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Moors S, Nakhostin D, Ilchenko D, Kulcsar Z, Starkey J, Winklhofer S, Ineichen BV. Cytotoxic lesions of the corpus callosum: a systematic review. Eur Radiol 2024; 34:4628-4637. [PMID: 38147170 PMCID: PMC11213749 DOI: 10.1007/s00330-023-10524-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 11/07/2023] [Accepted: 11/25/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVES Cytotoxic lesions of the corpus callosum (CLOCC) are a common magnetic resonance imaging (MRI) finding associated with various systemic diseases including COVID-19. Although an increasing number of such cases is reported in the literature, there is a lack of systematic evidence summarizing the etiology and neuroimaging findings of these lesions. Thus, the aim of this systematic review was to synthesize the applied nomenclature, neuroimaging and clinical features, and differential diagnoses as well as associated disease entities of CLOCC. MATERIALS AND METHODS A comprehensive literature search in three biomedical databases identified 441 references, out of which 324 were eligible for a narrative summary including a total of 1353 patients. RESULTS Our PRISMA-conform systematic review identifies a broad panel of disease entities which are associated with CLOCC, among them toxic/drug-treatment-associated, infectious (viral, bacterial), vascular, metabolic, traumatic, and neoplastic entities in both adult and pediatric individuals. On MRI, CLOCC show typical high T2 signal, low T1 signal, restricted diffusion, and lack of contrast enhancement. The majority of the lesions were reversible within the follow-up period (median follow-up 3 weeks). Interestingly, even though CLOCC were mostly associated with symptoms of the underlying disease, in exceptional cases, CLOCC were associated with callosal neurological symptoms. Of note, employed nomenclature for CLOCC was highly inconsistent. CONCLUSIONS Our study provides high-level evidence for clinical and imaging features of CLOCC as well as associated disease entities. CLINICAL RELEVANCE STATEMENT Our study provides high-level evidence on MRI features of CLOCC as well as a comprehensive list of disease entities potentially associated with CLOCC. Together, this will facilitate rigorous diagnostic workup of suspected CLOCC cases. KEY POINTS • Cytotoxic lesions of the corpus callosum (CLOCC) are a frequent MRI feature associated with various systemic diseases. • Cytotoxic lesions of the corpus callosum show a highly homogenous MRI presentation and temporal dynamics. • This comprehensive overview will benefit (neuro)radiologists during diagnostic workup.
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Affiliation(s)
- Selina Moors
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital of Zurich, Zurich, Switzerland
| | - Dominik Nakhostin
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital of Zurich, Zurich, Switzerland
| | - Dariya Ilchenko
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital of Zurich, Zurich, Switzerland
| | - Zsolt Kulcsar
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital of Zurich, Zurich, Switzerland
| | - Jay Starkey
- Department of Radiology, Oregon Health & Science University, Portland, OR, USA
| | - Sebastian Winklhofer
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital of Zurich, Zurich, Switzerland
| | - Benjamin V Ineichen
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital of Zurich, Zurich, Switzerland.
- Center for Reproducible Science, University of Zurich, Zurich, Switzerland.
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2
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Salari M, Etemadifar M, Ashourizadeh H. Diffuse subcortical white matter restriction: An uncommon finding on metronidazole toxicity. Neuroradiol J 2023; 36:119-124. [PMID: 35850612 PMCID: PMC9893164 DOI: 10.1177/19714009221111087] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Metronidazole is a common and widely used antibiotic to treat a wide range of infectious diseases and has been associated with serious neurologic disturbances which in some cases were irreversible. We present a metronidazole-induced encephalopathy in a 19-year-old girl after 7 days of metronidazole treatment, with diffusion restricted subcortical white matter lesions along with the corpus callosum involvements. Diverse clinical presentation of a serious neurologic disturbance caused by a common widely used antibiotic should be carefully addressed in the setting of both short- and long-term treatment.
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Affiliation(s)
- Mehri Salari
- Functional Neurosurgery Research
Center, Shohada Tajrish Neurosurgical Center of Excellence, Shahid Beheshti University of Medical
Sciences, Tehran, Iran
| | - Masoud Etemadifar
- Department of Functional
Neurosurgery, Medical School, Isfahan University of Medical
Science, Isfahan, Iran
| | - Helia Ashourizadeh
- Functional Neurosurgery Research
Center, Shohada Tajrish Neurosurgical Center of Excellence, Shahid Beheshti University of Medical
Sciences, Tehran, Iran
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3
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Radiologic and clinical features of infection related cytotoxic lesions of corpus callosum splenium in adults. JOURNAL OF SURGERY AND MEDICINE 2021. [DOI: 10.28982/josam.945513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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4
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Turtzo LC, Luby M, Jikaria N, Griffin AD, Greenman D, Bokkers RPH, Parikh G, Peterkin N, Whiting M, Latour LL. Cytotoxic Edema Associated with Hemorrhage Predicts Poor Outcome after Traumatic Brain Injury. J Neurotrauma 2021; 38:3107-3118. [PMID: 34541886 DOI: 10.1089/neu.2021.0037] [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] [Indexed: 01/01/2023] Open
Abstract
Magnetic resonance imaging (MRI) is used rarely in the acute evaluation of traumatic brain injury (TBI) but may identify findings of clinical importance not detected by computed tomography (CT). We aimed to characterize the association of cytotoxic edema and hemorrhage, including traumatic microbleeds, on MRI obtained within hours of acute head trauma and investigated the relationship to clinical outcomes. Patients prospectively enrolled in the Traumatic Head Injury Neuroimaging Classification study (NCT01132937) with evidence of diffusion-related findings or hemorrhage on neuroimaging were included. Blinded interpretation of MRI for diffusion-weighted lesions and hemorrhage was conducted, with subsequent quantification of apparent diffusion coefficient (ADC) values. Of 161 who met criteria, 82 patients had conspicuous hyperintense lesions on diffusion-weighted imaging (DWI) with corresponding regions of hypointense ADC in proximity to hemorrhage. Median time from injury to MRI was 21 (10-30) h. Median ADC values per patient grouped by time from injury to MRI were lowest within 24 h after injury. The ADC values associated with hemorrhagic lesions are lowest early after injury, with an increase in diffusion during the subacute period, suggesting transformation from cytotoxic to vasogenic edema during the subacute post-injury period. Of 118 patients with outcome data, 60 had Glasgow Outcome Scale Extended scores ≤6 at 30/90 days post-injury. Cytotoxic edema on MRI (odds ratio [OR] 2.91 [1.32-6.37], p = 0.008) and TBI severity (OR 2.51 [1.32-4.74], p = 0.005) were independent predictors of outcome. These findings suggest that in patients with TBI who had findings of hemorrhage on CT, patients with DWI/ADC lesions on MRI are more likely to do worse.
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Affiliation(s)
- L Christine Turtzo
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Marie Luby
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Neekita Jikaria
- Center for Neuroscience and Regenerative Medicine, Bethesda, Maryland, USA
| | | | - Danielle Greenman
- Center for Neuroscience and Regenerative Medicine, Bethesda, Maryland, USA
| | - Reinoud P H Bokkers
- Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Gunjan Parikh
- R Adams Shock Trauma Center and University of Maryland School of Medicine, Baltimore, Maryland, USA.,Division of Neurocritical Care and Emergency Neurology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Nicole Peterkin
- Center for Neuroscience and Regenerative Medicine, Bethesda, Maryland, USA
| | - Mark Whiting
- Center for Neuroscience and Regenerative Medicine, Bethesda, Maryland, USA
| | - Lawrence L Latour
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA.,Center for Neuroscience and Regenerative Medicine, Bethesda, Maryland, USA
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5
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Xu Z, Zhou Z, Jang W, Tian J, Hou G. Reversible splenial lesion syndrome with mental disorders as only manifestation. BMC Neurol 2021; 21:356. [PMID: 34525954 PMCID: PMC8442370 DOI: 10.1186/s12883-021-02391-6] [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: 06/01/2021] [Accepted: 09/06/2021] [Indexed: 11/20/2022] Open
Abstract
Background Reversible splenial lesion syndrome (RESLES) was reported to be associated with variable entities. However, much less is known about the cases in which the mental disorders act as the only manifestation. Method Total ten patients of RESLES were obtained in this retrospective study from Shenzhen Kangning Hospital. T1-fluid attenuated inversion recovery (T1-FLAIR), T2-weighted images, T2-FLAIR, diffusion-weighted images and apparent diffusion coefficient map were performed on all the patients. Clinical manifestations, laboratory examination results, magnetic resonance imaging (MRI) findings, treatments and outcomes were analyzed. Result All patients showed different mental disorders as the only manifestation. There were two cases of alcohol abuse, one of Asperger’s syndrome with malnutrition, one of infection and one of invasive pituitary adenoma. The other cases were diagnosis as major depressive disorder, dissociative and conversion disorders, undifferentiated somatoform disorder, unspecified psychosis and bipolar disorder, respectively. Three patients were completely recovered while the clinical symptoms of rest seven patients partially recovered at the follow-up three months later. Oval-shaped lesion centered on the splenial of corpus callosum (SCC) was observed in all patients using MRI. The lesions of SCC of all patients were completely resolved within five weeks. Conclusions We found that RESLES might only showed mental symptoms. On the one hand, for the patients with acute mental disorders, clinicians should be alert to the possibility of RESLES caused by physical disease. On the other hand, we suggest that mental disorder might be a precipitating factor of RESLES.
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Affiliation(s)
- Ziyun Xu
- Department of Radiology, Shenzhen Mental Health Center, Shenzhen Kangning Hospital, 518020, Shenzhen, China
| | - Zhaoguang Zhou
- Department of Radiology, Shenzhen Mental Health Center, Shenzhen Kangning Hospital, 518020, Shenzhen, China
| | - Wentao Jang
- Department of Radiology, Shenzhen Mental Health Center, Shenzhen Kangning Hospital, 518020, Shenzhen, China
| | - Jianhong Tian
- Department of Radiology, Shenzhen Mental Health Center, Shenzhen Kangning Hospital, 518020, Shenzhen, China
| | - Gangqiang Hou
- Department of Radiology, Shenzhen Mental Health Center, Shenzhen Kangning Hospital, 518020, Shenzhen, China.
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Bruggeman GF, Haitsma IK, Dirven CMF, Volovici V. Traumatic axonal injury (TAI): definitions, pathophysiology and imaging-a narrative review. Acta Neurochir (Wien) 2021; 163:31-44. [PMID: 33006648 PMCID: PMC7778615 DOI: 10.1007/s00701-020-04594-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 09/22/2020] [Indexed: 01/01/2023]
Abstract
Introduction Traumatic axonal injury (TAI) is a condition defined as multiple, scattered, small hemorrhagic, and/or non-hemorrhagic lesions, alongside brain swelling, in a more confined white matter distribution on imaging studies, together with impaired axoplasmic transport, axonal swelling, and disconnection after traumatic brain injury (TBI). Ever since its description in the 1980s and the grading system by Adams et al., our understanding of the processes behind this entity has increased. Methods We performed a scoping systematic, narrative review by interrogating Ovid MEDLINE, Embase, and Google Scholar on the pathophysiology, biomarkers, and diagnostic tools of TAI patients until July 2020. Results We underline the misuse of the Adams classification on MRI without proper validation studies, and highlight the hiatus in the scientific literature and areas needing more research. In the past, the theory behind the pathophysiology relied on the inertial force exerted on the brain matter after severe TBI inducing a primary axotomy. This theory has now been partially abandoned in favor of a more refined theory involving biochemical processes such as protein cleavage and DNA breakdown, ultimately leading to an inflammation cascade and cell apoptosis, a process now described as secondary axotomy. Conclusion The difference in TAI definitions makes the comparison of studies that report outcomes, treatments, and prognostic factors a daunting task. An even more difficult task is isolating the outcomes of isolated TAI from the outcomes of severe TBI in general. Targeted bench-to-bedside studies are required in order to uncover further pathways involved in the pathophysiology of TAI and, ideally, new treatments.
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Affiliation(s)
- Gavin F Bruggeman
- Department of Neurosurgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Iain K Haitsma
- Department of Neurosurgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Clemens M F Dirven
- Department of Neurosurgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Victor Volovici
- Department of Neurosurgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
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Pagola-Lorz I, Cámara M, Diaz-Pertuz E, Erro M. Coma por lesión reversible del cuerpo calloso. Neurologia 2020; 35:671-672. [DOI: 10.1016/j.nrl.2019.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 10/19/2019] [Indexed: 10/25/2022] Open
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8
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Pagola-Lorz I, Cámara M, Diaz-Pertuz E, Erro M. Coma secondary to a reversible lesion to the corpus callosum. NEUROLOGÍA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.nrleng.2019.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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9
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Rasmussen C, Niculescu I, Patel S, Krishnan A. COVID-19 and Involvement of the Corpus Callosum: Potential Effect of the Cytokine Storm? AJNR Am J Neuroradiol 2020; 41:1625-1628. [PMID: 32732269 DOI: 10.3174/ajnr.a6680] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 06/03/2020] [Indexed: 01/05/2023]
Abstract
Neurologic findings are being increasingly recognized in coronavirus disease 2019. We present a patient with a unique involvement of the corpus callosum that we relate to the cytokine storm seen in patients with Severe Acute Respiratory Syndrome coronavirus 2 infection. As the infection is increasingly seen around the world, recognition of these unique patterns may facilitate early identification of the progression of this disease and potentially facilitate appropriate management.
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Affiliation(s)
- C Rasmussen
- From the Departments of Diagnostic Radiology and Molecular Imaging (C.R., S.P., A.K.), and Internal Medicine (IN), Beaumont Health, Royal Oak, Michigan
| | - I Niculescu
- From the Departments of Diagnostic Radiology and Molecular Imaging (C.R., S.P., A.K.), and Internal Medicine (IN), Beaumont Health, Royal Oak, Michigan
| | - S Patel
- From the Departments of Diagnostic Radiology and Molecular Imaging (C.R., S.P., A.K.), and Internal Medicine (IN), Beaumont Health, Royal Oak, Michigan
| | - A Krishnan
- From the Departments of Diagnostic Radiology and Molecular Imaging (C.R., S.P., A.K.), and Internal Medicine (IN), Beaumont Health, Royal Oak, Michigan
- Oakland University William Beaumont School of Medicine (A.K.), Rochester, Michigan
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10
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Cirnigliaro G, Di Bernardo I, Caricasole V, Piccoli E, Scaramelli B, Pomati S, Villa C, Pantoni L, Dell'Osso B. Treatment-related transient splenial lesion of the Corpus Callosum in patients with neuropsychiatric disorders: a literature overview with a case report. Expert Opin Drug Saf 2020; 19:315-325. [PMID: 32063066 DOI: 10.1080/14740338.2020.1731472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: Transient-localized lesions of the splenium of the corpus callosum (SCC) have been described in various clinical conditions, some of them being attributed to the withdrawal of psychotropic drugs. The pathophysiology of the lesion reflects cytotoxic edema and reversible demyelination.Areas covered: The present article aimed at reviewing cases of transient SCC lesion exclusively related to changes in pharmacotherapy. It also reports the original case of a patient receiving a complex psychopharmacological therapy who developed a transient SCC lesion investigated by magnetic resonance imaging (MRI), magnetic resonance spectroscopy (MRS), and pharmacogenetic profiling.Expert opinion: To date, only one review on the subject has been published, analyzing 22 cases of transient SCC lesion arising in epileptic patients on antiepileptic therapy. It hypothesized that the nature of the lesion is a cytotoxic edema and the cases described in the subsequent 14 years seem to support this hypothesis. The authors reported the case of an Italian-Egyptian patient who developed a transient SCC lesion after the rapid withdrawal of Carbamazepine and Lurasidone. The lesion completely disappeared from the MRI performed after 1 month. Patient's ethnic group and its pharmacogenetic profile were considered as possible causes of altered drug metabolism and, likely, of the SCC lesion.
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Affiliation(s)
- Giovanna Cirnigliaro
- Department of Mental Health, Department of Biomedical and Clinical Sciences, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy
| | - Ilaria Di Bernardo
- Department of Mental Health, Department of Biomedical and Clinical Sciences, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy
| | - Valentina Caricasole
- Department of Mental Health, Department of Biomedical and Clinical Sciences, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy
| | - Eleonora Piccoli
- Department of Mental Health, Department of Biomedical and Clinical Sciences, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy
| | - Barbara Scaramelli
- Department of Mental Health, Department of Biomedical and Clinical Sciences, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy
| | - Simone Pomati
- Department of Biomedical and Clinical Sciences, Luigi Sacco Hospital, Neurology Unit, ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy
| | - Chiara Villa
- Department of Radiology, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Leonardo Pantoni
- Department of Biomedical and Clinical Sciences, Luigi Sacco Hospital, Neurology Unit, ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy.,Centro per lo studio dei meccanismi molecolari alla base delle patologie neuro-psico-geriatriche, University of Milan, Milan, Italy
| | - Bernardo Dell'Osso
- Department of Mental Health, Department of Biomedical and Clinical Sciences, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy.,Department of Psychiatry and Behavioral Sciences, Bipolar Disorders Clinic, Stanford University, CA, USA.,Centro per lo studio dei meccanismi molecolari alla base delle patologie neuro-psico-geriatriche, University of Milan, Milan, Italy.,"Aldo Ravelli" Center for Neurotechnology and Brain Therapeutic, University of Milan, Milan, Italy
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11
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Mohamed AZ, Corrigan F, Collins-Praino LE, Plummer SL, Soni N, Nasrallah FA. Evaluating spatiotemporal microstructural alterations following diffuse traumatic brain injury. Neuroimage Clin 2019; 25:102136. [PMID: 31865019 PMCID: PMC6931220 DOI: 10.1016/j.nicl.2019.102136] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 12/12/2019] [Accepted: 12/13/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Diffuse traumatic brain injury (TBI) is known to lead to microstructural changes within both white and grey matter detected in vivo with diffusion tensor imaging (DTI). Numerous studies have shown alterations in fractional anisotropy (FA) and mean diffusivity (MD) within prominent white matter tracts, but few have linked these to changes within the grey matter with confirmation via histological assessment. This is especially important as alterations in the grey matter may be predictive of long-term functional deficits. METHODS A total of 33 male Sprague Dawley rats underwent severe closed-head TBI. Eight animals underwent tensor-based morphometry (TBM) and DTI at baseline (pre-TBI), 24 hours (24 h), 7, 14, and 30 days post-TBI. Immunohistochemical analysis for the detection of ionised calcium-binding adaptor molecule 1 (IBA1) to assess microglia number and percentage of activated cells, β-amyloid precursor protein (APP) as a marker of axonal injury, and myelin basic protein (MBP) to investigate myelination was performed at each time-point. RESULTS DTI showed significant alterations in FA and RD in numerous white matter tracts including the corpus callosum, internal and external capsule, and optic tract and in the grey-matter in the cortex, thalamus, and hippocampus, with the most significant effects observed at 14 D post-TBI. TBM confirmed volumetric changes within the hippocampus and thalamus. Changes in DTI were in line with significant axonal injury noted at 24 h post-injury via immunohistochemical analysis of APP, with widespread microglial activation seen within prominent white matter tracts and the grey matter, which persisted to 30 D within the hippocampus and thalamus. Microstructural alterations in MBP+ve fibres were also noted within the hippocampus and thalamus, as well as the cortex. CONCLUSION This study confirms the widespread effects of diffuse TBI on white matter tracts which could be detected via DTI and extends these findings to key grey matter regions, with a comprehensive investigation of the whole brain. In particular, the hippocampus and thalamus appear to be vulnerable to ongoing pathology post-TBI, with DTI able to detect these alterations supporting the clinical utility in evaluating these regions post-TBI.
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Affiliation(s)
- Abdalla Z Mohamed
- Queensland Brain Institute, The University of Queensland, Building 79, Upland Road, Saint Lucia, Brisbane, QLD 4072, Australia
| | - Frances Corrigan
- Head Injury Laboratory, Division of Health Sciences, University of South Australia, Adelaide, SA 5000, Australia
| | - Lyndsey E Collins-Praino
- Cognition, Aging and Neurodegenerative Disease Laboratory (CANDL), Adelaide Medical School, University of Adelaide, Adelaide, SA 5005, Australia
| | - Stephanie L Plummer
- Translational Neuropathology Laboratory, Adelaide Medical School, University of Adelaide, Adelaide, SA 5005, Australia
| | - Neha Soni
- Queensland Brain Institute, The University of Queensland, Building 79, Upland Road, Saint Lucia, Brisbane, QLD 4072, Australia
| | - Fatima A Nasrallah
- Queensland Brain Institute, The University of Queensland, Building 79, Upland Road, Saint Lucia, Brisbane, QLD 4072, Australia.
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12
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Tetsuka S. Reversible lesion in the splenium of the corpus callosum. Brain Behav 2019; 9:e01440. [PMID: 31588684 PMCID: PMC6851813 DOI: 10.1002/brb3.1440] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 09/15/2019] [Accepted: 09/18/2019] [Indexed: 12/17/2022] Open
Abstract
AIM OF REVIEW The presence of isolated, reversible lesions in the splenium of the corpus callosum (SCC) is essential to confirm the diagnosis of mild encephalitis/encephalopathy. The lesions usually heal within a month after the onset of neurological symptoms. Magnetic resonance imaging (MRI) has increasingly been used as a diagnostic tool, which has led to the publication of an increasing number of case reports. These have highlighted some inconsistencies about encephalitis/encephalopathy. First, the condition is not always mild and may be severe. Second, reversible lesions in the SCC have been identified in various diseases and conditions other than viral encephalitis/encephalopathy. Third, lesions in SCC are not always completely reversible. On this note, this review describes the specific clinical and radiological features of encephalitis/encephalopathy. FINDINGS The reversible lesion in SCC is an MRI finding observable in a wide variety of diseases and conditions. Thus, it should be considered as a secondary change rather than a peculiar feature associated with mild encephalitis/encephalopathy. If reversible lesions are present in the SCC, the symptoms and prognosis are not necessarily favorable, with manifestations of encephalitis/encephalopathy varying from absent to severe. Neuroradiological features that appear as isolated high-intensity signals on diffusion-weighted images and a decreased apparent diffusion coefficient of the lesion might indicate a diagnosis of cytotoxic edema. Findings of previous studies suggest that cytokine-mediated cytotoxic edema of the SCC may be an important pathophysiological manifestation of this condition. CONCLUSION The reversible lesions in the SCC found on MRI are not exclusive to encephalitis/encephalopathy but may be secondary to other disorders.
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Affiliation(s)
- Syuichi Tetsuka
- Department of Neurology, International University of Health and Welfare Hospital, Nasushiobara, Japan
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13
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Cha T, Choi YJ, Oh JW, Kim CR, Park DW, Seol IJ, Moon JH. Respiratory syncytial virus-associated seizures in Korean children, 2011-2016. KOREAN JOURNAL OF PEDIATRICS 2018; 62:131-137. [PMID: 30360041 PMCID: PMC6477548 DOI: 10.3345/kjp.2018.07066] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 10/22/2018] [Indexed: 12/26/2022]
Abstract
Purpose Respiratory syncytial virus (RSV) infection can cause various neurological complications. This study aimed to investigate the RSV-associated neurologic manifestations that present with seizures. Methods We retrospectively reviewed the medical records of patients aged less than 15 years with laboratory-confirmed RSV infections and seizures between January 2011 and December 2016 in a regional hospital in South Korea. Results During this period, 1,193 patients with laboratory-confirmed RSV infection were identified. Of these, 35 (35 of 1,193, 2.93%; boys, 19; girls, 16; mean age: 20.8±16.6 months) presented with seizure. Febrile seizure was the most common diagnosis (27 of 35, 77.1%); simple febrile seizures in 13 patients (13 of 27, 48.1%) and complex febrile seizures in 14 (14 of 27, 51.9%). Afebrile seizures without meningitis or encephalopathy were observed in 5 patients (5 of 35, 14.3%), seizures with meningitis in 2 (2 of 35, 5.7%), and seizure with encephalopathy in 1 (1 of 35, 2.9%) patient. Lower respiratory symptoms were not observed in 8 patients. In a patient with encephalopathy, brain diffusion-weighted magnetic resonance imaging revealed transient changes in white matter, suggesting cytotoxic edema as the mechanism underlying encephalopathy. Most patients recovered with general management, and progression to epilepsy was noted in only 1 patient. Conclusion Although febrile seizures are the most common type of seizure associated with RSV infection, the proportion of patients with complex febrile seizures was higher than that of those with general febrile seizures. Transient cytotoxic edema may be a pathogenic mechanism in RSV-related encephalopathy with seizures.
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Affiliation(s)
- Teahyen Cha
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, Korea
| | - Young Jin Choi
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, Korea
| | - Jae-Won Oh
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, Korea
| | - Chang-Ryul Kim
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, Korea
| | - Dong Woo Park
- Department of Radiology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - In Joon Seol
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, Korea
| | - Jin-Hwa Moon
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, Korea
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14
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Piri Çınar B, Akar H, Taylan A. A Rare Cause of Reversible Splenial Lesion Syndrome: A Case Report with Epilepsy. Balkan Med J 2017; 35:122-123. [PMID: 28958981 PMCID: PMC5820443 DOI: 10.4274/balkanmedj.2017.0733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Bilge Piri Çınar
- Clinic of Neurology, Health Sciences University, Samsun Training and Research Hospital, Samsun, Turkey
| | - Handan Akar
- Clinic of Neurology, Health Sciences University, Samsun Training and Research Hospital, Samsun, Turkey
| | - Abdullah Taylan
- Clinic of Radiology, Health Sciences University, Samsun Training and Research Hospital, Samsun, Turkey
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Lin D, Rheinboldt M. Reversible splenial lesions presenting in conjunction with febrile illness: a case series and literature review. Emerg Radiol 2017; 24:599-604. [PMID: 28523438 DOI: 10.1007/s10140-017-1516-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 05/08/2017] [Indexed: 10/19/2022]
Abstract
Transient restricted diffusion and increased T2 signal intensity within the splenium of the corpus callosum is an increasingly recognized albeit uncommon imaging feature in the setting of acute encephalitis and antecedent viral illness. This review will discuss three index cases obtained from an institutional databank. Additionally, the current understanding of the underlying neurophysiologic pathogenesis will be discussed together with differential clinical and imaging diagnostic considerations, treatment options, and outcome metrics.
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Affiliation(s)
- David Lin
- Department of Radiology, Henry Ford Health System, 2799 West Grand Blvd, Detroit, MI, 48202, USA
| | - Matthew Rheinboldt
- Department of Radiology, Henry Ford Health System, 2799 West Grand Blvd, Detroit, MI, 48202, USA.
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Starkey J, Kobayashi N, Numaguchi Y, Moritani T. Cytotoxic Lesions of the Corpus Callosum That Show Restricted Diffusion: Mechanisms, Causes, and Manifestations. Radiographics 2017; 37:562-576. [PMID: 28165876 DOI: 10.1148/rg.2017160085] [Citation(s) in RCA: 157] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Cytotoxic lesions of the corpus callosum (CLOCCs) are secondary lesions associated with various entities. CLOCCs have been found in association with drug therapy, malignancy, infection, subarachnoid hemorrhage, metabolic disorders, trauma, and other entities. In all of these conditions, cell-cytokine interactions lead to markedly increased levels of cytokines and extracellular glutamate. Ultimately, this cascade can lead to dysfunction of the callosal neurons and microglia. Cytotoxic edema develops as water becomes trapped in these cells. On diffusion-weighted magnetic resonance (MR) images, CLOCCs manifest as areas of low diffusion. CLOCCs lack enhancement on contrast material-enhanced images, tend to be midline, and are relatively symmetric. The involvement of the corpus callosum typically shows one of three patterns: (a) a small round or oval lesion located in the center of the splenium, (b) a lesion centered in the splenium but extending through the callosal fibers laterally into the adjacent white matter, or (c) a lesion centered posteriorly but extending into the anterior corpus callosum. CLOCCs are frequently but not invariably reversible. Their pathologic mechanisms are discussed, the typical MR imaging findings are described, and typical cases of CLOCCs are presented. Although CLOCCs are nonspecific with regard to the underlying cause, additional imaging findings and the clinical findings can aid in making a specific diagnosis. Radiologists should be familiar with the imaging appearance of CLOCCs to avoid a misdiagnosis of ischemia. When CLOCCs are found, the underlying cause of the lesion should be sought and addressed. ©RSNA, 2017 An earlier incorrect version of this article appeared online. This article was corrected on February 13, 2017.
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Affiliation(s)
- Jay Starkey
- From the Department of Radiology, St Luke's International Hospital, 9-1 Akashicho, Chuo, Tokyo 104-8560, Japan (J.S., N.K., Y.N.); and the Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa (T.M.)
| | - Nobuo Kobayashi
- From the Department of Radiology, St Luke's International Hospital, 9-1 Akashicho, Chuo, Tokyo 104-8560, Japan (J.S., N.K., Y.N.); and the Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa (T.M.)
| | - Yuji Numaguchi
- From the Department of Radiology, St Luke's International Hospital, 9-1 Akashicho, Chuo, Tokyo 104-8560, Japan (J.S., N.K., Y.N.); and the Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa (T.M.)
| | - Toshio Moritani
- From the Department of Radiology, St Luke's International Hospital, 9-1 Akashicho, Chuo, Tokyo 104-8560, Japan (J.S., N.K., Y.N.); and the Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa (T.M.)
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Legionnaires Disease With Focal Neurologic Deficits and a Reversible Lesion in the Splenium of the Corpus Callosum. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2017. [DOI: 10.1097/ipc.0000000000000441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Progress of Research on Diffuse Axonal Injury after Traumatic Brain Injury. Neural Plast 2016; 2016:9746313. [PMID: 28078144 PMCID: PMC5204088 DOI: 10.1155/2016/9746313] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 10/25/2016] [Accepted: 11/15/2016] [Indexed: 12/02/2022] Open
Abstract
The current work reviews the concept, pathological mechanism, and process of diagnosing of DAI. The pathological mechanism underlying DAI is complicated, including axonal breakage caused by axonal retraction balls, discontinued protein transport along the axonal axis, calcium influx, and calpain-mediated hydrolysis of structural protein, degradation of axonal cytoskeleton network, the changes of transport proteins such as amyloid precursor protein, and changes of glia cells. Based on the above pathological mechanism, the diagnosis of DAI is usually made using methods such as CT, traditional and new MRI, biochemical markers, and neuropsychological assessment. This review provides a basis in literature for further investigation and discusses the pathological mechanism. It may also facilitate improvement of the accuracy of diagnosis for DAI, which may come to play a critical role in breaking through the bottleneck of the clinical treatment of DAI and improving the survival and quality of life of patients through clear understanding of pathological mechanisms and accurate diagnosis.
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Gupta M, Mishra SK, Kumar BSH, Khushu S, Rana P. Early detection of whole body radiation induced microstructural and neuroinflammatory changes in hippocampus: A diffusion tensor imaging and gene expression study. J Neurosci Res 2016; 95:1067-1078. [PMID: 27436454 DOI: 10.1002/jnr.23833] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 06/21/2016] [Accepted: 06/21/2016] [Indexed: 11/09/2022]
Abstract
Ionizing radiation is known to a cause systemic inflammatory response within hours of exposure that may affect the central nervous system (CNS). The present study was carried out to look upon the influence of radiation induced systemic inflammatory response in hippocampus within 24 hr of whole body radiation exposure. A Diffusion Tensor Imaging (DTI) study was conducted in mice exposed to a 5-Gy radiation dose through a 60 Co source operating at 2.496 Gy/min at 3 hr and 24 hr post irradiation and in sham-irradiated controls using 7 T animal MRI system. The results showed a significant decrease in Mean Diffusivity (MD), Radial Diffusivity (RD), and Axial Diffusivity (AD) in hippocampus at 24 hr compared with controls. Additionally, marked change in RD was observed at 3 hr. Increased serum C-Reactive Protein (CRP) level depicted an increased systemic/peripheral inflammation. The neuroinflammatory response in hippocampus was characterized by increased mRNA expression of IL-1β, IL-6, and Cox-2 at the 24 hr time point. Additionally, in the irradiated group, reactive astrogliosis was illustrated, with noticeable changes in GFAP expression at 24 hr. Altered diffusivity and enhanced neuroinflammatory expression in the hippocampal region showed peripheral inflammation induced changes in brain. Moreover, a negative correlation between gene expression and DTI parameters depicted a neuroinflammation induced altered microenvironment that might affect water diffusivity. The study showed that there was an influence of whole body radiation exposure on hippocampus even during the early acute phase that could be reflected in terms of neuroinflammatory response as well as microstructural changes. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Mamta Gupta
- NMR Research Centre, Institute of Nuclear Medicine and Allied Sciences, Delhi, India
| | - Sushanta Kumar Mishra
- NMR Research Centre, Institute of Nuclear Medicine and Allied Sciences, Delhi, India
| | - B S Hemanth Kumar
- NMR Research Centre, Institute of Nuclear Medicine and Allied Sciences, Delhi, India
| | - Subash Khushu
- NMR Research Centre, Institute of Nuclear Medicine and Allied Sciences, Delhi, India
| | - Poonam Rana
- NMR Research Centre, Institute of Nuclear Medicine and Allied Sciences, Delhi, India
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20
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Estimation of the Number of Compartments Associated With the Apparent Diffusion Coefficient in MRI: The Theoretical and Experimental Investigations. AJR Am J Roentgenol 2016; 206:455-62. [PMID: 26901002 DOI: 10.2214/ajr.15.14497] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The goal of the present study was to estimate the number of compartments and the mean apparent diffusion coefficient (ADC) value with the use of the DWI signal curve. MATERIALS AND METHODS A useful new mathematic model that includes internal correlation among subcompartments with a distinct number of compartments was proposed. The DWI signal was simulated to estimate the approximate association between the number of subcompartments and the molecular density, with density corresponding to the ratio of the ADC values of the compartments, as determined using the Monte Carlo method. RESULTS Various factors, such as energy depletion, temperature, intracellular water accumulation, changes in the tortuosity of the extracellular diffusion paths, and changes in cell membrane permeability, have all been implicated as factors contributing to changes in the ADC of water (ADCw); therefore, one may consider them as pseudocompartments in the new model proposed in this study. The lower the coefficient is, the lower the contribution of the compartment to the net signal will be. The results of the simulation indicate that when the number of compartments increases, the signal will become significantly lower, because the gradient factor (i.e., the b value) will increase. In other words, the signal curve is approximately linear at all b values when the number of compartments in which the tissues have been severely damaged is low; however, when the number of compartments is high, the curve will become constant at high b values, and the perfusion parameters will prevail on the diffusion parameters at low b values. Therefore, normal tissues will be investigated when the number of compartments and the ADC values are high and the b values are low, whereas damaged tissues will be evaluated when the number of compartments and the ADC values are low and the b values are high. CONCLUSION The present study investigates damaged tissues at high b values for which the effect of eddy currents will also be compensated. These b values will probably be used in functional MRI.
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Al Brashdi YH, Albayram MS. Reversible restricted-diffusion lesion representing transient intramyelinic cytotoxic edema in a patient with traumatic brain injury. Neuroradiol J 2015; 28:409-12. [PMID: 26306930 DOI: 10.1177/1971400915598071] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We report this case to increase the awareness of magnetic resonance imaging (MRI) features of reversible white matter abnormalities in diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) maps in a patient with traumatic brain injury (TBI). An eight-year-old girl, who was hit by a truck, was brought to the emergency department by the emergency medical service (EMS). Eleven days later, she experienced cognitive impairment requiring MRI evaluation. DWI and ADC maps showed restricted diffusion in the white matter of the corpus callosum, peri-atrial white matter, and in the right centrum semiovale. There were no significant hemorrhagic foci in these regions, which showed complete resolution on follow up DWI MRI 13 days later. This reported case revealed TBI-related transient reversible intramyelinic cytotoxic edema.
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22
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Rimkus CDM, Andrade CS, Leite CDC, McKinney AM, Lucato LT. Toxic leukoencephalopathies, including drug, medication, environmental, and radiation-induced encephalopathic syndromes. Semin Ultrasound CT MR 2014; 35:97-117. [PMID: 24745887 DOI: 10.1053/j.sult.2013.09.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Toxic leukoencephalopathies can be secondary to the exposure to a wide variety of exogenous agents, including cranial irradiation, chemotherapy, antiepileptic agents, drugs of abuse, and environmental toxins. There is no typical clinical picture, and patients can present with a wide array of signs and symptoms. Involvement of white matter is a key finding in this scenario, although in some circumstances other high metabolic areas of the central nervous system can also be affected. Magnetic resonance (MR) imaging usually discloses bilateral and symmetric white matter areas of hyperintense signal on T2-weighted and fluid-attenuated inversion recovery images, and signs of restricted diffusion are associated in the acute stage. In most cases, the changes are reversible, especially with prompt recognition of the disease and discontinuation of the noxious agent. Either the MR or clinical features may be similar to several nontoxic entities, such as demyelinating diseases, leukodystrophies, hepatic encephalopathy, vascular disease, hypoxic-ischemic states, and others. A high index of suspicion should be maintained whenever a patient presents recent onset of neurologic deficit, searching the risk of exposure to a neurotoxic agent. Getting to know the most frequent MR appearances and mechanisms of action of causative agents may help to make an early diagnosis and begin therapy, improving outcome. In this review, some of the most important causes of leukoencephalopathies are presented; as well as other 2 related conditions: strokelike migraine attacks after radiation therapy syndrome and reversible splenial lesions.
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Affiliation(s)
| | - Celi Santos Andrade
- Department of Radiology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Claudia da Costa Leite
- Department of Radiology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Alexander M McKinney
- Department of Radiology/Neuroradiology, University of Minnesota and Hennepin County Medical Centers, Minneapolis, MN
| | - Leandro Tavares Lucato
- Department of Radiology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
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23
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Tavanti F, Coppola V, Romano A, Beccia M, Giuliani G, Pierallini A, Bozzao A. Diffuse axonal injury with selective involvement of the corticospinal tract. A diffusion tensor imaging case study. Neuroradiol J 2014; 27:397-9. [PMID: 25196610 DOI: 10.15274/nrj-2014-10070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 06/29/2014] [Indexed: 11/12/2022] Open
Abstract
The identification of diffuse axonal injury (DAI) can be difficult, especially using conventional imaging (CT or MRI), which usually appears normal. Diffusion tensor imaging (DTI) is useful in identifying white matter abnormalities in patients with DAI. We describe the case of a 17-year-old female with severe closed head injury and right-side hemiparesis, studied with DTI and MR-tractography. In this case, DTI was useful to detect focal and diffuse signs of DAI.
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Affiliation(s)
- Francesca Tavanti
- NESMOS, Neuroradiology Department, S.Andrea Hospital, Sapienza University; Rome, Italy - e-mail:
| | - Valeria Coppola
- NESMOS, Neuroradiology Department, S.Andrea Hospital, Sapienza University; Rome, Italy
| | - Andrea Romano
- Fondazione San Raffaele; Ceglie Messapica, Brindisi, Italy
| | - Mario Beccia
- Fondazione San Raffaele; Ceglie Messapica, Brindisi, Italy
| | - Giorgia Giuliani
- NESMOS, Neuroradiology Department, S.Andrea Hospital, Sapienza University; Rome, Italy
| | | | - Alessandro Bozzao
- NESMOS, Neuroradiology Department, S.Andrea Hospital, Sapienza University; Rome, Italy
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Edlow BL, Giacino JT, Hirschberg RE, Gerrard J, Wu O, Hochberg LR. Unexpected recovery of function after severe traumatic brain injury: the limits of early neuroimaging-based outcome prediction. Neurocrit Care 2014; 19:364-75. [PMID: 23860665 DOI: 10.1007/s12028-013-9870-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Prognostication in the early stage of traumatic coma is a common challenge in the neuro-intensive care unit. We report the unexpected recovery of functional milestones (i.e., consciousness, communication, and community reintegration) in a 19-year-old man who sustained a severe traumatic brain injury. The early magnetic resonance imaging (MRI) findings, at the time, suggested a poor prognosis. METHODS During the first year of the patient's recovery, MRI with diffusion tensor imaging and T2*-weighted imaging was performed on day 8 (coma), day 44 (minimally conscious state), day 198 (post-traumatic confusional state), and day 366 (community reintegration). Mean apparent diffusion coefficient (ADC) and fractional anisotropy values in the corpus callosum, cerebral hemispheric white matter, and thalamus were compared with clinical assessments using the Disability Rating Scale (DRS). RESULTS Extensive diffusion restriction in the corpus callosum and bihemispheric white matter was observed on day 8, with ADC values in a range typically associated with neurotoxic injury (230-400 × 10(-6 )mm(2)/s). T2*-weighted MRI revealed widespread hemorrhagic axonal injury in the cerebral hemispheres, corpus callosum, and brainstem. Despite the presence of severe axonal injury on early MRI, the patient regained the ability to communicate and perform activities of daily living independently at 1 year post-injury (DRS = 8). CONCLUSIONS MRI data should be interpreted with caution when prognosticating for patients in traumatic coma. Recovery of consciousness and community reintegration are possible even when extensive traumatic axonal injury is demonstrated by early MRI.
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Affiliation(s)
- Brian L Edlow
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 175 Cambridge Street, Suite 300, Boston, MA, 02114, USA,
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25
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Increased gray matter diffusion anisotropy in patients with persistent post-concussive symptoms following mild traumatic brain injury. PLoS One 2013; 8:e66205. [PMID: 23776631 PMCID: PMC3679020 DOI: 10.1371/journal.pone.0066205] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 05/07/2013] [Indexed: 12/18/2022] Open
Abstract
A significant percentage of individuals diagnosed with mild traumatic brain injury (mTBI) experience persistent post-concussive symptoms (PPCS). Little is known about the pathology of these symptoms and there is often no radiological evidence based on conventional clinical imaging. We aimed to utilize methods to evaluate microstructural tissue changes and to determine whether or not a link with PPCS was present. A novel analysis method was developed to identify abnormalities in high-resolution diffusion tensor imaging (DTI) when the location of brain injury is heterogeneous across subjects. A normative atlas with 145 brain regions of interest (ROI) was built from 47 normal controls. Comparing each subject’s diffusion measures to the atlas generated subject-specific profiles of injury. Abnormal ROIs were defined by absolute z-score values above a given threshold. The method was applied to 11 PPCS patients following mTBI and 11 matched controls. Z-score information for each individual was summarized with two location-independent measures: “load” (number of abnormal regions) and “severity” (largest absolute z-score). Group differences were then computed using Wilcoxon rank sum tests. Results showed statistically significantly higher load (p = 0.018) and severity (p = 0.006) for fractional anisotropy (FA) in patients compared with controls. Subject-specific profiles of injury evinced abnormally high FA regions in gray matter (30 occurrences over 11 patients), and abnormally low FA in white matter (3 occurrences over 11 subjects). Subject-specific profiles provide important information regarding the pathology associated with PPCS. Increased gray matter (GM) anisotropy is a novel in-vivo finding, which is consistent with an animal model of brain trauma that associates increased FA in GM with pathologies such as gliosis. In addition, the individualized analysis shows promise for enhancing the clinical care of PPCS patients as it could play a role in the diagnosis of brain injury not revealed using conventional imaging.
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26
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Hyun Yoo J, Hunter J. Imaging Spectrum of Pediatric Corpus Callosal Pathology: A Pictorial Review. J Neuroimaging 2012; 23:281-95. [DOI: 10.1111/j.1552-6569.2011.00681.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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Vollmann H, Hagemann G, Mentzel HJ, Witte OW, Redecker C. Isolated reversible splenial lesion in tick-borne encephalitis: a case report and literature review. Clin Neurol Neurosurg 2011; 113:430-3. [PMID: 21371818 DOI: 10.1016/j.clineuro.2011.01.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Revised: 05/06/2010] [Accepted: 01/24/2011] [Indexed: 11/27/2022]
Abstract
Here, we demonstrate a first case of tick-borne encephalitis (TBE) associated with an isolated reversible splenial corpus callosum lesion (IRSL) and highlight the wide range of different clinical entities in which such alterations have been observed. A 42-year-old man showed fever, cephalgia and mild disturbance of coordination and gait. Diagnosis was ascertained by slight CSF-pleiocytosis and positive TBE-IgG as well as by positive intrathekal specific antibody index on follow-up. MRI demonstrated a single ovoid hyperintensity in T2 and DWI with reduction in ADC in the splenium of corpus callosum which was abrogated in follow-up after 6 weeks. Most entities of IRSL presented with excellent prognosis, including our novel case of TBE. We discuss different possible pathomechanisms and the so far unexplained propensity of the splenium for such alterations. Clinicians should be familiar with this phenomenon to avoid unnecessary diagnostic or therapeutic efforts.
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Affiliation(s)
- Henning Vollmann
- Department of Neurology, Friedrich-Schiller-University, Erlanger Allee 101, 07747 Jena, Germany
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28
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Gasparetto EL, Rueda Lopes FC, Domingues RC, Domingues RC. Diffusion Imaging in Traumatic Brain Injury. Neuroimaging Clin N Am 2011; 21:115-25, viii. [DOI: 10.1016/j.nic.2011.02.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Maller JJ, Thomson RHS, Lewis PM, Rose SE, Pannek K, Fitzgerald PB. Traumatic brain injury, major depression, and diffusion tensor imaging: making connections. ACTA ACUST UNITED AC 2010; 64:213-40. [PMID: 20388528 DOI: 10.1016/j.brainresrev.2010.04.003] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2009] [Revised: 03/15/2010] [Accepted: 04/06/2010] [Indexed: 12/17/2022]
Abstract
UNLABELLED It is common for depression to develop after traumatic brain injury (TBI), yet despite poorer recovery, there is a lack in our understanding of whether post-TBI brain changes involved in depression are akin to those in people with depression without TBI. Modern neuroimaging has helped recognize degrees of diffuse axonal injury (DAI) as being related to extent of TBI, but its ability to predict long-term functioning is limited and has not been considered in the context of post-TBI depression. A more recent brain imaging technique (diffusion tensor imaging; DTI) can measure the integrity of white matter by measuring the directionality or anisotropy of water molecule diffusion along the axons of nerve fibers. AIM To review DTI results in the TBI and depression literatures to determine whether this can elucidate the etiology of the development of depression after TBI. METHOD We reviewed the TBI/DTI (40 articles) and depression/DTI literatures (17 articles). No articles were found that used DTI to investigate depression post-TBI, although there were some common brain regions identified between the TBI/DTI and depression/DTI studies, including frontotemporal, corpus callosum, and structures contained within the basal ganglia. Specifically, the internal capsule was commonly reported to have significantly reduced fractional anisotropy, which agrees with deep brain stimulation studies. CONCLUSION It is suggested that measuring the degree of DAI by utilizing DTI in those with or without depression post-TBI, will greatly enhance prediction of functional outcome.
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Affiliation(s)
- Jerome J Maller
- Monash Alfred Psychiatry Research Centre, The Alfred and Monash University School of Psychology and Psychiatry, Melbourne Victoria, Australia.
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Muccio CF, De Simone M, Esposito G, De Blasio E, Vittori C, Cerase A. Reversible post-traumatic bilateral extensive restricted diffusion of the brain. A case study and review of the literature. Brain Inj 2010; 23:466-72. [PMID: 19408169 DOI: 10.1080/02699050902841912] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PRIMARY OBJECTIVE To increase the knowledge about diffuse traumatic brain injury (TBI) by reporting the magnetic resonance imaging (MRI) findings observed in a patient with reversible extensive restricted diffusion of the brain at diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) maps. CASE STUDY An 18-year-old patient was admitted after high-energy closed TBI. Glasgow Coma Scale score was 4. Head computed tomography showed small left frontal and temporal haemorrhagic contusions and a small haemorrhage in the left thalamus. Ten days later, brain MRI showed diffuse high-signal intensity on T2-weighted images and DWI and restricted diffusion in the subcortical white matter of both centri semiovali, genu and splenium of corpus callosum and parietal cortex bilaterally (mean ADC value = 0.434-0.811 x 10(-3) mm(2) s(-1)). Eleven days later, follow-up brain MRI showed gliotic changes in the left splenium of corpus callosum, a clearcut decrease of T2-weighted high-signal intensity and resolution of abnormalities at DWI and ADC maps in all other involved sites. This was confirmed 36 days later. Three months later, the patient did not show neurological, cognitive or neuropsychiatric deficits. CONCLUSIONS In the patient reported herein, closed TBI most likely induced diffuse excitotoxic injury of the brain which resulted in mainly reversible cytotoxic or intramyelinic oedema.
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Affiliation(s)
- Carmine Franco Muccio
- Unit of Neuroradiology, Department of Neurosciences, Azienda Ospedaliera Gaetano Rummo, Via dell'Angelo 1, Benevento, Italy.
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Babikian T, Tong KA, Galloway NR, Freier-Randall MC, Obenaus A, Ashwal S. Diffusion-weighted imaging predicts cognition in pediatric brain injury. Pediatr Neurol 2009; 41:406-12. [PMID: 19931161 DOI: 10.1016/j.pediatrneurol.2009.06.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2008] [Accepted: 06/06/2009] [Indexed: 11/30/2022]
Abstract
Apparent diffusion coefficient maps from diffusion-weighted imaging predict gross neurologic outcome in adults with traumatic brain injury. Few studies in children have been reported, and none have used apparent diffusion coefficient maps to predict long-term (>1 year) neurocognitive outcomes. In this study, pooled regional and total brain diffusion coefficients were used to predict long-term outcomes in 17 pediatric brain injury patients. Apparent diffusion coefficient values were grouped into peripheral and deep gray and white matter, posterior fossa, and total brain. Regions of interest excluded areas that appeared abnormal on T(2)-weighted images. Apparent diffusion coefficient values from peripheral regions were inversely correlated with cognitive functioning. No significant correlations were apparent between the cognitive scores and apparent diffusion coefficient values for deep tissue or the posterior fossa. Regression analyses suggested that combined peripheral gray and white matter apparent diffusion coefficients explained 42% of the variance in the combined neurocognitive index. Peripheral gray diffusion coefficients alone explained an additional 20% of variance after accounting for clinical variables. These results suggest that obtaining apparent diffusion coefficient values, specifically from peripheral brain regions, may predict long-term outcome after pediatric brain injury. Discrepancies in the literature on this topic, as well as possible explanations, including sampling and clinical considerations, are discussed.
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Affiliation(s)
- Talin Babikian
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, 760 Westwood Plaza, Room C8-746, Los Angeles, CA 90024, USA.
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Lipton ML, Gellella E, Lo C, Gold T, Ardekani BA, Shifteh K, Bello JA, Branch CA. Multifocal white matter ultrastructural abnormalities in mild traumatic brain injury with cognitive disability: a voxel-wise analysis of diffusion tensor imaging. J Neurotrauma 2009; 25:1335-42. [PMID: 19061376 DOI: 10.1089/neu.2008.0547] [Citation(s) in RCA: 176] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The purpose of the present study is to identify otherwise occult white matter abnormalities in patients suffering persistent cognitive impairment due to mild traumatic brain injury (TBI). The study had Institutional Review Board (IRB) approval, included informed consent and complied with the U.S. Health Insurance Portability and Accountability Act (HIPAA) of 1996. We retrospectively analyzed diffusion tensor MRI (DTI) of 17 patients (nine women, eight men; age range 26-70 years) who had cognitive impairment due to mild TBI that occurred 8 months to 3 years prior to imaging. Comparison was made to 10 healthy controls. Fractional anisotropy (FA) and mean diffusivity (MD) images derived from DTI (1.5 T; 25 directions; b = 1000) were compared using whole brain histogram and voxel-wise analyses. Histograms of white matter FA show an overall shift toward lower FA in patients. Areas of significantly decreased FA (p < 0.005) were found in the subject group in corpus callosum, subcortical white matter, and internal capsules bilaterally. Co-located elevation of mean diffusivity (MD) was found in the patients within each region. Similar, though less extensive, findings were demonstrated in each individual patient. Multiple foci of low white matter FA and high MD are present in cognitively impaired mild TBI patients, with a distribution that conforms to that of diffuse axonal injury. Evaluation of single subjects also reveals foci of low FA, suggesting that DTI may ultimately be useful for clinical evaluation of individual patients.
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Affiliation(s)
- Michael L Lipton
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York 10467, USA.
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Galloway NR, Tong KA, Ashwal S, Oyoyo U, Obenaus A. Diffusion-weighted imaging improves outcome prediction in pediatric traumatic brain injury. J Neurotrauma 2009; 25:1153-62. [PMID: 18842104 DOI: 10.1089/neu.2007.0494] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Diffusion-weighted imaging (DWI) and consequent apparent diffusion coefficient (ADC) maps have been used for lesion detection and as a predictor of outcome in adults with traumatic brain injury (TBI), but few studies have been reported in children. We evaluated the role of DWI and ADC for outcome prediction after pediatric TBI (n=37 TBI; n=10 controls). Fifteen regions of interest (ROIs) were manually drawn on ADC maps that were grouped for analysis into peripheral gray matter, peripheral white matter, deep gray and white matter, and posterior fossa. All ROIs excluded areas that appeared abnormal on T2-weighted images (T2WI). Acute injury severity was measured using the Glasgow Coma Scale (GCS) score, and 6-12-month outcomes were assessed using the Pediatric Cerebral Performance Category Scale (PCPCS) score. Patients were categorized into five groups: (1) controls; (2) all TBI patients; (3) mild/moderate TBI with good outcomes; (4) severe TBI with good outcomes; and (5) severe TBI with poor outcomes. ADC values in the peripheral white matter were significantly reduced in children with severe TBI with poor outcomes (72.8+/-14.4x10(-3) mm2/sec) compared to those with severe TBI and good outcomes (82.5+/-3.8x10(-3) mm2/sec; p<0.05). We also found that the average total brain ADC value alone had the greatest ability to predict outcome and could correctly predict outcome in 84% of cases. Assessment of DWI and ADC values in pediatric TBI is useful in evaluating injury, particularly in brain regions that appear normal on conventional imaging. Early identification of children at high risk for poor outcome may assist in aggressive clinical management of pediatric TBI patients.
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Affiliation(s)
- Nicholas R Galloway
- Department of Radiation Medicine, Loma Linda University, Loma Linda, California 92354, USA
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Hou DJ, Tong KA, Ashwal S, Oyoyo U, Joo E, Shutter L, Obenaus A. Diffusion-weighted magnetic resonance imaging improves outcome prediction in adult traumatic brain injury. J Neurotrauma 2007; 24:1558-69. [PMID: 17970619 DOI: 10.1089/neu.2007.0339] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In patients with traumatic brain injury (TBI), diffuse axonal injury (DAI) accounts for a significant amount of parenchymal injury. Diffusion weighted magnetic resonance imaging (DWI) is known to be sensitive for detecting visible DAI lesions. We focused on detection of non-visible, quantifiable diffusion changes in specific normal-appearing brain regions, using apparent diffusion coefficient (ADC) maps. Thirty-seven adults with TBI were compared to 35 age-matched control patients. DWI was performed and ADC maps were generated. Thirty-one regions of interest (ROI) were manually drawn on ADC maps and ADC values extracted. Brain ROIs were categorized into five zones: peripheral gray matter, peripheral white matter, deep gray matter, deep white matter, and posterior fossa. ADC results were compared with the severity of injury based on the admission Glasgow Coma Scale (GCS 3-8; severe; GSC 9-15 mild/moderate) and with long-term outcome (6-12 months after injury) using the Glasgow Outcome Scale (GOS 1-3, unfavorable; GOS: 4-5, favorable) score. Mean ADC values in all five brain zones were significantly different between TBI subjects and controls (p<or=0.05). Patients with more severe injury (i.e., GCS 3-8) had significantly different mean ADC values than control patients (p<or=0.05) and patients with unfavorable outcomes had significantly higher mean deep gray and white matter ADC values compared to those with favorable outcomes and to controls (p<or=0.05). Thus, ADC maps can be used to detect non-visible DAI lesions. In addition, injuries in the deep gray and white matter may be useful to predict outcome in adult TBI patients.
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Affiliation(s)
- Daniel J Hou
- Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
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Gallucci M, Limbucci N, Paonessa A, Caranci F. Reversible focal splenial lesions. Neuroradiology 2007; 49:541-4. [PMID: 17522852 DOI: 10.1007/s00234-007-0235-z] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2007] [Accepted: 03/23/2007] [Indexed: 11/25/2022]
Abstract
Reversible focal lesions in the splenium of the corpus callosum (SCC) have recently been reported. They are circumscribed and located in the median aspect of the SCC. On MRI, they are hyperintense on T2-W and iso-hypointense on T1-W sequences, with no contrast enhancement. On DWI, SCC lesions are hyperintense with low ADC values, reflecting restricted diffusion due to cytotoxic edema. The common element is the disappearance of imaging abnormalities with time, including normalization of DWI. Clinical improvement is often reported. The most established and frequent causes of reversible focal lesions of the SCC are viral encephalitis, antiepileptic drug toxicity/withdrawal and hypoglycemic encephalopathy. Many other causes have been reported, including traumatic axonal injury. The similar clinical and imaging features suggest a common mechanism induced by different pathological events leading to the same results. Edema and diffusion restriction in focal reversible lesions of the SCC have been attributed to excitotoxic mechanisms that can result from different mechanisms; no unifying relationship has been found to explain all the pathologies associated with SCC lesions. In our opinion, the similar imaging, clinical and prognostic aspects of these lesions depend on a high vulnerability of the SCC to excitotoxic edema and are less dependent on the underlying pathology. In this review, the relevant literature concerning reversible focal lesions in the SCC is analyzed and hypotheses about their pathogenesis are proposed.
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Affiliation(s)
- Massimo Gallucci
- Department of Radiology, S. Salvatore Hospital, University of L'Aquila, Via Natali - Coppito, 67100, L'Aquila, Italy.
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Pande AR, Ando K, Ishikura R, Nagami Y, Takada Y, Wada A, Watanabe Y, Miki Y, Uchino A, Nakao N. Clinicoradiological factors influencing the reversibility of posterior reversible encephalopathy syndrome: a multicenter study. ACTA ACUST UNITED AC 2006; 24:659-68. [PMID: 17186320 DOI: 10.1007/s11604-006-0086-2] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2006] [Accepted: 07/31/2006] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim of this retrospective study was to clarify the relation between the reversibility of posterior reversible encephalopathy syndrome (PRES) with three factors: the anatomical region of the brain involved, the background clinical cause, and the diffusion weighted image (DWI) intensity of PRES lesions. MATERIAL AND METHODS This multicenter study, conducted by the PRES Study Group of the Neuroradiology Workshop, involved 52 cases from 28 institutions. Initial and follow-up magnetic resonance imaging were compared regarding the reversibility of PRES lesions according to anatomical location and clinical background. Initial DWI and apparent diffusion coefficient (ADC) maps were reviewed in 20 cases. RESULTS Reversibility was significantly lower (P < 0.01) in the brain stem (44%) and deep white matter (47%) compared to the other cortical and subcortical areas (76%-91%). The reversibility was greater in the eclampsia subgroup followed by the hypertension and chemotherapy subgroups. DWI, even with ADC maps, had limitations in predicting the outcome of PRES lesions. CONCLUSION The typical cortical and subcortical PRES lesions showed reversibility, whereas the brain stem and deep white matter lesions showed less reversibility. PRES due to eclampsia showed maximum reversibility compared to hypertension- and drug-related PRES. DWI, even with ADC maps, had limitations in predicting the course of PRES.
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Affiliation(s)
- Ajaya R Pande
- Department of Radiology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya 663-8501, Japan
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Nelles M, Bien CG, Kurthen M, von Falkenhausen M, Urbach H. Transient splenium lesions in presurgical epilepsy patients: incidence and pathogenesis. Neuroradiology 2006; 48:443-8. [PMID: 16673074 DOI: 10.1007/s00234-006-0080-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2005] [Accepted: 03/03/2006] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Transient splenium corporis callosi (SCC) lesions are related to rapid reduction of antiepileptic drugs (AEDs). The range of substances with predilection for SCC changes, their pathophysiology and their occurrence are still unknown. METHODS In a prospective 2-year study an epilepsy-dedicated MRI protocol supplemented by DWI and ADC maps was performed after AED withdrawal for diagnostic seizure provocation in all patients with pharmacoresistant seizures locally admitted to the Department of Epileptology. RESULTS Of 891 presurgical epilepsy patients, 6 (0.7%) had SCC lesions with cytotoxic edema on DWI. Carbamazepine combined with other AEDs was administered in five of those patients. In the study period we observed identical lesions in a schizophrenic patient treated with olanzapine and citalopram, in a patient with oropharyngeal carcinoma treated with alkylating agents, and in a hypernatremic patient following neurohypophyseal granular cell tumor surgery. CONCLUSION Transient SCC lesions are related to rapid AED reduction but may occur in similar conditions with fluid balance alterations. We contribute further clinical data in this field to better classify the pharmaceuticals that are prone to the described cerebral cytotoxic side effects in the SCC and to clarify their incidence among presurgical epilepsy patients.
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Affiliation(s)
- M Nelles
- Department of Radiology/Neuroradiology, University of Bonn Medical Center, Sigmund Freud Str. 25, 53105 Bonn, Germany.
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Appenzeller S, Faria A, Marini R, Costallat LTL, Cendes F. Focal transient lesions of the corpus callosum in systemic lupus erythematosus. Clin Rheumatol 2006; 25:568-71. [PMID: 16404495 DOI: 10.1007/s10067-005-0174-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2005] [Revised: 11/14/2005] [Accepted: 12/03/2005] [Indexed: 10/25/2022]
Abstract
Focal lesions limited to the splenium of the corpus callosum are rare and little is known about their etiology. We describe three patients with systemic lupus erythematosus (SLE) that presented transient lesions of the corpus callosum. We reviewed three patients with SLE whose magnetic resonance imaging (MRI) results revealed focal lesions in the splenum of corpus callosum. The medical records, including clinical, serological, and treatment features, were reviewed to determine the etiology of these lesions. Of 115 patients who had MRI for research purposes, three patients with focal nonhemorrhagic lesions of the corpus callosum were identified. All patients had active SLE at the time of MRI. One patient had other findings on MRI, including cerebral venous thrombosis. On follow-up MRI, patients had an inactive disease and the corpus callosum lesions disappeared. A transient lesion in the splenium of corpus callosum seems to be a nonspecific endpoint of different disease processes leading to vasogenic edema. The complete and rapid reversibility in all cases with disease control is emphasized and any invasive diagnostic or therapeutic approach is discouraged.
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Affiliation(s)
- Simone Appenzeller
- Rheumatology Unit, Department of Internal Medicine, State University of Campinas (UNICAMP), Campinas, SP, Brazil
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Prilipko O, Delavelle J, Lazeyras F, Seeck M. Reversible cytotoxic edema in the splenium of the corpus callosum related to antiepileptic treatment: report of two cases and literature review. Epilepsia 2005; 46:1633-6. [PMID: 16190935 DOI: 10.1111/j.1528-1167.2005.00256.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE Clinically silent lesions localized in the splenium of the corpus callosum (SCC) are a rare finding in the magnetic resonance imaging (MRI) of patients receiving antiepileptic drugs (AEDs). They are usually of benign character but may induce unnecessary complementary examinations if their nature is unrecognized. So far, 22 cases have been described in the literature, for which different etiologies have been proposed. We describe two further cases and discuss the probable lesion etiology. METHODS We report two cases including a 25-year-old male patient and a 12-year-old female patient with a transient SCC lesion discovered in the context of a presurgical epilepsy evaluation. RESULTS Comprehensive MRIs, including diffusion tensor imaging-based fiber tracking of the lesion, revealed a cytotoxic edema not disrupting neuronal fibers. Serum arginine vasopressin (AVP) measurements revealed an altered secretion during the acute phase in one patient. CONCLUSIONS On the basis of our results, we hypothesize that the lesion consists of a cytotoxic edema, possibly induced by abrupt AED concentration changes and associated to alterations of AVP secretion.
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Affiliation(s)
- Olga Prilipko
- Presurgical Epilepsy Evaluation Unit, Program of Functional Neurology and Neurosurgery of the University Hospitals of Lausanne and Geneva, Switzerland.
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40
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Kosugi T, Isoda H, Imai M, Sakahara H. Reversible focal splenial lesion of the corpus callosum on MR images in a patient with malnutrition. Magn Reson Med Sci 2005; 3:211-4. [PMID: 16093640 DOI: 10.2463/mrms.3.211] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
T2-weighted MR (magnetic resonance) images of a 19-year-old woman undergoing concurrent chemoradiotherapy for a nasopharyngeal carcinoma revealed a lesion marked by focal hyper signal intensity in the splenium of the corpus callosum. The lesion was not visible two weeks later. She suffered from malnutrition caused by appetite loss during chemotherapy. We concluded that the lesion revealed by the abnormal signal intensity in the splenium had been caused by malnutrition.
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Affiliation(s)
- Takashi Kosugi
- Department of Radiology, Hamamatsu University School of Medicine, Japan.
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41
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Inglese M, Makani S, Johnson G, Cohen BA, Silver JA, Gonen O, Grossman RI. Diffuse axonal injury in mild traumatic brain injury: a diffusion tensor imaging study. J Neurosurg 2005; 103:298-303. [PMID: 16175860 DOI: 10.3171/jns.2005.103.2.0298] [Citation(s) in RCA: 418] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Diffuse axonal injury (DAI) is a major complication of traumatic brain injury (TBI) that leads to functional and psychological deficits. Although DAI is frequently underdiagnosed by conventional imaging modalities, it can be demonstrated using diffusion tensor imaging. The aim of this study was to assess the presence and extent of DAI in patients with mild TBI. METHODS Forty-six patients with mild TBI and 29 healthy volunteers underwent a magnetic resonance (MR) imaging protocol including: dual-spin echo, fluid-attenuated inversion recovery, T2-weighted gradient echo, and diffusion tensor imaging sequences. In 20 of the patients, MR imaging was performed at a mean of 4.05 days after injury. In the remaining 26, MR imaging was performed at a mean of 5.7 years after injury. In each case, mean diffusivity and fractional anisotropy were measured using both whole-brain histograms and regions of interest analysis. No differences in any of the histogram-derived measures were found between patients and control volunteers. Compared with controls, a significant reduction of fractional anisotropy was observed in patients' corpus callosum, internal capsule, and centrum semiovale, and there were significant increases of mean diffusivity in the corpus callosum and internal capsule. Neither histogram-derived nor regional diffusion tensor imaging metrics differed between the two groups. CONCLUSIONS Although mean diffusivity and fractional anisotropy abnormalities in these patients with TBI were too subtle to be detected with the whole-brain histogram analysis, they are present in brain areas that are frequent sites of DAI. Because diffusion tensor imaging changes are present at both early and late time points following injury, they may represent an early indicator and a prognostic measure of subsequent brain damage.
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Affiliation(s)
- Matilde Inglese
- Department of Radiology, New York University School of Medicine, New York, New York 10016, USA.
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Oppenheim C, Naggara O, Hamon M, Gauvrit JY, Rodrigo S, Bienvenu M, Ménégon P, Cosnard G, Meder JF. Imagerie par résonance magnétique de diffusion de l'encéphale chez l'adulte : technique, résultats normaux et pathologiques. ACTA ACUST UNITED AC 2005. [DOI: 10.1016/j.emcrad.2005.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Le TH, Mukherjee P, Henry RG, Berman JI, Ware M, Manley GT. Diffusion Tensor Imaging with Three-dimensional Fiber Tractography of Traumatic Axonal Shearing Injury: An Imaging Correlate for the Posterior Callosal “Disconnection” Syndrome: Case Report. Neurosurgery 2005; 56:E195-E201. [DOI: 10.1227/01.neu.0000144846.00569.3a] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2004] [Accepted: 08/27/2004] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE:
To demonstrate that magnetic resonance diffusion tensor imaging (DTI) with three-dimensional (3-D) fiber tractography can visualize traumatic axonal shearing injury that results in posterior callosal disconnection syndrome.
METHODS:
A 22-year-old man underwent serial magnetic resonance imaging 3 days and 12 weeks after blunt head injury. The magnetic resonance images included whole-brain DTI acquired with a single-shot spin echo echoplanar sequence. 3-D DTI fiber tractography of the splenium of the corpus callosum was performed. Quantitative DTI parameters, including apparent diffusion coefficient and fractional anisotropy, from the site of splenial injury were compared with those of a normal adult male volunteer.
RESULTS:
Conventional magnetic resonance images revealed findings of diffuse axonal injury, including a lesion at the midline of the splenium of the corpus callosum. DTI performed 3 days posttrauma revealed that the splenial lesion had reduced apparent diffusion coefficient and fractional anisotropy, reflecting a large decrease in the magnitude of diffusion parallel to the white matter fibers, which had partially recovered as revealed by follow-up DTI 12 weeks postinjury. 3-D tractography revealed an interruption of the white matter fibers in the posteroinferior aspect of the splenium that correlated with the patient's left hemialexia, a functional deficit caused by disconnection of the right visual cortex from the language centers of the dominant left hemisphere.
CONCLUSION:
DTI with 3-D fiber tractography can visualize acute axonal shearing injury, which may have prognostic value for the cognitive and neurological sequelae of traumatic brain injury.
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Affiliation(s)
- Tuong H. Le
- Department of Radiology, University of California, San Francisco, San Francisco, California
| | - Pratik Mukherjee
- Department of Radiology, University of California, San Francisco, San Francisco, California
| | - Roland G. Henry
- Department of Radiology, University of California, San Francisco, San Francisco, California
| | - Jeffrey I. Berman
- Department of Radiology, University of California, San Francisco, San Francisco, California
| | - Marcus Ware
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California
| | - Geoffrey T. Manley
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California
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Na SJ, Hong JM, Park JH, Chung TS, Lee KY. A case of reversible postpartum cytotoxic edema in preeclampsia. J Neurol Sci 2004; 221:83-7. [PMID: 15178218 DOI: 10.1016/j.jns.2004.02.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2003] [Revised: 01/06/2004] [Accepted: 02/09/2004] [Indexed: 11/20/2022]
Abstract
We report on a 32-year-old woman who developed reversible cortical blindness and right-sided weakness after cesarean section at 36 weeks of gestation, due to preeclampsia. An initial brain MRI demonstrated high signal intensity lesions in the bilateral occipito-parietal and left frontal lobes on T2-weighted and diffusion-weighted imaging. All of the lesions showed low signal intensity on apparent diffusion coefficient (ADC) map, which were compatible with cytotoxic edema, and MR angiography (MRA) showed diffuse vasospasm of the intracranial vessels. A follow-up brain MRI showed that most of the lesions disappeared and the vasospasm also resolved. This case suggests that the cytotoxic edema in preeclampsia may evolve differently from the pattern in cerebral infarction and explains the relatively benign course of the neurological signs in preeclampsia.
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Affiliation(s)
- Sang-Jun Na
- Department of Neurology, Yongdong Severance Hospital, Yonsei University College of Medicine, 146-92 Dogok-dong, Kangnam-ku, Seoul, South Korea
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45
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Schwarcz A, Bogner P, Meric P, Correze JL, Berente Z, Pál J, Gallyas F, Doczi T, Gillet B, Beloeil JC. The existence of biexponential signal decay in magnetic resonance diffusion-weighted imaging appears to be independent of compartmentalization. Magn Reson Med 2004; 51:278-85. [PMID: 14755652 DOI: 10.1002/mrm.10702] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
It is generally believed that the apparent diffusion coefficient (ADC) changes measured by diffusion-weighted imaging (DWI) in brain pathologies are related to alterations in the water compartments. The aim of this study was to elucidate the role of compartmentalization in DWI via biexponential analysis of the signal decay due to diffusion. DWI experiments were performed on mouse brain over an extended range of b-values (up to 10,000 mm(-2) s) under intact, global ischemic, and cold-injury conditions. DWI was additionally applied to centrifuged human erythrocyte samples with a negligible extracellular space. Biexponential signal decay was found to occur in the cortex of the intact mouse brain. During global ischemia, in addition to a drop in the ADC in both components, a shift from the volume fraction of the rapidly diffusing component to the slowly diffusing one was observed. In cold injury, the biexponential signal decay was still present despite the electron-microscopically validated disintegration of the membranes. The biexponential function was also applicable for fitting of the data obtained on erythrocyte samples. The results suggest that compartmentalization is not an essential feature of biexponential decay in diffusion experiments.
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Affiliation(s)
- Attila Schwarcz
- Department of Neurosurgery, University of Pécs, Pécs, Hungary.
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Huisman TAGM, Sorensen AG, Hergan K, Gonzalez RG, Schaefer PW. Diffusion-weighted imaging for the evaluation of diffuse axonal injury in closed head injury. J Comput Assist Tomogr 2003; 27:5-11. [PMID: 12544235 DOI: 10.1097/00004728-200301000-00002] [Citation(s) in RCA: 186] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE The purpose of this work was to compare diffusion-weighted imaging (DWI) with conventional MRI in the detection of shearing injuries in acute closed head injuries. METHOD Twenty-five patients (19 male, 6 female) were examined within 48 h of trauma. Conventional MRI included T2-weighted fast spin echo, fluid-attenuated inversion recovery (FLAIR), and T2*-weighted gradient echo sequences. Full tensor DWI with calculation of apparent diffusion coefficient (ADC) maps was also performed. Lesions were identified and compared on all sequences. RESULTS Four hundred twenty-seven lesions were counted by the combined use of all sequences. DWI identified 70 lesions not seen on conventional MRI. DWI identified 310 shearing injuries, followed by T2/FLAIR (n = 248) and T2* (n = 202). The majority of DWI-positive lesions showed decreased diffusion (65%). CONCLUSION DWI is valuable in closed head injury because it identifies additional shearing injuries not visible on T2/FLAIR or T2* sequences. Furthermore, DWI/ADC maps differentiate between lesions with decreased or increased diffusion. DWI is less sensitive than T2* imaging for detecting hemorrhagic lesions.
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Affiliation(s)
- Thierry A G M Huisman
- Department of Radiology, Neuroradiology Section, and MGH-NMR Center, Massachusetts General Hospital, Harvard Medical School, Charlestown-Boston, USA.
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Sagiuchi T, Tachibana S, Endo M, Hayakawa K. Diffusion-weighted MRI of the cervical cord in acute spinal cord injury with type II odontoid fracture. J Comput Assist Tomogr 2002; 26:654-6. [PMID: 12218837 DOI: 10.1097/00004728-200207000-00032] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The authors present a case of acute spinal cord injury demonstrated by diffusion-weighted MRI (DWI) of the cervical cord. DWI taken 2 hours after injury showed intramedullary hyperintensity with a decrease of the apparent diffusion coefficient (ADC) value at C1-C2 vertebral levels. On T -weighted images obtained 1 month after injury, the lesion was hyperintense, indicating the existence of myelomalacia. DWI of the cervical cord provided satisfactory images and was a useful method for detecting and visualizing of the affected cord in the super-early stage.(2)
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Affiliation(s)
- Takao Sagiuchi
- Department of Neurosurgery, Kitasato University School of Medicine, Kitasato, Japan.
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Garnett MR, Cadoux-Hudson TA, Styles P. How useful is magnetic resonance imaging in predicting severity and outcome in traumatic brain injury? Curr Opin Neurol 2001; 14:753-7. [PMID: 11723384 DOI: 10.1097/00019052-200112000-00012] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Major advances have been made in the ever-expanding field of magnetic resonance imaging and related technologies, such as magnetic resonance spectroscopy, haemodynamic and functional imaging. Although these magnetic resonance modalities are of great research interest, it is still questionable as to how useful these investigations are in the clinical setting. All of these modalities strive to define a few variables that might dominate the heterogeneous but common aetiopathology of traumatic brain injury. Recent studies have found that the use of various magnetic resonance imaging techniques at early and delayed time points can provide useful information with regard to the severity and clinical outcome of patients following traumatic brain injury. These new observations offer opportunities for improved clinical management in such patients.
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Affiliation(s)
- M R Garnett
- MRC Biochemical and Clinical Magnetic Resonance Unit, Department of Biochemistry, University of Oxford, Oxford OX2 9DL, UK
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