bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment of Extracranial Carotid Artery Pseudoaneurysms with Stent Grafts: Case Series
Authors: Gupta Rishi , Thomas Ajith J. , Masih Amit , Horowitz Michael B.
Published: October 2009

BACKGROUND AND PURPOSE

Extracranial carotid artery pseudoaneurysms are a rare entity with a poorly defined natural history. Treatment has been limited to open surgical repair and limited experience with endovascular repair. We review our experience with the use of stent grafts to treat this disease entity.

METHOD

We retrospectively reviewed the interventional databases of two university hospitals (Michigan State University and University of Pittsburgh Medical Center) between 2004 and 2006 to identify patients with carotid pseudoaneurysms that were treated with stent grafts. A total of five patients were identified.

RESULTS

Of the five patients treated, four presented with acute bleeding secondary to carcinomatous invasion of the carotid artery, while one presented with thromboembolic events. Four of the five were successfully occluded with stent grafts. The one patient in whom the bleeding could not be stopped with the stent graft expired due to cardiac arrest. There were no peri‐procedural complications noted as a result of stent graft placement.

CONCLUSIONS

Stent grafts can be utilized to treat pseudoaneurysms safely, but may not always stop active extravasation as an isolated therapy. Long‐term data is required to determine the durability of the treatment.
Magnetic Resonance Imaging Traits in Siblings Discordant for Alzheimer Disease
Authors: Cuenco Karen T. , Green Robert C. , Zhang J. , Lunetta Kathryn , Erlich Porat M. , Cupples L. Adrienne , Farrer Lindsay A. , DeCarli Charles ,   for the MIRAGE Study Group
Published: October 2009

BACKGROUND

Magnetic resonance imaging (MRI) can aid clinical assessment of brain changes potentially correlated with Alzheimer disease (AD). MRI traits may improve our ability to identify genes associated with AD‐outcomes. We evaluated semi‐quantitative MRI measures as endophenotypes for genetic studies by assessing their association with AD in families from the Multi‐Institutional Research in Alzheimer Genetic Epidemiology (MIRAGE) Study.

METHODS

Discordant siblings from multiple ethnicities were ascertained through a single affected proband. Semi‐quantitative MRI measures were obtained for each individual. The association between continuous/ordinal MRI traits and AD were analyzed using generalized estimating equations. Medical history and Apolipoprotein E (APOE)ɛ4 status were evaluated as potential confounders.

RESULTS

Comparisons of 214 affected and 234 unaffected subjects from 229 sibships revealed that general cerebral atrophy, white matter hyperintensities (WMH), and mediotemporal atrophy differed significantly between groups (each at P < .0001) and varied by ethnicity. Age at MRI and duration of AD confounded all associations between AD and MRI traits. Among unaffected sibs, the presence of at least one APOEɛ4 allele and MRI infarction was associated with more WMH after adjusting for age at MRI.

CONCLUSION

The strong association between MRI traits and AD suggests that MRI traits may be informative endophenotypes for basic and clinical studies of AD. In particular, WMH may be a marker of vascular disease that contributes to AD pathogenesis.
MRI Shows Dorsal Lesions and Spinal Cord Atrophy in Chronic Sensory Neuronopathies
Authors: França Marcondes C. , D'Abreu Anelyssa , Zanardi Verônica A. , Faria Andréia V. , Lopes‐Cendes Iscia , Nucci Anamarli , Cendes Fernando
Published: October 2009

BACKGROUND AND PURPOSE

Sensory neuronopathies (SN) represent a specific subgroup of peripheral nervous system diseases, characterized by degeneration of dorsal root ganglia (DRG) and its projections. We tried to estimate the frequency and extent of spinal cord MRI abnormalities in a group of patients with SN and correlate these with clinical and neurophysiological features.

METHODS

We performed spinal cord MRI scans in 16 chronic SN patients. Images were analyzed for the presence of posterior hyperintense lesions on T2WI and cord areas at C3 level were obtained using a previously validated method. A group of 14 healthy controls with similar age and gender distribution was used for comparison. ANOVA was employed for statistical analysis.

RESULTS

Posterior T2WI lesions were found in 13 out of 16 patients. Cord areas were significantly smaller in SN patients than controls (84.3 × 97.2 mm2, P < .05). Atrophy correlated with severity of sensory ataxia and neurophysiologic abnormalities but not with duration of disease.

CONCLUSIONS

These findings support volumetric spinal cord MRI as a useful tool in the assessment of chronic SN.
Endovascular Trapping of a Vertebral Artery Segment to Control PICA Origin Tearing
Authors: Nguyen Thanh N. , Roy Daniel , Guilbert Francois , Raymond Jean , Weill Alain
Published: October 2009

Iatrogenic perforation or rupture during aneurysm coiling can be difficult to manage and may lead to fatal bleeding. We describe a lifesaving technique of isolating the subarachnoid segment of the vertebral artery using two balloons to trap flow to a ruptured PICA aneurysm allowing time to coil the parent artery with the aneurysm.

CASE

A 58‐year‐old woman presented with Hunt Hess Grade 3 subarachnoid hemorrhage due to a 3 mm left PICA aneurysm. During placement of the first coil, aneurysm perforation was noted. Despite conventional measures to manage the perforation (anticoagulation reversal, balloon inflation, placement of a second coil, and ventricular drain), contrast extravasation persisted after 45 minutes. A second balloon was positioned via the right vertebral artery at the right vertebrobasilar junction and inflated. The first balloon was pulled back, inflated, allowing trapping of the ruptured site. The aneurysm and adjacent vertebral segment were rapidly coiled to occlude the ruptured site under local flow arrest. The patient awoke with dysarthria, left‐sided hemiparesis and dysphagia.

CONCLUSION

Trapping an arterial segment with two balloons may help in the management of PICA origin aneurysm perforation refractory to medical and current endovascular strategies. This technique, while potentially lifesaving, may engender ischemic complications.
Worsened MRI Findings During the Early Period of Treatment with Penicillin in a Patient with General Paresis
Authors: Zhang She‐Qing , Wan Bo , Ma Xiao‐Long , Zheng Hui‐Min
Published: October 2009

A 52‐year‐old man was diagnosed with general paresis, whose HIV antibodies were negative. After initiation of treatment with penicillin on the first day, no obvious clinical Jarisch‐Herxheimer reaction was found. However, 6 days after treatment, the patient was found more irritable and was unable to fall asleep at night. On the seventh day, worsened magnetic resonance imaging (MRI) abnormalities in the bilateral medial and anterior temporal lobes were unexpectedly discovered. These worsened MRI abnormalities improved quickly after the addition of dexamethasone treatment. We consider that these transient and slight mental symptoms may be associated with the transiently worsening phenomenon in cerebral MRI findings during the early period of treatment with penicillin. This indicates that some nonspecific inflammatory process has happened in the early stage of treatment, which necessitates the use of corticosteroids after the occurrence of systemic or mental symptoms.
Proton Magnetic Resonance Spectroscopy in School‐Aged Autistic Children
Authors: Vasconcelos Marcio Moacyr , Brito Adriana Rocha , Domingues Romeu Cortes , Da Cruz Luiz Celso Hygino , Gasparetto Emerson L. , Werner Jairo , Gonçalves João Pedro Sevalho
Published: October 2009

PURPOSE

This study aims to assess cerebral metabolites in school‐aged autistic patients through proton magnetic resonance spectroscopy.

METHODS

This case‐control study included 10 right‐handed male children (median age, 9.53 years ± 1.80) with autism according to DSM‐IV criteria, and 10 healthy age‐ and sex‐matched healthy controls (median age, 8.52 years ± 1.42). Imaging was performed on a 1.5‐T scanner utilizing a single voxel point‐resolved spectroscopy (PRESS) technique (TR = 1,500 ms, TE = 30 ms). Four cerebral areas were evaluated: bilateral anterior cingulate, left striatum, left cerebellar hemisphere, and left frontal lobe. Peak areas and ratios to creatine (Cr) of N‐acetylaspartate (NAA), choline (Cho), andmyo‐inositol (mI) were analyzed.

RESULTS

Compared with controls, autistic children showed a significant increase in mI (P= .021) and Cho (P= .042) peak areas in anterior cingulate and in mI/Cr ratio in anterior cingulate (P= .037) and left striatum (P= .035). The remaining metabolites and ratios were not significantly different between the 2 groups.

CONCLUSIONS

This study found a statistically significant increase in myo‐inositol and choline in anterior cingulate and left striatum of autistic children compared with controls. In contrast to previous studies, NAA peak area and NAA/Cr and NAA/Cho ratios had no statistically significant decrease in any of the 4brain regions.
Recovery of Reversed Basilar Artery Flow as Seen by Transcranial Sonography and MRA Source Images for Vertebral Dissection
Authors: Lee Sung Ik , Yang Hyun Duk , Son Il Hong , Han Sun Jung
Published: October 2009

The dissection of the intracranial vertebral artery (VAD) is a common cause of young age brain stem stroke. VAD can be detected by conventional angiography, but there is yet no agreement on the most effective tool to use for the detection of VAD. Here, we report a patient with VAD, who was diagnosed with an intimal flap within the left vertebral artery by the magnetic resonance angiography (MRA) source images. Transcranial Doppler (TCD) showed a reversed flow in the basilar artery. After 4 months, TCD and transcranial color‐coded Doppler (TCCD) confirmed a normal anterograde flow of the vertebro‐basilar arteries.
The Value of Diffusion‐Weighted Imaging in the Diagnosis of Marchiafava‐Bignami Disease: Apropos of a Case
Authors: Aggunlu Levent , Oner Yusuf , Kocer Belgin , Akpek Sergin
Published: October 2009

Marchiafava‐Bignami disease (MBD) is characterized by demyelination and necrosis of corpus callosum encountered in chronic alcoholic patients. Etiology is the deficiency of vitamin B complex. Magnetic resonance imaging (MRI) in MBD typically reveals focal lesions of high T2 and FLAIR signal intensity in the corpus callosum. We here present a 42‐year‐old male alcoholic diagnosed as MBD on the basis of MRI and diffusion‐weighted imaging (DWI) features. The patient totally recovered following appropriate vitamin B complex replacement therapy, despite reduced diffusion in the initial setting. This case report emphasizes on the important role played by MRI and DWI in the early diagnosis and follow‐up of this potentially fatal disease.
fMRI of Optokinetic Eye Movements With and Without a Contribution of Smooth Pursuit
Authors: Schraa‐Tam Caroline K.L , Van Der Lugt Aad , Smits Marion , Frens Maarten A. , Van Broekhoven P.C.A. , Van Der Geest Josef N.
Published: October 2009

BACKGROUND AND PURPOSE

Optokinetic eye movements are elicited when tracking a moving pattern. It can be argued that a moving pattern of stripes invokes both the optokinetic and the smooth pursuit eye movement system, which may confound the observed brain activation patterns using functional magnetic resonance imaging (fMRI). A moving pattern of limited‐lifetime‐dot stimulation does not target the smooth pursuit eye movement system.

METHODS

fMRI was used to compare the cortical activity elicited by an optokinetic eye movement response evoked by a moving pattern of stripes and a moving pattern of limited lifetime dots.

RESULTS

The eye movement behavior showed that both types of stimuli evoked an adequate and similar optokinetic eye movement response, but stimulation with stripes evoked more activation in the frontal and parietal eye fields, MT/V5, and in the cerebellar area VI than stimulation with limited‐lifetime dots.

CONCLUSIONS

These brain areas are implicated in smooth pursuit eye movements. Our results suggest that indeed both the optokinetic and the smooth pursuit eye movement system are involved in tracking a moving pattern of stripes.
Simultaneous Bilateral Carotid Stenting in One Session in High‐Risk Patients
Authors: Wang Yao‐Hung , Hsieh Hong‐Jen , Lee Chung‐Wei , Chen Ya‐Fang , Jeng Jiann‐Shing , Liu Hon‐Man
Published: October 2009

The authors report their experience in treating a group of 6 high‐risk patients with severe bilateral carotid disease by carotid artery stenting in a single session. The patients were men aged 53 to 83 years. All had bilateral, synchronous, symptomatic ischemic disease. Five of the 6 patients had severe bilateral carotid stenoses due to atherosclerotic disease: the sixth had a dissecting aneurysm on one side. All were treated with self‐expandable stents: a distal protection device was used. All stenting procedures were technically successful. Stenoses averaged 84 ± 8% before the procedure and 10 ± 7% after. No procedure‐related complications occurred and no 30‐day postoperative complications were found. One patient experienced bradhycardia and hypotension for 1 day and was treated medically. After careful preparation and perioperative procedures in a selected group of patients, simultaneous bilateral carotid stenting procedures are feasible when required and appear to be relatively safe.
MR Imaging of Primary Spinal Germinoma: A Case Report and Review of the Literature
Authors: Lu Nan‐Han , Sandy  , Chen Cheng‐Yu , Chou Jung‐Mao , Kuo Tai‐Hung , Yeh Ching‐Hui
Published: October 2009

Germinomas in the central nervous system (CNS) are uncommon tumors and occur usually in the pineal or suprasellar regions. Primary spinal germinoma is extremely rare. Here we reported a rare case of an extramedullary germinoma in a young adult who presented with progressive paraparesis and retention of stool and urine. The MR image features with their differential diagnoses were discussed along with literature review of all previously reported 22 cases.
Microemboli in Aneurysmal Subarachnoid Hemorrhage
Authors: Romano Jose G. , Rabinstein Alejandro A. , Arheart Kristopher L. , Nathan Sandra , Campo‐Bustillo Iszet , Koch Sebastian , Forteza Alejandro M.
Published: October 2009

BACKGROUND AND PURPOSE

The determinants of ischemic complications in subarachnoid hemorrhage (SAH) are not well defined. The objective of this study is to evaluate the role of microemboli in SAH‐related cerebral ischemia.

METHODS

Forty patients with aneurysmal SAH were monitored with transcranial Doppler (TCD) for the presence of embolic signals (ES) and vasospasm, and followed clinically for the development of cerebral ischemic symptoms, from the time the aneurysm was secured until day 14 posthemorrhage or discharge.

RESULTS

Microembolic signals were detected in 15/40 patients, appeared at a mean of 6.7 days after hemorrhage, and were often noted bilaterally. There was a close association between ES and cerebral ischemic symptoms (P= .003), and ES were commonly present in the distribution of the vessel with ischemic symptoms. Ultrasonographic vasospasm did not correlate with ischemia and there was no relationship between microembolic signals and vasospasm.

CONCLUSIONS

In this study, ES detected in over a third of SAH victims, were associated with the development of cerebral ischemic symptoms, and were not related to vasospasm, but rather appeared to be an independent risk factor for the development of ischemic symptoms in SAH.
Cutting Balloon Angioplasty for Carotid In‐Stent Restenosis: Case Reports and Review of the Literature
Authors: Shah Qaisar A. , Georgiadis Alexandros L. , Suri M. Fareed K. , Rodriguez Gustavo J. , Qureshi Adnan I.
Published: October 2009

Percutaneous stenting techniques are becoming more commonly used for treatment of carotid artery disease. One outcome of particular concern is in‐stent restenosis. Indications for treatment of in‐stent restenosis are not clearly defined. Use of traditional balloon angioplasty with or without stent placement is still considered the first option. Cutting balloon angioplasty has recently been used as an alternative treatment option for revascularization of in‐stent restenosis with higher procedural success rates and without the use of additional stents. We report our experience with cutting balloon angioplasty in treating 2 patients with carotid in‐stent restonosis, and review previous cases reported in the literature. A total of 16 patients have been treated with cutting balloon angioplasty. Among 11 patients for whom the clinical and angiographic information were available, 63% of patients were asymptomatic at the time of treatment, and more than 90% of patients showed either complete angiographic resolution or residual stenosis of less than 30%. Additional stent placement or angioplasty was required in only half of the patients, and 1 patient had recurrent stenosis. The review suggests that the procedure is safe and effective.
Transcranial Ultrasound of the Basal Ganglia in Sporadic Creutzfeldt‐Jakob Disease
Authors: Martin Müller , Thomas Treumann , Ekkehard Hewer , Katharina Stoeck
Published: October 2009

Creutzfeldt‐Jakob disease (CJD) is characterized by the core symptoms of rapid progressive dementia, myoclonus, and typical periodic sharp wave complexes (PSWC) on electroencephalography (EEG). In recent years, imaging techniques have become more and more important in the diagnostic process of CJD. Magnetic resonance imaging (MRI) is very characteristic and the most accurate imaging technique to be of help in diagnosing CJD. In this study, we applied transcranial color‐coded ultrasound (TCCS) in three cases of sporadic CJD. We found that all of them had in common a typical ultrasound tissue image of the lentiform nucleus, best to be described as a blurry inhomogeneous hyperechogenic signal pattern where usually the echogenicity is mostly homogeneously hypoechogenic.
Usefulness of 3‐Dimensional CT Angiograms Obtained by 64‐Section Multidetector Row CT Scanner for Dural Arteriovenous Fistula
Authors: Nakagawa Minoru , Sugiu Kenji , Tokunaga Koji , Tsuda Kohei , Imaoka Matsuhiro , Kawahara Atsushi , Fujiwara Kenjiro
Published: October 2009

The authors reported a case of a dural arteriovenous fistula (DAVF) in the left transverse‐sigmoid sinus, in which 3‐dimensional computed tomography (CT) angiograms (3D‐CTAs) by a 64‐section multidetector row CT scanner were useful for its diagnosis and treatment. The DAVF in the left transverse‐sigmoid sinus appeared on the digital subtraction angiogram. 3D‐CTAs were obtained by a 64‐section multidetector row CT scanner before an endovascular treatment. The feeders and draining veins of the DAVF were clearly demonstrated on the 3D‐CTAs, which clarified the relationship between the normal dural sinuses and DAVF. The DAVF was successfully treated with endovascular surgery, a transvenous embolization through the mastoid emissary vein, which was easily detected by using the 3D‐CTA, showing both the subcutaneous vein and calvalium. 3D‐CTAs by a 64‐section multidetector row CT scanner are useful for both diagnosis and treatment of DAVFs.
Central Nervous System Lymphoma Characterization by Diffusion‐Weighted Imaging and MR Spectroscopy
Authors: Zacharia T. Thomas , Law Meng , Naidich Thomas P. , Leeds Norman E.
Published: October 2009

PURPOSE

The characterization and differentiation of central nervous system (CNS) lymphoma has important diagnostic, therapeutic, and prognostic significance. The purpose of this study is to characterize the diffusion‐weighted imaging (DWI) and MR spectroscopic (MRS) findings in CNS lymphoma.

MATERIALS AND METHODS

Twenty consecutive patients (male [n= 12], female [n= 8]) with histopathologically proven CNS lymphoma were retrospectively evaluated during this study from July 2005 to April 2007. Patients included immunocompromised (n= 9) and immunocompetent (n= 11) individuals. MR Imaging (pretreatment n= 13), pre‐ and post‐treatment (n= 7) included DWI (n= 20) (b = 1000s/mm2) and ADC (apparent diffusion coefficient) maps of all patients. MRS was performed (n= 10) with PRESS (point‐resolved spectroscopy) sequence (multivoxel n= 8, single voxel n= 2) with a TE of 144 msec. All patients were histopathologically confirmed to have lymphoma by biopsy.

RESULTS

Areas of restricted diffusion were observed in 90 % (n= 18/20) on pretreatment scans. The diffusion restriction was variable on post‐treatment scans. Median metabolite ratios in 10 patients were Cho/Cr‐ 2.12, NAA/Cho ‐ .49, and NAA/Cr ‐ 1.64. Presence of lactate or lipid was noted in 90 % (n= 9/10). Sites of lesion location were subcortical white matter (n= 6), basal ganglia (n= 4), corpus callosum (n= 3), extra‐axial space including cavernous sinus (n= 5), cerebellum (n= 1), and lateral ventricle (n= 1).

CONCLUSION

Restricted diffusion is a consistent imaging finding in CNS lymphoma in immunocompetent patients. Spectroscopy is helpful in initial imaging diagnosis and post‐treatment surveillance. These lesions are usually paraventricular in location. MR imaging appearances differ among immunocompetent and immunosuppressed individuals in most cases.
Chronic Total Symptomatic Carotid Artery Occlusion Treated Successfully with Stenting and Angioplasty
Authors: Bhatt Archit , Majid Arshad , Kassab Mounzer , Gupta Rishi
Published: October 2009

OBJECTIVE AND IMPORTANCE

Treatment of symptomatic chronic totally occluded carotid artery has been limited to medical management. An ongoing clinical trial is examining the role of extracranial to intracranial bypass surgery in select patients with impaired cerebrovascular reserve based on PET imaging parameters. We describe a case utilizing stenting and angioplasty to treat a chronic total carotid occlusion as a potential alternative therapy.

CLINICAL PRESENTATION

A 55‐year‐old woman presented with a right hemispheric ischemic stroke in the setting due to a right internal carotid artery total occlusion.

INTERVENTION

She was treated medically with antiplatelet therapy and oral vasopressor agents. She returned with new symptoms 1 month later and was successfully treated with stenting and angioplasty. At the 9‐month follow‐up, she remains neurologically intact.

CONCLUSION

Stenting and angioplasty may be a therapeutic option in select patients with chronic total carotid occlusion. Further study is required to determine the safety profile of this treatment modality.
Combination of T2*W and FLAIR Abnormalities for the Prediction of Parenchymal Hematoma Following Thrombolytic Therapy in 100 Stroke Patients
Authors: Fiehler Jens , Siemonsen Susanne , Thomalla Goetz , Illies Till , Kucinski Thomas
Published: October 2009

INTRODUCTION

The objective of our study was to determine whether the combination of hypointense spots (“cerebral microbleeds,” CMBs) with a leukoaraiosis is associated with the risk of parenchymal hematoma (PH) after thrombolytic therapy.

PATIENTS AND METHODS

We analyzed magnetic resonance imaging (MRI) scans acquired within 6 hours after symptom onset from 100 ischemic stroke patients. Multiparametric MRI including a T2*‐weighted (T2*w) MRI and fluid attenuated inversion recovery (FLAIR) was performed before thrombolysis in all patients. Initial T2*w imaging was rated by two independent observers for the presence of CMBs smaller than 5 mm. White matter changes were evaluated using an adapted scale of Fazekas and Schmidt. PH was defined in follow‐up imaging.

FINDINGS

A PH was observed in seven per 100 patients. CMBs were detected by observer 1 in 22 and observer 2 in 20 patients. We found a very low sensitivity (0.14) for prediction of PH by the presence of CMBs. We found a concordant increase in the rate of PH when the periventricular hyperintensity in FLAIR was larger than a thin lining. Sensitivity was good‐to‐perfect (0.86 and 1.00, observers 1 and 2) and specificity was substantial (0.65 and 0.66). Using the combination of a periventricular matter lesion (PVML)>1 and the presence of CMBs did not improve the prediction of PH.

DISCUSSION

A marked periventricular hyperintensity in FLAIR imaging seems to be associated with a substantially increased risk of PH. A combination of CMBs with leukoaraiosis scores did not appear to be beneficial for prognosis.
Retrograde Back‐Coiling Technique for a Ruptured Aneurysm of a Double‐Origin Posterior Inferior Cerebellar Artery
Authors: Vora Nirav , Thomas Ajith J. , Horowitz Michael B. , Jovin Tudor
Published: October 2009

The double origin of the posterior inferior cerebellar artery (PICA) is a variant anastomosis of a residual lateral spinal artery and native intracranial PICA that has been associated with intracranial aneurysm formation. Because of this anastomosis, both origins of the PICA serve as aneurysmal‐feeding vessels. We describe a novel technique of coiling with intracranial stent assistance to treat such a lesion that has not been described previously to our review.
Cortical Laminar Necrosis Caused by Rapidly Corrected Hyponatremia
Authors: Roh Jee Hoon , Kim Ji Hyun , Oh Kyungmi , Kim Sin Gon , Park Kun‐Woo , Kim Byung‐Jo
Published: October 2009

Cortical laminar necrosis (CLN) is radiologically characterized by hyperintense cortical lesions on unenhanced T1‐weighted images. Hypoxia is the representative cause of CLN; however, the rapid correction of hyponatremia has also been suggested as another possible cause. We present a patient who developed CLN and a permanent neurologic sequel following the rapid correction of hyponatremia without hypoxic insult, and discuss the characteristics of CLN lesions in view of osmotic demyelination syndrome based on magnetic resonance (MR) image findings.
Comparative Reliability of Total Intracranial Volume Estimation Methods and the Influence of Atrophy in a Longitudinal Semantic Dementia Cohort
Authors: Pengas George , Pereira João M. S. , Williams Guy B. , Nestor Peter J.
Published: October 2009

BACKGROUND AND PURPOSE

Total intracranial volume (TIV) as a measure of premorbid brain size is often used to correct volumes of interest for interindividual differences in magnetic resonance imaging (MRI) studies. We directly compared the reliability of different TIV estimation methods to address whether such methods are influenced by brain atrophy in the neurodegenerative disease, semantic dementia.

METHODS

We contrasted several manual approaches using T1‐weighted, T2‐weighted, and proton density (PD) acquisitions with 2 automated methods (statistical parametric mapping 5 [SPM5] and FreeSurfer [FS]) in a cohort of semantic dementia subjects (n= 11) that had been imaged longitudinally.

RESULTS

Novel mid‐cranial sampling of either PD or T2‐weighted images were least susceptible to atrophy: of these, the PD method was both more precise and more user‐friendly. SPM5 also produced good results, providing automation for only a small loss in precision compared to the best manual methods. The T1 method that underestimated TIV as atrophy progressed was the least reproducible and the most labor‐intensive. Fully automated FS overestimated TIV with progressive atrophy, and the results were even worse after optimizing the transformation.

CONCLUSION

The mid‐cranial sampling of PD images achieved the best combination of precision, reliability, and user‐friendliness. SPM5 is an attractive alternative if the highest level of precision is not required.
Cranial Venous Outflow Under Lower Body Positive and Negative Pressure Conditions and Head‐Up and ‐Down Tilts
Authors: Stolz Erwin , Fox Bettina C , Hoffmann Oskar , Gerriets Tibo , Blaes Franz , Kraus Jörg , Kaps Manfred
Published: October 2009

BACKGROUND

Although there exists a large body of knowledge on the regulation of arterial cerebral hemodynamics, little is known about the cerebral venous outflow (CVO).

METHODS

In 19 healthy volunteers, the middle cerebral artery and the straight sinus were examined using transcranial Doppler sonography. Arterial and venous mean flow velocities (aFVmean, vFVmean, respectively) were registered continuously while applying lower body positive (LBPP) or negative (LBNP) pressure of 30 mmHg and performing head‐down (–20°, HDT) and ‐up (+30°, HUT) tilt manoeuvres. The arterial blood pressure was registered simultaneously with a noninvasive finger blood pressure monitor. Relative changes in parameters compared to the proceeding no‐pressure, no‐tilt baseline were used for analysis.

RESULTS

While aFVmean did not change significantly, vFVmean inc reased during LBPP by 10.5 ± 2.9% and decreased during LBNP by 15.1 ± 3.5% (mean ± standard error of mean [SEM], P < .01). HUT resulted in a decrease in vFVmean by 25.5 ± 3.3% and HDT, in an increase by 7.8 ± 3.2% (P < .01) without alteration in aFVmean. This may imply a decrease of cerebral blood volume (CBV) during LBPP and HDT and an increase during LBNP and HUT.

CONCLUSIONS

CVO cannot be neglected when studying cerebral hemodynamics because it might affect the CBV.
Empty Microcatheter Technique for the Deployment of a Self‐Expanding Stent to Treat Refractory Middle Cerebral Artery Occlusion in the Setting of Severe Proximal Tortuosity
Authors: Dabus Guilherme , Nogueira Raul G.
Published: October 2009

We report a case of an acute middle cerebral artery (M2 segment) occlusion that was refractory to intravenous tissue plasminogen activator (IV t‐PA), thrombectomy with the Merci® device, intra‐arterial infusion of urokinase and eptifibatide, and balloon angioplasty. The artery was so tortuous that over‐the‐wire stent placement failed and a salvage technique was required to place the self‐expanding stent.
Buying Time for Recanalization in Acute Stroke: Arterial Blood Infusion Beyond the Occluding Clot as a Neuroprotective Strategy
Authors: Ribó Marc , Molina Carlos , Alvarez Beatriz , Dinia Lavinia , Alvarez‐Sabin Jose , Matas Manel
Published: October 2009

BACKGROUND

Acute ischemic stroke treatment is meant to induce early reperfusion before ischemic lesion becomes definitive; unfortunately, in many cases, recanalization occurs too late. We present a case in which oxygenated blood was perfused through the occluding clot during intra‐arterial (IA) thrombolysis to anticipate reperfusion.

A 63‐year‐old woman was admitted 1 hour after acute left‐sided hemiplegia National Institutes of Health Stroke Scale (NIHSS 18). Transcranial Doppler (TCD) showed proximal right middle cerebral artery (MCA) occlusion. Systemic thrombolysis failed to recanalize MCA, so IA rescue was initiated. During the procedure, TCD recorded flow in MCA. A microcatheter was passed through the clot and 20 mL of oxygenated blood was injected over 2 minutes beyond occlusion. During blood perfusion, TCD detected nonpulsating flow in distal M2 branches. Then, tissue plasminogen activator (t‐PA) was injected directly intrathrombus; mechanic fragmentation was also attempted. No recanalization was observed, however, neurological status partially improved. The process was repeated until 6 hours after symptom onset. Only partial Thrombolysis in Cerebral Ischemia (TICI‐2a) recanalization was achieved, but physical examination revealed substantial improvement: NIHSS score of 11. Repeated TCD showed partial recanalization (9 hours) and complete recanalization (12 hours). At 24 hours, NIHSS score was 1.

CONCLUSION

Momentary reperfusion of ischemic penumbra with oxygenated blood is feasible and may allow to “buy time” until definitive reperfusion is achieved.
Various Origins of the Duplicated Middle Cerebral Artery
Authors: Tutar Nihal Uslu , Töre Hüseyin Gürkan , Kırbaş İsmail , Tarhan Nefise Çağla , Coşkun Mehmet
Published: October 2009

We describe the features of a duplicated middle cerebral artery identified by computed tomographic angiography that originates from a previously undefined origin, ie, from the petrous portion of the internal carotid artery. Recognition of this anomaly is important in patients with a possible aneurysm, which was not present in our patient.
Initial Experience in Establishing an Academic Neuroendovascular Service: Program Building, Procedural Types, and Outcomes
Authors: Qureshi Adnan I. , Janardhan Vallabh , Memon Muhammad Zeeshan , Suri M. Fareed K. , Shah Qaisar A. , Miley Jefferson T. , Puchta Amy E. , Taylor Robert A.
Published: October 2009

OBJECTIVE

To report our initial experience in setting up a neuroendovascular service in a university‐based comprehensive stroke center.

METHODS

We determined the rates of referral path, procedural type, and independently adjudicated 1‐month outcomes (actual rates) in first 150 procedures (120 patients) and subsequently compared with rates derived from pertinent clinical trials after adjustment for procedural type (predicted rates).

RESULTS

The patients were referred from the emergency department (n= 44), transferred from another hospital (n= 13), or admitted for elective procedures from the clinic (n= 63). The procedures included treatment of acute ischemic stroke (n= 12); extracranial carotid stent placement (n= 33); extracranial vertebral artery stent placement (n= 13); intracranial angioplasty and/or stent placement (n= 12); embolization for intracranial aneurysms (n= 35), arteriovenous malformations (n= 5), and tumors (n= 10); cerebral vasospasm treatment (n= 26); and others (n= 4). The technical success rate was 100% for intracranial aneurysm obliteration and extracranial carotid artery stent placement, and 95% for those undergoing intracranial or vertebral artery stent placements; and partial or complete recanalization was achieved in 72% of patients undergoing intra‐arterial thrombolysis. After adjusting for procedural type, the actual adverse event rate of 3% compared favorably with the predicted rate of 7% based on the results of clinical trials.

CONCLUSIONS

We provide estimates of procedure volumes and outcomes observed in the initial phase of setting up a neuroendovascular service with an active training program.
Selective White Matter Involvement in a Patient with Late Onset Krabbe Disease: MR, MR Spectroscopy, and Diffusion Tensor Study
Authors: Romano Andrea , De Simone Roberto , Fasoli Fabrizio , Ferrante Michele , Cipriani Valentina , Fantozzi Luigi Maria , Bozzao Alessandro
Published: October 2009

The most frequent type of Krabbe disease has an infantile onset. Unusual slowly progressive adult forms have also been described. We described a different involvement of white matter tracts where magnetic resonance signal alterations were evident in a case of a patient affected by late‐onset form of disease.
Axonal Dysfunction in the Deep White Matter in Machado‐Joseph Disease
Authors: D'Abreu Anelyssa , França Jr Marcondes , Appenzeller Simone , Lopes‐Cendes Iscia , Cendes Fernando
Published: October 2009

We evaluated spectroscopy findings at the deep white matter in Machado‐Joseph disease (MJD). We obtained brain MRI and single‐voxel proton MR spectroscopy (MRS) over the superior‐posterior region of the left hemisphere at the level of the corpus callosum in 40 patients (44.6 ± 2.3 years‐old) and 27 controls (31.4 ± 3.6 years). Four patients were excluded due to poor quality spectra. We observed a decrease in signal intensity of N‐acetylaspartate relative to creatine‐phosphocreatine signal (NAA/Cr) in MJD compared to control [1.63 ± 0.41 (1.15‐2.76) versus 1.97 ± .51 (1.50‐2.92); U test = 219.0; P < .001]. No statistical difference was observed in choline‐containing compounds relative to creatine (Cho/Cr). There was no significant correlation between NAA/Cr and clinical and genetic variables. Due to the younger age of the control group, we performed a secondary analysis in a subgroup of 15 MJD patients matched by age to 15 controls. Matching was performed blindly to MRS results and subject identification, except for age and sex. A statistically significant difference was observed in NAA/Cr ratios (U test = 44.0; P= .004), as well as Cho/Cr levels (U test = 53.0; P= .014). We conclude that the metabolic abnormalities observed in the deep white matter in MJD suggest extensive neuronal and axonal dysfunction in these patients.
Eight‐and‐a‐Half Syndrome
Authors: Sarwal Aarti , Garewal Mandeep , Sahota Sheena , Sivaraman Manjamalai
Published: October 2009

Eight‐and‐a‐half syndrome is a clinical entity comprised of one‐and‐a‐half syndrome with ipsilateral facial palsy. We report a case who presented with this constellation of findings with diffusion weighted images (DWI) and apparent diffusion coefficient (ADC) changes corresponding to the anatomical correlate in the dorsal pontine tegmentum.
Predicting the Histopathological Grade of Cerebral Gliomas Using High b value MR DW Imaging at 3‐Tesla
Authors: Alvarez‐Linera Juan , Benito‐León Julián , Escribano Jose , Rey G.
Published: October 2009

BACKGROUND

Our aim was to prospectively assess whether magnetic resonance (MR) diffusion‐weighted (DW) imaging using high b values can predict better than b value of 1,000 s/mm2 the histopathological grade of cerebral gliomas.

METHODS

Fifty‐four patients with histologically verified brain gliomas (35 high‐grade and 19 low‐grade gliomas) underwent MR DW imaging. Isotropic DW images and apparent diffusion coefficient (ADC) were obtained with b values of 1,000 and 3,000 s/mm2. Each tumor was evaluated as being hyperintense, iso‐intense or hypointense to normal, contralateral‐hemisphere white matter.

RESULTS

Most of the patients with high‐ and low‐grade gliomas showed areas of increased signal intensity on their isotropic images, obtained with a b value of 1,000 s/mm2. However, with a b value of 3,000 s/mm2 the areas of increased signal intensity were seen in 97.1% of the high‐grade gliomas, while 94.7% of the low‐grade gliomas showed no area of increased signal intensity. The mean area under the ROC curve for ADC ratio, obtained with a b value of 3,000 s/mm2, was significantly higher than that obtained with 1,000 s/mm2 (.932 vs. .856, P= .04).

CONCLUSION

High b value DW MR might be useful as a complementary tool in preoperative assessment of the histopathological grading of cerebral gliomas.
SPECT/CT Fusion Imaging in Radionuclide Cisternography for Localization of Liquor Leakage Sites
Authors: Novotny Clemens , Pötzi Christian , Asenbaum Susanne , Peloschek Philipp , Suess Erhard , Hoffmann Martha
Published: October 2009

OBJECTIVE

We report our experience with radionuclide cisternography (RC) with 111In‐diethylenthriamine penta‐acetic acid (DTPA) using a computed tomography (CT) mounted hybrid gamma camera in patients with cerebrospinal liquor leakage.

METHODS

SPECT/CT fusion imaging was performed in case of suspected tracer egress on planar or SPECT images in order to obtain a detailed correlation of the leakage site.

RESULTS

Leakage was detected in all 3 patients. Using SPECT/CT, the extradural tracer accumulation could be correlated to an anatomical structure, which had not been possible by evaluation of the scintigraphic studies alone.

CONCLUSION

Introducing SPECT/CT for radionuclide cisternography seems to be a valuable tool to facilitate the diagnosis of cerebrospinal liquor leakage.
Moyamoya Phenomenon Secondary to Intracranial Atherosclerotic Disease: Diagnosis by 3T Magnetic Resonance Imaging
Authors: Ashley, Jr William W. , Zipfel Gregory J. , Moran Christopher J. , Zheng Jie , Derdeyn Colin P.
Published: October 2009

Moyamoya phenomenon occurs in response to an occlusive vasculopathy affecting the distal internal carotid artery and its proximal branches. The nature of the occlusive vasculopathy is unknown in most patients. We present a patient in whom 3T magnetic resonance imaging was used to examine the arterial wall at the site of occlusion in a patient with unilateral moyamoya phenomenon. Signal characteristics were consistent with atherosclerotic disease. 3T magnetic resonance imaging may be useful for distinguishing the underlying etiology of moyamoya phenomenon in some patients.
Tract‐by‐Tract Morphometric and Diffusivity Analyses In Vivo of Spinocerebellar Degeneration
Authors: Terajima Kenshi , Matsuzawa Hitoshi , Shimohata Takayoshi , Akazawa Kouhei , Nishizawa Masatoyo , Nakada Tsutomu
Published: October 2009

BACKGROUND AND PURPOSE

Three‐dimensional anisotropy contrast (3DAC) based on a periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER) sequence on a 3.0T system is a new magnetic resonance imaging technique capable of providing images with significantly high anatomical resolution. The purpose of this study was to confirm whether this technique can characterize the degenerative processes in the brainstem of patients with spinocerebellar degeneration (SCD).

METHODS

3DAC images of 13 patients with multiple system atrophy with predominant cerebellar symptoms (MSA‐C) and seven International Cooperative Ataxia Rating Scale (ICARS) score‐matched patients with Machado‐Joseph disease (MJD) were created using a diffusion‐weighted PROPELLER sequence on a 3.0T system. The section of the middle pons was chosen for morphometric and diffusivity analyses.

RESULTS

The above analyses showed that atrophy and increased diffusivity of the ventral portion of the pons indicated MSA‐C, whereas atrophy and increased diffusivity of the pontine tegmentum indicated MJD. Furthermore, ICARS scores significantly correlated with both the severities of the pontine atrophy and the mean diffusivity values of the ventral pontocerebellar tracts.

CONCLUSIONS

This study demonstrated that 3DAC PROPELLER on a 3.0T system enables in vivo “tract by tract” quantitative analysis of pontine degeneration in SCD.
Imaging Cerebral Blood Flow in the Cognitively Normal Aging Brain with Arterial Spin Labeling: Implications for Imaging of Neurodegenerative Disease
Authors: Lee Charles , Lopez Oscar L. , Becker James T. , Raji Cyrus , Dai Weiying , Kuller Lewis H. , Gach H. Michael
Published: October 2009

INTRODUCTION

Arterial spin labeling (ASL) is a safe, noninvasive imaging method for evaluating cerebral blood flow (rCBF). The purpose of this article is to present ASL imaging features of 38 elderly cognitively normals (CN) with their rCBF values and an averaged profile of targeted anatomic regions rCBF values. METHODS: Thirty‐eight CN underwent MR imaging especially ASL with voxel morphometric techniques fusing the MR anatomical and ASL images to a standard reference brain (colin27). The ASL images were fused to echo planar images, which were then coregistered to high‐resolution anatomical SPGR images. rCBF was calculated per region of interest using a modified continuous arterial spin labeling (CASL) convolutional method. Anatomical regions were selected and identified by the Talairach atlas in SPM2.

RESULTS

We identified areas of decreased and increased perfusion (compared to the averaged rCBF of all 38 CN) corresponding to decreased and increased quantified rCBF. The most common sites for decreased perfusion were precuneus (53%), superior temporal (48%), and orbitofrontal (37%), and for increased perfusion the caudate (39%), posterior cingulate (34%), anterior cingulate (32%), and amygdala (32%).

CONCLUSION

There are regional variations in rCBF both increased and decreased with the posterior cingulate and precuneus cortex showing the highest averaged values and signal intensity (bright spots). These variations represent the normal profile of a CN elderly brain, with higher perfusion in areas associated with cognition, memory, and behavior. It is necessary to understand these normal variations in order to determine if there are perfusion changes in ASL detected in neurodegenerative disorders such as Alzheimer's disease.
Intravascular Ultrasound of Symptomatic Intracranial Stenosis Demonstrates Atherosclerotic Plaque with Intraplaque Hemorrhage: A Case Report
Authors: Meyers Philip M. , Schumacher H. Christian , Gray William A. , Fifi Johanna , Gaudet John G. , Heyer Eric J. , Chong Ji Y.
Published: October 2009

BACKGROUND

Intracranial artery stenosis is assumed to represent atherosclerotic plaque. Catheter cerebral arteriography shows that intracranial stenosis may progress, regress, or remain unchanged. It is counterintuitive that atherosclerotic plaque should spontaneously regress, raising questions about the composition of intracranial stenoses. Little is known about this disease entity in vivo. We provide the first demonstration of in vivo atherosclerotic plaque with intraplaque hemorrhage using intravascular ultrasound (IVUS).

CASE DESCRIPTION

A 35‐year‐old man with multiple vascular risk factors presented with recurrent stroke failing medical therapy. Imaging demonstrated left internal carotid artery occlusion, severe intracranial right internal carotid artery stenosis, and cerebral perfusion failure. Cerebral arteriography with IVUS confirmed 85% stenosis of the petrous right carotid artery due to atherosclerotic plaque with intraplaque hemorrhage. Intracranial stent‐supported angioplasty was performed with IRB approval. The patient recovered without complication.

CONCLUSIONS

This case supports the premise that symptomatic intracranial stenosis can be caused by atherosclerotic plaque complicated by intraplaque hemorrhage similar to coronary artery plaque. IVUS provides additional characteristics that define intracranial atherosclerosis and high‐risk features. To our knowledge, this is the first report of stroke due to unstable atherosclerotic plaque with intraplaque hemorrhage in vivo.
Pathological Laughing As a Manifestation in a Clinically Isolated Brainstem Syndrome: A Case Report
Authors: Kocer Belgin , Oner Yusuf , Batur Hale , Nazliel Bijen , Cengiz Bulent , Tali Turgut
Published: October 2009

The prevalence of pathological laughing and crying in multiple sclerosis (MS) is 10%. It has been speculated that the anatomical lesion responsible for the pathological laughing is located in the pontine base, prefrontal cortex, and cerebellum. We report an 18‐year‐old male patient presenting with pathological laughing and hypomania. In his neurological examination, he had a euphoric effect with ataxic walking and dysarthria speech. He had a bilateral conjugated gaze limitation, with a prominent bilateral horizontal nystagmus on left gaze, dysmetria, dysdiadokokinesia, and remarkable dysfunction in a heel‐to‐shin test on the left. The IgG index in cerebrospinal fluid was normal with an oligoclonal band was present. In cranial MRI, there was a lesion on central pons which was hypointense in T1 images with contrast enhancement and hyperintense in T2 and flair images. Also another lesion in right brachium pontis which did not contrast enhancement but was hyperintense on T2 and flair images was present. There was an elevation of myoinositol/creatine ratio and choline and a reduction of NAA in proton MR spectroscopy. MR spectroscopic evaluation of the patient demonstrated the demyelination process. There has been no report of patients in whom pathological laughter was the presenting symptom of clinically isolated brainstem syndrome.
Neurological Improvement Associated with Resolution of Irradiation‐Induced Myelopathy: Serial Magnetic Resonance Imaging and Positron Emission Tomography Findings
Authors: Uchida Kenzo , Nakajima Hideaki , Takamura Takaharu , Kobayashi Shigeru , Tsuchida Tatsuro , Okazawa Hidehiko , Baba Hisatoshi
Published: October 2009

We document serial magnetic resonance imaging (MRI) and [18F] 2‐fluoro‐2‐deoxyglucose (FDG)‐positron emission tomography (PET) findings in the process of improvement from delayed radiation necrosis of the spinal cord. A 61‐year‐old woman underwent radiotherapy for an oral carcinoma. Forty‐six months later she developed a left‐sided Brown‐Séquard syndrome, suggesting incomplete cervical cord transection below the cervico‐thoracic junction. Two months after starting steroid therapy, she had gradual clinical improvement, which continues 8 years after the termination of radiotherapy. Neurological improvement was associated with gradual resolution of an extensive high‐intensity area within the cervico‐thoracic spinal cord on MRI. Initially, the FDG‐PET showed linear and uniform increase in FDG uptake throughout the cervical spinal cord with standardized uptake value of 2.68 ± 0.16 (mean ± SD), but it returned to normal value (1.90 ± 0.14) at final follow‐up. Considering that the normalization of FDG uptake correlated with neurological recovery, the uniform‐ and diffuse‐increased FDG uptake noted in the initial course of myelopathy could reflect the metabolic activity of the compromised spinal cord.