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Cheema S, Mehta D, Qureshi A, Sayal P, Kamourieh S, Davagnanam I, Matharu M. Spontaneous intracranial hypotension. Pract Neurol 2024; 24:98-105. [PMID: 38135500 PMCID: PMC10958270 DOI: 10.1136/pn-2023-003986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2023] [Indexed: 12/24/2023]
Abstract
Spontaneous intracranial hypotension (SIH) is a highly disabling but treatable secondary cause of headache. Recent progress in neuroradiological techniques has catalysed understanding of its pathophysiological basis and clinical diagnosis, and facilitated the development of more effective investigation and treatment methods. A UK-based specialist interest group recently produced the first multidisciplinary consensus guideline for the diagnosis and treatment of SIH. Here, we summarise a practical approach to its clinical and radiological diagnosis, symptomatic and non-targeted interventional treatment, radiological identification of leak site and targeted treatment of the leak once it has been localised.
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Affiliation(s)
- Sanjay Cheema
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
- Headache and Facial Pain Group, National Hospital for Neurology and Neurosurgery, London, UK
| | - Dwij Mehta
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
- Headache and Facial Pain Group, National Hospital for Neurology and Neurosurgery, London, UK
| | - Ayman Qureshi
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Parag Sayal
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Salwa Kamourieh
- Headache and Facial Pain Group, National Hospital for Neurology and Neurosurgery, London, UK
| | - Indran Davagnanam
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, UK
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
| | - Manjit Matharu
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
- Headache and Facial Pain Group, National Hospital for Neurology and Neurosurgery, London, UK
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2
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Ratneswaren T, Chan N, Aeron-Thomas J, Sait S, Adesalu O, Alhawamdeh M, Benger M, Garnham J, Dixon L, Tona F, McNamara C, Taylor E, Lobotesis K, Lim E, Goldberg O, Asmar N, Evbuomwan O, Banerjee S, Holm-Mercer L, Senor J, Tsitsiou Y, Tantrige P, Taha A, Ballal K, Mattar A, Daadipour A, Elfergani K, Barker R, Chakravartty R, Murchison AG, Kemp BJ, Simister R, Davagnanam I, Wong OY, Werring D, Banaras A, Anjari M, Rodrigues JCL, Thompson CAS, Haines IR, Burnett TA, Zaher REY, Reay VL, Banerjee M, Sew Hee CSL, Oo AP, Lo A, Rogers P, Hughes T, Marin A, Mukherjee S, Jaber H, Sanders E, Owen S, Bhandari M, Sundayi S, Bhagat A, Elsakka M, Hashmi OH, Lymbouris M, Gurung-Koney Y, Arshad M, Hasan I, Singh N, Patel V, Rahiminejad M, Booth TC. COVID-19 Stroke Apical Lung Examination Study 2: a national prospective CTA biomarker study of the lung apices, in patients presenting with suspected acute stroke (COVID SALES 2). Neuroimage Clin 2024; 42:103590. [PMID: 38513535 DOI: 10.1016/j.nicl.2024.103590] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 01/26/2024] [Revised: 03/10/2024] [Accepted: 03/13/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Apical ground-glass opacification (GGO) identified on CT angiography (CTA) performed for suspected acute stroke was developed in 2020 as a coronavirus-disease-2019 (COVID-19) diagnostic and prognostic biomarker in a retrospective study during the first wave of COVID-19. OBJECTIVE To prospectively validate whether GGO on CTA performed for suspected acute stroke is a reliable COVID-19 diagnostic and prognostic biomarker and whether it is reliable for COVID-19 vaccinated patients. METHODS In this prospective, pragmatic, national, multi-center validation study performed at 13 sites, we captured study data consecutively in patients undergoing CTA for suspected acute stroke from January-March 2021. Demographic and clinical features associated with stroke and COVID-19 were incorporated. The primary outcome was the likelihood of reverse-transcriptase-polymerase-chain-reaction swab-test-confirmed COVID-19 using the GGO biomarker. Secondary outcomes investigated were functional status at discharge and survival analyses at 30 and 90 days. Univariate and multivariable statistical analyses were employed. RESULTS CTAs from 1,111 patients were analyzed, with apical GGO identified in 8.5 % during a period of high COVID-19 prevalence. GGO showed good inter-rater reliability (Fleiss κ = 0.77); and high COVID-19 specificity (93.7 %, 91.8-95.2) and negative predictive value (NPV; 97.8 %, 96.5-98.6). In subgroup analysis of vaccinated patients, GGO remained a good diagnostic biomarker (specificity 93.1 %, 89.8-95.5; NPV 99.7 %, 98.3-100.0). Patients with COVID-19 were more likely to have higher stroke score (NIHSS (mean +/- SD) 6.9 +/- 6.9, COVID-19 negative, 9.7 +/- 9.0, COVID-19 positive; p = 0.01), carotid occlusions (6.2 % negative, 14.9 % positive; p = 0.02), and larger infarcts on presentation CT (ASPECTS 9.4 +/- 1.5, COVID-19 negative, 8.6 +/- 2.4, COVID-19 positive; p = 0.00). After multivariable logistic regression, GGO (odds ratio 15.7, 6.2-40.1), myalgia (8.9, 2.1-38.2) and higher core body temperature (1.9, 1.1-3.2) were independent COVID-19 predictors. GGO was associated with worse functional outcome on discharge and worse survival after univariate analysis. However, after adjustment for factors including stroke severity, GGO was not independently predictive of functional outcome or mortality. CONCLUSION Apical GGO on CTA performed for patients with suspected acute stroke is a reliable diagnostic biomarker for COVID-19, which in combination with clinical features may be useful in COVID-19 triage.
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Affiliation(s)
- T Ratneswaren
- Charing Cross Hospital, London, UK; Addenbrooke's Hospital, Cambridge, UK
| | - N Chan
- Royal London Hospital, London, UK
| | | | - S Sait
- King's College Hospital, London, UK
| | | | | | - M Benger
- King's College Hospital, London, UK
| | | | - L Dixon
- Charing Cross Hospital, London, UK
| | - F Tona
- Charing Cross Hospital, London, UK
| | | | - E Taylor
- Charing Cross Hospital, London, UK
| | | | - E Lim
- Charing Cross Hospital, London, UK
| | | | - N Asmar
- Charing Cross Hospital, London, UK
| | | | | | | | - J Senor
- Charing Cross Hospital, London, UK
| | | | - P Tantrige
- Princess Royal University Hospital, Orpington, UK
| | - A Taha
- Princess Royal University Hospital, Orpington, UK
| | - K Ballal
- Princess Royal University Hospital, Orpington, UK
| | - A Mattar
- Princess Royal University Hospital, Orpington, UK
| | - A Daadipour
- Princess Royal University Hospital, Orpington, UK
| | - K Elfergani
- Princess Royal University Hospital, Orpington, UK
| | - R Barker
- Frimley Park Hospital, Surrey, UK
| | | | | | - B J Kemp
- John Radcliffe Hospital, Oxford, UK
| | | | | | - O Y Wong
- University College Hospital, London, UK
| | - D Werring
- Comprehensive Stroke Service, National Hospital for Neurology and Neurosurgery, University College Hospitals NHS Foundation Trust, London, UK; Stroke Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - A Banaras
- University College Hospital, London, UK
| | - M Anjari
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, UK
| | | | | | | | | | - R E Y Zaher
- Southampton General Hospital, Southampton, UK
| | - V L Reay
- Southampton General Hospital, Southampton, UK
| | - M Banerjee
- Southampton General Hospital, Southampton, UK
| | | | - A P Oo
- Southampton General Hospital, Southampton, UK
| | - A Lo
- Addenbrooke's Hospital, Cambridge, UK
| | - P Rogers
- Addenbrooke's Hospital, Cambridge, UK
| | - T Hughes
- Cardiff and Vale University Health Board, Cardiff, UK
| | - A Marin
- Cardiff and Vale University Health Board, Cardiff, UK
| | - S Mukherjee
- Cardiff and Vale University Health Board, Cardiff, UK
| | - H Jaber
- Cardiff and Vale University Health Board, Cardiff, UK
| | - E Sanders
- Cardiff and Vale University Health Board, Cardiff, UK
| | - S Owen
- Cardiff and Vale University Health Board, Cardiff, UK
| | | | - S Sundayi
- Watford General Hospital, Watford, UK
| | - A Bhagat
- Watford General Hospital, Watford, UK
| | - M Elsakka
- Watford General Hospital, Watford, UK
| | - O H Hashmi
- Norfolk and Norwich University Hospital, Norwich, UK
| | - M Lymbouris
- Norfolk and Norwich University Hospital, Norwich, UK
| | | | - M Arshad
- Norfolk and Norwich University Hospital, Norwich, UK
| | - I Hasan
- Norfolk and Norwich University Hospital, Norwich, UK
| | - N Singh
- Norfolk and Norwich University Hospital, Norwich, UK
| | - V Patel
- St Thomas' Hospital, London, UK
| | | | - T C Booth
- King's College Hospital, London, UK; School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK.
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Foster MA, Collorone S, Rose G, Plowman PN, Thom M, Davagnanam I, Acheson J, Toosy AT. Central Nervous System Lymphoma Mimicking Demyelinating Disease-A Case Report. J Neuroophthalmol 2024; 44:e55-e57. [PMID: 36166769 DOI: 10.1097/wno.0000000000001621] [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] [Indexed: 11/25/2022]
Affiliation(s)
- Michael A Foster
- Department of Neuroinflammation (MAF, SC), UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, United Kingdom; Adnexal Service, Moorfields Eye Hospital NHS Foundation Trust (GR), London, United Kingdom; Department of Clinical Oncology (PNP), St Bartholomew's Hospital, London, United Kingdom; Department of Clinical and Experimental Epilepsy (MT), UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, United Kingdom; Lysholm Department of Neuroradiology (ID), National Hospital for Neurology and Neurosurgery, London, United Kingdom; and Strabismus and Neuro-Ophthalmology Service (JA), Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
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Wong SH, Pontillo G, Kanber B, Prados F, Wingrove J, Yiannakas M, Davagnanam I, Gandini Wheeler-Kingshott CAM, Toosy AT. Visual Snow Syndrome Improves With Modulation of Resting-State Functional MRI Connectivity After Mindfulness-Based Cognitive Therapy: An Open-Label Feasibility Study. J Neuroophthalmol 2024; 44:112-118. [PMID: 37967050 PMCID: PMC10855987 DOI: 10.1097/wno.0000000000002013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
BACKGROUND Visual snow syndrome (VSS) is associated with functional connectivity (FC) dysregulation of visual networks (VNs). We hypothesized that mindfulness-based cognitive therapy, customized for visual symptoms (MBCT-vision), can treat VSS and modulate dysfunctional VNs. METHODS An open-label feasibility study for an 8-week MBCT-vision treatment program was conducted. Primary (symptom severity; impact on daily life) and secondary (WHO-5; CORE-10) outcomes at Week 9 and Week 20 were compared with baseline. Secondary MRI outcomes in a subcohort compared resting-state functional and diffusion MRI between baseline and Week 20. RESULTS Twenty-one participants (14 male participants, median 30 years, range 22-56 years) recruited from January 2020 to October 2021. Two (9.5%) dropped out. Self-rated symptom severity (0-10) improved: baseline (median [interquartile range (IQR)] 7 [6-8]) vs Week 9 (5.5 [3-7], P = 0.015) and Week 20 (4 [3-6], P < 0.001), respectively. Self-rated impact of symptoms on daily life (0-10) improved: baseline (6 [5-8]) vs Week 9 (4 [2-5], P = 0.003) and Week 20 (2 [1-3], P < 0.001), respectively. WHO-5 Wellbeing (0-100) improved: baseline (median [IQR] 52 [36-56]) vs Week 9 (median 64 [47-80], P = 0.001) and Week 20 (68 [48-76], P < 0.001), respectively. CORE-10 Distress (0-40) improved: baseline (15 [12-20]) vs Week 9 (12.5 [11-16.5], P = 0.003) and Week 20 (11 [10-14], P = 0.003), respectively. Within-subject fMRI analysis found reductions between baseline and Week 20, within VN-related FC in the i) left lateral occipital cortex (size = 82 mL, familywise error [FWE]-corrected P value = 0.006) and ii) left cerebellar lobules VIIb/VIII (size = 65 mL, FWE-corrected P value = 0.02), and increases within VN-related FC in the precuneus/posterior cingulate cortex (size = 69 mL, cluster-level FWE-corrected P value = 0.02). CONCLUSIONS MBCT-vision was a feasible treatment for VSS, improved symptoms and modulated FC of VNs. This study also showed proof-of-concept for intensive mindfulness interventions in the treatment of neurological conditions.
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Varmpompiti K, Chow G, Foster M, Kodali S, Prados F, Yiannakas MC, Kanber B, Burke A, Ogunbowale L, Davagnanam I, Toosy AT, Collorone S. Associations between cortical lesions, optic nerve damage, and disability at the onset of multiple sclerosis: insights into neurodegenerative processes. Mult Scler Relat Disord 2024; 83:105413. [PMID: 38215633 DOI: 10.1016/j.msard.2023.105413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 09/29/2023] [Revised: 12/12/2023] [Accepted: 12/25/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND Multiple sclerosis cortical lesions are areas of demyelination and neuroaxonal loss. Retinal layer thickness, measured with optical coherence tomography (OCT), is an emerging biomarker of neuroaxonal loss. Studies have reported correlations between cortical lesions and retinal layer thinning in established multiple sclerosis, suggesting a shared pathophysiological process. Here, we assessed the correlation between cortical lesions and OCT metrics at the onset of multiple sclerosis, examining, for the first time, associations with physical or cognitive disability. OBJECTIVE To examine the relationship between cortical lesions, optic nerve and retinal layer thicknesses, and physical and cognitive disability at the first demyelinating event. METHODS Thirty-nine patients and 22 controls underwent 3T-MRI, optical coherence tomography, and clinical tests. We identified cortical lesions on phase-sensitive inversion recovery sequences, including occipital cortex lesions. We measured the estimated total intracranial volume and the white matter lesion volume. OCT metrics included peripapillary retinal nerve fibre layer (pRNFL), ganglion cell and inner plexiform layer (GCIPL) and inner nuclear layer (INL) thicknesses. RESULTS Higher total cortical and leukocortical lesion volumes correlated with thinner pRNFL (B = -0.0005, 95 % CI -0.0008 to -0.0001, p = 0.01; B = -0.0005, 95 % CI -0.0008 to -0.0001, p = 0.01, respectively). Leukocortical lesion number correlated with colour vision deficits (B = 0.58, 95 %CI 0.039 to 1,11, p = 0.036). Thinner GCIPL correlated with a higher Expanded Disability Status Scale (B = -0.06, 95 % CI -1.1 to -0.008, p = 0.026). MS diagnosis (n = 18) correlated with higher cortical and leukocortical lesion numbers (p = 0.004 and p = 0.003), thinner GCIPL (p = 0.029) and INL (p = 0.041). CONCLUSION The association between cortical lesions and axonal damage in the optic nerve reinforces the role of neurodegenerative processes in MS pathogenesis at onset.
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Affiliation(s)
- Kyriakoula Varmpompiti
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Geoffrey Chow
- Centre for Medical Image Computing (CMIC), Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Michael Foster
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Srikirti Kodali
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Ferran Prados
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK; Centre for Medical Image Computing (CMIC), Department of Medical Physics and Biomedical Engineering, University College London, London, UK; eHealth Center, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Marios C Yiannakas
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Baris Kanber
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK; Centre for Medical Image Computing (CMIC), Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | | | | | - Indran Davagnanam
- Department of Brain Repair and Rehabilitation, University College London Institute of Neurology, Faculty of Brain Sciences, UCL, London, UK
| | - Ahmed T Toosy
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Sara Collorone
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK.
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Wade C, Williams T, Labrum R, Patel Y, Cali E, Davagnanam I, Adams ME, Barkhof F, Murphy E, Chataway J, Houlden H, Lynch DS. Leukoencephalopathy caused by a 17p13.3 microdeletion. J Neurol Neurosurg Psychiatry 2024; 95:290-292. [PMID: 37734926 DOI: 10.1136/jnnp-2023-331986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/01/2023] [Indexed: 09/23/2023]
Affiliation(s)
- Charles Wade
- Department of Neuroinflammation, UCL Queen Square Institute of Neurology, London, UCL Queen Square Institute of Neurology, London, UK
| | - Thomas Williams
- Department of Neuroinflammation, UCL Queen Square Institute of Neurology, London, UCL Queen Square Institute of Neurology, London, UK
| | - Robyn Labrum
- Rare & Inherited Disease Laboratory, North Thames Genomic Laboratory Hub, London, UK
| | - Yogen Patel
- Rare & Inherited Disease Laboratory, North Thames Genomic Laboratory Hub, London, UK
| | - Elisa Cali
- Department of Neuromuscular Diseases, University College London, London, UK
| | - Indran Davagnanam
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Matthew E Adams
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Frederik Barkhof
- Department of Neuroinflammation, UCL Queen Square Institute of Neurology, London, UCL Queen Square Institute of Neurology, London, UK
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
- Department of Radiology & Nuclear Medicine, Amsterdam UMC, Amsterdam, Netherlands
| | - Elaine Murphy
- Charles Dent Metabolic Unit, University College London Hospitals NHS Foundation Trust National Hospital for Neurology and Neurosurgery, London, UK
| | - Jeremy Chataway
- Department of Neuroinflammation, UCL Queen Square Institute of Neurology, London, UCL Queen Square Institute of Neurology, London, UK
- National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, London, UK
| | - Henry Houlden
- Department of Neuromuscular Diseases, University College London, London, UK
| | - David S Lynch
- Department of Neuromuscular Diseases, University College London, London, UK
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Cheema S, Anderson J, Angus-Leppan H, Armstrong P, Butteriss D, Carlton Jones L, Choi D, Chotai A, D'Antona L, Davagnanam I, Davies B, Dorman PJ, Duncan C, Ellis S, Iodice V, Joy C, Lagrata S, Mead S, Morland D, Nissen J, Pople J, Redfern N, Sayal PP, Scoffings D, Secker R, Toma AK, Trevarthen T, Walkden J, Beck J, Kranz PG, Schievink W, Wang SJ, Matharu MS. Multidisciplinary consensus guideline for the diagnosis and management of spontaneous intracranial hypotension. J Neurol Neurosurg Psychiatry 2023; 94:835-843. [PMID: 37147116 PMCID: PMC10511987 DOI: 10.1136/jnnp-2023-331166] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 04/21/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND We aimed to create a multidisciplinary consensus clinical guideline for best practice in the diagnosis, investigation and management of spontaneous intracranial hypotension (SIH) due to cerebrospinal fluid leak based on current evidence and consensus from a multidisciplinary specialist interest group (SIG). METHODS A 29-member SIG was established, with members from neurology, neuroradiology, anaesthetics, neurosurgery and patient representatives. The scope and purpose of the guideline were agreed by the SIG by consensus. The SIG then developed guideline statements for a series of question topics using a modified Delphi process. This process was supported by a systematic literature review, surveys of patients and healthcare professionals and review by several international experts on SIH. RESULTS SIH and its differential diagnoses should be considered in any patient presenting with orthostatic headache. First-line imaging should be MRI of the brain with contrast and the whole spine. First-line treatment is non-targeted epidural blood patch (EBP), which should be performed as early as possible. We provide criteria for performing myelography depending on the spine MRI result and response to EBP, and we outline principles of treatments. Recommendations for conservative management, symptomatic treatment of headache and management of complications of SIH are also provided. CONCLUSIONS This multidisciplinary consensus clinical guideline has the potential to increase awareness of SIH among healthcare professionals, produce greater consistency in care, improve diagnostic accuracy, promote effective investigations and treatments and reduce disability attributable to SIH.
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Affiliation(s)
- Sanjay Cheema
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
- Headache and Facial Pain Group, National Hospital for Neurology and Neurosurgery, London, UK
| | - Jane Anderson
- Neurology Department, Addenbrooke's Hospital, Cambridge, UK
| | | | - Paul Armstrong
- Neuroradiology Department, Institute of Neurological Sciences, Glasgow, UK
| | - David Butteriss
- Department of Neuroradiology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Lalani Carlton Jones
- Neuroradiology Department, Guy's and St Thomas' Hospitals NHS Trust, London, UK
- Neuroradiology Department, King's College Hospital NHS Foundation Trust, London, UK
| | - David Choi
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Amar Chotai
- Department of Neuroradiology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Linda D'Antona
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Indran Davagnanam
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
- Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Brendan Davies
- Neurology Department, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Paul J Dorman
- Department of Neurology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | | | - Simon Ellis
- Neurology Department, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Valeria Iodice
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
- Autonomic Unit, National Hospital for Neurology and Neurosurgery, London, UK
| | - Clare Joy
- CSF Leak Association, Strathpeffer, UK
| | - Susie Lagrata
- Headache and Facial Pain Group, National Hospital for Neurology and Neurosurgery, London, UK
| | | | - Danny Morland
- Department of Anaesthesia, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Justin Nissen
- Neurosurgery Department, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | | | - Nancy Redfern
- Department of Anaesthesia, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Parag P Sayal
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | | | | | - Ahmed K Toma
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | | | | | - Jürgen Beck
- Department of Neurosurgery, Medical Center-University of Freiburg, Freiburg, Germany
| | - Peter George Kranz
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Wouter Schievink
- Neurosurgery Department, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Shuu-Jiun Wang
- Neurology Department, Taipei Veterans General Hospital, Taipei, Taiwan
- Brain Research Center, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan
| | - Manjit Singh Matharu
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
- Headache and Facial Pain Group, National Hospital for Neurology and Neurosurgery, London, UK
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8
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Mehta D, Cheema S, Davagnanam I, Matharu M. Diagnosis and treatment evaluation in patients with spontaneous intracranial hypotension. Front Neurol 2023; 14:1145949. [PMID: 36970531 PMCID: PMC10036855 DOI: 10.3389/fneur.2023.1145949] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 02/21/2023] [Indexed: 03/12/2023] Open
Abstract
Spontaneous intracranial hypotension is characterized by an orthostatic headache and audiovestibular symptoms alongside a myriad of other non-specific symptoms. It is caused by an unregulated loss of cerebrospinal fluid at the spinal level. Indirect features of CSF leaks are seen on brain imaging as signs of intracranial hypotension and/or CSF hypovolaemia as well as a low opening pressure on lumbar puncture. Direct evidence of CSF leaks can frequently, but not invariably, be observed on spinal imaging. The condition is frequently misdiagnosed due to its vague symptoms and a lack of awareness of the condition amongst the non-neurological specialities. There is also a distinct lack of consensus on which of the many investigative and treatment options available to use when managing suspected CSF leaks. The aim of this article is to review the current literature on spontaneous intracranial hypotension and its clinical presentation, preferred investigation modalities, and most efficacious treatment options. By doing so, we hope to provide a framework on how to approach a patient with suspected spontaneous intracranial hypotension and help minimize diagnostic and treatment delays in order to improve clinical outcomes.
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Affiliation(s)
- Dwij Mehta
- Headache and Facial Pain Group, University College London (UCL) Queen Square Institute of Neurology, The National Hospital for Neurology and Neurosurgery, London, United Kingdom
- *Correspondence: Dwij Mehta
| | - Sanjay Cheema
- Headache and Facial Pain Group, University College London (UCL) Queen Square Institute of Neurology, The National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Indran Davagnanam
- Lysholm Department of Neuroradiology, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Manjit Matharu
- Headache and Facial Pain Group, University College London (UCL) Queen Square Institute of Neurology, The National Hospital for Neurology and Neurosurgery, London, United Kingdom
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9
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Cheema S, Anderson J, Duncan C, Davagnanam I, Armstrong P, Redfern N, Ordman A, D’Antona L, Nissen J, Sayal P, Vaughan-Huxley E, Lagrata S, Iodice V, Snape-Burns J, Joy C, Matharu M. Survey of healthcare professionals’ knowledge, attitudes and practices regarding spontaneous intracranial hypotension. BMJ Neurol Open 2022; 4:e000347. [PMID: 36110926 PMCID: PMC9445790 DOI: 10.1136/bmjno-2022-000347] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 08/26/2022] [Indexed: 11/30/2022] Open
Abstract
Objective To assess the knowledge, attitudes and practices of healthcare professionals regarding the diagnosis and management of spontaneous intracranial hypotension (SIH). Methods We performed a cross-sectional, web-based survey of multiple healthcare professional groups in the UK from June to August 2021. There were 227 respondents to the survey, including 62 general practitioners, 39 emergency medicine physicians, 38 neurologists, 35 radiologists, 20 neurosurgeons, 18 anaesthetists and 15 headache nurse specialists. The majority of the respondents were at the consultant level and all worked in the UK National Health Service. Results Few general practitioners or emergency medicine physicians had ever been involved in the care of a patient with SIH or received teaching about SIH. Only 3 of 62 (4.8%) general practitioners and 1 of 39 (2.5%) emergency medicine physicians were confident in recognising the symptoms of SIH. Most neurologists were confident in recognising SIH and performed MRI of the brain as a first-line investigation, although there was variability in the urgency of the request, whether contrast was given or MRI of the spine organised at the same time. Most said they never or rarely performed lumbar puncture for diagnosis of SIH. Most neuroradiologists, but few general radiologists, were confident in interpreting imaging of patients with suspected SIH. Lack of access to epidural blood patching, personnel able to perform myelography, and established management pathways were identified by many respondents as barriers to the treatment of SIH. Conclusions We have identified a lack of awareness of SIH among non-specialists, several barriers to optimal treatment of SIH and a variation in current management pathways. The results highlight the need for education of healthcare professionals about SIH and the development of clinical practice guidelines to enable delivery of optimal and equitable care for patients with SIH.
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Affiliation(s)
- Sanjay Cheema
- UCL Queen Square Institute of Neurology, London, UK
- Headache and Facial Pain Group, National Hospital for Neurology and Neurosurgery, London, UK
| | - Jane Anderson
- Neurology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Indran Davagnanam
- UCL Queen Square Institute of Neurology, London, UK
- Neuroradiology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Paul Armstrong
- Neuroradiology, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Nancy Redfern
- Anaesthetics, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | | | - Linda D’Antona
- UCL Queen Square Institute of Neurology, London, UK
- Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Justin Nissen
- Neurosurgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Parag Sayal
- Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | | | - Susie Lagrata
- Headache and Facial Pain Group, National Hospital for Neurology and Neurosurgery, London, UK
| | - Valeria Iodice
- Autonomic Unit, National Hospital for Neurology and Neurosurgery, London, UK
| | | | - Clare Joy
- CSF Leak Association, Strathpeffer, UK
| | - Manjit Matharu
- UCL Queen Square Institute of Neurology, London, UK
- Headache and Facial Pain Group, National Hospital for Neurology and Neurosurgery, London, UK
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10
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Budhdeo S, de Paiva ARB, Wade C, Lopes LCG, Della-Ripa B, Davagnanam I, Lucato L, Mummery CJ, Kok F, Houlden H, Werring DJ, Lynch DS. A rare cause of monogenic cerebral small vessel disease and stroke: Cathepsin A-related arteriopathy with strokes and leukoencephalopathy (CARASAL). J Neurol 2022; 269:6673-6677. [PMID: 35904593 DOI: 10.1007/s00415-022-11302-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Cathepsin A-related arteriopathy with strokes and leukoencephalopathy (CARASAL) is a rare monogenic cause of cerebral small vessel disease. To date, fewer than 15 patients with CARASAL have been described, all of common European ancestry. METHODS Clinical and imaging phenotypes of two patients are presented. Genetic variants were identified using targeted Sanger and focused exome sequencing, respectively. RESULTS Both patients carried the same pathogenic p.Arg325Cys mutation in CTSA. One patient of Chinese ethnicity presented with migraine, tinnitus and slowly progressive cognitive impairment with significant cerebral small vessel disease in the absence of typical cardiovascular risk factors. She later suffered an ischaemic stroke. A second patient from Brazil, of Italian ethnicity developed progressive dysphagia and dysarthria in his 50s, he later developed hearing loss and chronic disequilibrium. Magnetic resonance imaging in both cases demonstrated extensive signal change in the deep cerebral white matter, anterior temporal lobes, thalami, internal and external capsules and brainstem. CONCLUSIONS CARASAL should be considered in patients with early onset or severe cerebral small vessel disease, particularly where there are prominent symptoms or signs related to brainstem involvement, such as hearing dysfunction, tinnitus or dysphagia or where there is significant thalamic and brainstem involvement on imaging.
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Affiliation(s)
- Sanjay Budhdeo
- Department for Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Anderson Rodrigues Brandão de Paiva
- Neurology Department, Neurogenetics Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Neurology Department, Hospital São Rafael-Rede D'Or São Luiz, Salvador, Brazil
| | - Charles Wade
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Laura Cardia Gomes Lopes
- Department of Neurology, Psychology and Psychiatry, Universidade Estadual de São Paulo (UNESP), Botucatu, SP, Brazil
| | - Bruno Della-Ripa
- Neurology Department, Neurogenetics Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Indran Davagnanam
- Lysholm Department of Neuroradiology, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Leandro Lucato
- Diagnostic Neuroradiology Section, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Catherine J Mummery
- Dementia Research Centre, Department of Neurodegenerative Disease, National Hospital for Neurology and Neurosurgery, London, UK
| | - Fernando Kok
- Neurology Department, Neurogenetics Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Mendelics Genomic Analysis, São Paulo, Brazil
| | - Henry Houlden
- Department of Neuromuscular Disease, UCL Queen Square Institute of Neurology, London, UK
| | - David J Werring
- Stroke Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - David S Lynch
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
- Department of Neuromuscular Disease, UCL Queen Square Institute of Neurology, London, UK.
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11
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Murphy P, Williams F, Davagnanam I, Chan E, Murphy E, Hughes D, Quattrocchi G, Werring DJ, Lachman RH, Cipolotti L. Cognitive dysfunction and white matter hyperintensities in Fabry disease. J Inherit Metab Dis 2022; 45:782-795. [PMID: 34994980 DOI: 10.1002/jimd.12472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 12/02/2021] [Accepted: 12/30/2021] [Indexed: 11/08/2022]
Abstract
Fabry disease (FD) is an X-linked lysosomal storage disorder with multi-system involvement including cerebrovascular disease. Patients with FD also have a high risk of ischaemic stroke and TIA. White matter hyperintensities are common, but their clinical impact on cognition remains uncertain. Previous studies have examined the neuropsychological profile of FD, but have been inconclusive in part due to methodological limitations including small sample sizes. We sought to address these limitations in a case-control study of 26 patients with Fabry disease with mild to moderate disease symptoms matched with 18 healthy controls for age and premorbid intellectual level. We obtained detailed neuropsychological data and MRI neuroimaging data on the severity of white matter changes. Mood was accounted for as a possible confounder. Our results showed significant compromise of executive functions and information processing speed for the FD group. Error analyses suggested that the compromise of executive functions could not be entirely accounted for by slowed information processing speed. We demonstrated significant correlations between cognitive decline and the overall volume of white matter hyperintensities in the FD group. Our results point to significant compromise of cognition in FD even without stroke or mood difficulties. This suggests that neuropsychological assessment and rehabilitation should be routinely offered to patients with FD.
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Affiliation(s)
- Patrick Murphy
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Fay Williams
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, London, UK
- West Kent and Medway Neuropsychiatry Service, Kent, UK
| | - Indran Davagnanam
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Edgar Chan
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Elaine Murphy
- Charles Dent Metabolic Unit, National Hospital for Neurology and Neurosurgery, London, UK
| | - Derralynn Hughes
- Institute of Immunity & Transplantation, Royal Free Hospital, London, UK
| | - Gabriella Quattrocchi
- Comprehensive Stroke Service, National Hospital for Neurology and Neurosurgery, London, UK
| | - David J Werring
- Comprehensive Stroke Service, National Hospital for Neurology and Neurosurgery, London, UK
- Stroke Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Robin H Lachman
- Charles Dent Metabolic Unit, National Hospital for Neurology and Neurosurgery, London, UK
| | - Lisa Cipolotti
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, London, UK
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12
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Schiff ER, Aychoua N, Nutan S, Davagnanam I, Moore AT, Robson AG, Patel CK, Webster AR, Arno G. Variability of retinopathy consequent upon novel mutations in LAMA1. Ophthalmic Genet 2022; 43:671-678. [PMID: 35616092 DOI: 10.1080/13816810.2022.2076283] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 10/18/2022]
Abstract
PURPOSE Bi-allelic mutations in LAMA1 (laminin 1) (OMIM # 150320) cause Poretti-Boltshauser Syndrome (PTBHS), a rare non-progressive cerebellar dysplasia disorder with ophthalmic manifestations including oculomotor apraxia, high myopia, and retinal dystrophy. Only 38 variants, nearly all loss of function have been reported. Here, we describe novel LAMA1 variants and detailed retinal manifestations in two unrelated families. METHODS Whole-genome sequencing was conducted on three siblings of a consanguineous family with myopia and retinal dystrophy and on a child from an unrelated non-consanguineous couple. Clinical evaluation included full ophthalmic examination, detailed colour, autofluorescence retinal imaging, retinal optical coherence tomography (OCT), fluorescein angiography under anesthesia, and pattern and full-field electroretinography. RESULTS Genetic analysis revealed a novel homozygous LAMA1 frameshift variant, c.1492del p.(Arg498Glyfs *25), in the affected siblings in family 1 and a novel frameshift c.3065del p.(Gly1022Valfs *2) and a deletion spanning exons 17-23 in an unrelated individual in family 2. Two of the three siblings and the unrelated child had oculomotor apraxia in childhood; none of the siblings had symptoms of other neurological dysfunction as adults. All four had myopia. The affected siblings had a qualitatively similar retinopathy of wide-ranging severity. The unrelated patient had a severe abnormality of retinal vascular development, which resulted in vitreous haemorrhage and neovascular glaucoma in the left eye and a rhegmatogenous retinal detachment in the right eye. CONCLUSIONS This report describes the detailed retinal structural and functional consequences of LAMA1 deficiency in four patients from two families, and these exhibit significant variability with evidence of both retinal dystrophy and abnormal and incomplete retinal vascularisation.
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Affiliation(s)
- Elena R Schiff
- Moorfields Eye Hospital, London, UK.,UCL Institute of Ophthalmology, London, UK
| | | | - Savita Nutan
- North Thames Genomic Laboratory Hub, Great Ormond Street NHS Foundation Trust, London, UK
| | - Indran Davagnanam
- Moorfields Eye Hospital, London, UK.,National Hospital for Neurology and Neurosurgery, London, UK.,UCL Institute of Neurology, London, UK
| | - Anthony T Moore
- UCL Institute of Ophthalmology, London, UK.,University of California, San Francisco, San Francisco, California, USA
| | - A G Robson
- Moorfields Eye Hospital, London, UK.,UCL Institute of Ophthalmology, London, UK
| | - C K Patel
- Great Ormond Street Hospital, London, UK.,Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Andrew R Webster
- Moorfields Eye Hospital, London, UK.,UCL Institute of Ophthalmology, London, UK
| | - Gavin Arno
- Moorfields Eye Hospital, London, UK.,UCL Institute of Ophthalmology, London, UK.,North Thames Genomic Laboratory Hub, Great Ormond Street NHS Foundation Trust, London, UK
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13
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Lambru G, Lagrata S, Levy A, Cheema S, Davagnanam I, Rantell K, Kitchen N, Zrinzo L, Matharu M. Trigeminal microvascular decompression for short-lasting unilateral neuralgiform headache attacks. Brain 2022; 145:2882-2893. [PMID: 35325067 PMCID: PMC9420014 DOI: 10.1093/brain/awac109] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 02/02/2022] [Accepted: 02/15/2022] [Indexed: 11/13/2022] Open
Abstract
A significant proportion of patients with short-lasting unilateral neuralgiform headache attacks (SUNHA) are refractory to medical treatments. Neuroimaging studies have suggested a role for ipsilateral trigeminal neurovascular conflict with morphological changes in the pathophysiology of this disorder. We present the outcome of an uncontrolled open-label prospective single centre study conducted between 2012 and 2020, to evaluate the efficacy and safety of trigeminal microvascular decompression in refractory chronic SUNHA with magnetic resonance imaging evidence of trigeminal neurovascular conflict ipsilateral to the pain side. Primary endpoint was the proportion of patients who achieved an "excellent response", defined as 90-100% weekly reduction in attack frequency, or "good response", defined as a reduction in weekly headache attack frequency between 75% and 89% at final follow-up, compared to baseline. These patients were defined as responders. The study group consisted of 47 patients of whom 31 had SUNCT and 16 had SUNA (25 females, mean age ± SD 55.2 years ± 14.8). Participants failed to respond or tolerate a mean of 8.1 (±2.7) preventive treatments pre-surgery. Magnetic resonance imaging of the trigeminal nerves (n = 47 patients, n = 50 symptomatic trigeminal nerves) demonstrated ipsilateral neurovascular conflict with morphological changes in 39/50 (78.0%) symptomatic nerves and without morphological changes in 11/50 (22.0%) symptomatic nerves. Post-operatively, 37/47 (78.7%) patients obtained either an excellent or a good response. Ten patients (21.3%, SUNCT = 7 and SUNA = 3) reported no post-operative improvement. The mean post-surgery follow-up was 57.4 ± 24.3 months (range 11-96 months). At final follow-up, 31 patients (66.0%) were excellent/good responders. Six patients experienced a recurrence of headache symptoms. There was no statistically significant difference between SUNCT and SUNA in the response to surgery (p = 0.463). Responders at the last follow-up were however more likely not to have interictal pain (77.42% vs 22.58%, p = 0.021) and to show morphological changes on the magnetic resonance imaging (78.38% vs 21.62%, p = 0.001). The latter outcome was confirmed in the Kaplan Meyer analysis, where patients with no morphological changes were more likely to relapse overtime compared to those with morphological changes (p = 0.0001). All but one patient who obtained an excellent response without relapse, discontinued their preventive medications. Twenty-two post-surgery adverse events occurred in 18 patients (46.8%) but no mortality or severe neurological deficit was seen. Trigeminal microvascular decompression may be a safe and effective long-term treatment for short-lasting unilateral neuralgiform headache attacks patients with magnetic resonance evidence of neurovascular conflict with morphological changes.
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Affiliation(s)
- Giorgio Lambru
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Susie Lagrata
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Andrew Levy
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Sanjay Cheema
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Indran Davagnanam
- Lysholm Department of Neuroradiology, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Khadija Rantell
- Biostatistician, Education Unit, UCL Queen Square Institute of Neurology, London UK
| | - Neil Kitchen
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Ludvic Zrinzo
- Functional Neurosurgery Unit, Department of Clinical & Motor Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Manjit Matharu
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
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14
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Collorone S, Kanber B, Hashem L, Cawley N, Prados F, Davagnanam I, Barkhof F, Ciccarelli O, Toosy A. Visual Function and Brief Cognitive Assessment for Multiple Sclerosis in Optic Neuritis Clinically Isolated Syndrome Patients. J Neuroophthalmol 2022; 42:e22-e31. [PMID: 34561401 PMCID: PMC8834161 DOI: 10.1097/wno.0000000000001280] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In this study, we hypothesized that clinically isolated syndrome-optic neuritis patients may have disturbances in neuropsychological functions related to visual processes. METHODS Forty-two patients with optic neuritis within 3 months from onset and 13 healthy controls were assessed at baseline and 6 months with MRI (brain volumes, lesion load, and optic radiation lesion volume) and optical coherence tomography (OCT) (peripapillary retinal nerve fiber layer [RNFL], ganglion cell and inner plexiform layers [GCIPLs], and inner nuclear layer). Patients underwent the brief cognitive assessment for multiple sclerosis, high-contrast and low-contrast letter acuity, and color vision. RESULTS At baseline, patients had impaired visual function, had GCIPL thinning in both eyes, and performed below the normative average in the visual-related tests: Symbol Digit Modalities Test and Brief Visuospatial Memory Test-Revised (BVMT-R). Over time, improvement in visual function in the affected eye was predicted by baseline GCIPL (P = 0.015), RNFL decreased, and the BVMT-R improved (P = 0.001). Improvement in BVMT-R was associated with improvement in the high-contrast letter acuity of the affected eye (P = 0.03), independently of OCT and MRI metrics. CONCLUSION Cognitive testing, assessed binocularly, of visuospatial processing is affected after unilateral optic neuritis and improves over time with visual recovery. This is not related to structural markers of the visual or central nervous system.
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Affiliation(s)
- Sara Collorone
- NMR Research Unit (SC, BK, LH, NC, FP, OC, and AT), Queen Square MS Centre, Department of Neuroinflammation, Queen Square Institute of Neurology, Faculty of Brain Sciences, UCL, London, United Kingdom; Department of Medical Physics and Biomedical Engineering (BK, FP, and FB), Centre for Medical Image Computing (CMIC), University College London, London, United Kingdom; Universitat Oberta de Catalunya (FP), Barcelona, Spain; Department of Brain Repair and Rehabilitation (ID and FB), University College London Institute of Neurology, Faculty of Brain Sciences, UCL, London, United Kingdom; National Institute for Health Research (FB and OC), University College London Hospitals, Biomedical Research Centre, London, United Kingdom; and Department of Radiology and Nuclear Medicine (FB), Amsterdam University Medical Centers, Vrije Universiteit, the Netherlands
| | - Baris Kanber
- NMR Research Unit (SC, BK, LH, NC, FP, OC, and AT), Queen Square MS Centre, Department of Neuroinflammation, Queen Square Institute of Neurology, Faculty of Brain Sciences, UCL, London, United Kingdom; Department of Medical Physics and Biomedical Engineering (BK, FP, and FB), Centre for Medical Image Computing (CMIC), University College London, London, United Kingdom; Universitat Oberta de Catalunya (FP), Barcelona, Spain; Department of Brain Repair and Rehabilitation (ID and FB), University College London Institute of Neurology, Faculty of Brain Sciences, UCL, London, United Kingdom; National Institute for Health Research (FB and OC), University College London Hospitals, Biomedical Research Centre, London, United Kingdom; and Department of Radiology and Nuclear Medicine (FB), Amsterdam University Medical Centers, Vrije Universiteit, the Netherlands
| | - Leen Hashem
- NMR Research Unit (SC, BK, LH, NC, FP, OC, and AT), Queen Square MS Centre, Department of Neuroinflammation, Queen Square Institute of Neurology, Faculty of Brain Sciences, UCL, London, United Kingdom; Department of Medical Physics and Biomedical Engineering (BK, FP, and FB), Centre for Medical Image Computing (CMIC), University College London, London, United Kingdom; Universitat Oberta de Catalunya (FP), Barcelona, Spain; Department of Brain Repair and Rehabilitation (ID and FB), University College London Institute of Neurology, Faculty of Brain Sciences, UCL, London, United Kingdom; National Institute for Health Research (FB and OC), University College London Hospitals, Biomedical Research Centre, London, United Kingdom; and Department of Radiology and Nuclear Medicine (FB), Amsterdam University Medical Centers, Vrije Universiteit, the Netherlands
| | - Niamh Cawley
- NMR Research Unit (SC, BK, LH, NC, FP, OC, and AT), Queen Square MS Centre, Department of Neuroinflammation, Queen Square Institute of Neurology, Faculty of Brain Sciences, UCL, London, United Kingdom; Department of Medical Physics and Biomedical Engineering (BK, FP, and FB), Centre for Medical Image Computing (CMIC), University College London, London, United Kingdom; Universitat Oberta de Catalunya (FP), Barcelona, Spain; Department of Brain Repair and Rehabilitation (ID and FB), University College London Institute of Neurology, Faculty of Brain Sciences, UCL, London, United Kingdom; National Institute for Health Research (FB and OC), University College London Hospitals, Biomedical Research Centre, London, United Kingdom; and Department of Radiology and Nuclear Medicine (FB), Amsterdam University Medical Centers, Vrije Universiteit, the Netherlands
| | - Ferran Prados
- NMR Research Unit (SC, BK, LH, NC, FP, OC, and AT), Queen Square MS Centre, Department of Neuroinflammation, Queen Square Institute of Neurology, Faculty of Brain Sciences, UCL, London, United Kingdom; Department of Medical Physics and Biomedical Engineering (BK, FP, and FB), Centre for Medical Image Computing (CMIC), University College London, London, United Kingdom; Universitat Oberta de Catalunya (FP), Barcelona, Spain; Department of Brain Repair and Rehabilitation (ID and FB), University College London Institute of Neurology, Faculty of Brain Sciences, UCL, London, United Kingdom; National Institute for Health Research (FB and OC), University College London Hospitals, Biomedical Research Centre, London, United Kingdom; and Department of Radiology and Nuclear Medicine (FB), Amsterdam University Medical Centers, Vrije Universiteit, the Netherlands
| | - Indran Davagnanam
- NMR Research Unit (SC, BK, LH, NC, FP, OC, and AT), Queen Square MS Centre, Department of Neuroinflammation, Queen Square Institute of Neurology, Faculty of Brain Sciences, UCL, London, United Kingdom; Department of Medical Physics and Biomedical Engineering (BK, FP, and FB), Centre for Medical Image Computing (CMIC), University College London, London, United Kingdom; Universitat Oberta de Catalunya (FP), Barcelona, Spain; Department of Brain Repair and Rehabilitation (ID and FB), University College London Institute of Neurology, Faculty of Brain Sciences, UCL, London, United Kingdom; National Institute for Health Research (FB and OC), University College London Hospitals, Biomedical Research Centre, London, United Kingdom; and Department of Radiology and Nuclear Medicine (FB), Amsterdam University Medical Centers, Vrije Universiteit, the Netherlands
| | - Frederik Barkhof
- NMR Research Unit (SC, BK, LH, NC, FP, OC, and AT), Queen Square MS Centre, Department of Neuroinflammation, Queen Square Institute of Neurology, Faculty of Brain Sciences, UCL, London, United Kingdom; Department of Medical Physics and Biomedical Engineering (BK, FP, and FB), Centre for Medical Image Computing (CMIC), University College London, London, United Kingdom; Universitat Oberta de Catalunya (FP), Barcelona, Spain; Department of Brain Repair and Rehabilitation (ID and FB), University College London Institute of Neurology, Faculty of Brain Sciences, UCL, London, United Kingdom; National Institute for Health Research (FB and OC), University College London Hospitals, Biomedical Research Centre, London, United Kingdom; and Department of Radiology and Nuclear Medicine (FB), Amsterdam University Medical Centers, Vrije Universiteit, the Netherlands
| | - Olga Ciccarelli
- NMR Research Unit (SC, BK, LH, NC, FP, OC, and AT), Queen Square MS Centre, Department of Neuroinflammation, Queen Square Institute of Neurology, Faculty of Brain Sciences, UCL, London, United Kingdom; Department of Medical Physics and Biomedical Engineering (BK, FP, and FB), Centre for Medical Image Computing (CMIC), University College London, London, United Kingdom; Universitat Oberta de Catalunya (FP), Barcelona, Spain; Department of Brain Repair and Rehabilitation (ID and FB), University College London Institute of Neurology, Faculty of Brain Sciences, UCL, London, United Kingdom; National Institute for Health Research (FB and OC), University College London Hospitals, Biomedical Research Centre, London, United Kingdom; and Department of Radiology and Nuclear Medicine (FB), Amsterdam University Medical Centers, Vrije Universiteit, the Netherlands
| | - Ahmed Toosy
- NMR Research Unit (SC, BK, LH, NC, FP, OC, and AT), Queen Square MS Centre, Department of Neuroinflammation, Queen Square Institute of Neurology, Faculty of Brain Sciences, UCL, London, United Kingdom; Department of Medical Physics and Biomedical Engineering (BK, FP, and FB), Centre for Medical Image Computing (CMIC), University College London, London, United Kingdom; Universitat Oberta de Catalunya (FP), Barcelona, Spain; Department of Brain Repair and Rehabilitation (ID and FB), University College London Institute of Neurology, Faculty of Brain Sciences, UCL, London, United Kingdom; National Institute for Health Research (FB and OC), University College London Hospitals, Biomedical Research Centre, London, United Kingdom; and Department of Radiology and Nuclear Medicine (FB), Amsterdam University Medical Centers, Vrije Universiteit, the Netherlands
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15
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Nowak VA, Scully M, Davagnanam I, Bremner F. Neuro-ophthalmic complications with ChAdOx1 nCoV-19 vaccine-induced thrombocytopenia and thrombosis. Br J Hosp Med (Lond) 2021; 82:1-4. [PMID: 34726934 DOI: 10.12968/hmed.2021.0428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Marie Scully
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Fion Bremner
- National Hospital for Neurology and Neurosurgery, London, UK
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16
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Bala F, Siddiqui J, Sciacca S, Falzon AM, Benger M, Matloob SA, Miller FNAC, Simister RJ, Chatterjee I, Sztriha LK, Davagnanam I, Booth TC. Reply. AJNR Am J Neuroradiol 2021; 42:E54-E55. [PMID: 34016588 PMCID: PMC8367596 DOI: 10.3174/ajnr.a7161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- F Bala
- Department of NeuroradiologyKing's College Hospital, National Health Service Foundation TrustLondon, United Kingdom
| | - J Siddiqui
- Department of NeuroradiologyKing's College Hospital, National Health Service Foundation TrustLondon, United Kingdom
| | - S Sciacca
- Lysholm Department of Neuroradiology National Hospital for Neurology and NeurosurgeryUniversity College London Hospitals, National Health Service Foundation TrustLondon, United Kingdom
| | - A M Falzon
- Lysholm Department of Neuroradiology National Hospital for Neurology and NeurosurgeryUniversity College London Hospitals, National Health Service Foundation TrustLondon, United Kingdom
| | - M Benger
- Department of NeurologyKing's College Hospital, National Health Service Foundation TrustLondon, United Kingdom
| | - S A Matloob
- Department of Neurosurgery National Hospital for Neurology and NeurosurgeryUniversity College London Hospitals, National Health Service Foundation TrustLondon, United Kingdom
| | - F N A C Miller
- Department of RadiologyKing's College Hospital National Health Service Foundation TrustLondon, United Kingdom
| | - R J Simister
- Comprehensive Stroke ServiceUniversity College London Hospitals, National Health Service Foundation Trust, Stroke Research Centre, University College London Queen Square Institute of NeurologyLondon, United Kingdom
| | - I Chatterjee
- Comprehensive Stroke ServiceUniversity College London Hospitals, National Health Service Foundation TrustLondon, United Kingdom
| | - L K Sztriha
- Department of NeurologyKing's College Hospital National Health Service Foundation TrustLondon, United Kingdom
| | - I Davagnanam
- Lysholm Department of Neuroradiology National Hospital for Neurology and NeurosurgeryUniversity College London Hospitals, National Health Service Foundation TrustLondon, United KingdomBrain Repair & Rehabilitation Unit University College London Queen Square Institute of NeurologyLondon, United Kingdom
| | - T C Booth
- Department of NeuroradiologyKing's College Hospital, National Health Service Foundation TrustLondon, United KingdomSchool of Biomedical Engineering and Imaging SciencesKing's College LondonLondon, United Kingdom
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17
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Jurkute N, Bertacchi M, Arno G, Tocco C, Kim US, Kruszewski AM, Avery RA, Bedoukian EC, Han J, Ahn SJ, Pontikos N, Acheson J, Davagnanam I, Bowman R, Kaliakatsos M, Gardham A, Wakeling E, Oluonye N, Reddy MA, Clark E, Rosser E, Amati-Bonneau P, Charif M, Lenaers G, Meunier I, Defoort S, Vincent-Delorme C, Robson AG, Holder GE, Jeanjean L, Martinez-Monseny A, Vidal-Santacana M, Dominici C, Gaggioli C, Giordano N, Caleo M, Liu GT, Webster AR, Studer M, Yu-Wai-Man P. Pathogenic NR2F1 variants cause a developmental ocular phenotype recapitulated in a mutant mouse model. Brain Commun 2021; 3:fcab162. [PMID: 34466801 PMCID: PMC8397830 DOI: 10.1093/braincomms/fcab162] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2021] [Indexed: 11/28/2022] Open
Abstract
Pathogenic NR2F1 variants cause a rare autosomal dominant neurodevelopmental disorder referred to as the Bosch-Boonstra-Schaaf Optic Atrophy Syndrome. Although visual loss is a prominent feature seen in affected individuals, the molecular and cellular mechanisms contributing to visual impairment are still poorly characterized. We conducted a deep phenotyping study on a cohort of 22 individuals carrying pathogenic NR2F1 variants to document the neurodevelopmental and ophthalmological manifestations, in particular the structural and functional changes within the retina and the optic nerve, which have not been detailed previously. The visual impairment became apparent in early childhood with small and/or tilted hypoplastic optic nerves observed in 10 cases. High-resolution optical coherence tomography imaging confirmed significant loss of retinal ganglion cells with thinning of the ganglion cell layer, consistent with electrophysiological evidence of retinal ganglion cells dysfunction. Interestingly, for those individuals with available longitudinal ophthalmological data, there was no significant deterioration in visual function during the period of follow-up. Diffusion tensor imaging tractography studies showed defective connections and disorganization of the extracortical visual pathways. To further investigate how pathogenic NR2F1 variants impact on retinal and optic nerve development, we took advantage of an Nr2f1 mutant mouse disease model. Abnormal retinogenesis in early stages of development was observed in Nr2f1 mutant mice with decreased retinal ganglion cell density and disruption of retinal ganglion cell axonal guidance from the neural retina into the optic stalk, accounting for the development of optic nerve hypoplasia. The mutant mice showed significantly reduced visual acuity based on electrophysiological parameters with marked conduction delay and decreased amplitude of the recordings in the superficial layers of the visual cortex. The clinical observations in our study cohort, supported by the mouse data, suggest an early neurodevelopmental origin for the retinal and optic nerve head defects caused by NR2F1 pathogenic variants, resulting in congenital vision loss that seems to be non-progressive. We propose NR2F1 as a major gene that orchestrates early retinal and optic nerve head development, playing a key role in the maturation of the visual system.
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Affiliation(s)
- Neringa Jurkute
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Ophthalmology, University College London, London, UK
| | | | - Gavin Arno
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Ophthalmology, University College London, London, UK
| | - Chiara Tocco
- Université Côte d’Azur, CNRS, Inserm, iBV, Nice, France
| | - Ungsoo Samuel Kim
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Kim's Eye Hospital, Seoul, South Korea
| | - Adam M Kruszewski
- Department of Neurology, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Robert A Avery
- Division of Ophthalmology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Neurology, Perelman School of Medicine, Philadelphia, PA, USA
- Department of Ophthalmology, Perelman School of Medicine, Philadelphia, PA, USA
| | - Emma C Bedoukian
- Roberts Individualized Medical Genetics Center, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jinu Han
- Institute of Vision Research, Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Sung Jun Ahn
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Nikolas Pontikos
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Ophthalmology, University College London, London, UK
| | - James Acheson
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Trust, London, UK
| | - Indran Davagnanam
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Department of Brain Repair & Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
| | - Richard Bowman
- Department of Ophthalmology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Marios Kaliakatsos
- Paediatric Neurology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Alice Gardham
- North West Thames Regional Genetics Service, Northwick Park Hospital, Harrow, UK
| | - Emma Wakeling
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Ngozi Oluonye
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Wolfson Neurodisability Service, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Maddy Ashwin Reddy
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Elaine Clark
- Department of Neuroscience, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Elisabeth Rosser
- Department of Clinical Genetics, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Patrizia Amati-Bonneau
- MitoLab Team, UMR CNRS 6015 - INSERM U1083, Institut MitoVasc, Angers University and Hospital, Angers, France
- Department of Biochemistry and Genetics, University Hospital Angers, Angers, France
- Genetics and Immuno-cell Therapy Team, Mohammed First University, Oujda, Morocco
| | - Majida Charif
- MitoLab Team, UMR CNRS 6015 - INSERM U1083, Institut MitoVasc, Angers University and Hospital, Angers, France
- National Center for Rare Diseases, Inherited Sensory Disorders, Gui de Chauliac Hospital, Montpellier, France
| | - Guy Lenaers
- MitoLab Team, UMR CNRS 6015 - INSERM U1083, Institut MitoVasc, Angers University and Hospital, Angers, France
| | - Isabelle Meunier
- Institut des Neurosciences de Montpellier, INSERM INSERM U1051, Université de Montpellier, Montpellier, France
| | - Sabine Defoort
- Service d'exploration de la vision et neuro-ophtalmologie, CHRU de Lille, Lille, France
| | | | - Anthony G Robson
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Ophthalmology, University College London, London, UK
| | - Graham E Holder
- Institute of Ophthalmology, University College London, London, UK
- Yong Loo Lin School of Medicine, Department of Ophthalmology, National University of Singapore, Singapore, Singapore
| | - Luc Jeanjean
- Department of Ophthalmology, University Hospital of Nimes, Nimes, France
| | | | | | - Chloé Dominici
- University Côte d'Azur, CNRS UMR7284, INSERM U1081, Institute for Research on Cancer and Aging, Nice, France
| | - Cedric Gaggioli
- University Côte d'Azur, CNRS UMR7284, INSERM U1081, Institute for Research on Cancer and Aging, Nice, France
| | | | | | - Grant T Liu
- Division of Ophthalmology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Neurology, Perelman School of Medicine, Philadelphia, PA, USA
- Department of Ophthalmology, Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Andrew R Webster
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Ophthalmology, University College London, London, UK
| | | | - Patrick Yu-Wai-Man
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Ophthalmology, University College London, London, UK
- Cambridge Eye Unit, Addenbrooke’s Hospital, Cambridge University Hospitals, Cambridge, UK
- John van Geest Centre for Brain Repair and MRC Mitochondrial Biology Unit, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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18
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Man Chan Y, Wong Y, Khalid N, Wastling S, Flores-Martin A, Frank LA, Koohi N, Arshad Q, Davagnanam I, Kaski D. Prevalence of acute dizziness and vertigo in cortical stroke. Eur J Neurol 2021; 28:3177-3181. [PMID: 34115915 DOI: 10.1111/ene.14964] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 06/07/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE In posterior circulation stroke, vertigo can be a presenting feature. However, whether isolated hemispheric strokes present with vertigo is less clear, despite a few single case reports in the literature. Here, (a) the prevalence of vertigo/dizziness in acute stroke is explored and (b) the cortical distribution of the lesions in relation to both the known vestibular cortex and the evolution of the symptoms, are considered. METHODS Structured interviews were conducted in 173 consecutive unselected patients admitted to the hyperacute stroke unit at the University College London Hospitals. The interview was used to evaluate whether the patient was suffering from dizziness and/or vertigo before the onset of the stroke and at the time of the stroke (acute dizziness/vertigo), and the nature of these symptoms. RESULTS In all, 53 patients had cortical infarcts, of which 21 patients reported acute dizziness. Out of these 21, five patients reported rotational vertigo. Seventeen of the total 53 patients had lesions in known vestibular cortical areas distributed within the insular and parietal opercular cortices. CONCLUSIONS The prevalence of vertigo in acute cortical strokes was 9%, with no single locus of lesion overlap. There is growing evidence supporting a lateralized vestibular cortex, with speculation that cortical strokes affecting the right hemisphere are more likely to cause vestibular symptoms than left hemispheric strokes. A trend was observed for this association, with the right hemisphere affected in four of five patients who reported spinning vertigo at the onset of the stroke.
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Affiliation(s)
- Yuk Man Chan
- Centre for Vestibular and Behavioural Neuroscience, Department of Clinical and Movement Neurosciences, Institute of Neurology, University College London, London, UK
| | - Yean Wong
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, Queen Square, UK
| | - Noorulain Khalid
- Centre for Vestibular and Behavioural Neuroscience, Department of Clinical and Movement Neurosciences, Institute of Neurology, University College London, London, UK
| | - Stephen Wastling
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, Queen Square, UK
| | - Andreas Flores-Martin
- Academic Department of Neurosciences, Royal Hallamshire Hospital and University of Sheffield, Sheffield, UK
| | - Lucy-Anne Frank
- Centre for Vestibular and Behavioural Neuroscience, Department of Clinical and Movement Neurosciences, Institute of Neurology, University College London, London, UK
| | - Nehzat Koohi
- Centre for Vestibular and Behavioural Neuroscience, Department of Clinical and Movement Neurosciences, Institute of Neurology, University College London, London, UK.,The Ear Institute, University College London, London, UK.,Neuro-otology Department, University College London Hospitals, London, UK
| | - Qadeer Arshad
- inAmind Laboratory, Department of Psychology, Neuroscience and Behaviour, University of Leicester, Leicester, UK
| | - Indran Davagnanam
- Brain Repair and Rehabilitation Department, Queen Square Institute of Neurology, UCL, London, UK
| | - Diego Kaski
- Centre for Vestibular and Behavioural Neuroscience, Department of Clinical and Movement Neurosciences, Institute of Neurology, University College London, London, UK.,The Ear Institute, University College London, London, UK.,Neuro-otology Department, University College London Hospitals, London, UK
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19
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Collorone S, Prados F, Kanber B, Cawley NM, Tur C, Grussu F, Solanky BS, Yiannakas M, Davagnanam I, Wheeler-Kingshott CAMG, Barkhof F, Ciccarelli O, Toosy AT. Brain microstructural and metabolic alterations detected in vivo at onset of the first demyelinating event. Brain 2021; 144:1409-1421. [PMID: 33903905 PMCID: PMC8219367 DOI: 10.1093/brain/awab043] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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: 06/24/2020] [Revised: 11/03/2020] [Accepted: 12/03/2020] [Indexed: 12/22/2022] Open
Abstract
In early multiple sclerosis, a clearer understanding of normal-brain tissue microstructural and metabolic abnormalities will provide valuable insights into its pathophysiology. We used multi-parametric quantitative MRI to detect alterations in brain tissues of patients with their first demyelinating episode. We acquired neurite orientation dispersion and density imaging [to investigate morphology of neurites (dendrites and axons)] and 23Na MRI (to estimate total sodium concentration, a reflection of underlying changes in metabolic function). In this cross-sectional study, we enrolled 42 patients diagnosed with clinically isolated syndrome or multiple sclerosis within 3 months of their first demyelinating event and 16 healthy controls. Physical and cognitive scales were assessed. At 3 T, we acquired brain and spinal cord structural scans, and neurite orientation dispersion and density imaging. Thirty-two patients and 13 healthy controls also underwent brain 23Na MRI. We measured neurite density and orientation dispersion indices and total sodium concentration in brain normal-appearing white matter, white matter lesions, and grey matter. We used linear regression models (adjusting for brain parenchymal fraction and lesion load) and Spearman correlation tests (significance level P ≤ 0.01). Patients showed higher orientation dispersion index in normal-appearing white matter, including the corpus callosum, where they also showed lower neurite density index and higher total sodium concentration, compared with healthy controls. In grey matter, compared with healthy controls, patients demonstrated: lower orientation dispersion index in frontal, parietal and temporal cortices; lower neurite density index in parietal, temporal and occipital cortices; and higher total sodium concentration in limbic and frontal cortices. Brain volumes did not differ between patients and controls. In patients, higher orientation dispersion index in corpus callosum was associated with worse performance on timed walk test (P = 0.009, B = 0.01, 99% confidence interval = 0.0001 to 0.02), independent of brain and lesion volumes. Higher total sodium concentration in left frontal middle gyrus was associated with higher disability on Expanded Disability Status Scale (rs = 0.5, P = 0.005). Increased axonal dispersion was found in normal-appearing white matter, particularly corpus callosum, where there was also axonal degeneration and total sodium accumulation. The association between increased axonal dispersion in the corpus callosum and worse walking performance implies that morphological and metabolic alterations in this structure could mechanistically contribute to disability in multiple sclerosis. As brain volumes were neither altered nor related to disability in patients, our findings suggest that these two advanced MRI techniques are more sensitive at detecting clinically relevant pathology in early multiple sclerosis.
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Affiliation(s)
- Sara Collorone
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Ferran Prados
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK.,Centre for Medical Image Computing (CMIC), Department of Medical Physics and Biomedical Engineering, University College London, London, UK.,Universitat Oberta de Catalunya, Barcelona, Spain
| | - Baris Kanber
- Centre for Medical Image Computing (CMIC), Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Niamh M Cawley
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Carmen Tur
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Francesco Grussu
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK.,Centre for Medical Image Computing (CMIC), Department of Computer Sciences, University College London, London, UK
| | - Bhavana S Solanky
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Marios Yiannakas
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Indran Davagnanam
- Department of Brain Repair and Rehabilitation, University College London Institute of Neurology, Faculty of Brain Sciences, UCL, London, UK
| | - Claudia A M Gandini Wheeler-Kingshott
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Brain MRI 3T Research Centre, IRCCS Mondino Foundation, Pavia, Italy
| | - Frederik Barkhof
- Centre for Medical Image Computing (CMIC), Department of Medical Physics and Biomedical Engineering, University College London, London, UK.,Department of Brain Repair and Rehabilitation, University College London Institute of Neurology, Faculty of Brain Sciences, UCL, London, UK.,Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Vrije Universiteit, The Netherlands.,National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, London, UK
| | - Olga Ciccarelli
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK.,National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, London, UK
| | - Ahmed T Toosy
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
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20
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Ulivi L, Kanber B, Prados F, Davagnanam I, Merwick A, Chan E, Williams F, Hughes D, Murphy E, Lachmann RH, Wheeler-Kingshott CAMG, Cipolotti L, Werring DJ. White matter integrity correlates with cognition and disease severity in Fabry disease. Brain 2021; 143:3331-3342. [PMID: 33141169 DOI: 10.1093/brain/awaa282] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 10/07/2019] [Revised: 06/21/2020] [Accepted: 07/12/2020] [Indexed: 01/13/2023] Open
Abstract
Cerebral white matter pathology is a common CNS manifestation of Fabry disease, visualized as white matter hyperintensities on MRI in 42-81% of patients. Diffusion tensor imaging (DTI) MRI is a sensitive technique to quantify microstructural damage within the white matter with potential value as a disease biomarker. We evaluated the pattern of DTI abnormalities in Fabry disease, and their correlations with cognitive impairment, mood, anxiety, disease severity and plasma lyso-Gb3 levels in 31 patients with genetically proven Fabry disease and 19 age-matched healthy control subjects. We obtained average values of fractional anisotropy and mean diffusivity within the white matter and performed voxelwise analysis with tract-based spatial statistics. Using a standardized neuropsychological test battery, we assessed processing speed, executive function, anxiety, depression and disease severity. The mean age (% male) was 44.1 (45%) for patients with Fabry disease and 37.4 (53%) for the healthy control group. In patients with Fabry disease, compared to healthy controls the mean average white matter fractional anisotropy was lower in [0.423 (standard deviation, SD 0.023) versus 0.446 (SD 0.016), P = 0.002] while mean average white matter mean diffusivity was higher (749 × 10-6 mm2/s (SD 32 × 10-6) versus 720 × 10-6 mm2/s (SD 21 × 10-6), P = 0.004]. Voxelwise statistics showed that the diffusion abnormalities for both fractional anisotropy and mean diffusivity were anatomically widespread. A lesion probability map showed that white matter hyperintensities also had a wide anatomical distribution with a predilection for the posterior centrum semiovale. However, diffusion abnormalities in Fabry disease were not restricted to lesional tissue; compared to healthy controls, the normal appearing white matter in patients with Fabry disease had reduced fractional anisotropy [0.422 (SD 0.022) versus 0.443 (SD 0.017) P = 0.003] and increased mean diffusivity [747 × 10-6 mm2/s (SD 26 × 10-6) versus 723 × 10-6 mm2/s (SD 22 × 10-6), P = 0.008]. Within patients, average white matter fractional anisotropy and white matter lesion volume showed statistically significant correlations with Digit Symbol Coding Test score (r = 0.558, P = 0.001; and r = -0.633, P ≤ 0.001, respectively). Average white matter fractional anisotropy correlated with the overall Mainz Severity Score Index (r = -0.661, P ≤ 0.001), while average white matter mean diffusivity showed a strong correlation with plasma lyso-Gb3 levels (r = 0.559, P = 0.001). Our findings using DTI confirm widespread areas of microstructural white matter disruption in Fabry disease, extending beyond white matter hyperintensities seen on conventional MRI. Moreover, diffusion measures show strong correlations with cognition (processing speed), clinical disease severity and a putative plasma biomarker of disease activity, making them promising quantitative biomarkers for monitoring Fabry disease severity and progression.
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Affiliation(s)
- Leonardo Ulivi
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London WC1B 5EH, UK.,Department of Experimental and Clinical Medicine, Neurological Clinic, Pisa University, Pisa, Italy
| | - Baris Kanber
- Department of Neuroinflammation, UCL Queen Square Institute of Neurology, London WC1B 5EH, UK.,Centre for Medical Image Computing (CMIC), Department of Medical Physics and Biomedical Engineering, University College London, London, WC1V 6LJ, UK
| | - Ferran Prados
- Department of Neuroinflammation, UCL Queen Square Institute of Neurology, London WC1B 5EH, UK.,Centre for Medical Image Computing (CMIC), Department of Medical Physics and Biomedical Engineering, University College London, London, WC1V 6LJ, UK.,e-Health Centre, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Indran Davagnanam
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London WC1B 5EH, UK.,Academic Department of Neuroradiology, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, Queen Square, London WC1N 3BG, UK
| | - Aine Merwick
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London WC1B 5EH, UK.,Cork University Hospital, University College Cork, Wilton, Cork, Ireland
| | - Edgar Chan
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK
| | - Fay Williams
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK.,Charles Dent Metabolic Unit, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK
| | - Derralynn Hughes
- Lysosomal Storage Disorders Unit, Royal Free Hospital, London NW3 2PF, UK
| | - Elaine Murphy
- Charles Dent Metabolic Unit, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK
| | - R H Lachmann
- Charles Dent Metabolic Unit, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK
| | - Claudia A M Gandini Wheeler-Kingshott
- Department of Neuroinflammation, UCL Queen Square Institute of Neurology, London WC1B 5EH, UK.,Brain MRI 3T Research Centre, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioural Sciences, University of Pavia, Italy
| | - Lisa Cipolotti
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK
| | - David J Werring
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London WC1B 5EH, UK
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21
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D'Antona L, Jaime Merchan MA, Vassiliou A, Watkins LD, Davagnanam I, Toma AK, Matharu MS. Clinical Presentation, Investigation Findings, and Treatment Outcomes of Spontaneous Intracranial Hypotension Syndrome: A Systematic Review and Meta-analysis. JAMA Neurol 2021; 78:329-337. [PMID: 33393980 PMCID: PMC7783594 DOI: 10.1001/jamaneurol.2020.4799] [Citation(s) in RCA: 100] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Question What are the clinical presentation, investigation findings, and treatment outcomes of spontaneous intracranial hypotension? Findings This systematic review and meta-analysis of 144 articles provides a summary of the evidence on spontaneous intracranial hypotension and demonstrates that a significant minority of patients may have nonorthostatic headache, normal lumbar punctures, or normal imaging results. Treatment with 1 epidural blood patch is often successful, with large-volume blood patches giving better outcomes. Meaning A diagnosis of spontaneous intracranial hypotension should not be excluded based on the absence of one of its typical features; large epidural blood patches should be attempted if conservative treatment has failed. Importance Spontaneous intracranial hypotension (SIH) is a highly disabling but often misdiagnosed disorder. The best management options for patients with SIH are still uncertain. Objective To provide an objective summary of the available evidence on the clinical presentation, investigations findings, and treatment outcomes for SIH. Data Sources Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline–compliant systematic review and meta-analysis of the literature on SIH. Three databases were searched from inception to April 30, 2020: PubMed/MEDLINE, Embase, and Cochrane. The following search terms were used in each database: spontaneous intracranial hypotension, low CSF syndrome, low CSF pressure syndrome, low CSF volume syndrome, intracranial hypotension, low CSF pressure, low CSF volume, CSF hypovolemia, CSF hypovolaemia, spontaneous spinal CSF leak, spinal CSF leak, and CSF leak syndrome. Study Selection Original studies in English language reporting 10 or more patients with SIH were selected by consensus. Data Extraction and Synthesis Data on clinical presentation, investigations findings, and treatment outcomes were collected and summarized by multiple observers. Random-effect meta-analyses were used to calculate pooled estimates of means and proportions. Main Outcomes and Measures The predetermined main outcomes were the pooled estimate proportions of symptoms of SIH, imaging findings (brain and spinal imaging), and treatment outcomes (conservative, epidural blood patches, and surgical). Results Of 6878 articles, 144 met the selection criteria and reported on average 53 patients with SIH each (range, 10-568 patients). The most common symptoms were orthostatic headache (92% [95% CI, 87%-96%]), nausea (54% [95% CI, 46%-62%]), and neck pain/stiffness (43% [95% CI, 32%-53%]). Brain magnetic resonance imaging was the most sensitive investigation, with diffuse pachymeningeal enhancement identified in 73% (95% CI, 67%-80%) of patients. Brain magnetic resonance imaging findings were normal in 19% (95% CI, 13%-24%) of patients. Spinal neuroimaging identified extradural cerebrospinal fluid in 48% to 76% of patients. Digital subtraction myelography and magnetic resonance myelography with intrathecal gadolinium had high sensitivity in identifying the exact leak site. Lumbar puncture opening pressures were low, normal (60-200 mm H2O), and high in 67% (95% CI, 54%-80%), 32% (95% CI, 20%-44%), and 3% (95% CI, 1%-6%), respectively. Conservative treatment was effective in 28% (95% CI, 18%-37%) of patients and a single epidural blood patch was successful in 64% (95% CI, 56%-72%). Large epidural blood patches (>20 mL) had better success rates than small epidural blood patches (77% [95% CI, 63%-91%] and 66% [95% CI, 55%-77%], respectively). Conclusions and Relevance Spontaneous intracranial hypotension should not be excluded on the basis of a nonorthostatic headache, normal neuroimaging findings, or normal lumbar puncture opening pressure. Despite the heterogeneous nature of the studies available in the literature and the lack of controlled interventional studies, this systematic review offers a comprehensive and objective summary of the evidence on SIH that could be useful in guiding clinical practice and future research.
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Affiliation(s)
- Linda D'Antona
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom.,UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Melida Andrea Jaime Merchan
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Anna Vassiliou
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Laurence Dale Watkins
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Indran Davagnanam
- UCL Queen Square Institute of Neurology, London, United Kingdom.,Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Ahmed Kassem Toma
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom.,UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Manjit Singh Matharu
- UCL Queen Square Institute of Neurology, London, United Kingdom.,Headache and Facial Pain Group, National Hospital for Neurology and Neurosurgery, London, United Kingdom
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22
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Lambru G, Rantell K, O'Connor E, Levy A, Davagnanam I, Zrinzo L, Matharu M. Trigeminal neurovascular contact in SUNCT and SUNA: a cross-sectional magnetic resonance study. Brain 2021; 143:3619-3628. [PMID: 33301567 PMCID: PMC7807031 DOI: 10.1093/brain/awaa331] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/21/2020] [Accepted: 08/06/2020] [Indexed: 01/03/2023] Open
Abstract
Emerging data-points towards a possible aetiological and therapeutic relevance of trigeminal neurovascular contact in short lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and perhaps in short lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA). We aimed to assess the prevalence and significance of trigeminal neurovascular contact in a large cohort of consecutive SUNCT and SUNA patients and evaluate the radiological differences between them. The standard imaging protocol included high spatial and nerve-cistern contrast resolution imaging acquisitions of the cisternal segments of the trigeminal nerves and vessels. MRI studies were evaluated blindly by two expert evaluators and graded according to the presence, location and degree of neurovascular contact. The degree of contact was graded as with or without morphological changes. Neurovascular contact with morphological changes was defined as contact with distortion and/or atrophy. A total of 159 patients (SUNCT = 80; SUNA = 79) were included. A total of 165 symptomatic and 153 asymptomatic trigeminal nerves were analysed. The proportion of neurovascular contact on the symptomatic trigeminal nerves was higher (80.0%) compared to the asymptomatic trigeminal nerves (56.9%). The odds on having neurovascular contact over the symptomatic nerves was significantly higher than on the asymptomatic nerves [odds ratio (OR): 3.03, 95% confidence interval (CI) 1.84–4.99; P < 0.0001]. Neurovascular contact with morphological changes were considerably more prevalent on the symptomatic side (61.4%), compared to the asymptomatic side (31.0%) (OR 4.16, 95% CI 2.46–7.05; P < 0.0001). On symptomatic nerves, neurovascular contact with morphological changes was caused by an artery in 95.0% (n = 77/81). Moreover, the site of contact and the point of contact around the trigeminal root were respectively proximal in 82.7% (67/81) and superior in 59.3% (48/81). No significant radiological differences emerged between SUNCT and SUNA. The multivariate analysis of radiological predictors associated with the symptomatic side, indicated that the presence of neurovascular contact with morphological changes was strongly associated with the side of the pain (OR: 2.80, 95% CI 1.44–5.44; P = 0.002) even when adjusted for diagnoses. Our findings suggest that neurovascular contact with morphological changes is involved in the aetiology of SUNCT and SUNA. Along with a similar clinical phenotype, SUNCT and SUNA also display a similar structural neuroimaging profile, providing further support for the concept that the separation between them should be abandoned. Furthermore, these findings suggest that vascular compression of the trigeminal sensory root, may be a common aetiological factor between SUNCT, SUNA and trigeminal neuralgia thereby further expanding the overlap between these disorders.
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Affiliation(s)
- Giorgio Lambru
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Khadija Rantell
- Biostatistician, Education Unit, UCL Queen Square Institute of Neurology, London UK
| | - Emer O'Connor
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Andrew Levy
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Indran Davagnanam
- Lysholm Department of Neuroradiology, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Ludvic Zrinzo
- Functional Neurosurgery Unit, Department of Clinical and Motor Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Manjit Matharu
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
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23
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Nij Bijvank JA, Sánchez Aliaga E, Balk LJ, Coric D, Davagnanam I, Tan HS, Uitdehaag BMJ, van Rijn LJ, Petzold A. A model for interrogating the clinico-radiological paradox in multiple sclerosis: Internuclear ophthalmoplegia. Eur J Neurol 2021; 28:1617-1626. [PMID: 33426786 PMCID: PMC8248033 DOI: 10.1111/ene.14723] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 10/29/2020] [Revised: 12/15/2020] [Accepted: 12/17/2020] [Indexed: 11/26/2022]
Abstract
Background and purpose The clinico‐radiological paradox in multiple sclerosis (MS) is well recognized, relevant and yet poorly understood. The suitability of an in vivo model for the clinico‐radiological paradox was tested, using internuclear ophthalmoplegia (INO) and the medial longitudinal fasciculus (MLF). Methods In this cross‐sectional study lesions of the MLF were rated by an experienced MS neuroradiologist blinded to all other information. The presence of an INO was objectively determined by a validated infrared oculography protocol (DEMoNS). Clinical information, including the National Eye Institute Visual Function Questionnaire, was obtained. Results This study included 202 patients with MS. The clinico‐radiological paradox occurred in 50 patients (25%). This consisted of 45 patients having an INO without an MLF lesion and five patients with an MLF lesion but without an INO. The visual function overall score was related to the presence of an INO (p = 0.016), but not to MLF lesions seen on magnetic resonance imaging (MRI) (p = 0.207). A consensus list of potential causes for the clinico‐radiological paradox was compiled and the MRI images were deposited in a repository. Conclusion This study provides an objective and quantitative model to investigate the clinico‐radiological paradox. Our data suggest that pathology of the MLF is more frequently detected and more clinically relevant by infrared oculography than by MLF lesion rating on MRI.
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Affiliation(s)
- Jenny A Nij Bijvank
- Department of Neurology, MS Center and Neuro-ophthalmology Expertise Center, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Ophthalmology, Neuro-ophthalmology Expertise Center, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Esther Sánchez Aliaga
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Lisanne J Balk
- Department of Neurology, MS Center and Neuro-ophthalmology Expertise Center, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Danko Coric
- Department of Neurology, MS Center and Neuro-ophthalmology Expertise Center, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Indran Davagnanam
- National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, Moorfields Eye Hospital, UCL, London, UK
| | - H Stevie Tan
- Department of Ophthalmology, Neuro-ophthalmology Expertise Center, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Bernard M J Uitdehaag
- Department of Neurology, MS Center and Neuro-ophthalmology Expertise Center, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Laurentius J van Rijn
- Department of Ophthalmology, Neuro-ophthalmology Expertise Center, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Ophthalmology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Axel Petzold
- Department of Neurology, MS Center and Neuro-ophthalmology Expertise Center, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Ophthalmology, Neuro-ophthalmology Expertise Center, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,National Hospital for Neurology and Neurosurgery, Queen Square Institute of Neurology, Moorfields Eye Hospital, UCL, London, UK
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24
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Abstract
Objective To determine the prevalence and clinical predictors of pituitary adenomas in cluster headache patients, in order to determine the necessity of performing dedicated pituitary magnetic resonance imaging in patients with cluster headache. Methods A retrospective study was conducted of all consecutive patients diagnosed with cluster headache and with available brain magnetic resonance imaging between 2007 and 2017 in a tertiary headache center. Data including demographics, attack characteristics, response to treatments, results of neuroimaging, and routine pituitary function tests were recorded. Results Seven hundred and eighteen cluster headache patients attended the headache clinic; 643 underwent a standard magnetic resonance imaging scan, of whom 376 also underwent dedicated pituitary magnetic resonance imaging. Pituitary adenomas occurred in 17 of 376 patients (4.52%). Non-functioning microadenomas (n = 14) were the most common abnormality reported. Two patients, one of whom lacked the symptoms of pituitary disease, required treatment for their pituitary lesion. No clinical predictors of those adenomas were identified after multivariate analysis using random forests. Systematic pituitary magnetic resonance imaging scanning did not benefit even a single patient in the entire cohort. Conclusion The prevalence of pituitary adenomas in cluster headache is similar to that reported in the general population, thereby precluding an over-representation of pituitary lesions in cluster headache. We conclude that the diagnostic assessment of cluster headache patients should not include specific pituitary screening. Only patients with standard brain magnetic resonance imaging findings or symptoms suggestive of a pituitary disorder require brain magnetic resonance imaging with dedicated pituitary views.
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Affiliation(s)
- Lou Grangeon
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology, Queen Square, London, UK.,Headache and Facial Pain Group, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Emer O'Connor
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology, Queen Square, London, UK
| | - Daisuke Danno
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology, Queen Square, London, UK
| | | | - Sanjay Cheema
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology, Queen Square, London, UK
| | - Erling Tronvik
- Mathematics Institute of Orsay, Paris Sud University, Orsay, France.,Department of Neurology, St Olav's University Hospital, Trondheim, Norway.,NTNU (University of Science and Technology), Department of Neuromedicine and Movement Science, Trondheim, Norway
| | | | - Manjit Matharu
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology, Queen Square, London, UK
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25
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Siddiqui J, Bala F, Sciacca S, Falzon AM, Benger M, Matloob SA, Miller FNAC, Simister RJ, Chatterjee I, Sztriha LK, Davagnanam I, Booth TC. COVID-19 Stroke Apical Lung Examination Study: A Diagnostic and Prognostic Imaging Biomarker in Suspected Acute Stroke. AJNR Am J Neuroradiol 2021; 42:138-143. [PMID: 32943416 DOI: 10.3174/ajnr.a6832] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 08/17/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND PURPOSE Diagnosis of coronavirus disease 2019 (COVID-19) relies on clinical features and reverse-transcriptase polymerase chain reaction testing, but the sensitivity is limited. Carotid CTA is a routine acute stroke investigation and includes the lung apices. We evaluated CTA as a potential COVID-19 diagnostic imaging biomarker. MATERIALS AND METHODS This was a multicenter, retrospective study (n = 225) including CTAs of patients with suspected acute stroke from 3 hyperacute stroke units (March-April 2020). We evaluated the reliability and accuracy of candidate diagnostic imaging biomarkers. Demographics, clinical features, and risk factors for COVID-19 and stroke were analyzed using univariate and multivariate statistics. RESULTS Apical ground-glass opacification was present in 22.2% (50/225) of patients. Ground-glass opacification had high interrater reliability (Fleiss κ = 0.81; 95% CI, 0.68-0.95) and, compared with reverse-transcriptase polymerase chain reaction, had good diagnostic performance (sensitivity, 75% [95% CI, 56-87]; specificity, 81% [95% CI, 71-88]; OR = 11.65 [95% CI, 4.14-32.78]; P < .001) on multivariate analysis. In contrast, all other contemporaneous demographic, clinical, and imaging features available at CTA were not diagnostic for COVID-19. The presence of apical ground-glass opacification was an independent predictor of increased 30-day mortality (18.0% versus 5.7%, P = .017; hazard ratio = 3.51; 95% CI, 1.42-8.66; P = .006). CONCLUSIONS We identified a simple, reliable, and accurate COVID-19 diagnostic and prognostic imaging biomarker obtained from CTA lung apices: the presence or absence of ground-glass opacification. Our findings have important implications in the management of patients presenting with suspected stroke through early identification of COVID-19 and the subsequent limitation of disease transmission.
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Affiliation(s)
- J Siddiqui
- From the Departments of Neuroradiology (J.S., F.B., T.C.B.)
| | - F Bala
- From the Departments of Neuroradiology (J.S., F.B., T.C.B.)
| | - S Sciacca
- Lysholm Department of Neuroradiology (S.S., A.M.F., I.D.)
| | - A M Falzon
- Lysholm Department of Neuroradiology (S.S., A.M.F., I.D.)
| | | | - S A Matloob
- Department of Neurosurgery (S.A.M.), National Hospital for Neurology and Neurosurgery, University College London Hospitals, National Health Service Foundation Trust, London, UK
| | - F N A C Miller
- Radiology (F.N.A.C.M.), King's College Hospital, National Health Service Foundation Trust, London, UK
| | - R J Simister
- Comprehensive Stroke Service (R.J.S., I.C.), University College London Hospitals, National Health Service Foundation Trust, London, UK
- Stroke Research Centre (R.J.S.)
| | - I Chatterjee
- Comprehensive Stroke Service (R.J.S., I.C.), University College London Hospitals, National Health Service Foundation Trust, London, UK
| | | | - I Davagnanam
- Lysholm Department of Neuroradiology (S.S., A.M.F., I.D.)
- Brain Repair and Rehabilitation Unit (I.D.), University College London Queen Square Institute of Neurology, London, UK
| | - T C Booth
- From the Departments of Neuroradiology (J.S., F.B., T.C.B.)
- School of Biomedical Engineering and Imaging Sciences (T.C.B.), King's College London, Rayne Institute, St. Thomas' Hospital, London, UK
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26
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Siddiqui J, Bala F, Sciacca S, Falzon AM, Benger M, Matloob SA, Miller FNAC, Simister RJ, Chatterjee I, Sztriha LK, Davagnanam I, Booth TC. A Comparison of Chest Radiograph and CTA Apical Pulmonary Findings in Patients Presenting with Suspected Acute Stroke during the COVID-19 Pandemic. AJNR Am J Neuroradiol 2020; 42:E13-E14. [PMID: 33272951 DOI: 10.3174/ajnr.a6940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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)
- J Siddiqui
- Department of NeuroradiologyKing's College Hospital NHS Foundation TrustLondon, UK
| | | | - S Sciacca
- Lysholm Department of NeuroradiologyNational Hospital for Neurology and NeurosurgeryUniversity College London Hospitals NHS Foundation TrustLondon, UK
| | - A M Falzon
- Lysholm Department of NeuroradiologyNational Hospital for Neurology and NeurosurgeryUniversity College London Hospitals NHS Foundation TrustLondon, UK
| | - M Benger
- Department of NeurologyKing's College Hospital NHS Foundation TrustLondon, UK
| | - S A Matloob
- Department of NeurosurgeryNational Hospital for Neurology and NeurosurgeryUniversity College London Hospitals NHS Foundation TrustLondon, UK
| | - F N A C Miller
- Department of RadiologyKing's College Hospital NHS Foundation TrustLondon, UK
| | - R J Simister
- Comprehensive Stroke ServiceUniversity College London Hospitals NHS Foundation TrustLondon, UK.,Stroke Research CentreUniversity College London Queen Square Institute of NeurologyLondon, UK
| | - I Chatterjee
- Comprehensive Stroke ServiceUniversity College London Hospitals NHS Foundation TrustLondon, UK
| | - L K Sztriha
- Department of NeurologyKing's College Hospital NHS Foundation TrustLondon, UK
| | - I Davagnanam
- Lysholm Department of NeuroradiologyNational Hospital for Neurology and NeurosurgeryUniversity College London Hospitals NHS Foundation TrustLondon, UK.,Brain Repair & Rehabilitation UnitUniversity College London Queen Square Institute of NeurologyLondon, UK
| | - T C Booth
- Department of NeuroradiologyKing's College Hospital NHS Foundation TrustLondon, UK.,School of Biomedical Engineering and Imaging SciencesKing's College LondonLondon, UK
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27
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Hostettler IC, O'Callaghan B, Bugiardini E, O'Connor E, Vandrovcova J, Davagnanam I, Alg V, Bonner S, Walsh D, Bulters D, Kitchen N, Brown MM, Grieve J, Werring DJ, Houlden H. ANGPTL6 Genetic Variants Are an Underlying Cause of Familial Intracranial Aneurysms. Neurology 2020; 96:e947-e955. [PMID: 33106390 PMCID: PMC8105901 DOI: 10.1212/wnl.0000000000011125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 10/08/2020] [Indexed: 01/16/2023] Open
Abstract
Purpose To understand the role of the angiopoietin-like 6 gene (ANGPTL6) in intracranial aneurysms (IAs), we investigated its role in a large cohort of familial IAs. Methods Individuals with family history of IA were recruited to the Genetic and Observational Subarachnoid Haemorrhage (GOSH) study. The ANGPTL6 gene was sequenced using Sanger sequencing. Identified genetic variants were compared to a control population. Results We found 6 rare ANGPTL6 genetic variants in 9/275 individuals with a family history of IA (3.3%) (5 missense mutations and 1 nonsense mutation leading to a premature stop codon), none present in controls. One of these had been previously reported: c.392A>T (p.Glu131Val) on exon 2; another was very close: c.332G>A (p.Arg111His). Two further genetic variants lie within the fibrinogen-like domain of the ANGPTL6 gene, which may influence function or level of the ANGPTL6 protein. The last 2 missense mutations lie within the coiled-coil domain of the ANGPTL6 protein. All genetic variants were well conserved across species. Conclusion ANGPTL6 genetic variants are an important cause of IA. Defective or lack of ANGPTL6 protein is therefore an important factor in blood vessel proliferation leading to IA; dysfunction of this protein is likely to cause abnormal proliferation or weakness of vessel walls. With these data, not only do we emphasize the importance of screening familial IA cases for ANGPTL6 and other genes involved in IA, but also highlight the ANGPTL6 pathway as a potential therapeutic target. Classification of Evidence This is a Class III study showing some specificity of presence of the ANGPTL6 gene variant as a marker of familial intracranial aneurysms in a small subset of individuals with familial aneurysms.
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Affiliation(s)
- Isabel C Hostettler
- From the Stroke Research Centre (I.C.H., V.A., M.M.B., D.J.W.), MRC Centre for Neuromuscular Diseases (B.O., E.B.), and Department of Neuromuscular Disorders (E.B., J.V.), UCL Queen Square Institute of Neurology; Neurogenetics Laboratory (I.C.H., B.O., E.O., H.H.) and Departments of Neuroradiology (I.D.) and Neurosurgery (N.K., J.G.), the National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London; Department of Anaesthesia (S.B.), the James Cook University Hospital, Middlesbrough; Department of Neurosurgery (D.W.), King's College Hospital NHS Foundation Trust, London; and Department of Neurosurgery (D.B.), University Hospital Southampton NHS Foundation Trust
| | - Benjamin O'Callaghan
- From the Stroke Research Centre (I.C.H., V.A., M.M.B., D.J.W.), MRC Centre for Neuromuscular Diseases (B.O., E.B.), and Department of Neuromuscular Disorders (E.B., J.V.), UCL Queen Square Institute of Neurology; Neurogenetics Laboratory (I.C.H., B.O., E.O., H.H.) and Departments of Neuroradiology (I.D.) and Neurosurgery (N.K., J.G.), the National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London; Department of Anaesthesia (S.B.), the James Cook University Hospital, Middlesbrough; Department of Neurosurgery (D.W.), King's College Hospital NHS Foundation Trust, London; and Department of Neurosurgery (D.B.), University Hospital Southampton NHS Foundation Trust
| | - Enrico Bugiardini
- From the Stroke Research Centre (I.C.H., V.A., M.M.B., D.J.W.), MRC Centre for Neuromuscular Diseases (B.O., E.B.), and Department of Neuromuscular Disorders (E.B., J.V.), UCL Queen Square Institute of Neurology; Neurogenetics Laboratory (I.C.H., B.O., E.O., H.H.) and Departments of Neuroradiology (I.D.) and Neurosurgery (N.K., J.G.), the National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London; Department of Anaesthesia (S.B.), the James Cook University Hospital, Middlesbrough; Department of Neurosurgery (D.W.), King's College Hospital NHS Foundation Trust, London; and Department of Neurosurgery (D.B.), University Hospital Southampton NHS Foundation Trust
| | - Emer O'Connor
- From the Stroke Research Centre (I.C.H., V.A., M.M.B., D.J.W.), MRC Centre for Neuromuscular Diseases (B.O., E.B.), and Department of Neuromuscular Disorders (E.B., J.V.), UCL Queen Square Institute of Neurology; Neurogenetics Laboratory (I.C.H., B.O., E.O., H.H.) and Departments of Neuroradiology (I.D.) and Neurosurgery (N.K., J.G.), the National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London; Department of Anaesthesia (S.B.), the James Cook University Hospital, Middlesbrough; Department of Neurosurgery (D.W.), King's College Hospital NHS Foundation Trust, London; and Department of Neurosurgery (D.B.), University Hospital Southampton NHS Foundation Trust
| | - Jana Vandrovcova
- From the Stroke Research Centre (I.C.H., V.A., M.M.B., D.J.W.), MRC Centre for Neuromuscular Diseases (B.O., E.B.), and Department of Neuromuscular Disorders (E.B., J.V.), UCL Queen Square Institute of Neurology; Neurogenetics Laboratory (I.C.H., B.O., E.O., H.H.) and Departments of Neuroradiology (I.D.) and Neurosurgery (N.K., J.G.), the National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London; Department of Anaesthesia (S.B.), the James Cook University Hospital, Middlesbrough; Department of Neurosurgery (D.W.), King's College Hospital NHS Foundation Trust, London; and Department of Neurosurgery (D.B.), University Hospital Southampton NHS Foundation Trust
| | - Indran Davagnanam
- From the Stroke Research Centre (I.C.H., V.A., M.M.B., D.J.W.), MRC Centre for Neuromuscular Diseases (B.O., E.B.), and Department of Neuromuscular Disorders (E.B., J.V.), UCL Queen Square Institute of Neurology; Neurogenetics Laboratory (I.C.H., B.O., E.O., H.H.) and Departments of Neuroradiology (I.D.) and Neurosurgery (N.K., J.G.), the National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London; Department of Anaesthesia (S.B.), the James Cook University Hospital, Middlesbrough; Department of Neurosurgery (D.W.), King's College Hospital NHS Foundation Trust, London; and Department of Neurosurgery (D.B.), University Hospital Southampton NHS Foundation Trust
| | - Varinder Alg
- From the Stroke Research Centre (I.C.H., V.A., M.M.B., D.J.W.), MRC Centre for Neuromuscular Diseases (B.O., E.B.), and Department of Neuromuscular Disorders (E.B., J.V.), UCL Queen Square Institute of Neurology; Neurogenetics Laboratory (I.C.H., B.O., E.O., H.H.) and Departments of Neuroradiology (I.D.) and Neurosurgery (N.K., J.G.), the National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London; Department of Anaesthesia (S.B.), the James Cook University Hospital, Middlesbrough; Department of Neurosurgery (D.W.), King's College Hospital NHS Foundation Trust, London; and Department of Neurosurgery (D.B.), University Hospital Southampton NHS Foundation Trust
| | - Stephen Bonner
- From the Stroke Research Centre (I.C.H., V.A., M.M.B., D.J.W.), MRC Centre for Neuromuscular Diseases (B.O., E.B.), and Department of Neuromuscular Disorders (E.B., J.V.), UCL Queen Square Institute of Neurology; Neurogenetics Laboratory (I.C.H., B.O., E.O., H.H.) and Departments of Neuroradiology (I.D.) and Neurosurgery (N.K., J.G.), the National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London; Department of Anaesthesia (S.B.), the James Cook University Hospital, Middlesbrough; Department of Neurosurgery (D.W.), King's College Hospital NHS Foundation Trust, London; and Department of Neurosurgery (D.B.), University Hospital Southampton NHS Foundation Trust
| | - Daniel Walsh
- From the Stroke Research Centre (I.C.H., V.A., M.M.B., D.J.W.), MRC Centre for Neuromuscular Diseases (B.O., E.B.), and Department of Neuromuscular Disorders (E.B., J.V.), UCL Queen Square Institute of Neurology; Neurogenetics Laboratory (I.C.H., B.O., E.O., H.H.) and Departments of Neuroradiology (I.D.) and Neurosurgery (N.K., J.G.), the National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London; Department of Anaesthesia (S.B.), the James Cook University Hospital, Middlesbrough; Department of Neurosurgery (D.W.), King's College Hospital NHS Foundation Trust, London; and Department of Neurosurgery (D.B.), University Hospital Southampton NHS Foundation Trust
| | - Diederik Bulters
- From the Stroke Research Centre (I.C.H., V.A., M.M.B., D.J.W.), MRC Centre for Neuromuscular Diseases (B.O., E.B.), and Department of Neuromuscular Disorders (E.B., J.V.), UCL Queen Square Institute of Neurology; Neurogenetics Laboratory (I.C.H., B.O., E.O., H.H.) and Departments of Neuroradiology (I.D.) and Neurosurgery (N.K., J.G.), the National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London; Department of Anaesthesia (S.B.), the James Cook University Hospital, Middlesbrough; Department of Neurosurgery (D.W.), King's College Hospital NHS Foundation Trust, London; and Department of Neurosurgery (D.B.), University Hospital Southampton NHS Foundation Trust
| | - Neil Kitchen
- From the Stroke Research Centre (I.C.H., V.A., M.M.B., D.J.W.), MRC Centre for Neuromuscular Diseases (B.O., E.B.), and Department of Neuromuscular Disorders (E.B., J.V.), UCL Queen Square Institute of Neurology; Neurogenetics Laboratory (I.C.H., B.O., E.O., H.H.) and Departments of Neuroradiology (I.D.) and Neurosurgery (N.K., J.G.), the National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London; Department of Anaesthesia (S.B.), the James Cook University Hospital, Middlesbrough; Department of Neurosurgery (D.W.), King's College Hospital NHS Foundation Trust, London; and Department of Neurosurgery (D.B.), University Hospital Southampton NHS Foundation Trust
| | - Martin M Brown
- From the Stroke Research Centre (I.C.H., V.A., M.M.B., D.J.W.), MRC Centre for Neuromuscular Diseases (B.O., E.B.), and Department of Neuromuscular Disorders (E.B., J.V.), UCL Queen Square Institute of Neurology; Neurogenetics Laboratory (I.C.H., B.O., E.O., H.H.) and Departments of Neuroradiology (I.D.) and Neurosurgery (N.K., J.G.), the National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London; Department of Anaesthesia (S.B.), the James Cook University Hospital, Middlesbrough; Department of Neurosurgery (D.W.), King's College Hospital NHS Foundation Trust, London; and Department of Neurosurgery (D.B.), University Hospital Southampton NHS Foundation Trust
| | - Joan Grieve
- From the Stroke Research Centre (I.C.H., V.A., M.M.B., D.J.W.), MRC Centre for Neuromuscular Diseases (B.O., E.B.), and Department of Neuromuscular Disorders (E.B., J.V.), UCL Queen Square Institute of Neurology; Neurogenetics Laboratory (I.C.H., B.O., E.O., H.H.) and Departments of Neuroradiology (I.D.) and Neurosurgery (N.K., J.G.), the National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London; Department of Anaesthesia (S.B.), the James Cook University Hospital, Middlesbrough; Department of Neurosurgery (D.W.), King's College Hospital NHS Foundation Trust, London; and Department of Neurosurgery (D.B.), University Hospital Southampton NHS Foundation Trust
| | - David J Werring
- From the Stroke Research Centre (I.C.H., V.A., M.M.B., D.J.W.), MRC Centre for Neuromuscular Diseases (B.O., E.B.), and Department of Neuromuscular Disorders (E.B., J.V.), UCL Queen Square Institute of Neurology; Neurogenetics Laboratory (I.C.H., B.O., E.O., H.H.) and Departments of Neuroradiology (I.D.) and Neurosurgery (N.K., J.G.), the National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London; Department of Anaesthesia (S.B.), the James Cook University Hospital, Middlesbrough; Department of Neurosurgery (D.W.), King's College Hospital NHS Foundation Trust, London; and Department of Neurosurgery (D.B.), University Hospital Southampton NHS Foundation Trust
| | - Henry Houlden
- From the Stroke Research Centre (I.C.H., V.A., M.M.B., D.J.W.), MRC Centre for Neuromuscular Diseases (B.O., E.B.), and Department of Neuromuscular Disorders (E.B., J.V.), UCL Queen Square Institute of Neurology; Neurogenetics Laboratory (I.C.H., B.O., E.O., H.H.) and Departments of Neuroradiology (I.D.) and Neurosurgery (N.K., J.G.), the National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London; Department of Anaesthesia (S.B.), the James Cook University Hospital, Middlesbrough; Department of Neurosurgery (D.W.), King's College Hospital NHS Foundation Trust, London; and Department of Neurosurgery (D.B.), University Hospital Southampton NHS Foundation Trust.
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Lyndon D, Davagnanam I, Wilson D, Jichi F, Merwick A, Bolsover F, Jager HR, Cipolotti L, Wheeler-Kingshott C, Hughes D, Murphy E, Lachmann R, Werring DJ. MRI-visible perivascular spaces as an imaging biomarker in Fabry disease. J Neurol 2020; 268:872-878. [PMID: 33078310 PMCID: PMC7914182 DOI: 10.1007/s00415-020-10209-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 08/30/2020] [Accepted: 09/02/2020] [Indexed: 12/02/2022]
Abstract
Introduction Fabry disease (FD) is an X-linked lysosomal storage disorder resulting in vascular glycosphingolipid accumulation and increased stroke risk. MRI findings associated with FD include white matter hyperintensities (WMH) and cerebral microbleeds (CMBs), suggesting the presence of cerebral small vessel disease. MRI-visible perivascular spaces (PVS) are another promising marker of small vessel disease associated with impaired interstitial fluid drainage. We investigated the association of PVS severity and anatomical distribution with FD.
Patients and methods We compared patients with genetically proven FD to healthy controls. PVS, WMH, lacunes and CMBs were rated on standardised sequences using validated criteria and scales, blinded to diagnosis. A trained observer (using a validated rating scale), quantified the total severity of PVS. We used logistic regression to investigate the association of severe PVS with FD. Results We included 33 FD patients (median age 44, 44.1% male) and 20 healthy controls (median age 33.5, 50% male). Adjusting for age and sex, FD was associated with more severe basal ganglia PVS (odds ratio (OR) 5.80, 95% CI 1.03–32.7) and higher total PVS score (OR 4.03, 95% CI 1.36–11.89). Compared with controls, participants with FD had: higher WMH volume (median 495.03 mm3 vs 0, p = 0.0008), more CMBs (21.21% vs none, p = 0.04), and a higher prevalence of lacunes (21.21% vs. 5%, p = 0.23). Conclusions PVS scores are more severe in FD than control subjects. Our findings have potential relevance for FD diagnosis and suggest that impaired interstitial fluid drainage might be a mechanism of white matter injury in FD.
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Affiliation(s)
- D Lyndon
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, Institute of Neurology, Russell Square House, London, UK
| | - I Davagnanam
- Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, Queen Square, London, UK.
| | - D Wilson
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, Institute of Neurology, Russell Square House, London, UK.,New Zealand Brain Research Institute, Christchurch, New Zealand
| | - F Jichi
- Department of Biostatistics, University College of London, London, UK
| | - A Merwick
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, Institute of Neurology, Russell Square House, London, UK
| | - F Bolsover
- Charles Dent Metabolic Unit, National Hospital for Neurology and Neurosurgery, London, UK
| | - H R Jager
- Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, Queen Square, London, UK
| | - L Cipolotti
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - C Wheeler-Kingshott
- Department of Neuroinflammation Queen Square MS Centre, UCL Institute of Neurology, London, UK
| | - D Hughes
- Lysosomal Storage Disorders Unit, Royal Free Hospital, Rowland Hill Street, London, UK
| | - E Murphy
- Charles Dent Metabolic Unit, National Hospital for Neurology and Neurosurgery, London, UK
| | - R Lachmann
- Charles Dent Metabolic Unit, National Hospital for Neurology and Neurosurgery, London, UK
| | - D J Werring
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, Institute of Neurology, Russell Square House, London, UK
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29
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Manole A, Efthymiou S, O'Connor E, Mendes MI, Jennings M, Maroofian R, Davagnanam I, Mankad K, Lopez MR, Salpietro V, Harripaul R, Badalato L, Walia J, Francklyn CS, Athanasiou-Fragkouli A, Sullivan R, Desai S, Baranano K, Zafar F, Rana N, Ilyas M, Horga A, Kara M, Mattioli F, Goldenberg A, Griffin H, Piton A, Henderson LB, Kara B, Aslanger AD, Raaphorst J, Pfundt R, Portier R, Shinawi M, Kirby A, Christensen KM, Wang L, Rosti RO, Paracha SA, Sarwar MT, Jenkins D, Ahmed J, Santoni FA, Ranza E, Iwaszkiewicz J, Cytrynbaum C, Weksberg R, Wentzensen IM, Guillen Sacoto MJ, Si Y, Telegrafi A, Andrews MV, Baldridge D, Gabriel H, Mohr J, Oehl-Jaschkowitz B, Debard S, Senger B, Fischer F, van Ravenwaaij C, Fock AJM, Stevens SJC, Bähler J, Nasar A, Mantovani JF, Manzur A, Sarkozy A, Smith DEC, Salomons GS, Ahmed ZM, Riazuddin S, Riazuddin S, Usmani MA, Seibt A, Ansar M, Antonarakis SE, Vincent JB, Ayub M, Grimmel M, Jelsig AM, Hjortshøj TD, Karstensen HG, Hummel M, Haack TB, Jamshidi Y, Distelmaier F, Horvath R, Gleeson JG, Becker H, Mandel JL, Koolen DA, Houlden H. De Novo and Bi-allelic Pathogenic Variants in NARS1 Cause Neurodevelopmental Delay Due to Toxic Gain-of-Function and Partial Loss-of-Function Effects. Am J Hum Genet 2020; 107:311-324. [PMID: 32738225 PMCID: PMC7413890 DOI: 10.1016/j.ajhg.2020.06.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [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: 02/25/2020] [Accepted: 06/23/2020] [Indexed: 12/19/2022] Open
Abstract
Aminoacyl-tRNA synthetases (ARSs) are ubiquitous, ancient enzymes that charge amino acids to cognate tRNA molecules, the essential first step of protein translation. Here, we describe 32 individuals from 21 families, presenting with microcephaly, neurodevelopmental delay, seizures, peripheral neuropathy, and ataxia, with de novo heterozygous and bi-allelic mutations in asparaginyl-tRNA synthetase (NARS1). We demonstrate a reduction in NARS1 mRNA expression as well as in NARS1 enzyme levels and activity in both individual fibroblasts and induced neural progenitor cells (iNPCs). Molecular modeling of the recessive c.1633C>T (p.Arg545Cys) variant shows weaker spatial positioning and tRNA selectivity. We conclude that de novo and bi-allelic mutations in NARS1 are a significant cause of neurodevelopmental disease, where the mechanism for de novo variants could be toxic gain-of-function and for recessive variants, partial loss-of-function.
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Affiliation(s)
- Andreea Manole
- Department of Neuromuscular Disorders, University College London (UCL) Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Stephanie Efthymiou
- Department of Neuromuscular Disorders, University College London (UCL) Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Emer O'Connor
- Department of Neuromuscular Disorders, University College London (UCL) Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Marisa I Mendes
- Metabolic Unit, Department of Clinical Chemistry, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam Gastroenterology and Metabolism, Amsterdam, 1081 the Netherlands
| | - Matthew Jennings
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, CB2 0QQ UK
| | - Reza Maroofian
- Department of Neuromuscular Disorders, University College London (UCL) Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Indran Davagnanam
- Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Kshitij Mankad
- Department of Neuroradiology, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
| | - Maria Rodriguez Lopez
- Institute of Healthy Ageing, Department of Genetics, Evolution and Environment, University College London (UCL), London, WC1E 6BT, UK
| | - Vincenzo Salpietro
- Department of Neuromuscular Disorders, University College London (UCL) Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Ricardo Harripaul
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, ON, M5T 1R8, Canada; Institute of Medical Science and Department of Psychiatry, University of Toronto, Toronto, ON, M5T 1R8, Canada
| | - Lauren Badalato
- Department of Pediatrics, Queen's University, Kingston, ON, K7L 2V7, Canada
| | - Jagdeep Walia
- Department of Pediatrics, Queen's University, Kingston, ON, K7L 2V7, Canada
| | - Christopher S Francklyn
- Department of Biochemistry, University of Vermont College of Medicine, Burlington, VT 05405, USA
| | - Alkyoni Athanasiou-Fragkouli
- Department of Neuromuscular Disorders, University College London (UCL) Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Roisin Sullivan
- Department of Neuromuscular Disorders, University College London (UCL) Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Sonal Desai
- Department of Neurology and Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
| | - Kristin Baranano
- Department of Neurology and Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
| | - Faisal Zafar
- Department of Pediatrics, Multan Hospital, Multan, 60000, Pakistan
| | - Nuzhat Rana
- Department of Pediatrics, Multan Hospital, Multan, 60000, Pakistan
| | | | - Alejandro Horga
- Department of Neuromuscular Disorders, University College London (UCL) Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Majdi Kara
- Department of Pediatrics, Tripoli Children's Hospital, Tripoli, Libya
| | - Francesca Mattioli
- Institute for Genetics and Molecular and Cellular Biology (IGBMC), University of Strasbourg, CNRS UMR7104, INSERM U1258, Illkirch, 67404, France
| | - Alice Goldenberg
- Département de Génétique, centre de référence anomalies du développement et syndromes malformatifs, CHU de Rouen, Inserm U1245, UNIROUEN, Normandie Université, Centre Normand de Génomique et de Médecine Personnalisée, Rouen, 76031, France
| | - Helen Griffin
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, CB2 0QQ UK
| | - Amelie Piton
- Institute for Genetics and Molecular and Cellular Biology (IGBMC), University of Strasbourg, CNRS UMR7104, INSERM U1258, Illkirch, 67404, France
| | | | | | | | - Joost Raaphorst
- Department of Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, 6500HB Nijmegen, the Netherlands; Department of Neurology, Amsterdam Neuroscience Institute, Amsterdam University Medical Center, 1105AZ Amsterdam, the Netherlands
| | - Rolph Pfundt
- Department of Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, 6500HB Nijmegen, the Netherlands
| | - Ruben Portier
- Department of Neurology, Medisch Spectrum Twente, 7512KZ Enschede, the Netherlands
| | - Marwan Shinawi
- Department of Pediatrics, Divisions of Genetics and Genomic Medicine, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Amelia Kirby
- Division of Medical Genetics, SSM Health Cardinal Glennon Children's Hospital, Saint Louis University School of Medicine, St. Louis, MO 63104, USA
| | - Katherine M Christensen
- Division of Medical Genetics, SSM Health Cardinal Glennon Children's Hospital, Saint Louis University School of Medicine, St. Louis, MO 63104, USA
| | - Lu Wang
- Howard Hughes Medical Institute, University of California San Diego and Rady Children's Hospital, La Jolla, CA 92130, USA
| | - Rasim O Rosti
- Howard Hughes Medical Institute, University of California San Diego and Rady Children's Hospital, La Jolla, CA 92130, USA
| | - Sohail A Paracha
- Institute of Basic Medical Sciences, Khyber Medical University, 25100 Peshawar, Pakistan
| | - Muhammad T Sarwar
- Institute of Basic Medical Sciences, Khyber Medical University, 25100 Peshawar, Pakistan
| | - Dagan Jenkins
- Institute of Child Health, Guilford Street and Dubowitz Neuromuscular Centre, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
| | - Jawad Ahmed
- Institute of Basic Medical Sciences, Khyber Medical University, 25100 Peshawar, Pakistan
| | - Federico A Santoni
- Department of Genetic Medicine and Development, University of Geneva, 1206 Geneva, Switzerland; Department of Endocrinology, Diabetes, and Metabolism, University Hospital of Lausanne, 1011 Lausanne, Switzerland
| | - Emmanuelle Ranza
- Department of Genetic Medicine and Development, University of Geneva, 1206 Geneva, Switzerland; Service of Genetic Medicine, University Hospitals of Geneva, 1205 Geneva, Switzerland; Medigenome, The Swiss Institute of Genomic Medicine, Geneva, CH-1207, Switzerland
| | - Justyna Iwaszkiewicz
- Swiss Institute of Bioinformatics, Molecular Modeling Group, Batiment Genopode, Unil Sorge, Lausanne, CH-1015, Switzerland
| | - Cheryl Cytrynbaum
- Hospital for Sick Children, Division of Clinical and Metabolic Genetics, 555 University Ave., Toronto, M5G 1X8, Canada
| | - Rosanna Weksberg
- Hospital for Sick Children, Division of Clinical and Metabolic Genetics, 555 University Ave., Toronto, M5G 1X8, Canada
| | | | | | - Yue Si
- GeneDx, 207 Perry Parkway Gaithersburg, MD 20877, USA
| | | | - Marisa V Andrews
- Department of Pediatrics, Divisions of Genetics and Genomic Medicine, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Dustin Baldridge
- Department of Pediatrics, Divisions of Genetics and Genomic Medicine, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Heinz Gabriel
- CeGaT GmbH and Praxis für Humangenetik Tuebingen, Tuebingen, 72076, Germany
| | - Julia Mohr
- CeGaT GmbH and Praxis für Humangenetik Tuebingen, Tuebingen, 72076, Germany
| | | | - Sylvain Debard
- University of Strasbourg, CNRS, GMGM UMR 7156, Strasbourg, 67083, France
| | - Bruno Senger
- University of Strasbourg, CNRS, GMGM UMR 7156, Strasbourg, 67083, France
| | - Frédéric Fischer
- University of Strasbourg, CNRS, GMGM UMR 7156, Strasbourg, 67083, France
| | - Conny van Ravenwaaij
- University of Groningen, University Medical Center Groningen, Department of Neurology, Groningen, 9713, the Netherlands
| | - Annemarie J M Fock
- University of Groningen, University Medical Center Groningen, Department of Neurology, Groningen, 9713, the Netherlands
| | - Servi J C Stevens
- Department of Clinical Genetics, Maastricht University Medical Centre, Maastricht, 6211, the Netherlands
| | - Jürg Bähler
- Institute of Healthy Ageing, Department of Genetics, Evolution and Environment, University College London (UCL), London, WC1E 6BT, UK
| | - Amina Nasar
- Department of Pediatrics, Queen's University, Kingston, ON, K7L 2V7, Canada
| | - John F Mantovani
- Division of Child Neurology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Adnan Manzur
- Institute of Child Health, Guilford Street and Dubowitz Neuromuscular Centre, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
| | - Anna Sarkozy
- Institute of Child Health, Guilford Street and Dubowitz Neuromuscular Centre, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
| | - Desirée E C Smith
- Metabolic Unit, Department of Clinical Chemistry, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam Gastroenterology and Metabolism, Amsterdam, 1081 the Netherlands
| | - Gajja S Salomons
- Metabolic Unit, Department of Clinical Chemistry, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam Gastroenterology and Metabolism, Amsterdam, 1081 the Netherlands
| | - Zubair M Ahmed
- Department of Biochemistry and Molecular Biology, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
| | - Shaikh Riazuddin
- Jinnah Burn and Reconstructive Surgery Center, Allama Iqbal Medical College, University of Health Sciences, Lahore 54550, Pakistan
| | - Saima Riazuddin
- Department of Biochemistry and Molecular Biology, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
| | - Muhammad A Usmani
- Department of Biochemistry and Molecular Biology, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
| | - Annette Seibt
- Department of General Pediatrics, Heinrich-Heine-University, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Muhammad Ansar
- Department of Genetic Medicine and Development, University of Geneva, 1206 Geneva, Switzerland; Institute of Molecular and Clinical Ophthalmology Basel, Basel Switzerland
| | - Stylianos E Antonarakis
- Department of Genetic Medicine and Development, University of Geneva, 1206 Geneva, Switzerland; Service of Genetic Medicine, University Hospitals of Geneva, 1205 Geneva, Switzerland; iGE3 Institute of Genetics and Genomics of Geneva, 1211 Geneva, Switzerland
| | - John B Vincent
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, ON, M5T 1R8, Canada; Institute of Medical Science and Department of Psychiatry, University of Toronto, Toronto, ON, M5T 1R8, Canada
| | - Muhammad Ayub
- Department of Pediatrics, Queen's University, Kingston, ON, K7L 2V7, Canada
| | - Mona Grimmel
- Institute of Medical Genetics and Applied Genomics, University of Tuebingen, 72076 Tübingen, Germany
| | - Anne Marie Jelsig
- Department of Clinical Genetics, University Hospital of Copenhagen, Rigshospitalet, 2100, Denmark
| | - Tina Duelund Hjortshøj
- Department of Clinical Genetics, University Hospital of Copenhagen, Rigshospitalet, 2100, Denmark
| | - Helena Gásdal Karstensen
- Department of Clinical Genetics, University Hospital of Copenhagen, Rigshospitalet, 2100, Denmark
| | - Marybeth Hummel
- Department of Pediatrics, Section of Medical Genetics, West Virginia University, Morgantown, WV 26506-9600, USA
| | - Tobias B Haack
- Institute of Medical Genetics and Applied Genomics, University of Tuebingen, 72076 Tübingen, Germany; Centre for Rare Diseases, University of Tuebingen, 72076 Tübingen, Germany
| | - Yalda Jamshidi
- Genetics Centre, Molecular and Clinical Sciences Institute, St George's University of London, London, SW17 0RE, UK
| | - Felix Distelmaier
- Department of General Pediatrics, Heinrich-Heine-University, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Rita Horvath
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, CB2 0QQ UK
| | - Joseph G Gleeson
- Howard Hughes Medical Institute, University of California San Diego and Rady Children's Hospital, La Jolla, CA 92130, USA
| | - Hubert Becker
- University of Strasbourg, CNRS, GMGM UMR 7156, Strasbourg, 67083, France
| | - Jean-Louis Mandel
- Institute for Genetics and Molecular and Cellular Biology (IGBMC), University of Strasbourg, CNRS UMR7104, INSERM U1258, Illkirch, 67404, France
| | - David A Koolen
- Department of Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, 6500HB Nijmegen, the Netherlands
| | - Henry Houlden
- Department of Neuromuscular Disorders, University College London (UCL) Institute of Neurology, Queen Square, London, WC1N 3BG, UK.
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Davagnanam I, Chen Z, Hoskote C, Ding D, Yang B, Wang Y, Wang T, Li W, Duncan JS, Wang W, Sander JW, Kwan P. Prevalence of MRI abnormalities in people with epilepsy in rural China. Neurology 2020; 95:e1236-e1243. [PMID: 32611640 DOI: 10.1212/wnl.0000000000010171] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 03/05/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess the prevalence of brain MRI abnormalities in people with epilepsy in rural China and to compare it with that of individuals in the United Kingdom. METHODS Brain MRI scans were obtained in people with epilepsy who participated in a rural community-based program in China between July 2010 and December 2012. Individual epileptogenic lesion types were reviewed and their associations with seizure control examined. The MRI findings were compared with 2 previous similar studies in the United Kingdom. RESULTS Among the 597 individuals (58% male, median age 38 years) with MRI scans analyzed, 488 (82%) had active epilepsy. The MRI was abnormal in 389 individuals (65%), with potentially epileptogenic lesion in 224 (38%) and nonspecific abnormalities in 165 (28%), and 108 (18%) were potentially resectable. The potentially epileptogenic lesions were less frequently detected in children (<18 years old, 12 of 68, 18%) than in adults (212 of 529, 40%; p < 0.001). In people with potentially epileptogenic lesions, 67% (150 of 224) had failed ≥2 antiseizure medications. They had higher risk of uncontrolled epilepsy than those with normal MRI (risk ratio [RR] 1.25; p < 0.001) and those with nonspecific abnormality (RR 1.15; p = 0.002) after adjustment for age and sex. The diagnostic yield of MRI was similar to that reported in community- and hospital-based studies in the United Kingdom. CONCLUSIONS More than one-third of people with chronic epilepsy in rural China have potentially epileptogenic lesions identifiable on brain MRI, with two-thirds fulfilling the definition of pharmacoresistance. These findings highlight the magnitude of the unmet needs for epilepsy surgery in China.
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Affiliation(s)
- Indran Davagnanam
- From the Academic Department of Neuroradiology (I.D.), Department of Brain Repair and Rehabilitation, and NIHR University College London Hospitals (J.S.D., J.W.S.), Biomedical Research Centre, UCL Queen Square Institute of Neurology, London, UK; Clinical Epidemiology (Z.C.), School of Public Health and Preventive Medicine, and Department of Neuroscience (Z.C., P.K.), Central Clinical School, Monash University, Melbourne; Department of Medicine (Z.C., P.K.), Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Lysholm Department of Neuroradiology (C.H.), National Hospital for Neurology & Neurosurgery, Queen Square, London, UK; Institute of Neurology (D.D.), Huashan Hospital, Fudan University, Shanghai; Beijing Neurosurgical Institute (W.W.); Jiaozuo People's Hospital (B.Y.), Henan Province; Ningxia Medical University (Y.W.); Jincheng Emergency Medical Rescue Center (T.W.), Shanxi Province; Affiliated Second Hospital (W.L.), Hebei Medical University, China; Chalfont Centre for Epilepsy (J.S.D., J.W.S.), Chalfont St. Peter, UK; and Stichting Epilepsie Instellingen Nederland (J.W.S.), Heemstede, Netherlands
| | - Zhibin Chen
- From the Academic Department of Neuroradiology (I.D.), Department of Brain Repair and Rehabilitation, and NIHR University College London Hospitals (J.S.D., J.W.S.), Biomedical Research Centre, UCL Queen Square Institute of Neurology, London, UK; Clinical Epidemiology (Z.C.), School of Public Health and Preventive Medicine, and Department of Neuroscience (Z.C., P.K.), Central Clinical School, Monash University, Melbourne; Department of Medicine (Z.C., P.K.), Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Lysholm Department of Neuroradiology (C.H.), National Hospital for Neurology & Neurosurgery, Queen Square, London, UK; Institute of Neurology (D.D.), Huashan Hospital, Fudan University, Shanghai; Beijing Neurosurgical Institute (W.W.); Jiaozuo People's Hospital (B.Y.), Henan Province; Ningxia Medical University (Y.W.); Jincheng Emergency Medical Rescue Center (T.W.), Shanxi Province; Affiliated Second Hospital (W.L.), Hebei Medical University, China; Chalfont Centre for Epilepsy (J.S.D., J.W.S.), Chalfont St. Peter, UK; and Stichting Epilepsie Instellingen Nederland (J.W.S.), Heemstede, Netherlands
| | - Chandrashekar Hoskote
- From the Academic Department of Neuroradiology (I.D.), Department of Brain Repair and Rehabilitation, and NIHR University College London Hospitals (J.S.D., J.W.S.), Biomedical Research Centre, UCL Queen Square Institute of Neurology, London, UK; Clinical Epidemiology (Z.C.), School of Public Health and Preventive Medicine, and Department of Neuroscience (Z.C., P.K.), Central Clinical School, Monash University, Melbourne; Department of Medicine (Z.C., P.K.), Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Lysholm Department of Neuroradiology (C.H.), National Hospital for Neurology & Neurosurgery, Queen Square, London, UK; Institute of Neurology (D.D.), Huashan Hospital, Fudan University, Shanghai; Beijing Neurosurgical Institute (W.W.); Jiaozuo People's Hospital (B.Y.), Henan Province; Ningxia Medical University (Y.W.); Jincheng Emergency Medical Rescue Center (T.W.), Shanxi Province; Affiliated Second Hospital (W.L.), Hebei Medical University, China; Chalfont Centre for Epilepsy (J.S.D., J.W.S.), Chalfont St. Peter, UK; and Stichting Epilepsie Instellingen Nederland (J.W.S.), Heemstede, Netherlands
| | - Ding Ding
- From the Academic Department of Neuroradiology (I.D.), Department of Brain Repair and Rehabilitation, and NIHR University College London Hospitals (J.S.D., J.W.S.), Biomedical Research Centre, UCL Queen Square Institute of Neurology, London, UK; Clinical Epidemiology (Z.C.), School of Public Health and Preventive Medicine, and Department of Neuroscience (Z.C., P.K.), Central Clinical School, Monash University, Melbourne; Department of Medicine (Z.C., P.K.), Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Lysholm Department of Neuroradiology (C.H.), National Hospital for Neurology & Neurosurgery, Queen Square, London, UK; Institute of Neurology (D.D.), Huashan Hospital, Fudan University, Shanghai; Beijing Neurosurgical Institute (W.W.); Jiaozuo People's Hospital (B.Y.), Henan Province; Ningxia Medical University (Y.W.); Jincheng Emergency Medical Rescue Center (T.W.), Shanxi Province; Affiliated Second Hospital (W.L.), Hebei Medical University, China; Chalfont Centre for Epilepsy (J.S.D., J.W.S.), Chalfont St. Peter, UK; and Stichting Epilepsie Instellingen Nederland (J.W.S.), Heemstede, Netherlands
| | - Bin Yang
- From the Academic Department of Neuroradiology (I.D.), Department of Brain Repair and Rehabilitation, and NIHR University College London Hospitals (J.S.D., J.W.S.), Biomedical Research Centre, UCL Queen Square Institute of Neurology, London, UK; Clinical Epidemiology (Z.C.), School of Public Health and Preventive Medicine, and Department of Neuroscience (Z.C., P.K.), Central Clinical School, Monash University, Melbourne; Department of Medicine (Z.C., P.K.), Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Lysholm Department of Neuroradiology (C.H.), National Hospital for Neurology & Neurosurgery, Queen Square, London, UK; Institute of Neurology (D.D.), Huashan Hospital, Fudan University, Shanghai; Beijing Neurosurgical Institute (W.W.); Jiaozuo People's Hospital (B.Y.), Henan Province; Ningxia Medical University (Y.W.); Jincheng Emergency Medical Rescue Center (T.W.), Shanxi Province; Affiliated Second Hospital (W.L.), Hebei Medical University, China; Chalfont Centre for Epilepsy (J.S.D., J.W.S.), Chalfont St. Peter, UK; and Stichting Epilepsie Instellingen Nederland (J.W.S.), Heemstede, Netherlands
| | - Yingli Wang
- From the Academic Department of Neuroradiology (I.D.), Department of Brain Repair and Rehabilitation, and NIHR University College London Hospitals (J.S.D., J.W.S.), Biomedical Research Centre, UCL Queen Square Institute of Neurology, London, UK; Clinical Epidemiology (Z.C.), School of Public Health and Preventive Medicine, and Department of Neuroscience (Z.C., P.K.), Central Clinical School, Monash University, Melbourne; Department of Medicine (Z.C., P.K.), Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Lysholm Department of Neuroradiology (C.H.), National Hospital for Neurology & Neurosurgery, Queen Square, London, UK; Institute of Neurology (D.D.), Huashan Hospital, Fudan University, Shanghai; Beijing Neurosurgical Institute (W.W.); Jiaozuo People's Hospital (B.Y.), Henan Province; Ningxia Medical University (Y.W.); Jincheng Emergency Medical Rescue Center (T.W.), Shanxi Province; Affiliated Second Hospital (W.L.), Hebei Medical University, China; Chalfont Centre for Epilepsy (J.S.D., J.W.S.), Chalfont St. Peter, UK; and Stichting Epilepsie Instellingen Nederland (J.W.S.), Heemstede, Netherlands
| | - Taiping Wang
- From the Academic Department of Neuroradiology (I.D.), Department of Brain Repair and Rehabilitation, and NIHR University College London Hospitals (J.S.D., J.W.S.), Biomedical Research Centre, UCL Queen Square Institute of Neurology, London, UK; Clinical Epidemiology (Z.C.), School of Public Health and Preventive Medicine, and Department of Neuroscience (Z.C., P.K.), Central Clinical School, Monash University, Melbourne; Department of Medicine (Z.C., P.K.), Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Lysholm Department of Neuroradiology (C.H.), National Hospital for Neurology & Neurosurgery, Queen Square, London, UK; Institute of Neurology (D.D.), Huashan Hospital, Fudan University, Shanghai; Beijing Neurosurgical Institute (W.W.); Jiaozuo People's Hospital (B.Y.), Henan Province; Ningxia Medical University (Y.W.); Jincheng Emergency Medical Rescue Center (T.W.), Shanxi Province; Affiliated Second Hospital (W.L.), Hebei Medical University, China; Chalfont Centre for Epilepsy (J.S.D., J.W.S.), Chalfont St. Peter, UK; and Stichting Epilepsie Instellingen Nederland (J.W.S.), Heemstede, Netherlands
| | - Wenling Li
- From the Academic Department of Neuroradiology (I.D.), Department of Brain Repair and Rehabilitation, and NIHR University College London Hospitals (J.S.D., J.W.S.), Biomedical Research Centre, UCL Queen Square Institute of Neurology, London, UK; Clinical Epidemiology (Z.C.), School of Public Health and Preventive Medicine, and Department of Neuroscience (Z.C., P.K.), Central Clinical School, Monash University, Melbourne; Department of Medicine (Z.C., P.K.), Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Lysholm Department of Neuroradiology (C.H.), National Hospital for Neurology & Neurosurgery, Queen Square, London, UK; Institute of Neurology (D.D.), Huashan Hospital, Fudan University, Shanghai; Beijing Neurosurgical Institute (W.W.); Jiaozuo People's Hospital (B.Y.), Henan Province; Ningxia Medical University (Y.W.); Jincheng Emergency Medical Rescue Center (T.W.), Shanxi Province; Affiliated Second Hospital (W.L.), Hebei Medical University, China; Chalfont Centre for Epilepsy (J.S.D., J.W.S.), Chalfont St. Peter, UK; and Stichting Epilepsie Instellingen Nederland (J.W.S.), Heemstede, Netherlands
| | - John S Duncan
- From the Academic Department of Neuroradiology (I.D.), Department of Brain Repair and Rehabilitation, and NIHR University College London Hospitals (J.S.D., J.W.S.), Biomedical Research Centre, UCL Queen Square Institute of Neurology, London, UK; Clinical Epidemiology (Z.C.), School of Public Health and Preventive Medicine, and Department of Neuroscience (Z.C., P.K.), Central Clinical School, Monash University, Melbourne; Department of Medicine (Z.C., P.K.), Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Lysholm Department of Neuroradiology (C.H.), National Hospital for Neurology & Neurosurgery, Queen Square, London, UK; Institute of Neurology (D.D.), Huashan Hospital, Fudan University, Shanghai; Beijing Neurosurgical Institute (W.W.); Jiaozuo People's Hospital (B.Y.), Henan Province; Ningxia Medical University (Y.W.); Jincheng Emergency Medical Rescue Center (T.W.), Shanxi Province; Affiliated Second Hospital (W.L.), Hebei Medical University, China; Chalfont Centre for Epilepsy (J.S.D., J.W.S.), Chalfont St. Peter, UK; and Stichting Epilepsie Instellingen Nederland (J.W.S.), Heemstede, Netherlands
| | - Wenzhi Wang
- From the Academic Department of Neuroradiology (I.D.), Department of Brain Repair and Rehabilitation, and NIHR University College London Hospitals (J.S.D., J.W.S.), Biomedical Research Centre, UCL Queen Square Institute of Neurology, London, UK; Clinical Epidemiology (Z.C.), School of Public Health and Preventive Medicine, and Department of Neuroscience (Z.C., P.K.), Central Clinical School, Monash University, Melbourne; Department of Medicine (Z.C., P.K.), Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Lysholm Department of Neuroradiology (C.H.), National Hospital for Neurology & Neurosurgery, Queen Square, London, UK; Institute of Neurology (D.D.), Huashan Hospital, Fudan University, Shanghai; Beijing Neurosurgical Institute (W.W.); Jiaozuo People's Hospital (B.Y.), Henan Province; Ningxia Medical University (Y.W.); Jincheng Emergency Medical Rescue Center (T.W.), Shanxi Province; Affiliated Second Hospital (W.L.), Hebei Medical University, China; Chalfont Centre for Epilepsy (J.S.D., J.W.S.), Chalfont St. Peter, UK; and Stichting Epilepsie Instellingen Nederland (J.W.S.), Heemstede, Netherlands
| | - Josemir W Sander
- From the Academic Department of Neuroradiology (I.D.), Department of Brain Repair and Rehabilitation, and NIHR University College London Hospitals (J.S.D., J.W.S.), Biomedical Research Centre, UCL Queen Square Institute of Neurology, London, UK; Clinical Epidemiology (Z.C.), School of Public Health and Preventive Medicine, and Department of Neuroscience (Z.C., P.K.), Central Clinical School, Monash University, Melbourne; Department of Medicine (Z.C., P.K.), Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Lysholm Department of Neuroradiology (C.H.), National Hospital for Neurology & Neurosurgery, Queen Square, London, UK; Institute of Neurology (D.D.), Huashan Hospital, Fudan University, Shanghai; Beijing Neurosurgical Institute (W.W.); Jiaozuo People's Hospital (B.Y.), Henan Province; Ningxia Medical University (Y.W.); Jincheng Emergency Medical Rescue Center (T.W.), Shanxi Province; Affiliated Second Hospital (W.L.), Hebei Medical University, China; Chalfont Centre for Epilepsy (J.S.D., J.W.S.), Chalfont St. Peter, UK; and Stichting Epilepsie Instellingen Nederland (J.W.S.), Heemstede, Netherlands
| | - Patrick Kwan
- From the Academic Department of Neuroradiology (I.D.), Department of Brain Repair and Rehabilitation, and NIHR University College London Hospitals (J.S.D., J.W.S.), Biomedical Research Centre, UCL Queen Square Institute of Neurology, London, UK; Clinical Epidemiology (Z.C.), School of Public Health and Preventive Medicine, and Department of Neuroscience (Z.C., P.K.), Central Clinical School, Monash University, Melbourne; Department of Medicine (Z.C., P.K.), Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Lysholm Department of Neuroradiology (C.H.), National Hospital for Neurology & Neurosurgery, Queen Square, London, UK; Institute of Neurology (D.D.), Huashan Hospital, Fudan University, Shanghai; Beijing Neurosurgical Institute (W.W.); Jiaozuo People's Hospital (B.Y.), Henan Province; Ningxia Medical University (Y.W.); Jincheng Emergency Medical Rescue Center (T.W.), Shanxi Province; Affiliated Second Hospital (W.L.), Hebei Medical University, China; Chalfont Centre for Epilepsy (J.S.D., J.W.S.), Chalfont St. Peter, UK; and Stichting Epilepsie Instellingen Nederland (J.W.S.), Heemstede, Netherlands
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31
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Abstract
The anatomy of the brainstem is complex. It contains numerous cranial nerve nuclei and is traversed by multiple tracts between the brain and spinal cord. Improved MRI resolution now allows the radiologist to identify a higher level of anatomic detail, but an understanding of functional anatomy is crucial for correct interpretation of disease. Brainstem syndromes are most commonly due to occlusion of the posterior circulation or mass effect from intrinsic space-occupying lesions. These syndromes can have subtle imaging findings that may be missed by a radiologist unfamiliar with the anatomy or typical manifesting features. This article presents the developmental anatomy of the brainstem and discusses associated pathologic syndromes. Congenital and acquired syndromes are described and correlated with anatomic locations at imaging, with diagrams to provide a reference to aid in radiologic interpretation. ©RSNA, 2019.
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Affiliation(s)
- Sara Sciacca
- From the Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London WC1N 3BG, England (S.S., J.L., I.D.); and Department of Radiology, Frimley Health NHS Foundation Trust, Frimley, England (R.B.)
| | - Jeremy Lynch
- From the Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London WC1N 3BG, England (S.S., J.L., I.D.); and Department of Radiology, Frimley Health NHS Foundation Trust, Frimley, England (R.B.)
| | - Indran Davagnanam
- From the Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London WC1N 3BG, England (S.S., J.L., I.D.); and Department of Radiology, Frimley Health NHS Foundation Trust, Frimley, England (R.B.)
| | - Robert Barker
- From the Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London WC1N 3BG, England (S.S., J.L., I.D.); and Department of Radiology, Frimley Health NHS Foundation Trust, Frimley, England (R.B.)
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32
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Abstract
The cardinal features of neuromyelitis optica spectrum disorder (NMOSD) are optic neuritis, longitudinal extensive transverse myelitis and area postrema syndrome. Olfactory dysfunction is not listed as a feature in the NMOSD diagnostic criteria. Here, we present an aquaporin-4 antibody positive patient who, in addition to classical features of NMOSD, developed acute anosmia with magnetic resonance imaging (MRI) evidence of olfactory bulb abnormalities. While the association of anosmia and NMOSD has been rarely noted previously, to our knowledge, no prior cases have found this to be one of the presenting features of a relapse nor have they identified acute radiological correlates.
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Affiliation(s)
- Joseph Marshall
- Department of Neurology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
| | - Iris Kleerekooper
- Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, London, UK
| | - Indran Davagnanam
- Department of Brain Repair & Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
| | - S Anand Trip
- Department of Neurology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK/Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, London, UK
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33
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Chelban V, Alsagob M, Kloth K, Chirita-Emandi A, Vandrovcova J, Maroofian R, Davagnanam I, Bakhtiari S, AlSayed MD, Rahbeeni Z, AlZaidan H, Malintan NT, Johannsen J, Efthymiou S, Ghayoor Karimiani E, Mankad K, Al-Shahrani SA, Beiraghi Toosi M, AlShammari M, Groppa S, Haridy NA, AlQuait L, Qari A, Huma R, Salih MA, Almass R, Almutairi FB, Hamad MH, Alorainy IA, Ramzan K, Imtiaz F, Puiu M, Kruer MC, Bierhals T, Wood NW, Colak D, Houlden H, Kaya N. Genetic and phenotypic characterization of NKX6-2-related spastic ataxia and hypomyelination. Eur J Neurol 2019; 27:334-342. [PMID: 31509304 PMCID: PMC6946857 DOI: 10.1111/ene.14082] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 04/24/2019] [Accepted: 08/21/2019] [Indexed: 12/22/2022]
Abstract
Background and purpose Hypomyelinating leukodystrophies are a heterogeneous group of genetic disorders with a wide spectrum of phenotypes and a high rate of genetically unsolved cases. Bi‐allelic mutations in NKX6‐2 were recently linked to spastic ataxia 8 with hypomyelinating leukodystrophy. Methods Using a combination of homozygosity mapping, exome sequencing, and detailed clinical and neuroimaging assessment a series of new NKX6‐2 mutations in a multicentre setting is described. Then, all reported NKX6‐2 mutations and those identified in this study were combined and an in‐depth analysis of NKX6‐2‐related disease spectrum was provided. Results Eleven new cases from eight families of different ethnic backgrounds carrying compound heterozygous and homozygous pathogenic variants in NKX6‐2 were identified, evidencing a high NKX6‐2 mutation burden in the hypomyelinating leukodystrophy disease spectrum. Our data reveal a phenotype spectrum with neonatal onset, global psychomotor delay and worse prognosis at the severe end and a childhood onset with mainly motor phenotype at the milder end. The phenotypic and neuroimaging expression in NKX6‐2 is described and it is shown that phenotypes with epilepsy in the absence of overt hypomyelination and diffuse hypomyelination without seizures can occur. Conclusions NKX6‐2 mutations should be considered in patients with autosomal recessive, very early onset of nystagmus, cerebellar ataxia with hypotonia that rapidly progresses to spasticity, particularly when associated with neuroimaging signs of hypomyelination. Therefore, it is recommended that NXK6‐2 should be included in hypomyelinating leukodystrophy and spastic ataxia diagnostic panels.
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Affiliation(s)
- V Chelban
- Department of Neuromuscular Diseases, University College London Institute of Neurology, London, UK.,Department of Neurology and Neurosurgery, Institute of Emergency Medicine, Chisinau, Moldova
| | - M Alsagob
- Department of Genetics, KFSHRC, Riyadh, Saudi Arabia
| | - K Kloth
- Institute of Human Genetics, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - A Chirita-Emandi
- Genetics Department, University 'Victor Babes', Timisoara, Romania
| | - J Vandrovcova
- Department of Neuromuscular Diseases, University College London Institute of Neurology, London, UK
| | - R Maroofian
- Genetics Research Centre, Molecular and Clinical Sciences Institute, St George's University of London, London, UK
| | - I Davagnanam
- Brain Repair and Rehabilitation, University College London Institute of Neurology, London, UK
| | - S Bakhtiari
- Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, AZ, USA.,Department of Child Health, Cellular and Molecular Medicine, Department of Neurology, University of Arizona College of Medicine Phoenix, Phoenix, AZ, USA
| | - M D AlSayed
- Medical Genetics, KFSHRC, Riyadh, Saudi Arabia
| | - Z Rahbeeni
- Medical Genetics, KFSHRC, Riyadh, Saudi Arabia
| | - H AlZaidan
- Medical Genetics, KFSHRC, Riyadh, Saudi Arabia
| | - N T Malintan
- Clinical and Experimental Epilepsy, University College London Institute of Neurology, London, UK
| | - J Johannsen
- Department of Paediatrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - S Efthymiou
- Department of Neuromuscular Diseases, University College London Institute of Neurology, London, UK
| | - E Ghayoor Karimiani
- Genetics Research Centre, Molecular and Clinical Sciences Institute, St George's University of London, London, UK
| | - K Mankad
- Great Ormond Street Hospitals, London, UK
| | | | - M Beiraghi Toosi
- Department of Paediatric Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - M AlShammari
- Department of Genetics, KFSHRC, Riyadh, Saudi Arabia
| | - S Groppa
- Department of Neurology and Neurosurgery, Institute of Emergency Medicine, Chisinau, Moldova
| | - N A Haridy
- Department of Neuromuscular Diseases, University College London Institute of Neurology, London, UK.,Department of Neurology and Psychiatry, Assiut University Hospital, Assiut, Egypt
| | - L AlQuait
- Department of Genetics, KFSHRC, Riyadh, Saudi Arabia
| | - A Qari
- Medical Genetics, KFSHRC, Riyadh, Saudi Arabia
| | - R Huma
- Medical Genetics, KFSHRC, Riyadh, Saudi Arabia
| | - M A Salih
- Neurology Division, Department of Pediatrics, College of Medicine, King Saud University KFSHRC, Riyadh, Saudi Arabia
| | - R Almass
- Department of Genetics, KFSHRC, Riyadh, Saudi Arabia
| | - F B Almutairi
- Department of Genetics, KFSHRC, Riyadh, Saudi Arabia
| | - M H Hamad
- Neurology Division, Department of Pediatrics, College of Medicine, King Saud University KFSHRC, Riyadh, Saudi Arabia
| | - I A Alorainy
- Department of Radiology & Medical Imaging, College of Medicine, King Saud University KFSHRC, Riyadh, Saudi Arabia
| | - K Ramzan
- Department of Genetics, KFSHRC, Riyadh, Saudi Arabia
| | - F Imtiaz
- Department of Genetics, KFSHRC, Riyadh, Saudi Arabia
| | - M Puiu
- Genetics Department, University 'Victor Babes', Timisoara, Romania
| | - M C Kruer
- Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, AZ, USA.,Department of Child Health, Cellular and Molecular Medicine, Department of Neurology, University of Arizona College of Medicine Phoenix, Phoenix, AZ, USA
| | - T Bierhals
- Institute of Human Genetics, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - N W Wood
- Department of Neuromuscular Diseases, University College London Institute of Neurology, London, UK
| | - D Colak
- Department of Biostatistics, Epidemiology and Scientific Computing, KFSHRC, Riyadh, Saudi Arabia
| | - H Houlden
- Department of Neuromuscular Diseases, University College London Institute of Neurology, London, UK
| | - N Kaya
- Department of Genetics, KFSHRC, Riyadh, Saudi Arabia
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34
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Del Porto L, Hinds AM, Raoof N, Barras C, Davagnanam I, Hancox J, Adams G. Superior oblique enlargement in thyroid eye disease. J AAPOS 2019; 23:252.e1-252.e4. [PMID: 31344455 DOI: 10.1016/j.jaapos.2019.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 03/22/2019] [Accepted: 04/13/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To determine the extent of superior oblique enlargement in thyroid eye disease (TED) by comparing the cross-sectional superior oblique areas of TED patients with those of unaffected control subjects. METHODS The medical records of TED patients treated for strabismus from January 2005 to January 2016 were reviewed retrospectively for demographic and surgical data. The cross-sectional superior oblique area was compared to age-matched controls on high-resolution orbital computed tomography (CT) using a standardized protocol. RESULTS A total of 46 TED patients and 18 controls were included. The mean superior oblique cross-sectional area in TED subjects was 250% larger than in controls (22.88 ± 6.64 mm2 vs 9.32 ± 1.85 mm2. The mean cross-sectional area was >3 standard deviations from the mean of the control group in 96% of TED patients. CONCLUSIONS Superior oblique enlargement in TED may occur more frequently than generally recognized, challenging the notion that TED is primarily a disease of the rectus muscles.
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Affiliation(s)
- Lana Del Porto
- Moorfields Eye Hospital, London, United Kingdom; The Royal Victorian Eye and Ear Hospital, Melbourne, Australia.
| | | | - Naz Raoof
- Moorfields Eye Hospital, London, United Kingdom
| | - Christen Barras
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, United Kingdom; Radiology Department, Royal Melbourne Hospital, Melbourne, Australia
| | | | | | - Gillian Adams
- Moorfields Eye Hospital, London, United Kingdom; University College, London, United Kingdom
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35
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Bomsztyk J, Jareonsettasin P, Rismani A, Keddie S, Church A, Hart M, Hoskote C, Davagnanam I, Carroll A, Lunn M, D'Sa S. TREATMENT OF BING NEEL SYNDROME: USING A SLEDGEHAMMER TO CRACK A NUT? Hematol Oncol 2019. [DOI: 10.1002/hon.137_2631] [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: 11/08/2022]
Affiliation(s)
- J.A. Bomsztyk
- Haematology; University College London Hospital; London United Kingdom
| | - P. Jareonsettasin
- Haematology; University College London Hospital; London United Kingdom
| | - A. Rismani
- Haematology; University College London Hospital; London United Kingdom
| | - S. Keddie
- Neuroimmunology; National Hospital for Neurology and Neurosurgery; London United Kingdom
| | - A. Church
- Neuroimmunology; National Hospital for Neurology and Neurosurgery; London United Kingdom
| | - M.S. Hart
- Neuroimmunology; National Hospital for Neurology and Neurosurgery; London United Kingdom
| | - C. Hoskote
- Neuroradiology; National Hospital for Neurology and Neurosurgery; London United Kingdom
| | - I. Davagnanam
- Neuroradiology; National Hospital for Neurology and Neurosurgery; London United Kingdom
| | - A.S. Carroll
- Brain and Mind Research Institute; University of Sydney; Syndney Australia
| | - M.P. Lunn
- Neuroimmunology; National Hospital for Neurology and Neurosurgery; London United Kingdom
| | - S. D'Sa
- Haematology; University College London Hospital; London United Kingdom
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36
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Bomsztyk J, Jareonsettasin P, Carroll A, Keddie S, Church A, Hart M, Hoskote C, Davagnanam I, Rismani A, Lunn M, D'Sa S. BING NEEL SYNDROME: FIRST SUSPECT, THEN PROVE - A ROLE FOR CSF IgM ANALYSIS? Hematol Oncol 2019. [DOI: 10.1002/hon.138_2631] [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: 11/09/2022]
Affiliation(s)
- J.A. Bomsztyk
- Haematology; University College London Hospital; London United Kingdom
| | - P. Jareonsettasin
- Haematology; University College London Hospital; London United Kingdom
| | - A.S. Carroll
- Brain and Mind Research Institute; University of Sydney; Syndney Australia
| | - S. Keddie
- Neuroimmunology; National Hospital for Neurology and Neurosurgery; London United Kingdom
| | - A. Church
- Neuroimmunology; National Hospital for Neurology and Neurosurgery; London United Kingdom
| | - M.S. Hart
- Neuroimmunology; National Hospital for Neurology and Neurosurgery; London United Kingdom
| | - C. Hoskote
- National Hospital for Neurology and Neurosurgery; Neuroradiology; London United Kingdom
| | - I. Davagnanam
- National Hospital for Neurology and Neurosurgery; Neuroradiology; London United Kingdom
| | - A. Rismani
- Haematology; University College London Hospital; London United Kingdom
| | - M.P. Lunn
- Neuroimmunology; National Hospital for Neurology and Neurosurgery; London United Kingdom
| | - S. D'Sa
- Haematology; University College London Hospital; London United Kingdom
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37
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Lynch DS, Wade C, Paiva ARBD, John N, Kinsella JA, Merwick Á, Ahmed RM, Warren JD, Mummery CJ, Schott JM, Fox NC, Houlden H, Adams ME, Davagnanam I, Murphy E, Chataway J. Practical approach to the diagnosis of adult-onset leukodystrophies: an updated guide in the genomic era. J Neurol Neurosurg Psychiatry 2019; 90:543-554. [PMID: 30467211 PMCID: PMC6581077 DOI: 10.1136/jnnp-2018-319481] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 09/24/2018] [Accepted: 10/07/2018] [Indexed: 12/13/2022]
Abstract
Adult-onset leukodystrophies and genetic leukoencephalopathies comprise a diverse group of neurodegenerative disorders of white matter with a wide age of onset and phenotypic spectrum. Patients with white matter abnormalities detected on MRI often present a diagnostic challenge to both general and specialist neurologists. Patients typically present with a progressive syndrome including various combinations of cognitive impairment, movement disorders, ataxia and upper motor neuron signs. There are a number of important and treatable acquired causes for this imaging and clinical presentation. There are also a very large number of genetic causes which due to their relative rarity and sometimes variable and overlapping presentations can be difficult to diagnose. In this review, we provide a structured approach to the diagnosis of inherited disorders of white matter in adults. We describe clinical and radiological clues to aid diagnosis, and we present an overview of both common and rare genetic white matter disorders. We provide advice on testing for acquired causes, on excluding small vessel disease mimics, and detailed advice on metabolic and genetic testing available to the practising neurologist. Common genetic leukoencephalopathies discussed in detail include CSF1R, AARS2, cerebral arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), and mitochondrial and metabolic disorders.
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Affiliation(s)
- David S Lynch
- Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK .,Department of Neurology, Royal Free Hospital, London, UK
| | - Charles Wade
- Department of Neurology, Royal Free Hospital, London, UK
| | | | - Nevin John
- Department of Neuroinflammation, UCL Institute of Neurology, London, UK
| | - Justin A Kinsella
- Department of Neurology, St Vincent's University Hospital University College Dublin, Dublin, Ireland
| | - Áine Merwick
- Department of Neurology, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Rebekah M Ahmed
- Memory and Cognition Clinic, Department of Clinical Neurosciences, Royal Prince Alfred Hospital and the Brain and Mind Centre, University of Sydney, Camperdown, New South Wales, Australia
| | - Jason D Warren
- Dementia Research Centre, UCL Institute of Neurology, London, UK
| | | | | | - Nick C Fox
- Dementia Research Centre, UCL Institute of Neurology, London, UK
| | - Henry Houlden
- Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK
| | - Matthew E Adams
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Indran Davagnanam
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, UK.,Brain Repair & Rehabilitation, UCL Institute of Neurology, London, UK
| | - Elaine Murphy
- Charles Dent Metabolic Unit, National Hospital for Neurology and Neurosurgery Queen Square, London, UK
| | - Jeremy Chataway
- Department of Neuroinflammation, UCL Institute of Neurology, London, UK
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Prezerakos GK, Khan F, Davagnanam I, Smith F, Casey AT. FM1-7 Cranio-cervical instability in ehlers-danlos syndrome employing upright, dynamic MR imaging; a comparative study. J Neurol Neurosurg Psychiatry 2019. [DOI: 10.1136/jnnp-2019-abn.69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
ObjectivesEhlers-Danlos syndrome (EDS) is a hereditary connective tissue disorder leading to hypemobile joints including the craniocervical junction. Neck pain is a prominent feature. Structural abnormalities may have a dynamic element and thus may not be captured in a recumbent MRI. There is currently a lack of evidence1 assessing the use and diagnostic impact of positional MRI in Ehlers-Danlos syndrome. We aim to evaluate structural features and dynamic instability in an EDS cohort employing dynamic MR imaging against a non EDS symptomatic cohort.DesignComparative Study.SubjectsPatients diagnosed with Ehlers-Danlos syndrome and control subjects (non EDS with cervical spondylosis) were included in this study.MethodsCranio – cervical spine global and segmental movement parameters in the neutral, extension and flexion positions were measured from T2-weighted images in the midline sagittal plane. These parameters included the clivo axial angle, grabb oakes line, C2 sagittal vertical axis, C0-C1 angle, C1-2 angle, cervical lordosis and T1 slope.ResultsThe clivo- axial angle measured in neutral was 139.7±10.4 degrees in the EDS group vs 148.9±8.4 in the control group (p<0.01) The cervical range of movement between flexion and extension was 74.6±24.4 in the EDS group vs 39.4±11.3 in the controls (p<0.0001).ConclusionsEDS patients with neck symptoms exhibit different static as well as dynamic craniocervical structural features compared to a general population control.ReferenceOnt Health Technol Assess Ser [Internet]2015July;15(13):1–24.
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Wang F, Chen Z, Davagnanam I, Hoskote C, Ding D, Wang W, Yang B, Wang Y, Wang T, Li W, Sander JW, Kwan P. Comparing two classification schemes for seizures and epilepsy in rural China. Eur J Neurol 2018; 26:422-427. [PMID: 30414301 DOI: 10.1111/ene.13857] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 11/05/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE The International League against Epilepsy (ILAE) updated the classifications of seizures and epilepsies in 2017. The 2017 classifications were compared with the 1980s classifications in rural China. METHODS People with epilepsy receiving treatment under the National Epilepsy Control Programme were recruited from rural areas in China. Their seizures and epileptic syndrome were classified using the 1980s ILAE classification system and then re-classified according to the 2017 system. Differences in seizure, epilepsy and aetiology classifications were identified. RESULTS A total of 597 individuals (58% males, aged 6-78 years) were included. Amongst them 535 (90%) had a single seizure type, 57 (9.55%) had two types and five (0.84%) had three. There was complete agreement between the 1981 and 2017 classifications for the 525 individuals with focal seizures. Seizures originally classified as generalized in 10 of 65 individuals were re-classified as unknown in the 2017 classification. Compared to the 1980s classifications, the proportion of individuals with unknown seizures and unknown epilepsy increased from 1.2% (7/597) to 2.8% (17/597, P = 0.002), and unknown aetiology increased from 32% (189/597: 182 cryptogenic and seven unclassified) to 39% (230/597; P < 0.001) in the 2017 classifications. CONCLUSIONS The 1980s and 2017 classifications had 100% agreement in classifying focal seizures and epilepsy in rural China. A small but significant proportion of generalized seizures and epilepsy and aetiologies classified in the old classifications were re-classified to unknown in the new classifications. These results highlight the need for improvement in clinical evaluation of people with epilepsy in resource-poor settings.
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Affiliation(s)
- F Wang
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China.,Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Z Chen
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - I Davagnanam
- Academic Department of Neuroradiology, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, London, UK
| | - C Hoskote
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, UK
| | - D Ding
- Fudan University, Shanghai, China
| | - W Wang
- Beijing Neurosurgical Institute, Beijing, China
| | - B Yang
- Jiaozuo People's Hospital, Henan, China
| | - Y Wang
- Ningxia Medical University, Ningxia, China
| | - T Wang
- Jincheng Emergency Medical Rescue Center, Jincheng, China
| | - W Li
- Affiliated Second Hospital, Hebei Medical University, Hebei, China
| | - J W Sander
- NIHR University College London Hospitals, Biomedical Research Centre, UCL Institute of Neurology, London, UK.,Chalfont Centre for Epilepsy, Chalfont St Peter, UK.,Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands
| | - P Kwan
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong, China.,Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
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Werring DJ, Merwick A, Davagnanam I, Phyu P, Bolsover F, Jichi F, Wheeler-Kingshott C, Golay X, Hughes D, Cipolotti L, Murphy E, Lachmann RH. Author response: Increased resting cerebral blood flow in adult Fabry disease: MRI arterial spin labeling study. Neurology 2018; 91:1072. [DOI: 10.1212/wnl.0000000000006621] [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: 11/15/2022] Open
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O’Connor E, Vandrovcova J, Bugiardini E, Chelban V, Manole A, Davagnanam I, Wiethoff S, Pittman A, Lynch DS, Efthymiou S, Marino S, Manzur AY, Roberts M, Hanna MG, Houlden H, Matthews E, Wood NW. Mutations in XRCC1 cause cerebellar ataxia and peripheral neuropathy. J Neurol Neurosurg Psychiatry 2018; 89:1230-1232. [PMID: 29472272 PMCID: PMC6227798 DOI: 10.1136/jnnp-2017-317581] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 01/19/2018] [Accepted: 01/24/2018] [Indexed: 11/04/2022]
Affiliation(s)
- Emer O’Connor
- Department of Molecular Neuroscience, Institute of Neurology, University College London, London, UK
| | - Jana Vandrovcova
- Department of Molecular Neuroscience, Institute of Neurology, University College London, London, UK
| | - Enrico Bugiardini
- Department of Molecular Neuroscience, Institute of Neurology, University College London, London, UK
| | - Viorica Chelban
- Department of Molecular Neuroscience, Institute of Neurology, University College London, London, UK
| | - Andreea Manole
- Department of Molecular Neuroscience, Institute of Neurology, University College London, London, UK
| | - Indran Davagnanam
- Department of Brain Repair and Rehabilitation, Institute of Neurology, University College London, London, UK
| | - Sarah Wiethoff
- Department of Molecular Neuroscience, Institute of Neurology, University College London, London, UK
| | - Alan Pittman
- Department of Molecular Neuroscience, Institute of Neurology, University College London, London, UK
| | - David S Lynch
- Department of Molecular Neuroscience, Institute of Neurology, University College London, London, UK
| | - Stephanie Efthymiou
- Department of Molecular Neuroscience, Institute of Neurology, University College London, London, UK
| | - Silvia Marino
- Department of Neuropathology, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Adnan Y Manzur
- Department of Neurology, Great Ormond Street Hospital for Children, London, UK
| | - Mark Roberts
- Department of Neurology, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Michael G Hanna
- Medical Research Council Center for Neuromuscular Diseases, University College London and National Hospital for Neurology and Neurosurgery, London, UK
| | - Henry Houlden
- Department of Molecular Neuroscience, Institute of Neurology, University College London, London, UK
| | - Emma Matthews
- Medical Research Council Center for Neuromuscular Diseases, University College London and National Hospital for Neurology and Neurosurgery, London, UK
| | - Nicholas W Wood
- Department of Molecular Neuroscience, Institute of Neurology, University College London, London, UK
- Neurogenetics Laboratory, The National Hospital for Neurology and Neurosurgery, London, UK
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Affiliation(s)
- Julian Hermes
- From the Klinik für Radiologie und Neuroradiologie (J.H.), UKSH Campus Kiel, Germany; Lysholm Department of Neuroradiology (R.L.) and Department of Neurosurgery (L.W.), National Hospital for Neurology and Neurosurgery; and Brain Repair & Rehabilitation Department (I.D.), UCL Institute of Neurology, Queen Square, UK.
| | - Rahul Lakshmanan
- From the Klinik für Radiologie und Neuroradiologie (J.H.), UKSH Campus Kiel, Germany; Lysholm Department of Neuroradiology (R.L.) and Department of Neurosurgery (L.W.), National Hospital for Neurology and Neurosurgery; and Brain Repair & Rehabilitation Department (I.D.), UCL Institute of Neurology, Queen Square, UK
| | - Laurence Watkins
- From the Klinik für Radiologie und Neuroradiologie (J.H.), UKSH Campus Kiel, Germany; Lysholm Department of Neuroradiology (R.L.) and Department of Neurosurgery (L.W.), National Hospital for Neurology and Neurosurgery; and Brain Repair & Rehabilitation Department (I.D.), UCL Institute of Neurology, Queen Square, UK
| | - Indran Davagnanam
- From the Klinik für Radiologie und Neuroradiologie (J.H.), UKSH Campus Kiel, Germany; Lysholm Department of Neuroradiology (R.L.) and Department of Neurosurgery (L.W.), National Hospital for Neurology and Neurosurgery; and Brain Repair & Rehabilitation Department (I.D.), UCL Institute of Neurology, Queen Square, UK
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Phyu P, Merwick A, Davagnanam I, Bolsover F, Jichi F, Wheeler-Kingshott C, Golay X, Hughes D, Cipolotti L, Murphy E, Lachmann RH, Werring DJ. Increased resting cerebral blood flow in adult Fabry disease: MRI arterial spin labeling study. Neurology 2018; 90:e1379-e1385. [PMID: 29661900 DOI: 10.1212/wnl.0000000000005330] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 01/23/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess resting cerebral blood flow (CBF) in the whole-brain and cerebral white matter (WM) and gray matter (GM) of adults with Fabry disease (FD), using arterial spin labeling (ASL) MRI, and to investigate CBF correlations with WM hyperintensity (WMH) volume and the circulating biomarker lyso-Gb3. METHODS This cross-sectional, case-control study included 25 patients with genetically confirmed FD and 18 age-matched healthy controls. We quantified resting CBF using Quantitative Signal Targeting With Alternating Radiofrequency Labeling of Arterial Regions (QUASAR) ASL MRI. We measured WMH volume using semiautomated software. We measured CBF in regions of interest in whole-brain, WM, and deep GM, and assessed correlations with WMH volume and plasma lyso-Gb3. RESULTS The mean age (% male) for FD and healthy controls was 42.2 years (44%) and 37.1 years (50%). Mean whole-brain CBF was 27.56 mL/100 mL/min (95% confidence interval [CI] 23.78-31.34) for FD vs 22.39 mL/100 mL/min (95% CI 20.08-24.70) for healthy controls, p = 0.03. In WM, CBF was higher in FD (22.42 mL/100 mL/min [95% CI 17.72-27.12] vs 16.25 mL/100 mL/min [95% CI 14.03-18.48], p = 0.05). In deep GM, CBF was similar between groups (40.41 mL/100 mL/min [95% CI 36.85-43.97] for FD vs 37.46 mL/100 mL/min [95% CI 32.57-42.35], p = 0.38). In patients with FD with WMH (n = 20), whole-brain CBF correlated with WMH volume (r = 0.59, p = 0.006), not with plasma lyso-Gb3. CONCLUSION In FD, resting CBF is increased in WM but not deep GM. In FD, CBF correlates with WMH, suggesting that cerebral perfusion changes might contribute to, or result from, WM injury.
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Affiliation(s)
- Po Phyu
- From the Stroke Research Centre, Department of Brain Repair and Rehabilitation (P.P., A.M., I.D., X.G., D.J.W.), UCL Institute of Neurology; Charles Dent Metabolic Unit (A.M., E.M., R.H.L.), National Hospital for Neurology and Neurosurgery, London; Beaumont Hospital and Royal College of Surgeons in Ireland (A.M.), Beaumont, Dublin; Academic Department of Neuroradiology (I.D., X.G.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London; Department of Neuropsychology (F.B., L.C.), National Hospital for Neurology and Neurosurgery; Department of Biostatistics (F.J.), UCL and University College London Hospitals; Department of Neuroinflammation (C.W.-K.), UCL Institute of Neurology; and Lysosomal Storage Disorders Unit (D.H.), Royal Free Hospital, London, UK
| | - Aine Merwick
- From the Stroke Research Centre, Department of Brain Repair and Rehabilitation (P.P., A.M., I.D., X.G., D.J.W.), UCL Institute of Neurology; Charles Dent Metabolic Unit (A.M., E.M., R.H.L.), National Hospital for Neurology and Neurosurgery, London; Beaumont Hospital and Royal College of Surgeons in Ireland (A.M.), Beaumont, Dublin; Academic Department of Neuroradiology (I.D., X.G.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London; Department of Neuropsychology (F.B., L.C.), National Hospital for Neurology and Neurosurgery; Department of Biostatistics (F.J.), UCL and University College London Hospitals; Department of Neuroinflammation (C.W.-K.), UCL Institute of Neurology; and Lysosomal Storage Disorders Unit (D.H.), Royal Free Hospital, London, UK
| | - Indran Davagnanam
- From the Stroke Research Centre, Department of Brain Repair and Rehabilitation (P.P., A.M., I.D., X.G., D.J.W.), UCL Institute of Neurology; Charles Dent Metabolic Unit (A.M., E.M., R.H.L.), National Hospital for Neurology and Neurosurgery, London; Beaumont Hospital and Royal College of Surgeons in Ireland (A.M.), Beaumont, Dublin; Academic Department of Neuroradiology (I.D., X.G.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London; Department of Neuropsychology (F.B., L.C.), National Hospital for Neurology and Neurosurgery; Department of Biostatistics (F.J.), UCL and University College London Hospitals; Department of Neuroinflammation (C.W.-K.), UCL Institute of Neurology; and Lysosomal Storage Disorders Unit (D.H.), Royal Free Hospital, London, UK
| | - Fay Bolsover
- From the Stroke Research Centre, Department of Brain Repair and Rehabilitation (P.P., A.M., I.D., X.G., D.J.W.), UCL Institute of Neurology; Charles Dent Metabolic Unit (A.M., E.M., R.H.L.), National Hospital for Neurology and Neurosurgery, London; Beaumont Hospital and Royal College of Surgeons in Ireland (A.M.), Beaumont, Dublin; Academic Department of Neuroradiology (I.D., X.G.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London; Department of Neuropsychology (F.B., L.C.), National Hospital for Neurology and Neurosurgery; Department of Biostatistics (F.J.), UCL and University College London Hospitals; Department of Neuroinflammation (C.W.-K.), UCL Institute of Neurology; and Lysosomal Storage Disorders Unit (D.H.), Royal Free Hospital, London, UK
| | - Fatima Jichi
- From the Stroke Research Centre, Department of Brain Repair and Rehabilitation (P.P., A.M., I.D., X.G., D.J.W.), UCL Institute of Neurology; Charles Dent Metabolic Unit (A.M., E.M., R.H.L.), National Hospital for Neurology and Neurosurgery, London; Beaumont Hospital and Royal College of Surgeons in Ireland (A.M.), Beaumont, Dublin; Academic Department of Neuroradiology (I.D., X.G.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London; Department of Neuropsychology (F.B., L.C.), National Hospital for Neurology and Neurosurgery; Department of Biostatistics (F.J.), UCL and University College London Hospitals; Department of Neuroinflammation (C.W.-K.), UCL Institute of Neurology; and Lysosomal Storage Disorders Unit (D.H.), Royal Free Hospital, London, UK
| | - Claudia Wheeler-Kingshott
- From the Stroke Research Centre, Department of Brain Repair and Rehabilitation (P.P., A.M., I.D., X.G., D.J.W.), UCL Institute of Neurology; Charles Dent Metabolic Unit (A.M., E.M., R.H.L.), National Hospital for Neurology and Neurosurgery, London; Beaumont Hospital and Royal College of Surgeons in Ireland (A.M.), Beaumont, Dublin; Academic Department of Neuroradiology (I.D., X.G.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London; Department of Neuropsychology (F.B., L.C.), National Hospital for Neurology and Neurosurgery; Department of Biostatistics (F.J.), UCL and University College London Hospitals; Department of Neuroinflammation (C.W.-K.), UCL Institute of Neurology; and Lysosomal Storage Disorders Unit (D.H.), Royal Free Hospital, London, UK
| | - Xavier Golay
- From the Stroke Research Centre, Department of Brain Repair and Rehabilitation (P.P., A.M., I.D., X.G., D.J.W.), UCL Institute of Neurology; Charles Dent Metabolic Unit (A.M., E.M., R.H.L.), National Hospital for Neurology and Neurosurgery, London; Beaumont Hospital and Royal College of Surgeons in Ireland (A.M.), Beaumont, Dublin; Academic Department of Neuroradiology (I.D., X.G.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London; Department of Neuropsychology (F.B., L.C.), National Hospital for Neurology and Neurosurgery; Department of Biostatistics (F.J.), UCL and University College London Hospitals; Department of Neuroinflammation (C.W.-K.), UCL Institute of Neurology; and Lysosomal Storage Disorders Unit (D.H.), Royal Free Hospital, London, UK
| | - Deralynn Hughes
- From the Stroke Research Centre, Department of Brain Repair and Rehabilitation (P.P., A.M., I.D., X.G., D.J.W.), UCL Institute of Neurology; Charles Dent Metabolic Unit (A.M., E.M., R.H.L.), National Hospital for Neurology and Neurosurgery, London; Beaumont Hospital and Royal College of Surgeons in Ireland (A.M.), Beaumont, Dublin; Academic Department of Neuroradiology (I.D., X.G.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London; Department of Neuropsychology (F.B., L.C.), National Hospital for Neurology and Neurosurgery; Department of Biostatistics (F.J.), UCL and University College London Hospitals; Department of Neuroinflammation (C.W.-K.), UCL Institute of Neurology; and Lysosomal Storage Disorders Unit (D.H.), Royal Free Hospital, London, UK
| | - Lisa Cipolotti
- From the Stroke Research Centre, Department of Brain Repair and Rehabilitation (P.P., A.M., I.D., X.G., D.J.W.), UCL Institute of Neurology; Charles Dent Metabolic Unit (A.M., E.M., R.H.L.), National Hospital for Neurology and Neurosurgery, London; Beaumont Hospital and Royal College of Surgeons in Ireland (A.M.), Beaumont, Dublin; Academic Department of Neuroradiology (I.D., X.G.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London; Department of Neuropsychology (F.B., L.C.), National Hospital for Neurology and Neurosurgery; Department of Biostatistics (F.J.), UCL and University College London Hospitals; Department of Neuroinflammation (C.W.-K.), UCL Institute of Neurology; and Lysosomal Storage Disorders Unit (D.H.), Royal Free Hospital, London, UK
| | - Elaine Murphy
- From the Stroke Research Centre, Department of Brain Repair and Rehabilitation (P.P., A.M., I.D., X.G., D.J.W.), UCL Institute of Neurology; Charles Dent Metabolic Unit (A.M., E.M., R.H.L.), National Hospital for Neurology and Neurosurgery, London; Beaumont Hospital and Royal College of Surgeons in Ireland (A.M.), Beaumont, Dublin; Academic Department of Neuroradiology (I.D., X.G.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London; Department of Neuropsychology (F.B., L.C.), National Hospital for Neurology and Neurosurgery; Department of Biostatistics (F.J.), UCL and University College London Hospitals; Department of Neuroinflammation (C.W.-K.), UCL Institute of Neurology; and Lysosomal Storage Disorders Unit (D.H.), Royal Free Hospital, London, UK
| | - Robin H Lachmann
- From the Stroke Research Centre, Department of Brain Repair and Rehabilitation (P.P., A.M., I.D., X.G., D.J.W.), UCL Institute of Neurology; Charles Dent Metabolic Unit (A.M., E.M., R.H.L.), National Hospital for Neurology and Neurosurgery, London; Beaumont Hospital and Royal College of Surgeons in Ireland (A.M.), Beaumont, Dublin; Academic Department of Neuroradiology (I.D., X.G.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London; Department of Neuropsychology (F.B., L.C.), National Hospital for Neurology and Neurosurgery; Department of Biostatistics (F.J.), UCL and University College London Hospitals; Department of Neuroinflammation (C.W.-K.), UCL Institute of Neurology; and Lysosomal Storage Disorders Unit (D.H.), Royal Free Hospital, London, UK
| | - David John Werring
- From the Stroke Research Centre, Department of Brain Repair and Rehabilitation (P.P., A.M., I.D., X.G., D.J.W.), UCL Institute of Neurology; Charles Dent Metabolic Unit (A.M., E.M., R.H.L.), National Hospital for Neurology and Neurosurgery, London; Beaumont Hospital and Royal College of Surgeons in Ireland (A.M.), Beaumont, Dublin; Academic Department of Neuroradiology (I.D., X.G.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London; Department of Neuropsychology (F.B., L.C.), National Hospital for Neurology and Neurosurgery; Department of Biostatistics (F.J.), UCL and University College London Hospitals; Department of Neuroinflammation (C.W.-K.), UCL Institute of Neurology; and Lysosomal Storage Disorders Unit (D.H.), Royal Free Hospital, London, UK.
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Sudre CH, Gomez Anson B, Davagnanam I, Schmitt A, Mendelson AF, Prados F, Smith L, Atkinson D, Hughes AD, Chaturvedi N, Cardoso MJ, Barkhof F, Jaeger HR, Ourselin S. Bullseye's representation of cerebral white matter hyperintensities. J Neuroradiol 2018; 45:114-122. [PMID: 29132940 PMCID: PMC5867449 DOI: 10.1016/j.neurad.2017.10.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 10/03/2017] [Accepted: 10/17/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Visual rating scales have limited capacities to depict the regional distribution of cerebral white matter hyperintensities (WMH). We present a regional-zonal volumetric analysis alongside a visualization tool to compare and deconstruct visual rating scales. MATERIALS AND METHODS 3D T1-weighted, T2-weighted spin-echo and FLAIR images were acquired on a 3T system, from 82 elderly participants in a population-based study. Images were automatically segmented for WMH. Lobar boundaries and distance to ventricular surface were used to define white matter regions. Regional-zonal WMH loads were displayed using bullseye plots. Four raters assessed all images applying three scales. Correlations between visual scales and regional WMH as well as inter and intra-rater variability were assessed. A multinomial ordinal regression model was used to predict scores based on regional volumes and global WMH burdens. RESULTS On average, the bullseye plot depicted a right-left symmetry in the distribution and concentration of damage in the periventricular zone, especially in frontal regions. WMH loads correlated well with the average visual rating scores (e.g. Kendall's tau [Volume, Scheltens]=0.59 CI=[0.53 0.62]). Local correlations allowed comparison of loading patterns between scales and between raters. Regional measurements had more predictive power than global WMH burden (e.g. frontal caps prediction with local features: ICC=0.67 CI=[0.53 0.77], global volume=0.50 CI=[0.32 0.65], intra-rater=0.44 CI=[0.23 0.60]). CONCLUSION Regional-zonal representation of WMH burden highlights similarities and differences between visual rating scales and raters. The bullseye infographic tool provides a simple visual representation of regional lesion load that can be used for rater calibration and training.
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Affiliation(s)
- C H Sudre
- Translational Imaging Group, CMIC, Department of Medical Physics and Biomedical Engineering, University College London, Room 8.04 8th floor Malet Place Engineering Building, 2, Malet Place, WC1E 7JE London, UK; Dementia Research Centre, UCL Institute of Neurology, WC1N 3BG London, UK.
| | - B Gomez Anson
- Santa Creu i Sant Pau Hospital, Universitat Autonòma Barcelona, 08041 Barcelona, Spain.
| | - I Davagnanam
- Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, Queen Square, WCN1 3BG London, UK; Brain Repair and Rehabilitation, UCL Institute of Neurology, WC1N 3BG London, UK.
| | - A Schmitt
- Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, Queen Square, WCN1 3BG London, UK.
| | - A F Mendelson
- Translational Imaging Group, CMIC, Department of Medical Physics and Biomedical Engineering, University College London, Room 8.04 8th floor Malet Place Engineering Building, 2, Malet Place, WC1E 7JE London, UK.
| | - F Prados
- Translational Imaging Group, CMIC, Department of Medical Physics and Biomedical Engineering, University College London, Room 8.04 8th floor Malet Place Engineering Building, 2, Malet Place, WC1E 7JE London, UK.
| | - L Smith
- Cardiometabolic Phenotyping Group, UCL Institute of Cardiovascular Science, W1CE 6HX London, UK.
| | - D Atkinson
- Centre for Medical Imaging, UCL Faculty of Medical Science, NW1 2PG London, UK.
| | - A D Hughes
- Cardiometabolic Phenotyping Group, UCL Institute of Cardiovascular Science, W1CE 6HX London, UK.
| | - N Chaturvedi
- Cardiometabolic Phenotyping Group, UCL Institute of Cardiovascular Science, W1CE 6HX London, UK.
| | - M J Cardoso
- Translational Imaging Group, CMIC, Department of Medical Physics and Biomedical Engineering, University College London, Room 8.04 8th floor Malet Place Engineering Building, 2, Malet Place, WC1E 7JE London, UK; Dementia Research Centre, UCL Institute of Neurology, WC1N 3BG London, UK.
| | - F Barkhof
- Translational Imaging Group, CMIC, Department of Medical Physics and Biomedical Engineering, University College London, Room 8.04 8th floor Malet Place Engineering Building, 2, Malet Place, WC1E 7JE London, UK; Brain Repair and Rehabilitation, UCL Institute of Neurology, WC1N 3BG London, UK.
| | - H R Jaeger
- Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, Queen Square, WCN1 3BG London, UK; Brain Repair and Rehabilitation, UCL Institute of Neurology, WC1N 3BG London, UK.
| | - S Ourselin
- Translational Imaging Group, CMIC, Department of Medical Physics and Biomedical Engineering, University College London, Room 8.04 8th floor Malet Place Engineering Building, 2, Malet Place, WC1E 7JE London, UK; Dementia Research Centre, UCL Institute of Neurology, WC1N 3BG London, UK.
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Affiliation(s)
- Julian Schwarting
- From the Lysholm Department of Neuroradiology (J.S., R.L.), National Hospital for Neurology and Neurosurgery, Queen Square; and Brain Repair & Rehabilitation Department (I.D.), UCL Institute of Neurology, Queen Square, UK.
| | - Rahul Lakshmanan
- From the Lysholm Department of Neuroradiology (J.S., R.L.), National Hospital for Neurology and Neurosurgery, Queen Square; and Brain Repair & Rehabilitation Department (I.D.), UCL Institute of Neurology, Queen Square, UK
| | - Indran Davagnanam
- From the Lysholm Department of Neuroradiology (J.S., R.L.), National Hospital for Neurology and Neurosurgery, Queen Square; and Brain Repair & Rehabilitation Department (I.D.), UCL Institute of Neurology, Queen Square, UK
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Lawlor M, Danesh-Meyer H, Levin LA, Davagnanam I, De Vita E, Plant GT. Glaucoma and the brain: Trans-synaptic degeneration, structural change, and implications for neuroprotection. Surv Ophthalmol 2017; 63:296-306. [PMID: 28986311 DOI: 10.1016/j.survophthal.2017.09.010] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [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: 01/27/2017] [Revised: 09/11/2017] [Accepted: 09/22/2017] [Indexed: 01/20/2023]
Abstract
A recent hypothesis to enter the literature suggests that glaucoma is a neurodegenerative disease. The basis for this has been the finding of central nervous system changes in glaucoma patients on histology and neuroimaging. It is known that retinal ganglion cell pathology of any cause leads to anterograde and retrograde retinal ganglion cell degeneration, as well as trans-synaptic (transneuronal) anterograde degeneration. Trans-synaptic degeneration has been demonstrated in a range of optic neuropathies including optic nerve transection, optic neuritis, and hereditary optic neuropathies. More recently, similar changes have been confirmed in glaucoma patients using the neuroimaging techniques of voxel-based morphometry and diffusion tensor imaging. Some studies have reported brain changes in glaucoma outside the retino-geniculo-cortical pathway; however, these are preliminary and exploratory in nature. Further research is required to identify whether the degenerative brain changes in glaucoma are entirely secondary to the optic neuropathy or whether there is additional primary central nervous system pathology. This has critical implications for neuroprotective and regenerative treatment strategies and our basic understanding of glaucoma.
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Affiliation(s)
- Mitchell Lawlor
- Save Sight Institute, Discipline of Clinical Ophthalmology and Eye Health, University of Sydney, Sydney, New South Wales, Australia; Department of Neuro-Ophthalmology, Moorfields Eye Hospital, London, United Kingdom.
| | - Helen Danesh-Meyer
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand; University of Melbourne, Parkville, Victoria, Australia
| | - Leonard A Levin
- Departments of Ophthalmology and Neurology & Neurosurgery, McGill University, Montreal, Quebec, Canada; Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Wisconsin, USA
| | - Indran Davagnanam
- Department of Neuro-Ophthalmology, Moorfields Eye Hospital, London, United Kingdom; Academic Neuroradiological Unit, Department of Brain Repair & Rehabilitation, UCL Institute of Neurology, London, United Kingdom; Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, UCL Hospitals Foundation Trust, London, United Kingdom
| | - Enrico De Vita
- Academic Neuroradiological Unit, Department of Brain Repair & Rehabilitation, UCL Institute of Neurology, London, United Kingdom; Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, UCL Hospitals Foundation Trust, London, United Kingdom; Department of Biomedical Engineering, King's College London, London, United Kingdom
| | - Gordon T Plant
- Department of Neuro-Ophthalmology, Moorfields Eye Hospital, London, United Kingdom; Department of Neuro-Ophthalmology, National Hospital for Neurology and Neurosurgery, London, United Kingdom; The Medical Eye Unit, St Thomas' Hospital, London, United Kingdom
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Chelban V, Vandrovcova J, Lynch D, Zanetti N, Patel N, Ryten M, Botía J, Eftymiou S, Davagnanam I, Wood N, Rothman J, Alkuraya F, Houlden H. Mutations in nkx6-2 cause progressive spastic-ataxia and hypomyelination. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.467] [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: 11/29/2022]
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48
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Davendralingam N, Davagnanam I, Stidworthy MF, Baldrey V, Peters LM, Stapleton N. Transmission of Mycobacterium xenopi to a pet albino ferret ( Mustela putorius furo) from a domestic aquarium. Vet Rec 2017; 181:vetrec-2016-104250. [PMID: 28774941 DOI: 10.1136/vr.104250] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 12/09/2016] [Revised: 05/12/2017] [Accepted: 06/12/2017] [Indexed: 11/03/2022]
Abstract
A three-year-old ferret presented with a three-month history of rapid clinical deterioration necessitating euthanasia shortly after initial veterinary assessment. Postmortem PCR testing confirmed Mycobacterium xenopi which is most commonly identified in amphibians, reptiles and aquatic life. Infection of a captive-bred domestic ferret is highly unusual. A collaborative effort involving medical doctors, clinical veterinarians and veterinary pathologists investigated the potential sources of human-animal, animal-animal and environmental-animal M xenopi transmission. No human-animal or animal-animal risks were identified. As the affected ferret was the only ferret to have regular exposure to the owner's aquarium, a postmortem study of a dead guppy and aquarium water analysis were performed which confirmed mycobacteriosis. Although M xenopi was not specifically cultured, as a slow-growing organism, M xenopi may have been outgrown by more rapidly growing mycobacteria or Gram-positive bacilli present in the water. Thus, transmission of M xenopi via aquarium exposure was certainly plausible. This is the second documented case of M xenopi in a ferret and the first to determine a source of infection. This report highlights the previously recognised risk of mycobacterial exposure from aquaria and that caution is required before allowing domestic ferrets to have contact with potentially infected water reservoirs due to its fatal nature in this vulnerable species.
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Affiliation(s)
- Natasha Davendralingam
- Department of Radiology, Royal London Hospital, London, UK
- Department of Radiology, Barts and The London School of Medicine and Dentistry, London, UK
| | | | - Mark Frederick Stidworthy
- Department of Pathology, International Zoo Veterinary Group, Keighley, West Yorkshire, UK
- Department of Pathology, IZVG, Leeds, UK
| | - Vicki Baldrey
- Beaumont Sainsbury Animal Hospital, Royal Veterinary College, London, UK
| | | | - Nadene Stapleton
- Beaumont Sainsbury Animal Hospital, Royal Veterinary College, London, UK
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Hwang YT, Lakshmanan R, Davagnanam I, Thompson AGB, Lynch DS, Houlden H, Bajaj N, Eriksson SH, Bamiou DE, Warren JD. Brainstem phenotype of cathepsin A-related arteriopathy with strokes and leukoencephalopathy. Neurol Genet 2017; 3:e165. [PMID: 28702507 PMCID: PMC5499977 DOI: 10.1212/nxg.0000000000000165] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 05/12/2017] [Indexed: 11/15/2022]
Affiliation(s)
- Yun Tae Hwang
- Dementia Research Centre (Y.T.H., J.D.W.), Department of Neurodegenerative Disease (A.G.B.T.), Department of Molecular Neuroscience (D.S.L., H.H.), UCL Institute of Neurology, and UCL Ear Institute (D.-E.B.), University College London; Lysholm Department of Neuroradiology (R.L., I.D.) and Department of Clinical and Experimental Epilepsy (S.H.E.), National Hospital for Neurology and Neurosurgery, London; and Department of Neurology (N.B.), Queen's Medical Centre, Nottingham, United Kingdom
| | - Rahul Lakshmanan
- Dementia Research Centre (Y.T.H., J.D.W.), Department of Neurodegenerative Disease (A.G.B.T.), Department of Molecular Neuroscience (D.S.L., H.H.), UCL Institute of Neurology, and UCL Ear Institute (D.-E.B.), University College London; Lysholm Department of Neuroradiology (R.L., I.D.) and Department of Clinical and Experimental Epilepsy (S.H.E.), National Hospital for Neurology and Neurosurgery, London; and Department of Neurology (N.B.), Queen's Medical Centre, Nottingham, United Kingdom
| | - Indran Davagnanam
- Dementia Research Centre (Y.T.H., J.D.W.), Department of Neurodegenerative Disease (A.G.B.T.), Department of Molecular Neuroscience (D.S.L., H.H.), UCL Institute of Neurology, and UCL Ear Institute (D.-E.B.), University College London; Lysholm Department of Neuroradiology (R.L., I.D.) and Department of Clinical and Experimental Epilepsy (S.H.E.), National Hospital for Neurology and Neurosurgery, London; and Department of Neurology (N.B.), Queen's Medical Centre, Nottingham, United Kingdom
| | - Andrew G B Thompson
- Dementia Research Centre (Y.T.H., J.D.W.), Department of Neurodegenerative Disease (A.G.B.T.), Department of Molecular Neuroscience (D.S.L., H.H.), UCL Institute of Neurology, and UCL Ear Institute (D.-E.B.), University College London; Lysholm Department of Neuroradiology (R.L., I.D.) and Department of Clinical and Experimental Epilepsy (S.H.E.), National Hospital for Neurology and Neurosurgery, London; and Department of Neurology (N.B.), Queen's Medical Centre, Nottingham, United Kingdom
| | - David S Lynch
- Dementia Research Centre (Y.T.H., J.D.W.), Department of Neurodegenerative Disease (A.G.B.T.), Department of Molecular Neuroscience (D.S.L., H.H.), UCL Institute of Neurology, and UCL Ear Institute (D.-E.B.), University College London; Lysholm Department of Neuroradiology (R.L., I.D.) and Department of Clinical and Experimental Epilepsy (S.H.E.), National Hospital for Neurology and Neurosurgery, London; and Department of Neurology (N.B.), Queen's Medical Centre, Nottingham, United Kingdom
| | - Henry Houlden
- Dementia Research Centre (Y.T.H., J.D.W.), Department of Neurodegenerative Disease (A.G.B.T.), Department of Molecular Neuroscience (D.S.L., H.H.), UCL Institute of Neurology, and UCL Ear Institute (D.-E.B.), University College London; Lysholm Department of Neuroradiology (R.L., I.D.) and Department of Clinical and Experimental Epilepsy (S.H.E.), National Hospital for Neurology and Neurosurgery, London; and Department of Neurology (N.B.), Queen's Medical Centre, Nottingham, United Kingdom
| | - Nin Bajaj
- Dementia Research Centre (Y.T.H., J.D.W.), Department of Neurodegenerative Disease (A.G.B.T.), Department of Molecular Neuroscience (D.S.L., H.H.), UCL Institute of Neurology, and UCL Ear Institute (D.-E.B.), University College London; Lysholm Department of Neuroradiology (R.L., I.D.) and Department of Clinical and Experimental Epilepsy (S.H.E.), National Hospital for Neurology and Neurosurgery, London; and Department of Neurology (N.B.), Queen's Medical Centre, Nottingham, United Kingdom
| | - Sofia H Eriksson
- Dementia Research Centre (Y.T.H., J.D.W.), Department of Neurodegenerative Disease (A.G.B.T.), Department of Molecular Neuroscience (D.S.L., H.H.), UCL Institute of Neurology, and UCL Ear Institute (D.-E.B.), University College London; Lysholm Department of Neuroradiology (R.L., I.D.) and Department of Clinical and Experimental Epilepsy (S.H.E.), National Hospital for Neurology and Neurosurgery, London; and Department of Neurology (N.B.), Queen's Medical Centre, Nottingham, United Kingdom
| | - Doris-Eva Bamiou
- Dementia Research Centre (Y.T.H., J.D.W.), Department of Neurodegenerative Disease (A.G.B.T.), Department of Molecular Neuroscience (D.S.L., H.H.), UCL Institute of Neurology, and UCL Ear Institute (D.-E.B.), University College London; Lysholm Department of Neuroradiology (R.L., I.D.) and Department of Clinical and Experimental Epilepsy (S.H.E.), National Hospital for Neurology and Neurosurgery, London; and Department of Neurology (N.B.), Queen's Medical Centre, Nottingham, United Kingdom
| | - Jason D Warren
- Dementia Research Centre (Y.T.H., J.D.W.), Department of Neurodegenerative Disease (A.G.B.T.), Department of Molecular Neuroscience (D.S.L., H.H.), UCL Institute of Neurology, and UCL Ear Institute (D.-E.B.), University College London; Lysholm Department of Neuroradiology (R.L., I.D.) and Department of Clinical and Experimental Epilepsy (S.H.E.), National Hospital for Neurology and Neurosurgery, London; and Department of Neurology (N.B.), Queen's Medical Centre, Nottingham, United Kingdom
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Chelban V, Patel N, Vandrovcova J, Zanetti MN, Lynch DS, Ryten M, Botía JA, Bello O, Tribollet E, Efthymiou S, Davagnanam I, Bashiri FA, Wood NW, Rothman JE, Alkuraya FS, Houlden H, Houlden H. Mutations in NKX6-2 Cause Progressive Spastic Ataxia and Hypomyelination. Am J Hum Genet 2017; 100:969-977. [PMID: 28575651 PMCID: PMC5473715 DOI: 10.1016/j.ajhg.2017.05.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [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: 03/13/2017] [Accepted: 05/08/2017] [Indexed: 11/29/2022] Open
Abstract
Progressive limb spasticity and cerebellar ataxia are frequently found together in clinical practice and form a heterogeneous group of degenerative disorders that are classified either as pure spastic ataxia or as complex spastic ataxia with additional neurological signs. Inheritance is either autosomal dominant or autosomal recessive. Hypomyelinating features on MRI are sometimes seen with spastic ataxia, but this is usually mild in adults and severe and life limiting in children. We report seven individuals with an early-onset spastic-ataxia phenotype. The individuals come from three families of different ethnic backgrounds. Affected members of two families had childhood onset disease with very slow progression. They are still alive in their 30s and 40s and show predominant ataxia and cerebellar atrophy features on imaging. Affected members of the third family had a similar but earlier-onset presentation associated with brain hypomyelination. Using a combination of homozygozity mapping and exome sequencing, we mapped this phenotype to deleterious nonsense or homeobox domain missense mutations in NKX6-2. NKX6-2 encodes a transcriptional repressor with early high general and late focused CNS expression. Deficiency of its mouse ortholog results in widespread hypomyelination in the brain and optic nerve, as well as in poor motor coordination in a pattern consistent with the observed human phenotype. In-silico analysis of human brain expression and network data provides evidence that NKX6-2 is involved in oligodendrocyte maturation and might act within the same pathways of genes already associated with central hypomyelination. Our results support a non-redundant developmental role of NKX6-2 in humans and imply that NKX6-2 mutations should be considered in the differential diagnosis of spastic ataxia and hypomyelination.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Henry Houlden
- Department of Molecular Neuroscience, University College London, London WC1N 3BG, UK; Neurogenetics Laboratory, The National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
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