Bilateral Subcortical White Matter Research Articles

Snake bite-induced leukoencephalopathy

A 15-year-old girl was brought to the casualty with an alleged history of snake bite on the ring finger of her right hand (A), which showed digital ischemia. The patient was unresponsive with severe respiratory distress. Patient management was done through elective intubation, cardiopulmonary Resuscitation with lifesaving emergency medications were given followed by anti snake venom. Finger reconstructive plastic surgery was performed after the patient became stable. On MR Imaging of the brain, the T2 and FLAIR sequences (B) showed symmetrical hyperintensities in the bilateral caudate nucleus and lentiform nucleus. Diffusion-weighted imaging (C) shows the cortical rim of restriction in bilateral subcortical white matter and corpus callosum and with corresponding low signal intensity on A.D.C. There was no associated haemorrhage. Neurological signs and symptoms after a venomous snake bite are most often related to venom´s toxic effects, which are anticoagulant/procoagulant activity or neurotoxicity. Some patients develop neurological complications related to cerebral hypoxia, which are related to hypotensive shock that may accompany some snake bite envenomation. Neuromuscular disorders, that is, damage to the peripheral nervous system, occur most often after the bite of elapids but may also occur following a viper bite. The effect of neurotoxins may start from minutes to a few hours after the inoculation of venom, causing weakness related to a blockage of synaptic transmission at either presynaptic or postsynaptic levels.

Transcriptome of rat subcortical white matter and spinal cord after spinal injury and cortical stimulation

Spinal cord injury disrupts ascending and descending neural signals causing sensory and motor dysfunction. Neuromodulation with electrical stimulation is used in both clinical and research settings to induce neural plasticity and improve functional recovery following spinal trauma. However, the mechanisms by which electrical stimulation affects recovery remain unclear. In this study we examined the effects of cortical electrical stimulation following injury on transcription at several levels of the central nervous system. We performed a unilateral, incomplete cervical spinal contusion injury in rats and delivered stimulation for one week to the contralesional motor cortex to activate the corticospinal tract and other pathways. RNA was purified from bilateral subcortical white matter and 3 levels of the spinal cord. Here we provide the complete data set in the hope that it will be useful for researchers studying electrical stimulation as a therapy to improve recovery from the deficits associated with spinal cord injury.

糖尿病性ケトアシドーシスを契機に診断された孤発型エオジン好性神経核内封入体病の1例(Incidental diagnosis of sporadic neuronal intracellular inclusion disease in an elderly woman with diabetic ketoacidosis: a case report)

要旨 患者は77歳の女性。2型糖尿病の基礎疾患があり，近医に定期通院中であった。入院日の2日前から意識障害が出現，症状が進行増悪し，緊急入院当日になりJapan coma scale 300の意識障害を呈したため家人により救急要請され当院救急外来に搬送された。来院時の頭部CT，MRI検査では急性期脳血管障害の所見はなく，血液・尿検査結果から尿路感染症を契機に発症した糖尿病性ケトアシドーシスと診断した。意識障害の原因として高血糖性昏睡が考えられた。集学的治療管理目的に入院し，各病態に対して適切な治療介入を行った。しかしながら24時間以上が経過しても意識障害が遷延した。入院時に撮影した頭部MRI検査結果を見直したところ，拡散強調画像にて両側皮質下白質に特徴的な線状あるいは弧状の高信号域がみられ，神経核内封入体病が疑われた。全身管理を継続し，その後リハビリテーション目的に他院へ転院した。エオジン好性神経核内封入体病は，神経細胞核内にエオジン好性封入体を形成し，軽度認知機能低下症状から，脳卒中様症状など多彩な臨床像を呈する神経変性疾患である。救急医にとって本疾患は馴染みが薄く，特徴的な頭部MRI画像所見であっても知らなければ容易に見逃してしまう可能性がある。高齢者の割合増加とともに救急搬送が増加している今日の救急医療において，本疾患の認知が重要である。

Diffusion-Weighted MR Imaging in a Prospective Cohort of Children with Cerebral Malaria Offers Insights into Pathophysiology and Prognosis.

Validation of diffusion-weighted images obtained on 0.35T MR imaging in Malawi has facilitated meaningful review of previously unreported findings in cerebral malaria. Malawian children with acute cerebral malaria demonstrated restricted diffusion on brain MR imaging, including an unusual pattern of restriction isolated to the subcortical white matter. We describe the patterns of diffusion restriction in cerebral malaria and further evaluate risk factors for and outcomes associated with an isolated subcortical white matter diffusion restriction. Between 2009 and 2014, comatose Malawian children admitted to the hospital with cerebral malaria underwent admission brain MR imaging. Imaging data were compiled via NeuroInterp, a RedCap data base. Clinical information obtained included coma score, serum studies, and coma duration. Electroencephalograms were obtained between 2009 and 2011. Outcomes captured included death, neurologic sequelae, or full recovery. One hundred ninety-four/269 (72.1%) children with cerebral malaria demonstrated at least 1 area of diffusion restriction. The most common pattern was bilateral subcortical white matter involvement (41.6%), followed by corpus callosum (37.5%), deep gray matter (36.8%), cortical gray matter (17.8%), and posterior fossa (8.9%) involvement. Sixty-one (22.7%) demonstrated isolated subcortical white matter diffusion restriction. These children had lower whole-blood lactate levels (OR, 0.9; 95% CI, 0.85-0.98), were less likely to require anticonvulsants (OR, 0.6; 95% CI, 0.30-0.98), had higher average electroencephalogram voltage (OR, 1.01; 95% CI, 1.00-1.02), were less likely to die (OR, 0.09; 95% CI, 0.01-0.67), and were more likely to recover without neurologic sequelae (OR, 3.7; 95% CI, 1.5-9.1). Restricted diffusion is common in pediatric cerebral malaria. Isolated subcortical white matter diffusion restriction is a unique imaging pattern associated with less severe disease and a good prognosis for full recovery. The underlying pathophysiology may be related to selective white matter vulnerability.

Cilostazol is Effective to Prevent Stroke-Associated Pneumonia in Patients Receiving Tube Feeding.

Stroke-associated pneumonia (SAP) is a frequent complication in acute ischemic stroke (IS) patients, especially those receiving tube feeding (TF). In this retrospective study, we investigated whether or not cilostazol, a pluripotent phosphodiesterase III-specific inhibitor with anti-platelet and vasculogenic effects, can prevent SAP in these patients and reduce their duration of stay in intensive care unit/hospitalization. We recruited 158 IS patients receiving TF. Patients' characteristics (including age, gender, past history), National Institute of Health Stroke Scale and serum albumin level on admission, concomitant medications associated with SAP prevention (including cilostazol), and stroke characteristics (bilateral subcortical white matter lesion, brainstem involvement, large infarction, and asymptomatic hemorrhagic infarction) were compared between the SAP(-) and SAP(+) groups. Cilostazol was more frequently used in the SAP(-) group (20.8% vs. 6.1%, p < 0.05). Duration of intensive care unit was longer in patients with SAP (9 ± 8 vs. 6 ± 6days, p < 0.05). However, the length of stay in an intensive care unit and duration of hospitalization were not reduced due to the prevention of SAP by cilostazol treatment. Cilostazol administration was associated with reduced SAP incidence in acute IS patients receiving TF.

Cortical Anarthria in An Arabic Speaking Unilingual: A Case Report

A 59-year-old, Arabic, right handed female with history of hypertension and ischemic heart disease presented with sudden onset anarthria associated with right arm weakness. Language examination showed Anarthira with inability to produce more than rare unintelligible single syllables. Comprehension was intact. She correctly wrote but could not verbalize object names nor read aloud. She wrote easily but made spelling mistakes with long sentences. Motor exam only revealed slight hyper-reflexia and weakness of right upper extremity. Imaging showed a lesion in the left corona radiata and bilateral subcortical white matter hyper intensities. She was diagnosed with acute ischemic stroke and received routine antithrombotic treatment. Within two days, she started producing single words, with slow, effortful and abnormal long vowels. This report describes the clinical and radiological aspects of a case of cortical anarthria in an Arabic-speaking subject.

Delayed Posthypoxic Leucoencephalopaty: Is a Rare Condition in Patients after Episodes with Hypoxia Due to Drug Overdose with Opioids, Benzodiazepines and Barbiturates, Among Other Causes

Patients suffering from acute hypoxic episodes with respiratory failure and initial recovery, may in rare occasions present with neurological and neuropsychological symptoms occurring 2 to 4 weeks after recovery from the hypoxic episode. This rare entity is named Delayed Posthypoxic Leucoencephalopaty (DPHL). The patients present with typical MRI-findings of bilateral subcortical white matter lesions. The primary hypoxic episodes might, among other causes, be due to drug overdose with opioids, benzodiazepines and barbiturates. There is no evidence-based treatment for the condition and the majority of patients with DPHL recover spontaneously.

Common Late-Onset Subcortical Cerebral Hemorrhage Following Excessive Alcohol Consumption

year old male patient who was suffering from cooperation disorder and bilaterally blindness was admitted to our emergency service. He was addicted to alcohol and had excessive alcohol consumption the day before. Cranial nonenhanced CT was normal. T2 weighed MR imaging performed at 1,5 T unit showed high signal intensity in bilateral putaminal foci.In this localization diffusion-weighed images(DWI) were hyperintense due to restricted diffusion and low ADC values. After two weeks, drowsiness and confusion were appeared suddenly. Cranial nonenhanced CT was showed extensive subcortical white matter and basal gan- glia abnormalities consistent with edema and hemorrhagic changes. The patient was transferred to intensive care unit and died after one day. In methanol intoxication, cerebral and intraventricular hemorrhage, cerebellar necrosis, diffuse cerebral edema, bilateral subcortical white matter necrosis and edema were defined It should also be known that 2 or 3 weeks after ingestion of methyl alcohol, the deterioration of the patient's general situation is responsible for cerebral subcortical hemorrhage. We have also thought that patients' mortality and morbidity can be reduced with radiological imaging due to early diagnosis.