1
|
Mallick D, Acharjee A, Acharjee P, Trigun SK. Restoration of hippocampal adult neurogenesis by CDRI-08 (Bacopa monnieri extract) relates with the recovery of BDNF-TrkB levels in male rats with moderate grade hepatic encephalopathy. Int J Dev Neurosci 2024. [PMID: 38795011 DOI: 10.1002/jdn.10350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 05/01/2024] [Accepted: 05/14/2024] [Indexed: 05/27/2024] Open
Abstract
Modulation of in vivo adult neurogenesis (AN) is an evolving concept in managing neurodegenerative diseases. CDRI-08, a bacoside-enriched fraction of Bacopa monnieri, has been demonstrated for its neuroprotective actions, but its effect on AN remains unexplored. This article describes the status of AN by monitoring neuronal stem cells (NSCs) proliferation, differentiation/maturation markers and BDNF-TrkB levels (NSCs signalling players) vs. the level of neurodegeneration and their modulations by CDRI-08 in the hippocampal dentate gyrus (DG) of male rats with moderate grade hepatic encephalopathy (MoHE). For NSC proliferation, 10 mg/kg b.w. 5-bromo-2'-deoxyuridine (BrdU) was administered i.p. during the last 3 days, and for the NSC differentiation study, it was given during the first 3 days to the control, the MoHE (developed by 100 mg/kg b.w. of thioacetamide i.p. up to 10 days) and to the MoHE male rats co-treated with 350 mg/kg b.w. CDRI-08. Compared with the control rats, the hippocampus DG region of MoHE rats showed significant decreases in the number of Nestin+/BrdU+ and SOX2+/BrdU+ (proliferating) and DCX+/BrdU+ and NeuN+/BrdU+ (differentiating) NSCs. This was consistent with a similar decline in BDNF+/TrkB+ NSCs. However, all these NSC marker positive cells were observed to be recovered to their control levels, with a concordant restoration of total cell numbers in the DG of the CDRI-08-treated MoHE rats. The findings suggest that the restoration of hippocampal AN by CDRI-08 is consistent with the recovery of BDNF-TrkB-expressing NSCs in the MoHE rat model of neurodegeneration.
Collapse
Affiliation(s)
- Debasmit Mallick
- Biochemistry Section, Department of Zoology, Institute of Science, Banaras Hindu University, Varanasi, India
| | - Arup Acharjee
- Department of Zoology, University of Allahabad, Prayagraj, India
| | - Papia Acharjee
- Biochemistry Section, Department of Zoology, Institute of Science, Banaras Hindu University, Varanasi, India
| | - Surendra Kumar Trigun
- Biochemistry Section, Department of Zoology, Institute of Science, Banaras Hindu University, Varanasi, India
| |
Collapse
|
2
|
Zahr N, Sullivan E, Pfefferbaum A. [WITHDRAWN] Serum biomarkers of liver fibrosis identify changes in striatal metabolite levels. RESEARCH SQUARE 2024:rs.3.rs-2729490. [PMID: 37034697 PMCID: PMC10081358 DOI: 10.21203/rs.3.rs-2729490/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
The full text of this preprint has been withdrawn by the authors due to author disagreement with the posting of the preprint. Therefore, the authors do not wish this work to be cited as a reference. Questions should be directed to the corresponding author.
Collapse
|
3
|
Lim CG, Hahm MH, Lee HJ. Hepatic encephalopathy on magnetic resonance imaging and its uncertain differential diagnoses: a narrative review. JOURNAL OF YEUNGNAM MEDICAL SCIENCE 2023; 40:136-145. [PMID: 36624654 PMCID: PMC10076915 DOI: 10.12701/jyms.2022.00689] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/11/2022] [Indexed: 04/12/2023]
Abstract
Hepatic encephalopathy (HE) is a severe neuropsychiatric abnormality in patients with either acute or chronic liver failure. Typical brain magnetic resonance imaging findings of HE are bilateral basal ganglia high signal intensities due to manganese deposition in chronic liver disease and hyperintensity in T2, fluid-attenuated inversion recovery, or diffusion-weighted imaging (DWI) with hemispheric white matter changes including the corticospinal tract. Low values on apparent diffusion coefficient mapping of the affected area on DWI, indicating cytotoxic edema, can be observed in acute HE. However, neuropsychological impairment in HE ranges from mild deficits in psychomotor abilities affecting quality of life to stupor or coma with higher grades of hepatic dysfunction. In particular, the long-lasting compensatory mechanisms for the altered metabolism in chronic liver disease make HE imaging results variable. Therefore, the clinical relevance of imaging findings is uncertain and differentiating HE from other metabolic diseases can be difficult. The recent introduction of concepts such as "acute-on-chronic liver failure (ACLF)," a new clinical entity, has led to a change in the clinical view of HE. Accordingly, there is a need to establish a corresponding concept in the field of neuroimaging diagnosis. Herein, we review HE from a historical and etiological perspective to increase understanding of brain imaging and help establish an imaging approach for advanced new concepts such as ACLF. The purpose of this manuscript is to provide an understanding of HE by reviewing neuroimaging findings based on pathological and clinical concepts of HE, thereby assisting in neuroimaging interpretation.
Collapse
Affiliation(s)
- Chun Geun Lim
- Department of Radiology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Myong Hun Hahm
- Department of Radiology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Hui Joong Lee
- Department of Radiology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
- Corresponding author: Hui Joong Lee, MD, PhD Department of Radiology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, 130 Dongduk-ro, Jung-gu, Daegu 41944, Korea Tel.: +82-53-420-5397 • Fax: +82-53-422-2677 • E-mail:
| |
Collapse
|
4
|
Acharya C, Bajaj JS. Hepatic Encephalopathy and Liver Transplantation: The Past, Present, and Future Toward Equitable Access. Liver Transpl 2021; 27:1830-1843. [PMID: 34018659 DOI: 10.1002/lt.26099] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 04/22/2021] [Accepted: 05/10/2021] [Indexed: 02/06/2023]
Abstract
Cirrhosis is a debilitating chronic disease with high morbidity and mortality, with the only real cure being liver transplantation (LT). Currently, we allocate organs for transplantation based on the Model for End-Stage Liver Disease-Sodium (MELD-Na) score that does not account for hepatic encephalopathy (HE). HE affects patients, families, and the health care system because of high rates of recurrence and major readmission burden. Moreover, HE casts a long shadow even after LT. Accounting for HE and incorporating it into the current allocation system has many proponents, but the framework to do this is currently lacking because of differences in consensus or in operationalization parameters. We review the latest evidence of the burden of HE, management of HE before and after LT, and evaluate pros and cons of several methods of diagnosing HE objectively to ensure early and equitable access to LT in this underserved population.
Collapse
Affiliation(s)
- Chathur Acharya
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and Central Virginia Veterans Healthcare System, Richmond, VA
| | - Jasmohan S Bajaj
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and Central Virginia Veterans Healthcare System, Richmond, VA
| |
Collapse
|
5
|
Cheon SY, Song J. The Association between Hepatic Encephalopathy and Diabetic Encephalopathy: The Brain-Liver Axis. Int J Mol Sci 2021; 22:ijms22010463. [PMID: 33466498 PMCID: PMC7796499 DOI: 10.3390/ijms22010463] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/02/2021] [Accepted: 01/03/2021] [Indexed: 12/13/2022] Open
Abstract
Hepatic encephalopathy (HE) is one of the main consequences of liver disease and is observed in severe liver failure and cirrhosis. Recent studies have provided significant evidence that HE shows several neurological symptoms including depressive mood, cognitive dysfunction, impaired circadian rhythm, and attention deficits as well as motor disturbance. Liver disease is also a risk factor for the development of diabetes mellitus. Diabetic encephalopathy (DE) is characterized by cognitive dysfunction and motor impairment. Recent research investigated the relationship between metabolic changes and the pathogenesis of neurological disease, indicating the importance between metabolic organs and the brain. Given that a diverse number of metabolites and changes in the brain contribute to neurologic dysfunction, HE and DE are emerging types of neurologic disease. Here, we review significant evidence of the association between HE and DE, and summarise the common risk factors. This review may provide promising therapeutic information and help to design a future metabolic organ-related study in relation to HE and DE.
Collapse
Affiliation(s)
- So Yeong Cheon
- Department of Biotechnology, College of Biomedical & Health Science, Konkuk University, Chungju 27478, Korea;
| | - Juhyun Song
- Department of Anatomy, Chonnam National University Medical School, Hwasun 58128, Jeollanam-do, Korea
- Correspondence: ; Tel.: +82-61-379-2706; Fax: +82-61-375-5834
| |
Collapse
|
6
|
Karanfilian BV, Cheung M, Dellatore P, Park T, Rustgi VK. Laboratory Abnormalities of Hepatic Encephalopathy. Clin Liver Dis 2020; 24:197-208. [PMID: 32245527 DOI: 10.1016/j.cld.2020.01.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Currently, there is no gold standard serologic or imaging modality to detect hepatic encephalopathy (HE). It is a clinical diagnosis gathered from the history and physical. Imaging is nonspecific; however, PET and MRI have shown areas of utility, but are not widely available, cost-efficient, or necessary for diagnosis. Electroencephalogram has shown promise as it can be used in conjunction with the Portal Systemic Hepatic Encephalopathy Score test to diagnose minimal HE. Further research on these techniques would need to be performed to identify strict criteria and cutoffs for diagnosing HE as well as associated sensitivities and specificities.
Collapse
Affiliation(s)
- Briette Verken Karanfilian
- Department of Internal Medicine, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA; Department of Medicine, 125 Paterson Street, New Brunswick, NJ 08901, USA
| | - Maggie Cheung
- Department of Internal Medicine, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA; Department of Medicine, 125 Paterson Street, New Brunswick, NJ 08901, USA
| | - Peter Dellatore
- Department of Internal Medicine, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA; Department of Medicine, 125 Paterson Street, New Brunswick, NJ 08901, USA
| | - Taeyang Park
- Department of Internal Medicine, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA; Department of Medicine, 125 Paterson Street, New Brunswick, NJ 08901, USA
| | - Vinod K Rustgi
- Department Gastroenterology and Hepatology, Rutgers-Robert Wood Johnson Medical School, 125 Paterson Street, Suite 5100B, New Brunswick, NJ 08901, USA.
| |
Collapse
|
7
|
de Amorim JC, Torricelli AK, Frittoli RB, Lapa AT, Dertkigil SSJ, Reis F, Costallat LT, França Junior MC, Appenzeller S. Mimickers of neuropsychiatric manifestations in systemic lupus erythematosus. Best Pract Res Clin Rheumatol 2019; 32:623-639. [PMID: 31203921 DOI: 10.1016/j.berh.2019.01.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Systemic lupus erythematosus (SLE), presenting with new onset or worsening neuropsychiatric (NP) symptoms, is a challenge in clinical practice. Mimickers such as infections, drug-induced side effects, metabolic abnormalities, malignancies, and alcohol-related disorders have to be excluded, before attributing the manifestations to disease activity. Proper diagnosis is essential to guide adequate management and reduce morbidity and mortality. In this review article, we will highlight clinical, laboratorial, and neuroradiological features that are helpful to assist in the differential diagnosis.
Collapse
Affiliation(s)
- Jaqueline Cristina de Amorim
- Graduate Program of Child and Adolescent Health, School of Medical Science, University of Campinas, Brazil; Laboratory of Autoimmune Diseases, School of Medical Science, University of Campinas, Brazil
| | | | - Renan Bazuco Frittoli
- Laboratory of Autoimmune Diseases, School of Medical Science, University of Campinas, Brazil; Graduate Program of Physiopathology, School of Medical Science, University of Campinas, Brazil
| | - Aline Tamires Lapa
- Graduate Program of Child and Adolescent Health, School of Medical Science, University of Campinas, Brazil; Laboratory of Autoimmune Diseases, School of Medical Science, University of Campinas, Brazil
| | | | - Fabiano Reis
- Department of Radiology, School of Medical Science, University of Campinas, Brazil
| | - Lilian Tl Costallat
- Rheumatology Unit, Department of Medicine, School of Medical Science, University of Campinas, Brazil
| | | | - Simone Appenzeller
- Laboratory of Autoimmune Diseases, School of Medical Science, University of Campinas, Brazil; Rheumatology Unit, Department of Medicine, School of Medical Science, University of Campinas, Brazil.
| |
Collapse
|
8
|
Maksimovskiy AL, Fortier CB, Milberg WP, McGlinchey RE. A structural MRI study of differential neuromorphometric characteristics of binge and heavy drinking. Addict Behav Rep 2019; 9:100168. [PMID: 31193798 PMCID: PMC6542838 DOI: 10.1016/j.abrep.2019.100168] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 01/31/2019] [Accepted: 02/03/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Alcohol misuse often manifests in two different patterns of drinking; Binge Drinking (BD; ≥4 (women) or ≥ 5 (men) drinks/day, ≤12 days/month) or Heavy Drinking (HD; ≥3 (women) or ≥4 (men) drinks/day, ≥16 days/month). Although direct comparisons have not been made, structural MRI studies indicate that the two types of drinking behaviors might be associated with different neuromorphometric characteristics. METHODS This study used a cross-sectional design to compare brain structure (using MRI derived subcortical volume and cortical thickness measures) between participants with histories of BD (N = 16), HD (N = 15), and Healthy Controls (HC; N = 21). Whole-brain analyses were used to quantify group differences in subcortical volume and cortical thickness. Resulting cortical thickness clusters were quantified for their areas of overlap with resting-state network parcellations. RESULTS BD was associated with decreased volumes of the bilateral global pallidus and decreased cortical thickness within the left superior-parietal cluster (p < .05). This cortical cluster overlapped in surface area with the dorsal-attention (50.86%) and the fronto-parietal network parcellations (49.14%). HD was associated with increased cortical thickness in the left medial occipito-parietal cluster (p < .05). This cluster primarily overlapped with the visual network parcellation (89%) and, to a lesser extent, with a widespread number of network parcellations (dorsal-attention: 3.8%; fronto-parietal: 3.5%; default-mode: 3.2%). CONCLUSIONS These data indicate that histories of BD and HD patterns are associated with distinct neuromorphometric characteristics. BD was associated with changes within the executive control networks and the globus pallidus. HD was associated with widespread changes, that are primarily localized within the visual network.
Collapse
Affiliation(s)
- Arkadiy L. Maksimovskiy
- Translational Research Center for TBI and Stress-related Disorders (TRACTS), VA Boston Healthcare System, Boston, MA, United States of America
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
- McLean Imaging Center, McLean Hospital, 115 Mill Street, Belmont, MA, 02478, United States of America
| | - Catherine B. Fortier
- Translational Research Center for TBI and Stress-related Disorders (TRACTS), VA Boston Healthcare System, Boston, MA, United States of America
- Geriatric Research Education and Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA, United States of America
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
| | - William P. Milberg
- Translational Research Center for TBI and Stress-related Disorders (TRACTS), VA Boston Healthcare System, Boston, MA, United States of America
- Geriatric Research Education and Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA, United States of America
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
| | - Regina E. McGlinchey
- Translational Research Center for TBI and Stress-related Disorders (TRACTS), VA Boston Healthcare System, Boston, MA, United States of America
- Geriatric Research Education and Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA, United States of America
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
| |
Collapse
|
9
|
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: 52] [Impact Index Per Article: 10.4] [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.
Collapse
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
| |
Collapse
|
10
|
Zahr NM, Pfefferbaum A. Alcohol's Effects on the Brain: Neuroimaging Results in Humans and Animal Models. Alcohol Res 2017; 38:183-206. [PMID: 28988573 PMCID: PMC5513685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Brain imaging technology has allowed researchers to conduct rigorous studies of the dynamic course of alcoholism through periods of drinking, sobriety, and relapse and to gain insights into the effects of chronic alcoholism on the human brain. Magnetic resonance imaging (MRI) studies have distinguished alcohol-related brain effects that are permanent from those that are reversible with abstinence. In support of postmortem neuropathological studies showing degeneration of white matter, MRI studies have shown a specific vulnerability of white matter to chronic alcohol exposure. Such studies have demonstrated white-matter volume deficits as well as damage to selective gray-matter structures. Diffusion tensor imaging (DTI), by permitting microstructural characterization of white matter, has extended MRI findings in alcoholics. MR spectroscopy (MRS) allows quantification of several metabolites that shed light on brain biochemical alterations caused by alcoholism. This article focuses on MRI, DTI, and MRS findings in neurological disorders that commonly co-occur with alcoholism, including Wernicke's encephalopathy, Korsakoff's syndrome, and hepatic encephalopathy. Also reviewed are neuroimaging findings in animal models of alcoholism and related neurological disorders. This report also suggests that the dynamic course of alcoholism presents a unique opportunity to examine brain structural and functional repair and recovery.
Collapse
Affiliation(s)
- Natalie M Zahr
- Natalie M. Zahr, Ph.D., is a Research Scientist in the Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California; and Program Director of Translational Imaging, Neuroscience Program, SRI International, Menlo Park, California. Adolf Pfefferbaum, M.D., is Professor of Psychiatry and Behavioral Sciences at Stanford University School of Medicine, Stanford, California; and Distinguished Scientist and Center Director of the Neuroscience Program, SRI International, Menlo Park, California
| | - Adolf Pfefferbaum
- Natalie M. Zahr, Ph.D., is a Research Scientist in the Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California; and Program Director of Translational Imaging, Neuroscience Program, SRI International, Menlo Park, California. Adolf Pfefferbaum, M.D., is Professor of Psychiatry and Behavioral Sciences at Stanford University School of Medicine, Stanford, California; and Distinguished Scientist and Center Director of the Neuroscience Program, SRI International, Menlo Park, California
| |
Collapse
|
11
|
Zahr NM, Mayer D, Rohlfing T, Sullivan EV, Pfefferbaum A. Imaging neuroinflammation? A perspective from MR spectroscopy. Brain Pathol 2014; 24:654-64. [PMID: 25345895 PMCID: PMC4493672 DOI: 10.1111/bpa.12197] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 08/06/2014] [Indexed: 12/30/2022] Open
Abstract
Neuroinflammatory mechanisms contribute to the brain pathology resulting from human immunodeficiency virus (HIV) infection. Magnetic resonance spectroscopy (MRS) has been touted as a suitable method for discriminating in vivo markers of neuroinflammation. The present MRS study was conducted in four groups: alcohol dependent (A, n = 37), HIV-infected (H, n = 33), alcohol dependent + HIV infected (HA, n = 38) and healthy control (C, n = 62) individuals to determine whether metabolites would change in a pattern reflecting neuroinflammation. Significant four-group comparisons were evident only for striatal choline-containing compounds (Cho) and myo-inositol (mI), which follow-up analysis demonstrated were due to higher levels in HA compared with C individuals. To explore the potential relevance of elevated Cho and mI, correlations between blood markers, medication status and alcohol consumption were evaluated in H + HA subjects. Having an acquired immune deficiency syndrome (AIDS)-defining event or hepatitis C was associated with higher Cho; lower Cho levels, however, were associated with low thiamine levels and with highly active antiretroviral HIV treatment (HAART). Higher levels of mI were related to greater lifetime alcohol consumed, whereas HAART was associated with lower mI levels. The current results suggest that competing mechanisms can influence in vivo Cho and mI levels, and that elevations in these metabolites cannot necessarily be interpreted as reflecting a single underlying mechanism, including neuroinflammation.
Collapse
Affiliation(s)
- Natalie M. Zahr
- Department of Psychiatry and Behavioral SciencesStanford University School of Medicine (MC5723)StanfordCA
- Neuroscience ProgramSRI InternationalMenlo ParkCA
| | - Dirk Mayer
- Neuroscience ProgramSRI InternationalMenlo ParkCA
- Diagnostic Radiology and Nuclear MedicineUniversity of Maryland School of MedicineBaltimoreMD
| | | | - Edith V. Sullivan
- Department of Psychiatry and Behavioral SciencesStanford University School of Medicine (MC5723)StanfordCA
| | - Adolf Pfefferbaum
- Department of Psychiatry and Behavioral SciencesStanford University School of Medicine (MC5723)StanfordCA
- Neuroscience ProgramSRI InternationalMenlo ParkCA
| |
Collapse
|
12
|
Chavez-Tapia NC, Cesar-Arce A, Barrientos-Gutiérrez T, Villegas-López FA, Méndez-Sanchez N, Uribe M. A systematic review and meta-analysis of the use of oral zinc in the treatment of hepatic encephalopathy. Nutr J 2013; 12:74. [PMID: 23742732 PMCID: PMC3689058 DOI: 10.1186/1475-2891-12-74] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 06/04/2013] [Indexed: 02/07/2023] Open
Abstract
Background and aim Because low serum zinc levels precipitate hepatic encephalopathy, zinc supplementation is considered a potential therapeutic option. The aim of this study was to assess the effects of oral zinc supplementation in the treatment of hepatic encephalopathy. Methods For this systematic review and meta-analysis, data sources included electronic databases (CENTRAL, MEDLINE, EMBASE) and manual searching. Randomized clinical trials of adult patients diagnosed with liver cirrhosis and hepatic encephalopathy were included. The types of interventions considered were any oral zinc supplementation versus no intervention, placebo, or other interventions for the management of hepatic encephalopathy. The data were analyzed by calculating the RR for each trial and expressing the uncertainty as 95% CI. Continuous data were analyzed by calculating the standard mean differences (SMD) between groups within each trial and their 95% CI. Statistical heterogeneity was defined as a P-value > 0.10 (χ2) or I2 > 25%. Results Four trials with a total of 233 patients were included. Oral zinc supplementation was associated with a significant improvement in performance on the number connection test (SMD –0.62; 95% CI –1.12 to –0.11) reported in three trials (n = 189), but not with encephalopathy recurrence reduction (RR 0.64; 95% CI 0.26 to 1.59) reported in two trials (n = 169). Other clinically significant outcomes (mortality, liver related morbidity, quality of life) were not reported. Conclusion Oral zinc supplementation improved performance on the number connection test, but no evidence about other clinical or biochemical outcomes was available.
Collapse
|
13
|
Sarma MK, Huda A, Nagarajan R, Hinkin CH, Wilson N, Gupta RK, Frias-Martinez E, Sayre J, Guze B, Han SH, Thomas MA. Multi-dimensional MR spectroscopy: towards a better understanding of hepatic encephalopathy. Metab Brain Dis 2011; 26:173-84. [PMID: 21698453 PMCID: PMC3181227 DOI: 10.1007/s11011-011-9250-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Accepted: 06/06/2011] [Indexed: 12/14/2022]
Abstract
Hepatic encephalopathy (HE) is normally diagnosed by neuropsychological (NP) tests. The goals of this study were to quantify cerebral metabolites, separate glutamate (Glu) from glutamine (Gln) in patients with minimal hepatic encephalopathy (MHE) as well as healthy subjects using the prior-knowledge fitting (ProFit) algorithm on data acquired by two-dimensional (2D) localized correlated spectroscopy (L-COSY) on two different MR scanners, and to correlate the metabolite changes with neuropsychological (NP) tests. We studied 14 MHE patients and 18 healthy controls using a GE 1.5 T Signa MR scanner. Another group of 16 MHE patients and 18 healthy controls were studied using a Siemens 1.5 T Avanto MR scanner. The following parameters were used for L-COSY: TR/TE = 2 s/30 ms, 3 × 3 × 3 cm(3) voxel size, 96 Δt(1) increments with 8 averages per Δt(1). Using the ProFit algorithm, we were able to differentiate Gln from Glu on the GE 1.5 T data in the medial frontal white/gray matter. The ratios of myo-inositol (mI), Glu, total choline, scyllo-inositol (sI), phosphoethanolamine (PE), and total N-acetyl aspartate (NAA) showed statistically significant decline in HE patients compared to healthy controls, while the ratio of Gln was significantly increased. Similar trend was seen in the ProFit quantified Siemens 1.5 T data in the frontal and occipito-parietal white/gray regions. Among the NP domain scores, motor function, cognitive speed, executive function and the global scores showed significant differences. Excellent correlations between various NP domains and metabolite ratios were also observed. ProFit based cerebral metabolite quantitation enhances the understanding and basis of the current hypothesis of MHE.
Collapse
Affiliation(s)
- Manoj K. Sarma
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Amir Huda
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
- Department of Physics, California State University, Fresno, California, USA
| | - Rajakumar Nagarajan
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Charles H. Hinkin
- Department of Psychiatry, David Geffen School of Medicine, University of California, Los Angeles, California, USA
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Neil Wilson
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Rakesh K. Gupta
- Department of Radiology, Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Lucknow, India
| | - Enrique Frias-Martinez
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - James Sayre
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Barry Guze
- Department of Psychiatry, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Steven-Huy Han
- Department of Hepatology, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - M. Albert Thomas
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
- Department of Psychiatry, David Geffen School of Medicine, University of California, Los Angeles, California, USA
- Correspondence: M. Albert Thomas PhD, Department of Radiological Sciences, David Geffen School of Medicine at UCLA, CHS BL 428, 10833 Le Conte Avenue, Los Angeles, CA 90095-1721, USA, Tel: +1-310-206-4191, Fax: +1-310-825-5837,
| |
Collapse
|
14
|
Cohen RA, Harezlak J, Gongvatana A, Buchthal S, Schifitto G, Clark U, Paul R, Taylor M, Thompson P, Tate D, Alger J, Brown M, Zhong J, Campbell T, Singer E, Daar E, McMahon D, Tso Y, Yiannoutsos CT, Navia B. Cerebral metabolite abnormalities in human immunodeficiency virus are associated with cortical and subcortical volumes. J Neurovirol 2010; 16:435-44. [PMID: 20961212 DOI: 10.3109/13550284.2010.520817] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Cerebral metabolite disturbances occur among human immunodeficiency virus (HIV)-infected people, and are thought to reflect neuropathology, including proinflammatory processes, and neuronal loss. HIV-associated cortical atrophy continues to occur, though its basis is not well understood, and the relationship of cerebral metabolic disturbance to structural brain abnormalities in HIV has not been well delineated. We hypothesized that metabolite disturbances would be associated with reduced cortical and subcortical volumes. Cerebral volumes were measured in 67 HIV-infected people, including 10 people with mild dementia (acquired immunodeficiency syndrome [AIDS] dimentia complex [ADC] stage >1) via automated magnetic resonance imaging (MRI) segmentation. Magnetic resonance spectroscopy (MRS) was used to measure levels of cerebral metabolites N-acetylaspartate (NAA), myo-inositol (MI), choline-containing compounds (Cho), glutamate/glutamine (Glx), and creatine (Cr) from three brain regions (frontal gray matter, frontal white matter, basal ganglia). Analyses were conducted to examine the associations between MRS and cerebral volumetric measures using both absolute and relative metabolite concentrations. NAA in the mid-frontal gray matter was most consistently associated with cortical (global, frontal, and parietal), ventricular, and caudate volumes based on analysis of absolute metabolite levels, whereas temporal lobe volume was associated with basal ganglia NAA and Glx, and Cho concentrations in the frontal cortex and basal ganglia. Hippocampal volume was associated with frontal white matter NAA, whereas thalamic volume was associated with both frontal white matter NAA and basal ganglia Glx. Analyses of relative metabolite concentrations (referenced to Cr) yielded weaker effects, although more metabolites were retained as significant predictors in the models than the analysis of absolute concentrations. These findings demonstrate that reduced cortical and subcortical volumes, which have been previously found to be linked to HIV status and history, are also strongly associated with the degree of cerebral metabolite disturbance observed via MRS. Reduced cortical and hippocampal volumes were most strongly associated with decreased NAA, though reduced Glx also tended to be associated with reduced cortical and subcortical volumes (caudate and thalamus) as well, suggesting both neuronal and glial disturbances. Interestingly, metabolite-volumetric relationships were not limited to the cortical region from which MRS was measured, possibly reflecting shared pathophysiological processes. The relationships between Cho and volumetric measures suggest a complicated relationship possibly related to the effects of inflammatory processes on brain volume. The findings demonstrate the relationship between MRI-derived measures of cerebral metabolite disturbances and structural brain integrity, which has implication in understanding HIV-associated neuropathological mechanisms.
Collapse
Affiliation(s)
- Ronald A Cohen
- Department of Neuropsychology, The Miriam Hospital, Alpert School of Medicine, Brown University School of Medicine, Providence, Rhode Island 02903, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
McPhail MJW, Taylor-Robinson SD. The role of magnetic resonance imaging and spectroscopy in hepatic encephalopathy. Metab Brain Dis 2010; 25:65-72. [PMID: 20221679 DOI: 10.1007/s11011-010-9171-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Accepted: 01/28/2010] [Indexed: 01/22/2023]
Abstract
Hepatic encephalopathy (HE) is a diverse manifestation of acute and chronic liver failure, ranging from cognitive impairment, only detectable on psychometric evaluation through to confusion, coma and death from cerebral oedema. While there is widespread acceptance of its importance, there is little consensus on how best to diagnose and monitor HE. Clinical descriptions, psychometric testing, electroencephalography and magnetic resonance (MR) imaging (and lately, MR spectroscopy) have all been proposed. MR techniques, in contrast to other modalities, have the benefit of objectivity and of being able to interrogate the brain directly with respect to changes in brain size, function and the metabolic disturbances thought to underlie HE, particularly in the context of astrocyte swelling. Modern clinical MRI scanners with multinuclear MR spectroscopy capabilities and brain mapping software can demonstrate structural and functional cellular changes using volumetric MRI, magnetization transfer MRI, diffusion-weighting MRI, functional MRI with oxygenation measurements and in vivo and in vitro (1)H and (31)P MR spectroscopy. This review describes the relative merits of these techniques and provides guidance on the directions for future research and translation into clinical practice.
Collapse
Affiliation(s)
- Mark J W McPhail
- Liver and Anti-Viral Centre, Department of Hepatology, Division of Medicine, Imperial College London, 10th Floor QEQM Building, St Mary's Hospital Campus, South Wharf Road, London, W2 1NY, United Kingdom
| | | |
Collapse
|
16
|
Singhal A, Nagarajan R, Kumar R, Huda A, Gupta RK, Thomas MA. Magnetic resonance T2-relaxometry and 2D L-correlated spectroscopy in patients with minimal hepatic encephalopathy. J Magn Reson Imaging 2010; 30:1034-41. [PMID: 19856435 DOI: 10.1002/jmri.21943] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To evaluate T(2)-relaxation changes in patients with minimal hepatic encephalopathy (MHE) using T(2) relaxometry and to correlate T(2) values with brain metabolites evaluated using 2D magnetic resonance spectroscopy (MRS). MATERIALS AND METHODS Eight MHE patients and 13 healthy subjects were evaluated using T(2) relaxometry, and eight patients and nine healthy subjects underwent 2D MRS in right frontal and left occipital regions. Whole-brain T(2)-relaxation maps were compared between MHE and control subjects using analysis-of-covariance, with age and gender included as covariates. T(2) values derived from the right frontal and left occipital lobes were correlated with the metabolite ratios. RESULTS Multiple brain regions including anterior and mid cingulate cortices, right anterior and left posterior insular cortices, right prefrontal, medial frontal, and right superior temporal cortices showed significantly increased T(2) values in MHE patients compared to control subjects. MRS showed significantly increased ratios of glutamine/glutamate (Glx) and decreased ratios of myo-inositol, taurine, choline, and myo-inositol/choline (mICh) with respect to creatine (Cr_d) in patients compared to controls. Frontal Glx/Cr_d showed significantly positive correlation with T(2) values. CONCLUSION MHE patients showed significantly increased T(2) values in multiple brain regions reflecting increased free water content and T(2) values in frontal lobe correlated with the increased Glx/Cr_d ratio.
Collapse
Affiliation(s)
- Aparna Singhal
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California 90095-1721, USA
| | | | | | | | | | | |
Collapse
|
17
|
Foerster BR, Conklin LS, Petrou M, Barker PB, Schwarz KB. Minimal hepatic encephalopathy in children: evaluation with proton MR spectroscopy. AJNR Am J Neuroradiol 2009; 30:1610-3. [PMID: 19509075 DOI: 10.3174/ajnr.a1652] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Minimal hepatic encephalopathy (MHE) in children is difficult to evaluate because of lack of standardized neuropsychological tests for all age ranges. The purpose of this retrospective study of children with clinically suspected MHE was to investigate relationships between brain MR spectroscopy metabolites and biochemical markers of encephalopathy as well as measures of liver disease severity. MATERIALS AND METHODS A total of 12 children (age range, 9-19 years; 8 female) with clinically suspected MHE were studied by short TE brain MR spectroscopy on a 1.5T magnet. We estimated gray matter (GM) and white matter (WM) metabolite concentrations using "LCModel" software. Regional metabolite concentrations were examined for correlation with various parameters, including plasma ammonia, the ratio of branched-chain to aromatic amino acids (BCAA/AAA), model for end stage liver disease/pediatric end stage liver disease (MELD/PELD) and Child-Pugh scores, bilirubin, albumin, and platelet counts. RESULTS Myo-inositol (mIns) levels correlated with BCAA/AAA ratios (r = 0.86; P = .002 for GM and r = 0.77; P = .01 for WM). WM choline (Cho) levels and GM mIns levels showed significant negative correlation with ammonia levels (r = -0.58; P = .04 and r = -0.65; P = .02, respectively). A positive significant correlation trend was present for GM glutamine/glutamate (Glx) and ammonia levels (r = 0.66; P = .05). There was no correlation of brain MR spectroscopy parameters and severity of liver disease. CONCLUSIONS Brain MR spectroscopy metabolites in children with suspected MHE show significant correlations with plasma ammonia levels and BCAA/AAA. As in adults, brain MR spectroscopy in children may be helpful in establishing a diagnosis of MHE.
Collapse
Affiliation(s)
- B R Foerster
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, 600 N. Wolfe Street, Baltimore, MD 21287, USA.
| | | | | | | | | |
Collapse
|
18
|
Foerster BR, Conklin LS, Petrou M, Barker PB, Schwarz KB. Minimal hepatic encephalopathy in children: evaluation with proton MR spectroscopy. AJNR. AMERICAN JOURNAL OF NEURORADIOLOGY 2009. [PMID: 19509075 DOI: 10.3174/ajnr.a165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND PURPOSE Minimal hepatic encephalopathy (MHE) in children is difficult to evaluate because of lack of standardized neuropsychological tests for all age ranges. The purpose of this retrospective study of children with clinically suspected MHE was to investigate relationships between brain MR spectroscopy metabolites and biochemical markers of encephalopathy as well as measures of liver disease severity. MATERIALS AND METHODS A total of 12 children (age range, 9-19 years; 8 female) with clinically suspected MHE were studied by short TE brain MR spectroscopy on a 1.5T magnet. We estimated gray matter (GM) and white matter (WM) metabolite concentrations using "LCModel" software. Regional metabolite concentrations were examined for correlation with various parameters, including plasma ammonia, the ratio of branched-chain to aromatic amino acids (BCAA/AAA), model for end stage liver disease/pediatric end stage liver disease (MELD/PELD) and Child-Pugh scores, bilirubin, albumin, and platelet counts. RESULTS Myo-inositol (mIns) levels correlated with BCAA/AAA ratios (r = 0.86; P = .002 for GM and r = 0.77; P = .01 for WM). WM choline (Cho) levels and GM mIns levels showed significant negative correlation with ammonia levels (r = -0.58; P = .04 and r = -0.65; P = .02, respectively). A positive significant correlation trend was present for GM glutamine/glutamate (Glx) and ammonia levels (r = 0.66; P = .05). There was no correlation of brain MR spectroscopy parameters and severity of liver disease. CONCLUSIONS Brain MR spectroscopy metabolites in children with suspected MHE show significant correlations with plasma ammonia levels and BCAA/AAA. As in adults, brain MR spectroscopy in children may be helpful in establishing a diagnosis of MHE.
Collapse
Affiliation(s)
- B R Foerster
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, 600 N. Wolfe Street, Baltimore, MD 21287, USA.
| | | | | | | | | |
Collapse
|
19
|
Randolph C, Hilsabeck R, Kato A, Kharbanda P, Li YY, Mapelli D, Ravdin LD, Romero-Gomez M, Stracciari A, Weissenborn K. Neuropsychological assessment of hepatic encephalopathy: ISHEN practice guidelines. Liver Int 2009; 29:629-35. [PMID: 19302444 DOI: 10.1111/j.1478-3231.2009.02009.x] [Citation(s) in RCA: 146] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Low-grade or minimal hepatic encephalopathy (MHE) is characterised by relatively mild neurocognitive impairments, and occurs in a substantial percentage of patients with liver disease. The presence of MHE is associated with a significant compromise of quality of life, is predictive of the onset of overt hepatic encephalopathy and is associated with a poorer prognosis for outcome. Early identification and treatment of MHE can improve quality of life and may prevent the onset of overt encephalopathy, but to date, there has been little agreement regarding the optimum method for detecting MHE. The International Society on Hepatic Encephalopathy and Nitrogen Metabolism convened a group of experts for the purpose of reviewing available data and making recommendations for a standardised approach for neuropsychological assessment of patients with liver disease who are at risk of MHE. Specific recommendations are presented, along with a proposed methodology for further refining these assessment procedures through prospective research.
Collapse
|
20
|
Garcia M, Huppertz HJ, Ziyeh S, Buechert M, Schumacher M, Mader I. Valproate-induced metabolic changes in patients with epilepsy: Assessment with1H-MRS. Epilepsia 2009; 50:486-92. [DOI: 10.1111/j.1528-1167.2008.01801.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
21
|
Huda A, Gupta R, Rajakumar N, Thomas M. Role of Magnetic Resonance in Understanding the Pathogenesis of Hepatic Encephalopathy. MAGNETIC RESONANCE INSIGHTS 2008; 2:109-122. [PMID: 20890387 PMCID: PMC2947384 DOI: 10.4137/mri.s973] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
A spectrum of neuropsychiatric abnormalities caused by portosystemic venous shunting occurs in hepatic encephalopathy (HE) patients with or without liver dysfunction. It is not completely clear how the astrocyte swelling leads to glial-neuronal dysfunction, and how the symptoms are manifested in HE. A major goal of this work is to review the current status of information available from the existing magnetic resonance (MR) modalities including MR imaging (MRI) and MR Spectroscopy (MRS) as well as other modalities in the understanding the pathogenesis of HE. First, we discuss briefly neuron-histopathology, neurotoxins, neuropsychological and neurophysiological tests. A short review on the progress with single-photon emission computed tomography (SPECT) and positron emission tomography (PET) is then presented. In the remaining part of the manuscript, the following topics pertinent to understanding the pathogenesis of HE are discussed: MRI, diffusion tensor imaging (DTI), one-dimensional MRS based single- and multi-voxel based spectroscopic imaging techniques and two-dimensional MRS.
Collapse
Affiliation(s)
- A. Huda
- Department of Physics, California State University, Fresno, CA 93740
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA 90095
| | - R.K. Gupta
- Department of Radiology, Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Lucknow, India
| | - N. Rajakumar
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA 90095
| | - M.A. Thomas
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA 90095
| |
Collapse
|
22
|
De Roock S, Hantson P, Laterre PF, Duprez T. Extensive pallidal and white matter injury following cocaine overdose. Intensive Care Med 2007; 33:2030-1. [PMID: 17618415 DOI: 10.1007/s00134-007-0773-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2007] [Indexed: 10/23/2022]
|
23
|
Autti T, Joensuu R, Aberg L. Decreased T2 signal in the thalami may be a sign of lysosomal storage disease. Neuroradiology 2007; 49:571-8. [PMID: 17334752 DOI: 10.1007/s00234-007-0220-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2006] [Accepted: 01/23/2007] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Lysosomal disorders are rare and are caused by genetically transmitted lysosomal enzyme deficiencies. A decreased T2 signal in the thalamus has occasionally been reported. AIMS Because the finding of bilateral abnormal signal intensity of the thalamus on T2-weighted images has not been systematically reviewed, and its value as a diagnostic tool critically evaluated, we carried out a systematic review of the literature. METHODS Articles in English with 30 trios of keywords were collected from PubMed. Exclusion criteria were lack of conventional T2-weighted images in the protocol and not being a human study. Finally, 111 articles were included. The thalamus was considered affected only if mentioned in the text or in the figure legends. RESULTS Some 117 patients with various lysosomal diseases and five patients with ceruloplasmin deficiency were reported to have a bilateral decrease in T2 signal intensity. At least one article reported a bilateral decrease in signal intensity of the thalami on T2-weighted images in association with GM1 and GM2 gangliosidosis and with Krabbe's disease, aspartylglucosaminuria, mannosidosis, fucosidosis, and mucolipidosis IV. Furthermore, thalamic alteration was a consistent finding in several types of neuronal ceroid lipofuscinosis (NCL) including CLN1 (infantile NCL), CLN2 (classic late infantile NCL), CLN3 (juvenile NCL), CLN5 (Finnish variant late infantile NCL), and CLN7 (Turkish variant late infantile NCL). CONCLUSION A decrease in T2 signal intensity in the thalami seems to be a sign of lysosomal disease.
Collapse
Affiliation(s)
- Taina Autti
- Helsinki Medical Imaging Center, Helsinki University Central Hospital, P.O. Box 340, 00029-HUS, Helsinki, Finland.
| | | | | |
Collapse
|