Posterior Lobe Research Articles

Atypical Posterior Reversible Encephalopathy with Spinal Cord Involvement (PRES-SCI) − A Rare Entity

Posterior reversible encephalopathy (PRES) is a clinico-radiological syndrome that is characterized by headache, altered mental status, seizure, and visual disturbances and is associated with vasogenic edema of white matter predominantly affecting the posterior circulation, that is, occipital lobe and parietal lobe of brain. Atypical sites of involvement include temporal lobes, deep white matter, ganglio-thalamic complexes, brain stem, and cerebellum. Posterior reversible encephalopathy with spinal cord involvement (PRES-SCI) is a new rare entity first described in 2014 by Havenon with about 21 cases reported till 2017. As is with PRES, PRES-SCI is also mostly seen in setting of acute accelerated hypertension with clinical presentation of headache, vomiting, and acute hypertensive retinopathy. This variant of PRES has been reported to be more common in young male patients. In this case report, we present two rare cases of PRES-SCI in a 14-year-old female and 6-year-old male.

Effectiveness of T2 biologics in patients with common variable immune deficiency and allergic respiratory disease

IntroductionMany patients with common variable immune deficiency (CVID) have a history suggestive of allergic respiratory disease including chronic rhinosinusitis (CRS) and asthma. The underlying immunologic defect, the presence of comorbid conditions such as bronchiectasis or interstitial lung disease, and recurrent infections may make the diagnosis of these conditions difficult. T2 biologics targeting allergic inflammatory pathways are now the standard of care for severe persistent asthma and CRS with nasal polyposis (CRSwNP). The efficacy of these agents in patients with CVID is unknown. MethodsWe performed a retrospective analysis of patients with CVID at a single academic medical center and identified those who had ever been prescribed a T2 biologic. ResultsWe identified 8 patients with CVID who had ever been prescribed T2 biologics: 6 patients with severe persistent asthma and 2 patients with CRSwNP. All patients had CVID without inflammatory complications with therapeutic IgG levels on immune globulin replacement therapy. Comorbid bronchiectasis was identified in 3 patients and no patients had GLILD. Two patients were taking omalizumab, two on mepolizumab, 1 on benralizumab, and 1 on dupilumab for severe persistent asthma and 2 on dupilumab for CRSwNP. Only 4 patients in this group (50%) had subjective improvement of symptoms and objective clinical benefit based on ability to wean off of corticosteroids and fewer exacerbations per year. Only 1 of these patients had objective improvement in FEV1 by >200mL. Neither of the 2 patients treated with dupilumab for CRswNP reported improvement and the biologic was discontinued. Of the 2 patients with asthma who were found to have eosinophilia on bronchoalveolar fluid analysis, both of these patients had clinical improvement on eosinophil-targeted biologic therapy. All 3 patients who were tested were found to have elevated serum T2 cytokines including IL-4, but this did not predict response to therapy.Table 1(abstract: 191) Demographic and immunologic data of 8 patients with CVID on T2 biologiesAgeGenderT2 biologicIndicationBronchiectasisIncrease in FEV1 by >200mLClinical responseIgG (mg/dL)IgA (mg/dL)IgM (mg/dL)IgE (kU/L)Absolute eosinophil count(K/μL)CD19B cell count (cells/μL)Th2 Cytokine PanelBAL Eosinophils%CT ThoraxBronchoscopy-Pathology82Fomalizumabsevere persistent asthmayesnono1551522923430049Not availableNot availableBasal abnormalitycharacterized by ground glass opacities (GGO), centrilobular nodularity with small focus of consolidation posterior right lower lobe (RLL). Additional focus of patchy groundglass posterior right lung (RL).Not available74Mmepolizumabsevere persistent asthmayesnoyes11681623141681600176Not available25Resolution of right upper lobe (RUL) apical nodule and branching tubular opacity. New clustered nodularity in the posterior RLL with faint GGO in the upper lobes. Moderate bronchial wall thickening, greatest in the lower lobes.Bronchial wall with smooth muscle hypertrophy. Lung parenchyma without evidence of inflammation, fibrosis, or malignancy.57Fomalizumabsevere persistent asthmanonoyes89725221687100103Not available0Diffuse bronchial dilation without bronchial wall thickening. Mild patchy air trapping.Largely denuded and edematous bronchial wall with minima] chronic inflammation, focal subepithelial elastosis, focal expansion of the subbasal lamina, mild increase in mucous secretion.37Fdupilumabchronic rhinosinusitis with nasal Polyposisnonot applicableno787<10<20<2100187elevated IL-4, IL-6Not availableResolved patchy GGO with exception of a new tiny focus of GGO in the basal RLL. Stable mild diffuse bronchial wall thickening.Not available73Fbenralizumabsevere persistentnoyesyes84635<20<2100179Not available4Mild to moderate airway inflammation and diffuse air-trapping. Minimal left basilar linear atelectasis/scarring is new. TracheobronchomalaciaBronchial wall with moderate chronic inflammation and eosionphils (peak 12/hpf), thickened subbasal lamina, mild smooth muscle hypertrophy.43Fdupilumabsevere persistent asthmanonot availableyes12614313556.5056elevated IL-4, IL-5, IL-6Not availableBenign right oblique fissure. 2 small nodules.Not available56Fdupilumabyesnot applicableno95476602.625027Not available1chronic rhinosinusitis with nasal polyposisMultiple new areas of peribronchovascular consolidation and confluent GGO. Widespread tree-inbud nodularity. Mild cylindricalbronchiectasis. Dilated main pulmonary trunk.Bronchial wall with moderate chronic inflammation and scattered eosinophils (6/hpf), thickened subbasal lamina. No granulomas. Right lung bronchial wall with moderate chronic inflammation. Lung parenchyma with airway centered mild interstitial chronic inflammation49 Fmepolizumabsevere persistent asthmanonono166845189510049Not available0Mild bronchial wall thickening and scattered air trapping. Patchy GGO in the left upper lobe with minimal involvement of the lower lobes. Dynamic expiratory images demonstrates evidence of tracheobronchomalacia.Bronchial wall with patchy mild to moderate chronic inflammation with rare neutrophils and eosinophils. Mild smooth muscle hypertrophy. Patchy squamous metaplasia and respiratory bronchiolitis in the left lung.*Clinical response is measured by reduction in exacerbations and/or ability to wean off of corticosteroids for individuals with severe asthma and is measured by improvement in sinonasal symptoms and reduced nasal polypoid burden for CRSwNP. [Display omitted] [Display omitted] ConclusionPatients with CVID may benefit from more direct sampling of nasal mucosal and bronchial secretions (sputum, bronchoalveolar lavage) to determine the potential benefit from T2 biologics in severe allergic respiratory disease. Prospective analyses in larger cohorts following objective indices of improvement as well as changes in serum and mucosal biomarkers are necessary.

Yuexiconcha nov. gen. – A resilifer-bearing palaeotaxodont (Bivalvia, Protobranchia) from the Ordovician of Guangdong, South China

A unique, new palaeotaxodont (Protobranchia) genus and species, Yuexiconcha duplicata Zhang, Niu and Johnston, is proposed and described. It is characterized by: a medium-sized, transversely elongated, sub-elliptical shell; heterotaxodont dentition; and posterior tooth row consisting of crowded gradidentate dentition, partially and dorsally overlapped by an additional tooth row that emanates from the beak to form a bitaxodont dentition (new term). Most significantly, a prominent resilifer separates the anterior and posterior tooth rows and shows slight to moderate excavation into the hinge-plate. While a resilifer indicates phylogenetic proximity with Nuculoidea, Yuexiconcha nov. gen. is readily distinguished by its bitaxodont posterior dentition and a more elongate posterior shell lobe and so is provisionally placed in the Family Nuculidae, Order Nuculida. The hinge of Yuexiconcha nov. gen. indicates that a resilifer in palaeotaxodonts first developed in the Ordovician, rather than in the Silurian (Wenlock) as thought previously. Specimens described herein were collected from a fine-grained siliciclastic rock unit in the upper part of the Dongchong Formation in western Guangdong, South China. Other components of the biota occurring with the bivalves are uncommon and include trilobites and brachiopods that indicate a late Middle–early Late Ordovician (late Darriwilian–early Sandbian) age.

Histological improvement in chronic hepatitis C-autoimmune hepatitis overlap syndrome by glecaprevir and pibrentasvir.

A 60-year-old man with type-2 diabetes and chronic hepatitis C (HCV) was diagnosed with single hepatocellular carcinoma (HCC) of 67mm in the hepatic posterior right lobe. Lenvatinib 8mg was initiated but discontinued because of grade 3 liver injury. The patient continued to have prolonged liver injury and persistently high immunoglobulin G levels. Antinuclear antibody titer increased from 1:40 to 1:320. Histopathological examination of a liver biopsy specimen revealed interface hepatitis with lymphocyte and plasma cell infiltration, rosette formation, and emperipolesis, suggesting the possibility of autoimmune hepatitis (AIH). First, treatment with prednisolone was initiated; however, the response was poor. After starting glecaprevir/pibrentasvir (GLE/PIB) as direct-acting antivirals (DAA), HCV RNA rapidly disappeared, and serological liver function improved. After confirmation of sustained virological response 24, HCC recurrence was observed, and partial hepatectomy was performed. Background liver findings showed that liver parenchymal inflammation improved compared with that before DAA treatment. This is the first case of HCV-AIH overlap syndrome treated with DAA using GLE/PIB. Liver function improved within a short treatment period of 8weeks, as confirmed using serology and histology.

Post-COVID-19 Brain [18F] FDG-PET Findings: A Retrospective Single-Center Study in the United States.

The pathophysiology of neurologic manifestations of postacute sequelae of Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) infection is not clearly understood. Our aim was to investigate brain metabolic activity on [18F] FDG-PET/CT scans in patients with a history of coronavirus disease 2019 (COVID-19) infection before imaging. This retrospective study included 45 patients who underwent [18F] FDG-PET/CT imaging for any reason and had, at least once, tested positive for COVID-19 at any time before imaging. Fifteen patients had available [18F] FDG-PET scans obtained under identical conditions before the infection. A group of 52 patients with melanoma or multiple myeloma who underwent [18F] FDG-PET/CT were used as controls. Whole-brain 2-sample t test analysis was performed using SPM software to identify clusters of hypo- and hypermetabolism and compare brain metabolic activity between patients with COVID-19 and controls. Paired sample t test comparison was also performed for 15 patients, and correlations between metabolic values of clusters and clinical data were measured. Compared with the control group, patients with a history of COVID-19 infection exhibited focal areas of hypometabolism in the bilateral frontal, parietal, occipital, and posterior temporal lobes and cerebellum (P = .05 uncorrected at the voxel level, family-wise error-corrected at the cluster level) that peaked during the first 2 months, improved to near-complete recovery around 6 months, and disappeared at 12 months. Hypermetabolism involving the brainstem, cerebellum, limbic structures, frontal cortex, and periventricular white matter was observed only at 2-6 months after infection. Older age, neurologic symptoms, and worse disease severity scores positively correlated with the metabolic changes. This study demonstrates a profile of time-dependent brain PET hypo- and hypermetabolism in patients with confirmed SARS-CoV-2 infection.

Assessing the Location, Relative Expression and Subclass of Dopamine Receptors in the Cerebellum of Hemi-Parkinsonian Rats

Parkinson’s Disease (PD) is a neurodegenerative disease with loss of dopaminergic neurons in the nigrostriatal pathway resulting in basal ganglia (BG) dysfunction. This is largely why much of the preclinical and clinical research has focused on pathophysiological changes in these brain areas in PD. The cerebellum is another motor area of the brain. Yet, if and how this brain area responds to PD therapy and contributes to maintaining motor function fidelity in the face of diminished BG function remains largely unanswered. Limited research suggests that dopaminergic signaling exists in the cerebellum with functional dopamine receptors, tyrosine hydroxylase (TH) and dopamine transporters (DATs); however, much of this information is largely derived from healthy animals and humans. Here, we identified the location and relative expression of dopamine 1 receptors (D1R) and dopamine 2 receptors (D2R) in the cerebellum of a hemi-parkinsonian male rat model of PD. D1R expression was higher in PD animals compared to sham animals in both hemispheres in the purkinje cell layer (PCL) and granule cell layer (GCL) of the cerebellar cortex. Interestingly, D2R expression was higher in PD animals than sham animals mostly in the posterior lobe of the PCL, but no discernible pattern of D2R expression was seen in the GCL between PD and sham animals. To our knowledge, we are the first to report these findings, which may lay the foundation for further interrogation of the role of the cerebellum in PD therapy and/or pathophysiology.

Raising Clinical Suspicion for Mitochondrial Encephalopathy, Lactic Acidosis, and Stroke-like Episodes (MELAS): Recurrent Seizures, Stroke-like Episodes, and Cortical Atrophy in Young Patients (P3-1.007)

<h3>Objective:</h3> Phenotypic variability and lack of familiarity with criteria can make diagnosis of MELAS challenging. Clinicians should be cognizant and consider early MR spectroscopy with genetic screening. <h3>Background:</h3> MELAS is a rare, progressive mitochondrial disorder that can be missed if clinical suspicion is low. <h3>Design/Methods:</h3> A thorough chart review was conducted. <h3>Results:</h3> <h3>Case 1:</h3> A 33-year-old female presented with recurrent right-sided visual scotomas. MRI showed focal DWI changes to the occipital lobe. Continuous video-EEG showed subclinical occipital lobe seizures. The patient had a recurrent episode of right-sided vision changes, speech difficulty and poor comprehension. MRI showed cortical atrophy and DWI abnormalities without ADC mismatch in the left occipital and left posterior temporal lobes. Stroke and infectious workup was unrevealing. Another episode of numbness, hearing loss, and word-finding difficulty prompted MR spectroscopy, screening lactate level, and genetic analysis. The diagnosis of MELAS was established based on the patient’s recurrent seizures, cortical visual loss, acute lesions on MRI, high plasma lactate, and a confirmed, possibly pathogenic mutation in MT-TL1. She suffered from neurological deterioration and passed away 6 months later. <h3>Case 2:</h3> Patient is a 26-year-old male with a long history of migraines with visual disturbances. MRI showed edema in the left occipital lobe. Subsequently, he presented with an intractable headache associated with left-sided peripheral vision loss and left leg weakness. MRI was notable for hyperintense flair signal in the right occipital lobe and marked atrophy. EEG showed frequent seizures and workup for stroke and encephalitis was unrevealing. Lactate levels were elevated and genetic screening was notable for MT-TL1 mutation. <h3>Conclusions:</h3> Patients younger than 40 with stroke-like symptoms, brain atrophy disproportionate to age, and negative infectious and vascular workup should be evaluated for MELAS. MR Spectroscopy, lactate levels, and genetic testing are important non-invasive screening measures. <b>Disclosure:</b> Mr. Tallavajhala has nothing to disclose. Dr. Bochenek has stock in JNJ, Abbott, Moderna, Pfizer. Ms. Dwivedi has nothing to disclose. Ms. Caffio-Learner has nothing to disclose. Miss Suliman has nothing to disclose. Dr. Bashir has nothing to disclose. Dr. Kurukumbi has nothing to disclose.

The Outcome of Traumatic Intra-diploic Meningoencephalocele with Recurrent seizures - A case report and literature review of 20 cases (P12-1.004)

<h3>Objective:</h3> We highlight an under-recognized epileptic pathology in a 56-year-old left-handed female with progressive right facial numbness and weekly focal seizures characterized by episodic aphasia. Additionally, we provide a thorough literature review of reported IDME patients along with their clinical presentation and outcomes. <h3>Background:</h3> Delayed neurological symptoms may arise years later in traumatic intradiploic meningoencephalocele (IDME) which creates potential diagnostic and therapeutic challenges. <h3>Design/Methods:</h3> Retrospective chart review and literature search. <h3>Results:</h3> 56-year-old left-handed female presented with progressive right facial numbness and focal seizures characterized by episodes of aphasia for a year. Episodes are characterized by worsening right facial numbness followed by garbled speech, word-finding difficulty, and grammatical errors when she attempts to talk or text over the phone, while she remains conscious and is aware of her surroundings. Her only epilepsy risk factor was minor head trauma ten years prior to presentation. Episodes were evaluated in the Epilepsy Monitoring Unit at Cleveland Clinic Foundation. An ictal event characterized by rhythmic sharply contoured delta and theta activity in the left hemisphere, most prominently in the left frontocentral region, This was clinically associated with numbness in the right side of the face progressing into an aphasic seizure. She was found to have left frontoparietal intradiploic meningoencephalocele (IDME) on imaging studies. Positron emission tomography (PET) showing mild metabolism corresponding to Intradiploic meningoencephalocele in left parietal bone, and subtle hypometabolism in the adjacent posterior left frontal lobe operculum. She had a craniotomy for encephalocele resection and mesh cranioplasty. At 3-year follow-up visit, patient was seizure free without residual neurological deficits. She remains on lacosamide 100 mg BID as seizures recurred after attempting to discontinue it. <h3>Conclusions:</h3> Traumatic IDME is a rare disorder and a presentation with seizures specifically is rarely encountered. A cranioplasty and dural repair, with or without resecting the projecting parenchyma, is likely the definitive treatment. <b>Disclosure:</b> Dr. Alsallom has nothing to disclose. Dr. Alzahrany has nothing to disclose. Dr. Gonzalez has nothing to disclose. Dr. Jehi has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for wolters kluwer. Dr. Jehi has a non-compensated relationship as a PI with Cleveland Clinic that is relevant to AAN interests or activities.

Ketamine Induced RCVS (P3-12.008)

<h3>Objective:</h3> To present a case of RCVS induced by ketamine infusions compounded with triptan and NSAID usage. <h3>Background:</h3> A 47 yo female with a history of depression and migraines presented with a persistent headache for 3 days. On the day of presentation, the patient reported the “worst headache of her life”. The headache was “sharp and squeezing”, frontal and retro-orbital in location, radiating to the back of her head, and exasperated by laying flat. The patient reported taking multiple high-dose NSAIDs along with sumatriptan. She had completed a 3-week course of ketamine infusions (75 mg twice weekly for depression) with last infusion 2 days prior to presentation. She was also on a chronic SSRI for depression. Patient denied any alcohol or current recreational drug use, but did report a history of opioid dependency. Initial CT head demonstrated a moderate-sized right frontal lobe subarachnoid and a small subarachnoid in the right posterior parietal lobe. CTA of head and neck demonstrated vasospasm of the left supraclinoid ICA, left M1 segment, and basilar artery. The location, radiographic appearance, and temporal course was consistent with RCVS. CT Angiogram was negative for any luminal irregularity, focal stenosis, or narrowing. MRI brain with contrast redemonstrated the subarachnoid hemorrhage without evidence of a vasculitic process. Lab work-up was negative for ANA, C4, C3, Sjogren’s Antibodies, RF, Anti-DNAs Ab. CRP and ESR were mildly elevated suggesting mild inflammation. <h3>Design/Methods:</h3> N/A <h3>Results:</h3> The etiology of the headache and subarachnoid hemorrhage was suspected to be medication induced RCVS in the setting of concomitant use of sumatriptan, SSRI, and high doses of ketamine. <h3>Conclusions:</h3> Although a rare phenomena, RCVS is a concerning cause of thunderclap headache that should be recognized. RCVS is not a common occurrence with ketamine usage but clinicians should be aware is this possible adverse effect. <b>Disclosure:</b> Dr. Mufti has nothing to disclose. Dr. Canlas has nothing to disclose. Dr. Ritenuti has nothing to disclose.

Neurosarcoidosis Induced by TNF-alpha Inhibitor in a Patient with Ankylosing Spondylitis (P9-5.002)

<h3>Objective:</h3> To report a case of neurosarcoidosis associated with infliximab administration. <h3>Background:</h3> Sarcoidosis is a systemic immune mediated disease that can affect any organ. Neurological involvement accounts for 5–10% of cases and can be life-threatening. Infliximab, a TNF-alpha inhibitor agent, is used in the treatment of sarcoidosis. However, rarely, it can paradoxically induce sarcoidosis. <h3>Design/Methods:</h3> Case report. <h3>Results:</h3> A 35-year-old male with ankylosing spondylitis complained of refractory and recurrent headaches, confusion, and word-finding difficulties for 2 weeks duration. Symptoms began after the infliximab infusion, which he has been receiving for 2 years, was changed to a biosimilar product. Initial routine testing and MRI brain with/without contrast were unremarkable. He was treated for migraines including a 4-day course of steroids. However, the symptoms worsened. On presentation, the physical examination revealed inattentiveness, difficulty recognizing familiar faces, impaired calculations, and decreased fluency. EEG demonstrated moderate generalized background slowing with frequent runs of generalized rhythmic delta activity. Laboratory testing showed slightly elevated ESR (24 mm/h) and CRP (2.8 mg/dL). CSF was significant for WBC 174 cells/mcL, protein 133.4 mg/dL, ACE 4.6 U/L, CD4:CD8 ratio 3:1. CT chest, abdomen and pelvis demonstrated diffuse lymphadenopathy. Repeat MRI brain demonstrated leptomeningeal enhancement most pronounced in the bilateral posterior temporal and occipital lobes. CT facial bones with contrast described increased density with central enhancement of the right maxillary sinus. Biopsy of a left inguinal lymph node revealed noncaseating granulomas consistent with sarcoid. Treatment with prednisone resulted in significant clinical improvement and resolution of leptomeningeal enhancement at 1 month. These findings are suggestive of neurosarcoidosis with possible involvement of the leptomeninges, sinuses and lymph nodes. <h3>Conclusions:</h3> Most case reports in the literature of TNF-alpha inhibitors inducing sarcoidosis describe involvement of lungs, skin, and lymph nodes. This case highlights a rare complication of TNF-alpha inhibitor resulting in neurosarcoidosis. <b>Disclosure:</b> Dr. Pak has nothing to disclose. Dr. Askari has received personal compensation for serving as an employee of Stony Brook Hospital University. Dr. Treidler has nothing to disclose.

Reversible Neuroimaging findings associated with Kratom use. (P12-5.021)

<h3>Objective:</h3> To report a case of reversible ischemic changes on MRI associated with chronic kratom use in a patient presenting with encephalopathy and seizures <h3>Background:</h3> Mitragyna speciosa, or kratom, is a psychoactive substance that targets multiple opioid receptors and has been an unregulated and under-reported substance of abuse. Its use has been reported to cause liver toxicity, respiratory depression, neuropsychiatric issues and even death. Its neurological side effects at this time are not well established. <h3>Design/Methods:</h3> We report a case of a 23-year-old male with a medical history significant for polysubstance abuse who presented for acute encephalopathy and seizure-like episode, requiring ICU admission and intubation for airway protection. <h3>Results:</h3> Patient initially presented with hypotension, leukocytosis, and lactic acidosis concerning sepsis. He was started on broad spectrum antibiotics for meningitis coverage and Keppra to prevent further seizures. Urine toxicology screen was negative. Once examined off sedation, the patient was noted to have right upper extremity weakness with babinski reflex on right concerning stroke therefore an MRI was obtained. It revealed small areas of confluent juxtacortical white matter abnormality high in the posterior frontal lobes bilaterally with some true diffusion restriction on the left suggestive of acute infarct. However, the appearance was unusual for a stroke. Further history from the family revealed that the patient uses Kratom on a daily basis for a number of years to help with anxiety. He had no further seizures and his mental status improved during the remainder of his hospitalization. Repeat MRI Brain 2 months after initial presentation showed resolution of the abnormalities. <h3>Conclusions:</h3> Kratom has been reported in the past to cause neurological issues like seizures or PRES. This case shows reversible ischemic neuroimaging findings of Kratom use in a patient with a stroke-like presentation. <b>Disclosure:</b> Dr. Pisati has nothing to disclose. Dr. Shah has nothing to disclose. Dr. Thaliath has nothing to disclose. Dr. Maryala has nothing to disclose. Dr. Allam has nothing to disclose.

Teaching NeuroImages: Prosopagnosia heralding anti-NMDA receptor encephalitis

A 23-year-old right-hand-dominant woman presented with 3 weeks of progressive difficulty recognizing faces, including her own, subsequently developing psychosis. Noncontrast CT head and MRI brain with contrast revealed a nonenhancing lesion of the right posterior temporal lobe and fusiform gyrus, with corresponding hypermetabolism on FDG-PET/CT brain (figure). EEG demonstrated right posterior temporal slowing. CSF and serum anti–NMDA receptor (NMDAR) antibodies were positive, with CT abdomen/pelvis revealing ovarian teratoma. Teratoma removal, plasmapheresis, and 1 cycle of rituximab yielded symptom resolution over 1 month. Anti-NMDAR encephalitis rarely presents with prosopagnosia,1 and in this case, is likely secondary to right fusiform gyrus dysfunction.2

New discoveries on the interaction between testosterone and oxytocin in male rats ― Testosterone-mediated effects of oxytocin in the prevention of obesity

Sex steroid hormones are important for the maintenance of metabolism in both sexes. Oxytocin (OT) is a neuropeptide that is synthesized in hypothalamic regions, secreted from the posterior lobe of the pituitary gland, and is involved in the control of appetite, body weight, and metabolism. Estrogen and OT both play a role in the metabolism of nutrients, and OT has potential in the prevention of obesity. However, the relationship between testosterone and OT remains unclear. Therefore, the present study investigated the relationship between testosterone and OT in hypogonadal male rats and male rats receiving testosterone replacement therapy. The results obtained showed that testosterone increased serum OT levels and promoted the secretion of adiponectin from visceral fat, and reduced body fat directly and/or indirectly through OT and adiponectin. Testosterone also increased the expression of OT receptors in the hypothalamus to increase sensitivity to OT, and perhaps because of this, OT administration had the effect of reducing food intake and body weight gain in both normal and castrated rats, and this effect was stronger in normal rats. In other words, the preventative effects of OT on obesity may be synergistic with testosterone. Collectively, the present results indicate that testosterone exerts indirect effects to prevent obesity and atherosclerosis through OT and adiponectin. In conclusion, testosterone replacement therapy is useful for preventing obesity caused by hypogonadism, and OT has potential in supportive medicine to prevent obesity and adult diseases.

Brain Areas Critical for Picture Naming: A Systematic Review and Meta-Analysis of Lesion-Symptom Mapping Studies.

Lesion-symptom mapping (LSM) studies have revealed brain areas critical for naming, typically finding significant associations between damage to left temporal, inferior parietal, and inferior fontal regions and impoverished naming performance. However, specific subregions found in the available literature vary. Hence, the aim of this study was to perform a systematic review and meta-analysis of published lesion-based findings, obtained from studies with unique cohorts investigating brain areas critical for accuracy in naming in stroke patients at least 1 month post-onset. An anatomic likelihood estimation (ALE) meta-analysis of these LSM studies was performed. Ten papers entered the ALE meta-analysis, with similar lesion coverage over left temporal and left inferior frontal areas. This small number is a major limitation of the present study. Clusters were found in left anterior temporal lobe, posterior temporal lobe extending into inferior parietal areas, in line with the arcuate fasciculus, and in pre- and postcentral gyri and middle frontal gyrus. No clusters were found in left inferior frontal gyrus. These results were further substantiated by examining five naming studies that investigated performance beyond global accuracy, corroborating the ALE meta-analysis results. The present review and meta-analysis highlight the involvement of left temporal and inferior parietal cortices in naming, and of mid to posterior portions of the temporal lobe in particular in conceptual-lexical retrieval for speaking.

PD23-12 A CLOSER LOOK AT CEREBELLAR REGIONS INVOLVED IN LOWER URINARY TRACT CONTROL IN MEN AND WOMEN: A 7T FUNCTIONAL MRI RESTING-STATE STUDY

You have accessJournal of UrologyCME1 Apr 2023PD23-12 A CLOSER LOOK AT CEREBELLAR REGIONS INVOLVED IN LOWER URINARY TRACT CONTROL IN MEN AND WOMEN: A 7T FUNCTIONAL MRI RESTING-STATE STUDY Charles Mazeaud, Jessica Bernard, Betsy Salazar, Hamida Rajab, Christof Karmonik, and Rose Khavari Charles MazeaudCharles Mazeaud More articles by this author , Jessica BernardJessica Bernard More articles by this author , Betsy SalazarBetsy Salazar More articles by this author , Hamida RajabHamida Rajab More articles by this author , Christof KarmonikChristof Karmonik More articles by this author , and Rose KhavariRose Khavari More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003296.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Functional magnetic resonance imaging (fMRI) is an increasingly powerful tool for assessing supraspinal control of lower urinary tract (LUT) function. Cerebellum being a small infratentorial part of the central nervous system has been a challenging region to study with functional neuroimaging until recently. We focused on resting state functional connectivity (FC), which is the temporal dependency link between different brain regions in the absence of a task, to explore the cerebral network. In this study, we evaluated for the first time the FC of the cerebellum with the whole brain utilizing a high-resolution 7 Tesla MRI scanner. METHODS: We included healthy men and women with no reported history of neurological disease or LUT symptoms. Individuals were asked to drink 500ml of water, and then empty their bladder before entering the MRI room. They had a 7T MRI initial run (10min) of resting state fMRI (rsfMRI-empty) acquisition. When patients felt the urge to void a second identical rsfMRI-full acquisition was performed. Data were preprocessed and denoised with the CONN toolbox in Matlab. A blood oxygen level-dependent (BOLD) signal contrast map was generated for rsFC-empty and rsFC-full bladder conditions. We established a priori cerebellum regions of interest (ROIs) from the literature to perform seed-to-voxel analysis with nonparametric statistics based on the Threshold Free Cluster Enhancement method and a voxel threshold of p<0.05. RESULTS: Twenty individuals (10 men, 10 women) with an average age of 27 years (IQR [24-27,5]) participated in the study. We placed 26 different 4-mm seeds throughout the cerebellum and assessed their FC with the rest of the brain. Three of these (left cerebellar tonsil, right posterolateral lobe, right posterior lobe) showed significant differences in connectivity with areas associated with the full bladder condition (Figure 1). The FC between men and women was similar for each of these. CONCLUSIONS: Our preliminary results demonstrate for the first time that cerebellar network connectivity is associated with a full bladder state and is involved in LUT function. Elucidating the role of the cerebellum in bladder function paves the way to a better understanding of urinary pathologies affecting this area. Source of Funding: Funding was provided by the NIH, NIDDK R03DK126994-01 award, and the Houston Methodist Clinician Scientist Award © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e677 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Charles Mazeaud More articles by this author Jessica Bernard More articles by this author Betsy Salazar More articles by this author Hamida Rajab More articles by this author Christof Karmonik More articles by this author Rose Khavari More articles by this author Expand All Advertisement PDF downloadLoading ...

Microsurgical anatomy of the isthmic cingulum: a new white matter crossroad and neurosurgical implications in the posteromedial interhemispheric approaches and the glioma invasion patterns.

The dichotomy of the cingulum bundle into the dorsal supracallosal and ventral parahippocampal parts is widely accepted; however, the retrosplenial component with its multiple alternative connections has not been revealed. The aim of this study was to delineate the microsurgical anatomy of a connectionally transition zone, the isthmic cingulum, in relation to the posteromedial interhemispheric access to the atrium and discuss the relevant patterns of glioma invasion on the basis of its fiber connections. White matter (WM) fibers were dissected layer by layer in a medial-to-lateral, lateral-to-medial, and posterior-to-anterior fashion. All related tracts and their connections were generated using deterministic tractography. The magnetic resonance imaging (MRI) tractography findings were correlated with those of fiber dissection. A medial parieto-occipital approach to reach the atrium was performed with special emphasis on the cingulate isthmus and underlying WM connections. The isthmic cingulum, introduced as a retrosplenial connectional crossroad for the first time, displayed multiple connections to the splenium and the superior thalamic radiations. Another new finding was the demonstration of lateral hemispheric extension of the isthmic cingulum fibers through the base of the posterior part of the precuneus at the base of the parieto-occipital sulcus. The laterally crossing cingulum fibers were interconnected with three distinct association tracts: the middle longitudinal (MdLF), the inferior frontooccipital fasciculi (IFOF), and the claustro-cortical fibers (CCF). In the process of entry to the atrium during posterior interhemispheric approaches, the splenial and thalamic connections, as well as the laterally crossing fibers of the isthmic cingulum, were all in jeopardy. The connectional anatomy of the retrosplenial area is much more complicated than previously known. The isthmic cingulum connections may explain the concept of interhemispheric and medial to lateral cerebral hemisphere invasion patterns in medial parieto-occipital and posteromesial temporal gliomas. The isthmic cingulum is of key importance in posteromedial interhemispheric approaches to both: the atrium and the posterior mesial temporal lobe.

Changes in dynamic and static brain fluctuation distinguish minimal hepatic encephalopathy and cirrhosis patients and predict the severity of liver damage.

Minimal hepatic encephalopathy (MHE) is characterized by mild neuropsychological and neurophysiological alterations that are not detectable by routine clinical examination. Abnormal brain activity (in terms of the amplitude of low-frequency fluctuation (ALFF) has been observed in MHE patients. However, little is known concerning temporal dynamics of intrinsic brain activity. The present study aimed to investigate the abnormal dynamics of brain activity (dynamic ALFF; dALFF) and static measures [static ALFF; (sALFF)] in MHE patients and to strive for a reliable imaging neuromarkers for distinguishing MHE patients from cirrhosis patients. In addition, the present study also investigated whether intrinsic brain activity predicted the severity of liver damage. Thirty-four cirrhosis patients with MHE, 28 cirrhosis patients without MHE, and 33 age-, sex-, and education-matched healthy controls (HCs) underwent resting-state magnetic resonance imaging (rs-fMRI). dALFF was estimated by combining the ALFF method with the sliding-window method, in which temporal variability was quantized over the whole-scan timepoints and then compared among the three groups. Additionally, dALFF, sALFF and both two features were utilized as classification features in a support vector machine (SVM) to distinguish MHE patients from cirrhosis patients. The severity of liver damage was reflected by the Child-Pugh score. dALFF, sALFF and both two features were used to predict Child-Pugh scores in MHE patients using a general linear model. Compared with HCs, MHE patients showed significantly increased dALFF in the left inferior occipital gyrus, right middle occipital gyrus, and right insula; increased dALFF was also observed in the right posterior lobe of the cerebellum (CPL) and right thalamus. Compared with HCs, noMHE patients exhibited decreased dALFF in the right precuneus. In contrast, compared with noMHE patients, MHE patients showed increased dALFF in the right precuneus, right superior frontal gyrus, and right superior occipital gyrus. Furthermore, the increased dALFF values in the left precuneus were positively associated with poor digit-symbol test (DST) scores (r = 0.356, p = 0.038); however, dALFF in the right inferior temporal gyrus (ITG) was negatively associated with the number connection test-A (NCT-A) scores (r = -0.784, p = 0.000). A significant positive correlation was found between dALFF in the left inferior occipital gyrus (IOG) and high blood ammonia levels (r = 0.424, p = 0.012). Notably, dALFF values yielded a higher classification accuracy than sALFF values in distinguishing MHE patients from cirrhosis patients. Importantly, the dALFF values predicted the Child-Pugh score (r = 0.140, p = 0.030), whereas sALFF values did not in the current dataset. Combining two features had high accuracy in classification in distinguishing MHE patients from cirrhotic patients and yielded prediction in the severity of liver damage. These findings suggest that combining dALFF and sALFF features is a useful neuromarkers for distinguishing MHE patients from cirrhosis patients and highlights the important role of dALFF feature in predicting the severity of liver damage in MHE.

Altered isotropic volume fraction in gray matter after sleep deprivation and its association with visuospatial memory: A neurite orientation dispersion and density imaging study.

Diffusion magnetic resonance imaging (dMRI) studies have revealed microstructural abnormalities in white matter resulting from sleep deprivation (SD). This study aimed to adopt neurite orientation dispersion and density imaging (NODDI) to investigate the effect of SD on gray matter (GM) microstructural properties and its association to visuospatial memory (VSM). Twenty-four healthy women underwent two sessions of dMRI scanning and visuospatial ability assessment by Complex Figure Test (CFT), once during rested wakefulness (RW) and once after 24 h of SD. We calculated NODDI metrics, including intracellular volume fraction (ICVF), orientation dispersion index (ODI), and isotropic volume fraction (ISO). Differences in NODDI-related metrics between RW and SD were determined using a voxel-wise paired t-test. We identified an association between NODDI metrics and CFT results using Spearman's correlation coefficient. Sleep deprivation worsened subjects' performance in the delayed-CFT trial. We observed no significant difference in ICVF and ODI between RW and SD. After SD, subjects showed decreases in ISO, primarily in the prefrontal cortex and temporal lobe, while exhibiting ISO increases in the anterior and posterior cerebellar lobe and cerebellar vermis. Furthermore, ISO change in the left superior, middle and inferior frontal gyrus was significantly correlated with completion time change in delayed-CFT trial performance. Our results suggested that SD hardly affected the density and spatial organization of neurites in GM, but the extra-neurite water molecule diffusion process was affected (perhaps resulting from neuroinflammation), which contributed to VSM dysfunction.

Childhood sexual abuse related to brain activity abnormalities in right inferior temporal gyrus among major depressive disorder

Regional brain activity abnormalities have been reported in major depressive disorder (MDD) with childhood trauma (CT). However, these findings were variable and equivocal. The present study aims to explore further the correlation between CT and the amplitude of low-frequency fluctuations (ALFF) alteration in MDD. In this study, we recruited 60 healthy controls (HCs) and 66 MDD patients to complete resting-state fMRI scans. All MDD patients were evaluated clinical symptoms and childhood trauma experience using the Hamilton Depression Rating Scale-17 (HDRS-17), the Hamilton Anxiety Scale (HAMA), and the Childhood Trauma Questionnaire (CTQ). Compared to HCs, MDD patients demonstrated significantly altered ALFF in the right middle occipital gyrus (MOG), bilateral inferior temporal gyrus (ITG), bilateral cerebellum posterior lobe, bilateral anterior cingulate gyrus (ACC), and bilateral superior frontal gyrus (SFG). More importantly, we found negative correlation between childhood sexual abuse (CSA) scores and ALFF value appeared mainly in the right ITG among MDD patients. After adjusting for covariates (age, gender, mean framewise displacement (FD), HDRS-17, and HAMA scores), this correlation remained significant. Meanwhile, ALFF in the right ITG could distinguish MDD patients with or without CSA (area under the curve (AUC) = 0.713). Our findings revealed that the regional brain activity abnormalities in the right ITG might be a potential biomarker for MDD patients with CSA.

Altered Functional Connectivity Strength in Distinct Brain Networks of Children With Early-Onset Schizophrenia.

Schizophrenia is regarded as a brain network or connectome disorder that is associated with neurodevelopment. Children with early-onset schizophrenia (EOS) provide an opportunity to evaluate the neuropathology of schizophrenia at a very early stage without potential confounding factors. But dysfunction in brain networks of schizophrenia is inconsistent. To identify abnormal functional connectivity (FC) in EOS patients and relationships with clinical symptoms, we aimed to reveal neuroimaging phenotypes of EOS. Prospective, cross-sectional. Twenty-six female/22 male patients (age:14.3 ± 3.45 years) with first-episode EOS, 27 female/22 male age- and gender-matched healthy controls (HC) (age:14.1 ± 4.32). 3-T, resting-state (rs) gradient-echo echo-planar imaging and three-dimensional magnetization-prepared rapid gradient-echo imaging. Intelligence quotient (IQ) was measured by the Wechsler Intelligence Scale-Fourth edition for Children (WISC-IV). The clinical symptoms were evaluated by the Positive and Negative Syndrome Scale (PANSS). FC strength (FCS) from rs functional MRI (rsfMRI) was used to investigate functional integrity of global brain regions. In addition, associations between regionally altered FCS and clinical symptoms in EOS patients were examined. Two-sample t-test controlling for sample size, diagnostic method, brain volume algorithm, and age of the subjects, Bonferroni correction, Pearson's correlation analysis. A P-value <0.05 with a minimum cluster size of 50 voxels was considered statistically significant. Compared with HC, EOS patients had significantly lower total IQ scores (IQ:91.5 ± 16.1), increased FCS in the bilateral precuneus, left dorsolateral prefrontal cortex, left thalamus, and left parahippocampus (paraHIP), and decreased FCS in the right cerebellum posterior lobe and right superior temporal gyrus. The PANSS total score of EOS patients (PANSS total score:74.30 ± 7.23) was found to be positively correlated to FCS in the left paraHIP (r=0.45). Our study revealed that disrupted FC of brain hubs illustrate multiple abnormalities in brain networks in EOS patients. 1 TECHNICAL EFFICACY STAGE: 2.