnetic Resonance Imaging could be considered as the first-choice diagnostic exam, offering a complete diagnostic set of information both in the discrimination between ischemic/hemorrhagic stroke and in the identification of underlying causes. In addition, Magnetic Resonance vascular techniques supply further information about cerebral arterial and venous circulation. Computed Tomography, for its limits and radiation exposure, should be used only when Magnetic Resonance is not available and on unstable patients. 1.

Research paper thumbnail of Degenerative Disease of the Spine

Neuroimaging Clinics of North America, 2007

Research paper thumbnail of Pediatric Stroke: Clinical Findings and Radiological Approach

Stroke Research and Treatment, 2011

This paper focuses on radiological approach in pediatric stroke including both ischemic stroke (A... more This paper focuses on radiological approach in pediatric stroke including both ischemic stroke (Arterial Ischemic Stroke and Cerebral Sinovenous Thrombosis) and hemorrhagic stroke. Etiopathology and main clinical findings are examined as well. Magnetic Resonance Imaging could be considered as the first-choice diagnostic exam, offering a complete diagnostic set of information both in the discrimination between ischemic/hemorrhagic stroke and in the identification of underlying causes. In addition, Magnetic Resonance vascular techniques supply further information about cerebral arterial and venous circulation. Computed Tomography, for its limits and radiation exposure, should be used only when Magnetic Resonance is not available and on unstable patients.

Research paper thumbnail of Cavernous angioma of the corpus callosum causing recurrent intraventricular hemorrhages

European Journal of Radiology Extra

Primary intraventricular hemorrhage (PIVH) is an uncommon type of non-traumatic cerebral hemorrha... more Primary intraventricular hemorrhage (PIVH) is an uncommon type of non-traumatic cerebral hemorrhage, limited to the ventricular system, very rare in adults and in children, with diverse aetiology and variable course.The aetiology is varied, and it should be emphasized that vascular malformations cause 34% of PIVH, and in 21–47% no cause is found.When a primary intraventricular hemorrhage is detected in a young patient it is mandatory to rule out an underlying lesion such as arteriovenous malformations (AVMs).The diagnosis may be suspected when there is sudden onset of headache, nausea and vomiting with or without reduced level of consciousness.Nevertheless, even if clinical features can suggest the diagnosis of PIVH, cerebral computed tomography (CT) scan is required for confirmation, and magnetic resonance (MR) imaging and/or catheter angiography are necessary for diagnosis of aetiology.A rare case of PIVH is represented by intraventricular cavernous angioma.We report a case of iso...

Research paper thumbnail of Reversible focal splenial lesions

Neuroradiology, 2007

Reversible focal lesions in the splenium of the corpus callosum (SCC) have recently been reported... more Reversible focal lesions in the splenium of the corpus callosum (SCC) have recently been reported.They are circumscribed and located in the median aspect of the SCC. On MRI, they are hyperintense on T2-W and isohypointense on T1-W sequences, with no contrast enhancement. On DWI, SCC lesions are hyperintense with low ADC values, reflecting restricted diffusion due to cytotoxic edema. The common element is the disappearance of imaging abnormalities with time, including normalization of DWI. Clinical improvement is often reported. The most established and frequent causes of reversible focal lesions of the SCC are viral encephalitis, antiepileptic drug toxicity/withdrawal and hypoglycemic encephalopathy. Many other causes have been reported, including traumatic axonal injury. The similar clinical and imaging features suggest a common mechanism induced by different pathological events leading to the same results. Edema and diffusion restriction in focal reversible lesions of the SCC have been attributed to excitotoxic mechanisms that can result from different mechanisms; no unifying relation-ship has been found to explain all the pathologies associated with SCC lesions. In our opinion, the similar imaging, clinical and prognostic aspects of these lesions depend on a high vulnerability of the SCC to excitotoxic edema and are less dependent on the underling pathology. In this review, the relevant literature concerning reversible focal lesions in the SCC is analyzed and hypotheses about their pathogenesis are proposed.

Research paper thumbnail of Are bilateral cavernous hemangiomas of the orbit rare entities? The role of MRI in a retrospective study

European Journal of Radiology, 2008

Cavernous hemangioma is a benign orbital extraocular vascular lesion consisting of large dilated ... more Cavernous hemangioma is a benign orbital extraocular vascular lesion consisting of large dilated venous channels with fibrous, well-delineated capsule and hemosiderin deposition. Cavernous hemangioma is considered to be almost always unilateral and bilateral cases have been rarely described. The aim of our study is to evaluate imaging characteristics of cavernous hemangioma and evaluate the prevalence of bilateral cases. We studied 14 patients with cavernous hemangioma of the orbit with surgical confirmation. MRI was performed on a 1.5-T unit before and after contrast agent administration. Each MR examination had been retrospectively evaluated in order to define signal patterns, dimensions, location and other main imaging characteristics. In 3 out of the 14 cases studied (21.4%) bilateral cavernous hemangiomas were found. Thirteen masses appeared isointense on T1, two were hypointense, and two heterogeneous. On T2, 12 were hyperintense, 3 were heterogeneous, 1 isointense, and 1 hypointense. Contrast enhancement was inhomogeneous in 5, homogeneous and intense in 12 cases. The size ranged from 3mm up to 21 mm (average 14.57). In four patients also CT scan without contrast administration of the orbits was performed. Bilateral cavernous hemangioma appears to be more frequent than as predicted by the literature. In our opinion the main reason of this incongruence is related to technological advances. Our results could also be related to carelessness of radiologists to inspect the other orbit for possible concomitant lesions, and thus invites to major attention in exploring both orbits for eventual bilateral lesions.

Research paper thumbnail of Radiological strategy in acute stroke in children

European Journal of Radiology, 2010

The aim of the study was to estimate the preponderance of patterns of pediatric stroke, ischemic ... more The aim of the study was to estimate the preponderance of patterns of pediatric stroke, ischemic or hemorrhagic, their etiologies and the correct diagnostic protocol for acute management. Forty-one consecutive pediatric patients (age range 5-16 years) with an acute stroke observed in acute phase during a 10-year period, were retrospectively evaluated. Twenty-three patients underwent magnetic resonance imaging (MRI), 3 cases were studied by computed tomography (CT) without MRI, and 15 underwent both CT and MRI studies. In 9 cases, intra-arterial digital subtraction angiography (IADSA) was performed after non-invasive preliminary assessment. Seventeen hemorrhagic (41%) and 24 ischemic (59%) strokes were found. Among hemorrhagic forms, 5 cases were due to arteriovenous malformation (AVM), 7 to cavernoma, and 2 to aneurysm. Among ischemic forms, 2 were due to sickle-cell disease, 1 to hyperomocysteinemia, 1 to moyamoya syndrome, 1 to pseudoxantoma elasticum, 3 to prothrombotic state, 1 to Fabry's disease, 1 concomitant with CO intoxication, 5 to venous sinus thrombosis, and 4 to cardio-embolic state. Etiology remains unknown in 8 cases (20.5%). This study shows a moderate prevalence of ischemic over hemorrhagic strokes. Moreover, personal experience suggests that MRI is always more informative than CT and in selected cases should be the first-choice examination in the acute phase.