1
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Misser SK, Mchunu N, Lotz JW, Kjonigsen L, Ulug A, Archary M. Neuroquantification enhances the radiological evaluation of term neonatal hypoxic-ischaemic cerebral injuries. SA J Radiol 2023; 27:2728. [PMID: 38223530 PMCID: PMC10784209 DOI: 10.4102/sajr.v27i1.2728] [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: 06/02/2023] [Accepted: 10/28/2023] [Indexed: 01/16/2024] Open
Abstract
Background Injury patterns in hypoxic-ischaemic brain injury (HIBI) are well recognised but there are few studies evaluating cerebral injury using neuroquantification models. Objectives Quantification of brain volumes in a group of patients with clinically determined cerebral palsy. Method In this retrospective study, 297 children with cerebral palsy were imaged for suspected HIBI with analysis of various cerebral substrates. Of these, 96 children over the age of 3 years with a clinical diagnosis of cerebral palsy and abnormal MRI findings underwent volumetric analyses using the NeuroQuant® software solution. The spectrum of volumetric changes and the differences between the various subtypes (and individual subgroups) of HIBI were compared. Results Compared with the available normative NeuroQuant® database, the average intracranial volume was reduced to the 1st percentile in all patient groups (p < 0.001). Statistically significant differences were observed among the types and subgroups of HIBI. Further substrate volume reductions were identified and described involving the thalami, brainstem, hippocampi, putamina and amygdala. The combined volumes of five regions of interest (frontal pole, putamen, hippocampus, brainstem and paracentral lobule) were consistently reduced in the Rolandic basal ganglia-thalamus (RBGT) subtype. Conclusion This study determined a quantifiable reduction of intracranial volume in all subtypes of HIBI and predictable selective cerebral substrate volume reduction in subtypes and subgroups. In the RBGT subtype, a key combination of five substrate injuries was consistently noted, and thalamic, occipital lobe and brainstem volume reduction was also significant when compared to the watershed subtype. Contribution This study demonstrates the value of integrating an artificial intelligence programme into the radiologists' armamentarium serving to quantify brain injuries more accurately in HIBI. Going forward this will be an inevitable evolution of daily radiology practice in many fields of medicine, and it would be beneficial for radiologists to embrace these technological innovations.
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Affiliation(s)
- Shalendra K Misser
- Department of Radiology, Lake Smit and Partners Inc., Durban, South Africa
- Department of Radiology, Faculty of Health Sciences, University of KwaZulu-Natal, Duban, South Africa
| | - Nobuhle Mchunu
- Biostatistics Research Unit, South African Medical Research Council, Durban, South Africa
- Department of Statistics, Faculty of Science, School of Mathematics, Statistics and Computer Sciences, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Jan W Lotz
- Department of Radiodiagnosis, Faculty of Sciences, Stellenbosch University, Cape Town, South Africa
| | | | - Aziz Ulug
- Cortechs Labs, San Diego, United States of America
| | - Moherndran Archary
- Department of Pediatrics, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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2
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Blauen A, Lenfant C, Duprez T, Nassogne M. Erratum: Subacute brainstem ischemic syndrome in juvenile neurofibromatosis type 2: An under-recognized condition. Clin Case Rep 2023; 11:e6804. [PMID: 36619483 PMCID: PMC9811064 DOI: 10.1002/ccr3.6804] [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: 12/10/2022] [Accepted: 12/10/2022] [Indexed: 01/05/2023] Open
Abstract
[This corrects the article DOI: 10.1002/ccr3.6686.].
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Affiliation(s)
- Aglaë Blauen
- Department of Child Neurology, Cliniques Universitaires Saint‐LucUniversité Catholique de LouvainBrusselsBelgium
| | - Christine Lenfant
- Department of Radiology, Cliniques Universitaires Saint‐LucUniversité Catholique de LouvainBrusselsBelgium
| | - Thierry Duprez
- Department of Radiology, Cliniques Universitaires Saint‐LucUniversité Catholique de LouvainBrusselsBelgium
| | - Marie‐Cécile Nassogne
- Department of Child Neurology, Cliniques Universitaires Saint‐LucUniversité Catholique de LouvainBrusselsBelgium
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3
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Blauen A, Lenfant C, Duprez T, Nassogne M. Subacute brainstem ischemic syndrome in juvenile neurofibromatosis type 2: An underrecognized condition. Clin Case Rep 2022; 10:e6686. [PMID: 36483869 PMCID: PMC9723389 DOI: 10.1002/ccr3.6686] [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: 07/21/2022] [Accepted: 11/08/2022] [Indexed: 12/12/2022] Open
Abstract
We report the case of a teenager with a neurofibromatosis Type 2 (NF2) presenting a locked-in syndrome due to a brainstem ischemic syndrome. The presence of sudden or rapidly worsening onset of neurological deficits in NF2 patients, should evoke this underknown entity and not only tumors as predisposed by NF2.
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Affiliation(s)
- Aglaë Blauen
- Department of Child NeurologyCliniques Universitaires Saint‐Luc, Université Catholique de LouvainBrusselsBelgium
| | - Christine Lenfant
- Department of RadiologyCliniques Universitaires Saint‐Luc, Université Catholique de LouvainBrusselsBelgium
| | - Thierry Duprez
- Department of RadiologyCliniques Universitaires Saint‐Luc, Université Catholique de LouvainBrusselsBelgium
| | - Marie‐Cécile Nassogne
- Department of RadiologyCliniques Universitaires Saint‐Luc, Université Catholique de LouvainBrusselsBelgium
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4
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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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5
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Sarma A, Heck JM, Bhatia A, Krishnasarma RS, Pruthi S. Magnetic resonance imaging of the brainstem in children, part 2: acquired pathology of the pediatric brainstem. Pediatr Radiol 2021; 51:189-204. [PMID: 33464360 DOI: 10.1007/s00247-020-04954-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 09/10/2020] [Accepted: 12/20/2020] [Indexed: 10/22/2022]
Abstract
Part 1 of this series of two articles describes conventional and advanced MRI techniques that are useful for evaluating brainstem pathologies. In addition, it provides a review of the embryology, normal progression of myelination, and clinically and radiologically salient imaging anatomy of the normal brainstem. Finally, it discusses congenital diseases of the brainstem with a focus on distinctive imaging features that allow for differentiating pathologies. Part 2 of this series of two articles includes discussion of neoplasms; infections; and vascular, demyelinating, toxic, metabolic and miscellaneous disease processes affecting the brainstem. The ultimate goal of this pair of articles is to empower the radiologist to add clinical value in the care of pediatric patients with brainstem pathologies.
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Affiliation(s)
- Asha Sarma
- Department of Radiology and Radiological Sciences, Monroe Carell Jr. Children's Hospital, Vanderbilt University Medical Center, 2200 Children's Way, Nashville, TN, 37232, USA
| | - Josh M Heck
- Department of Radiology and Radiological Sciences, Monroe Carell Jr. Children's Hospital, Vanderbilt University Medical Center, 2200 Children's Way, Nashville, TN, 37232, USA
| | - Aashim Bhatia
- Department of Radiology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| | - Rekha S Krishnasarma
- Department of Radiology and Radiological Sciences, Monroe Carell Jr. Children's Hospital, Vanderbilt University Medical Center, 2200 Children's Way, Nashville, TN, 37232, USA
| | - Sumit Pruthi
- Department of Radiology and Radiological Sciences, Monroe Carell Jr. Children's Hospital, Vanderbilt University Medical Center, 2200 Children's Way, Nashville, TN, 37232, USA.
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6
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Battini R, Olivieri G, Milone R, Mazio F, Scalise R, Verdolotti T, Primiano G, Genovese O, Mercuri E, Servidei S. Spinal cord demyelination in children: A diagnostic challenge in neuropaediatrics for a good outcome. Brain Dev 2020; 42:457-461. [PMID: 32209270 DOI: 10.1016/j.braindev.2020.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 03/06/2020] [Accepted: 03/10/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Biotinidase deficiency (BTD) is an autosomal recessive inborn error of metabolism provoking progressive biotin depletion, which causes, in turn, multiple carboxylase deficiency. Its infantile onset is characterized by intractable seizures associated with lethargy, psychomotor regression, hypotonia, feeding and respiratory problems, and cutaneous abnormalities. CASE DESCRIPTION We describe a 52-month-old female whose clinical and neuroradiological pictures were consistent with myelopathy, which is generally more frequent in older patients, as well as with symptoms of an infantile onset of biotinidase deficiency, revealed at 17 months. RESULTS A biochemical biotinidase test revealed a profound deficiency of biotinidase detecting a 10% residual enzymatic activity, which led to the diagnosis of BTD. Gene sequencing revealed a compound heterozigous mutation (c.454A > C/c.1612C > T). CONCLUSION Our findings suggest that even if myelopathy is uncommonly reported in BTD, and generally occurs in older children, its presence in childhood-onset floppiness should always be considered as a possible marker for an atypical presentation of BTD. Although, until recently, BTD myelopathy was believed to be prevalent in older children, a spinal cord involvement has also been described in at least nine cases in early infancy. Thus, another early diagnosis suggests that myelopathy may be more frequent than previously thought, and it is probably underdiagnosed because spinal MRI is not always routinely performed on these children. Early recognition of BTD disease is important as it would lead to prompt treatment, preventing irreversible brain damage and increasing the chances of complete recovery.
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Affiliation(s)
- Roberta Battini
- Department of Clinical and Experimental Medicine, University of Pisa, Italy; Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy.
| | - Giorgia Olivieri
- Division of Metabolism, Bambino Gesu' Children's Hospital, IRCCS, Rome, Italy
| | - Roberta Milone
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
| | - Federica Mazio
- Dipartimento di Scienze Biomediche Avanzate, Università Federico II di Napoli, Italy
| | - Roberta Scalise
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
| | - Tommaso Verdolotti
- Department of Radiological Sciences, A. Gemelli Hospital, Catholic University, Rome, Italy
| | - Guido Primiano
- UOC Neurofisiopatologia Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | | | - Serenella Servidei
- UOC Neurofisiopatologia Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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7
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Benghanem S, Mazeraud A, Azabou E, Chhor V, Shinotsuka CR, Claassen J, Rohaut B, Sharshar T. Brainstem dysfunction in critically ill patients. Crit Care 2020; 24:5. [PMID: 31907011 PMCID: PMC6945639 DOI: 10.1186/s13054-019-2718-9] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 12/23/2019] [Indexed: 02/06/2023] Open
Abstract
The brainstem conveys sensory and motor inputs between the spinal cord and the brain, and contains nuclei of the cranial nerves. It controls the sleep-wake cycle and vital functions via the ascending reticular activating system and the autonomic nuclei, respectively. Brainstem dysfunction may lead to sensory and motor deficits, cranial nerve palsies, impairment of consciousness, dysautonomia, and respiratory failure. The brainstem is prone to various primary and secondary insults, resulting in acute or chronic dysfunction. Of particular importance for characterizing brainstem dysfunction and identifying the underlying etiology are a detailed clinical examination, MRI, neurophysiologic tests such as brainstem auditory evoked potentials, and an analysis of the cerebrospinal fluid. Detection of brainstem dysfunction is challenging but of utmost importance in comatose and deeply sedated patients both to guide therapy and to support outcome prediction. In the present review, we summarize the neuroanatomy, clinical syndromes, and diagnostic techniques of critical illness-associated brainstem dysfunction for the critical care setting.
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Affiliation(s)
- Sarah Benghanem
- Department of Neurology, Neuro-ICU, Sorbonne University, APHP Pitié-Salpêtrière Hospital, Paris, France
- Medical ICU, Cochin Hospital, AP-HP, Paris, France
| | - Aurélien Mazeraud
- Department of Neuro-ICU, GHU-Paris, Paris-Descartes University, Paris, France
- Laboratory of Experimental Neuropathology, Pastuer Institute, Paris, France
| | - Eric Azabou
- Department of Physiology, Clinical Neurophysiology Unit, APHP, Raymond Poincaré Hospital, University of Versailles Saint Quentin en Yvelines, Garches, France
| | - Vibol Chhor
- Department of Intensive Care Medicine, Saint-Joseph Hospital, Paris, France
| | - Cassia Righy Shinotsuka
- Intensive Care Unit and Postgraduate Program, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
- D'Or Institute for Research and Education, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Jan Claassen
- Department of Neurology, Neuro-ICU, Columbia University, New York, NY, USA
| | - Benjamin Rohaut
- Department of Neurology, Neuro-ICU, Sorbonne University, APHP Pitié-Salpêtrière Hospital, Paris, France
- Department of Neurology, Neuro-ICU, Columbia University, New York, NY, USA
- Institut du Cerveau et de la Moelle épinière, ICM, INSERM UMRS 1127, CNRS UMR 7225, Pitié- Salpêtrière Hospital, Paris, F-75013, France
| | - Tarek Sharshar
- Department of Neuro-ICU, GHU-Paris, Paris-Descartes University, Paris, France.
- Laboratory of Experimental Neuropathology, Pastuer Institute, Paris, France.
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8
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Moharamzad Y, Sanei Taheri M, Niaghi F, Shobeiri E. Brainstem glioma: Prediction of histopathologic grade based on conventional MR imaging. Neuroradiol J 2017; 31:10-17. [PMID: 29148317 DOI: 10.1177/1971400917743099] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Objective The objective of this article is to investigate the association between specific MR imaging findings and histopathologic grading (low-grade vs. high-grade) of brainstem gliomas (BSGs). Methods Sixty-two males and 34 females (mean (standard deviation, SD) age of 24.61 (17.20) years, range = 3 to 70 years) with histologically diagnosed BSG underwent conventional 1.5 T MR imaging, which included T1-weighted (T1W), T2W, and post-contrast T1W sequences. There were 39 children (mean age of 9.38 years) and 57 adults (mean age of 35 years). A binary logistic regression analysis was used to explore associations between MRI features and histopathological grade of the BSG. Results Binary logistic regression revealed that necrosis (adjusted odds ratio (OR) = 16.07; 95% confidence interval (CI) = 3.20 to 80.52; p = 0.001) and inhomogeneous contrast enhancement (adjusted OR = 8.04; 95% CI = 1.73 to 37.41; p = 0.008) as significant predictors of high-grade BSG. The equation (Nagelkerke R2 = 0.575) is Logit ( p high-grade BSG) = (2.77 × necrosis) + (2.08 × heterogeneous contrast enhancement) - 3.13. Sensitivity and specificity values were respectively 66.7% and 96.0% for necrosis and 85.7% and 65.9% for inhomogeneous contrast-enhancing lesions. In the pediatric age group, only inhomogeneous contrast enhancement (adjusted OR = 40; 95% CI = 3.95 to 445.73; p = 0.002) was a significant predictor for high-grade BSG. Conclusion Conventional MR imaging features such as necrosis and inhomogeneous contrast enhancement in adults and heterogeneous contrast enhancement in children suggest high-grade BSG.
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Affiliation(s)
- Yashar Moharamzad
- 1 School of Medicine, 48464 Kermanshah University of Medical Sciences , Kermanshah, Iran
| | - Morteza Sanei Taheri
- 2 Department of Radiology, Shohada Hospital, 48486 Shahid Beheshti University of Medical Sciences , Iran
| | - Farhad Niaghi
- 2 Department of Radiology, Shohada Hospital, 48486 Shahid Beheshti University of Medical Sciences , Iran
| | - Elham Shobeiri
- 1 School of Medicine, 48464 Kermanshah University of Medical Sciences , Kermanshah, Iran
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9
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Kim C, Potluri P, Khalil A, Gaut D, McManus M, Compton S, Wallace DC, Yadava N. An X-chromosome linked mouse model (Ndufa1 S55A) for systemic partial Complex I deficiency for studying predisposition to neurodegeneration and other diseases. Neurochem Int 2017; 109:78-93. [PMID: 28506826 DOI: 10.1016/j.neuint.2017.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 04/07/2017] [Accepted: 05/08/2017] [Indexed: 01/19/2023]
Abstract
The respiratory chain Complex I deficiencies are the most common cause of mitochondrial diseases. Complex I biogenesis is controlled by 58 genes and at least 47 of these cause mitochondrial disease in humans. Two of these are X-chromosome linked nuclear (nDNA) genes (NDUFA1 and NDUFB11), and 7 are mitochondrial (mtDNA, MT-ND1-6, -4L) genes, which may be responsible for sex-dependent variation in the presentation of mitochondrial diseases. In this study, we describe an X-chromosome linked mouse model (Ndufa1S55A) for systemic partial Complex I deficiency. By homologous recombination, a point mutation T > G within 55th codon of the Ndufa1 gene was introduced. The resulting allele Ndufa1S55A introduced systemic serine-55-alanine (S55A) mutation within the MWFE protein, which is essential for Complex I assembly and stability. The S55A mutation caused systemic partial Complex I deficiency of ∼50% in both sexes. The mutant males (Ndufa1S55A/Y) displayed reduced respiratory exchange ratio (RER) and produced less body heat. They were also hypoactive and ate less. They showed age-dependent Purkinje neurons degeneration. Metabolic profiling of brain, liver and serum from males showed reduced heme levels in mutants, which correlated with altered expressions of Fech and Hmox1 mRNAs in tissues. This is the first genuine X-chromosome linked mouse model for systemic partial Complex I deficiency, which shows age-dependent neurodegeneration. The effect of Complex I deficiency on survival patterns of males vs. females was different. We believe this model will be very useful for studying sex-dependent predisposition to both spontaneous and stress-induced neurodegeneration, cancer, diabetes and other diseases.
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Affiliation(s)
- Chul Kim
- Pioneer Valley Life Sciences Institute, Springfield, MA 01199, USA
| | - Prasanth Potluri
- Center for Mitochondrial and Epigenomic Medicine at the Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Ahmed Khalil
- Pioneer Valley Life Sciences Institute, Springfield, MA 01199, USA
| | - Daria Gaut
- Center for Mitochondrial and Epigenomic Medicine at the Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Meagan McManus
- Center for Mitochondrial and Epigenomic Medicine at the Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Shannon Compton
- Pioneer Valley Life Sciences Institute, Springfield, MA 01199, USA
| | - Douglas C Wallace
- Center for Mitochondrial and Epigenomic Medicine at the Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Nagendra Yadava
- Pioneer Valley Life Sciences Institute, Springfield, MA 01199, USA; Division of Endocrinology, Diabetes & Metabolism at Baystate Medical Center, Tufts University School of Medicine, Springfield, MA 01199, USA.
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10
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Rossi Espagnet MC, Pasquini L, Napolitano A, Cacchione A, Mastronuzzi A, Caruso R, Tomà P, Longo D. Magnetic resonance imaging patterns of treatment-related toxicity in the pediatric brain: an update and review of the literature. Pediatr Radiol 2017; 47:633-648. [PMID: 27933410 DOI: 10.1007/s00247-016-3750-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 09/23/2016] [Accepted: 11/02/2016] [Indexed: 02/07/2023]
Abstract
Treatment-related neurotoxicity is a potentially life-threatening clinical condition that can represent a diagnostic challenge. Differentiating diagnoses between therapy-associated brain injury and recurrent disease can be difficult, and the immediate recognition of neurotoxicity is crucial to providing correct therapeutic management, ensuring damage reversibility. For these purposes, the knowledge of clinical timing and specific treatment protocols is extremely important for interpreting MRI patterns. Neuroradiologic findings are heterogeneous and sometimes overlapping, representing the compounding effect of the different treatments. Moreover, MRI patterns can be acute, subacute or delayed and involve different brain regions, depending on (1) the mechanism of action of the specific medication and (2) which brain regions are selectively vulnerable to specific toxic effects. This review illustrates the most common radiologic appearance of radiotherapy, chemotherapy and medication-associated brain injury in children, with special focus on the application of advanced MRI techniques (diffusion, perfusion and proton spectroscopy) in the diagnosis of the underlying processes leading to brain toxicity.
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Affiliation(s)
- Maria Camilla Rossi Espagnet
- Neuroradiology Unit, Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy.
| | - Luca Pasquini
- Neuroradiology Unit, Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy.,NESMOS Department, Sant' Andrea Hospital, Sapienza University, Via di Grottarossa 1035, Rome, Italy
| | - Antonio Napolitano
- Enterprise Risk Management, Medical Physics Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Antonella Cacchione
- Department of Hematology/Oncology and Stem Cell Transplantation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Angela Mastronuzzi
- Department of Hematology/Oncology and Stem Cell Transplantation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Roberta Caruso
- Department of Hematology/Oncology and Stem Cell Transplantation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Paolo Tomà
- Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Daniela Longo
- Neuroradiology Unit, Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
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11
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Aghajan Y, Levy ML, Mo JQ, Crawford JR. Acute brainstem haemorrhage as a presenting feature of high-grade glioma. BMJ Case Rep 2016; 2016:bcr-2016-217370. [PMID: 27659914 DOI: 10.1136/bcr-2016-217370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Yasmin Aghajan
- University of California San Diego, School of Medicine, San Diego, California, USA
| | - Michael L Levy
- Department of Neurosurgery, University of California San Diego, San Diego, California, USA
| | - Jun Qin Mo
- Department of Pathology, University of California San Diego, San Diego, California, USA
| | - John Ross Crawford
- Department of Neurosciences and Pediatrics, University of California San Diego, San Diego, California, USA
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