Ventricle Width Research Articles

MORPHOLOGICAL AND PERFUSION PREDICTORS OF DISTANT CEREBRAL DISORDERS IN CARDIAC SURGERY PATIENTS

Aim. To assess the preoperative morphological state of the brain and the state of cerebral circulation in patients referred for coronary bypass surgery to identify predictors of long-term cerebral disorders.Material and Methods. The study included 33 male patients, divided into 2 groups according to the presence or the absence of distant neurological complications 5 years after surgery. All patients underwent non-contrast computed tomography of the brain and perfusion computed tomography. Computed tomography was repeated 5 years after surgery.Results. The perfusion indices in all measurement zones in patients of the two groups did not significantly differ. Significant differences in width of the third ventricle and ventricular-cranial index between patients of groups 1 and 2 were not identified. The incidence rates of leukoaraiosis significantly differed: leukoaraiosis was detected significantly more frequently in group 2 (78% of cases) than in patients of group 1 (31%), p=0.0455.Discussion. The dimensions of the brain cavity system and the preoperative state of the microcirculatory blood flow were not predictors of long-term postoperative neurological disorders. Five years after surgery, patients of group 2 showed clinical and morphological signs of past ischemic changes, which were not detected in patients of group 1 suggesting that leukoaraiosis was an unfavorable prognostic indicator of postoperative cerebrovascular disorders in the long-term period.Conclusion. When referring a patient with the presence of morphological manifestations of cerebral microangiopathy in the form of the leukoaraiosis phenomenon for cardiac surgery, these patients should be considered at risk requiring administration of the necessary set of measures for the prevention of long-term cerebral disorders.

MORPHOLOGICAL AND PERFUSION PREDICTORS OF DISTANT CEREBRAL DISORDERS IN CARDIAC SURGERY PATIENTS

Aim. To assess the preoperative morphological state of the brain and the state of cerebral circulation in patients referred for coronary bypass surgery to identify predictors of long-term cerebral disorders.Material and Methods. The study included 33 male patients, divided into 2 groups according to the presence or the absence of distant neurological complications 5 years after surgery. All patients underwent non-contrast computed tomography of the brain and perfusion computed tomography. Computed tomography was repeated 5 years after surgery.Results. The perfusion indices in all measurement zones in patients of the two groups did not significantly differ. Significant differences in width of the third ventricle and ventricular-cranial index between patients of groups 1 and 2 were not identified. The incidence rates of leukoaraiosis significantly differed: leukoaraiosis was detected significantly more frequently in group 2 (78% of cases) than in patients of group 1 (31%), p=0.0455.Discussion. The dimensions of the brain cavity system and the preoperative state of the microcirculatory blood flow were not predictors of long-term postoperative neurological disorders. Five years after surgery, patients of group 2 showed clinical and morphological signs of past ischemic changes, which were not detected in patients of group 1 suggesting that leukoaraiosis was an unfavorable prognostic indicator of postoperative cerebrovascular disorders in the long-term period.Conclusion. When referring a patient with the presence of morphological manifestations of cerebral microangiopathy in the form of the leukoaraiosis phenomenon for cardiac surgery, these patients should be considered at risk requiring administration of the necessary set of measures for the prevention of long-term cerebral disorders.

Postoperative Confusion in Patients with Parkinson Disease Undergoing Deep Brain Stimulation of the Subthalamic Nucleus

Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is an established treatment for patients with Parkinson disease. One adverse event is the development of postoperative confusion. The aim of this study was to report the incidence and associated factors of postoperative confusion after STN DBS surgery. This was a retrospective cohort study by chart review of patients with Parkinson disease who underwent STN DBS in a Brazilian public academic hospital from January 2013 to October 2017. The primary outcome was the incidence of postoperative confusion. The association of the outcome and imaging and clinical variables was evaluated. Among 49 patients who underwent STN DBS for Parkinson disease, the incidence of postoperative confusion was 26.5% (95% confidence interval 15%-41.1%). Univariate analysis identified the following variables associated with development of confusion: age (63.2 ± 7.8 years vs. 55.4 ± 9.1 years, P= 0.009), disease duration (16.5 ± 5.1 years vs. 13.2 ± 4.2 years, P= 0.027), Charlson comorbidity index (2 [interquartile range 1-3] vs. 1 [0-1 interquartile range], P= 0.002), width of the third ventricle (5.4 ± 2.1 mm vs. 4 ± 1.6 mm, P= 0.018), and cella media index (5 ± 1 vs. 5.6 ± 0.8, P= 0.018). After adjustment, Charlson comorbidity index remained significant (adjusted relative risk 1.64, 95% confidence interval 1.17-2.3, P= 0.004). The incidence of postoperative confusion in this cohort was 26.5%. After analysis of confounding factors, the Charlson comorbidity index was significantly associated with postoperative confusion.

МАЛОИНВАЗИВНАЯ ТЕХНИКА ЭНДОСКОПИЧЕСКОЙ ВЕНТРИКУЛОЦИСТЕРНОСТОМИИ ДНА III ЖЕЛУДОЧКА У ДЕТЕЙ С ОККЛЮЗИОННОЙ ГИДРОЦЕФАЛИЕЙ

Objective: To introduce into clinical practice a new minimally invasive technique of endoscopic third ventriculocisternostomy (ETV) in children with occlusive hydrocephalus with using a semi-rigid needle-shaped miniature neuroendoscope. Methods: Reviewed 131 cases (73 boys, 58 girls) occlusive hydrocephalus of various genesis in children aged 1 month to 5 years, which was performed by ETV proposed by the first author of the methodology. The period of observation of children after treatment was 24.2±3.8 months. Results: Applying a minimally invasive technique of ETV with using a semi-rigid needle-shaped miniature neuroendoscope which significantly reduced the length of the soft tissue incision in the access areas, and the use of a more advanced toolkit – to reduce the size of the twist drill hole in the skull by more than 2 times. Access to the lateral ventricle is done by means of blunt trephination of the dura without the need for significant corticectomy or coagulation and is accompanied by minimal damage to the parencima of the brain. This is very important, given the operation in children with occlusive hydrocephalus, in whom the brain is already damaged by organic changes. Constant endoscopic control when accessing the lateral ventricle increases safety and reduces the risk of damage to vascular and nerve structures. It can be performed in cases of pathologies affecting the anatomical relationships of the lateral and third ventricle such as severe narrowing or complete occlusion of the interpeduncular cistern, narrow (slit) ventricles of the brain (width of the third ventricle is less than 8 mm in the anterior sections), narrow foramen of Monro, anteroposterior size of prepontine cistern less than 6 mm. Lethal outcomes was not, and the effectiveness of surgical treatment was 77%. Postoperative neurological, endocrine and infectious complications have not been observed Conclusion: A minimally invasive technique of performing ETV using a semi-rigid needle-shaped miniature neuroendoscope is an effective and safe method of surgical treatment occlusive hydrocephalus, which minimizes surgical trauma at all stages, reduces intra- and postoperative complications and can be recommended for widespread clinical use. Keywords: Endoscopic ventriculostomy , obstructive hydrocephalus, semi-rigid needle-shaped miniature neuroendoscope, stenosis of cerebral aqueduct, floor of the third ventricle, basal cisterns.

Relationship between stroke severity, extensity of leukoaraiosis, and brain atrophy in patients with ischaemic stroke.

PurposeLeukoaraiosis (LA), according to the latest classification, is white matter hyperintensity – morphological findings of small blood vessel disease of the brain. This radiological detection of small vessels disease is important because there are no technical possibilities to assess small vessels of the brain using computed tomography (CT) or magnetic resonance imaging (MRI) angiography. Our aim was to analysis the relationship between the extension of leukoaraiosis and severity of ischaemic stroke and brain atrophy.Material and methodsWe retrospectively analysed 77 head CT scans of patients admitted from the emergency room (ER) to the Radiology Department due to suspected stroke. We assessed the severity of leukoaraiosis using the van Swieten scale and brain atrophy by numerous linear measurements.ResultsStatistical analysis failed to demonstrate differences between LA1 and LA2 groups with regard to stroke severity in National Institutes of Health Stroke Scale (NIHSS) (p = 0.2159). There were no differences with regard to clinical severity of stroke between the study groups divided depending on the extent of brain atrophy. There were statistically significant differences with regard to the anterior horn width of the right and left lateral ventricle, posterior horn width of the right and left lateral ventricle, distance between occipital horn of the left lateral ventricle and internal surface of the cranium and third ventricle width depending on the severity of leukoaraiosis.ConclusionsThe results of our studies present an association between the degree leukoaraiosis extension and brain atrophy, but no association between central nervous system tissue atrophy of extent of leukoaraiosis and ischaemic stroke severity.

A Comprehensive Clinical Decision Support Application Software tool for estimate of the Fourth Ventricle volume using Brain Computed Tomography scan for Clinical Application

The physiology and anatomy of the ventricular system has become an area of research for clinicians in neuropsychiatry to help manage neurologic diseases as well as other diseases such as chronic alcoholism. The objective of this study is to develop an easy and user-friendly graphical user interface for calculating fourth ventricle volume. Materials used were Minitab statistical tool and MeVisLab modelling tool. The methodology involved the use of MeVisLab measurements tool to measure the linear and volume dimensions using Voxel Count Method. Whilst the modeling was done with Minitab statistical tool to model the relationship between the linear and volume measurements. Minitab statistical modeling tool and the written code was done with python programming language. Minitab statistical software was used to model the relationship between the fourth Ventricle Volume and the product of fourth ventricle length (VL), fourth ventricle width (VW) and fourth ventricle thickness (VT). Ten model equations were developed; five each for males and females for the age group (21-30, 31-40, 41-50, 51-60 and 61-70). A comprehensive decision support application software tool has been developed for easy, accurate and user-friendly GUI as part of diagnostic procedure for the calculation of volume of fourth ventricle to aid neurological diagnosis in clinical practice. These would help neurosurgeons in their diagnosis, localization and surgical removal of tumors and lesions (craniopharyngiomas and gliomas) surrounding the ventricular system.

Morphometric analysis of lateral and third ventricles by computerized tomography for early diagnosis of hydrocephalus

IntroductionBrain ventricles are dilated with accumulation of excess cerebrospinal fluid in it, which can cause the pressure damage to the surrounding structures. This study aims to highlight the reference range values for lateral and third ventricles of brain for easy diagnosis and management of hydrocephalic patients. Material and methodsWe calculated the frontal horn ratio(FHR), bi- caudate ratio(BCR), Evan’s ratio(ER), cella media ratio(CMR), bi-frontal index(BFI), bi- occipital index(BOI), third ventricle width(TVW), third ventricle sylvian fissure ratio index (TSFI), and third ventricle ratio (TVR) in 120 apparently normal CT-Head images and forty hydrocephalic images by taking linear measurements withdicom image software. Descriptive statistics –mean, standard deviation, standard error, 95% confidence interval were calculated for each parameter. Independent student t- test, age regression analysis, and Spearman’s rank correlation coefficient were applied accordingly. ResultsBCR, ER, TSFI showed significant correlation with the age and anteroposterior diameter of brain. BCR and TVW were significantly higher in males. In normal images, 95% confidence limits for FHR [0.295-0.309], TVW [6.104–6.92], TSFI [0.538–0.558] were found. The mean FHR and TVR in hydrocephalic patients were 0.42 and 0.072. DiscussionSince Frontal horn ratio and Third ventricle ratio do not depend upon the age, sex and size of brain, these two parameters can be used as the screening and monitoring tools in patients with hydrocephalus.

Meta analysis of fetal lateral ventriculomegaly and prognosis

Objective: To explore the neurological development of fetal with ventriculomegaly at 1 year after birth by systematically reviewing the domestic and international literature about prognosis of fetal ventriculomegaly. Methods: Wanfang database, CNKI, CBM, PubMed, EMBASE and the Cochrane Library were online searched to collect relevant literature published from January 1st, 1980 to November 22th, 2017. Literature were extracted based on the Newcastle-Ottawa Scale (NOS) , and analyzed by R software for meta-analysis. The corresponding model was selected according to the results of heterogeneity test to comprehensively analyze the prognosis of the fetus with ventriculomegaly. Results: Five studies were included in the meta analysis, all of them were of high quality (scores>5) . (1) The good prognosis rate of nervous system was 88% (95%CI:0.77-0.95) in fetus with mild ventriculomegaly, was 57% (95%CI:0.18-0.91) in those with moderate ventriculomegaly, and was 36% (95%CI:0.16-0.59) in those with severe ventriculomegaly. (2) The good prognosis rate of the nervous system was 86% (95%CI:0.75-0.94) in fetus with the isolated ventriculomegaly, while was 58% (95%CI:0.20-0.91) in those with non-isolated ventriculomegaly. The incidence of chromosomal abnormalities was 7% (95%CI:0.05-0.09) in ventriculomegaly. The improvement rate of lateral ventricle width in pregnancy was 41% (95%CI:0.27-0.57) . Conclusions: The prognosis of nervous system with mild ventriculomegaly is better than that of moderate and severe ventriculomegaly. The prognosis of nervous system with isolated ventriculomegaly is better than that of non-isolated ventriculomegaly. Fetal ventriculomegaly may be associated with fetal chromosomal abnormalities and intrauterine infection. The variation of fetal lateral ventricular width should be monitored regularly during pregnancy, the risk of poor prognosis should be informed, and pediatrician should be asked for evaluation.

Prenatal Sonographic Head Circumference and Cerebral Ventricle Width Measurements Before and After Open Fetal Myelomeningocele Repair - Prediction of Shunting During the First Year of Life.

The aim of this study was to describe the sonographic evolution of fetal head circumference (HC) and width of the posterior horn of the lateral ventricle (Vp) after open fetal myelomeningocele (fMMC) repair and to assess whether pre- or postoperative measurements are helpful to predict the need for shunting during the first year of life. All 30 children older than one year by January 2017 who previously had fMMC repair at the Zurich Center for Fetal Diagnosis and Therapy were included. Sonographic evolution of fetal HC and Vp before and after fMMC repair was assessed and compared between the non-shunted (N = 16) and the shunted group (N = 14). ROC curves were generated for the fetal HC Z-score and Vp in order to show their predictive accuracy for the need for shunting until 1year of age. HC was not an independent factor for predicting shunting. However, the need for shunting was directly dependent on the preoperative Vp as well as the Vp before delivery. A Vp > 10 mm at evaluation for fMMC repair or > 15 mm before delivery identifies 100 % of the infants needing shunt placement at a false-positive rate of 44 % and 25 %, respectively. All fetuses with a Vp > 15 mm at first evaluation received a shunt. Fetuses demonstrating a Vp of > 15 mm before in utero MMC repair are extremely likely to develop hydrocephalus requiring a shunt during the first year of life. This compelling piece of evidence must be appropriately integrated into prenatal counseling.

The width of the third ventricle associates with cognition and behaviour in motor neuron disease.

An enlarged width of the third ventricle (WTV) has been described in amyotrophic lateral sclerosis (ALS) patients, although its clinical meaning is unknown. The aims of this study were to evaluate the contribution of demographical, clinical and genetic factors to the WTV in different motor neuron disease (MND) phenotypes and to assess its brain structural correlates. The WTV was measured by transcranial ultrasound in 107 MND patients (82 diagnosed with classical ALS, 16 with progressive muscular atrophy and 9 with primary lateral sclerosis) and 25 controls. Genetic analysis, and neurological and neuropsychological examinations were performed in patients. Brain volumetric analysis of MR images was obtained in 85 patients. The association of WTV with demographical, clinical, genetic and neuropsychological variables as well as with brain volumes was assessed by multivariable models. Eighteen patients were diagnosed with genetic MND and 42.3% of patients showed executive or behavioural impairment (EBI). MND patients showed larger WTV than controls. The WTV was significantly associated with age, spinal onset and the presence of EBI, but not with the genetic background, the phenotype or disability. Greater WTV was also associated with reduced subcortical grey matter volume, but not with the cortical or the white matter volume. The enlargement of the WTV found in the different MND phenotypes is attributable to the subcortical grey matter atrophy and is associated with cognitive and behavioural impairment. Larger longitudinal studies are needed to determine its role as biomarker in MND patients with frontotemporal dementia.

Prenatal echocardiography diagnosis of Ebstein’s anomaly at 11-14 weeks of gestation: the first results of multicenter study

Retrospectively, as a result of fetus’ ultrasound screening at 11–14 weeks of gestation, 30 cases of diagnosis of Ebstein’s anomaly (EA) were analyzed. Among these cases — 8 were detected and 22 non-detected. The resulting quality of prenatal ultrasound diagnosis of EA at 11–14 weeks of gestation is equal to 26,7 %. The average value of nuchal translucency thickness among the all group of 30 fetuses is equal to 2,97 mm. Only in 6 cases (20 %) this marker exceeds 3 mm, including 3 cases of cystic hygroma. In most cases nasal bone was detected and was estimated as “+”. The heart rate was normal, the cardiac arrhythmia was not detected. EA diagnosis in early pregnancy was based on searching the clinical features of fetus’ 4-chamber cardiac view: cardiac axis deviation to the left, right atrium extension, tricuspid valve displacement, and expressed tricuspid regurgitation. These features were diagnosed in all 8 cases. Combined extracardiac pathology was presented in 3 cases as cystic hygroma, that equals 9,6 %. In one case chromosomal pathology was detected (trisomy 21), but only in 7 cases the fetus’ karyotype was defined. Among the combined congenital heart disease, detected in more than the half of the cases of the late diagnosis, the obstructive lesions of pulmonary artery (PA) have the prevalence. The estimations, we made, of cardiothoracic index calculation, as a marker of cardiomegaly at EA at 11–14 weeks of gestation, were ineffective. More value for diagnosis of disproportion cardiac chambers had the ratio of right ventricle width to left ventricle width, in that cases in which that ratio increases 1,5 (62,5 % cases). Cardiac axis left deviation was detected in 87,5 % cases, the average deviation was 83°. The average index Celermajer was equal to 1,08 and in the 50% of cases was combined with high risks of infant mortality.

A new MR imaging index for differentiation of progressive supranuclear palsy-parkinsonism from Parkinson's disease

IntroductionDifferentiating clinically progressive supranuclear palsy-parkinsonism (PSP-P) from Parkinson's disease (PD) may be challenging, especially in the absence of vertical supranuclear gaze palsy (VSGP). The Magnetic Resonance Parkinsonism Index (MRPI) has been reported to accurately distinguish between PSP and PD, yet few data exist on the usefulness of this biomarker for the differentiation of PSP-P from PD. MethodsThirty-four patients with PSP-P, 46 with PSP-Richardson's syndrome (PSP-RS), 53 with PD, and 53 controls were enrolled. New consensus criteria for the clinical diagnosis of PSP were used as the reference standard. The MRPI, and a new index termed MRPI 2.0 including the measurement of the third ventricle width (MRPI multiplied by third ventricle width/frontal horns width ratio), were calculated on T1-weighted MR images. ResultsThe MRPI differentiated patients with PSP-P from those with PD with sensitivity and specificity of 73.5% and 98.1%, respectively, while the MRPI 2.0 showed higher sensitivity (100%) and similar specificity (94.3%) in differentiating between these two groups. Both biomarkers showed excellent performance in differentiating PSP-P patients with VSGP from those with PD, but the MRPI 2.0 was much more accurate (95.8%) than MRPI in differentiating PSP-P patients with slowness of vertical saccades from PD patients. ConclusionThe MRPI 2.0 accurately differentiated PSP-P patients from those with PD. This new index was more powerful than MRPI in differentiating PSP patients in the early stage of the disease with slowness of vertical saccades from patients with PD, thus helping clinicians to consolidate the diagnosis based on clinical features, in vivo.

Clinical significance and prognosis of asymmetric ventricles in fetuses

Objective To investigate the clinical significance and prognosis of ultrasound-identified asymmetric ventricles in fetuses, and to provide evidences for clinical consultation and management. Methods From January 2014 to May 2017, 142 singleton fetuses were enrolled who were diagnosed with asymmetric ventricles through prenatal ultrasound in Peking University First Hospital and successfully followed up after birth. Asymmetric ventricles included simple lateral ventricular asymmetry [lateral ventricular widths were normal (<10 mm) but with a difference of ≥2 mm between the two lateral ventricles and unilateral ventricular widening (only one lateral ventricle was ≥10 mm in width and the other was <10 mm). All 142 fetuses were divided into two groups according to whether they had other abnormalities (including abnormal ultrasound soft markers and structural abnormalities) or not. Clinical and imaging data of them were analyzed retrospectively. They were followed up for at least six months after birth. Neurological development regarding language, behavior and motor was evaluated using Denver Developmental Screening Test. Results There were 109 cases without other abnormalities and among them, 38 (35%) spontaneously recovered in utero, two (2%) became worse, and 69 (63%) remained unchanged. Thirty-one of the 109 cases received fetal cranial MRI and abnormal brain development was found in only one case. No abnormal findings were reported in karyotyping in 38 cases and viral detection in 31 cases. One hundred and five fetuses were successfully delivered and four were induced including two cases for wider in unilateral lateral ventricle, one of continued widening, and one with abnormal brain development suggested by fetal cranial MRI. Among the 33 cases with other abnormalities, two were spontaneously recovered in utero, one became worse , 15 unchanged and 15 were induced. Of the 20 cases underwent chromosomal examination, one unbalanced chromosome translocation was identified. Twelve fetuses underwent cranial MRI among which two were found abnormal (periventricular cyst and brain asymmetry). Sixteen cases were aborted including 15 with major abnormalities (major deformity or absence of extremities) and one with mild abnormality (abnormal ultrasound soft markers with progression in lateral ventricular width ≥15 mm in in-utero follow-up). Seventeen cases were born including 16 with mild abnormalities and one with severe abnormality (unilateral renal cystic disease without chromosome abnormality). No significant developmental abnormality in language, behavior and motor was reported during follow-up. Conclusions Asymmetric ventricles have no significant impact on fetal growth and postnatal development. The prognosis of asymmetric ventricles mainly depends on the width of lateral ventricles in utero and concomitant abnormalities. Therefore, close attention should be paid on monitoring and follow-up. Key words: Hydrocephalus; Lateral ventricles; Ultrasonography, prenatal; Prognosis

Preliminary Results of Emergency Computed Tomography–Guided Ventricular Drain Placement—Precision for the Most Difficult Cases

External ventricular drainage (EVD) catheter placement is one of the most commonly performed neurosurgical procedures. The study's objective was to compare a computed tomography (CT) bolt scan-guided approach for the placement of EVDs with conventional landmark-based insertion. In this retrospective case-control study, we analyzed patients undergoing bolt-kit EVD catheter placement, either CT-guided or landmark-based, between 2013 and 2016. The CT bolt scan-guided approach was based on a dose-reduced CT scan after bolt fixation with immediate image reconstruction along the axis of the bolt to evaluate the putative insertion axis. If needed, angulation of the bolt was corrected and the procedure repeated before the catheter was inserted. Primary endpoint was the accuracy of insertion. Secondary endpoints were the overall number of attempts, duration of intervention, complication rates, and cumulative radiation dose. In total, 34 patients were included in the final analysis. In the group undergoing CT-guided placement, the average ventricle width was significantly smaller (P=0.04) and average midline shift significantly more pronounced (P= 0.01). CT-guided placement resulted in correct positioning of the catheter in the ipsilateral frontal horn in all 100% of the cases compared with landmark-guided insertion (63%; P= 0.01). Application of the CT-guided approach increased the number of total CT scans (3.6 ± 1.9) and the overall radiation dose (3.34 ± 1.61 mSv) compared with the freehand insertion group (1.84 ± 2.0 mSv and 1.55 ± 1.66 mSv). No differences were found for the other secondary outcome parameters. CT-guided bolt-kit EVD catheter placement is feasible and accurate in the most difficult cases.

Paradigm-shift: radiological changes in the asymptomatic iNPH-patient to be: an observational study

BackgroundMany radiological signs are known for the diagnosis of idiopathic normal pressure hydrocephalus (iNPH). However, there is little information about these signs in the pre-symptomatic phase. For pathophysiological investigative purposes we conducted a descriptive image analysis study on pre-symptomatic patients.MethodsPatients that had contact with either the neurological or neurosurgical department of the university hospital Tuebingen from 2010 through 2016 with magnetic resonance images > 3 years before onset of symptoms, were included. The date of onset and severity of symptoms, date of first imaging and birth date were recorded. Evan’s index (EI), width of the third ventricle (3VW), tight high convexity (THC), Sylvian fissure, extent of white matter hyperintensities and aqueductal flow were assessed in images before and around symptom onset.ResultsTen patients were included. In all ten patients the first symptom was gait disturbance. Nine of ten pre-symptomatic images showed classic signs for iNPH. EI showed a significant increase between the pre-symptomatic and symptomatic phase. 3VW showed a trend for increase without significance. THC changed back and forth over time within some patients.ConclusionsIn accordance with the scarce literature available, radiological changes are present at least 3 years before onset of iNPH-symptoms. EI seems to be a robust measure for pre-symptomatic radiological changes. Extrapolating the data, the development of iNPH typical changes might be an insidious process and the development of THC might be a variable and non-linear process. Further studies with larger sample sizes are necessary to put these findings into the pathophysiological perspective for the development of iNPH.

Structural MRI correlates of cognitive function in multiple sclerosis

BackgroundCognitive impairment (CI) has been associated with numerous magnetic resonance imaging (MRI) indices in multiple sclerosis (MS) patients. In this study we investigated the association of a large set of 2D and 3D MRI markers with cognitive function in MS. MethodsA sample of 61 RRMS patients (mean age 41.8 ± 10.6 years old, 44 women, mean disease duration 137.9 ± 83.9 months) along with 51 age and gender matched healthy controls was used in this cross-sectional study. Neuropsychological and other tests, along with a large set of 2D/3D MRI evaluations were made. Results44.3% of patients had CI. CI patients had more disability, physical fatigue than non-CI patients and more psychological distress than non-CI patients and HCs. Also, CI patients had significantly larger third ventricle width and volume, smaller coprus callosum index and larger lesion volume than non-CI patients. These MRI markers also significantly predicted cognitive scores after adjusting for age and education, explaining about 30.6% of the variance of the total cognitive score. ConclusionsSelected linear and volumetric MRI indices predict cognitive function in MS. Future studies should expand these results by exploring longitudinal changes and producing normative data.

Hyperechogenicity of Lenticular Nuclei in Primary Cervical Dystonia

Dystonia is one of the most common movement disorders, but the pathogenesis of primary dystonia is not fully understood. One of the proposed pathomechanisms is the deficiency or dysfunction of ATP-dependent Menkes protein responsible for the extracellular transport of copper within subcortical nuclei, the lack of which could lead to increased accumulation of copper in the lenticular nucleus (LN). In 1995, Naumann et al. performed transcranial sonography (TCS) on patients with dystonia for the first time. Other researchers confirmed more frequent occurrence of hyperechogenic LN more than 70% patients with cervical dystonia. The aim of our study was therefore to evaluate the prevalence of hyperechogenic changes in lenticular nucleus of the brain in patients with cervical dystonia. 108 patients were considered eligible for inclusion; 42 of them were subsequently excluded due to occurrence of exclusion criteria. Thus, the study involved 66 patients and 71 controls. Hyperechogenicity of the lenticular nucleus was found more often in patients with cervical dystonia than in controls (p<0.0001). It was unilateral in majority of patients (75.8%). The average surface area of hyperechogenic changes is bigger in dystonic patients compare with control group 0,05 (± 0,10) vs 0,005 (± 0,02) on the left side and 0,10 (± 0,12) vs. 0.004 (± 0.02) on the right side. Hyperechogenicity of lenticular nuclei were observed in the case of 8 patients (11.2%) within the control group and they were unilateral changes. Substantia nigra hyperechogenicity did not differ between the two groups. We did not find a correlation between the size of the observed changes and dystonia severity or duration of the disease. The only correlation was the association between the width of the third ventricle and age of patients. We suggest that the hyperechogenic changes within the lenticular nuclei are prevalent in patient with primary cervical dystonia and are an important diagnostic clue.

Speckle Tracking in Transcranial Ultrasound Allows Noninvasive Analysis of Pulsation Patterns of the Third Ventricle.

Cerebrospinal fluid (CSF) flow is sensitive to many cerebral disorders. We aimed to develop a noninvasive bedside method to detect physiological and pathological CSF phenomena by measuring pulsation patterns of the third ventricle. By transcranial B-mode ultrasound, electrocardiography (ECG)-gated video loops of the third ventricle were acquired. "Speckle tracking" software was used to quantify the relative change of its width. We conducted measurements of nine cardiac cycles in 11 healthy subjects in sitting and in supine position during Valsalva maneuver to investigate the influence of an increased intracranial pressure on the relative deformation of the third ventricle. In one patient with occlusive hydrocephalus, 19 cardiac cycles were measured in sitting position before and after removal of a tumorous obstruction of the aqueduct of Sylvius. Healthy subjects expressed a pulse-related increased width of the third ventricle ([Formula: see text]: +5.69, 95% confidence interval [CI] = [4.38, 7.00]). No significant difference was found between the sitting and the supine position in healthy adults. In the preoperative state of occlusive hydrocephalus, we found a negative, pulse-related deformation ([Formula: see text]: -1.86, 95% CI = [-2.15, -1.58]) with delayed onset. After surgery, the deformation pattern resembled that of our healthy controls. The difference between pre- and postoperative condition was significant (p < 0.001). Transcranial B-mode sonography can be used to record small movements of the sidewalls of the third ventricle. This noninvasive bedside method is suitable to assess CSF pulsatility within the third ventricle and might be able to distinguish between physiological and pathological flows.

Early elective delivery for fetal ventriculomegaly: are neurosurgical and medical complications mitigated by this practice?

Antenatally diagnosed ventriculomegaly (VM) requires the balance of risks of neurological injury with premature delivery. The purpose of this study was to evaluate outcomes related to early elective delivery due to fetal VM at our institution. We retrospectively assessed 120 babies (2008-2012) with antenatally diagnosed fetal VM. Inclusion criteria for ("early") cohort were (1) elective delivery occurred for expedited neurosurgical intervention between 32 and 36weeks EGA and (2) fetal VM noted on official antenatal ultrasound. The comparative "near term" cohort differed only in that delivery occurred at 37+ weeks EGA. Statistical significance for comparative analyses set a priori at p < 0.05. Babies electively delivered early had a lower birthweight (p < 0.0001), greater ventricle width (p < 0.0001), and underwent initial CSF diversion sooner (p = 0.014). The early cohort (n = 22), compared to near term (n = 50), had a lower birthweight (p < 0.0001), greater ventricle width (p < 0.0001), and underwent initial CSF diversion sooner (p = 0.014). The early cohort required more repeat procedures: (45 vs. 22% p = 0.021), and VPS removals after VPS infections (41 vs. 12%, p = 0.010). Additionally, newborn respiratory failure (32 vs. 6%, p = 0.037) was more common. Finally, of four babies who died in the early cohort, 2/4 died for prematurity-associated pulmonary hypoplasia. While early elective delivery for fetal VM expedites intervention for rapidly expanding ventricles, few benefits were identified. Our study concluded those infants that were delivered earlier had increased VPS infections, repeat neurosurgical procedures, and medical co-morbidities. A multi-institutional prospective observational study would be needed in order to confirm the clinical implications of such practice.

Quantitative transcranial sonography in Wilson's disease and healthy controls: Cut-off values and functional correlates

To compare transcranial sonography (TCS) findings in patients with predominantly neurological Wilson's disease (WD) to those from controls, and to correlate TCS data with the clinical profile of WD. Patients with WD (n=40/f=18) and healthy, matched controls (n=49/f=20) were assessed in terms of TCS, serum copper and iron parameters, and clinical scales, such as the Unified Wilson's Disease Rating Scale (UWDRS), Addenbrooke's Cognitive Examination–Revised (ACE-R), Mini Mental State Examination (MMSE), and Beck Depression Inventory. Lenticular nuclei and substantia nigra echogenic area cut-off values clearly differentiated WD patients from controls (area under the curve: 95.4% and 79.4%). Substantia nigra echogenic area was significantly larger in male than in female patients (p=0.001). Compared with controls, patients showed hyperechogenicity also in thalami and midbrain tegmentum/tectum; third ventricle width was increased and midbrain axial area was reduced. In the WD group, male gender correlated with substantia nigra echogenic area (r=0.515, p=0.0007) and serum ferritin levels (r=0.479, p=0.002); lenticular nuclei hyperechogenicity correlated with dystonia (r=0.326, p=0.04) and dysarthria (r=0.334, p=0.035); third ventricle width correlated with dystonia (r=0.439 p=0.005), dysarthria (r=0.449, p=0.004), parkinsonism (r=0.527, p<0.001), UWDRS neurological and total scores (both r=0.504, p=0.0009), MMSE (r=−0.496, p=0.001), and ACE-R (r=−0.534, p=0.0004). Lenticular nuclei echogenic area allowed highly accurate discrimination between patients and controls. The gender differences in substantia nigra echogenicity and iron metabolism are of interest in further studies in WD. TCS reflects different dimensions of WD pathology clearly differentiable from healthy controls and correlating with various clinical characteristics of WD.