Medullary Veins Research Articles

Inflammatory biomarkers and cerebral small vessel disease: a community-based cohort study

Background and purposeAlthough inflammation has been proposed to be a candidate risk factor for cerebral small vessel disease (CSVD), previous findings remain largely inconclusive and vary according to disease status...

Subpial Hemorrhage : ADistinctive Neonatal Stroke Pattern.

Subpial hemorrhage is arare form of neonatal stroke, still poorly understood. The aim of this study was to characterize acohort of term and preterm neonates with subpial hemorrhages and contribute to abetter knowledge of this condition. Clinical records and magnetic resonance (MR) imaging data of all neonates with subpial hemorrhage followed at apediatric hospital between 2010 and 2020 were retrospectively reviewed. A total of 10 patients were included in the analysis, 40% of whom were term neonates. Operative vaginal delivery was registered in 30%. Temporal was the most common location of subpial hemorrhage (70%), and all patients displayed underlying brain infarction. Acharacteristic yin-yang pattern was present in 90% of the study cohort, and ingurgitation of medullary veins on susceptibility weighted imaging in 80%. Cerebellar microbleeds were observed in 60% of neonates, both term and preterm. When available, MR angiography and venography were unremarkable. Patients' clinical outcome was variable, with early prematurity not associated to worse outcomes. Subpial hemorrhage has adistinctive MR pattern, with underlying parenchymal venous infarction, and can occur in term and preterm neonates. This study results suggest an association between subpial hemorrhage and cerebellar microbleeds but further studies are required to confirm it and better understand the pathophysiology of subpial hemorrhage.

Surgical disconnection of a hypoglossal canal dural arteriovenous fistula demonstrating rapid progression of medulla oblongata disturbance: illustrative case.

BACKGROUNDDural arteriovenous fistulas of the hypoglossal canal (HCDAVFs) with dominant drainage to perimedullary veins are extremely rare. These patients are prone to develop slow and progressive myelopathy, however, their clinical course has not been fully elucidated. We report an unusual case of HCDAVF in which the patient demonstrated rapid progression of hemiplegia and respiratory insufficiency.OBSERVATIONSAn 82-year-old woman demonstrated motor weakness of the left extremities. T2-weighted magnetic resonance imaging showed a high intensity area in the right medulla oblongata and angiography revealed HCDAVF with dominant drainage to the anterior medullary vein through the anterior condylar vein. Within 3 days, her hemiparesis and respiratory function worsened, and she needed mechanical ventilation. Considering that venous congestion in the medulla oblongata could cause the symptoms, we immediately performed surgical obliteration of the anterior condylar vein. The disappearance of HCDAVF was confirmed by angiography and the patient was weaned from mechanical ventilation 3 days postoperatively. Her left hemiplegia gradually resolved and she was independent in daily life 8 months after the operation.LESSONSHCDAVFs with dominant drainage to the perimedullary veins can demonstrate rapid progression of medulla oblongata disturbance. Early disconnection should be considered to provide an opportunity for substantial recovery.

Deep medullary veins are associated with widespread brain structural abnormalities

Our aim is to investigate the association of cerebral deep medullary veins (DMVs) with white matter microstructural integrity and regional brain atrophy in MRI. In a community-based cohort of 979 participants (mean age 55.4 years), DMVs were identified on susceptibility-weighted imaging. Brain structural measurements including gray matter and hippocampus volumes, as well as diffusion tensor metrics, were evaluated. The mean (SD)number of DMVs was 19.0 (1.7). A fewer number of DMVs was related to lower fractional anisotropy and higher mean diffusivity in multiple voxels on the white matter skeleton (threshold-free cluster enhancement corrected p < 0.05, adjusted for age and sex). Also, fewer DMVs were significantly related to a lower gray matter fraction and a hippocampal fraction (0.10 and 0.11 per DMV, respectively; SE, 0.03 for both; p < 0.001 for both). A significant correlation between DMVs’ reduction and cortical atrophy was observed in the bilateral occipital lobes, temporal lobes, hippocampus, and frontal lobes (p < 0.001, adjusted for age, sex, and total intracranial volume). Our results provided evidence that cerebral small venules disease play a role in brain parenchymal lesions and neurodegenerative processes.

Medullary vein architecture modulates the white matter BOLD cerebrovascular reactivity signal response to CO2: Observations from high-resolution T2* weighted imaging at 7T

Brain stress testing using blood oxygenation level-dependent (BOLD) MRI to evaluate changes in cerebrovascular reactivity (CVR) is of growing interest for evaluating white matter integrity. However, even under healthy conditions, the white matter BOLD-CVR response differs notably from that observed in the gray matter. In addition to actual arterial vascular control, the venous draining topology may influence the WM-CVR response leading to signal delays and dispersions. These types of alterations in hemodynamic parameters are sometimes linked with pathology, but may also arise from differences in normal venous architecture. In this work, high-resolution T2*weighted anatomical images combined with BOLD imaging during a hypercapnic breathing protocol were acquired using a 7 tesla MRI system. Hemodynamic parameters including base CVR, hemodynamic lag, lag-corrected CVR, response onset and signal dispersion, and finally ΔCVR (corrected CVR minus base CVR) were calculated in 8 subjects. Parameter maps were spatially normalized and correlated against an MNI-registered white matter medullary vein atlas. Moderate correlations (Pearson's rho) were observed between medullary vessel frequency (MVF) and ΔCVR (0.52; 0.58 for total WM), MVF and hemodynamic lag (0.42; 0.54 for total WM), MVF and signal dispersion (0.44; 0.53 for total WM), and finally MVF and signal onset (0.43; 0.52 for total WM). Results indicate that, when assessed in the context of the WM venous architecture, changes in the response shape may only be partially reflective of the actual vascular reactivity response occurring further upstream by control vessels. This finding may have implications when attributing diseases mechanisms and/or progression to presumed impaired WM BOLD-CVR.

Hydrocephalus in Vein of Galen Malformations.

Vein of Galen malformation (VOGM) is a fistulous arteriovenous malformation presenting in the early childhood. Hydrocephalus with VOGM develops in one half of patients during the course of the disease. The concept of hydrodynamic disorders is the key to understand the development of hydrocephalus. VOGM results in venous hypertension that secondarily disturbs cerebrospinal fluid (CSF) absorption leading to hydrocephalus and occurs frequently in infants and young children. The medullary veins are thought to be the main pathway for absorption of CSF by the cerebrofugal gradient act as the driving force. In neonates, the cavernous sinus is poorly developed and brain does not use it for venous drainage along with poor jugular bulb maturation results in poor venous drainage reserve. The presence of high flow vascular malformation with poor venous drainage reserve leads to hydrodynamic disorder, poor CSF absorption, and hydrocephalus. Apart from this, hydrocephalus secondary to intraventricular hemorrhage and physical obstruction of the enlarged VOGM at the aqueduct has been proposed. The management strategy is to perform timely endovascular treatment to correct the hydrodynamic disorder and avoid ventricular shunting. Trans-arterial embolization is the effective way, as it decreases flow in the malformation, secondarily the venous hypertension, and thereby improving the clinical symptoms related to hydrodynamic disorder. Ventricular diversion procedure is indicated in symptomatic hydrocephalus after exhausting our effort to reduce hydrodynamic pressure by endovascular embolization.

A Novel Imaging Biomarker for Cerebral Small Vessel Disease Associated With Cognitive Impairment: The Deep-Medullary-Veins Score

Objective: To explore the biomarkers of cerebral small vessel disease (CSVD) associated with cognitive impairment.Methods: A total of 69 patients with CSVD were enrolled in the study, and baseline clinical and imaging data were reviewed retrospectively. The following neuroimaging biomarkers of CSVD were identified: high-grade white matter hyperintensity (HWMH), cerebral microbleeds (CMB), enlarged perivascular space (PVS), and lacunar infarct (LI). A total score for CSVD was calculated. The deep medullary veins (DMVs) were divided into six segments according to the regional anatomy. The total DMV score (0–18) was derived from the sum of the scores of the six individual segments, the scores of which ranged from 0 to 3, for a semiquantitative assessment of the DMV that was based on segmental continuity and visibility.Results: The DMV score, patient age, and total CSVD score were independently associated with the presence or absence of cognitive impairment in patients with CSVD (P < 0.05). By integrating patient age and the total CSVD and DMV scores, the area under the curve of the receiver operating characteristic curve (AUROC) for predicting CSVD associated with cognitive impairment was 0.885, and the sensitivity and specificity were 64.71 and 94.23%, respectively.Conclusions: The DMV score may be a novel imaging biomarker for CSVD associated with cognitive impairment. The integration of the DMV score with age and total CSVD score should increase the predictive value of the DMV score for CSVD associated with cognitive impairment.

The Prognostic Impact of Susceptibility-Weighted Imaging Prominent Veins in Acute Ischemic Stroke: A Systematic Review and Meta-Analysis.

PurposeWe aimed to determine the prognostic impact of prominent veins (PVS) after an acute ischemic stroke identified on susceptibility-weighted imaging (PVS-SWI).MethodsWe searched for studies published in PubMed, Embase, Cochrane Library and Chinese Biomedical Literature Database. Poor functional prognosis, early neurological deterioration, and hemorrhagic transformation were evaluated. Risk ratios (RR) were pooled implementing a random effect model. We performed a subgroup analysis by treatment, location (cortical/medullary) and a sensitivity analysis by follow-up time.ResultsSixteen studies were included (a total of 1605 patients) in the quantitative meta-analysis. PVS-SWI were related with a poor functional outcome (RR 1.62, 95% CI 1.25 to 2.10), especially in the patients receiving thrombolysis (RR 2.19, 95% CI 1.53 to 3.15) and an augmented risk of early neurological damage (RR 2.85, 95% CI 2.31 to 3.51). Both cortical and medullary prominent veins were accompanied by a poor functional outcome (RR 1.82, 95% CI 1.30 to 2.56/RR 2.59, 95% CI 1.98 to 3.38). PVS-SWI were not associated with poor functional outcomes when patients were treated conservatively (RR 1.35, 95% CI 0.82 to 2.22), or with an increased risk of hemorrhagic transformation (RR 0.97, 95% CI 0.64 to 1.47).ConclusionPVS-SWI were related to a poor functional prognosis and an increased risk of early neurological damage. In patients treated conservatively, PVS-SWI were not accompanied by a poor prognosis. PVS-SWI were not associated with an augmented risk of hemorrhagic transformation.

Contralateral deep medullary veins is associated with poor functional outcomes in ischemic stroke patients with atrial fibrillation and/or rheumatic heart disease

Little is known about the association between deep medullary veins (DMVs) and outcomes of ischemic stroke patients with atrial fibrillation (AF) and/or rheumatic heart disease(RD). Our aim is to investigate the prognostic implications of DMVs in ischemic stroke patients with AF and/or RD.

Dural Arteriovenous Fistula with Retrograde Drainage into the Cortical Veins (Case Report)

We present clinical case of a patient who was referred for brain MRI to clarify the cause of a first-time seizure. MRI examination showed cortical and medullary veins ectasia in the left cerebral hemisphere with multiple cerebral microbleeds around the medullary veins. The revealed changes were considered as a manifestation of regional venous hypertension, however, its cause remained unclear. We decided to perform non-contrast 3D-TOF angiography that revealed a dural arteriovenous fistula between the left occipital artery and the sigmoid venous sinus with retrograde drainage into cortical veins (Borden type II, Cognard type IIb). Early diagnosis and treatment of «aggressive» dural arteriovenous fistulas avoids the development of lifethreatening complications (an annual hemorrhage rate of 8,1%).

Endovascular treatment of medullary bridging vein-draining dural arteriovenous fistulas: foramen magnum vs. craniocervical junction lesions.

Dural arteriovenous fistulas (AVFs) draining to medullary bridging vein (MBV) are located at foramen magnum (FM) and craniocervical junction (CCJ). Such fistulas are rare but pose a challenge to endovascular management. This study was undertaken to assess clinical manifestations, angiographic features, and outcomes of endovascular treatment in patients with MBV dural AVFs. A number of our patients (N = 22) were diagnosed with MBV dural AVF and treated by endovascular means. There were 9 FM lesions and 13 CCJ lesions. We reviewed clinical records and imaging studies to define clinical characteristics, vascular anatomic details, and treatment outcomes, comparing FM- and CCJ-level subsets. Subjects ranged from 37 to 74years of age (mean, 57.7years) with male predominance (2.7:1). They presented with intracranial hemorrhage (11/22, 50%), myelopathy (8/22, 36%), or nonspecific symptoms (3/22, 14%). In 17 patients (77.3%), the shunts showed complete or near-complete occlusion following endovascular treatment (FM, 100%; CCJ, 61.5%). However, seven patients experienced ischemic events (FM, 11.1%; CCJ, 46.2%) and one patient sustained a hemorrhagic complication. No hemorrhages recurred during follow-up monitoring, and myelopathic symptoms abated. MBV dural AVFs are highly aggressive lesions for which proper diagnosis and treatment are of utmost importance. Although transarterial embolization proved highly successful in FM lesions, shunt occlusion was less frequent in the CCJ subset, with greater risk of ischemic complications.

MRI-visible perivascular spaces in basal ganglia but not centrum semiovale or hippocampus were related to deep medullary veins changes

Our purpose is to assess the role of deep medullary veins (DMVs) in pathogenesis of MRI-visible perivascular spaces (PVS) in patients with cerebral small vessel disease (cSVD). Consecutive patients recruited in the CIRCLE study (ClinicalTrials.gov ID: NCT03542734) were included. Susceptibility Weighted Imaging-Phase images were used to evaluate DMVs based on a brain region-based visual score. T2 weighted images were used to evaluate PVS based on the five-point score, and PVS in basal ganglia (BG-PVS), centrum semiovale (CSO-PVS) and hippocampus (H-PVS) were evaluated separately. 270 patients were included. The severity of BG-PVS, CSO-PVS and H-PVS was positively related to the increment of age (all p < 0.05). The severity of BG-PVS and H-PVS was positively related to DMVs score (both p < 0.05). Patients with more severe BG-PVS had higher Fazekas scores in both periventricle and deep white matter (both p < 0.001) and higher frequency of hypertension (p = 0.008). Patients with more severe H-PVS had higher frequency of diabetes (p < 0.001). Besides, high DMVs score was an independent risk factor for more severe BG-PVS (β = 0.204, p = 0.001). Our results suggested that DMVs disruption might be involved in the pathogenesis of BG-PVS.

Vascular Involvement in Neurosarcoidosis

Background and ObjectivesCerebrovascular manifestations in neurosarcoidosis (NS) were previously considered rare but are being increasingly recognized. We report our preliminary experience in patients with NS who underwent high-resolution vessel wall imaging (VWI).MethodsA total of 13 consecutive patients with NS underwent VWI. Images were analyzed by 2 neuroradiologists in consensus. The assessment included segment-wise evaluation of larger- and medium-sized vessels (internal carotid artery, M1-M3 middle cerebral artery; A1-A3 anterior cerebral artery; V4 segments of vertebral arteries; basilar artery; and P1-P3 posterior cerebral artery), lenticulostriate perforator vessels, and medullary and deep cerebral veins. Cortical veins were not assessed due to flow-related artifacts. Brain biopsy findings were available in 6 cases and were also reviewed.ResultsMean patient age was 54.9 years (33–71 years) with an M:F of 8:5. Mean duration between initial diagnosis and VWI study was 18 months. Overall, 9/13 (69%) patients had vascular abnormalities. Circumferential large vessel enhancement was seen in 3/13 (23%) patients, whereas perforator vessel involvement was seen in 6/13 (46%) patients. Medullary and deep vein involvement was also seen in 6/13 patients. In addition, 7/13 (54%) patients had microhemorrhages in susceptibility-weighted imaging, and 4/13 (31%) had chronic infarcts. On biopsy, 5/6 cases showed perivascular granulomas with vessel wall involvement in all 5 cases.DiscussionOur preliminary findings suggest that involvement of intracranial vascular structures may be a common finding in patients with NS and should be routinely looked for. These findings appear concordant with previously reported autopsy literature and need to be validated on a larger scale.

Diffusion along perivascular spaces reveals evidence supportive of glymphatic function impairment in Parkinson disease

BackgroundReduced diffusion along perivascular spaces in adults with Alzheimer's-disease-related-dementias has been reported and attributed to reduced glymphatic function. ObjectivesTo apply quantitative measures of diffusion along, and orthogonal to, perivascular spaces in a cohort of older adults with and without clinical symptoms of alpha-synuclein related neurodegeneration. Methods181 adults with Parkinson disease (PD) or essential tremor (ET) additionally sub-classified by the presence of cognitive impairment underwent 3 T MRI. Diffusion-tensor-imaging (spatial resolution = 2x2x2 mm; b-value = 1000 s/mm2; directions = 33) measures of diffusion (mm2/s) parallel and orthogonal to perivascular spaces at the level of the medullary veins, and the ratio of these measures (ALPS-index), were calculated. Regions were identified by a board-certified neuroradiologist from T1-weighted and T2-weighted MRI. Evaluations of motor impairment and mild cognitive impairment (MCI) were interpreted by a board-certified neurologist and neuropsychologist, respectively. Multiple regression with false discovery rate correction was applied to understand how diffusion metrics related to (i) disease category (PD vs. ET), (ii) cognition (MCI status), and (iii) white matter disease severity from the Fazekas score. ResultsThe ALPS-index was reduced in PD compared to ET participants (p = 0.037). No association between the ALPS-index and MCI status, but an inverse association between the ALPS-index and Fazekas score (p = 0.002), was observed. The ALPS-index was inversely associated with age (p = 0.007). ConclusionDiffusion aberrations near perivascular spaces are evident in patients with alpha-synuclein related neurodegenerative disorders, and are related to age and white matter disease severity.

Spinal arteriovenous malformation in a pediatric patient with a history of congenital syphilis: a case report

BackgroundSpinal arteriovenous malformations in children are extremely rare and pose great risk for intraoperative hemorrhage. Congenital syphilis sometimes presents with vascular symptoms, however, there is little published on patients with a history of congenital syphilis presenting with spinal arteriovenous malformations.Case presentationA 15-month-old female with a history of congenital syphilis presented with urinary retention, fever, and subacute onset of paraplegia. MRI showed a lesion at T8-L1, angiogram was performed which confirmed the presence of a complex type IVc arteriovenous malformation and fistula from Artery of Adamkiewicz at L1-L2. It also showed peri medullary dilated veins and a pseudoaneurysm that compressed the spinal cord at T8-T10. Somatosensory evoked potentials and motor-evoked potentials were not recordable on the bilateral lower extremities prior to surgery. Once the patient was optimized for surgery, osteoplastic laminotomies from T6-T12 were performed. The dura was opened and the intradural, intramesenchymal hematoma was evacuated. There were two episodes of brisk arterial bleeding with hypotension during resection of the hematoma. The patient was taken to the angiography suite from the OR to successfully coil the large aneurysm. Intraoperative spinal cord monitoring remained undetectable in the bilateral lower extremities. The patient’s paraplegia remained unchanged from preoperative presentation.ConclusionCongenital syphilis may present with vascular changes that might impact surgical approaches and treatment outcomes in patients with spinal arteriovenous malformations. Preparation for massive transfusion and intraoperative monitoring are imperative in ensuring a safe perioperative experience.

An Overview of Venous Abnormalities Related to the Development of Lesions in Multiple Sclerosis.

The etiology of multiple sclerosis (MS) is currently understood to be autoimmune. However, there is a long history and growing evidence for disrupted vasculature and flow within the disease pathology. A broad review of the literature related to vascular effects in MS revealed a suggestive role for abnormal flow in the medullary vein system. Evidence for venous involvement in multiple sclerosis dates back to the early pathological work by Charcot and Bourneville, in the mid-nineteenth century. Pioneering work by Adams in the 1980s demonstrated vasculitis within the walls of veins and venules proximal to active MS lesions. And more recently, magnetic resonance imaging (MRI) has been used to show manifestations of the central vein as a precursor to the development of new MS lesions, and high-resolution MRI using Ferumoxytol has been used to reveal the microvasculature that has previously only been demonstrated in cadaver brains. Both approaches may shed new light into the structural changes occurring in MS lesions. The material covered in this review shows that multiple pathophysiological events may occur sequentially, in parallel, or in a vicious circle which include: endothelial damage, venous collagenosis and fibrin deposition, loss of vessel compliance, venous hypertension, perfusion reduction followed by ischemia, medullary vein dilation and local vascular remodeling. We come to the conclusion that a potential source of MS lesions is due to locally disrupted flow which in turn leads to remodeling of the medullary veins followed by endothelial damage with the subsequent escape of glial cells, cytokines, etc. These ultimately lead to the cascade of inflammatory and demyelinating events which ensue in the course of the disease.

Are prominent medullary veins better than prominent cortical veins as predictors of early clinical outcome in patients with acute ischemic stroke?

The prominent vessel sign (PVS) on susceptibility-weighted imaging (SWI) can be dichotomized into prominent cortical veins (PCV) and prominent medullary veins (PMV). This study was designed to compare the predictive value of PCV and PMV in the evaluation of the severity of acute ischemic stroke (AIS) in patients within the reperfusion window. Forty-seven consecutive patients with AIS within the middle cerebral artery territory were recruited. Magnetic resonance imaging was performed within 8 hours of symptom onset and at 7 days after stroke onset. Infarct volume was measured, and the early clinical outcome at 7 days was assessed using the modified Rankin Scale. PVS was dichotomized into cases with both PCV and PMV and cases with only PCV according to location. Patients with both PCV and PMV (n=32) had higher admission National Institutes of Health Stroke Scale scores (p = 0.020), larger infarct volumes at baseline (p = 0.026) and 7 days (p = 0.007), and larger infarct growth at 7 days (p = 0.050) than those with PCV only. Multivariate regression analysis showed that both the time of onset at baseline (p = 0.013) and infarct growth at 7 days (p = 0.014) could independently predict poor early clinical outcome. PMV may predict poor early clinical outcome in AIS patients, and reperfusion therapy may, therefore, be required more urgently in patients with PMV.

Clinical Implications of the “Brush Sign” in Susceptibility-Weighted Imaging for Moyamoya Disease

Objective: Infarction is one of the most common postoperative complications after surgical revascularization for moyamoya disease (MMD). Increased conspicuity of deep medullary veins (DMVs) on susceptibility-weighted imaging (SWI), known as “brush sign,” could predict the severity of MMD. This study aimed to reveal the features of the “brush sign” in preoperative SWI and to verify its relationship to postoperative infarction. Methods: Consecutive patients with MMD who had undergone cerebral revascularization surgery were included. Routine preoperative SWI was performed. The “brush sign” was defined according to the number of the conspicuous DMVs > 5 detected on SWI. Postoperative infarctions were defined as the high-intensity signal on postoperative DWI images, with or without neurologic deficits. The modified Rankin scale (mRS) was applied to evaluate the prognosis of patients. Results: In the enrolled 100 hemispheres, 35 were presented with the “brush sign.” Patients with ischemic onset manifestation and previous infarction history tended to present with the “brush sign.” Multivariate analysis showed that the “brush sign” (OR 13.669; 95% CI, 1.747–106.967, p = 0.013) and decreased rCBF (OR 6.050; 95% CI, 1.052–34.799, p = 0.044) were independent risk factors of postoperative infarction. Besides, the “brush sign” showed a significant correlation with a higher mRS score at discharge (p = 0.047). Conclusion: The findings strongly suggest that the presence of the “brush sign” preoperatively can be a predictor of infarction after surgical revascularization for ischemic MMD. It may contribute to an improved surgical result through focused perioperative management based on appropriate surgical risk stratification.

Assessment of the DTI-ALPS Parameter Along the Perivascular Space in Older Adults at Risk of Dementia.

Recently, there has been growing interest in the glymphatic system (the functional waste clearance pathway for the central nervous system and its role in flushing solutes (such as amyloid ß and tau), metabolic, and other cellular waste products in the brain. Herein, we investigate a recent potential biomarker for glymphatic activity (the diffusion tensor imaging along the perivascular space [DTI-ALPS] parameter) using diffusion MRI imaging in an elderly cohort comprising 10 cognitively normal, 10 mild cognitive impairment (MCI), and 16 Alzheimer's disease (AD). All 36 participants imaged on a Siemens 3.0T Tim Trio. Single-SE diffusion weighted Echo-planar imaging scans were acquired as well as T1 magnetization prepared rapid gradient echo, T2 axial, and susceptibility weighted imaging. Three millimeter regions of interest were drawn in the projection and association fibers adjacent to the medullary veins at the level of the lateral ventricle. The DTI-ALPS parameter was calculated in these regions and correlated with cognitive status, Mini-Mental State Examination (MMSE), and ADASCog11 measures. Significant correlations were found between DTI-ALPS and MMSE and ADASCog11 in the right hemisphere adjusting for age, sex, and APoE ε4 status. Significant differences were also found in the right DTI-ALPS indices between cognitively normal and AD groups (P < .026) and MCI groups (P < .025) in a univariate general linear model corrected for age, sex, and APoE ε4. Significant differences in apparent diffusion coefficient between cognitively normal and AD groups were found in the right projection fibers (P = .028). Further work is needed to determine the utility of DTI-ALPS index in larger elderly cohorts and whether it measures glymphatic activity.

Deep Medullary Vein White Matter Injury Global Severity Score Predicts Neurodevelopmental Impairment.

To examine associations between the deep medullary vein white matter injury global severity scoring system and neurodevelopmental impairment. This is a prospective observational cohort study of infants born at ≥32 weeks, diagnosed with deep medullary vein thrombosis and infarction on neuroimaging in the first month of life. Developmental testing was performed using validated measures for early, preschool, and school-age follow-up. Nineteen (37%) patients had major neurodevelopmental impairment. Global severity score was higher among patients with neurodevelopmental impairment (21.6 vs 13.4, P = .04). Overall, 78% of patients with epilepsy had neurodevelopmental impairment. A greater degree of asymmetry with right-sided injury predominance was associated with lower Bayley-III cognitive scores and presence of neurodevelopmental impairment (P < .01). Results suggest a need for targeted clinical surveillance for patients with a high global severity score and/or asymmetric, predominantly right cerebral white matter injury and for those who develop epilepsy.