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Lee HI, Kwon E, Oh E, Jeong SH. Antisaccades in Spinocerebellar Ataxia Type 17 With Middle Cerebellar Peduncle Hyperintensities Without Hot-Cross-Bun Sign. J Clin Neurol 2024; 20:342-344. [PMID: 38713080 PMCID: PMC11076195 DOI: 10.3988/jcn.2023.0397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/06/2023] [Accepted: 02/08/2024] [Indexed: 05/08/2024] Open
Affiliation(s)
- Hak-In Lee
- Department of Neurology, Chungnam National University Hospital, Daejeon, Korea
| | - Eunjin Kwon
- Department of Neurology, Chungnam National University Hospital, Daejeon, Korea
| | - Eungseok Oh
- Department of Neurology, Chungnam National University Hospital, Daejeon, Korea
- Department of Neurology, Chungnam National University School of Medicine, Daejeon, Korea
| | - Seong-Hae Jeong
- Department of Neurology, Chungnam National University Hospital, Daejeon, Korea
- Department of Neurology, Chungnam National University School of Medicine, Daejeon, Korea.
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2
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Gao Y, Zhao Y, Li M, Lawless RD, Schilling KG, Xu L, Shafer AT, Beason-Held LL, Resnick SM, Rogers BP, Ding Z, Anderson AW, Landman BA, Gore JC. Functional alterations in bipartite network of white and grey matters during aging. Neuroimage 2023; 278:120277. [PMID: 37473978 PMCID: PMC10529380 DOI: 10.1016/j.neuroimage.2023.120277] [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: 04/14/2023] [Revised: 06/23/2023] [Accepted: 07/11/2023] [Indexed: 07/22/2023] Open
Abstract
The effects of normal aging on functional connectivity (FC) within various brain networks of gray matter (GM) have been well-documented. However, the age effects on the networks of FC between white matter (WM) and GM, namely WM-GM FC, remains unclear. Evaluating crucial properties, such as global efficiency (GE), for a WM-GM FC network poses a challenge due to the absence of closed triangle paths which are essential for assessing network properties in traditional graph models. In this study, we propose a bipartite graph model to characterize the WM-GM FC network and quantify these challenging network properties. Leveraging this model, we assessed the WM-GM FC network properties at multiple scales across 1,462 cognitively normal subjects aged 22-96 years from three repositories (ADNI, BLSA and OASIS-3) and investigated the age effects on these properties throughout adulthood and during late adulthood (age ≥70 years). Our findings reveal that (1) heterogeneous alterations occurred in region-specific WM-GM FC over the adulthood and decline predominated during late adulthood; (2) the FC density of WM bundles engaged in memory, executive function and processing speed declined with age over adulthood, particularly in later years; and (3) the GE of attention, default, somatomotor, frontoparietal and limbic networks reduced with age over adulthood, and GE of visual network declined during late adulthood. These findings provide unpresented insights into multi-scale alterations in networks of WM-GM functional synchronizations during normal aging. Furthermore, our bipartite graph model offers an extendable framework for quantifying WM-engaged networks, which may contribute to a wide range of neuroscience research.
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Affiliation(s)
- Yurui Gao
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA.
| | - Yu Zhao
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Muwei Li
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Richard D Lawless
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Electrical and Computer Engineering, Vanderbilt University, Nashville, TN, USA
| | - Kurt G Schilling
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lyuan Xu
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Electrical and Computer Engineering, Vanderbilt University, Nashville, TN, USA
| | - Andrea T Shafer
- Laboratory of Behavioral Neuroscience, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| | - Lori L Beason-Held
- Laboratory of Behavioral Neuroscience, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| | - Susan M Resnick
- Laboratory of Behavioral Neuroscience, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| | - Baxter P Rogers
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Zhaohua Ding
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA; Department of Electrical and Computer Engineering, Vanderbilt University, Nashville, TN, USA; Department of Computer Science, Vanderbilt University, Nashville, TN, USA
| | - Adam W Anderson
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Bennett A Landman
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Electrical and Computer Engineering, Vanderbilt University, Nashville, TN, USA; Department of Computer Science, Vanderbilt University, Nashville, TN, USA
| | - John C Gore
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.
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3
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Liu H, Lin J, Shang H. Voxel-based meta-analysis of gray matter and white matter changes in patients with spinocerebellar ataxia type 3. Front Neurol 2023; 14:1197822. [PMID: 37576018 PMCID: PMC10413272 DOI: 10.3389/fneur.2023.1197822] [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: 03/31/2023] [Accepted: 07/10/2023] [Indexed: 08/15/2023] Open
Abstract
Purpose Increasing neuroimaging studies have revealed gray matter (GM) and white matter (WM) anomalies of several brain regions by voxel-based morphometry (VBM) studies on patients with spinocerebellar ataxia type 3 (SCA3); however, the findings of previous studies on SCA3 patients by VBM studies remain inconsistent. The study aimed to identify consistent findings of gray matter (GM) and white matter (WM) changes in SCA3 patients by voxel-wise meta-analysis of whole-brain VBM studies. Methods VBM studies comparing GM or WM changes in SCA3 patients and healthy controls (HCs) were retrieved from PubMed, Embase, Web of Science, and Medline databases from January 1990 to February 2023. Manual searches were also conducted, and authors of studies were contacted for additional data. The coordinates with significant differences in GM and WM between SCA3 patients and HCs were extracted from each cluster. A meta-analysis was performed using anisotropic effect size-based signed differential mapping (AES-SDM) software. Results A total of seven studies comprising 160 SCA3 patients and 165 HCs were included in the GM volume meta-analysis. Three studies comprising 57 SCA3 patients and 63 HCs were included for WM volume meta-analysis. Compared with HC subjects, the reduced GM volume in SCA3 patients was found in the bilateral cerebellar hemispheres, cerebellar vermis, pons, right lingual gyrus, and right fusiform gyrus. The decreased WM volume was mainly concentrated in the bilateral cerebellar hemispheres, right corticospinal tract, middle cerebellar peduncles, cerebellar vermis, and left lingual gyrus. No increased density or volume of any brain structures was found. In the jackknife sensitivity analysis, the results remained largely robust. Conclusion Our meta-analysis clearly found the shrinkage of GM and WM volume in patients with SCA3. These lesions are involved in ataxia symptoms, abnormal eye movements, visual impairment, cognitive impairment, and affective disorders. The findings can explain the clinical manifestations and provide a morphological basis for SCA3.
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Affiliation(s)
- Hai Liu
- Department of Neurology, Laboratory of Neurodegenerative Disorders, Rare Disease Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Neurology, Xuanhan County People's Hospital, Dazhou, Sichuan, China
| | - Junyu Lin
- Department of Neurology, Laboratory of Neurodegenerative Disorders, Rare Disease Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Huifang Shang
- Department of Neurology, Laboratory of Neurodegenerative Disorders, Rare Disease Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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4
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Kuang Q, Huang M, Lei Y, Wu L, Jin C, Dai J, Zhou F. Clinical and cognitive correlates tractography analysis in patients with white matter hyperintensity of vascular origin. Front Neurosci 2023; 17:1187979. [PMID: 37397447 PMCID: PMC10311635 DOI: 10.3389/fnins.2023.1187979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/30/2023] [Indexed: 07/04/2023] Open
Abstract
Purpose White matter hyperintensity lesions (WMHL) in the brain are a consequence of cerebral small vessel disease and microstructural damage. Patients with WMHL have diverse clinical features, and hypertension, advanced age, obesity, and cognitive decline are often observed. However, whether these clinical features are linked to interrupted structural connectivity in the brain requires further investigation. This study therefore explores the white matter pathways associated with WMHL, with the objective of identifying neural correlates for clinical features in patients with WMHL. Methods Diffusion magnetic resonance imaging (MRI) and several clinical features (MoCA scores, hypertension scores, body mass index (BMI), duration of hypertension, total white matter lesion loads, and education.) highly related to WMHL were obtained in 16 patients with WMHL and 20 health controls. We used diffusion MRI connectometry to explore the relationship between clinical features and specific white matter tracts using DSI software. Results The results showed that the anterior splenium of the corpus callosum, the inferior longitudinal fasciculus, the anterior corpus callosum and the middle cerebellar peduncle were significantly correlated with hypertension scores (false discovery rate (FDR) = 0.044). The anterior splenium of the corpus callosum, the left thalamoparietal tract, the inferior longitudinal fasciculus, and the left cerebellar were significantly correlated with MoCA scores (FDR = 0.016). The anterior splenium of corpus callosum, inferior fronto-occipital fasciculus, cingulum fasciculus, and fornix/fimbria were significantly correlated with body mass index (FDR = 0.001). Conclusion Our findings show that hypertension score, MoCA score, and BMI are important clinical features in patients with WMHL, hypertension degree and higher BMI are associated with whiter matter local disconnection in patients with WMHL, and may contribute to understanding the cognitive impairments observed in patients with WMHL.
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Affiliation(s)
- Qinmei Kuang
- Department of Radiology, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Clinical Research Center for Medical Imaging in Jiangxi Province, Nanchang, China
| | - Muhua Huang
- Department of Radiology, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Clinical Research Center for Medical Imaging in Jiangxi Province, Nanchang, China
| | - Yumeng Lei
- Department of Radiology, Nanchang First Hospital, Nanchang, Jiangxi, China
| | - Lin Wu
- Department of Radiology, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Clinical Research Center for Medical Imaging in Jiangxi Province, Nanchang, China
| | - Chen Jin
- Department of Radiology, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Clinical Research Center for Medical Imaging in Jiangxi Province, Nanchang, China
| | - Jiankun Dai
- GE Healthcare, MR Research China, Beijing, China
| | - Fuqing Zhou
- Department of Radiology, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Clinical Research Center for Medical Imaging in Jiangxi Province, Nanchang, China
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5
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Giulivi C, Wang JY, Hagerman RJ. Artificial neural network applied to fragile X-associated tremor/ataxia syndrome stage diagnosis based on peripheral mitochondrial bioenergetics and brain imaging outcomes. Sci Rep 2022; 12:21382. [PMID: 36496525 PMCID: PMC9741636 DOI: 10.1038/s41598-022-25615-2] [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: 05/04/2022] [Accepted: 12/01/2022] [Indexed: 12/13/2022] Open
Abstract
No proven prognosis is available for the neurodegenerative disorder fragile X-associated tremor/ataxia syndrome (FXTAS). Artificial neural network analyses (ANN) were used to predict FXTAS progression using data from 127 adults (noncarriers and FMR1 premutation carriers with and without FXTAS) with five outcomes from brain MRI imaging and 22 peripheral bioenergetic outcomes from two cell types. Diagnosis accuracy by ANN predictions ranged from 41.7 to 86.3% (depending on the algorithm used), and those misclassified usually presented a higher FXTAS stage. ANN prediction of FXTAS stages was based on a combination of two imaging findings (white matter hyperintensity and whole-brain volumes adjusted for intracranial volume) and four bioenergetic outcomes. Those at Stage 3 vs. 0-2 showed lower mitochondrial mass, higher oxidative stress, and an altered electron transfer consistent with mitochondrial unfolded protein response activation. Those at Stages 4-5 vs. 3 had higher oxidative stress and glycerol-3-phosphate-linked ATP production, suggesting that targeting mGPDH activity may prevent a worse prognosis. This was confirmed by the bioenergetic improvement of inhibiting mGPDH with metformin in affected fibroblasts. ANN supports the prospect of an unbiased molecular definition in diagnosing FXTAS stages while identifying potential targets for personalized medicine.
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Affiliation(s)
- Cecilia Giulivi
- grid.27860.3b0000 0004 1936 9684Department of Molecular Biosciences, School of Veterinary Medicine, University of California Davis, Davis, CA USA ,grid.413079.80000 0000 9752 8549MIND Institute, University of California at Davis Medical Center, Sacramento, CA USA
| | - Jun Yi Wang
- grid.413079.80000 0000 9752 8549MIND Institute, University of California at Davis Medical Center, Sacramento, CA USA ,grid.27860.3b0000 0004 1936 9684Center for Mind and Brain, University of California Davis, Davis, CA USA
| | - Randi J. Hagerman
- grid.413079.80000 0000 9752 8549MIND Institute, University of California at Davis Medical Center, Sacramento, CA USA ,grid.413079.80000 0000 9752 8549Department of Pediatrics, University of California at Davis Medical Center, Sacramento, CA USA
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Vogrig A, Janes F, Del Negro I, Gigli GL, Valente M. Response to Letter to the Editor on the article “Acute disseminated encephalomyelitis after SARS-CoV-2 vaccination”. Clin Neurol Neurosurg 2022; 213:107129. [PMID: 35065531 PMCID: PMC8760631 DOI: 10.1016/j.clineuro.2022.107129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 01/05/2022] [Indexed: 11/16/2022]
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Khan F, Sharma N, Ud Din M, Akabalu IG. Clinically Isolated Brainstem Progressive Multifocal Leukoencephalopathy: Diagnostic Challenges. AMERICAN JOURNAL OF CASE REPORTS 2022; 23:e935019. [PMID: 35001072 PMCID: PMC8762610 DOI: 10.12659/ajcr.935019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patient: Female, 47-year-old
Final Diagnosis: Brainstem progressive multifocal leukoencephalopathy
Symptoms: Dizziness • intermittent slurred speech • right-sided facial droop and numbness
Medication: —
Clinical Procedure: Lumbar puncture
Specialty: Neurology
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Affiliation(s)
- Faisal Khan
- Department of Neurology, Sam Houston State University College of Osteopathic Medicine, Huntsville, TX, USA.,Research Fellow, Houston Medical Clerkship, Sugar Land, TX, USA
| | - Neha Sharma
- Research Fellow, Houston Medical Clerkship, Sugar Land, TX, USA
| | - Moin Ud Din
- Research Fellow, Houston Medical Clerkship, Sugar Land, TX, USA
| | - Ijeoma Gloria Akabalu
- Medical Student 4, Caribbean Medical University School of Medicine, Willemstad, Curacao, Netherlands Antilles
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8
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Kritikos M, Huang C, Clouston SAP, Pellecchia AC, Mejia-Santiago S, Carr MA, Hagan T, Kotov R, Gandy S, Sano M, Horton M, Bromet EJ, Lucchini RG, Luft BJ. DTI Connectometry Analysis Reveals White Matter Changes in Cognitively Impaired World Trade Center Responders at Midlife. J Alzheimers Dis 2022; 89:1075-1089. [PMID: 35964183 PMCID: PMC9730899 DOI: 10.3233/jad-220255] [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] [Indexed: 01/03/2023]
Abstract
BACKGROUND More than 8% of responders who participated in the search and rescue efforts at the World Trade Center (WTC) following 9/11 developed early-onset cognitive impairment (CI). Approximately 23% were also diagnosed with chronic post-traumatic stress disorder (PTSD). OBJECTIVE To shed light on the pathophysiology of these WTC-related conditions, we examined diffusion connectometry to identify altered white matter tracts in WTC responders with CI and/or PTSD compared to unaffected responders. METHODS 99 WTC responders (mean age 56 years) consisting of CI-/PTSD- (n = 27), CI+/PTSD- (n = 25), CI-/PTSD+ (n = 24), and CI+/PTSD+ (n = 23) were matched on age, sex, occupation, race, and education. Cognitive status was determined using the Montreal Cognitive Assessment and PTSD status was determined using the DSM-IV SCID. Diffusion tensor imaging was acquired on a 3T Siemens Biograph mMR scanner. Connectometry analysis was used to examine whole-brain tract-level differences in white matter integrity as reflected by fractional anisotropy (FA) values after adjusting for confounders. RESULTS Analyses identified that FA was negatively correlated with CI and PTSD status in the fornix, cingulum, forceps minor of the corpus callosum and the right uncinate fasciculus. Furthermore, FA was negatively correlated with PTSD status, regardless of CI status in the superior thalamic radiation and the cerebellum. CONCLUSION This is the first connectometry study to examine altered white matter tracts in a sample of WTC responders with CI and/or PTSD. Results from this study suggest that WTC responders with early-onset CI may be experiencing an early neurodegenerative process characterized by decreased FA in white matter tracts.
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Affiliation(s)
- Minos Kritikos
- Program in Public Health and Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Chuan Huang
- Department of Radiology, Renaissance School of Medicine at Stony Brook, Stony Brook, NY
| | - Sean A. P. Clouston
- Program in Public Health and Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Alison C. Pellecchia
- Stony Brook World Trade Center Wellness Program, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Stephanie Mejia-Santiago
- Stony Brook World Trade Center Wellness Program, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Melissa A. Carr
- Stony Brook World Trade Center Wellness Program, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Thomas Hagan
- Department of Radiology, Renaissance School of Medicine at Stony Brook, Stony Brook, NY
| | - Roman Kotov
- Department of Psychiatry, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Sam Gandy
- James J Peters VA Medical Center, 130 West Kingsbridge Road, Bronx NY, 10468
- Department of Psychiatry and Mount Sinai Alzheimer’s Disease Research Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Center for Cognitive Health and Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mary Sano
- Department of Psychiatry and Mount Sinai Alzheimer’s Disease Research Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Center for Cognitive Health and Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Megan Horton
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinair, New York, NY, USA
| | - Evelyn J. Bromet
- Department of Psychiatry, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Roberto G. Lucchini
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinair, New York, NY, USA
| | - Benjamin J. Luft
- Stony Brook World Trade Center Wellness Program, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
- Department of Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
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Neuro-image: bilateral acute infarction of the middle cerebellar peduncles. Acta Neurol Belg 2021; 121:1339-1340. [PMID: 33449271 DOI: 10.1007/s13760-020-01584-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 12/18/2020] [Indexed: 10/22/2022]
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10
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Molecular Pathogenesis and Peripheral Monitoring of Adult Fragile X-Associated Syndromes. Int J Mol Sci 2021; 22:ijms22168368. [PMID: 34445074 PMCID: PMC8395059 DOI: 10.3390/ijms22168368] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 12/16/2022] Open
Abstract
Abnormal trinucleotide expansions cause rare disorders that compromise quality of life and, in some cases, lifespan. In particular, the expansions of the CGG-repeats stretch at the 5’-UTR of the Fragile X Mental Retardation 1 (FMR1) gene have pleiotropic effects that lead to a variety of Fragile X-associated syndromes: the neurodevelopmental Fragile X syndrome (FXS) in children, the late-onset neurodegenerative disorder Fragile X-associated tremor-ataxia syndrome (FXTAS) that mainly affects adult men, the Fragile X-associated primary ovarian insufficiency (FXPOI) in adult women, and a variety of psychiatric and affective disorders that are under the term of Fragile X-associated neuropsychiatric disorders (FXAND). In this review, we will describe the pathological mechanisms of the adult “gain-of-function” syndromes that are mainly caused by the toxic actions of CGG RNA and FMRpolyG peptide. There have been intensive attempts to identify reliable peripheral biomarkers to assess disease progression and onset of specific pathological traits. Mitochondrial dysfunction, altered miRNA expression, endocrine system failure, and impairment of the GABAergic transmission are some of the affectations that are susceptible to be tracked using peripheral blood for monitoring of the motor, cognitive, psychiatric and reproductive impairment of the CGG-expansion carriers. We provided some illustrative examples from our own cohort. Understanding the association between molecular pathogenesis and biomarkers dynamics will improve effective prognosis and clinical management of CGG-expansion carriers.
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Tokumaru AM, Saito Y, Murayma S. Diffusion-Weighted Imaging is Key to Diagnosing Specific Diseases. Magn Reson Imaging Clin N Am 2021; 29:163-183. [PMID: 33902901 DOI: 10.1016/j.mric.2021.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This article reviews diseases for which persistent signal abnormalities on diffusion-weighted imaging are the key to their diagnosis. Specifically, updated knowledge regarding the neuroimaging patterns of the following diseases is summarized: sporadic Creutzfeldt-Jakob disease, neuronal intranuclear inclusion disease, and hereditary diffuse leukoencephalopathy with axonal spheroids-colony-stimulating factor receptors/adult-onset leukoencephalopathy with axonal spheroids and pigmented glia. In addition, their differential diagnoses; clinical manifestations; and pathologic, genetic, and imaging correlates are discussed.
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Affiliation(s)
- Aya Midori Tokumaru
- Department of Diagnostic Radiology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan.
| | - Yuko Saito
- Brain Bank for Aging Research, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan
| | - Shigeo Murayma
- Brain Bank for Aging Research, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan; Brain Bank for Neurodevelopmental, Neurological and Psychiatric Disorders, United Graduate School of Child Development, Osaka University, 2-2, Yamadaoka, Suita-shi, Osaka-fu 565-0871, Japan
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12
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Lux D, Edwards M, Zhang L. Suspecting unwitnessed hypoglycaemia. Pract Neurol 2021; 21:practneurol-2020-002887. [PMID: 33850032 DOI: 10.1136/practneurol-2020-002887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2021] [Indexed: 11/03/2022]
Abstract
Hypoglycaemic coma can present with acute neurological dysfunction mimicking stroke. It may be masked by normoglycaemia due to physiological compensatory mechanisms (Somogyi phenomenon). Specific MR brain scan changes should alert the clinician to consider this alternative to stroke in the acute setting in patients with a history of recurrent hypoglycaemia, even when the blood glucose is not low at presentation. Rapid identification and treatment of hypoglycaemia may confer a good prognosis with radiological resolution.
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Affiliation(s)
- Danielle Lux
- Department of Neurology and Stroke Medicine, St George's Hospital Atkinson Morley Regional Neuroscience Centre, London, Greater London, UK
| | - Mark Edwards
- Department of Neurology, St George's Hospital Atkinson Morley Regional Neuroscience Centre, London, Greater London, UK
| | - Liqun Zhang
- Department of Neurology and Stroke Medicine, St George's Hospital Atkinson Morley Regional Neuroscience Centre, London, Greater London, UK
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13
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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: 8] [Impact Index Per Article: 2.0] [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.
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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
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14
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Naik SS, Vanidassane I, Dhamija E, Sharma A. A unique presentation of 5-fluorouracil (5-FU) induced cerebral encephalopathy. Indian J Radiol Imaging 2020; 30:214-217. [PMID: 33100691 PMCID: PMC7546294 DOI: 10.4103/ijri.ijri_17_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 09/10/2019] [Accepted: 04/08/2020] [Indexed: 12/14/2022] Open
Abstract
5-Fluorouracil (5-FU), a commonly used antimetabolite and antineoplastic agent, has been approved for the treatment of various cancers. It is associated with systemic side-effects such as gastrointestinal problems, neutropenia. 5-FU-related encephalopathy is very rarely reported. Imaging with computed tomography (CT) and magnetic resonance imaging (MRI) plays a key role in diagnosing and monitoring the changes. Since the prognosis of cerebral involvement is usually good if recognized and treated in time, the reporting radiologist and treating physician should be familiar with them. We present a rare case of 5-FU-induced encephalopathy that was diagnosed based on her clinical and MRI findings and managed successfully.
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Affiliation(s)
| | | | - Ekta Dhamija
- Department of Radiodiagnosis, IRCH, AIIMS, New Delhi, India
| | - Atul Sharma
- Department of Medical Oncology, IRCH, AIIMS, New Delhi, India
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15
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Differential value of brain magnetic resonance imaging in multiple system atrophy cerebellar phenotype and spinocerebellar ataxias. Sci Rep 2019; 9:17329. [PMID: 31758059 PMCID: PMC6874541 DOI: 10.1038/s41598-019-53980-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 11/05/2019] [Indexed: 02/08/2023] Open
Abstract
Clinically differentiating multiple system atrophy cerebellar (MSA-C) phenotype and spinocerebellar ataxias (SCAs) is challenging especially in the early stage. We assessed diagnostic value of brain magnetic resonance imaging (MRI) in differentiating MSA-C and SCAs based at different disease stages (<3, 3–7, and >7 years of disease duration). Overall, 186 patients with probable MSA-C and 117 with genetically confirmed SCAs were included. Hot cross bun (HCB) signs and middle cerebellar peduncle (MCP) hyperintensities were exclusively prevalent in MSA-C compared to SCAs at <3 years (HCB, 44.6% versus 0.9%; MCP hyperintensities, 38.3% versus 0.9%, respectively). Sensitivity, specificity, and positive predictive value (PPV) for HCB signs to differentiate MSA-C from SCAs were 45%, 99%, and 99% and those for MCP hyperintensities were 68%, 99%, and 99%, respectively; considering both HCB signs and MCP hyperintensities, specificity and PPV were 100%. However, the differential value of MRI signs decreased over time. MCP widths were smaller and showed more significant decrease in MSA-C than in SCAs. In conclusion, pontine and MCP changes were exclusively prominent in early stage MSA-C rather than in SCAs. Therefore, we should consider disease duration when interpreting pontine and MCP changes in brain MRIs, which will help better differentiate MSA-C and SCAs.
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16
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Successful treatment of non-HIV progressive multifocal leukoencephalopathy: case report and literature review. J Neurol 2019; 267:731-738. [PMID: 31728711 DOI: 10.1007/s00415-019-09629-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 11/05/2019] [Accepted: 11/07/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Progressive multifocal leukoencephalopathy (PML) is a subacute onset demyelinating disease caused by JC virus and characterized by multifocal involvement of the subcortical white matter and cerebellar hemispheres or peduncles on magnetic resonance imaging (MRI). However, non-HIV PML patients with brain lesions limited to the cerebellum and brainstem have not been well characterized. METHODS We report a 68-year-old man with systemic lupus erythematosus under treatment with immunosuppressants who developed non-HIV PML with brain lesions limited to the cerebellum and brainstem and successfully treated with a combination of mefloquine and mirtazapine. We performed a literature review to characterize patients with non-HIV PML with brain lesions limited to the cerebellum and brainstem. RESULTS Eight cases with non-HIV brainstem/cerebellar form PML were identified including our case. All cases had compromised status related underlying diseases. Four (50%) had a good prognosis. Five cases were treated, including 3 with favourable outcomes. Between the good prognosis group (n = 4) and the poor prognosis group (n = 4), treatment status for PML and the interval between the initial manifestation and diagnosis did not differ. Among those who performed contrast-enhanced brain imaging, lesion enhancement was related to good prognosis (good prognosis group vs. poor prognosis group; 100% vs. 0%). CONCLUSION PML should be considered in the differential diagnosis of brain lesions limited to the cerebellum and brainstem in immunocompromised patients. The presence of immune response against JC virus and inflammatory reactions may indicate good prognosis in non-HIV brainstem/cerebellar form PML.
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17
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He XW, Zhao R, Li GF, Zheng B, Wu YL, Shi YH, Liu YS, Zhuang MT, Yin JW, Cui GH, Liu JR. Lack of Correlation Between Intracranial Carotid Artery Modified Woodcock Calcification Score and Prognosis of Patients With Acute Ischemic Stroke After Intravenous Thrombolysis. Front Neurol 2019; 10:696. [PMID: 31312173 PMCID: PMC6614196 DOI: 10.3389/fneur.2019.00696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 06/13/2019] [Indexed: 01/01/2023] Open
Abstract
There have been few studies about the association between intracranial carotid artery calcification (ICAC) and acute ischemic stroke (AIS) prognosis after intravenous thrombolysis (IVT). We aimed to analyze the association between ICAC and prognosis (including symptomatic intracranial hemorrhage (sICH), functional outcome and death) of AIS patients treated with IVT. In this retrospective study, we consecutively included 232 AIS patients treated with IVT between April 2012 and December 2018. ICAC was evaluated using the modified Woodcock calcification visual score on non-enhanced cranial computed tomography scans. Poor functional outcome was defined as a modified Rankin Scale score > 2 at 3 months. We found that the modified Woodcock calcification score was associated with ICH, poor outcome, and death in univariable analyses on the symptomatic side and/or bilaterally. However, after adjustment for other different covariates, the results showed no significant difference. We documented that the presence and severity of ICAC did not significantly modify the beneficial effects of rtPA treatment in AIS.
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Affiliation(s)
- Xin-Wei He
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rong Zhao
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ge-Fei Li
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bo Zheng
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi-Lan Wu
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan-Hui Shi
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi-Sheng Liu
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mei-Ting Zhuang
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jia-Wen Yin
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guo-Hong Cui
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jian-Ren Liu
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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18
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Prasad S, Pandey U, Saini J, Ingalhalikar M, Pal PK. Atrophy of cerebellar peduncles in essential tremor: a machine learning-based volumetric analysis. Eur Radiol 2019; 29:7037-7046. [PMID: 31161314 DOI: 10.1007/s00330-019-06269-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/16/2019] [Accepted: 05/07/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Subtle cerebellar signs are frequently observed in essential tremor (ET) and may be associated with cerebellar dysfunction. This study aims to evaluate the macrostructural integrity of the superior, middle, and inferior cerebellar peduncles (SCP, MCP, ICP) and cerebellar gray and white matter (GM, WM) volumes in patients with ET, and compare these volumes between patients with and without cerebellar signs (ETc and ETnc). METHODS Forty patients with ET and 37 age- and gender-matched healthy controls were recruited. Atlas-based region-of-interest analysis of the SCP, MCP, and ICP and automated analysis of cerebellar GM and WM volumes were performed. Peduncular volumes were employed in a multi-variate classification framework to attempt discrimination of ET from controls. RESULTS Significant atrophy of bilateral MCP and ICP and bilateral cerebellar GM was observed in ET. Cerebellar signs were present in 20% of subjects with ET. Comparison of peduncular and cerebellar volumes between ETnc and ETc revealed atrophy of right SCP, bilateral MCP and ICP, and left cerebellar WM in ETc. The multi-variate classifier could discriminate between ET and controls with a test accuracy of 86.66%. CONCLUSIONS Patients with ET have significant atrophy of cerebellar peduncles, particularly the MCP and ICP. Additional atrophy of the SCP is observed in the ETc group. These abnormalities may contribute to the pathogenesis of cerebellar signs in ET. KEY POINTS • Patients with ET have significant atrophy of bilateral middle and inferior cerebellar peduncles and cerebellar gray matter in comparison with healthy controls. • Patients of ET with cerebellar signs have significant atrophy of right superior cerebellar peduncle, bilateral middle and inferior cerebellar peduncle, and left cerebellar white matter in comparison with ET without cerebellar signs. • A multi-variate classifier employing peduncular volumes could discriminate between ET and controls with a test accuracy of 86.66%.
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Affiliation(s)
- Shweta Prasad
- Department of Clinical Neurosciences and Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bangalore, Karnataka, 560029, India
| | - Umang Pandey
- Symbiosis Center for Medical Image Analysis, Symbiosis International (Deemed) University, Lavale, Mulshi, Pune, Maharashtra, 412115, India
| | - Jitender Saini
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bangalore, Karnataka, 560029, India
| | - Madhura Ingalhalikar
- Symbiosis Center for Medical Image Analysis, Symbiosis International (Deemed) University, Lavale, Mulshi, Pune, Maharashtra, 412115, India.,Symbiosis Institute of Technology, Symbiosis International (Deemed) University, Lavale, Mulshi, Pune, Maharashtra, 412115, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bangalore, Karnataka, 560029, India.
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19
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Saleh C, Wilmes S, Blackham KA, Cordier D, Hug K, Hund-Georgiadis M. The cerebellar peduncle as localization of a recurrent atypical plexus papilloma: A case report. Surg Neurol Int 2019; 10:65. [PMID: 31528403 PMCID: PMC6744829 DOI: 10.25259/sni-189-2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 03/11/2019] [Indexed: 11/04/2022] Open
Abstract
Background: Choroid plexus papillomas (CPPs) are infrequently encountered brain tumors with the majority originating in the ventricular system. Rarely, CPP occurs outside of the ventricles. Case Description: We report the case of a recurrent CPP that initially originated within the fourth ventricle, though years later it recurred in the left middle cerebellar peduncle. Conclusion: Patients with cerebellar plexus papilloma need long-term follow-up comprising regular magnetic resonance imagings since, in patients with a history of CPP, any new mild symptomatology, even years after the initial presentation, may be an early sign of tumor recurrence.
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Affiliation(s)
- Christian Saleh
- REHAB Basel, Clinic for Neurorehabilitation and Paraplegiology, University Hospital Basel
| | - Stefanie Wilmes
- REHAB Basel, Clinic for Neurorehabilitation and Paraplegiology, University Hospital Basel
| | - Kristine Ann Blackham
- Department of Radiology, Division of Diagnostic and Interventional Neuroradiology, University Hospital Basel
| | - Dominik Cordier
- Department of Neurosurgery, University Hospital Basel, Basel, Switzerland
| | - Kerstin Hug
- REHAB Basel, Clinic for Neurorehabilitation and Paraplegiology, University Hospital Basel
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20
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Beraldo GL, Brito ABC, Delamain MT, Souza CAD, Lima CSP, Bonfitto JFL, Queiroz LDS, Reis F. Primary infratentorial diffuse large b-cell lymphoma: a challenging diagnosis in an immunocompetent patient. ACTA ACUST UNITED AC 2019; 65:136-140. [PMID: 30892435 DOI: 10.1590/1806-9282.65.2.136] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 05/26/2018] [Indexed: 11/21/2022]
Abstract
We describe the case of a female patient, 52 years old, with dizziness and left motor incoordination for 2 weeks. Brain MRI magnetic resonance imaging) revealed a hyperintense lesion on T2-weighted images, without restricted diffusion, in the left middle cerebellar peduncle. Spectroscopy demonstrated peak of lipids and perfusion did not show any elevation in relative cerebral blood volume (rCBV). The patient underwent an open biopsy and resection, and the diagnosis of diffuse large B-cell lymphoma (DLBCL) was established. The patient received intravenous dexamethasone with symptoms remission, followed by four cycles of methotrexate plus cytarabine. After 3 months, the patient returned with decreased consciences level and a new MRI revealed a right superior frontal gyrus lesion with features suggesting a lymphomatous lesion. The patient died five days after her relapse.
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Affiliation(s)
- Gabriel Laverdi Beraldo
- Department of Radiology, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo, SP, Brasil
| | | | - Márcia Torresan Delamain
- Department of Internal Medicine, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo, SP, Brasil
| | - Carmino Antonio de Souza
- Department of Internal Medicine, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo, SP, Brasil
| | - Carmen Silvia Passos Lima
- Department of Internal Medicine, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo, SP, Brasil
| | - João Felipe Leite Bonfitto
- Department of Pathology, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo, SP, Brasil
| | - Luciano de Souza Queiroz
- Department of Pathology, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo, SP, Brasil
| | - Fabiano Reis
- Department of Radiology, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo, SP, Brasil
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21
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Han Q, Yang J, Xiong H, Shang H. Voxel-based meta-analysis of gray and white matter volume abnormalities in spinocerebellar ataxia type 2. Brain Behav 2018; 8:e01099. [PMID: 30125476 PMCID: PMC6160648 DOI: 10.1002/brb3.1099] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 07/21/2018] [Accepted: 07/23/2018] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To identify the consistent findings from the whole-brain voxel-based morphometry (VBM) studies on spinocerebellar ataxia type 2 (SCA2). METHODS The whole-brain VBM studies comparing SCA2 patients and healthy controls (HCs) were systematically searched in PubMed, Embase databases from January 2000 to June 2017. The coordinates with significant differences in gray matter (GM) and white matter (WM) between SCA2 patients and HCs were extracted separately from each cluster. A meta-analysis was performed using anisotropic effect size-based signed differential mapping (AES-SDM) software. RESULTS A total of five studies with 65 SCA2 patients and 124 HCs were included in the GM meta-analysis. Four of the five studies with 50 SCA2 patients and 109 HCs were included in the WM meta-analysis. Significant and consistent GM volume reductions were detected in bilateral cerebellar hemispheres, cerebellar vermis, the right fusiform gyrus, the right parahippocampal gyrus, and the right lingual gyrus. The WM volume reductions were observed in bilateral cerebellar hemispheres, cerebellar vermis, middle cerebellar peduncles, pons, and bilateral cortico-spinal projections. The findings of the study remained largely unchanged in jackknife sensitivity analysis. CONCLUSIONS The consistent findings from our meta-analysis showed that GM volume reductions in SCA2 patients were not limited in cerebellum while significant WM volume reductions widely existed in cerebellum and pyramidal system. The findings provide morphological basis for further studies on SCA2.
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Affiliation(s)
- Qing Han
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jing Yang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hai Xiong
- Department of Geriatrics, The Fourth Affiliated Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Huifang Shang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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22
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Heidelberg D, Ronsin S, Bonneville F, Hannoun S, Tilikete C, Cotton F. Main inherited neurodegenerative cerebellar ataxias, how to recognize them using magnetic resonance imaging? J Neuroradiol 2018; 45:265-275. [PMID: 29920348 DOI: 10.1016/j.neurad.2018.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 05/09/2018] [Accepted: 05/28/2018] [Indexed: 12/12/2022]
Abstract
Ataxia is a neurodegenerative disease resulting from brainstem, cerebellar, and/or spinocerebellar tracts impairments. Symptoms onset could vary widely from childhood to late-adulthood. Autosomal cerebellar ataxias are considered as one of the most complex group in neurogenetics. In addition to their genetic heterogeneity, there is an important phenotypic variability in the expression of cerebellar impairment, complicating the genetic mutation research. A pattern recognition approach using brain MRI measures of atrophy, hyperintensities and iron-induced hypointensity of the dentate nuclei, could be therefore helpful in guiding genetic research. This review will discuss a pattern recognition approach that, associated with the age at disease onset, and clinical manifestations, may help neuroradiologists differentiate the most frequent profiles of ataxia.
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Affiliation(s)
- D Heidelberg
- Faculty of Medicine, Claude-Bernard Lyon 1 University, 69000 Lyon, France; Service de radiologie and Laboratoire d'anatomie de Rockefeller, centre hospitalier Lyon Sud, hospices civils de Lyon, 69000 Lyon, France
| | - S Ronsin
- Neuro-ophtalmology unit and neurology D, Neurological and Neurosurgical Hospital P. Wertheimer, Hospices Civils de Lyon, 69000 Lyon, France
| | - F Bonneville
- Service de neuroradiologie diagnostique et thérapeutique, Hôpitaux de Toulouse, Hôpital Pierre-Paul-Riquet, 31000 Toulouse, France
| | - S Hannoun
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, 1107, 2020 Beirut, Lebanon
| | - C Tilikete
- Faculty of Medicine, Claude-Bernard Lyon 1 University, 69000 Lyon, France; Neuro-ophtalmology unit and neurology D, Neurological and Neurosurgical Hospital P. Wertheimer, Hospices Civils de Lyon, 69000 Lyon, France; Lyon neuroscience research center, Inserm U1028, CNRS UMR5292, Impact Team, 69000 Lyon, France
| | - F Cotton
- Faculty of Medicine, Claude-Bernard Lyon 1 University, 69000 Lyon, France; Service de radiologie and Laboratoire d'anatomie de Rockefeller, centre hospitalier Lyon Sud, hospices civils de Lyon, 69000 Lyon, France; CREATIS, Inserm U1044/CNRS UMR 5220, 69000 Lyon, France.
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Morales H, Kong M. Stroke Mimics: The Quest for Leptomeningeal Anastomoses and Isolated Diffusion-Weigthed MR Signal. Semin Ultrasound CT MR 2018; 39:425-440. [PMID: 30244758 DOI: 10.1053/j.sult.2018.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Stroke is caused by occlusion of a medium- or large-sized vessel in the brain. The treatment with either intravenous or intra-arterial thrombolysis is based on an accurate and time-sensitive diagnosis. On clinical and imaging grounds a number of entities-seizures, toxic-metabolic, infectious, or demyelinating diseases-can mimic stroke. Identifying them is paramount as the treatment differs significantly. Prior imaging reviews have focused on the nonterritorial distribution of these mimics. However, some important questions arise here. Are the vascular territories and their boundaries invariable in the human brain? Where should we draw the lines separating arterial territories? van der Zwan and colleagues addressed these questions decades ago. For him and others, the leptomeningeal anastomoses-a contentious concept for some but increasingly linked to collateral flow in stroke-is an important anatomic structure with significant variations in their distribution and pathophysiology. Variations in blood supply appear larger that traditionally taught. We revisit this concept and entertained their implications in cases of stroke mimics. For instance, the distribution of abnormalities in some toxic-metabolic processes appear to correlate with areas where rich leptomeningeal anastomoses are expected. We will also explore the concept of hyperintense signal on diffusion weighted-imaging with no correlated changes on apparent diffusion coefficient maps. We name this finding as "isolated DWI signal" and lay-out its importance in the recognition of many entities mimicking stroke. Taking together, the discussed anatomic and imaging concepts will help radiologists and clinicians to recognize not only the common but the unusual entities imitating stroke in the emergency room.
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Affiliation(s)
- Humberto Morales
- Section of Neuroradiology, University of Cincinnati Medical Center.
| | - Marshall Kong
- Section of Neuroradiology, University of Cincinnati Medical Center
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24
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Iapadre G, Morana G, Vari MS, Pinto F, Lanteri P, Tessa A, Santorelli FM, Striano P, Verrotti A. A novel homozygous MFN2 mutation associated with severe and atypical CMT2 phenotype. Eur J Paediatr Neurol 2018; 22:563-567. [PMID: 29361379 DOI: 10.1016/j.ejpn.2017.12.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 12/12/2017] [Accepted: 12/28/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Charcot-Marie-Tooth (CMT) neuropathies represent the most common forms of inherited polyneuropathies. CMT2A, the axonal form, accounts for about one third of all CMT cases. Variants in the MFN2 gene have been recognized to be a major cause of CMT2A. To date, more than 100 pathogenetic mutations in MFN2 have been identified, leading to different neurological clinical spectrum, varying from hereditary neuropathies to more severe clinical phenotypes. Pathogenic variants in MFN2 mainly act in a dominant manner, although in a few sporadic or familial cases, homozygous or compound heterozygous mutations have been reported. RESULTS We describe a child carrying a novel homozygous MFN2 mutation leading to an early-onset sensorimotor axonal neuropathy with an atypical and severe phenotype. CONCLUSION The case highlights a very rare mechanism of inheritance for MFN2 mutations and expands the clinical and allelic variance of severe CMT2A phenotype. Moreover, it proposes the involvement of cerebellar peduncles observed at neuroimaging as a novel clue to suspect the diagnosis and address genetic testing.
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Affiliation(s)
- Giulia Iapadre
- Department of Pediatrics, University of L'Aquila, L'Aquila, Italy
| | - Giovanni Morana
- Neuroradiology, Department of Head and Neck, "G. Gaslini" Institute, Genova, Italy
| | - Maria Stella Vari
- Pediatric Neurology and Muscular Diseases Unit, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, "G. Gaslini" Institute, Genova, Italy
| | - Francesca Pinto
- Pediatric Neurology and Muscular Diseases Unit, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, "G. Gaslini" Institute, Genova, Italy
| | - Paola Lanteri
- Child Neuropsychiatry, Department of Head and Neck, "G. Gaslini" Institute, Genova, Italy
| | - Alessandra Tessa
- Molecular Medicine and Neurogenetics, IRCCS Stella Maris, Pisa, Italy
| | | | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, "G. Gaslini" Institute, Genova, Italy
| | - Alberto Verrotti
- Department of Pediatrics, University of L'Aquila, L'Aquila, Italy.
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Subacute Sclerosing Panencephalitis of the Brainstem as a Clinical Entity. Med Sci (Basel) 2017; 5:medsci5040026. [PMID: 29112137 PMCID: PMC5753655 DOI: 10.3390/medsci5040026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 10/30/2017] [Accepted: 11/03/2017] [Indexed: 12/16/2022] Open
Abstract
Subacute sclerosing panencephalitis (SSPE) is a rare progressive neurological disorder of early adolescence caused by persistent infection of the measles virus, which remains prevalent worldwide despite an effective vaccine. SSPE is a devastating disease with a characteristic clinical course in subcortical white matter; however, atypical presentations of brainstem involvement may be seen in rare cases. This review summarizes reports to date on brainstem involvement in SSPE, including the clinical course of disease, neuroimaging presentations, and guidelines for treatment. A comprehensive literature search was performed for English-language publications with keywords “subacute sclerosing panencephalitis” and “brainstem” using the National Library of Medicine PubMed database (March 1981–September 2017). Eleven articles focusing on SSPE of the brainstem were included. Predominant brainstem involvement remains uncharacteristic of SSPE, which may lead to misdiagnosis and poor outcome. A number of case reports have demonstrated brainstem involvement associated with other intracranial lesions commonly presenting in later SSPE stages (III and IV). However, brainstem lesions can appear in all stages, independent of higher cortical structures. The varied clinical presentations complicate diagnosis from a neuroimaging perspective. SSPE of the brainstem is a rare but important clinical entity. It may present like canonical SSPE or with unique clinical features such as absence seizures and pronounced ataxia. While SSPE generally progresses to the brainstem, it can also begin with a primary focus of infection in the brainstem. Awareness of varied SSPE presentations can aid in early diagnosis as well as guide management and treatment.
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Cicilet S, Furruqh F, Biswas A, Philip B. Hot cross bun and bright middle cerebellar peduncle signs in cerebellar type multiple system atrophy. BMJ Case Rep 2017; 2017:bcr-2017-220576. [PMID: 29092964 DOI: 10.1136/bcr-2017-220576] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Soumya Cicilet
- Department of Radiology, St John's Medical College Hospital, Bangalore, Karnataka, India
| | - Farha Furruqh
- Department of Radiology, St John's Medical College Hospital, Bangalore, Karnataka, India
| | - Asthik Biswas
- Department of Radiology, St John's Medical College Hospital, Bangalore, Karnataka, India
| | - Babu Philip
- Department of Radiology, St John's Medical College Hospital, Bangalore, Karnataka, India
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Park J, Kwon KY. Reversible Dementia with Middle Cerebellar Peduncle Hyperintensity: 1-Year Follow-Up of HIV-Negative Neurosyphilis. J Clin Neurol 2017; 13:437-438. [PMID: 28831790 PMCID: PMC5653637 DOI: 10.3988/jcn.2017.13.4.437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 05/06/2017] [Accepted: 05/10/2017] [Indexed: 11/17/2022] Open
Affiliation(s)
- Jisang Park
- Department of Radiology, Soonchunhyang University Gumi Hospital, Soonchunhyang University School of Medicine, Gumi, Korea
| | - Kyum Yil Kwon
- Department of Neurology, Soonchunhyang University Seoul Hospital, Soonchunhyang University School of Medicine, Seoul, Korea.
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28
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The Pediatric Cerebellum in Inherited Neurodegenerative Disorders: A Pattern-recognition Approach. Neuroimaging Clin N Am 2017; 26:373-416. [PMID: 27423800 DOI: 10.1016/j.nic.2016.03.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Evaluation of imaging studies of the cerebellum in inherited neurodegenerative disorders is aided by attention to neuroimaging patterns based on anatomic determinants, including biometric analysis, hyperintense signal of structures, including the cerebellar cortex, white matter, dentate nuclei, brainstem tracts, and nuclei, the presence of cysts, brain iron, or calcifications, change over time, the use of diffusion-weighted/diffusion tensor imaging and T2*-weighted sequences, magnetic resonance spectroscopy; and, in rare occurrences, the administration of contrast material.
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Pichler Hefti J, Hoigné-Perret P, Kottke R. Extensive Microhemorrhages of the Cerebellar Peduncles After High-Altitude Cerebral Edema. High Alt Med Biol 2017; 18:182-184. [PMID: 28128652 DOI: 10.1089/ham.2016.0103] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Pichler Hefti, Jacqueline, Philipp Hoigné-Perret, and Raimund Kottke. Extensive microhemorrhages of the cerebellar peduncles after high-altitude cerebral edema. High Alt Med Biol. 18:182-184, 2017.-Neuromagnetic resonance imaging (MRI) of subjects who suffered from high-altitude cerebral edema (HACE) typically shows cerebral microhemorrhages (MH) of the corpus callosum, in particular the splenium, and supratentorial white matter. This is a case report of a 43-year-old male, who suffered from unusually prolonged severe ataxia and amnesia after having been rescued during the ascent to Mount Everest at 6400 m. MRI of the brain 63 days after the incident showed the typical MH in the corpus callosum, but, in addition, extensive MH were found in the middle cerebellar peduncles. These infratentorial MH might reflect the pronounced atactic gait disorder. This case describes the first HACE-associated MH in the cerebellar peduncles in a high-altitude mountaineer indicating a potential vulnerability of infratentorial brain areas to hypobaric hypoxia.
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Affiliation(s)
- Jacqueline Pichler Hefti
- 1 Division of Pneumology, Inselspital University and University Hospital Bern , Bern, Switzerland
| | | | - Raimund Kottke
- 3 Radiology, Kinderspital Zurich, University Children's Hospital , Zurich, Switzerland
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