Neuroimaging In Patients Research Articles

Isolated vestibular syndrome in posterior circulation stroke: Frequency and involved structures.

Dizziness/vertigo is a common symptom of posterior circulation stroke and usually accompanies other neurologic symptoms and signs. Although strokes involving the brainstem or cerebellum may produce isolated vestibular syndrome (isolated vertigo or imbalance), the overall frequency and involved structures of isolated vestibular syndrome in the posterior circulation stroke remain uncertain. Isolated vestibular syndrome occurs in approximately 25% of the patients with posterior circulation stroke, and mostly involves the cerebellum, inferior or superior cerebellar peduncles, and caudal lateral or rostral dorsolateral medulla. The occasional negative neuroimaging in patients with acute isolated vascular vertigo highlights the importance of appropriate bedside evaluation in acute vestibular syndrome.

3D-Neuronavigation <em>In Vivo</em> Through a Patient's Brain During a Spontaneous Migraine Headache

A growing body of research, generated primarily from MRI-based studies, shows that migraine appears to occur, and possibly endure, due to the alteration of specific neural processes in the central nervous system. However, information is lacking on the molecular impact of these changes, especially on the endogenous opioid system during migraine headaches, and neuronavigation through these changes has never been done. This study aimed to investigate, using a novel 3D immersive and interactive neuronavigation (3D-IIN) approach, the endogenous µ-opioid transmission in the brain during a migraine headache attack in vivo. This is arguably one of the most central neuromechanisms associated with pain regulation, affecting multiple elements of the pain experience and analgesia. A 36 year-old female, who has been suffering with migraine for 10 years, was scanned in the typical headache (ictal) and nonheadache (interictal) migraine phases using Positron Emission Tomography (PET) with the selective radiotracer [11C]carfentanil, which allowed us to measure µ-opioid receptor availability in the brain (non-displaceable binding potential - µOR BPND). The short-life radiotracer was produced by a cyclotron and chemical synthesis apparatus on campus located in close proximity to the imaging facility. Both PET scans, interictal and ictal, were scheduled during separate mid-late follicular phases of the patient's menstrual cycle. During the ictal PET session her spontaneous headache attack reached severe intensity levels; progressing to nausea and vomiting at the end of the scan session. There were reductions in µOR BPND in the pain-modulatory regions of the endogenous µ-opioid system during the ictal phase, including the cingulate cortex, nucleus accumbens (NAcc), thalamus (Thal), and periaqueductal gray matter (PAG); indicating that µORs were already occupied by endogenous opioids released in response to the ongoing pain. To our knowledge, this is the first time that changes in µOR BPND during a migraine headache attack have been neuronavigated using a novel 3D approach. This method allows for interactive research and educational exploration of a migraine attack in an actual patient's neuroimaging dataset.

Poster #S148 SOCIAL COGNITION, LANGUAGE, AND SOCIAL FUNCTIONING IN 7 YEAR OLD CHILDREN WITH FAMILIAL HIGH RISK FOR DEVELOPING SCHIZOPHRENIA SPECTRUM DISORDER OR BIPOLAR DISORDER. PART OF THE HIGH RISK AND RESILIENCE STUDY – VIA 7

With the contribution of social neuroscience in neuropsychiatry, a large body of literature has suggested that schizophrenia is a product of a dysfunction in the ‘social brain’. The rising interest in the field of social neuroscience has provided an instrumental foundation for understanding how the social brain may be going wrong in schizophrenia, and how neurobiologic abnormalities may help to explain deficits in social cognition. So far, work using animal disease models and neuroimaging in patients has already made progress in uncovering some of the neurobiologic factors related to social cognitive deficits in schizophrenia. This chapter will summarize the work to date in this area, while also raising some crucial unresolved issues in this field by taking a critical view on the literature, and making future suggestions for research.

Poster #T142 SOCIAL COGNITION AND INTERACTION TRAINING-TABLET FOR OUTPATIENTS WITH SCHIZOPHRENIA: A PRELIMINARY STUDY

With the contribution of social neuroscience in neuropsychiatry, a large body of literature has suggested that schizophrenia is a product of a dysfunction in the ‘social brain’. The rising interest in the field of social neuroscience has provided an instrumental foundation for understanding how the social brain may be going wrong in schizophrenia, and how neurobiologic abnormalities may help to explain deficits in social cognition. So far, work using animal disease models and neuroimaging in patients has already made progress in uncovering some of the neurobiologic factors related to social cognitive deficits in schizophrenia. This chapter will summarize the work to date in this area, while also raising some crucial unresolved issues in this field by taking a critical view on the literature, and making future suggestions for research.

Neuroimaging for Headache: Usually Unnecessary But Ordered Often

The American College of Radiology recommends against routine neuroimaging in patients with uncomplicated headache. A new study suggests that the rate of neuroimaging is inappropriately high and continues to increase. U.S. investigators used a nationally representative survey of ambulatory care to identify all office visits made by adults for …

Early Features in Neuroimaging of Two Siblings With Molybdenum Cofactor Deficiency

We report the features of neuroimaging within 24 hours after birth in 2 siblings with molybdenum cofactor deficiency. The first sibling was delivered by emergency cesarean section because of fetal distress and showed pedaling and crawling seizures soon after birth. Brain ultrasound revealed subcortical multicystic lesions in the frontal white matter, and brain MRI at 4 hours after birth showed restricted diffusion in the entire cortex, except for the area adjacent to the subcortical cysts. The second sibling was delivered by elective cesarean section. Cystic lesions were seen in the frontal white matter on ultrasound, and brain MRI showed low signal intensity on T1-weighted image and high signal intensity on T2-weighted image in bifrontal white matter within 24 hours after birth, at which time the infant sucked sluggishly. Clonic spasm appeared at 29 hours after birth. The corpus callosum could not be seen clearly on ultrasound or MRI in both infants. Cortical atrophy and white matter cystic lesions spread to the entire hemisphere and resulted in severe brain atrophy within ~1 month in both infants. Subcortical multicystic lesions on ultrasound and a cortex with nonuniform, widespread, restricted diffusion on diffusion-weighted images are early features of neuroimaging in patients with molybdenum cofactor deficiency type A.

Neuroimaging of Patients With Disorders of Consciousness: From Bench To Bedside?

Neuroimaging of Patients With Disorders of Consciousness: From Bench To Bedside?

Clinical applications of neuroimaging in patients with Alzheimer's disease: a review from the Fourth Canadian Consensus Conference on the Diagnosis and Treatment of Dementia 2012.

In May 2012, the Fourth Canadian Consensus Conference on the Diagnosis and Treatment of Dementia brought together in Montreal experts from around Canada to update Canadian recommendations for the diagnosis and management of patients with neurodegenerative conditions associated with deterioration of cognition. Multiple topics were discussed. The present paper is a highly condensed version of those recommendations that were produced to support discussions in the field of neuroimaging for clinical diagnosis of those conditions.

Four new patients with Gomez–Lopez‐Hernandez syndrome and proposed diagnostic criteria

Gomez-Lopez-Hernandez syndrome (GLHS) is a rare neurocutaneous disorder. We are aware of thirty previously reported cases. We present four additional patients with this condition. Previously reported patients have shown the hallmark triad of rhombocephalosynapsis, trigeminal anesthesia, and bilateral parietal or parieto-occipital alopecia. Rhombencephalosynapsis consists of agenesis of the cerebellar vermis, fusion of the cerebellar hemispheres, and the dentate nuclei. The gene or genes responsible for GLHS remain unknown. Alopecia is seen in all previously reported cases of GLHS. Additional craniofacial findings such as low-set and posteriorly rotated ears, midface retrusion, craniosynostosis, and brachyturricephaly are also very common in this syndrome. Trigeminal anesthesia, reported in the original three patients, is seen in just over half of reported patients. Most patients with GLHS have motor delays, intellectual disability, and hypotonia. Unusual stereotypic movements of the head are seen in many patients with GLHS. Neuroimaging of patients with GLHS shows rhombencephalosynapsis is universally present, with ventriculomegaly/hydrocephalus and cerebellar hypoplasia being common. We propose that rhombencephalosynapsis and scalp alopecia are necessary, but by themselves not sufficient, for a diagnosis of GLHS. Additional findings of trigeminal anesthesia or one of two major craniofacial findings (brachycephaly and/or turricephaly or midface retrusion) are sufficient to make a diagnosis of GLHS. Additional categories of probable and possible GLHS are proposed for patients whose examination may be compatible with a diagnosis of GLHS, but CNS imaging has not yet been obtained. © 2013 Wiley Periodicals, Inc.

Study of Neuroimaging in Patients with Refractory Eclampsia

ABSTRACT Need Despite availability of intensive care units and improved antenatal care some women still die from eclampsia. Eclampsia is associated with increased risk of maternal death from 1.8% in developing countries to 14% in developing countries. Cerebral complications are the major cause of death in eclampsia patients. Eclampsia along with hypercoagulopathy of pregnancy is a high risk patient for development of cerebrovascular thrombosis/ischemic strokes. Eclampsia patients who are refractory to the routine treatment have been found to have various CNS pathological conditions amenable to the medical treatment. Aim and objectives To study the neurological changes in patients with eclampsia and to delineate the pathophysiology in patients with refractory eclampsia. Materials and methods Prospective study design where 30 patients were included in the study. All patients were admitted in the eclampsia room with h/o convulsions. All patients were put on MgSO4 therapy and antihypertensives. The patients who are refractory to the treatment, such as having recurrent convulsions despite on MgSO4 were selected for neuroimaging with CT scan. neuroimaging is done with Phillips Tomoscan CT scanner where slices of 10 mm thickness were taken through the entire brain in the transaxial plane. Abdomen shielding is done with lead shield to prevent radiation hazard. Results Sr. Findings Number of patients Percentage 1 Cerebral edema 20 Mild to moderate 17 56 Severe 3 10 2 Hypertensive encephalopathy 5 16 3 Posterior reversible encephalopathy syndrome 11 36 4 Cerebral infarction 4 13 5 Cortical venous sinus thrombosis 2 16 6 Tuberculomas 2 6 7 Meningitis 1 3 8 Hydrocephalus 1 3 9 Normal 4 13 Conclusion Eclampsia patients who were refactory to the treatment with MgSO4 and antihypertensives have been found to have very significant and morbid CNS pathological conditions. Neuroimaging in this patients have done a pivotal role in identifying the abnormality and rectifying it with medical means which has surely improved patients condition and have reduced morbidity. How to cite this article Patil MM. Study of Neuroimaging in Patients with Refractory Eclampsia. J South Asian Feder Obst Gynae 2013;5(1):4-7.

高次脳機能障害を引き起こす外傷性脳損傷の画像評価

高次脳機能障害を引き起こす外傷性脳損傷の画像評価

PHS55 Inequalities and Avoidable Costs of Imaging Test in the Diagnosis and Monitoring of Patients With Stroke in the Canary Islands

To determine the variations and inequalities in accessing to diagnostic imaging tests in patients with stroke. Others objectives are to determine the degree of inadequate use of imaging and the subsequent avoidable costs at hospitals in the Canary Islands. Data on patients with a diagnosis of stroke were extracted from hospital databases during the period 2005-2010. Trends in the use of MRI and CT for the diagnosis and clinical management of stroke in recent years were analyzed. Inequalities in access to imaging tests were analyzed by using logistic regression models. The information was classified according to their scientific evidence in “adequate” or “inadequate”. Whenever imaging tests were classified as “inadequate”, avoidable costs were computed. A higher Charlson comorbidity index and younger age increase the chance of receiving an MRI in patients with stroke. In addition, results show a slight increment in the use of MRI in recent years at four referral hospitals in the Canary Islands. We obtained a total avoidable cost of 0.27%. Although the variations found in the use of both tests are remarkable, only 0.3% of the total expenditure attributable to neuroimaging in patients with stroke could be avoided in a conservative scenario.

Role of neuroimaging in patients with atypical eclampsia.

Despite availability of intensive care units and improved antenatal care, some women still die from Eclampsia. Eclampsia is associated with increased risk of maternal death varying from 1.8% in developed countries to 14% in developing countries. Cerebral complications are the major cause of death in eclampsia patients. Eclampsia along with hypercoagulopathy of pregnancy is a high risk fact for patient in respect of development of cerebrovascular thrombosis/ischemic strokes. Eclampsia patients who are refractory to the routine treatment have been found to have various CNS pathological conditions amenable to the medical treatment. (1) To study the neuropathophysiology behind an eclamptic seizure to reduce the morbidity associated with it. (2) To study the role of neuroimaging in patients with atypical eclampsia. Prospective study design included 30 patients for the study. All patients were admitted in the eclampsia room with h/o convulsions. All patients were put on MgSO4 therapy and antihypertensives. The patients who are refractory to the treatment such as having recurrent convulsions despite therapy MgSO4 were selected for neuroimaging with CT scan. Neuroimaging is done using Phillips Tomoscan CT scanner where slices of 10-mm thickness were taken through the entire brain in the transaxial plane. Abdomen shielding is done with lead shield to prevent radiation hazard. [Table: see text]. Eclampsia patients who were refractory to the treatment with MgSO4 and antihypertensives have been found to have very significant and morbid CNS pathological conditions. Neuroimaging in these patients have done a pivotal role in identifying the abnormality and rectifying it with medical means which had definitely improved patient's condition and have reduced morbidity.

DTI reveals hypothalamic and brainstem white matter lesions in patients with idiopathic narcolepsy

Symptomatic narcolepsy is often related to hypothalamic, pontine, or mesencephalic lesions. Despite evidence of disturbances of the hypothalamic hypocretin system in patients with idiopathic narcolepsy, neuroimaging in patients with idiopathic narcolepsy revealed conflicting results and there is limited data on possible structural brain changes that might be associated with this disorder. We investigated with diffusion tensor imaging (DTI) whether microstructural abnormalities in the brain of eight patients with idiopathic narcolepsy with cataplexy are detectable compared to 12 healthy controls using a 1.5T MRI scanner. Whole-head DTI scans were analyzed without an a priori hypothesis. Voxelwise statistical analysis of fractional anisotropy (FA) data was performed using Tract-Based Spatial Statistics (TBSS), a non-linear analysis approach. Patients with narcolepsy showed microstructural white matter changes in the right hypothalamus as well as in the left mesencephalon, pons, and medulla oblongata. Additionally, areas in the left temporal lobe, the pre- and postcentral gyrus, the frontal and parietal white matter, the corona radiata, the right internal capsule, and the caudate nucleus had altered microstructure in patients with narcolepsy. Our study shows widespread microstructural white matter changes that are not visible on conventional MRI scans in patients with idiopathic narcolepsy. In support of the evidence from patients with symptomatic narcolepsy, we found microstructural changes in the hypothalamus, mesencephalon, pons, and medulla oblongata. Changes are in accordance with disturbances of the hypothalamic hypocretin system and its projections to mesencephalic and pontine areas regulating REM sleep.

Abstract 3430: Superficial and Large Infarcts on Neuroimaging in Patients with Cryptogenic Stroke are Associated with the Presence or Absence of Patent Foramen Ovale

Introduction We aim to determine whether radiological findings are associated with patent foramen ovale (PFO) among patients with cryptogenic stroke (CS). Radiological findings associated with the presence of a PFO may represent stroke patterns typical of paradoxical embolism which may be distinct from other mechanisms of CS. Methods This project is part of the Risk of Paradoxical Embolism (RoPE) Study, an international collaboration that has combined individual-level data for subjects with CS and TIA who have known PFO status from 12 component studies (n=3665). For this study 7 databases (n=3023) were used that included subjects with and without PFO, and with radiologic data. Five variables were tested for their relationship with PFO status: 1) protocol-defined large vs. small infarct , 2) Index stroke seen on imaging, 3) superficial vs. deep infarct, 4) multiple index lesions, 5) Prior stroke, i.e. chronic infarct on index imaging. Results are presented in the table . Odds ratios and p-values are adjusted for age, database, sex, diabetes, hypertension, smoking, and history of stroke/TIA. This is the largest study to report the radiological characteristics of patients with CS who are known to have, or not to have, a PFO. Some prior studies had null findings but were limited by small sample size and low statistical power. Because CS unrelated to PFO may also be embolic, the radiological pattern of paradoxical embolism may not be expected to be different from other cryptogenic emboli. Despite this, PFOs were significantly more common in CS patients with large and with superficial infarcts. Conversely, infarcts that were small and deep were associated with PFO absence. This suggests that lacunar disease may account for some non-PFO related CS. Conclusion Participants were significantly more likely to have a PFO if they had 1) an index stroke seen on neuroimaging, 2) a large stroke, 3) a superficial stroke; there was no effect of the variables prior ( i.e. chronic) infarct or multiple vs. single infarcts. Further analyses may help to clarify the ability of neuroimaging to predict the finding of a PFO.

Wide variation and rising utilization of stroke magnetic resonance imaging: Data from 11 States

Neuroimaging is an essential component of the acute stroke evaluation. Magnetic resonance imaging (MRI) is more accurate than computed tomography (CT) for the diagnosis of stroke, but is more costly and time-consuming. We sought to describe changes in MRI utilization from 1999 to 2008. We performed a serial cross-sectional study with time trends of neuroimaging in patients with a primary International Classification of Diseases, 9th Edition, Clinical Modification discharge diagnosis of stroke admitted through the emergency department in the State Inpatient Databases from 10 states. MRI utilization was measured by Healthcare Cost and Utilization Project criteria. Data were included for states from 1999 to 2008 where MRI utilization could be identified. A total of 624,842 patients were hospitalized for stroke in the period of interest. MRI utilization increased in all states. Overall, MRI absolute utilization increased 38%, and relative utilization increased 235% (28% of strokes in 1999 to 66% in 2008). Over the same interval, CT utilization changed little (92% in 1999 to 95% in 2008). MRI use varied widely by state. In 2008, MRI utilization ranged from a low of 55% of strokes in Oregon to a high of 79% in Arizona. Diagnostic imaging was the fastest growing component of total hospital costs (213% increase from 1999 to 2007). MRI utilization during stroke hospitalization increased substantially, with wide geographic variation. Rather than replacing CT, MRI is supplementing it. Consequently, neuroimaging has been the fastest growing component of hospitalization cost in stroke. Recent neuroimaging practices in stroke are not standardized and may represent an opportunity to improve the efficiency of stroke care.

Sağ Hemisfer ve Serebellumla Sınırlı Görüntüleme Bulguları Olan Herpes Simpleks Ensefalitinden Sonra Gelişen Duygudurum Bozukluğu

Herpes simplex (HSV) encephalitis may cause psychiatric syndromes including mood disorder episodes. A case of secondary mood disorder after HSV encephalitis is reported in this paper. The aim of this case presentation is to discuss the neuroanatomic regions of the brain associated with secondary mood disorders in the light of the patient's neuroimaging findings. A 62-year-old patient with HSV encephalitis developed a depressive episode for the first time followed by a manic episode. The patient's magnetic resonance imaging scan showed cerebral atrophy mainly affecting the right temporal lobe and cerebellar atrophy as well as perfusion defects in the right amygdala, right basal ganglion and right temporal cortex as seen in the single-photon emission computed tomography (SPECT). The findings were consistent with defects located exclusively in the right cerebral hemisphere. To the best of our knowledge, the cerebellar pathology has been demonstrated for the first time in a mood disorder case secondary to HSV. Neuroimaging findings of the secondary mood disorder cases may contribute to a better understanding of the neuroanatomical regions of this, yet not fully understood mood disorder.

Phenotypic signatures of genetic frontotemporal dementia

Frontotemporal dementia (FTD) is a clinically, pathologically and genetically heterogeneous disorder. Mutations in a number of genes are associated with FTD, although until recently only two [progranulin (GRN) and microtubule-associated protein tau (MAPT)] were known to be major causes of the disease. This review describes recent progress in identifying clinical and neuroanatomical phenotypes associated with autosomal-dominant FTD. Around a third to a half of FTD patients have an autosomal dominant pattern of inheritance. Up to 10% of patients have a mutation in GRN and a similar proportion have a mutation in MAPT. Recently a group of patients have been shown to have a hexanucleotide repeat expansion in the noncoding region of chromosome 9 open reading frame 72 (C9ORF72). A further group of patients have an autosomal dominant family history but no mutations in any of the known genes including a group of patients who have the same pathology as GRN mutations (type A TDP-43 pathology) but are negative for GRN mutations. Clinical phenotypes vary across the different mutations. Neuroimaging studies show that GRN and MAPT mutations have distinct patterns of atrophy--asymmetric fronto-temporo-parietal atrophy with GRN versus relatively symmetric medial temporal and orbitofrontal lobe atrophy with MAPT mutations. Neuroimaging of patients with an expansion in C9ORF72 has yet to be studied in detail. Genetic FTD is heterogeneous but certain phenotypic signatures of the major causative genes can be identified.

Current neuroimaging modalities in differential diagnosis of radiation-induced brain injury in patients with brain tumors

Differentiation of tumor recurrence from radiation-induced brain changes is the main challenge of neuroimaging in patients with treated cerebral tumor. The review presents the limitations of structural imaging and additional opportunities of perfusion imaging techniques, proton magnetic resonance spectroscopy and positron emission tomography in discriminating recurrent tumor from radiation injury.

Review of structural neuroimaging in patients with refractory obsessivecompulsive disorder

The notion that some special brain regions may be involved in the pathogenesis of obsessive-compulsive disorder (OCD) dates back to the beginning of the twentieth century. Structural neuroimaging studies in the past 2 decades have revealed important findings that facilitate understanding of OCD pathogenesis. Current knowledge based on functional and structural neuroimaging investigations largely emphasizes abnormalities in fronto-striatal-thalamic-cortical and orbitofronto-striato-thalamic circuits in the pathophysiology of OCD. However, these neuroimaging studies did not focus on refractory OCD. The present review mainly focused on structural neuroimaging performed in OCD, which had been ignored previously, and highlighted current evidence supporting that orbito-frontal cortex and thalamus are key brain regions, and that the hippocampus-amygdala complex is associated with refractoriness to the available treatment strategies. However, to fully reveal the neuroanatomy of refractoriness, longitudinal studies with larger samples are required.