Left Temporal Lobe Research Articles

Cerebral perfusion in type 2 diabetes mellitus: A preliminary study with MR perfusion

BackgroundType 2 diabetes mellitus (T2DM) is associated with altered cerebral vasoreactivity, cognitive impairment, and functional decline. Magnetic Resonance (MR) perfusion can be used to assess cerebral blood flow (CBF). The aim of this study is to analyze the association between diabetes mellitus and cerebral perfusion. MethodsThe study included 52 patients diagnosed with T2DM and 39 healthy individuals. The diabetic patients were classified into three groups (PRP: proliferative retinopathy, NPRP: non-proliferative retinopathy, Non-RP: non-retinopathy DM). The rCBF measurements of cortical gray matter and thalami were carried out using the region of interest. Reference quantitative measurements were performed from ipsilateral white matter. ResultsThe comparison between the T2DM group and the control group revealed that rCBF values of bilateral frontal lobes, cingulate gyrus, medial temporal lobe, thalami and right occipital lobe were measured to be significantly lower in the T2DM group (p < 0.05). No significant difference was detected between the two groups in terms of rCBF values of the left occipital lobe and anterior aspect of the left temporal lobe (p > 0.05). The rCBF values were lower in the anterior aspect of the right temporal lobe and the difference showed borderline statistical significance (p = 0.058). No significant difference was detected regarding mean rCBF values measured in the regions of cerebral hemispheres among the three patient groups with T2DM (p˃0.05). ConclusionRegional hypoperfusion was encountered in most of the lobes in the T2DM group when compared with the healthy group. However, in terms of rCBF values, there was no significant difference among the three groups with T2DM.

Episodic Memory in Amnestic Behavioral Frontotemporal Dementia and Alzheimer's Disease.

Behavioral frontotemporal dementia (bvFTD) may present with episodic memory deficits. In 38 patients with bvFTD and 61 with Alzheimer's disease (AD) specific measures of verbal memory (learning curves and serial position effects) were studied through the Rey Auditory Verbal Learning test. Forty-two percent of bvFTD showed deficits of delayed recall memory similar to that found in AD including the serial position effects. Amnestic bvFTD had more severe atrophy in the left mesial temporal lobe than non-amnestic bvFTD. AD-like memory deficits are not infrequent in bvFTD and may be in part related to mesial temporal lobe atrophy.

Amyloid accumulation in the medial temporal area starts in the mild cognitive impairment stage of Alzheimer’s disease in [18F]flutemetamol positron emission tomography

AbstractBackgroundThis study was aimed to evaluate the hierarchical accumulation of amyloid in the Alzheimer’s brain according to clinical stage using [18F]flutemetamol positron emission tomography.MethodThis was a prospective, single‐cohort study of volunteers who lived independently in Itabashi‐ku (Tokyo, Japan). One hundred thirty‐six participants (female/male = 96/40, mean age/standard deviation = 79.2/4.0 years) were recruited. Two subjects, one with meningeal thickening and another with sequelae in the brain, and 17 visually amyloid‐negative MCI subjects who possibly had neurodegenerative disease other than Alzheimer’s disease were excluded from the further analysis. We applied voxel‐based regression slope analysis using composite voxel of interest values calculated with Cortex ID Suite (GE Healthcare) and [18F]flutemetamol positron emission tomography images in three groups: 70 amyloid‐negative cognitively normal (CN) participants, 29 amyloid‐positive cognitively normal (PreC) participants, and 18 amyloid‐positive MCI (MCI+) participants. Statistical Parametric Mapping 12 software was used for analysis.ResultCompared with the CN group, the PreC group showed accelerated amyloid accumulation in a wide area, except for the medial temporal lobe, paracentral sulcus, and medial occipital lobe. In amyloid‐positive subjects, amyloid accumulation was quicker in the paracentral sulcus, occipital cortex, and left medial temporal lobe in the MCI+ group than in the PreC group. Additional voxel of interest analyses were applied to the statistically significant areas. In the right posterior cingulate area, there was no significant difference between the PreC and MCI+ groups; however, the PreC and MCI+ groups showed a significantly quicker amyloid accumulation than the CN group. In contrast, in the left medial temporal area, the increase of amyloid accumulation was greater only in the MCI+ group compared to the PreC and CN groups.ConclusionIn amyloid‐positive subjects, amyloid accumulation in the left medial temporal lobe did not increase in the preclinical stage. In the medial temporal and occipital lobes, which are relatively spared from amyloid accumulation, it is considered to start late in the MCI stage and not in the preclinical stage. Further study of volume and other biomarkers is requreid to evaluate the regional pathophysiological variability of AD.

68969: Comparative Study Of Neuropsychology、MRI and 18F‐FDG PET in Patients with Alzheimer’s Disease and Semantic Dementia

AbstractBackgroundConfusion between Alzheimer’s disease (AD) and semantic dementia (SD) in early diagnosis is common, and most previous studies have been based on clinical diagnoses without a pathological diagnosis by biomarkers.Method15 patients 18F‐AV 45 PET (+) with AD and 9 patients 18F‐AV 45 PET (‐) with SD enrolled. All patients underwent the following examinations: (1) Neuropsychological tests, including Mini‐Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Activities of Daily Living (ADL), Boston Nomenclature Test (BNT), and Neuropsychiatric Scale table (NPI). (2) 3.0 head MRI examination, the imaging results were evaluated by MTA‐Scale, Koedam scale, and Kipps scale. (3) 18F‐FDG PET examination, PET images were quantitatively analyzed by Neuro Q software.ResultADL score increased in both groups, and the ADL score in the AD group was higher than that in the SD group (P = 0.035). BNT score decreased in both groups, but the BNT score in the SD group was lower than that in the AD group (P = 0.013). There were differences between the two groups in several psycho‐behavioral symptoms; delusions symptoms in the AD group were more prominent than those in the SD group (P = 0.009), and euphoria and disinhibition symptoms in the SD group were more pronounced than AD group (P = 0.015 and 0.015, respectively). The MRI atrophy rating scale showed that the left hippocampus, left frontal lobe, left anterior, and posterior temporal lobe atrophy in the SD group was more severe than that of the AD group (P = 0.018, 0.018, 0.022, and 0.044, respectively). Compared with the two groups of patients, the brain regions with significantly decreased metabolism in the AD group included the right inferior parietal lobule, right posterior cingulate gyrus, and left posterior cingulate gyrus (P = 0.037, 0.014, and 0.037, respectively); the brain regions with significantly decreased metabolism were left inferior frontal gyrus, left medial anterior temporal lobe, right medial anterior temporal lobe, left inferior lateral temporal lobe and left caudate nucleus (P = 0.017, 0.003, 0.037, 0.003, and 0.017, respectively).ConclusionNeuropsychology, brain structure, and brain metabolism aid in AD and SD differential diagnosis.

Semantic variant Primary Progressive Aphasia: Additional semantic features in Chinese language users

AbstractBackgroundTo date, most literature on Primary Progressive Aphasia (PPA) has been based on English language users. Yet, there are more than 7,000 living languages worldwide with vast heterogeneities in their linguistic features. Contrary to English language, Chinese language is a classifier language in which it is grammatically mandatory to have classifiers present between numerals and nouns. In addition, Chinese characters typically have an abundance of homophones (i.e., words with same pronunciation but vary in orthography and meaning) and heteronyms (i.e., words with same orthography but vary in meaning and pronunciation). Chinese language users rely on semantic knowledge to identify the accurate classifiers, homophones, and heteronym pronunciations. Thus, we hypothesize that Chinese‐speaking semantic variant (sv) PPA patients have difficulties producing classifiers, homophones, and heteronyms.MethodTo assess classifier production, participants are presented with pictures of nouns. Participants are first tasked with producing noun‐specific classifiers spontaneously. If failed, they are presented with four classifiers to select. To evaluate homophone selection skills, participants are shown short sentences with one character/word removed. They are then tasked to complete the sentences by choosing one of the four homophones presented. For heteronym reading, participants are asked to read out loud Chinese compound words with heteronyms (e.g., “windmill” and “wind up”).ResultWe recruited 22 controls and 47 PPA individuals (12 svPPA, 10 nonfluent variant (nfv) PPA and 25 logopenic variant (lv) PPA). In classifier production test, svPPA and lvPPA patients produce fewer accurate classifiers (p&lt;0.0001, p = 0.001), with svPPA showing least improvement when presented with multiple choices (p = 0.003). In homophone selection test, svPPA and lvPPA scored lower than controls (p&lt;0.0001 and p = 0.007). For heteronym reading test, svPPA showed the lowest performance when tasked with reading heteronym characters (p = 0.001). Using voxel‐based morphometry, we noted that the ability to produce classifiers, read heteronyms and identify heteronyms are correlated with grey matter volumetric changes over the anterior portion of the left temporal lobe and fusiform gyri, brain regions associated with language semantic functions.ConclusionPPA symptomatology may vary across languages. Thus, studying PPA symptoms via a linguistically diverse approach potentially provides a more comprehensive understanding to the syndrome.

Частота и нозологическая структура причин застойного диска зрительного нерва по данным специализированной нейрохирургической клиники

Purpose. Evaluation of the frequency of congestive optic nerve discs (COND), its severity, nosological causes of occurrence in patients with various craniocerebral pathologies. Material and methods. The presence of COND was detected in 48 patients (38 %): in 39 patients it was bilateral, in 9 patients it was unilateral. Their age ranges from 1 year to 76 years. The structure of the stages of the COND: stage 1 – 63 eyes; stage 2 – 2 eyes; stage 3 – 4 eyes; stage 4 – 16 eyes; stage 5 – 2 eyes. Results. Bilateral COND had: a 75-year-old man with a volumetric lesion of the left temporal lobe, 2 patients with choroid neoplasms against the background of multiple metastatic lesions of the brain and internal organs. 21 patients had benign intracranial hypertension, 2 patients had brain contusion, subdural hematoma. A 51-year-old patient has a ruptured aneurysm of the middle cerebral artery on the left. A one-year-old child has an acute subdural hematoma of the right hemisphere due to a severe brain contusion due to a closed craniocerebral injury. Among 9 patients with unilateral COND: 6 patients had space-occupying formations in the corresponding fronto-parietal, parietal, temporal lobes of the brain, sellar region, cavernous angioma of the parietal lobe. In 2 patients, the consequences of severe craniocerebral injuries, in a 21-yearold patient penetrating craniocerebral injury with subarachnoid hemorrhage. Conclusions. The frequency of COND in patients with various craniocerebral pathologies was 38 %. Keywords: congestive optic nerve discs, craniocerebral pathology, neurosurgical department patients

Early Detection of Dementia using Risk Classification in MCI: Outcomes of Shanghai Mild Cognitive Impairment Cohort Study.

The purpose of this study is to identify the risk factors and risk classification associated with the conversion from mild cognitive impairment (MCI) to Alzheimer's disease (AD) dementia to facilitate early intervention and the design of clinical trials for AD. The study comprised a prospective cohort study of 400 subjects with MCI who had annual follow-ups for 3 years. During an average follow-up period of 3.5 years, 109 subjects were diagnosed with all cause of dementia, of whom 104 subjects converted to Alzheimer's dementia and 5 subjects converted to other types of dementia. The cumulative conversion rate was 5.5% (95% CI: 3.4, 8.6), 16.3% (95% CI: 12.9, 21.1), and 31.0% (95% CI: 25.4, 36.5) in each of the first 3 follow-up years, respectively. The factors associated with a greater risk of conversion from MCI to AD included smoking status, ApoE4 carrier status, right hippocampal volume (rt. HV), left temporal lobe volume, and scores on the Revised Chinese version of the Alzheimer's Disease Assessment Scale-Cognitive Subscale 13 (ADAS-Cog-C). The risk classification of the ADAS-Cog-C or Preclinical Alzheimer Cognitive Composite (PACC) score combined with the rt. HV showed a conversion difference among the groups at every annual follow-up. A simple risk classification using the rt. HV and neuropsychological test scores, including those from the ADAS-Cog-C and PACC, could be a practicable and efficient approach to indentify individuals at risk of all-cause dementia.

An Unusual Case of Corynebacterium simulans causes Infective Endocarditis with Embolic Events

Corynebacterium species are often treated as contaminants. However, there were several recent outbreaks involving Corynebacterium species reported across the globe. We report a rare case of Corynebacterium simulans causes infective endocarditis which led to debilitating embolic events. A 39-year-old lady presented with a prolonged fever for three weeks. She was in septic shock and had dense right hemiplegia, a pansystolic murmur at the mitral area and hepatosplenomegaly. There were no peripheral stigmata of infective endocarditis. An urgent computed tomography (CT) of the brain showed an infarct at the left corona radiata extending to the left parietal, left basal ganglia and left temporal lobe. She deteriorated and required mechanical ventilation and intensive care. Echocardiogram showed vegetation at both her anterior and posterior mitral valve leaflets leading to severe mitral regurgitation. Splenic infarction was seen in her contrasted computed tomography (CECT) of her abdomen. Her three samples of blood culture were positive for Corynebacterium simulans. She deteriorated rapidly and went into multi-organ failure and succumbed. Corynebacterium species should be taken seriously and should not be neglected as a contaminant as it can cause potentially fatal complications as described in this case report.

Comparative dosimetric study of radiotherapy in high-grade gliomas based on the guidelines of EORTC and NRG-2019 target delineation.

Radiotherapy is one of the most important treatments for high-grade glioma (HGG), but the best way to delineate the target areas for radiotherapy remains controversial, so our aim was to compare the dosimetric differences in radiation treatment plans generated based on the European Organization for Research and Treatment of Cancer (EORTC) and National Research Group (NRG) consensus to provide evidence for optimal target delineation for HGG. We prospectively enrolled 13 patients with a confirmed HGG from our hospital and assessed dosimetric differences in radiotherapy treatment plans generated according to the EORTC and NRG-2019 guidelines. For each patient, two treatment plans were generated. Dosimetric parameters were compared by dose-volume histograms for each plan. The median volume for planning target volume (PTV) of EORTC plans, PTV1 of NRG-2019 plans, and PTV2 of NRG-2019 plans were 336.6 cm3 (range, 161.1-511.5 cm3), 365.3 cm3 (range, 123.4-535.0 cm3), and 263.2 cm3 (range, 116.8-497.7 cm3), respectively. Both treatment plans were found to have similar efficiency and evaluated as acceptable for patient treatment. Both treatment plans showed well conformal index and homogeneity index and were not statistically significantly different (P = 0.397 and P = 0.427, respectively). There was no significant difference in the volume percent of brain irradiated to 30, 46, and 60 Gy according to different target delineations (P = 0.397, P = 0.590, and P = 0.739, respectively). These two plans also showed no significant differences in the doses to the brain stem, optic chiasm, left and right optic nerves, left and right lens, left and right eyes, pituitary, and left and right temporal lobes (P = 0.858, P = 0.858, P = 0.701 and P = 0.794, P = 0.701 and P = 0.427, P = 0.489 and P = 0.898, P = 0.626, and P = 0.942 and P = 0.161, respectively). The NRG-2019 project did not increase the dose of organs at risk (OARs) radiation. This is a significant finding that further lays the groundwork for the application of the NRG-2019 consensus in the treatment of patients with HGGs. The effect of radiotherapy target area and glial fibrillary acidic protein (GFAP) on the prognosis of high-grade glioma and its mechanism, number ChiCTR2100046667. Registered 26 May 2021.

Maintaining her image: A social comparative evaluation of the particularity of mothers in the Chinese cultural context

In Chinese culture, the mother holds a special meaning in one’s self-concept, and is perceived as being stablyincorporated into and consistent with the self. However, it is unclear whether the evaluation of mothers by individuals is affected following the initiation of upward and downward social comparisons (USC and DSC). This experiment manipulated USC and DSC by evaluating positive and negative public figures and used functional near-infrared spectroscopy to record changes in brain activity during the evaluation. It was found that participants’ evaluations of their mothers and their brain activity did not differ from the self during USC, verifying the equivalence of the mother and the self. In DSC, participants made significantly more positive social judgments about their mothers, accompanied by greater activation of the left temporal lobe. These results suggest that the mother was not only stably incorporated into the self but was in a position of even greater importance than the self. In DSC in particular, individuals are more likely to maintain a positive image of their mother.

Behavioral and oscillatory signatures of switch costs in highly proficient bilinguals

Bilinguals with a high proficiency in their first (L1) and second language (L2) often show comparable reaction times when switching from their L1 to L2 and vice-versa (“symmetrical switch costs”). However, the neurophysiological signatures supporting this effect are not well understood. Here, we ran two separate experiments and assessed behavioral and MEG responses in highly proficient Spanish-Basque bilinguals while they overtly name pictures in a mixed-language context. In the behavioral experiment, bilinguals were slower when naming items in switch relative to non-switch trials, and this switch cost was comparable for both languages (symmetrical). The MEG experiment mimicked the behavioral one, with switch trials showing more desynchronization than non-switch trials across languages (symmetric neural cost) in the alpha band (8–13 Hz). Source-localization revealed the engagement of right parietal and premotor areas, which have been linked to language selection and inhibitory control; and of the left anterior temporal lobe (ATL), a cross-linguistic region housing conceptual knowledge that generalizes across languages. Our results suggest that highly proficient bilinguals implement a language-independent mechanism, supported by alpha oscillations, which is involved in cue-based language selection and facilitates conceptually-driven lexical access in the ATL, possibly by inhibiting non-target lexical items or disinhibiting target ones.

Early language exposure affects neural mechanisms of semantic representations.

One signature of the human brain is its ability to derive knowledge from language inputs, in addition to nonlinguistic sensory channels such as vision and touch. How does human language experience modulate the mechanism by which semantic knowledge is stored in the human brain? We investigated this question using a unique human model with varying amounts and qualities of early language exposure: early deaf adults who were born to hearing parents and had reduced early exposure and delayed acquisition of any natural human language (speech or sign), with early deaf adults who acquired sign language from birth as the control group that matches on nonlinguistic sensory experiences. Neural responses in a semantic judgment task with 90 written words that were familiar to both groups were measured using fMRI. The deaf group with reduced early language exposure, compared with the deaf control group, showed reduced semantic sensitivity, in both multivariate pattern (semantic structure encoding) and univariate (abstractness effect) analyses, in the left dorsal anterior temporal lobe (dATL). These results provide positive, causal evidence that language experience drives the neural semantic representation in the dATL, highlighting the roles of language in forming human neural semantic structures beyond nonverbal sensory experiences.

Deficits in naming pictures of objects are associated with glioma infiltration of the inferior longitudinal fasciculus: A study with diffusion MRI tractography, volumetric MRI, and neuropsychology.

It has been suggested that the inferior longitudinal fasciculus (ILF) may play an important role in several aspects of language processing such as visual object recognition, visual memory, lexical retrieval, reading, and specifically, in naming visual stimuli. In particular, the ILF appears to convey visual information from the occipital lobe to the anterior temporal lobe (ATL). However, direct evidence proving the essential role of the ILF in language and semantics remains limited and controversial. The first aim of this study was to prove that patients with a brain glioma damaging the left ILF would be selectively impaired in picture naming of objects; the second aim was to prove that patients with glioma infiltrating the ATL would not be impaired due to functional reorganization of the lexical retrieval network elicited by the tumor. We evaluated 48 right-handed patients with neuropsychological testing and magnetic resonance imaging (MRI) before and after surgery for resection of a glioma infiltrating aspects of the left temporal, occipital, and/or parietal lobes; diffusion tensor imaging (DTI) was acquired preoperatively in all patients. Damage to the ILF, inferior frontal occipital fasciculus (IFOF), uncinate fasciculus (UF), arcuate fasciculus (AF), and associated cortical regions was assessed by means of preoperative tractography and pre-/pos-toperative MRI volumetry. The association of fascicles damage with patients' performance in picture naming and three additional cognitive tasks, namely, verbal fluency (two verbal non-visual tasks) and the Trail Making Test (a visual attentional task), was evaluated. Nine patients were impaired in the naming test before surgery. ILF damage was demonstrated with tractography in six (67%) of these patients. The odds of having an ILF damage was 6.35 (95% CI: 1.27-34.92) times higher among patients with naming deficit than among those without it. The ILF was the only fascicle to be significantly associated with naming deficit when all the fascicles were considered together, achieving an adjusted odds ratio of 15.73 (95% CI: 2.30-178.16, p = .010). Tumor infiltration of temporal and occipital cortices did not contribute to increase the odd of having a naming deficit. ILF damage was found to be selectively associated with picture naming deficit and not with lexical retrieval assessed by means of verbal fluency. Early after surgery, 29 patients were impaired in naming objects. The association of naming deficit with percentage of ILF resection (assessed by 3D-MRI) was confirmed (beta = -56.78 ± 20.34, p = .008) through a robust multiple linear regression model; no significant association was found with damage of IFOF, UF or AF. Crucially, postoperative neuropsychological evaluation showed that naming scores of patients with tumor infiltration of the anterior temporal cortex were not significantly associated with the percentage of ILF damage (rho = .180, p > .999), while such association was significant in patients without ATL infiltration (rho = -.556, p = .004). The ILF is selectively involved in picture naming of objects; however, the naming deficits are less severe in patients with glioma infiltration of the ATL probably due to release of an alternative route that may involve the posterior segment of the AF. The left ILF, connecting the extrastriatal visual cortex to the anterior region of the temporal lobe, is crucial for lexical retrieval on visual stimulus, such as in picture naming. However, when the ATL is also damaged, an alternative route is released and the performance improves.

Dural arteriovenous fistula presenting with stroke-like symptoms and regional cerebral hyperperfusion: a case report

BackgroundNon-hemorrhagic focal neurological deficit is one of the clinical manifestations of intracranial dural arteriovenous fistulas (DAVF). When symptoms appear suddenly, it is difficult to distinguish it from ischemic stroke in certain circumstances, which might easily lead to misdiagnosis. Here, we report a rare case of DAVF with sudden onset sensory aphasia mimicking hyperacute stroke but presented with unexpected regional hyperperfusion on the site corresponding to its symptoms.Case presentationA 76-year-old male with histories of atrial fibrillation and hypertension was admitted to the emergency department due to sudden sensory aphasia. The diagnosis of ischemic stroke was made based on clinical experience after non-contrast CT excluding hemorrhage. As in the absence of clear contraindication, the patient received intravenous thrombolysis. On the cerebral CT perfusion, the left temporal lobe, where the sensory speech center is located, was manifested as regional hyperperfusion. Thrombolysis was subsequently halted, but scheduled cranial imaging indicated hemorrhagic transformation. According to the radiological hint from cranial MRI, the patient was suspected of having DAVF, which was finally confirmed by cerebral digital subtraction angiography.ConclusionWhen DAVF is presented as sudden onset focal neurological deficit, cranial CT perfusion at an early stage might reveal an abnormal hyperperfusion pattern. Clinicians should be aware of the diagnostic possibility of DAVF in this situation and double-review the CT angiography image to reduce missed diagnoses.

Revealing the influence of bias in a letter acuity identification task: A noisy template model

In clinical testing of visual acuity, it is often assumed that performance reflects sensory abilities and observers do not exhibit strong biases for or against specific letters, but this assumption has not been extensively tested. We re-analyzed single-letter identification data as a function of letter size, spanning the resolution threshold, for 10 Sloan letters at central and paracentral visual field locations. Individual observers showed consistent letter biases across letter sizes. Preferred letters were named much more often and others less often than expected (group averages ranged from 4% to 20% across letters, where the unbiased rate was 10%). In the framework of signal detection theory, we devised a noisy template model to distinguish biases from differences in sensitivity. When bias varied across letter templates the model fitted very well - much better than when sensitivity varied without bias. The best model combined both, having substantial biases and small variations in sensitivity across letters. The over- and under-calling decreased at larger letter sizes, but this was well-predicted by template responses that had the same additive bias for all letter sizes: with stronger inputs (larger letters) there was less opportunity for bias to influence which template gave the biggest response. The neural basis for such letter bias is not known, but a plausible candidate is the letter-recognition machinery of the left temporal lobe. Future work could assess whether such biases affect clinical measures of visual performance. Our analyses so far suggest very small effects in most settings.

Altered brain functional networks after Quchi (LI 11) acupuncture: An EEG analysis.

As a unique traditional Chinese medicine therapy, the central effect of acupuncture has received increasing attention. Functional brain networks can provide connectivity information among brain regions. The study goal is to explore the regulatory effect of acupuncture on the brain functional network. This paper analyzes the electroencephalography (EEG)-based power spectrum and brain functional network elicited by acupuncture at Quchi (LI 11). The power spectrum results showed that acupuncture at LI 11 decreased the energy in the alpha frequency, mainly in the central region, left parietal lobe, left temporal lobe and left frontal lobe. Moreover, functional brain networks converted from the magnitude-squared coherence matrix in the alpha band are reconstructed. The results show that acupuncture did not alter the basic properties of the brain functional connection network. During acupuncture, the average node degree, average clustering coefficient, and small-world property of the brain functional connection network decreased after acupuncture compared with that before it. However, the average characteristic path length increased after acupuncture compared with before. Acupuncture at LI 11 altered the brain's electrical activity. In the meantime, this acupuncture reduced the network's internal connectivity and information transfer efficiency.

Semantic Variant Primary Progressive Aphasia Associated with the C9orf72 Hexanucleotide Expansion – A Longitudinal Case Report (P13-6.004)

<h3>Objective:</h3> To highlight a rare phenotypic expression of the chromosome 9 open reading frame 72 (<i>C9orf72</i>) hexanucleotide expansion, and showcase three years of clinical, neuropsychological, MRI, and FDG-PET data. <h3>Background:</h3> The <i>C9orf72</i> expansion is associated with frontotemporal dementia, parkinsonism, ALS, or some combination of these phenotypes. Of the FTD variants, the behavioral variant FTD phenotype is most common. Language variants are rare, and there is little longitudinal data on such cases. <h3>Design/Methods:</h3> Case report. <h3>Results:</h3> The patient is a member of a large FTD/ALS kindred with the <i>C9orf72</i> expansion, and he has been followed longitudinally with annual visits over 3 years (4 evaluations) in the ALLFTD (www.allftd.org) natural history research program focused on frontotemporal lobar degeneration. At age 67 he began experiencing mild word finding difficulties, trouble identifying objects on a shopping list, and mild face blindness. These symptoms have progressed, and other than mild memory impairment and mild apathy, there are no other significant cognitive/behavioral/motor features. Neuropsychological testing has shown progressive deficits in high frequency object naming and loss of semantic word knowledge. MRI has demonstrated progressive atrophy of the left anterior temporal lobe. FDG-PET has shown progressive hypometabolism predominantly in the left anterior temporal lobe, with mild involvement of the prefrontal, cingulate, and parietal cortices. Clinical genetic testing has confirmed the presence of the hexanucleotide expansion in <i>C9orf72</i>. He now carries the diagnosis of semantic variant primary progressive aphasia (svPPA) and continues to be followed longitudinally. <h3>Conclusions:</h3> This report characterizes the clinical, neuropsychological, and multimodal neuroimaging findings that are typical of svPPA, which in this case is associated with the <i>C9orf72</i> expansion. This case displays the importance of assessing language in patients with a known <i>C9orf72</i> expansion when determining if a cognitive syndrome is present. <b>Disclosure:</b> Dr. Switzer has nothing to disclose. The institution of Dr. Fields has received research support from National Institutes of Health. The institution of Dr. Fields has received research support from Patient-Centered Outcomes Research Institute. The institution of Dr. Kantarci has received research support from Eli Lilly. The institution of Dr. Kantarci has received research support from NIH. The institution of Dr. Kantarci has received research support from ADDF. Dr. Lowe has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for AVID Radiopharmaceutical. Dr. Lowe has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Eisai Inc. The institution of Dr. Lowe has received research support from AVID Radiopharmaceuticals. Dr. Corriveau-Lecavalier has nothing to disclose. Dr. Jones has nothing to disclose. Dr. Botha has received research support from NIH. Dr. Knopman has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for DIAN TU study. The institution of Dr. Knopman has received research support from NIH. Dr. Ramanan has nothing to disclose. Dr. Gavrilova has nothing to disclose. The institution of Maria Lapid has received research support from NIA. Ms. Forsberg has nothing to disclose. Mr. Nelson has nothing to disclose. Mr. Kolander has nothing to disclose. Dr. Boeve has received personal compensation in the range of $10,000-$49,999 for serving as an officer or member of the Board of Directors for Rainwater Charitable Foundation. The institution of Dr. Boeve has received research support from Alector. The institution of Dr. Boeve has received research support from GE Healthcare. The institution of Dr. Boeve has received research support from Transposon. The institution of Dr. Boeve has received research support from Cognition Therapeutics. Dr. Boeve has received publishing royalties from a publication relating to health care.

Longitudinal alterations in brain morphometry mediated the effects of bullying victimization on cognitive development in preadolescents.

Bullying victimization is associated with a doubled risk of attempting suicide in adulthood. Two longitudinal brain morphometry studies identified the fusiform gyrus and putamen as vulnerable to bullying. No study identified how neural alterations may mediate the effect of bullying on cognition. We assessed participants with caregiver-reported bullying (N = 323) and matched non-bullied controls (N = 322) from the Adolescent Brain Cognitive Development Study dataset to identify changes in brain morphometry associated with ongoing bullying victimization over two years and determine whether such alterations mediated the effect of bullying on cognition.Bullied children (38.7% girls, 47.7% racial minorities, 9.88 ± 0.62 years at baseline) had poorer cognitive performance (P < 0.05), larger right hippocampus (P = 0.036), left entorhinal cortex, left superior parietal cortex, and right fusiform gyrus volumes (all P < 0.05), as well as larger surface areas in multiple other frontal, parietal, and occipital cortices. Thinner cortices were also found in the left hemisphere, particularly in the left temporal lobe, and right frontal region (all P < 0.05). Importantly, larger surface area in the fusiform cortices partially suppressed (12–16%), and thinner precentral cortices partially mitigated, (7%) the effect of bullying on cognition (P < 0.05). These findings highlight the negative impact of prolonged bullying victimization on brain morphometry and cognition.

Cerebral Vasculitis in a patient receiving Risankizumab, an Inhibitor of Interleukin-23: First Case Report (P12-3.013)

<h3>Objective:</h3> NA <h3>Background:</h3> Iatrogenic neuroinflammation has been frequently reported in recent years owing to expanding biologic therapies for the treatment of a wide range of disorders including Psoriasis. Here we report a case of Central Nervous System (CNS) vasculitis after initiation of Risankizumab, a monoclonal antibody against Interleukin-23 (IL23) used to treat Psoriasis. <h3>Design/Methods:</h3> Case report. <h3>Results:</h3> A 29-year-old female with moderate psoriasis who was started on Risankizumab about one month prior, presented with encephalopathy and left temporal lobe focal seizures with refractory status epilepticus. Her MRI showed punctate infarcts and areas of enhancement in the left temporal lobe and leptomeninges overlying the left convexity. Extensive work up revealed increased Erythrocyte Sedimentation Rate (72 mm/hr) and positive Cardiolipin (IgM and IgG) and Beta-2 Glycoprotein (IgM and IgG) antibodies suggesting antiphospholipid syndrome (APS) for which she was started on anticoagulation. Lumbar puncture revealed normal opening pressure, glucose, protein and five nucleated cells. Oligoclonal bands, meningitis/encephalitis and autoimmune encephalitis panels were negative. Subsequent brain MRI showed new areas of ischemic lesions. Cerebral angiogram was unremarkable. Biopsy revealed focal perivascular lymphocytes (CD45 and CD3 immunohistochemical stained) infiltration in dural vessels consistent with small-vessel vasculitis. She was treated with high dose steroids with clinical improvement and subsequently planned to treat with Cyclophosphamide. Risankizumab was discontinued due to possible association. <h3>Conclusions:</h3> Iatrogenic neuroinflammation has been increasingly recognized during the new era of biological molecules and monoclonal antibodies for systemic inflammatory disorders and malignancies. Tumor necrosis factor inhibitors and immune checkpoint inhibitors are more commonly associated with neuroinflammation. To the best of our knowledge, this is the first reported case of APS and CNS vasculitis possibly associated with the initiation of IL23 inhibitor Risankizumab. Although causality cannot be established with a single case, it suggests a possible association. <b>Disclosure:</b> Dr. Cabrera Pulla has nothing to disclose. Dr. Amirjanyan has nothing to disclose. Qian Wu has nothing to disclose. Dr. Mui has nothing to disclose. Dr. Imitola has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis . The institution of Dr. Imitola has received research support from biogen. Dr. Imitola has a non-compensated relationship as a Board Member with National MS Society that is relevant to AAN interests or activities. Dr. Imitola has a non-compensated relationship as a Committee Member with International Society for Stem Cell Research that is relevant to AAN interests or activities. Dr. Coban has nothing to disclose.

Intracranial extension in COVID-19 associated mucormycosis cases (P4-10.001)

<h3>Objective:</h3> To describe COVID-19 associated rhino-orbital-cerebral mucormycosis (ROCM) patients. <h3>Background:</h3> During the rampantly spreading pandemic of COVID-19, India observed a surge in mucormycosis cases. The most common form of secondary infection noted in COVID-19 infected immunocompromised patients was mucormycosis. The infection mainly spread through the nasal passage and in few uncontrolled cases, it crossed the dura mater and presented itself as rhino-orbital-cerebral mucormycosis. <h3>Design/Methods:</h3> The study was conducted after Institute Ethics Committee approval. ROCM cases were studied in detail, their demographic, radiological data, treatment details and 90 days’ follow-up are described. <h3>Results:</h3> The most effective tool for diagnosis and confirmation of mucormycosis within time is magnetic resonance imaging (MRI) and histopathological techniques. The chief complaints of patients inflicted with COVID-19 associated mucormycosis were headache, fever, ophthamloplegia, ptosis, ulceration, diminution of vision, and general weakness. Infarcts were observed in 55.55% (15/27) of the cases, in right parietal lobe, right periventricular region, right cerebral infarcts, acute infarct in left frontal parietal lobe, bilateral frontal and left occipital lobe. Most common form of infarct was lacunar infarct. Haemorrhage was detected in only three patients 11.53% (3/26). Abscess formation was seen in 26.92% (7/26) patients in right temporal region, cavernous sinus and left temporal lobe. Three of the patients displayed meninges involvement and thrombosis was seen in 44% (11/25) of the total patients in internal carotid artery (ICA) in six patients, in cavernous sinus in two patients and in superior ophthalmic vein in one patient. <h3>Conclusions:</h3> Our case-series showed intracranial extension of mucormycosis in COVID-19 patients predominantly inform of thrombosis followed by intracranial abscess and haemorrhage. Appropriate care, anti-fungal medication and surgical procedures should be performed in conjunction to manage the spread of disease. <b>Disclosure:</b> Ms. Tangri has nothing to disclose. Awadh K. Pandit has nothing to disclose. Mr. Misra has nothing to disclose. Dr. Srivastava has nothing to disclose. Vishnu VY has nothing to disclose. Rajesh Kumar Singh has nothing to disclose. Divya MR has nothing to disclose.