Temporal Lobe Lesions Research Articles

Did H.M. exhibit accelerated long-term forgetting? Measuring forgetting in amnesia

The early investigations of patient H.M. inaugurated the modern era of memory research. During the 1970s and 1980s, a key debate over whether H.M. with bilateral medial temporal lobe lesions exhibited accelerated long-term forgetting attracted an increasing interest in forgetting research among amnestic patients. Huppert and Piercy (1979) examined H.M.’s performance in visual recognition at 10-minute, 1-day, and 7-day intervals and suggested that H.M. was subjected to rapid forgetting compared with Korsakoff patients and healthy participants reported in Huppert and Piercy (1978). In contrast, Freed et al. (1987) employed the same experimental paradigm and concluded that forgetting rates in H.M. did not differ from those in healthy controls. These incompatible findings highlighted a methodological challenge in measuring forgetting in the cross-group comparison design, where closely equalising the initial performance between patient and control groups is usually suggested. The re-analysis in this viewpoint, using both linear- and nonlinear-based modelling, reconciled the discrepancy between the aforementioned studies. Our results indicated that the rate of forgetting in H.M. did not differ from that in healthy controls, regardless of whether the initial performance was closely matched. Here, we suggest that the cross-group comparisons in forgetting studies do not necessarily seek a perfect match in initial performance unless the risks of confounding encoding and retrieval processes can be effectively controlled.

Anti-LGI1 Antibody-Associated Encephalitis Misdiagnosed as Schizophrenia: A Case Report.

Anti-leucine-rich glioma-inactivated 1 (LGI1) antibody-associated encephalitis is a rare but clinically significant form of autoimmune encephalitis, predominantly affecting middle-aged men. Its heterogeneous clinical presentation often leads to misdiagnosis, commonly as other neurological or psychiatric disorders. This report details the case of a 46-year-old male who initially presented with depressive symptoms, personality changes, and visual hallucinations. Over time, his condition progressed to include memory impairment, disorganized behavior, and seizures. Initially misdiagnosed with schizophrenia, the correct diagnosis of LGI1 antibody-associated encephalitis was eventually established through positive serum and cerebrospinal fluid (CSF) tests for LGI1 antibodies. Neuroimaging findings revealed characteristic bilateral temporal lobe lesions. The patient demonstrated marked improvement following treatment with methylprednisolone and intravenous immunoglobulin, ultimately achieving significant recovery. This case highlights the critical importance of comprehensive antibody testing and neuroimaging in patients presenting with nonspecific psychiatric and neurological symptoms to prevent misdiagnosis and delays in appropriate treatment. The article also reviews the pathogenesis, clinical manifestations, diagnostic approaches, and therapeutic strategies for LGI1 antibody-associated encephalitis, aiming to enhance clinical awareness and optimize patient outcomes.

Prosopagnosia: face blindness and its relationship to neurological disorders

This study examines the neurological and neuropathological conditions, and clinical, imaging, and demographic traits linked to prosopagnosia. Out of 475 potential cases, 327 met criteria for probable or definite prosopagnosia. One patient had Niemann-Pick type C and another had a forkhead box G1 gene mutation; ten patients (80% male) had developmental prosopagnosia. Of 317 with acquired prosopagnosia, 228 had degenerative causes, primarily primary prosopagnosia syndrome, Alzheimer's disease dementia, posterior cortical atrophy, and semantic dementia. Non-degenerative cases often involved ischemic and hemorrhagic infarcts. Transient non-degenerative prosopagnosia, linked to hypoxic encephalopathy and migraines, improved over time. Degenerative prosopagnosia patients often showed temporal lobe involvement on PET scans, while non-degenerative patients had right temporal and occipital lobe lesions on MRI. Pathological findings included Alzheimer's, Lewy body disease, and frontotemporal lobar degeneration. Facial recognition loss spans various neurological illnesses.

Verbal short term memory contribution to sentence comprehension decreases with increasing syntactic complexity in people with aphasia

Sentence comprehension requires the integration of linguistic units presented in a temporal sequence based on a non-linear underlying syntactic structure. While it is uncontroversial that storage is mandatory for this process, there are opposing views regarding the relevance of general short-term-/working-memory capacities (STM/WM) versus language specific resources. Here we report results from 43 participants with an acquired brain lesion in the extended left hemispheric language network and resulting language deficits, who performed a sentence-to-picture matching task and an experimental task assessing phonological short-term memory. The sentence task systematically varied syntactic complexity (embedding depth and argument order) while lengths, number of propositions and plausibility were kept constant. Clinical data including digit-/ block-spans and lesion size and site were additionally used in the analyses. Correlational analyses confirm that performance on STM/WM-tasks (experimental task and digit-span) are the only two relevant predictors for correct sentence-picture-matching, while reaction times only depended on age and lesion size. Notably increasing syntactic complexity reduced the correlational strength speaking for the additional recruitment of language specific resources independent of more general verbal STM/WM capacities, when resolving complex syntactic structure. The complementary lesion-behaviour analysis yielded different lesion volumes correlating with either the sentence-task or the STM-task. Factoring out STM measures lesions in the anterior temporal lobe correlated with a larger decrease in accuracy with increasing syntactic complexity. We conclude that overall sentence comprehension depends on STM/WM capacity, while increases in syntactic complexity tax another independent cognitive resource.

Clinical characteristics and outcomes of patients with Herpes Simplex Encephalitis in Vietnam: a retrospective study

BackgroundHerpes simplex encephalitis (HSE) is an important central nervous infection with severe neurological sequelae. The aim of this study was to describe clinical characteristic and outcomes of patients with HSE in Vietnam.MethodsThis was a retrospective study of 66 patients with herpes simplex encephalitis who admitted to the National Hospital for Tropical Diseases, Hanoi, Vietnam from 2018 to 2021. The detection of herpes simplex virus (HSV) in cerebrospinal fluid was made by the real-time PCR assay. We reported the clinical manifestation on admission and evaluated clinical outcomes at the hospital discharge by modified Rankin Scale (mRS). Multivariate logistic regression analysis was used to analyze the independent risk factors of severe outcomes.ResultsOf the 66 patients with laboratory confirmed HSE, the median age was 53 years (IQR 38–60) and 44 patients (69.7%) were male. The most common manifestations included fever (100%), followed by the consciousness disorder (95.5%). Other neurological manifestation were seizures (36.4%), memory disorders (31.8%), language disorders (19.7%) and behavioral disorders (13.6%). Conventional magnetic resonance imaging (MRI) showed 93.8% patients with temporal lobe lesions, followed by abnormalities in insula (50%), frontal lobe (34.4%) and 48.4% of patients had bilateral lesions. At discharge, 19 patients (28.8%) completely recovered, 15 patients (22.7%) had mild sequelae, 28 patients (42.4%) had moderate to severe sequelae. Severe neurological sequelae were memory disorders (55.8%), movement disorders (53.5%), language disorders (30.2%). Multivariate logistic regression analysis showed that Glasgow score decrement at admission, seizures, and time duration from onset of symptoms to the start of Acyclovir treatment > 4 days were independent factors associated with severe outcomes in HSE patients.ConclusionGlasgow score decrement, seizures and delay treatment with Acyclovir were associated with the poor outcome of patients with HSE.

Lesionectomy for Temporal Lobe Lesion Can Results in Reduced Need of Antiepileptic Drugs.

Lesionectomy for Temporal Lobe Lesion Can Results in Reduced Need of Antiepileptic Drugs.

Causes of missed MRI diagnosis of radiotherapy-induced temporal lobe injury in nasopharyngeal carcinoma.

Radiotherapy is the primary treatment for nasopharyngeal carcinoma, but it frequently leads to radiotherapy-induced temporal lobe injury (RTLI). Magnetic resonance imaging (MRI) is the main diagnostic method for RTLI after radiotherapy for nasopharyngeal carcinoma, but it is prone to missed diagnoses. This study aims to investigate the causes of missed diagnoses of RTLI in nasopharyngeal carcinoma patients undergoing MRI after radiotherapy. Clinical and MRI data from nasopharyngeal carcinoma patients diagnosed and treated with radiotherapy at Xiangya Hospital of Central South University, from January 2010 to April 2021, were collected. Two radiologists reviewed all head and neck MRIs (including nasopharyngeal and brain MRIs) before and after radiotherapy of identify cases of late delayed response-type RTLI for the first time. If the original diagnosis of the initial RTLI in nasopharyngeal carcinoma patients did not report temporal lobe lesions, it was defined as a missed diagnosis. The first diagnosis of RTLI cases was divided into a missed diagnosis group and a non-missed diagnosis group. Clinical and imaging data were compared between the 2 groups, and multivariate logistic regression analysis was used to identify independent risk factors for MRI missed diagnoses of initial RTLI. A total of 187 nasopharyngeal carcinoma with post-radiotherapy RTLI were included. The original diagnostic reports missed 120 cases and accurately diagnosed 67 cases, with an initial RTLI diagnosis accuracy rate of 35.8% and a missed diagnosis rate of 64.2%. There were statistically significant differences between the missed diagnosis group and the non-missed diagnosis group in terms of lesion size, location, presence of contralateral temporal lobe lesions, white matter high signal, cystic degeneration, hemorrhage, fluid attenuated inversion recovery (FLAIR), and examination site (all P<0.05). Multivariate logistic regression analysis showed that lesions ≤25 mm, non-enhancing lesions, lesions without cystic degeneration or hemorrhage, lesions located only in the medial temporal lobe, and MRI examination only of the nasopharynx were independent risk factors for missed MRI diagnosis of initial RTLI (all P<0.05). The missed diagnosis of initial RTLI on MRI is mainly related to lesion size and location, imaging characteristics, and MRI examination site.

Lateral Transorbital Endoscope-Assisted Resection of Anterior Temporal Lobe Neoplasm: 2-Dimensional Operative Video.

Transorbital neuroendoscopic surgery (TONES) is a minimally invasive approach, providing excellent access to extradural pathology of the sphenoid wing, orbital apex, Meckel's cave, and lateral cavernous sinus.1-10 Few cases of intradural pathology, such as gliomas or epileptic foci of the temporal lobe, have been described, apart from cadaveric anatomic studies.11-13 In this video, we present the case of a 63-year-old man with first time seizure. MRI demonstrated a fluid-attenuated inversion recovery hyperintense, noncontrast enhancing medial temporal lobe lesion consistent with low grade glioma. While frontotemporal craniotomy is the standard approach for this lesion, the TONES approach detailed in the video (the patient consented to the procedure and to the publication of his image) provided excellent access to the lesion, which minimized unnecessary trauma or removal of the lateral temporal lobe during the approach.4,14,15 The dura was closed primarily, overlayed with abdominal fat and fibrin glue, and a lumbar drain was left in place for 24 hours. The TONES approach avoided not only temporal lobe violation but also temporalis muscle disruption and any sort of external bone manipulation, which expedited the patient's recovery.16 The patient's eyelid incision was barely visible as early as postoperative day 7 with minimal ecchymosis. Postoperative MRI demonstrated a gross total resection. Pathology was consistent with a central nervous system World Health Organization grade 1 dysembryoplastic neuroepithelial tumor, a low-grade lesion with low risk of recurrence.17,18.

The hippocampus supports precise memory for public events regardless of their remoteness

The necessity of the human hippocampus and surrounding medial temporal lobe structures to semantic memory remains contentious. Impaired semantic memory following hippocampal lesions could arise either due to partially intertwined episodic memories and/or retrograde/anterograde effects. In this study, we tested amnesic individuals with lesions in hippocampus and surrounding medial temporal lobe (n = 7) and age-matched controls (n = 14) on their ability to precisely recall the dates of famous public events that occurred either before (i.e., pre-lifetime) or after participants’ birth date (lifetime). We show that deficits in dating precision are greatest for recent lifetime events, consistent with the notion that recent event memory may be particularly intertwined with episodic memory. At the same time, individuals with medial temporal lobe lesions showed more subtle impairments in their ability to date pre-birth and remote lifetime events precisely. Together, these findings suggest that the hippocampus and surrounding medial temporal lobe structures are important for representational precision of semantic memories regardless of their remoteness.

Nghiên cứu đặc điểm lâm sàng, cận lâm sàng và đánh giá kết quả điều trị ở bệnh nhân động kinh sau chấn thương sọ não

Background: Post-traumatic epilepsy (PTE) results in a huge burden and reduces patients' quality of life. Understanding clinical, subclinical characteristics and assessing treatment results helps to improve management strategies for epilepsy after traumatic brain injury (TBI). Objectives: 1. To describe clinical and subclinical characteristics of patients with PTE at Vietnam - Cuba Friendship Dong Hoi Hospital. 2. To evaluate initial results of the treatment of PTE after 3 months. Methods: A cross-sectional descriptive study with follow-up on 58 patients with PTE receiving examination and treatment at Vietnam - Cuba Friendship Dong Hoi Hospital from April 2022 to June 2023. Results: Clinical: Late PTE (occurring &gt; 1 week after TBI) accounted for 69% with 6.9% of first seizures occurred from 1 week - 6 months after TBI while 3.4% happened between 6 months - 1 year. Most seizures lasting less than 5 minutes (86.2%); 37.9% had ³ 1 seizure per month; 32.8% had 1 seizure weekly and daily attacks accounted for 24.1%. Focal seizure registered the majority (89.6%) while generalized seizures accounted for 10.4%; there was a difference in type of seizure between early PTE and late PTE. Subclinical: Abnormal electroencephalogram (EEG) was recorded in 24.1% of cases with following characteristics: diffuse slowing in both hemispheres (6.9%), localized slow waves (17.2%). Lesion location on CT/MRI: temple 53.4% and forehead 46.6%. Treatment results: 87.9% of TBI cases were treated conservatively and 12.1% were treated surgically. Antiepileptic medications: Depakin (62.5%), Tegretol (13.8%), Phenytoin (13.8%), Keppra (8.6%); treatment adherence rate was very high (89.7%). The recurrence rate was 37.9%, this was lower in the group of early PTE compared with late PTE (22.2% versus 45%). During 3 months of treatment, the majority had 1 - 4 seizures (72.2%) and 19.0% needed re-hospitalization. Neurological complications were recorded in 12.1% of cases. Aura happened in 43.1% of cases, more frequently in late PTE when compared with early PTE (50.0% and 27.8%, respectively). Conclusion: Prophylaxis of PTE should be considered in TBI patients having seizures without EEG abnormalities or in elderly patients with temporal and frontal lobe lesions.

Pure amnestic seizure: A clinico-intracranial EEG study.

Enduring anterograde amnesia is caused by lesions in bilateral mesial temporal lobes. However, whether transient dysfunction of bilateral mesial temporal regions induces reversible amnesia has not been proven. We investigated this association in patients with epilepsy and analyzed the electroclinical correlation during pure amnestic seizures (PAS). PAS are defined as seizures with anterograde amnesia as the only ictal manifestation, accompanied by preserved responsiveness and other cognitive functions. We retrospectively searched our intracranial EEG database to find PAS. Pure ictal amnesia was confirmed by immediate and comprehensive ictal examinations. Among 401 patients who underwent intracranial EEG recording, three patients with temporal lobe epilepsy (TLE) manifesting PAS were identified. The patients talked and behaved normally during seizure but did not remember the episodes afterwards. Ictal discharges were confined to bilateral mesial temporal regions, with no or mild involvement of surrounding structures. Spread of low-voltage fast activities to bilateral mesial temporal regions corresponded to onset of ictal anterograde amnesia. Two patients underwent unilateral mesial temporal resection and became seizure-free with improvement in cognitive functions. PAS is a rare ictal semiology in TLE. Bilateral mesial temporal regions that play a critical role in memory encoding are presumably the symptomatogenic zones for PAS.

Gesture profiles distinguish primary progressive aphasia variants: a preliminary study

ABSTRACT Background Primary progressive aphasia (PPA) is a neurodegenerative syndrome characterized by progressive language deficits. The main variants of PPA – semantic (svPPA), logopenic (lvPPA), and nonfluent (nfvPPA) – can be challenging to distinguish. Limb apraxia often co-occurs with PPA, but it is unclear whether PPA variants are associated with different gesture deficits. Prior evidence from stroke indicates that temporal lobe lesions are associated with reduced benefit from meaning in gesture performance. Temporal lesions are also associated with greater deficits in hand postures compared to arm kinematics in gesture imitation. Aims We tested the hypothesis that svPPA, who primarily exhibit temporal lobe atrophy, would differentially show this pattern. In addition, we predicted that as a group, individuals with PPA would more accurately produce meaningful than meaningless gestures and kinematic components than hand postures, as found in neurotypical adults and individuals with stroke. Methods & Procedures Participants with PPA completed meaningful and meaningless gesture imitation tasks. Performance was scored for hand posture and arm kinematic components. Bayesian mixed-effect models examined trial-level gesture imitation accuracy, while controlling for dementia severity and random effects of subjects and items. Fixed effects included an interaction between PPA variant, task condition/meaning, and gesture component. Outcomes & Results We found a critical interaction between PPA variant, meaning, and gesture component. In particular, unlike lvPPA and nfvPPA, svPPA subjects’ hand postures failed to benefit from gesture meaning. This preliminary research extends prior findings on the role of the temporal lobe in action representations associated with manipulable objects, and is among the first to demonstrate distinct gesture imitation patterns between PPA variants. Conclusions Characterizing gesture deficits in PPA may help inform diagnostics, compensatory communication strategies, and models of praxis.

Depersonalization and derealization as sequelae of a temporal lobe lesion: a case report

BackgroundDepersonalization and derealization can occur not just from psychiatric causes but also from various organic etiologies, such as seizures and intracerebral structural abnormalities. However, there have been no previous reported cases to the authors’ knowledge detailing isolated depersonalization and derealization in the absence of clinical seizure activity or other psychiatric pathology, as sequelae of structural intracerebral lesions.Case presentationIn this case report, we detail the unique presentation of a 68-year-old woman under the care of palliative medicine who experienced depersonalization and derealization secondary to a metastatic lesion in her temporal lobe, in the parahippocampal gyrus to medial occipitotemporal gyrus region. These symptoms were present in the absence of any clinical seizure activity or other psychiatric symptomatology and largely resolved with the use of steroidal therapy, before returning secondary to disease progression.ConclusionsWe discuss the relationship among isolated depersonalization and derealization with pathology of the left posterior temporal lobe in the context of this interesting case. This case expands our knowledge of the neurobiology of these phenomena, given the specific localization of the intracerebral pathology and temporal specificity of symptoms relative to tumor growth and treatment course.

Predictors of Cognitive Functions After Stroke Assessed Using the Wechsler Adult Intelligence Scale: A Retrospective Study.

The mechanism(s) of cognitive impairment remains complex, making it difficult to confirm the factors influencing poststroke cognitive impairment (PSCI). This study quantitatively investigated the degree of influence and interactions of clinical indicators of PSCI. Information from 270 patients with PSCI and their Wechsler Adult Intelligence Scale (WAIS-RC) scores, totaling 18 indicators, were retrospectively collected. Correlations between the indicators and WAIS scores were calculated. Multiple linear regression model(MLR), genetic algorithm modified Back-Propagation neural network(GA-BP), logistic regression model (LR), XGBoost model (XGB), and structural equation model were used to analyze the degree of influence of factors on the WAIS and their mediating effects. Seven indicators were significantly correlated with the WAIS scores: education, lesion side, aphasia, frontal lobe, temporal lobe, diffuse lesions, and disease course. The MLR showed significant effect of education, lesion side, aphasia, diffuse lesions, and frontal lobe on the WAIS. The GA-BP included five factors: education, aphasia, frontal lobe, temporal lobe, and diffuse lesions. LR predicted that the lesion side contributed more to mild cognitive impairment, while education, lesion side, aphasia, and course of the disease contributed more to severe cognitive impairment. XGB showed that education, side of the lesion, aphasia, and diffuse lesions contributed the most to PSCI. Aphasia plays a significant mediating role in patients with severe PSCI. Education, lesion side, aphasia, frontal lobe, and diffuse lesions significantly affected PSCI. Aphasia is a mediating variable between clinical information and the WAIS in patients with severe PSCI.

Correlation of visual field deficits and q-ball high-resolution fiber tractography of the optic radiation for adjacently located intracerebral lesions: preliminary results from a single-center prospective study

Visual field deficits (VFDs) are common in patients with temporal and occipital lobe lesions. Diffusion tensor fiber tractography (DTI-FT) is widely used for surgery planning to reduce VFDs. Q-ball high-resolution fiber tractography (QBI-HRFT) improves upon DTI. This study aims to evaluate the effectiveness of DTI-FT and QBI-HRFT for surgery planning near the optic radiation (OR) as well as the correlation between VFDs, the nearest distance from the lesion to the OR fiber bundle (nD-LOR), and the lesion volume (LV). This ongoing prospective clinical trial collects clinical and imaging data of patients with lesions in deterrent areas. The present subanalysis included eight patients with gliomas near the OR. Probabilistic HRFT based on QBI-FT and conventional DTI-FT were performed for OR reconstruction based on a standard diffusion-weighted magnetic resonance imaging sequence in clinical use. Quantitative analysis was used to evaluate the lesion volume (LV) and nD-LOR. VFDs were determined based on standardized automated perimetry. We included eight patients (mean age 51.7 years [standard deviation (SD) 9.5]) with lesions near the OR. Among them, five, two, and one patients had temporodorsal, occipital, and temporal lesions, respectively. Four patients had normal vision preoperatively, while four patients had preexisting VFD. QBI-FT analysis indicated that patients with VFD exhibited a significantly smaller median nD-LOR (mean, −4.5; range −7.0; −2.3) than patients without VFD (mean, 7.4; range −4.3; 27.2) (p = 0.050). There was a trend towards a correlation between tumor volume and nD-LOR when QBI-FT was used (rs = −0.6; p = 0.056). A meticulous classification of the spatial relationship between the lesions and OR according to DTI-FT and QBI-FT was performed. The results indicated that the most prevalent orientations were the FT bundles located laterally and intrinsically in relation to the tumor. Compared with conventional DTI-FT, QBI-FT suggests reliable and more accurate results when correlated to preoperative VFDs and might be preferred for preoperative planning and intraoperative use of nearby lesions, particularly for those with larger volumes. A detailed analysis of localization, surgical approach together with QBI-FT and DTI-FT could reduce postoperative morbidity regarding VFDs. The display of HRFT techniques intraoperatively within the navigation system should be pursued for this issue.

Improving Diagnostic Performance of MRI for Temporal Lobe Epilepsy With Deep Learning-Based Image Reconstruction in Patients With Suspected Focal Epilepsy.

To evaluate the diagnostic performance and image quality of 1.5-mm slice thickness MRI with deep learning-based image reconstruction (1.5-mm MRI + DLR) compared to routine 3-mm slice thickness MRI (routine MRI) and 1.5-mm slice thickness MRI without DLR (1.5-mm MRI without DLR) for evaluating temporal lobe epilepsy (TLE). This retrospective study included 117 MR image sets comprising 1.5-mm MRI + DLR, 1.5-mm MRI without DLR, and routine MRI from 117 consecutive patients (mean age, 41 years; 61 female; 34 patients with TLE and 83 without TLE). Two neuroradiologists evaluated the presence of hippocampal or temporal lobe lesions, volume loss, signal abnormalities, loss of internal structure of the hippocampus, and lesion conspicuity in the temporal lobe. Reference standards for TLE were independently constructed by neurologists using clinical and radiological findings. Subjective image quality, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were analyzed. Performance in diagnosing TLE, lesion findings, and image quality were compared among the three protocols. The pooled sensitivity of 1.5-mm MRI + DLR (91.2%) for diagnosing TLE was higher than that of routine MRI (72.1%, P < 0.001). In the subgroup analysis, 1.5-mm MRI + DLR showed higher sensitivity for hippocampal lesions than routine MRI (92.7% vs. 75.0%, P = 0.001), with improved depiction of hippocampal T2 high signal intensity change (P = 0.016) and loss of internal structure (P < 0.001). However, the pooled specificity of 1.5-mm MRI + DLR (76.5%) was lower than that of routine MRI (89.2%, P = 0.004). Compared with 1.5-mm MRI without DLR, 1.5-mm MRI + DLR resulted in significantly improved pooled accuracy (91.2% vs. 73.1%, P = 0.010), image quality, SNR, and CNR (all, P < 0.001). The use of 1.5-mm MRI + DLR enhanced the performance of MRI in diagnosing TLE, particularly in hippocampal evaluation, because of improved depiction of hippocampal abnormalities and enhanced image quality.

Acute Hemorrhagic Leukoencephalitis with Concurrent Retinal Vasculitis in an Elderly Japanese Patient: A Case Report.

A 68-year-old Japanese man developed a fever, headache, hiccups, and altered consciousness. Brain magnetic resonance imaging (MRI) revealed a hemorrhagic lesion in the right temporal lobe and multiple high-intensity white matter lesions. A brain biopsy showed pathological findings consistent with acute disseminated encephalomyelitis (ADEM), suggesting a diagnosis of acute hemorrhagic leukoencephalitis (AHLE), an aggressive ADEM variant. The patient also developed myodesopsia and was diagnosed with retinal vasculitis, likely due to a hyperimmune state caused by AHLE. Corticosteroids enabled full recovery. Although AHLE is uncommon in elderly individuals, clinicians should be aware of its occurrence in this patient subgroup and recognize potential retinal manifestations associated with AHLE.

Brain magnetic resonance imaging as predictors in pediatric anti-N-methyl-D-aspartate receptor encephalitis

ObjectiveTo investigate the associations between brain magnetic resonance imaging (MRI) changes and clinical profiles in children with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis. MethodsClinical data and brain MRI results of children diagnosed with anti-NMDAR encephalitis in Guangzhou Women and Children's Medical Center from October 2014 to June 2022 were retrospectively studied. ResultsA total of 143 children (Male: female 54:89) were enrolled, with a mean onset age of 6.8 years (6.8 ± 3.1). 40.6 % (58/143) of patients had abnormal initial brain MRI. Lesions in temporal lobe (34.5 %, 20/58) and frontal lobe (25.9 %, 15/58) were relatively common. Children with abnormal initial brain MRI were prone to have fever (P = 0.023), dystonia (P = 0.037), positive MOG antibodies (P = 0.015), higher cerebrospinal fluid (CSF) white blood cell count (WBC) (P = 0.019) and to receive rituximab treatment (P = 0.037). There were no significant differences in modified Rankin Scale (mRS) scores before immunotherapy, after immunotherapy and at last follow-up between the normal initial brain MRI group and abnormal group. No initial brain MRI changes were found to be associated with relapses. Brain MRI was reviewed in 72 patients at last follow-up with a median follow-up time of 25.5 months and 48.6 % (35/72) of patients had abnormal brain MRI. The mRS score of the group with normal brain MRI at last follow-up was significantly lower than that of the abnormal group. ConclusionsAbout 40.0 % of children with anti-NMDAR encephalitis had abnormal initial brain MRI. Initial brain MRI was associated with certain clinical profiles, but not with relapse and prognosis. Around half of patients had abnormal brain MRI at last follow-up and were prone to have higher mRS score.

10119-ACT-9 LONG-TERM USAGE OF TUMOR-TREATING FIELDS THERAPY FOR TREATMENT OF MALIGNANT GLIOMA

Abstract OBJECTIVE Tumor-Treating Fields therapy has been the standard therapy for newly diagnosed glioblastoma since 2018 in Japan. The patients are recommended to use the system for 18 or more hours per day. In practice, some patients could not use it long-term and dropped out from this therapy. We examined factors related to interruption of NovoTTF use. METHODS We reviewed the clinical course of NovoTTF-100A system (NovoTTF) in cases at our hospital from April 2018 to May 2023. We compared the group that continued to use NovoTTF or used it until the disease progressed (Group A) with the group that discontinued it for their own reasons (Group B). RESULTS There were 22 patients, 14 in group A and 8 in group B. The mean preoperative tumor volume was 25.3 cm3 in group A and 38.7 cm3 in group B (p=0.27). The mean number of days of NovoTTF use was 437 in Group A and 27 in Group B (p&amp;lt;0.05). The mean usage rate was 70% in group A and 22% in group B (p&amp;lt;0.05). Tumors were located in 6 frontal lobes, 3 temporal lobes, 3 parietal lobes, 1 basal ganglia, and 1 thalamus in group A, while 1 frontal lobe, 6 temporal lobes, and 1 parietal lobe in group B. Among six temporal lobe cases in group B, five revealed temporal lesions in the dominant hemisphere, causing moderate or severe aphasia before surgery. CONCLUSION The group that continued NovoTTF maintained its usage rate as well as the number of days of use, while the group of cases that discontinued for their own reasons had a low use rate. Five of the eight discontinued cases had temporal lobe lesions in the dominant hemisphere and had aphasia symptoms. Difficulties in understanding the need for NovoTTF may have contributed to the discontinuation.

10126-ACT-10 FACTORS AFFECTING THE PATTERN OF RECURRENCE OF IDH-WILDTYPE GLIOBLASTOMA

Abstract INTRODUCTION IDH-wildtype glioblastoma is a quite poor prognosis disease with which almost all cases recur in spite of postoperative radiation and chemotherapy. Survival rates are particularly low after dissemination. METHODS We included 120 patients with IDH-wild type glioblastoma treated at our hospital from January 2015 to December 2019. Patient backgrounds, MGMT promotor methylation status, imaging findings, and recurrence patterns were analyzed. Subependymal, subarachnoid, and spinal dissemination, plus distant metastasis, were defined as non-local recurrence. RESULTS Of 105 patients with a single lesion at diagnosis, 65 had local recurrence and 15 had non-local recurrence. 36 of 65 patients had local recurrence and 12 had non-local recurrence in the second recurrence. 17 of 36 patients had local recurrence and 8 had non-local recurrence in the third recurrence. The cumulative number of non-local recurrences was 54 (45.0%). Surgical ventricular opening and tumor proximity to the ventricles were associated with non-local recurrence (p=0.006, p=0.019). The patients with tumor proximity to the ventricle had non-local recurrence at the first recurrence and those with non-proximity to the ventricle had non-local recurrence at the second or later recurrence (p=0.038). MGMT promotor methylation status and postoperative ischemia were not significantly different from non-local recurrence (p=0.122, p=0.088), but MGMT promotor unmethylation was a risk factor for early non-local recurrence, especially within 1 year (p=0.033). Frontal lobe lesions were less frequently disseminated and more frequently MGMT promotor methylated (p=0.032, p=0.024). Parietal lobe lesions had more MGMT promotor methylation (p=0.006), and temporal lobe lesions had more dissemination (p=0.023). Distant metastasis commonly occurred from the frontal lobe to the ipsilateral or contralateral, and the frontal lobe was frequently associated. CONCLUSION IDH-wildtype glioblastoma is characterized by repeated local recurrence and cumulative non-local recurrence. The pattern of recurrence differs depending on the tumor localization, especially adjacent to ventricle, and MGMT promotor methylation status.