Fellow’s choices:

G. Zuccoli, D. Santa Cruz, M. Bertolini, A. Rovira, M. Gallucci, C. Carollo, and N. Pipitone
MR Imaging Findings in 56 Patients with Wernicke Encephalopathy: Nonalcoholics May Differ from Alcoholics.
AJNR Am J Neuroradiol first published on October 22, 2008 as doi: 10.3174/ajnr.A1280

As neuroradiologists we are familiar with the MRI findings of Wernicke’s particularly as seen in alcoholic patients. It is becoming clear that this disease may be seen in patients with inadequate intake of vitamin B1, something that may happen particularly in the elderly. In this large series, the authors compared the imaging findings between 32 non-alcoholics and 24 alcoholic Wernicke patients. They found that the typical abnormalities seen in the mamillary bodies were present in alcoholics while atypical findings were seen in non-alcoholic patients.

J. Takanashi, H. Tada, H. Terada, and A.J. Barkovich
Excitotoxicity in Acute Encephalopathy with Biphasic Seizures and Late Reduced Diffusion.
AJNR Am J Neuroradiol first published on August 13, 2008 as doi: 10.3174/ajnr.A1247

This case report (3 patients) describes a fairly new entity: acute encephalopathy secondary to biphasic seizures and late reduced diffusion. To develop this entity patients need to have a prolonged initial febrile seizure followed by multiple secondary seizures on days 4 to 6. Diffuse white matter abnormalities with restricted ADC develop on days 3-9 and thereafter disappear. In this study, MRS showed elevation of glutamate/glutamine in these patients in the subacute phase. Thus, it possible that excitotoxic damage is involved in this newer entity.

R. Kapur, A.R. Sepahdari, M.F. Mafee, A.M. Putterman, V. Aakalu, L.J.A. Wendel, and P. Setabutr
MR Imaging of Orbital Inflammatory Syndrome, Orbital Cellulitis, and Orbital Lymphoid Lesions: The Role of Diffusion-Weighted Imaging .
AJNR Am J Neuroradiol first published on November 6, 2008 as doi: 10.3174/ajnr.A1315

Conventional imaging techniques generally fail to distinguish between inflammatory and lymphoid orbital diseases. Making this differentiation is important because these diseases are treated differently. The authors evaluated T1, T2, DWI and ADC in patients with orbital lesions and found that lymphoid lesions had lower ADC than inflammatory syndrome and cellulitis. They concluded that DWI may helpful in initially triaging the patients toward appropriate therapies

Editor’s choices:

R. Habibi, M.M. Lell, R. Steiner, S.G. Ruehm, J.W. Sayre, K. Nael, and J.P. Finn
High-Resolution 3T MR Angiography of the Carotid Arteries: Comparison of Manual and Semiautomated Quantification of Stenosis.
AJNR Am J Neuroradiol first published on October 8, 2008 as doi: 10.3174/ajnr.A1302

Contrast enhanced MRA of the carotid arteries in the neck has an exquisite resolution. The authors evaluated three different semiautomated tools against manual measurements of stenosis. They concluded that their automated approaches allowed for accurate assessments of arterial dimensions as seen on contrast enhanced MRI at least for diameter measurements according to the NASCET criteria.

S.-H. Im, M.H. Han, O.-K. Kwon, B.J. Kwon, S.H. Kim, J.E. Kim, and C.W. Oh
Endovascular Coil Embolization of 435 Small Asymptomatic Unruptured Intracranial Aneurysms: Procedural Morbidity and Patient Outcome.
AJNR Am J Neuroradiol first published on September 3, 2008 as doi: 10.3174/ajnr.A1290

In this article the authors defined small aneurysms as those having less than 7 mm in diameter. This rather large series (370 patients harboring 435 such aneurysms) looked at their procedure-related morbidity/mortality, immediate and short term angiographic results and clinical outcomes. Initial occlusion was complete (N = 334), near complete (N = 87) or incomplete (N = 22). They had 44 procedure-related complications but only one lead to a persistent neurological deficit. They concluded that endovascular treatment showed good short term results with low risk.

V. Panagiotopoulos, E. Gizewski, S. Asgari, J. Regel, M. Forsting, and I. Wanke
Embolization of Intracranial Arteriovenous Malformations with Ethylene-Vinyl Alcohol Copolymer (Onyx).
AJNR Am J Neuroradiol first published on October 8, 2008 as doi: 10.3174/ajnr.A1314

Although embolization of cerebral AVMs with adhesives is a frequently used method of treatment it is not clear which embolic material is best. In the article, the authors embolized 82 AVM patients with Onyx and analyzed their results with respect to degree of obliteration and complications. They achieved complete cure in 24% of their patients with a morbidity of 3.8% and mortality of 2.4%. They concluded that although initial complete obliteration may be successful, morbidomortality should be further assessed.