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Kadom N, Lasiecka ZM, Nemeth AJ, Rykken JB, Lui YW, Seidenwurm D. Patient Engagement in Neuroradiology: A Narrative Review and Case Studies. AJNR Am J Neuroradiol 2024; 45:250-255. [PMID: 38216301 DOI: 10.3174/ajnr.a8077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 09/20/2023] [Indexed: 01/14/2024]
Abstract
The field of patient engagement in radiology is evolving and offers ample opportunities for neuroradiologists to become involved. The patient journey can serve as a model that inspires patient engagement initiatives. The patient journey in radiology may be viewed in 5 stages: 1) awareness that an imaging test is needed, 2) considering having a specific imaging test, 3) access to imaging, 4) imaging service delivery, and 5) ongoing care. Here, we describe patient engagement opportunities based on literature review and paired with case studies by practicing neuroradiologists.
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Affiliation(s)
- Nadja Kadom
- From the Emory University School of Medicine (N.K.), Children's Healthcare of Atlanta, Atlanta, Georgia
| | | | - Alexander J Nemeth
- Northwestern University, Feinberg School of Medicine, Northwestern Memorial Hospital (A.J.N.), Chicago, Illinois
| | | | - Yvonne W Lui
- New York University, Grossman School of Medicine (Y.W.L.), New York, New York
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2
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Mani K, Shah K, Kadom N, Seidenwurm D, Nemeth AJ. Peer Learning in Neuroradiology: Not as Easy as It Sounds. AJNR Am J Neuroradiol 2023; 44:1109-1115. [PMID: 37793783 PMCID: PMC10549937 DOI: 10.3174/ajnr.a7973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/21/2023] [Indexed: 10/06/2023]
Affiliation(s)
- K Mani
- University Radiology GroupRutgers University School of MedicineNewark, New Jersey
| | - K Shah
- MD Anderson Cancer CenterHouston, Texas
| | - N Kadom
- Emory University School of MedicineChildren's Healthcare of AtlantaAtlanta, Georgia
| | | | - A J Nemeth
- Northwestern University, Feinberg School of MedicineNorthwestern Memorial HospitalChicago, Illinois
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Jenkins LM, Kogan A, Malinab M, Ingo C, Sedaghat S, Bryan NR, Yaffe K, Parrish TB, Nemeth AJ, Lloyd-Jones DM, Launer LJ, Wang L, Sorond F. Blood pressure, executive function, and network connectivity in middle-aged adults at risk of dementia in late life. Proc Natl Acad Sci U S A 2021; 118:e2024265118. [PMID: 34493658 PMCID: PMC8449402 DOI: 10.1073/pnas.2024265118] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 06/15/2021] [Indexed: 11/18/2022] Open
Abstract
Midlife blood pressure is associated with structural brain changes, cognitive decline, and dementia in late life. However, the relationship between early adulthood blood pressure exposure, brain structure and function, and cognitive performance in midlife is not known. A better understanding of these relationships in the preclinical stage may advance our mechanistic understanding of vascular contributions to late-life cognitive decline and dementia and may provide early therapeutic targets. To identify resting-state functional connectivity of executive control networks (ECNs), a group independent components analysis was performed of functional MRI scans of 600 individuals from the Coronary Artery Risk Development in Young Adults longitudinal cohort study, with cumulative systolic blood pressure (cSBP) measured at nine visits over the preceding 30 y. Dual regression analysis investigated performance-related connectivity of ECNs in 578 individuals (mean age 55.5 ± 3.6 y, 323 female, 243 Black) with data from the Stroop color-word task of executive function. Greater connectivity of a left ECN to the bilateral anterior gyrus rectus, right posterior orbitofrontal cortex, and nucleus accumbens was associated with better executive control performance on the Stroop. Mediation analyses showed that while the relationship between cSBP and Stroop performance was mediated by white matter hyperintensities (WMH), resting-state connectivity of the ECN mediated the relationship between WMH and executive function. Increased connectivity of the left ECN to regions involved in reward processing appears to compensate for the deleterious effects of WMH on executive function in individuals across the burden of cumulative systolic blood pressure exposure in midlife.
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Affiliation(s)
- Lisanne M Jenkins
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611;
| | - Alexandr Kogan
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611
| | - Matthew Malinab
- Faculty of Applied Sciences, Simon Fraser University, Burnaby, BC, Canada, V5A 1S6
| | - Carson Ingo
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611
| | - Sanaz Sedaghat
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611
| | - Nick R Bryan
- Department of Radiology, University of Pennsylvania School of Medicine, Philadelphia, PA 19103
| | - Kristine Yaffe
- Weill Institute for Neurosciences, University of California, San Francisco, CA 94121
| | - Todd B Parrish
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611
- McCormick School of Engineering, Northwestern University, Chicago, IL 60208
| | - Alexander J Nemeth
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611
| | - Lenore J Launer
- Intramural Research Program, National Institute on Aging, Baltimore, MD 20814
| | - Lei Wang
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611
| | - Farzaneh Sorond
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611
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Lewis C, Levine A, Balmert LC, Chen L, Sherwani SS, Nemeth AJ, Grafman J, Gottesman R, Brown CH, Hogue CW. Neurocognitive, Quality of Life, and Behavioral Outcomes for Patients With Covert Stroke After Cardiac Surgery: Exploratory Analysis of Data From a Prospectively Randomized Trial. Anesth Analg 2021; 133:1187-1196. [PMID: 34319914 PMCID: PMC8542565 DOI: 10.1213/ane.0000000000005690] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Asymptomatic brain ischemic injury detected with diffusion-weighted magnetic resonance imaging (DWI) is reported in more than one-half of patients after cardiac surgery. There are conflicting findings on whether DWI-detected covert stroke is associated with neurocognitive dysfunction after surgery, and it is unclear whether such ischemic injury affects quality of life or behavioral outcomes. The purpose of this study was to perform exploratory analysis on whether covert stroke after cardiac surgery is associated with delayed neurocognitive recovery 1 month after surgery, impaired quality of life, anxiety, or depression. METHODS Analysis of data collected in a prospectively randomized study in patients undergoing cardiac surgery testing whether basing mean arterial pressure (MAP) targets during cardiopulmonary bypass to be above the lower limit of cerebral autoregulation versus usual practices reduces the frequency of adverse neurological outcomes. A neuropsychological testing battery was administered before surgery and then 1 month later. Patients underwent brain magnetic resonance imaging (MRI) between postoperative days 3 and 5. The primary outcome was DWI-detected ischemic lesion; the primary end point was change from baseline in domain-specific neurocognitive Z scores 1 month after surgery. Secondary outcomes included a composite indicator of delayed neurocognitive recovery, quality of life measures, state and trait anxiety, and Beck Depression Inventory scores. RESULTS Of the 164 patients with postoperative MRI data, clinical stroke occurred in 10 patients. Of the remaining 154 patients, 85 (55.2%) had a covert stroke. There were no statistically significant differences for patients with or without covert stroke in the change from baseline in Z scores in any of the cognitive domains tested adjusted for sex, baseline cognitive score, and randomization treatment arm. The frequency of delayed neurocognitive recovery (no covert stroke, 15.1%; covert stroke, 17.6%; P = .392), self-reported quality of life measurements, anxiety rating, or depression scores were not different between those with or without DWI ischemic injury. CONCLUSIONS More than one-half of patients undergoing cardiac surgery demonstrated covert stroke. In this exploratory analysis, covert stroke was not found to be significantly associated with neurocognitive dysfunction 1 month after surgery; evidence of impaired quality of life, anxiety, or depression, albeit a type II error, cannot be excluded.
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Affiliation(s)
| | | | | | - Liqi Chen
- Division of Biostatistics, Department of Preventive Medicine
| | | | | | - Jordan Grafman
- Shirley Ryan Abilitylab and the Department of Rehabilitation and Physical Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Charles H Brown
- Department of Anesthesiology & Critical Care, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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Hamidi A, Sabayan B, Sorond F, Nemeth AJ, Borhani-Haghighi A. A Case of Covid-19 Respiratory Illness with Subsequent Seizure and Hemiparesis. Galen Med J 2020; 9:e1915. [PMID: 34466611 PMCID: PMC8343613 DOI: 10.31661/gmj.v9i0.1915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/01/2020] [Accepted: 05/07/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Neurological manifestations and complications are common in viral infections, and they are significant sources for clinical deterioration and poor clinical outcomes. Case report: The current report presents a 38year-old man with Covid-19 respiratory illness who subsequently developed neurological complications and clinical worsening leading to death. This patient sought medical attention after five days of progressive cough, fever, and dyspnea. On arrival in the emergency room, he was found to have hypoxic respiratory failure resulting in intubation and intensive care unit (ICU) admission. Chest CT scan was characteristic for Covid-19 infection, and PCR test on tracheal samples confirmed the diagnosis. On day nine of admission, he developed generalized tonic colonic seizure associated with deterioration of mental status and hemiparesis. Repeated brain CT scans showed subcortical hypoattenuation with associated sulcal effacement in the left occipital and posterior parietal lobes concerning for ischemic changes. The patient passed away on day 17 despite supportive measures. CONCLUSION This observation and recent evidence on Covid-19 CNS involvement highlight the need for further studies on early recognition of neurological complications in Covid-19 patients.
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Affiliation(s)
- Ava Hamidi
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Behnam Sabayan
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Frazaneh Sorond
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Alexander J Nemeth
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Jenkins LM, Garner CR, Kurian S, Higgins JP, Parrish TB, Sedaghat S, Nemeth AJ, Lloyd-Jones DM, Launer LJ, Hausdorff JM, Wang L, Sorond FA. Cumulative Blood Pressure Exposure, Basal Ganglia, and Thalamic Morphology in Midlife. Hypertension 2020; 75:1289-1295. [PMID: 32223376 DOI: 10.1161/hypertensionaha.120.14678] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
High blood pressure (BP) negatively affects brain structure and function. Hypertension is associated with white matter hyperintensities, cognitive and mobility impairment in late-life. However, the impact of BP exposure from young adulthood on brain structure and function in mid-life is unclear. Identifying early brain structural changes associated with BP exposure, before clinical onset of cognitive dysfunction and mobility impairment, is essential for understanding mechanisms and developing interventions. We examined the effect of cumulative BP exposure from young adulthood on brain structure in a substudy of 144 (61 female) individuals from the CARDIA (Coronary Artery Risk Development in Young Adults) study. At year 30 (Y30, ninth visit), participants (56±4 years old) completed brain magnetic resonance imaging and gait measures (pace, rhythm, and postural control). Cumulative systolic and diastolic BP (cumulative systolic blood pressure, cDBP) over 9 visits were calculated, multiplying mean values between 2 consecutive visits by years between visits. Surface-based analysis of basal ganglia and thalamus was achieved using FreeSurfer-initiated Large Deformation Diffeomorphic Metric Mapping. Morphometric changes were regressed onto cumulative BP to localize regions of shape variation. Y30 white matter hyperintensity volumes were small and positively correlated with cumulative BP but not gait. Negative morphometric associations with cumulative systolic blood pressure were seen in the caudate, putamen, nucleus accumbens, pallidum, and thalamus. A concave right medial putamen shape mediated the relationship between cumulative systolic blood pressure and stride width. Basal ganglia and thalamic morphometric changes, rather than volumes, may be earlier manifestation of gray matter structural signatures of BP exposure that impact midlife gait.
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Affiliation(s)
- Lisanne M Jenkins
- From the Department of Psychiatry and Behavioral Sciences (L.M.J., L.W.), Northwestern University, Chicago, IL
| | - Chaney R Garner
- Department of Neurology (C.R.G., S.K., S.S., A.J.N., F.A.S.), Northwestern University, Chicago, IL
| | - Shawn Kurian
- Department of Neurology (C.R.G., S.K., S.S., A.J.N., F.A.S.), Northwestern University, Chicago, IL
| | - James P Higgins
- Department of Radiology (J.P.H., T.B.P., A.J.N., L.W.), Northwestern University, Chicago, IL
| | - Todd B Parrish
- Department of Radiology (J.P.H., T.B.P., A.J.N., L.W.), Northwestern University, Chicago, IL
| | - Sanaz Sedaghat
- Department of Neurology (C.R.G., S.K., S.S., A.J.N., F.A.S.), Northwestern University, Chicago, IL.,Department of Preventive Medicine (S.S., D.M.L.-J.), Northwestern University, Chicago, IL
| | - Alexander J Nemeth
- Department of Neurology (C.R.G., S.K., S.S., A.J.N., F.A.S.), Northwestern University, Chicago, IL.,Department of Radiology (J.P.H., T.B.P., A.J.N., L.W.), Northwestern University, Chicago, IL
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine (S.S., D.M.L.-J.), Northwestern University, Chicago, IL
| | | | - Jeffrey M Hausdorff
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center (J.M.H.)
| | - Lei Wang
- From the Department of Psychiatry and Behavioral Sciences (L.M.J., L.W.), Northwestern University, Chicago, IL.,Department of Radiology (J.P.H., T.B.P., A.J.N., L.W.), Northwestern University, Chicago, IL
| | - Farzaneh A Sorond
- Department of Neurology (C.R.G., S.K., S.S., A.J.N., F.A.S.), Northwestern University, Chicago, IL
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7
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Mahinrad S, Kurian S, Garner CR, Sedaghat S, Nemeth AJ, Moscufo N, Higgins JP, Jacobs DR, Hausdorff JM, Lloyd-Jones DM, Sorond FA. Cumulative Blood Pressure Exposure During Young Adulthood and Mobility and Cognitive Function in Midlife. Circulation 2019; 141:712-724. [PMID: 31747780 DOI: 10.1161/circulationaha.119.042502] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND High blood pressure (BP) is a known risk factor for mobility and cognitive impairment in older adults. This study tested the association of cumulative BP exposure from young adulthood to midlife with gait and cognitive function in midlife. Furthermore, we tested whether these associations were modified by cerebral white matter hyperintensity (WMH) burden. METHODS We included 191 participants from the CARDIA study (Coronary Artery Risk Development in Young Adults), a community-based cohort of young individuals followed over 30 years. Cumulative BP was calculated as the area under the curve (mm Hg×years) from baseline up to year 30 examination. Gait and cognition were assessed at the year 30 examination. Cerebral WMH was available at year 30 in a subset of participants (n=144) who underwent magnetic resonance imaging. Multiple linear regression models were used to assess the association of cumulative BP exposure with gait and cognition. To test effect modification by WMH burden, participants were stratified at the median of WMH and tested for interaction. RESULTS Higher cumulative systolic and diastolic BPs were associated with slower walking speed (both P=0.010), smaller step length (P=0.011 and 0.005, respectively), and higher gait variability (P=0.018 and 0.001, respectively). Higher cumulative systolic BP was associated with lower cognitive performance in the executive (P=0.021), memory (P=0.015), and global domains (P=0.010), and higher cumulative diastolic BP was associated with lower cognitive performance in the memory domain (P=0.012). All associations were independent of socio-demographics and vascular risk factors (body mass index, smoking, diabetes mellitus and total cholesterol). The association between cumulative BP and gait was moderated by WMH burden (interaction P<0.05). However, the relation between cumulative BP and cognitive function was not different based on the WMH burden (interaction P>0.05). CONCLUSIONS Exposure to higher BP levels from young to midlife is associated with worse gait and cognitive performance in midlife. Furthermore, WMH moderates the association of cumulative BP exposure with gait, but not with cognitive function in midlife. The mechanisms underpinning the impact of BP exposure on brain structure and function must be investigated in longitudinal studies using a life course approach.
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Affiliation(s)
- Simin Mahinrad
- Departments of Neurology (S.M., S.K., C.R.G., A.J.N., F.A.S.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Shawn Kurian
- Departments of Neurology (S.M., S.K., C.R.G., A.J.N., F.A.S.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Chaney R Garner
- Departments of Neurology (S.M., S.K., C.R.G., A.J.N., F.A.S.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Sanaz Sedaghat
- Preventive Medicine (S.S., D.M.L.-J.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Alexander J Nemeth
- Departments of Neurology (S.M., S.K., C.R.G., A.J.N., F.A.S.), Northwestern University Feinberg School of Medicine, Chicago, IL.,Department of Radiology, Division of Neuroradiology (A.J.N.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Nicola Moscufo
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (N.M.)
| | - James P Higgins
- Radiology and Biomedical Engineering (J.P.H.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (D.R.J.Jr.)
| | - Jeffrey M Hausdorff
- Center for the Study of Movement Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Israel (J.M.H.).,Sagol School of Neuroscience and Department of Physical Therapy, Tel Aviv University, Israel (J.M.H.).,Rush Alzheimer's Disease Center and Department of Orthopaedic Surgery, Rush University, Chicago, IL (J.M.H.)
| | - Donald M Lloyd-Jones
- Preventive Medicine (S.S., D.M.L.-J.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Farzaneh A Sorond
- Departments of Neurology (S.M., S.K., C.R.G., A.J.N., F.A.S.), Northwestern University Feinberg School of Medicine, Chicago, IL
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Nomura Y, Faegle R, Hori D, Al-Qamari A, Nemeth AJ, Gottesman R, Yenokyan G, Brown C, Hogue CW. Cerebral Small Vessel, But Not Large Vessel Disease, Is Associated With Impaired Cerebral Autoregulation During Cardiopulmonary Bypass: A Retrospective Cohort Study. Anesth Analg 2019; 127:1314-1322. [PMID: 29677060 PMCID: PMC6533899 DOI: 10.1213/ane.0000000000003384] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Impaired cerebral blood flow (CBF) autoregulation during cardiopulmonary bypass (CPB) is associated with stroke and other adverse outcomes. Large and small arterial stenosis is prevalent in patients undergoing cardiac surgery. We hypothesize that large and/or small vessel cerebral arterial disease is associated with impaired cerebral autoregulation during CPB. METHODS A retrospective cohort analysis of data from 346 patients undergoing cardiac surgery with CPB enrolled in an ongoing prospectively randomized clinical trial of autoregulation monitoring were evaluated. The study protocol included preoperative transcranial Doppler (TCD) evaluation of major cerebral artery flow velocity by a trained vascular technician and brain magnetic resonance imaging (MRI) between postoperative days 3 and 5. Brain MRI images were evaluated for chronic white matter hyperintensities (WMHI) by a vascular neurologist blinded to autoregulation data. "Large vessel" cerebral vascular disease was defined by the presence of characteristic TCD changes associated with stenosis of the major cerebral arteries. "Small vessel" cerebral vascular disease was defined based on accepted scoring methods of WMHI. All patients had continuous TCD-based autoregulation monitoring during surgery. RESULTS Impaired autoregulation occurred in 32.4% (112/346) of patients. Preoperative TCD demonstrated moderate-severe large vessel stenosis in 67 (25.2%) of 266 patients with complete data. In adjusted analysis, female sex (odds ratio [OR], 0.46; 95% confidence interval [CI], 0.25-0.86; P = .014) and higher average temperature during CPB (OR, 1.23; 95% CI, 1.02-1.475; P = .029), but not moderate-severe large cerebral arterial stenosis (P = .406), were associated with impaired autoregulation during CPB. Of the 119 patients with available brain MRI data, 42 (35.3%) demonstrated WMHI. The presence of small vessel cerebral vascular disease was associated with impaired CBF autoregulation (OR, 3.25; 95% CI, 1.21-8.71; P = .019) after adjustment for age, history of peripheral vascular disease, preoperative hemoglobin level, and preoperative treatment with calcium channel blocking drugs. CONCLUSIONS These data confirm that impaired CBF autoregulation is prevalent during CPB predisposing affected patients to brain hypoperfusion or hyperperfusion with low or high blood pressure, respectively. Small vessel, but not large vessel, cerebral vascular disease, male sex, and higher average body temperature during CPB appear to be associated with impaired autoregulation.
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Affiliation(s)
- Yohei Nomura
- From the Division of Cardiac Surgery, Department of Surgery and
| | - Roland Faegle
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daijiro Hori
- From the Division of Cardiac Surgery, Department of Surgery and
| | | | - Alexander J Nemeth
- Radiology, Division of Neuroradiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Rebecca Gottesman
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Gayane Yenokyan
- The Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland
| | - Charles Brown
- Department of Anesthesiology & Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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Hill VB, Cankurtaran CZ, Liu BP, Hijaz TA, Naidich M, Nemeth AJ, Gastala J, Krumpelman C, McComb EN, Korutz AW. A Practical Review of Functional MRI Anatomy of the Language and Motor Systems. AJNR Am J Neuroradiol 2019; 40:1084-1090. [PMID: 31196862 DOI: 10.3174/ajnr.a6089] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 04/24/2019] [Indexed: 11/07/2022]
Abstract
Functional MR imaging is being performed with increasing frequency in the typical neuroradiology practice; however, many readers of these studies have only a limited knowledge of the functional anatomy of the brain. This text will delineate the locations, anatomic boundaries, and functions of the cortical regions of the brain most commonly encountered in clinical practice-specifically, the regions involved in movement and language.
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Affiliation(s)
- V B Hill
- From the Departments of Radiology (V.B.H., C.Z.C., B.P.L., T.A.H., M.N., A.J.N., J.G., C.K., E.N.M., A.W.K.)
| | - C Z Cankurtaran
- From the Departments of Radiology (V.B.H., C.Z.C., B.P.L., T.A.H., M.N., A.J.N., J.G., C.K., E.N.M., A.W.K.)
| | - B P Liu
- From the Departments of Radiology (V.B.H., C.Z.C., B.P.L., T.A.H., M.N., A.J.N., J.G., C.K., E.N.M., A.W.K.).,Radiation Oncology (B.P.L.), Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - T A Hijaz
- From the Departments of Radiology (V.B.H., C.Z.C., B.P.L., T.A.H., M.N., A.J.N., J.G., C.K., E.N.M., A.W.K.)
| | - M Naidich
- From the Departments of Radiology (V.B.H., C.Z.C., B.P.L., T.A.H., M.N., A.J.N., J.G., C.K., E.N.M., A.W.K.)
| | - A J Nemeth
- From the Departments of Radiology (V.B.H., C.Z.C., B.P.L., T.A.H., M.N., A.J.N., J.G., C.K., E.N.M., A.W.K.).,Neurology (A.J.N.)
| | - J Gastala
- From the Departments of Radiology (V.B.H., C.Z.C., B.P.L., T.A.H., M.N., A.J.N., J.G., C.K., E.N.M., A.W.K.)
| | - C Krumpelman
- From the Departments of Radiology (V.B.H., C.Z.C., B.P.L., T.A.H., M.N., A.J.N., J.G., C.K., E.N.M., A.W.K.)
| | - E N McComb
- From the Departments of Radiology (V.B.H., C.Z.C., B.P.L., T.A.H., M.N., A.J.N., J.G., C.K., E.N.M., A.W.K.)
| | - A W Korutz
- From the Departments of Radiology (V.B.H., C.Z.C., B.P.L., T.A.H., M.N., A.J.N., J.G., C.K., E.N.M., A.W.K.)
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Korutz AW, Hijaz TA, Collins JD, Nemeth AJ. Reply. AJNR Am J Neuroradiol 2018; 39:E56. [PMID: 29496727 DOI: 10.3174/ajnr.a5575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
| | | | | | - A J Nemeth
- Departments of Radiology and Neurology Northwestern University Feinberg School of Medicine Chicago, Illinois
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11
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Affiliation(s)
| | | | | | | | - B P Knight
- Department of Medicine, Division of Cardiology
| | - A J Nemeth
- Departments of Radiology and Neurology Northwestern University Feinberg School of Medicine Chicago, Illinois
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Korutz AW, Obajuluwa A, Lester MS, McComb EN, Hijaz TA, Collins JD, Dandamudi S, Knight BP, Nemeth AJ. Pacemakers in MRI for the Neuroradiologist. AJNR Am J Neuroradiol 2017; 38:2222-2230. [PMID: 28705821 DOI: 10.3174/ajnr.a5314] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Cardiac implantable electronic devices are frequently encountered in clinical practice in patients being screened for MR imaging examinations. Traditionally, the presence of these devices has been considered a contraindication to undergoing MR imaging. Growing evidence suggests that most of these patients can safely undergo an MR imaging examination if certain conditions are met. This document will review the relevant cardiac implantable electronic devices encountered in practice today, the background physics/technical factors related to scanning these devices, the multidisciplinary screening protocol used at our institution for scanning patients with implantable cardiac devices, and our experience in safely performing these examinations since 2010.
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Affiliation(s)
- A W Korutz
- From the Departments of Radiology (A.W.K., A.O., M.S.L., E.N.M., T.A.H., J.D.C., A.J.N.)
| | - A Obajuluwa
- From the Departments of Radiology (A.W.K., A.O., M.S.L., E.N.M., T.A.H., J.D.C., A.J.N.)
| | - M S Lester
- From the Departments of Radiology (A.W.K., A.O., M.S.L., E.N.M., T.A.H., J.D.C., A.J.N.)
| | - E N McComb
- From the Departments of Radiology (A.W.K., A.O., M.S.L., E.N.M., T.A.H., J.D.C., A.J.N.)
| | - T A Hijaz
- From the Departments of Radiology (A.W.K., A.O., M.S.L., E.N.M., T.A.H., J.D.C., A.J.N.)
| | - J D Collins
- From the Departments of Radiology (A.W.K., A.O., M.S.L., E.N.M., T.A.H., J.D.C., A.J.N.)
| | - S Dandamudi
- Medicine, Division of Cardiology (S.D., B.P.K.)
| | - B P Knight
- Medicine, Division of Cardiology (S.D., B.P.K.)
| | - A J Nemeth
- From the Departments of Radiology (A.W.K., A.O., M.S.L., E.N.M., T.A.H., J.D.C., A.J.N.).,Neurology (A.J.N.), Northwestern University Feinberg School of Medicine, Chicago, Illinois
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13
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Pape TLB, Rosenow JM, Steiner M, Parrish T, Guernon A, Harton B, Patil V, Bhaumik DK, McNamee S, Walker M, Froehlich K, Burress C, Odle C, Wang X, Herrold AA, Zhao W, Reda D, Mallinson T, Conneely M, Nemeth AJ. Placebo-Controlled Trial of Familiar Auditory Sensory Training for Acute Severe Traumatic Brain Injury: A Preliminary Report. Neurorehabil Neural Repair 2015; 29:537-47. [PMID: 25613986 DOI: 10.1177/1545968314554626] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Sensory stimulation is often provided to persons incurring severe traumatic brain injury (TBI), but therapeutic effects are unclear. OBJECTIVE This preliminary study investigated neurobehavioral and neurophysiological effects related to sensory stimulation on global neurobehavioral functioning, arousal, and awareness. METHODS A double-blind randomized placebo-controlled trial where 15 participants in states of disordered consciousness (DOC), an average of 70 days after TBI, were provided either the Familiar Auditory Sensory Training (FAST) or Placebo of silence. Global neurobehavioral functioning was measured with the Disorders of Consciousness Scale (DOCS). Arousal and awareness were measured with the Coma-Near-Coma (CNC) scale. Neurophysiological effect was measured using functional magnetic resonance imaging (fMRI). RESULTS FAST (n = 8) and Placebo (n = 7) groups each showed neurobehavioral improvement. Mean DOCS change (FAST = 13.5, SD = 8.2; Placebo = 18.9, SD = 15.6) was not different, but FAST patients had significantly (P = .049; 95% confidence interval [CI] = -1.51, -.005) more CNC gains (FAST = 1.01, SD = 0.60; Placebo = 0.25, SD = 0.70). Mixed-effects models confirm CNC findings (P = .002). Treatment effect, based on CNC, is large (d = 1.88, 95% CI = 0.77, 3.00). Number needed to treat is 2. FAST patients had more fMRI activation in language regions and whole brain (P values <.05) resembling healthy controls' activation. CONCLUSIONS For persons with DOC 29 to 170 days after TBI, FAST resulted in CNC gains and increased neural responsivity to vocal stimuli in language regions. Clinicians should consider providing the FAST to support patient engagement in neurorehabilitation.
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Affiliation(s)
- Theresa Louise-Bender Pape
- Edward Hines Jr VA Hospital, Hines, IL, USA Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Joshua M Rosenow
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA Northwestern Memorial Hospital, Chicago, IL, USA
| | - Monica Steiner
- Edward Hines Jr VA Hospital, Hines, IL, USA Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA
| | - Todd Parrish
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ann Guernon
- Edward Hines Jr VA Hospital, Hines, IL, USA Marianjoy Rehabilitation Hospital, Wheaton, IL, USA
| | | | - Vijaya Patil
- Edward Hines Jr VA Hospital, Hines, IL, USA Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA
| | - Dulal K Bhaumik
- Edward Hines Jr VA Hospital, Hines, IL, USA University of Illinois at Chicago, Chicago, IL, USA
| | - Shane McNamee
- Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
| | | | | | | | | | - Xue Wang
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Weihan Zhao
- University of Illinois at Chicago, Chicago, IL, USA
| | | | | | - Mark Conneely
- Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
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14
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Rozenfeld MN, Nemeth AJ, Walker MT, Mohan P, Wang X, Parrish TB, Opal P. An investigation of diffusion imaging techniques in the evaluation of spinocerebellar ataxia and multisystem atrophy. J Clin Neurosci 2014; 22:166-72. [PMID: 25439745 DOI: 10.1016/j.jocn.2014.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 08/30/2014] [Indexed: 12/14/2022]
Abstract
Multisystem system atrophy and spinocerebellar ataxia are rare neurodegenerative ataxias that can be difficult to diagnose, with important prognostic and treatment implications. The purpose of this study is to evaluate various methods of diffusion imaging and tractography in their effectiveness at differentiating these diseases from control subjects. Our secondary aim is determining whether diffusion abnormalities correspond with clinical disease severity. Diffusion imaging and tractography were performed on five patients and seven age-matched controls. Fractional anisotropy, generalized fractional anisotropy, and apparent diffusion coefficient values and corticospinal tract volumes were measured within various diffusion and probabilistic tractography models, including standard diffusion tensor and Q-ball tractography. Standard diffusion based fractional anisotropy and apparent diffusion coefficient values were significantly altered in patients versus controls in the middle cerebellar peduncles and central pons. Tractography based fractional anisotropy and generalized fractional anisotropy values were significantly lower in patients versus controls when corticospinal tracts were drawn in a craniocaudal direction (bilaterally using Q-ball imaging, only on the right using diffusion tensor imaging). The right corticospinal tract volume was significantly smaller in patients versus controls when created using Q-ball imaging in a caudocranial direction. There was no correlation between diffusion alteration and clinical symptomatology. In conclusion, various diffusion-based techniques can be effective in differentiating ataxic patients from control subjects, although the selection of diffusion algorithm and tract growth technique and direction is non-trivial.
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Affiliation(s)
- Michael N Rozenfeld
- Department of Radiology, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637, USA.
| | - Alexander J Nemeth
- Department of Radiology, Northwestern University, Chicago, IL, USA; Ken and Ruth Davee Department of Neurology, Northwestern University, Chicago, IL, USA
| | - Matthew T Walker
- Northshore University Health Systems, Department of Radiology, Evanston, IL, USA
| | - Prasoon Mohan
- St. Francis Hospital, Department of Radiology, Evanston, IL, USA
| | - Xue Wang
- Department of Radiology, Northwestern University, Chicago, IL, USA
| | - Todd B Parrish
- Department of Radiology, Northwestern University, Chicago, IL, USA
| | - Puneet Opal
- Ken and Ruth Davee Department of Neurology, Northwestern University, Chicago, IL, USA.
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15
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Guth JC, Gerard EE, Nemeth AJ, Liotta EM, Prabhakaran S, Naidech AM, Maas MB. Subarachnoid extension of hemorrhage is associated with early seizures in primary intracerebral hemorrhage. J Stroke Cerebrovasc Dis 2014; 23:2809-2813. [PMID: 25194742 DOI: 10.1016/j.jstrokecerebrovasdis.2014.07.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 06/26/2014] [Accepted: 07/07/2014] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Seizures are common in patients with subarachnoid hemorrhage, potentially by inciting cortical irritability. Seizures are also commonly seen after intracerebral hemorrhage (ICH), although the mechanisms and risk factors within that population are not well understood. The objective of this study is to evaluate whether subarachnoid hemorrhage extension (SAHE) is associated with early seizures in patients with primary ICH. METHODS Patients with primary ICH were enrolled into a prospective registry between December 2006 and July 2012. Patients were managed per a structured protocol. SAHE was identified on imaging by expert reviewers blinded to outcomes. Electroencephalograms were routinely obtained in patients with unexplained, poor level of arousal. Seizure was determined by clinically observed convulsions or traditional electroencephalographic criteria. Early seizures were defined as occurring within 3 days of hemorrhage. A binary logistic regression model was developed to test whether the occurrence of SAHE was independently associated with seizures. RESULTS A total of 234 patients were studied. Of these, 93 (40%) had SAHE and 9 (4%) had early seizures. SAHE was associated with early seizures (P = .03). No additional variables were identified by regression modeling to mediate the association between SAHE and early seizures (odds ratio 5.62 [95% confidence interval 1.14-27.7], P = .034). CONCLUSIONS SAHE is associated with early seizures in patients with primary ICH. Further study is needed to confirm these findings and determine whether modifications to routine care based on the presence of SAHE would be of benefit.
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Affiliation(s)
- James C Guth
- Division of Vascular and Critical Care Neurology, Department of Neurology, Northwestern University, Chicago, IL.
| | - Elizabeth E Gerard
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Northwestern University, Chicago, IL
| | - Alexander J Nemeth
- Division of Neuroradiology, Department of Radiology, Northwestern University, Chicago, IL
| | - Eric M Liotta
- Division of Vascular and Critical Care Neurology, Department of Neurology, Northwestern University, Chicago, IL
| | - Shyam Prabhakaran
- Division of Vascular and Critical Care Neurology, Department of Neurology, Northwestern University, Chicago, IL
| | - Andrew M Naidech
- Division of Vascular and Critical Care Neurology, Department of Neurology, Northwestern University, Chicago, IL
| | - Matthew B Maas
- Division of Vascular and Critical Care Neurology, Department of Neurology, Northwestern University, Chicago, IL
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16
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Romanova AL, Nemeth AJ, Berman MD, Guth JC, Liotta EM, Naidech AM, Maas MB. Magnetic resonance imaging versus computed tomography for identification and quantification of intraventricular hemorrhage. J Stroke Cerebrovasc Dis 2014; 23:2036-2040. [PMID: 25085346 DOI: 10.1016/j.jstrokecerebrovasdis.2014.03.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 02/27/2014] [Accepted: 03/05/2014] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Intraventricular hemorrhage (IVH) may be difficult to detect especially when in small amounts and may affect outcomes. The objective of this study was to compare the sensitivity of magnetic resonance imaging (MRI) vs computed tomography (CT) for the identification and quantification of IVH. METHODS Patients with primary intracerebral hemorrhage were enrolled into a prospective registry between December 2006 and June 2013. Diagnostic and surveillance neuroimaging studies were analyzed for the presence of IVH and quantified by Graeb score. In subjects who developed IVH and underwent both MRI and CT, each MRI was paired with the CT scan done at the closest time point, and Graeb scores were compared with the Wilcoxon signed rank test for related samples. RESULTS There were 289 subjects in the cohort with IVH found in 171. Sixty-eight pairs of MRI and CT were available for comparison. CT failed to detect IVH in 3% of cases, whereas MRI was 100% sensitive. MRI and CT yielded equal Graeb scores in 72% of the pairs, and MRI Graeb score was higher in 24% (P = .007). CONCLUSIONS MRI identifies small volumes of IVH in cases not detected by CT and yields higher estimates of intraventricular blood volume. These data indicate that consideration of technical differences is needed when comparing images from the 2 modalities in the evaluation for IVH.
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Affiliation(s)
- Anna L Romanova
- Division of Neurocritical Care, Department of Neurology, Northwestern University, Chicago, Illinois
| | - Alexander J Nemeth
- Division of Neuroradiology, Department of Radiology, Northwestern University, Chicago, Illinois
| | - Michael D Berman
- Division of Neurocritical Care, Department of Neurology, Northwestern University, Chicago, Illinois
| | - James C Guth
- Division of Neurocritical Care, Department of Neurology, Northwestern University, Chicago, Illinois
| | - Eric M Liotta
- Division of Neurocritical Care, Department of Neurology, Northwestern University, Chicago, Illinois
| | - Andrew M Naidech
- Division of Neurocritical Care, Department of Neurology, Northwestern University, Chicago, Illinois
| | - Matthew B Maas
- Division of Neurocritical Care, Department of Neurology, Northwestern University, Chicago, Illinois.
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17
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Futterer SF, Nemeth AJ, Grimm SA, Ragin AB, Chandler JP, Muro K, Marymont MH, Raizer JJ. Diffusion abnormalities of the corpus callosum in patients receiving bevacizumab for malignant brain tumors: suspected treatment toxicity. J Neurooncol 2014; 118:147-53. [PMID: 24574050 DOI: 10.1007/s11060-014-1409-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 02/18/2014] [Indexed: 10/25/2022]
Abstract
Bevacizumab has been reported to cause diffusion restriction in the tumor bed of patients with malignant gliomas. This study evaluated prolonged diffusion restriction, in the corpus callosum (CC), of patients with malignant brain tumors treated with bevacizumab. We retrospectively reviewed our database of patients treated with bevacizumab for malignant brain tumors looking for those with restricted diffusion in the CC. CC ADC ratio measurements were obtained prior to and following treatment. Correlation was made with biopsy (n = 3) and MR perfusion (n = 7) and PET (n = 4). The temporal evolution of these changes relative to therapy was examined with mixed effects regression analysis. Nine patients (eight malignant gliomas, one malignant meningioma) out of 146 patients were found to have developed areas of diffusion restriction in the CC. These areas tended to enlarge and coalesce over serial MRIs and persisted for up to 22 months. Hypoperfusion was demonstrated in MR perfusion in 7/7. PET was hypometabolic in all 4. Biopsy of the CC showed no tumor in 3/3. ADC ratio measurements indicated a significant overall effect of time (F(16,60) = 11.2; p < 0.0001), consistent with persistent diffusion restriction over the measured time periods. Bevacizumab causes prolonged diffusion restriction in the CC. The negative MR perfusion, FDG PET and histopathology suggest this is a toxicity of bevacizumab and not active tumor. Awareness of these changes can assist in patient care.
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Affiliation(s)
- Stephen F Futterer
- Neuroradiology Section, Department of Radiology, Northwestern Memorial Hospital, Northwestern University, 676 N. Saint Clair St., Ste. # 1400, Chicago, IL, USA
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18
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Nawas MT, Daruwalla VJ, Spirer D, Micco AG, Nemeth AJ. Complicated necrotizing otitis externa. Am J Otolaryngol 2013; 34:706-9. [PMID: 23927998 DOI: 10.1016/j.amjoto.2013.07.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 07/01/2013] [Indexed: 10/26/2022]
Abstract
Necrotizing (malignant) otitis externa (NOE) is a rare and invasive infection originating in the external acoustic meatus seen most commonly in diabetes and other immunocompromised states. After a protracted course, disease can smolder and extend into the mastoid, skull base, dural sinuses, and intracranially. We present a case of NOE complicated by mastoiditis, dural sinus thrombosis, and Bezold's abscess in an uncontrolled diabetic presenting with a prolonged course of facial nerve palsy. We stress the importance of maintaining a high index of clinical suspicion for NOE in diabetic patients and offering timely, aggressive treatment to mitigate its complications.
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19
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Maas MB, Nemeth AJ, Rosenberg NF, Kosteva AR, Prabhakaran S, Naidech AM. Delayed intraventricular hemorrhage is common and worsens outcomes in intracerebral hemorrhage. Neurology 2013; 80:1295-9. [PMID: 23516315 DOI: 10.1212/wnl.0b013e31828ab2a7] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To evaluate the incidence, characteristics, and clinical consequences of delayed intraventricular hemorrhage (dIVH). METHODS Patients with primary intracerebral hemorrhage (ICH) were enrolled into a prospective registry between December 2006 and February 2012. Patients were managed, and serial neuroimaging obtained, per a structured protocol. Initial and delayed IVH were identified on imaging, along with ICH volumes, with outcomes blinded. Multivariate models were developed to test whether the occurrence of dIVH was a predictor of functional outcomes independent of known predictors, including the ICH score elements and ICH growth. RESULTS A total of 216 patients were studied, and 104 (48%) had IVH on initial imaging. Of the 112 with no IVH, 23 (21%) subsequently developed IVH. Emergent surgical intervention, mostly ventriculostomy placement, was required after discovery of dIVH in 10 (43%) of these 23. In multivariate models adjusting for all elements of the ICH score and hematoma growth, dIVH was an independent predictor of death at 14 days (p = 0.015) and higher modified Rankin Scale scores at 3 months (all p = 0.037). The effect of dIVH remained significant in a secondary analysis that adjusted for all other variables significant in the univariate analysis. CONCLUSIONS Similar to hematoma expansion dIVH is independently associated with death and poor outcomes. Because IVH is easily detected by serial neuroimaging and often requires emergent surgical intervention, monitoring for dIVH is recommended.
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Affiliation(s)
- Matthew B Maas
- Department of Neurology, Northwestern University, Chicago, IL, USA.
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20
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Maas MB, Nemeth AJ, Rosenberg NF, Kosteva AR, Guth JC, Liotta EM, Prabhakaran S, Naidech AM. Subarachnoid Extension of Primary Intracerebral Hemorrhage is Associated With Poor Outcomes. Stroke 2013; 44:653-7. [DOI: 10.1161/strokeaha.112.674341] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Extension of hemorrhage into the subarachnoid space is observed in primary intracerebral hemorrhage (ICH), yet the phenomenon has undergone limited study and is of unknown significance. The objective of this study is to evaluate the incidence, characteristics, and clinical consequences of subarachnoid hemorrhage extension (SAHE) in ICH on functional outcomes.
Methods—
Patients with primary ICH were enrolled into a prospective registry between December 2006 and June 2012. Patients were managed and serial neuroimaging was obtained per a structured protocol. Presence of any subarachnoid blood on imaging was identified as SAHE by expert reviewers blinded to outcomes. Regression models were developed to test whether the occurrence of SAHE was an independent predictor of functional outcomes as measured with the modified Rankin Scale.
Results—
Of 234 patients with ICH, 93 (39.7%) had SAHE. Interrater agreement for SAHE was excellent (kappa=0.991). SAHE was associated with lobar hemorrhage location (65% of SAHE vs 19% of non-SAHE cases;
P
<0.001) and larger hematoma volumes (median 23.8 vs 6.7;
P
<0.001). Fever (69.9% vs 51.1%;
P
=0.005) and seizures (8.6% vs 2.8%;
P
=0.07) were more common in patients with SAHE. SAHE was a predictor of death by day 14 (odds ratio, 4.45; 95% confidence interval, 1.88–10.53;
P
=0.001) and of higher (worse) modified Rankin Scale scores at 28 days (odds ratio, 1.76 per mRS point; 95% confidence interval, 1.01–3.05;
P
=0.012) after adjustment for ICH score.
Conclusions—
SAHE is associated with worse modified Rankin Scale independent of traditional ICH severity measures. Underlying mechanisms and potential treatments of SAHE require further study.
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Affiliation(s)
- Matthew B. Maas
- From the Departments of Neurology (M.B.M., N.F.R., A.R.K., J.C.G., E.M.L., S.K.P, A.M.N.) and Radiology (A.J.N.), Northwestern University, Chicago, IL
| | - Alexander J. Nemeth
- From the Departments of Neurology (M.B.M., N.F.R., A.R.K., J.C.G., E.M.L., S.K.P, A.M.N.) and Radiology (A.J.N.), Northwestern University, Chicago, IL
| | - Neil F. Rosenberg
- From the Departments of Neurology (M.B.M., N.F.R., A.R.K., J.C.G., E.M.L., S.K.P, A.M.N.) and Radiology (A.J.N.), Northwestern University, Chicago, IL
| | - Adam R. Kosteva
- From the Departments of Neurology (M.B.M., N.F.R., A.R.K., J.C.G., E.M.L., S.K.P, A.M.N.) and Radiology (A.J.N.), Northwestern University, Chicago, IL
| | - James C. Guth
- From the Departments of Neurology (M.B.M., N.F.R., A.R.K., J.C.G., E.M.L., S.K.P, A.M.N.) and Radiology (A.J.N.), Northwestern University, Chicago, IL
| | - Eric M. Liotta
- From the Departments of Neurology (M.B.M., N.F.R., A.R.K., J.C.G., E.M.L., S.K.P, A.M.N.) and Radiology (A.J.N.), Northwestern University, Chicago, IL
| | - Shyam Prabhakaran
- From the Departments of Neurology (M.B.M., N.F.R., A.R.K., J.C.G., E.M.L., S.K.P, A.M.N.) and Radiology (A.J.N.), Northwestern University, Chicago, IL
| | - Andrew M. Naidech
- From the Departments of Neurology (M.B.M., N.F.R., A.R.K., J.C.G., E.M.L., S.K.P, A.M.N.) and Radiology (A.J.N.), Northwestern University, Chicago, IL
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Maas MB, Nemeth AJ, Rosenberg NF, Kosteva AR, Guth JC, Liotta EM, Prabhakaran SK, Naidech AM. Abstract TP310: Subarachnoid Extension of Intracerebral Hemorrhage and Perihematomal Ischemic Compression Are Related, Harmful Processes. Stroke 2013. [DOI: 10.1161/str.44.suppl_1.atp310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Decreased diffusion is associated with poor outcomes in primary intracerebral hemorrhage (ICH), although the mechanism of that phenomenon is uncertain. Two distinct types of decreased diffusion have been observed, perihematomal ischemia (PHI) and distant areas of ischemia. Extension of hemorrhage into the subarachnoid (SAH) and intraventricular (IVH) compartments may be indicators of high perihematomal pressures and diminished brain parenchyma compliance. The objective of this study is to evaluate for an association between PHI and poor outcomes, and to evaluate whether PHI is associated with SAH and IVH as markers of injurious perihematomal pressure.
Methods:
Patients with primary ICH were enrolled into a prospective registry between December 2006 and July 2012. Patients were managed, and serial neuroimaging obtained, per a structured protocol. MRI was performed on all salvageable patients when possible. SAH, IVH and PHI were identified on imaging, along with ICH volumes, by expert reviewers blinded to outcomes. An ordinal regression model was used to evaluate for an association between PHI and modified Rankin Scale (mRS) at 28 days, adjusted for ICH Score. A binary logistic regression models was developed to identify an association between PHI and other potential predictors of malignant peri-hematomal pressures: SAH, IVH, initial hematoma volume, and supra- versus infratentorial location.
Results:
94 patients were studied. 27 (28.7%) had SAH and 44 (46.8%) had IVH. PHI was associated with mRS at 28 days (odds ratio 2.88 [95% CI 1.23-6.75]), independent of ICH Score. PHI was associated with SAH (3.74 [1.25-11.21]), whereas no significant association was found with IVH, hematoma volume or location.
Conclusions:
PHI is independently associated with poor outcomes in primary ICH. PHI is associated with SAH, but not hemorrhage volume, location or decompression into the ventricular system. These findings suggest that PHI and subarachnoid hemorrhage extension are associated, unique markers for injurious perihematomal pressure.
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22
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Maas MB, Nemeth AJ, Rosenberg NF, Kosteva AR, Guth JC, Liotta EM, Prabhakaran SK, Naidech AM. Abstract TP309: Subarachnoid Extension of Hemorrhage Is Associated with Poor Outcomes in Primary Intracerebral Hemorrhage. Stroke 2013. [DOI: 10.1161/str.44.suppl_1.atp309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Extension of hemorrhage into the subarachnoid space is observed in primary intracerebral hemorrhage (ICH), yet the phenomenon has undergone limited study and is of unknown significance. The objective of this study is to evaluate the incidence, characteristics and clinical consequences of subarachnoid hemorrhage extension (SAHE) in ICH.
Methods:
Patients with primary ICH were enrolled into a prospective registry between December 2006 and July 2012. Patients were managed, and serial neuroimaging obtained, per a structured protocol. SAHE was identified on imaging, along with ICH volumes, by expert reviewers blinded to outcomes. Ordinal regression models were developed to test whether the occurrence of SAHE was a predictor of functional outcomes independent of ICH Score, with confirmation of model validity by appropriate tests.
Results:
234 patients were studied, and 93 (39.7%) had SAHE. SAHE was associated with lobar hemorrhage location (65% of SAHE versus 19% of non-SAHE cases, p<0.001), and larger hematoma volumes (median 23.8 versus 6.65, p<0.001). SAHE was a predictor of higher modified Rankin Scale scores (mRS) at discharge (odds ratio 2.22 per mRS point [95% CI 1.29-3.81]) and 28 days (1.80 [1.04-3.11]) after adjustment for ICH Score.
Conclusions:
SAHE is associated with poor outcomes independent of traditional ICH severity measures. Further exploration of this phenomenon to understand the underlying mechanisms of harm is needed.
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Naidech AM, Maas MB, Nemeth AJ, Russell EJ. Response to Letter by Nishikawa Regarding Article, “Blood Pressure Reduction, Decreased Diffusion on MRI, and Outcomes After Intracerebral Hemorrhage”. Stroke 2012. [DOI: 10.1161/strokeaha.111.643007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Andrew M. Naidech
- Northwestern University Feinberg School of Medicine
Chicago, IL (Naidech, Maas, Nemeth, Russell)
| | - Matthew B. Maas
- Northwestern University Feinberg School of Medicine
Chicago, IL (Naidech, Maas, Nemeth, Russell)
| | - Alexander J. Nemeth
- Northwestern University Feinberg School of Medicine
Chicago, IL (Naidech, Maas, Nemeth, Russell)
| | - Eric J. Russell
- Northwestern University Feinberg School of Medicine
Chicago, IL (Naidech, Maas, Nemeth, Russell)
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Sondag MJ, Wattamwar AS, Aleppo G, Nemeth AJ. Case 179. Radiology 2011. [DOI: 10.1148/radiol.11102325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Garg RK, Liebling SM, Maas MB, Nemeth AJ, Russell EJ, Naidech AM. Blood pressure reduction, decreased diffusion on MRI, and outcomes after intracerebral hemorrhage. Stroke 2011; 43:67-71. [PMID: 21980211 DOI: 10.1161/strokeaha.111.629493] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND PURPOSE Decreased diffusion (DD) consistent with acute ischemia may be detected on MRI after acute intracerebral hemorrhage (ICH), but its risk factors and impact on functional outcomes are not well-defined. We tested the hypotheses that DD after ICH is related to acute blood pressure (BP) reduction and lower hemoglobin and presages worse functional outcomes. METHODS Patients who underwent MRI were prospectively evaluated for DD by certified neuroradiologists blinded to outcomes. Hemoglobin and BP data were obtained via electronic queries. Outcomes were obtained at 14 days and 3 months with the modified Rankin Scale, a functional scale scored from 0 (no symptoms) to 6 (dead). We used logistic regression for dependence or death (modified Rankin Scale score 4-6). RESULTS DD distinct from the hematoma was found on MRI in 39 of 95 patients (41%). DD was associated with greater BP reductions from baseline and a higher risk of dependence or death at 3 months (odds ratio, 4.8; 95% confidence interval, 1.7-13.9; P=0.004) after correction for ICH score (1.8 per point; 95% confidence interval, 1.2-3.1; P=0.01). Lower hemoglobin was associated with worse ICH score, larger hematoma volume, and worse outcomes, but not DD. CONCLUSIONS DD is common after ICH, associated with greater acute BP reductions, and associated with disability and death at 3 months in multivariate analysis. The potential benefits of acute BP reduction to reduce hematoma growth may be limited by DD. The prevention and treatment of cerebral ischemia manifested as DD are potential methods to improve outcomes.
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Abstract
Posterior reversible encephalopathy syndrome (PRES) and venous thrombosis are frequently encountered first in the emergency setting and share some common characteristics. The clinical presentation in both entities is vague, and the brain parenchymal findings of PRES syndrome may resemble those of venous thrombosis in some ways. Both entities often occur in a bilateral posterior distribution and may be associated with reversible parenchymal findings if the inciting factor is treated. These diagnoses should be at the forefront of the differential diagnosis when confronted with otherwise unexplained brain edema, among other findings described in this article.
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Affiliation(s)
- Bojan D Petrovic
- Neuroradiology Section, Department of Radiology, NorthShore University HealthSystem, 2650 Ridge Avenue, Evanston, IL 60201, USA.
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Nemeth AJ, Walker MT. Preface. Radiol Clin North Am 2011; 49:xi. [DOI: 10.1016/j.rcl.2010.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Aghaei Lasboo A, Nemeth AJ, Russell EJ, Siegel GJ, Karagianis A. The use of the "puffed-cheek" computed tomography technique to confirm the diagnosis of pneumoparotitis. Laryngoscope 2010; 120:967-9. [PMID: 20422692 DOI: 10.1002/lary.20879] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Pneumoparotitis is a rare etiology of symptomatic parotid gland enlargement that is often misdiagnosed clinically. Pneumoparotitis results from air refluxing into the parotid ductal system via an incompetent Stensen duct orifice. We report a protracted case of pneumoparotitis evaluated with the "puffed-cheek" computed tomography technique to help confirm the diagnosis.
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Affiliation(s)
- Anahita Aghaei Lasboo
- Department of Radiology, Northwestern University-Feinberg School of Medicine, Chicago, Illinois, USA.
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Liu BP, Bové MJ, Nemeth AJ. Posterior glottic stenosis with a calcified interarytenoid scar band: CT and laryngoscopic correlation. AJNR Am J Neuroradiol 2010; 31:1969-71. [PMID: 20075094 DOI: 10.3174/ajnr.a1980] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
A 52-year-old man with burn injuries and prolonged intubation developed PGS with hoarseness, dyspnea, and bilateral vocal cord immobility. On CT, a calcified interarytenoid scar band was identified, corresponding to an interarytenoid scar on laryngoscopy. Endoscopic laser lysis of the calcified scar band relieved the symptoms. We present laryngoscopic and CT findings of PGS with interarytenoid calcification along with the postlysis findings. The classification, clinical findings, imaging, and management of PGS are reviewed.
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Affiliation(s)
- B P Liu
- Northwestern Memorial Hospital, Feinberg School of Medicine of Northwestern University, Chicago, Illinois, USA.
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Boz E, Nemeth AJ, Wagener KB, Jeon K, Smith R, Nazirov F, Bockstaller MR, Alamo RG. Well-Defined Precision Ethylene/Vinyl Fluoride Polymers: Synthesis and Crystalline Properties. Macromolecules 2008. [DOI: 10.1021/ma071403n] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Boz E, Ghiviriga I, Nemeth AJ, Jeon K, Alamo RG, Wagener KB. Random, Defect-Free Ethylene/Vinyl Halide Model Copolymers via Condensation Polymerization. Macromolecules 2007. [DOI: 10.1021/ma071594u] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Emine Boz
- The George and Josephine Butler Polymer Research Laboratory and Center for Macromolecular Science and Engineering, Department of Chemistry, University of Florida, Gainesville, Florida 32611-7200, and FAMU/FSU College of Engineering, Department of Chemical and Biomedical Engineering, Florida State University, Tallahassee, Florida 32310-6046
| | - Ion Ghiviriga
- The George and Josephine Butler Polymer Research Laboratory and Center for Macromolecular Science and Engineering, Department of Chemistry, University of Florida, Gainesville, Florida 32611-7200, and FAMU/FSU College of Engineering, Department of Chemical and Biomedical Engineering, Florida State University, Tallahassee, Florida 32310-6046
| | - Alexander J. Nemeth
- The George and Josephine Butler Polymer Research Laboratory and Center for Macromolecular Science and Engineering, Department of Chemistry, University of Florida, Gainesville, Florida 32611-7200, and FAMU/FSU College of Engineering, Department of Chemical and Biomedical Engineering, Florida State University, Tallahassee, Florida 32310-6046
| | - Keesu Jeon
- The George and Josephine Butler Polymer Research Laboratory and Center for Macromolecular Science and Engineering, Department of Chemistry, University of Florida, Gainesville, Florida 32611-7200, and FAMU/FSU College of Engineering, Department of Chemical and Biomedical Engineering, Florida State University, Tallahassee, Florida 32310-6046
| | - Rufina G. Alamo
- The George and Josephine Butler Polymer Research Laboratory and Center for Macromolecular Science and Engineering, Department of Chemistry, University of Florida, Gainesville, Florida 32611-7200, and FAMU/FSU College of Engineering, Department of Chemical and Biomedical Engineering, Florida State University, Tallahassee, Florida 32310-6046
| | - Kenneth B. Wagener
- The George and Josephine Butler Polymer Research Laboratory and Center for Macromolecular Science and Engineering, Department of Chemistry, University of Florida, Gainesville, Florida 32611-7200, and FAMU/FSU College of Engineering, Department of Chemical and Biomedical Engineering, Florida State University, Tallahassee, Florida 32310-6046
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Boz E, Nemeth AJ, Ghiviriga I, Jeon K, Alamo RG, Wagener KB. Precision Ethylene/Vinyl Chloride Polymers via Condensation Polymerization. Macromolecules 2007. [DOI: 10.1021/ma070933g] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Emine Boz
- The George and Josephine Butler Polymer Research Laboratory and Center for Macromolecular Science and Engineering, Department of Chemistry, University of Florida, Gainesville, Florida 32611-7200, and Department of Chemical and Biomedical Engineering, FAMU/FSU College of Engineering, Tallahassee, Florida 32310-6046
| | - Alexander J. Nemeth
- The George and Josephine Butler Polymer Research Laboratory and Center for Macromolecular Science and Engineering, Department of Chemistry, University of Florida, Gainesville, Florida 32611-7200, and Department of Chemical and Biomedical Engineering, FAMU/FSU College of Engineering, Tallahassee, Florida 32310-6046
| | - Ion Ghiviriga
- The George and Josephine Butler Polymer Research Laboratory and Center for Macromolecular Science and Engineering, Department of Chemistry, University of Florida, Gainesville, Florida 32611-7200, and Department of Chemical and Biomedical Engineering, FAMU/FSU College of Engineering, Tallahassee, Florida 32310-6046
| | - Keesu Jeon
- The George and Josephine Butler Polymer Research Laboratory and Center for Macromolecular Science and Engineering, Department of Chemistry, University of Florida, Gainesville, Florida 32611-7200, and Department of Chemical and Biomedical Engineering, FAMU/FSU College of Engineering, Tallahassee, Florida 32310-6046
| | - Rufina G. Alamo
- The George and Josephine Butler Polymer Research Laboratory and Center for Macromolecular Science and Engineering, Department of Chemistry, University of Florida, Gainesville, Florida 32611-7200, and Department of Chemical and Biomedical Engineering, FAMU/FSU College of Engineering, Tallahassee, Florida 32310-6046
| | - Kenneth B. Wagener
- The George and Josephine Butler Polymer Research Laboratory and Center for Macromolecular Science and Engineering, Department of Chemistry, University of Florida, Gainesville, Florida 32611-7200, and Department of Chemical and Biomedical Engineering, FAMU/FSU College of Engineering, Tallahassee, Florida 32310-6046
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Nemeth AJ, Henson JW, Mullins ME, Gonzalez RG, Schaefer PW. Improved detection of skull metastasis with diffusion-weighted MR imaging. AJNR Am J Neuroradiol 2007; 28:1088-92. [PMID: 17569964 PMCID: PMC8134158 DOI: 10.3174/ajnr.a0501] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND PURPOSE Metastasis to the skull is clinically important, but routine MR imaging offers moderate sensitivity for skull-metastasis detection in our experience. We sought to determine if diffusion-weighted MR imaging (DWI) could improve the detection of skull metastasis in patients with primary carcinomas that metastasized to bone compared with conventional MR imaging. MATERIALS AND METHODS Seventy-five patients from the tumor registry of our institution with extracranial primary malignancy who had brain MR imaging with DWI and radionuclide bone scanning (RNBS, gold standard) within a 6-week interval were evaluated. Thirty-eight patients demonstrated increased radiopharmaceutical uptake on RNBS, consistent with skull metastasis of any size, and the remaining 37 were control subjects. Two readers correlated the DWI and conventional MR imaging with RNBS. RESULTS The overall sensitivity of DWI for detection of skull metastases was 68.4%-71.1% (kappa=0.68) versus 42.1%-55.3% (kappa=0.65) for conventional MR imaging. Breast cancer (n=20) was detected with greatest sensitivity of 86.7%-93.3% (kappa=0.80) for DWI versus 60%-80% (kappa=0.5) for conventional MR imaging. Lung cancer (n=32) was detected with 63.6%-72.7% sensitivity (kappa=0.56), and prostate cancer (n=8) with 14.3% sensitivity (kappa=0.5) for DWI versus 27.3%-36.4% (kappa=0.81) and 14.3-42.9% (kappa=0), respectively, for conventional MR imaging. CONCLUSIONS DWI is a useful sequence for identifying focal skull metastases for breast and lung malignancies and, compared with conventional MR imaging, provides improved detection of these lesions. DWI is insensitive for detecting skull metastases from prostate carcinoma.
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Affiliation(s)
- A J Nemeth
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
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Nemeth AJ, Lie-Nemeth TJ, Marota JJA, Pryor JC, Rabinov JD, Hirsch JA. Vertebral augmentation complicated by perioperative addisonian crisis. Pain Physician 2006; 9:257-60. [PMID: 16886035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
BACKGROUND We describe a case of perioperative Addisonian crisis induced by vertebral augmentation. While several complications of vertebral augmentation have been reported previously, related to the technical procedure, to our knowledge, perioperative Addisonian crisis from vertebral augmentation has not been reported in the literature. OBJECTIVE To report an Addisonian crisis perioperative to vertebral augmentation. DESIGN Case report. METHOD Retrospective case review. RESULTS The patient had a history of adrenal insufficiency treated previously with steroids. He developed an L3 vertebral compression fracture, failed conservative therapy and was eventually referred for vertebral augmentation. Immediately after starting the procedure, the patient developed profound hypotension unresponsive to intravenous fluids and vasopressors, consistent with Addisonian crisis. After intravenous steroids had resolved the Addisonian crisis, he underwent vertebral augmentation without further complication. CONCLUSION Addisonian crisis may be triggered by vertebral augmentation. Practitioners need to recognize immediately this potentially lethal disorder in patients with known or suspected adrenal insufficiency and treat with intravenous hydrocortisone.
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Affiliation(s)
- Alexander J Nemeth
- Division of Neuroradiology, Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA.
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Abstract
The association of a benign ovarian tumor with ascites and hydrothorax that resolve after tumor resection is known as Meigs syndrome, and its importance was first emphasized by Meigs and Cass in 1937. The importance of Meigs syndrome is that the presence of ascites and pleural effusion does not necessarily indicate that a pelvic mass is malignant. The benign tumors in Meigs syndrome are usually fibromas or fibrothecomas and constitute 4% of all ovarian neoplasms. The authors present a case of Meigs syndrome with an ovarian fibroma. They focus on the evaluation of pleural fluid in the setting of an ovarian mass and then briefly discuss the imaging of ovarian fibromas and fibrothecomas.
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Affiliation(s)
- Alexander J Nemeth
- Department of Diagnostic Radiology and Nuclear Medicine, Rush-Presbyterian-St Luke's Medical Center, Chicago, IL 60612-3864, USA.
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Nemeth AJ. Lasers and wound healing. Dermatol Clin 1993; 11:783-9. [PMID: 8222362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The advances in laser surgery over the past decade have been remarkable and have significantly altered the management of a host of dermatologic disorders. This article focuses on the CO2 laser as a cutting and vaporization tool and reviews the features that distinguish CO2 laser-induced wounds from those created by a scalpel. Tissue welding, wound management after skin treatment with the visible light lasers based on the principle of selective photothermolysis, as well as the controversial field of low-energy laser therapy (biostimulation) are also addressed.
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Affiliation(s)
- A J Nemeth
- Laser and Dermatology Center, Clearwater, Florida
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Abstract
BACKGROUND Keloids and hypertrophic scars are benign fibrous growths which usually occur after trauma in predisposed individuals. Their etiology, clinical manifestations and treatment are diverse. OBJECTIVE The purpose of this article is to review the pertinent literature concerning keloids and hypertrophic scars as well as present my own perspective on the subject. It is my hope that the information contained herein will help both the dermatologist and dermatologic surgeon better understand and manage these vexing lesions. METHODS Medline literature search as well as original material. RESULTS There is no one right way to treat all keloids and hypertrophic scars. Treatment results have been variable. CONCLUSION The management of keloids and hypertrophic scars can be difficult and frustrating for both patient and physician. A better understanding of keloid pathogenesis may lead to improved therapies by which keloid growth and regrowth may be obviated.
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Affiliation(s)
- A J Nemeth
- Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Florida
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41
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Pardes JB, Nemeth AJ. Adverse sequelae of venous hypertension. Semin Dermatol 1993; 12:66-71. [PMID: 8512796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Venous hypertension and venous ulcers are clinical entities that are expected to increase as the population ages. This article will review the current clinical and laboratory data pertinent to lipodermatosclerosis and venous ulcer development. An understanding of these putative pathophysiologic mechanisms may help the clinician to better diagnose and manage such patients.
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Affiliation(s)
- J B Pardes
- Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, FL
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Nemeth AJ, Eaglstein WH, Taylor JR, Peerson LJ, Falanga V. Faster healing and less pain in skin biopsy sites treated with an occlusive dressing. Arch Dermatol 1991; 127:1679-83. [PMID: 1952972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
We prospectively studied 174 patients on whom 226 unsutured parallel incisional (shave) and 3-mm punch skin biopsies were performed. Two wound-care programs, occlusive dressing therapy and conventional therapy, were compared. The biopsy sites were evaluated after 1 or 2 weeks for healing, pain, and infection. We found that healing was unrelated to the indication for biopsy or the patients' age, gender, or race. Occlusive dressing therapy-treated shave biopsy sites were 3.83 times more likely to be healed than those treated with conventional therapy. Regardless of the treatment method, a facial shave biopsy site was 3.6 times more likely to be healed than a biopsy site in other locations. No punch biopsy site had healed after 1 week. At 2 weeks, only 7% and 36% of conventional therapy- and occlusive dressing therapy-treated punch biopsy sites, respectively, had healed. Pain at the biopsy site was six times more common in both shave and punch biopsy sites treated with conventional therapy. The absence of pain with occlusive dressing therapy was significant for both types of biopsy. One punch biopsy site treated with conventional therapy became infected, and one treated with occlusive dressing therapy was suspected of being infected. Forty patients, who had biopsy sites treated with both therapies, preferred occlusive dressing therapy over conventional therapy by a ratio of 3:1 because of ease of wound care and lack of pain. We conclude that occlusive dressing therapy may be the wound management of choice for shave biopsy sites. Since punch biopsy sites do not heal readily, it may be more appropriate to suture them, at least until therapies are developed that more effectively speed their healing.
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Affiliation(s)
- A J Nemeth
- Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, FL 33101
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Nemeth AJ, Klein AD, Gould EW, Schachner LA. Childhood bullous pemphigoid. Clinical and immunologic features, treatment, and prognosis. Arch Dermatol 1991; 127:378-86. [PMID: 1998369 DOI: 10.1001/archderm.127.3.378] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A 2 1/2-month-old female infant presented with multiple tense bullae on the hands and feet. Analysis of biopsy specimens confirmed our clinical impression of childhood bullous pemphigoid. Confirmatory data included type IV collagen mapping of the basement membrane zone, a readily available technique that helps distinguish childhood bullous pemphigoid from childhood epidermolysis bullosa acquisita. To our knowledge, our patient is the youngest described with childhood bullous pemphigoid, and we use this opportunity to review the literature and examine the clinical and immunologic features, treatment, and prognosis of this rare childhood immunobullous disorder.
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Affiliation(s)
- A J Nemeth
- Department of Dermatology, Cutaneous Surgery, University of Miami School of Medicine, FL 33101
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Abstract
Factor XIII is a blood coagulation factor which may also be produced in an intracellular location. The 'a' subunit of this factor has been found in a number of different cell types and has been shown to stimulate the proliferation of fibroblasts in vitro. We have examined cutaneous, central nervous system and renal lesions from persons with tuberous sclerosis using a standard immunohistochemical assay to see if factor XIIIa is expressed in these hamartomatous growths. We found factor XIIIa in most of the stromal cells composing the skin lesions of tuberous sclerosis as well as in cells of subependymal giant cell astrocytoma of the brain and the stromal cells in renal angiomyolipoma. Expression of factor XIIIa may be of significance in the formation of fibrous growths in tuberous sclerosis.
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Affiliation(s)
- N S Penneys
- Department of Dermatology, University of Miami School of Medicine, Florida
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Abstract
Factor XIIIa (FXIIIa), a blood and intracellularly produced coagulation factor, has been found in a variety of cell types including fibroblast-like mesenchymal cells, and has been shown to stimulate the proliferation of fibroblasts and some neoplastic cells in vitro. We have already shown that the dendritic fibroblasts composing the fibrous papule contain this factor. We hypothesized that histopathologically similar fibrovascular tumors may also express FXIIIa and, in this report, show that the large stellate fibroblasts found in acquired digital fibrokeratomas, angiofibromas (adenoma sebaceum of Pringle), and oral fibroma (oral fibrous hyperplasia) also express FXIIIa. We postulate that FXIIIa, possibly acting as a growth factor, may be a common denominator in the pathogenesis of these tumors. Another possibility is that these tumors may be the consequence of a local overproduction of FXIIIa in response to an, as yet, unidentified stimulus.
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Affiliation(s)
- A J Nemeth
- Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Florida
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Abstract
We studied the effect of edema removal on transcutaneous oxygen tension (TcPO2) in eight patients with leg ulcers. An external pneumatic compression device was effective in removing edema from the ulcerated limbs over a 5-day course of treatment, at which time all treated limbs were clinically free of edema. TcPO2 levels at room air at the ulcer site were markedly reduced when compared with the control chest site, both before and after external pneumatic compression device therapy (p less than 0.001). Edema removal, however, did not significantly alter TcPO2 values (p greater than 0.9). No significant positional effects on TcPO2 values were noted with patients supine, sitting, or with the affected limbs elevated. Five patients (63%) had increased TcPO2 values adjacent to the ulcer site when receiving supplemental oxygen. For these patients, TcPO2 values increased after oxygen inhalation, both before and after edema removal (p less than 0.05). We conclude that TcPO2 values are markedly reduced in ulcerated edematous limbs. Edema, however, may not constitute a barrier to oxygen diffusion through the skin and does not account for the low TcPO2 values in the ulcerated edematous limb. Therefore the positive therapeutic effect of removing edema is unlikely to be related to better oxygenation of the tissues.
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Affiliation(s)
- A J Nemeth
- Department of Dermatology, University of Pittsburgh School of Medicine, Pennsylvania
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Abstract
Few data exist on the prognosis of venous ulcers. We therefore prospectively studied 14 patients with severe venous ulcers for up to 18 months and examined various possible prognostic factors, including transcutaneous oxygen tension (TcPO2) measurements of skin next to the ulcers. The ulcers had been present for a mean duration of 15.6 months before referral to our clinic. During the study only four patients (29%) had ulcers that were healed with conservative management consisting of topical and systemic antibiotics and conventional and occlusive dressings. We observed that the number of ulcers, their duration before admission to the study, and the extent of lipodermatosclerosis were more pronounced in the unhealed group. For all patients the mean ulcer TcPO2 level (5.6 +/- 1.5 mm Hg, mean +/- standard error) was significantly reduced when compared with the control chest site (62.4 +/- 2.1 mm Hg) (p less than 0.001; paired t test). The mean ulcer TcPO2 was not significantly different between the healed (4.5 +/- 2.0 mm Hg) and unhealed groups (6.1 +/- 2.0 mm Hg). We conclude that TcPO2 levels may not be predictive of the response to therapy in venous ulcers. TcPO2 levels may be markedly reduced, but even extremely low levels are not incompatible with healing.
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Affiliation(s)
- A J Nemeth
- Department of Dermatology, University of Pittsburgh School of Medicine, Pennsylvania
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Abstract
Factor XIIIa, a blood coagulation factor, has been found in a variety of cell types, including dendritic reticulum cells and fibroblast-like mesenchymal cells. We hypothesized that fibrous papule, a lesion of uncertain histogenesis, was composed of dermal stellate cells and in this report demonstrate that this neoplasm consists of cells that contain this factor. Nevus cells do not contain factor XIIIa.
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Affiliation(s)
- A J Nemeth
- Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, FL
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Falanga V, Moosa HH, Nemeth AJ, Alstadt SP, Eaglstein WH. Dermal pericapillary fibrin in venous disease and venous ulceration. Arch Dermatol 1987; 123:620-3. [PMID: 3555351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Pericapillary fibrin deposition is thought to contribute to the pathogenesis of venous ulceration. To our knowledge, however, there is no previous evidence that pericapillary fibrin is deposited in the tissue adjacent to venous ulcers. We prospectively studied patients with ulcers of the lower extremities for the presence of dermal pericapillary fibrin in the skin adjacent tot he ulcers. On direct immunofluorescence, pericapillary fibrin was found in 14 (93%) of the 15 patients with venous ulceration but in only one (7%) of the 14 subjects with ulcers due to other causes. We also confirmed the presence of dermal pericapillary fibrin in legs with venous disease without ulcerations. We conclude that the pericapillary fibrin is easily demonstrable in the dermis adjacent to venous ulcers. In the evaluation of ulcers due to uncertain causes, the presence of dermal pericapillary fibrin may provide additional diagnostic help.
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