Left Occipital Lobe Research Articles

Right hemisphere dominance for language in a woman with schizophrenia and a porencephalic cyst of the left hemisphere

ABSTRACTA large left hemisphere porencephalic cyst was incidentally found in a 48-year-old woman (MS) with a Diagnostic and Statistical Manual (DSM)-5 diagnosis of schizophrenia. The encephaloclastic characteristics of the cyst indicated that it was acquired between the 22nd and 24th gestational weeks, after the major waves of neuronal migration had tapered off. The cyst destroyed the left temporal and occipital lobes, and the inferior parietal lobule. Surprisingly, MS had no evidence of aphasia, alexia, agraphia, or ideational apraxia; in contrast, cognitive functions dependent on the integrity of the right hemisphere were severely impaired. To test the hypothesis that the development of language in MS took place at the expense of functions that are normally carried out by the right hemisphere, we investigated MS’s correlates of oral comprehension with fMRI as a proxy for auditory comprehension and other cognitive functions strongly lateralized to the posterior left hemisphere, such as ideational praxis and reading. Comprehension of spoken language engaged the homologous of Wernicke’s area in the right planum temporale. Porencephaly may represent a natural model of neuroplasticity supervening at predictable epochs of prenatal development.

Impaired Picture Arrangement subscores (WAIS-III) associated with decreased place orientation and frontal/occipital blood flow in Alzheimer's disease: Implications for social judgment dysfunction. The Osaki-Tajiri Project

Alzheimer's disease (AD) patients manifest not only memory impairment but also deficit of social judgment. However, contrary to frequently recognized deficit, only two neuropsychological tests have been established for assessing “judgment” : the Cognitive Abilities Screening Instrument domain Abstraction & judgment and the Picture Arrangement subscale of WAIS-III. For the former, we previously reported an association with decreased regional cerebral blood flow (rCBF) in the left parietal lobe. Herein, we analyzed the scores of the Picture Arrangement test. Forty-nine AD patients were classified into two groups, i.e., the high and low PA score groups. The 99mTc-ECD SPECT investigation was performed with the voxel-based analysis using SPM5. The Mini-Mental State Examination subscores of “place orientation” showed a correlation with the PA scores. The low PA score group exhibited significantly decreased rCBFs in the Left Inferior Frontal Gyrus (LIFG), Left Superior Frontal Gyrus (LSFG) and Right Occipital Lobe (ROL), compared with the high PA score group. The ability of PA may be associated with the place orientation, which may be necessary to re-arrange the pictures. The ROL was related to visual recognition. The LSFG may be involved in executive function or “frontal reasoning.”

Amplitude of low-frequency fluctuation (ALFF) and fractional ALFF in migraine patients: a resting-state functional MRI study

To evaluate the amplitude of low-frequency oscillations (LFOs) of the brain in migraine patients using amplitude of low-frequency fluctuation (ALFF) and fractional ALFF in the interictal period, in comparison to healthy controls (HCs). A total of 54 subjects, including 30 migraineurs and 24 gender- and age-matched HCs completed the fMRI. All the data and ALFF, fALFF analyses were preprocessed with the Data Processing Assistant for Resting-State fMRI (DPARSF). All of the statistical analyses were performed using the REST software to explore the differences in ALFF and fALFF between migraine patients and HCs. In contrast to HCs, migraine patients showed significant ALFF increase in the left medulla and pons, the bilateral cerebellum posterior lobe and right insula. The regions showing decreased ALFF in migraine patients included the bilateral cerebellum posterior lobe, left cerebellum anterior lobe, bilateral orbital cortex, right middle frontal gyrus, bilateral occipital lobe, right fusiform gyrus, and bilateral postcentral gyrus. The fALFFs in migraine patients were significantly increased in the bilateral insular and left orbital cortex, but were decreased in the left occipital lobe and bilateral cerebellum posterior lobe. These ALFF and fALFF alterations in the brain regions of migraineurs are in keeping with the domains associated with pain and cognition. Such brain functional alteration may contribute to further understanding of migraine-related network imbalances demonstrated in previous studies.

Analysis of the Metabolic and Structural Brain Changes in Patients With Torture-Related Post-Traumatic Stress Disorder (TR-PTSD) Using ¹⁸F-FDG PET and MRI.

Many people exposed to torture later suffer from torture-related post-traumatic stress disorder (TR-PTSD). The aim of this study was to analyze the morphologic and functional brain changes in patients with TR-PTSD using magnetic resonance imaging (MRI) and positron emission tomography (PET).This study evaluated 19 subjects. Thirteen subcortical brain structures were evaluated using FSL software. On the T1-weighted images, normalized brain volumes were measured using SIENAX software. The study compared the volume of the brain and 13 subcortical structures in 9 patients suffering from TR-PTSD after torture and 10 healthy volunteers (HV). Diffusion-weighted imaging (DWI) was performed in the transverse plane. In addition, the 18F-FDG PET data were evaluated to identify the activity of the elected regions.The mean left hippocampal volume for the TR-PTSD group was significantly lower than in the HV group (post hoc test (Bonferroni) P < 0.001). There was a significant difference between the gray matter volume of the patients with TR-PTSD and the HV group (post hoc test (Bonferroni) P < 0.001). The TR-PTSD group showed low significant expansion of the ventricles in contrast to the HV group (post hoc test (Bonferroni) P < 0.001). Diffusion-weighted imaging revealed significant differences in the right frontal lobe and the left occipital lobe between the TR-PTSD and HV group (post hoc test (Bonferroni) P < 0.001).Moderate hypometabolism was noted in the occipital lobe in 6 of the 9 patients with TR-PTSD, in the temporal lobe in 1 of the 9 patients, and in the caudate nucleus in 5 of the 9 patients. In 2 cases, additional hypometabolism was observed in the posterior cingulate cortex and in the parietal and frontal lobes.The findings from this study show that TR-PTSD might have a deleterious influence on a set of specific brain structures. This study also demonstrated that PET combined with MRI is sensitive in detecting possible metabolic and structural brain changes in TR-PTSD.

Alteration of parahippocampal gyrus functional connectivity in the role of memory disorder after concussion: a fMRI study

Objective To investigate the alteration of functional connectivity and its significance in post-concussion syndrome (PCS) patients with memory disorders using resting-state functional magnetic resonance imaging (rs-fMRI). Methods From September 2014 to April 2015, 28 PCS patients with memory disorders admitted to the Department of Neurosurgery, Anhui Provincial Hospital, Anhui Medical University and 28 health controls (HC) recruited in the same period were studied. The RS-fMRI data were collected and processed. The left and right parahippocampal gyri were used as the regions of interest (ROI) to make functional connectivity with the whole brain and were analyzed in order to obtain the altered brain areas of hippocampal gyrus and whole brain functional connectivity in patients with PCS. Results The functional connectivity of the left parahippocampal gyrus and bilateral prefrontal lobe, bilateral temporal lobe, right precuneus, and right precentral gyrus reduced (all P<0.05), and the functional connectivity with the bilateral occipital lobe, bilateral lingual lobe, and left superior parietal lobule enhanced (all P<0.05). The functional connectivity of the right parahippocampal gyrus, right inferior frontal gyrus, bilateral temporal lobe, and bilateral occipital lobe reduced (all P<0.05), and the functional connectivity with the bilateral middle frontal gyrus, left inferior frontal gyrus, right orbital frontal gyrus, left inferior temporal gyrus, left middle occipital lobe, bilateral angular gyrus, right lingual lobe, and left parietal lobule enhanced (all P<0.05). Conclusion In resting state, the abnormality of function connectivity of the parahippocampal gyrus in patients with PCS may be one of the reasons for resulting in memory impairment in patients with PCS. Key words: Post-concussion syndrome; Parahippocampal gyrus; Functional connectivity; Functional magnetic resonance imaging

Imaging findings of Paragonimus westermani

PurposeTo analyze the imaging findings of pulmonary and extra-pulmonary paragonimiasis. MethodsThe imaging findings of serologically and clinically confirmed 22 cases of Paragonimus westermani infection identified over a five-year period (2010–2015) were retrospectively analyzed. Chest CT (n = 22), brain CT (n = 2) & MRI (n = 1), abdomen CT (n = 3) scans were available. ResultsChest CT scan was abnormal in 20 patients and the CT findings were as follows: nodule (n = 18), ground glass opacity (GGO) (n = 12), worm cyst (n = 10), migration track (n = 7), fibrosis (n = 5), pleural effusion (n = 15), pleural thickening (n = 10), pleural calcification (n = 1). Hilar or mediastinal lymphadenopathy was noted in three patients. Brain CT scan showed patchy low density in the left occipital lobe in one patient and patchy mixed density in the right basal ganglia and kidney-shaped low density area in the left basal ganglia in another patient. Brain MRI scan revealed a circular lesion with ring enhancement in the right parietal lobe. Abdominal CT scan showed conglomerated small cystic or serpentine lesions and migration track in the right lobe of liver and spleen. ConclusionsThe imaging findings of P. westermani is so diverse and non-specific due to its complex life cycle and several life stages during infestation of human; however, common features include nodule, GGO, worm cyst, migration track, pleural effusion, pleural thickening on chest CT scan; patchy low or mixed density lesions on brain CT scan; ring enhancing lesion on brain MRI scan; conglomerated small cystic or serpentine lesions and migration track in liver and spleen on abdominal CT scan. The characteristic imaging features of paragonimiasis are worm cyst and migration track.

Abnormal Neural Network of Primary Insomnia: Evidence from Spatial Working Memory Task fMRI

Background: Contemporary functional MRI (fMRI) methods can provide a wealth of information about the neural mechanisms associated with primary insomnia (PI), which centrally involve neural network circuits related to spatial working memory. Methods: A total of 30 participants diagnosed with PI and without atypical brain anatomy were selected along with 30 age- and gender-matched healthy controls. Subjects were administered the Pittsburgh Sleep Quality Index (PSQI), Hamilton Rating Scale for Depression and clinical assessments of spatial working memory, followed by an MRI scan and fMRI in spatial memory task state. Results: Statistically significant differences between PSQI and spatial working memory were observed between PI patients and controls (p < 0.01). Activation of neural networks related to spatial memory task state in the PI group was observed at the left temporal lobe, left occipital lobe and right frontal lobe. Lower levels of activation were observed in the left parahippocampal gyrus, right parahippocampal gyrus, bilateral temporal cortex, frontal cortex and superior parietal lobule. Conclusion: Participants with PI exhibited characteristic abnormalities in the neural network connectivity related to spatial working memory. These results may be indicative of an underlying pathological mechanism related to spatial working memory deterioration in PI, analogous to recently described mechanisms in other mental health disorders.

Occipital seizures and persistent homonymous hemianopia with T2 hypointensity on MRI in nonketotic hyperglycemia.

IntroductionNonketotic hyperglycemia (NKH) is known to cause focal motor or secondarily generalized seizures. Occipital seizures in NKH are seldom reported, especially with visual hallucinations and persistent homonymous hemianopia (HH) with characteristic radiological and electroencephalographic (EEG) findings.SummaryOur patient was a middle-aged man who presented with a new onset, single episode of generalized tonic–clonic seizure and NKH. He complained of seeing intermittent colorful stripes in his right visual field. Examination revealed persistent complete right HH and he was observed to have complex partial seizures.Magnetic resonance imaging (MRI) showed subcortical T2 hypointensity within the left occipital lobe in T2W and FLAIR images. The EEG showed electrographic seizures originating from the left occipital region. Random blood glucose at presentation was 581 mg/dl with HbA1c of 11.4%.The seizure and visual field deficits were successfully terminated by the introduction of antiseizure medication and glycemic control.ConclusionOccipital seizures with visual field deficits can occur in hyperglycemic states. These can be associated with specific MRI brain and EEG changes. The HH is reversible with apt treatment primarily including glycemic control with or without antiseizure medication.

The Network of Brodmanns Area 22 in Lexico-semantic Processing: A Pooling-data Connectivity Study

Background and Objective:Modern neuroimaging has demonstrated that cognitive functions are based in networks of interconnected modules. The purpose of this paper was to analyze the connectivity of Brodmann's area (BA) 22 in lexico-semantic tasks. MethodsA connectivity fMRI co-activation study was performed by pooling data of lexico-semantic tasks in which BA22 (core of Wernicke's area) was reported. 283 subjects reported in 21 experiments were analyzed. Analysis of Likelihood Estimates of pooled data was utilized to generate the connectivity map; thresholds at p< 0.01 were corrected for multiple comparisons with false discovery rate. Resulting images were co-registered into MNI standard space.Results:network consisting of 13 clusters of activation was obtained. Main clusters were located in the left posterior temporal and left inferior frontal gyrus; in addition to these canonical areas, left insula, pre-supplementary motor area, left BA37, primary auditory areas and left occipital lobe were also involved. Conclusions: BA22-related networks involved in lexico-semantics processing were demonstrated utilizing a pooling-data connectivity study. Significance, interpretation and limitations of the results are discussed.

The cognitive neuroplasticity of reading recovery in chronic aphasia: A representational similarity approach

The cognitive neuroplasticity of reading recovery in chronic aphasia: A representational similarity approach

The Role of Peritumoral Perfusion Values in Differentiation of Multicentric Glial Tumors and Cranial Metastasis

Introduction: Although MRI is the primary modality in the diagnosis of cranial metastasis, advanced MRI techniques such as spectroscopy, perfusion, diffusion weighted imaging, and diffusion tensor imaging are used to distinguish cranial metastasis from other pathologies. Since cranial metastasis are often highly vascular lesions, on perfusion examination they tend to exhibit elevated cerebral blood volume (rCBV). However since high-grade glial tumors also exhibit elevated rCBV, perfusion imaging cannot accurately differentiate between these two groups. Peritumoral rCBV values are actually more reliable in differential diagnosis of multicentric glial tutors and cranial metastasis. Case report: A fifty-six-year-old male presented with progressive weakness in his left arm. MRI revealed multiple, different-sized lesions with a wide range of intensity changes. Some of the lesions displayed substantial peritumoral vasogenic edema. On DWI sequences, lesions demonstrated peripheral restricted diffusion. MRP sequences didn't show elevated rCBV values in T2-hyperintense peritumoral edema areas. The excisional biopsy of the lesion in left occipital lobe performed and the lesion's pathology result was reported as small-cell lung carcinoma metastasis, supporting our primary radiologic diagnosis. Discussion: Advanced MRI techniques such as perfusion, spectroscopy, diffusion-weighted imaging (DWI) and diffusion tensor imaging (DTI) are used in the context of distinguishing cranial metastasis from high-grade glial tumors. Perfusion parameters like rCBV and rCBF are important to distinguish metastatic lesions from cranial lymphoma and benign cranial masses like abcess. However, since both cranial metastasis and high-grade glial lesions are both hypervacular, comparison of rCBV of the enhancing component of lesions cannot differentiate between these two groups. In such cases, rCBV values obtained from the peritumoral T2 hyperintense edema component of the lesion can help us. Conclusion: Multicentric glial tumors are on the differential diagnosis list of cranial metastasis. When conventional MRI techniques are insufficient to differentiate these two entities, perfusion values obtained from the peritumoral edema areas might be helpful.

Psychophysiological Effects of Orchid and Rose Fragrances on Humans

This study aimed to determine the effects of floral fragrances on human brain waves and moods. A total of 44 subjects participated in this experiment. Group 1 consisted of 11 male and 14 female college students with a mean age of 24.5 years (± 2.23) and Group 2 consisted of 10 males and 9 females with a mean age of 54.3 years (± 2.98). Subjects were exposed to floral fragrances of Rosa hybrida , ‘Hera’ (hereafter referred to as “rose”), Cymbidium faberi(hereafter referred to as “orchid”), or odorless control flowers (hereafter referred to as “control”). Experiments took place in three rooms (rose, orchid, and control). Electroencephalographs (EEGs) were recorded during exposure to the odors and the data were processed using quantitative electroencephalographic (QEEG) techniques. The changing EEG patterns wereanalyzed by brain mapping and compressed spectral arrays, and the subjects’ preferences (hedonic evaluations) were quantified with an A1 index. Increased activation of absolute alpha waves was verified on six of the eight EEG channels, with the right frontal and left occipital lobes exhibiting no changes and the left parietal region showing the greatest activation. According to the QEEG measurements in the electrode sites over the frontal, temporal, parietal, and occipital lobes, the strongest absolute alpha waves were induced in the parietal lobes, followed by the temporal lobes, with the other lobes showing no significant changes. On brain maps, the orchid fragrance induced greater absolute alpha and absolute mid-beta activities compared with the rose and control fragrances, and the rose fragrance induced high absolute mid-beta activation. To identify emotional responses to floral fragrances, the subjects were requested to fill in a questionnaire and the resulting odor-related emotional descriptors were analyzed using semantic differential and factor analysis. Principal component analysis identified “elegant” as the first principal component describing the floral fragrance, followed by “refreshing” and “aromatic.” The subjects gave orchid higher scores for “elegant” and “refreshing,” while finding rose more “aromatic.” Differences in hedonic evaluation revealed by the A1 index appeared in the 65-115 sec range of scent exposure time. The subjects with ages of around 50 years showed olfactory preferences throughout the entire experimental time of 160 sec, most markedly in the later time segment (115-165 sec), showing an increasing preference with increasing exposure time. We conclude that rose fragrance can improve concentration by creating an aromatic environment conducive to a concentrated and calm state of mind, and orchid fragrance can make people feel pampered and relaxed by creating an elegant and refreshing environment.

The curious case of an invisible dog: a patient with non-psychiatric visual hallucinations

A 74-year-old man reported experiencing hallucinations of a dog standing on his right side, following a recent episode of infective endocarditis. There was no history of reduced conscious level, psychosis or substance misuse. Neurological examination revealed an isolated right inferior quadrantopia, and the hallucinations were visible only in the area of the visual defect. A computed tomography scan confirmed a left occipital lobe infarct, congruent with the clinical signs. The infarct was deemed to be have originated from a septic embolus of his infected aortic valve and he was diagnosed with Charles Bonnet's syndrome (CBS). CBS is characterized by the presence of stereotyped visual hallucinations on a background of partial sight and in the absence of any psychotic illness. Early recognition can prevent wrongful diagnosis of a psychiatric condition, which may provide comfort to patients. Management is centred on reassurance and counselling, with medical therapies reserved only for patients experiencing distressing hallucinations.

Reversible posterior leukoencephalopathy syndrome following combinatorial cisplatin and pemetrexed therapy for lung cancer in a normotensive patient: A case report and literature review.

Reversible posterior leukoencephalopathy syndrome (RPLS) is a rare neurological syndrome of the brain, causing symptoms such as headaches, seizures, altered mental status and visual disturbances. The condition is predominantly associated with hypertension, eclampsia, renal impairment, cytotoxic drugs, immunosuppressive agents and molecular targeted agents, but the precise underlying mechanism of RPLS is not fully understood. The present study describes the case of a 65-year-old female patient with stage IIA non-small cell lung cancer who received cisplatin/pemetrexed treatment at the Leo W. Jenkins Cancer Center. Following 3 cycles of this therapy, the patient was referred to the Emergency Department of Vidant Medical Center with an altered mental status, subsequently presenting with epileptic seizures, a fever and a headache. A neurological examination revealed generalized hyperreflexia and paraparesis, with extensor posturing of the bilateral lower extremities. The lumbar puncture and electroencephalography results were normal, but cranial computed tomography (CT) scans revealed attenuation abnormalities in the bilateral parietal region and the left occipital lobe, with suspected metastasis. Cranial T2-weighted magnetic resonance imaging (MRI) indicated bilateral regions of increased signal intensity in the occipital, temporal and periventricular white matter. The patient was treated with anticonvulsants, steroids and antihypertensive drugs, recovered gradually from the symptoms and regained full consciousness. However, the patient reported residual weakness, presenting with an Eastern Cooperative Oncology Group score of 3, reflective of an inability to independently perform daily activities and self-care. A brain MRI performed 10 days later demonstrated that the subcortical edema had partially subsided. The patient was discharged on day 15 post-admission. A follow-up cranial CT examination 1 month later indicated a partial resolution of the abnormalities. The present report reviews similar associated cases, and also discusses the clinical features and mechanisms underlying RPLS. Although it is typically reversible, RPLS is a serious and potentially life-threatening adverse condition if left untreated. Early recognition of this condition is crucial for the prompt control of the patient's blood pressure or withdrawal of cytotoxic drugs in order to reverse this syndrome.

Lesions of the Central Nervous System in Leukemia: Pathologic and Magnetic Resonance Imaging (MRI) Features in 14 Patients

Lesions of the central nervous system (CNS) were seen during and after treatment of leukemia. We aimed to characterize the specific pathology and MRI findings observed in leukemia patients with CNS lesions and to determine their value in the management of such patients. The data from stereotactic biopsy for pathology (12 patients) and MRI examinations (14 patients) were retrospectively evaluated. Factors that predisposed to the lesions of CNS were reviewed from the medical records. Among the 14 patients, 4 had a CNS infection, 2 had a neurodegenerative disorder, 8 had CNS leukemia. The clinical diagnosis based on clinical presentation and MRI features was not consistent with the pathological diagnosis in 2 patients: in one patient, the clinical diagnosis was a CNS infection, though the patient's pathological diagnosis was CNS leukemia; in the other patient, the clinical diagnosis was CNS leukemia, but the pathological diagnosis was glial cell hyperplasia. CNS lesions in leukemia have a wide range of causes. Apart from the relapse of leukemia in CNS, there are treatment related neurotoxicities and infections that are caused by immunocompromised states. Stereotactic biopsy for pathological confirmation has the advantages of minimal invasion and convenience, which remains the gold standard for diagnosing the nature of CNS lesions. Because many CNS lesions of leukemia are treatable, early correctly diagnosis is essential.Table 1Medical records of 14 leukemia patients with CNS lesionscaseAge, y /SexLeukemia typeA/I*Clinical presentationMRI findingsclinical diagnosisStereotactic biopsy for pathology diagnosisOutcome115/MAML (M5)14/3 d after CyclosporinSeizureMRI: The left occipital lobe, right frontal lobe low-density lesions with enhancement of capsule wall.InfectionFungal brain abscessesImproved238/MAML34/9 mo after allo-HSCTFeverMRI: Scattered lesions at the right frontal lobe. Short T1, long T2 signal.InfectionNot performedImproved320/MALL20/during 2nd course of chemoHeadache, limb ticMRI: Bilateral cerebral hemisphere cortex multiple long T1 and T2 signal nodular lesions.InfectionFungal brain abscessesImproved454/MAPL53/2 mo after Retinoic acidHeadache, limb numb, seizureMRI: Bilateral posterior parietal lobe showing patchy enhancement.LeukemiaLeukemiaImproved57/MALL (B cell)7/during the chemoHeadacheMRI: a cystic lesion in the right temporal lobe and cerebellum obvious edema.InfectionLeukemiaProgressed626/FAML (M4)25/during 4th course of chemoFever, ticMRI: Mixed signals at the left frontotemporal top border zone.InfectionBrain abscessesImproved725/MALL (T cell)21/3 y after immuno-suppressive agentHeadache, limb weaknessMRI: Mixed signals at right hemisphere, perilesional mild enhancement.LeukemiaT cell leukemia/lymphomaImproved816/MALL (T cell)16/ at the diagnosis of leukemiaHeadache, blurred visionMRI: Scattered, abnormal signal of sizes at the cerebellum.LeukemiaNot performedProgressed949/MALL (B cell)49/1 mo after chemononeMRI: Glial cell proliferation around lesion at right parietal lobe.LeukemiaGlial cell hyperplasiaImproved1060/MCMML57/4 y after allo-HSCTNausea, right limb weaknessMRI: a 2.5×2 cm2 lesion in left basal ganglia.LeukemiaChronic myelomonocytic leukemiaDied1126/MALL (B cell)20/9 mo after last course of chemoHeadacheMRI: lesions at the left temporal lobe, perilesional with obvious edema.LeukemiaB cell leukemia/lymphomaImproved1229/FAML (M5b)27/1 mo after last course of chemononeMRI: Bilateral cerebellum, left occipital lobe abnormal signal enhanced on T1 with Gd.LeukemiaLeukemiaImproved1342/MALL41/3 mo after allo-HSCTDizziness, Walking instabilityMRI: The left cerebellar hemisphere visible nodular enhancement lesions.LeukemiaLeukemiaImproved1423/FALL (B cell)23/1 mo after allo-ASCTheadacheMRI: The right paracele white matter lesions visible long T1, long T2 signal, the boundary is not clear, edema is not obvious, no enhancemen.Degenerative diseaseNerve cell degenerationImproved*A, the age when the diagnosis was made for leukemia.I, the interval between the last treatment and the onset of neurological symptoms. [Display omitted] [Display omitted] [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

RARE-21GLIOBLASTOMA WITH LEPTOMENINGEAL AND INTRAMEDULLARY METASTASES AT TIME OF INITIAL DIAGNOSIS IN AN ELDERLY PATIENT: A CASE REPORT

Unfortunately, glioblastoma multiforme (GBM) continues to be an incurable, highly aggressive central nervous system malignancy. Extracranial dissemination of GBM is exceedingly rare, with most case reports indicating dissemination either as a post-surgical result or at time of disease progression. Here we present a case of an 85 year old woman who initially presented with confusion, falls, and episodic aphasia. MRI of the brain demonstrated a 2.2cm enhancing mass in the left occipital lobe. Patient was subsequently found to have leptomeningeal and intramedullary metastases at the time of initial diagnosis. Biopsy of the occipital mass was consistent with MGMT methylated GBM. Given patient's age and performance status, along with recent data supporting the efficacy of temozolomide monotherapy in elderly patient with MGMT methylated glioblastoma, patient elected to withhold brain radiation, proceeding with temozolomide monotherapy with palliative radiation therapy to her spinal deposits. She unfortunately experienced a rapid decline, with an overall survival of 6 weeks. This case presents a patient where MGMT monotherapy did not stabilize her disseminated disease. Further, the lack of radiographic evidence of direct tumor extension into the cerebrospinal fluid suggests a more invasive tumor phenotype allowing for the early dissemination. Further tumor biology research is required in this subset of patients regarding the mechanism for extracranial disease dissemination.

RARE-14PACLITAXEL IN THE TREATMENT OF PRIMARY MENINGEAL ANGIOSARCOMA

Primary angiosarcoma of the central nervous system (PACNS) is an extremely rare malignancy. The meninges represent an uncommon site of origin of PACNS. This report describes a recurrent meningeal PACNS treated with paclitaxel in an effort to raise awareness and suggest treatment options for this rare entity. A 36-year-old man presented to our facility with a 4-month history of worsening headaches and complete right homonymous hemianopia. Neuroimaging revealed a left occipital lobe hematoma with an underlying left tentorial tumor. After maximal resection, neuropathological examination revealed features of a malignant endothelial cell angiosarcoma. Of note, two years prior to presentation he had an acute intraparenchymal hemorrhage in the same location without clear etiology. Patient received adjuvant conformal radiation therapy (6040 cGy in 33 fractions) but experienced progression by imaging in less than a year. He subsequently received stereotactic radiosurgery followed by weekly paclitaxel (90mg/m2) day 1, 8 and 15 in 4-weeks cycle based on literature suggesting activity of this regimen in advanced angiosarcomas. He is tolerating treatment with stable disease for at least 6 months and retains a good performance status. This case of a meningeal PACNS highlights the importance of recognizing this entity in the setting of hemorrhagic lesions of the CNS. To our knowledge, this is the first report of the usefulness of paclitaxel in the treatment of this rare malignancy. This case will be updated at the time of the meeting.

Epileptic Ictal Hyperperfusion on Arterial Spin Labeling Perfusion and Diffusion-Weighted Magnetic Resonance Images in Posterior Reversible Encephalopathy Syndrome

The hemodynamic state of the posterior dominant vasogenic edema in posterior reversible encephalopathy syndrome (PRES) is controversial. The aim of this retrospective study was to examine the contribution of epileptic ictal hyperperfusion in patients with PRES using combined magnetic resonance perfusion imaging with arterial spin labeling (ASL) and diffusion-weighted magnetic resonance imaging (MRI). A detailed review of chronological MRI findings in 2 patients, including diffusion-weighted imaging (DWI) and ASL, with special reference to clinical and electroencephalographic findings, was performed. At the onset of PRES, both patients developed secondary generalized seizures. At the first PRES episode in Case 1, ASL and DWI clearly depicted "ictal hyperperfusion" and prolonged epilepsy-induced cytotoxic edema in the left parieto-occipital lobe cortex, located around the vasogenic edema of the PRES lesion in the left occipital lobe (hypoperfused area). At the second and third episodes (2 and 7 months after the first episode, respectively), although recurrent PRES was ruled out, ASL and DWI clearly demonstrated ictal hyperperfusion in the left posterior temporal and parieto-occipital lobes associated with partial nonconvulsive status epilepticus, which developed around the PRES-related old hematoma lesion. In Case 2, peri-ictal MRI findings of ictal ASL hyperperfusion and cortical hyperintensity on DWI were also noted in the left parieto-occipital lobe, but were mild compared with Case 1. Combined use of DWI and ASL can provide information on hemodynamic state associated with epileptic ictal hyperperfusion in the various phases of PRES.

Combination of drainage and chemotherapy for treatment of a Staphylococcus aureus brain abscess in a pre-term infant

Introduction: Neonatal brain abscess is an uncommon intracranial suppuration that usually occurs as a complication of bacterial meningitis or septicaemia. Staphylococcus aureus rarely causes brain abscesses during the first months of life. Case presentation: A case of a premature infant who developed cerebellar, left temporal and left occipital lobe abscesses after S. aureus sepsis is presented. The pus provided the same S. aureus strain of the sepsis. The patient was treated with vancomycin for 37 days, accompanied by extraction of the purulent material. The abscesses resolved and no sequelae remained. Conclusion: It appears that long antibiotic treatment regimes, when associated with early pus drainage, are effective in resolving infection and abscesses caused by S. aureus in neonates.

Myelination Is Associated with Processing Speed in Early Childhood: Preliminary Insights.

Processing speed is an important contributor to working memory performance and fluid intelligence in young children. Myelinated white matter plays a central role in brain messaging, and likely mediates processing speed, but little is known about the relationship between myelination and processing speed in young children. In the present study, processing speed was measured through inspection times, and myelin volume fraction (VFM) was quantified using a multicomponent magnetic resonance imaging (MRI) approach in 2- to 5-years of age. Both inspection times and VFM were found to increase with age. Greater VFM in the right and left occipital lobes, the body of the corpus callosum, and the right cerebellum was significantly associated with shorter inspection times, after controlling for age. A hierarchical regression showed that VFM in the left occipital lobe predicted inspection times over and beyond the effects of age and the VFM in the other brain regions. These findings are consistent with the hypothesis that myelin supports processing speed in early childhood.