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Jayakumar PN, Nagarajan K. Alkaline pH in intracranial tuberculomas: A 31Phosphorus magnetic resonance spectroscopy study. J Neurosci Rural Pract 2022; 13:791-794. [PMID: 36743769 PMCID: PMC9894005 DOI: 10.25259/jnrp-2022-6-25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 09/30/2022] [Indexed: 12/03/2022] Open
Abstract
Objectives Intracranial tuberculomas are one of the common causes of space-occupying lesions of the brain in developing countries. Proton (1H) magnetic resonance spectroscopy (MRS) has shown lipid peak in intracranial tuberculomas as a characteristic feature. Phosphorus (31P) MRS has been used to evaluate intracranial lesions and to calculate tissue pH non-invasively. The aim of this study is to evaluate intracranial tuberculomas using 31PMRS. Materials and Methods Intracranial tuberculomas proven by stereotactic or surgical biopsy were included in the study. After routine T1- and T2-weighted sequences, 31P MRS was performed using single-voxel intravoxel in vivo spectroscopy (ISIS) technique in the central core of the tuberculoma (voxel size 1-2 mm3). The pH was estimated using Petroff 's method using the chemical shift between phosphocreatine and Pi. Results 31P MRS was available for 26 patients, in which there was significant positive correlation between high-energy phosphate metabolites, (markers of bioenergetic status), and low-energy phosphate metabolites (membrane phospholipids and inorganic phosphate). The calculated pH was slightly alkaline and varied from 6.97 to 7.22. Conclusion Intracranial tuberculomas showed alkaline pH in 31P MRS and this may be useful in the characterization of these lesions and possibly also in their treatment.
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Affiliation(s)
- Peruvamba N Jayakumar
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Krishnan Nagarajan
- Department of Radio-Diagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Rajvanshi N, Bhakat R, Saxena S, Rohilla J, Basu S, Nandolia KK, Agrawal S, Bhat NK, Chacham S. Magnetic Resonance Spectroscopy in Children With Developmental Delay: Time to Look Beyond Conventional Magnetic Resonance Imaging (MRI). J Child Neurol 2021; 36:440-446. [PMID: 33305985 DOI: 10.1177/0883073820978006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Developmental delay (DD) is an important long-term neuromorbidity owing to various insults to the developing brain and neuroimaging plays a key role in evaluating these children. Magnetic resonance spectroscopy (MRS) is the only noninvasive method to determine the levels of various metabolites in the brain which aids in delineating the underlying abnormalities. A total of 48 children aged between 6 months to 6 years with developmental delay were included and evaluated with neuroimaging in our study. Sensitivity of MRS in children with DD and DD plus (DD along with seizures, abnormal motor findings, behavior, brainstem evoked response audiometry, visual assessment, and microcephaly) was 81.2% and 89.6% respectively. 86.6% of children with microcephaly had abnormal MRS. MRS detected abnormalities in two-thirds of children with normal magnetic resonance imaging (MRI). Children with behavioral abnormalities had significantly lower N-acetyl aspartate (NAA)-creatine and NAA-choline ratios on MRS. Thus, MRS is additive to MRI in delineating the underlying pathophysiology in children with DD.
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Affiliation(s)
- Nikhil Rajvanshi
- Department of Pediatrics, 442339All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Rahul Bhakat
- Department of Pediatrics, 442339All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Sudhir Saxena
- Department of Radio-Diagnosis & Imaging, 442339All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Jitendra Rohilla
- Department of Psychiatry, 442339All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Sriparna Basu
- Department of Neonatology, 442339All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Khanak Kumar Nandolia
- Department of Radio-Diagnosis & Imaging, 442339All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Sonam Agrawal
- Department of Pediatrics, 442339All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Nowneet Kumar Bhat
- Department of Pediatrics, 442339All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Swathi Chacham
- Department of Pediatrics, 442339All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Value of Multimodal Imaging Approach to Diagnosis of Neurosarcoidosis. Brain Sci 2019; 9:brainsci9100243. [PMID: 31546573 PMCID: PMC6827049 DOI: 10.3390/brainsci9100243] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 09/17/2019] [Accepted: 09/19/2019] [Indexed: 12/18/2022] Open
Abstract
Background: Neurosarcoidosis is a highly variable condition with many clinical and radiological manifestations, that can lead to difficult identification of isolated central nervous system (CNS) forms, because it could mimic inflammatory, infective or neoplastic disorders. Conventional magnetic resonance imaging (MRI) is gold standard to evaluate CNS involvement in neurosarcoidosis, despite the reported high sensitivity but low specificity in the diagnosis. Case presentation: Here, we describe a 52-year-old man that presented to our hospital with a 10-year history of focal seizures, progressive cognitive decline and motor impairment. Neurological examination revealed ataxic gait, bilateral telekinetic and postural tremor, brisk reflexes, left extensor plantar response and hypoesthesia to the right side of body. Brain 3T-magnetic resonance imaging (MRI) showed a leukoencephalopathy with multifocal nodular lesions hyperintense on T2/ fluid attenuated inversion recovery (FLAIR) weighted images involving basal ganglia, periventricular and deep white matter. The interpretation of this pattern on conventional MRI was unclear, opening a challenge on the differential diagnosis between inflammatory, infective or neoplastic disorders. Thus, to better understand the nature of these nodules, single-voxel 1H-magnetic resonance spectroscopy (1H-MRS), contrast enhanced computed tomography (CT) scan and fluorine-18-fluorodeoxyglucose-positron emission tomography (18F-FDG-PET)/3T-MRI were performed. The parenchymal multifocal lesions exhibited slight N-acetyl-aspartate/creatine reduction without abnormal peaks on 1H-MRS, enhancement after the administration of contrast agent on CT and hypermetabolism on 18F-FDG-PET/3T-MRI. All these findings excluded primary neoplasms, metastasis, neurotuberculosis, neurocysticercosis and brain abscess, strongly suggesting a diagnosis of neurosarcoidosis. Therefore, a whole-body 18F-FDG-PET/CT was performed in order to identify subclinical extraneural sarcoidosis localizations, and a hypermetabolic nodule of the left lung upper lobe was found. Subsequently, a biopsy documented the presence of systemic sarcoidosis, supporting a diagnosis of probable neurosarcoidosis. Conclusions: This case demonstrated that a multimodal neuroimaging approach can provide different but complementary evidences to suspect sarcoidosis, especially in apparently CNS isolated forms.
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Ghosh RN, Vyas S, Singh P, Khandelwal N, Sankhyan N, Singhi P. Perfusion magnetic resonance imaging in differentiation of neurocysticercosis and tuberculoma. Neuroradiology 2018; 61:257-263. [DOI: 10.1007/s00234-018-2118-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 10/16/2018] [Indexed: 12/18/2022]
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Morales H, Alfaro D, Martinot C, Fayed N, Gaskill-Shipley M. MR spectroscopy of intracranial tuberculomas: A singlet peak at 3.8 ppm as potential marker to differentiate them from malignant tumors. Neuroradiol J 2015; 28:294-302. [PMID: 26246099 DOI: 10.1177/1971400915592077] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE The diagnosis of intracranial tuberculomas is often challenging. Our purpose is to describe the most common metabolic patterns of tuberculomas by MR spectroscopy (MRS) with emphasis on potential specific markers. METHODS Single-voxel MRS short echo time was performed in 13 cases of tuberculomas proven by histology and/or response to anti-mycobacterial therapy. For comparison MRS was also performed in 19 biopsy-proven malignant tumors (13 high-grade gliomas and six metastasis). Presence of metabolic peaks was assessed visually and categorical variables between groups were compared using chi-square. Metabolite ratios were compared using Mann-Whitney test and diagnostic accuracy of the metabolite ratios was compared using receiver-operating characteristic (ROC) curves analysis. RESULTS Spectroscopic peaks representing lipids and glutamate/glutamine (Glx) as well as a peak at ∼3.8 ppm were well defined in 77% (10/13), 77% (10/13) and 69% (nine of 13) of tuberculomas, respectively. Lipid and Glx peaks were also present in most of the malignant lesions, 79% (15/19) and 74% (14/19) respectively. However, a peak at ∼3.8 ppm was present in only 10% (two of 19) of the tumor cases (p < 0.001). Higher Cho/Cr and mI/Cr ratios helped discriminate malignant lesions with an area under the ROC curve of 0.86 (SE: 0.078, p < 0.002, CI: 0.7-1) and 0.8 (SE: 0.1, p < 0.009, CI: 0.6-1), respectively. Threshold values between 1.7-1.9 for Cho/Cr and 0.8-0.9 for mI/Cr provided high specificity (91% for both metabolites) and adequate sensitivity (75% and 80%, respectively) for discrimination of malignant lesions. CONCLUSION A singlet peak at ∼3.8 ppm is present in the majority of tuberculomas and absent in most malignant tumors, potentially a marker to differentiate these lesions. The assignment of the peak is difficult from our analysis; however, guanidinoacetate (Gua) is a possibility. Higher Cho/Cr and mI/Cr ratios should favor malignant lesions over tuberculomas. The presence of lipids and Glx is non-specific.
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Affiliation(s)
- Humberto Morales
- Section of Neuroradiology, Department of Radiology, University of Cincinnati Medical Center, USA
| | | | | | | | - Mary Gaskill-Shipley
- Section of Neuroradiology, Department of Radiology, University of Cincinnati Medical Center, USA
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Differentiation of intracranial tuberculomas and high grade gliomas using proton MR spectroscopy and diffusion MR imaging. Eur J Radiol 2012; 81:4057-63. [DOI: 10.1016/j.ejrad.2012.06.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Revised: 06/03/2012] [Accepted: 06/05/2012] [Indexed: 11/30/2022]
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Seth R, Kalra V, Sharma U, Jagannathan N. Magnetic resonance spectroscopy in ring enhancing lesions. Indian Pediatr 2010; 47:803-4. [PMID: 21048271 DOI: 10.1007/s13312-010-0107-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We report a 4 year old girl with ring enhancing lesions in brain CT, initially diagnosed as neurocysticercosis but did not respond to cysticidal therapy. A Magnetic resonance spectropscopy (MRS) revealed lipid peaks suggestive of tuberculoma which was successfully treated with antituberculosis therapy. This report highlights the role of MRS in the diagnosis of ring enhancing lesios.
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Affiliation(s)
- R Seth
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110 029, India.
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Jang SW, Kim SJ, Kim SM, Lee JH, Choi CG, Lee DH, Kim EJ, Lee JK. MR spectroscopy and perfusion MR imaging findings of intracranial foreign body granuloma: a case report. Korean J Radiol 2010; 11:359-63. [PMID: 20461191 PMCID: PMC2864864 DOI: 10.3348/kjr.2010.11.3.359] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2009] [Accepted: 10/17/2009] [Indexed: 11/23/2022] Open
Abstract
We report a case of intracranial foreign body granuloma that showed features of a high grade tumor on magnetic resonance (MR) imaging. However, the relative cerebral blood volume was not increased in the enhancing mass on perfusion MRI and the choline/creatine ratio only slightly increased on MR spectroscopy. The results suggest that the lesion is benign in nature. Perfusion MRI and MR spectroscopy may be helpful to differentiate a foreign body granuloma from a neoplastic condition.
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Affiliation(s)
- Seung Won Jang
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Wilbers J, Idema A, Gijtenbeek A. A bilateral foot drop due to neuroschistosomiasis. J Neurol 2010; 257:853-5. [DOI: 10.1007/s00415-010-5464-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2009] [Revised: 01/06/2010] [Accepted: 01/11/2010] [Indexed: 11/25/2022]
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Sinha S, Sharma B. Neurocysticercosis: A review of current status and management. J Clin Neurosci 2009; 16:867-76. [DOI: 10.1016/j.jocn.2008.10.030] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2008] [Revised: 10/28/2008] [Accepted: 10/31/2008] [Indexed: 10/20/2022]
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Abstract
Neurocysticercosis (NCC) is a common cause of seizures and neurologic disease. Although there may be variable presentations depending on the stage and location of cysts in the nervous system, most children (> 80%) present with seizures particularly partial seizures. About a third of cases have headache and vomiting. Diagnosis is made by either CT or MRI. Single enhancing lesions are the commonest visualization of a scolex confirms the diagnosis. Some cases have multiple cysts with a characteristic starry-sky appearance. Management involves use of anticonvulsants for seizures and steroids for cerebral edema. The use of cysticidal therapy continues to be debated. Controlled studies have shown that cysticidal therapy helps in increased and faster resolution of CT lesions. Improvement in long-term seizure control has not yet been proven. Children with single lesions have a good outcome and seizure recurrence rate is low. Children with multiple lesions have recurrent seizures. Extraparenchymal NCC has a guarded prognosis but it is rare in children. In endemic areas NCC must be considered in the differential diagnosis of seizures and various other neurological disorders.
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Thurnher MM, Donovan Post MJ. Neuroimaging in the Brain in HIV-1–Infected Patients. Neuroimaging Clin N Am 2008; 18:93-117; viii. [DOI: 10.1016/j.nic.2007.12.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Kingsley PB, Shah TC, Woldenberg R. Identification of diffuse and focal brain lesions by clinical magnetic resonance spectroscopy. NMR IN BIOMEDICINE 2006; 19:435-62. [PMID: 16763970 DOI: 10.1002/nbm.1039] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
The purpose of this paper is to facilitate the comparison of magnetic resonance (MR) spectra acquired from unknown brain lesions with published spectra in order to help identify unknown lesions in clinical settings. The paper includes lists of references for published MR spectra of various brain diseases, including pyogenic abscesses, encephalitis (herpes simplex, Rasmussen's and subacute sclerosing panencephalitis), neurocysticercosis, tuberculoma, cysts (arachnoid, epidermoid and hydatid), acute disseminated encephalomyelitis (ADEM), adrenoleukodystrophy (ALD), Alexander disease, Canavan's disease, Krabbe disease (globoid cell leukodystrophy), Leigh's disease, megalencephalic leukoencephalopathy with cysts, metachromatic leukodystrophy (MLD), Pelizaeus-Merzbacher disease, Zellweger syndrome, HIV-associated lesions [cryptococcus, lymphoma, toxoplasmosis and progressive multifocal leukoencephalopathy (PML)], hydrocephalus and tuberous sclerosis. Each list includes information on the echo time(s) (TE) of the published spectra, whether a control spectrum is shown, whether the corresponding image and voxel position are shown and the patient ages if known. The references are listed in the approximate order of usefulness, based on spectral quality, number of spectra, range of echo times and whether the voxel positions are shown. Spectra of Zellweger syndrome, cryptococcal infection, toxoplasmosis and lymphoma are included, along with a spectrum showing propanediol (propylene glycol).
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Affiliation(s)
- Peter B Kingsley
- Department of Radiology, North Shore University Hospital, 300 Community Drive, Manhasset, NY 11030, USA.
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Hunter RL, Olsen M, Jagannath C, Actor JK. Trehalose 6,6'-dimycolate and lipid in the pathogenesis of caseating granulomas of tuberculosis in mice. THE AMERICAN JOURNAL OF PATHOLOGY 2006; 168:1249-61. [PMID: 16565499 PMCID: PMC1606544 DOI: 10.2353/ajpath.2006.050848] [Citation(s) in RCA: 116] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/04/2006] [Indexed: 11/20/2022]
Abstract
Trehalose 6,6'-dimycolate (TDM) is the most abundant, most granulomagenic, and most toxic lipid extractable from the surface of virulent Mycobacterium tuberculosis (MTB). We further examined its toxicity, which requires activation by oily surfaces. Injections of MTB and/or TDM into sensitized mice induced caseating granulomas that centered on oil droplets. If large doses of MTB were injected in saline, caseating granulomas developed in adipose tissue, but MTB with surface TDM removed induced only acute inflammation that did not persist. Variations in protocols produced several variants of caseating granulomas, each with characteristics of human tuberculosis. In each instance, MTB were localized in fat cells or oil drops during initiation of caseating granulomas suggesting that necrosis was caused by activation of the toxicity of TDM toxicity. Evidence extending these findings to the lung was derived from the observation that in sensitized mice, as in humans, tuberculosis development stimulates accumulation of lipid selectively in alveoli. MTB preferentially associated with lipid droplets in developing necrotic foci in late-stage murine tuberculosis. This supports the hypothesis that pulmonary tuberculosis sequesters MTB in a protected environment that accumulates lipid until it is able to activate the toxicity of TDM and initiate necrosis that results in caseating granulomas.
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Affiliation(s)
- Robert L Hunter
- Department of Pathology and Laboratory Medicine, MSB 2.136, 6431 Fannin, Houston, TX 77030, USA.
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do Amaral LLF, Ferreira RM, da Rocha AJ, Ferreira NPDF. Neurocysticercosis: evaluation with advanced magnetic resonance techniques and atypical forms. Top Magn Reson Imaging 2005; 16:127-44. [PMID: 16340333 DOI: 10.1097/01.rmr.0000189106.78146.98] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Neurocysticercosis (NCC) is the most common helminthic infection of the central nervous system, but its diagnosis remains difficult. The purpose of this article is to perform a critical analysis of the literature and show our experience in the evaluation of NCC. We discuss the advanced MR technique applications such as diffusion and perfusion-weighted imaging, spectroscopy, cisternography with FLAIR, and supplemental O2 and 3D-CISS. The typical manifestations of NCC are described; emphasis is given to the unusual presentations. The atypical forms of neurocysticercosis were divided into: intraventricular, subarachnoid, spinal, orbital, and intraparenchymatous. Special attention was also given to reactivation of previously calcified lesions and neurocysticercosis associated with mesial temporal sclerosis.
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da Rocha AJ, Maia ACM, Ferreira NPDF, do Amaral LLF. Granulomatous diseases of the central nervous system. Top Magn Reson Imaging 2005; 16:155-87. [PMID: 16340335 DOI: 10.1097/01.rmr.0000189109.62899.a1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Infectious diseases of the central nervous system (CNS), particularly those accompanied by the formation of granulomas, are a constant diagnostic challenge in some specific regions of the world, above all in developing countries. The pattern of image seen on CT or MR scan is the result of the inter-relations between the individual characteristics of the infectious agent and the capacity of each host to mount an appropriate inflammatory response to that specific type of aggression, inside one particular compartment of the CNS. Taking these parameters into account we will discuss the several patterns of image found in parasitic, bacterial, and fungal granulomatous infections.
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Pretell EJ, Martinot C, Garcia HH, Alvarado M, Bustos JA, Martinot C. Differential Diagnosis Between Cerebral Tuberculosis and Neurocysticercosis by Magnetic Resonance Spectroscopy. J Comput Assist Tomogr 2005; 29:112-4. [PMID: 15665695 DOI: 10.1097/01.rct.0000149959.63294.8f] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Single enhancing brain lesions (SELs), mostly as a result of neurocysticercosis or tuberculosis, are a common cause of seizures. Ten patients with SELs caused by neurocysticercosis (n=6) or tuberculosis (n=4) were examined by proton magnetic resonance spectroscopy. Tuberculomas had a high peak of lipids, more choline, and less N-acetylaspartate and creatine. The choline/creatine ratio was greater than 1 in all tuberculomas but in none of the cysticerci. Magnetic resonance spectroscopy differentiates SELs caused by cysticercosis or tuberculosis and may avoid brain biopsies or unnecessary antituberculosis treatments.
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Affiliation(s)
- E Javier Pretell
- Cysticercosis Unit, Instituto Especializado en Ciencias Neurologicas, Lima, Peru
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Abstract
Neurocysticercosis is a major cause of neurologic disease worldwide. The clinical presentations are pleomorphic depending on the stage and location of cysts in the nervous system. Most children (> 80%) present with seizures, particularly partial seizures; headache and vomiting are seen in about a third of cases. Diagnosis is made by either computed tomography (CT) or magnetic resonance imaging. Single enhancing lesions are the most common finding. Visualization of a scolex confirms the diagnosis. Some cases have multiple cysts; the "starry-sky" appearance in cases with innumerable cysts is characteristic. Most children require anticonvulsants. Corticosteroids are indicated in those with cerebral edema. The efficacy of cysticidal therapy continues to be debated. Controlled studies suggest that cysticidal therapy helps in increased and faster resolution of CT lesions, but there is no conclusive evidence that it improves long-term seizure control. The prognosis in cases with single lesions is good; seizure control is achieved with a single anticonvulsant, and the recurrence rate is low. Children with multiple lesions have recurrent seizures. Extraparenchymal neurocysticercosis is rare in children and carries a poor prognosis. Neurocysticercosis must be considered in the differential diagnosis of seizures and a wide variety of neurologic disorders, particularly in endemic areas.
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Affiliation(s)
- Pratibha Singhi
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Gulati S, Shah T, Menon S, Jayasundar R, Kalra V. Magnetic resonance spectroscopy in pediatric neurology. Indian J Pediatr 2003; 70:317-25. [PMID: 12793309 DOI: 10.1007/bf02723588] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
In the last three decades a range of non-invasive biophysical techniques have been developed, of which Magnetic Resonance (MR) has proved to be the most versatile. Its non-invasive and safe nature has made it the most important diagnostic and research tool in clinical medicine. MR Spectroscopy (MRS) is the only technique in clinical medicine that provides non-invasive access to living chemistry in situ. This article focuses mainly on proton MRS in brain and also phosphorus MRS in calf muscle, with particular reference to the pediatric population, the normal spectrum and its use in various disease conditions in the practice of pediatric neurology. Few representative case studies among different disease groups have also been detailed.
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Affiliation(s)
- Sheffali Gulati
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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