Neuroimaging Procedures Research Articles

EEG-Derived Markers to Improve Prognostic Evaluation of Disorders of Consciousness.

Disorders of consciousness (DoC) are characterized by alteration in arousal and/or awareness commonly caused by severe brain injury. There exists a consensus on adopting advanced neuroimaging and electrophysiological procedures to improve diagnosis/prognosis of DoC patients. Currently, these procedures are prevalently applied in a research-oriented context and their translation into clinical practice is yet to come. The aim of the study consisted in the identification of measures derived from routinary electroencephalography (EEG) able to support clinicians in the prediction of DoC patients' outcome. In the present study, a routine EEG was recorded during rest from a sample of 58 DoC patients clinically diagnosed as Unresponsive Wakefulness State (UWS) and Minimally Conscious State (MCS) and followed-up for 3 months. EEG-based features characterizing brain activity in terms of spectral content and resting state networks organization were used in a predictive machine learning model to i) identify which were the most promising features in predicting patients' exit from the DoC, regardless of the clinical diagnosis and ii) verify whether such features would have been the same best discriminating UWS from MCS or specific of the outcome prediction. A predictive machine learning model was built on EEG features related to spectral content and resting state networks which returned up to 85% of performance accuracy in outcome prediction and 76% in DoC state recognition (UWS vs MCS). We provided preliminary evidence for the exploitation of a routine EEG to improve the clinical management of non-communicative patients to be confirmed in a larger DoC population.

The etiological spectrum of miliary brain lesions: A systematic review of published cases and case series.

This systematic review aimed to evaluate the published cases with miliary brain lesions and their etiological factors, clinical manifestations, diagnostic procedures, and outcomes. A comprehensive search of PubMed, Scopus, Embase, and Google Scholar was conducted using the specified search strategy. Eligibility criteria included cases with miliary lesions in the brain confirmed through neuroimaging and various diagnostic procedures. The PRISMA guidelines were followed, and the PROSPERO registration number for the protocol is CRD42023445849. Data from 130 records provided details of 140 patients. Tuberculosis was the primary cause in 93 cases (66.4%), malignancies in 36 cases (25.7%), and other causes accounted for the remaining 11% cases. Tuberculosis patients averaged 35.7years old, while those with malignancies averaged 55.44years. Tuberculosis symptoms primarily included fever, headache, and altered sensorium, whereas malignant cases often exhibited progressive encephalopathy, headache, and specific neurological deficits. Distinctive indicators for CNS tuberculosis were choroidal tubercles and paradoxical reactions. Additionally, 63 tuberculosis patients showed miliary lung shadows and 49 had abnormal CSF findings. For the malignancy group, 13 exhibited miliary lung lesions, and 8 had CSF abnormalities. Regarding outcomes, a significant mortality disparity was observed, with 58.3% in the malignancy group, compared to 10.8% in the tuberculosis group and 27.3% in other cases. Miliary brain lesions are a crucial imaging abnormality that necessitates prompt work up. In an immunocompromised state, diagnostic possibilities of miliary brain lesions are more varied and often pose a bigger challenge.

A PROSPECTIVE STUDY OF ALZHEIMER’S DISEASE DIAGNOSIS AND PROGNOSIS (VALCODIS COHORT)

AbstractBackgroundThe Valencian Cognitive Diseases Study (VALCODIS) provides a large cohort of cases suffering from neurodegenerative diseases causing cognitive problems in their initial phases. This cohort is being obtained from admitted patients at Cognitive Disorders Unit Hospital Universitari i Politècnic La Fe (Valencia, Spain), as a basis to contribute on the Alzheimer’s disease (AD) diagnosis and prognosis research.MethodPatients who come to the Cognitive Disorders Unit at Neurology Department of Hospital La Fe can be recruited to the VALCODIS cohort after their informed consent have been obtained. Patients with moderate and severe dementia are not proposed to participate. Included patients were studied with standard analytical and neuroimaging procedures, commonly brain MR, and CSF biomarkers determination (β‐amyloid‐42, β‐amyloid‐40, p‐Tau, t‐Tau, neurofilament light chain). Patients on anticoagulation, other contraindications or not suitable for LP can be included if an amyloid brain PET can be obtained. In some patients, brain PET with FDG is also obtained. After amyloid status is assured, a detailed neuropsychological evaluation is obtained in every patient using at least MMSE, CDR, RBANS and GDS scales. Finally, blood samples were taken to determine some potential biomarkers (lipid peroxidation, lipids, proteins, microRNAs) and stored simultaneously with CSF samples.ResultA total of 1100 participants aged 50 to 80 years, who were on follow up from January 2017 to August 2022 have been included in the VALCODIS cohort. This cohort is composed by early AD patients (mild cognitive impairment (MCI), mild dementia), other dementias in their initial phases (frontotemporal dementia, Lewy body dementia, vascular dementia) and cognitively healthy persons. Also, some of MCI‐AD patients were followed‐up at 2 years to carry out a prognosis study, by means of neuropsychological evaluation and blood biomarkers.ConclusionThe VALCODIS cohort represents a valuable infrastructure describing 6‐year experience about early and specific AD diagnosis, and prognosis. This cohort will provide a large number of patients, biologically diagnosed by CSF biomarkers, as well as their demographical, clinical and biochemical data. In addition, the biological samples (blood, plasma, urine, saliva, CSF) were stored to carry out further biomarkers studies.

Association between Trust of Researchers and Interest in Participation in Alzheimer’s Disease Biomarker Research

AbstractBackgroundThe study examined whether trust in researchers affects interest in AD (Alzheimer’s disease) biomarker research participation, specifically AD blood biomarkers and MRI and PET neuroimaging, and whether this was independent of other factors commonly associated with hesitancy to participate in research, including race and knowledge of AD.Methods258 community‐dwelling Black and 141 non‐Hispanic White adults (age ≥ 55) who had never participated in AD research completed a survey about their perceptions of AD biomarker research. The survey asked participants to select one of three responses, “Yes,” “Unsure,” and “No” to 6 trust statements, with yes being the highest level of trust. Questions specifically assessed whether survey participants trusted researchers to keep information confidential, be honest, component, not cause harm, treat them equally, and share results with them and their community. Those who answered yes to all 6 questions were categorized as having very high trust, and those who answered no or unsure to any of the 6 questions were categorized as having lower trust. Ordinal logistic regression models were used for the analysis of outcome variables with three possible responses (i.e. interest in participation in an AD biomarker study and individual procedures, motivators for research participation). We adjusted for age, education, sex, race, and knowledge about AD.ResultParticipants with very high trust in researchers were less hesitant about doing AD biomarker research (OR 0.32 (95% CI (0.20‐0.52), P < 0.001). Participants with concerns about confidentiality, study risks, and being treated equally had greater hesitancy about doing AD biomarker research (P’s < 0.05). Concerns about researchers’ competency were associated specifically with lower interest in doing neuroimaging procedures (P’s < 0.05). Very high trust in researchers was associated with greater interest in return of results, particularly brain scans (OR 1.92 (95% CI 1.06‐3.48), P = 0.032).ConclusionEven after other factors known to affect AD research participation, trust remains a highly significant factor affecting the interest in AD research participation in blood biomarker neuroimaging procedures. Recruitment strategies for AD biomarker research may need to address participants’ trust concerns, specifically confidentiality, study risks, and equity.

Neuroimaging and machine learning for studying the pathways from mild cognitive impairment to alzheimer’s disease: a systematic review

BackgroundThis systematic review synthesizes the most recent neuroimaging procedures and machine learning approaches for the prediction of conversion from mild cognitive impairment to Alzheimer’s disease dementia.MethodsWe systematically searched PubMed, SCOPUS, and Web of Science databases following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) systematic review guidelines.ResultsOur search returned 2572 articles, 56 of which met the criteria for inclusion in the final selection. The multimodality framework and deep learning techniques showed potential for predicting the conversion of MCI to AD dementia.ConclusionFindings of this systematic review identified that the possibility of using neuroimaging data processed by advanced learning algorithms is promising for the prediction of AD progression. We also provided a detailed description of the challenges that researchers are faced along with future research directions. The protocol has been registered in the International Prospective Register of Systematic Reviews– CRD42019133402 and published in the Systematic Reviews journal.

Neural Plasticity Changes Induced by Motor Robotic Rehabilitation in Stroke Patients: The Contribution of Functional Neuroimaging.

Robotic rehabilitation is one of the most advanced treatments helping people with stroke to faster recovery from motor deficits. The clinical impact of this type of treatment has been widely defined and established using clinical scales. The neurofunctional indicators of motor recovery following conventional rehabilitation treatments have already been identified by previous meta-analytic investigations. However, a clear definition of the neural correlates associated with robotic neurorehabilitation treatment has never been performed. This systematic review assesses the neurofunctional correlates (fMRI, fNIRS) of cutting-edge robotic therapies in enhancing motor recovery of stroke populations in accordance with PRISMA standards. A total of 7, of the initial yield of 150 articles, have been included in this review. Lessons from these studies suggest that neural plasticity within the ipsilateral primary motor cortex, the contralateral sensorimotor cortex, and the premotor cortices are more sensitive to compensation strategies reflecting upper and lower limbs' motor recovery despite the high heterogeneity in robotic devices, clinical status, and neuroimaging procedures. Unfortunately, the paucity of RCT studies prevents us from understanding the neurobiological differences induced by robotic devices with respect to traditional rehabilitation approaches. Despite this technology dating to the early 1990s, there is a need to translate more functional neuroimaging markers in clinical settings since they provide a unique opportunity to examine, in-depth, the brain plasticity changes induced by robotic rehabilitation.

Mild Cognitive Impairment – Prospects for Prognosis and Management

The term mild cognitive impairment (MCI) has traditionally been used to refer to a transitional period between normal cognitive function and clinically probable Alzheimer’s disease (AD). Many studies report high reversion rates, however, with some 30% to 50% of those diagnosed with MCI reverting to “normal” cognition at subsequent follow-up. The detection of differentiable predisposing factors, reflected in the dichotomy between the annual reversion rate to normal cognition and the conversion rate to dementia, indicates that there are modifiable factors that may be contributing to cognitive decline. The clinical prospect for dementia and the presence of these predisposing factors have together made a strong case for early diagnosis and therapeutic intervention. Current efforts seek to identify tools capable of resolving the causal ambiguities inherent in MCI and to develop therapeutic avenues addressing such underlying aspects before long lasting and irreversible cognitive loss. This review explores three arenas for which there is especial promise for determining and modulating prognosis: in the diagnostic realm, novel neuroimaging procedures and biomarkers and, in the domain of therapy, network based non-invasive neurostimulation therapies. Particular examples include novel structural and dynamical MRI procedures for assessing connectivity and its alterations during disease, inflammation and miRNA markers, and non-invasive procedures for rehabilitating deteriorating brain functions. The advances occurring in these select areas indicate that the determination of MCI’s multi-etiology is a realistic goal that can ground prognosis assessment and therapeutic outcome.

An updated review on Brain Tumour

A cluster of irregular brain cells referred to as a brain tumor. Early detection of brain tumours is crucial for enhancing treatment options and raising patient survival rates, hence it is a crucial responsibility of medical practitioners. This review's goal is to give comprehensive information about brain tumours, including their categorization, risk factors, associated symptoms, diagnoses, and treatment regimens. Each form of brain tumour has its own biology, course of therapy, and high chance of development in relation to certain risk factors.The indications and symptoms of a brain tumour might include localised brain invasion, compression of nearby tissues, and elevated intracranial pressure (ICP). A thorough neurologic examination, extensive history taking, and the appropriate diagnostic neuroimaging procedures are all necessary for the accurate assessment of the patient with a suspected brain tumour.Treatment plans, based on a number of variables, include surgery, radiation, chemotherapy, and immunotherapy

Electroacupuncture for the management of symptom clusters in cancer patients and survivors (EAST)

BackgroundNeuropsychiatric symptoms, comprising cognitive impairment, fatigue, insomnia, depression, and anxiety, are prevalent and may co-occur during and after chemotherapy treatment for cancer. Electroacupuncture (EA), which involves mild electrical stimulation with acupuncture, holds great potential in addressing the management of individual symptoms. However, there is a lack of studies evaluating if EA can manage concurrent neuropsychiatric symptoms in cancer (i.e., symptom cluster). Hence, we designed a trial to evaluate the efficacy, safety, and feasibility of administering EA as an intervention to mitigate neuropsychiatric symptom clusters amongst cancer patients and survivors.MethodsThe EAST study is a randomized, sham-controlled, patient- and assessor-blinded clinical trial. Sixty-four cancer patients and survivors with complaints of one or more neuropsychiatric symptom(s) in the seven days prior to enrollment are recruited from the University of California Irvine (UCI) and Children’s Hospital of Orange County (CHOC). Individuals with needle phobia, metastases, bleeding disorders, electronic implants, epilepsy, exposure to acupuncture in the three months prior to enrollment, and who are breastfeeding, pregnant, or planning to get pregnant during the duration of the study will be excluded. Screening for metal fragments and claustrophobia are performed prior to the optional neuroimaging procedures. Recruited patients will be randomized (1:1) in random blocks of four or six to receive either ten weekly verum EA (treatment arm, vEA) or weekly sham EA (control arm, sEA) treatment visits with a follow-up appointment four to twelve weeks after their last treatment visit. The treatment arm will receive EA at 13 acupuncture points (acupoints) chosen for their therapeutic effects, while the control arm receives minimal EA at 7 non-disease-related acupoints. Questionnaires and cognitive assessments are administered, and blood drawn to assess changes in symptom clusters and biomarkers, respectively.ConclusionThe EAST study can provide insight into the efficacy of EA, an integrative medicine modality, in the management of cancer symptom clusters in routine clinical practice.Trial registrationThis trial is registered with clinicaltrials.gov NCT05283577.

The yield of neuroimaging in patients presenting to the emergency department with isolated neuro-ophthalmological complaints: A retrospective chart review.

Neuro-ophthalmological emergencies require prompt assessment and management to avoid vision or life-threatening sequelae. The decision to perform a neuroimaging procedure is based on the clinical judgment of the medical team, without defined indications. This study aims to identify presenting symptoms and physical exam findings associated with relative positive findings on neuroimaging studies. Electronic medical records of patients presenting to the emergency department (ED) with isolated neuro-ophthalmologic complaints between January 1, 2013 and September 30, 2019 were reviewed. We collected data on the clinical presentation, neuroimaging procedures and results, consults, and diagnoses. Two hundred eleven patients' charts were reviewed. Most presented with unilateral eye complaints (53.6%), and the most common symptoms were blurred vision (77.3%) and headaches (42.2%). A total of 126 imaging procedures were performed of which 74.6% were normal, while 25.4% showed relevant abnormal findings. Complaining of blurry vision (P = .038) or visual field changes (P = .014) at presentation as well as having a visual field defect (P = .016), abnormal pupil reactivity (P = .028), afferent pupillary defect (P = .018), or abnormal optic disc exam (P = .009) were associated with positive findings on imaging. Neuroimaging is more likely to yield positive findings in patients presenting to the ED with visual field irregularities, afferent pupillary defects, or abnormal optic discs. These findings - when combined with the proper clinical setting - should lower the threshold to proceed with neuroimaging in the emergency department. Based on our results, larger-scale studies might lead to a well-structured algorithm to be followed by ED physicians in decision making.

Approach to acute psychosis in older adults.

Approach to acute psychosis in older adults.

The Role of Brain Activity in Characterizing Successful Reading Intervention in Children With Dyslexia.

Studies of reading intervention in dyslexia have shown changes in performance and in brain function. However, there is little consistency in the location of brain regions associated with successful reading gains in children, most likely due to variability/limitations in methodologies (study design, participant criteria, and neuroimaging procedures). Ultimately for the results to be meaningful, the intervention has to be successful, be assessed against a control, use rigorous statistics, and take biological variables (sex) into consideration. Using a randomized, crossover design, 31 children with dyslexia were assigned to a phonological- and orthographic-based tutoring period as well as a within-subjects control period to examine: (1) intervention-induced changes in behavior (reading performance) and in brain activity (during reading); and (2) behavioral and brain activity pre-intervention data that predicted intervention-induced gains in reading performance. We found gains in reading ability following the intervention, but not following the control period, with no effect of participants’ sex. However, there were no changes in brain activity following the intervention (regardless of sex), suggesting that individual brain changes are too variable to be captured at the group level. Reading gains were not predicted by pre-intervention behavioral data, but were predicted by pre-intervention brain activity in bilateral supramarginal/angular gyri. Notably, some of this prediction was only found in females. Our results highlight the limitations of brain imaging in detecting the neural correlates of reading intervention in this age group, while providing further evidence for its utility in assessing eventual success of intervention, especially if sex is taken into consideration.

The German research consortium for the study of bipolar disorder (BipoLife): a magnetic resonance imaging study protocol

BackgroundBipolar disorder is one of the most severe mental disorders. Its chronic course is associated with high rates of morbidity and mortality, a high risk of suicide and poor social and occupational outcomes. Despite the great advances over the last decades in understanding mental disorders, the mechanisms underlying bipolar disorder at the neural network level still remain elusive. This has severe consequences for clinical practice, for instance by inadequate diagnoses or delayed treatments. The German research consortium BipoLife aims to shed light on the mechanisms underlying bipolar disorders. It was established in 2015 and incorporates ten university hospitals across Germany. Its research projects focus in particular on individuals at high risk of bipolar disorder, young patients in the early stages of the disease and patients with an unstable highly relapsing course and/or with acute suicidal ideation.MethodsFunctional and structural magnetic resonance imaging (MRI) data was acquired across nine sites within three different studies. Obtaining neuroimaging data in a multicenter setting requires among others the harmonization of the acquisition protocol, the standardization of paradigms and the implementation of regular quality control procedures. The present article outlines the MRI imaging protocols, the acquisition parameters, the imaging paradigms, the neuroimaging quality assessment procedures and the number of recruited subjects.DiscussionThe careful implementation of a MRI study protocol as well as the adherence to well-defined quality assessment procedures is one key benchmark in the evaluation of the overall quality of large-scale multicenter imaging studies. This article contributes to the BipoLife project by outlining the rationale and the design of the MRI study protocol. It helps to set the necessary standards for follow-up analyses and provides the technical details for an in-depth understanding of follow-up publications.

Specific age-correlated activation of top hierarchical motor control areas during gait-like plantar stimulation: An fMRI study.

A better understanding of gait disorders that are associated with aging is crucial to prevent adverse outcomes. The functional study of gait remains a thorny issue due to technical constraints inherent to neuroimaging procedures, as most of them require to stay supine and motionless. Using an MRI‐compatible system of boots reproducing gait‐like plantar stimulation, we investigated the correlation between age and brain fMRI activation during simulated gait in healthy adults. Sixty‐seven right‐handed healthy volunteers aged between 20 and 77 years old (49.2 ± 18.0 years; 35 women) were recruited. Two paradigms were assessed consecutively: (a) gait‐like plantar stimulation and (b) chaotic and not gait‐related plantar stimulation. Resulting statistical parametric maps were analyzed with a multiple‐factor regression that included age and a threshold determined by Monte‐Carlo simulation to fulfill a family‐wise error rate correction of p < .05. In the first paradigm, there was an age‐correlated activation of the right pallidum, thalamus and putamen. The second paradigm showed an age‐correlated deactivation of both primary visual areas (V1). The subtraction between results of the first and second paradigms showed age‐correlated activation of the right presupplementary motor area (Brodmann Area [BA] 6) and right mid‐dorsolateral prefrontal cortex (BA9‐10). Our results show age‐correlated activity in areas that have been associated with the control of gait, highlighting the relevance of this simulation model for functional gait study. The specific progressive activation of top hierarchical control areas in simulated gait and advancing age corroborate a progressive loss of automation in healthy older adults.

Comparison shopping: Is neuropsychological evaluation more expensive than neuroimaging?

Objective: This study empirically examined if neuropsychological evaluation (NPE) is expensive compared to other diagnostic procedures such as neuroimaging. Method: We aggregated data on charges for NPE and common neuroimaging procedures (e.g., head CT and brain MRI) from hospitals in the U.S. Charges for five-hour NPE and eight-hour NPE were compared to charges for head CT and brain MRI, respectively. Difference scores were calculated between five-hour NPE and head CT and between eight-hour NPE and brain MRI. A charge difference of $250 or less was considered minimal. NPE and neuroimaging charges were compared across U.S. regions. Results: Median head CT charges were $1942 to $2699. Median brain MRI charges were $3103 to $4487. Median five-hour NPE charges were $1855 to $1977. Median eight-hour NPE charges were $2757 to $2917. Head CT and five-hour NPE charges were not significantly different. Eight-hour NPE and brain MRI charges were not significantly different. Charge differences between five-hour NPE and head CT were minimal in 32.3% of hospitals. Charge differences between eight-hour NPE and brain MRI were minimal in 21.2% of hospitals. U.S. regions were not significantly different in charges for NPE or neuroimaging. Conclusions: Findings provide preliminary data on charges for NPE in relation to charges for common imaging procedures. NPE does not appear to be more expensive than neuroimaging and, in fact, appears comparable. Future research might expand the information on NPE charges to include additional settings.

Correlation of Neuroimaging Findings with Clinical Presentation and Laboratory Data in Patients with COVID-19: A Single-Center Study

Background This study was aimed at revealing neuroimaging findings in COVID-19 patients and at discussing their relationship with epidemiological data and some laboratory parameters. Materials and Method. This study included 436 cases of COVID-19 and 40 cases of non-COVID-19 acute/subacute thromboembolism who underwent at least one neuroimaging procedure due to neurological symptoms between April 2020 and December 2020. The group of COVID-19-positive acute/subacute thromboembolism cases was compared with both the group of normal brain imaging cases and the non-COVID-19 acute/subacute thromboembolism group in terms of demographic data and laboratory parameters. Results When the acute/subacute thromboembolism group and neuroimaging findings were compared in terms of negative group, presence of comorbid disease, D-dimer level, and lymphocyte count in COVID-19 patients, a statistically significant difference was found (p = 0.047, 0.014, and <0.001, respectively). COVID-19-positive and COVID-19-negative acute/subacute thromboembolism cases that were compared in terms of gender, neuroimaging reason, C-reactive protein, D-dimer level and lymphocyte count, a statistically significant difference was found (p = 0.003, <0.001, 0.005, 0.02, and <0.001, respectively). Conclusion Acute thromboembolic events are common in patients with COVID-19 due to a potentially increased procoagulant process. Neurological evaluation and, if necessary, detailed neuroimaging should be performed, especially in cases with high D-dimer levels.

Neuro-computational approaches for objective assessment of visual function

Retinal pathologies affect the structure and function of post-retinal visual pathways. These post-retinal alterations bear the potential to obstruct the aim of innovative retinal treatment to restore visual function. Current developments in the field of neuroimaging and the associated neurocomputational approaches enable a detailed assessment of this interrelationship. As aconsequence, they open up the possibility to anticipate the success of treatment. This review article demonstrates how innovations particularly in magnetic resonance imaging (MRI)-based anatomical, functional, and diffusion imaging can guide visual pathway assessments that are relevant for ophthalmological applications. Specific examples of retinal and visual pathway pathologies in the context of a detailed analysis of the visual pathway are described. A concept is introduced of how to translate the meaningful but technically and computationally challenging neuroimaging procedures into aclinical setting in order to effectively connect these procedures to innovative treatment approaches.

Abstract P586: Care and Outcomes of Pediatric Community vs. In-Hospital Stroke

Introduction: In-hospital stroke refers to stroke occurring during an acute care hospitalization. Unlike stroke occurring in the community, there is a potential for rapid diagnosis and treatment given access to resources. Existing research in adults however suggest higher rates of morbidity and mortality compared to community onset stroke patients. Worse outcomes may be multifactorial, including risk factors inherent to the inpatient status and relative contraindication for acute therapy . However, little is known of the care and outcomes of in hospital stroke in pediatric patients. Objectives: Our goal was to evaluate the stroke care and outcome of pediatric patients with in-hospital and community onset stroke. Our primary outcome was the time from stroke symptoms to the first neuroimaging procedure( less than 4.5 hours, 4.5 to 12 hours, 12 hours to 24 hours or greater than 24 hours). Secondary outcomes include type neuroimaging preformed, stroke risk factors, clinical stroke presentation, length of stay, and discharge destination. Methods: Retrospective chart review of children &gt; 28 days and less than or equal to 18 years with diagnosis of acute stroke by clinical and radiographic criteria admitted between January 2009 and September 2019. Results: We screened a total of 779 patients, and identified 63 patients with in hospital strokes and 109 patients with community strokes. The largest percentage of in-hospital strokes had imaging obtained between 4.5 to 12 hours from last known well vs. over 24 hours in the community stroke group. CT was the most common imaging obtained in both groups. The major stroke risk factor was cardiac disease in the in-hospital stroke group versus infection in the community group. Clinical presentation was more common to be focal in the community group, versus non-focal in the in-hospital group. Length of stay was longer in the in-hospital stroke group and discharge destination was more commonly rehab in the in-hospital group vs. home in the community group .Mortality was higher in the in-hospital population. Conclusion: Patients with in-hospital stroke have more rapid diagnosis, but have increase rates of mortality . Presentations in this group are more commonly non-focal, and the largest stroke risk factor is cardiac disease.

Thalamic atrophy in patients with pure hereditary spastic paraplegia type 4.

SPG4 is an autosomal dominant pure form of hereditary spastic paraplegia (HSP) caused by mutations in the SPAST gene. HSP is considered an upper motor neuron disorder characterized by progressive spasticity and weakness of the lower limbs caused by degeneration of the corticospinal tract. In other neurodegenerative motor disorders, the thalamus and basal ganglia are affected, with a considerable impact on disease progression. However, only a few works have studied these brain structures in HSP, mainly in complex forms of this disease. Our research aims to detect potential alterations in the volume and shape of the thalamus and various basal ganglia structures by comparing 12 patients with pure HSP and 18 healthy controls. We used two neuroimaging procedures: automated segmentation of the subcortical structures (thalamus, hippocampus, caudate nucleus, globus pallidus, and putamen) in native space and shape analysis of the structures. We found a significant reduction in thalamic volume bilaterally, as well as an inward deformation, mainly in the sensory-motor thalamic regions in patients with pure HSP and a mutation in SPG4. We also observed a significant negative correlation between the shape of the thalamus and clinical scores (the Spastic Paraplegia Rating Scale score and disease duration). Moreover, we found a 'Group × Age' interaction that was closely related to the severity of the disease. No differences in volume or in shape were found in the remaining subcortical structures studied. Our results suggest that changes in structure of the thalamus could be an imaging biomarker of disease progression in pHSP.

Probing Neurovisceral Integration via Functional Near-Infrared Spectroscopy and Heart Rate Variability.

The neurovisceral integration model (NVM) proposes that an organism’s ability to flexibly adapt to its environment is related to biological flexibility within the central autonomic network (CAN). One important aspect of this flexibility is behavioral inhibition (Thayer and Friedman, 2002). During a behavioral inhibition task, the CAN, which comprises a series of feedback loops, must be able to integrate information and react to these inputs flexibly to facilitate optimal performance. The functioning of the CAN is shown to be associated with respiratory sinus arrhythmia (RSA), as the vagus nerve is part of this feedback system. Although the NVM has been examined through neural imaging and RSA, only a few studies have examined these measures simultaneously during the neuroimaging procedure. Furthermore, these studies were done at rest or used tasks that were not targeted at processes associated with the NVM, such as behavioral inhibition and cognitive flexibility. For this reason, the present study assessed RSA and neural activation in the pre-frontal cortex simultaneously while participants completed a behavior inhibition task. RSA and functional near-infrared spectroscopy were collected in 38 adults, and resting levels of pre-frontal activation were negatively related to RSA, but pre-frontal activation during the behavior inhibition task was not. The negative relationship between RSA and oxygenated hemoglobin is consistent with previous functional magnetic resonance imaging work examining the NVM at baseline and should be further studied. Additional research investigating how this relationship may change based on task demands or environmental contexts would help clarify the applicability of the model.