Atlantic water intrusion triggers rapid retreat and regime change at previously stable Greenland glacier

Ice discharge from Greenland's marine-terminating glaciers contributes to half of all mass loss from the ice sheet, with numerous mechanisms proposed to explain their retreat. Here, we examine K.I.V Steenstrups Nordre Bræ ('Steenstrup') in Southeast Greenland, which, between 2018 and 2021, retreated ~7 km, thinned ~20%, doubled in discharge, and accelerated ~300%. This rate of change is unprecedented amongst Greenland's glaciers and now places Steenstrup in the top 10% of glaciers by contribution to ice-sheet-wide discharge. In contrast to expected behaviour from a shallow, grounded tidewater glacier, Steenstrup was insensitive to high surface temperatures that destabilised many regional glaciers in 2016, appearing instead to respond to a >2 °C anomaly in deeper Atlantic water (AW) in 2018. By 2021, a rigid proglacial mélange had developed alongside notable seasonal variability. Steenstrup's behaviour highlights that even long-term stable glaciers with high sills are vulnerable to sudden and rapid retreat from warm AW intrusion.

Correction to: Spectrum of movement disorders and neurotransmitter abnormalities in paediatric POLG disease

Due to a typesetting error the wrong Table 2 was used. The correct Table 2 is shown here.

Spectrum of movement disorders and neurotransmitter abnormalities in paediatric POLG disease

OBJECTIVES

To describe the spectrum of movement disorders and cerebrospinal fluid (CSF) neurotransmitter profiles in paediatric patients with POLG disease.

METHODS

We identified children with genetically confirmed POLG disease, in whom CSF neurotransmitter analysis had been undertaken. Clinical data were collected retrospectively. CSF neurotransmitter levels were compared to both standardised age-related reference ranges and to non-POLG patients presenting with status epilepticus.

RESULTS

Forty-one patients with POLG disease were identified. Almost 50% of the patients had documented evidence of a movement disorder, including non-epileptic myoclonus, choreoathetosis and ataxia. CSF neurotransmitter analysis was undertaken in 15 cases and abnormalities were seen in the majority (87%) of cases tested. In many patients, distinctive patterns were evident, including raised neopterin, homovanillic acid and 5-hydroxyindoleacetic acid levels.

CONCLUSIONS

Children with POLG mutations can manifest with a wide spectrum of abnormal movements, which are often prominent features of the clinical syndrome. Underlying pathophysiology is probably multifactorial, and aberrant monoamine metabolism is likely to play a role.

Droplet distribution and airborne bacteria in an experimental shower unit

Although human exposure to water aerosols is common in residential showers, the droplet distribution patterns generated in showers are not well understood nor is the bacteria released during shower operation. In this study, a two-phase flow Particle Tracking Velocimetry (PTV) algorithm was successfully used to characterize the spatial spray pattern and velocity field in two experimental showers (one low-flow and one high-flow). In addition, the airborne bacteria present in the shower over nearly 5 months of controlled operation was determined for both showers. The results indicate that the droplet velocity out of the low-flow showerhead (which had fewer orifices) was significantly higher than that out of the high-flow showerhead resulting in a higher aerosol number concentration in the low-flow shower and more consistent wetting of the shower wall. Both showerheads generated droplets in the respirable range and genera of potential health concern were observed in the shower aerosols measured both prior to and following shower operation. The study provides one of the first visualizations of droplet spray patterns in residential showers and provides insight into the airborne bacteria present in showers.

Effect of 2,3,7,8-Tetrachloro-di-benzo-p-dioxin on T Cell Subpopulations in the Thymus and Spleen of Mice with Chronic Toxoplasma gondii Infection

In the current study, the effect of exposure to the environmental pollutant, 2,3,7,8-tetrachloro-di-benzo- p-dioxin (TCDD), on mice having chronic infection with Toxoplasma gondii was investigated. For this purpose, four groups of mice were used—mice treated with vehicle, mice treated with TCDD alone, mice infected with T. gondii alone, and mice receiving a combination of TCDD treatment and T. gondii infection. Histological examination and tissue cyst enumeration were performed to indicate the level of infection of the brain. The immune status was studied by enumerating the cellularity as well as the percentages and absolute numbers of the lymphocyte subsets based on the expression of CD4 and CD8 markers in the thymus and spleen. Our studies demonstrated that there was a significant decrease in the total number of thymocytes in TCDD-treated mice that were either uninfected or infected with T. gondii when compared to vehicle controls. However, there was no significant difference observed in thymic cellularity in mice that were infected with T. gondii alone when compared to the uninfected vehicle controls. In addition, the ratio and the total numbers of CD4+, CD8+, CD4–CD8–(double negative, DN) and CD4+CD8+ (double positive, DP) T cell subsets in the thymus from various groups were determined. There was no change in the percentages of T cell subsets in TCDD-treated mice or T. gondii-infected mice when compared to the vehicle controls. However, there was a decrease in the percentage of DPT cells and an increase in the DN and CD8+ T cells in mice that received a combination of TCDD-treatment and T. gondii infection when compared to mice receiving the vehicle or TCDD-treatment alone or infection with T. gondii alone. There was also a decrease in the absolute numbers of the DP and CD4+ T cells and an increase in the CD8+ T cells in the thymus of mice receiving the combination of TCDD-treatment and T. gondii infection when compared to vehicle controls. The splenic cellularity as well as the percentage and absolute numbers of the CD4+ and CD8+ T cell subsets and the non-T cells were not altered in all the groups tested. The natural history of T. gondii infection was not altered following TCDD treatment as demonstrated by no significant differences in brain lesion scores and the number of tissue cysts in the brains of these mice.

NAPB - a novel SNARE-associated protein for early-onset epileptic encephalopathy

Next-generation sequencing has accelerated the identification of disease genes in many rare genetic disorders including early-onset epileptic encephalopathies (EOEEs). While many of these disorders are caused by neuronal channelopathies, the role of synaptic and related neuronal proteins are increasingly being described. Here, we report a 6-year-old girl with unexplained EOEE characterized by multifocal seizures and profound global developmental delay. Recessive inheritance was considered due to parental consanguinity and Irish Traveller descent. Exome sequencing was performed. Variant prioritization identified a homozygous nonsense variant in the N-ethylmaleimide-sensitive factor attachment protein, beta (NAPB) gene resulting in a premature stop codon and 46% loss of the protein. NAPB plays a role in soluble N-ethylmaleimide-sensitive fusion attachment protein receptor (SNARE)-complex dissociation and recycling (synaptic vesicle docking). Knockout mouse models of the murine ortholog Napb have been previously reported. These mice develop recurrent post-natal epileptic seizures in the absence of structural brain changes. The identification of a disease-causing variant in NAPB further recognizes the importance of the SNARE complex in the development of epilepsy and suggests that this gene should be considered in patients with unexplained EOEE.

PLA2G6-associated neurodegeneration (PLAN): further expansion of the clinical, radiological and mutation spectrum associated with infantile and atypical childhood-onset disease

Phospholipase A2 associated neurodegeneration (PLAN) is a major phenotype of autosomal recessive Neurodegeneration with Brain Iron Accumulation (NBIA). We describe the clinical phenotypes, neuroimaging features and PLA2G6 mutations in 5 children, of whom 4 presented with infantile neuroaxonal dystrophy (INAD). One other patient was diagnosed with the onset of PLAN in childhood, and our report highlights the diagnostic challenges associated with this atypical PLAN subtype. In this series, the neuroradiological relevance of classical PLAN features as well as apparent claval hypertrophy' is explored. Novel PLA2G6 mutations were identified in all patients. PLAN should be considered not only in patients presenting with a classic INAD phenotype but also in older patients presenting later in childhood with non-specific progressive neurological features including social communication difficulties, gait disturbance, dyspraxia, neuropsychiatric symptoms and extrapyramidal motor features.

Proteolytic bacteria in the lower digestive tract of poultry may affect avian influenza virus pathogenicity

Proteolytic cleavage of hemagglutinin is required for cell entry by receptor-mediated endocytosis and plays a key role in pathogenicity of the influenza virus. Despite several studies describing relationships between bacterial proteases and influenza A viral activation in mammals, very little is known about the role of the normal bacterial flora of birds on hemagglutinin activation. We examined the indigenous intestinal microflora of 100 mixed-sex, 27-d-old Ross chickens from a commercial poultry facility for protease-secreting bacteria. Protease-secreting bacteria were isolated from 82 of 100 chickens with 50 birds exhibiting 2 or more protease-secreting bacterial species. A total of 20 protease-secreting bacterial species were identified: 17 gram-positive cocci, 2 gram-positive rods, and 1 gram-negative rod. Enterococcus faecalis, Enterococcus gallinarum, and Proteus mirabilis were the most frequently observed protease-secreting bacterial species. The presence of proteolytic bacteria in the intestinal tract of poultry in this study suggests the possibility of yet-to-be-described role(s) in cleavage of hemagglutinin that may alter the pathogenicity of avian influenza viruses.

Sensory-motor polyneuropathy occurring in variant maple syrup urine disease

Maple syrup urine disease (MSUD; OMIM 248600) results from an inherited deficiency of the branched-chain ketoacid dehydrogenase (BCKD) complex. Approximately 20% of patients with BCKD deficiency are non-classic variants of MSUD with differing clinical severity. Outcomes for this cohort are generally favourable; episodes of metabolic decompensation do not appear to correlate with adverse events if acute management is promptly provided. A case of predominantly axonal sensory-motor neuropathy following metabolic decompensation which persisted for a number of months is presented in an adolescent girl with variant (intermediate type) MSUD. EMG and nerve conduction studies suggested a pre-existent asymptomatic chronic neuropathy, exacerbated by the acute decompensation. Peak leucine concentration at decompensation was 1083 μmol/L. The patient had laboratory signs of secondary mitochondrial respiratory chain dysfunction at presentation. She had been on a moderate dose of thiamine prior to decompensation; thiamine and pyridoxine blood concentrations were normal. This, to our knowledge, is the first report of a neuropathy presenting in a patient with a decompensation of variant MSUD. We propose that this presentation resembles the intermittent neuropathy observed in pyruvate dehydrogenase deficiency and may reflect secondary inhibition of pyruvate dehydrogenase activity by MSUD metabolites.

Further delineation of Pitt-Hopkins syndrome: phenotypic and genotypic description of 16 novel patients

BACKGROUND

Haploinsufficiency of the gene encoding for transcription factor 4 (TCF4) was recently identified as the underlying cause of Pitt-Hopkins syndrome (PTHS), an underdiagnosed mental-retardation syndrome characterised by a distinct facial gestalt, breathing anomalies and severe mental retardation.

METHODS

TCF4 mutational analysis was performed in 117 patients with PTHS-like features.

RESULTS

In total, 16 novel mutations were identified. All of these proven patients were severely mentally retarded and showed a distinct facial gestalt. In addition, 56% had breathing anomalies, 56% had microcephaly, 38% had seizures and 44% had MRI anomalies.

CONCLUSION

This study provides further evidence of the mutational and clinical spectrum of PTHS and confirms its important role in the differential diagnosis of severe mental retardation.

Cerebral palsy after maternal trauma in pregnancy

Ten children (six males, four females) with spastic (n=9) and mixed spastic-dyskinetic (n=1) cerebral palsy were born at term to mothers who earlier in the pregnancy had been involved in accidents without suffering overt abdominal injury, placental abruption, or premature onset of labour. At follow-up (at ages 2-24y), Gross Motor Function Classification System levels were II (n=7) and V (n=3). Cognitive level was normal in five patients, while learning disability was mild to moderate in two and severe in three. Magnetic resonance imaging of the brain in all children, assessed blind to the dates of maternal trauma in pregnancy, showed lesions consistent with prenatal vascular insult at the time of the trauma. Feasible mechanisms of brain injury include reduced placental blood flow and/or placental embolization.

Mitochondrial cytopathies, phenotypic heterogeneity and a high incidence

Mitochondrial respiratory chain disorders account for significant and varied presentations in paediatric practice. The true prevalence of these disorders in the paediatric population is still not well documented with predicted geographic variation. We report a retrospective analysis over a seven year period of cases presenting to a tertiary care centre and associated clinical features. The overall prevalence of mitochondrial disorders in our population is higher than expected (1/9,000 births), explained in part by multiple presentations in a consanguineous subgroup of the population (Irish travellers).

A second locus for Aicardi-Goutieres syndrome at chromosome 13q14-21

BACKGROUND

Aicardi-Goutières syndrome (AGS) is an autosomal recessive, early onset encephalopathy characterised by calcification of the basal ganglia, chronic cerebrospinal fluid lymphocytosis, and negative serological investigations for common prenatal infections. AGS may result from a perturbation of interferon alpha metabolism. The disorder is genetically heterogeneous with approximately 50% of families mapping to the first known locus at 3p21 (AGS1).

METHODS

A genome-wide scan was performed in 10 families with a clinical diagnosis of AGS in whom linkage to AGS1 had been excluded. Higher density genotyping in regions of interest was also undertaken using the 10 mapping pedigrees and seven additional AGS families.

RESULTS

Our results demonstrate significant linkage to a second AGS locus (AGS2) at chromosome 13q14-21 with a maximum multipoint heterogeneity logarithm of the odds (LOD) score of 5.75 at D13S768. The AGS2 locus lies within a 4.7 cM region as defined by a 1 LOD-unit support interval.

CONCLUSIONS

We have identified a second AGS disease locus and at least one further locus. As in a number of other conditions, genetic heterogeneity represents a significant obstacle to gene identification in AGS. The localisation of AGS2 represents an important step in this process.

Short-chain acyl-CoA dehydrogenase deficiency associated with early onset severe axonal neuropathy

Two unusual cases of axonal neuropathy associated with short-chain acyl-CoA dehydrogenase (SCAD) deficiency are described. These two unrelated infants presented with profound generalised weakness, particularly affecting the upper limbs. Clinical examination revealed generalised peripheral hypotonia and weakness, with absent deep tendon reflexes. An axonal polyneuropathy was confirmed on electromyogram (EMG) and nerve conduction studies (NCS) and, following an extensive metabolic screen, an acylcarnitine and organic acid profile consistent with a short-chain fatty acid beta-oxidation defect was found. In both cases, SCAD deficiency was confirmed by enzyme analysis. Genetic analysis showed the presence of common gene variations in the SCAD gene. SCAD deficiency is a rare disorder with a wide clinical phenotype. SCAD deficiency associated with axonal neuropathy has not previously been reported. As highlighted in these cases, it may be necessary to include axonal neuropathy as a presenting feature of SCAD.

Development of vigabatrin-induced lesions in the rat brain studied by magnetic resonance imaging, histology, and immunocytochemistry

Vigabatrin, the gamma-aminobutyric acid transaminase (GABA-T)-inhibiting anticonvulsant drug, was given orally at a dose of 275 mg/kg/day to rats (n = 6) in their feed for a period of 12 weeks, during which T2-weighted magnetic resonance images (MRIs) and diffusion-weighted MRIs (DWIs) were collected at weeks 1, 3, 6, 9, and 12. Half the rats (n = 3; and half their age-matched littermate controls; n = 3) were then killed for histopathological confirmation of the observed VGB-induced cerebellar and cortical white-matter lesions. VGB was removed from the diet and additional MRIs of the remaining rats taken at weeks 14, 17, 20, and 24, at which time they (n = 3), along with remaining controls (n = 3), were also killed for histopathology. The T2-weighted MRIs acquired were used to compute T2 relaxation time maps. Statistically significant VGB-induced T2 increases were observed in the frontal and occipital cortices and in the cerebellar white matter (CWM). The cerebellar lesions were more clearly discerned by eye in the DWIs than by T2-contrast alone. During the recovery period the VGB-treatment group CWM-T2 and CWM-DWI hyperintensity greatly decreased as the reversible lesion disappeared. As expected, histological and immunocytochemical examinations demonstrated the presence of intra-myelinic edema, microvacuolation, and reactive astrocytosis in the CWM and cortex after 12 weeks VGB-treatment. In the remaining animals microvacuolation of the white matter had not completely resolved during the 12-week recovery phase. The data show that quantitative MRI T2-relaxometry can be used to detect VGB-induced CNS pathology, and also suggest that DWI is particularly sensitive to the cerebellar lesion. The reversible neurotoxicity of global GABA-elevation in experimental animals is discussed.

Straight-chain acyl-CoA oxidase deficiency presenting with dysmorphia, neurodevelopmental autistic-type regression and a selective pattern of leukodystrophy

We report a rare case of straight-chain acyl-CoA oxidase deficiency (McKusick 264470) presenting with dysmorphism, neurodevelopmental regression and leukodystrophy.

Neonatal seizures and limb malformations associated with liver-specific complex IV respiratory chain deficiency

An eight-week-old infant, the fourth child of consanguineous parents presented with intractable neonatal seizures. The mother had two previous miscarriages. The infant initially presented on day one with multifocal myoclonus, complex partial and generalised tonic-clonic seizures. On examination, there were dysmorphic hands and feet, with absent nails and terminal phalanges of the fingers and toes, hepatomegaly, marked axial and peripheral hypotonia and severe global developmental delay. Ophthalmological assessment showed 'salt and pepper' pigmentary retinopathy. The urinary organic acid profile revealed a marked increase in tricarboxylic acid metabolites. Urinary phosphate reabsorption was reduced at 84%. Type I fibre atrophy was seen on muscle histology, and a cytochrome c oxidase deficiency was found only on enzymology of liver tissue. Limb malformations associated with respiratory chain defects have rarely been reported. To our knowledge, this child has the most severe limb anomaly associated with a tissue-specific complex IV respiratory chain defect.

Neurotoxicity and immunotoxicity assessment in CBA/J mice with chronic Toxoplasma gondii infection and multiple oral exposures to methylmercury

The present study was conducted to determine the effect of multiple low doses of methylmercury (MeHg) on the course of a chronic Toxoplasma gondii infection. Four groups of 6-wk-old female CBA/J mice either were fed 25 T. gondii tissue cysts of the ME-49 strain or were vehicle control. Six weeks later, half of each group was orally gavaged with 8-mg/kg body weight doses of MeHg on days 0, 2, 4, 7, 10, and 13, totaling 4 experimental groups. Mice were killed on day 17 or 18 after MeHg exposure. Flow cytometric analysis of lymphocyte subpopulations in the thymus demonstrated a significant increase in the percentage of CD4- CD8+ T-cells in mice exposed to MeHg with a concurrent T. gondii infection. Groups of mice exposed to MeHg showed a decrease in total thymic cellularity and cellularity of all T-cell subpopulations when compared with control mice, but viability of these cells was unaffected. Splenic cell viability was decreased in mice exposed to MeHg, but alterations in T-cell subpopulations were not noted. These data indicate that multiple low doses of MeHg may not exacerbate chronic toxoplasmosis, but MeHg-induced effects on the immune system were evident.

Diffusion tensor imaging detects corticospinal tract involvement at multiple levels in amyotrophic lateral sclerosis

BACKGROUND

Histopathological studies of amyotrophic lateral sclerosis (ALS) are of end stage disease. Diffusion tensor imaging (DTI) provides the opportunity to investigate indirectly corticospinal tract pathology of ALS in vivo.

METHODS

DTI was used to study the water diffusion characteristics of the corticospinal tracts in 21 patients with ALS and 14 normal controls. The authors measured the fractional anisotropy (FA) and mean diffusivity (MD) along the pyramidal tracts from the internal capsules down to the pyramids. A mixed model regression analysis was used to compare FA and MD between the ALS and control groups.

RESULTS

FA showed a downward linear trend from the cerebral peduncles to the pyramids and was lower in the ALS group than controls at multiple levels of the corticospinal tract. At the internal capsules, FA was higher on the right. MD showed an upward trend, progressing caudally from the internal capsules to the pyramids. MD was higher at the level of the internal capsule in the ALS group, but caudally this difference was not maintained. No correlations were found between clinical markers of disability and water diffusion indices.

CONCLUSIONS

These findings provide insights into the pathological processes of ALS. Differences in diffusion characteristics at different anatomical levels may relate to underlying tract architecture or the distribution of pathological damage in ALS. Further development may permit monitoring of progression and treatment of disease.

An unusual case of benign reflex myoclonic epilepsy of infancy

A previously healthy one-year-old boy, the youngest child of unrelated parents, presented with a four-week history of episodes of myoclonus triggered only by tactile stimulation to his head. There had been no loss of developmental skills. The electroencephalogram (EEG) revealed generalised polyspike wave activity both with and without clinical correlate. The infant was started on sodium valproate, which resulted in cessation of the myoclonic episodes one week after starting therapy. At subsequent follow-up (at 18 months) the infant was seizure free and a repeat EEG was normal. This case of non-progressive reflex myoclonic epilepsy of infancy triggered only by head tapping (and not by acoustic stimuli) is an extremely rare phenomenon. Reflex myoclonic epilepsy of infancy represents a distinct subtype of myoclonic epilepsy in infancy. It should be considered as an age-dependent idiopathic generalised epileptic syndrome with an apparently good prognosis.

Neurotoxicity and immunotoxicity assessment in CBA/J mice with chronic Toxoplasma gondii infection and single-dose exposure to methylmercury

Toxoplasma gondii is a protozoan parasite that localizes in the brain where it can cause life-threatening disease. Methylmercury (MeHg) is a well-documented neurotoxicant that accumulates in the brain. We investigated end points associated with immunotoxicity and neurotoxicity in mice exposed to MeHg during a chronic T. gondii infection. Two groups of 6-week-old, female CBA/J mice were either fed 25 T. gondii tissue cysts of the ME-49 strain or given vehicle. Six weeks later, half of the mice in each group were orally gavaged with a single dose of 20 mg/kg body weight of MeHg, creating four groups of mice (vehicle control, T. gondii, MeHg, and T. gondii/MeHg). Mice were sacrificed 7 days post MeHg exposure. MeHg exposure caused a significant decrease in mouse body weight. MeHg administration resulted in an increase of splenic cellularity and spleen-to-body weight ratios. MeHg had no significant effect on the percentages of CD4(+), CD8(+), or non-T-cell subpopulations in the spleen. MeHg dosed mice demonstrated an increase in absolute numbers of splenic CD4(+), CD8(+), or non-T cells when compared to mice in control and T. gondii-infected groups. Thymic CD4(+)CD8(+) T-cell subpopulations were decreased (p <.05) by MeHg with or without a concurrent T. gondii infection. There was a significant (p <.05) increase in brain tissue cyst counts within the group exposed to both MeHg and T. gondii (16 +/- 4, mean +/- SE, n = 7) versus T. gondii alone (4 +/- 1, n = 8). Histopathological examination demonstrated encephalitis, gliosis, and meningitis in brains from mice infected with T. gondii. These data indicate that exposure to both MeHg and T. gondii has synergistic effects, with effects of MeHg especially on the immune system.

Magnetic resonance imaging findings within 5 days of status epilepticus in childhood

The nature of the relationships between status epilepticus, acute hippocampal injury, mesial temporal sclerosis (MTS) and temporal lobe epilepsy remains unclear. The aim of this study was to investigate whether generalized status epilepticus is associated with brain abnormalities, especially in the mesial temporal lobe, within 5 days of the acute event. Such changes may be the first part of a causative pathophysiological sequence relating status epilepticus and MTS. Thirty-five children with a history of status epilepticus, including 21 with a history of prolonged febrile convulsion (PFC), underwent qualitative and quantitative MRI investigations within 5 days of the acute episode. Quantitative assessments of the hippocampus included T(2) relaxometry and hippocampal volumetry. Hippocampal volumes were large in patients with PFC when compared with controls. In addition, T(2) relaxation time was elevated in patients with PFC compared with control subjects during the first 2 days of the acute event. No difference was observed in patients examined 3-5 days after the event. Patients with afebrile status epilepticus had a variety of imaging abnormalities including elevated hippocampal T(2) values, but no evidence of hippocampal enlargement. PFC is associated with hippocampal abnormalities, consistent with hippocampal oedema, whilst non-febrile status epilepticus is not. A systematic longitudinal study is required to characterize the evolution of these abnormalities and to determine whether any patient develops MTS.

Limitations and requirements of diffusion tensor fiber tracking: an assessment using simulations

Diffusion tensor fiber tracking potentially can give information about in vivo brain connectivity. However, this technique is difficult to validate due to the lack of a gold standard. Fiber tracking reliability will depend on the quality of the data and on the robustness of the algorithms used. Information about the effects of various anatomical and image acquisition parameters on fiber tracking reliability may be used in the design of imaging sequences and of tracking algorithms. In this study, tracking was performed on two different simulated models to study the effects on tracking quality of SNR, anisotropy, curvature, fiber cross-section, background anisotropy, step size, and interpolation. Tracking was also performed on volunteer data to assess the relevance of the simulations to real data. Our results show that, in general, tracking with high SNR and high anisotropy using interpolation and a low step size gives the most reliable results. Partial volume effects are shown to have a detrimental effect when the background is anisotropic and when tracking narrow fibers. The results derived from real data show similar trends and thus support the findings of the simulations. These simulations may therefore help to determine which structures can be tracked for a given image quality.

The amygdala and temporal lobe simple partial seizures: a prospective and quantitative MRI study

PURPOSE

To determine whether specific temporal lobe simple partial seizures (SPSs) are associated with an abnormal amygdala T2 (AT2) ipsilateral to the seizure focus in patients with intractable unilateral temporal lobe epilepsy (TLE). AT2 relaxation time mapping is a sensitive method for the detection of abnormal tissue in the amygdala in patients with refractory TLE. The relation between an abnormal AT2 in the epileptic temporal lobe and amygdala seizure onset has not been established.

METHODS

Fifty patients with intractable unilateral TLE and concordant data during presurgical evaluation were included. Patients with a foreign-tissue lesion on standard magnetic resonance imaging (MRI) were excluded. All had AT2 mapping. Fifteen types of SPSs were ascertained prospectively, systematically, and blinded to the results of AT2 mapping. The SPSs of patients with a normal AT2 (n = 25) were compared with those of patients with an abnormal AT2 ipsilateral to the seizure focus (n = 25).

RESULTS

The group of patients with an abnormal AT2 reported a median of six types of SPSs (range 1-11), in comparison with a median of three types of SPSs (range, 0-7) for the group with a normal AT2 (p<0.01). Déjà vu, a warm sensation, an indescribable strange sensation, a cephalic sensation, and fear were associated with an abnormal AT2. The combination of déjà vu, a cephalic sensation, a warm sensation, a gustatory hallucination, and an indescribable strange sensation discriminated best between the 25 patients with a normal and the 25 patients with an abnormal AT2.

CONCLUSIONS

A high number and the types of different SPSs provide clinical evidence for early involvement of the amygdala during seizures in patients with refractory unilateral TLE and an abnormal AT2 in the epileptic temporal lobe

Bilateral subdural collections--an unusual feature of possible Kawasaki disease

A case of possible Kawasaki disease presenting with bilateral subdural collections is reported. A 6-month-old boy was admitted to hospital following a prolonged partial seizure. He showed signs of worsening encephalopathy and was treated for presumed infective meningoencephalitis. Imaging revealed bilateral subdural collections. Pyrexia and irritability continued despite appropriate antibiotic and antiviral therapy suggesting a vasculitic process. The mucocutaneous signs normally associated with Kawasaki disease were subtle and fleeting in this infant. There was a dramatic clinical response to intravenous immunoglobulin and high dose aspirin. At 2-year follow-up the boy has made a complete recovery with no echocardiographic evidence of coronary artery aneurysm and resolution of subdural collections. Kawasaki disease or other vasculitides should be considered in the differential diagnosis of acute subdural collections in infancy.

Acute changes in MRI diffusion, perfusion, T(1), and T(2) in a rat model of oligemia produced by partial occlusion of the middle cerebral artery

Oligemic regions, in which the cerebral blood flow is reduced without impaired energy metabolism, have the potential to evolve toward infarction and remain a target for therapy. The aim of this study was to investigate this oligemic region using various MRI parameters in a rat model of focal oligemia. This model has been designed specifically for remote-controlled occlusion from outside an MRI scanner. Wistar rats underwent remote partial MCAO using an undersize 0.2 mm nylon monofilament with a bullet-shaped tip. Cerebral blood flow (CBF(ASL)), using an arterial spin labeling technique, the apparent diffusion coefficient of water (ADC), and the relaxation times T(1) and T(2) were acquired using an 8.5 T vertical magnet. Following occlusion there was a decrease in CBF(ASL) to 35 +/- 5% of baseline throughout the middle cerebral artery territory. During the entire period of the study there were no observed changes in the ADC. On occlusion, T(2) rapidly decreased in both cortex and basal ganglia and then normalized to the preocclusion values. T(1) values rapidly increased (within approximately 7 min) on occlusion. In conclusion, this study demonstrates the feasibility of partially occluding the middle cerebral artery to produce a large area of oligemia within the MRI scanner. In this region of oligemic flow we detect a rapid increase in T(1) and decrease in T(2). These changes occur before the onset of vasogenic edema. We attribute the acute change in T(2) to increased amounts of deoxyhemoglobin; the mechanisms underlying the change in T(1) require further investigation.

Rapid-onset dystonia-parkinsonism: a clinical and genetic analysis of a new kindred

BACKGROUND

Rapid-onset dystonia-parkinsonism (RDP) is an autosomal dominant disorder linked to chromosome 19q13 that is characterized by sudden onset of primarily bulbar and upper limb dystonia with parkinsonism.

METHODS

The authors evaluated 12 individuals from three generations of an Irish family and obtained detailed medical records on a deceased member. The authors describe the clinical, psychiatric, and genetic features of the affected individuals.

RESULTS

Five of eight affected members developed sudden-onset (several hours to days) dystonia with postural instability. Four of the five also had bulbar symptoms. Two have stable focal or segmental limb dystonia. One has intermittent hemidystonia with dysarthria that comes on abruptly in times of stress or anxiety. Three had a history of profound difficulty socializing, and at presentation two developed depression. Three patients had a trial of dopamine agonists without benefit. Genetic analysis suggests linkage to chromosome 19 with lod score of 2.1 at zero recombination.

CONCLUSION

This is the third reported family with chromosome 19q13 rapid-onset dystonia-parkinsonism. Psychiatric morbidity appeared common in affected members of this family and may be part of the RDP phenotype.

Familial Prader-Willi syndrome: case report and a literature review

Prader-Willi syndrome (PWS) is a neurobehavioural disorder arising through a number of different genetic mechanisms. All involve loss of paternal gene expression from chromosome 15q11q13. Although the majority of cases of PWS are sporadic, precise elucidation of the causative genetic mechanism is essential for accurate genetic counselling as the recurrence risk varies according to the mechanism involved. A pair of siblings affected by PWS is described. Neither demonstrates a microscopically visible deletion in 15q11q13 or maternal disomy. Methylation studies at D15S63 and at the SNRPN locus confirm the diagnosis of PWS. Molecular studies reveal biparental inheritance in both siblings with the exception of D15S128 and D15S63 where no paternal contribution is present indicating a deletion of the imprinting centre. Family studies indicate that the father of the siblings carries the deletion which, he has inherited from his mother. The recurrence risk for PWS in his offspring is 50%.

Typical Friedreich's ataxia without GAA expansions and GAA expansion without typical Friedreich's ataxia

We clinically assessed and performed polymerase chain reaction analysis for the GAA trinucleotide repeat expansion in 103 patients from 73 families in Ireland, with a prior clinical diagnosis of Friedreich's ataxia (FA) or an unclassified progressive ataxic syndrome. The patients were classified as "typical" or "atypical" FA according to Harding's mandatory clinical diagnostic criteria. All patients underwent blood glucose analysis, and electrocardiography and echocardiography was performed in 99 and 101 patients, respectively. Mutation screening for expanded CAG trinucleotide repeats, associated with spinocerebellar ataxia (SCA) 1, 2, 3 and 6 was performed in 86 patients overall, including all GAA negative patients. Forty-nine of 56 typical patients and 13 of 47 atypical patients were either homozygous or heterozygous for the GAA expansion. Seven patients with a typical FA phenotype were negative for the GAA expansion. Although one of these patients had vitamin E deficiency, and two had raised alpha-fetoprotein levels, three other GAA negative patients with a typical FA phenotype had no other identifiable cause for their ataxia, once again raising the possibility of locus heterogeneity in FA. It is also possible that these patients have two point mutations in the X25 gene, or that they have another ataxic syndrome mimicking the FA phenotype. Two families who were homozygous for the GAA expansion exhibited intrafamilial phenotypic variability. Only one GAA negative patient had the SCA 3 mutation, and this was the only patient in the study with a possible autosomal dominant inheritance pattern. In the homozygous GAA population typical patients had significantly more repeats on the smaller allele than atypical patients, and there was an inverse relationship between the number of repeats on the smaller allele and the age at presentation. There was also an inverse relationship between the repeat size on both the larger and the smaller of the two alleles and the age at becoming wheelchair bound. There was no significant relationship between repeat size and the other indices of disease severity, including the presence or absence of diabetes or cardiomyopathy. This is the first large study of an Irish population with progressive ataxia that has shown a similar phenotype/genotype relationship to studies of FA in other European and non-European populations. The relatively low sensitivity and specificity of Harding's clinical diagnostic criteria must be appreciated when clinically assessing patients with a progressive ataxic syndrome. Although molecular genetic analysis now plays an essential role in diagnosis and classification, patients with a typical FA phenotype without any identifiable cause for their ataxia exist.

Deficiency of dolichol-phosphate-mannose synthase-1 causes congenital disorder of glycosylation type Ie

Congenital disorders of glycosylation (CDG), formerly known as carbohydrate-deficient glycoprotein syndromes, lead to diseases with variable clinical pictures. We report the delineation of a novel type of CDG identified in 2 children presenting with severe developmental delay, seizures, and dysmorphic features. We detected hypoglycosylation on serum transferrin and cerebrospinal fluid beta-trace protein. Lipid-linked oligosaccharides in the endoplasmic reticulum of patient fibroblasts showed an accumulation of the dolichyl pyrophosphate Man(5)GlcNAc(2) structure, compatible with the reduced dolichol-phosphate-mannose synthase (DolP-Man synthase) activity detected in these patients. Accordingly, 2 mutant alleles of the DolP-Man synthase DPM1 gene, 1 with a 274C>G transversion, the other with a 628delC deletion, were detected in both siblings. Complementation analysis using DPM1-null murine Thy1-deficient cells confirmed the detrimental effect of both mutations on the enzymatic activity. Furthermore, mannose supplementation failed to improve the glycosylation status of DPM1-deficient fibroblast cells, thus precluding a possible therapeutic application of mannose in the patients. Because DPM1 deficiency, like other subtypes of CDG-I, impairs the assembly of N-glycans, this novel glycosylation defect was named CDG-Ie.

Hashimoto's thyroiditis--a rare but treatable cause of encephalopathy in children

Hashimoto's encephalopathy is a very rare complication of Hashimoto's thyroiditis. It is a progressive or relapsing encephalopathy associated with elevation of thyroid specific autoantibodies. Patients usually present when euthyroid and this diagnosis should be considered in any unexplained encephalopathy or progressive cognitive decline in the euthyroid patient.

Vicarious calibration of the moderate-resolution imaging spectroradiometer airborne simulator thermal-infrared channels

We made an experimental vicarious calibration of the Moderate Resolution Imaging Spectroradiometer (MODIS) Airborne Simulator (MAS) thermal infrared (TIR) channel data acquired in the field campaign near Mono Lake, Calif. on 10 March 1998 to demonstrate the advantage of using high-elevation sites in dry atmospheric conditions for vicarious calibration. With three lake-surface sites and one snow-field site, we estimated the MAS noise-equivalent temperature difference as 0.7-1.0 degrees C for bands 30-32 in the 3.68-4.13-microm region and 0.1-0.5 degrees C for bands 42, 45, 46, and 48 in the 8-13.5-microm region. This study shows that the MAS calibration error is within +/-0.4 degrees C in the split-window channels (at 11 and 12 microm) and larger in other TIR channels based on the MAS data over Mono Lake and in situ measurement data over the snow-field site.

Reperfusion in a gerbil model of forebrain ischemia using serial magnetic resonance FAIR perfusion imaging

BACKGROUND AND PURPOSE

Existing methods for the quantitative measurement of the changing cerebral blood flow (CBF) during reperfusion suffer from poor spatial or temporal resolution. The aim of this study was to implement a recently developed MRI technique for quantitative perfusion imaging in a gerbil model of reperfusion. Flow-sensitive alternating inversion recovery (FAIR) is a noninvasive procedure that uses blood water as an endogenous tracer.

METHODS

Bilateral forebrain ischemia of 4 minutes' duration was induced in gerbils (n=8). A modified version of FAIR with improved time efficiency was used to provide CBF maps with a time resolution of 2.8 minutes after recirculation had been initiated. Quantitative diffusion imaging was also performed at intervals during the reperfusion period.

RESULTS

On initiating recirculation after the transient period of ischemia, the FAIR measurements demonstrated either a symmetrical, bilateral pattern of flow impairment (n=4) or an immediate side-to-side difference that became apparent with respect to the cerebral hemispheres in the imaged slice (n=4). The flow in each hemisphere displayed a pattern of recovery close to the preocclusion level or, alternatively, returned to a lower level before displaying a delayed hypoperfusion and a subsequent slow recovery. The diffusion measurements during this latter response suggested the development of cell swelling during the reperfusion phase in the striatum.

CONCLUSIONS

The CBF during the reperfusion period was monitored with a high time resolution, noninvasive method. This study demonstrates the utility of MRI techniques in following blood flow changes and their pathophysiological consequences.

Early changes in water diffusion, perfusion, T1, and T2 during focal cerebral ischemia in the rat studied at 8.5 T

The time evolution of water diffusion, perfusion, T1, and T2 is investigated at high magnetic field (8.5 T) following permanent middle cerebral artery occlusion in the rat. Cerebral blood flow maps were obtained using arterial spin tagging. Although the quantitative perfusion measurements in ischemic tissue still pose difficulties, the combined perfusion and diffusion data nevertheless distinguish between a "moderately affected area," with reduced perfusion but normal diffusion; and a "severely affected area," in which both perfusion and diffusion are significantly reduced. Two novel magnetic resonance imaging observations are reported, namely, a decrease in T2 and an increase in T1, both within the first few minutes of ischemia. The rapid initial decrease in T2 is believed to be associated with an increase in deoxyhemoglobin levels, while the initial increase in T1 may be related to several factors, such as flow effects, an alteration in tissue oxygenation, and changes in water environment.

Metabolism and morphology of brown adipose tissue from Brahman and Angus newborn calves

The objective of this study was to compare adipocyte morphology and lipogenesis between breed types (Angus vs Brahman) in brown adipose tissue (BAT) and white adipose tissue (WAT) from newborn calves. The Brahman calves (n = 7) were born during the fall season, whereas the Angus calves were born in fall (n = 6) or the following spring (n = 4). At parturition, Brahman cows were lighter than fall Angus cows, but were heavier than spring Angus cows (P < .05). Birth weights and perirenal BAT weights were greater in spring-born, but not in fall-born Angus calves, than in Brahman calves (P < .05). Fall-born Angus BAT contained 63% more (P < .05) adipocytes/100 mg tissue and contained a greater proportion (P < .05) of adipocytes with mean diameters of 40 to 50 microm, and fewer adipocytes with diameters of 60 microm or greater, than Brahman BAT. Brahman BAT contained two-to-three times as many beta-receptors as Angus BAT (P < .05), although the dissociation constant (Kd) was not different between breed types. Mitochondria in Brahman BAT were primarily spherical, whereas Angus BAT mitochondria were elongated, and mitochondrial cross-sectional area tended (P = .08) to be greater in Brahman BAT than in Angus BAT. The mitochondrial uncoupling protein (UCP) mRNA concentration (per 10(6) cells) was greater in Brahman BAT than in BAT from fall-born Angus calves. Lipogenesis from acetate was greater in Angus BAT than in Brahman BAT (P < .05), and glucose and palmitate contributed a greater proportion of carbon to lipogenesis in Brahman BAT than in Angus BAT. These differences in lipogenesis between breed types were not observed in s.c. WAT. The WAT from both breed types contained adipocytes with distinct brown adipocyte morphology, suggesting an involution of BAT to WAT in utero. We conclude that differences in UCP gene expression cannot cause the greater peak thermogenesis of Angus calves; however, differences between breed types in lipid metabolism and(or) mitochondrial morphology may contribute to this phenomenon.

Familial cerebellar hypoplasia and pancytopenia without chromosomal breakages

Two siblings manifested a neuro-haematologic syndrome characterised by low birth weight, failure to thrive, chronic persistent tongue ulceration, severe truncal ataxia and pancytopenia without either telangiectasia or chromosomal instability. One sibling died from sepsis and the cerebellum demonstrated reduced cellularity of the molecular and granular layers with relative preservation of Purkinje cells and minimal gliosis. A surviving sibling has shown haematologic progression to a myelodysplastic disorder. There was no evidence of any chromosomal instability following exposure of fibroblasts and lymphocytes to irradiation. Monosomy-7 was not present in the surviving sibling. We suspect that these two patients represent another example of the rare Hoyeraal-Hreidarsson syndrome and we are currently engaged in very close monitoring of the surviving sibling for evidence of any karyotypic abnormality.

High attenuation gyri CT in postasphyxial encephalopathy

Two term infants suffering severe asphyxial events were found to have diffusely high attenuation of the cortical gyri on CT scanning within 12 days. The findings are consistent with haemorrhagic necrosis or microcalcification. This feature has rarely been described in the literature. The evolution of the CT appearance, the possible neuropathological findings and the relationship with hypoxic-ischaemic encephalopathy are discussed.

Chronic active destructive herpes simplex encephalitis with recovery of viral DNA 12 years after disease onset

Acute herpes simplex encephalitis (HSE) carries significant morbidity and mortality even after early treatment with antiviral agents (7). As well as causing acute neurological disease, Herpes viruses are associated with relapsing--remitting (Varicella--Zoster, Epstein-Barr) and chronic (Rasmussen encephalitis) disease processes (1). A two-year-old girl developed acute HSE which was followed by a 10-year neurologic illness characterised by asymmetric spastic tetraparesis, pseudobulbar palsy, the opercular syndrome of Foix-Chavany-Marie (4) and seizures. The neurological signs remained static until the child died suddenly 12 years after disease onset. Neuropathologic examination demonstrated active chronic encephalitis. Herpes simplex virus (HSV) DNA was recovered from formalin-fixed paraffin-embedded brain tissue. This case provides additional evidence for the development of chronic neurological disease attributable to persistence of herpes simplex virus type 1.

Aicardi-Goutières syndrome: an expanding phenotype

The Aicardi-Goutières syndrome (AGS) is an autosomal recessive progressive encephalopathy associated with basal ganglia calcification, white-matter abnormality, cerebro-spinal fluid (CSF) pleocytosis and elevated CSF interferon alpha (IFN alpha). Two brothers of consanguineous parents who presented in the first year with developmental delay are reported. The first boy is normocephalic with spastic diplegia and normal I.Q. Tests in the second year of life showed punctate calcification of the basal ganglia and subcortical white matter and CSF pleocytosis. At 9 years clinical and imaging features are unchanged and CSF including IFN alpha is normal. The second boy at 21 months has dystonic cerebral palsy, slight fall-off in head growth and cognitive delay. Imaging abnormalities are more severe than those in the brother, CSF examination reveals pleocytosis and marked increase in IFN alpha. Detailed metabolic and viral studies were negative in both cases. Although the clinical course is not progressive, it is suggested that the brothers have AGS and represent the mild end of the spectrum of the disorder. CSF examination (including IFN alpha), should be performed early in children with an apparently static encephalopathy and brain calcification, as typical abnormalities decrease or disappear with age.