1
|
Lambert AT, Sætre DO, Ratajczak-Tretel B, Gleditsch J, Høie G, Al-Ani R, Pesonen M, Atar D, Aamodt AH. Imaging features for the identification of atrial fibrillation in cryptogenic stroke patients. J Neurol 2024:10.1007/s00415-024-12397-y. [PMID: 38904781 DOI: 10.1007/s00415-024-12397-y] [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: 03/16/2024] [Revised: 04/18/2024] [Accepted: 04/22/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Whether specific imaging aspects can be used to identify cryptogenic stroke (CS) patients with high risk of underlying atrial fibrillation (AF) remains unclear. The purpose of this study was to evaluate brain-imaging features in CS patients and their utility as AF predictors. METHODS The Nordic Atrial Fibrillation and Stroke study was a prospective observational study of CS and transient ischemic attack patients undergoing 12-month cardiac-rhythm monitoring, biomarker and clinical assessments. In this imaging sub-study, brain magnetic resonance imaging and computed tomography scans from 106 patients were assessed for acute and chronic ischemic lesions in relation to AF occurrence and included in a score to predict AF. Receiver operating characteristics (ROC) curve was used to evaluate the discriminative ability of the score and for its dichotomization for predictive model. RESULTS Age, periventricular white-matter hyperintensities (PVWMH), acute lesion size, and vessel occlusion were significantly associated with AF. Acute and chronic cortical infarcts as well as chronic cerebellar infarcts were numerically more frequent in the AF group than the non-AF group. A score consisting of six features (0-6 points) was proposed (age ≥ 65 years, chronic cortical or cerebellar lesions, acute cortical lesions, PVWMH ≥ 2 in Fazekas scale, vessel occlusion, and acute lesion size ≥ 10 mm). Area under ROC curve was 0.735 and a score of ≥ 3 points was a predictor of AF. CONCLUSIONS The suggested score was shown to identify CS patients with an increased risk of underlying AF.
Collapse
Affiliation(s)
- Anna Tancin Lambert
- Department of Neurology, Østfold Hospital Trust, Grålum, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Dag Ottar Sætre
- Dapartment of Radiology, Østfold Hospital Trust, Grålum, Norway
| | - Barbara Ratajczak-Tretel
- Department of Neurology, Østfold Hospital Trust, Grålum, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jostein Gleditsch
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Dapartment of Radiology, Østfold Hospital Trust, Grålum, Norway
| | - Gudrun Høie
- Department of Cardiology, Østfold Hospital Trust, Grålum, Norway
| | - Riadh Al-Ani
- Department of Cardiology, Østfold Hospital Trust, Grålum, Norway
| | - Maiju Pesonen
- Center for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Dan Atar
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Anne Hege Aamodt
- Department of Neurology, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, 0372, Oslo, Norway.
| |
Collapse
|
2
|
Qin S, Teng H, Li A, Wang L, Hu R, Fu D. Subarachnoid hemorrhage with Takotsubo syndrome as the prominent manifestation: A case and literature review. Heliyon 2024; 10:e30057. [PMID: 38694106 PMCID: PMC11059115 DOI: 10.1016/j.heliyon.2024.e30057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 04/18/2024] [Accepted: 04/18/2024] [Indexed: 05/03/2024] Open
Abstract
Background Takotsubo syndrome, which is often induced by physical or psychological stress, is typically a cardiac syndrome with transient left ventricular dysfunction in the absence of obstructive coronary artery disease. Subarachnoid hemorrhage with typical symptoms and signs is frequently reported, whereas the incidence of subarachnoid hemorrhage with Takotsubo syndrome as the prominent manifestation without a typical headache is rarely reported. Case description We present a rare case of a 63-year-old male patient with cough and fever as the first manifestations, accompanied by mild dizziness, headache, and mental discomfort; however, the patient was eventually diagnosed with atypical subarachnoid hemorrhage with Takotsubo syndrome. The patient underwent general anesthesia downwards stent-assisted spring coil embolization and was discharged from the hospital after postoperative treatment consisting of anti-cerebrovascular spasm, anti-platelet aggregation, and cerebrospinal fluid replacement. Conclusion This case demonstrates the association between Takotsubo syndrome and subarachnoid hemorrhage. When patients present with unexplained pulmonary edema with mild neurologic symptoms, clinicians should be alerted to subarachnoid hemorrhage and Takotsubo syndrome.
Collapse
Affiliation(s)
- Shihong Qin
- The Fifth Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Hunan Normal University, Changsha, China
- The Fifth Department of Pulmonary and Critical Care Medicine, Hunan Provincial People's Hospital, Changsha, China
| | - Huifang Teng
- The Fifth Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Hunan Normal University, Changsha, China
- The Fifth Department of Pulmonary and Critical Care Medicine, Hunan Provincial People's Hospital, Changsha, China
| | - Aiping Li
- The Fourth Department of Neurology, The First Affiliated Hospital of Hunan Normal University, Changsha, China
- The Fourth Department of Neurology, Hunan Provincial People's Hospital, Changsha, China
| | - Lile Wang
- The Fifth Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Hunan Normal University, Changsha, China
- The Fifth Department of Pulmonary and Critical Care Medicine, Hunan Provincial People's Hospital, Changsha, China
| | - Ruicheng Hu
- The Fifth Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Hunan Normal University, Changsha, China
- The Fifth Department of Pulmonary and Critical Care Medicine, Hunan Provincial People's Hospital, Changsha, China
| | - Daiyan Fu
- The Fifth Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Hunan Normal University, Changsha, China
- The Fifth Department of Pulmonary and Critical Care Medicine, Hunan Provincial People's Hospital, Changsha, China
| |
Collapse
|
3
|
Erdoğan MŞ, Arpak ES, Keles CSK, Villagra F, Işık EÖ, Afşar N, Yucesoy CA, Mur LAJ, Akanyeti O, Saybaşılı H. Biochemical, biomechanical and imaging biomarkers of ischemic stroke: Time for integrative thinking. Eur J Neurosci 2024; 59:1789-1818. [PMID: 38221768 DOI: 10.1111/ejn.16245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/12/2023] [Accepted: 12/16/2023] [Indexed: 01/16/2024]
Abstract
Stroke is one of the leading causes of adult disability affecting millions of people worldwide. Post-stroke cognitive and motor impairments diminish quality of life and functional independence. There is an increased risk of having a second stroke and developing secondary conditions with long-term social and economic impacts. With increasing number of stroke incidents, shortage of medical professionals and limited budgets, health services are struggling to provide a care that can break the vicious cycle of stroke. Effective post-stroke recovery hinges on holistic, integrative and personalized care starting from improved diagnosis and treatment in clinics to continuous rehabilitation and support in the community. To improve stroke care pathways, there have been growing efforts in discovering biomarkers that can provide valuable insights into the neural, physiological and biomechanical consequences of stroke and how patients respond to new interventions. In this review paper, we aim to summarize recent biomarker discovery research focusing on three modalities (brain imaging, blood sampling and gait assessments), look at some established and forthcoming biomarkers, and discuss their usefulness and complementarity within the context of comprehensive stroke care. We also emphasize the importance of biomarker guided personalized interventions to enhance stroke treatment and post-stroke recovery.
Collapse
Affiliation(s)
| | - Esra Sümer Arpak
- Institute of Biomedical Engineering, Boğaziçi University, Istanbul, Turkey
| | - Cemre Su Kaya Keles
- Institute of Biomedical Engineering, Boğaziçi University, Istanbul, Turkey
- Institute of Structural Mechanics and Dynamics in Aerospace Engineering, University of Stuttgart, Stuttgart, Germany
| | - Federico Villagra
- Department of Life Sciences, Aberystwyth University, Aberystwyth, Wales, UK
| | | | - Nazire AfÅŸar
- Neurology, Acıbadem Mehmet Ali Aydınlar University, İstanbul, Turkey
| | - Can A Yucesoy
- Institute of Biomedical Engineering, Boğaziçi University, Istanbul, Turkey
| | - Luis A J Mur
- Department of Life Sciences, Aberystwyth University, Aberystwyth, Wales, UK
| | - Otar Akanyeti
- Department of Computer Science, Llandinam Building, Aberystwyth University, Aberystwyth, UK
| | - Hale Saybaşılı
- Institute of Biomedical Engineering, Boğaziçi University, Istanbul, Turkey
| |
Collapse
|
4
|
Dekeyzer S, Vanden Bossche S, De Cocker L. Anything but Little: a Pictorial Review on Anatomy and Pathology of the Cerebellum. Clin Neuroradiol 2023; 33:907-929. [PMID: 37410171 DOI: 10.1007/s00062-023-01326-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 06/09/2023] [Indexed: 07/07/2023]
Abstract
Despite its small size the cerebellum is an anatomically complex and functionally important part of the brain. Traditionally the cerebellum is viewed as a motor control structure entirely devoted to motor control and learning, but recent functional magnetic resonance imaging (fMRI) studies demonstrated significant involvement of the cerebellum in higher order cognitive functions. The anatomical complexity of the cerebellum is reflected by the several nomenclature systems that exist for the description of cerebellar anatomy. The cerebellum can be affected by a variety of pathological processes, including congenital, infectious and inflammatory, neoplastic, vascular, degenerative and toxic metabolic diseases. The purpose of this pictorial review is to (1) provide a general overview of cerebellar anatomy and function, (2) demonstrate normal cerebellar anatomy on imaging studies, and (3) illustrate both common as well as rare pathological conditions affecting the cerebellum.
Collapse
Affiliation(s)
- Sven Dekeyzer
- Department of Radiology and Medical Imaging, Ghent University Hospital (UZG), Corneel Heymanslaan 10, 9000, Gent, Belgium.
- Department of Radiology, Antwerp University Hospital (UZA), Drie Eikenstraat 655, 2650, Edegem, Belgium.
| | - Stephanie Vanden Bossche
- Department of Radiology, Antwerp University Hospital (UZA), Drie Eikenstraat 655, 2650, Edegem, Belgium
- Department of Radiology, AZ Sint Jan Bruges, Ruddershove 10, 8000, Bruges, Belgium
| | - Laurens De Cocker
- Department of Radiology, AZ Maria Middelares Gent, Buitenring-Sint-Denijs 30, 9000, Gent, Belgium
| |
Collapse
|
5
|
Herson AB, Falk JD, Phrathep DD, Igbonagwam CB, Fischer ST, Miller BT, Leary D. The Value of Interdisciplinary Collaboration in Lateral Medullary Syndrome Rehabilitation: A Case Report. Cureus 2023; 15:e40065. [PMID: 37425557 PMCID: PMC10326168 DOI: 10.7759/cureus.40065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 06/06/2023] [Indexed: 07/11/2023] Open
Abstract
Wallenberg's syndrome, also known as lateral medullary syndrome (LMS), is a neurological condition resulting from damage to the lateral portion of the medulla oblongata. We present a case of a 64-year-old man with Wallenberg's syndrome who presented for acute rehabilitation after sustaining a cerebrovascular accident (CVA). As seen in our patient, common symptoms of LMS include difficulty swallowing, hoarseness, ipsilateral weakness, and ipsilateral loss of sensation or numbness. Although the prognosis following infarction is often good, dysfunction in swallowing is one of the key deficits that have a long-term impact on patient quality of life. We aim to emphasize the significance of the interdisciplinary approach to achieving favorable health outcomes in patients with LMS.
Collapse
Affiliation(s)
- Andrew B Herson
- Physical Medicine and Rehabilitation, Lake Erie College of Osteopathic Medicine, Jacksonville, USA
| | - Justin D Falk
- Physical Medicine and Rehabilitation, Lake Erie College of Osteopathic Medicine, Jacksonville, USA
| | - Davong D Phrathep
- Physical Medicine and Rehabilitation, Lake Erie College of Osteopathic Medicine, Jacksonville, USA
| | - Chigozie B Igbonagwam
- Physical Medicine and Rehabilitation, Lake Erie College of Osteopathic Medicine, Jacksonville, USA
| | - Steven T Fischer
- Physical Medicine and Rehabilitation, Lake Erie College of Osteopathic Medicine, Jacksonville, USA
| | - Brooke T Miller
- Physical Medicine and Rehabilitation, Lake Erie College of Osteopathic Medicine, Jacksonville, USA
| | - Daniel Leary
- Physical Medicine and Rehabilitation, AdventHealth Tampa, Tampa, USA
| |
Collapse
|
6
|
David AM, Jaleel A, Joy Mathew CM. Misdiagnosis of Cerebellar Infarcts and Its Outcome. Cureus 2023; 15:e35362. [PMID: 36974239 PMCID: PMC10039737 DOI: 10.7759/cureus.35362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2023] [Indexed: 02/25/2023] Open
Abstract
Cerebellar infarction, a rare category of stroke, is often misdiagnosed but not given much importance in the available literature. Its presentation overlaps with symptoms of other neurologic, cardiovascular, gastrointestinal, and systemic conditions and therefore is nonspecific. Early diagnosis and management of cerebellar strokes are of utmost importance as the lack of a proper diagnosis may increase overall morbidity and mortality. Lack of awareness of the warning signs and symptoms, non-specificity of symptoms, absence of neurological deficits, and imaging discrepancies are some of the factors contributing to misdiagnosis and delayed treatment. If symptomatology is considered, it is found that symptoms of posterior circulation stroke were more frequently misdiagnosed compared to anterior circulation. Nausea and vomiting increased the chance further. Some other rare presentations include gastrointestinal symptoms, isolated vertigo, and symptoms of inner ear disease. Overdependence on radiological investigations often masks the significance of clinical examination. Ischemic stroke may appear normal in the initial 48 hours in the computed tomography scan of the brain or bony artefacts may hide the lesion. Permanent disabling deficits can follow a cerebellar stroke and the complications, which include hydrocephalus, brain stem compression, and gait abnormalities, necessitate prompt identification and management. In this review article, we aim at analysing various case reports of cerebellar infarction, the most common presentations that were under-evaluated, and their outcomes, thereby highlighting the importance of proper diagnosis and reporting of cerebellar infarction in the future. A thorough knowledge of the association between various clinical presentations of cerebellar stroke and its misdiagnosis helps clinicians to be more vigilant about the disease.
Collapse
|
7
|
Fotakopoulos G, Brotis AG, Paterakis K, Kapsalaki E, Fountas KN. Posterior Fossa Intra-Axial Lesion: There Are Pathologies Beyond Metastases. Asian J Neurosurg 2022; 17:680-682. [PMID: 36570746 PMCID: PMC9771626 DOI: 10.1055/s-0042-1757433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Cerebellar metastases represent the most common lesion requiring surgical treatment in the daily neurosurgical praxis. We report a rare case with Lhermitte-Duclos disease presenting to the neurosurgical outpatient department and describe our diagnostic and treatment challenges. A 57-year-old man presented with transient cerebellar manifestations, including walking difficulties, dizziness, and a persistent occipital headache. The magnetic resonance imaging demonstrated a high-intensity lesion in the right cerebellar hemisphere on T2-weighted images. We initially considered surgery to establish a histopathological diagnosis. However, the magnetic resonance spectroscopy was compatible with a dysplastic gangliocytoma of the cerebellum. Therefore, we preferred a more conservative approach. Posterior fossa contrast-enhancing lesions are much more than metastases. The role of advanced magnetic resonance in avoiding unnecessary surgical interventions is priceless.
Collapse
Affiliation(s)
- George Fotakopoulos
- Department of Neurosurgery, General University Hospital of Larissa, Larissa, Greece,Address for correspondence George Fotakopoulos, MD, MSc, PhD Department of Neurosurgery, General University Hospital of LarissaVounargo, Pyrgou, Ilias, 27100Greece
| | - Alexandros G. Brotis
- Department of Neurosurgery, General University Hospital of Larissa, Larissa, Greece
| | | | - Eftychia Kapsalaki
- Department of Radiology, University of Thessaly, Medical School of Thessaly, Thessaly, Greece
| | - Kostas N. Fountas
- Department of Neurosurgery, General University Hospital of Larissa, Larissa, Greece
| |
Collapse
|
8
|
Wang W, Ji J, Wang C, Wang Y. Topography and etiologies of cerebellar infarcts presenting as isolated acute vestibular syndrome. Neurol Sci 2022; 43:5969-5976. [DOI: 10.1007/s10072-022-06249-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 06/28/2022] [Indexed: 11/28/2022]
|
9
|
Lei A, Zhang Y, Liang F, Zhang J, Cai J. Adoption of Magnetic Resonance Image Features under Segmentation Algorithm in Effect Evaluation of Ginkgo Diterpenoid Lactone Glucamine Injection in Treatment of Cerebral Infarction. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:4558702. [PMID: 35510178 PMCID: PMC9033383 DOI: 10.1155/2022/4558702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 03/22/2022] [Indexed: 11/25/2022]
Abstract
Magnetic resonance imaging (MRI) image segmentation based on a segmentation algorithm was performed to assess neurological function in patients with acute cerebral infarction, to investigate the efficacy evaluation of Ginkgo diterpene lactones meglumine injection (GDLI) in the treatment of cerebral infarction and the efficiency of MRI image segmentation algorithm. First, the results of the fast semisupervised segmentation algorithm (algorithm group) and traditional processing (control group) were compared and analyzed. The recall rate, accuracy, recognition accuracy, and segmentation time of the two groups were compared. The control group was given conventional treatment, while the algorithm group was given GDLI based on conventional treatment. Finally, the difference in serum vascular endothelial growth factor (VEGF), hypoxia-inducible factor-la (HIF-la), angiotensin (Ang)-1, Ang-2, and interleukin (IL)-6 protein concentration was analyzed after treatment. The algorithm evaluation results showed that the accuracy and recall rate of MRI images recognized by the algorithm group fluctuate at 90%. In the control group, the accuracy and recall rate of MRI image results fluctuated at 80%, and the data were statistically different (p < 0.05). The clinical index test results showed that the serum VEGF content of the test group was higher than that of the control group, and the data was statistically different (p < 0.05). In addition, the cerebral blood flow (CBF) and cerebral blood volume (CBV) of the lesion side of the algorithm group were greatly higher than those of the control group on the 30th day, and the differences were significant (p < 0.05). There was little difference between the method presented in this study and the manual delineation by a physician. Compared with traditional manual segmentation, this method greatly reduced the time required for the segmentation of lesions. The diagnostic specificity, sensitivity, and accuracy of the images segmented by the fast semisupervised algorithm were higher than those of the conventional method, and the diagnostic accuracy of acute cerebral infarction was high. In addition, it was sensitive and accurate to detect acute cerebral infarction, which provided a reliable reference for early diagnosis and condition judgment of patients.
Collapse
Affiliation(s)
- Aidi Lei
- Department of Neurology, The Fifth Hospital of Xiamen, Xiamen 361101, Fujian, China
| | - Yanbo Zhang
- Department of Neurology, The Second Affiliated Hospital of Shandong First Medical University, Taian 271000, Shandong, China
| | - Fulong Liang
- Department of Neurology, The Fifth Hospital of Xiamen, Xiamen 361101, Fujian, China
| | - Jianli Zhang
- Department of Neurology, The Fifth Hospital of Xiamen, Xiamen 361101, Fujian, China
| | - Jinle Cai
- Department of Neurology, The Fifth Hospital of Xiamen, Xiamen 361101, Fujian, China
| |
Collapse
|
10
|
Wiseman K, Gor D, Upadrasta G, Udongwo N, Lanpher K, Douedi S, Patel SV. A Cerebrovascular Accident Presenting With Bilateral Vocal Cord Paresis. Cureus 2021; 13:e17840. [PMID: 34660047 PMCID: PMC8501465 DOI: 10.7759/cureus.17840] [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] [Accepted: 09/08/2021] [Indexed: 11/05/2022] Open
Abstract
Diagnosing a stroke requires careful attention to clinical indicators on physical exam, especially the more subtle manifestations of cerebellar lesions. An 85-year-old male with vascular risk factors and new-onset atrial fibrillation was admitted for left upper extremity weakness, headaches, and tremors. The patient developed stridor during hospitalization and was found to have a new cerebellar infarct with hemorrhagic transformation on computed tomography (CT) of the head, with laryngoscopy showing bilateral vocal cord paresis. While strokes outside of the cerebellum are a known cause of unilateral vocal cord paresis, cerebellar strokes are a rare culprit and rarely cause bilateral cord paresis. Consideration beyond the more common pulmonary and iatrogenic causes of vocal cord paresis should be considered, with particular attention to stroke.
Collapse
Affiliation(s)
- Kyle Wiseman
- Internal Medicine, Jersey Shore University Medical Center, Neptune City, USA
| | - Dhairya Gor
- Internal Medicine, Jersey Shore University Medical Center, Neptune City, USA
| | - Gautham Upadrasta
- Internal Medicine, Jersey Shore University Medical Center, Neptune City, USA
| | - Ndausung Udongwo
- Internal Medicine, Jersey Shore University Medical Center, Neptune City, USA
| | - Kara Lanpher
- Internal Medicine, Jersey Shore University Medical Center, Neptune City, USA
| | - Steven Douedi
- Internal Medicine, Jersey Shore University Medical Center, Neptune City, USA
| | - Swapnil V Patel
- Internal Medicine, Jersey Shore University Medical Center, Neptune City, USA
| |
Collapse
|
11
|
Borojevic B, Choi PMC. Early space-occupying cerebellar oedema requiring decompressive craniectomy following a clinically minor stroke. BMJ Case Rep 2021; 14:14/7/e243815. [PMID: 34312138 PMCID: PMC8314700 DOI: 10.1136/bcr-2021-243815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We describe a patient presented with clinically a small cerebellar ischaemic stroke but required emergency decompression within 24 hours of symptoms onset after incidental finding of severe mass effect on imaging without any change in her mild clinical symptoms. Her initial multimodal acute stroke imaging, non-contrast CT of the brain and CT angiography from aortic arch to vertex were normal. CT perfusion showed a very small deficit only. The malignant mass effect was picked on an MRI scan performed routinely as part of a clinical trial, 32 hours after stroke. Our case highlights stroke evolution, and mass effect may be insidious and faster than anticipated in the posterior fossa. Cerebellar stroke of any severity diagnosed clinically and radiologically may benefit from routine follow-up imaging at 24 hours from onset.
Collapse
Affiliation(s)
- Branko Borojevic
- Department of Neurosciences, Eastern Health, Box Hill, Victoria, Australia
| | - Philip M C Choi
- Department of Neurosciences, Eastern Health, Box Hill, Victoria, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| |
Collapse
|
12
|
Pellegrini JR, Munshi R, Cao B, Olson S, Cappello V. Hitting a Wall: An Ambiguous Case of Wallenberg Syndrome. Cureus 2021; 13:e16268. [PMID: 34373821 PMCID: PMC8346262 DOI: 10.7759/cureus.16268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2021] [Indexed: 11/26/2022] Open
Abstract
Wallenberg syndrome is the most common stroke of the posterior circulation. Diagnosis of Wallenberg syndrome is often overlooked as initial MRI may show no visible lesion. We present an atypical case of Wallenberg syndrome in which the initial MRI of the brain was normal. Our patient is a 65-year-old male who was brought in by emergency medical services complaining of right-sided facial droop, slurred speech, and left-sided weakness for one day. Physical examination showed decreased left arm and leg strength compared to the right side, decreased left facial temperature sensations, decreased left arm and leg temperature sensations, and difficulty sitting upright with an associated leaning towards the left side. An initial magnetic resonance imaging (MRI) of the brain with and without contrast revealed no abnormality. In light of such a high suspicion for stroke based on the patient’s neurologic deficits, a repeat MRI of the brain was performed three days later and exposed a small focus of bright signal (hyperintensity) on T2-weighted fluid-attenuated inversion recovery and diffusion-weighted imaging (DWI) in the left posterior medulla. Wallenberg syndrome, also known as lateral medullary syndrome or posterior inferior cerebellar artery syndrome, is a constellation of symptoms caused by posterior vascular accidents. The neurological deficits associated with this disease are due to damage of the lateral medulla, inferior cerebellar peduncle, nucleus of trigeminal nerve, nucleus and fibers of vagus and glossopharyngeal nerves, descending sympathetic tract, spinothalamic tract, and/or vestibular nuclei. MRI with DWI is the gold standard to confirm the diagnosis. Wallenberg syndrome has the potential to leave patients extremely debilitated. Early detection, management, and rehabilitation are critical for improving post-stroke recovery.
Collapse
Affiliation(s)
| | - Rezwan Munshi
- Internal Medicine, Nassau University Medical Center, East Meadow, USA
| | - Bohao Cao
- Internal Medicine, Nassau University Medical Center, East Meadow, USA
| | - Samuel Olson
- Physical Medicine and Rehabilitation, Stony Brook University, Stony Brook, USA
| | - Vincent Cappello
- Internal Medicine, Nassau University Medical Center, East Meadow, USA
| |
Collapse
|
13
|
Dong J, Zhao S, Meng Y, Zhang Y, Li S. Magnetic resonance imaging reconstruction algorithm under complex convolutional neural network in diagnosis and prognosis of cerebral infarction. PLoS One 2021; 16:e0251529. [PMID: 33999951 PMCID: PMC8128241 DOI: 10.1371/journal.pone.0251529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 04/28/2021] [Indexed: 11/19/2022] Open
Abstract
This study was to explore the application value of magnetic resonance imaging (MRI) image reconstruction model based on complex convolutional neural network (CCNN) in the diagnosis and prognosis of cerebral infarction. Two image reconstruction methods, frequency domain reconstruction network (FDRN) and image domain reconstruction network (IDRN), were introduced based on the CCNN algorithm. In addition, they were integrated to form two new MRI image reconstruction models, namely D-FDRN and D-IDRN. The peak signal to noise ratio (PSNR) value and structural similarity index measure (SSIM) value of the image were compared and analyzed before and after the integration. The MRI images of patients with cerebral infarction in the dataset were undertaken as the data source, the average diffusion coefficient (DCavg) and apparent diffusion coefficient (ADC) values of different parts of the MRI image were measured, respectively. The correlation of the vein abnormality grading (VABG) to the infarct size and the degree of stenosis of the responsible vessel was analyzed in this study. The results showed that the PSNR and SSIM values of the MRI reconstructed image of the D-IDRN algorithm based on the CCNN algorithm in this study were higher than those of other algorithms. There was a positive correlation between the VABG and the infarct size (r = 0.48 and P = 0.002), and there was a positive correlation between the VABG the degree of stenosis of the responsible vessel (r = 0.58 and P < 0.0001). The ADC value of the central area of the infarct on the affected side was significantly greatly lower than that of the normal side (P < 0.01), and the DCavg value of the central area of the infarct was much lower in contrast to the normal side (P < 0.05). It indicated that an image reconstruction algorithm constructed in this study could improve the quality of MRI images. The ADC value and DCavg value changed in the infarct central area could be used as the basis for the diagnosis of cerebral infarction. If the vein was abnormal, the patient suffered from severe vascular stenosis, large infarction area, and poorer prognosis.
Collapse
Affiliation(s)
- Jie Dong
- School of Physics and Microelectronics, Zhengzhou University, Zhengzhou, P.R. China
| | - Shujun Zhao
- School of Physics and Microelectronics, Zhengzhou University, Zhengzhou, P.R. China
| | - Yun Meng
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, P.R. China
| | - Yong Zhang
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, P.R. China
| | - Suxiao Li
- School of Physics and Microelectronics, Zhengzhou University, Zhengzhou, P.R. China
| |
Collapse
|
14
|
Subclavian Steal Syndrome, Cerebellar Infarctions, and Alcohol. Am J Med 2021; 134:e317-e318. [PMID: 33127369 DOI: 10.1016/j.amjmed.2020.09.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 09/04/2020] [Indexed: 11/21/2022]
|
15
|
From Cerebellar Apoplexy in 1849 to Cerebellar Stroke in the 2020s: Robert Dunn's Contribution. THE CEREBELLUM 2021; 20:340-345. [PMID: 33646479 DOI: 10.1007/s12311-021-01240-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/29/2021] [Indexed: 10/22/2022]
Abstract
Stroke of the cerebellum represents about 10% of strokes of the brain. Both infarction and hemorrhage manifest with symptoms related to the location and extent of the lesion(s). Bilateral cerebellar infarcts constitute up to one third of all cerebellar infarctions. The leading cause of cerebellar infarcts is emboli of cardiac origin or from intra-arterial sources. Potential complications include brainstem compression and hydrocephalus. Malignant cerebellar edema is a life-threatening complication of ischemic posterior circulation stroke requiring urgent management. The advent of MRI has revolutionized the early diagnosis in vivo, showing small and large territorial infarcts, hemorrhages, and venous infarcts. Endovascular procedures are growingly applied and are impacting on the prognosis of stroke, although cerebellar stroke from occlusion of small cerebellar arteries is currently not accessible to thrombectomy. Surgical procedures of space-occupying stroke include external ventricular drainage, suboccipital craniotomy, or combined procedures. In 1849, Robert Dunn (1799-1877), an English surgeon, reported the details of a case of apoplexy of the cerebellum in a 52-year-old man, pointing to the importance of post-mortem studies of patients followed meticulously during lifetime. Dunn discussed inflammation surrounding hemorrhage as a source of cerebral degeneration, linking for the first time cerebellar stroke, neuroinflammation, and atherosclerosis.
Collapse
|
16
|
Hill LK, Hoang DM, Chiriboga LA, Wisniewski T, Sadowski MJ, Wadghiri YZ. Detection of Cerebrovascular Loss in the Normal Aging C57BL/6 Mouse Brain Using in vivo Contrast-Enhanced Magnetic Resonance Angiography. Front Aging Neurosci 2020; 12:585218. [PMID: 33192479 PMCID: PMC7606987 DOI: 10.3389/fnagi.2020.585218] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 09/11/2020] [Indexed: 12/28/2022] Open
Abstract
Microvascular rarefaction, or the decrease in vascular density, has been described in the cerebrovasculature of aging humans, rats, and, more recently, mice in the presence and absence of age-dependent diseases. Given the wide use of mice in modeling age-dependent human diseases of the cerebrovasculature, visualization, and quantification of the global murine cerebrovasculature is necessary for establishing the baseline changes that occur with aging. To provide in vivo whole-brain imaging of the cerebrovasculature in aging C57BL/6 mice longitudinally, contrast-enhanced magnetic resonance angiography (CE-MRA) was employed using a house-made gadolinium-bearing micellar blood pool agent. Enhancement in the vascular space permitted quantification of the detectable, or apparent, cerebral blood volume (aCBV), which was analyzed over 2 years of aging and compared to histological analysis of the cerebrovascular density. A significant loss in the aCBV was detected by CE-MRA over the aging period. Histological analysis via vessel-probing immunohistochemistry confirmed a significant loss in the cerebrovascular density over the same 2-year aging period, validating the CE-MRA findings. While these techniques use widely different methods of assessment and spatial resolutions, their comparable findings in detected vascular loss corroborate the growing body of literature describing vascular rarefaction aging. These findings suggest that such age-dependent changes can contribute to cerebrovascular and neurodegenerative diseases, which are modeled using wild-type and transgenic laboratory rodents.
Collapse
Affiliation(s)
- Lindsay K. Hill
- Department of Chemical and Biomolecular Engineering, NYU Tandon School of Engineering, Brooklyn, NY, United States
- Department of Radiology, Center for Advanced Imaging Innovation and Research (CAI2R), NYU Grossman School of Medicine, New York, NY, United States
- Department of Radiology, Bernard and Irene Schwartz Center for Biomedical Imaging, NYU Grossman School of Medicine, New York, NY, United States
- Department of Biomedical Engineering, SUNY Downstate Medical Center, Brooklyn, NY, United States
| | - Dung Minh Hoang
- Department of Radiology, Center for Advanced Imaging Innovation and Research (CAI2R), NYU Grossman School of Medicine, New York, NY, United States
- Department of Radiology, Bernard and Irene Schwartz Center for Biomedical Imaging, NYU Grossman School of Medicine, New York, NY, United States
| | - Luis A. Chiriboga
- Department of Pathology, NYU Grossman School of Medicine, New York, NY, United States
| | - Thomas Wisniewski
- Department of Pathology, NYU Grossman School of Medicine, New York, NY, United States
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, United States
- Department of Psychiatry, NYU Grossman School of Medicine, New York, NY, United States
| | - Martin J. Sadowski
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, United States
- Department of Psychiatry, NYU Grossman School of Medicine, New York, NY, United States
- Department of Biochemistry and Molecular Pharmacology, NYU Grossman School of Medicine, New York, NY, United States
| | - Youssef Z. Wadghiri
- Department of Radiology, Center for Advanced Imaging Innovation and Research (CAI2R), NYU Grossman School of Medicine, New York, NY, United States
- Department of Radiology, Bernard and Irene Schwartz Center for Biomedical Imaging, NYU Grossman School of Medicine, New York, NY, United States
| |
Collapse
|
17
|
Jiang J, Wang J, Lin M, Wang X, Zhao J, Shang X. Bilateral middle cerebellar peduncle lesions: Neuroimaging features and differential diagnoses. Brain Behav 2020; 10:e01778. [PMID: 32755074 PMCID: PMC7559600 DOI: 10.1002/brb3.1778] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 07/16/2020] [Accepted: 07/19/2020] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES Lesions limited to the bilateral middle cerebellar peduncles (MCPs) are uncommon. This retrospective study investigated diseases with a proclivity for the bilateral MCPs and explored the associations between their neuroimaging features and clinical findings for the differential diagnosis of such lesions. METHODS We enrolled 26 patients who were admitted to our department between January 2016 and March 2019 with bilateral MCP abnormalities on magnetic resonance imaging (MRI). The demographic, clinical, and neuroimaging characteristics, and the biomarkers and diagnoses were evaluated. RESULTS Although all patients exhibited symmetrical bilateral MCP hypointensities on T1-weighted imaging and hyperintensities on T2-weighted and fluid-attenuated inversion recovery imaging, they were diagnosed with different conditions. Diagnoses included acute cerebral infarction (ACI) (n = 9, 34.62%), Wallerian degeneration (WD) (n = 8, 30.77%), multiple system atrophy (MSA) (n = 6, 23.08%), neuromyelitis optica (NMO) (n = 1, 3.85%), heroin-induced leukoencephalopathy (n = 1, 3.85%), and primary central nervous system lymphoma (PCNSL) (n = 1, 3.85%). Patients with ACI exhibited bilateral MCP-restricted diffusion hyperintensities on diffusion-weighted imaging and corresponding stenosis or occlusion of the vertebrobasilar system. The initial MRI of patients with WD depicted pontine infarctions, while symmetrical MCP lesions were observed on follow-up MRI. Symmetrical MCP lesions, cruciform hyperintensity, and marked atrophy in the posterior fossa were characteristic manifestations of MSA. Longitudinally extensive myelitis affecting more than three vertebral segments on cervical MRI and positive serum AQP4-IgG may be indicative of NMO. Heroin-induced leukoencephalopathy was characterized by extra-symmetrical lesions in the posterior limbs of the internal capsules, while the anterior limbs were spared. PCNSL was indicated by a significant and characteristic "fist" sign on contrast-enhanced MRI. CONCLUSIONS Bilateral MCP lesions were most frequently observed in cerebrovascular diseases, followed by neurodegenerative diseases, inflammatory diseases, toxic encephalopathies, and lymphomas. Our findings demonstrate that bilateral MCP signal abnormalities are more common in patients with ACI and WD, with fewer degenerative processes than previously believed. The high frequency of WD may be attributed to the specific awareness of this pathology. WD can also present with stage-related restricted diffusion and should not be mistaken for a new infarction. The symmetrical bilateral MCP hypointensities on T1-weighted imaging and hyperintensities on T2-weighted imaging often raise concern regarding a demyelinating process. Our findings emphasize that neurologists should consider the aforementioned conditions and correlate the specific neuroimaging characteristics and medical history before arriving at the final diagnosis.
Collapse
Affiliation(s)
- Jiwei Jiang
- Department of Neurology, The First Affiliated Hospital of China Medical University, Shenyang City, Liaoning Province, China
| | - Jirui Wang
- Department of Neurology, The First Affiliated Hospital of China Medical University, Shenyang City, Liaoning Province, China
| | - Meiqing Lin
- Department of Neurology, The First Affiliated Hospital of China Medical University, Shenyang City, Liaoning Province, China
| | - Xiaoting Wang
- Department of Neurology, The First Affiliated Hospital of China Medical University, Shenyang City, Liaoning Province, China
| | - Jinli Zhao
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang City, Liaoning Province, China
| | - Xiuli Shang
- Department of Neurology, The First Affiliated Hospital of China Medical University, Shenyang City, Liaoning Province, China
| |
Collapse
|
18
|
Sugiyama A, Sato N, Kimura Y, Fujii H, Shigemoto Y, Suzuki F, Tanei ZI, Saito Y, Sasaki M, Takahashi Y, Matsuda H, Kuwabara S. The cerebellar white matter lesions in dentatorubral-pallidoluysian atrophy. J Neurol Sci 2020; 416:117040. [PMID: 32711193 DOI: 10.1016/j.jns.2020.117040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 07/04/2020] [Accepted: 07/13/2020] [Indexed: 11/29/2022]
Abstract
Dentatorubral-pallidoluysian atrophy (DRPLA) is an autosomal dominant neurodegenerative disorder caused by a CAG nucleotide repeat expansion in atrophin 1. A previous report described cerebellar white matter lesions on magnetic resonance imaging (MRI) in elderly-onset DRPLA patients, but this finding has not been fully investigated in a total population of DRPLA patients, including juvenile or early-adult onset patients. Herein, we attempted to determine the frequency, distribution pattern, and features of the cerebellar white matter lesions in 30 consecutive DRPLA patients. We also assessed the relationships between the cerebellar white matter lesions and clinical parameters and other MRI findings. The cerebellar white matter lesions were found in 43% of the 30 DRPLA patients, and in 70% of the late adult-onset DRPLA patients. In approx. Two-thirds of the patients with cerebellar white matter lesions, the lesions were localized in the paravermal area (paravermal lesions). Multiple logistic regression analyses revealed that the Fazekas grade of 'cerebral' white matter lesions was independently associated with 'cerebellar' white matter lesions. In conclusion, cerebellar white matter lesions are one of the distinctive MRI features in DRPLA patients, especially in patients with older age at onset. Cerebellar white matter lesions, as well as cerebral white matter lesions, might originate from the disease process of DRPLA itself, and they often have a characteristic distribution of paravermal lesions.
Collapse
Affiliation(s)
- Atsuhiko Sugiyama
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan; Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Noriko Sato
- Department of Radiology, National Center of Neurology and Psychiatry, Tokyo, Japan.
| | - Yukio Kimura
- Department of Radiology, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Hiroyuki Fujii
- Department of Radiology, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Yoko Shigemoto
- Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Tokyo, Japan; Department of Radiology, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Fumio Suzuki
- Department of Radiology, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Zen-Ichi Tanei
- Department of Neurology and Neuropathology (the Brain Bank for Aging Research), Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Yuko Saito
- Department of Pathology and Laboratory Medicine, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Masayuki Sasaki
- Department of Child Neurology, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Yuji Takahashi
- Department of Neurology, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Hiroshi Matsuda
- Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Satoshi Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| |
Collapse
|
19
|
Ter Schiphorst A, Tatu L, Thijs V, Demattei C, Thouvenot E, Renard D. Small obliquely oriented cortical cerebellar infarctions are associated with cardioembolic stroke. BMC Neurol 2019; 19:100. [PMID: 31103038 PMCID: PMC6525367 DOI: 10.1186/s12883-019-1328-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 05/08/2019] [Indexed: 11/17/2022] Open
Abstract
Background A revised classification of cerebellar infarctions (CI) may uncover unrecognized associations with etiologic stroke subtypes. We hypothesized that obliquely oriented small cortical cerebellar infarction (SCCI) representing end zone infarctions on MRI would be associated with cardiac embolism. Methods We retrospectively analyzed consecutive stroke patients recruited between January–December 2016 in our center. Analyzed baseline characteristics: sex, age, cardiovascular risk factors, history of stroke or atrial fibrillation (AF). TOAST classification was used for determining stroke subtype. Acute infarction location (anterior/posterior/mixed anterior-posterior circulation), acute uni- or multiterritorial infarction, and acute or chronic CI/SCCI/non-SCCI were assessed by MRI, and vertebrobasilar stenosis/occlusion by vessel imaging. Pre-specified analysis was also performed in patients without known high cardioembolic risk (known AF history or acute multiterritorial infarction). Results We included 452 patients (CI in 154, isolated SCCI in 55, isolated non-SCCI in 50, and mixed SCCI/non-SCCI in 49). Both SCCI and non-SCCI were associated with AF history (SCCI, p = 0.021; non-SCCI, p = 0.004), additional acute posterior circulation infarction (p < 0.001 both CI-subtypes), multiterritorial infarctions (SCCI, p = 0.003; non-SCCI, p < 0.001) and cardioembolic more frequent than large-artery atherosclerosis origin (p < 0.001 for both CI-subtypes). SCCI was associated with older age (p < 0.001), whereas non-SCCI was associated with stroke history (p = 0.036) and vertebrobasilar stenosis/occlusion (p = 0.002). SCCI were older (p = 0.046) than non-SCCI patients, had less frequently prior stroke (p < 0.001), and more frequent cardioembolic infarction (p = 0.025). In patients without known high cardioembolic risk (n = 348), SCCI was strongly associated with subsequent cardioembolism diagnosis (OR 3.00 [CI 1.58–5.73, p < 0.001]). No such association was present in non-SCCI. Conclusions Acute or chronic SCCI are strongly associated with a cardioembolic origin.
Collapse
Affiliation(s)
- Adrien Ter Schiphorst
- Department of Neurology, Nîmes University Hospital, Hôpital Carémeau, 4, Rue du Pr Debré, 30029, Nîmes, Cedex 4, France
| | - Lavinia Tatu
- Department of Neurology, Nîmes University Hospital, Hôpital Carémeau, 4, Rue du Pr Debré, 30029, Nîmes, Cedex 4, France
| | - Vincent Thijs
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Vic, Australia.,Department of Neurology, Austin Health, Heidelberg, Vic, Australia
| | - Christophe Demattei
- Service de Biostatistique, Epidémiologie Clinique, Santé Publique et Innovation en Méthodologie (BESPIM), Nîmes University Hospital, Nîmes, France
| | - Eric Thouvenot
- Department of Neurology, Nîmes University Hospital, Hôpital Carémeau, 4, Rue du Pr Debré, 30029, Nîmes, Cedex 4, France.,Institut de Génomique Fonctionnelle, UMR5203, INSERM 1191, Université Montpellier, Montpellier, France
| | - Dimitri Renard
- Department of Neurology, Nîmes University Hospital, Hôpital Carémeau, 4, Rue du Pr Debré, 30029, Nîmes, Cedex 4, France.
| |
Collapse
|
20
|
Vernooij MW, Barkhof F. Neuroimaging in Normal Brain Aging. Clin Neuroradiol 2019. [DOI: 10.1007/978-3-319-68536-6_63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
21
|
Arterial spin labeling MR imaging for the clinical detection of cerebellar hypoperfusion in patients with spinocerebellar degeneration. J Neurol Sci 2018; 394:58-62. [PMID: 30216759 DOI: 10.1016/j.jns.2018.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 08/27/2018] [Accepted: 09/05/2018] [Indexed: 11/21/2022]
Abstract
PURPOSE The aim of this study was to evaluate the clinical utility of arterial spin labeling (ASL) magnetic resonance imaging (MRI) for the detection of cerebellar hypoperfusion in patients with spinocerebellar degeneration (SCD). METHODS Regional cerebral blood flow (CBF) were obtained from ASL and 123I-IMP single-photon emission computed tomography (SPECT) images by volume-of-interest analysis in patients with SCD (n = 16). Regional CBF were also measured by ASL in age-matched controls (n = 19) and by SPECT in separate controls (n = 17). The cerebellar CBF values were normalized to the CBF values for the whole gray matter (nCBF) in ASL and SPECT. RESULTS The mean cerebellar nCBF measured by ASL was lower in patients with SCD (0.70 ± 0.09) than in the controls (0.91 ± 0.05) (p < 0.001), which was consistent with the comparison using SPECT (0.82 ± 0.05 vs. 0.98 ± 0.05, p < 0.001). The cerebellar nCBF measured by ASL significantly correlated with that determined by SPECT in patients (r = 0.56, p < 0.001). CONCLUSIONS ASL imaging showed decreased cerebellar blood flow, which correlated with that measured by SPECT, in patients with SCD. These findings suggest the clinical utility of noninvasive MRI with ASL for detecting cerebellar hypoperfusion in addition to atrophy, which would aid the diagnosis of SCD.
Collapse
|
22
|
Neuroimaging in Normal Brain Aging. Clin Neuroradiol 2018. [DOI: 10.1007/978-3-319-61423-6_63-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
|