Diagnostics

Research

14 pages, 1751 KB

Open AccessArticle

Morphological Variability of Sphenoid Sinus Pneumatization and Its Impact on Adjacent Neurovascular Structures

by Panagiotis Papadopoulos-Manolarakis, George Triantafyllou, Christos Georgalas, Ioannis Paschopoulos, George Stranjalis and Maria Piagkou

Diagnostics 2026, 16(5), 809; https://doi.org/10.3390/diagnostics16050809 - 9 Mar 2026

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Abstract

Background/Objectives: The sphenoid sinus (SS) exhibits marked morphological variability, influencing the relationship of critical neurovascular skull base structures. This study aimed to characterize sphenoid sinus pneumatization (SSP) patterns and assess their impact on the course of the internal carotid artery (ICA), optic [...] Read more.

Background/Objectives: The sphenoid sinus (SS) exhibits marked morphological variability, influencing the relationship of critical neurovascular skull base structures. This study aimed to characterize sphenoid sinus pneumatization (SSP) patterns and assess their impact on the course of the internal carotid artery (ICA), optic nerve (ON), Vidian nerve (VN), and maxillary nerve (MN) within a Greek adult population. Methods: A retrospective analysis of 253 adult skull base computed tomography (CT) scans was performed. The degree and direction of SSP were classified according to established radiological criteria. Anterior, lateral, and posterior extensions were evaluated. The course of adjacent neurovascular structures was categorized as typical, protruding, or dehiscent. Associations between pneumatization types and neurovascular variants were analyzed. Results: The sellar complete type was the predominant SS pattern (63.2%), followed by sellar incomplete (27.7%) and presellar (8.7%) types; agenesis was rare (0.4%). Posterior (63.6%) and lateral (46.6%) extensions were most common. Lateral and posterior pneumatization significantly correlated with protrusion and/or dehiscence of adjacent neurovascular structures, particularly the ICA, ON, and VN. LW extension was strongly associated with ON protrusion (96%), while PP and full-lateral extensions correlated with VN protrusion (56.1% and 79.9%, respectively). No significant sex- or side-related differences were identified. Conclusions: SSP demonstrates extensive morphological variability that significantly affects the anatomical course and osseous coverage of neighboring neurovascular structures. Comprehensive preoperative CT evaluation of SS anatomy is essential for planning endoscopic transsphenoidal and extended skull base procedures to minimize the risk of neurovascular injury. Full article

(This article belongs to the Special Issue Brain/Neuroimaging 2025–2026)

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13 pages, 2350 KB

Open AccessArticle

Differentiation of Intracranial Dural Metastases and Meningiomas Using DSC Perfusion MRI and Machine Learning

by Seyit Erol, Halil Özer, Ahmet Baytok, Ayşe Arı and Hakan Cebeci

Diagnostics 2026, 16(5), 781; https://doi.org/10.3390/diagnostics16050781 - 5 Mar 2026

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Abstract

Background/Objectives: To assess the diagnostic performance of dynamic susceptibility contrast (DSC) perfusion MRI parameters and machine learning methods for differentiating intracranial dural metastases (IDMs) from meningiomas. Methods: This retrospective diagnostic accuracy study included 56 patients (mean age: 57.6 ± 11.2 years; 20 men) [...] Read more.

Background/Objectives: To assess the diagnostic performance of dynamic susceptibility contrast (DSC) perfusion MRI parameters and machine learning methods for differentiating intracranial dural metastases (IDMs) from meningiomas. Methods: This retrospective diagnostic accuracy study included 56 patients (mean age: 57.6 ± 11.2 years; 20 men) with dural-based intracranial lesions (65 lesions): 18 patients with IDM (27 lesions) and 38 patients with meningiomas (38 lesions). All patients underwent DSC perfusion MRI. Relative cerebral blood volume (rCBV), relative cerebral blood flow (rCBF), diffusion metrics, and dynamic time–signal intensity curve parameters were extracted. Group comparisons were performed using nonparametric statistical tests. Machine learning models, including linear discriminant analysis (LDA), were developed using patient-level grouped nested cross-validation to avoid data leakage. Diagnostic performance was evaluated using out-of-fold receiver operating characteristic (ROC) analysis, calibration assessment, and clinically oriented thresholds prioritizing metastasis sensitivity. Results: rCBV_mean and rCBF_mean were significantly higher in meningiomas than in dural metastases (median rCBV_mean: 4.71 vs. 2.95; median rCBF_mean: 3.44 vs. 2.02; both p < 0.001). Diffusion metrics and dynamic perfusion parameters, including wash-in time, percentage signal recovery, and wash-out slope, did not differ significantly between groups (p > 0.05). Univariate ROC analysis demonstrated strong discrimination for both rCBF_mean (AUC: 0.82; 95% CI: 0.72, 0.90) and rCBV_mean (AUC: 0.82; 95% CI: 0.72, 0.91). An LDA model integrating rCBF_mean and rCBV_mean achieved an out-of-fold AUC of 0.81 (95% CI: 0.72, 0.89) and improved specificity (85%) at a fixed metastasis sensitivity of 85%. Conclusions: DSC perfusion MRI-derived rCBF and rCBV are robust biomarkers for differentiating IDMs from meningiomas. An interpretable machine learning model integrating these parameters improves diagnostic specificity while maintaining high sensitivity. Full article

(This article belongs to the Special Issue Brain/Neuroimaging 2025–2026)

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13 pages, 806 KB

Open AccessArticle

Structural Brain Changes in Patients with Congenital Anosmia: MRI-Based Analysis of Gray- and White-Matter Volumes

by Shun-Hung Lin, Hsian-Min Chen and Rong-San Jiang

Diagnostics 2025, 15(15), 1927; https://doi.org/10.3390/diagnostics15151927 - 31 Jul 2025

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Abstract

Background: Congenital anosmia (CA) is a rare condition characterized by a lifelong inability to perceive odors, which significantly affects daily life and may be linked to broader neurodevelopmental alterations. This study aimed to investigate structural brain differences in patients with CA using MRI, [...] Read more.

Background: Congenital anosmia (CA) is a rare condition characterized by a lifelong inability to perceive odors, which significantly affects daily life and may be linked to broader neurodevelopmental alterations. This study aimed to investigate structural brain differences in patients with CA using MRI, focusing on gray matter (GM) and white matter (WM) changes and their implications for neurodevelopment. Methods: This retrospective study included 28 patients with CA and 28 age- and gender-matched healthy controls. Patients with CA were diagnosed at a single medical center between 1 January 2001 and 30 August 2024. Controls were randomly selected from an imaging database and had no history of olfactory dysfunction. Brain Magnetic Resonance Imaging (MRI)was analyzed using volumetric analysis in SPM12.GM and WM volumes were quantified across 11 anatomical brain regions based on theWFU_PickAtlas toolbox, including frontal, temporal, parietal, occipital, limbic, sub-lobar, cerebellum (anterior/posterior), midbrain, the pons, and the frontal–temporal junction. Left–right hemispheric comparisons were also conducted. Results: Patients with CA exhibited significantly smaller GM volumes compared to healthy controls (560.6 ± 114.7 cc vs. 693.7 ± 96.3 cc, p < 0.001) but larger WM volumes (554.2 ± 75.4 cc vs. 491.1 ± 79.7 cc, p = 0.015). Regionally, GM reductions were observed in the frontal (131.9 ± 33.7 cc vs. 173.7 ± 27.0 cc, p < 0.001), temporal (81.1 ± 18.4 cc vs. 96.5 ± 14.1 cc, p = 0.001), parietal (52.4 ± 15.2 cc vs. 77.2 ± 12.4 cc, p < 0.001), sub-lobar (57.8 ± 9.7 cc vs. 68.2 ± 10.2 cc, p = 0.001), occipital (39.1 ± 13.0 cc vs. 57.8 ± 8.9 cc, p < 0.001), and midbrain (2.0 ± 0.5 cc vs. 2.3 ± 0.4 cc, p = 0.006) regions. Meanwhile, WM increases were notable in the frontal(152.0 ± 19.9 cc vs. 139.2 ± 24.0 cc, p = 0.027), temporal (71.5 ± 11.5 cc vs. 60.8 ± 9.5 cc, p = 0.001), parietal (75.8 ± 12.4 cc vs. 61.9 ± 11.5 cc, p < 0.001), and occipital (58.7 ± 10.3 cc vs. 41.9 ± 7.9 cc, p < 0.001) lobes. A separate analysis of the left and right hemispheres revealed similar patterns of reduced GM and increased WM volumes in patients with CA across both sides. An exception was noted in the right cerebellum-posterior, where patients with CA showed significantly greater WM volume (5.625 ± 1.667 cc vs. 4.666 ± 1.583 cc, p = 0.026). Conclusions: This study demonstrates widespread structural brain differences in individuals with CA, including reduced GM and increased WM volumes across multiple cortical and sub-lobar regions. These findings suggest that congenital olfactory deprivation may impact brain maturation beyond primary olfactory pathways, potentially reflecting altered synaptic pruning and increased myelination during early neurodevelopment. The involvement of the cerebellum further implies potential adaptations beyond motor functions. These structural differences may serve as potential neuroimaging markers for monitoring CA-associated cognitive or emotional comorbidities. Full article

(This article belongs to the Special Issue Brain/Neuroimaging 2025–2026)

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20 pages, 4466 KB

Open AccessArticle

by Ho-Ching Yang, Tyler Nguyen, Fletcher A. White, Kelly M. Naugle and Yu-Chien Wu

Diagnostics 2025, 15(5), 642; https://doi.org/10.3390/diagnostics15050642 - 6 Mar 2025

Cited by 2 | Viewed by 4207

Abstract

Background: This study used diffusion tensor imaging (DTI) to detect brain microstructural changes in participants with mild traumatic brain injury (mTBI) who experienced post-traumatic headaches, a common issue that affects quality of life and rehabilitation. Despite its prevalence, the mechanisms behind post-traumatic headache [...] Read more.

Background: This study used diffusion tensor imaging (DTI) to detect brain microstructural changes in participants with mild traumatic brain injury (mTBI) who experienced post-traumatic headaches, a common issue that affects quality of life and rehabilitation. Despite its prevalence, the mechanisms behind post-traumatic headache are not well understood. Methods: Participants were recruited from Level 1 trauma centers, and MRI scans, including T1-weighted anatomical imaging and DTI, were acquired 1 month post-injury. Advanced imaging techniques corrected artifacts and extracted diffusion tensor measures reflecting white-matter integrity. Pain sensitivity assays were collected at 1 and 6 months post-injury, including quantitative sensory testing and psychological assessments. Results: Significant aberrations in axial diffusivity in the forceps major were observed in mTBI participants (n = 12) compared to healthy controls (n = 10) 1 month post-injury (p = 0.02). Within the mTBI group, DTI metrics at 1 month were significantly associated with pain-related and psychological outcomes at 6 months. Statistical models revealed group differences in the right sagittal stratum (p < 0.01), left insula (p < 0.04), and left superior longitudinal fasciculus (p < 0.05). Conclusions: This study shows that DTI metrics at 1 month post-injury are sensitive to mTBI and predictive of chronic pain and psychological outcomes at 6 months. Full article

(This article belongs to the Special Issue Brain/Neuroimaging 2025–2026)

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Review

Jump to: Research, Other

34 pages, 385 KB

Open AccessReview

Machine Learning in MRI Brain Imaging: A Review of Methods, Challenges, and Future Directions

by Martyna Ottoni, Anna Kasperczuk and Luis M. N. Tavora

Diagnostics 2025, 15(21), 2692; https://doi.org/10.3390/diagnostics15212692 - 24 Oct 2025

Cited by 1 | Viewed by 3802

Abstract

In recent years, machine learning (ML) has been increasingly used in many fields, including medicine. Magnetic resonance imaging (MRI) is a non-invasive and effective diagnostic technique; however, manual image analysis is time-consuming and prone to human variability. In response, ML models have been [...] Read more.

In recent years, machine learning (ML) has been increasingly used in many fields, including medicine. Magnetic resonance imaging (MRI) is a non-invasive and effective diagnostic technique; however, manual image analysis is time-consuming and prone to human variability. In response, ML models have been developed to support MRI analysis, particularly in segmentation and classification tasks. This work presents an updated narrative review of ML applications in brain MRI, with a focus on tumor classification and segmentation. A literature search was conducted in PubMed and Scopus databases and Mendeley Catalog (MC)—a publicly accessible bibliographic catalog linked to Elsevier’s Scopus indexing system—covering the period from January 2020 to April 2025. The included studies focused on patients with primary or secondary brain neoplasms and applied machine learning techniques to MRI data for classification or segmentation purposes. Only original research articles written in English and reporting model validation were considered. Studies using animal models, non-imaging data, lacking proper validation, or without accessible full texts (e.g., abstract-only records or publications unavailable through institutional access) were excluded. In total, 108 studies met all inclusion criteria and were analyzed qualitatively. In general, models based on convolutional neural networks (CNNs) were found to dominate current research due to their ability to extract spatial features directly from imaging data. Reported classification accuracies ranged from 95% to 99%, while Dice coefficients for segmentation tasks varied between 0.83 and 0.94. Hybrid architectures (e.g., CNN-SVM, CNN-LSTM) achieved strong results in both classification and segmentation tasks, with accuracies above 95% and Dice scores around 0.90. Transformer-based models, such as the Swin Transformer, reached the highest performance, up to 99.9%. Despite high reported accuracy, challenges remain regarding overfitting, generalization to real-world clinical data, and lack of standardized evaluation protocols. Transfer learning and data augmentation were frequently applied to mitigate limited data availability, while radiomics-based models introduced new avenues for personalized diagnostics. ML has demonstrated substantial potential in enhancing brain MRI analysis and supporting clinical decision-making. Nevertheless, further progress requires rigorous clinical validation, methodological standardization, and comparative benchmarking to bridge the gap between research settings and practical deployment. Full article

(This article belongs to the Special Issue Brain/Neuroimaging 2025–2026)

Other

Jump to: Research, Review

18 pages, 3224 KB

Open AccessCase Report

Left Pulvinar Thalamic Tumor with Ventricular Atrial Extension Presenting as Network-Level Cognitive and Gait Dysfunction

by Florin Mihail Filipoiu, Stefan Oprea, Cosmin Pantu, Matei Șerban, Răzvan-Adrian Covache-Busuioc, Corneliu Toader, Mugurel Petrinel Radoi, Octavian Munteanu and Raluca Florentina Tulin

Diagnostics 2026, 16(6), 836; https://doi.org/10.3390/diagnostics16060836 - 11 Mar 2026

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Abstract

Background and Clinical Significance: Deep thalamic and periventricular lesions are uncommon in adults but can result in significant loss of function because of their convergence on three interdependent processes: thalamocortical state regulation, throughput of periventricular long association systems, and ventricular compartmental compliance. The [...] Read more.

Background and Clinical Significance: Deep thalamic and periventricular lesions are uncommon in adults but can result in significant loss of function because of their convergence on three interdependent processes: thalamocortical state regulation, throughput of periventricular long association systems, and ventricular compartmental compliance. The resulting combination of executive control collapse, retrieval-weighted language fragility, and load-sensitive gait instability may occur early after a lesion forms an atrial/posterior horn interface, and pressure-linked autonomic symptoms may be late to develop. Screening deficits will likely be minimal and therefore underreported. Objective/Aim: To present a thalamic–atrial/posterior horn tumor case with quantified load-sensitive cognitive–language–gait dysfunction and to detail a physiology-guided, sequence-driven decompression approach emphasizing ventricular relaxation and perforator-preserving, interface-limited thalamic resection. Case Presentation: A 56-year-old female patient experienced a 3-month, rapidly progressive decline in her cognitive and language abilities. The clinical progression was not stepwise or punctuated by a single “sentinel” event. She had a moderate level of cognitive impairment consistent with both Broca’s and Wernicke’s aphasias (MoCA: 22/30) and suffered from significant interference effects and increased cost of task-switching. Her ability to generate novel responses and name objects was significantly impaired; however, she was able to repeat words and phrases appropriately. In addition, she exhibited a severe sustained attention signature and a high error rate during dual-task performance, indicating severe gait instability, although her overall global anchors were nearly neutral (GCS 15; FOUR 15/16; NIHSS 2). Nausea and vomiting occurred simultaneously with the cognitive and language decline, suggesting decreased intracranial compliance. MRI revealed a heterogeneous left-sided thalamic tumor extending into the posterior horn of the lateral ventricle. The tumor caused deformation of the lateral ventricle and midline displacement. The patient underwent microsurgical intervention using a physiology-conscious sequence of graded cerebrospinal fluid (CSF) equilibration and primary mechanical removal of the tumor from the ventricular system. Additionally, decompression of the thalamus was performed in a manner that was cognizant of the boundaries formed by the perforating arteries of the thalamus. Early resolution of pressure symptoms was noted postoperatively. Objective measures demonstrated significant improvement in the patient’s executive functioning, language skills, attentional errors, and dual-task performance stability. The patient remained functionally independent at discharge and at subsequent follow-up visits. Surveillance imaging did not demonstrate any evidence of tumor recurrence. Conclusions: The clinical presentation described above is supportive of a model in which the synergy between deep network damage and distortion of the posterior ventricular compartment amplifies network dysfunction. Additionally, the use of quantitative stress-phenotyping makes it possible to identify deep network pathology early in its course. Finally, the physiology-guided decompression approach that was used in this case has the potential to increase functional reserve in patients with pathology that requires millimeter transitions. Full article

(This article belongs to the Special Issue Brain/Neuroimaging 2025–2026)

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17 pages, 1110 KB

Open AccessCase Report

Giant Right Sphenoid Wing Meningioma as a Reversible Frontal Network Lesion: A Pseudo-bvFTD Case with Venous-Sparing Skull-Base Resection

by Valentin Titus Grigorean, Octavian Munteanu, Felix-Mircea Brehar, Catalina-Ioana Tataru, Matei Serban, Razvan-Adrian Covache-Busuioc, Corneliu Toader, Cosmin Pantu, Alexandru Breazu and Lucian Eva

Diagnostics 2026, 16(2), 224; https://doi.org/10.3390/diagnostics16020224 - 10 Jan 2026

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Abstract

Background and Clinical Significance: Giant sphenoid wing meningiomas are generally viewed as skull base masses that compress frontal centers and their respective pathways gradually enough to cause a dysexecutive–apathetic syndrome, which can mimic primary neurodegenerative disease. The aim of this report is [...] Read more.

Background and Clinical Significance: Giant sphenoid wing meningiomas are generally viewed as skull base masses that compress frontal centers and their respective pathways gradually enough to cause a dysexecutive–apathetic syndrome, which can mimic primary neurodegenerative disease. The aim of this report is to illustrate how bedside phenotyping and multimodal imaging can disclose similar clinical presentations as surgically treatable network lesions. Case Presentation: An independent, right-handed older female developed an incremental, two-year decline of her ability to perform executive functions, extreme apathy, lack of instrumental functioning, and a frontal-based gait disturbance, culminating in a first generalized seizure and a newly acquired left-sided upper extremity pyramidal sign. Standardized neuropsychological evaluation revealed a predominant frontal-based dysexecutive profile with intact core language skills, similar to behavioral-variant frontotemporal dementia (bvFTD). MRI demonstrated a large, right fronto-temporo-basal extra-axial tumor attached to the sphenoid wing with homogeneous postcontrast enhancement, significant vasogenic edema within the frontal projection pathways, and a marked midline displacement of structures with an open venous pathway. With the use of a skull-base flattening pterional craniotomy with early devascularization followed by staged internal debulking, arachnoid preserving dissection, and conservative venous preservation, the surgeon accomplished a Simpson Grade I resection. Sequential improvements in the patient’s frontal “re-awakening” were demonstrated through postoperative improvements on standardized stroke, cognitive and functional assessment scales that correlated well with persistent decompression and symmetric ventricles on follow-up images. Conclusions: This case illustrates the possibility of a non-dominant sphenoid wing meningioma resulting in a pseudo-degenerative frontal syndrome and its potential for reversal if recognized as a network lesion and treated with tailored, venous-sparing skull-base surgery. Contrast-enhanced imaging and routine frontal testing in atypical “dementia” presentations may aid in identifying additional patients with potentially surgically remediable cases. Full article

(This article belongs to the Special Issue Brain/Neuroimaging 2025–2026)

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4 pages, 1478 KB

Open AccessInteresting Images

Vestibulocochlear Neuritis as a Paradoxical Reaction in an Immunocompetent Patient with Tuberculous Meningitis

by Sekai Tsujimoto, Koji Hayashi, Mamiko Sato, Yuka Nakaya, Toyoaki Miura and Yasutaka Kobayashi

Diagnostics 2025, 15(24), 3179; https://doi.org/10.3390/diagnostics15243179 - 12 Dec 2025

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Abstract

A 30-year-old previously healthy man presented with fever and headache. HIV tests yielded negative results. Cerebrospinal fluid (CSF) analysis revealed pleocytosis (619/µL), elevated protein (210.3 mg/dL) and adenosine deaminase levels, and decreased glucose levels. A positive CSF culture for tuberculosis confirmed the patient [...] Read more.

A 30-year-old previously healthy man presented with fever and headache. HIV tests yielded negative results. Cerebrospinal fluid (CSF) analysis revealed pleocytosis (619/µL), elevated protein (210.3 mg/dL) and adenosine deaminase levels, and decreased glucose levels. A positive CSF culture for tuberculosis confirmed the patient had tuberculous meningitis (TBM). He was treated with methylprednisolone, isoniazid, rifampicin, pyrazinamide, and ethambutol (all highly sensitive). His compliance with medication was good. After six weeks of treatment, he was discharged in stable condition. Eight weeks after onset, he was readmitted with vertigo and right deafness. CSF examination showed worsened pleocytosis (819/µL) and protein levels (4296.1 mg/dL). Contrast-enhanced MRI revealed enhancement of meninges in the brainstem and spinal cord as well as the right vestibulocochlear nerve. No brain abscesses were observed. Based on these findings, a paradoxical reaction (PR) with vestibulocochlear neuritis following antituberculous therapy initiation was suspected. He received oral prednisolone, leading to rapid resolution of vestibulocochlear symptoms within two days. Although cranial nerve enhancement due to PR has been mentioned in the literature, specific imaging demonstrating it is scarce. This case highlights PR as a cause of cranial neuropathy in TBM and provides clear radiological evidence of direct inflammatory spread to the vestibulocochlear nerve, bridging a gap in the current literature. Full article

(This article belongs to the Special Issue Brain/Neuroimaging 2025–2026)

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20 pages, 2289 KB

Open AccessCase Report

Anatomically Precise Microsurgical Resection of a Posterior Fossa Cerebellar Metastasis in an Elderly Patient with Preservation of Venous Outflow, Dentate Nucleus, and Cerebrospinal Fluid Pathways

by Nicolaie Dobrin, Felix-Mircea Brehar, Daniel Costea, Adrian Vasile Dumitru, Alexandru Vlad Ciurea, Octavian Munteanu and Luciana Valentina Munteanu

Diagnostics 2025, 15(24), 3131; https://doi.org/10.3390/diagnostics15243131 - 9 Dec 2025

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Abstract

Background and Clinical Significance: Adults suffering from cerebellar metastases are often at high risk for rapid deterioration of their neurological status because the posterior fossa has limited compliance and the location of these metastases are close to the brain stem and important [...] Read more.

Background and Clinical Significance: Adults suffering from cerebellar metastases are often at high risk for rapid deterioration of their neurological status because the posterior fossa has limited compliance and the location of these metastases are close to the brain stem and important cerebrospinal fluid (CSF) pathways. In this paper, we present a longitudinal, patient-centered report on the history of an elderly individual who suffered from cognitive comorbidities and experienced a sudden loss of function in her cerebellum. Our goal in reporting this case is to provide a comparison between the patient’s pre-operative and post-operative neurological examinations; the imaging studies she had before and after surgery; the surgical techniques utilized during her operation; and the outcome of her post-operative course in a way that will be helpful to other patients who have experienced a similar situation. Case Presentation: We report the case of an 80-year-old woman who initially presented with progressive ipsilateral limb-trunk ataxia, impaired smooth pursuit eye movement, and rebound nystagmus, but preserved pyramidal and sensory functions. Her quantitative bedside assessments included some of the components of the Scale for the Assessment and Rating of Ataxia (SARA), and a National Institute of Health Stroke Scale (NIHSS) score of 3. These findings indicated dysfunction of the left neocerebellar hemisphere and possible dentate nucleus involvement. The patient’s magnetic resonance imaging (MRI) results demonstrated an expansive mass with surrounding vasogenic edema and marked compression and narrowing of the exits of the fourth ventricle which placed the patient’s CSF pathways at significant risk of occlusion, while the aqueduct and inlets were patent. She then underwent a left lateral suboccipital craniectomy with controlled arachnoidal CSF release, preservation of venous drainage routes, subpial corticotomy oriented along the lines of the folia, stepwise internal debulking, and careful protection of the cerebellar peduncles and dentate nucleus. Dural reconstruction utilized a watertight pericranial graft to restore the cisternal compartments. Her post-operative intensive care unit (ICU) management emphasized optimal venous outflow, normoventilation, and early mobilization. Histopathology confirmed the presence of metastatic carcinoma, and staging suggested that the most likely source of the primary tumor was the lungs. Immediately post-operation, computed tomography (CT) imaging revealed a smooth resection cavity with open foramina of Magendie and Luschka, intact contours of the brain stem, and no evidence of bleeding or hydrocephalus. The patient’s neurological deficits, including dysmetria, scanning dysarthria, and ataxic gait, improved gradually during the first 48 h post-operatively. Upon discharge, the patient demonstrated an improvement in her limb-kinetic subscore on the International Cooperative Ataxia Rating Scale (ICARS) and demonstrated independent ambulation. At two weeks post-operation, CT imaging revealed decreasing edema and stable cavity size, and the patient’s modified Rankin scale had improved from 3 upon admission to 1. There were no episodes of CSF leakage, wound complications, or new cranial nerve deficits. A transient post-operative psychotic episode that was likely secondary to her underlying Alzheimer’s disease was managed successfully with short-course pharmacotherapy. Conclusions: The current case study demonstrates the value of anatomy-based microsurgical planning, preservation of venous and CSF pathways, and targeted peri-operative management to facilitate rapid recovery of function in older adults who suffer from cerebellar metastasis and cognitive comorbidities. The case also demonstrates the importance of early multidisciplinary collaboration to allow for timely initiation of both adjuvant stereotactic radiosurgery and molecularly informed systemic therapy. Full article

(This article belongs to the Special Issue Brain/Neuroimaging 2025–2026)

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12 pages, 4734 KB

Open AccessCase Report

Another Rare Cause of Hypertrophic Olivary Degeneration Following Cavernous Malformation Hemorrhage: A Case Report

by Sigita Skrastiņa, Marija Roddate, Kristaps Rancāns, Evija Miglāne, Aleksandrs Kalniņš and Arturs Balodis

Diagnostics 2025, 15(16), 2048; https://doi.org/10.3390/diagnostics15162048 - 15 Aug 2025

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Abstract

Introduction: Hypertrophic olivary degeneration (HOD) is a rare form of trans-synaptic degeneration involving the Guillain–Mollaret triangle, characterized by enlargement of the inferior olivary nucleus—unlike the atrophy typical of most neurodegenerative processes. It is usually associated with stroke, surgical injury, or demyelination, but [...] Read more.

Introduction: Hypertrophic olivary degeneration (HOD) is a rare form of trans-synaptic degeneration involving the Guillain–Mollaret triangle, characterized by enlargement of the inferior olivary nucleus—unlike the atrophy typical of most neurodegenerative processes. It is usually associated with stroke, surgical injury, or demyelination, but rarely follows hemorrhage from a cavernous malformation (CM). This report presents a case of HOD secondary to a mesencephalic CM hemorrhage, with emphasis on imaging findings and diagnostic considerations. Case Description: A 55-year-old woman presented with acute-onset, right-sided facial, torso, and limb hypoesthesia, along with gait instability. Neurological examination revealed sensory impairment in the right maxillary (V2) and mandibular (V3) trigeminal territories, as well as diminished pain and temperature sensation throughout the right hemibody. MRI revealed a hemorrhage in the posterior mesencephalon near the left red nucleus, leading to the diagnosis of a CM with an associated venous angioma. She was managed conservatively and improved clinically. Six months later, MRI showed hypertrophy and T2/FLAIR hyperintensity of the left inferior olive, consistent with developing HOD. At 1.5 years follow-up, olivary enlargement had progressed—now consistent with stage 2 HOD—and a bilateral palatal tremor was observed, more pronounced on the right side. DTI revealed asymmetric volume loss in the left brainstem fiber pathways at the level of the medulla oblongata, confirming trans-synaptic degeneration. Conclusions: This case highlights HOD as a rare but important complication of mesencephalic CM hemorrhage. Recognition of its characteristic imaging features—olivary hypertrophy with persistent T2/FLAIR hyperintensity—is essential for accurate diagnosis. DTI supports the trans-synaptic mechanism, helping distinguish HOD from other pathologies and preventing unnecessary investigations. Full article

(This article belongs to the Special Issue Brain/Neuroimaging 2025–2026)

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14 pages, 2045 KB

Open AccessCase Report

Fast Evolving Glioblastoma in a Pregnant Woman: Diagnostic and Therapeutic Challenges

by Ivan Bogdanovic, Rosanda Ilic, Aleksandar Kostic, Aleksandar Miljkovic, Filip Milisavljevic, Marija M. Janjic, Ivana M. Bjelobaba, Danijela Savic and Vladimir Bascarevic

Diagnostics 2025, 15(15), 1836; https://doi.org/10.3390/diagnostics15151836 - 22 Jul 2025

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Background and Clinical Significance: Gliomas diagnosed during pregnancy are rare, and there are no established guidelines for their management. Effective treatment requires a multidisciplinary approach to balance maternal health and pregnancy preservation. Case Presentation: We here present a case of rapidly progressing glioma [...] Read more.

Background and Clinical Significance: Gliomas diagnosed during pregnancy are rare, and there are no established guidelines for their management. Effective treatment requires a multidisciplinary approach to balance maternal health and pregnancy preservation. Case Presentation: We here present a case of rapidly progressing glioma in a 33-year-old pregnant woman. The patient initially presented with a generalized tonic–clonic seizure at 21 weeks’ gestation. Imaging revealed a tumor in the right cerebral lobe, involving both cortical and subcortical structures, while magnetic resonance spectroscopy suggested a low-grade glioma. The patient remained clinically stable for two months but then developed severe headaches; MRI showed a worsening mass effect. At 34 weeks’ gestation, an emergency and premature caesarean section was performed under general anesthesia. The patient then underwent a craniotomy for maximal tumor resection, which was histologically and molecularly diagnosed as IDH wild-type glioblastoma (GB). Using qPCR, we found that the GB tissue showed upregulated expression of genes involved in cell structure (GFAP, VIM) and immune response (SSP1, TSPO), as well as increased expression of genes related to potential hormone response (AR, CYP19A1, ESR1, GPER1). After surgery, the patient showed resistance to Stupp protocol therapy, which was substituted with lomustine and bevacizumab combination therapy. Conclusions: This case illustrates that glioma may progress rapidly during pregnancy, but a favorable obstetric outcome is achievable. Management of similar cases should respect both the need for timely treatment and the patient’s informed decision. Full article

(This article belongs to the Special Issue Brain/Neuroimaging 2025–2026)

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