Areas Of Hypo Research Articles

Brain positron emission tomography in idiopathic normal-pressure hydrocephalus: new 18F-fluorodeoxyglucose pattern in a long-known syndrome.

Patients with idiopathic normal-pressure hydrocephalus (iNPH) can show a global reduction in cerebral glucose metabolism at [18F]Fluorodeoxyglucose (FDG) PET. The presence of caudate hypometabolism has been identified as a potential biomarker in iNPH, yet there is limited evidence of hypermetabolic findings in patients with iNPH so far. We retrieved retrospectively patients with iNPH and normal cognitive assessment, evaluated before surgery undergoing brain [18F]FDG-PET. The 18F-FDG-PET brain scans were compared to those of a control group of healthy subjects, matched for age and sex, by statistical parametric mapping (SPM) to identify areas of relative hypo- and hypermetabolism. Furthermore, the existence of a correlation between areas of hypo- and hypermetabolism in the patient group was tested. Seven iNPH patients (mean age 74 ± 6 years) were found in the hospital database. SPM group analysis revealed clusters of significant hypometabolism (P = 0.001) in the iNPH group in the dorsal striatum, involving caudate and putamen bilaterally. Clusters of significant hypermetabolism (P = 0.001) were revealed in the bilateral superior and precentral frontal gyrus (BA 4, 6). A significant inverse correlation between striatal hypometabolism and bilateral superior and precentral frontal gyrus hypermetabolism was revealed (P < 0.001 corrected for multiple comparisons). In this cohort, patients with iNPH showed subcortical hypometabolism, including bilateral dorsal striatum. To the best of our knowledge, this is the first report demonstrating a hypermetabolic pattern in the primary motor and premotor areas, and showing an inverse correlation between the striatum and motor cortex in patients with iNPH.

Моніторинг стану здоров’я дітей з коарктацією аорти в післяопераційному періоді

Purpose - to improve the observation of children after surgical treatment of the aortic coarctation. Materials and methods. A retrospective analysis of 87 case histories of patients with aortic coarctation in the preoperative period was performed; 44 patients underwent daily blood pressure monitoring, nitric oxide levels in 61 children were determined in the postoperative period; histological examination of 15 coarctated aortic sites was performed; quality of life was assessed in 56 patients with aortic coarctation after surgical treatment. Results. According to daily blood pressure monitoring, an inadequate increase in blood pressure during physical and mental activity was obtained; a violation of the circadian rhythm of blood pressure with insufficient decrease in systolic and diastolic or excessive decrease in diastolic pressure was detected. The results of the assessment of blood pressure variability revealed a significant difference in the standard deviation of the mean daily diastolic blood pressure (62.5 (55; 75)), daily diastolic blood pressure (72.5 (57; 78.5)), and an increase in the circadian systolic blood pressure index (16 (11.5; 17)). The level of nitric oxide in the blood of a group of patients with arterial hypertension was 4.18±0.86 μmol/l (M±SD - mean ± standard deviation). in the control group - 5.51±0.69 μmol/l. Thus, a significant decrease in nitric oxide in the group with arterial hypertension was established (t=-5.45; p&lt;0.001). It was also diagnosed that in the group of patients with stable arterial hypertension, the level of nitric oxide was 3.74±0.79 μmol/l, and in the subgroup of patients with labile hypertension - 4.44±0.80 μmol/l, the subgroups in the content of nitric oxide significantly differed from each other (t=2.91; p&lt;0.01), as well as from the values of the control group: with stable arterial hypertension (t=-6.72; p&lt;0.001) and labile arterial hypertension (t=-4.41; p&lt;0.001). The dependence of the level of nitric oxide in serum on the time of the postoperative period and the type of arterial hypertension was established. The histological features of area of narrowing in the form of foci of necrosis of cells and fibers, areas of hypo- and anelastosis, the presence of newly formed vessels of capillary type were identified and studied. The main factors in reducing the quality of life of patients with coarctation of the aorta in the postoperative period are the presence of arterial hypertension, restriction of physical activity, parents’ оverprotection. Conclusions. Based on the data obtained, an individual observation card of a patient with aortic coarctation was created. A set of clinical, instrumental and laboratory signs that may be a leading role in the occurrence and course of arterial hypertension in children (concomitant cardiovascular and somatic pathologies, initial level of systolic and diastolic blood pressure, level of the final product of nitric oxide in serum, structural features of the aortic wall) has been determined. An original method of examination of patients with aortic coarctation in the postoperative period was proposed. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

An ulcerated nodule on the tip of the tongue of a patient with skin lesions

A 66-year-old male patient was referred with a chief complaint of an asymptomatic ulcerated nodule on the tongue with 2 months of evolution. The patient’s medical history included hypertension; multiple basal cell carcinomas on the skin, which were surgically treated; and prostate cancer, which was still being treated with radiotherapy. The patient also reported the use of antiandrogens. Information on tobacco or alcohol consumption was not elicited. Extraoral examination revealed facial lesions characterized by areas of hypo- and hyperpigmentation of the skin, actinic lentigines, actinic keratosis, and actinic cheilitis (Figure 1A-1D).

A Broken Heart: A Rare Complication of Hyponatremia

We present a case of a 47-year-old female with a history of anxiety, depression, and alcohol dependence with history of alcohol withdrawal seizures, who presented after a witnessed seizure episode. She admitted to drinking only copious amounts of black tea 1 week prior to presentation in an attempt to quit alcohol. She was subsequently found to be severely hyponatremic with a serum sodium level of 112 mEq/L and was admitted to the intensive care unit. Approximately 48 h after admission, she experienced sudden-onset of dizziness, diaphoresis, and nausea, with a heart rate of 42 beats/min and blood pressure of 70/40 mm Hg. STAT EKG revealed new T-wave inversions in the lateral and precordial leads and troponin was elevated to 5.99 ng/mL. Treatment was initiated for NSTEMI with continuous heparin infusion, aspirin, clopidogrel, carvedilol, and lisinopril. Transthoracic echocardiogram revealed apical and mid ventricular dyskinesia with hyperkinesis of the basal walls, with an estimated left ventricular ejection fraction of 35%. Cardiac catheterization revealed no significant coronary disease with ejection fraction 30-35% and similar areas of hypo and hyperkinesis, classic for apical ballooning syndrome. This case not only illustrates the rare phenomenon of hyponatremia-induced Takotsubo cardiomyopathy, but is one of the only incidents caused by primary polydipsia. J Med Cases. 2018;9(5):147-150 doi: https://doi.org/10.14740/jmc3050e

Recidiva de lepra y reacción tipo II en paciente tratado con poliquimioterapia (PQT)

La lepra es una enfermedad infecciosa crónica propia de países de África, Asia, Oceanía y América Latina. Es causada por el Mycobacterium leprae que se manifiesta de forma variada como zonas de hipo o anestesia, máculas hipocrómicas, con o sin engrosamiento neural. En algunas ocasiones, después de haber completado el ciclo terapéutico recomendado por la Organización Mundial de la Salud, puede presentar recidivas, apareciendo nuevas lesiones clínicas o aumentando el índice bacilar. Esta características pueden confundirse con el eritema nodoso leproso, caracterizado por ser una reacción antígeno-anticuerpo que fija complemento mediante la cual el sistema inmune combate antígenos bacilares. En este texto se describe un caso de recidiva de lepra lepromatosa y lesiones compatibles con eritema nodoso leproso después de haber sido tratado con poliquimioterapia.

Focusing effects of L‐dopa in Parkinson's disease

Previous fMRI motor studies in Parkinson's disease (PD) have suggested that L-dopa may "normalize" areas of hypo- and hyperactivity. However, results from these studies, which were largely based on analyzing BOLD signal amplitude, have been conflicting. Examining only amplitude changes at distinct loci may thus be inadequate in fully capturing the activation changes induced by L-dopa. In this article, we extended prior analyses on the effects of L-dopa by investigating both amplitude and spatial changes of brain activation before and after L-dopa. Ten subjects with PD, both on and off medication, and ten healthy, age-matched controls performed a visuo-motor tracking task in which they sinusoidally squeezed a bulb at 0.25, 0.5, and 0.75 Hz. This task was contrasted with static squeezing to generate fMRI activation maps. To investigate the effects of L-dopa, we examined the amplitude and spatial variance of the BOLD response within anatomically-defined regions of interest (ROIs). L-dopa had significant main effects on the amplitude of BOLD signal in bilateral primary motor cortex and left SMA. In contrast, L-dopa-mediated spatial changes were apparent in bilateral cerebellar hemispheres, M1, SMA, and right prefrontal cortex. Moreover, L-dopa appeared to normalize the spatial distribution of ROI activation in PD to that of the controls. Specifically, L-dopa had a "focusing" effect on activity-an effect more pronounced than the typically-measured fMRI amplitude changes. This observation is consistent with modeling studies, which demonstrated that dopamine increases the signal-to-noise ratio at the neuronal level with a resultant focusing of representations at the macroscopic level.

Right ventricular MR abnormalities in myotonic dystrophy and relationship with intracardiac electrophysiologic test findings: initial results.

To prospectively determine whether a relationship exists between magnetic resonance (MR) imaging abnormalities of the right ventricle (RV) and intracardiac electrophysiologic (EP) test results in patients with myotonic dystrophy. Conventional T1-weighted single-shot black-blood fast spin-echo and gradient-echo MR imaging of the heart was prospectively performed in 32 patients with myotonic dystrophy who required EP testing. Patients were divided into two groups according to EP test results: (a) inducible (n = 15), indicating inducible ventricular tachyarrhythmias, and (b) noninducible (n = 17). Morphologic and functional MR data were analyzed by two independent investigators. Nonparametric statistical methods and kappa statistics were used. No morphologic or functional abnormalities of the RV wall were observed in noninducible patients. Increased signal intensity of the RV wall, indicative of fatty replacement, was identified in 13 inducible patients. Myocardial thinning of the RV was observed in six inducible patients. An overlap of morphologically abnormal areas and areas of hypo- or dyskinesis were present in 11 inducible patients. RV outflow tract diameter was larger and RV ejection fraction was smaller in inducible patients than in noninducible patients, although differences were not significant. Interobserver agreement for MR findings was good (increased signal intensity: kappa = 0.87, P >.30 [pairwise Wilcoxon signed rank test]; myocardial thinning: kappa = 0.87, P >.30; hypo- or dyskinesis: kappa = 1.00, P >.99). There was a strong relationship between MR abnormalities and inducibility during EP testing (increased signal intensity, P <.001; myocardial thinning, P <.01; hypo- or dyskinesis, P <.01). The relationship between MR morphologic and functional RV abnormalities and EP testing suggests potential for the use of MR imaging as a noninvasive method to estimate the individual risk of arrhythmia in patients with myotonic dystrophy.

Xanthoma of the Temporal Bone: Case Report

OBJECTIVE AND IMPORTANCE: Xanthomas of the cranium that are not accompanied by endocrine or metabolic abnormalities are extremely rare. It is very important to understand the pathological features of this disease, for differential diagnosis from other diseases. CLINICAL PRESENTATION: A 62-year-old woman presented to the hospital with headaches. Cranial x-rays revealed bone destruction in the right temporal bone, with osteosclerosis in the area surrounding the lesion. In computed tomographic scans, the bone cortex was intact and the diploë was dilated because of the large mass of the lesion. T1-weighted magnetic resonance imaging findings were heterogeneous, with areas of hypo- and isointensity; T2-weighted magnetic resonance imaging findings were also heterogeneous, with areas of hypo- and hyperintensity. INTERVENTION: Total removal of the tumor was performed, followed by cranioplasty using artificial bone. DIAGNOSIS: Histologically, lipid-containing foamy cells were dense and a cholesterin granuloma was observed. There was no reason to infer other diseases, and a diagnosis of xanthoma of the temporal bone was reached. CONCLUSION: Xanthomatous lesions are observed in various pathological conditions, including malignant diseases. Xanthomas are benign lesions and the prognoses for patients with these lesions are satisfactory, even after partial excision. Therefore, it is quite important to distinguish xanthomas from other diseases that produce xanthomatous lesions.

Fan-shaped hepatic parenchymal damage after ethanol injection therapy for hepatocellular carcinoma: MRI appearances.

T1- and T2-weighted magnetic resonance (MR) images frequently show fan-shaped areas of hypo- or hyperintensity in the hepatic parenchyma adjacent to a treated hepatocellular carcinoma after percutaneous ethanol injection (PEI) therapy. These areas correspond to abnormal contrast enhancement on serial dynamic MR images. The purpose of the present study was to describe the location, appearance, and frequency of these abnormalities because it is important to understand these entities for the correct assessment of therapeutic efficacy. MR imaging including a multisection dynamic study was performed in 20 consecutive patients with hepatocellular carcinoma treated with PEI therapy. We retrospectively evaluated the presence of fan-shaped hypointensities adjacent to treated tumors in the liver parenchyma on T1-weighted images and hyperintensities on T2-weighted images and corresponding fan-shaped contrast enhancement on both arterial-dominant and delayed-phase dynamic MR images. We review the location, appearance, and frequency of these findings, and we discuss the possible causes on the basis of pathologic examinations. Seven (35%) of the 20 patients showed fan-shaped hyperintense areas adjacent to the treated tumors on T2-weighted images. These areas showed isointensity in five patients and hypointensity in two patients on T1-weighted images. Of these seven patients, one (14%) underwent the MR imaging within 1 month after the completion of PEI therapy, and six (86%) had it 2-9 months after the completion of PEI therapy (mean = 6 months). In all seven patients, fan-shaped hyperperfusion abnormalities corresponding to these areas of hyperintensity on T2-weighted images were seen on both arterial-dominant and delayed-phase dynamic MR images. Pathologically, the coagulative necrosis of the hepatocytes with sinusoidal dilatation and the restoration by the development of fibrous tissue were seen in these fan-shaped areas. The fan-shaped areas of abnormal intensity on T1- and T2-weighted images and contrast enhancement on dynamic MR images seem to be attributable to pathologic changes in the normal liver parenchyma induced by the toxic reaction of ethanol. Awareness of the occurrence of such abnormalities in the peripheral liver parenchyma adjacent to the treated tumor is important for the correct assessment of therapeutic efficacy.

Gliomatosis cerebri.

To characterize gliomatosis cerebri on computed tomographic (CT) and magnetic resonance (MR) images. MR and CT studies of 22 patients with cerebral gliomatosis were reviewed retrospectively. Tumor was confirmed with autopsy (n=5) or biopsy. Distribution and extent of disease were assessed, and disease progression was followed. Tumor involved at least two lobes of the brain in all patients, with extension to the corpus callosum in 12, basal ganglia and thalamus in 17, brain stem in three, and cerebellum in two patients. Widespread invasion with hyperintensity was noted on proton-density- and T2-weighted MR images. At CT, areas of hypo- or isoattenuation were noted, and no contrast enhancement occurred. Extent of tumor was greater on MR images than on concurrent CT scans in all patients. The MR findings closely correlated with the autopsy findings. Gliomatosis cerebri is best detected with MR imaging. The pattern is infiltrative with enlargement of cerebral structures.

Nontumorous attenuation changes on CT arterial portography.

We prospectively studied the frequency and the distribution of nontumorous attenuation changes during CT arterial portography. Computed tomography arterial portograms were obtained in 67 consecutive patients. The frequency and distribution of nontumorous attenuation changes (pseudolesions, areas of hypo- or hyperperfusion) were analyzed and related to the size of the tumor, the vascular status assessed by Doppler examination, and the presence of chronic liver disease. Pseudolesions were detected in 19 patients (28%). They were typical in 13 cases and atypical (round shaped or located in the caudate or right lobe) in 6. Segmental, lobar, or diffuse perfusion defects were seen in 36 patients (54%). In 56% of the cases, they were adjacent to large tumors and related to compression or thrombosis of intrahepatic portal branches as demonstrated by sonographic and Doppler findings. Areas of hyperperfusion were detected in 14 patients (21%). Of these cases, eight (57%) were peritumoral hyperperfusion. In all cases, the mean diameter of the tumors was large and there was compression of adjacent hepatic vein as demonstrated by sonographic and Doppler findings. Nontumorous attenuation changes are common in CT arterial portography. Factors leading to these artifacts include size of the tumor and vascular consequences of the tumor. Sonographic and Doppler studies may play a role in predicting these factors.