Left Frontal Lobe Research Articles

Neural Correlates of the Dual-Level Transformational Leadership Model

Introduction/Main Objectives: This study considered neural processes of transformational leadership based on quantitative electroencephalography (qEEG). Background Problems: This research aims at providing biomarkers for effective (i.e., transformational) leadership. Novelty: We considered transformational leadership on a detailed level, namely its individual-focused and group-focused sub-dimensions, to analyze the underlying brain processes. As for the individual-focused sub-dimensions of transformational leadership, we utilized innovation and performance orientation, while for the group-focused sub-dimensions, we choose vision and team spirit. Research Methods: Fifty-two dyads, consisting of (a) student pairs and (b) supervisor-subordinate dyads, participated in a simulated role-play that was intended to be a performance review while the electrical activity of the brain was recorded. Finding/Results: Results show that the group-focused sub-dimensions of transformational leadership could be positively linked to right frontal lobe coherence and negatively linked to left frontal lobe coherence. Results showed no relation between the individual-focused sub-dimensions and frontal lobe coherence. Conclusion: The results allow for a deeper understanding of the neural processes of transformational leadership and its individual-focused and group-focused sub-dimensions, respectively.

Traumatic Falcine Artery Aneurysm Resulting in Intracranial Hemorrhage

A 50-year-old man presented with mild unconsciousness after a fall-induced head injury. Initial imaging revealed a left-sided acute subdural hematoma. After transportation to our hospital, his condition deteriorated, leading to the discovery of a new hemorrhage and an anterior falcine artery aneurysm upon further examination. The patient underwent successful decompressive craniectomy and endovascular occlusion. This case, the first reported of a traumatic anterior falcine artery aneurysm, suggests the initial injury caused both the hematoma and aneurysm. The aneurysm's specific location near the crista galli likely contributed to the formation of the traumatic aneurysm, and the compression of the left frontal lobe by the acute subdural hematoma caused the subsequent hemorrhage. This case highlights the importance of considering traumatic aneurysms in atypical postinjury hemorrhages and adds to the understanding of traumatic intracranial aneurysms' mechanisms.

Management of Posttraumatic Cerebrospinal Fluid Leak with Secondary Diffuse Pneumocephalus Complicated by Meningitis and Communicating Hydrocephalus – Illustrative Case Report

Rhinorrhea is a possible complication after different types of traumatic brain injury or neurosurgical procedures, such as skull base operations. Pneumocephalus is a rarely noted complication after severe traumatic brain injury, and it may be accompanied by meningitis and ventriculitis, especially when treatment has been delayed. Treatment of these entities includes conservative and surgical approaches. Pneumocephalus may result in neurologic disturbances threatening a life. Therefore, active patient management with a multidisciplinary team is required to prevent poor outcomes. In the literature, limited cases of rhinorrhea and pneumocephalus are available, including in our country. Pneumocephalus may also occur spontaneously. In 2015, Pishbin et al. identified 10 cases of spontaneous pneumocephalus. The precise incidence of diffuse pneumocephalus after traumatic brain injury is unknown, reported as <1% of cases with rare complications. In this case, a 41-year-old male patient presented at a tertiary university hospital with the chief complaint of headache. A month prior to admission, the patient was discharged from another hospital with multiple skull and facial fractures, pneumocephalus, and traumatic subarachnoid hemorrhage in the left frontal lobe due to fights (Le Fort III). During the second hospitalization, the patient’s clinical status deteriorated. A repeated brain CT demonstrated diffuse pneumocephalus. Rhinorrhea was still present. The external lumbal drainage procedure was performed without stopping the cerebrospinal fluid leak. In children, pediatric inferior turbinate hypertrophy is a frequent cause of nasal breathing difficulties. In this case, no such hypertrophy was observed. It should be considered a nasal obstructive disease not necessarily related to adult entities, frequently associated with other nasal or craniofacial disorders. Early diagnosis and endoscopic management of rhinorrhea, nasal obstruction, and associated complications is vital, as delays can lead to life-threatening issues like hydrocephalus/meningitis. Eventually, the patient developed meningitis and acute communicating hydrocephalus. Right ventriculostomy with a programmable ventriculoperitoneal shunt placement was done (pressure 110 cm H<sub>2</sub>O), stopping the rhinorrhea. This is an extremely rare case where a patient, after cerebrospinal fluid (CSF) leakage, develops severe complications, including pneumocephalus, meningitis, ventriculitis, and acute communicating hydrocephalus. In the literature, we did not come across case reports presenting all the complications as in this case. This case report will raise knowledge and awareness of such entities, adding to the rare, similar cases reported so far.

Dynamic nonreversibility view of intrinsic brain organization and brain dynamic analysis of repetitive transcranial magnitude stimulation.

Intrinsic neural activities are characterized as endless spontaneous fluctuation over multiple time scales. However, how the intrinsic brain organization changes over time under local perturbation remains an open question. By means of statistical physics, we proposed an approach to capture whole-brain dynamics based on estimating time-varying nonreversibility and k-means clustering of dynamic varying nonreversibility patterns. We first used synthetic fMRI to investigate the effects of window parameters on the temporal variability of varying nonreversibility. Second, using real test-retest fMRI data, we examined the reproducibility, reliability, biological, and physiological correlation of the varying nonreversibility substates. Finally, using repetitive transcranial magnetic stimulation-fMRI data, we investigated the modulation effects of repetitive transcranial magnetic stimulation on varying nonreversibility substate dynamics. The results show that: (i) as window length increased, the varying nonreversibility variance decreased, while the sliding step almost did not alter it; (ii) the global high varying nonreversibility states and low varying nonreversibility states were reproducible across multiple datasets and different window lengths; and (iii) there were increased low varying nonreversibility states and decreased high varying nonreversibility states when the left frontal lobe was stimulated, but not the occipital lobe. Taken together, these results provide a thermodynamic equilibrium perspective of intrinsic brain organization and reorganization under local perturbation.

Exploring Brain Dynamics via EEG and Steady-State Activation Map Networks in Music Composition.

In recent years, the integration of brain-computer interface technology and neural networks in the field of music generation has garnered widespread attention. These studies aimed to extract individual-specific emotional and state information from electroencephalogram (EEG) signals to generate unique musical compositions. While existing research has focused primarily on brain regions associated with emotions, this study extends this research to brain regions related to musical composition. To this end, a novel neural network model incorporating attention mechanisms and steady-state activation mapping (SSAM) was proposed. In this model, the self-attention module enhances task-related information in the current state matrix, while the extended attention module captures the importance of state matrices over different time frames. Additionally, a convolutional neural network layer is used to capture spatial information. Finally, the ECA module integrates the frequency information learned by the model in each of the four frequency bands, mapping these by learning their complementary frequency information into the final attention representation. Evaluations conducted on a dataset specifically constructed for this study revealed that the model surpassed representative models in the emotion recognition field, with recognition rate improvements of 1.47% and 3.83% for two different music states. Analysis of the attention matrix indicates that the left frontal lobe and occipital lobe are the most critical brain regions in distinguishing between 'recall and creation' states, while FP1, FPZ, O1, OZ, and O2 are the electrodes most related to this state. In our study of the correlations and significances between these areas and other electrodes, we found that individuals with musical training exhibit more extensive functional connectivity across multiple brain regions. This discovery not only deepens our understanding of how musical training can enhance the brain's ability to work in coordination but also provides crucial guidance for the advancement of brain-computer music generation technologies, particularly in the selection of key brain areas and electrode configurations. We hope our research can guide the work of EEG-based music generation to create better and more personalized music.

Investigating amplitude of low-frequency fluctuation and possible links with cognitive impairment in childhood and adolescence onset schizophrenia: a correlation study.

Cognitive impairment (CI) is a distinctive characteristic of schizophrenia, with evidence suggesting that childhood and adolescence onset schizophrenia (CAOS), representing severe but rare forms of schizophrenia, share continuity with adult-onset conditions. While relationships between altered brain function and CI have been identified in adults with schizophrenia, the extent of brain function abnormalities in CAOS remains largely unknown. In this study, we employed resting-state functional magnetic resonance imaging (rs-fMRI) to investigate functional alterations in brain areas among patients with CAOS. To assess CI across multiple cognitive domains, we utilized the Stroop Color and Word Tests (SCWT) and MATRICS Consensus Cognitive Battery (MCCB) tests. Our objective was to explore the associations between functional CI and the amplitude of low-frequency fluctuation (ALFF) levels in these patients. We enrolled 50 patients diagnosed with CAOS and 33 healthy controls (HCs) matched for sex and age. Cognitive functions were assessed using the MCCB and SCWT methods. Rs-fMRI data were acquired using gradient-echo echo-planar imaging sequences. Voxel-based ALFF group maps were compared through two-sample t-tests in SPM8. Subsequently, correlation analyses were conducted to identify associations between ALFF levels and cognitive scores. In comparison to HCs, patients exhibited significantly increased ALFF levels in the right fusiform gyrus, frontal lobe, and caudate, as well as the left frontal lobe and caudate. Conversely, reduced ALFF levels were observed in the temporal and left medial frontal lobes. Significant differences were identified between HCs and patients in terms of total cognitive scores, ALFF levels, and domain scores. All test scores were decreased, except for TMA. Correlation analyses between ALFF levels and cognitive functions in patients with CAOS differed from those in HCs. Pearson correlation analyses revealed positive associations between Brief Visuospatial Memory Test - Revised (BVMT-R) scores and ALFF levels in the left medial frontal gyrus. Digital Span Test (DST) scores were negatively correlated with ALFF levels in the right caudate, and Maze Test values were negatively correlated with levels in the left caudate. However, Pearson correlation analyses in HCs indicated that color and Hopkins Verbal Learning Test (HVLT-R) scores positively correlated with ALFF levels in the left frontal lobe, while color-word and symbol coding scores negatively correlated with levels in the right caudate. Altered ALFF levels in the brain may be linked to cognitive impairment (CI) in patients with CAOS. We highlighted the pathophysiology of schizophrenia and provide imaging evidence that could potentially aid in the diagnosis of CAOS.

Examınatıon of famous use ın televısıon advertısements wıth electroencephalogram (EEG)

Objective: The research aims to analyze the changes in brain activity of emotions caused by the use of celebrities in television (TV) commercials using Electroencephalography (EEG). It tries to determine the positive (liking, having fun) and negative (disliking, bored) emotions of the audience with Electroencephalography (EEG). Method: We tried to determine the emotional states of the volunteers who watched the commercials by examining the theta activities in different parts of their brains. A questionnaire was applied to 36 volunteers in our research before and after watching the advertisements. EEG recordings were made while the volunteers were watching the commercials. Theta activities obtained as a result of EEG recording were tabulated as duration. The hypotheses were tested by using the responses of the volunteers to the questionnaires and the EEG results comparatively with frequency tables and the Independent-Samples T test. Originality/Relevance: Both the preparation and broadcasting of TV advertisements, which have a very important place in marketing communication, can be very costly for businesses. Neuromarketing, which encourages interdisciplinary work, allows the use of methods, designs, theories and technologies used in neuroscience in areas such as marketing and advertising. In this study, with the help of EEG, one of the techniques used in neuromarketing, it has been tried to determine the emotions that the advertisements will create in the audience. It is among the few experimental studies conducted in Turkey. Results: Although EEG results shows that the activity intensity in the left hemisphere and left frontal lobe was higher than the activity intensity observed in the right hemisphere and right frontal lobe in the volunteers watching TV commercials, and the activity intensity in the left hemisphere and left frontal lobe in the volunteers where the advertisements created positive emotions, and the activity intensity in the left hemisphere and left frontal lobe in the volunteers, where the advertisements created negative emotions, statistically, as our hypotheses suggest, no significant activity difference was observed. Theoretical/methodological contributions: The research contributes to the scientific community by deepening the knowledge on neuromarketing, which is under development in Turkey as in many countries. It also provides clues about the use of neuromarketing in advertising research. This study will contribute to the preparation of effective advertisements by understanding the emotions of the audience. Managerial implications: Research findings can help businesses and advertisers prepare more effective commercials, thereby saving businesses costs.

A Case Report of Stroke-like Syndrome: Tuberculous Encephalopathy

Background: Stroke-like syndrome is a stroke mimic, usually common in the young and accurate diagnosis has considerable impact in terms of treatment choices and outcomes. Objectives: To emphasise the need for high index of suspicion and the need for multidisciplinary approach and accurate diagnosis of stroke-like syndrome. Case Report: 32 years old woman who presented with recurrent headache of a year duration with right upper limb weakness of 3 months that later involved lower limb 1month and inability to talk 2 days to presentation. Examination revealed a young woman, conscious but aphasic, emaciated, afebrile, anicteric and nil pedal oedema. Neurological findings includes expressive aphasia, right facioparesis and right hemiparesis. Other systemic examinations were essentially normal. A diagnosis of left hemispheric ischaemic stroke was initially entertained. Brain computerized tomography revealed infarct involving the left frontal and temporal lobes but Echocardiography revealed Tuberculous pericarditis, a suspicion of stroke mimic of infective origin was entertained. Diagnosis was confirmed by ‘trial of treatment’ of anti-tuberculosis, which resulted in dramatic resolution of symptoms within 4 weeks of anti-tuberculosis drugs. Conclusion: There is need for high index of suspicion, accurate diagnosis and multidisciplinary approach for appropriate treatment choices and outcomes.

Evaluation of Brain MRI Findings in Patients Referred with Seizures

Introduction: Seizures are one of the common and warning signs of brain diseases, which doctors often use CT-scan or MRI for diagnose. The present study was conducted with the aim of evaluation of brain MRI of the patients referred with seizures in order to determine their brain lesions and involvement.
 Methods: The study was carried out using a retrospective cross-sectional descriptive method. All the patients with seizures referred for MRI to the Radiology Department of Shahid Sadoughi Hospital in Yazd City, Iran during 2016-2020 were examined. By referring to the archives of the radiology department, the records and MRI of the patients referred with seizures were extracted. Then, the data were extracted from the Hospital Information System and the patients' files; after that they were analyzed with SPSS version 16.
 Results: The present study was conducted on 105 patients with seizures for brain MRI. 48.6% (51 people) of patients were male and 51.4% (54 people) were female. The average age of the patients was 34.17 ± 10.50 years. MRI was normal in 59% of the patients. 16.2% Non-Specific, 6.7% Mass and 4.8% evidence of Encephalomalacia were also reported. The most lesions with 10.5% were related to left frontal lobe and 2.9% were related to right frontal lobe. 99% of seizures were unspecified convulsion and 1% were postprocedural disorder of nervous system. There was no significant relationship between the gender of the patients and their diagnosis (P>0.471).
 Conclusion: Wide abnormalities such as mass, edema, encephalomalacia and demyelination are observed in the MRI of the patients with seizures and are often located in the frontal lobe. In general, seizures can cause transient and reversible brain abnormalities in MRI.

Common and distinct patterns underlying different linguistic tasks: multivariate disconnectome symptom mapping in poststroke patients.

Numerous studies have been devoted to neural mechanisms of a variety of linguistic tasks (e.g. speech comprehension and production). To date, however, whether and how the neural patterns underlying different linguistic tasks are similar or differ remains elusive. In this study, we compared the neural patterns underlying 3 linguistic tasks mainly concerning speech comprehension and production. To address this, multivariate regression approaches with lesion/disconnection symptom mapping were applied to data from 216 stroke patients with damage to the left hemisphere. The results showed that lesion/disconnection patterns could predict both poststroke scores of speech comprehension and production tasks; these patterns exhibited shared regions on the temporal pole of the left hemisphere as well as unique regions contributing to the prediction for each domain. Lower scores in speech comprehension tasks were associated with lesions/abnormalities in the superior temporal gyrus and middle temporal gyrus, while lower scores in speech production tasks were associated with lesions/abnormalities in the left inferior parietal lobe and frontal lobe. These results suggested an important role of the ventral and dorsal stream pathways in speech comprehension and production (i.e. supporting the dual stream model) and highlighted the applicability of the novel multivariate disconnectome-based symptom mapping in cognitive neuroscience research.

EEG brain network variability is correlated with other pathophysiological indicators of critical patients in neurology intensive care unit

Continuous electroencephalogram (cEEG) plays a crucial role in monitoring and postoperative evaluation of critical patients with extensive EEG abnormalities. Recently, the temporal variability of dynamic resting-state functional connectivity has emerged as a novel approach to understanding the pathophysiological mechanisms underlying diseases. However, little is known about the underlying temporal variability of functional connections in critical patients admitted to neurology intensive care unit (NICU). Furthermore, considering the emerging field of network physiology that emphasizes the integrated nature of human organisms, we hypothesize that this temporal variability in brain activity may be potentially linked to other physiological functions. Therefore, this study aimed to investigate network variability using fuzzy entropy in 24-hour dynamic resting-state networks of critical patients in NICU, with an emphasis on exploring spatial topology changes over time. Our findings revealed both atypical flexible and robust architectures in critical patients. Specifically, the former exhibited denser functional connectivity across the left frontal and left parietal lobes, while the latter showed predominantly short-range connections within anterior regions. These patterns of network variability deviating from normality may underlie the altered network integrity leading to loss of consciousness and cognitive impairment observed in these patients. Additionally, we explored changes in 24-hour network properties and found simultaneous decreases in brain efficiency, heart rate, and blood pressure between approximately 1 pm and 5 pm. Moreover, we observed a close relationship between temporal variability of resting-state network properties and other physiological indicators including heart rate as well as liver and kidney function. These findings suggest that the application of a temporal variability-based cEEG analysis method offers valuable insights into underlying pathophysiological mechanisms of critical patients in NICU, and may present novel avenues for their condition monitoring, intervention, and treatment.

P-57 A case of pituitary carcinoma treated with osilodrostat for severe Cushing's syndrome

Abstract Introduction Pituitary carcinoma is a rare disorder accounting for 0.1–0.2% of pituitary tumors. We present a case of a male subject with ACTH-secreting pituitary carcinoma with metastasis to the spine, achieving eucortisolism on osilodrostat treatment. Clinical Case A 31-year-old male presented with complaints of pain in the rear-left thigh, numbness in the left-hand fingers and shoulder. MRI revealed an invasive pituitary tumor which had spread to the left frontal and temporal lobes with infiltration of the dura mater and compression of the left part of the optic chiasm, multiple formations in the large hemispheres, hemispheres of the cerebellum, in the right internal auditory meatus and at the level of the C1 vertebra compatible with metastasis. Spinal MRI showed a mass at Th6, L1-S2 level compatible with metastasis (Fig.1). The patient was diagnosed with Cushing's disease (CD) at 23 (late-night serum cortisol 1450 nmol/L (64–327), late-night salivary cortisol (LNSC) 66.4 nmol/L (0.5–9.65), 24hUFC 608 nmol/L (100–379), ACTH 107.3 pg/mL (7.2–63.3)) and underwent transsphenoidal pituitary surgery for pituitary macroadenoma 26×18×29 mm with biochemical remission. Two years later his symptoms of CD relapsed and he had a second transsphenoidal surgery. Histological examination showed an atypical corticotroph tumor with Ki67 – 11.6%. Two months after surgery, Kiber knife surgery was performed. However, 2 years later he had gradual deterioration of vision due to loss of lateral margins. A third transcranial adenomectomy was performed with following panhypopituitarism and diabetes insipidus. The tumor was positively stained for ACTH and also contained some atypical features including nuclear pleomorphism. Postoperative chemotherapy adjuvant treatment with Temozolomide and Carboplatin was prescribed. After 6 cycles, proton radiotherapy was done. In order to control hypercortisolism the patient received ketoconazole 800 mg per day, cabergoline 1 mg twice weekly and pasireotide 1.8 mg per day. However, it was not possible to achieve remission of hypercortisolism. As an adverse event of pasireotide, diabetes mellitus developed, which required insulin therapy and finally lead to pasireotide cessation. Ketoconazole and cabergoline were discontinued and osilodrostat treatment was initiated with a final dose of 5 mg daily over 2 years. He also received another course of radiation therapy at the age of 31 years. Over the past 2 years of observation, his ACTH level ranged from 37 pg/mL to 325.1 pg/ml. In spite of tumor progression and raised ACTH, the patient remains in eucortisolism (late-night serum cortisol 163.3 nmol/L, LNSC 5.21 nmol/L, 24hUFC 70.14 nmol/L) on osilodrostat 10 mg daily. Conclusion In this case osilodrostat was effective at controlling hypercortisolism, but its effects on the tumor are unknown. As this patient is the first described case of corticotroph carcinoma tumor treated with Osilodrostat, the results should be taken with caution.Figure 1.Pituitary and spinal MRI of the patientT1-weighted MRI demonstrating (A) chiasmal-sellar region formation, (B) formation in the rigt internal auditory meatus, (C) a highly invasive sacral L1–S2 metastasis

Whole-brain traumatic controlled cortical impact to the left frontal lobe: Magnetic resonance image-based texture analysis.

This research assesses the capability of texture analysis (TA) derived from high-resolution (HR) T2-weighted magnetic resonance imaging to identify primary sequelae following 1-5 hours of controlled cortical impact mild or severe traumatic brain injury (TBI) to the left frontal cortex (focal impact) and secondary (diffuse) sequelae in the right frontal cortex, bilateral corpus callosum, and hippocampus in rats. The TA technique comprised first-order (histogram-based) and second-order statistics (including gray-level co-occurrence matrix, gray-level run length matrix, and neighborhood gray-level difference matrix). Edema in the left frontal impact region developed within 1 hour and continued throughout the 5-hour assessments. The TA features from HR images confirmed the focal injury. There was no significant difference among radiomics features between the left and right corpus callosum or hippocampus from 1 to 5 hours following a mild or severe impact. The adjacent corpus callosum region and the distal hippocampus region (s), showed no diffuse injury 1-5 hours after mild or severe TBI. These results suggest that combining HR images with TA may enhance detection of early primary and secondary sequelae following TBI.

Diagnóstico clínico de hemangiomatose neonatal disseminada: um relato de caso

Hemangioma is the most common vascular tumor of childhood. It may present as multiple cutaneous hemangiomas on rare occasions, with or without visceral involvement. The condition of lesions restricted to the skin is called benign neonatal hemangiomatosis, and in the case of visceral lesions associated with cutaneous lesions, the denomination is disseminated or diffuse neonatal hemangiomatosis (DNH). For the diagnosis of DNH, three criteria must be met: onset in the neonatal period, involvement of three or more organs, and absence of malignancy in hemangiomas. ASAS, a full-term, vaginally delivered newborn, weight: 3560g, length: 52cm, head circumference: 35cm, APGAR: 9/9. Maternal history of syphilis during pregnancy - mother adequately treated in pregnancy. At birth, she presented with purpuric lesions of variable size on the chest, limbs, feet, and hands, which discolored under digital pressure; larger lesions with relief, not scaly. He developed severe heart failure and was admitted to the Neonatal Intensive Care Unit (NICU) in a secondary hospital in the Federal District. Imaging tests were performed: Computed tomography of the skull, thorax, and total abdomen, which revealed the presence of a possible hemangioma in the left frontal lobe, telangiectasias in the lungs, and multiple hepatic hemangiomas. He had a clinical diagnosis of DNH. The case described corroborates the fact that knowledge about the disease is relevant, as early diagnosis can lead to more accurate approaches that may reduce morbidity and mortality from the disease.

Acute Cerebrovascular Accident in Pregnancy Due to Hyperhomocysteinaemia Secondary to Vitamin B12 Deficiency: A Case Report

Stroke in pregnancy is rare but is one of the leading causes of morbidity and mortality in developed countries. Pregnancy, as a prothrombotic state, acts as a precursor for stroke. Preeclampsia, eclampsia, amniotic fluid embolism, hypertension, diabetes, and many other factors predispose to the development of stroke. Endothelial cell injury leading to arteriosclerosis, causing a stroke, has been associated with raised homocysteine levels. Hereby, the authors present a case of a 26-year-old Gravida 3 Pregnancy 1 Live 1 Abortion 1 (G3P1L1A1) at 35 weeks gestation with a cephalic presentation who complained of a headache for two days, sudden onset of weakness in the right upper limb and lower limb with an inability to walk without support and inability to speak since 12 hours, associated with one episode of vomiting. Magnetic Resonance Imaging (MRI) brain showed acute infarcts in the left fronto-parietal lobes and capsule region with haemorrhagic transformation in the left frontal lobe. Serum vitamin B12 measured by Electroluminescence Assay (ECLA) was found to be low at 113pg/mL (normal range -191-771pg/mL). Serum homocysteine levels measured by enzymatic method were elevated at 46 umol/L (normal range 3-18 umol/L). A diagnosis at 34 weeks of pregnancy with acute cerebrovascular accident with right hemiparesis with Broca’s aphasia due to hyperhomocysteinaemia secondary to vitamin B12 deficiency was made. Prompt diagnosis and treatment are known to decrease morbidity in women with cerebrovascular accidents. MRI brain with venogram is known to be the gold standard procedure in diagnosing stroke. Thrombolytic therapy has proven beneficial in the treatment of the disease and in preventing its progression. Prenatal and natal supplementation with folic acid/vitamin B12 in the first trimester of pregnancy prevents Vitamin B12 deficiency and raised homocysteine levels in the maternal serum, thereby decreasing the incidence of stroke.

Multiple dural arteriovenous fistulas showing isolated subcortical white matter T2 hyperintensity with gadolinium enhancement

We describe a 44-year-old man with a complaint of atonic seizures of the left upper limb, followed by generalized seizures. Brain MRI showed isolated juxtacortical white matter T2 hyperintensity with gadolinium (Gd) enhancement of the adjacent cortical gray matter and subcortical white matter in the right frontal convexity. Treatment with levetiracetam was effective for seizure suppression, and he had no other neurological abnormalities. Human leukocyte antigen typing revealed B54 and Cw1, which indicated the possibility of neuro-Sweet disease. However, a general examination, which included vital signs and eye and skin findings, was normal. A cerebrospinal fluid test showed a mild elevation in protein levels without pleocytosis and a normal range of interleukin-6. Electroencephalography showed intermittent slow waves without epileptic discharge in the bilateral temporal lobes. We detected subtle flow voids in the pia mater of the left frontal lobe, which suggested cerebrovascular disease, and specifically, the possibility of dural arteriovenous fistulas. Computed tomography angiography showed abnormally dilated perimedullary veins in the left frontal lobe. Cerebral angiography confirmed the existence of four dural arteriovenous fistulas, which included two retrograde leptomeningeal venous drainages in the right frontal cortical veins supplied by the anterior branch of the right middle meningeal artery. The other dural arteriovenous fistulas were retrograde leptomeningeal venous drainages in the left frontal cortical veins supplied by the anterior and posterior convexity branches of the left middle meningeal artery. The patient underwent successful endovascular embolization of all dural arteriovenous fistulas with Onyx injection. A follow-up MRI showed gradual improvement of the T2 hyperintensity and Gd enhancement. He remained seizure-free for 2 years following endovascular embolization.

Morphological changes of cerebral gray matter in spinocerebellar ataxia type 3 using fractal dimension analysis.

Spinocerebellar ataxia type 3 (SCA3), or Machado-Joseph disease, presents as a cerebellar cognitive affective syndrome (CCAS) and represents the predominant SCA genotype in Taiwan. Beyond cerebellar involvement, SCA3 patients exhibit cerebral atrophy. While prior neurodegenerative disease studies relied on voxel-based morphometry (VBM) for brain atrophy assessment, its qualitative nature limits individual and region-specific evaluations. To address this, we employed fractal dimension (FD) analysis to quantify cortical complexity changes in SCA3 patients. We examined 50 SCA3 patients and 50 age- and sex-matched healthy controls (HC), dividing MRI cerebral gray matter (GM) into 68 auto-anatomical subregions. Using three-dimensional FD analysis, we identified GM atrophy manifestations in SCA3 patients. Results revealed lateral atrophy symptoms in the left frontal, parietal, and occipital lobes, and fewer symptoms in the right hemisphere's parietal and occipital lobes. Focal areas of atrophy included regions previously identified in SCA3 studies, alongside additional regions with decreased FD values. Bilateral postcentral gyrus and inferior parietal gyrus exhibited pronounced atrophy, correlating with Scale for the Assessment and Rating of Ataxia (SARA) scores and disease duration. Notably, the most notable focal areas were the bilateral postcentral gyrus and the left superior temporal gyrus, serving as imaging biomarkers for SCA3. Our study enhances understanding of regional brain atrophy in SCA3, corroborating known clinical features while offering new insights into disease progression.

Prefrontal Cortex Oxygenation During Walking in an Acute Ischaemic Stroke Patient with Severe Internal Carotid Artery Stenosis: A Case Report.

This study investigated the oxygenation in the prefrontal cortex (PFC) during walking in a 75-year-old male patient in the acute phase of a left frontal lobe cerebral infarction complicated by severe left internal carotid artery stenosis. The patient regained independent ambulation on the fifth day after the onset of symptoms, and the study was conducted on the eighth day after the onset of symptoms. The patient rested for 10s before walking for 70s. Then he rested for 60s. The levels of oxyhaemoglobin (O2Hb), deoxyhaemoglobin (HHb), and total haemoglobin (THb) in the PFC were quantified during the rest and walking phases using a wearable near-infrared spectroscopy device. Comparative analysis with baseline values during rest revealed decreases in the O2Hb, HHb, and THb in both hemispheres of the PFC during walking (O2Hb: -19.76/ -14.88μmol/L, HHb: -1.18/ -2.00μmol/L, THb: -20.96/ -16.88μmol/L, right/left, respectively). The recovery of the O2Hb was delayed by 15.8seconds in the affected hemisphere. These findings support the effectiveness of wearable NIRS for the evaluation of cerebral oxygenation during rehabilitation in patients with acute stroke to facilitate evaluations and individualise patient care.

Examining the relationship between anxiety and regional brain volumes in the National Alzheimer's Coordinating Center uniform, imaging, and biomarker datasets

Anxiety has been associated with a greater risk of Alzheimer's disease (AD). Existing research has identified structural differences in regional brain tissue in participants with anxiety, but results have been inconsistent. We sought to determine the association between anxiety and regional brain volumes, and the moderation effect of APOE ε4. Using data from participants in the National Alzheimer's Coordinating Center (NACC) Uniform Data Set, with complete imaging (MRI) and biomarker data (n = 1533), multiple linear regression estimated the adjusted effect of anxiety on 30 structural MRI regions. The moderation effect of APOE ε4 on the relation between structural MRI regions and anxiety was assessed as was the moderation effect of cognitive status. False discovery rate was used to adjust for multiple comparisons. After controlling for intracranial volume, age, sex, years of education, race, Hispanic ethnicity, and cognitive status, seven MRI regions demonstrated lower volumes among participants with anxiety: total cerebrum gray matter volume, right hippocampus volume, hippocampal volume (total), right and left frontal lobe cortical gray matter volume, and right and total temporal lobe cortical gray matter volume. Findings suggest that anxiety is associated with significant atrophy in multiple brain regions, with corresponding ventricular enlargement. Future research should investigate if anxiety-related changes to brain morphology contribute to greater AD risk.

Prosopagnosia: face blindness and its association with neurological disorders.

Loss of facial recognition or prosopagnosia has been well-recognized for over a century. It has been categorized as developmental or acquired depending on whether the onset is in early childhood or beyond, and acquired cases can have degenerative or non-degenerative aetiologies. Prosopagnosia has been linked to involvement of the fusiform gyri, mainly in the right hemisphere. The literature on prosopagnosia comprises case reports and small case series. We aim to assess demographic, clinical and imaging characteristics and neurological and neuropathological disorders associated with a diagnosis of prosopagnosia in a large cohort. Patients were categorized as developmental versus acquired; those with acquired prosopagnosia were further subdivided into degenerative versus non-degenerative, based on neurological aetiology. We assessed regional involvement on [18F] fluorodeoxyglucose-PET and MRI of the right and left frontal, temporal, parietal and occipital lobes. The Intake and Referral Center at the Mayo Clinic identified 487 patients with possible prosopagnosia, of which 336 met study criteria for probable or definite prosopagnosia. Ten patients, 80.0% male, had developmental prosopagnosia including one with Niemann-Pick type C and another with a forkhead box G1 gene mutation. Of the 326 with acquired prosopagnosia, 235 (72.1%) were categorized as degenerative, 91 (27.9%) as non-degenerative. The most common degenerative diagnoses were posterior cortical atrophy, primary prosopagnosia syndrome, Alzheimer's disease dementia and semantic dementia, with each diagnosis accounting for >10% of this group. The most common non-degenerative diagnoses were infarcts (ischaemic and haemorrhagic), epilepsy-related and primary brain tumours, each accounting for >10%. We identified a group of patients with non-degenerative transient prosopagnosia in which facial recognition loss improved or resolved over time. These patients had migraine-related prosopagnosia, posterior reversible encephalopathy syndrome, delirium, hypoxic encephalopathy and ischaemic infarcts. On [18F] fluorodeoxyglucose-PET, the temporal lobes proved to be the most frequently affected regions in 117 patients with degenerative prosopagnosia, while in 82 patients with non-degenerative prosopagnosia, MRI revealed the right temporal and right occipital lobes as most affected by a focal lesion. The most common pathological findings in those with degenerative prosopagnosia were frontotemporal lobar degeneration with hippocampal sclerosis and mixed Alzheimer's and Lewy body disease pathology. In this large case series of patients diagnosed with prosopagnosia, we observed that facial recognition loss occurs across a wide range of acquired degenerative and non-degenerative neurological disorders, most commonly in males with developmental prosopagnosia. The right temporal and occipital lobes, and connecting fusiform gyrus, are key areas. Multiple different pathologies cause degenerative prosopagnosia.