bluuebunny/crossref_metadata_2025 huggingface dataset:
Cervical Myelopathy from Rheumatoid Pannus As Detected by Magnetic Resonance Imaging
Authors: Adelman Harold M. , Flannery Michael T. , Wallach Paul M. , Shah Chunilal P.
Published: February 2016

The rheumatoid inflammatory process can lead to pannus formation, bone destruction, and ligamentous laxity allowing at lantoaxial subluxation. Spinal cord and brainstem compression may cause neurological signs and symptoms. This reports on a patient in whom magnetic resonance imaging identified periodontoid pannus and atlantoaxial subluxation with spinal cord and medullary compression, manifested clinically by symptoms and signs consistent with cervical myelopathy. Posterior C1‐2 fusion with atlantoaxial stabilization led to a reduction of pannus and neurological improvement.
Ictal 99mTc HM‐PAO Brain Single‐Photon Emission Computed Tomography in Electroencephalographic Nonlocalizable Partial Seizures
Authors: Kuzniecky Ruben , Mountz James M. , Thomas Frank
Published: February 2016

A 9‐year‐old child with intractable focal epilepsy was studied for possible surgical treatment. Multiple electroencephalographic studies did not localize the epileptic focus. An ictal single‐photon emission computed tomography (SPECT) study with technetium 99m‐hexamethylpropyleneamineoxime demonstrated a focal area of hyperperfusion. Through three‐dimensional, functional to anatomical image‐matching techniques, the focus was overlaid on the magnetic resonance image localizing the cortical convolution responsible for the epileptogenic focus. Subdural electroencephalographic studies performed for seizure localization and functional mapping confirmed this location. This case emphasized the usefulness of ictal SPECT scans in patients with seizures nonlocalizable by electroencephalography being evaluated for epilepsy surgery.
Transcranial Doppler Ultrasound and Magnetoencephalography in Migraine
Authors: Rieke Klaus , Gallen Christopher C. , Baker Leslie , Dalessio Donald J. , Schwartz Barry J. , Torruella Ann K. , Otis Shirley M.
Published: February 2016

Eighty subjects‐30 migraineurs during the attack, 30 patients in the interictal period, and 20 healthy volunteers‐were studied using two technologies for functional assessment: transcranial Doppler ultrasound and magnetoencephalography. Transcranial Doppler studies showed an increased mean flow velocity at rest (p < 0.05) in the middle cerebral artery on the side of the headache and a decreased vasomotor response to C02 (p < 0.001) on the same side compared to control subjects. Biomagnetic measurements of somatosensory evoked fields of 11 patients and 11 control subjects in this study did not demonstrate differences between migraineurs and the control group in current flow or latency measures. The data from this study tend to support the hypothesis of vascular disease as a primary underlying deficit in migraine.
Magnetic Resonance Imaging Findings on Carbon Monoxide Intoxication
Authors: Murata S. , Asaba H. , Hiraishi K. , Narabayashi I. , Naritomi H. , Sakai T.
Published: February 2016

Four patients who had carbon monoxide intoxication were examined by brain magnetic resonance imaging (MRI) and computed tomography (CT). Three were unconscious in the acute stage of intoxication. On regaining consciousness. neuropsychological symptoms and signs remained. In these patients, T2‐weighted MRI demonstrated hyperintensity lesions in the cerebral cortex, most prominent in the watershed zone. The fourth patient had only memory disturbance and was not unconscious during the acute intoxication. The T1‐weighted MRI showed hyperintensity in the bilateral pallidal regions. MRI demonstrated lesions more clearly than did CT.
Superiority of Functional over Structural Neuroimaging in the Diagnosis of Primary Progressive Aphasia
Authors: Gulati Anil , Hier Daniel B. , Trepashko Donald W. , Hughes John R.
Published: February 2016

For a 68‐year‐old man with the syndrome of primary progressive aphasia, functional brain imaging techniques (single‐photon emission computed tomography and topographic electroencephalographic mapping) proved superior to anatomical imaging techniques (magnetic resonance imaging and computed tomography) in delineating the left temporal lobe abnormality.
lnterleukin‐2 and Cisplatinum Therapy Toxicity Mimicking Basilar Artery Disease
Authors: Estol Conrado J , Atkins Michael , Mier James M , Caplan Louis R
Published: February 2016

A 51‐year‐old woman receiving cis‐platinum and interleukin‐2 for metastatic melanoma developed a clinical picture suggesting basilar artery occlusion. Magnetic resonance imaging and computed tomography showed bilateral occipital lucencies.
Perils and Pitfalls of Magnetic Resonance Imaging in the Diagnosis of Multiple Sclerosis
Authors: Schiffer R. B. , Giang Daniel W. , Mushlin Alvin , Ketonen Leena , Joy Stephen , Kido Dan , Goodman AndreW D. , Mattson David H. , Mooney Cathy ,   The Rochester-Toronto MRI Study Group
Published: February 2016

Purpose. Magnetic resonance imaging (MRI) has come to assume a position of major importance in the diagnostic process for multiple sclerosis (MS). The authors believe that a tendency toward overreliance on MRI results in isolation from clinical findings continues to result in both false‐positive and false‐negative diagnostic errors. Methods. To evaluate this, MRI results in newly referred patients with clinical findings suggestive, but not diagnostic, for MS, were studied prospectively. Results. Of 99 consecutive referrals for suspected MS, there were 3 false‐positive diagnoses of MS and 7 false‐negatives, when the MRis were read in isolation from specific clinical data. None of the scans in the false‐negative groups were normal. Representative images of both groups are provided. Conclusion. In newly referred patients who fall short of criteria for definite MS, it remains dangerous for both clinicians and radiologists to rely too heavily only on MRI results.
Single‐Photon Emission Computed Tomographic Perfusion Imaging in Autopsy‐Diagnosed Dementia
Authors: Jagust William J. , Reed Bruce R. , Ellis William G. , Eberling Jamie L. , Budinger Thomas F.
Published: February 2016

Physiological imaging of regional cerebral blood flow with single‐photon emission computed tomography (SPECT) has been proposed to be diagnostically useful in the evaluation of patients with dementia because of the frequent finding of temporal and parietal lobe hypoperfusion in patients with Alzheimer's disease (AD). A major limitation of SPECT to date has been the selection of patients using clinical criteria, which may be unreliable in excluding patients with non‐Alzheimer dementias from study. SPECT with the perfusion tracer 123l‐N‐isopropyl‐p‐iodoamphetamine was used to study 16 dementia patients who were subsequently followed to autopsy, as well as 16 elderly control subjects. Eleven dementia patients had the diagnosis of AD confirmed by autopsy, while 5 had other, nonAD dementias. SPECT perfusion patterns were evaluated as regional ratios of lobar radioactivity counts normalized to either activity counts in the occipital lobes (occipital ratio) or activity counts in the entire tomographic slice (whole‐slice ratio). Results showed that the relative frontal perfusion differentiated non‐AD patients from control subjects and AD patients regardless of which ratio method was used, while temporal and parietal relative perfusion ratios were more effective at differentiating AD from non‐AD patients when the whole‐slice ratio was used, although the ratio used did not affect the differentiation of AD patients from control subjects. Scatterplots of the whole‐slice ratio in the right parietal and left temporal lobes showed no overlap between AD and non‐AD patients and control subjects. These results support the diagnostic utility of SPECT in the clinical evaluation of dementia patients, particularly in distinguishing AD from non‐AD dementias during life.
Striatal Glucose Metabolism and Pattern of Cerebral Regional Interactions in Choreic Disorders
Authors: Pietrini P. , Azari N. P. , Pettigrew K. D. , Horwitz B. , Kozachuk W. , Kumar A. , Salerno J. , Grady C. L. , Haxby J. V. , Aronin N. , Marshall P. , Schapiro M. B.
Published: February 2016

With positron emission tomography (PET), cerebral glucose metabolism was studied in 5 patients with familial inverted chorea, a progressive choreiform disease with no dementia, and in age‐ and sex‐matched control subjects. Computed tomography scans excluded cortical or striatal atrophy. PET scans showed no group differences in striatal glucose metabolism. However, when a discriminant analysis method was applied to the PET metabolic data, a discriminant function, reflecting functional interactions involving the striatum, successfully distinguished the patients from the control subjects. These results indicate striatal involvement in the pathophysiology of familial inverted chorea, and emphasize the importance of alternative methods of analyzing regional PET data.
Periodic Variations in Transcranial Doppler Mean Velocities
Authors: Giller Cole A. , Lam Michael , Roseland Angela
Published: February 2016

Although serial transcranial Doppler measurements of blood flow velocity are of considerable clinical utility, their use assumes that the velocity signals are stable and unchanging during short time periods. Contrary to this assumption, the authors found significant variations in mean velocity signals in both normal subjects and patients, which may confound the interpretation of serial studies. Signals were continuously obtained for 5 to 1 0 minutes from the middle cerebral artery of 11 normal subjects and 18 patients (22 studies) with a variety of neurosurgical disorders. The average difference between the peak and the trough in the waves observed in the normal population was 11 ± 4% (standard error of mean), and 5 of the 11 had at least one wave with a difference of more than 20%. The average difference between the peak and trough signals in the neurosurgical population was 14 ± 13% (SEM) and 13 of the 22 studies showed at least one wave with a difference of more than 20%. These variations were consistently seen and may be related to similar variations in blood pressure or intracranial pressure waves. Whatever the origin, these variations should be recognized during the interpretation of transcranial Doppler signals in clinical practice.
The Use of Magnetic Resonance Imaging in Monitoring Interferon Therapy of Multiple Sclerosis
Authors: Koopmans R. A. , Li D. K. B. , Redekop w. K. , Zhao G. J. , Palmer M. R. , Kastrukoff L. F. , Paty D. W.
Published: February 2016

Magnetic resonance imaging (MRI) was used to evaluate the efficacy of systemic lymphoblastoid interferon therapy in chronic progressive multiple sclerosis. The clinical outcome of this trial has been reported previously. Thirty‐six patients with chronic progressive multiple sclerosis were treated with interferon daily for 6 months and 27 received placebo. Patients had MRI at the outset of the study and after 6 and 24 months. Lesion activity and changes in lesion load were determined. As the study progressed, both the interferon‐ and the placebo‐treated group developed more active lesions. There was no difference in lesion activity between the two groups. Comparison of lesion load, however, showed a trend toward improvement after 6 months for the interferon‐treated group. This difference between the two groups had disappeared by the end of the study. We conclude that lymphoblastoid interferon was not effective in decreasing active MRI‐detected lesions or in decreasing MRI lesion load in patients with chronic progressive multiple sclerosis.
Brain Oxidative Metabolism in Parkinson's Disease Studied by Phosphorus 31 Magnetic Resonance Spectroscopy
Authors: Montagna P. , Pierangeli G. , Cortelli P. , Zaniol P. , Funicello R. , Lugaresi E. , Barbiroli B.
Published: February 2016

Ten patients with Parkinson's disease were studied by phosphorus 31 magnetic resonance spectroscopy. The brain phosphocreatine‐inorganic phosphate ratio was abnormal owing to an increased inorganic phosphate content, and the phosphorylation potential was consequently reduced. Phosphocreatine and ADP levels and pH were normal. These findings indicate abnormal brain energy metabolism in Parkinson's disease.
Neuroimaging Studies of Cerebral “visceral Larva Migrans” Syndrome
Authors: Zachariah Sally B , Zachariah Babu , Varghese Rachel
Published: February 2016

“Visceral larva migrans” syndrome is a zoonotic disease caused by the migration or presence in human tissue of nematode larva from lower‐order animals. This syndrome includes generalized illness. eosino philia. and symptoms arising from larval invasions of different organs including the liver, lungs. eyes, and central nervous system. There has been only one case report of the computed tomographic (CT) and magnetic resonance imaging (MRI) appearances of cerebral toxocaral disease . Described here is a patient with cerebral toxocaral disease with a high eosinophil count and toxocaral titer in the serum and abnormal CT and MRI findings who had spontaneous recovery of the clinical symptoms.
Bilateral Diabetic Thigh Muscle Infarction
Authors: Barohn Richard J , Bazan Carlos , Timmons James H , Tegeler Charles
Published: February 2016

A 19‐year‐old woman with insulin‐dependent diabetes mellitus developed pain and tenderness in the medial aspect of the left thigh and calf, followed 1 week later by similar symptoms in the right leg. Technetium 99m pyrophosphate (PYP) radionuclide scans showed increased flow and uptake in the medial thigh muscles. Magnetic resonance imaging (MRI) of the thigh showed increased signal on proton density and T2‐weighted images in the medial and lateral thigh compartments. High‐resolution B‐mode ultrasound showed hyperechoic changes in the anteromedial thigh muscles, with loss of normal myofascial interfaces, and a mixed appearance, bilaterally. Two months later, after the symptoms had begun to resolve, the images had improved. This case documents bilateral diabetic thigh infarction identified by abnormal technetium 99m PYP flow studies, MRI signal, and B‐mode ultrasound imaging.
Letters
Authors: Ikeda Ken , Mitsumoto Hiroshi , Antar Mohamed , Dashefsky Larry H
Published: February 2016

A 42‐year‐old woman with a diagnosis of amyotrophic lateral sclerosis (ALS) for I year was found to have selective lesions in the corticospinal tract on brain magnetic resonance images (MRIs). Positron emission tomography (PET) revealed focal hypometabolism in the left motor and motor association cortex. We report this interesting case in which MRI findings were closely correlated with those of PET.
Sequential Positron Emission Tomographic Evaluations of Brain Metabolism in Acute Herpes Encephalitis
Authors: Meyer M. A. , Hubner K. F. , Raja S , Hunter K , Paulsen W. A.
Published: February 2016

This first known positron emission tomography report on metabolic changes in acute herpes simplex virus (HSV‐1) encephalitis demonstrates focal hypermetabolism in areas of cerebral cortex adjacent to actively inflamed hippocampus acutely infected with HSV‐1 . When neuropsychiatric symptoms recurred in a previously healthy 61‐year‐old patient 1 month after recovering from acute HSV‐1 encephalitis, repeat positron emission tomography with fluorodeoxyglucose was helpful in ruling out recurrent active infection by showing marked hypometabolism throughout the previously infected temporal lobe.
Multiple Giant Intracranial Aneurysms Associated with Lymphomatoid Granulomatosis: A Magnetic Resonance Imaging and Angiographic Study
Authors: Capone Patrick M , Mechtler Laszlo L , Bates Vernice E , Kanna Arvo , Kinkel Peter R.
Published: February 2016

Lymphomatoid granulomatosis is an uncommon lymphoproliferative disorder that frequently has central nervous system manifestations. Lymphomatoid granulomatosis has clinical features similar to both vasculitis and lymphoma. The pathological hallmarks of this disease include necrotic angiecentric and angiodestructive infiltrations of premalignant or malignant lymphoid cells. There are, to the authors' knowledge, only a few magnetic resonance imaging reports and no magnetic resonance angiographic reports of this disorder. Presented here is a case of lymphomatoid granulomatosis producing multiple giant fusiform and saccular aneurysms throughout the major intracerebral arteries, along with patterns of vascular beading typically seen with vasculitis demonstrated by magnetic resonance angiography.
Response of Recurrent Brain Metastases in Malignant Melanoma to 5‐Fluorouracil and Interferon‐α Therapy
Authors: Phuphanich Surasak , Jacobs Marianne , Spiers Alexander
Published: February 2016

A 36‐year‐old woman underwent removal of a stage II malignant melanoma from the left ankle in 1985. A single brain metastasis to the right frontal lobe was removed in July 1986. Postoperatively, she received 5‐fluorouracil, cisplatin, and etoposide (VP‐16) in conjunction with radiation therapy. She achieved remission until March 1988, when left hemiparesis occurred suddenly. Computed tomography and magnetic resonance scans revealed multiple brain metastases. She was treated with a combination of 5‐fluorouracil, 1,000 mg/m2 in a 24‐hour continuous IV infusion for 5 days; interferon‐α, 10 million units in subcutaneous injection daily for 10 days; and oral cimetidine, 1,200 mg daily for 7 days. This regimen, repeated every 4 to 6 weeks for four cycles, was well tolerated, with complete remission of neurological deficits and resolution of the lesions seen on the brain scans until she died 11 months later of intracranial hemorrhage secondary to severe thrombocytopenia.
Man‐in‐the‐Barrel Syndrome Associated with Closed Head Injury
Authors: Crisostomo Edgardo A , Suslavich Frank J
Published: February 2016

A patient who sustained closed head injury demonstrated brachial diplegia and intact leg strength, a case of man‐in‐the‐barrel syndrome. Extensive hemorrhagic contusion was seen in the inferior frontal lobes bilaterally. Although aptly descriptive, the syndrome is neither predictive of an exact anatomical substrate nor representative of a specific etiology.
Localization of Motor Areas Adjacent to Arteriovenous Malformations: A Positron Emission Tomographic Study
Authors: Grafton Scott T , Martin Neil A , Mazziotta John C , Woods Roger P , Vinuela Fernando , Phelps Michael E
Published: February 2016

Motor cortex activity was localized with positron emission tomography (PET) in 4 patients with large arteriovenous malformations adjacent to or undercutting the left primary motor cortex. Relative cerebral blood flow responses were measured during execution of a visually guided motor tracking task performed with the right index finger, hand, great toe, tongue, or eyes alone (control) and mapped onto each patient's corresponding magnetic resonance imaging (MRI) scan. The relative cerebral blood flow responses in the contralateral precentral gyrus, adjacent to each arteriovenous malformation, demonstrated a normal somatotopic distribution, similar to that in a control population. In the 3 patients with preserved motor function, responses were also present in the ipsilateral primary motor cortex, bilateral supplementary motor area, and ipsilateral anterior cerebellum, similar in location to those of a control population. In the fourth patient with a hemiparesis, responses were attenuated in the primary motor cortex, increased in the supplementary motor area, and absent in the cerebellum. The results demonstrate that PET cerebral blood flow mapping can localize motor cortex despite the presence of significant blood flow abnormalities in adjacent arteriovenous malformations. The method, particularly when combined with MRI, may be used in the planning of surgical, radiation, or embolization therapy.
Spontaneous Resolution of Arachnoid Cyst
Authors: Mokri Bahram , Houser O. Wayne , Dinapoli Robert P.
Published: February 2016

The natural history of arachnoid cysts is not uniform; some cysts enlarge and some remain unchanged. A less recognized course is spontaneous resolution. A patient with an arachnoid cyst that resolved spontaneously is described, previously reported cases of 6 patients are reviewed, and possible mechanisms for resolution of the cysts are discussed.
Ruptured Intracranial Dermoid Tumor Secondary to Closed Head Trauma
Authors: Phillips W. Eugene , Martinez Carlos R. , Cahill David W.
Published: February 2016

A patient with an intracranial dermoid tumor that ruptured secondary to closed head trauma is described. Intracranial dermoid tumors (cysts) have been reported to rupture spontaneously during or following surgery. To the authors' knowledge, rupture of a dermoid cyst following closed head trauma has not been reported.
Early Single‐Photon Emission Computed Tomography in Mild Head Trauma
Authors: Masdeu J. C. , Van Heertum R. L. , Kleiman A. , Anselmi G. , Kissane K. , Horng J. , Yudd A. , Luck D. , Grundman M.
Published: February 2016

Although computed tomography (CT) and magnetic resonance imaging scans often appear normal after mild head trauma, many patients experience attentional or other cognitive disturbances that are difficult to quantify by neuropsychological testing in the absence of a premorbid profile. Within 2 days of mild head trauma, 14 patients with normal‐appearing brain CTs were studied with single‐photon emission computed tomography (SPECT). They were compared to 15 normal control subjects and to 12 patients with mild human immunodeficiency virus (HlV) encephalopathy. Ten of 14 head trauma patients were separated from the normal control subjects by both independent readers, blinded to the clinical diagnosis. None of the SPECT results from normal control subjects were ‘read’ as trauma. Trauma could not be differentiated from HlV encephalopathy. The observed percentage agreement between raters was 0.83 (K = 0.72). SPECT is more sensitive than CT in detecting brain injury after mild head trauma.
Distributional Patterns of Multiple Sclerosis Brain Lesions Magnetic Resonance ImagingClinical Correlation
Authors: Gonzalez Carlos F. , Sacchetti T. Swirsky , Mitchell David , Lublin Fred D. , Knobler Robert L. , Ehrlich Saundra M.
Published: February 2016

Forty–one patients with multiple sclerosis were studied with magnetic resonance imaging (MRI) and a battery of neuropsychological tests to determine the pattern of lobar distribution of lesions in the relapsing–progressive and relapsing–remitting forms of the disease. Correlation of lesions with the patient's cognitive and emotional dysfunction was also obtained. The results of this study indicate that patients with relapsing–progressive multiple sclerosis are characterized by the large or coalescent lesions located predominantly in the periventricular area. These lesions were more frequently found in the parietooccipital areas and were accompanied by significant cognitive dysfunction and severe personality changes. The patients with relapsing–remitting disease, however, were characterized by punctiform or small discrete lesions predominantly located in the intermediate and subcortical areas. These lesions were more frequently seen in the parietooccipital regions and the patients had significantly less severe cognitive and emotional involvement than did the patients with relapsing–progressive disease. Recognition of these patterns was easily accomplished by MRI. In this investigation MRI studies were utilized as an index of the pathological changes occurring at one point in time in the evaluation of the disease. Only repeated MRI studies and continuous clinical observation can establish the final diagnosis.
An Absent Ophthalmic Artery or Carotid Siphon Signal on Transcranial Doppler Confirms the Presence of Severe Ipsilateral Internal Carotid Artery Disease
Authors: Wilterdink J. L. , Feldmann E. , Bragoni M. , Brooks J. M. , Benavides J. G.
Published: February 2016

Transcranial Doppler ultrasound provides a useful adjunct to extracranial ultrasound in the diagnosis of carotid bifurcation disease. Previous studies have shown that collateral flow patterns and diminished flow velocities in the ipsilateral middle cerebral artery correlate with hemodynamically significant carotid disease. In a series of 7,054 carotid duplex and transcranial Doppler examinations, 12.5% (95% confidence interval [CI]: 8.7, 16.4) of 287 ophthalmic arteries ipsilateral to an apparent carotid occlusion had no detectable flow signal, compared with 0.5% (95% Cl: 0.3, 0.7) of 6,767 ophthalmic arteries ipsilateral to a nonoccluded carotid artery (p < 0.001 ). Carotid siphon signals were not detectable in 24.4% (95% Cl: 19.4, 29.4) of arteries ipsilateral to the carotid occlusion, versus 1.0% (95% Cl: 0.8, 1.3) ipsilateral to nonoccluded carotid arteries (p < 0.001 ). A significant number of absent ophthalmic artery and carotid siphon signals (5.7 and 8.7%, respectively) were also found in patients with 80 to 99% extracranial carotid stenosis. A subset of 216 studies with angiographic correlation confirmed the high association of these transcranial Doppler findings with severe stenosis or occlusion of the internal carotid artery. Primary ophthalmological disease or siphon occlusion did not explain these findings. An absent ophthalmic artery or carotid siphon signal on transcranial Doppler examination is believed to represent a failure to detect slow flow distal to severe carotid bifurcation lesions. As a sign of ipsilateral carotid occlusion, the sensitivities of absent ophthalmic artery and carotid siphon signals are quite low (12.5 and 24.4%, respectively). The high specificities of 99.5 and 99.0%, however, make these findings useful in confirming the diagnosis of presumptive carotid occlusion by carotid duplex ultrasound.
Serial Transcranial Doppler Sonography in Ischemic Strokes in Middle Cerebral Artery Territory
Authors: Ni Xiu‐Shi , Horner Susanna , Fazekas Franz , Niederkorn Kurt
Published: February 2016

The changes in middle cerebral artery (MCA) blood flow velocity were serially evaluated in 31 patients with acute ischemic strokes in the MCA territory using transcranial Doppler ultrasound. In patients with a poor clinical prognosis, MCA mean velocity on the infarcted side (MV,) was significantly decreased within 48 hours after onset, compared with that on the opposite side (MV2 ) (p < 0.01 ). However, this change was not significant in patients with a good clinical prognosis. As predictors of poor clinical prognosis, an MV, of 40 cm/sec or less and an asymmetry index of ‐ 20% or less showed positive predictive values of 93 and 88%, with sensitivities of 72 and 83% and specificities of 92 and 85%, respectively. An MV, slower than 20 cm/sec or an asymmetry index below ‐50% had a 100% positive predictive value and a 100% specificity, but less sensitivity (17 and 44%, respectively). Combining an MV, of 40 em/sec or less with an asymmetry index of ‐20% or less resulted in a 100% positive predictive value and a 100% specificity, with a relatively high sensitivity of 67%. As predictors of good clinical prognosis, an MV, faster than 40 cm/sec and an asymmetry index above ‐20% showed positive predictive values of 71 and 79%, with sensitivities of 92 and 85% and specificities of 72 and 83%, respectively. The clinical prognosis based on MV, seems particularly reliable for MCA territorial and cortical infarctions.
Successful Medical Treatment of a Spinal Histoplasmoma
Authors: Kelly David R. , Smith Charles D. , McQuillen Michael P.
Published: February 2016

A woman with previously treated disseminated histoplasmosis was admitted with progressive paraparesis. Magnetic resonance imaging showed multifocal cerebritis and spinal histoplasmoma. She recovered following a second treatment with amphotericin B. This is the fourth reported patient with intramedullary spinal histoplasmoma, and the first demonstrating successful treatment of the lesion with medical therapy alone.
Critical Neck Position as an Independent Risk Factor for Posterior Circulation Stroke
Authors: Weintraub Michael I. , Khoury Andre
Published: February 2016

The purpose of this study was to compare the effects of critical neck angulation (rotation and hyperextension) on vertebral artery perfusion in symptomatic and control populations and to determine whether this represents a risk factor for ischemic stroke.
Tomographic Electroencephalography/Magnetoencephalography
Authors: Thatcher Robert W.
Published: February 2016

New developments in multimodal registration of electroencephalography (EEG), magnetic resonance imaging (MRI), and pOSitron emission tomography (PET) are presented as a method to create a tomographic EEG. Three‐dimensional information about the x,y,z location of the sources of event‐related potentials is corroborated through the use of experimental design and coregistration with MRI and PET. Once the three‐dimension allocation of event‐related potential dipole sources IS identified and corroborated, pseudoinverse procedures are used to derive a new EEG voltage sequence from each of the dipoles Each denved EEG dipole time series is analogous to recording EEG from a deeply implanted electrode and constitutes a four‐dimensional tomographic EEG (ie, three‐dimensional space plus time) EEG coherence and phase analyses are then performed on the dipole‐derived time series to study the temporal and spatial dynamics of neural network switching during voluntary finger movements. The purpose of this article is to demonstrate a new method to exploit the time domain dynamics of neural network switching in behaving human subjects.
Contrast‐enhanced Magnetic Resonance Imaging of the Lumbosacral Roots in the Dysimmune Inflammatory Polyneuropathies
Authors: Bertorini T. , Halford H. , Lawrence J. , Vo D. , Wassef M.
Published: February 2016

The diagnosis of acute Guillain‐Barre syndrome and chronic inflammatory demyelinating polyradiculoneuropathy is based on clinical characteristics, abnormalities on nerve conduction studies, and nerve biopsy specimens indicating demyelination. Inflammation and edema are also common findings in nerve specimens Immunotherapy is helpful in these dysimmune conditions. Occasionally the diagnosis is difficult to make, particularly when electrophysiological testing or nerve biopsy findings are not characteristic. The authors found contrast enhancement of lumbosacral roots in patients with chronic inflammatory demyelinating polyradiculoneuropathy and Guillain‐Barre syndrome, but not m those with other demyelinating neuropathies. Contrast‐enhanced magnetic resonance imaging could be a useful tool in the diagnosis of the dysimmune inflammatory neuropathies.
Single‐Photon Emission Computed Tomography of the Brain in Acute Mania and Schizophrenia
Authors: O'Connell Ralph A. , Van Heertum Ronald L. , Luck Dana , Yudd Anthony P. , Cueva Jeanette E. , Billick Stephen B. , Cordon David J. , Gersh Richard J. , Masdeu Joseph C.
Published: February 2016

Single‐photon emission computed tomography (SPECT) imaging with n‐isopropyl1odoamphetamine (IMP) was performed on 11 patients with bipolar mania, 21 acute schizophrenics, and 15 healthy control subjects. Subjects were evaluated with neuropsychological tests and psychiatnc rating scales. SPECT bram studies were blindly evaluated to assess the degree of radiopharmaceutical uptake in three neuroanatomical regions of interest in each hemisphere. All the control subjects, 1 manic patient and 1 schizophrenic patient had normal brain SPECT uptake patterns. The scans of all others were read as abnormal. Hypofrontality was noted in some schizophrenics and maniacs. A significant increase in tracer uptake in temporal lobes was observed in both patient groups, more prominently in the manic patients. Increased and decreased basal ganglia uptake was also observed in patients. Both manic and schizophrenic patients showed cortical tracer heterogeneity of varying degree. The patterns of cerebral SPECT uptake seen in these acute psychoses were not specific for a diagnosis, but may be associated with dimensions of psychopathology. Because the patterns are different from those seen in cerebrovascular disease and the dementias, they may prove to be helpful in differential diagnosis.
Evaluation of the VentricularSystem in Adults byTranscranial DuplexSonography
Authors: Seidel Günter , Gerriets Tibo , Kaps Manfred , Hutzelmann Alfred
Published: February 2016

Transcranial duplex color‐flow sonography provides visualization
of intracranial structures, and measures angle‐corrected blood
flow velocity in the basal cerebral artenes of adults. In 44 patients
with central nervous system disease, the oblique diameters
of the third and the middle part of the lateral ventricle were measured
by transcranial duplex color‐flow sonography using a system
with a 2.5‐MHz transducer, and compared to computed
tomography measurements. The correlation coefficients for the
third and lateral ventncle measurements were r = 0.83
(p < 0.0001, N = 38) and 0.73 (p < 0.0001, N = 78), respectively.
A second investigation was performed by transcranial duplex
to evaluate intraobserver and mterobserver reproducibility.
The correlation coefficient representing interobserver reproducibility
in 27 patients was r = 0.87 (p < 0.0001, N = 47) for the
lateral ventricle and r = 0.9 (p < 0.0001, N = 49) for the third
ventricle. The intraobserver reproducibility correlation coefficient
was r = 0.93 (p < 0.0001, N = 22) for the lateral ventricle in
12 patients. In 49 healthy volunteers the oblique diameters of
the lateral and third ventricles were age dependent measuring
16.7 ± 2.3 mm and 4.8 ± 1.9 mm, respectively, in those
younger than 59 years, compared to 19.0 ± 2.9 mm and
7.6 ± 2.1 mm in those 60 years or older. Therefore, transcranial
duplex color‐flow sonography measures noninvasively the third
and the lateral ventncle in adults.
Ophthalmoplegia and Facial Numbness Following Treated Squamous Carcinoma of the Forehead
Authors: Hwang Te‐Long , Kolb Todd A. , Domers Martin
Published: February 2016

A 62‐year‐old man presented with progressive diplopia, left ptosis, proptosis, complete ophthalmoplegia, facial numbness, and headache of 21/2 months' duration. The symptoms started 1 month after surgical resect1on of a squamous cell carcinoma in the left side of the forehead. Imaging studies helped localize the lesion, correlatmg with clmJcal features. The differential diagnosis IS discussed. The final diagnosis was confirmed by autopsy.
Peak Velocity Overestimation and Linear‐Array Spectral Doppler
Authors: Eicke B. Martin , Kremkau Frederick W , Hinson Hans , Tegeler Charles H
Published: February 2016

Ultrasound Instruments are used to evaluate blood flow velocities in the human body. Most clinical instruments perform velocity calculations based on the Doppler principle and measure the frequency shift of a reflected ultrasound beam. Doppler‐only instruments use single‐frequency, s1ngle‐crystal transducers. Linearand annular‐array multiple‐crystal transducers are used for duplex scanning (simultaneous B‐mode image and Doppler). Clinical interpretation relies primarily on determination of peak velocities or frequency shifts as identified by the Doppler spectrum. Understanding of the validity of these measurements is important for Instruments in clnical use. The present study exammed the accuracy with which several ultrasound instruments could estimate velocities based on the Identification of the peak of the Doppler spectrum, across a range of different angles of insonation, on a Doppler string phantom. The stnng was running in a water tank at constant speeds of 50, 100, and 150 em/sec and also in a sine wave pattern at 100ߚ or 150ߚcm/sec amplitude. Angles of msonatlon were 30, 45, 60, and 70 degrees. The single‐frequency, single‐crystal transducers (PC Dop 842, 2‐M Hz pulsed‐wave, 4‐MHz continuous‐wave) provided acceptably accurate velocity estimates at all tested velocities independent of the angle of insonation. All duplex Doppler instruments with linear‐array transducers (Philips P700, 5.0‐MHz; Hewlett‐Packard Sonos 1000, 7.5‐MHz; ATL Ultramark 9 HDI, 7 5‐MHz) exhibited a consistent overestimation of the true flow velocity due to mcreasing intrinsic spectral broadening with increasing angle of insonation. At an angle of insonation of 60 degrees the peak of the Doppler spectrum overestimated the true flow velocity by 25% and at 70 degrees, by 33%. The most likely explanation of this phenomenon is the wide aperture of these probes, with potential angle diversity of the reflected ultrasound beams along the surface area (footprint) of the probe. The use of an Intensity‐weighted peak velocity (centroid), with calculation of the velocity which includes 95% of the spectral points, rather than the absolute peak of the spectrum, proved to be more accurate and was angle Independent in these Instruments.
Progressive Multifocal Leukoencephalopathy Presenting as Multiple Enhancing Lesions on MRI: Case Report and Literature Review
Authors: Newton Herbert B , Makley Michael , Makley Michael , Li Jiashun
Published: February 2016

This report describes an immunocompetent patient with memory loss and motor abnormalities whose magnetic resonance images demonstrated multiple enhancing white matter lesions, including one that was cystic, suggestive of metastatic tumors or abscesses. Neuropathological evaluation at biopsy and subsequent autopsy revealed progressive multifocalleukoencephalopathy. Magnetic resonance evidence of enhancement and cystic changes are rare findings in progressive multifocal leukoencephalopathy, but should be considered in the differential diagnosis, especially in patients without evidence for primary malignancy or infection.
Gray‐to‐White Matter Ratios of HMPAO in the Human Brain
Authors: Burke George , Smith Joseph , Eubig Casimir , Corley James
Published: February 2016

The gray‐to‐white matter ratio of technetium 99m‐hexamethylpropyleneamine oxime (99mTc‐HMPAO) in 14 anesthetized patients undergoing partial brain resection for treatment of complex partial seizures. The gray‐to‐wh1te matter ratio of 99mTc‐HMPAO was 1.8: 1 (standard deviation 0.6) in the temporal lobe. Many of the biopsied specimens demonstrated histopathological abnormalities.
Transcranial Color‐Coded Real‐Time Sonography of Intracranial Veins
Authors: Becker Georg , Bogdahn Ulrich , Gehlberg Claus , hlich Thomas Frö , Hofmann Erich , Schlief M. D. Reinhard
Published: February 2016

Sonographic findings in patients with superior sagittal sinus thrombosis were compared to those in healthy adults. Two patients with angiographically venf1ed superior sagittal sinus thrombosis were exam1ned by transcranial color‐coded real‐time sonography (TCCS) after mtravenous application of a pulmonary stable ultrasound contrast agent For comparison, 10 patients without venous pathology had contrast‐enhanced TCCS; in addition, 30 healthy adults had plain TCCS to determme the identification rate for deep and superficial venous segments and to define normal values of venous blood flow velocities. The straight sinus was identified in 22 of 30 healthy subjects by plain TCCS, and in 9 of 10 pat1ents by contrast‐enhanced TCCS. The mean peak and angle‐corrected blood flow velocity was 19.1 ± 7.1 em/sec. The super1or and inferior sagittal sinuses were identified by contrast‐enhanced TCCS in 2 and 1 subjects, respectively; they were never seen on pla1n TCCS. In the 2 patients with sagittal smus thrombosis a distinct increase of blood flow velocity was recorded from the stra1ght sinus (83 and 92 em/sec), most likely reflecting collateral circulation. These preliminary data mdicate that TCCS and particularly contrast‐enhanced TCCS permit identification and blood flow measurements within the deep and occasionally, the superficial venous system. TCCS may contribute to an assessment of hemodynamic repercussions of venous thrombosis and may indicate the risk of venous infarction and hemorrhage.
Color‐coded Ultrasound Diagnosis of Vascular Occlusion in Acute Ischemic Stroke
Authors: Martin P. J. , Pye I. F. , Abbott R. J. , Naylor A. R.
Published: February 2016

A combination of extracranial and transcranial color‐coded sonography was used to identify the patterns of vascular occlusion in 47 patients with acute ischemic stroke. Total anterior circulation infarction (n = 20) was associated with internal carotid artery (ICA) or middle cerebral artery (MCA) occlusion (n = 8 and 9, respectively), or with significant reduction in ipsilateral MCA velocities (n = 5) Patients with partial anterior circulation (n = 22) infarction had patency of the ipsilateral ICA and MCA. In this group, significant reduction of ipsilateral MCA velocities (n = 7) was associated with more extensive infarcts on conventional neuroimaging (n = 6), suggesting multiple MCA branch occlusions. Ultrasound imagmg was unable to identify underlying vascular pathology in patients with postenor circulation infarction or with lacunar infarction (n = 5). An ultrasound‐based approach enables noninvasive identification of major vascular pathology of the anterior cerebral circulation in patients with acute cerebral infarction. It may be useful for the rapid identification of patients most and those least likely to benefit from acute intervention, and for monitoring their response.
Automatic Magnetic Resonance Tissue Characterization for Three‐Dimensional Magnetic Resonance Imaging of the Brain
Authors: Phillips W. Eugene , Phuphanich S. , Velthuizen Robert P. , Silbiger Martin L.
Published: February 2016

Computer‐assisted diagnostic systems enhance the mformation available from magnetic resonance imaging. Segmentations are the basis on which three‐dimensional volume renderings are made. The application of a raw data‐based, operator‐Independent (automatic), magnetic resonance segmentation technique for tissue differentiation is demonstrated. Segmentation images of vasogenic edema with gross and histopathological correlation are presented for demonstration of the technique. A pixel was classified mto a tissue class based on a feature vector using unsupervised fuzzy clustering techniques as the pattern recognition method. Correlation of fuzzy segmentations and gross and histopathology were successfully performed. Based on the results of neuropathological correlation, the application of fuzzy magnetic resonance image segmentation to a patient with a brain tumor and extensive edema represents a viable technique for automatically displaying clinically Important tissue differentiation. With this pattern recognition technique, it is possible to generate automatic segmentation images that display diagnostically relevant neuroanatomical and neuropathological tissue contrast information from raw magnetic resonance data for use in three‐dimensional volume reconstructions.
Kinetics of Elimination and Acute Consequences of Cerebral Air Embolism
Authors: Annane Djillali , Troché Gilles , Delisle Françoise , Devauchelle Patrick , Hassine Daniel , Paraire Françoise , Raphaël Jean Claude , Gajdos Philippe
Published: February 2016

The pathophysiology of arterial air embolism inducing brain injuries remains unclear. Previous experiments demonstrated the usefulness of computed tomography (CT) in the detection of air emboli in canine brain. This canine study investigates CT's ability to detect small air bubbles and to determine the kinetics of air elimination from cerebral arteries and it's relationship with clinical, electroencephalographic (EEG), and histological manifestations. CT detects small air embolism, and intracerebral air volume strongly correlates with injected air dose (r2 = 0.86, p = 2 × 10 3) Air clearance time significantly depends on intracerebral air volume (r2 = 0.86, p = 0 04) and on the number of bubbles (r2 = 0.71, p = 0 03), whereas half–life of air elimination does not. No relationship was found between injected air dose, air clearance time, intracerebral volume of air, and clinical, EEG, and histological findings. The data indicate that CT accurately detects small air bubbles in the early course of cerebral air embolism, that air elimination from cerebral arteries follows a first–order compartment model, and that early CT findings do not correlate with clinical, EEG, and histological manifestations.
Cervical (C2) Herpes Zoster Infection Followed by Pontine Infarction
Authors: Patrick James T. , Russell Eric , Meyer Joel , Biller Jose , Saver Jeffrey L.
Published: February 2016

This article reports a man who had herpes varicella zoster cervicalis with delayed stroke in the posterior circulation. Empiric trea tment was acyclovir, methylprednisolone, and aspirin. Pontine infarction involving migration of the virus via cerv icovasc ular innervation from C2 dorsal root ganglia to the vertebrobasilar circulation with attendant ang iitis/angiopathy and thrombosis is proposed.
Changes in Cerebral Blood Flow as Monitored by Transcranial Doppler During Voluntary Hyperventilation and Their Effect on the Electroencephalogram
Authors: Duarte J. , Markus H. , Harrison M. J. G.
Published: February 2016

Hyperventilation results in a fall 1n carbon dioxide concentration, a fall in cerebral blood flow, and slowing of activity on the electroencephalogram. The temporal relationship and duration of these responses are uncertain, and were investigated using Simultaneous monitoring of cerebral blood flow velocity and of the electroencephalograph, with end‐tidal carbon dioxide monitoring. Sixteen patients and 9 normal volunteers were studied. Cerebral blood flow velocity in the middle cerebral artery was measured using transer anial Doppler sonography during 3 minutes of hyperventilation and during a 3‐minute recovery penod Electroencephalographic recordings were rated by both visual score and measurement of the dominant posterior frequency. End‐tidal expired carbon dioxide tension was monitored during the same hyperventilation protocol in the volunteers. Flow velocity fell rapidly during act1ve hyperventilation. Electroencephalographic slowing closely correlated with the decrease in flow velocity (r = 0.86), but lagged behind t. In healthy volunteers capnographic records showed a very tight coupling between end‐tidal carbon dioxide concentration and flow velocity (r = 0.94). Three mmutes after hyperventilation, carbon dioxide concentration, cerebral blood flow velocity, and electroencephalographic activity were still not back to the resting state. The fall in both cerebral blood flow velocity and carbon dioxide concentration are related to but precede electroencephalographic slowing. The abnormalities persist for at least 3 minutes after hyperventilation and this must be taken into account in clinical electroencephalography. Transcranial Doppler sonography is well suited to monitoring short‐term changes in the cerebral circulation.
Basal Ganglia and Frontal Lobe Glucose Metabolism
Authors: Goldman Serge , Dethy Sophie , Lotstra Françoise , Biver Françoise , Stanus Etienne , Wikler David , Hildebrand J. , Mendlewicz Julien , Luxen André
Published: February 2016

Positron emission tomography (PET) with 18F‐fluoro‐2‐deoxy‐Dglucose (FDG) is frequently used to study the metabolic correlates of movement and mental disorders. These studies generally focus on changes in the frontal cortex and the basal ganglia. The reproducibility of glucose metabolism estimates in these structures was tested in 13 normal subjects studied at rest usmg a standard and simple protocol. A reproducible dorsoventral metabolic gradient was demonstrated in the frontal cortex. Such a grad1ent was not present in the basal ganglia when the upper region of interest in the caudate nucleus, where the lower metabolic rate of glucose was probably attnbutable to partial volume effects, was not considered. Absolute values of glucose metabolic rates varied by 6.4 to 12.5% m the frontal cortex and by 6.8 to 14.7% in the basal ganglia. Vamtions in normalized values in the basal gangl1a ranged from 4.0 to 8.6%. The number of subjects required to detect statistical differences in group companson or in test‐retest studies was calculated for different anticipated levels of change. With the variability detected in this expenment, less than 10 subjects were expected to be sufficient to detect a 15% change in most regions and in both types of studies.