Effects of chicken essence tablets on resting metabolic rate

Resting energy expenditure (REE) values after consuming chicken essence tablets were significantly higher than those observed after consuming skim milk protein tablets (control trial). The increased thermogenic effects continued at least for a period of one hour and gradually decreased towards the baseline. The REE values during control treatment did not show such an augmented response.

Pretreatment ADC Histogram Analysis as a Prognostic Imaging Biomarker for Patients with Recurrent Glioblastoma Treated with Bevacizumab: A Systematic Review and Meta-analysis

BACKGROUND

The mean ADC value of the lower Gaussian curve (ADC_L) derived from the bi-Gaussian curve-fitting histogram analysis has been reported as a predictive/prognostic imaging biomarker in patients with recurrent glioblastoma treated with bevacizumab; however, its systematic summary has been lacking.

PURPOSE

We applied a systematic review and meta-analysis to investigate the predictive/prognostic performance of ADC_L in patients with recurrent glioblastoma treated with bevacizumab.

DATA SOURCES

We performed a literature search using PubMed, Scopus, and EMBASE.

STUDY SELECTION

A total of 1344 abstracts were screened, of which 83 articles were considered potentially relevant. Data were finally extracted from 6 studies including 578 patients.

DATA ANALYSIS

Forest plots were generated to illustrate the hazard ratios of overall survival and progression-free survival. The heterogeneity across the studies was assessed using the Cochrane Q test and I² values.

DATA SYNTHESIS

The pooled hazard ratios for overall survival and progression-free survival in patients with an ADC_L lower than the cutoff values were 1.89 (95% CI, 1.53-2.31) and 1.98 (95% CI, 1.54-2.55) with low heterogeneity among the studies. Subgroup analysis of the bevacizumab-free cohort showed a pooled hazard ratio for overall survival of 1.20 (95% CI, 1.08-1.34) with low heterogeneity.

LIMITATIONS

The conclusions are limited by the difference in the definition of recurrence among the included studies.

CONCLUSIONS

This systematic review with meta-analysis supports the prognostic value of ADC_L in patients with recurrent glioblastoma treated with bevacizumab, with a low ADC_L demonstrating decreased overall survival and progression-free survival. On the other hand, the predictive role of ADC_L for bevacizumab treatment was not confirmed.

Effects of acute exercise on visual reaction time

We examined the effects of acute exercise on reaction time to visual stimuli presented in the central portion and periphery of the visual field. Twelve participants performed reaction time tasks at rest and during cycling at 65 % peak oxygen uptake in two visual conditions. We used circular black-and-white checkerboard patterns as visual stimuli. The participants were asked to respond as quickly as possible to pattern reversal of the visual stimulus by releasing a response button. Reaction time was fractionated into Premotor time and Motor time. Premotor time in the peripheral condition significantly increased (p < 0.025) during exercise (mean +/- SE; 195.9 +/- 7.9 ms) from that at rest (183.7 +/- 6.8 ms). Premotor time in the central condition did not differ between at rest (185.3 +/- 7.6 ms) and during exercise (188.4 +/- 6.6 ms). These data suggest that the ability to respond to visual stimuli presented in the periphery of the visual field is vulnerable to moderate to severe exercise, as compared with the ability to respond to visual stimuli presented in the central portion of the visual field. An exercise-induced increase in arousal level and a consequent narrowing of attentional focus would explain the present results.

Adiponectin gene single-nucleotide polymorphisms and treatment response to obesity

BACKGROUND

In the adiponectin gene polymorphisms, single-nucleotide polymorphism (SNP)-45 and SNP276 have reportedly been associated with obesity, Type 2 diabetes, and other features of metabolic syndrome.

AIM

Whether these adiponectin SNP affect obesity-related parameters during caloric restriction in obese subjects.

SUBJECTS AND METHODS

Thirty- two obese Japanese women were treated by meal replacement with a low calorie diet for 8 weeks and asked to maintain their habitual lifestyle. Obesity-related parameters were measured before and after the treatment period. We determined four SNP (T45G, I164T, G276T, and C-11377G) using a fluorescent allele-specific DNA primer assay systemand FRET probe assay system.

RESULTS

After the treatment, the extent of decrease in waist circumference was greater in the subjects with the G/G or G/T genotype of SNP276 than in those with the T/T genotype (p=0.026). As for SNP45, the extent of decrease in triglyceride levels was greater in the subjects with the T/T genotype than in those with the T/G genotype (p=0.003). For SNP-11377, the extent of decrease in systolic blood pressure and fasting plasma glucose was greater in the subjects with the C/G or G/G genotype than in those with the C/C genotype (p=0.044).

CONCLUSION

Our findings indicate that each SNP in the adiponectin gene might modify the change in obesity-related parameters during meal replacement with a low calorie diet.

Diagnostic Role of Diffusion-Weighted and Dynamic Contrast-Enhanced Perfusion MR Imaging in Paragangliomas and Schwannomas in the Head and Neck

BACKGROUND AND PURPOSE

Distinguishing schwannomas from paragangliomas in the head and neck and determining succinate dehydrogenase (SDH) mutation status in paragangliomas are clinically important. We aimed to assess the clinical usefulness of DWI and dynamic contrast-enhanced MR imaging in differentiating these 2 types of tumors, as well as the SDH mutation status of paragangliomas.

MATERIALS AND METHODS

This retrospective study from June 2016 to June 2020 included 42 patients with 15 schwannomas and 27 paragangliomas (10 SDH mutation-positive and 17 SDH mutation-negative). ADC values, dynamic contrast-enhanced MRI parameters, and tumor imaging characteristics were compared between the 2 tumors and between the mutation statuses of paragangliomas as appropriate. Multivariate stepwise logistic regression analysis was performed to identify significant differences in these parameters.

RESULTS

Fractional plasma volume (P ≤ .001), rate transfer constant (P = .038), time-to-maximum enhancement (P < .001), maximum signal-enhancement ratio (P < .001) and maximum concentration of contrast agent (P < .001), velocity of enhancement (P = .002), and tumor characteristics including the presence of flow voids (P = .001) and enhancement patterns (P = .027) showed significant differences between schwannomas and paragangliomas, though there was no significant difference in ADC values. In the multivariate logistic regression analysis, fractional plasma volume was identified as the most significant value for differentiation of the 2 tumor types (P = .014). ADC values were significantly higher in nonhereditary than in hereditary paragangliomas, while there was no difference in dynamic contrast-enhanced MR imaging parameters.

CONCLUSIONS

Dynamic contrast-enhanced MR imaging parameters show promise in differentiating head and neck schwannomas and paragangliomas, while DWI can be useful in detecting SDH mutation status in paragangliomas.

Interlimb co-ordination of force and movement-related cortical potentials

The question we asked in this study was how the cerebral hemispheres are coordinated when the two hands simultaneously generate force at the same level. Interlimb co-ordination of contractions at 20% of the maximal level was investigated during bilateral (BL) and unilateral (UL) handgrip in eight male right-handed subjects. The accuracy as determined by the force error was larger during BL than during UL for the left hand only. The movement-related cortical potential (MRCP) of C3 (left precentral cortex) was studied during UL right and BL handgrip and the C4 (right precentral cortex) during UL left and BL handgrip. At the phase of the readiness potential (-1.0 to -0.6 s prior to the force onset), similar levels of correlation in the C3 (C4) MRCP amplitudes (P < 0.05) between UL right (UL left) and BL handgrip were observed. At the phase of the negative slope (-0.6 to -0.2 s) and the motor potential (-0.2 to -0.05 s), C3 revealed almost the same levels of correlation as for the readiness potential, whereas in C4 a marked decrease was noted. Accordingly, from this study the force error and movement-related cortical potentials would indicate that the left dominant hemisphere is specialized not only for unilateral contractions but also for bilateral contractions.

Further evaluation of physical fitness age versus physiological age in women

The present study was conducted to examine further whether adult women who are in a state of high physical fitness possess high physiological functions, and also to investigate whether those who exercise regularly are able to maintain a high quality of various physiological functions. The subjects of this study were 249 healthy Japanese adult women (aged 20-70 years). Of these subjects 30 had jogged or walked regularly for more than 3 years. The physiological ages (PA) and physical fitness ages (FA) of the individuals were estimated from 17 physiological function tests and 5 physical fitness tests, respectively, by principal components analyses. The results indicated that there was a significant correlation between PA and FA (r = 0.76, P < 0.01). To examine this relationship in more detail, the subjects were classified into three physical fitness groups (high, normal and low) based on the deviation from the regression line of FA. Comparison of the mean PA among three physical fitness groups revealed that the high physical fitness groups demonstrated a much lower PA (physiologically younger), while the low physical fitness groups showed a relatively higher PA (physiologically older) in spite of their equivalent chronological ages. From this series of studies, a new concept is proposed where different individuals have different peak physiological capacities, but that these capacities change with age at similar rates. It is suggested that interventions such as exercise and a proper diet for promoting health could increase peak functional capacity but have little effect on the rate of decline.

Inter-relationships among anticipatory EMG activity, Hoffmann reflex amplitude and EMG reaction time during voluntary standing movement

In order to understand the process of executing a voluntary standing movement, the parameters latency (AEA-LT), duration (AEA-DUR) and amplitude (AEA-AMP) of the anticipatory electromyographic (EMG) activity (AEA) in the tibialis anterior muscle, Hoffmann (H) reflex amplitude in the soleus muscle (Sol) prior to the onset of EMG activity in that muscle, and EMG reaction time (EMG-RT) were measured during heel raising from the standing position. The following results were obtained: the three parameters of AEA correlated with EMG-RT in each subject; the average values for all nine normal subjects were r = 0.856 for AEA-DUR, r = 0.448 for AEA-LT and r = -0.215 for AEA-AMP; for the group the mean value of AEA-DUR correlated significantly with that of EMG-RT (r = 0.983, P less than 0.01), while no such significant correlation was observed for AEA-LT; the average value of the AEA-DUR in three slower EMG-RT performers (SLOW-PFM) was significantly longer (P less than 0.05) than that in three faster ones (FAST-PFM), while no significant difference in the AEA-LT was observed; and lastly the total area of the anticipatory suppression of the Sol H reflex amplitude in the SLOW-PFM was greater than that in the FAST-PFM. These results suggest that AEA-DUR, representing postural responses, rather than AEA-LT, reflecting cognitive processes, may have had a close link with EMG-RT, and that the increased suppression in Sol H reflex amplitude originated from the increased anticipatory postural requirement, thus bringing about the EMG-RT delay.

H-reflex modulations during voluntary and automatic movements following upper motor neuron damage

OBJECTIVES

It is not known whether similar mechanisms account for the impairments of voluntary movement and automatic postural responses of individuals with spasticity secondary to damage to the sensorimotor cortex and its projections (i.e. upper motor neuron syndrome (UMN)).

METHODS

The present study examined changes in soleus H-reflexes preceding and during voluntary tibialis anterior (TA) muscle contraction of standing subjects and during balance platform induced postural perturbations that elicited similar TA muscle contractions. Twenty-two subjects (12 non-disabled; 4 with spastic-type cerebral palsy; 6 with adult-onset cerebral vascular accident) participated in the study. Data were analyzed using ANOVAs and Tukey HSD post-hoc comparison tests to assess the timing and magnitude of soleus H-reflex amplitude changes relative to the onset of TA muscle activation.

RESULTS

Results indicated that, regardless of the level of TA activation, soleus H-reflexes of subjects with UMN involvement did not demonstrate inhibition either. during voluntary movements or during automatic postural perturbations.

CONCLUSIONS

These findings indicate that postural reflexes, as well as volitional movements, are impaired following UMN damage and that deficits in neural pathways subserving reciprocal inhibition contribute to the impairments.

Retrospective, dual-centre review of imaging findings in neurosarcoidosis at presentation: prevalence and imaging sub-types

AIM

To assess the prevalence of various imaging manifestations in neurosarcoidosis (NS) patients at presentation and to explore if specific imaging findings may cluster in different sub-groups.

MATERIALS AND METHODS

A retrospective, dual-institution, systematic imaging review was undertaken of the magnetic resonance imaging (MRI) findings in 100 consecutive NS patients who presented over a 15-year period. Clustering analysis (k-mode) was performed to evaluate co-occurrence of imaging findings.

RESULTS

Non-enhancing white matter (NEWM) lesions were the most common imaging abnormality (56%), followed by leptomeningeal (47%) and pachymeningeal (32%) involvement. Other common manifestations included cranial nerve involvement (30%), parenchymal granulomas (27%), hypothalamic-pituitary-adrenal axis involvement (26%), and hydrocephalus (14%). Additionally, a higher prevalence of perivascular enhancement (23%), cerebrovascular events (including ischaemic and haemorrhagic events; 17%), and ependymal involvement (20%) were noted than recognised previously. Additional k-mode analysis was performed to explore underlying disease sub-clusters. This was evaluated for clusters varying between two though five (k=2-5). For k=4, the analysis revealed that the imaging findings may possibly be divided into disease sub-sets of four groups, each with varying distribution of imaging manifestations and clinical manifestations.

CONCLUSION

Overall, NEWM lesions and meningeal involvement are the most common imaging manifestations of NS. The prevalence of perivascular enhancement, cerebrovascular events, and ependymal involvement is likely higher than reported previously. Additionally, different imaging findings in NS may cluster together and imaging subtypes in NS possibly exist.

Role of the Apparent Diffusion Coefficient as a Predictor of Tumor Progression in Patients with Chordoma

BACKGROUND AND PURPOSE

Diffusion-weighted imaging may aid in distinguishing aggressive chordoma from nonaggressive chordoma. This study explores the prognostic role of the apparent diffusion coefficient in chordomas.

MATERIALS AND METHODS

Sixteen patients with residual or recurrent chordoma were divided postoperatively into those with an aggressive tumor, defined as a growing tumor having a doubling time of <1 year, and those with a nonaggressive tumor on follow-up MR images. The ability of the ADC to predict an aggressive tumor phenotype was investigated by receiver operating characteristic analysis. The prognostic role of ADC was assessed using a Kaplan-Meier curve with a log-rank test.

RESULTS

Seven patients died during a median follow-up of 48 months (range, 4-126 months). Five of these 7 patients were in the aggressive tumor group, and 2 were in the nonaggressive tumor group. The mean ADC was significantly lower in the aggressive tumor group than in the nonaggressive tumor group (P = .002). Receiver operating characteristic analysis showed that a cutoff ADC value of 1.494 × 10^-3 × mm²/s could be used to diagnose aggressive tumors with an area under the curve of 0.983 (95% CI, 0.911-1.000), a sensitivity of 1.000 (95% CI, 0.541-1.000), and a specificity of 0.900 (95% CI, 0.555-0.998). Furthermore, a cutoff ADC of ≤1.494 × 10^-3 × mm²/s was associated with a significantly worse prognosis (P = .006).

CONCLUSIONS

Lower ADC values could predict tumor progression in postoperative chordomas.

Electrical activity and soreness in muscles after exercise

Electrical activity and soreness in the quadriceps muscles were examined during a 48-h period after eccentric (EC) and concentric contraction (CC) to study the amplitude and frequency characteristics of the electrical signal after exercise and to study the relationship between the electrical signal and muscle soreness. The exercise protocol included a step test performed for 15 min using a 46-cm step in which one quadriceps contracted eccentrically and one contracted concentrically. Electrical activity was quantified by computing both root mean square electromyograph (rmsEMG) and mean power frequency of the myoelectrical signal during low-level contractions of the muscles. Recordings of muscle activity were made before exercise, immediately after exercise, 1, 12, 24 and 48 h after exercise in 12 volunteer subjects (mean age 28.5 yr). Recordings were made with the subject seated, holding the leg being tested slightly off the ground. Subjects were given a subjective pain rating scale. The before exercise values for rmsEMG (EC = 13.3 microV; CC = 13 microV) and mean power frequency (EC = 55.3 Hz; CC = 54.4 Hz) were within the range that would be expected for surface electrodes. The mean rating of soreness for the eccentrically exercised muscles ranged from slightly uncomfortable at 12 h after exercise to sore during the period 24-48 h after exercise. Subjects reported the concentrically exercised muscles as normal to slightly uncomfortable during the whole recording period. Analysis of variance revealed a significant (P less than 0.05) difference between EC and CC rmsEMG value at 1 h after exercise (EC = 17.2 +/- 7.6; CC = 12.3 +/- 5.5) and at 12 h after exercise (EC = 15.0 +/- 5.0; CC = 12.3 +/- 4.2). The results suggest that an increase in the electrical activity of muscles is needed to produce the same pre-exercise contraction after performing eccentric exercise.(ABSTRACT TRUNCATED AT 250 WORDS)

Assessment of MR Imaging and CT in Differentiating Hereditary and Nonhereditary Paragangliomas

BACKGROUND AND PURPOSE

Head and neck paragangliomas have been reported to be associated with mutations of the succinate dehydrogenase enzyme family. The aim of this study was to assess whether radiologic features could differentiate between paragangliomas in the head and neck positive and negative for the succinate dehydrogenase mutation.

MATERIALS AND METHODS

This single-center retrospective review from January 2015 to January 2020 included 40 patients with 48 paragangliomas (30 tumors positive for succinate dehydrogenase mutation in 23 patients and 18 tumors negative for the succinate dehydrogenase mutation in 17 patients). ADC values and tumor characteristics on CT and MR imaging were evaluated by 2 radiologists. Differences between the 2 cohorts in the diagnostic performance of ADC and normalized ADC (ratio to ADC in the medulla oblongata) values were evaluated using the independent samples t test. P < .05 was considered significant.

RESULTS

ADC_mean (1.07 [SD, 0.25]/1.04 [SD, 0.12] versus 1.31 [SD, 0.16]/1.30 [SD, 0.20]× 10^-3 mm²/s by radiologists 1 and 2; P < .001), ADC_maximum (1.49 [SD, 0.27]/1.49 [SD, 0.20] versus 2.01 [SD, 0.16]/1.87 [SD, 0.20] × 10^-3 mm²/s; P < .001), normalized ADC_mean (1.40 [SD, 0.33]/1.37 [SD, 0.16] versus 1.73 [SD, 0.22]/1.74 [SD, 0.27]; P < .001), and normalized ADC_maximum (1.95 [SD, 0.37]/1.97 [SD, 0.27] versus 2.64 [SD, 0.22]/2.48 [SD, 0.28]; P < .001) were significantly lower in succinate dehydrogenase mutation-positive than mutation-negative tumors. ADC_minimum, normalized ADC_minimum, and tumor characteristics were not statistically significant.

CONCLUSIONS

ADC is a promising imaging biomarker that can help differentiate succinate dehydrogenase mutation-positive from mutation-negative paragangliomas in the head and neck.

"Dazed and diffused": making sense of diffusion abnormalities in neurologic pathologies

To review diffusion abnormalities seen in diffusion-weighted MRI in neurological pathologies. We examine the clinical significance of the abnormalities in a broad spectrum of neurological diseases and highlight our current understanding of their causes. Diffusion abnormalities seen on diffusion-weighted MRI can play an important role in the diagnosis and follow-up of a broad spectrum of neurological diseases. A thorough understanding of the appearance and significance of these abnormalities is critical in patient management.

Surface electromyographic evaluation of the neuromuscular activation of the inspiratory muscles during progressively increased inspiratory flow under inspiratory-resistive loading

This study aimed to evaluate neuromuscular activation in the scalene and sternocleidomastoid muscles using surface electromyography (EMG) during progressively increased inspiratory flow, produced by increasing the respiratory rate under inspiratory-resistive loading using a mask ventilator. Moreover, we attempted to identify the EMG inflection point (EMG^IP) on the graph, at which the root mean square (RMS) of the EMG signal values of the inspiratory muscles against the inspiratory flow velocity acceleration abruptly increases, similarly to the EMG anaerobic threshold (EMG^AT) reported during incremental-resistive loading in other skeletal muscles. We measured neuromuscular activation of healthy male subjects and found that the inspiratory flow velocity increased by approximately 1.6-fold. We successfully observed an increase in RMS that corresponded to inspiratory flow acceleration with ρ ≥ 0.7 (Spearman's rank correlation) in 17 of 27 subjects who completed the experimental protocol. To identify EMG^IP, we analyzed the fitting to either a straight or non-straight line related to the increasing inspiratory flow and RMS using piecewise linear spline functions. As a result, EMG^IP was identified in the scalene and sternocleidomastoid muscles of 17 subjects. We believe that the identification of EMG^IP in this study infers the existence of EMG^AT in inspiratory muscles. Application of surface EMG, followed by identification of EMG^IP, for evaluating the neuromuscular activation of respiratory muscles may be allowed to estimate the signs of the respiratory failure, including labored respiration, objectively and non-invasively accompanied using accessory muscles in clinical respiratory care.

MR evaluation of talonavicular angle in congenital talipes equinovarus

The talonavicular relationship in 14 patients with talipes equinovarus was quantified using gradient echo sequences. The angle formed between the short axis of the navicular and the long axis of the talus was measured. There is a significant difference in the talonavicular angle between patients who had posteromedial release (PMR) and those who had posterior release (PR) or casting only (P=.0004). This method provides an objective assessment of residual deformity following surgical and conservative management of talipes equinovarus.

Spectrum of Epstein-Barr virus infection in Japanese children: a pictorial essay

Epstein-Barr virus (EBV) infection has been associated with infectious mononucleosis, EBV-associated hemophagocytic syndrome (EBV-AHS), chronic active EBV infection (CAEBV), lymphomas, inflammatory pseudotumor, lymphomatoid granulomatosis, and nasopharyngeal carcinoma. EBV-AHS and CAEBV are more lethal than infectious mononucleosis with imaging findings of gallbladder wall thickening, pleural effusion, cardiomegaly, and hepatomegaly. EBV infection is also associated with benign and malignant tumors.

Effects of standing cycling and the use of toe stirrups on maximal oxygen uptake

Twenty-eight subjects (6 normal men, 14 distance runners, and 8 rowers) were tested for maximal oxygen uptake (VO2max) and associated physiological measures during bicycle ergometer exercise with toe stirrups while standing (BEts) and during treadmill exercise (TM). Correlation between BEts VO2max and TM VO2max was high (r = 0.901, p less than 0.05). No significant difference existed between the two VO2max values (60.3 +/- 8.9 vs. 60.5 +/- 9.7 ml.kg-1.min-1; n = 28). No differences were found even when three different subgroups were separately compared. It is concluded that the higher VO2max elicited during BEts as compared with normal sitting cycling may be attributed to the increased muscle blood flow and/or involvement of a larger muscle mass, the latter being partly evidenced by the observation of greater electromyographic activity during BEts.

Effects of chronic hypoxia on the whole-body insulin action in rats

The effect of chronic hypoxia on the whole-body insulin action in rats was investigated. Rats were kept in a hypobaric hypoxia chamber maintained at a simulated altitude of 4000 m for 10 weeks. At the end of the experimental period, the mean body weight of the hypoxic rats was significantly lower than that of the control rats. The muscle weight to body ratio of the quadriceps muscle in hypoxic rats was larger than that in control rats, but those of the gastrocnemius, soleus, and extensor digitorum longus muscles did not differ between the control and hypoxic rats. On the other hand, the epididymal fat pads of hypoxic rats were markedly smaller than those of the control rats. The results of a euglycemic clamp experiment with infusions of 14 and 3.6 mU insulin.kg-1.min-1 indicated that the steady-state glucose infusion rate was not statistically different between hypoxic and control rats. It is suggested that chronic hypoxia did not influence the whole-body insulin action on glucose transport activity.

Prognostic Factors of Stroke-Like Migraine Attacks after Radiation Therapy (SMART) Syndrome

BACKGROUND AND PURPOSE

Prognostic factors of stroke-like migraine attacks after radiation therapy (SMART) syndrome have not been fully explored. This study aimed to assess clinical and imaging features to predict the clinical outcome of SMART syndrome.

MATERIALS AND METHODS

We retrospectively reviewed the clinical manifestations and imaging findings of 20 patients with SMART syndrome (median age, 48 years; 5 women) from January 2016 to January 2020 at 4 medical centers. Patient demographics and MR imaging features at the time of diagnosis were reviewed. This cohort was divided into 2 groups based on the degree of clinical improvement (completely versus incompletely recovered). The numeric and categoric variables were compared as appropriate.

RESULTS

There were statistically significant differences between the completely recovered group (n = 11; median age, 44 years; 2 women) and the incompletely recovered group (n = 9; median age, 55 years; 3 women) in age, months of follow-up, and the presence of steroid treatment at diagnosis (P = .028, .002, and .01, respectively). Regarding MR imaging features, there were statistically significant differences in the presence of linear subcortical WM susceptibility abnormality, restricted diffusion, and subcortical WM edematous changes in the acute SMART region (3/11 versus 8/9, P = .01; 0/11 versus 4/9, P = .026; and 2/11 versus 7/9, P = .022, respectively). Follow-up MRIs showed persistent susceptibility abnormality (11/11) and subcortical WM edematous changes (9/9), with resolution of restricted diffusion (4/4).

CONCLUSIONS

Age, use of steroid treatment at the diagnosis of SMART syndrome, and MR imaging findings of abnormal susceptibility signal, restricted diffusion, and subcortical WM change in the acute SMART region can be prognostic factors in SMART syndrome.