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Niksolat M, Mokhtari M, Kamalzadeh L, Nabi S. Fahr's disease with neuropsychiatric symptoms and intermittent course: a case report. Neurocase 2024; 30:48-53. [PMID: 38757414 DOI: 10.1080/13554794.2024.2353392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 04/22/2024] [Indexed: 05/18/2024]
Abstract
Fahr's disease is a rare neurodegenerative disorder with brain calcifications and neuropsychiatric symptoms. It can have variable phenotypic expression and intermittent symptomatology, making diagnosis challenging. In this report, we describe a young female patient presenting with symptoms of psychosis and confusion, which could be indicative of a delirium superimposed on the cerebral vulnerability associated with Fahr's disease. Notably, about two years prior, she experienced multiple episodes of tonic-clonic seizures that spontaneously resolved without pharmacological intervention. She had no previous psychiatric history. Following comprehensive investigations, other organic causes were ruled out, and Fahr's disease was diagnosed based on bilateral symmetrical brain calcifications seen on a head CT scan. Her treatment regimen encompassed antipsychotics and anticonvulsants. This case highlights the importance of considering Fahr's disease as a differential diagnosis in patients with new-onset neuropsychiatric symptoms. The case also explores the atypical early onset and intermittent nature of symptoms in the absence of a positive family history, highlighting the complexity of Fahr's disease. A multidisciplinary approach and regular follow-up are crucial for optimizing patient care and monitoring disease progression. Further research is needed to enhance our understanding of Fahr's disease and develop standardized treatment strategies for this rare condition.
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Affiliation(s)
- Maryam Niksolat
- Geriatric Mental Health Research Center, Department of Geriatric Medicine, School of Medicine, Iran University of Medical Science, Tehran, Iran
| | - Mahisa Mokhtari
- Department of Neurology, School of Medicine, Firoozabadi Clinical and Research Development Unit, Iran University of Medical Science, Tehran, Iran
| | - Leila Kamalzadeh
- Geriatric Mental Health Research Center, Department of Psychiatry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Somaye Nabi
- Department of Emergency Medicine, School of Medicine, Firoozabadi Clinical and Research Development Unit, Iran University of Medical Science, Tehran, Iran
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2
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Berrabeh S, Messaoudi N, Elmehraoui O, Assarrar I, Karabila I, Jamal A, Zeryouh N, Rouf S, Latrech H. Hypoparathyroidism and Fahr's Syndrome: A Case Series. Cureus 2023; 15:e40502. [PMID: 37461775 PMCID: PMC10350282 DOI: 10.7759/cureus.40502] [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] [Accepted: 06/15/2023] [Indexed: 07/20/2023] Open
Abstract
Fahr's syndrome is defined by the presence of striato-pallido-dentate calcifications. It is a rare entity with clinical polymorphism, and it occurs in patients with dysparathyroidism, especially those with hypoparathyroidism. It must be distinguished from Fahr's disease (FD), which is defined by the presence of intracerebral calcifications without phosphocalcic metabolism abnormality. In this paper, we report the particulars of five patients diagnosed with Fahr's syndrome revealed by neurological and cognitive disorders, seizures, and abnormal movements associated with tetany crisis. In all cases, brain imaging and biological examinations led to the diagnosis of Fahr's syndrome related to hypoparathyroidism. The evolution was favorable after treatment. Fahr's syndrome is a rare and serious condition for which treatment is simple and effective. Our observations shed light on the necessity of evaluating phosphocalcic metabolism and exploring cerebral calcifications in patients with neurological disorders.
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Affiliation(s)
- Soumiya Berrabeh
- Department of Endocrinology-Diabetology and Nutrition, Mohammed VI University Hospital Center, Oujda, MAR
- Department of Endocrinology-Diabetology and Nutrition, Faculty of Medicine and Pharmacy, Mohamed First University, Oujda, MAR
| | - Najoua Messaoudi
- Department of Endocrinology-Diabetology and Nutrition, Mohammed VI University Hospital Center, Oujda, MAR
- Department of Endocrinology-Diabetology and Nutrition, Faculty of Medicine and Pharmacy, Mohamed First University, Oujda, MAR
| | - Ouafae Elmehraoui
- Department of Endocrinology-Diabetology and Nutrition, Mohammed VI University Hospital Center, Oujda, MAR
- Department of Endocrinology-Diabetology and Nutrition, Faculty of Medicine and Pharmacy, Mohamed First University, Oujda, MAR
| | - Imane Assarrar
- Department of Endocrinology-Diabetology and Nutrition, Mohammed VI University Hospital Center, Oujda, MAR
- Department of Endocrinology-Diabetology and Nutrition, Faculty of Medicine and Pharmacy, Mohamed First University, Oujda, MAR
| | - Ikram Karabila
- Department of Endocrinology-Diabetology and Nutrition, Mohammed VI University Hospital Center, Oujda, MAR
- Department of Endocrinology-Diabetology and Nutrition, Faculty of Medicine and Pharmacy, Mohamed First University, Oujda, MAR
| | - Anouar Jamal
- Department of Endocrinology-Diabetology and Nutrition, Mohammed VI University Hospital Center, Oujda, MAR
- Department of Endocrinology-Diabetology and Nutrition, Faculty of Medicine and Pharmacy, Mohamed First University, Oujda, MAR
| | - Nabila Zeryouh
- Department of Endocrinology-Diabetology and Nutrition, Mohammed VI University Hospital Center, Oujda, MAR
- Department of Endocrinology-Diabetology and Nutrition, Faculty of Medicine and Pharmacy, Mohamed First University, Oujda, MAR
| | - Siham Rouf
- Department of Endocrinology-Diabetology and Nutrition, Mohammed VI University Hospital Center, Oujda, MAR
- Department of Endocrinology-Diabetology and Nutrition/Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy, Mohamed First University, Oujda, MAR
| | - Hanane Latrech
- Department of Endocrinology-Diabetology and Nutrition, Mohammed VI University Hospital Center, Oujda, MAR
- Department of Endocrinology-Diabetology and Nutrition/Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy, Mohamed First University, Oujda, MAR
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3
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Wang H, Chai C, Wu G, Li J, Zhao C, Fu D, Zhang S, Wang H, Wang B, Zhu J, Shen W, Xia S. Cerebral blood flow regulates iron overload in the cerebral nuclei of hemodialysis patients with anemia. J Cereb Blood Flow Metab 2023; 43:749-762. [PMID: 36545834 PMCID: PMC10108183 DOI: 10.1177/0271678x221147363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 09/16/2022] [Accepted: 10/09/2022] [Indexed: 12/24/2022]
Abstract
Hemodialysis patients exhibit anemia-related cerebral hyperperfusion and iron deposition (ID). However, the mechanisms underlying the pathology of cerebral ID are not clear. We investigated the role of cerebral blood flow (CBF) in the pathophysiology of cerebral ID in hemodialysis patients with anemia. This study recruited 33 hemodialysis patients with anemia and thirty-three healthy controls (HCs). All the subjects underwent quantitative susceptibility mapping (QSM) and arterial spin labeling (ASL) to measure ID and CBF in the cerebral nuclei. Furthermore, we evaluated lacunar infarction (LI), cerebral microbleeds, and total white matter hyperintensity volume (TWMHV). Hemodialysis patients with anemia showed significantly higher ID and CBF in some nuclei compared to the HCs after adjusting for age, sex, and total intracranial volume (TIV) [P < 0.05, false discovery rate (FDR) corrected]. CBF showed a positive correlation with ID in both patients and HCs after adjustments for age, gender, and TIV (P < 0.05, FDR corrected). Serum phosphorus, calcium, TWMHV, hypertension, and dialysis duration were independently associated with ID (P < 0.05). Hemoglobin, serum phosphorus, and LI were independently associated with CBF (P < 0.05). Mediation analysis demonstrated that CBF mediated the effects between hemoglobin and ID. Our study demonstrated that CBF mediated aberrant cerebral ID in hemodialysis patients with anemia.
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Affiliation(s)
- Huiying Wang
- The School of Medicine, Nankai
University, Tianjin, China
| | - Chao Chai
- Department of Radiology, Tianjin
First Central Hospital, School of Medicine, Nankai University, Tianjin,
China
- Imaging Medicine Institute of
Tianjin, Tianjin, China
| | - Gemuer Wu
- The School of Medicine, Nankai
University, Tianjin, China
| | - Jinping Li
- Department of Hemodialysis, Tianjin
First Central Hospital, School of Medicine, Nankai University, Tianjin,
China
| | - Chenxi Zhao
- Department of Radiology, First
Central Clinical College, Tianjin Medical University, Tianjin, China
| | - Dingwei Fu
- Department of Radiology, First
Central Clinical College, Tianjin Medical University, Tianjin, China
| | | | - Huapeng Wang
- Department of Radiology, First
Central Clinical College, Tianjin Medical University, Tianjin, China
| | - Beini Wang
- Department of Radiology, First
Central Clinical College, Tianjin Medical University, Tianjin, China
| | - Jinxia Zhu
- MR Collaboration, Siemens
Healthcare, Northeast Asia, Beijing, China
| | - Wen Shen
- Department of Radiology, Tianjin
First Central Hospital, School of Medicine, Nankai University, Tianjin,
China
- Imaging Medicine Institute of
Tianjin, Tianjin, China
| | - Shuang Xia
- Department of Radiology, Tianjin
First Central Hospital, School of Medicine, Nankai University, Tianjin,
China
- Imaging Medicine Institute of
Tianjin, Tianjin, China
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4
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Magaki S, Chen Z, Severance A, Williams CK, Diaz R, Fang C, Khanlou N, Yong WH, Paganini-Hill A, Kalaria RN, Vinters HV, Fisher M. Neuropathology of microbleeds in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). J Neuropathol Exp Neurol 2023; 82:333-344. [PMID: 36715085 PMCID: PMC10025882 DOI: 10.1093/jnen/nlad004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Cerebral microbleeds (CMBs) detected on magnetic resonance imaging are common in patients with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). The neuropathologic correlates of CMBs are unclear. In this study, we characterized findings relevant to CMBs in autopsy brain tissue of 8 patients with genetically confirmed CADASIL and 10 controls within the age range of the CADASIL patients by assessing the distribution and extent of hemosiderin/iron deposits including perivascular hemosiderin leakage (PVH), capillary hemosiderin deposits, and parenchymal iron deposits (PID) in the frontal cortex and white matter, basal ganglia and cerebellum. We also characterized infarcts, vessel wall thickening, and severity of vascular smooth muscle cell degeneration. CADASIL subjects had a significant increase in hemosiderin/iron deposits compared with controls. This increase was principally seen with PID. Hemosiderin/iron deposits were seen in the majority of CADASIL subjects in all brain areas. PVH was most pronounced in the frontal white matter and basal ganglia around small to medium sized arterioles, with no predilection for the vicinity of vessels with severe vascular changes or infarcts. CADASIL subjects have increased brain hemosiderin/iron deposits but these do not occur in a periarteriolar distribution. Pathogenesis of these lesions remains uncertain.
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Affiliation(s)
- Shino Magaki
- Section of Neuropathology, Department of Pathology and Laboratory Medicine, Ronald Reagan UCLA Medical Center and David Geffen School of Medicine, Los Angeles, California, USA
| | - Zesheng Chen
- Section of Neuropathology, Department of Pathology and Laboratory Medicine, Ronald Reagan UCLA Medical Center and David Geffen School of Medicine, Los Angeles, California, USA
| | - Alyscia Severance
- Section of Neuropathology, Department of Pathology and Laboratory Medicine, Ronald Reagan UCLA Medical Center and David Geffen School of Medicine, Los Angeles, California, USA
| | - Christopher K Williams
- Section of Neuropathology, Department of Pathology and Laboratory Medicine, Ronald Reagan UCLA Medical Center and David Geffen School of Medicine, Los Angeles, California, USA
| | - Ramiro Diaz
- Section of Neuropathology, Department of Pathology and Laboratory Medicine, Ronald Reagan UCLA Medical Center and David Geffen School of Medicine, Los Angeles, California, USA
| | - Chuo Fang
- Department of Neurology, University of California-Irvine School of Medicine, Irvine, California, USA
| | - Negar Khanlou
- Section of Neuropathology, Department of Pathology and Laboratory Medicine, Ronald Reagan UCLA Medical Center and David Geffen School of Medicine, Los Angeles, California, USA
| | - William H Yong
- Section of Neuropathology, Department of Pathology and Laboratory Medicine, Ronald Reagan UCLA Medical Center and David Geffen School of Medicine, Los Angeles, California, USA
| | - Annlia Paganini-Hill
- Department of Neurology, University of California-Irvine School of Medicine, Irvine, California, USA
| | - Rajesh N Kalaria
- Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - Harry V Vinters
- Section of Neuropathology, Department of Pathology and Laboratory Medicine, Ronald Reagan UCLA Medical Center and David Geffen School of Medicine, Los Angeles, California, USA
- Department of Neurology, Ronald Reagan UCLA Medical Center and David Geffen School of Medicine, Los Angeles, California, USA
- Brain Research Institute, Ronald Reagan UCLA Medical Center and David Geffen School of Medicine, Los Angeles, California, USA
| | - Mark Fisher
- Department of Neurology, University of California-Irvine School of Medicine, Irvine, California, USA
- Department of Pathology and Laboratory Medicine, University of California-Irvine School of Medicine, Irvine, California, USA
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5
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Goodyear BG, Heidari F, Ingram RJM, Cortese F, Sharifi N, Kaplan GG, Ma C, Panaccione R, Sharkey KA, Swain MG. Multimodal Brain MRI of Deep Gray Matter Changes Associated With Inflammatory Bowel Disease. Inflamm Bowel Dis 2023; 29:405-416. [PMID: 35590449 PMCID: PMC9977255 DOI: 10.1093/ibd/izac089] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Behavioral symptoms, including mood disorders, substantially impact the quality of life of patients with inflammatory bowel disease (IBD), even when clinical remission is achieved. Here, we used multimodal magnetic resonance imaging (MRI) to determine if IBD is associated with changes in the structure and function of deep gray matter brain regions that regulate and integrate emotional, cognitive, and stress responses. METHODS Thirty-five patients with ulcerative colitis (UC) or Crohn's disease (CD) and 32 healthy controls underwent 3 Tesla MRIs to assess volume, neural activity, functional connection strength (connectivity), inflammation, and neurodegeneration of key deep gray matter brain regions (thalamus, caudate, pallidum, putamen, amygdala, hippocampus, and hypothalamus) involved in emotional, cognitive and stress processing. Associations with sex, presence of pain, disease activity, and C-reactive protein (CRP) concentration were examined. RESULTS Significantly increased activity and functional connectivity were observed in cognitive and emotional processing brain regions, including parts of the limbic system, basal ganglia, and hypothalamus of IBD patients compared with healthy controls. Inflammatory bowel disease patients exhibited significantly increased volumes of the amygdala and hypothalamus, as well as evidence of neurodegeneration in the putamen and pallidum. Hippocampal neural activity was increased in IBD patients with active disease. The volume of the thalamus was positively correlated with CRP concentration and was increased in females experiencing pain. CONCLUSIONS Patients with IBD exhibit functional and structural changes in the limbic and striatal systems. These changes may be targets for assessing or predicting the response to therapeutic interventions aimed at improving comorbid emotional and cognitive symptoms.
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Affiliation(s)
- Bradley G Goodyear
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.,Department of Radiology, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,The Seaman Family MR Research Centre, University of Calgary, Calgary, Alberta, Canada.,The Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Faranak Heidari
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada.,The Seaman Family MR Research Centre, University of Calgary, Calgary, Alberta, Canada
| | - Richard J M Ingram
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada.,The Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
| | - Filomeno Cortese
- The Seaman Family MR Research Centre, University of Calgary, Calgary, Alberta, Canada
| | - Nastaran Sharifi
- The Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
| | - Gilaad G Kaplan
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada.,The Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
| | - Christopher Ma
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada.,The Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
| | - Remo Panaccione
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada.,The Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
| | - Keith A Sharkey
- Department of Physiology & Pharmacology, University of Calgary, Calgary, Alberta, Canada.,The Snyder Institute for Chronic Diseases, University of Calgary, Calgary, Alberta, Canada.,The Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Mark G Swain
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada.,The Snyder Institute for Chronic Diseases, University of Calgary, Calgary, Alberta, Canada.,The Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
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6
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Battistella G, Simonyan K. Clinical Implications of Dystonia as a Neural Network Disorder. ADVANCES IN NEUROBIOLOGY 2023; 31:223-240. [PMID: 37338705 DOI: 10.1007/978-3-031-26220-3_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Isolated dystonia is a neurological disorder of diverse etiology, multifactorial pathophysiology, and wide spectrum of clinical presentations. We review the recent neuroimaging advances that led to the conceptualization of dystonia as a neural network disorder and discuss how current knowledge is shaping the identification of biomarkers of dystonia and the development of novel pharmacological therapies.
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Affiliation(s)
- Giovanni Battistella
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, USA
| | - Kristina Simonyan
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, USA.
- Department of Neurology, Massachusetts General Hospital, and Harvard Medical School, Boston, MA, USA.
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7
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Kim H, Jang J, Kang J, Jang S, Nam Y, Choi Y, Shin NY, Ahn KJ, Kim BS. Clinical Implications of Focal Mineral Deposition in the Globus Pallidus on CT and Quantitative Susceptibility Mapping of MRI. Korean J Radiol 2022; 23:742-751. [PMID: 35695315 PMCID: PMC9240299 DOI: 10.3348/kjr.2022.0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/02/2022] [Accepted: 03/23/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess focal mineral deposition in the globus pallidus (GP) by CT and quantitative susceptibility mapping (QSM) of MRI scans and evaluate its clinical significance, particularly cerebrovascular degeneration. MATERIALS AND METHODS This study included 105 patients (66.1 ± 13.7 years; 40 male and 65 female) who underwent both CT and MRI with available QSM data between January 2017 and December 2019. The presence of focal mineral deposition in the GP on QSM (GPQSM) and CT (GPCT) was assessed visually using a three-point scale. Cerebrovascular risk factors and small vessel disease (SVD) imaging markers were also assessed. The clinical and radiological findings were compared between the different grades of GPQSM and GPCT. The relationship between GP grades and cerebrovascular risk factors and SVD imaging markers was assessed using univariable and multivariable linear regression analyses. RESULTS GPCT and GPQSM were significantly associated (p < 0.001) but were not identical. Higher GPCT and GPQSM grades showed smaller gray matter (p = 0.030 and p = 0.025, respectively) and white matter (p = 0.013 and p = 0.019, respectively) volumes, as well as larger GP volumes (p < 0.001 for both). Among SVD markers, white matter hyperintensity was significantly associated with GPCT (p = 0.006) and brain atrophy was significantly associated with GPQSM (p = 0.032) in at univariable analysis. In multivariable analysis, the normalized volume of the GP was independently positively associated with GPCT (p < 0.001) and GPQSM (p = 0.002), while the normalized volume of the GM was independently negatively associated with GPCT (p = 0.040) and GPQSM (p = 0.035). CONCLUSION Focal mineral deposition in the GP on CT and QSM might be a potential imaging marker of cerebral vascular degeneration. Both were associated with increased GP volume.
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Affiliation(s)
- Hyojin Kim
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jinhee Jang
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
| | - Junghwa Kang
- Division of Biomedical Engineering, Hankuk University of Foreign Studies, Yongin, Korea
| | - Seungun Jang
- Division of Biomedical Engineering, Hankuk University of Foreign Studies, Yongin, Korea
| | - Yoonho Nam
- Division of Biomedical Engineering, Hankuk University of Foreign Studies, Yongin, Korea
| | - Yangsean Choi
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Na-Young Shin
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kook-Jin Ahn
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Bum-Soo Kim
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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8
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Tsolaki E, Csincsik L, Xue J, Lengyel I, Bertazzo S. Nuclear and cellular, micro and nano calcification in Alzheimer's disease patients and correlation to phosphorylated Tau. Acta Biomater 2022; 143:138-144. [PMID: 35259518 DOI: 10.1016/j.actbio.2022.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 02/25/2022] [Accepted: 03/02/2022] [Indexed: 12/26/2022]
Abstract
Brain calcification (calcium phosphate mineral formation) has been reported in the past 100 years in the brains of Alzheimer's disease (AD) patients. However, the association between calcification and AD, the triggers for calcification, and its role within the disease are not clear. On the other hand, hyperphosphorylated Tau protein (pTau) tangles have been widely studied and recognized as an essential factor in developing AD. In this work, calcification in the brains of AD patients is characterized by advanced electron microscopy and fluorescence microscopy. Results are then compared to samples from cognitively healthy, age-matched donors, and the colocalization of calcification and pTau is investigated. Here, we show that AD patients' brains present microcalcification associated with the neural cell nuclei and cell projections, and that these are strongly related to the presence of pTau. The link between microcalcification and pTau suggests a potential mechanism of brain cell damage. Together with the formation of amyloid plaques and neurofibrillary tangles, microcalcification in neuronal cells adds to a better understanding of the pathology of AD. Finally, the presence of microcalcification in the neuronal cells of AD patients may assist in AD diagnosis, and may open avenues for developing intervention strategies based on inhibition of calcification. STATEMENT OF SIGNIFICANCE: Brain calcification has been reported in the past 100 years in the brains of Alzheimer's disease (AD) patients. However, the association between calcification and AD is not clear. Hyperphosphorylated Tau protein (pTau) has been studied and recognized as a key factor in developing AD. We show here that AD patients' brains present microcalcification associated with the neuronal cell nuclei and cell projections, and that these are related to the presence of pTau. The study of calcification in brain cells can contribute to a better understanding of the biochemical mechanisms associated with AD and might also reveal that calcification is part of the full disease mechanism. Moreover, this work opens the possibility for using calcification as a biomarker to identify AD.
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9
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Ayerdem G, Bosma MJ, Vinke JSJ, Ziengs AL, Potgieser ARE, Gansevoort RT, Bakker SJL, De Borst MH, Eisenga MF. Association of Endogenous Erythropoietin Levels and Iron Status With Cognitive Functioning in the General Population. Front Aging Neurosci 2022; 14:862856. [PMID: 35462689 PMCID: PMC9024369 DOI: 10.3389/fnagi.2022.862856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 03/15/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundEmerging data suggest that erythropoietin (EPO) promotes neural plasticity and that iron homeostasis is needed to maintain normal physiological brain function. Cognitive functioning could therefore be influenced by endogenous EPO levels and disturbances in iron status.ObjectiveTo determine whether endogenous EPO levels and disturbances in iron status are associated with alterations in cognitive functioning in the general population.Materials and MethodsCommunity-dwelling individuals from the Prevention of Renal and Vascular End-Stage Disease (PREVEND) study, a general population-based cohort in Groningen, Netherlands, were surveyed between 2003 and 2006. Additionally, endogenous EPO levels and iron status, consisting of serum iron, transferrin, ferritin, and transferrin saturation were analyzed. Cognitive function was assessed by scores on the Ruff Figural Fluency Test (RFFT), as a reflection of executive function, and the Visual Association Test (VAT), as a reflection of associative memory.ResultsAmong 851 participants (57% males; mean age 60 ± 13 years), higher endogenous EPO levels were independently associated with an improved cognitive function, reflected by RFFT scores (ß = 0.09, P = 0.008). In multivariable backward linear regression analysis, EPO levels were among the most important modifiable determinants of RFFT scores (ß = 0.09, P = 0.002), but not of VAT scores. Of the iron status parameters, only serum ferritin levels were inversely associated with cognitive function, reflected by VAT scores, in multivariable logistic regression analysis (odds ratio, 0.77; 95% confidence interval 0.63–0.95; P = 0.02 for high performance on VAT, i.e., ≥11 points). No association between iron status parameters and RFFT scores was identified.ConclusionThe findings suggest that endogenous EPO levels and serum ferritin levels are associated with specific cognitive functioning tests in the general population. Higher EPO levels are associated with better RFFT scores, implying better executive function. Serum ferritin levels, but not other iron status parameters, were inversely associated with high performance on the VAT score, implying a reduced ability to create new memories and recall recent past. Further research is warranted to unravel underlying mechanisms and possible benefits of therapeutic interventions.
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Affiliation(s)
- Gizem Ayerdem
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Matthijs J. Bosma
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Joanna Sophia J. Vinke
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Aaltje L. Ziengs
- Department of Neuropsychology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Adriaan R. E. Potgieser
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Ron T. Gansevoort
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Stephan J. L. Bakker
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Martin H. De Borst
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Michele F. Eisenga
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- *Correspondence: Michele F. Eisenga,
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10
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Lorio S, Sedlacik J, So PW, Parkes HG, Gunny R, Löbel U, Li YF, Ogunbiyi O, Mistry T, Dixon E, Adler S, Cross JH, Baldeweg T, Jacques TS, Shmueli K, Carmichael DW. Quantitative MRI susceptibility mapping reveals cortical signatures of changes in iron, calcium and zinc in malformations of cortical development in children with drug-resistant epilepsy. Neuroimage 2021; 238:118102. [PMID: 34058334 PMCID: PMC8350142 DOI: 10.1016/j.neuroimage.2021.118102] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 04/14/2021] [Accepted: 04/19/2021] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Malformations of cortical development (MCD), including focal cortical dysplasia (FCD), are the most common cause of drug-resistant focal epilepsy in children. Histopathological lesion characterisation demonstrates abnormal cell types and lamination, alterations in myelin (typically co-localised with iron), and sometimes calcification. Quantitative susceptibility mapping (QSM) is an emerging MRI technique that measures tissue magnetic susceptibility (χ) reflecting it's mineral composition. We used QSM to investigate abnormal tissue composition in a group of children with focal epilepsy with comparison to effective transverse relaxation rate (R2*) and Synchrotron radiation X-ray fluorescence (SRXRF) elemental maps. Our primary hypothesis was that reductions in χ would be found in FCD lesions, resulting from alterations in their iron and calcium content. We also evaluated deep grey matter nuclei for changes in χ with age. METHODS QSM and R2* maps were calculated for 40 paediatric patients with suspected MCD (18 histologically confirmed) and 17 age-matched controls. Patients' sub-groups were defined based on concordant electro-clinical or histopathology data. Quantitative investigation of QSM and R2* was performed within lesions, using a surface-based approach with comparison to homologous regions, and within deep brain regions using a voxel-based approach with regional values modelled with age and epilepsy as covariates. Synchrotron radiation X-ray fluorescence (SRXRF) was performed on brain tissue resected from 4 patients to map changes in iron, calcium and zinc and relate them to MRI parameters. RESULTS Compared to fluid-attenuated inversion recovery (FLAIR) or T1-weighted imaging, QSM improved lesion conspicuity in 5% of patients. In patients with well-localised lesions, quantitative profiling demonstrated decreased χ, but not R2*, across cortical depth with respect to the homologous regions. Contra-lateral homologous regions additionally exhibited increased χ at 2-3 mm cortical depth that was absent in lesions. The iron decrease measured by the SRXRF in FCDIIb lesions was in agreement with myelin reduction observed by Luxol Fast Blue histochemical staining. SRXRF analysis in two FCDIIb tissue samples showed increased zinc and calcium in one patient, and decreased iron in the brain region exhibiting low χ and high R2* in both patients. QSM revealed expected age-related changes in the striatum nuclei, substantia nigra, sub-thalamic and red nucleus. CONCLUSION QSM non-invasively revealed cortical/sub-cortical tissue alterations in MCD lesions and in particular that χ changes in FCDIIb lesions were consistent with reduced iron, co-localised with low myelin and increased calcium and zinc content. These findings suggest that measurements of cortical χ could be used to characterise tissue properties non-invasively in epilepsy lesions.
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Affiliation(s)
- Sara Lorio
- Developmental Neurosciences, Great Ormond Street Institute of Child Health, University College London, London, UK; Wellcome EPSRC Centre for Medical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London SE1 7EH, UK
| | - Jan Sedlacik
- Biomedical Engineering Department, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK; Center for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Po-Wah So
- Department of Neuroimaging, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Harold G Parkes
- Department of Neuroimaging, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Roxana Gunny
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Ulrike Löbel
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Yao-Feng Li
- Developmental Biology and Cancer Programme, UCL Great Ormond Street Institute of Child Health, University College London and Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; Pathology Department, Tri-Service General Hospital and National Defence Medical Centre, Taipei, Taiwan, ROC
| | - Olumide Ogunbiyi
- Developmental Biology and Cancer Programme, UCL Great Ormond Street Institute of Child Health, University College London and Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Talisa Mistry
- Developmental Biology and Cancer Programme, UCL Great Ormond Street Institute of Child Health, University College London and Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Emma Dixon
- MRI Group, Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Sophie Adler
- Developmental Neurosciences, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - J Helen Cross
- Developmental Neurosciences, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Torsten Baldeweg
- Developmental Neurosciences, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Thomas S Jacques
- Developmental Biology and Cancer Programme, UCL Great Ormond Street Institute of Child Health, University College London and Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Karin Shmueli
- MRI Group, Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - David W Carmichael
- Developmental Neurosciences, Great Ormond Street Institute of Child Health, University College London, London, UK; Wellcome EPSRC Centre for Medical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London SE1 7EH, UK.
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11
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Gozt A, Hellewell S, Ward PGD, Bynevelt M, Fitzgerald M. Emerging Applications for Quantitative Susceptibility Mapping in the Detection of Traumatic Brain Injury Pathology. Neuroscience 2021; 467:218-236. [PMID: 34087394 DOI: 10.1016/j.neuroscience.2021.05.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 12/16/2022]
Abstract
Traumatic brain injury (TBI) is a common but heterogeneous injury underpinned by numerous complex and interrelated pathophysiological mechanisms. An essential trace element, iron is abundant within the brain and involved in many fundamental neurobiological processes, including oxygen transportation, oxidative phosphorylation, myelin production and maintenance, as well as neurotransmitter synthesis and metabolism. Excessive levels of iron are neurotoxic and thus iron homeostasis is tightly regulated in the brain, however, many details about the mechanisms by which this is achieved are yet to be elucidated. A key mediator of oxidative stress, mitochondrial dysfunction and neuroinflammatory response, iron dysregulation is an important contributor to secondary injury in TBI. Advances in neuroimaging that leverage magnetic susceptibility properties have enabled increasingly comprehensive investigations into the distribution and behaviour of iron in the brain amongst healthy individuals as well as disease states such as TBI. Quantitative Susceptibility Mapping (QSM) is an advanced neuroimaging technique that promises quantitative estimation of local magnetic susceptibility at the voxel level. In this review, we provide an overview of brain iron and its homeostasis, describe recent advances enabling applications of QSM within the context of TBI and summarise the current state of the literature. Although limited, the emergent research suggests that QSM is a promising neuroimaging technique that can be used to investigate a host of pathophysiological changes that are associated with TBI.
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Affiliation(s)
- Aleksandra Gozt
- Curtin University, Faculty of Health Sciences, Curtin Health Innovation Research Institute, Bentley, WA Australia; Perron Institute for Neurological and Translational Science, Nedlands, WA Australia
| | - Sarah Hellewell
- Curtin University, Faculty of Health Sciences, Curtin Health Innovation Research Institute, Bentley, WA Australia
| | - Phillip G D Ward
- Australian Research Council Centre of Excellence for Integrative Brain Function, VIC Australia; Turner Institute for Brain and Mental Health, Monash University, VIC Australia
| | - Michael Bynevelt
- Neurological Intervention and Imaging Service of Western Australia, Sir Charles Gairdner Hospital, Nedlands, WA Australia
| | - Melinda Fitzgerald
- Curtin University, Faculty of Health Sciences, Curtin Health Innovation Research Institute, Bentley, WA Australia; Perron Institute for Neurological and Translational Science, Nedlands, WA Australia.
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12
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Incidental evidence of hypointensity in brain grey nuclei on routine MR imaging: when to suspect a neurodegenerative disorder? Neurol Sci 2021; 43:643-650. [PMID: 33931819 DOI: 10.1007/s10072-021-05292-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 04/26/2021] [Indexed: 10/21/2022]
Abstract
Deep grey nuclei of the human brain accumulate minerals both in aging and in several neurodegenerative diseases. Mineral deposition produces a shortening of the transverse relaxation time which causes hypointensity on magnetic resonance (MR) imaging. The physician often has difficulties in determining whether the incidental hypointensity of grey nuclei seen on MR images is related to aging or neurodegenerative pathology. We investigated the hypointensity patterns in globus pallidus, putamen, caudate nucleus, thalamus and dentate nucleus of 217 healthy subjects (ages, 20-79 years; men/women, 104/113) using 3T MR imaging. Hypointensity was detected more frequently in globus pallidus (35.5%) than in dentate nucleus (32.7%) and putamen (7.8%). A consistent effect of aging on hypointensity (p < 0.001) of these grey nuclei was evident. Putaminal hypointensity appeared only in elderly subjects whereas we did not find hypointensity in the caudate nucleus and thalamus of any subject. In conclusion, the evidence of hypointensity in the caudate nucleus and thalamus at any age or hypointensity in the putamen seen in young subjects should prompt the clinician to consider a neurodegenerative disease.
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13
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Bartstra JW, van den Beukel TC, Van Hecke W, Mali WPTM, Spiering W, Koek HL, Hendrikse J, de Jong PA, den Harder AM. Intracranial Arterial Calcification: Prevalence, Risk Factors, and Consequences: JACC Review Topic of the Week. J Am Coll Cardiol 2021; 76:1595-1604. [PMID: 32972537 DOI: 10.1016/j.jacc.2020.07.056] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/09/2020] [Accepted: 07/20/2020] [Indexed: 02/07/2023]
Abstract
Intracranial large and small arterial calcifications are a common incidental finding on computed tomography imaging in the general population. Here we provide an overview of the published reports on prevalence of intracranial arterial calcifications on computed tomography imaging and histopathology in relation to risk factors and clinical outcomes. We performed a systematic search in Medline, with a search filter using synonyms for computed tomography scanning, (histo)pathology, different intracranial arterial beds, and calcification. We found that intracranial calcifications are a frequent finding in all arterial beds with the highest prevalence in the intracranial internal carotid artery. In general, prevalence increases with age. Longitudinal studies on calcification progression and intervention studies are warranted to investigate the possible causal role of calcification on clinical outcomes. This might open up new therapeutic directions in stroke and dementia prevention and the maintenance of the healthy brain.
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Affiliation(s)
- Jonas W Bartstra
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
| | - Tim C van den Beukel
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Wim Van Hecke
- Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Willem P T M Mali
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Wilko Spiering
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Huiberdina L Koek
- Department of Geriatrics, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Jeroen Hendrikse
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Pim A de Jong
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Annemarie M den Harder
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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14
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Fahr's syndrome due to hypoparathyroidism revisited: A case of parkinsonism and a review of all published cases. Clin Neurol Neurosurg 2021; 202:106514. [PMID: 33529967 DOI: 10.1016/j.clineuro.2021.106514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Fahr's syndrome due to hypoparathyroidism refers to bilateral basal ganglia (BG) calcifications and manifests with movement disorders, seizures, cognitive and behavioral symptoms. CASE PRESENTATION We report a case of a 74-year-old woman, who presented with parkinsonism due to post-surgical hypoparathyroidism and normal DaT scan, despite extensive calcifications of the BG, periventricular white matter, and cerebellum. METHODS A comprehensive literature review of all reported cases of Fahr's syndrome due to hypoparathyroidism was conducted in the electronic databases PubMed and Web of science. Moreover, demographic and clinical characteristics of the patients overall were calculated and associated with radiological findings. RESULTS We reviewed a total of 223 cases with Fahr's syndrome due to hypoparathyroidism (124 female, 99 male). Mean age on presentation was 44.6 ± 17.7 years. Thirty nine percent of patients had idiopathic hypoparathyroidism, 35.4 % acquired and 25.6 % pseudohypoparathyroidism. Almost half of the patients had tetany, seizures or a movement disorder and approximately 40 % neuropsychiatric symptoms. The patients with a movement disorder had a 2.23 likelihood of having neuropsychiatric symptoms as well (OR 2.23, 95 % CI 1.29-3.87). Moreover, there was a statistically significant association between the phenotype severity (i.e. the presence of more than one symptom) and the extent of brain calcifications (χ2 = 32.383, p = 0.009). CONCLUSION Fahr's syndrome is a rare disorder, which nonetheless manifests with several neurological symptoms. A head CT should be considered for patients with hypoparathyroidism and neurological symptoms. More studies using DaT scan are needed to elucidate the effects of calcifications on the dopaminergic function of the BG.
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15
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Mellagui Y, Aabdi M, Ouachaou J, Bkiyar H, Housni B. Delayed awakening from general anesthesia revealing Fahr syndrome: Case report and literature review. Clin Case Rep 2020; 8:3337-3339. [PMID: 33363929 PMCID: PMC7752567 DOI: 10.1002/ccr3.3183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 05/29/2020] [Accepted: 07/05/2020] [Indexed: 11/10/2022] Open
Abstract
Fahr syndrome (FS) is defined by the presence of bilateral and symmetrical intracerebral nonarteriosclerotic calcifications, localized in the central gray nuclei. We report the case of a patient who presented a postoperative delay in awakening and whose biological and radiological investigations revealed a FS.
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Affiliation(s)
- Yassine Mellagui
- Department of Anesthesia ‐Intensive Care UnitFaculty of Medicine and Pharmacy of OujdaMohammed VI Hospital CenterMohammed I UniversityOujdaMorocco
| | - Mohammed Aabdi
- Department of Anesthesia ‐Intensive Care UnitFaculty of Medicine and Pharmacy of OujdaMohammed VI Hospital CenterMohammed I UniversityOujdaMorocco
| | - Jamal Ouachaou
- Department of Anesthesia ‐Intensive Care UnitFaculty of Medicine and Pharmacy of OujdaMohammed VI Hospital CenterMohammed I UniversityOujdaMorocco
| | - Houssam Bkiyar
- Department of Anesthesia ‐Intensive Care UnitFaculty of Medicine and Pharmacy of OujdaMohammed VI Hospital CenterMohammed I UniversityOujdaMorocco
| | - Brahim Housni
- Department of Anesthesia ‐Intensive Care UnitFaculty of Medicine and Pharmacy of OujdaMohammed VI Hospital CenterMohammed I UniversityOujdaMorocco
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16
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Snyder-Keller A, Bolivar VJ, Zink S, Kramer LD. Brain Iron Accumulation and the Formation of Calcifications After Developmental Zika Virus Infection. J Neuropathol Exp Neurol 2020; 79:767-776. [PMID: 32483612 DOI: 10.1093/jnen/nlaa043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 04/24/2020] [Indexed: 12/20/2022] Open
Abstract
Intracranial calcifications (ICC) are the most common neuropathological finding in the brains of children exposed in utero to the Zika virus (ZIKV). Using a mouse model of developmental ZIKV infection, we reported widespread calcifications in the brains of susceptible mice that correlated in multiple ways with the behavioral deficits observed. Here, we examined the time course of ICC development and the role of iron deposition in this process, in 3 genetically distinct inbred strains of mice. Brain iron deposits were evident by Perls' staining at 2 weeks post infection, becoming increasingly dense and coinciding with calcium buildup and the formation of ICCs. A regional analysis of the brains of susceptible mice (C57BL/6J and 129S1/SvImJ strains) revealed the presence of iron initially in regions containing many ZIKV-immunoreactive cells, but then spreading to regions containing few infected cells, most notably the thalamus and the fasciculus retroflexus. Microglial activation was widespread initially and later delineated the sites of ICC formation. Behavioral tests conducted at 5-6 weeks of age revealed greater deficits in mice with the most extensive iron deposition and calcification of subcortical regions, such as thalamus. These findings point to iron deposition as a key factor in the development of ICCs after developmental ZIKV infection.
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Affiliation(s)
- Abigail Snyder-Keller
- Wadsworth Center, New York State Department of Health.,Department of Biomedical Sciences, University at Albany School of Public Health, Albany, New York
| | - Valerie J Bolivar
- Wadsworth Center, New York State Department of Health.,Department of Biomedical Sciences, University at Albany School of Public Health, Albany, New York
| | - Steven Zink
- Wadsworth Center, New York State Department of Health
| | - Laura D Kramer
- Wadsworth Center, New York State Department of Health.,Department of Biomedical Sciences, University at Albany School of Public Health, Albany, New York
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17
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Bulk M, Hegeman-Kleinn I, Kenkhuis B, Suidgeest E, van Roon-Mom W, Lewerenz J, van Duinen S, Ronen I, van der Weerd L. Pathological characterization of T2*-weighted MRI contrast in the striatum of Huntington's disease patients. Neuroimage Clin 2020; 28:102498. [PMID: 33395988 PMCID: PMC7677121 DOI: 10.1016/j.nicl.2020.102498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 11/02/2020] [Accepted: 11/03/2020] [Indexed: 01/19/2023]
Abstract
Previous MRI studies consistently reported iron accumulation within the striatum of patients with Huntington's disease (HD). However, the pattern and origin of iron accumulation is poorly understood. This study aimed to characterize the histopathological correlates of iron-sensitive ex vivo MRI contrast change in HD brains. To this end, T2*-weighted 7T MRI was performed on postmortem tissue of the striatum of three control subjects and 10 HD patients followed by histological examination. In addition, formalin-fixed paraffin-embedded material of three control subjects and 14 HD patients was selected for only histology to identify the cellular localization of iron using stainings for iron, myelin, microglia and astrocytes. As expected HD striata showed prominent atrophy. Compared to controls, the striatum of HD patients was in general more hypointense on T2*-weighted high-field MRI and showed a more intense histopathological staining for iron. In addition, T2*-weighted MRI identified large focal hypointensities within the striatum of HD patients. Upon histological examination, these large focal hypointensities frequently colocalized with enlarged perivascular spaces and iron was found within the vessel wall and reactive astrocytes. In conclusion, we show that the striatum of HD patients has a distinctive phenotype on T2*-weighted MRI compared to control subjects. On ex vivo MRI, these contrast changes are heavily biased by enlarged perivascular spaces from which it is currently unknown whether this is a fixation artefact or a disease specific observation. Clinically, the observation of iron within reactive astrocytes is of importance for the interpretation and understanding of the potential underlying mechanisms of T2*-weighted MRI results in HD patients.
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Affiliation(s)
- Marjolein Bulk
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Human Genetics, Leiden University Medical Center, Leiden, the Netherlands.
| | | | - Boyd Kenkhuis
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Human Genetics, Leiden University Medical Center, Leiden, the Netherlands
| | - Ernst Suidgeest
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Willeke van Roon-Mom
- Department of Human Genetics, Leiden University Medical Center, Leiden, the Netherlands
| | - Jan Lewerenz
- Department of Neurology, Ulm University Hospital, Ulm, Germany
| | - Sjoerd van Duinen
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Itamar Ronen
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Louise van der Weerd
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Human Genetics, Leiden University Medical Center, Leiden, the Netherlands
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18
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Pathological Mineralization: The Potential of Mineralomics. MATERIALS 2019; 12:ma12193126. [PMID: 31557841 PMCID: PMC6804219 DOI: 10.3390/ma12193126] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 09/11/2019] [Accepted: 09/19/2019] [Indexed: 12/11/2022]
Abstract
Pathological mineralization has been reported countless times in the literature and is a well-known phenomenon in the medical field for its connections to a wide range of diseases, including cancer, cardiovascular, and neurodegenerative diseases. The minerals involved in calcification, however, have not been directly studied as extensively as the organic components of each of the pathologies. These have been studied in isolation and, for most of them, physicochemical properties are hitherto not fully known. In a parallel development, materials science methods such as electron microscopy, spectroscopy, thermal analysis, and others have been used in biology mainly for the study of hard tissues and biomaterials and have only recently been incorporated in the study of other biological systems. This review connects a range of soft tissue diseases, including breast cancer, age-related macular degeneration, aortic valve stenosis, kidney stone diseases, and Fahr’s syndrome, all of which have been associated with mineralization processes. Furthermore, it describes how physicochemical material characterization methods have been used to provide new information on such pathologies. Here, we focus on diseases that are associated with calcium-composed minerals to discuss how understanding the properties of these minerals can provide new insights on their origins, considering that different conditions and biological features are required for each type of mineral to be formed. We show that mineralomics, or the study of the properties and roles of minerals, can provide information which will help to improve prevention methods against pathological mineral build-up, which in the cases of most of the diseases mentioned in this review, will ultimately lead to new prevention or treatment methods for the diseases. Importantly, this review aims to highlight that chemical composition alone cannot fully support conclusions drawn on the nature of these minerals.
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19
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Dafsari HS, Sprute R, Wunderlich G, Daimagüler HS, Karaca E, Contreras A, Becker K, Schulze-Rhonhof M, Kiening K, Karakulak T, Kloss M, Horn A, Pauls A, Nürnberg P, Altmüller J, Thiele H, Assmann B, Koy A, Cirak S. Novel mutations in KMT2B offer pathophysiological insights into childhood-onset progressive dystonia. J Hum Genet 2019; 64:803-813. [PMID: 31165786 DOI: 10.1038/s10038-019-0625-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 05/09/2019] [Accepted: 05/21/2019] [Indexed: 11/09/2022]
Abstract
Rapid progress has recently been made in the elucidation of the genetic basis of childhood-onset inherited generalized dystonia (IGD) due to the implementation of genomic sequencing methodologies. We identified four patients with childhood-onset IGD harboring novel disease-causing mutations in lysine-specific histone methyltransferase 2B gene (KMT2B) by whole-exome sequencing. The main focus of this paper is to gain novel pathophysiological insights through understanding the molecular consequences of these mutations. The disease course is mostly progressive, evolving from lower limbs into generalized dystonia, which could be associated with dysarthria, dysphonia, intellectual disability, orofacial dyskinesia, and sometimes distinct dysmorphic facial features. In two patients, motor performances improved after bilateral implantation of deep brain stimulation in the globus pallidus internus (GPi-DBS). Pharmacotherapy with trihexyphenidyl reduced dystonia in two patients. We discovered three novel KMT2B mutations. Our analyses revealed that the mutation in patient 1 (c.7463A > G, p.Y2488C) is localized in the highly conserved FYRC domain of KMT2B. This mutation holds the potential to alter the inter-domain FYR interactions, which could lead to KMT2B instability. The mutations in patients 2 and 3 (c.3596_3697insC, p.M1202Dfs*22; c.4229delA, p.Q1410Rfs*12) lead to predicted unstable transcripts, likely to be subject to degradation by non-sense-mediated decay. Childhood-onset progressive dystonia with orofacial involvement is one of the main clinical manifestations of KMT2B mutations. In all, 26% (18/69) of the reported cases have T2 signal alterations of the globus pallidus internus, mostly at a younger age. Anticholinergic medication and GPi-DBS are promising treatment options and shall be considered early.
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Affiliation(s)
- Hormos Salimi Dafsari
- Department of Pediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Rosanne Sprute
- Department of Pediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Gilbert Wunderlich
- Center for Rare Diseases, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Hülya-Sevcan Daimagüler
- Department of Pediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Ezgi Karaca
- Izmir Biomedicine and Genome Center, Izmir, Turkey.,Izmir International Biomedicine and Genome Institute, Dokuz Eylül University, Izmir, Turkey
| | - Adriana Contreras
- Department of Pediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Kerstin Becker
- Department of Pediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Mira Schulze-Rhonhof
- Department of Pediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Karl Kiening
- Department of Neurosurgery, University Hospital, Heidelberg, Germany
| | - Tülay Karakulak
- Izmir Biomedicine and Genome Center, Izmir, Turkey.,Izmir International Biomedicine and Genome Institute, Dokuz Eylül University, Izmir, Turkey
| | - Manja Kloss
- Department of Neurology, University Hospital, Heidelberg, Germany
| | - Annette Horn
- Department of General Pediatrics and Neonatology, University Children's Hospital, Düsseldorf, Germany
| | - Amande Pauls
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Peter Nürnberg
- Cologne Center for Genomics (CCG), Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Janine Altmüller
- Cologne Center for Genomics (CCG), Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Holger Thiele
- Cologne Center for Genomics (CCG), Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Birgit Assmann
- Department of Neuropediatrics, University Children's Hospital, Heidelberg, Germany
| | - Anne Koy
- Department of Pediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Center for Rare Diseases, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Sebahattin Cirak
- Department of Pediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany. .,Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine, University of Cologne, Cologne, Germany. .,Center for Rare Diseases, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
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Hamed SA. Neurologic conditions and disorders of uremic syndrome of chronic kidney disease: presentations, causes, and treatment strategies. Expert Rev Clin Pharmacol 2019; 12:61-90. [PMID: 30501441 DOI: 10.1080/17512433.2019.1555468] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Sherifa A. Hamed
- Department of Neurology and Psychiatry, Assiut University Hospital, Assiut, Egypt
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Harper AM, Clayson L, Wardlaw JM, Valdés Hernández MDC. Considerations on accuracy, pattern and possible underlying factors of brain microbleed progression in older adults with absence or mild presence of vascular pathology. J Int Med Res 2018; 46:3518-3538. [PMID: 29578354 PMCID: PMC6135998 DOI: 10.1177/0300060518755623] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Objective To analyse brain microbleed (BMB) progression, its possible underlying factors, and the influence of inter-observer differences, in older individuals with none or mild vascular pathology. Methods This study analysed magnetic resonance images, cognitive, demographic and laboratory data from all individuals from the Alzheimer's Disease (AD) Neuroimaging Initiative database who had the required sequences for identifying BMBs over three consecutive years at the time the database was accessed (January 2016). BMBs were assessed independently by two observers with similar levels of experience. Results A total of 291 patients were included in the study. The number of individuals with BMBs and the number of BMBs per individual slightly and nonsignificantly increased across three consecutive years (Y1: 55/291 [19%]; Y2: 61/291 [21%]; Y3: 66/291 [23%]) with 1-2 BMBs and (Y1: 11/291 [4%]; Y2: 12/291 [4%]; Y3: 14/291 [5%]) with ≥ 3 BMBs. Both observers identified a similar pattern of BMB prevalence and progression in each cognitive group (normal < early/late mild cognitive impairment (MCI) > AD patients) despite inter-observer differences (1.5 BMBs, 95% confidence interval -3.7, 6.2], κ=0.543), which were mainly in the cortex. Serum cholesterol was the main predictor of change in BMB count between time-points but did not predict overall progression. Conclusions Inter-observer differences are always present and it is difficult to ascertain their influence in the analysis of BMB progression, which was observed in cognitively normal and MCI individuals, but not in AD patients. This should be confirmed in further studies.
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Affiliation(s)
- Alice M Harper
- 1 College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Lauren Clayson
- 1 College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Joanna M Wardlaw
- 2 Department of Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,3 Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK.,4 UK Dementia Research Institute at The University of Edinburgh, Edinburgh, UK
| | - Maria Del C Valdés Hernández
- 2 Department of Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,3 Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK.,4 UK Dementia Research Institute at The University of Edinburgh, Edinburgh, UK
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22
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Aggarwal M, Li X, Gröhn O, Sierra A. Nuclei-specific deposits of iron and calcium in the rat thalamus after status epilepticus revealed with quantitative susceptibility mapping (QSM). J Magn Reson Imaging 2018; 47:554-564. [PMID: 28580758 PMCID: PMC5839879 DOI: 10.1002/jmri.25777] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 05/15/2017] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To investigate pathological changes in the rat brain after pilocarpine-induced status epilepticus using quantitative susceptibility mapping (QSM). MATERIALS AND METHODS 3D multiecho gradient-echo (GRE) data were acquired from ex vivo brains of pilocarpine-injected and age-matched control rats at 11.7T. Maps of R2* and quantitative susceptibility were calculated from the acquired 3D GRE magnitude and phase data, respectively. QSM and R2* maps were compared with Perls' (iron) and Alizarin-red-S (calcium) stainings in the same brains to investigate the pathophysiological basis of susceptibility contrast. RESULTS Bilaterally symmetric lesions were detected in reproducible thalamic regions of pilocarpine-treated rats, characterized by hyperintensity in R2* maps. In comparison, quantitative susceptibility maps demonstrated heterogeneous contrast within the lesions, with distinct hyperintense (paramagnetic) and hypointense (diamagnetic) areas. Comparison with histological assessment revealed localized deposits of iron- and calcium-positive granules in thalamic nuclei corresponding to paramagnetic and diamagnetic areas delineated in the susceptibility maps, respectively. Pronounced differences were observed in the lesions between background-corrected phase images and reconstructed susceptibility maps, indicating unreliable differentiation of iron and calcium deposits in phase maps. Multiple linear regression showed a significant association between susceptibility values and measured optical densities (ODs) of iron and calcium in the lesions (R2 = 0.42, P < 0.001), with a positive dependence on OD of iron and negative dependence on OD of calcium. CONCLUSION QSM can detect and differentiate pathological iron and calcium deposits with high sensitivity and improved spatial accuracy compared to R2* or GRE phase images, rendering it a promising technique for diagnosing thalamic lesions after status epilepticus. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2018;47:554-564.
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Affiliation(s)
- Manisha Aggarwal
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Xu Li
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- F. M. Kirby Research Center, Kennedy Krieger Institute, Baltimore, MD, United States
| | - Olli Gröhn
- A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Alejandra Sierra
- A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
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Dietrich P, Johnson IM, Alli S, Dragatsis I. Elimination of huntingtin in the adult mouse leads to progressive behavioral deficits, bilateral thalamic calcification, and altered brain iron homeostasis. PLoS Genet 2017; 13:e1006846. [PMID: 28715425 PMCID: PMC5536499 DOI: 10.1371/journal.pgen.1006846] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 07/31/2017] [Accepted: 06/01/2017] [Indexed: 02/07/2023] Open
Abstract
Huntington's Disease (HD) is an autosomal dominant progressive neurodegenerative disorder characterized by cognitive, behavioral and motor dysfunctions. HD is caused by a CAG repeat expansion in exon 1 of the HD gene that is translated into an expanded polyglutamine tract in the encoded protein, huntingtin (HTT). While the most significant neuropathology of HD occurs in the striatum, other brain regions are also affected and play an important role in HD pathology. To date there is no cure for HD, and recently strategies aiming at silencing HTT expression have been initiated as possible therapeutics for HD. However, the essential functions of HTT in the adult brain are currently unknown and hence the consequence of sustained suppression of HTT expression is unpredictable and can potentially be deleterious. Using the Cre-loxP system of recombination, we conditionally inactivated the mouse HD gene homologue at 3, 6 and 9 months of age. Here we show that elimination of Htt expression in the adult mouse results in behavioral deficits, progressive neuropathological changes including bilateral thalamic calcification, and altered brain iron homeostasis.
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Affiliation(s)
- Paula Dietrich
- Department of Physiology, The University of Tennessee, Health Science Center, Memphis, Tennessee, United States of America
| | - Irudayam Maria Johnson
- Department of Physiology, The University of Tennessee, Health Science Center, Memphis, Tennessee, United States of America
| | - Shanta Alli
- Department of Physiology, The University of Tennessee, Health Science Center, Memphis, Tennessee, United States of America
| | - Ioannis Dragatsis
- Department of Physiology, The University of Tennessee, Health Science Center, Memphis, Tennessee, United States of America
- * E-mail:
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Pirpamer L, Hofer E, Gesierich B, De Guio F, Freudenberger P, Seiler S, Duering M, Jouvent E, Duchesnay E, Dichgans M, Ropele S, Schmidt R. Determinants of iron accumulation in the normal aging brain. Neurobiol Aging 2016; 43:149-55. [DOI: 10.1016/j.neurobiolaging.2016.04.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 03/22/2016] [Accepted: 04/05/2016] [Indexed: 12/13/2022]
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Del C Valdés Hernández M, Ritchie S, Glatz A, Allerhand M, Muñoz Maniega S, Gow AJ, Royle NA, Bastin ME, Starr JM, Deary IJ, Wardlaw JM. Brain iron deposits and lifespan cognitive ability. AGE (DORDRECHT, NETHERLANDS) 2015; 37:100. [PMID: 26378028 PMCID: PMC5005839 DOI: 10.1007/s11357-015-9837-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 09/07/2015] [Indexed: 06/05/2023]
Abstract
Several studies have reported associations between brain iron deposits and cognitive status, and cardiovascular and neurodegenerative diseases in older individuals, but the mechanisms underlying these associations remain unclear. We explored the associations between regional brain iron deposits and different factors of cognitive ability (fluid intelligence, speed and memory) in a large sample (n = 662) of individuals with a mean age of 73 years. Brain iron deposits in the corpus striatum were extracted automatically. Iron deposits in other parts of the brain (i.e., white matter, thalamus, brainstem and cortex), brain tissue volume and white matter hyperintensities (WMH) were assessed separately and semi-automatically. Overall, 72.8 % of the sample had iron deposits. The total volume of iron deposits had a small but significant negative association with all three cognitive ability factors in later life (mean r = -0.165), but no relation to intelligence in childhood (r = 0.043, p = 0.282). Regression models showed that these iron deposit associations were still present after control for a variety of vascular health factors, and were separable from the association of WMH with cognitive ability. Iron deposits were also associated with cognition across the lifespan, indicating that they are relevant for cognitive ability only at older ages. Iron deposits might be an indicator of small vessel disease that affects the neuronal networks underlying higher cognitive functioning.
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Affiliation(s)
- Maria Del C Valdés Hernández
- Department of Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, 49 Little France Crescent, Chancellor's Building, Edinburgh, EH16 4SB, UK.
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK.
| | - Stuart Ritchie
- Department of Psychology, University of Edinburgh, Edinburgh, UK
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - Andreas Glatz
- Department of Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, 49 Little France Crescent, Chancellor's Building, Edinburgh, EH16 4SB, UK
| | - Mike Allerhand
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - Susana Muñoz Maniega
- Department of Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, 49 Little France Crescent, Chancellor's Building, Edinburgh, EH16 4SB, UK
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - Alan J Gow
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
- Department of Psychology, School of Life Sciences, Heriot-Watt University, Edinburgh, UK
| | - Natalie A Royle
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - Mark E Bastin
- Department of Medical and Radiological Sciences, University of Edinburgh, Edinburgh, UK
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - John M Starr
- Department of Geriatric Medicine, University of Edinburgh, Edinburgh, UK
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - Ian J Deary
- Department of Psychology, University of Edinburgh, Edinburgh, UK
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - Joanna M Wardlaw
- Department of Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, 49 Little France Crescent, Chancellor's Building, Edinburgh, EH16 4SB, UK
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
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Automated segmentation of multifocal basal ganglia T2*-weighted MRI hypointensities. Neuroimage 2014; 105:332-46. [PMID: 25451469 PMCID: PMC4275576 DOI: 10.1016/j.neuroimage.2014.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Revised: 09/08/2014] [Accepted: 10/03/2014] [Indexed: 12/17/2022] Open
Abstract
Multifocal basal ganglia T2*-weighted (T2*w) hypointensities, which are believed to arise mainly from vascular mineralization, were recently proposed as a novel MRI biomarker for small vessel disease and ageing. These T2*w hypointensities are typically segmented semi-automatically, which is time consuming, associated with a high intra-rater variability and low inter-rater agreement. To address these limitations, we developed a fully automated, unsupervised segmentation method for basal ganglia T2*w hypointensities. This method requires conventional, co-registered T2*w and T1-weighted (T1w) volumes, as well as region-of-interest (ROI) masks for the basal ganglia and adjacent internal capsule generated automatically from T1w MRI. The basal ganglia T2*w hypointensities were then segmented with thresholds derived with an adaptive outlier detection method from respective bivariate T2*w/T1w intensity distributions in each ROI. Artefacts were reduced by filtering connected components in the initial masks based on their standardised T2*w intensity variance. The segmentation method was validated using a custom-built phantom containing mineral deposit models, i.e. gel beads doped with 3 different contrast agents in 7 different concentrations, as well as with MRI data from 98 community-dwelling older subjects in their seventies with a wide range of basal ganglia T2*w hypointensities. The method produced basal ganglia T2*w hypointensity masks that were in substantial volumetric and spatial agreement with those generated by an experienced rater (Jaccard index = 0.62 ± 0.40). These promising results suggest that this method may have use in automatic segmentation of basal ganglia T2*w hypointensities in studies of small vessel disease and ageing. A novel method segmented focal T2*-weighted MRI hypointensities automatically. The method was validated with MRI of a novel phantom and 98 elderly subjects. The subject masks from the method and an experienced rater overlapped substantially. The method is potentially useful for research into small vessel disease and ageing.
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Valdés Hernández MDC, Glatz A, Kiker AJ, Dickie DA, Aribisala BS, Royle NA, Muñoz Maniega S, Bastin ME, Deary IJ, Wardlaw JM. Differentiation of calcified regions and iron deposits in the ageing brain on conventional structural MR images. J Magn Reson Imaging 2013; 40:324-33. [PMID: 24923620 DOI: 10.1002/jmri.24348] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 07/26/2013] [Indexed: 11/10/2022] Open
Abstract
PURPOSE In the human brain, minerals such as iron and calcium accumulate increasingly with age. They typically appear hypointense on T2*-weighted MRI sequences. This study aims to explore the differentiation and association between calcified regions and noncalcified iron deposits on clinical brain MRI in elderly, otherwise healthy subjects. MATERIALS AND METHODS Mineral deposits were segmented on co-registered T1- and T2*-weighted sequences from 100 1.5 Tesla MRI datasets of community-dwelling individuals in their 70s. To differentiate calcified regions from noncalcified iron deposits we developed a method based on their appearance on T1-weighted images, which was validated with a purpose-designed phantom. Joint T1- and T2*-weighted intensity histograms were constructed to measure the similarity between the calcified and noncalcified iron deposits using a Euclidean distance based metric. RESULTS We found distinct distributions for calcified regions and noncalcified iron deposits in the cumulative joint T1- and T2*-weighted intensity histograms across all subjects (correlations ranging from 0.02 to 0.86; mean = 0.26 ± 0.16; t = 16.93; P < 0.001) consistent with differences in iron and calcium signal in the phantom. The mean volumes of affected tissue per subject for calcified and noncalcified deposits were 236.74 ± 309.70 mm(3) and 283.76 ± 581.51 mm(3); respectively. There was a positive association between the mineral depositions (β = 0.32, P < 0.005), consistent with existing literature reports. CONCLUSION Calcified mineral deposits and noncalcified iron deposits can be distinguished from each other by signal intensity changes on conventional 1.5T T1-weighted MRI and are significantly associated in brains of elderly, otherwise healthy subjects.
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Affiliation(s)
- Maria del C Valdés Hernández
- Brain Research Imaging Centre, Department of Neuroimaging Sciences, University of Edinburgh, Edinburgh, United Kingdom; Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, United Kingdom; SINAPSE (Scottish Imaging Network, A Platform for Scientific Excellence) collaboration, Scotland, United Kingdom
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Glatz A, Valdés Hernández MC, Kiker AJ, Bastin ME, Deary IJ, Wardlaw JM. Characterization of multifocal T2*-weighted MRI hypointensities in the basal ganglia of elderly, community-dwelling subjects. Neuroimage 2013; 82:470-80. [PMID: 23769704 PMCID: PMC3776225 DOI: 10.1016/j.neuroimage.2013.06.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 06/05/2013] [Indexed: 12/29/2022] Open
Abstract
Multifocal T2*-weighted (T2*w) hypointensities in the basal ganglia, which are believed to arise predominantly from mineralized small vessels and perivascular spaces, have been proposed as a biomarker for cerebral small vessel disease. This study provides baseline data on their appearance on conventional structural MRI for improving and automating current manual segmentation methods. Using a published thresholding method, multifocal T2*w hypointensities were manually segmented from whole brain T2*w volumes acquired from 98 community-dwelling subjects in their early 70s. Connected component analysis was used to derive the average T2*w hypointensity count and load per basal ganglia nucleus, as well as the morphology of their connected components, while nonlinear spatial probability mapping yielded their spatial distribution. T1-weighted (T1w), T2-weighted (T2w) and T2*w intensity distributions of basal ganglia T2*w hypointensities and their appearance on T1w and T2w MRI were investigated to gain further insights into the underlying tissue composition. In 75/98 subjects, on average, 3 T2*w hypointensities with a median total volume per intracranial volume of 50.3 ppm were located in and around the globus pallidus. Individual hypointensities appeared smooth and spherical with a median volume of 12 mm3 and median in-plane area of 4 mm2. Spatial probability maps suggested an association between T2*w hypointensities and the point of entry of lenticulostriate arterioles into the brain parenchyma. T1w and T2w and especially the T2*w intensity distributions of these hypointensities, which were negatively skewed, were generally not normally distributed indicating an underlying inhomogeneous tissue structure. Globus pallidus T2*w hypointensities tended to appear hypo- and isointense on T1w and T2w MRI, whereas those from other structures appeared iso- and hypointense. This pattern could be explained by an increased mineralization of the globus pallidus. In conclusion, the characteristic spatial distribution and appearance of multifocal basal ganglia T2*w hypointensities in our elderly cohort on structural MRI appear to support the suggested association with mineralized proximal lenticulostriate arterioles and perivascular spaces. A rater segmented focal hypointensities on T2*w brain MRI from 98 elderly subjects. On average 3 focal hypointensities were found in the basal ganglia of 75 subjects. Their spatial distribution suggests an association with lenticulostriate arterioles. Signal intensity distributions suggest an underlying inhomogeneous tissue structure.
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Affiliation(s)
- Andreas Glatz
- Brain Research Imaging Centre (BRIC), Neuroimaging Sciences, University of Edinburgh, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK.
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Lin D, Ding J, Liu JY, He YF, Dai Z, Chen CZ, Cheng WZ, Zhou J, Wang X. Decreased serum hepcidin concentration correlates with brain iron deposition in patients with HBV-related cirrhosis. PLoS One 2013; 8:e65551. [PMID: 23776499 PMCID: PMC3679136 DOI: 10.1371/journal.pone.0065551] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 04/25/2013] [Indexed: 02/06/2023] Open
Abstract
Purpose Excessive brain iron accumulation contributes to cognitive impairments in hepatitis B virus (HBV)-related cirrhotic patients. The underlying mechanism remains unclear. Hepcidin, a liver-produced, 25-aminoacid peptide, is the major regulator of systemic iron metabolism. Abnormal hepcidin level is a key factor in some body iron accumulation or deficiency disorders, especially in those associated with liver diseases. Our study was aimed to explore the relationship between brain iron content in patients with HBV-related cirrhosis and serum hepcidin level. Methods Seventy HBV-related cirrhotic patients and forty age- sex-matched healthy controls were enrolled. Brain iron content was quantified by susceptibility weighted phase imaging technique. Serum hepcidin as well as serum iron, serum transferrin, ferritin, soluble transferrin receptor, total iron binding capacity, and transferrin saturation were tested in thirty cirrhotic patients and nineteen healthy controls. Pearson correlation analysis was performed to investigate correlation between brain iron concentrations and serum hepcidin, or other iron parameters. Results Cirrhotic patients had increased brain iron accumulation compared to controls in the left red nuclear, the bilateral substantia nigra, the bilateral thalamus, the right caudate, and the right putamen. Cirrhotic patients had significantly decreased serum hepcidin concentration, as well as lower serum transferring level, lower total iron binding capacity and higher transferrin saturation, compared to controls. Serum hepcidin level negatively correlated with the iron content in the right caudate, while serum ferritin level positively correlated with the iron content in the bilateral putamen in cirrhotic patients. Conclusions Decreased serum hepcidin level correlated with excessive iron accumulation in the basal ganglia in HBV-related cirrhotic patients. Our results indicated that systemic iron overload underlined regional brain iron repletion. Serum hepcidin may be a clinical biomarker for brain iron deposition in cirrhotic patients, which may have therapeutic potential.
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Affiliation(s)
- Dong Lin
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jing Ding
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jian-Ying Liu
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yi-Feng He
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhi Dai
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Cai-Zhong Chen
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei-Zhong Cheng
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jian Zhou
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Organ Transplantation, Shanghai, China
| | - Xin Wang
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China
- Institute of Brain Science and State Key Laboratory of Medical Neurobiology, Shanghai, China
- * E-mail:
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Hingwala DR, Kesavadas C, Thomas B, Kapilamoorthy TR. Susceptibility weighted imaging in the evaluation of movement disorders. Clin Radiol 2013; 68:e338-48. [PMID: 23541097 DOI: 10.1016/j.crad.2012.12.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Revised: 12/12/2012] [Accepted: 12/14/2012] [Indexed: 10/27/2022]
Abstract
Movement disorders are neurodegenerative disorders associated with abnormalities of brain iron deposition. In this presentation, we aim to describe the role of susceptibility weighted imaging (SWI) in the imaging of patients with movement disorders and differentiate between the various disorders. SWI is a high-resolution, fully velocity-encoded gradient-echo magnetic resonance imaging (MRI) sequence that consists of using both magnitude and phase information. We describe briefly the physics behind this sequence and the post-processing techniques used. The anatomy of the midbrain and basal ganglia in normal subjects on SWI is covered. A number of neurodegenerative disorders are associated with abnormal iron deposition, which can be detected due to the susceptibility effects.
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Affiliation(s)
- D R Hingwala
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
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El Otmani H, Lahlou I, Raji L, Omari S, Belmansour Y, Moutaouakil F, Boulaajaj FZ, Mouden M, Gam I, Hakim K, El Moutawakil B, Rafai MA, Fadel H, Slassi I. [Striatopallidodentate calcinosis, hypoparathyroidism and neurological features: a case series study]. Rev Neurol (Paris) 2013; 169:495-501. [PMID: 23523016 DOI: 10.1016/j.neurol.2012.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2012] [Revised: 11/12/2012] [Accepted: 11/14/2012] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The respective roles of hypocalcemia and intracerebral calcifications in the occurrence of various neurological manifestations in hypoparathyroidism is not entirely clear. Nevertheless, therapeutic and prognostic implications are important. OBJECTIVES We analyze the neurological clinical aspects observed in hypoparathyroidism and correlate them to the biological calcium abnormality and radiological CT scan findings. We also compare these results with data reported in the idiopathic form of striatopallidodentate calcinosis. PATIENTS The neurological clinical, CT scan findings and outcome have been retrospectively studied in patients recruited during 13 years (2000-2012) for neurological features associated with hypoparathyroidism or pseudohypoparathyroidism. RESULTS Twelve patients with primary hypoparathyroidism (n=5), secondary to thyroidectomy (n=4) and pseudohypoparathyroidism (n=3) were studied. The sex-ratio was 1 and mean age was 39 years. All patients had a tetany, 60% had epilepsy, associated in one patient with "benign" intracranial hypertension; 50% had behavioral changes. Response to calcium therapy was excellent for all these events. Moderate cognitive deficit was noted in three patients (25%), parkinsonism in two patients and hyperkinetic movement disorders in one other. These events were not responsive to calcium therapy and were more common in cases of extensive brain calcifications and in patients who had pseudohypoparathroidism. COMMENTS This study suggests that, in patients with hypoparathyroidism, epilepsy and psychiatric disorders are induced by hypocalcemia and reversible after its correction. Cognitive and extrapyramidal impairment seem to be related to the progressive extension of intracerebral calcification, particularly in patients with a late diagnosis. In patients with pseudohypoparathyroidism, this finding is different because of the contribution of other factors, specific to this disease.
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Affiliation(s)
- H El Otmani
- Service de neurologie, CHU d'Ibn Rochd, 1, rue des Hôpitaux, Casablanca, Maroc.
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Zhang Y, Guo X, Wu A. Association between a novel mutation in SLC20A2 and familial idiopathic basal ganglia calcification. PLoS One 2013; 8:e57060. [PMID: 23437308 PMCID: PMC3577762 DOI: 10.1371/journal.pone.0057060] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 01/17/2013] [Indexed: 01/30/2023] Open
Abstract
Familial idiopathic basal ganglia calcification (FIBGC) is a rare, autosomal dominant disorder involving bilateral calcification of the basal ganglia. To identify gene mutations related to a Chinese FIBGC lineage, we evaluated available individuals in the family using CT scans. DNA was extracted from the peripheral blood of available family members, and both exonic and flanking intronic sequences of the SLC20A2 gene were amplified by PCR and then sequenced. Non-denaturing polyacrylamide gel electrophoresis (PAGE) was used to confirm the presence of mutations. Allele imbalances of the SLC20A2 gene or relative quantity of SLC20A2 transcripts were evaluated using qRT-PCR. A novel heterozygous single base-pair deletion (c.510delA) within the SLC20A2 gene was identified. This deletion mutation was found to co-segregate with basal ganglia calcification in all of the affected family members but was not detected in unaffected individuals or in 167 unrelated Han Chinese controls. The mutation will cause a frameshift, producing a truncated SLC20A2 protein with a premature termination codon, most likely leading to the complete loss of function of the SLC20A2 protein. This mutation may also lead to a reduction in SLC20A2 mRNA expression by approximately 30% in cells from affected individuals. In conclusion, we identified a novel mutation in SLC20A2 that is linked to FIBGC. In addition to the loss of function at the protein level, decreasing the expression of SLC20A2 mRNA may be another mechanism that can regulate SLC20A2 function in IBGC individuals. We propose that the regional expression pattern of SLC20A1 and SLC20A2 might explain the unique calcification pattern observed in FIBGC patients.
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Affiliation(s)
- Yang Zhang
- Research Center for Medical Genomics, Key Laboratory of Medical Cell Biology, Ministry of Education, College of Basic Medical Science, China Medical University, Shenyang, China
| | - Xianan Guo
- Research Center for Medical Genomics, Key Laboratory of Medical Cell Biology, Ministry of Education, College of Basic Medical Science, China Medical University, Shenyang, China
| | - Anhua Wu
- Research Center for Medical Genomics, Key Laboratory of Medical Cell Biology, Ministry of Education, College of Basic Medical Science, China Medical University, Shenyang, China
- Department of Neurosurgery, the First Affiliated Hospital of China Medical University, Shenyang, China
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Tohno Y, Tohno S, Azuma C, Minami T, Ke L, Ongkana N, Sinthubua A, Mahakkanukrauh P. Mineral composition of and the relationships between them of human basal ganglia in very old age. Biol Trace Elem Res 2013; 151:18-29. [PMID: 23111949 DOI: 10.1007/s12011-012-9535-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Accepted: 10/18/2012] [Indexed: 12/29/2022]
Abstract
Trace elements and the relationships among them were investigated by direct chemical analysis in three basal ganglia regions in very old age individuals and age- and gender-related differences were assessed. After ordinary dissections at Nara Medical University were finished, the caudate nucleus, putamen, and globus pallidus belonging to the basal ganglia were removed from the identical cerebra of the subjects who consisted of 22 men and 23 women, ranging in age from 70 to 101 years (average age = 83.3 ± 7.5 years). After incineration with nitric acid and perchloric acid, the element contents were determined by inductively coupled plasma-atomic emission spectrometry. It was found that the Ca, P, and Mg contents increased significantly in the putamen with aging and the Mg content increased significantly in the globus pallidus with aging, but no elements increased significantly in the caudate nucleus with aging. Regarding the relationships among elements in the basal ganglia, extremely significant direct correlations were found among the Ca, P, and Mg contents in the putamen. These results suggested that slight calcification occurred in the putamen in very old age. With regard to seven elements of Ca, P, S, Mg, Zn, Fe, and Na, it was examined whether there were significant correlations among the caudate nucleus, putamen, and globus pallidus. It was found that there were extremely significant direct correlations among all of the three basal ganglia in the P content. Likewise, with regard to the Fe content, there were extremely or very significant direct correlations among all of the three basal ganglia. Regarding the gender difference in elements, it was found that the Ca content of the caudate nucleus was significantly higher in women than in men.
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Affiliation(s)
- Yoshiyuki Tohno
- Department of Anatomy, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
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Abstract
Magnetic resonance imaging (MRI) enables a noninvasive in vivo quantification of iron in various organs. Several techniques have been developed that detect signal alterations derived mainly from the magnetic properties of ferritin and hemosiderin, the major iron storage compounds. High magnetic susceptibility of ferritin shortens the transversal relaxation time of nearby water protons and thus induces a focal signal extinction of iron-rich areas in T2-weighted (T2w) MRI. T2w tissue contrast is additionally influenced by other factors such as water content, myelin density, and the presence of other metals. Therefore, more specific methods are needed with higher specificity to iron. These in vivo techniques can be divided into three groups: relaxometry, magnetic field correlation imaging and phase-based contrast covering susceptibility-weighted imaging, and quantitative susceptibility mapping. The differential diagnosis of various neurological disorders is aided by characteristic patterns of iron depositions. Reliable estimates of cerebral tissue iron concentration are equally important in studying physiological age-related as well as pathological conditions in neurodegenerative, neuroinflammatory, and vascular diseases. In the future, monitoring changes in iron storage and content may serve as sensitive biomarker for diagnosis as well as treatment monitoring.
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Affiliation(s)
- Petr Dusek
- Department of Neurology and Center of Clinical Neuroscience, Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic; Institut für interventionelle und diagnostische Neuroradiologie, Universitätsmedizin Göttingen, Göttingen, Germany.
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Liu JY, Ding J, Lin D, He YF, Dai Z, Chen CZ, Cheng WZ, Wang H, Zhou J, Wang X. T2* MRI of minimal hepatic encephalopathy and cognitive correlates in vivo. J Magn Reson Imaging 2012; 37:179-86. [PMID: 23011760 DOI: 10.1002/jmri.23811] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Accepted: 08/07/2012] [Indexed: 01/02/2023] Open
Abstract
PURPOSE To evaluate regional brain iron deposition in minimal hepatic encephalopathy (MHE) patients using T2*-weighted gradient-echo imaging and to explore the relationship between T2* MR changes and cognitive performance. MATERIALS AND METHODS Forty hepatitis-B virus (HBV)-related cirrhotic patients and 22 age-, sex-, and education-matched healthy controls were included in this study. Of the patients, twenty eight patients were diagnosed with MHE. All subjects were administered Number Connection Test-A (NCT-A), Letter Digit Substitution Test (LDST), Rey-Osterrieth Complex Figure Test (RCFT), and the Mini-Mental State Examination (MMSE). T2*-weighted gradient-echo images were acquired using 3 Tesla MRI. Phase values (putative iron levels) in the frontal-basal ganglia-thalamocortical circuits were measured. Spearman correlation and multiple linear regression analysis were performed. RESULTS MHE patients exhibited significantly prolonged NCT-A time and decreased LDST, RCFT immediate and delayed recall scores. Significant decreases of phase values in the bilateral putamen were detected in MHE patients compared to without MHE patients and controls. Multiple linear regression analysis confirmed significant correlations between the phase values in the putamen and right frontal white matter and cognitive performances by MHE patients. CONCLUSION Decreased phase values in the frontal cortical-basal ganglial circuits independently contribute to cognitive impairments in MHE patients.
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Affiliation(s)
- Jian-Ying Liu
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China
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Bazin D, Daudon M, Combes C, Rey C. Characterization and some physicochemical aspects of pathological microcalcifications. Chem Rev 2012; 112:5092-120. [PMID: 22809072 DOI: 10.1021/cr200068d] [Citation(s) in RCA: 132] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- D Bazin
- Laboratoire de Physique des Solides, CNRS, Université Paris-Sud, 91405 Orsay, France.
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Valdés Hernández MDC, Maconick LC, Tan EMJ, Wardlaw JM. Identification of mineral deposits in the brain on radiological images: a systematic review. Eur Radiol 2012; 22:2371-81. [PMID: 22688125 DOI: 10.1007/s00330-012-2494-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Revised: 03/29/2012] [Accepted: 04/04/2012] [Indexed: 01/11/2023]
Abstract
OBJECTIVES MRI has allowed the study of mineral deposition in the brain throughout life and in disease. However, studies differ in their reporting of minerals on MRI for reasons that are unclear. METHODS We conducted a systematic review from 1985 to July 2011 to determine the appearance of iron, calcium, copper and manganese on MRI and CT and their reliability. We assessed which imaging investigations provided the most consistent results compared with histology. RESULTS Of 325 papers on minerals imaging, we included 46 studies that confirmed findings either directly or indirectly using a non-imaging method such as histology. Within this group, there was inconsistency in the identification of iron probably because of changes in its paramagnetic properties during its degradation. Iron appeared consistently hypointense only on T2*-weighted MRI, and along with calcified areas, hyperattenuated on CT. Appearance of copper, calcium and manganese, although consistently reported as hyperintense on T1-weighted MRI, was confirmed histologically in few studies. On T2-weighted imaging, calcified areas were always reported as hypointense, while the appearance of iron depended on the concentration, location and degradation stage. CONCLUSIONS More work is required to improve the reliability of imaging methods to detect and differentiate brain mineral deposition accurately. KEY POINTS There is inconsistency in reporting the appearance of minerals on radiological images. • Only 46 studies confirmed mineral appearance using a non-imaging method. • Iron is the mineral more widely studied, consistently hypointense on T2*-weighted MRI. • T1-weighted MRI consistently reported copper, calcium and manganese hyperintense. • Calcium is consistently reported hypointense on T2-weighted MRI and hyperattenuating on CT.
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Wardlaw JM, Bastin ME, Valdés Hernández MC, Maniega SM, Royle NA, Morris Z, Clayden JD, Sandeman EM, Eadie E, Murray C, Starr JM, Deary IJ. Brain aging, cognition in youth and old age and vascular disease in the Lothian Birth Cohort 1936: rationale, design and methodology of the imaging protocol. Int J Stroke 2012; 6:547-59. [PMID: 22111801 DOI: 10.1111/j.1747-4949.2011.00683.x] [Citation(s) in RCA: 141] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
RATIONALE As the population of the world ages, age-related cognitive decline is becoming an ever-increasing problem. However, the changes in brain structure that accompany normal aging, and the role they play in cognitive decline, remain to be fully elucidated. AIMS This study aims to characterize changes in brain structure in old age, and to investigate relationships between brain aging and cognitive decline using the Lothian Birth Cohort 1936. Here, we report the rationale, design and methodology of the brain and neurovascular imaging protocol developed to study this cohort. DESIGN An observational, longitudinal study of the Lothian Birth Cohort 1936, which comprises 1091 relatively healthy individuals now in their 70s and living in the Edinburgh area. They are surviving participants of the Scottish Mental Survey 1947, which involved a test of general intelligence taken at age 11 years. At age 70 years, the Lothian Birth Cohort 1936 undertook detailed cognitive, medical and genetic testing, and provided social, family, nutritional, quality of life and physical activity information. At mean age 73 years they underwent detailed brain MRI and neurovascular ultrasound imaging, repeat cognitive and other testing. The MRI protocol is designed to provide qualitative and quantitative measures of gray and white matter atrophy, severity and location of white matter lesions, enlarged perivascular spaces, brain mineral deposits, microbleeds and integrity of major white matter tracts. The neurovascular ultrasound imaging provides velocity, stenosis and intima-media thickness measurements of the carotid and vertebral arteries. STUDY This valuable imaging dataset will be used to determine which changes in brain structural parameters have the largest effects on cognitive aging. Analysis will include multimodal image analysis and multivariate techniques, such as factor analysis and structural equation modelling. Especially valuable is the ability within this sample to examine the influence that early life intelligence has on brain structural parameters in old age, and the role of genetic, vascular, educational and lifestyle factors. OUTCOMES Final outcomes include associations between early and late life cognition and integrity of key white matter tracts, volume of gray and white matter, myelination, brain water content, and visible abnormalities such as white matter lesions and mineral deposits; and influences of vascular risk factors, diet, environment, social metrics, education and genetics on healthy brain aging. It is intended that this information will help to inform and develop strategies for successful cognitive aging.
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Affiliation(s)
- Joanna M Wardlaw
- Brain Research Imaging Centre, Division of Clinical Neurosciences, University of Edinburgh, Edinburgh, UK
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Penke L, Valdés Hernandéz MC, Maniega SM, Gow AJ, Murray C, Starr JM, Bastin ME, Deary IJ, Wardlaw JM. Brain iron deposits are associated with general cognitive ability and cognitive aging. Neurobiol Aging 2012; 33:510-517.e2. [DOI: 10.1016/j.neurobiolaging.2010.04.032] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2009] [Revised: 03/26/2010] [Accepted: 04/27/2010] [Indexed: 10/19/2022]
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40
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Gerhauser I, Wohlsein P, Ernst H, Germann PG, Baumgärtner W. Vacuolation and mineralisation as dominant age-related findings in hamster brains. ACTA ACUST UNITED AC 2012; 65:375-81. [PMID: 22257562 DOI: 10.1016/j.etp.2011.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Revised: 11/08/2011] [Accepted: 12/04/2011] [Indexed: 11/24/2022]
Abstract
Syrian golden hamsters (Mesocricetus auratus) are laboratory animals increasingly used for research and toxicological studies. Despite the need for an adequate knowledge of spontaneously occurring lesions, studies investigating the background pathology of different organ systems in hamsters are lacking. The aim of this study was to investigate the occurrence of spontaneous, age-dependent lesions in the central nervous system of this species. Multiple brain and spinal cord transverse sections of 520 hamsters of 1, 3, 6, 12, and 24 months of age were investigated using histology and immunohistochemistry. Vacuolation of grey matter neuropil and mineralisation especially in the brain stem were the most prominent findings. They gradually increased in severity and frequency with age. Vacuolation and mineralisation affected approximately 100% and 50% of 24-month-old hamsters, respectively. In addition, pigment deposition and mast cell infiltration were commonly detected. Whether vacuolation and mineralisation represent an incidental finding or are related to a cognitive dysfunction syndrome remains to be determined.
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Affiliation(s)
- Ingo Gerhauser
- Department of Pathology, University of Veterinary Medicine Hannover, Bünteweg 17, D-30559 Hannover, Germany.
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41
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Strio-pallido-dentate calcinosis: a diagnostic approach in adult patients. Neurol Sci 2011; 32:537-45. [PMID: 21479613 DOI: 10.1007/s10072-011-0514-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Accepted: 03/10/2011] [Indexed: 02/06/2023]
Abstract
Familial idiopathic bilateral strio-pallido-dentate calcinosis is a rare autosomal dominant disorder characterized by massive symmetric calcification, detectable by CT, into the globus pallidus and striatum, with or without the involvement of the dentate nucleus, thalamus and white matter in the absence of alterations of calcium metabolism. Clinically, it has been associated with movement and/or neuropsychiatric disorders with age at onset typically in the fourth or fifth decade. Other sporadic or familial diseases can be responsible for brain calcifications with a similar anatomic strio-pallidal or strio-pallido-dentate pattern and, a restricted number of them, for neurological symptoms with onset in adulthood. Moreover, physiological age-related basal ganglia calcifications are often incidentally found, although with a far different CT aspect, in elderly patients with movement disorders. Indentifying familial and idiopathic cases may offer the opportunity to study the molecular mechanisms underlying this minerals deposition.
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Valdés Hernández MC, Jeong TH, Murray C, Bastin ME, Chappell FM, Deary IJ, Wardlaw JM. Reliability of two techniques for assessing cerebral iron deposits with structural magnetic resonance imaging. J Magn Reson Imaging 2010; 33:54-61. [DOI: 10.1002/jmri.22361] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
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43
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Autoimmune polyendocrine syndrome type I and brain calcinosis. Parkinsonism Relat Disord 2010; 16:101-4. [DOI: 10.1016/j.parkreldis.2009.07.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2009] [Revised: 06/01/2009] [Accepted: 07/29/2009] [Indexed: 11/21/2022]
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Rodríguez MJ, Prats A, Malpesa Y, Andrés N, Pugliese M, Batlle M, Mahy N. Pattern of Injury with a Graded Excitotoxic Insult and Ensuing Chronic Medial Septal Damage in the Rat Brain. J Neurotrauma 2009; 26:1823-34. [DOI: 10.1089/neu.2008.0553] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Manuel J. Rodríguez
- Unitat de Bioquímica, Ginecologia, Pedriatria, Radiologia i Medicina Funcional, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Facultat de Medicina. Universitat de Barcelona, Barcelona, Spain
| | - Alberto Prats
- Departament d'Obstetrícia, Ginecologia, Pedriatria, Radiologia i Medicina Funcional, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Facultat de Medicina. Universitat de Barcelona, Barcelona, Spain
| | - Yolanda Malpesa
- Unitat de Bioquímica, Ginecologia, Pedriatria, Radiologia i Medicina Funcional, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Facultat de Medicina. Universitat de Barcelona, Barcelona, Spain
| | - Noemí Andrés
- Unitat de Bioquímica, Ginecologia, Pedriatria, Radiologia i Medicina Funcional, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Facultat de Medicina. Universitat de Barcelona, Barcelona, Spain
| | - Marco Pugliese
- Unitat de Bioquímica, Ginecologia, Pedriatria, Radiologia i Medicina Funcional, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Facultat de Medicina. Universitat de Barcelona, Barcelona, Spain
| | - Montserrat Batlle
- Unitat de Bioquímica, Ginecologia, Pedriatria, Radiologia i Medicina Funcional, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Facultat de Medicina. Universitat de Barcelona, Barcelona, Spain
| | - Nicole Mahy
- Unitat de Bioquímica, Ginecologia, Pedriatria, Radiologia i Medicina Funcional, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Facultat de Medicina. Universitat de Barcelona, Barcelona, Spain
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Brunoni AR, Nakata AC, Tung TC, Busatto GF. Vitamin D-Resistant Rickets Type II-A, Basal Ganglia Calcification, and Catatonia: A Casual or Causal Relationship? PSYCHOSOMATICS 2009; 50:420-4. [DOI: 10.1176/appi.psy.50.4.420] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Saito T, Nakamura M, Shimizu T, Oda K, Ishiwata K, Ishii K, Isse K. Neuroradiologic evidence of pre-synaptic and post-synaptic nigrostriatal dopaminergic dysfunction in idiopathic Basal Ganglia calcification: a case report. J Neuroimaging 2008; 20:189-91. [PMID: 19021829 DOI: 10.1111/j.1552-6569.2008.00314.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Idiopathic basal ganglia calcification (IBGC) is a neuropathological condition known to manifest as motor disturbance, cognitive impairment, and psychiatric symptoms. The pathophysiology of the psychiatric symptoms of IBGC, however, remains controversial. A previous biochemical study suggested that dopaminergic impairment is involved in IBGC. We thus hypothesized that dopaminergic dysfunction might be related with the psychiatric manifestations of IBGC. We used positron emission tomography to measure glucose metabolism and dopaminergic function in the basal ganglia of an IBGC patient with psychiatric symptoms. The results showed that widespread hypometabolism was evident in the frontal, temporal, and parietal cortices while the decline in dopaminergic function was severe in the bilateral striatum. The functional decline of the dopamine system in the calcified area of the bilateral striatum and the disruption of cortico-subcortical circuits may contribute to clinical manifestations of IBGC in our patient.
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Affiliation(s)
- Takahiro Saito
- Department of Psychiatry, Tokyo Metropolitan Toshima Hospital, Tokyo, Japan.
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Simonyan K, Tovar-Moll F, Ostuni J, Hallett M, Kalasinsky VF, Lewin-Smith MR, Rushing EJ, Vortmeyer AO, Ludlow CL. Focal white matter changes in spasmodic dysphonia: a combined diffusion tensor imaging and neuropathological study. ACTA ACUST UNITED AC 2007; 131:447-59. [PMID: 18083751 DOI: 10.1093/brain/awm303] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Spasmodic dysphonia is a neurological disorder characterized by involuntary spasms in the laryngeal muscles during speech production. Although the clinical symptoms are well characterized, the pathophysiology of this voice disorder is unknown. We describe here, for the first time to our knowledge, disorder-specific brain abnormalities in these patients as determined by a combined approach of diffusion tensor imaging (DTI) and postmortem histopathology. We used DTI to identify brain changes and to target those brain regions for neuropathological examination. DTI showed right-sided decrease of fractional anisotropy in the genu of the internal capsule and bilateral increase of overall water diffusivity in the white matter along the corticobulbar/corticospinal tract in 20 spasmodic dysphonia patients compared to 20 healthy subjects. In addition, water diffusivity was bilaterally increased in the lentiform nucleus, ventral thalamus and cerebellar white and grey matter in the patients. These brain changes were substantiated with focal histopathological abnormalities presented as a loss of axonal density and myelin content in the right genu of the internal capsule and clusters of mineral depositions, containing calcium, phosphorus and iron, in the parenchyma and vessel walls of the posterior limb of the internal capsule, putamen, globus pallidus and cerebellum in the postmortem brain tissue from one patient compared to three controls. The specificity of these brain abnormalities is confirmed by their localization, limited only to the corticobulbar/corticospinal tract and its main input/output structures. We also found positive correlation between the diffusivity changes and clinical symptoms of spasmodic dysphonia (r = 0.509, P = 0.037). These brain abnormalities may alter the central control of voluntary voice production and, therefore, may underlie the pathophysiology of this disorder.
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Affiliation(s)
- Kristina Simonyan
- Laryngeal and Speech Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, 10 Center Drive, Building 10, Room 5D38, Bethesda, MD 20892-1416, USA.
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48
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Harder SL, Hopp KM, Ward H, Neglio H, Gitlin J, Kido D. Mineralization of the deep gray matter with age: a retrospective review with susceptibility-weighted MR imaging. AJNR Am J Neuroradiol 2007; 29:176-83. [PMID: 17989376 DOI: 10.3174/ajnr.a0770] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND PURPOSE Susceptibility-weighted imaging (SWI) is an advanced MR imaging sequence that can be implemented at high resolution. This sequence can be performed on conventional MR imaging scanners and is very sensitive to mineralization. The purpose of this study was to establish the course of mineralization in the deep gray matter with age by using SWI. MATERIALS AND METHODS We retrospectively reviewed susceptibility-weighted images of 134 patients (age range, 1 to 88 years). Inclusion criteria comprised a normal conventional MR imaging (T1, T2, and fluid-attenuated inversion recovery sequences). We statistically analyzed the relative signal intensities of the globus pallidus, putamen, substantia nigra, caudate nucleus, red nucleus, and thalamus for correlation with age. The putamen was graded according to a modified scale, based on previous work that described a systematic pattern of mineralization with age. Bands of hypointensity in the globus pallidus, dubbed "waves," were also evaluated. RESULTS We documented decreasing intensity (ie, increasing mineralization) with age in all deep gray matter areas analyzed. We confirmed the age-related posterolateral to anteromedial progression of mineralization in the putamen. Characteristic medial and lateral bands of mineralization were exhibited in the globus pallidus in all children and young adults older than 3 years. Finally, an increase in the number of "waves" present in the globus pallidus was associated with increased age by category. CONCLUSION This study documents the course and pattern of mineralization in the deep gray matter with age, as determined by SWI. These findings may play a role in evaluating diseased brains in the future.
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Affiliation(s)
- S L Harder
- Department of Medical Imaging, Royal University Hospital, Saskatoon, Saskatchewan, Canada.
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Shakibai SV, Johnson JP, Bourgeois JA. Paranoid delusions and cognitive impairment suggesting Fahr's disease. PSYCHOSOMATICS 2006; 46:569-72. [PMID: 16288137 DOI: 10.1176/appi.psy.46.6.569] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The authors present the case of a 60-year-old woman with elaborate paranoid delusions and cognitive impairment found during a workup for atypical chest pain. Clinical evaluation revealed mild dementia, and radiography showed basal ganglia calcification consistent with Fahr's disease. She was treated with risperidone and transferred to a psychiatric inpatient unit for definitive care. Psychiatrists should consider Fahr's disease as a differential diagnosis in the evaluation of psychosis and cognitive impairment when neuroimaging reveals calcification of the basal ganglia.
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Affiliation(s)
- Shamim V Shakibai
- Department of Psychiatry and Behavioral Sciences, Davis Medical Center, University of California, 2230 Stockton Blvd., Sacramento, CA 95817, USA
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