Stroke Occurring in 18F-FDG PET/CT Session.

Neurobiological evidence of sexual dimorphism in limbic circuitry of US Veterans

Cerebral amyloid angiopathy (CAA) is characterized by the deposition of amyloid in the walls of leptomeningeal and cerebral cortical arteries. The classic clinical features of CAA include recurrent hemorrhages in the cerebral cortex and subcortical white matter, often accompanied by dementia.1 We describe a 71-year-old man with CAA who presented with an unusual constellation of recurrent unilateral cerebral hemorrhages, mass effect, and meningeal enhancement on MRI. The patient is a 71-year-old, right-handed man who awoke with a headache and mild weakness of his right arm. Brain CT revealed a 1-cm hyperdensity in the left superior posterior frontal lobe, compatible with a focal hemorrhage. On follow-up 4 months later, MRI showed resolution of the left frontal hematoma and contrast enhancement in the left occipital lobe. An additional MRI performed 1 month later showed mass effect in the left occipital lobe, as well as new meningeal enhancement in the left temporal, parietal, and occipital lobes (figure, A). Gradient recall echo …

A previously healthy 2-year-old boy presented with status epilepticus following intermittent vomiting. Computed tomography scan showed a 7cm mass on the left occipital lobe with midline shift, inferior cerebellar herniation, and diffuse cerebral edema. The extensive dissemination to bilateral cerebral hemispheres, brain stem, and optic nerve was also observed. He underwent brain biopsy from the lesion on his left occipital lobe. The histopathological diagnosis determined the diffuse or epithelial proliferation of astrocytic tumor cells with high mitotic rate, positive for p53 and glial fibrillary acidic protein positive staining consistent with high-grade glioma. The progressive tumor led to communicating hydrocephalus, that was favorably controlled by cerebrospinal fluid shunting. The data from the FoundationOne CDx cancer genome profile disclosed a novel VCL- anaplastic lymphoma kinase (ALK) fusion in the tumor cells of the patient. ALK rearrangement was determined to be positive for the tumor cells assessed by fluorescence in situ hybridization. Only 4 pediatric cases of glioma with ALK-rearrangement have ever been reported. All of them received subtotal or gross total resections and then survived with or without chemotherapy. This is the first case of glioma harboring VCL as a novel partner of ALK fusion gene. After the favorable response to the first-line chemotherapy, subsequent irradiation therapy has now been scheduled. The molecular classification of high-grade glioma may help to expand the targeted therapy for unresectable advanced brain tumor.

We aimed to investigate the role of combined apparent diffusion coefficient (ADC) values and relative cerebral blood flow (rCBF) values in the diagnosis of mild cognitive impairment (MCI) patients. The present prospective research enrolled 156 MCI patients and 58 healthy elderly people who came to our hospital from January 2021 to February 2023. T1W, T2W, diffusion-weighted imaging, and arterial spin labeling sequences were performed on all subjects, and ADC values and rCBF values were measured at the workstation. Clinical and demographic data of all patients were collected while mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA) scores were used to assess patients' cognitive abilities. The MCI group had significantly lower rCBF values in the left frontal lobe, left occipital lobe, right frontal lobe, and right occipital lobe than the HC group. The ADC values in the left frontal lobe as well as the right frontal lobe were remarkably elevated in the MCI group than in the HC group. MoCA and MMSE scores were positively correlated with rCBF values in the left frontal, right frontal, left occipital, and right occipital lobes and negatively correlated with ADC values in the left and right frontal lobes. Combined ADC values and rCBF values from the left frontal lobe for the diagnosis of MCI had a higher sensitivity and specificity with the AUC was 0.877, sensitivity 81.0%, specificity 82.7%. Additionally, pressure fasting plasma glucose, ADC of the left frontal lobe, right frontal lobe, rCBF of left frontal lobe and rCBF of left frontal lobe were the risk factors of patients with MCI. In summary, our results indicated that the ADC values and rCBF values were changed in MCI group compared to HC group and correlated with MMSE and MoCA scores.

"Dyslexia is one of the most frequent specific learning disorders which has often been associated with deficits in phonological awareness mainly caused by auditory and visual inabilities to recognize and discriminate phonemes and graphemes within words. Neuroimaging techniques like EEG recordings have been widely used to assess hemispheric differences in brain activation between students with dyslexia and their typical counterparts. Although dyslexia is a lifelong disorder which persists into adulthood, very few studies have been carried out targeting in adult population. In this study, we examined the brain activation differences between 14 typical (control group) and 12 university students with dyslexia (experimental group). The participants underwent two tasks consisting of 50 3-word groups characterized by different degrees of auditory and visual distinctiveness. The whole procedure was recorded with a 14-sensor sophisticated wearable EEG recording device (Emotiv EPOC+). The findings from the auditory task revealed statistically significant differences among the two sets of groups in the left temporal lobe in ?, ? and ? rhythms, in the left occipital lobe in ? rhythm, and in the right prefrontal area in ?, ? and ? rhythms, respectively. The students with dyslexia reported higher mean scores only in ? rhythm in the left temporal lobe, and in ?, ? and ? rhythms in the right prefrontal area. Concerning the visual task, statistically significant differences were evident in the left temporal lobe in ?, ? rhythms, in the occipital lobe in ?, ? and ? rhythms, in the parietal lobe in ? rhythm, and in the right occipital lobe in ?, ? and ? rhythms. The students with dyslexia reported higher mean scores only in the ? rhythm of both the left and right occipital lobe. The results indicate that there are differences in the hemispheric brain activation of students with or without dyslexia in various rhythms in both experimental conditions, thus, shedding light in the neurophysiological discrepancies between the two groups. It also lays great emphasis on the necessity of carrying out more studies in adult population with dyslexia."

Study on the Relationship between Cerebral Blood Perfusion, Neuronal Cytokines and Cognitive Function in Patients with Alzheimer's Disease

Acute ischemic stroke involving the entire vascular distribution of a carotid or middle cerebral artery can cause massive cerebral edema. This study evaluated external decompression for the treatment of massive stroke and analyzed possible prognostic factors. Twenty-four patients with acute massive cerebral infarction, which had progressed to tentorial herniation and impending death, underwent external decompression after medical therapy failed to achieve an effective response. The neurological outcome 2 months after surgery using the Glasgow Outcome Scale was severe disability in 14 patients, vegetative state in two, and death in eight. The overall mortality was 33%. Various characteristics (age, sex, etiology, side of hemispheric infarction, pupillary asymmetry, Japan Coma Scale, distribution of infarction, hemorrhagic infarction, midline shift, tentorial herniation) were evaluated to determine the factors associated with high mortality after surgical intervention. There was no statistically significant relationship between any variable and mortality. Mortality was especially high in the patients with preoperative consciousness level of 200, anterior, middle, and posterior cerebral artery territory infarction, and stage III of tentorial herniation. Postoperatively, all patients with severe disability returned to a clear level of consciousness. Six patients with dominant hemisphere stroke had some measure of communicative skills in spite of aphasia. External decompression is a life-saving treatment for patients with massive cerebral infarction and can provide a reasonable quality of life even for those with dominant hemisphere strokes. Decompressive surgery should be considered and performed as soon as possible if computed tomography demonstrates signs of descending tentorial herniation.

BackgroundTo identify changes in brain activation patterns in bipolar disorder (BD) and unipolar depression (UD) patients.Methodology/Principal FindingsResting-state fMRI scans of 16 healthy controls, 17 BD and 16 UD patients were obtained. T-test of normalized regional homogeneity (ReHo) was performed in a voxel-by-voxel manner. A combined threshold of á = 0.05, minimum cluster volume of V = 10503 mm3 (389 voxels) were used to determine ReHo differences between groups. In UD group, fMRI revealed ReHo increases in the left middle occipital lobe, right inferior parietal lobule, right precuneus and left convolution; and ReHo decreases in the left parahippocampalgyrus, right precentralgyrus, left postcentralgyrus, left precentralgyrus and left cingulated. In BD group, ReHo increases in the right insular cortex, left middle frontal gyrus, left precuneus, left occipital lobe, left parietal, left superior frontal gyrus and left thalamus; and ReHo decreases in the right anterior lobe of cerebellum, pons, right precentralgyrus, left postcentralgyrus, left inferior frontal gyrus, and right cingulate. There were some overlaps in ReHo profiles between UD and BD groups, but a marked difference was seen in the thalamus of BD.Conclusions/SignificanceThe resting-state fMRI and ReHo mapping are a promising tool to assist the detection of functional deficits and distinguish clinical and pathophysiological signs of BD and UD.

BackgroundNonketotic hyperglycemia often causes seizures. Recently, seizures associated with nonketotic hyperglycemia have been found to be associated with subcortical T2 hypointensity on magnetic resonance imaging, especially in the occipital lobes. However, the mechanism remains unclear, although iron accumulation is suggested. We present a case of occipital lobe seizures associated with nonketotic hyperglycemia supporting the hypothesis that the mechanism of subcortical T2 hypointensity is iron accumulation using gradient-echo T2*-weighted magnetic resonance imaging.Case presentationA 65-year-old Japanese man complained of intermittent pastel-colored flashing lights. On neurological examination, he also had lower right-side quadrant hemianopia. No other abnormal neurological findings were found. On laboratory analysis, his blood glucose level was 370 mg/dL, HbA1c was 11.4 %, and serum osmolarity was 326 mOsm/L. No ketones were detected in urine. A magnetic resonance imaging scan of his head showed subcortical T2 and T2* hypointensity in his left occipital lobe. Single-photon emission computed tomography with I123-N-isopropyl-iodoamphetamine revealed hyperperfusion in the left dominant occipital lobe. These magnetic resonance imaging abnormalities resolved during clinical recovery and treatment to control his blood sugar level. Therefore, a diagnosis of occipital lobe seizures associated with nonketotic hyperglycemia was made.ConclusionsTo the best of our knowledge, this is the first case of occipital lobe seizures associated with nonketotic hyperglycemia supporting the role of iron accumulation as a mechanism for subcortical T2 hypointensity using T2*-magnetic resonance imaging.

Glioblastoma multiforme (GBM) tumors are intracranial lesions with varying shapes that grow rapidly. GBM tumors most commonly present as solitary lesions and multiple lesions are rare. The aim of the present case report was to investigate the imaging features of glioblastoma multiforme (GBM). In this study, the case of a 60-year-old patient who was hospitalized due to seizures is presented. Magnetic resonance imaging (MRI) revealed multiple lesions, heterogeneous in size, with peritumoral edema and ring-shaped enhancement. The lesions grew rapidly within 10 days of hospitalization and were initially misdiagnosed as either infections or intracranial metastatic tumors as a result of imaging examinations. The patient was subsequently administered mannitol, diazepam, Tegretol and ceftriaxone. After treatment, the patient recovered and regained full consciousness. However, MRI examination 23 days after hospitalization revealed that the multiple lesions in the left temporal and left occipital lobes had increased in size. Therefore, resection of the tumor in the left temporal occipital lobe was performed. Histopathological examination identified GBM (grade IV) in the left temporal and parietal lobes. The patient succumbed to the disease 7 months after surgery due to GBM recurrence. The findings of the present case indicate that GBM may progress rapidly with a doubling time of 10 days and multiple cystic alterations. Furthermore, if diagnosis of GBM is unclear, early biopsy is recommended.

BackgroundSchizophrenia (SCZ) is a severe mental illness that causes a substantial burden for individuals, families, and society. Early identification and intervention are crucial for improving patient outcomes. Prior to the onset of psychotic disorders, such as SCZ, individuals may go through a prodromal phase, known as clinical high risk for psychosis (CHR). Among those identified as CHR, the subtype termed attenuated psychosis syndrome (APS) is particularly significant, as it is associated with an increased risk of progression to psychosis and is commonly encountered in clinical practice. Although previous studies had reported structural brain differences in APS patients, no wide consensus has been reached.Aims & ObjectivesThis study aimed to elucidate structural brain differences among APS, SCZ, and healthy controls (HCs) using structural magnetic resonance imaging (MRI) data, thereby advancing our understanding of the neurophysiological mechanisms underlying in APS.MethodA total of 39 HCs, 38 APS, and 35 SCZ patients were finally included. T1-weighted MRI data were processed using SPM12 and CAT12 to quantify cortical thickness and gray matter volume (GMV) among the three groups were evaluated using analysis of covariance (ANCOVA), in which age, gender, years of education were regarded as covariates. The analysis was conducted using the Desikan-Killiany 40 template and the third version of the Automated Anatomical Labeling atlas. Voxel-level significance was set at P < 0.001, and False Discovery Rate correction was applied, yielding a cluster-level significance threshold of P < 0.05.ResultsCompared with HCs group, the APS and SCZ groups demonstrated a reduction in the cortical thickness in the left lateral occipital lobe. Compared with SCZ group, the APS and HCs groups exhibited a significant increase in the cortical thickness in some regions of the frontal and parietal lobes. Correlation analysis revealed that in the APS group, the thickness of the left triangular part of the inferior frontal gyrus and the right supramarginal gyrus exhibited significant negative correlations with reasoning and problem-solving ability scores. In the SCZ group, the cortical thickness of the left cuneus, inferior parietal lobule, and superior parietal lobule exhibited positive correlations with information processing speed scores. Additionally, compared with the SCZ group, the GMV in the frontal and insular regions was significantly increased in the APS and HCs groups.Discussion & ConclusionsThis study revealed significant differences in cortical thickness and GMV across specific brain regions among the HCs, APS, and SCZ patients, which may reflect underlying pathophysiological mechanisms of SCZ. Specifically, the reduced cortical thickness in the left occipital lobe may be associated with individual susceptibility to SCZ, while thinning cortical thickness in the frontal and parietal lobes, along with reduced GMV in the frontal and insular lobes, may be linked to the disease state of SCZ. The more widespread and severe damage to cortical thickness and GMV in SCZ patients compared with the APS, suggested a gradient pattern of brain structural impairment between the APS and SCZ patients.

A 66-year-old, right-handed male, was admitted to our hospital with difficulty in recognizing faces and colors. He had suffered a stroke in the right occipital region three years earlier that had induced left homonymous hemianopsia, but not prosopagnosia. A neurological examination revealed prosopagnosia, color agnosia, constructional apraxia, and topographical disorientation, but not either hemineglect or dressing apraxia. The patient was unable to distinguish faces of familiar persons such as his family and friends, as well as those of unfamiliar persons such as doctors and nurses. Brain MRI demonstrated an old infarction in the right medial occipital lobe and a new hemorrhagic infarction in the left medial occipital lobe, including the fusiform and lingual gyrus. It is unclear whether a purely right medial occipital lesion can be responsible for prosopagnosia, or whether bilateral medial occipital lesions are necessary for this occurrence. The current case indicated that bilateral medial occipital lesions play an important role in inducing porsopagnosia.

Objective: To evaluate the usefulness of intravenous contrast administration in cranial computed tomography (CT) in a general hospital with a magnetic resonance imaging (MRI) facility, and to establish a protocol to determine which patients would benefit most from using contrast-enhanced cranial CT. Subjects and Methods: Five hundred and forty-seven patients who underwent routine nonenhanced CT (NECT) and contrast-enhanced CT (CECT) of the brain between June 1997 and June 2001 were divided into three groups. Group A: 496 patients in whom CECT was done in spite of normal NECT; group B: 16 patients in whom CECT was considered necessary irrespective of NECT findings, and group C: 35 patients in whom NECT was abnormal and CECT was performed. Results: Contrast-enhanced cranial CT changed and/or confirmed the diagnosis in 1 of 496 in group A, 2 of 16 in group B, and 12 of 35 in group C, thereby indicating that CECT was useful in the diagnosis of groups B and C. Conclusion: CECT is unlikely to be useful in patients with normal NECT in the appropriate clinical setting. A protocol is presented for the use of contrast media in cranial CT in a general hospital with an MRI facility. Using this protocol only 9.7% of patients for cranial CT would have needed CECT, resulting in considerable cost savings without affecting the quality of the service to the patient in a general hospital.

BackgroundGangliogliomas are rare tumors of the central nervous system. They can occur anywhere in the central nervous system but are most commonly located in the temporal lobe and are mainly found in children. Anaplastic ganglioglioma can result from either de novo or transformation of a pre-existing lesion.Case presentationWe report a case of de novo anaplastic ganglioglioma in the parieto occipital region, which is a rare location. A 34-year-old lady presented with features of raised intracranial pressure (ICP) with right side hemiparesis. Contrast-enhanced magnetic resonance imaging (CEMRI) of the brain showed well-defined intense heterogenously enhancing solid cystic mass lesion 5.3 × 5.2 cm in the left parieto occipital region with mass effect and midline shift. Intraoperatively, a cystic mass lesion with reddish brown nodule was seen in the left occipital lobe. Complete tumor excision was done. Microscopic and IHC examination was suggestive of anaplastic ganglioglioma. The post-operative period was uneventful. The patient received 60-Gy radiotherapy with temozolamide as adjuvant therapy, and repeat imaging showed no tumor recurrence.ConclusionAnaplastic gangliogliomas are rare tumors with parieto occipital as rare location.

<h3>Objective:</h3> Phenotypic variability and lack of familiarity with criteria can make diagnosis of MELAS challenging. Clinicians should be cognizant and consider early MR spectroscopy with genetic screening. <h3>Background:</h3> MELAS is a rare, progressive mitochondrial disorder that can be missed if clinical suspicion is low. <h3>Design/Methods:</h3> A thorough chart review was conducted. <h3>Results:</h3> <h3>Case 1:</h3> A 33-year-old female presented with recurrent right-sided visual scotomas. MRI showed focal DWI changes to the occipital lobe. Continuous video-EEG showed subclinical occipital lobe seizures. The patient had a recurrent episode of right-sided vision changes, speech difficulty and poor comprehension. MRI showed cortical atrophy and DWI abnormalities without ADC mismatch in the left occipital and left posterior temporal lobes. Stroke and infectious workup was unrevealing. Another episode of numbness, hearing loss, and word-finding difficulty prompted MR spectroscopy, screening lactate level, and genetic analysis. The diagnosis of MELAS was established based on the patient’s recurrent seizures, cortical visual loss, acute lesions on MRI, high plasma lactate, and a confirmed, possibly pathogenic mutation in MT-TL1. She suffered from neurological deterioration and passed away 6 months later. <h3>Case 2:</h3> Patient is a 26-year-old male with a long history of migraines with visual disturbances. MRI showed edema in the left occipital lobe. Subsequently, he presented with an intractable headache associated with left-sided peripheral vision loss and left leg weakness. MRI was notable for hyperintense flair signal in the right occipital lobe and marked atrophy. EEG showed frequent seizures and workup for stroke and encephalitis was unrevealing. Lactate levels were elevated and genetic screening was notable for MT-TL1 mutation. <h3>Conclusions:</h3> Patients younger than 40 with stroke-like symptoms, brain atrophy disproportionate to age, and negative infectious and vascular workup should be evaluated for MELAS. MR Spectroscopy, lactate levels, and genetic testing are important non-invasive screening measures. <b>Disclosure:</b> Mr. Tallavajhala has nothing to disclose. Dr. Bochenek has stock in JNJ, Abbott, Moderna, Pfizer. Ms. Dwivedi has nothing to disclose. Ms. Caffio-Learner has nothing to disclose. Miss Suliman has nothing to disclose. Dr. Bashir has nothing to disclose. Dr. Kurukumbi has nothing to disclose.