Online dating cosimo grasso

Online dating cosimo grasso

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Vincenzo G Grasso is a resident of NY. Lookup the home address and phone and other contact details for this person Five-act Renaissance comedy in Italian prose, first performed in to celebrate the marriage of Duke Cosimo I and Eleonora of Toledo, online dating cosimo grasso. This ed.

contains the "intermedi", and also gives details of online dating cosimo grasso costumes and musical instruments used in the performance. Differential diagnosis of brainstem lesions, either isolated or in association with cerebellar and supra-tentorial lesions, can be challenging, online dating cosimo grasso. Knowledge of the structural organization is crucial for the differential diagnosis and establishment of prognosis of pathologies with involvement of the brainstem, online dating cosimo grasso.

Familiarity with the location of the lesions in the brainstem is essential, especially in the pediatric population. Magnetic resonance imaging MRI is the most sensitive and specific imaging technique for diagnosing disorders of the posterior fossa and, particularly, the brainstem, online dating cosimo grasso.

High magnetic static field MRI allows detailed visualization of the morphology, signal intensity and metabolic content of the brainstem nuclei, together with visualization of the normal development and myelination. In this pictorial essay we review the brainstem pathology in pediatric patients and consider the MR imaging patterns that may help the radiologist to differentiate among vascular, toxico-metabolic, infective-inflammatory, degenerative and neoplastic processes, online dating cosimo grasso.

Helpful MR tips can guide the differential diagnosis: These include the location and morphology of lesions, the brainstem vascularization territories, gray and white matter distribution and tissue selective vulnerability. Core tip: Magnetic resonance imaging differential diagnosis of online dating cosimo grasso lesions in children is depicted with an anatomical-based pictorial online dating cosimo grasso approach, online dating cosimo grasso.

The brainstem is the portion of the neuraxis that connects the brain to the spinal cord and cerebellum. It is cranio-caudally made up of diencephalon-midbrain, pons, and medulla.

The gray matter of the brain stem is grouped in clusters, some of which form the nuclei of the cranial nerves[ 1 ], online dating cosimo grasso. The white matter is composed by the axons of descending and ascending pathways connecting the neurons of the cerebral cortex with the spinal cord, the cerebellum, and the brainstem gray matter nuclei.

In the sagittal and axial view, the brainstem may be subdivided into 3 laminae, which extend throughout its entire length. From the dorsal to ventral side, online dating cosimo grasso, these laminae are called tectum, tegmentum, and basis[ online dating cosimo grasso ].

The tectum is the quadrigeminal plate in the midbrain, the superior medullary velum in the pons and the inferior medullary velum in the medulla oblongata.

The basis is the ventral lamina and contains the pyramidal descending pathways cortico-bulbar and cortico-spinal tracts ; at the level of the pons it reaches its largest size due to the presence of numerous central nuclei pontine nuclei that receive numerous fibers projecting to the cerebellum.

The tegmentum is placed between the tectum and basis and is divided into 2 layers: The dorsal one contains online dating cosimo grasso the somato-motor and general sensory cranial nerve nuclei while the ventral one contains the supplementary motor nuclei the substantia nigra and red nucleus in the midbrain and the inferior olivary nucleus in the medulla. The sensory tracts or lemniscus cross the rest of the tegmentum and are surrounded by the reticular online dating cosimo grasso 1 ].

Also, the pratique ductal gray matter, surrounding the Sylvian acqueduct and 4 th ventricle needs to be mentioned. Thus, in respect to the other portions online dating cosimo grasso the neuraxis, the gray and white matter of the brainstem are intermingled within each other making the topography of lesions challenging. The conventional MR imaging protocol in children should be adapted to the age of the patient and acquisition volumes should cover the whole brain down to the foramen magnum.

T2 weighted sequences perform better than fluid attenuated inversion recovery FLAIR images for detecting posterior fossa T2 hyperintense lesions, with an increase of sensitivity using multiplanar images[ 2 ]. FLAIR sequences are online dating cosimo grasso not useful in less than 12 mo old online dating cosimo grasso.

Optimized online dating cosimo grasso brain MR imaging protocols are described in detail in Table 1 1. A common feature of brainstem lesions is signal hyperintensity on turbo spin-echo T2-weighted T2W images; these lesions may be focal or diffuse and span from partial to complete involvement online dating cosimo grasso the axial planes and across multiple levels cranio-caudally[ 34 ]. Especially in children, on the sole basis of signal intensity it is not possible to differentiate acute and chronic lesions neither lesions of different etiology.

Moreover, online dating cosimo grasso, in the case of chronic metabolic or inflammatory diseases, acute lesions may develop on a pattern of chronic damage and make the interpretation of findings challenging.

In this pictorial essay we review the brainstem pathology in pediatric patients and consider the MR imaging patterns that may help the radiologist to differentiate among vascular, toxic-metabolic, infective-inflammatory and neoplastic processes. Helpful MR tips can guide the differential diagnosis: These include the knowledge of the brainstem vascularization territories, gray and white matter distribution and tissue selective vulnerability.

Brainstem vascularization territories: In the transverse plane, paramedian, online dating cosimo grasso, short circumferential and long circumferential arteries originating from the vertebro-basilar arteries are known. Ischemic and septic emboli tend to pass along the arterial tree as far distally as their size permits in the terminal vascularisation of the brainstem[ 5 ]. The border zones of this arterial terminal vascularisation are located at the tegmentum, online dating cosimo grasso, especially in medulla and pons, and have been proposed as the most online dating cosimo grasso sites of hypoxic-ischemic injury in online dating cosimo grasso 67 ].

Gray and white matter topography: Gray matter nuclei in the brainstem intermingle within the white matter pathways. However, online dating cosimo grasso, most of the gray matter structures are deep and most of the white matter is peripheral in the brainstem due to the fibers packing of the pyramids anteriorly and of the superior, middle and inferior cerebellar peduncles laterally and posteriorly in the pons.

Thus, white matter diseases are expected to preferentially involve peripheral zones in the brainstem without a cranio-caudal specificity, online dating cosimo grasso. Tissue selective vulnerability: Gray matter nuclei are known to online dating cosimo grasso more vulnerable to metabolic insults because of higher metabolic demands as compared to the white matter.

Since the gray matter nuclei, especially the reticular formation, extend from midbrain to medulla oblongata, online dating cosimo grassoonline dating cosimo grasso, metabolic diseases do not show cranio-caudal specificity, online dating cosimo grasso, online dating cosimo grasso.

Online dating cosimo grasso tend to pass along the arterial tree as far distally as their size permits in the terminal vascularisation of the brainstem and may lead to T2 hyperintense CSF-like infarcts Figure 1.

A reduction in apparent diffusion coefficient ADC values can be seen between 3 h and 15 d online dating cosimo grasso onset of an arterial ischemic insult[ 9 ]. Due to the small size of the brainstem in children and to the known low sensitivity of echo planar imaging sequences in the posterior cranial fossa, false negatives online dating cosimo grasso frequent[ 10 ]. Ischemic lesions, when detected, are usually small in size and associated with faint T2 or FLAIR hyperintense lesions.

In these cases, however, hyperintense signal is still observed on diffusion weighted images acquired at elevated b values b or b Nevertheless, the brainstem is usually considered an ischemia-resistant site of the central nervous system and a high-density vessel network of collateral perforators is considered to confer resistance to ischemic insults in this region[ 9 ]. In the neonatal period, however, the development of this network may not be complete and children with hypoxic-ischemic encephalopathy in the perinatal period are susceptible to damage in the brainstem tegmentum[ 7 ], online dating cosimo grasso.

Tegmental lesions are columnar-shaped online dating cosimo grasso the coronal planes, bilateral and usually symmetrical, with specific involvement of caudal pons and medulla oblongata and are associated with oral motor dysfunction and gavage feeding[ 7 ] Figure 2.

Vascular malformations also are encountered in the brainstem of children. These include low flow malformations such as developmental venous anomaly, cavernous hemangioma and capillary telangiectasia and high flow malformations such as arterio-venous malformation. The MRI pattern is characteristic for each online dating cosimo grasso these online dating cosimo grasso entities and commonly the diagnosis is not challenging, online dating cosimo grasso.

The MR signal intensity and morphology at conventional online dating cosimo grasso are identical to those observed in the adult population[ 3 ]. Among syndromes related to genetic inborn errors of metabolism, mitochondrial encephalopathies are the most frequent affecting the brainstem. Mitochondrial diseases include a wide range of clinical syndromes associated with deficits of the oxidative phosphorylation, caused by partial or complete deficits of one or more enzymatic complexes of online dating cosimo grasso respiratory chain[ 12 ].

Hereditary transmission may be autosomal recessive, autosomal dominant, online dating cosimo grassoX-linked or maternal[ 13 ], online dating cosimo grasso. The defect of the online dating cosimo grasso respiratory chain may, in fact, online dating cosimo grassobe caused by genetic mutations of either nuclear DNA online dating cosimo grasso mitochondrial DNA[ 14 - 17 ].

Metabolic vulnerability is an important issue for the involvement of the brainstem in these diseases[ 18 ]: In fact, cells and tissues with high metabolic demand are more susceptible to specifically incur damage due to their inability or incomplete ability to reduce oxygen and finally produce ATP energy molecules[ 19 ].

The clinical presentation of these diseases is multi-systemic because different tissues and organs are involved, online dating cosimo grasso. The diagnosis is challenging due to the extreme genetic and phenotypic heterogeneity, online dating cosimo grasso, online dating cosimo grasso. Due to their pathogenesis, the brainstem lesions are symmetrical, online dating cosimo grasso, sometimes confined to the same specific location bilaterally.

The substantia nigra, mainly the online dating cosimo grasso reticulata, the medullary and pontine tegmentum and the inferior colliculi are reported as the most frequent sites[ 20 ]. The inferior olivary nuclei are often online dating cosimo grasso, although this is not seen in children who die before 1 year of age[ 20 ]. The loss of Purkinje cells and cerebellar involvement is, in fact, more characteristic of other mitochondrial encephalopathies such as myoclonic epilepsy with ragged-red fibers MERRFmitochondrial encephalopathy, lactic acidosis and stroke-like episodes MELAS online dating cosimo grasso Kearns-Sayre syndrome[ 23 ].

However, online dating cosimo grasso, differential diagnosis may be challenging because brainstem lesions have been described in these other mitochondrial disease, such as the involvement of the periacqueduttal gray matter and the superior cerebellar peduncles in MERRF[ 24 ], the bilateral medullary tegmentum in Kearns-Sayre syndrome[ 25 ] or brainstem infarct-like lesions that do not respect vascular territories in MELAS[ 26 ].

One recently identified multisystem mitochondrial disease with specific involvement of specific white matter tracts is the Leukoencephalopathy with Brainstem and Spinal cord involvement and Lactate elevation online dating cosimo grasso is consequent to mutations in the DARS2 online dating cosimo grasso encoding the mitochondrial aspartyl-tRNA synthetase[ ].

In this syndrome, the MRI pattern of bilateral and symmetric involvement of white matter of medial lemniscus and pyramids, dorsal columns, online dating cosimo grasso, superior and inferior cerebellar peduncles, cerebellar white matter, online dating cosimo grasso, associated with elevated lactate in magnetic resonance spectroscopy is specific, diagnostic and helpful for genetic characterization[ 28 ].

Among metabolic syndromes involving the brainstem, the central pontine myelinolysis, online dating cosimo grasso, is the Online dating cosimo grasso feature of the osmotic demyelination syndrome, a metabolic syndrome occurring in patients who experience severe alterations of plasma osmolality or receive rapid correction of hyponatremia[ 29 ]. The T2 hyperintensity specifically involves the central pons with signal changes related to alteration of the integrity of the myelin sheaths but not of the axons.

The signal alteration may extend cranially to the midbrain and laterally to the middle cerebellar peduncles[ 29 ]. When extra-pontine myelinolisis is associated, online dating cosimo grassobilateral and symmetric T2 hyperintensity of the basal ganglia is observed[ 22 ], online dating cosimo grasso. This condition is transient and, if the correct steady state of osmolality is established, the lesion tends to completely resolve.

Despite the underlying mechanisms of this condition are still under debate and investigation, online dating cosimo grassothe MRI alterations are greatest at 3 to 6 mo after the beginning of treatment and reversible in nature[ 30 ] Figure 8. The terms rhombo-encephalitis and brainstem encephalitis are interchangeably used and referred to the involvement of infra-tentorial structures brainstem and cerebellum in the former and brainstem only in the latter in the context of an inflammatory disease, either infectious, autoimmune or paraneoplastic.

The most frequent agents associated with involvement of the brainstem are Listeria monocytogenes and enterovirus 71, followed by herpes simplex viruses[ 32 ].

MRI findings in these pathological conditions are not specific; lesions are usually multiple, patchy and asymmetric hyperintense on T2 weighted images and are not typically associated with T1 contrast enhancement Figure online dating cosimo grasso. Selective vulnerability of the substantia nigra has been shown for some specific viral encephalitides St, online dating cosimo grasso.

Louis encephalitis and Japanese encephalitis [ ]. Patchy enhancement and abscess formation with ring enhancement after contrast agent injection can be observed at all levels of the brainstem in Listeria monocytogenes infection[ 35 ] and in the miliary pattern of tuberculosis[ 36 ] due to the formation of abscesses Figure Abscesses are mainly located at the pons online dating cosimo grasso show a faint T2 hyperintensity due to vasogenic edema.

The central portion of the lesions may be iso- or hyperintense on T2 weighted images[ 37 ]. In the case of tuberculomas, the signal of the central portion is hypointense on T2 weighted images[ 38 ]. Due to the hematogenous spread, abscesses usually show a distribution resembling the arterial embolic strokes. When there is a clinical suspicion of infection, online dating cosimo grasso, diagnosis may be reached by measuring the levels of antibodies, by blood and CSF culture tests.

For viral encephalitides, polymerase chain reaction allows to demonstrate the presence of viral DNA in the CSF. Brainstem lesions in the course of encephalitis may be associated with supra-tentorial alterations, in some cases with specific symmetric and bilateral involvement of the basal ganglia[ 22 ] Figure 9. After the demonstration of the pathogenetic role of immunoglobulin G anti-ganglioside GQ1b antibodies, patients with a clinical presentation ranging from ophtalmoplegia and ataxia to altered consciousness and areflexia, previously described as Miller-Fisher syndrome or Bickerstaff encephalitis or Guillan-Barrè syndrome were classified as affected of an unique anti-GQ1b antibody syndrome[ 40 - 42 ], with variable central and peripheral nervous system involvement.

In these syndromes, immune cross-reaction seems to be triggered by previous exposure to Campylobacter jejuni[ 42 ] and Mycoplasma pneumoniae[ 43 ]. Bickerstaff encephalitis may mimic a glioma: Metabolic profile at MR spectroscopy, MRI re-evaluation after corticosteroid treatment and CSF levels of online dating cosimo grasso autoantibodies guide the differential diagnosis Figure After common viral infections such as influenza A, influenza B, parainfluenza II, human herpes virus 6, coxsackie virus or enterovirus, a rapidly progressive encephalopathy known as acute necrotizing encephalopathy ANE may occur in otherwise healthy children[ 44 ].

Both familiar and sporadic forms have developed in patients harboring missense mutations of the nuclear pore gene Ran-binding 2[ 45 ] Figure ANE is considered different from Acute Disseminated Encephalomyelitis ADEM. ADEM is, online dating cosimo grasso, in most of the cases, a monophasic and multifocal inflammatory disease that has a typical temporal relationship with an infection or a vaccination occurred 1 to 3 wk before the clinical onset[ ].

Brainstem lesions have a MR appearance indistinguishable from online dating cosimo grasso of multiple sclerosis lesions; however, in patients with ADEM there is a higher frequency of midbrain lesions and lesions are more symmetrical and bilateral than in patients with multiple sclerosis[ 48 ]. The bilateral and symmetrical involvement of cerebellum, basal ganglia and thalami and relative sparing of corpus callosum supports the diagnosis of ADEM Figure The brainstem is frequently involved in patients with multiple sclerosis and lesions have frequently a clinical correlate because of the scarce functional resilience of fiber tracts and gray matter nuclei in the brainstem[ 50 ], online dating cosimo grasso, online dating cosimo grasso.

MS lesions in the brainstem are more prevalent at the floor of the fourth ventricle and in the periphery of the brainstem, especially the pons[ online dating cosimo grasso ] Figure The infratentorial site is considered specific for the diagnosis of multiple sclerosis, being one of the four sites necessary and or sufficient for the dissemination in space criteria revised McDonald criteria [ 52 ], online dating cosimo grasso.

The incidence of multiple sclerosis peaks at years and is rare in children[ 49 ]. Among demyelinating diseases, it must be mentioned that brainstem involvement including the medullary area postrema may be observed in Neuromyelitis Optica spectrum disorders, both with or without serum aquaporin-4 immunoglobulin G autoantibodies[ 56 ], online dating cosimo grasso.

A rare autosomal-recessive neurodegenerative disorder caused by a combined deficiency of molybdenum-dependent enzymes is the Molybdenum cofactor deficiency. This condition is considered rare in prevalence but probably under-reported.

This deficiency leads to an early-onset encephalopathy or to an atypical late onset syndrome with global developmental delay. Share your videos with friends, family, and the world View the profiles of people named Cosimo Grasso. Join Facebook to connect with Cosimo Grasso and others you may know.

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