bluuebunny/crossref_metadata_2025 huggingface dataset:
Ultrasonography for Diagnosis and Management of Carotid Artery Atherosclerosis; A Position Paper of the American Society of Neuroimaging
Authors: Weinberger Jesse , Tegeler Charles H , McKinney William M , Wechsler Lawrence R , Toole James
Published: February 2016

The importance of identifying patients with carotid artery stenoSIS has attained greater significance in light of recent treatment tnals of the efficacy of medical and surgical treatment of both symptomatic and asymptomatic carotid stenosis. Doppler and B‐mode ultrasonography can accurately diagnose and quantify stenosis at the cervical carotid artery bifurcation. The development of duplex color‐flow instruments has enhanced the sensitivity and specificity of this examination. Ultrasonography should be employed as an mitial examination to identify patients with carotid artery stenosis and determine whether further evaluation or treatment is necessary.
Unusual Lytic Intraosseous Meningioma
Authors: Levin Mark , Wertheim Shelley E. , Klein Edward , Klein Edward
Published: February 2016

Lytic intraosseous meningiomas are rare This unusual case presented a diagnostic and treatment challenge.
SPECT Functional Brain Imaging; Technical Considerations
Authors: Devous Michael D.
Published: February 2016

The technical aspects of functional brain single‐photon emission computed tomography (SPECT) imaging, referring primarily to the most common SPECT brain function measure‐regional cerebral blood flow‐are reviewed. SPECT images of regional cerebral blood flow are mfluenced by a number of factors unrelated to pathology, including tomographic quality, radiopharmaceuticals, environmental conditions at the t1me of rad1otracer administration, charactenst1cs of the subject (e.g., age, sex), image presentation, and image processing techniques. Modern SPECT scans yield excellent image quality, and instrumentation continues to improve. The armamentarium of regional cerebral blood flow and receptor radiopharmaceuticals 1s rapidly expanding. Standards regarding the environment for patient imaging and image presentation are emerg1ng. However, there 1s still much to learn about the circumstances for performance and evaluation of SPECT functional brain imaging. Challenge tests, primarily established in cerebrovascular disease (i.e , the acetazolamide test), offer great promise in defining the extent and nature of disease, as well as predicting therapeutic responses. Clearly, SPECT brain imaging is a powerful clinical and research tool. However, SPECT will only achieve its full potential in the management of patients with cerebral pathology through close cooperation among members of the nuclear medicine, neurology, psychiatry, neurosurgery, and internal medicine specialties.
Viral Infections of the Brain
Authors: Masdeu Joseph C. , Heertum Ronald L. Van , Dayem Hussein Abdei
Published: February 2016

Brain infections are generally well visualized by contrastenhanced computed tomography or magnetic resonance imaging. However, these modalities are often unrevealing in the encephalopathy produced by the human immunodeficiency virus and in the early stages of herpes simplex encephalitis. Several studies have documented the greater sensitivity of perfusion single‐photon emission computed tomography (SPECT) in human immunodeficiency virus encephalopathy. In herpes simplex encephalitis, a few case reports have documented that SPECT may depict increased perfusion m the characteristically involved temporal and other l1mb1c structures when computed tomography and magnetic resonance imaging are normal.
Clinical Experience and Perspectives with Echo Enhanced Transcranial Doppler and Duplex Imaging
Authors: Ries Femand
Published: February 2016

The skull, which represents a highly effective bone barrier, challenges both technical quality and clinical interpretation of transcranial ultrasonographic neuroimages, as no other specialty in ultrasonography experiences an average loss between 80% and 100% of emitted ultrasound energy.
Scientific Session I: Embolus Detection
Authors: Siebler M. , Sitzer M. , Rose G. , Steinmetz H.
Published: February 2016

Previo!ls work has shown that cerebral microemholism detected with transcranial Doppler sonography distal to internal carotid artery (ICA) stenosis occurs more frequent in recently symptomatic compared to asymptomatic patients. It has remained unclear whether cerebral microemholism also indicates a higher risk of future cerebral retinal ischemia.
Scientific Session II: Neuropediatric Ultrasound and Long‐Term Transcranial Doppler Monitoring
Authors: E Michel , S Hillebrand , J vonTwickel , G Jorch , B Zernikow
Published: February 2016

The non‐linear relationship between instantaneous arterial blood pressure (BP) and cerebral blood flow velocity (CBFv) is well explained by the concept of critical closing pressure (CCP). Aim. Are there any links between cerebrovascular impedance and CCP7 Methods. In 10 preterm neonates (ga 25–32 wks; bw 685–1730 g; age 1–7 d) we Doppler traced CBFv (a. carotis int.). BP was traced simultaneously (aa. rad/umb/temp.). The time series of instantaneous CBFv and BP (sample rate was 50 Hz) were subjected to Fast Fourier Transform. Cerebrovascular impedance was calculated as the square root of the ratio of the corresponding peaks in the power spectra of BP and CBFv at zero frequency, and at heart rate (H) and harmonics (xH). Peaks with a signal/noise ratio worse than 5 db were rejected. Impedance was normalized to impedance at zero frequency (1O). Results. Spectral peaks could be distinguished at least up to 3H, and in some patients up to 11 H. Uniformly, the impedance between H and 3H (about 2 to 6 Hz) was 5‐fold reduced compared to 1O
Scientific Session V: Extra‐ and Intracranial Flow Imaging
Authors: KENTON A.
Published: February 2016

Power Doppler (PD) ultrasonography is a novel method of imaging which encodes the total Doppler power into colour. Advantages over conventional colour‐coded Doppler (CD) include higher signal to noise ratio, relative angle independence and absence of aliasing on the display. We undertook a d1rect companson of PD and CD
Free Communications (Section D)
Authors: D Bosone , M Zaletel , G Micieli , S Marcheselli , G Nappi
Published: February 2016

In TCD studies, the pulsatility index (PI), which is based on flow waveform analysis, are widely used for assessment of cerebral vascular resistance (CVR). However, PI is not very accurate, because it has many sources of variability and error. We propose a ratio between mean arterial pressure (MAP) and mean velocity (Vm) for an index of CVR. If we assume that the lumen of basal cerebral vessels is constant than MAPNm should be directly proportional to CVR. The aim of our study was to evaluate validity of MAPNm. For this purpose different vasodilatatory stimuli, which affected cerebral resistance and conductive vessels, were used. Hyperventilation (HV) and rebreathing (RE) change blood pCO2, which has predominantly an influence on resistance vessels. Clonidine, alfa‐adrenegic blocker, produce vasodilation on perifery. L‐arginine (L‐arg), precursor of nitro oxide, supposed to be able to induce vasodilatation of cerebral vessels. Nitroglicerinc (NTG) acts primarily on conductive vessels. Ten heathy subjects, both gender, aged from 21 to 57 years (mean 33.4+−11.9 years) participated in our study. HV and RE were performed using capnograph (Oxicap, Ohmeda) We registered end‐tidel (ET) CO2. Clonidin was administrated intramusculary at dose? L‐arg was infused at rate 5mg/kg/min for 30 minutes. NTG was applied sublingualy at dose 0.6 mg. The response of cerebral circulation was continously monitored by Multi‐dop X (OWL, Germany), usmg bitemporal probes for recording of Vm in middle cerebral artenes. Simultaneously the MAP and heart rate (HR) were sampled by pletysmographic device (Finapress. Ohmeda, USA).During RE MAP increased (p=.035), HR did not change, PI (p=.0006) and MAP/Vm (p=.0002) decreased. Dunng HV MAP decreased (p=014), HR increased (p=.048), PI (p=.0001) and MAPNm (p<0001) increased. We found good correlation between changes of PI and MAPNm (r=73, p<01) as well as between changes of MAP/Vm and ET CO2 (r=78, p<01) and moderate correlation between changes of PI and ET CO2 (r=53, p=016) After Clonidine administration MAP decreased (p<0001). HR did not change significantly,PI (p=.04) as well as MAP/Vm (p=.017) decreased. There was no correlation between PI and MAV/Vm. After L=arg infusion MAP and HR did not change, while PI (p<.001) and MAP/Vm (p<.001) decreased. No correlation between PI and MAP/Vm was found. After NTG MAP decreased (p=0.019), HR did not change as well as PI, while MAP/Vm (p=0084) mcrcased There was no correlation between PI and MAP/Vm
NON‐LINEAR APPLIED TO TCD SIGNALS
Authors: Vhegen JHR , Keunem RWM , Mum CJ
Published: February 2016

over the last two decades non‐linear analysis (Chaos theory) has become a standard tool for system analysis in many diverse fields for example hydrodynamres or the complex rhythms that are observed in physiological systems (EEG,ECG).
ACCURACY OF ULTRASOUND IN THE DETECTION OF CARPAL TUNNEL SYNDROME
Authors: Iglseder B , Zenzmaier R , Lesicky O , Fettweis R. , Ladumer G
Published: February 2016

BACKGROUND AND PURPOSE: Compression of the median nerve at the wrist is one of the most common disorders of the peripheral nerve system Histologic investigations are characterized by epi‐ and endoneural edema, proliferation of fibroblasts and perineural and neural shrinking Local pathological processes as rheumatoid arthritis, amyloidosis or ganglia are less common causes, whereas carpal tunnel syndrome is most often due to excessive use of the hands.
Coronary Artery Bypass Grafting‐Associated Ischemic Stroke; A Clinical and Neuroradiological Study
Authors: Wijdicks Eelco F. M. , Jack Clifford R.
Published: February 2016

Ischemic stroke occurring after coronary artery bypass grafting (CABG) has been attributed to various factors. Little is known about the perioperative course and radiological topography of CABG‐associated strokes. In this study the clinical and computed tomography features of 25 patients with ischemic stroke following coronary artery bypass grafting were evaluated. Four patients awakened with focal signs, and 21 developed an ischemic stroke 1 to 22 days after surgery. All 4 patients with early stroke had prolonged episodes of operative hypotension. Three of these patients had multiple subcortical and cortical infarcts. Of the 21 patients with late‐onset ischemic stroke, 19 had single‐territory infarcts (middle cerebral artery territory, N = 12; posterior cerebral artery territory, N = 4; anterior cerebral artery territory, N = 3). Two patients had multiple territory infarcts in the anterior and posterior circulation. No watershed infarcts were found in any of the 25 patients. New‐onset atrial fibrillation and location of ischemic stroke in a single vascular territory were more common in patients who had an ischemic stroke after an asymptomatic interval. Duplex sonographic findings of the carotid arteries and oculoplethysmography (OPG) were available for 13 patients. Only 1 patient had an ipsilateral carotid stenosis. Of 21 patients who underwent postoperative two‐dimensional echocardiography (with additional transesophageal echocardiography in 4), 2 had a left ventricular thrombus. These findings support the concept that post‐CABG stroke is likely embolic.
Quantitative Computed Tomography and Magnetic Resonance Imaging in Aging and Alzheimer's Disease; A Review
Authors: Smith Charles D.
Published: February 2016

In recent aging research, quantitative techniques have been used to overcome limitations of qualitative interpretation of magnetic resonance and computed tomographic imaging. The purpose of this review is to summarize imaging results emphasizing quantitative studies using these two modalities in human aging. Magnetic resonance spectroscopy is viewed as an extension of imaging, and results of in vivo spectroscopic studies are included. Because Alzheimer's disease (AD) is closely related to aging, a discussion of quantitative imaging techniques that may distinguish normal elderly from patients with AD is included.
Epidural Hematoma Producing Brown‐Sequard Syndrome: A Case Due to Ruptured Hemangioma with Magnetic Resonance Imaging Findings
Authors: Ehsan Tajammul , Henderson Jaimie M. , Manepalli Anantha N.
Published: February 2016

A man developed spontaneous spinal epidural hematoma secondary to ruptured hemangioma with a clinical picture resembling acute partial Brown‐Sequard syndrome. Diagnosis by magnetic resonance imaging (MRI) allowed prompt surgical decompression and complete reversal of the neurological deficits. The diagnosis, etiology, and MRI findings of spinal epidural hematomas are discussed.
Detection of Intracranial Internal Carotid Artery and Middle Cerebral Artery Vasospasm Following Subarachnoid Hemorrhage
Authors: Burch Christina M. , Wozniak Marcella A. , Sloan Michael A. , Rothman Michael I. , Rigamonti Daniele , Permutt Thomas , Numaguchi Yuji
Published: February 2016

Little is known about the accuracy of transcranial Doppler (TCD) sonography in detecting intracranial internal carotid artery (IICA) and middle cerebral artery (MCA) vasospasm. TCD was performed in 49 patients with subarachnoid hemorrhage to evaluate 90 IICAs and 87 MCAs during the vasospasm period. When a mean velocity of at least 90 cm/sec was used to indicate IICA vasospasm, there were 11 positive, 42 negative, 4 false‐positive, and 33 false‐negative results. Sensitivity was 25% and specificity was 93%. When a mean velocity of at least 120 cm/sec was used to indicate MCA vasospasm, there were 15 positive, 45 negative, 3 false‐positive, and 24 false‐negative results (15 operator errors). Sensitivity was 38.5% and specificity was 93.7%. When the diagnostic criterion was changed to at least 130 cm/sec, specificities were 100% (IICA) and 96% (MCA) and positive predictive values were 100% (IICA) and 87% (MCA). The authors conclude that TCD accurately detects IICA and MCA vasospasm when flow velocities are at least 130 cm/sec. However, its sensitivity may be underestimated and the importance of operator error, overestimated.
Quantified Volumes of Temporal Lobe Structures in Patients with Epilepsy
Authors: Breier Joshua I. , Leonard Christiana M. , Bauer Russell M. , Roper Steven , Lucas Timothy H. , Gilmore Robin L.
Published: February 2016

The T1‐weighted volumetric magnetic resonance images of 31 patients with intractable temporal lobe epilepsy, and 13 control subjects matched for age and sex, were subjected to semiautomated threshold analysis. The method used proved to be relatively fast and reliable. An index of temporal lobe interhemispheric asymmetry was extracted by thresholding high‐signal (white matter) pixels. Patients had significantly more asymmetrical indices for white matter and hippocampal volumes than did control subjects, and the two indices were significantly correlated, providing evidence for the validity of the white matter index. Differences in both indices were consistent with decreased tissue on the side of the focus. In classification analyses a combination of these two indices correctly predicted the side of focus at a greater rate than did either used alone. Findings provide support for the hypothesis that seizure activity is associated with atrophy in both mesial and lateral temporal lobe structures.
Computed TomographyNegative Acute Thalamic Hematoma
Authors: Nakada Tsutomu , Kwee Ingrid L.
Published: February 2016

A case of acute thalamic hematoma not detected by computed tomography (CT) but unequivocally diagnosed by magnetic resonance imaging (MRI) is presented. A 79‐year‐old woman presented with acute left hemiparesis. The results of CT obtained on admission as well as on the seventh hospital day were negative for a hematoma. By contrast, serial MRis exhibited chronological changes in the relaxation properties characteristic of acute hematoma in the thalamus . The case illustrates
Subacute Sclerosing Panencephalitis and Acquired Immunodeficiency Syndrome: Role of Electroencephalography and Magnetic Resonance Imaging
Authors: Koppel B.S. , Poon T.P , Khandji A. , Pavlakis S. G. , Pedley T. A.
Published: February 2016

Subacute sclerosing panencephalitis (SSPE) had largely disappeared from the United States because of nearly universal measles vaccination, but it has reemerged in children infected with human immunodeficiency virus (HIV) . Two children with SSPE are described . The first was HIV positive and presented with seizures and encephalopathy at the age of 21 months. The second developed myoclonus and dementia at age 4 years; she was not infected with HIV, but her mother had acquired immunodeficiency syndrom. Magnetic resonance imaging findings were nonspecific and could have been compatible with HIV encephalopathy. Electroencephalography was characteristic of SSPE, showing high‐voltage, periodic slow‐wave complexes and background slowing . The diagnosis of SSPE was confirmed by brain biopsy or high measles antibody titers in the cerebrospinal fluid.
Chagasic Granulomatous Encephalitis in Immunosuppressed Patients; Computed Tomography and Magnetic Resonance Imaging Findings
Authors: Lorenzo Guillermo A. Di , Pagano Miguel A , Taratuto Ana L , Garau Maria L , Meli Francisco J , Pomsztein Marcelo D
Published: February 2016

American trypanosomiasis (Chagas' disease), a zoonosis caused by Trypanosoma cruzi with a high incidence in Latin America, may induce an uncommon form of localized encephalitis termed “chagoma,” found in few immunocompromised patients. The computed tomography (CT) and magnetic resonance imaging (MRI) findings of brain chagoma are reported for 3 males (ages 32, 32, and 9 yr), the first 2 infected with human immunodeficiency virus (HIV) and the third with acute lymphoblastic leukemia. Diagnosis was confirmed by biopsy. CT disclosed a single, supratentorial, nodular‐shaped lesion that substantially enhanced with contrast material, localized in parietal or frontal lobes. T1‐weighted MRI showed hypointense lesions that enhanced with gadolinium‐diethylenetriaminepentaacetic acid, corresponding to extensive hyperintense areas on T2‐weighted images, producing mass effect. The imaging pattern of brain chagoma presented here is similar to that of cerebral toxoplasmosis and should be considered in the differential diagnosis of an intracerebral mass lesion in immunocompromised patients.
Functional Imaging Predicts Cognitive Decline in Alzheimer's Disease
Authors: Jagust W. J. , Haan M. N. , Eberling J. L. , Wolfe N. , Reed B. R.
Published: February 2016

Eighteen patients with Alzheimer's disease were studied with positron emission tomographic measurements of regional cerebral metabolism of glucose. All patients were initially diagnosed and evaluated, underwent positron emission tomography, and then were followed with annual reevaluations, at which time the Mini‐Mental State Examination (MMSE) was performed. Patients were followed for an average of 2.5 years, and the rate of cognitive decline was calculated by determining the rate of change in the MMSE score defined as the MMSE score at the initial evaluation minus the MMSE score at the last examination, divided by the number of months between testing. The regional cerebral metabolic rates for glucose determined at the time of the first MMSE were then regressed on these changes in scores. Results showed that glucose metabolic rates in posterior temporal and primary visual cortex regions were significantly correlated with the subsequent rate of cognitive deterioration. These associations were not confounded by age, length of follow‐up, baseline MMSE score, or education. Stratification on gender suggested that these associations were much stronger in women than in men. These results replicate previous findings showing that functional brain imaging is predictive of the rate of cognitive decline in Alzheimer's disease.
The Spectrum of Neuroimaging Abnormalities in Solvent Abuse and Their Clinical Correlation
Authors: Caldemeyer Karen S. , Armstrong Sheri W. , George Kristi K. , Moran Catherine C. , Pascuzzi Robert M.
Published: February 2016

The brain magnetic resonance (MR) images and medical records of 6 patients with a history of chronic toluene abuse were reviewed retrospectively. The imaging findings were correlated with clinical impairment. The major findings consisted of atrophy (6 patients), white matter T2 hyperintensity (6 patients), and T2 hypointensity involving the basal ganglia and thalami (5 patients). Also seen was focal enhancement, previously unreported for patients who abused toluene. This study showed a correlation between the degree of neurological impairment and extent of white matter disease. There was no correlation between the severity of white matter changes on MR images and the presence of T2 hypointensity or duration of toluene abuse. There was no definite clinical evidence of damage to the basal ganglia and thalami despite the MR imaging finding of T2 hypointensity. Temporal evidence against the theory that toluene accumulation causes the T2 hypointensity was found.
Distinctive Serial Magnetic Resonance Changes in a Young Woman with Rapidly Evolved Neurocysticercosis, with Positron Emission Tomography Results
Authors: Nagayama M. , Shinohara Y. , Nagakura K. , Izumi Y. , Takagi S.
Published: February 2016

A woman aged 21 years noticed numbness of the left hand, dysarthria, and right hemiparesis. Magnetic resonance imaging (MRI) showed homogeneously enhanced lesions in the bilateral cerebral white matter; these enlarged within 2 weeks, showing ringlike enhancement, and then spontaneously decreased in size and enhancement. Neurocysticercosis was confirmed by repeated, significantly positive serology results and the dramatic response to praziquantel. Subsequently, positron emission tomography (PET) revealed persisting regions of possibly decreased cerebral uptake of [18F]2–fluoro–2–deoxyglucose. This is the first documentation of such distinctive serial MRI changes and the results of PET in neurocysticercosis.
Dislocation of the Third Ventricle Due to Space‐Occupying Stroke Evaluated by Transcranial Duplex Sonography
Authors: Seidel, G. , Gerriets T. , Kaps, M. , Missler, U.
Published: February 2016

Transcranial color‐coded duplex sonography is a recently introduced method for visualizing (1) the blood flow velocity of the basal cerebral arteries and (2) the brain parenchyma as an acoustic impedance image. Dislocation of the third ventricle due to space‐occupying stroke is an important clinical marker. This study evaluated the dislocation of the third ventricle from the brain midline by transcranial duplex sonography in 10 healthy volunteers. The mean dislocation was 0.2 ± 0.3 mm. Eighteen stroke patients were investigated within 12 hours by both duplex sonography and computed tomography (CT) and the dislocation of the third ventricle was measured. Correlation between the two methods was high (r = 0.87, N = 27). Twelve stroke patients divided into three subgroups according to the extent of the space‐occupying effects of the lesion were followed for 3 weeks. The increase and decrease of the dislocation of the third ventricle over the time were monitored. In conclusion, transcranial duplex sonography is a reliable tool to monitor dislocation of the third ventricle due to space‐occupying stroke.
Neuroimaging Abnormalities with Hypoqlossal Nerve Palsies
Authors: Batchelor, Tracy T. , Krol, George S. , DeAngelis, Lisa M.
Published: February 2016

Seven patients with acute or chronic unilateral hypoglossal nerve lesions were evaluated by magnetic resonance imaging and computed tomography. In patients with acute to subacute tongue paralysis, the base of the ipsilateral side of the tongue appeared expanded and showed increased signal intensity on T2‐weighted images. This appearance was suggestive of an infiltrative mass lesion within the tongue. These radiographic findings are due to the pathophysiological process of nerve injury and muscle denervation.
Acute Transverse Myelitis After Influenza Vaccination: Magnetic Resonance Imaging Findings
Authors: Bakshi Rohit , Mazziotta John C.
Published: February 2016

Descriptions in the literature of magnetic resonance imaging (MRI) findings in postvaccination myelitis are scarce. Described here is a case of acute transverse myelitis that occurred after administration of an influenza vaccination. T1–weighted MRIs showed diffuse, fusiform spinal cord enlargement, extending from C–3 to rostral thoracic levels. Intramedullary lesions containing increased T2 signal were found in the areas of cord enlargement. The involvement on MRI was profound, extending far
Symmetrical Cerebral Metastasis Presenting with Bilateral Upper Extremity Weakness
Authors: Wilek Eric J. , Gerard Perry S. , Keilson Marshall , Bashevkin Michael , Lieberman Jeffery
Published: February 2016

This report describes a man with known metastatic disease who presented with bilateral upper extremity weakness. The cause was discovered to be symmetrical cerebral metastases.
Neuroimaging Findings in Rasmussen's Syndrome
Authors: Yacubian Elza M. T. , Marie Sueli K. N. , Valério Rosa M. F. , Jorge Carmen L. , Yamaga Liliam , Buchpiguel Carlos A.
Published: February 2016

Rasmussen's syndrome is a progressive childhood disease of unknown cause characterized by severe epilepsy, hemiparesis, mental deterioration, inflammation of one cerebral hemisphere, and brain atrophy. Computed tomography, single‐photon emission computed tomography (SPECT), and magnetic resonance (MR) neuroimaging findings of 8 patients with pathologically confirmed Rasmussen's syndrome were evaluated retrospectively. All patients showed a predominance of the atrophy in the temporo‐insular region and cerebral hemispheric alterations on MR images in a similar extension as seen on SPECT studies. Focal increase in regional cerebral blood flow was observed in the 4 patients presenting with epilepsia partialis continua at the time of hexamethyl‐propyleneamineoxime injection. Extensive cortical hypoperfusion was noted in the other 4 patients who received the injection during the interictal state. Cerebellar functional abnormalities were present in 6 patients, 2 of them with structural damage.
Ultrasonographic Assessment of the Prevalence of Fasciculations in Lesions of the Peripheral Nervous System
Authors: Scheel Alexander K. , Toepfer, Marcell , Kunkel, Mathias , Finkenstaedt, Michael , Reimers, Carl D.
Published: February 2016

In previous studies, ultrasonography was a very sensitive method in detecting fasciculations. The present study was intended to examine the prevalence of ultrasonographically visible fasciculations in patients with neuromuscular diseases affecting the lower extremities. Ultrasonography of 9 muscles (rectus femoris, vastus lateralis, vastus intermedius, vastus medialis, sartorius, semitendinosus, tibialis anterior, gastrocnemius, and soleus muscles) was performed bilaterally in 70 adult healthy subjects and 172 patients with various neuromuscular diseases. Fasciculations were detected in 109 (63%) of 172 patients. The median value of affected muscles was 10 (range 1–18). Patients with spinal muscular atrophy (37/38, p < 0.001), hereditary motor and sensory neuropathy (24/25, p < 0.001), and lumbosacral radiculopathy with motor deficits (24/29, p < 0.001) exhibited fasciculations more frequently than did healthy volunteers. Radiculopathy with sensory deficits, lesions of either plexus or peripheral nerves, compartment syndrome, and myopathy were not associated with a significantly enhanced prevalence of fasciculations in the patient group compared to the control group. In summary, fasciculations are a frequent ultrasonographic sign in neuromuscular diseases. They are almost regularly found in patients with spinal muscular atrophy and those with hereditary motor and sensory neuropathy. Thus, the absence of fasciculations in ultrasonographic assessment should give cause for reconsidering these diagnoses.
Clinical and Diagnostic Findings in a Patient with Creutzfeldt‐Jakob Disease (Type Heidenhain)
Authors: Staffen W. , Trinka E. , Iglseder B. , Pilz P. , Homann N. , Ladurner G.
Published: February 2016

A 61‐year‐old woman had Creutzfeldt‐Jakob disease, type Heidenhain, that progressed for 4 months until death, 3 of which she spent in a hospital. The diagnosis was verified by autopsy. Consecutive brain computed tomography, magnetic resonance imaging, blood flow measurements, electroencephalography (EEG), and routine laboratory tests were performed. All imaging techniques showed non‐specific pathological changes, whereas EEG revealed alterations indicative for Creutzfeldt‐Jakob disease.
Unusual Lateralization of Adrenoleukodystrophy Lesions on Neuroimaging
Authors: Terakaw Haruhiko , Yanagihara Takehiko , Abe Kazuo
Published: February 2016

In a 37‐year‐old man with adrenoleukodys trophy, magnetic resonance imaging showed abnormal signal intensities in the left corticospinal tract and the right cere‐bellar hemisphere. The patient had corresponding pyramidal and cerebellar signs, which might represent cerebral diaschisis.
A Longitudinal Magnetic Resonance Imaging Study of the Cervical Cord in Multiple Sclerosis
Authors: Filippi Massimo , Colombo Bruno , Rovaris Marco , Pereira Clodoaldo , Martinelli Vittorio , Comi Giancarlo
Published: February 2016

This study was performed to evaluate the correlation between changes of crosssectional cord area and disability in multiple sclerosis. Axial magnetic resonance images at the C‐5 spinal level were obtained at entry and 12 months later for 29 patients with clinically definite multiple sclerosis. The degree of disability was inversely correlated at entry and follow‐up with the crosssectional area and the transverse diameter of the spinal cord. In addition, changes in disability correlated inversely with changes in cross‐sectional area (r = ‐0.4, p = 0.04). These findings suggest that cross‐sectional cord area at C‐5 might be a useful marker of disease evolution.
Brain Hemangiomas of Infancy
Authors: Hundt C. , Auberger K. , Munch G. , Willemsen U. F. , Grantzow R. , Schneider K.
Published: February 2016

Vascular birthmarks of the skin can be associated with hemangiomas or arteriovenous malformations of different organs. Computed tomography and magnetic resonance imaging (MRI) combined with angiography are the diagnostic tools used in children, adolescents, and adults to depict vascular malformation or bleeding. In infants, ultrasound examination through the anterior fontanelle is possible. This report describes 2 mature infants with brain hemangiomas primarily detected by real‐time sonography: In both the brain lesions were associated with cutaneous and other vascular birthmarks. MRI was used to verify the brain hemangiomas. Subsequent follow‐up evaluations during therapy were easily performed by ultrasonography.
Sensitivity and Reproducibility of Fast‐FLAIR, FSE, and TGSE Sequences for the MRI Assessment of Brain Lesion Load in Multiple Sclerosis: A Preliminary Study
Authors: Rovaris Marco , Yousry Tarek , Calori Gigliola , Fesl Gunther , Voltz Raymond , Filippi Massimo
Published: February 2016

Fast fluid‐attenuated inversion recovery (fast‐FLAIR), fast spin echo (FSE), and turbo‐gradient spin echo (TGSE), new pulse sequences for magnetic resonance imaging (MRI), are able to display multiple sclerosis (MS) lesions more conspicuously (fastFLAIR) and with shorter imaging times (FSE, TGSE) than is conventional spin‐echo MRI. In this study, we scanned 7 MS patients, using fast‐FLAIR (18 axial brain slices), FSE (27 slices), and TGSE (9 slices) sequences in the same session, to compare the brain MRI lesion loads detected by these different sequences and the intraobserver reproducibility of these measurements. On the subset of slices (n = 9) covered by all three measurements, the mean lesion load was 7,577 mm3 on fast‐FLAIR, 5,248 mm3 on FSE, and 3,080 mm3 on TGSE (p = 0.006) sequences. The mean intraobserver coefficients of variation were 2. 92% for fast‐FLAIR, 2.86% for FSE, and 4.31% for TGSE (not significant). These findings demonstrate that both fast‐FLAIR and FSE sequences may be potentially useful for serial MRI studies for monitoring clinical trials, while TGSE might be useful for speeding diagnostic MRI in MS patients. Longitudinal, clinically correlated studies using these new MRI sequences are needed to confirm these preliminary data.
Diagnostic Value of Three‐Dimensional Transcranial Contrast Duplex Sonography
Authors: Delcker, Andreas , Turowski B.
Published: February 2016

This study evaluated intracranial cerebral arteries using a new data acquisition system for transcranial three‒dimensional (3D) ultrasonography with and without an echo contrast agent, with confirmation by cerebral angiography. Ten patients, studied with diagnostic cerebral angiography, were examined without knowledge of the angiographic results. Data acquisition through the transtemporal acoustic window was performed using a magnetic sensor system to track the spatial orientation of the ultrasound probe while scanning the volume of interest. A color transcranial duplex system with a power Doppler mode was used, and 3D data sets were acquired before and after the injection of transpulmonary‒stable ultrasound contrast medium. Ipsilateral to the transducer, the anterior cerebral artery (ACA) in 90%, middle cerebral artery (MCA) in 60%, all three or more branches of the MCA in 60%, posterior cerebral artery (PCA) in 60%, and posterior communicating artery (PCoA) in 60% were successfully imaged without the echo contrast agent. With the contrast agent, the ACA, MCA, three or more branches of the MCA, PCA, and PCoA were visible in 100%. The anterior communicating artery was visualized in 40% without contrast enhancement and in 90% with contrast enhancement. Contralateral to the transducer, the ACA (60%), MCA (30%), all three or more branches of the MCA (10%), PCA (20%), and PCoA (20%) were successfully imaged without contrast. Contrast enhancement improved the imaging success rate for the ACA (90%), MCA (80%), three or more branches of the MCA (80%), PCA (100%), and PCoA (100%). A transpulmonary‒stable ultrasound contrast agent used in combination with 3D transcranial duplex ultrasonography can significantly improve the success rate for transcranial color duplex imaging of intracranial arteries.
A 66‐Year‐Old Woman with a Rapidly Progressing Dementia and Basal Ganglia Involvement
Authors: Gold, Michael , Rojiani, Amyn , Murtaugh, Reed
Published: February 2016

A 66‐year‐old woman presented with a rapidly progressive dementia initially characterized by an auditory agnosia. She experienced a rapid progression of her aphasia and developed ataxia and myoclonus. An initial neurological evaluation suggested a left parieto‐temporal lesion, however, neuroimaging did not reveal any. An MRI of her brain demonstrated highly focal T2 hyperintensities in her basal ganglia. The patient was diagnosed with Creutzfeldt‐Jacob Disease (CJD) on the basis of the presence of two proteins in the CSF that are highly sensitive and specific for CJD. Pathological examination confirmed the diagnosis. The differential diagnosis and utility of MRI in patients with CJD is discussed.
An Approach to Imaging the Dizzy Patient
Authors: MacDonald C. Bruce , Melhem Elias R.
Published: February 2016

Disease of the vestibular system involves a lengthy differential diagnosis, from the relatively trivial to potentially life–threatening conditions. As a definitive specific diagnosis is often difficult to make, imaging may be used simply to “rule out” serious pathology. In this context, suboptimal imaging choices may be unnecessarily expensive and may fail to document the pathology. In contrast, an orderly investigation includes appropriate audiometric and vestibular tests, which when reviewed in the clinical context, indicate the most pertinent imaging modalities. This enables the clinician to plan a cost–effective, definitive imaging strategy. This review considers the role of imaging in an integrated approach to investigating the dizzy patient. A discussion of vestibular pathology is presented to assist in the review, and several cases are provided as examples.
Transcranial Power–Mode Duplex Ultrasound in Two Patients with Moyamoya Syndrome
Authors: Morgenstern C. , Griewing B. , Müller–Esch G. , Zeller J. A. , Kessler Ch.
Published: February 2016

Moyamoya syndrome is characterized by the reticulated collateralization of the intracranial vasculature distal to an occlusion of proximal intracranial vessels. In the present study this pathology was visualized in 2 patients, aged 29 and 32 years, using
Microemboli on Transcranial Doppler in Patients with Spontaneous Carotid Artery Dissection
Authors: Koennecke Hans-Christian , Trocio Samuel H. , Mast Henning , Mohr J. P.
Published: February 2016

High‐intensity transient signals on transcranial Doppler sonography (TCD) are associated with atherosclerotic stenosis of the internal carotid artery. Few data exist regarding the detection of high‐intensity transient signals in dissected carotid arteries. In the present study, 6 patients with spontaneous carotid dissection, defined by magnetic resonance techniques and duplex sonography, were examined by TCD. Both middle cerebral arteries were monitored simultaneously for 30 minutes. Four of the patients had ipsilateral cerebral ischemia, while 2 presented with other symptoms. High‐intensity transient signals were detected in the middle cerebral artery ipsilateral to the dissection in 3 of the 4 patients with cerebral ischemia and in none of the patients with other presenting symptoms. No microemboli were found contralateral to the dissected arteries. Microemboli can be detected distally from dissected carotid arteries. The present findings support the assumption that embolism is a major cause of stroke in patients with carotid dissection, and suggest that high‐intensity transient signals are more common among patients with cerebral ischemia secondary to dissection.
Diffusion‐Weighted Magnetic Resonance Imaging Characteristics of Hemorrhagic Transformation in Experimental Embolic Stroke
Authors: Yenari, Midori A. , Beaulieu, Christian , Steinberg, Gary K. , Moseley, Michael E.
Published: February 2016

Diffusion‐weighted magnetic resonance imaging (MRI) can detect ischemia within minutes of onset, but its ability to reliably detect hyperacute cerebral hemorrhage is unknown. The present study characterized diffusion‐weighted, T2‐weighted, and contrast‐enhanced T1‐weighted MRI appearances of hemorrhagic transformation within 5 hours of onset in experimental embolic stroke. Apparent diffusion coefficients and MRI signal characteristics were noted within corresponding regions of hemorrhage observed on gross pathology. Apparent diffusion coefficients were significantly increased within hemorrhagic lesions, but were still within the expected range for bland ischemia. The appearance of the hemorrhagic lesions on diffusion‐weighted MRI was also very heterogeneous and not very useful for clinical screening. Other MRI modalities should be investigated, but computed tomography remains the only widely available clinical method of reliably detecting cerebral hemorrhage.
Algorithm on the Clinical Evaluation of Epilepsy
Authors: Ho, Susan S. , Kuzniecky, Ruben I.
Published: February 2016

Epilepsy is an important public health problem because of its prevalence in the community and the economic disadvantage associated with its chronic morbidity. Uncontrolled seizures are potentially life‐threatening and have adverse psychosocial consequences. Surgery is an effective but underutilized therapy for some patients with medically refractory seizures. However, this form of treatment demands precise localization of the epileptogenic zone. In recent years there have been major advances in the development of various imaging techniques for seizure localization. The best combination of diagnostic testing with regard to cost‐benefit has been debated. A rational strategy for the deployment of these techniques is discussed.
Spinal Leptomeningeal Hemangioblastomatosis in von Hippel‐Lindau Disease: Magnetic Resonance and Pathological Findings
Authors: Bakshi Rohit , Mechtler Laszlo L. , Patel Malti J. , Lindsay Bret D. , Messinger Sol , Gibbons Kevin J.
Published: February 2016

A 55–year–old man with von Hippel–Lindau disease presented with quadriparesis. Muitiple enhancing cervical and thoracic spinal masses were seen on magnetic resonance imaging (MRI). A rim of diffuse, nodular enhancement linking all of the discrete masses was apparent on the surface of the cervical and thoracic regions of the cord. Surgical exploration revealed multiple extramedullary–intradural and intramedullary masses, extending to and infiltrating the cord; the leptomeninges contained numerous small tumor seeds at several levels. The excised spinal masses were diagnosed as capillary hemangioblastomas, which infiltrated the pia mater. Diffuse, intense, spinal leptomeningeal enhancement on MRI associated with multiple hemangioblastomas has not been previously reported and may be referred to as spinal “leptomeningeal hemangioblastomatosis.”
Memory Processes in Depressed Geriatric Patients With and Without Subcortical Hyperintensities on MRI
Authors: Jenkins Melissa , Malloy Paul , Salloway Stephen , Cohen Ronald , Rogg Jeffrey , Tung Glenn , Kohn Robert , Westlake Robert , Johnson Eileen Gillard , Richardson Emily
Published: February 2016

In this study, 12 patients over age 60 with depression with moderate to severe subcortical hyperintensities (SH) localized to the periventricular white matter were identified by quantitative MRI. Using the California Verbal Learning Test, they were compared with 12 age‐, education‐, and severity‐matched patients with depression with minimal white matter changes on specific aspects of memory performance. Patients with cortical lesions, neurologic or systemic illness affecting cognition, and history of substance abuse were excluded. Patients in the group with high SH showed reduced use of semantic encoding strategies (p < 0.05), reduced learning efficiency (p < 0.05), and a greater discrepancy between free recall and recognition discriminability (p < 0.05) than their low SH counterparts. This pattern of performance on memory tasks is similar to that found in previous studies to be associated with subcortical degenerative disorders such as Huntington's and Parkinson's diseases. Geriatric patients with depression with SH may represent a subgroup with greater subcortical involvement, with associated cognitive and functional decline.
Hand Gripping and Acetazolamide Effect in Normal Persons and Patients with Carotid Artery Disease
Authors: Stoll Martin , Seidel Antje , Schimrigk Klaus , Hamann Gerhard F.
Published: February 2016

Transcranial Doppler measurement (TCD) of cerebrovascular reserve (CVR) is usually performed by the C02 test, the acetazolamide test, or the breath–holding test. Since these tests are time–consuming and labor–intensive, alternative methods such as the hand–gripping test are of interest. Twenty–one normal persons and 25 patients with unilateral carotid artery disease were studied. Flow velocity changes in both middle cerebral arteries (MCAs) during bilateral hand gripping were measured by TCD and compared with acetazolamide test results. The increase in MCA mean flow velocity (FVmean) during hand gripping was 18.0 ± 6.3% in normal persons; the increases in the poststenotic MCA were 15.8 ± 9.7% in all patients and 9.4 ± 5.4% in patients with impaired CVR as determined by the acetazolamide test. Only in the group with impaired acetazolamide reactivity was the increase in the poststenotic MCA significantly lower compared to that in controls (p < 0.01 ) and to the contralateral, nonstenotic side (p < 0.01). Nevertheless the FVmean increases in both tests showed a weak, but significant correlation (r = 0.59, p < 0.01) All FVmean increases during hand gripping were significantly (p < 0.01) lower than those during the acetazolamide test. The test appears as a weaker stimulus for MCA blood flow velocity increase than the acetazolamide test. Thus, only a substantial reduction of acetazolamide reactivity leads to a reduced MCA FVmean increase using hand gripping. Although it is highly specific but less sensitive, hand gripping does not appear to be suitable as a screening measure of CVR, but might be useful in addition to standard tests.
Bilateral Anterior Inferior Cerebellar Artery Territory Infarcts
Authors: Chang H. M. , Linn H. H. , Caplan R.
Published: February 2016

lilateral anterior inferior cerebellar artery (AICA) territory infarcts are rare. Their ocurrence usually signifies severe intracranial lertebrobasilar disease. Unlike head commuted tomography, magnetic resonance (MR) imaging reveals these infarcts clearly and MR angiography allows the intracranial vasculature to be defined noninvasively. We now report a patient with bilateral AICA territory infarcts.
Basimeningeal/Spinal Axis Primitive Neuroectodermal Tumor Without Intraaxial Lesion: Radiological Features
Authors: Lazzara Elizabeth W. , Ragland Ronald L. , Smith Thomas W. , Knorr John R. , Weiner Milton A. , Kamath Sanjay V. , Lau Kam Ying
Published: February 2016

Over a 12‐year period, the authors encountered 2 patients with spinal axis/ basimeningeal primitive neuroectodermal tumor (PNET) involving the spinal axis extramedullary, intradural compartment and the basimeninges. In neither patient was an intraaxial focus demonstrated. A 48‐year‐old woman had computed tomography (CT) findings of hydrocephalus and later abnormal basimeningeal enhancement. Cervical myelography revealed a low cervical intradural block. A 10‐year‐old boy was evaluated initially with non‐contrast‐enhanced CT of the brain, which revealed hydrocephalus. Contrast‐enhanced CT revealed abnormal basimeningeal enhancement implicating cisternal obstruction. Subsequent magnetic resonance examination of the entire spine with and without gadolinium enhancement revealed diffuse abnormal enhancement of the spinal axis intradural, extramedullary compartment. While intraaxial PNETs are well recognized, the patients described here represent a distinctly unusual pattern of intradural spinal meningeal and basimeningeal infiltration by PNET in the absence of a demonstrable intraaxial lesion.
Isolated Straight Sinus Thrombosis: Clinical and Neuroradiologic Correlates
Authors: Valeriano James , Bhagavatula Kumar , Ku Andrew , Snyder Peter J.
Published: February 2016

A rare case of straight sinus thrombosis in a 36‐year‐old female with sudden onset of status migrainosus is presented. This condition was demonstrated by a linear density in the midline on a noncontrast computed tomography scan, as a filling defect at the location of straight sinus on magnetic resonance imaging, and by the inability to visualize blood flow in the straight sinus on magnetic resonance venography, w ith a similar demonstration on a 4‐vessel digital subtraction angiography.
Presymptomatic Brain Lesions on MRI in a Patient with Intravascular Malignant Lymphomatosis
Authors: Hashimoto H. , Naritomi H. , Kazui S. , Yamamoto H. , Kinugawa H. , Miyashita K. , Abe S. , Sawada T.
Published: February 2016

A 58‐year‐old man with intravascular malignant lymphomatosis initially developed myeloradiculopathy without cerebral symptoms. His MRI, however, demonstrated solid, wedge‐shaped, and well‐demarcated lesions in the deep white matter and a string‐shaped lesion along with nerve fibers in the splenium of corpus callosum. A variety of cerebral symptoms manifested a month afterward. The possibility of this disease should be considered in cases of undiagnosed myeloradiculopathy with such silent brain lesions.