The causes for pseudoachalasia include primary malignancy of esophagus or gastroesophageal junction, 53.9%, secondary malignancies such as metastasis from lung or breast, 14.9%, benign disorders like mesenchymal tumors, secondary amyloidosis and peripheral neuropathy, 12.6%, and as a postoperative complication following antireflux surgery, 11.9%. Other rare causes are neurological disorders like meningomyelocele, brain metastasis, infiltration by lymphoma and paraneoplastic syndromes associated with small cell carcinoma lung, bronchial carcinoids and pleural mesothelioma.
Tuesday, December 29, 2009
Sunday, December 27, 2009
Saturday, December 19, 2009
Two year old male boy presented with recurrent episodes of transient ischemic attacks since the age of 6 months following which he has delayed milestones. The boy also has seizures since one year. He was referred to MRI brain for further evaluation.
Figure a) T1weighted image at the level of basal ganglia show multiple tiny low intensity rounded areas seen in bilateral basal ganglia (arrows) which appear hyperintense on T2 weighted images suggestive of collateral vessels. c) Fluid attenuation inversion recovery (FLAIR) sequence showing atrophy involving bilateral frontal and left parietal cortical areas with chronic ischemic changes. d) Volume rendered 3D time of flight frontal projection cerebral angiography showing significant stenosis in the supraclinoid internal carotid arteries on both the sides with absent flow in the anterior and middle cerebral arteries and multiple collaterals in bilateral basal ganglia appearing as “puff of smoke” (moyamoya). Cause is unknown in this boy.
- Hoffman HJ. Moyamoya disease and syndrome. Clin Neurol Neurosurg1997; 99 Suppl 2 : S39-44
- Gosalakkal JA. Moyamoya disease: a review. Neurol India. 2002 Mar;50(1):6-10.
- Fujisawa I, Asato R, Nishimura K, Togashi K, Itoh K, Noma S, et al. Moyamoya disease: MR imaging. Radiology. 1987 Jul;164(1):103-5.