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Zahr N, Pfefferbaum A. Serum albumin and white matter hyperintensities. RESEARCH SQUARE 2024:rs.3.rs-3822513. [PMID: 38260299 PMCID: PMC10802700 DOI: 10.21203/rs.3.rs-3822513/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Urine albumin, high in kidney disease, predicts cardiovascular incidents and CNS white matter hyperintensity (WMH) burdens. Serum albumin - a more general biomarker which can be low in several disorders - including kidney and liver disease, malnutrition, and inflammation - also predicts cardiovascular events and is associated with cognitive impairment in several clinical populations; relations between serum albumin and WMH prevalence, however, have rarely been evaluated. In a sample of 160 individuals with alcohol use disorder (AUD), 142 infected with HIV, and 102 healthy controls, the hypothesis was tested that lower serum albumin levels would predict larger WMH volumes and worse cognitive performance irrespective of diagnosis. After considering traditional cardiovascular risk factors (e.g., age, sex, body mass index (BMI), nicotine use, hypertension, diabetes) and study-relevant variables (i.e., primary diagnoses, race, socioeconomic status, hepatitis C virus status), serum albumin survived false discovery rate (FDR)-correction in contributing variance to larger periventricular but not deep WMH volumes. This relationship was salient in the AUD and HIV groups, but not the control group. In secondary analyses, serum albumin and periventricular WMH along with age, sex, diagnoses, BMI, and hypertension were considered for hierarchical contribution to variance in performance in 4 cognitive domains. Albumin survived FDR-correction for significantly contributing to visual and verbal learning and memory performance after accounting for diagnosis. Relations between albumin and markers of liver integrity [e.g., aspartate transaminase (AST)] and blood status (e.g., hemoglobin, red blood cell count, red cell distribution width) suggest that in this sample, albumin reflects both liver dysfunction and hematological abnormalities. The current results suggest that albumin, a simple serum biomarker available in most clinical settings, can predict variance in periventricular WMH volumes and performance in visual and verbal learning and memory cognitive domains. Whether serum albumin contributes mechanistically to periventricular WMH prevalence will require additional investigation.
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Quelch D, Roderique-Davies G, John B. Alcohol-related brain damage: an umbrella (term) for the approaching post-COVID monsoon. Future Healthc J 2023; 10:313-320. [PMID: 38162212 PMCID: PMC10753228 DOI: 10.7861/fhj.2023-0022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Individuals with alcohol-related brain damage (ARBD) represent a population whose healthcare needs often go unmet. This is the result of a lack of not only an awareness surrounding the condition by healthcare professionals, but also healthcare service inclusion and delivery, more broadly. The Coronavirus 2019 (COVID-19) pandemic and the associated lockdowns dramatically affected the accessibility and availability of addiction services globally, while also driving changes in alcohol consumption among the most vulnerable. In the absence of change, this culmination of increased high-risk drinking behaviour, lack of awareness by healthcare professionals and severely limited service delivery for individuals living with ARBD post COVID-19, represents a perfect storm that is rapidly approaching our health and care services world-wide. Collectively, this will reduce positive health outcomes in an already at-risk group.
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Affiliation(s)
- Darren Quelch
- Addictions Research Group, Applied Psychology Research and Innovation Group, Faculty of Life Science and Education, University of South Wales, Pontypridd, UK
| | - Gareth Roderique-Davies
- Addictions Research Group, Applied Psychology Research and Innovation Group, Faculty of Life Science and Education, University of South Wales, Pontypridd, UK
| | - Bev John
- Addictions Research Group, Applied Psychology Research and Innovation Group, Faculty of Life Science and Education, University of South Wales, Pontypridd, UK
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Eva L, Brehar FM, Florian IA, Covache-Busuioc RA, Costin HP, Dumitrascu DI, Bratu BG, Glavan LA, Ciurea AV. Neuropsychiatric and Neuropsychological Aspects of Alcohol-Related Cognitive Disorders: An In-Depth Review of Wernicke's Encephalopathy and Korsakoff's Syndrome. J Clin Med 2023; 12:6101. [PMID: 37763040 PMCID: PMC10532206 DOI: 10.3390/jcm12186101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/16/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023] Open
Abstract
Alcohol-related cognitive disorders have long been an area of study, yet they continue to pose challenges in the diagnosis, treatment, and understanding of underlying neuropsychiatric mechanisms. The present article offers a comprehensive review of Wernicke's Encephalopathy and Korsakoff's Syndrome, two conditions often seen on a continuum of alcohol-related brain damage. Drawing on current medical literature, neuroimaging studies, and clinical case reports, we explore the neuropsychiatric and neuropsychological profiles, symptomatology, and differential diagnoses of these disorders. We delve into the biochemical pathways implicated in the development of WE and KS, notably thiamine deficiency and its impact on neurotransmitter systems and neural networks. The article also addresses the challenges in early diagnosis, often complicated by non-specific symptoms and co-occurring psychiatric conditions. Furthermore, we review the current state of treatment protocols, including pharmacological and non-pharmacological interventions. Finally, the article highlights gaps in current knowledge and suggests directions for future research to improve diagnosis, treatment, and patient outcomes. Understanding the nuanced interplay between the neuropsychiatric and neuropsychological aspects of WE and KS is crucial for both clinicians and researchers alike, in order to provide effective treatment and to advance our understanding of these complex conditions.
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Affiliation(s)
- Lucian Eva
- Faculty of Medicine, Dunarea de Jos University, 800010 Galati, Romania;
- Department of Neurosurgery, Clinical Emergency Hospital “Prof. Dr. Nicolae Oblu”, 700309 Iasi, Romania
| | - Felix-Mircea Brehar
- Department of Neurosurgery, Clinical Emergency Hospital “Bagdasar-Arseni”, 041915 Bucharest, Romania
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (R.-A.C.-B.); (H.P.C.); (D.-I.D.); (B.-G.B.); (L.-A.G.); (A.V.C.)
| | - Ioan-Alexandru Florian
- Department of Neurosciences, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Razvan-Adrian Covache-Busuioc
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (R.-A.C.-B.); (H.P.C.); (D.-I.D.); (B.-G.B.); (L.-A.G.); (A.V.C.)
| | - Horia Petre Costin
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (R.-A.C.-B.); (H.P.C.); (D.-I.D.); (B.-G.B.); (L.-A.G.); (A.V.C.)
| | - David-Ioan Dumitrascu
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (R.-A.C.-B.); (H.P.C.); (D.-I.D.); (B.-G.B.); (L.-A.G.); (A.V.C.)
| | - Bogdan-Gabriel Bratu
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (R.-A.C.-B.); (H.P.C.); (D.-I.D.); (B.-G.B.); (L.-A.G.); (A.V.C.)
| | - Luca-Andrei Glavan
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (R.-A.C.-B.); (H.P.C.); (D.-I.D.); (B.-G.B.); (L.-A.G.); (A.V.C.)
| | - Alexandru Vlad Ciurea
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (R.-A.C.-B.); (H.P.C.); (D.-I.D.); (B.-G.B.); (L.-A.G.); (A.V.C.)
- Neurosurgery Department, Sanador Clinical Hospital, 010991 Bucharest, Romania
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Oke IO, Mughees W, Patel H, Oladunjoye O, York E. A Case of Osmotic Demyelination Syndrome in a Chronic Alcoholic With Moderate Hyponatremia. Cureus 2021; 13:e15129. [PMID: 34159031 PMCID: PMC8212914 DOI: 10.7759/cureus.15129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Osmotic demyelination syndrome (ODS) is a clinical syndrome seen following aggressive correction of severe hyponatremia. Chronic alcohol use, malnutrition, and electrolyte derangement are additional risk factors promoting the demyelination in ODS. A 49-year-old female with a history of untreated mood disorder, hypertension, alcohol, and tobacco abuse presented to the emergency department (ED) with a three-month history of generalized body weakness. She also had a history of recurrent falls, difficulty walking, inadequate food and water intake, progressively worsening jaundice, and confusion which started about the same time. Her vital signs were normal; some of the significant physical examination findings were: sclera icterus, abdominal distension, bilateral pedal edema, hand tremors, rotary nystagmus, paraparesis, 1+ bilateral knee jerk, and absent bilateral ankle jerk. She had moderate hyponatremia, mild hypokalemia, deranged liver function test with a cholestatic pattern and transaminitis, hypoalbuminemia, elevated ammonia, lipase, in keeping with alcoholic liver disease and acute pancreatitis. In the ED, she received a normal saline infusion, and her serum sodium rose by just 6 mmol/L within the first 24 hours. She had drainage of her ascitic fluid and treatment with thiamine, folic acid, prednisone, lactulose, rifaximin, furosemide, spironolactone, and Ceftriaxone with improvement in clinical and laboratory abnormalities. Her lower extremity weakness persisted despite physical therapy, prompting neurologic evaluation. MRI of the lumbar spine showed an old compression fracture and lumbar spinal stenosis, while MRI brain findings were consistent with Osmotic demyelination. At the time of discharge to a rehabilitation facility, her serum sodium was 132 mmol/L, but her leg weakness persisted. Although rare, ODS can occur in the setting of moderate hyponatremia if there are additional risk factors that lower the threshold for demyelination.
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Affiliation(s)
- Ibiyemi O Oke
- Internal Medicine, Reading Hospital - Tower Health, West Reading, USA
| | - Waneeza Mughees
- Internal Medicine, Drexel University College of Medicine, Philadelphia, USA
| | - Hinal Patel
- Internal Medicine, Drexel University College of Medicine, Philadelphia, USA
| | | | - Eugene York
- Internal Medicine, Reading Hospital - Tower Health, West Reading, USA
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Fitts W, Vogel AC, Mateen FJ. The Changing Face of Osmotic Demyelination Syndrome: A Retrospective, Observational Cohort Study. Neurol Clin Pract 2020; 11:304-310. [PMID: 34484930 DOI: 10.1212/cpj.0000000000000932] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 05/07/2020] [Indexed: 11/15/2022]
Abstract
Objective To describe the long-term outcomes of osmotic demyelination syndrome (ODS) in an updated cohort. Methods We performed a retrospective medical records review of cases of ODS at the Massachusetts General and Brigham and Women's Hospitals using International Classification of Diseases-9th edition codes and a text-based search for central pontine myelinolysis, extrapontine myelinolysis, and osmotic demyelination syndrome (1999-2018). Cases were individually selected based on patients having neuroimaging and symptoms consistent with ODS and no other potentially explanatory etiology. Modified Rankin scale (mRS) scores were extracted at prehospitalization, hospital discharge, 6 months post discharge, and the most recently available clinical visit. Results We identified 45 cases of ODS (mean age 48.4 years, range 0.07-75 years; 58% female patients). Common comorbidities included liver disease (27%, n = 12), alcoholism (44%, n = 20), and kidney failure (20%, n = 9). Twenty-nine percent of patients had a rapid correction of hyponatremia. Twenty-nine percent had other electrolyte abnormalities. Only 59% (24/41) of patients with complete electrolyte data had abnormalities that could explain their ODS. At the 6-month follow-up, 16% of the patients were dead and 60% of patients had minimal-to-no disability (mRS 0-2). Conclusions ODS has a diverse range of clinical presentations. Not all patients have electrolyte abnormalities. The prognosis is generally favorable, although 1 in 6 patients had died at 6 months, likely because of underlying disease states.
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Affiliation(s)
- Whitney Fitts
- Children's Hospital of Philadelphia (WF), PA; Department of Neurology (WF, ACV, FJM), Massachusetts General Hospital, Boston; Harvard Medical School (WF, FJM), Boston, MA
| | - Andre C Vogel
- Children's Hospital of Philadelphia (WF), PA; Department of Neurology (WF, ACV, FJM), Massachusetts General Hospital, Boston; Harvard Medical School (WF, FJM), Boston, MA
| | - Farrah J Mateen
- Children's Hospital of Philadelphia (WF), PA; Department of Neurology (WF, ACV, FJM), Massachusetts General Hospital, Boston; Harvard Medical School (WF, FJM), Boston, MA
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Clergue-Duval V, Questel F, Azuar J, Paquet C, Cognat E, Amami J, Queneau M, Dereux A, Barré T, Bellivier F, Farid K, Vorspan F. Brain 18FDG-PET pattern in patients with alcohol-related cognitive impairment. Eur J Nucl Med Mol Imaging 2019; 47:281-291. [DOI: 10.1007/s00259-019-04487-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 08/14/2019] [Indexed: 10/26/2022]
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Fritz M, Klawonn AM, Zahr NM. Neuroimaging in alcohol use disorder: From mouse to man. J Neurosci Res 2019; 100:1140-1158. [PMID: 31006907 DOI: 10.1002/jnr.24423] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 02/15/2019] [Accepted: 03/14/2019] [Indexed: 02/06/2023]
Abstract
This article provides an overview of recent advances in understanding the effects of alcohol use disorders (AUD) on the brain from the perspective of magnetic resonance imaging (MRI) research in preclinical models and clinical studies. As a noninvasive investigational tool permitting assessment of morphological, metabolic, and hemodynamic changes over time, MRI offers insight into the dynamic course of alcoholism beginning with initial exposure through periods of binge drinking and escalation, sobriety, and relapse and has been useful in differential diagnosis of neurological diseases associated with AUD. Structural MRI has revealed acute and chronic effects of alcohol on both white and gray matter volumes. MR Spectroscopy, able to quantify brain metabolites in vivo, has shed light on biochemical alterations associated with alcoholism. Diffusion tensor imaging permits microstructural characterization of white matter fiber tracts. Functional MRI has allowed for elucidation of hemodynamic responses at rest and during task engagement. Positron emission tomography, a non-MRI imaging tool, has led to a deeper understanding of alcohol-induced receptor and neurotransmitter changes during various stages of drinking and abstinence. Together, such in vivo imaging tools have expanded our understanding of the dynamic course of alcoholism including evidence for regional specificity of the effects of AUD, hints at mechanisms underlying the shift from casual to compulsive use of alcohol, and profound recovery with sustained abstinence.
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Affiliation(s)
- Michael Fritz
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Anna M Klawonn
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Natalie M Zahr
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California.,Neuroscience Program, SRI International, Menlo Park, California
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Abstract
Alcohol use disorder (AUD) has been a major cause of family, social, and personal strife for centuries, with current prevalence estimates of 14% for 12-month and 29% lifetime AUD. Neuropsychological testing of selective cognitive, sensory, and motor functions complemented with in vivo brain imaging has enabled tracking the consequences of AUD, which follows a dynamic course of development, maintenance, and recovery or relapse. Controlled studies of alcoholism reviewed herein provide evidence for disruption of selective functions involving executive, visuospatial, mnemonic, emotional, and attentional processes, response inhibition, prosody, and postural stability and brain systems supporting these functions. On a hopeful front, longitudinal study provides convincing evidence for improvement in brain structure and function following sustained sobriety. These discoveries have a strong legacy in the International Neuropsychological Society (INS), starting from its early days when assumptions regarding which brain regions were disrupted relied solely on patterns of functional sparing and impairment deduced from testing. This review is based on the symposium presentation delivered at the 2017 annual North American meeting of the INS in celebration of the 50th anniversary since its institution in 1967. In the spirit of the meeting's theme, "Binding the Past and Present," the lecture and this review recognized the past by focusing on early, rigorous neuropsychological studies of alcoholism and their influence on research currently conducted using imaging methods enabling hypothesis testing of brain substrates of observed functional deficits. (JINS, 2017, 23, 843-859).
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Kollmer J, Sahm F, Hegenbart U, Purrucker JC, Kimmich C, Schönland SO, Hund E, Heiland S, Hayes JM, Kristen AV, Röcken C, Pham M, Bendszus M, Weiler M. Sural nerve injury in familial amyloid polyneuropathy: MR neurography vs clinicopathologic tools. Neurology 2017; 89:475-484. [PMID: 28679600 DOI: 10.1212/wnl.0000000000004178] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 05/04/2017] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To detect and quantify lesions of the small-caliber sural nerve (SN) in symptomatic and asymptomatic transthyretin familial amyloid polyneuropathy (TTR-FAP) by high-resolution magnetic resonance neurography (MRN) in correlation with electrophysiologic and histopathologic findings. METHODS Twenty-five patients with TTR-FAP, 10 asymptomatic carriers of the mutated transthyretin gene (mutTTR), and 35 age- and sex-matched healthy controls were prospectively included in this cross-sectional case-control study. All participants underwent 3T MRN with high-structural resolution (fat-saturated, T2-weighted, and double-echo sequences). Total imaging time was ≈45 minutes per patient. Manual SN segmentation was performed from its origin at the sciatic nerve bifurcation to the lower leg with subsequent evaluation of quantitative microstructural and morphometric parameters. Additional time needed for postprocessing was ≈1.5 hours per participant. Detailed neurologic and electrophysiologic examinations were conducted in the TTR group. RESULTS T2 signal and proton spin density (ρ) reliably differentiated between TTR-FAP (198.0 ± 13.3, 429.6 ± 15.25), mutTTR carriers (137.0 ± 16.9, p = 0.0009; 354.7 ± 21.64, p = 0.0029), and healthy controls (90.0 ± 3.4, 258.2 ± 9.10; p < 0.0001). Marked differences between mutTTR carriers and controls were found for T2 signal (p = 0.0065) and ρ (p < 0.0001). T2 relaxation time was higher in patients with TTR-FAP only (p = 0.015 vs mutTTR carriers, p = 0.0432 vs controls). SN caliber was higher in patients with TTR-FAP vs controls and in mutTTR carriers vs controls (p < 0.0001). Amyloid deposits were histopathologically detectable in 10 of 14 SN specimens. CONCLUSIONS SN injury in TTR-FAP is detectable and quantifiable in vivo by MRN even in asymptomatic mutTTR carriers. Differences in SN T2 signal between controls and asymptomatic mutTTR carriers are derived mainly from an increase of ρ, which overcomes typical limitations of established diagnostic methods as a highly sensitive imaging biomarker for early detection of peripheral nerve lesions. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that MRN accurately identifies asymptomatic mutTTR carriers.
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Affiliation(s)
- Jennifer Kollmer
- From the Department of Neuroradiology (J.K., S.H., M.P., M.B.), Amyloidosis Center Heidelberg (J.K., U.H., J.C.P., C.K., S.O.S., E.H., A.V.K., M.W.), Department of Neuropathology (F.S.), Medical Department V (U.H., C.K., S.O.S.), Department of Neurology (J.C.P., E.H., M.W.), Division of Experimental Radiology (S.H.), Department of Neuroradiology, and Medical Department III (A.V.K.), Heidelberg University Hospital; CCU Neuropathology (F.S.), German Consortium for Translational Cancer Research, German Cancer Research Center, Heidelberg, Germany; Department of Neurology (J.M.H.), University of Michigan, Ann Arbor; Department of Pathology (C.R.), University of Kiel; and Department of Neuroradiology (M.P.), Würzburg University Hospital, Germany.
| | - Felix Sahm
- From the Department of Neuroradiology (J.K., S.H., M.P., M.B.), Amyloidosis Center Heidelberg (J.K., U.H., J.C.P., C.K., S.O.S., E.H., A.V.K., M.W.), Department of Neuropathology (F.S.), Medical Department V (U.H., C.K., S.O.S.), Department of Neurology (J.C.P., E.H., M.W.), Division of Experimental Radiology (S.H.), Department of Neuroradiology, and Medical Department III (A.V.K.), Heidelberg University Hospital; CCU Neuropathology (F.S.), German Consortium for Translational Cancer Research, German Cancer Research Center, Heidelberg, Germany; Department of Neurology (J.M.H.), University of Michigan, Ann Arbor; Department of Pathology (C.R.), University of Kiel; and Department of Neuroradiology (M.P.), Würzburg University Hospital, Germany
| | - Ute Hegenbart
- From the Department of Neuroradiology (J.K., S.H., M.P., M.B.), Amyloidosis Center Heidelberg (J.K., U.H., J.C.P., C.K., S.O.S., E.H., A.V.K., M.W.), Department of Neuropathology (F.S.), Medical Department V (U.H., C.K., S.O.S.), Department of Neurology (J.C.P., E.H., M.W.), Division of Experimental Radiology (S.H.), Department of Neuroradiology, and Medical Department III (A.V.K.), Heidelberg University Hospital; CCU Neuropathology (F.S.), German Consortium for Translational Cancer Research, German Cancer Research Center, Heidelberg, Germany; Department of Neurology (J.M.H.), University of Michigan, Ann Arbor; Department of Pathology (C.R.), University of Kiel; and Department of Neuroradiology (M.P.), Würzburg University Hospital, Germany
| | - Jan C Purrucker
- From the Department of Neuroradiology (J.K., S.H., M.P., M.B.), Amyloidosis Center Heidelberg (J.K., U.H., J.C.P., C.K., S.O.S., E.H., A.V.K., M.W.), Department of Neuropathology (F.S.), Medical Department V (U.H., C.K., S.O.S.), Department of Neurology (J.C.P., E.H., M.W.), Division of Experimental Radiology (S.H.), Department of Neuroradiology, and Medical Department III (A.V.K.), Heidelberg University Hospital; CCU Neuropathology (F.S.), German Consortium for Translational Cancer Research, German Cancer Research Center, Heidelberg, Germany; Department of Neurology (J.M.H.), University of Michigan, Ann Arbor; Department of Pathology (C.R.), University of Kiel; and Department of Neuroradiology (M.P.), Würzburg University Hospital, Germany
| | - Christoph Kimmich
- From the Department of Neuroradiology (J.K., S.H., M.P., M.B.), Amyloidosis Center Heidelberg (J.K., U.H., J.C.P., C.K., S.O.S., E.H., A.V.K., M.W.), Department of Neuropathology (F.S.), Medical Department V (U.H., C.K., S.O.S.), Department of Neurology (J.C.P., E.H., M.W.), Division of Experimental Radiology (S.H.), Department of Neuroradiology, and Medical Department III (A.V.K.), Heidelberg University Hospital; CCU Neuropathology (F.S.), German Consortium for Translational Cancer Research, German Cancer Research Center, Heidelberg, Germany; Department of Neurology (J.M.H.), University of Michigan, Ann Arbor; Department of Pathology (C.R.), University of Kiel; and Department of Neuroradiology (M.P.), Würzburg University Hospital, Germany
| | - Stefan O Schönland
- From the Department of Neuroradiology (J.K., S.H., M.P., M.B.), Amyloidosis Center Heidelberg (J.K., U.H., J.C.P., C.K., S.O.S., E.H., A.V.K., M.W.), Department of Neuropathology (F.S.), Medical Department V (U.H., C.K., S.O.S.), Department of Neurology (J.C.P., E.H., M.W.), Division of Experimental Radiology (S.H.), Department of Neuroradiology, and Medical Department III (A.V.K.), Heidelberg University Hospital; CCU Neuropathology (F.S.), German Consortium for Translational Cancer Research, German Cancer Research Center, Heidelberg, Germany; Department of Neurology (J.M.H.), University of Michigan, Ann Arbor; Department of Pathology (C.R.), University of Kiel; and Department of Neuroradiology (M.P.), Würzburg University Hospital, Germany
| | - Ernst Hund
- From the Department of Neuroradiology (J.K., S.H., M.P., M.B.), Amyloidosis Center Heidelberg (J.K., U.H., J.C.P., C.K., S.O.S., E.H., A.V.K., M.W.), Department of Neuropathology (F.S.), Medical Department V (U.H., C.K., S.O.S.), Department of Neurology (J.C.P., E.H., M.W.), Division of Experimental Radiology (S.H.), Department of Neuroradiology, and Medical Department III (A.V.K.), Heidelberg University Hospital; CCU Neuropathology (F.S.), German Consortium for Translational Cancer Research, German Cancer Research Center, Heidelberg, Germany; Department of Neurology (J.M.H.), University of Michigan, Ann Arbor; Department of Pathology (C.R.), University of Kiel; and Department of Neuroradiology (M.P.), Würzburg University Hospital, Germany
| | - Sabine Heiland
- From the Department of Neuroradiology (J.K., S.H., M.P., M.B.), Amyloidosis Center Heidelberg (J.K., U.H., J.C.P., C.K., S.O.S., E.H., A.V.K., M.W.), Department of Neuropathology (F.S.), Medical Department V (U.H., C.K., S.O.S.), Department of Neurology (J.C.P., E.H., M.W.), Division of Experimental Radiology (S.H.), Department of Neuroradiology, and Medical Department III (A.V.K.), Heidelberg University Hospital; CCU Neuropathology (F.S.), German Consortium for Translational Cancer Research, German Cancer Research Center, Heidelberg, Germany; Department of Neurology (J.M.H.), University of Michigan, Ann Arbor; Department of Pathology (C.R.), University of Kiel; and Department of Neuroradiology (M.P.), Würzburg University Hospital, Germany
| | - John M Hayes
- From the Department of Neuroradiology (J.K., S.H., M.P., M.B.), Amyloidosis Center Heidelberg (J.K., U.H., J.C.P., C.K., S.O.S., E.H., A.V.K., M.W.), Department of Neuropathology (F.S.), Medical Department V (U.H., C.K., S.O.S.), Department of Neurology (J.C.P., E.H., M.W.), Division of Experimental Radiology (S.H.), Department of Neuroradiology, and Medical Department III (A.V.K.), Heidelberg University Hospital; CCU Neuropathology (F.S.), German Consortium for Translational Cancer Research, German Cancer Research Center, Heidelberg, Germany; Department of Neurology (J.M.H.), University of Michigan, Ann Arbor; Department of Pathology (C.R.), University of Kiel; and Department of Neuroradiology (M.P.), Würzburg University Hospital, Germany
| | - Arnt V Kristen
- From the Department of Neuroradiology (J.K., S.H., M.P., M.B.), Amyloidosis Center Heidelberg (J.K., U.H., J.C.P., C.K., S.O.S., E.H., A.V.K., M.W.), Department of Neuropathology (F.S.), Medical Department V (U.H., C.K., S.O.S.), Department of Neurology (J.C.P., E.H., M.W.), Division of Experimental Radiology (S.H.), Department of Neuroradiology, and Medical Department III (A.V.K.), Heidelberg University Hospital; CCU Neuropathology (F.S.), German Consortium for Translational Cancer Research, German Cancer Research Center, Heidelberg, Germany; Department of Neurology (J.M.H.), University of Michigan, Ann Arbor; Department of Pathology (C.R.), University of Kiel; and Department of Neuroradiology (M.P.), Würzburg University Hospital, Germany
| | - Christoph Röcken
- From the Department of Neuroradiology (J.K., S.H., M.P., M.B.), Amyloidosis Center Heidelberg (J.K., U.H., J.C.P., C.K., S.O.S., E.H., A.V.K., M.W.), Department of Neuropathology (F.S.), Medical Department V (U.H., C.K., S.O.S.), Department of Neurology (J.C.P., E.H., M.W.), Division of Experimental Radiology (S.H.), Department of Neuroradiology, and Medical Department III (A.V.K.), Heidelberg University Hospital; CCU Neuropathology (F.S.), German Consortium for Translational Cancer Research, German Cancer Research Center, Heidelberg, Germany; Department of Neurology (J.M.H.), University of Michigan, Ann Arbor; Department of Pathology (C.R.), University of Kiel; and Department of Neuroradiology (M.P.), Würzburg University Hospital, Germany
| | - Mirko Pham
- From the Department of Neuroradiology (J.K., S.H., M.P., M.B.), Amyloidosis Center Heidelberg (J.K., U.H., J.C.P., C.K., S.O.S., E.H., A.V.K., M.W.), Department of Neuropathology (F.S.), Medical Department V (U.H., C.K., S.O.S.), Department of Neurology (J.C.P., E.H., M.W.), Division of Experimental Radiology (S.H.), Department of Neuroradiology, and Medical Department III (A.V.K.), Heidelberg University Hospital; CCU Neuropathology (F.S.), German Consortium for Translational Cancer Research, German Cancer Research Center, Heidelberg, Germany; Department of Neurology (J.M.H.), University of Michigan, Ann Arbor; Department of Pathology (C.R.), University of Kiel; and Department of Neuroradiology (M.P.), Würzburg University Hospital, Germany
| | - Martin Bendszus
- From the Department of Neuroradiology (J.K., S.H., M.P., M.B.), Amyloidosis Center Heidelberg (J.K., U.H., J.C.P., C.K., S.O.S., E.H., A.V.K., M.W.), Department of Neuropathology (F.S.), Medical Department V (U.H., C.K., S.O.S.), Department of Neurology (J.C.P., E.H., M.W.), Division of Experimental Radiology (S.H.), Department of Neuroradiology, and Medical Department III (A.V.K.), Heidelberg University Hospital; CCU Neuropathology (F.S.), German Consortium for Translational Cancer Research, German Cancer Research Center, Heidelberg, Germany; Department of Neurology (J.M.H.), University of Michigan, Ann Arbor; Department of Pathology (C.R.), University of Kiel; and Department of Neuroradiology (M.P.), Würzburg University Hospital, Germany
| | - Markus Weiler
- From the Department of Neuroradiology (J.K., S.H., M.P., M.B.), Amyloidosis Center Heidelberg (J.K., U.H., J.C.P., C.K., S.O.S., E.H., A.V.K., M.W.), Department of Neuropathology (F.S.), Medical Department V (U.H., C.K., S.O.S.), Department of Neurology (J.C.P., E.H., M.W.), Division of Experimental Radiology (S.H.), Department of Neuroradiology, and Medical Department III (A.V.K.), Heidelberg University Hospital; CCU Neuropathology (F.S.), German Consortium for Translational Cancer Research, German Cancer Research Center, Heidelberg, Germany; Department of Neurology (J.M.H.), University of Michigan, Ann Arbor; Department of Pathology (C.R.), University of Kiel; and Department of Neuroradiology (M.P.), Würzburg University Hospital, Germany.
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T2 relaxation time alterations underlying neurocognitive deficits in alcohol-use disorders (AUD) in an Indian population: A combined conventional ROI and voxel-based relaxometry analysis. Alcohol 2015; 49:639-46. [PMID: 26537482 DOI: 10.1016/j.alcohol.2015.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Revised: 07/11/2015] [Accepted: 07/12/2015] [Indexed: 01/26/2023]
Abstract
Long-term heavy alcohol consumption has traditionally been associated with impaired cognitive abilities, such as deficits in abstract reasoning, problem solving, verbal fluency, memory, attention, and visuospatial processing. The present study aimed at exploring these neuropsychological deficits in alcohol-use disorders (AUD) in an Indian population using the Postgraduate Institute Battery of Brain Dysfunction (PGIBBD) and their possible correlation with alterations in T2 relaxation times (T2-RT), using whole-brain voxel-based relaxometry (VBR) and conventional region of interest (ROI) approach. Multi-echo T2 mapping sequence was performed on 25 subjects with AUD and 25 healthy controls matched for age, education, and socioeconomic status. Whole-brain T2-RT measurements were conducted using VBR and conventional ROI approach. The study was carried out on a 3T whole-body MR scanner. Post processing for VBR and ROI analysis was performed using SPM 8 software and vendor-provided software, respectively. A PGIBBD test battery was conducted on all subjects to assess their cognitive abilities, and the results were reported as raw scores. VBR and ROI results revealed that AUD subjects showed prolonged T2-RTs in cerebellum bilaterally, parahippocampal gyrus bilaterally, right anterior cingulate cortex, left superior temporal gyrus, left middle frontal gyrus, and left calcarine gyrus. A significant correlation was also observed between the neuropsychological test raw scores and alterations in T2-RT in AUD subjects. Our results are consistent with previous studies suggesting tissue disruption or gliosis or demyelination as a possible reason for prolonged T2-RTs. This damage to brain tissue, which is evident as prolonged T2-RT, could possibly be associated with impaired cognitive abilities noticeable in AUD subjects.
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11
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Straube A, Klein M, Erbguth F, Maschke M, Klawe C, Sander D, Hilz MJ, Ziemssen T, Klucken J, Kohl Z, Winkler J, Bettendorf M, Staykov D, Berrouschot J, Dörfler A. Metabolische Störungen. NEUROINTENSIV 2015. [PMCID: PMC7175475 DOI: 10.1007/978-3-662-46500-4_36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Im folgenden Kapitel werden die verschiedenen metabolischen Störungen betrachtet. Zunächst wird auf die allgemeinen und spezifischen neurologischen Komplikationen bei Organtransplantation eingegangen. Dann geht es um die metabolischen Enzephalopathien: Störungen der Gehirntätigkeit bei angeborenen und erworbenen Stoffwechselerkrankungen im engeren Sinn, Elektrolytstörungen, Hypovitaminosen, zerebrale Folgen einzelner Organdysfunktionen, zerebrale Hypoxien, Endotheliopathien und Mitochondropathien. Anschließend werden das Alkoholdelir und die Wernicke-Enzephalopathie erörtert. Bei zahlreichen akuten Erkrankungen von Gehirn, Rückenmark und peripherem Nervensystem treten typische Störungen vegetativer Systeme auf, deren Erkennung und Therapie insbesondere bei Intensivpatienten eine vitale Bedeutung haben kann: die autonomen Störungen. Bei der zentralen pontinen Myelinolyse kommt es zu einer akuten, vorwiegend fokal-symmetrischen Demyelinisierung im Hirnparenchym. Auch Basalganglienerkrankungen können intensivmedizinisch relevant werden. Und schließlich wird die akute Stressreaktion betrachtet, die aufgrund der vielfältigen metabolischen und endokrinen Veränderungen bei kritischen Erkrankungen entsteht. Gerade das RCVS als neuere Krankheitsentität und wichtige Differenzialdiagnose zur Vaskulitis des ZNS verdient einen eigenen Platz, in diesem Unterkapitel werden ebenfalls verwandte Syndrome wie die hypertensive Enzephalopathie und das PRES abgehandelt.
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12
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Preti A, Muscio C, Boccardi M, Lorenzi M, de Girolamo G, Frisoni G. Impact of alcohol consumption in healthy adults: a magnetic resonance imaging investigation. Psychiatry Res 2014; 224:96-103. [PMID: 25172407 DOI: 10.1016/j.pscychresns.2014.06.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 02/17/2014] [Accepted: 06/22/2014] [Indexed: 02/05/2023]
Abstract
The impact of alcohol on brain morphology was studied in a large group of cognitively intact people whose consumption of alcohol was below the threshold for abuse. Participants were 367 healthy subjects, aged 18 years or older, who underwent magnetic resonance imaging (MRI) for reasons other than cognitive impairment. MRI analyses were carried out using SPM8 software on the MATLAB 7.9 platform. Gray matter (GM) and white matter (WM) volumes were normalized for intracranial volume. Participants were interviewed about their lifetime consumption of alcohol, nicotine and other available illicit substances. Direct WM and GM comparisons between alcohol users and non-users did not detect significant differences. Differences also did not emerge from multiple regression analyses or in the subgroup aged 65 or older. Based on this study's findings, we cannot infer a detrimental effect of alcohol on the brain of normal adults. These data may be considered to provide reference information for clinical studies.
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Affiliation(s)
- Antonio Preti
- Genneruxi Medical Center, Cagliari, Italy; IRCCS Centro San Giovanni di Dio-Fatebenefratelli, via Pilastroni 4, 20125 Brescia, Italy
| | - Cristina Muscio
- IRCCS Centro San Giovanni di Dio-Fatebenefratelli, via Pilastroni 4, 20125 Brescia, Italy
| | - Marina Boccardi
- IRCCS Centro San Giovanni di Dio-Fatebenefratelli, via Pilastroni 4, 20125 Brescia, Italy
| | - Marco Lorenzi
- IRCCS Centro San Giovanni di Dio-Fatebenefratelli, via Pilastroni 4, 20125 Brescia, Italy
| | - Giovanni de Girolamo
- IRCCS Centro San Giovanni di Dio-Fatebenefratelli, via Pilastroni 4, 20125 Brescia, Italy
| | - Giovanni Frisoni
- IRCCS Centro San Giovanni di Dio-Fatebenefratelli, via Pilastroni 4, 20125 Brescia, Italy.
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13
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Singh TD, Fugate JE, Rabinstein AA. Central pontine and extrapontine myelinolysis: a systematic review. Eur J Neurol 2014; 21:1443-50. [PMID: 25220878 DOI: 10.1111/ene.12571] [Citation(s) in RCA: 153] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 08/01/2014] [Indexed: 11/28/2022]
Abstract
The purpose was to perform a systematic review of studies on central pontine and extrapontine myelinolysis [forms of osmotic demyelination syndrome (ODS)] and define the spectrum of causes, risk factors, clinical and radiological presentations, and functional outcomes of this disorder. A thorough search of the literature was conducted using multiple databases (PubMed, Ovid Medline and Google) and bibliographies of key articles to identify all case series of adult patients with ODS published from 1959 to January 2013. Only series with five or more cases published in English were considered. Of the 2602 articles identified, 38 case series were included comprising a total of 541 patients who fulfilled our inclusion criteria. The most common predisposing factor was hyponatremia (78%) and the most common presentation was encephalopathy (39%). Favorable recovery occurred in 51.9% of patients and death in 24.8%. Liver transplant patients with ODS had a combined rate of death and disability of 77.4%, compared with 44.7% in those without liver transplantation (P < 0.001). ODS is found to have a good recovery in more than half of cases and its mortality has decreased with each passing decade. Favorable prognosis is possible in patients of ODS, even with severe neurological presentation. Further research is required to confirm the differences found in liver transplant recipients.
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Affiliation(s)
- T D Singh
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
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Delavar Kasmaei H, Baratloo A, Soleymani M, Nasiri Z. Imaging-based diagnosis of wernicke encephalopathy: a case report. Trauma Mon 2014; 19:e17403. [PMID: 25717447 PMCID: PMC4310158 DOI: 10.5812/traumamon.17403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Revised: 01/30/2014] [Accepted: 02/10/2014] [Indexed: 12/31/2022] Open
Abstract
Introduction: Wernicke encephalopathy (WE) is a medical emergency characterized by ataxia, confusion, nystagmus and ophthalmoplegia resulting from thiamin deficiency. Alcoholism is the common cause for this disease. Case Presentation: A 41 year old man was brought to our emergency department (ED) complaining of confusion. One week earlier he had started to experience severe nausea and vomiting followed by diplopia, dysarthria and also dysphagia. One day later he had experienced gait disturbance and progressive ataxia accompanied with confusion, apathy and disorientation. He had no history of alcoholism, drug abuse or previous surgery but had history of untreated Crohn disease. Just before arrival to our emergency department, he had been hospitalized in another center for about a week but all investigations had failed to provide a conclusive diagnosis. Upon admission to our ED, he was dysarthric and replied with inappropriate answers. On physical examination, bilateral horizontal nystagmus in lateral gaze, left abducens nerve palsy and upward gaze palsy were seen. Gag reflex was absent and plantar reflexes were upwards bilaterally. After reviewing all the previously performed management measures, MRI was performed and was consistent with the diagnosis of WE. Treatment with thiamine led to partial resolution of his upward gaze palsy and nystagmus on the first day. At the end of the third day of treatment, except for gate ataxia, all other symptoms completely resolved and he was fully conscious. After the fifth day his gait became normal and after one week he was discharged in good general condition. Discussion: After reviewing the current literature, it seems that brain MRI can be helpful in the diagnosis of WE in patients with the classic clinical trial in the absence of clear risk factors.
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Affiliation(s)
- Hosein Delavar Kasmaei
- Department of Neurology, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Alireza Baratloo
- Department of Emergency Medicine, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Maryam Soleymani
- Department of Neurology, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Maryam Soleymani, Department of Neurology, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran. Tel.: +98-9117042319, Fax: +98-2122721155, E-mail:
| | - Zahra Nasiri
- Department of Neurology, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
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Fiber tracking functionally distinct components of the internal capsule. Neuropsychologia 2010; 48:4155-63. [PMID: 20974161 DOI: 10.1016/j.neuropsychologia.2010.10.023] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Revised: 10/11/2010] [Accepted: 10/15/2010] [Indexed: 11/23/2022]
Abstract
The internal capsule conveys information from primary and supplementary motor areas, frontopontine and thalamic peduncles to brain stem and cerebellar regions, and from thalamus to prefrontal cortex. Neurological accidents involving the internal capsule indicate differential functional correlates with its sectors. To examine the microstructural condition of this fiber system and to test functional correlates of its sectors in health and aging, 12 younger and 12 older adults were examined with diffusion tensor imaging (DTI) fiber tracking and neuropsychological tests. Greater age-related degradation was evident in the anterior than posterior limb and in the superior than inferior division of the internal capsule. The superior division age effect was especially notable in axial and radial diffusivity. Fractional anisotropy (FA) across the three (anterior, genu, posterior) fiber bundles of the inferior division accounted for 27-73% of the variance for each neuropsychological domain. Identification of a triple dissociation indicated selective correlations between anterior FA and set shifting, genu FA and motor skills, and posterior FA and fluency. Quantitative fiber tracking combined with assessment of cognitive and motor functions enabled the identification of selective brain structure-function relations in healthy adults without lesions that were previously observed only in patients with lesions of the internal capsule.
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Zahr NM, Pitel AL, Chanraud S, Sullivan EV. Contributions of studies on alcohol use disorders to understanding cerebellar function. Neuropsychol Rev 2010; 20:280-9. [PMID: 20809198 DOI: 10.1007/s11065-010-9141-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Accepted: 08/18/2010] [Indexed: 12/27/2022]
Abstract
Neuropathological, neuropsychological, and neuroimaging studies of human alcoholism provide evidence for degradation of frontal, pontine, thalamic, and cerebellar brain sites and disturbed associated functions. Current studies using neuroimaging combined with examination of executive functions, traditionally considered the sole purview of the frontal lobes, have identified a role for the cerebellum serving as a compensatory processing adjunct to enable normal performance on challenging tasks tapping executive functions. This overview proposes that disruption of an executive frontocerebellar network is a major contributor to characteristic behaviors of alcoholism that, on the one hand, enable alcohol use disorders, and on the other hand, lead to compensation for dysfunctions in alcoholism traditionally considered frontally-based.
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Affiliation(s)
- Natalie M Zahr
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305, USA
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Abstract
INTRODUCTION ADHD has a high comorbidity with substance use disorders (SUD). Both diseases have profound social, psychological, and economic consequences and are therefore highly relevant for health systems. The high comorbidity indicates some shared underlying neurobiological substrates. Knowing these substrates may increase the understanding of the disease and help identify therapeutic processes. METHOD Neuroimaging studies of ADHD were reviewed and similarities with SUD identified. For this a PubMed research was conducted with the search terms ADHD, SUD, MRI or positron emission tomography (PET) or spectroscopy or imaging. RESULTS Similarities were found, in both PET and fMRI studies, between patients with ADHD and those with addiction-related craving. Results from structural MRI and MR spectroscopy do not support a common pathophysiological background, probably because of the lack of studies on craving. DISCUSSION ADHD and SUD-related craving share some neurobiological similarities. One reason may be that patients with addiction show more craving when they also suffer from ADHD. The present review thus supports the conclusion from an earlier meta-analysis of clinical studies which found that adequate treatment of ADHD reduces craving and relapse into substance use.
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Affiliation(s)
- Thomas Frodl
- Department of Psychiatry, School of Medicine, Trinity College Dublin, Dublin 2, Ireland.
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Sullivan EV, Rohlfing T, Pfefferbaum A. Pontocerebellar volume deficits and ataxia in alcoholic men and women: no evidence for "telescoping". Psychopharmacology (Berl) 2010; 208:279-90. [PMID: 19943036 PMCID: PMC2819225 DOI: 10.1007/s00213-009-1729-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2009] [Accepted: 11/08/2009] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Brain volume shrinkage is common in treatment-seeking patients with alcohol use disorders. Whether women are more vulnerable to brain dysmorphology than men despite lower alcohol consumption levels or shorter dependency ("telescoping effect") remains controversial and has not been considered with respect to infratentorial structures or their potential contribution to ataxia. METHODS The 200 participants included 64 men and 31 women with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition alcohol dependence and 105 controls. An infratentorial region (pons, cerebellar hemispheres, vermis (anterior, posterior, and inferior sectors), fissures, cisterns, fourth ventricle) was quantified with atlas-based parcellation. To enable comparison of men and women, regional tissue volumes were expressed as ratios of tissue in the volume. Participants also completed quantitative ataxia testing. RESULTS Total infratentorial and vermian tissue ratios were significantly smaller in alcoholics than controls; alcoholic women did not show disproportionately greater volume deficits than alcoholic men. A re-analysis including alcoholic men and women matched in alcohol consumption, onset age, abstinence duration, and age revealed again that alcoholic women did not have disproportionately greater regional vermian volume deficits than alcoholic men. Alcoholic men and women were impaired in all measures of ataxia, which correlated with low infratentorial tissue ratios in men. DISCUSSION Alcoholic men showed deficits of pontocerebellar volume ratios, yet alcoholic women did not display signs of "telescoping". Further, alcoholic men and women both showed signs of ataxia of gait and balance, related to affected pontocerebellar systems in the men but not the women, suggesting the need to consider other neural substrates for ataxia in women.
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Affiliation(s)
- Edith V. Sullivan
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, 401 Quarry Road, Stanford, CA 94305-5723, USA, . Neuroscience Program, School of Medicine, Stanford University, Stanford, CA, USA
| | | | - Adolf Pfefferbaum
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, 401 Quarry Road, Stanford, CA 94305-5723, USA. Neuroscience Program, SRI International, Menlo Park, CA, USA
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19
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Abstract
There is no specialized alcohol addiction area in the brain; rather, alcohol acts on a wide range of excitatory and inhibitory nervous networks to modulate neurotransmitters actions by binding with and altering the function of specific proteins. With no hemato-encephalic barrier for alcohol, its actions are strongly related to the amount of intake. Heavy alcohol intake is associated with both structural and functional changes in the central nervous system with long-term neuronal adaptive changes contributing to the phenomena of tolerance and withdrawal. The effects of alcohol on the function of neuronal networks are heterogeneous. Because ethanol affects neural activity in some brain sites but is without effect in others, its actions are analyzed in terms of integrated connectivities in the functional circuitry of neuronal networks, which are of particular interest because of the cognitive interactions discussed in the manuscripts contributing to this review. Recent molecular data are reviewed as a support for the other contributions dealing with cognitive disturbances related to alcohol acute and addicted consumption.
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Affiliation(s)
- Claude Tomberg
- Brain Research Unit, Faculty of Medicine and CENOLI, Free University of Brussels, Belgium
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Morphological and glucose metabolism abnormalities in alcoholic Korsakoff's syndrome: group comparisons and individual analyses. PLoS One 2009; 4:e7748. [PMID: 19936229 PMCID: PMC2777409 DOI: 10.1371/journal.pone.0007748] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2009] [Accepted: 10/09/2009] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Gray matter volume studies have been limited to few brain regions of interest, and white matter and glucose metabolism have received limited research attention in Korsakoff's syndrome (KS). Because of the lack of brain biomarkers, KS was found to be underdiagnosed in postmortem studies. METHODOLOGY/PRINCIPAL FINDINGS Nine consecutively selected patients with KS and 22 matched controls underwent both structural magnetic resonance imaging and (18)F-fluorodeoxyglucose positron emission tomography examinations. Using a whole-brain analysis, the between-group comparisons of gray matter and white matter density and relative glucose uptake between patients with KS and controls showed the involvement of both the frontocerebellar and the Papez circuits, including morphological abnormalities in their nodes and connection tracts and probably resulting hypometabolism. The direct comparison of the regional distribution and degree of gray matter hypodensity and hypometabolism within the KS group indicated very consistent gray matter distribution of both abnormalities, with a single area of significant difference in the middle cingulate cortex showing greater hypometabolism than hypodensity. Finally, the analysis of the variability in the individual patterns of brain abnormalities within our sample of KS patients revealed that the middle cingulate cortex was the only brain region showing significant GM hypodensity and hypometabolism in each of our 9 KS patients. CONCLUSIONS/SIGNIFICANCE These results indicate widespread brain abnormalities in KS including both gray and white matter damage mainly involving two brain networks, namely, the fronto-cerebellar circuit and the Papez circuit. Furthermore, our findings suggest that the middle cingulate cortex may play a key role in the pathophysiology of KS and could be considered as a potential in vivo brain biomarker.
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Pfefferbaum A, Rosenbloom M, Rohlfing T, Sullivan EV. Degradation of association and projection white matter systems in alcoholism detected with quantitative fiber tracking. Biol Psychiatry 2009; 65:680-90. [PMID: 19103436 PMCID: PMC2663629 DOI: 10.1016/j.biopsych.2008.10.039] [Citation(s) in RCA: 172] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2008] [Revised: 10/27/2008] [Accepted: 10/28/2008] [Indexed: 11/19/2022]
Abstract
BACKGROUND Excessive alcohol use can cause macrostructural tissue shrinkage with regional preference for frontal systems. The extent and locus of alcoholism's effect on white matter microstructure is less known. METHODS Quantitative fiber tracking derived from diffusion tensor imaging (DTI) assessed the integrity of samples of 11 major white matter bundles in 87 alcoholics (59 men, 28 women) and 88 healthy control subjects (42 men, 46 women). Fiber integrity was expressed as fractional anisotropy (FA) and apparent diffusion coefficient (ADC), quantified separately for longitudinal diffusivity (lambdaL), a putative index of axonal integrity, and transverse diffusivity (lambdaT), a putative index of myelin integrity. RESULTS Alcoholism affected FA and diffusivity, particularly lambdaT, of several fiber bundles. Frontal and superior sites (frontal forceps, internal and external capsules, fornix, and superior cingulate and longitudinal fasciculi) showed greatest abnormalities in alcoholics relative to control subjects. More posterior and inferior bundles were relatively spared. Lifetime alcohol consumption correlated with regional DTI measures in alcoholic men but not women. When matched for alcohol exposure, alcoholic women showed more DTI signs of white matter degradation than alcoholic men in several fiber bundles. Among all alcoholics, poorer performance on speeded tests correlated with DTI signs of regional white matter degradation. CONCLUSIONS This survey of multiple brain fiber systems revealed a differential pattern of alcoholism's effect on regional FA and diffusivity with functional consequences attributable in part to compromised fiber microstructure with prominence in signs of myelin degradation. Sex-based differences suggest that women are at enhanced risk for alcoholism-related degradation in selective white matter systems.
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Affiliation(s)
- Adolf Pfefferbaum
- Neuroscience Program, SRI International, Menlo Park, California, USA
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Diffusion tensor tractography in mesencephalic bundles: relation to mental flexibility in detoxified alcohol-dependent subjects. Neuropsychopharmacology 2009; 34:1223-32. [PMID: 18615012 DOI: 10.1038/npp.2008.101] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Components of the corticocerebellar circuit and the midbrain individually play a central role in addictive processes and have been associated with altered volumes and impairment of cognitive flexibility in alcohol-dependent subjects. The microstructure of white matter bundles composing the corticocerebellar network and passing through the midbrain was studied using diffusion tensor imaging in a group of detoxified alcohol-dependent men (n=20) and a group of healthy men (n=24). The relationship between properties of these white matter bundles and cognitive flexibility performance was investigated in alcohol-dependent subjects. Bundles connecting two regions of interest were analyzed using a fiber-tracking quantitative approach, which provided estimates of the fractional anisotropy and the apparent diffusion coefficient, as well as the number of tracked fibers normalized by the volume of regions of interest. Within the bundles running between the midbrain and pons, a mean of 18% fewer fibers per unit volume were tracked in alcohol-dependent men than in healthy controls. In addition, the normalized number of these fibers correlated with the performance in the Trail-Making Test part-B. Even though the alcohol-dependent subjects were detoxified and apparently neurologically intact, their earlier excessive use of alcohol seems to be associated with altered neural microstructure of mesencephalic white matter bundles, which may contribute to their cognitive flexibility impairment.
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Abstract
AIM Presented is the neuroradiological signature of acute Wernicke's encephalopathy (WE), derived from different types of magnetic resonance imaging (MRI) sequences. WE results from thiamine depletion, and its most typical antecedent is chronic alcohol dependence. Brain regions observed with in vivo MRI affected in acute WE include the mammillary bodies, periaqueductal and periventricular gray matter, collicular bodies and thalamus. These affected areas are usually edematous and are best visualized and quantified with MRI sequences that highlight such tissue. Following the acute WE phase and resolution of edema and inflammation of affected brain tissue, WE, if not adequately treated with thiamine repletion, can herald Korsakoff's syndrome (KS), with its symptomatic hallmark of global amnesia, that is, the inability to commit newly encountered (episodic) information to memory for later recall or recognition. METHODS Neuropathology of KS detectable with MRI has a different neuroradiological signature from the acute stage and can be observed as tissue shrinkage or atrophy of selective brain structures, including the mammillary bodies and thalamus and ventricular expansion, probably indicative of atrophy of surrounding gray matter nuclei. Quantification of these and additional gray matter structures known to underlie global amnesia reveal substantial bilateral volume deficits in the hippocampus, in addition to the mammillary bodies and thalamus, and modest deficits in the medial septum/diagonal band of Broca. The infratentorium is also affected, exhibiting volume deficits in cerebellar hemispheres, anterior superior vermis and pons, contributing to ataxia of gait and stance. RESULTS Consideration of WKS structural brain changes in the context of the neuropathology of non-WKS alcoholism revealed a graded pattern of volume deficits, from mild in non-WKS alcoholics to moderate or severe in WKS, in the mammillary bodies, hippocampus, thalamus, cerebellum and pons. The development and resolution of brain structures affected in acute, chronic and treated WE was verified in longitudinal MRI study of rats that modeled of the interaction of extensive alcohol consumption and thiamine depletion and repletion. CONCLUSIONS Thus, neuroradiological examination with MRI is valuable in the diagnosis of acute WE and enables in vivo tracking of the progression of the brain pathology of WE from the acute pathological phase to resolution with thiamine treatment or to progression to KS without treatment. Further, in vivo MRI facilitates translational studies to model antecedent conditions contributing to the development, sequelae and treatment of WE.
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Affiliation(s)
- Edith V Sullivan
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA.
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Glahn DC, Thompson PM, Blangero J. Neuroimaging endophenotypes: strategies for finding genes influencing brain structure and function. Hum Brain Mapp 2007; 28:488-501. [PMID: 17440953 PMCID: PMC6871286 DOI: 10.1002/hbm.20401] [Citation(s) in RCA: 205] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2007] [Revised: 03/01/2007] [Accepted: 03/05/2007] [Indexed: 11/09/2022] Open
Abstract
It is vitally important to identify the genetic determinants of complex brain-related disorders such as autism, dementia, mood disorders, and schizophrenia. However, the search for genes predisposing individuals to these illnesses has been hampered by their genetic and phenotypic complexity and by reliance upon phenomenologically based qualitative diagnostic systems. Neuroimaging endophenotypes are quantitative indicators of brain structure or function that index genetic liability for an illness. These indices will significantly improve gene discovery and help us to understand the functional consequences of specific genes at the level of systems neuroscience. Here, we review the feasibility of using neuroanatomic and neuropsychological measures as endophenotypes for brain-related disorders. Specifically, we examine specific indices of brain structure or function that are genetically influenced and associated with neurological and psychiatric illness. In addition, we review genetic approaches that capitalize on the use of quantitative traits, including those derived from brain images.
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Affiliation(s)
- David C Glahn
- Department of Psychiatry and Research Imaging Center, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA.
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25
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Hoque R, Ledbetter C, Gonzalez-Toledo E, Misra V, Menon U, Kenner M, Rabinstein AA, Kelley RE, Zivadinov R, Minagar A. The Role of Quantitative Neuroimaging Indices in the Differentiation of Ischemia From Demyelination: An Analytical Study With Case Presentation. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2007; 79:491-519. [PMID: 17531856 DOI: 10.1016/s0074-7742(07)79022-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND PURPOSE Differentiation of acute and subacute ischemic stroke lesions from acute demyelinating lesions of multiple sclerosis (MS) may not be possible on conventional magnetic resonance imaging (MRI). Both lesion types enhance on T1 with gadolinium (Gd) contrast and both are hyperintense on diffusion-weighted imaging (DWI). This study is an analysis of two quantitative MR indices: (1) calculated apparent diffusion coefficients (ADCs) and (2) T2 relaxation times (T2R) as means toward differentiating acute ischemic lesions from acute demyelinating lesions. Chronic ischemic and demyelinating lesions were evaluated for comparison as well. METHODS The MRI of nine patients with both acute and chronic ischemic lesions and six patients with both acute and chronic demyelinating lesions were analyzed for ADC and T2Rs. The indices were measured by manually placing regions of interest (ROIs) at the anatomic center of the acute lesion. Acute ischemic lesions were chosen by their hyperintensity on DWI and hypointensity on ADC mapping. Acute demyelinating lesions were selected by peripheral contrast enhancement after the administration of Gd. Computation of the ADC involved the diffusion coefficient on a region by region basis as follows: D = -(b(0)/b(1000))ln(S(b1000)/S(b0)), where S(b1000) is the signal intensity on DWI and S(b0) is the signal intensity on T2 with diffusion sensitivities of b(0) and b(1000), respectively. Computation of the T2R was made as follows: T2R = (TE(T2)--TE(PD))/(ln SI(PD)--ln SI(T2)), where TE is the echo time of the different pulse sequences, SI is signal intensity on the different echo sequences, and PD represents proton density sequence. RESULTS Twenty-nine acute ischemia, 27 acute demyelination, 28 chronic ischemia, and 43 chronic demyelination image sets were analyzed. The differences between ADC(acute infarct) (0.760) versus ADC(acute plaque) (1.106) were significant (p < 0.02). The differences between T2R(acute infarct) (235.5) versus T2R(acute plaque) (170.5) were also significant (p < 0.02). CONCLUSIONS ADC in combination with T2R is a useful tool to differentiate acute ischemic from acute demyelinating lesions. The use of these neuroimaging indices along with magnetic resonance spectroscopy metabolite ratios is then demonstrated in elucidating the pathophysiological mechanism for a case of delayed posttraumatic bilateral internuclear ophthalmoplegia.
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Affiliation(s)
- Romy Hoque
- Department of Neurology, Louisiana State University Health Sciences Center, Shreveport, Louisiana 71103, USA
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26
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Abstract
A 43-year-old lady presented with bilateral foot drop due to alcohol-related peripheral neuropathy. There was no history of electrolyte disturbance or altered consciousness. Cranial nerve, bulbar and pyramidal symptoms and signs were absent. Nerve conduction studies confirmed the neuropathy. Inadvertently requested neuroimaging of brain demonstrated signal change typical of central pontine myelinolysis. Asymptomatic pontine myelinolysis occurs rarely in alcoholics in the absence of bulbar dysfunction. It is important for physicians to be aware of the clinical entity of asymptomatic pontine myelinolysis to avoid misinterpretation of abnormalities detected on cerebral imaging in alcoholic individuals.
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Affiliation(s)
- S S M Razvi
- Department of Neurology, Institute of Neurological Sciences, Southern General Hospital, Glasgow, UK.
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Abstract
Over the past 20 years it has become increasingly apparent that hyponatremic encephalopathy is a major cause of inhospital morbidity and mortality, particularly in postoperative patients. The factors that may lead to death or permanent brain damage and the susceptible patient groups have been gradually elucidated. Hyponatremic encephalopathy most commonly leads to brain damage in young women and in prepubescent children. The causes of brain damage include brain edema, cerebral hypoxemia, decreased brain blood flow, increased intracranial pressure, and improper therapy. Cerebral hypoxia occurs through a combination of impaired brain adaptation and cerebral vasoconstriction. Brain adaptation consists largely of brain cell loss of sodium and potassium by means of the Na-K adenosine triphosphatase (ATPase) system. There is also loss of organic osmolytes. The brain Na-K ATPase system is impaired by a combination of vasopressin plus estrogen and is stimulated by testosterone. Similarly, vasopressin plus estrogen leads to cerebral vasoconstriction, resulting in a decrement of brain oxygen utilization and cerebral blood flow. Vasopressin also directly decreases brain production of ATP. The combination leads to hypoxic brain damage, which appears to be the major cause of brain damage associated with hyponatremic encephalopathy. Measurement of arterial PO2 in patients with symptomatic hyponatremia usually demonstrates a PO2 <50 mm Hg. Improper therapy is another possible cause of brain damage in patients with hyponatremic encephalopathy. The type and distribution of such lesions are similar to those found in patients with hyponatremic encephalopathy who have severe hypoxia. Current scientific knowledge indicates that patient survival can be improved through aggressive treatment of hypoxia associated with hyponatremic encephalopathy, particularly in young women.
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Affiliation(s)
- Allen I Arieff
- Department of Medicine, School of Medicine, University of California, San Francisco, San Francisco, California 94965, USA.
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Pfefferbaum A, Adalsteinsson E, Sullivan EV. Dysmorphology and microstructural degradation of the corpus callosum: Interaction of age and alcoholism. Neurobiol Aging 2006; 27:994-1009. [PMID: 15964101 DOI: 10.1016/j.neurobiolaging.2005.05.007] [Citation(s) in RCA: 146] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2005] [Revised: 04/29/2005] [Accepted: 05/04/2005] [Indexed: 11/17/2022]
Abstract
Chronic alcohol abuse is a ubiquitous health and societal problem, with a growing prevalence in the older population. Alcoholism is a source of substantial deterioration in brain tissue and has been consistently observed in vivo and postmortem in white matter. To quantify the potential compounded effect of age and alcoholism, we used conventional structural MRI and diffusion tensor imaging (DTI) to examine the macrostructural and microstructural integrity of the corpus callosum, one of the most prominent white matter structures of the brain, in 131 adults, age 27-75 years. Compared with the 74 controls, the 40 alcoholic men and 17 alcoholic women, who were abstinent from alcohol for an average of 3 months, showed similar patterns and extents of callosal shrinkage, which was greatest in the genu and body and less prominent in the splenium. Microstructural integrity was measured with DTI as fractional anisotropy, an index of intravoxel orientational coherence of white matter fibers, and bulk mean diffusivity, an index of the amount of intravoxel water motility. The macrostructural shrinkage was accompanied by abnormalities in anisotropy and diffusivity of the microstructural environment of these callosal regions, indicative of disruption of structural constituents of local brain white matter. Correlational analyses revealed an age-alcohol interaction, where older alcoholics had smaller genu and splenium and higher diffusivity in these regions than younger alcoholics. Significant correlations between regional MRI and DTI measures and performance on working memory, visuospatial ability, and gait and balance provided evidence for the functional ramifications of the callosal abnormalities in the alcoholics. Thus, despite abstinence from alcohol, the interaction of age and recent alcoholism history exerted a compounded untoward effect on callosal macrostructure and microstructure.
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Affiliation(s)
- Adolf Pfefferbaum
- Neuroscience Program, SRI International, 333 Ravenswood Avenue, Menlo Park, CA 94025, USA.
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Pfefferbaum A, Adalsteinsson E, Sullivan EV. Supratentorial profile of white matter microstructural integrity in recovering alcoholic men and women. Biol Psychiatry 2006; 59:364-72. [PMID: 16125148 DOI: 10.1016/j.biopsych.2005.06.025] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2005] [Revised: 05/26/2005] [Accepted: 06/20/2005] [Indexed: 11/29/2022]
Abstract
BACKGROUND Postmortem and in vivo studies consistently report degeneration of brain white matter in alcohol-dependent men and women. The full extent of the white matter involvement in uncomplicated alcoholism, however, is unknown, yet knowledge of the distribution of white matter degradation might provide clues to mechanisms underlying the pathology. METHODS To examine whether the white matter involvement is widespread or, alternatively, is regionally restricted in uncomplicated alcoholism, we used in vivo magnetic resonance diffusion tensor imaging (DTI) to quantify the microstructure of brain tissue. Accordingly, we acquired DTI data in 57 alcoholics (40 men, 17 women) who had been sober, on average, for 3 months and 74 demographically-matched control subjects (32 men, 42 women). Alcoholic men had consumed about twice as much alcohol in their lifetimes as the alcoholic women. Supratentorial white matter fractional anisotropy (FA), a DTI measure of intravoxel orientational coherence of tissue, was calculated across the full anterior-posterior extent of the brain in coronal sections, and a slice profile of the mean white matter FA was created for each subject. Group differences between alcoholics and control subjects were tested for each slice in three regions: the left and right hemispheres and a midsagittal sample; men and women were tested separately. RESULTS Alcoholic men and women each showed widespread FA deficits in all three regions relative to their gender-matched control subjects that were evident on a slice-by-slice basis. Furthermore, the number of slices showing FA deficits was significantly greater in the alcoholic men than women. CONCLUSIONS The widespread distribution of white matter deficits is in contrast to the highly regional-specific deficits seen in nutritional deficiency syndromes that can accompany alcoholism.
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Sullivan EV, Pfefferbaum A. Neurocircuitry in alcoholism: a substrate of disruption and repair. Psychopharmacology (Berl) 2005; 180:583-94. [PMID: 15834536 DOI: 10.1007/s00213-005-2267-6] [Citation(s) in RCA: 322] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2005] [Accepted: 03/10/2005] [Indexed: 10/25/2022]
Abstract
The chronic, excessive consumption of alcohol results in significant modification of selective neural systems of the brain structure, physiology, and function. Quantitative MR structural imaging, diffusion tensor imaging (DTI), and functional MRI (fMRI), together with neuropsychological challenges, have enabled rigorous in vivo characterization of the results of alcoholism on the brain in the human condition. Neuroimaging has also enabled longitudinal study for the examination of alcoholism's dynamic course through periods of drinking and sobriety. Controlled studies have revealed compelling evidence for alcohol-related brain structural and functional modification--some longstanding, some transient, and some compensatory. Patterns of circuitry disruption identified through structural and functional MRI studies suggest a central role for degradation of frontocerebellar neuronal nodes and connecting circuitry affecting widespread brain regions and contributing to alcoholism's salient, enduring, and debilitating cognitive and motor deficits--executive dysfunction, visuospatial impairment, and ataxia.
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Affiliation(s)
- Edith V Sullivan
- Department of Psychiatry and Behavioral Sciences and Neuroscience Program, Stanford University School of Medicine, Stanford, CA 94305-5723, USA.
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31
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Seneviratne J. An ataxic man who loved his beer. J Clin Neurosci 2005; 12:444, 452. [PMID: 15925778 DOI: 10.1016/j.jocn.2005.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2004] [Accepted: 01/15/2005] [Indexed: 10/25/2022]
Affiliation(s)
- J Seneviratne
- Department of Neurology, The Royal Melbourne Hospital, Vic., Australia
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Bloomer CW, Langleben DD, Meyerhoff DJ. Magnetic resonance detects brainstem changes in chronic, active heavy drinkers. Psychiatry Res 2004; 132:209-18. [PMID: 15664792 DOI: 10.1016/j.pscychresns.2004.06.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2003] [Revised: 06/03/2004] [Accepted: 06/05/2004] [Indexed: 11/30/2022]
Abstract
Neuropathological and neuroimaging studies show cortical and subcortical volume loss in alcohol-dependent individuals. Using quantitative magnetic resonance imaging (MRI) and proton magnetic resonance spectroscopic imaging ((1)H MRSI), we studied the size and potential cellular injury of the brainstem in untreated heavy alcohol drinkers. The brainstem is considered critical in the development and maintenance of drug and alcohol dependence. Two methods of brainstem size determination were compared: standard volumetry vs. midsagittal MR image area measurement. Heavy drinkers (n=12) and light drinkers (n=10) were compared with MRI; (1)H MRSI brainstem data were obtained from a subset of this cohort. Chronic heavy drinking was associated with significantly smaller midsagittal areas of the brainstem, midbrain, and pons, and with significantly smaller overall brainstem volume. Heavy drinking was also associated with significantly lower ratios of N-acetyl-aspartate and choline-containing metabolites compared with creatine-containing compounds in the brainstem, independent of brainstem atrophy. Additionally, brainstem volume and midsagittal brainstem area were correlated (r=0.78). These structural and metabolite findings are consistent with neuronal injury in the brainstem of untreated chronic heavy drinkers. The results also indicate that the midsagittal MRI brainstem area is an easily determined and reliable indicator of brainstem volume.
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Affiliation(s)
- Courtnay W Bloomer
- University of Pennsylvania-Presbyterian Medical Center, Philadelphia, PA 19104, USA
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Fama R, Pfefferbaum A, Sullivan EV. Perceptual Learning in Detoxified Alcoholic Men: Contributions From Explicit Memory, Executive Function, and Age. Alcohol Clin Exp Res 2004; 28:1657-65. [PMID: 15547452 DOI: 10.1097/01.alc.0000145690.48510.da] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Visuospatial and visuoperceptual deficits have consistently been observed in detoxified alcoholics; however, the severity of impairment varies with test and task type. Identifying the component processes and factors that underlie a particular deficit may reveal why some visuospatial and visuoperceptual tasks are more compromised than others and may lead to the specification of neural systems that are particularly vulnerable in alcoholism. METHODS We examined visuoperception and perceptual learning with a picture fragment identification task in 51 recently detoxified nonamnesic alcoholic men (aged 29-66 years) compared with 63 normal control men (aged 21-70 years). Executive function and explicit declarative memory were also assessed. RESULTS Despite deficits in the primary components of visuoperception and explicit memory for visuospatial stimuli, the alcoholics showed normal perceptual learning. Although the alcoholics and controls performed at comparable levels on the perceptual learning task, multiple regression analyses indicated that the factors accounting for perceptual learning variance differed between and within groups. Visuoperceptual abilities consistently predicted perceptual learning in the control subjects but not the alcoholic subjects. Explicit memory contributed to perceptual learning performance in both the alcoholic and control groups. Frontal executive ability consistently predicted perceptual learning in the alcoholic subjects, but it had predictive ability only in the control subjects as time elapsed. Age was significantly correlated with perceptual learning performance in both groups. Lifetime alcohol consumption, but not alcoholism duration, was an independent predictor of 1-hr perceptual learning. CONCLUSIONS These correlational analyses suggest that controls invoke basic visuospatial processes to perform a perceptual learning task, whereas alcoholics invoke higher-order cognitive processes (i.e., frontal executive systems) to perform the same task at normal levels. Use of more demanding cognitive systems by the alcoholics may be less efficient and more costly to processing capacity than those invoked by controls.
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Affiliation(s)
- Rosemary Fama
- Neuroscience Program, SRI International, Menlo Park, California, USA
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Sullivan EV. Compromised pontocerebellar and cerebellothalamocortical systems: speculations on their contributions to cognitive and motor impairment in nonamnesic alcoholism. Alcohol Clin Exp Res 2004; 27:1409-19. [PMID: 14506401 DOI: 10.1097/01.alc.0000085586.91726.46] [Citation(s) in RCA: 156] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Corticopontocerebellar and cerebellothalamocortical circuits underlie a wide range of neuropsychological processes compromised by alcoholism. The analyses herein tested whether abnormalities of volumes of brain structures forming nodes of these separate feed-forward and feedback systems are selectively related to each other and whether any of these noncortical regions can account for cognitive and motor deficits occurring as sequelae of chronic alcoholism. METHODS Regional brain measures originated from our prior neuroimaging studies, showing in alcoholics significant volume deficits in the principal structures of interest: cerebellar hemispheres, vermis, pons, and thalamus as well as prefrontal, frontal, and parietal cortex. Neuropsychological functions targeted for analysis-problem solving, visuospatial ability, and static postural stability-showed 0.6 to 1.6 SD deficits in these alcoholic men. RESULTS In alcoholics, the patterns of correlations were consistent with dissociation of thalamic and pontine circuitry. Pontine and thalamic volumes were not correlated with each other. Pontine volumes correlated with white matter volumes of anterior superior vermis and gray and white matter volumes of the cerebellar hemispheres but not with cortical regional volumes. Thalamic volumes correlated with gray matter volumes of the cerebellar hemispheres, parietal cortex, and inferior posterior vermian lobule, which itself correlated with parietal, prefrontal, and frontal cortical volumes. Controls did not show these correlational patterns. Brain structure-function relationships in alcoholics examined with multiple regression identified anterior vermian but not prefrontal or parietal volume as a unique predictor of balance scores; vermian and thalamic but not prefrontal cortical volumes as predictors of card sorting scores; and cerebellar hemispheric white matter but not parietal cortical volume as a predictor of visuospatial ability. CONCLUSIONS Each major node of frontocerebellar circuitry shows volume deficits in alcoholics but can be independently compromised. Disruption of these circuits may underlie alcoholism-related neuropsychological deficits, either by abnormalities present in individual nodes or by disconnection via interruption of selective circuitry.
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Affiliation(s)
- Edith V Sullivan
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, California 94305-5723, USA.
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Harper C, Garrick T, Matsumoto I, Pfefferbaum A, Adalsteinsson E, Sullivan E, Dodd P, Lewohl J, Butterworth R. How important are brain banks for alcohol research? Alcohol Clin Exp Res 2003; 27:310-23. [PMID: 12605081 DOI: 10.1097/01.alc.0000052585.81056.ca] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This article contains the proceedings of a symposium at the 2002 RSA/ISBRA Meeting in San Francisco, organized and chaired by Clive Harper and co-chaired by Izuru Matsumoto. The presentations were (1) Introduction, by Clive Harper; (2) The quality of tissue-a critical issue, by Therese Garrick; (3) The first systematic brain tissue donor program in Japan, by Izuru Matsumoto; (4) Brain scans after death-really! by Adolf Pfefferbaum, Elfar Adalsteinsson, and Edith Sullivan; (5) Capture that (genial) expression, by Joanne Lewohl and Peter Dodd; and (6) Neurochemical/pharmacological studies: experimental design and limitations, by Roger Butterworth.
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Affiliation(s)
- Clive Harper
- University of Sydney and Royal Prince Alfred Hospital, New South Wales, Australia.
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Pfefferbaum A, Rosenbloom M, Serventi KL, Sullivan EV. Corpus Callosum, Pons, and Cortical White Matter in Alcoholic Women. Alcohol Clin Exp Res 2002. [DOI: 10.1111/j.1530-0277.2002.tb02552.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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