Multiple system atrophy (MSA) is a synucleinopathy, characterized by combined manifestations of cerebellar, parkinsonian, and autonomic features. It is subdivided into two main types-parkinsonian MSA (MSA-P) and cerebellar MSA (MSA-C). Magnetic resonance imaging (MRI) of the brain is a valuable tool in diagnosing this condition as it shows many characteristic features, such as the 'hot cross bun' sign. This is a cruciform hyperintensity imaging feature, seen at the level of pons in axial T2-weighted MRI images. This sign is typically seen in patients with MSA-C. This reported case describes a patient with MSA-C with characteristics brain MRI features.

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Acute calcific tendinitis of the longus colli muscle is an inflammatory condition associated with calcifications in longus colli muscle fibers which can present as acute neck pain. We present a case of a patient presenting with acute neck pain. MRI showed retropharyngeal effusion and edema of the left side longus colli muscle. CT showed amorphous calcifications in prevertebral region at C2 level which is a characteristic finding. Effusion in left lateral atlantoaxial joint is an uncommon associated finding in this condition which was seen in this case. It is important to recognize imaging features to prevent unnecessary investigations and surgical intervention.

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Background: Establishment and use of "diagnostic reference levels" (DRLs) is essential for proper use and audit of ionizing radiation in medicine and other radiation applications. Nigeria does not yet have a guideline for DRL. The European Commission reference dose levels were applied to routine computed tomography (CT) examinations in Nigeria's major hospitals. Aim: To determine the dose of CT examinations at the University College Hospital, Ibadan, Nigeria and provide a template for dose optimization. Materials and Methods: Data were obtained from a GE Brightspeed multidetector CT scanner. The dose characteristics and estimates were derived from computed tomography dose index (CTDI _vol ), and dose length product (DLP) with the effective dose (E) calculated using software developed by ImPACTscan group with the National Radiological Protection Board-S250 conversion coefficients data for a random sampling of 1 per 10 typical CT patients. Results: The mean values of CTDI _vol in mGy were 73.5 ± 4.2 (head), 22.7 ± 6.7 (chest), 37.9 ± 5.6 (abdomen), 28.2 ± 8.3 (abdomen-pelvis), 41.4 ± 13.2 (cervical spine), and 40.1 ± 4.2 (lumbar spine) examinations. The corresponding mean values of DLP in mGy.cm were 1898, 1189, 1902, 2548, 1372, and 1563, respectively. The calculated E values in mSv for the above examinations were 2.8, 11.8, 22.5, 39.6, 4.6, and 29.0, respectively. All values consistently exceeded recommended ECRDLs except the CTDI _vol for chest, cervical, and abdomen-pelvis examinations. Conclusion: CT doses were higher than EC recommended guidelines necessitating a need for optimization of CT practice and the requirement for a CT dose survey in Nigeria.

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Background: Computerized Tomography (CT) findings of Cerebrovascular Accidents (CVA) in patients in Calabar, Nigeria, have not been previously reported. The aim is to document the CT findings and the pattern and demographic features of the condition. Materials and Methods: We prospectively studied 87 consecutive patients, presenting over a 12-month period with diagnosis of stroke. The sociodemographic and clinical data as well as the CT findings were collected. Statistical analysis was done using the computer software STATA 10 corp., Texas, USA. Results: There were 49 males and 37 females with a median age of 56 years (45.75-67). The ischemic type of CVA predominated, (81.4%), with no significant gender difference (P = 0.99). The peak age of stroke was in those less than 50 years (33.7%). The individuals with hemorrhagic stroke were younger than those with ischemic stroke (median of 48 and 59 years, respectively). Conclusion: Stroke incidence in Calabar has evolved so much, as to affect a much younger age group and the female to male ratio is fast approaching equality. The hemorrhagic type tends to affect younger males. It is recommended that young people presenting with stroke in the Calabar area, particularly where a CT scan is not available, must be suspected to have a hemorrhagic stroke.

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Background: The Iridium-192 radionuclide source is commonly used for high-dose-rate brachytherapy of uterine cervical cancer. The cobalt-60 radionuclide source, which is more economical, is now available with dosimetric properties similar to iridium-192. Objective: To evaluate late gastrointestinal and genitourinary complications, and also the survival pattern in cervical cancer patients treated with cobalt-60 high-dose-rate brachytherapy, three years after treatment. Materials and Methods: Seventy patients, who were treated with high-dose-rate brachytherapy using the cobalt-60 radionuclide source were followed up for three years. All the patients received 45 Gy of external beam radiotherapy in 22 daily fractions, with 19.5 Gy from high-dose-rate brachytherapy, in three fractions, over three weeks, using the cobalt-60 radio nuclide source. The patients also received concurrent cisplatin-based chemotherapy. Late complications were assessed every three months, using Radiation Therapy Oncology Group (RTOG) late toxicity criteria. The pattern of disease control was also assessed. Results: Late complications in the bowel were, six (9%) grade 1, four (6%) grade 2, one (1%) grade 3, and one (1%) grade 4. The late complications affecting the bladder were 5 (7%) grade 1 and 1 (1%) grade 4. Twenty-eight patients (40%) were alive without disease, seven (10%) were alive with disease, seven (10%) died of persistent disease, four (6%) died of metastatic disease, while 24 (34%) were lost to follow-up. Conclusion: The late complications were similar to those reported for Iridium-192 as a source of high-dose brachytherapy. Cobalt-60 high-dose-rate brachytherapy is tolerable, effective, and economical for low resource settings.

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Giant cell tumor of bone is a benign tumor composed of diffuse osteoclastic giant cells and mononuclear stromal cells. Giant cell tumor of small bones of hands and feet are different in behavior than Giant cell tumor of long bones. Giant cell tumor of toe is very rare (less than 2%), when it involve the toes, it more commonly affects younger age group and is more aggressive in nature. We report a case of Giant cell tumor of distal phalanx of great toe, which was difficult to differentiate radiologically with giant cell reparative granuloma. En bloc resection of the tumor was done and Giant cell tumor was confirmed on histopathology.

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Aims: The present clinico-radiological study was done to evaluate the morphological variants of soft palate in oral submucous fibrosis (OSMF) patients using digital lateral cephalometry. Different variations in the morphology of soft palate were compared with stages of OSMF. Further, soft palate morphology in OSMF patients was compared radiographically with that of normal population. Materials and Methods: A total number of 100 patients who were a part of this study were divided in two equal Groups. Group 1 comprised of 50 patients clinically diagnosed with OSMF and Group 2 included 50 routine patients. Results: Six different morphological variants of soft palate were found. Among the study Groups, type 1soft palate was most commonly seen (56%) whereas type 5 was the least common variant. Majority of patients belonged to stage II OSMF and type 1soft palate was commonly seen in this stage of disease whereas butt shaped soft palate (type 3) was more common in stage III OSMF. Conclusion: In OSMF, type 1 and 2 are commonly seen but as the diseases advances, these are replaced by type 3 and 6 variants. In OSMF patients, there in reduction in the anterio-posterior dimension of soft palate.

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Intracranial dermoid cysts are rare benign lesions of neuraxis. They present with symptoms of a space occupying lesion or rupture leading to chemical meningitis. Rupture of dermoid cyst result in the characteristic neuroimaging pattern. We recently encountered an interesting patient in sixth decade of life who presented with spontaneous rupture of intracranial dermoid cyst leading to chemical meningitis. We report the case for its unusual presentation and complete recovery.

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Background: Neuroimaging can help to determine whether a seizure in a patient results from a structural abnormality of the brain or its surroundings. It is useful in a variety of clinical settings. The present study was undertaken to find the role of computed tomography (CT) scan in patients of seizure disorders. Materials and Methods: This was a prospective study of 2 years duration. The sample size was 100. Nonenhanced CT (NECT) scan was performed in all patients on single slice helical CT scanner. All patients with history of seizures were included in the study. Any patient with evidence of biochemical or metabolic abnormality was excluded. Results: The mean age of patients was 27.47 ± 19.82 years. The sensitivity of NECT was 49%. Following contrast-enhanced CT (CECT) study, the overall sensitivity came to be 51%. Also, the scans in which NECT was unable to provide a conclusive diagnosis, CECT provided a confirmatory diagnosis in most of them (34 patients, 69.38% of 49 patients). Space-occupying lesions were the most common finding and were more commonly associated with simple seizures with or without generalization. Conclusion: CT scan plays a very important role as a preliminary tool in radiological assessment of patients presenting with seizure. In about half of the seizure patients, it is able to diagnose or suggest the abnormality. It is valuable in making a diagnosis particulary in Indian subcontinent, where infective causes in form of space occupying lesions and infections are most important cause of seizure.

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Background: Paragonimiasis is one of the re-emerging public health diseases. Most of the presenting symptoms of pulmonary paragonimiasis are similar to those of tuberculosis (TB), which is also another major public health issue. Unfortunately both infections occur in the same environment of low socioeconomic status. Clinical and radiological differentiation between pulmonary paragonimiasis and tuberculosis can be difficult. Aim: This study was therefore designed to identify the chest radiological features that could be consistently used to differentiate between pulmonary TB and paragonimiasis in children. Materials and Methods: Two hundred and forty children aged five to eighteen years, were selected by stratified random samplings from a public primary and a secondary school in Ewang village, Mbo local government area of Akwa Ibom State, Nigeria. These children were screened for pulmonary paragonimiasis and pulmonary tuberculosis using sputum microscopy and Ziehl Neilson staining, respectively. Thereafter, the chest radiographs of children who were sputa-positive for paragonimus egg and acid fast bacilli were taken on full inspiration. Statistical Analysis: The data was analyzed with the STATA 10 software, produced by Stata Corp, Texas, USA. The results were expressed as means, standard deviations (SD), as well as percentages. A P < 0.05 was considered statistically significant. Results: A total of 204 children were examined; 91 (44.6%) were males and 113 (55.4%) were females. Ten (4.9%) of the subjects were sputum-positive for the paragonimus egg, while four (1.96%) of the subjects were sputum-positive for tuberculosis. The signs and symptoms of both diseases were similar. Radiologically, subcutaneous tissue wasting was an important differentiating feature between both diseases (P = 0.002). Conclusion: The study has shown that paragonimiasis and tuberculosis in children coexist in this locality. The clinical features of both conditions were similar hence differentiation on clinical grounds was difficult. Thus in a child being investigated for tuberculosis, the absence of subcutaneous tissue wasting radiologically should prompt further investigation for paragonimiasis.

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