Anterior Horn Of Lateral Ventricle Research Articles

Relationship between disproportionately enlarged subarachnoid-space hydrocephalus and white matter tract integrity in normal pressure hydrocephalus

Normal pressure hydrocephalus (NPH) patients had altered white matter tract integrities on diffusion tensor imaging (DTI). Previous studies suggested disproportionately enlarged subarachnoid space hydrocephalus (DESH) as a prognostic sign of NPH. We examined DTI indices in NPH subgroups by DESH severity and clinical symptoms. This retrospective case–control study included 33 NPH patients and 33 age-, sex-, and education-matched controls. The NPH grading scales (0–12) were used to rate neurological symptoms. Patients with NPH were categorized into two subgroups, high-DESH and low-DESH groups, by the average value of the DESH scale. DTI indices, including fractional anisotropy, were compared across 14 regions of interest (ROIs). The high-DESH group had increased axial diffusivity in the lateral side of corona radiata (1.43 ± 0.25 vs. 1.72 ± 0.25, p = 0.04), and showed decreased fractional anisotropy and increased mean, and radial diffusivity in the anterior and lateral sides of corona radiata and the periventricular white matter surrounding the anterior horn of lateral ventricle. In patients with a high NPH grading scale, fractional anisotropy in the white matter surrounding the anterior horn of the lateral ventricle was significantly reduced (0.36 ± 0.08 vs. 0.26 ± 0.06, p = 0.03). These data show that DESH may be a biomarker for DTI-detected microstructural alterations and clinical symptom severity.

Moving silicone oil particles in the ventricle: a case report and updated review

BackgroundThe movement of intraventricular silicone oil observed in the supine position is extremely rare. Herein, we describe a patient who presented with dynamically moving silicone oil particles in the ventricle when changing position and provide an updated review of this phenomenon.Case presentationWe report a case of a 70-year-old woman who presented with intraventricular hyperdensities that were occasionally found on brain computed tomography (CT). Initial nonenhanced brain CT demonstrated nondependent hyperdensities in the bilateral anterior horns of the lateral ventricles, the third ventricle, and the right suprasellar cistern, mimicking an intraventricular hemorrhage. Further brain magnetic resonance imaging (MRI) in the supine position revealed abnormal signals in the bilateral anterior horns of the lateral ventricles, the posterior horn of the right lateral ventricle, the third ventricle, the right suprasellar cistern, and the bilateral eyeballs, with isosignal intensities surrounded by low-signal chemical shift artifacts on T1-weighted imaging and variable signals (hypo- or hyperintensity) on T2-weighted imaging. The lesion in the anterior horn of the right ventricle largely moved to the posterior horn of the ipsilateral ventricle. The final craniocervical CT angiography showed that the lesion in the posterior horn had moved back to the anterior horn of the right lateral ventricle. These features were consistent with intraventricular silicone oil migration. The final spinal MRI did not demonstrate a migration of silicone oil into the spinal subarachnoid space.Discussion and conclusionsThis case report describes a dynamic process of silicone oil displacement in the supine position and provides a comprehensive imaging presentation. The moving pattern and a characteristic chemical shift artifact on MRI are key to the diagnosis and may help prevent unnecessary examinations or intervention.

Abstract 49: White Matter Hyperintensity Spatial Pattern Variations reflect distinct Cerebral Small Vessel Disease Pathologies

Introduction: Cerebral small vessel disease (SVD) comprise of heterogeneous pathologies affecting small cerebral vessels. A novel phenotyping approach using etiology-based SVD imaging markers may improve discovery of SVD-related mechanisms. Topographical patterns seen in common SVD subtypes (hypertension-related (HTN) and cerebral amyloid angiopathy (CAA)) suggest that spatial location may reflect regionally different SVD pathology. We propose a machine-learning method leveraging spatial location information to partition WMH (a representative SVD imaging marker) into patterns that can discriminate underlying SVD pathology. Method: We selected subjects with WMH on FLAIR MRI from the Alzheimer’s Disease Neuroimaging Initiative database and created WMH segmentation maps using a custom deep learning algorithm. We performed voxel-based spectral clustering analysis on aligned WMH maps to group image voxels into clusters, maximizing within-group and minimizing between-group similarities. HTN-SVD risk was scored using serial blood pressure measurements and medication history. We quantified CAA risk using the Boston criteria. We used multivariable regression to evaluate extent to which different WMH clusters influenced CAA and HTN-SVD risks. Demographics and total WMH volume were included as covariates. Results: We analyzed 878 subjects; 39% were hypertensive, 4.4% had probable CAA. We observed partitioning of WMH into five distinct clusters, which demonstrate recognizable spatial distributions that suggest biological relevance (deep, periventricular, subcortical, anterior horns of lateral ventricles, posterior predominant). Multivariable regression models revealed independent associations of WMH clusters with CAA (posterior predominant WM; p=0.02; ß=0.63), and HTN-SVD (deep WM; p=0.01; ß=0.20). Conclusion: WMH occur in unique spatial patterns that reflect different underlying SVD pathology. WMH spatial pattern variations may serve as etiology-based SVD imaging markers, providing a critical new tool in efforts to resolve homogeneous disease mechanisms among heterogeneous disease presentations. Such strategy enhances genomic studies, allowing more comprehensive modelling of genetic effects on SVD pathogenesis.

Implication of GPR40 Signaling in the Subventricular Zone Neurogenesis after Ischemia via Cross-Talk between Neural Progenitors and Microglia

Objective: Sub-ventricular Zone (SVZ) of the anterior horn of lateral ventricle is a source of neural stem cells in the adult mammalian brain along with hippocampal Sub-granular Zone (SGZ). Previously, we demonstrated that transient global brain ischemia in adult monkeys increases the number of neuronal progenitors in the SGZ via G-protein-coupled Receptor 40 (GPR40) signaling. Sonic Hedgehog (SHH) is indispensable for ischemia-induced neural progenitor proliferation in rodents. Although GPR40 is expressed in the SVZ, GPR40 synergy with SHH remains unelucidated in adult SVZ neurogenesis. Here, we studied GPR40 implication in SVZ neurogenesis using monkey model.Methods: Adult monkeys underwent 20 min transient global brain ischemia by clamping both the innominate and left subclavian arteries. On days 3, 4, 7, 9 and 15 after ischemia/reperfusion, when SVZ neurogenesis increases, as it was shown previously by the authors, the brain samples were resected and normal and post-ischemic monkey SVZ tissues were used for Western blot and immunofluorescence histochemistry analysis.Results: Ischemia/reperfusion increased GPR40 protein levels, proliferation of GPR40-positive stem/progenitor cells, the number of GPR40/PSA-NCAM or GPR40/doublecortin co-expressing immature neurons and GPR40- positive microglial cells in the SVZ vascular niche. GPR40 up-regulation correlated with that of SHH, Notch1 and β1-integrin; GPR40 co-localized with stem/progenitor cell markers in post-ischemic SVZ. GPR40-positive microglia showed the highest SHH expression relative to other cell types. SHH binding to Patched1 in the cells that surrounded GPR40/SHH-expressing microglia occurred within the distance of SHH paracrine secretion.Conclusion: These data suggest that GPR40 is related to post-ischemic neurogenesis in the primate SVZ, GPR40-positive microglia support SHH paracrine secretion in the SVZ, and the cross-talk between perivasucular microglia and neuronal progenitors may be crucial in the vascular niche to activate neurogenesis by SHH and Notch1 signaling.

Morphometric Study of Anterior Horn of Lateral Ventricle of Brain and Its Correlation with Age, Gender and Side: A CT Study

Morphometric Study of Anterior Horn of Lateral Ventricle of Brain and Its Correlation with Age, Gender and Side: A CT Study

Why a Catheter Can Be Correctly Placed in the Anterior Horn of Lateral Ventricle by Inserting Perpendicular to the Frontal Bone on the Ventricular Drainage? Demonstration of the Accuracy of an Inserting Path by Computed Tomographic Image Study and Clinical Practices.

Why a catheter can be correctly placed in the ventricle by inserting perpendicular to the frontal bone on the ventricular drainage? We performed a study on the accuracy of a path perpendicular to the skull surface into the anterior horn using computed tomography (CT), and a clinical study. Twenty patients were studied on CT images. Using the curved multi-planar reconstruction method, the curved frontal skull and brain were reconstructed to flat structures, and perpendicular lines were drawn from the flat surface to the foramen of Monro on the reconstructed images. In clinical practice, we made a device which guided a catheter inserting perpendicular to the frontal skull surface, and used it in the ventricular drainage surgery for 148 hydrocephalic patients (158 surgeries). We discovered that the curved surface of the frontal bone around Kocher’s point represents the surface of a globe (mean radius, 75.9 ± 4.3 mm) centering on the foramen of Monro. The distribution of points ranged from 13.5–43.5 mm (mean, 43.5 ± 6.1 mm) to the midline, with points appearing more laterally as ventricular size increased. A catheter was placed in the ventricle in 148 surgeries (99.4%), and the catheter reached the ventricle with correct orientation toward the foramen of Monro in 128 (81.0%). The reason why the ventricular insertion perpendicular to the frontal bone surface can provide a consistent path toward the foramen of Monro is that the curved surface of the frontal bone around Kocher’s point represents the surface of a globe centered on the foramen of Monro.

Value of CT perfusion imaging in pressure modulation after ventriculoperitoneal shunt

Objective To investigate the value of CT perfusion imaging(CTP) in pressure modulation after ventriculoperitoneal shunt (VP) and determine the relationship between consciousness variation and cerebral perfusion. Methods Thirty cases in a vegetative or minimally conscious state after VP for posttraumatic hydrocephalus were included. There were 26 males and 4 females, aged (56.4±9.2) years. Duration of disease was (88.7±38.0)d. Consciousness evaluation and CT perfusion scan were performed before and two weeks after pressure modulation. Based on the consciousness state, the patients were allocated into consciousness unimproved (n=17) and improved groups (n=13). Relative cerebral blood flow (rCBF), relative cerebral blood volume (rCBV), relative mean transit time (rMTT) and relative time to peak (rTTP) were evaluated before and after pressure modulation. Results In consciousness improved group rCBF in the alba around anterior horn of lateral ventricle was significantly improved after pressure modulation compared to that before pressure modulation (1.08±0.55 vs. 0.75±0.32, P 0.05). In consciousness improved group all the measures showed no significant changes in other regions such as encephalomalacia focus, forehead lobe, temporal lobe, basal ganglia and occipital lobe (P>0.05). However, none was significantly different in consciousness unimproved group (P>0.05). Conclusions CTP has some reference value on pressure modulation of posttraumatic hydrocephalus patients treated with VP. Consciousness improvement is related to the increased cerebral perfusion in the alba around anterior horn of lateral ventricle. Key words: Perfusion imaging; Hydrocephalus; Ventriculoperitoneal shunt

MRI in NMO: How to differentiate from MS

Neuromyelitis Optica (NMO) is characterized by simultaneous or sequential acute transverse myelitis and optic neuritis. Spinal cord lesions extending over 3 or more vertebral segments are the typical MRI finding in NMO. Shorter MRI lesions can be found very early during relapse or in residual atrophic stages. Some of the lesions may appear hypointense on corresponding T1-weighted images which reflects sever inflammation with necrosis. T1-weighted hypointensities may help in differentiating NMO lesions from MS in spinal cord. “Snake-eye” or “owl-eye” sign a common feature of spinal artery ischemia has been reported to be transiently observed at an early stage of NMO. Brain MRI is initially normal in most patients with NMO but serial imaging may depict lesions in up to 85% of the patients at later stages. Brain lesions are usually nonspecific but may fulfill the Barkhof criteria for dissemination in space. Acute, large, edematous callosal lesions with a heterogeneous intensity occasionally develop in patients with NMO (marbled pattern). In contrast, in MS, callosal lesions are small, non-edematous, and the intensity was homogeneous in the acute phase and located at the lower margin of the corpus callosum. Multiple patchy enhancements with blurred margins (cloudlike enhancement) have been reported to be typical for NMO. Pencil-like ependymal enhancement is another type of enhancement around the anterior horns of lateral ventricles. Extensive hemispheric lesions, periependymal lesions surrounding the aqueduct, the third and fourth ventricles and brain stem lesions should raise the diagnosis of NMO. Actually NMO should be considered in any atypical lesion for MS in appropriate clinical settings. The extensive hemispheric lesions differed from those observed in regions of high AQP4 expression and were likely related to vasogenic edema; they sometimes looked like “spilled ink” and followed the white-matter tracts.

Significance of fatal head injuries associated with subependymal hemorrhage at the anterior horns of lateral ventricles

We hypothesize the following items based on 41 autopsy cases with or without head injuries especially on subependymal injuries at the anterior horns of the lateral cerebral ventricles. The subependymal injuries at the regions (1) are not seen in fatal cases that did not have intracranial injuries, (2) have nothing to do with technical procedures for removal of the whole brain at autopsy, (3) are frequently associated with axonal injuries, (4) are presumed to be formed by rotating head injuries in a sagittal direction.

Intracranial Germinoma as a Very Rare Cause of Panhypopituitarism in a 23-year Old Man

A 23 year-old patient was referred to the endocrine outpatient clinic with the suspicion of diabetes insipidus as he complained of nycturia and polydipsia since 2-3 months. Further he presented with nausea, vomiting, loss of appetite, rapid weight loss, diffuse body pain and fatigue. No headache, blurred vision, or fever were reported. The clinical examination showed sexual infantilism (poor beard, pubic and axillary hair growth, small testis). The patient's skin was strikingly pale as well as dry and scaly. Lymph node palpation was unremarkable. Endocrine evaluation revealed diabetes insipidus as well as complete anterior pituitary insufficiency. MR imaging demonstrated contrast-enhancing mass lesions at the pineal gland, hypothalamus, and anterior horn of lateral ventricles bilaterally. The localization pattern deemed to be highly suspicious for intracranial germinoma. As beta-HCG and AFP were negative in serum and cerebrospinal fluid the diagnosis of germinoma was confirmed histologically. After radiotherapy with cranio-spinal radiation therapy with 24 Gy followed by two weeks of local tumor boost with 16 Gy, the posttherapy MRI scan indicated complete tumor removal. This case demonstrates a very rare and potentially curable tumor as the cause of panhypopituitarism in adults.

Treatment of Psychiatric Symptoms Associated With a Frontal Lobe Tumor Through Surgical Resection

Treatment of Psychiatric Symptoms Associated With a Frontal Lobe Tumor Through Surgical Resection

A baby with bulging anterior fontanelle

A 7-month-old Saudi girl was admitted in March, 1999, for evaluation of a bulging anterior fontanelle, noticed by her mother 1 week earlier. There was no history of fever or vomiting. She was born at term by normal vaginal delivery following a normal pregnancy. Birth weight was not known. She had been exclusively breast fed since birth. On examination her weight was 5·75 kg, length 59 cm, and head circumference 41·5 cm (all just below 3rd percentile). The anterior fontanelle was wide open, measuring 6 6 cm, and persistently bulging even at rest, although not tense or pulsating. There was mild frontal and parietal bossing, but there was no swelling of wrists or ankles, no bowing of legs, no rachitic rosary, and no Harrison sulcus. She had mild generalised hypotonia but the rest of the examination was normal. On investigation her haemoglobin was 105 g/L, white cell count 13·2 10/L with normal differential, serum calcium 2·39 mmol/L (normal 2·2–2·7 mmol/L), phosphate 0·74 mmol/L (0·87–1·45 mmol/L), and alkaline phosphatase 3970 U/L (98–279 U/L). Urea, creatinine, and other electrolytes were normal. Chest radiograph showed normal heart and lungs but anterior ends of the ribs and upper end of humerus showed evidence of early rickets in the form of mild widening, cupping and fraying (figure). Similar changes were found on the lower ends of radius and ulna on wrist radiograph. Skull radiograph showed thin cortex with slight beaten silver appearance. Computed tomogram scan of brain showed mild dilatation of the anterior horn of lateral ventricles which was within normal limits. Nutritional rickets was diagnosed and she was discharged on vitamin D3, 3000 IU daily for 4 weeks, and her mother was advised to start a weaning diet. 4 months after discharge her weight was 6·6 kg, length 66 cm, and head circumference 43·5 cm which were still below the 3rd percentile but progressing on the same line. Her anterior fontanelle measured 4 4 cm with no bulging. Systemic CASE REPORT

Recovery of Gonadal Function After Resection of an Oligodendroglioma Localized in the Anterior Horn of the Lateral Ventricle: Relation to Pulsatile Secretion of Luteinizing Hormone

Abstract A 21-year-old man with an oligodendroglioma in the anterior horn of the right lateral ventricle complained of sexual dysfunction and showed lowered concentrations of serum testosterone (1.1 ng/ml) with normal pituitary function. Human chorionic gonadotropin testing revealed a good testosterone response (1.1 to 4.9 ng/ml) and a clomiphene test revealed no gonadotropin response. Pulsatile secretion of luteinizing hormone (LH) was absent preoperatively. After removal of the tumor, serum concentration of testosterone increased to the normal range, LH pulsatility appeared, and the patient had no complaints of sexual dysfunction. In this patient, the loss of LH pulsatility responsible for his hypogonadism was caused by the lateral ventricle tumor compressing the surrounding structures, and this was corrected by tumor resection.

Vascularization in infantile brain tumors induced by human adenovirus type 12 in rats.

Early vascular changes in the undifferentiated infantile brain tumors induced by human adenovirus type 12 (Ad 12) in rats were studied using the India ink injection method, scanning electron microscopy (SEM) of vascular corrosion casts, transmission electron microscopy, and the peroxidase anti peroxidase method for glial fibrillary acidic protein detection. The process of vascularization of solid type tumors was divided into five phases: Stage O, no remarkable changes; Stage I, dilatation of vessels; Stage II, formation of vascular network; Stage III, fine branching in the vascular network; and Stage IV, necrosis. SEM of vascular replica in Stage III suggested compression of the vessels by proliferating tumor cells. In the tapetum region, Stage I was recognized in solid type tumors 100 to 230 (m = 180) micrometer in diameter, while in the olfactory lobes and in the anterior horn of lateral ventricle closely adjacent to the vascular gray matter, Stage I occurred in much larger tumors. In the diffuse type tumors, the dilatation of vessels was first noticed when the tumors were about 1600 micrometers in diameter. The solid type tumors mainly developed in the poorly vascular subventricular zone, while the diffuse type ones were usually found deep in the vascular gray matter. The results indicate that vascularization is closely related to the local vascularity and the growth pattern of the microtumors, and that of the solid type tumors induced by Ad 12 may be a model of vascular changes in infantile brain tumors which mostly develop and grow rapidly in the subventricular zone which have poor vascular development.

Granulomatous encephalitis, intracranial arteritis, and mycotic aneurysm due to a free-living ameba

Primary amebic meningoencephalitis and granulomatous amebic encephalitis are well recognized clinicopathological entities caused by free-living amebas. Associated arteritis and "mycotic aneurysms" with infiltration of intracranial arteries by lymphocytes, amebic trophozoites and cysts have not been previously reported. A 26-month-old girl had a 3-week history of encephalitis, characterized, initially, by vomiting and low-grade fever. Subsequently, she developed ataxia, generalized weakness, lethargy, and esotropia. The first CSF showed 490 RBC/microliters, 705 WBC/microliters with 90% mononuclears. Her pupils reacted briskly to light. Moderate nuchal rigidity, nystagmus, fixed downward gaze, anisocoria, bilateral 6th nerve palsy, left arm monoparesis and left Babinski were present. CAT scan revealed slight symmetrical dilatation of anterior horns of lateral ventricles and an area of abnormal enhancement above the 3rd ventricle. She died 14 days after admission, 5 weeks after onset of symptoms. The brain showed focal necrotizing encephalopathy, involving thalami, cerebellum, brain stem, and cervical and upper thoracic spinal cord. Numerous free-living amebic trophozoites and cysts were present within a chronic granulomatous encephalitis. There were trombosis of basilar, posterior cerebral, and vertebral arteries with profuse chronic panarteritis, fibrinoid necrosis, and mycotic aneurysms.