Cranial Magnetic Resonance Imaging Scans Research Articles

Contribution of automated hippocampal volume measurements to radiological diagnosis in cases of mesial temporal sclerosis

Aims: Epilepsy, particularly drug-resistant epilepsy in adults, is often caused by Mesial Temporal Sclerosis (MTS), which can develop after brain injury from febrile illnesses or trauma. Magnetic Resonance Imaging (MRI) is crucial for diagnosing MTS, although challenges such as patient movement and mild or bilateral hippocampal atrophy can complicate the diagnosis. T1-weighted hippocampal volume measurements are effective in detecting MTS, with recent software advancements enabling automatic hippocampal segmentation. This study compared the hippocampal volumes and indices between adults with MTS and a control group of similar age and sex in the Turkish population. This study aimed to highlight structural differences in the hippocampus associated with MTS. Methods: This study involved a retrospective review of cranial MRIs scans from patients with MTS, confirmed through histopathological examination after epilepsy surgery. To ensure unbiased comparisons, a control group was selected using propensity score matching by age and gender. Two experienced neuroradiologists independently assessed the MRIs findings for MTS without knowledge of hippocampal volumetric data. Hippocampal volumes were measured using FreeSurfer software and standardized using the hippocampal volume index (HVI) and hippocampal asymmetry index (HAI). Results: In our study of 38 patients, MTS was found in 55.2% of patients on the right side and in 44.8% of patients on the left side, with no bilateral cases. Visual MRI analysis identified MTS in 84.2% of patients, with an area under of curve (AUC) of 0.921. Automatic volumetry detected MTS in 23 patients with an AUC of 0.791. Combining both methods, MTS was diagnosed in 33 patients, with an AUC of 0.922. Conclusion: Automated volumetric analyses have been shown to enhance the detection of hippocampal volume loss in patients with MTS.

Cerebral small vessel injury in mice with damage to ACE2-expressing cerebral vascular endothelial cells and post COVID-19 patients.

The angiotensin-converting enzyme 2 (ACE2), which is expressed in cerebral vascular endothelial cells (CVECs), has been currently identified as a functional receptor for SARS-CoV-2. We specifically induced injury to ACE2-expressing CVECs in mice and evaluated the effects of such targeted damage through magnetic resonance imaging (MRI) and cognitive behavioral tests. In parallel, we recruited a single-center cohort of COVID-19 survivors and further assessed their brain microvascular injury based on cognition and emotional scales, cranial MRI scans, and blood proteomic measurements. Here, we show an array of pathological and behavioral alterations characteristic of cerebral small vessel disease (CSVD) in mice that targeted damage to ACE2-expressing CVECs, and COVID-19 survivors. These CSVD-like manifestations persist for at least 7 months post-recovery from COVID-19. Our findings suggest that SARS-CoV-2 may induce cerebral small vessel damage with persistent sequelae, underscoring the imperative for heightened clinical vigilance in mitigating or treating SARS-CoV-2-mediated cerebral endothelial injury throughout infection and convalescence. Cerebral small vessel disease-associated changes were observed after targeted damage to angiotensin-converting enzyme 2-expressing cerebral vascular endothelial cells. SARS-CoV-2 may induce cerebral small vessel damage with persistent sequelae. Clinical vigilance is needed in preventing SARS-CoV-2-induced cerebral endothelial damage during infection and recovery.

The effect of live music therapy on white matter microstructure in very preterm infants – A randomized controlled trial

ObjectiveMusic therapy (MT) is proposed to enrich the acoustic environment of very preterm infants (VPT) on the neonatal intensive care unit during a vulnerable period of brain development. The objective of this study was to investigate the effect of MT on the white matter (WM) microstructure. It is hypothesized that MT affects WM integrity in VPT. MethodsRandomized controlled trial enrolling infants born <32 weeks’ gestation. Infants were randomized to MT or standard care. Live MT was provided twice weekly from the second postnatal week onwards by a trained music therapist. At term equivalent age, participants underwent a cranial magnetic resonance imaging scan including sequences for diffusion tensor imaging analysis. Differences in WM microstructure were assessed using tract based spatial statistics with fractional anisotropy. ResultsOf 80 infants enrolled, 42 were eligible for diffusion tensor imaging analysis (MT: n = 22, standard care: n = 20). While primary tract based spatial statistics analysis revealed no significant differences between groups, post hoc analysis with uncorrected p-values and a significance threshold of p < 0.01 revealed significant fractional anisotropy differences in several WM tracts including the bilateral superior longitudinal fasciculus, the left forceps minor and left fasciculus uncinatus, the corpus callosum, the left external capsule, and the right corticospinal tract. ConclusionPost hoc analysis results suggest an effect of MT on WM integrity in VPT. Larger studies including long-term outcome are necessary to confirm these effects of MT on WM microstructure and to assess its impact on clinical neurodevelopment. Clinical trial registrationClinical trial number DRKS00025753.

Hashimoto’s thyroiditis presenting solely with psychotic symptoms: A case report

This case report highlights the infrequent occurrences of myxedema psychosis and pituitary hyperplasia as secondary complications of Hashimoto&amp;rsquo;s thyroiditis. The subject of interest is a 16-year-old female patient who displayed persistent symptoms of delusions, auditory hallucinations, and depression without any discernible cause. The physical examination did not reveal any notable abnormalities. Despite a continuous 4-week treatment regimen involving antipsychotic and antidepressant medications, the patient experienced a deterioration of psychotic symptoms, which resulted in substantial impairment in social functioning. Cranial magnetic resonance imaging scan detected an enlarged pituitary gland and laboratory tests indicated abnormal thyroid function and the presence of specific thyroiditis autoantibodies. Combined with these results, thyroid ultrasound findings revealed features that were consistent with Hashimoto&amp;rsquo;s thyroiditis. Consequently, the patient was prescribed levothyroxine sodium replacement therapy, as well as low-dose antipsychotic and antidepressant medications, which led to a gradual amelioration of their psychotic symptoms. Following 6 months of treatment, the patient was ordered to stop taking the antipsychotic and antidepressant drugs but continue with levothyroxine sodium replacement therapy exclusively. The results of the 1-year follow-up demonstrated the restoration of thyroid function to normal levels, the normalization of pituitary size and structure, and the absence of any psychotic symptoms. These findings provide evidence for a diagnosis of myxedema psychosis and secondary pituitary hyperplasia caused by hypothyroidism associated with Hashimoto&amp;rsquo;s thyroiditis. This emphasizes the significance of supplementary tests in the diagnostic procedures carried out by psychiatrists.

Relationship of Serum Microsomal Prostaglandin E2 Levels with Residual Tumor Volume in Patients with Astrocytoma.

This study aimed to investigate the relationship between tumor volume and serum microsomal prostaglandin E2 (mPGE2) levels in patients with astrocytic tumors. The study included patients with astrocytic tumors who were treated at our clinic between August 2015 and December 2016. Preoperative and postoperative contrast-enhanced cranial magnetic resonance imaging (MRI) scans were performed (within the first 24 h), and preoperative and postoperative residual tumor volumes were calculated. Microsomal prostaglandin E2 (mPGE2) levels were measured and compared in the serum samples of the patients before surgery, on the first day after surgery, and at 1 week after the surgery. The study included 20 patients, 13 of whom were males and 7 were females, with a mean age of 57.20 ± 14.66 yr. The mean postoperative tumor volume was 9,180.69 mm3 (range, 0.00-41,961.60), which was significantly lower than the preoperative mean tumor volume of 37,323.84 mm3 (range, 4,457.40-108,247.20; z = -3.920, p 0.001). On the first postoperative day, the mean mPGE2 level was 1,776.50 pg/ml (range, 771-5,010), which was similar to the preoperative mean mPGE2 level of 1,769.20 pg/ml (range, 681-3,480). On the seventh postoperative day, the mean mPGE2 level was 955.50 pg/ml (range, 31-2,130), which was significantly lower than the preoperative and postoperative first-day mean mPGE2 levels (p 0.001). No correlation was found between preoperative and postoperative tumor volumes and mPGE2 levels. Compared with preoperative mPGE2 levels, mPGE2 levels decreased significantly on the seventh postoperative day. However, no correlation was observed between the tumor volume removed and decrease in mPGE2 levels.

Bridging Reduced Grip Strength and Altered Executive Function: Specific Brain White Matter Structural Changes in Patients with Alzheimer's Disease.

To investigate the correlation between specific fiber tracts and grip strength and cognitive function in patients with Alzheimer's disease (AD) by fixel-based analysis (FBA). AD patients were divided into AD with low grip strength (AD-LGS, n=29) and AD without low grip strength (AD-nLGS, n=25), along with 31 normal controls (NC). General data, neuropsychological tests, grip strength and cranial magnetic resonance imaging (MRI) scans were collected. FBA evaluated white matter (WM) fiber metrics, including fiber density (FD), fiber cross-sectional (FC), and fiber density and cross-sectional area (FDC). The mean fiber indicators of the fiber tracts of interest (TOI) were extracted in cerebral region of significant statistical differences in FBA to further compare the differences between groups and analyze the correlation between fiber properties and neuropsychological test scores. Compared to AD-nLGS group, AD-LGS group showed significant reductions in FDC in several cerebral regions. In AD patients, FDC values of bilateral uncinate fasciculus and left superior longitudinal fasciculus were positively correlated with Clock Drawing Test scores, while FDC of splenium of corpus callosum, bilateral anterior cingulate tracts, forceps major, and bilateral inferior longitudinal fasciculus were positively correlated with the Executive Factor Score of Memory and Executive Screening scale scores. Reduced grip strength in AD patients is associated with extensive impairment of WM structural integrity. Changes in FDC of specific WM fiber tracts related to executive function play a significant mediating role in the reduction of grip strength in AD patients.

Abstract WMP101: Plasma Proteomic Determinants Of White Matter Hyperintensities And Covert Brain Infarction In The Cardiovascular Health Study

Background: Identification of novel biomarkers of cerebral small vessel disease is critical to elucidate pathophysiology and guide therapeutic development for prevention. We evaluated plasma proteomic associations of clinically asymptomatic, covert brain infarction (cBI) and white matter hyperintensity (WMH) burden on cranial magnetic resonance imaging (MRI) in the population-based Cardiovascular Health Study (CHS). Methods: Eligible CHS participants underwent one or two cranial MRI scans (~5 years apart) and aptamer-based SOMAScan platform measurement of up to 7288 plasma proteins concurrent with the initial MRI. cBI was defined by MRI signal characteristics and size ≥ 3 mm, and WMH burden was graded (WMG) 0 (least) to 9 (most severe). The relationship between 1-standard deviation increase in each log 2 -normalized plasma protein fluorescence was modeled separately with incident cBI and WMG worsening (≥1 grade increase) using multivariable relative risk regression, adjusting for demographics, estimated glomerular filtration rate (eGFR), and stroke risk factors. In secondary analyses, multivariable linear regression evaluated the cross-sectional relationship between each plasma protein with number of cBI and WMG on initial MRI. Bonferroni correction, based on the number of principal components that explained 99% of the protein fluorescence variance in CHS participants, accounted for multiple comparisons (p&lt;2.1x10 -5 (0.05/2377)). Results: For eligible participants (n=2615), mean age was 74.4 ± 4.9 years, 61.7% were women, and 16.4% were Black. After adjustment for demographics, eGFR, and stroke risk factors, multiple circulating proteins were associated with cBI and WMG (Table). Conclusion: Multiple plasma proteins - implicated in systemic inflammation, fatty acid metabolism, neuronal adhesion/migration, and cellular cytoskeletal integrity/remodeling - were independently associated with cBI and WMG in a cohort of older adults.

Illustration of a patient with stroke developing ipsilateral tremor-like grasp phenomenon

An 83-year-old right-handed woman with coronary artery disease (CAD) was admitted due to acute-onset confusion, visual impairment, and right-sided paresis. Upon admission, the patient was lethargic and disorientated in terms of time and place. The visual field examination revealed right-sided homonymous hemianopsia, and the motor examination revealed paralysis on the right side (which was of grade 4 according to the medical research council). She also had the grasp reflex on her left hand. A Cranial magnetic resonance imaging (MRI) scan revealed acute infarction in the territory of the left posterior cerebral artery (PCA) ([Figure 1]). On the second day of follow-up, the patient developed ipsilateral involuntary movements of her left hand and foot that were compatible with the tremor-like grasp phenomenon ([Video 1]).[1] [2] Of note, a routine electroencephalogram (EEG) did not show an epileptiform discharge. The movements were fully recovered one week later without additional interventions. We herein report a very rare entity of a motor symptom ipsilateral to an acute brain injury that has been hypothesized to be due to hyperexcitation of the frontal lobe, contralateral to the movements.[2]

Morphological brain alterations in dialysis- and non-dialysis-dependent patients with chronic kidney disease.

To 1) investigate the morphological brain-tissue changes in patients with dialysis- and non-dialysis-dependent chronic kidney disease (CKD); 2) analyze the effects of CKD on whole-brain cortical thickness, cortical volume, surface area, and surface curvature; and 3) analyze the correlation of these changes with clinical and biochemical indices.This study included normal controls (NCs, n = 34) and patients with CKD who were divided into dialysis (dialysis-dependent chronic kidney disease [DD-CKD], n = 26) and non-dialysis (non-dialysis patients who underwent cranial magnetic resonance imaging scans [NDD-CKD], n = 26) groups. Cortical thickness, volume, surface area, and surface curvature in each group were calculated using FreeSurfer software. Brain morphological indicators with statistical differences were correlated with clinical and biochemical indicators.Patients with CKD exhibited a significant and widespread decrease in cortical thickness and volume compared with NCs. Among the brain regions associated with higher neural activity, patients with CKD exhibited more significant morphological changes in the paracentral gyrus, transverse temporal gyrus, and lateral occipital cortex than in other brain regions. Cortical thickness and volume in patients with CKD correlated with blood pressure, lipid, hemoglobin, creatinine, and urea nitrogen levels. The extent of brain atrophy was further increased in the DD-CKD group compared with that in the NDD-CKD group.Patients with CKD potentially exhibit a certain degree of structural brain-tissue imaging changes, with morphological changes more pronounced in patients with DD-CKD, suggesting that blood urea nitrogen and dialysis may be influential factors in brain morphological changes in patients with CKD.

Successful rescue of disseminated Nocardia infection with multiple abscesses in a patient with membranous nephropathy after cardiopulmonary resuscitation: A three-year follow-up.

Nocardiosis manifests as an opportunistic infection, primarily affecting individuals who are immunocompromised and susceptible to the infection. We present a case study of one patient with nephrotic syndrome and membranous nephropathy, who underwent treatment with prednisone and cyclosporine in 2016. In early 2017, the patient was diagnosed with a "fungal infection" and discontinued the use of cyclosporine. After one month of anti-infection therapy, a cranial magnetic resonance imaging scan showed multiple abscesses in the right temporal region. The diagnosis of nocardiosis was confirmed based on the presence of metastatic abscess masses, multiple lung and brain lesions, and a positive culture of Nocardia in the drainage. We changed the anti-infection therapy to a combination of trimethoprim-sulfamethoxazole (TMP-SMX), minocycline, and voriconazole. However, the patient experienced a sudden cardiac arrest and subsequently recovered after cardiopulmonary resuscitation. During the five-month follow-up period following the discharge, the patient displayed an enhanced nutritional status and stable renal function. The focal infection ultimately resolved during the subsequent three years. Neuro-infection caused by Nocardia should be considered in immunocompromised patients, and TMP-SMX is the preferred initial therapy; however, because of the high mortality rate, a long-term combination therapy with imipenem, cefotaxime, amikacin, and TMP-SMX is suggested.

Intracranial Arachnoid Cysts in Adulthood: A Retrospective, Multicenter Magnetic Resonance Imaging-Based Study of 15,108 Patients.

To retrospectively evaluate the cranial magnetic resonance imaging (MRI) features and determine the incidence of intracranial arachnoid cysts (ACs) based on sex, age, location, size, affected side, Galassi type, and their association with hydrocephalus, mega cisterna magna (MCM), bone erosion, and midline brain shift in 15,108 patients during outpatient headache evaluations. Between 2012 and 2022, cranial MRI scans of 15,108 adult patients aged 20-70 years undergoing outpatient evaluations for headaches were retrospectively reviewed to analyze the features of ACs detected incidentally. Patients who had previously undergone a craniotomy or craniectomy were excluded from the study. The relationship between the location of AC and hydrocephalus did not show statistically significant differences between the supratentorial and infratentorial subgroups (p = 0.557). The relationship between the location of AC and MCM showed statistically significant differences between the two groups (p = 0.008). MCMs occur more commonly in supratentorial ACs than in posterior fossa ACs. The increased use of MRI in assessing patients with headaches has resulted in an increased detection of ACs. Although managing asymptomatic lesions typically involves periodic follow-ups, symptomatic lesions can sometimes require surgical treatment, such as AC fenestration, cyst aspiration, endoscopic shunt placement, or microneurosurgery.

Rhino-orbital mucormycosis after COVID-19 in the emergency department

Introduction &#x0D; Rhino-orbital mucormycosis (ROM) is an acute and fulminant infection. The number of ROM cases developing after coronavirus disease 2019 (COVID-19) is increasing.&#x0D; Case Report&#x0D; A 62-year-old male patient was admitted to the emergency department in northern Syria complaining of new-onset vision loss, swelling, and severe swelling of the left eye. It was noted that a 3-day course of prednisolone 250 mg was given to treat COVID-19. We found that he had a history of diabetes mellitus (DM) for 10 years. Physical examination revealed ptosis, proptosis, and ocular movement restriction in all directions in the left eye. All other systemic examinations were normal. A cranial and orbital magnetic resonance imaging scan performed after hospitalization for further evaluation and treatment showed an increase in the density of the sphenoid, ethmoid, and frontal sinus walls in the left orbit. Despite antifungal and surgical treatment, the patient died on day 14.&#x0D; Conclusion&#x0D; The use of steroids in treatment and the presence of concomitant DM are the main predisposing factors. The prognosis of this disease, which has a high mortality and morbidity, is adversely affected in geographic regions where health care is inadequate.

Neuroimaging Findings in Pediatric Patients with Thalassemia Major.

Background: Cranial magnetic resonance imaging (MRI) studies about iron accumulation in children with thalassemia major are quite limited. Aim: This study aimed to detect neurological findings with cranial MRIs in the pediatric patients with thalassemia major who did not develop any neurological complications. Materials and Methods: Pediatric patients with thalassemia major who followed in the Pediatric Hematology Unit between 1 July 2017 and 1 January 2019 were included in the study. The patients underwent cranial MRI scans. Results: A total of 30 patients were included. The median age was 15 (range from 4–18) years old. We found that 7 patients had a splenectomy and 19 of the remaining 23 patients had splenomegaly. In addition, 13 of the patients had hepatomegaly, 10 had skeletal deformities, and 17 had growth retardation. The mean ferritin level was 3772.3 ± 2524.8. We detected various pathologies on cranial MRI images of 10 (33.3%) patients. In 3 of these patients, millimeter-sized ischemia-compatible lesions were found in the cerebral white matter, which did not fit any arterial area, and 5 patients had hyperintense lesions in the basal ganglia. Conclusion: Our study is valuable since 1/3 of our pediatric patients with thalassemia major were detected with intracranial pathology.

Hyperparathyroidism and cerebral calcifications:a case report

ABSTRACT The evidence of hyperparathyroidism associated with cerebral calcifications is rare. We report a case with primary hyperparathyroidism (PHPT) and cerebral calcifications. A 63-year-old female patient with a history of hypertension presented to the neurology department due to bradykinesia and declining memory for one year. Cranial CT and magnetic resonance imaging (MRI) scan revealed symmetrical calcifications in the basal ganglia, dentate nucleus of the cerebellum and in the gray and white matter junction. In the literature review, a total of 6 patients with PHPT had cerebral calcifications. Parathyroidectomy may provide a significant remission of cerebral calcifications in a patient with PHPT.

An extremely rare case of pituitary functioning gonadotroph microadenoma accompanied by ovarian hyperstimulation syndrome in a woman of reproductive age

ObjectiveTo report a case of pituitary functioning gonadotroph microadenoma accompanied by ovarian hyperstimulation syndrome (OHSS) in a woman of reproductive age.DesignA case report.SettingTertiary care unit of a university hospital.PatientsA 42-year-old parous woman with bilateral ovarian enlargement presumed to be secondary to a functioning gonadotroph pituitary microadenoma.InterventionsOral contraceptives and endoscopic transsphenoidal surgery for adenoma that initially could not be visualized on a magnetic resonance imaging (MRI) scan.Main Outcome MeasuresMedical and radiographic assessment of endogenously induced OHSS and its resolution after treatment.ResultsThe patient was diagnosed with OHSS secondary to elevations in endogenous levels of follicle-stimulating hormone (FSH). The cranial contrast-enhanced MRI scan did not show any apparent tumor in the pituitary gland. She was, therefore, treated with oral contraceptives, which resulted in a modest resolution of ovarian enlargement; however, this treatment became ineffective 3 years later. A small pituitary adenoma (maximum diameter of 8 mm) was suspected on repeated MRI (2 years after the first MRI). Selective adenomectomy was performed, which resulted in normalization of the ovarian size and resumption of regular menstrual cycles.ConclusionsWe report a case of a functional pituitary microadenoma secreting FSH in quantities significant enough to result in OHSS. The excessive FSH production was resistant to medical therapy; however, surgical treatment was ultimately successful.

The longest reported sibling survivors of a severe form of congenital myasthenic syndrome with the ALG14 pathogenic variant

Congenital myasthenic syndromes (CMS) is a group of diseases that causes abnormalities at the neuromuscular junction owing to genetic anomalies. The pathogenic variant in ALG14 results in a severe pathological form of CMS causing end-plate acetylcholine receptor deficiency. Here, we report the cases of two siblings with CMS associated with a novel variant in ALG14. Immediately after birth, they showed hypotonia and multiple joint contractures with low Apgar scores. Ptosis, low-set ears, and high-arched palate were noted. Deep tendon reflexes were symmetrical. They showed worsening swallowing and respiratory problems; hence, nasal feeding and tracheotomy were performed. Cranial magnetic resonance imaging scans revealed delayed myelination and cerebral atrophy. Exome sequencing indicated that the siblings had novel compound heterozygous missense variants, c.590T>G (p.Val197Gly) and c.433G>A (p.Gly145Arg), in exon 4 of ALG14. Repetitive nerve stimulation test showed an abnormal decrease in compound muscle action potential. After treatment with pyridostigmine, the time off the respirator increased. Their epileptic seizures were well controlled by anti-epileptic drugs. Their clinical course is stable even now at the ages of 5 and 2 years, making them the longest reported survivors of a severe form of CMS with the ALG14 variant thus far.

Influence of orthodontic brackets and permanent retainers on the diagnostic image quality of MRI scans: A preliminary study.

Orthodontic treatment with fixed mechanotherapy using appliances and permanent retainers bonded after treatment is a routine procedure performed in clinical dentistry. Patients with braces or retainers sometimes need to undergo magnetic resonance imaging (MRI) for various reasons. Radiologists do not know the exact impact of the materials used in orthodontics on the diagnostic image quality of MRI scans. The aim of the study was to evaluate the influence of different types of orthodontic brackets and permanent retainers on the diagnostic image quality of MRI scans. Twenty patients with bonded brackets (stainless steel buccal/labial, stainless steel lingual, ceramic self-ligating with metal slots, ceramic, and polycarbonate) and 18 patients with bonded fixed retainers (titanium, fiber-reinforced composite, multi-stranded stainless steel, and different combinations of permanent retainers) participated in the study. The same adhesive was used for bonding. Cranial MRI scans of 6 regions were acquired for each subject, using a 1.5T MAGNETOM machine. Six radiologists evaluated the images and provided scores based on the modified receiver operating characteristic (ROC) analysis of distortion. The paired Wilcoxon signed-rank test was used to assess differences between the materials and the anatomic sites with regard to the distortion rating scale. Cohen's kappa coefficient (κ) was applied to establish the interrater reliability. A statistically significant difference was found between stainless steel brackets (both buccal/ labial and lingual) and all other experimental materials in terms of mean distortion scores (p = 0.020 or p = 0.024). The interrater reliability proved to be high. Stainless steel buccal/labial and lingual brackets caused maximum distortion of the images, which became non-diagnostic; hence, such brackets should be removed before MRI. Ceramic and polycarbonate brackets as well as fiber-reinforced composite retainers did not distort the images; thus, they need not be removed. Ceramic self-ligating brackets with metal slots, titanium retainers, multi-stranded stainless steel retainers, and combinations of fixed retainers caused minimal distortion; however, the images were still diagnostic. Hence, patients using these materials may not need to have them removed before MRI.

Complex intracranial vascular complications caused by essential thrombocythemia: a critical case report

BackgroundEssential thrombocythemia (ET) is a myeloproliferative neoplasm characterized by elevated and dysfunctional platelets. ET can result in systemic thrombotic and hemorrhagic complications, and it’s a rare cause of stroke. The coexistence of multiple vascular lesions has seldom been reported in patients with essential thrombocythemia.Case presentationA young woman presented with isolated and persistent vertigo and vomiting. The CT scan indicated a hyperdense lesion in the right cerebellar hemisphere. No signs of cerebral artery malformation were observed in the CT angiography (CTA). Besides, the blood tests indicated an increase in platelet and white blood cell counts. The patient then suddenly developed a transient unconsciousness with left horizontal nystagmus when staring to the right. The subsequent cranial magnetic resonance imaging (MRI) scans indicated a diffuse and acute infarction of the pons and hemorrhage in the bilateral cerebellums. Further digital subtraction angiography (DSA) revealed a progressive and critical intracranial vertebral arterial occlusion. The patient’s clinical condition stabilized after cytoreductive therapy with interferon-α (IFN-α), even though endovascular and antiplatelet treatments were restricted because of the simultaneous presence of intracerebral hemorrhage (ICH) and ischemic stroke. A JAK2 V617F mutation was later detected through genetic testing, further confirming the diagnosis of ET. The patient was treated with a continuous regimen of IFN-α, and an antiplatelet treatment (aspirin) was added after ICH. The 1-year follow-up indicated normal platelet levels and no additional stroke event.ConclusionsThis case demonstrates that ET can be a rare cause of the cerebrovascular disease (CVD), even though the coexistence of ischemic and hemorrhagic complications. Underlying hematological system diseases should be taken into account when abnormal hemogram and CVD are concurrent in a patient. An early multidisciplinary diagnosis and intervention could significantly improve patient’s prognosis.

Software-based noise reduction in cranial magnetic resonance imaging: Influence on image quality.

ObjectivesTo investigate acoustic noise reduction, image quality and white matter lesion detection rates of cranial magnetic resonance imaging (MRI) scans acquired with and without sequence-based acoustic noise reduction software.Material and methodsThirty-one patients, including 18 men and 13 women, with a mean age of 58.3±14.5 years underwent cranial MRI. A fluid-attenuated inversion recovery (FLAIR) sequence was acquired with and without acoustic noise reduction using the Quiet Suite (QS) software (Siemens Healthcare). During data acquisition, peak sound pressure levels were measured with a sound level meter (Testo, Typ 815). In addition, two observers assessed subjective image quality for both sequences using a five-point scale (1 very good—5 inadequate). Signal-to-noise ratio (SNR) was measured for both sequences in the following regions: white matter, gray matter, and cerebrospinal fluid. Furthermore, lesion detection rates in white matter pathologies were evaluated by two observers for both sequences. Acoustic noise, image quality including SNR and white matter lesion detection rates were compared using the Mann-Whitney-U-test.ResultsPeak sound pressure levels were slightly but significantly reduced using QS, P≤0.017. Effective sound pressure, measured in Pascal, was decreased by 19.7%. There was no significant difference in subjective image quality between FLAIR sequences acquired without/with QS: observer 1: 2.03/2.07, P = 0.730; observer 2: 1.98/2.10, P = 0.362. In addition, SNR was significantly increased in white matter, P≤0.001, and gray matter, P = 0.006, using QS. The lesion detection rates did not decline utilizing QS: observer 1: P = 0.944 observer 2: P = 0.952.ConclusionsSequence-based noise reduction software such as QS can significantly reduce peak sound pressure levels, without a loss of subjective image quality and increase SNR at constant lesion detection rates.

Hyponatremia is a potential predictor of progression in radiation-induced brain necrosis: a retrospective study

BackgroundTo investigate the prognostic value of hyponatremia, defined as serum sodium level < 135 mEq/L, in radiation-induced brain necrosis (RN) patients.MethodsWe performed a retrospective analysis of the RN patients (The patients included in our study had a history of primary cancers including nasopharyngeal carcinoma/glioma/oral cancer and received radiotherapy previously and then were diagnosed with RN) treated in Sun yat-sen Memorial Hospital from January 2013 to August 2015. Patients without cranial magnetic resonance imaging (MRI) scan and serum sodium data were excluded. Progression was identified when the increase of edema area ≥ 25% on the MRI taken in six months comparing with those taken at the baseline. Factors that might associate with prognosis of RN were collected. Multivariable logistic regression analyses were used to identify potential predictors.ResultsWe total included 135 patients, 32 (23.7%) of them with hyponatremia and 36 (26.7%) with RN progression. Percentage of progression was roughly three fold in hyponatremia patients compared with nonhyponatremia patients (53.1% versus 18.4%), translating into a 5-fold increased odds ratio (P < 0.001). Multivariable analyses identified hyponatremia as a potential predictor of progression (OR, 4.82; 95% CI [1.94–11.94]; P = 0.001).ConclusionsHyponatremia was identified as a potential predictor for the progression of patients with RN. Hyponatremia management in patients with RN should be paid much more concern in clinical practice.