|
|
| Line 67: |
Line 67: |
|
| |
|
|
| |
|
| Potenziali Evocati Motori della radice trigeminale | | =====Potenziali Evocati Motori della radice trigeminale===== |
| | [[File:Meningioma 3 by Gianni Frisardi.jpg|thumb|'''Figura 3:''' Risposta evocata dalle due radici trigeminali.]]Nel nostro laboratorio di neurofisiologia masticatoria abbiamo messo a punto una tecnica di elettrostimolazione trasncraniale elettrica delle due radici trigeminali in simultanea e sincronizzate con lo stimolo elettrico. Nei vari capitoli già pubblicati sono riportati alcune informazioni tecniche sul metodo ma ci ripromettiamo di esporli in modo esaustivo nella sezione 'Scienza straordinaria' Un questa sede possiamo solo considerare e confermare una asimmetria notevole di ampiezza delle risposte evocate motorie come mostrato in figura 3. I markers 1A e 2A indicano la latenza che a differenza del periodo silente è simmetrica e questo dato conferma che il danno strutturale riguarda le fibre sensitive comprese quelle propriocettive dai muscoli masticatori. |
|
| |
|
| Potenziali Evocati Motori della radice trigeminale
| | Possiamo a questo punto non solo confermare e giustificare la scelta neurologica del contesto diagnostico ma anche concludere con una pre diagnosi di danno neurologico cerebellare con coinvolgimento dell'area mesencefalica trigeminale. Contestualmente interrompiamo il riciclarsi dell'intervento riabilitativo protesico per indirizzare il paziente immediatamente al reparto radiologico per una Risonanza Magnetica dell'encefalo.<blockquote> |
|
| |
|
| [[File:Meningioma 3 by Gianni Frisardi.jpg|center|thumb|'''Figura 1:''' Ciclo di recupero del Riflesso Massetere Inibitorio (rcMIR)]] | | lesione espansiva solida con effetto massa, non è chiaro se abbia un’origine sopra o sotto tentoriale, sicuramente determina fenomeni compressivi sul mesencefalo - tronco e probabilmente sul quarto ventricolo con dilatazione delle cisterne e dei ventricoli a monte. Che si tratti di un meningioma è molto probabile perché non ha edema perilesionale.</blockquote> |
| <blockquote> | | <center> |
| | [[File:Meningioma 5 by Gianni Frisardi.jpg|center|500x500px]] Figura 4: |
| | </center> |
|
| |
|
| | ==='''Final considerations'''=== |
|
| |
|
| To simplify the examination, the rcMIR w<nowiki/>as evoked by electric<nowiki/>ally stimulating the left side only. The EMG responses correspond to the EMG tracings of the right masseter (Ch1) and left masseter (Ch2). Thus, on the traces, each marker indicates the channel number, while the letters indicate the sequences of latencies.
| |
|
| |
|
| *The S1 stimulus sp<nowiki/>lits the acquisition into pre and post analysis and generates the SPs and the AI.
| | As we can see from the 'Visual Cognitive gallery', the neurological context is enriched by the contribution deriving from the decryption of the machine language through the <sub>rc</sub>MIR (<math>\gamma_4</math>) test to definitively close the diagnosis with the MR report (<math>\gamma_5</math>). The diagnostic model Masticationpedia not only supports the doctor in complex diagnoses but above all it is an element of implementation of our basic knowledge <math>(Kb)</math>. It will be useful to represent this cognitive interpretation by correlating it to the images of the assertions of the neurological context. |
| | |
| *The stimulus S2 delivered 150 ms from S1, called interstimulus (IS), evokes the second SP sequence and the IA.
| |
| | |
| *The SP of S1 and S2 are determined automatically by the software which positions the markers on the first and last minimum value elaborated on the traces for the generation of SP1 and SP2, and contextually calculates their duration. The IA duration is calculated between the last minimum value of SP1 and the first minimum value of SP2.
| |
| </blockquote> | |
| In the tested subject the S2 stimulus was able to evoke both SPs, while in a normal subject the S2 stimulus is normally able to evoke only the SP1 or at most one SP2 of reduced duration. As shown in Table 2, the duration of S2-evoked SP1 was found to be very stable, with no significant differences in the duration of S1-generated SP1 (Δ= -1ms for Ch1 and Δ= -2 ms for Ch2) while the from S2 on the right and left masseter (61 ms and 54 ms, respectively) was longer than that evoked by S1 (39 ms and 35 ms, respectively). The differences were +22 ms for Ch1 (right masseter) and +19 ms for Ch2 (left masseter). Consequently, the duration of the AI showed clear differences between S2 and S1. The duration of the S2-evoked AI was 12 ms vs. 23 ms of S1 stimulus for the right masseter (Ch1) and 17 ms vs 30 ms of S1 for the left masseter (Ch2) with a difference between the responses evoked by S2 minus S1 of -11 ms and -13 ms, respectively.
| |
|
| |
|
| <Center> | | <Center> |
| Line 92: |
Line 89: |
| File:Meningioma 5 by Gianni Frisardi.jpg|'''Figura 4:''' Presenza di un meningioma nella base crani di diametro 8 cm | | File:Meningioma 5 by Gianni Frisardi.jpg|'''Figura 4:''' Presenza di un meningioma nella base crani di diametro 8 cm |
| </gallery> | | </gallery> |
| </Center>
| |
|
| |
|
| |
| {{Q2|The test showed a high speed of recovery of the synaptic responses of the trigeminal system, index of neuronal hyperexcitability. This led the clinician to urgently request an MRI of the brain to define the correct diagnosis.}}
| |
|
| |
| ====3rd Step: brain MNR====
| |
| MRI of the brain, using Turbo Spin Echo, Fluid Attenuated Inversion Recovery, and Gradient Echo sequences, was conducted before and after intravenous administration of contrast medium. Results showed the presence of a roundish area of approximately 1.5 cm in diameter located in the vicinity of the quadrigeminal cistern at the level of the pineal gland. There was also a slight dilation of the supratentorial ventricular system, which appeared in the axis and was most evident in the proximity of the temporal horns, with a periventricular rim with a transependymal fluid absorption phenomenon.<ref>Peter H Yang, Alison Almgren-Bell, Hongjie Gu, Anna V Dowling, Sangami Pugazenthi, Kimberly Mackey, Esther B Dupépé, Jennifer M Strahle. Etiology- and region-specific characteristics of transependymal cerebrospinal fluid flow. J Neurosurg Pediatr. 2022 Aug 12;1-11. doi: 10.3171/2022.7.PEDS2246. Online ahead of print.</ref> The signal characteristics of the formation suggested a provisional diagnosis of pineal cavernoma. (Figures 2 and 3)
| |
|
| |
| <center></center>
| |
|
| |
|
| |
| {{Q2|Definitive diagnosis: Pineal cavernoma}}
| |
|
| |
| ==='''Final considerations'''===
| |
|
| |
|
| |
| As we can see from the 'Visual Cognitive gallery', the neurological context is enriched by the contribution deriving from the decryption of the machine language through the <sub>rc</sub>MIR (<math>\gamma_4</math>) test to definitively close the diagnosis with the MR report (<math>\gamma_5</math>). The diagnostic model Masticationpedia not only supports the doctor in complex diagnoses but above all it is an element of implementation of our basic knowledge <math>(Kb)</math>. It will be useful to represent this cognitive interpretation by correlating it to the images of the assertions of the neurological context.
| |
|
| |
|
| <center></center>
| |
|
| |
|
| <center></center>
| |
|
| |
|
|
| |
|