bluuebunny/crossref_metadata_2025 huggingface dataset:
Size of the Corpus Callosum in Cerebral Palsy
Authors: Sheth Raj D. , Schaefer G. Bradley , Keller Gina M. , Hobbs Gerald R. , Ortiz Orlando , Bodensteiner John B.
Published: February 2016

It has been suggested that the size of the corpus callosum may have diagnostic significance in cerebral palsy, although this relationship is incompletely defined. Ninety‐one patients with cerebral palsy had been studied by magnetic resonance imaging in the 5‐year period from 1990 to 1994. Fifty‐seven of these 91 patients had a technically appropriate midsagittal magnetic resonance image for quantitative morphometric analysis. The ratio of the area of the corpus callosum to the area of the supratentorial brain was compared to published age‐ and gender‐specific norms. Imaging findings were correlated with clinical history and cause of cerebral palsy. The corpus callosum was of normal size in 43 patients and more than 2 standard deviations below the mean in 14 patients. The causes for cerebral palsy included hypoxic ischemic encephalopathy (32), cerebral dysgenesis (8), and porencephalic strokes (6); the etiology could not be established in 11 patients. The size of the corpus callosum was highly correlated with the cause of cerebral palsy, such that all patients with cerebral dysgenesis had hypoplasia of the corpus callosum (one‐sided z test, p < 0.0001). Conversely, the callosum was of normal size in 32 of 38 patients with hypoxic ischemic encephalopathy and porencephalic strokes. The presence of a hypoplastic corpus callosum is highly associated with cerebral dysgenesis as a cause for cerebral palsy.
The Evaluation of Symptomatic Carotid Artery Disease
Authors: Bragoni Maura , Feldmann Edward , Wilterdink Janet
Published: February 2016

Severe, symptomatic carotid artery disease is most often diagnosed by conventional cerebral angiography. Noninvasive tests are commonly used to identify candidates for angiography and endarterectomy. The purpose of this study, a mail and telephone survey of academic and community neurologists, neurosurgeons, and vascular surgeons in Rhode Island in 1994, was to determine which noninvasive tests physicians used to evaluate these patients and how the test results were used to select patients for angiography. One hundred (86%) of a possible 116 responses were collected. Seventy‐six percent of physicians chose carotid duplex ultrasound as the first diagnostic test, a percentage significantly higher than that for any other test (p < 0.0001). Fourteen percent chose angiography without a prior screening test, 3% chose magnetic resonance angiography (MRA) prior to angiography, 6% chose carotid duplex ultrasound plus MRA prior to angiography, and 1 % chose MRA without angiography. The specific noninvasive test results required for angiography referral were surprisingly variable, both within and across the three physician specialties. Vascular surgeons and neurosurgeons were more likely to choose angiography without prior screening tests than were neurologists. In conclusion, the majority of specialty physicians in the state of Rhode Island chose carotid ultrasound as the screening test of choice for the evaluation of a potential endarterectomy candidate. Few responding physicians chose MRA in combination with carotid duplex ultrasound prior to angiography, or MRA prior to angiography or MRA alone. Awareness of the actual practice patterns of specialists may lead to programs of education for physicians to improve practice and patient outcome through more refined use of diagnostic tests prior to angiography or endarterectomy.
“Semantic” Conduction Aphasia from a Posterior Insular Cortex Infarction
Authors: Marshall Ronald M. , Lazar Ronald M. , Mohr J. P. , Van Heertum Ronald L. , Mast Henning
Published: February 2016

A unique infarction limited to the posterior insula and intrasylvian parietal opercular cortex produced a subtype of conduction aphasia, characterized by a predominance of semantic paraphasias. Temporal lobe hypoperfusion seen on hexa methyl pro‐pyleneamineoxime single‐photon emission computed tomography in the absence of any signs of ischemia suggested that cortical diaschisis played a role in the emergence of this syndrome.
Adult‐Onset Complex Partial Seizures as the Presenting Sign in Colpocephaly: MRI and PET Correlates
Authors: Wunderlich Gilbert , Schlaug Gottfried , Jäncke Lutz , Benecke Reiner , Seitz Rudiger J.
Published: February 2016

In a 30‐year‐old man, adult‐onset complex partial seizures were associated with colpocephaly as evident from magnetic resonance images. The structurally normal lateral neocortex of the right temporal lobe showed a severe reduction in regional glucose consumption corresponding to the epileptic focus as judged from the surface electroencephalogram. In contrast to previously reported patients, this patient had no focal neurological signs, and neuropsychological testing revealed normal general intelligence. Thus, this patient adds a benign variant to the clinical spectrum of this cerebral developmental disorder.
Pseudoprogression of Cerebral Cavernous Angiomas: The Importance of Proper Magnetic Resonance Imaging Technique
Authors: Valanne Leena K. , Ketonen Leena M. , Berg Michel J.
Published: February 2016

Magnetic resonance imaging (MRI) is the method of choice to detect cerebral cavernous angiomas. Specifically tailored MRI studies are necessary to evaluate patients with cerebral cavernous angiomas. The patient described here, for whom serial MRIs performed on different scanners falsely suggested rapid disease progression, illustrates the point.
Enlarged Virchow–Robin Spaces along the Medullary Perforators in a Child with Seizures
Authors: Afifi Adel K.
Published: February 2016

Enlarged Virchow–Robin spaces along the medullary perforators on brain magnetic resonance images (MRIs) of a 4–year–old, neurologically intact child with seizures are described. The differential diagnosis of cystic spaces in the centrum semiovale is discussed. The sparse MRI literature on bright signal intensities in childhood is reviewed.
Detection of Brain Activation Signal from Functional Magnetic Resonance Imaging Data
Authors: Ruan S. , Jaggi C. , Constans J. M. , Bloyet D.
Published: February 2016

An image–processing strategy for functional magnetic resonance imaging (fMRI) data sets consisting of sequential images of the same slice of brain tissue is considered. An algorithm of detection based on the likelihood–ratio test and the noise properties in fMRI is introduced. Since the data have a poor signal–to–noise ratio, and in order to make detection reliable, the algorithm is organized in two steps: (1) pixel detection, which detects all pixels having significant changes, thus building regions of interest (ROIs), and (2) region detection, which selects the most likely activated region from obtained ROIs. The detection method is applied to experimental fMRI data from the motor cortex and compared with the cross–correlation method and Student's t test commonly applied by others. The results obtained using the likelihood–ratio test show improvement in the detection of activated regions.
Medial Temporal Lobe Heterotopia as a Cause of Increased Hippocampal and Amygdaloid MRI Volumes
Authors: Watson Craig , Nielsen Surl L. , Cobb Cully , Burgerman Robert , Williamson Bill
Published: February 2016

Magnetic resonance imaging (MRI)–based volumetric measurements of the hippocampus and amygdala are useful in detecting hippocampal and amygdaloid sclerosis in patients with temporal lobe epilepsy. In these pathological entities, volumetric MRI analysis shows the epileptogenic structures to be atrophic when compared to the normal, nonepileptogenic side. Described are 2 patients with increased hippocampal and amygdaloid volumes on the side of seizure onset due to medial temporal lobe heterotopias. Care must be taken in the interpretation of volumetric MRI data to make certain that asymmetries in hippocampal and amygdaloid measurements are due to atrophy and sclerosis of the abnormal side and not to increased tissue such as heterotopic gray matter.
Midsagittal Corpus Callosum Area, Intelligence and Language In Epilepsy
Authors: Atkinson Denis S. , Abou-Khalil Bassel , Charles P. David , Welch Larry
Published: February 2016

Alterations in midsagittal corpus callosum (CC) area and morphology have been suggested in several disease processes of the nervous system. In addition, some studies found a relation of CC area to handedness, language dominance, and gender. The relation of CC area to measures of intelligence and memory and the effect of epilepsy on CC area have received less attention. In this study CC area was measured on midsagittal magnetic resonance images in 48 patients undergoing presurgical evaluation of epilepsy and in 20 control subjects. All patients had the Wada test and formal neuropsychological testing. The mean CC area of the epilepsy group was significantly smaller than that of control subjects (p < 0.00001). CC area showed a positive correlation with presurgical performance IQ (p = 0.008) and full‐scale IQ (p = 0.048), but not with memory scores or language dominance. There was no relation of CC area to location of epileptic focus, seizure types, age at onset, epilepsy duration, or etiology. The presence of an atrophic lesion was associated with a smaller CC area. The correlation of total CC area with performance and full‐scale IQs may reflect axonal loss in patients with a low IQ, resulting from the etiology of epilepsy or the epilepsy itself.
Feasibility of SPECT for Studies of Brain Perfusion During Cardiopulmonary Bypass
Authors: Marochnik Sergei , Alexandrov Andrei V. , Anthone David , Lewin Carl , Caldwell Curtis B. , Pullicino Patrick M.
Published: February 2016

Single–photon emission computed tomography (SPECT) and transcranial Doppler (TCD) ultrasonography were used to assess brain perfusion during cardiopulmonary bypass. Intravenous injections of technetium 99 m–hexamethylpropyleneamineoxime (99mTc–HMPAO) were administered before surgery and intraoperatively after the first 2 minutes in the first patient and at the end (42 minutes) of cardiopulmonary bypass in the second patient. The total middle cerebral artery territory counts were calculated using the region–of–interest method and compared to cerebellar regional counts. 99mTc–HMPAO uptake on SPECT scans was increased at the beginning and at the end of cardiopulmonary bypass, compared to baseline preoperative values (11–17%) in the presence of multiple microembolic signals on TCD (n, = 35 and n2 = 42 for unilateral middle cerebral artery monitoring). These results indicate the feasibility of using HMPAO–SPECT to study brain perfusion changes during cardiac surgery. A combination of SPECT and TCD ultrasonography may be used to study the impact of microembolism during cardiac surgery with cardiopulmonary bypass.
Reversible Magnetic Resonance Imaging Lesions in Wilson's Disease: Clinical‐Anatomical Correlation
Authors: Takahashi, Wakoh , Yoshii, Fumihito , Shinohara, Yukito
Published: February 2016

Described herein is a patient with Wilson's disease who had tremor as a prominent neurological manifestation. T2‐weighted magnetic resonance imaging showed abnormal high signal intensities in the bilateral lenticular nuclei, thalami, and red nuclei of the midbrain. Improvement of tremor with copper chelating agents was well correlated with a decrease of the abnormal signals in the thalami and the red nuclei.
Spinal Myoclonus Following lntrathecal Administration of Diatrizoate Meglumine
Authors: Sam, Maria C. , Gubnann, Ludwig
Published: February 2016

Life‐threatening myoclonus developed in a patient following inadvertent intrathecal usage of 60% diatrizoate meglumine. Rhabdomyolysis and myoglobinuria occurred. The patient was successfully treated with midazolam and vecuronium and complete recovery occurred.
Subdural Empyema in a 12–Year–Old Girl: The Value of Magnetic Resonance Imaging
Authors: Maytal Joseph , Patel Mahendra , Apeatu Samuel , Schneider Steven , Eviatar Lydia
Published: February 2016

A 12–year–old girl presented with an acute history of fever, headaches, and focal neurological deficits. An initial computed tomography (CT) scan of the head was nondiagnostic whereas plain and gadolinium–enhanced magnetic resonance imaging (MRI) detected an extensive subdural empyema. The report emphasizes the hazard of relying on a nondiagnostic CT scan in a septic patient with deteriorating neurological function, and the need of MRI with contrast enhancement if subdural empyema is a serious clinical concern.
Clinical and Magnetic Resonance Imaging Changes Correlate in a Clinical Trial Monitoring Cyclosporine Therapy for Multiple Sclerosis
Authors: Zhao Guo Jun , Li David K. B. , Wolinsky Jerry S. , Koopmans Robert A. , Mietlowski William , Redekop William K. , Riddehough Andrew , Cover Keith , Paty Donald W.
Published: February 2016

Magnetic resonance imaging (MRI) was used to monitor cyclosporine therapy for chronic progressive multiple sclerosis in a multicenter clinical trial and an analysis was performed to determine whether there was a correlation between clinical changes and MRI changes. MRI was performed on 163 patients at the onset and completion of the 2–year study. Burden of disease (BOD, lesion load) was quantitated by a single observer using a computer program. Active lesions were also identified. The Expanded Disability Status Scale (EDSS) score was determined every 3 months. MRI data did not show any effect of cyclosporine treatment on BOD progression (mean 24.5% increase/yr) or lesion activity. However, there was a statistically significant positive correlation between the baseline total BOD value and the baseline EDSS score (r = 0.221, p = 0.005) and a positive correlation between the percent changes in BOD from baseline to exit and EDSS score (r = 0.186, p = 0.018). The study supports the concepts that MRI is a useful technique in monitoring therapeutic trials and that MRI is a direct measure of pathology.
Risk Factors Differ for Carotid Artery Plaque With and Without Acoustic Shadowing
Authors: Duncan Bruce B. , Metcalf Patricia , Crouse John R. , Li Rongling , Sharrett A. Richey , Tegeler Charles , Tyroler H. A. , Heiss Gerardo
Published: February 2016

To investigate the association of gender, ethnicity, and several cardiovascular risk factors with carotid artery plaque and plaque with acoustic shadowing in a population‐based sample, high‐resolution B‐mode ultrasonography was used to characterize lesions in the common and internal carotid arteries, and at the carotid bifurcation in 12,796 US men and women, aged 45 to 64 years, participating in the Atherosclerosis Risk in Communities Study (ARIC) baseline survey. In multiple logistic regression analyses, male gender (odds ratio and 95% confidence interval: 1.52 [1.39–1.67]) and increased total (1.47 [1.32–1.63]) and low‐density‐lipoprotein cholesterol (1.49 [1.34–1.65]) levels were statistically significantly associated only with the presence of plaque. In contradistinction, smoking (2.22 [1.79–2.75]) and hypertension (1.54 [1.30–1.82]) were additionally associated with acoustic shadowing. Hyperfibrinogenemia (1.33 [1.12–1.59]) was associated only with lesions accompanied by acoustic shadowing. While ethnicity associations with plaque alone varied across the artery segments, among those with plaque, being white was uniformly associated with acoustic shadowing. After multivariable adjustment, high‐density‐lipoprotein cholesterol was not associated with either manifestation of atherosclerosis. In conclusion, differences were seen in the associations of established cardiovascular risk factors with discretely characterized carotid artery plaque lesions, according to the presence or absence of acoustic shadowing suggestive of mineralization of plaque.
Visualization of the Cerebral Circulation Using Three–dimensional Transcranial Power Doppler Ultrasound Imaging
Authors: Lyden Patrick D. , Nelson Thomas R.
Published: February 2016

The purpose of this study was to evaluate the anatomy of the cerebral circulation, particularly the circle of Willis, using three–dimensional ultrasound (3DUS) imaging. Image data were obtained through the right transtemporal window from 8 young, healthy volunteers by acquiring gray–scale and color Doppler spectral (CDI) and energy (CDE) images using two–dimensional ultrasound equipment with a 2–MHz probe. Images and transducer position coordinates were fed into a graphics workstation, reprojected, analyzed to extract the blood flow signal, volume rendered, and displayed interactively. The architecture of the cerebral circulation was evaluated from multiple orientations using stereo viewing glasses and rotation to enhance the understanding of vessel position. The primary vessels of the cerebral circulation including the circle of Willis and bilateral views of the branching arteries (middle, anterior, and posterior cerebral arteries and internal carotid artery) could be imaged readily with 3DUS through one transtemporal window. Acquisition time was typically less than 30 seconds. Volume–rendering methods greatly assisted in showing the overall spatial relationships and continuity of cranial vessels. Secondary branches of the cerebral arteries were seen in 2 patients. Color data from two–dimensional ultrasound imaging that otherwise might be identified as artifact was found to represent continuous small vessels on three–dimensional viewing. 3DUS facilitates imaging of cranial vascular anatomy by clarifying overall spatial relationships and enhancing comprehension, compared to two–dimensional ultrasound methods. The method is rapid and the circle of Willis can be visualized from one side of the head.
Three‐dimensional Ultrasound Angiography (Power Mode) for the Quantification of Carotid Artery Atherosclerosis
Authors: Griewing, Bernd , Schminke, Ulf , Morgenstern, Christoph , Walker, Margaret L. , Kessler, Christof
Published: February 2016

Three‐dimensional (3D) ultrasound angiography was performed to diagnose carotid artery atherosclerosis. Thirty‐five patients (15 women, 20 men) with a history of cerebrovascular disease were examined using conventional color‐coded Doppler ultrasound and 3D ultrasound angiography. Carotid stenosis was initially diagnosed using continuous‐wave Doppler ultrasound. To determine intraobserver and interobserver reliabilities, 21 patients were evaluated using 3D ultrasound on three occasions. Sixty‐five percent of patients were diagnosed with stenosis of more than 50%. Twenty‐two percent of plaques had a smooth surface, 72.9% were ulcerated, and 5.1 % were indeterminate. Data collection for 3D imaging required 5 minutes per patient, whereas image processing and plaque volume quantification required 30 minutes. Plaque volume ranged from 0.053 to 0.685 ml. The intraobserver and interobserver variabilities were 4.16 and 5.87%, respectively (r = 0.96, p < 0.0001; r = 0.89, p < 0.0001). 3D Color Doppler and 3D ultrasound angiography assessments of plaque volume differed by 8.5%. Plaques were more precisely differentiated using 3D ultrasound, and plaque volume quantification was less affected by echo shadowing after 3D reconstruction. In comparison to other techniques for the quantification of atherosclerotic lesions, 3D ultrasound angiography offers a more precise quantitative method for prospective, clinical studies of atherosclerosis.
Optic Chiasmal Compression by Venous Aneurysm: Magnetic Resonance Imaging Diagnosis
Authors: Wolansky Leo J. , Shaderowfsky Paul D. , Sander Robert , Frohman Larry P. , Kalnin Andrew J. , Lee Huey-Jen
Published: February 2016

The overwhelming majority of traumatic carotid cavernous fistulas present with a bruit, arterialization of conjunctival vessels, or an elevated intraocular pressure. Described herein is a patient who presented with progressive deterioration of vision, without any of the above signs. Magnetic resonance imaging demonstrated compression of the optic chiasm by a venous aneurysm arising from a carotid cavernous fistula. This entity should be considered in patients who present with progressive visual loss.
Successful Surgical Removal of an Asymptomatic Optic Nerve Hemangioblastoma in von Hippel–Lindau Disease
Authors: Raila Frank A. , Zimmerman James , Azordegan Phillip , Fratkin Jonathan , Parent Andrew D.
Published: February 2016

An asymptomatic patient with a family history of von Hippel–Lindau disease carried the abnormal gene for this disease. An imaging survey that consisted of computed tomography, magnetic resonance imaging, and cerebral angiography revealed an optic nerve hemangioblastoma. The potential for visual loss in the future was the indication for microsurgical intervention. This was the first asymptomatic optic nerve hemangioblastoma to be imaged and the first to be successfully removed without any permanent neurological deficits or vision loss.
Shoot First, Draw Later Peroneal Nerve Palsy: A Sonographic Study
Authors: Walker Francis O. , Jackson G. Hagan
Published: February 2016

A 32–year–old man had an unusual gunshot wound to the leg, causing a peroneal nerve palsy. Sonography provided useful complementary findings to the electrodiagnostic localization of the injury.
Indications for Differential Diagnosis of Nontumor Central Nervous System Diseases from Tumors
Authors: Mineura Katsuyoshi , Sasajima Toshio , Kowada Masayoshi , Ogawa Toshihide , Hatazawa Jun , Uemura Kazuo
Published: February 2016

To accurately differentiate nontumor central nervous system (CNS) diseases from brain tumors, we retrospectively evaluated the cerebral circulation and metabolism in patients with nontumor CNS diseases using positron emission tomography (PET). Regional cerebral blood flow (rCBF), cerebral blood volume (rCBV), oxygen extraction fraction (rOEF), the metabolic rates of oxygen (rCMR02), and of glucose (rCMRGI), and the uptake of 11C–methyl–L–methionine (11C–Met) were visually evaluated in lesions and compared with values for the contralateral white matter regions. PET findings were correlated with those of x–ray computed tomography (CT) and magnetic resonance imaging (MRI), and were analyzed for nontumor CNS diseases and cerebral gliomas. rCBF and rCBV were changeable from disease to disease or from stage to stage of disease progression. rOEF and rCMR02 remained low in 5 and 6, respectively, of 9 nontumor CNS diseases examined, whereas these parameters were increased in CNS infections such as brain abscess. Overall, noteworthy was the locally increased rOEF and rCMR02 in the patients with a brain abscess in contrast to the values for patients with gliomas. rCMRGI reflected biological characteristics of each disease, and correlated with cell density, whether reactive glial cells or inflammatory cells. 11C–Met was accumulated at a certain stage of nontumor CNS diseases, which implied uptake of the tracer as a result of disruption of the blood–brain barrier as well as metabolic incorporation.
A New Method for Fixation of Probes for Transcranial Doppler Ultrasound
Authors: Giller Cole A. , Giller Angela M.
Published: February 2016

Although monitoring of blood velocity in the cerebral arteries with transcranial Doppler ultrasound is standard practice, methods for fixation of the ultrasound probe to the skull continue to impose a technical challenge. This report describes a novel method of probe fixation in which an inexpensive polymer block is custom–made for each patient to hold the probe at a fixed angle. In addition to comfort and durability, its major advantage is that the polymer block prevents dislodgment of the probe from the intended angle by forces of gravity or by patient movement. Thirty–one temporal windows were monitored with this technique, with stable signals obtained in all subjects despite aggressive movements. Disadvantages include the inability to insonate more than one vessel and the cost for each block. However, the method is quick, is relatively inexpensive, and provides significant advantages of probe stability.
Emergency Imaging of the Acute Stroke Patient
Authors: Johnston Karen C. , Haley E. Clarke
Published: February 2016

Patients presenting with suspected acute stroke require rapid diagnosis and treatment. Neuroimaging is critical in determining acute‐stroke type and thus appropriate management. A review of various neuroimaging techniques and their role in the evaluation of both acute ischemic stroke and acute hemorrhagic stroke is provided.
Three‐dimensional Reconstruction of Melanotic Neuroectodermal Tumor of Infancy Involving the Occipital Bone and Dura
Authors: Raila Frank A , Parent Andrew D , Ward Brad A , Fratkin Jonathan D
Published: February 2016

A rare case of melanotic neuroectodermal tumor of infancy involving the right occipital bone in an 11‐month‐old infant is described. The bone tumor and its dural extension were surgically removed. Threedimensional reconstruction of the tumor and brain from neuroimaging data added worthwhile information for preoperative planning. Microscopic examination revealed melanotic and neuroblastic tissue in a fibrillary matrix involving the expanded bone and superficial dura. A focal osteoblastic cranial mass in an infant should alert the clinician to consider this tumor.
Locked‐in Syndrome with Bilateral Peduncular Infarct
Authors: Park Sun A , Sohn Young H , Kim Won C
Published: February 2016

Locked‐in syndrome due to midbrain infarct is very rare. This report describes a patient with locked‐in syndrome whose magnetic resonance images showed bilateral infarcts in the cerebral peduncle. Cerebral angiography disclosed bilateral irregular thrombotic narrowing of the vertebral and proximal basilar arteries with rostral basilar artery occlusion, a previously unreported finding.
Congenital Muscular Torticollis: Magnetic Resonance Imaging and Ultrasound Diagnosis
Authors: Entel Robert J , Carolan Frederick J
Published: February 2016

The magnetic resonance imaging (MRI) and sonographic appearances of congenital muscular torticollis were studied in a 6‐week‐old female infant who presented with a firm mass in the right sternocleidomastoid muscle and clinical signs of torticollis. MRI and ultrasound were performed to exclude neoplasm. MRI showed a diffusely enlarged, right sternocleidomastoid muscle that was isointense to normal muscle on T1‐weighted conventional spin‐echo images. The muscle became progressively brighter and more heterogeneous in signal intensity on proton density‐ and T2‐weighted conventional spin‐echo sequences. A thin rim of bright signal intensity on the T2‐ weighted images surrounded most of the muscle. Ultrasound demonstrated fusi‐form enlargement with patchy inhomogeneous areas of increased echogenicity. At 14 weeks there were signs of clinical improvement, with softening of the mass and decreased torticollis.
Different Flow Patterns in Infarction of the Middle Cerebral Artery
Authors: Zbornikova Vera
Published: February 2016

Difficulties exist in distinguishing patients with currently recanalized mainstem occlusion of the middle cerebral artery (MCA) from branch occlusion. Thirty‐five patients, 8 women and 27 men, at a mean age of 64 ± 15 (standard deviation) years, with clinical signs of infarction in the MCA territory confirmed by computed tomography (CT), were evaluated by repeated clinical and transcranial Doppler sonography within 2 days of the event, 2 to 5 days later, and at 2 weeks after admission. The quotient MCA 1/MCA C, derived to evaluate side differences, is defined as mean velocity (MV) in the MCA on the infarcted (I) side divided by MV in the MCA on the contralateral (C) side. Occlusion of the MCA was found in 13 of 35 patients at the first examination. A very high MV of 94 ± 6 em/sec with an abnormal turbulent flow pattern was found in 3 patients at the first examination, consistent with pseudostenosis after recanalization. The remaining 19 patients with a patent MCA had a lower MV in the affected side compared to the healthy side (37 ± 15 and 54 ± 20 em/sec, p < 0.001). Five (38%) of 13 patients with acute MCA mainstem occlusions demonstrated recanalization at the second examination, within 1 week after the onset of stroke, with a MV of 82 ± 44 em/sec and pulsatility index (PI) of 0.68 ± 0.38, which differed (p < 0.05) from the MV of 46 ± 19 em/sec and PI of 0.99 ± 0.20 in the remainder. The MCA 1/MCA C quotient revealed a difference (p < 0.01) between primarily patent vessels and recanalization at the second examination. A tendency to a better prognosis was found in originally patent or later recanalized vessels. Progression of neurological signs was noted in 3 (23%) of 13 patients with MCA occlusion and in 1 (4%) of 22 with nonoccluded MCAs.
Occipital Pole Area and Language Dominance
Authors: Charles Philip David , Abou‐Khalil Bassel , Bakar Mustafa , Mayville Christina L. , Atkinson Denis S. , Kirshner Howard S.
Published: February 2016

A previous report demonstrated a relationship between asymmetries of occipital lobe length measured on magnetic resonance images (MRis) and the hemisphere verified as dominant for language. This study sought to discern whether asymmetry in occipital pole area is more predictive of the hemisphere dominant for language. Language dominance was identified by the Wada test in 55 patients evaluated for surgical treatment of epilepsy. In a blinded fashion, an examiner measured bilateral occipital pole area on MRis for each patient. Asymmetry of the occipital pole area on the MRI made at 10 mm above the tentorium was significantly related to language dominance. This twod‐imensional analysis was better than previously described linear measurements in discriminating patients with left‐hemisphere dominance for language.
Self‐Paced Versus Metronome‐Paced 7 Finger Movements
Authors: Wessel, Karl , Zeffiro, Thomas , Toro, Camilo , Hallett, Mark
Published: February 2016

To evaluate the hypothesis that self‐paced movements are mediated primarily by the supplementary motor area, whereas externally triggered movements are mainly affected by the lateral premotor cortex, different movements in 6 healthy volunteers were studied while changes in regional cerebral blood flow (rCBF) were measured using positron emission tomography (PET) and15O‐labeled water. Subjects made a series of finger opposition movements initiated in a self‐paced manner every 4 to 6 seconds, and separately, made continuous finger opposition movements at a frequency of 2 Hz paced by a metronome. The primary motor cortex, lateral area 6, cerebellum on both sides, and caudal cingulate motor area, and the putamen and thalamus on the contralateral side were more active during the metronome‐paced movements. The increase in rCBF in these areas are likely the result of the larger number of movements per minute made with the externally triggered task. The anterior supplementary motor area and rostal cingulate motor area in the midline, prefrontal cortices bilaterally, and lobus parietalis inferior on the ipsilateral side were more active during the self‐paced movements. Increase in rCBF in those areas, which include medial premotor structures, may be related to the increased time devoted to planning the movement in this condition.
Vasodilatory Responses and Magnetic Resonance Angiography
Authors: Levine, Ross L. , Turski, Patrick A. , Turnipseed, William D. , Dulli, Douglas A. , Grist, Thomas M.
Published: February 2016

This study measured the responses of both extracranial (internal carotid arteries) and intracranial (middle cerebral/angular, basilar arteries) intravascular arterial volume flow rates to acetazolamide using phase‐contrast magnetic resonance angiography. Twenty‐eight newly studied patients were subdivided into four groups: Group I‐Nonocclusive, asymptomatic (n = 7, or 14 carotid and middle cerebral/angular artery sides); Group II‐unilateral carotid transient ischemic attacks, nonhemodynamic (embolic), varying stenoses (n = 11); Group III‐unilateral carotid transient ischemic attacks, hemodynamic, varying stenoses (n = 5); and Group IV‐unilateral carotid occlusion, asymptomatic (n = 5). The data were separated into nonischemic and ischemic sides so as to illustrate group differences based on vasodilatory responses to acetazolamide. For example, the percent change in volume flow rates over baseline values for the ischemic‐side middle cerebral arteries of Group III was significantly the lowest of all of the vasodilatory responses (‒25 ± 11% vs 40 ± 14% for group II ischemic middle cerebral/angular artery sides, p = 0.008). Group III patients also had significantly lower standing blood pressures (p = 0.012), higher number of transient ischemic attacks (p = 0.008), and shorter duration of events (p = 0.013). Determinations of volume flow rate continue to assist in determining the degree of hemodynamic compromise of a particular vascular territory.
Using Transcranial Duplex Sonography for Monitoring Vessel Patency During Surgery for Intracranial Aneurysms
Authors: Mursch, Kay , Schaake, Theodor , Markakis, Evangelos
Published: February 2016

This article reports a method for reliable intraoperative monitoring of blood flow velocities in the basal cerebral arteries during clipping of intracerebral aneurysms. Transcranial color‐coded duplex sonography provides practical integration of transcranial Doppler technology with real‐time imaging capabilities through the intact human skull. With a computerized sonography system equipped with a 2.5‐MHz probe in 50 healthy volunteers, the contralateral internal carotid artery, A1 and A2, as well as M1 and P1 vessels were identified and measured in most patients. In 13 patients undergoing clipping of intracranial aneurysms, the technique successfully imaged 12; it allowed definitive identification of vessels potentially threatened by clipping and not fully visible to the surgeon. Data were easily comparable to preoperative data. This noninvasive, repeatable neuroimaging technique provides useful intraoperative information about intracranial hemodynamics during clipping of intracranial aneurysms.
Fast Inversion Recovery for Myelin Suppression (FIRMS)
Authors: Wolansky, Leo J. , Chiang, Peter K. , Liu, Wen-Ching , Gonzales, Reynaldo N. , Holodny, Andrei I. , Baker, Stephen R.
Published: February 2016

Fast inversion recovery for myelin suppression is a new magnetic resonance sequence with the ability to increase gray‐white matter contrast. This can improve the definition of normal anatomical structures.
Fluctuating MRI Findings in a Patient with Central Nervous System Idiopathic Hypereosinophilic Syndrome: A Case Report
Authors: Doherty Elizabeth A.
Published: February 2016

Central nervous system involvement in the idiopathic hypereosinophilic syndrome is well recognized and is probably the result of an eosinophilic–derived neurotoxin. This report documents evanescent magnetic resonance imaging findings correlating with active central nervous system disease and subsequent treatment effects.
Central Nervous System Lesions Associated with Crohn's Disease
Authors: Brohee P. , Violon P. , Mavroudakis N. , Pirotte B. , Brotchi J. , Zegers de Be D. , Hildebrand J.
Published: February 2016

Central nervous system vasculitis is an exceptional extraintestinal manifestation of Crohn's disease. Reported here are 2 cases, highlighting the difficulty of differential diagnosis with multiple sclerosis and stressing the importance of early immunosuppressive therapy.
lntraoperative Color Duplex Sonography of Basal Arteries During Aneurysm Surgery
Authors: Woydt M. , Greiner K. , Perez J. , Krone A. , Roosen K.
Published: February 2016

This prospective study aimed at (1) characterizing the duplex sonographic appearance of cerebral aneurysms, (2) visualizing their location, and (3) ensuring the complete occlusion of the aneurysm as well as the patency of the basal arteries during aneurysm surgery. During 9 months 30 craniotomies for aneurysm clipping in 29 patients were monitored intraoperatively by Bmode and color–coded duplex sonography. Following craniotomy the aneurysm and the preaneurysmatic and postaneurysmatic arteries were sonographically visualized before and after clipping and removal of the spatulas. Twenty–seven (90%) of 30 aneurysms appeared as a hypoechoic structure. Together with the typical dichromatic picture in the color mode and the characteristic bidirectional flow pattern in the duplex mode, 29 (97%) of 30 aneurysms were identified and localized anatomically correctly. Eighty (99%) of 81 relevant vessels were visualized and measured with the Doppler mode. After clipping, flow was detectable in all major arteries except 3 middle cerebral artery (MCA) branches. In 1, occlusion was confirmed by postoperative angiography. In the other 2, early postoperative computed tomography showed an infarction of the corresponding MCA territories. This study demonstrated the potential of color duplex sonography to visualize and characterize cerebral aneurysms and adjacent basal arteries before and after clipping. It offers a noninvasive intraoperative method to control the patency of basal arteries and complete occlusion of the aneurysm.
Power Doppler Compared to Color‐Coded Duplex Sonography in the Assessment of the Basal Cerebral Circulation
Authors: Postert Thomas , Meves Saskia , Börnke Christian , Przuntek Horst , Büttner Thomas
Published: February 2016

Power–based transcranial duplex sonography (p–TDS) is a new promising ultrasound technique that generates intravascular coloc slgnols from the omplltode of the echo slgnol. The pcesentinvestigation was undertaken to determine the advantages and limitations of power Doppler in the assessment of the basal cerebral circulation compared with transcranial color–coded realtime sonography (TCCS) and contrast–enhanced transcranial color–coded real–time sonography (CE–TCCS). Thirty–eight patients without cerebrovascular diseases were examined with p–TDS and TCCS, and in 11 patients CE–TCCS studies were performed. The M1 segment could be identified in 100% by both ultrasound techniques. p–TDS visualized M2 (67/70 vs 46/70, p < 0.0001), A2 (63/70 vs 46/70, p < 0.001), and P2 (67/70 vs 44/70, p < 0.0001) segments significantly more frequently and accurately compared to TCCS. The posterior communicating artery (25170) and P3 segments (32/70) were only detectable by p–TDS and not by conventional TCCS. In comparison with CE–TCCS, p–TDS had no important advantages in the detection of intracranial vessels. In conclusion, p–TDS and CE–TCCS were superior to TCCS with regard to identification of the basal arterial circulation. Both methods permit noninvasive and reliable identification of the basal cerebral circulation.
Balloon Angioplasty of lntracranial Arteries for Stroke Prevention
Authors: Callahan A. S. , Berger Brian L.
Published: February 2016

Stroke from surgically inaccessible intracranial atherostenosis remains a formidable clinical challenge. While antithrombotic or antiplatelet therapy may prevent distal embolism, there is no effective program for plaque stabilization preventing progression of atherosclerotic stenosis. In patients with isolated circulations (single vertebral with absent posterior communicating arteries, single carotid with contralateral internal carotid artery occlusion, or single carotid with an absent anterior communicating artery), occlusion of the stenotic vessel may produce a low flow–mediated stroke. Fifteen patients with atherosclerotic intracranial stenoses were treated by balloon angioplasty after medical therapy with warfarin failed. Treated territories included the distal internal carotid, proximal middle cerebral, distal vertebral, and basilar arteries. Dilation was successful in all vessels, with residual stenoses averaging less than 30%. Two complications included one paramedian pontine stroke and a single vessel rupture that proved fatal. There was no recurrence of transient ischemic attacks and no restenosis at the angioplasty site over a follow–up period of more than 24 months. In this small series, balloon angioplasty of intracranial vessels provided a therapeutic option for secondary stroke prevention in highly selected patients. Further studies will be necessary to establish the efficacy and safety of endovascular treatment in larger series.
Acute Bilateral Infarcts of the Posterior Inferior Cerebellar Artery
Authors: Sorenson E. J. , Wijdicks E. F. M. , Thielen K. R. , Cheng T. M.
Published: February 2016

Acute bilateral infarcts in the territory of the posterior inferior cerebellum artery are rare and poorly documented in the literature. Thus, this report describes the clinical course and outcome in 3 patients. Although one was associated with coronary artery bypass surgery, the etiology was not known. Despite large territorial infarcts, the patients recovered to ambulation with minimal assistance.
Ultrasonic Bruits in the Circle of Willis Due to a Large Nonfunctioning Pituitary Adenoma
Authors: Nagai Hidemasa , Moritake Kouzo , Nagao Seiichi , Yamasaki Toshiki
Published: February 2016

In a man with a histologically verified nonfunctioning pituitary adenoma with suprasellar extension, Doppler signals resembled those associated with bruits (ultrasonic bruits). These signals were detected in the anterior circulation of Willis both preoperatively and intraoperatively. The large tumor was resected subtotally via a right orbitozygomatic approach. The use of microvascular sonography for intraoperative monitoring can provide information on the potential cerebrovascular complications of surgery. No previous studies on the presence of ultrasonic bruits associated with pituitary adenomas have been reported. The clinical implications for the surgical treatment of pituitary adenomas are discussed.
Comparison of 2D‐ and 3DFT Multiple Overlapping Thin‐Slab Acquisition TOF MR Angiography in Carotid Disease
Authors: Melhem Elias R. , Poon Edward K. , Weinreich David M. , Martinez Rafael D. , Gazit Inna E.
Published: February 2016

We intended to compare two–dimensional Fourier transform (2DFT) with three–dimensional Fourier transform (3DFT) multiple overlapping thin–slab acquisition (MOTSA) time–of–flight (TOF) magnetic resonance angiography for percent diameter stenosis, length of stenosis, and apparent occlusion at the carotid bifurcation. For that, 101 symptomatic patients (n = 202 carotid bifurcations) were evaluated with 3DFT MOTSA TOF and 2DFT TOF. Three observers measured the percent diameter stenosis from oblique axial multiplanar reformatted (MPR) images and length of stenosis from maximum intensity projection (MIP) images. Kappa analysis assessed interobserver agreement, and the Wilcoxon signed rank test was used to compare the two MR angiographic techniques. There was a significant difference in the percent diameter stenosis (p < 0.01) and length of carotid stenosis (p < 0.01) between 2DFT and 3DFT MOTSA TOF magnetic resonance angiography. Stenosis was greater in 33% of carotid arteries and was upgraded (NASCET) in 17% of carotid arteries on the 2DFT TOF. The number of apparently occluded carotid arteries was equal with both MRA techniques. There was good agreement between the three observers (k = .50).
Magnetic Resonance Imaging of Traumatic Cervical Nerve Injuries
Authors: Wysoki Michael , Koenigsberg Robert A. , Camras Lawrence , Ortiz Orlando , O'Mara Ellen , Faro Scott H.
Published: February 2016

Posttraumatic cervical injuries represent a spectrum of injuries ranging from simple traction to frank nerve root avulsion with meningocele formation . The authors describe 3 patients with cervical nerve injuries, depicted by magnetic resonance imaging, highlighting unusual imaging manifestations.
Spontaneous Cerebrospinal Fluid Rhinorrhea in a Patient with Pseudotumor Cerebri
Authors: Camras Lawrence R. , Ecanow Jacob S. , Abood Christopher A.
Published: February 2016

Spontaneous cerebrospinal fluid rhinorrhea developed in a 46‐year‐old woman with pseudotumor cerebri. The origin of the fistula, the use of contrast computed tomographic cisternography to evaluate this lesion, and its surgical treatment are discussed.
Primary Intravascular Lymphomatosis Associated with Mycobacterium marinum
Authors: Sokol Deborah K. , Azzarelli Biagio , Smith Richard R. , Kassing Laura C. , Roos Karen L. , Pascuzzi Robert M. , Blinkhorn Richard J.
Published: February 2016

Intravascular lymphomatosis (IVL) is a rare condition in which neoplastic cells preferentially infiltrate blood vessels of the central nervous system. Nonspecific symptoms associated with IVL include dementia, seizures, and multifocal cerebrovascular events. IVL was discovered at autopsy of a patient whose neurological deficits were predated by a particularly aggressive form of Mycobacterium marinum soft–tissue infection. It is speculated that IVL may have had an occult effect on the patient's cellmediated immunity that predisposed him to this normally innocuous mycobacteria.
Reversible Impairment in Cognition and Midbrain Hematoma
Authors: Lee Kwen Peterkin , Pullicino Patrick , Krenzer Robert
Published: February 2016

A 78–year–old man presented with a 2–week history of cognitive decline. Computed tomography (CT) showed obstructive hydrocephalus due to a small midbrain hematoma. He regained premorbid neurological status after ventriculostomy. Spontaneous midbrain hemorrhage is a rare cause of cognitive decline that can be diagnosed by CT and treated by shunting.
Magnetic Resonance Imaging Features of Solitary Inflammatory Brain Masses
Authors: Bakshi Rohit , Glass Jon , Louis David N. , Hochberg Fred H.
Published: February 2016

Brain lesions in inflammatory diseases may present as solitary masses, prompting a biopsy. We present neuroimaging and histologic findings in five patients with solitary, inflammatory, demyelinating mass lesions located in the supratentorial white matter and gray–white junction. The patients presented with seizures, focal neurologic signs, and neuroimaging findings that indicated the possibility of a neoplasm. Computed tomography (CT) revealed enhancing, sing le hypodense lesions associated with mild or no mass effect. On MRI, the lesions were hypointense on T3–weighted images and hyperintense on T2–weighted images. Variable patterns of enhancement were noted on CT and MRI, including homogeneous/patchy (n = 3) and ring/nodular (n = 1) enhancement. There was no evidence of calcification or hemorrhage. Biopsies revea led a leukoencephalitis and demyelination, with varying degrees of demyelination among the cases. The syndrome, re lating to a solitary lesion, was corticosteroid–sensitive, and it ultimately stabilized. Extensive longitudinal evaluations fai led to reveal multiple sclerosis, infection, or neoplasm. Solitary inflammatory lesions add to the differential diagnosis of large, supratentorial, solitary spaceoccupying lesions noted on CT and MRI scans.
Intra‐axial Posterior Fossa Cryptococcosis: MRI Findings
Authors: Wong David C.
Published: February 2016

Two case reports of intra‐axial posterior fossa cryptococcosis in immunocompetent patients are presented. Magnet ic resonance findings of solitary abscesses with mildly irregular peripheral enhancement within t he medulla, and irregular peripheral enhancement with a nodular component w ith in the right cerebellum are described.
Spontaneous Resolution of Subdural Hematoma: MRI Findings
Authors: Sander Howard W. , Haddad Samir , Masdeu Joseph C.
Published: February 2016

A 33‐year‐old man suffered a traumatic subdural hematoma with complete spontaneous resolution, as demonstrated by computed tomography scanning and magnetic resonance imaging. After resolution, there was obliteration of the subarachnoid space on the affected side, giving rise to relative dilation of the subarachnoid space over the uninvolved convexity. A resolved subdural hematoma should be considered in the differential diagnosis of such an asymmetry.