bluuebunny/crossref_metadata_2025 huggingface dataset:
Central Nervous System Aspergillosis; Analysis of 26 Patients
Authors: Boes B. , Bashir R. , Boes C. , Hahn F. , McConnell J. R. , McComb R.
Published: February 2016

The clinical presentation, risk factors, laboratory data, and neuroimaging and neuropathological findings in 26 patients with autopsy proved central nervous system (CNS) aspergillosis are reviewed. Eleven patients had hematological malignancies (8 underwent bone marrow transplantation), 8 patients underwent liver transplantation, and 3 patients had acquired immunodeficiency syndrome. Four had illnesses resulting in immunosuppression (systemic lupus erythematosus, infected aortic graft, neuroblastoma, and fulminant hepatic failure). The most common presenting clinical symptoms of CNS aspergillosis were fever and a strokelike syndrome. Risk factors for developing CNS aspergillosis included neutropenia, immunosuppressive therapy, low CD4 counts, and retransplantation. Spinal fluid findings were nondiagnostic. Computed tomograms and magnetic resonance scans of the head showed low‐density lesions or hemorrhagic infarctions. Most aspergillosis cases occurred in the setting of widely disseminated disease commonly arising from the lung. Pathologically, multiple areas of necrosis throughout the brain were seen. Aspergillus invasion of blood vessel walls was seen microscopically. Amphotericin B with or without flucytosine was not effective treatment.
Cerebral Vasocapacitance in Human Aging
Authors: Levine Ross L. , Hanson Joan M. , Nickles Robert J.
Published: February 2016

To show a relationship between age and cerebral blood flow as well as between age and cerebral vasocapacitance to induced hypercapnia or cerebral reserve percentage, positron emission tomography (PET) with fluorine‐18‐fluoromethane was used to study 36 normal subjects and 36 patients, all free of stroke, who presented with transient ischemic attacks in a unilateral carotid distribution. Symptomatic‐side data have been published elsewhere. All asymptomatic carotid arteries were either normal or had nonstenotic plaque, and subjects were free of intracranial stenoses. Cerebral blood flow and cerebral reserve percentage were calculated for both middle cerebral artery flow territories. Serum hematocrit, expired carbon dioxide tension, and mean arterial blood pressure did not distinguish the two groups of patients or show an age effect. For the 72 normal nonstenotic sides in the volunteers, linear regression showed that while increasing age was significantly related to decreasing cerebral blood flow in the middle cerebral artery, there was no particular relationship between age and decreasing cerebral reserve percentage. In patients, while no overwhelming linear relationships were found between age and decreases in either cerebral blood flow or cerebral reserve percentage, the latter values approached significance as declining cerebral reserve percentage did relate to increasing age. Over a 60‐year range in normal subjects, cerebral blood flow declined 37% with age; there was a 21% age‐related decrease when normal subjects 50 years and younger were compared to those 50 years and older. Cerebral blood flow is impaired by the aging process in normal subjects and both cerebral blood flow and cerebral reserve percentage of the middle cerebral artery are lowered, presumably by some aspect of the atherosclerotic or ischemic process in patients.
Editor's Note
Authors: Prockop Leon D.
Published: February 2016

To accelerate publication time of articles in Journal of Neuroimaging, the American Society of Neuroimaging has decided to establish a new policy that authors will no longer be able to review copyedited manuscript. This, as you know, is standard practice among many of the world's leading journals.
Control for Carbon DioxideRelated Changes in Flow Velocity by Transcranial Doppler Monitoring
Authors: Knappertz V. A , Rothacher G , Sievers C , Krämer G , Kübler A , Lehnert H , C. H Tegeler
Published: February 2016

Transcranial Doppler ultrasonography can monitor changes in intracranial blood flow velocity over time in a variety of experimental and clinical settings with excellent temporal resolution. Alterations in arterial carbon dioxide pressure exert a profound influence on blood flow velocity. Such changes exhibit important individual fluctuation depending on respiratory status. This limits the ability of transcranial Doppler to accurately study subtle changes in blood flow velocity, independent of the respiratory state of the subject. Suggested here is a method to control for the respiration artifact on blood flow velocity. The middle cerebral artery of 7 healthy male volunteers was studied with transcranial Doppler under resting conditions, monitoring end‐tidal carbon dioxide concentration and blood flow velocity. Hyperventilation was performed both voluntarily and with pharmacological induction by human corticotropin‐releasing hormone. These studies were carried out both with and without the use of counterregulation of the end‐tidal carbon dioxide concentration via a respiration unit, with an adjustable carbon dioxide‐oxygen gas supply preventing significant changes in end‐tidal carbon dioxide. The blood flow velocity in the middle cerebral artery during maximal voluntary hyperventilation decreased from baseline values of 100% to 44.4 ± 4.3% (a 55.6% decrease), and with human corticotropin‐ releasing hormone‐induced involuntary hyperventilation, to 65.1 ± 5.3% (a 34.9% decrease). With the control method, blood flow velocities during voluntary and pharmacological hyperventilation were 100 ± 1.6% and 100 ± 2.8%, respectively. This method allows for control of respiration‐induced artifacts during transcranial Doppler monitoring, and can be used to assess the effect of direct or indirect blood flow velocity stimuli independent of respiratory status.
Triple‐Dose Versus Single‐Dose Gadoteridol in Multiple Sclerosis Patients
Authors: Wolansky Leo J. , Bardini John A. , Cook Stuart D. , Zimmer Alan E. , Sheffet Amiram , Lee Huey-Jen
Published: February 2016

Nine patients with multiple sclerosis underwent brain magnetic resonance imaging (MRI) to evaluate the contrast enhancement of individual lesions after a single dose and a triple dose of gadolinium. A single dose (0.1 mmol/kg) of gadoteridol was administered and after a delay, axial T1‐weighted images were obtained. After an additional 0.2‐mmol/kg dose, the same T1‐weighted sequence was repeated. An unblinded reader simultaneously viewed the images from both doses, and utilizing a computer console to rule out flow artifacts, created a gold standard of “definite” enhancing lesions. Using this system, he determined that there was a total of 12 definite enhancing lesions among the patients. This reader also evaluated lesion conspicuity. The contrast‐noise ratio was calculated for each lesion. A second reader, blinded to the dose used, then evaluated the number of enhancing lesions at both doses. The unblinded reader noted increased lesion conspicuity after the triple dose. Contrast‐noise ratios were significantly (p < 0.001) higher after the triple dose (mean, 9.19) than after the single dose (mean, 2.97). The blinded reader detected 11 of the 12 definite lesions on MRis after the triple dose (sensitivity, 92 %) but saw only 6 on MRis after the single dose (sensitivity, 50%). The difference was significant (p < 0.001 ). Subjective analysis of the films revealed an increase in “ghosting artifacts” at the high dose. Administration of tripledose gadolinium provides increased lesion conspicuity and an improved lesion detection rate when compared to single‐dose gadolinium in patients with multiple sclerosis.
Magnetic Resonance Imaging of Neurodegenerative Diseases
Authors: Hauser Robert A. , Olanow C. W.
Published: February 2016

Magnetic resonance imaging (MRI) has become an important diagnostic tool in the evaluation of neurodegenerative diseases. Although MRI currently does not yield sufficient predictive power to provide a diagnosis in most individual cases, important features have been identified in population studies that help support or exclude a clinical diagnosis under consideration. In parkinsonian patients, putamenal signal hypointensity is commonly observed in patients with atypical parkinsonism. In demented patients, hippocampal atrophy and prolonged T2 relaxation may help identify individuals with Alzheimer's disease. Caudate and putamenal atrophy are seen in Huntington's disease and may serve as markers of disease progression.
Recent Developments in Transcranial Doppler Sonography
Authors: Babikian Viken , Wechsler Lawrence
Published: February 2016

Transcranial Doppler mapping, dual monitoring, color imaging, emboli detection, and insonation after administration of contrast media are recent technological advances that promise to bring new capabilities to transcranial Doppler ultrasonography, and are likely to change its applications in the near future. This article presents a critical review of these developments.
Hiccups and Brainstem Compression
Authors: Ward Brad A. , Smith Robert R.
Published: February 2016

A 70‐year‐old man presented with a 12‐year history of intractable hiccups. Magnetic resonance imaging and cerebral angiography revealed dolichoectasia of the right vertebral artery with compression of the brainstem at the pontomedullary level.
Magnetic Resonance Imaging Findings in Japanese Encephalitis
Authors: Shoji H. , Kida H. , Hino H. , Matsuura S. , Kojima K. , Abe T , Utsunomiya H. , Okada Y. , Nakamura Y. , Okudera T.
Published: February 2016

Ten patients with Japanese encephalitis diagnosed by serological criteria underwent magnetic resonance imaging (MRI) in axial and coronal sections. In 6, a second MRI study was done. The MRI findings were compared with the clinical outcome. Four patients died within several months of onset, 2 had sequelae such as hemiparesis and dementia, and the remaining 4 had no sequelae. In 9 of 10 patients, either diffuse or patchy white matter lesions were observed bilaterally, together with abnormalities in areas such as the thalamus, basal ganglia, and brainstem. For 3 patients who died or remained demented, the second MRI revealed extensive, diffuse white matter abnormalities. This study indicates that Japanese encephalitis can produce white matter involvement, although gray matter structures such as the thalamus, basal ganglia, and brainstem are more severely affected. The severity of these MRI lesions correlated with the clinical outcome.
Relationship of Cranial Midline Shift to Outcome of Very‐LowBirth‐Weight Infants with Periventricular Hemorrhagic Infarction
Authors: Gibson John Y. , Massingale Twila W. , Graves Glen R. , LeBlanc Michael H. , Meydrech Edward F.
Published: February 2016

The purpose of this study was to determine the relationship of a cranial midline shift accompanying periventricular hemorrhagic infarction to subsequent handicap in very‐low‐birth‐weight infants. A study group of 44 infants with intraventricular hemorrhage and an associated periventricular hemorrhagic infarction was retrospectively selected from 1,080 very‐low‐birth‐weight infants evaluated by cranial sonography. A cranial midline shift is defined sonographically as displacement of the septum pellucidum (or cavum septi pellucidi) more than 3 mm from the spatial midline. The midline is measured as half the distance between the right and left inner tables on an anterior coronal view. Other sonographic data recorded were the size of the lateral ventricle, the intracranial hemisphere, and the periventricular hemorrhagic infarction. Also noted was the appearance of the area of infarction at the time of initial detection of a midline shift. After discharge, the infants were periodically evaluated for major handicap in vision, hearing, cognition, and motor activity. A midline shift was identified in 29 (66%) of 44 infants with periventricular hemorrhagic infarction. Seven (24%) of the 29 infants with midline shift and 3 (20%) of the 15 infants without a midline shift died. In all of the 22 surviving infants with a midline shift and in 3 (25%) of 12 survivors without a midline shift, a handicap developed (p < 0.01). As a predictor of handicap, midline shift showed a sensitivity of 88% and a specificity of 100%. Predictability was not improved by combining midline shift with the size of the parenchymal infarct. Cranial midline shift associated with periventricular hemorrhagic infarction is a valuable predictor of handicap in very‐low‐birth‐weight infants.
Accurate Measurement of Carotid Stenosis
Authors: Toole James F. , Castaldo John E.
Published: February 2016

The methods used for measurement of carotid artery stenosis are not uniform. Witness the chaos that developed when the North American Symptomatic Carotid Endarterectomy Trial (NASCET) group changed its classification system from area to linear measurements only to discover that the European Carotid Stenosis Trial (ECST) used still another angiographic definition of degree of stenosis so that the data from the two studies were not comparable. Fortunately, this has been reconciled by recalculation of the data. In still other studies, using unvalidated ultrasound instruments has made it difficult or impossible to compare results. In part, these problems have been the result of misdirected attempts to amalgamate concepts from Doppler and duplex ultrasound with those of arteriography. The former is more precise and accurate than the latter, yet its methodology is harder to apply and has not been generally distributed. Even such anatomical terms as “carotid bulb” are not standard. Ultrasonographers consider it to be the distal common carotid artery, to vascular surgeons it is the carotid sinus, while still others consider it to be both or neither. The present authors advocate a uniform methodology utilizing duplex ultrasound and predict that it plus magnetic resonance angiography will become the standard by which extracranial carotid artery disease is evaluated in the
Group C Streptococcal Leptomeningitis and Brain Abscess Secondary to Frontal Sinusitis: A Case Report
Authors: Koenigsberg Robert A , Roman Nancy , Turtz Alan , Goldman Warren
Published: February 2016

Group C streptococcus has emerged as a potentially lethal pathogen causing serious intracranial infections. The pediatric population in particular has been susceptible to this pathogen; its virulence has increased due to antibiotic resistance. This organism has rarely been reported in the literature as a cause of brain abscess [1‐5]. Herein is a report of pansinusitis secondary to group C streptococcus, complicated by an extensive intracranial infection in an adolescent.
Computed Tomography Detection of a Cerebral Calcific Embolus Following Coronary Catheterization
Authors: Kirk Gerald R. , Johnson Jay K.
Published: February 2016

A 77‐year‐old man underwent coronary artery angiography quite well. However, several attempts were required to pass the pigtail catheter across a calcified stenotic aortic valve. On return to the floor, motor aphasia and right hemiparesis developed and improved steadily within a few days. Computed tomography (CT) of the head revealed a calcific density in the left middle cerebral artery. The authors believe the calcific plaque originated from the calcified aorta and aortic valve. The patient was discharged within 48 hours with minimal neurological signs. Spontaneous calcified emboli to cranial vessels from calcific aortic stenosis or other sources are rare. CT detection of a calcific plaque in a cranial vessel following coronary vessel catheterization is well documented in this patient.
Comparison of Magnetic Resonance Imaging and Histology in Collagenase‐induced Hemorrhage in the Rat
Authors: Brown Mark S. , Kornfeld Mario , Mun-Bryce Sheila , Sibbitt Randy R. , Rosenberg Gary A.
Published: February 2016

Complex changes in the appearance of blood on magnetic resonance images (MRis) complicate interpretation of intracerebral hemorrhage. In this study senal MRIs of intracerebral hemorrhage were obta1ned at 1. 5 T, using a recently developed model for brain hemorrhage, and the MRI findings were compared with histological findings. Hemorrhages were mduced in 24 adult rats by the stereotactic injection of 0.5 unit of bactenal collagenase into the caudate/putamen. Initially, there was hypointensity seen on both T1‐ and T2‐weighted images. Conversion to hyperintensity began on both T1‐ and T2‐weighted images around 10 hours, when red blood cell lysis was observed histologically. By 24 hours, complete conversion to marked hyperintensity had occurred. Calculated T2 values increased twofold to fivefold after lysis, indicating that T2 effects dominate the convers1on to hyper‐intensity seen after red blood cell lysis. At 24 hours there was a rim of intact red blood cells around the lesion, which was hypointense on MRI at a time when iron stains were negative. Fresh blood appears hypointense on T1‐ and T2‐weighted images both at the early stages of a bleed and at later stages when rebleeding occurs. Collagenase‐induced hemorrhage is a useful animal model to follow the evolution of paramagnetic effects of blood on MRI.
Magnetic Resonance Evidence of Perineural Metastasis
Authors: Hayat Ghazala , Ehsan Tajammul , Selhorst John B , Manepali Anantha
Published: February 2016

Contiguous spread along perineural and endoneural spaces, that is, perineural tumor extension, in cutaneous squamous cell carcinoma is fairly common. Infrequently, these tumors spread and involve intracranial structures. One consequence of th1s complication is meningeal carcinomatosis which is underrecognized. Herein described is a patient with recurrent cutaneous squamous cell carcinoma with perineural invasion along the maxillary nerve that was subsequently shown by magnetic resonance imaging to the trigeminal root The patient Initially presented with a cavernous sinus syndrome but despite aggressive treatment, extensive meningeal carcinomatosis and cauda equina dysfunction developed. Awareness of perineural invasion and proper evaluation are crucial. Penneural spread intracranially worsens the prognosis and limits treatment options to palliation.
Epidural Mass Related to Calvarial Aneurysmal Bone Cyst: Computed Tomographic and Magnetic Resonance Demonstration
Authors: Ragland Ronald L. , Weaver John P , Smith Thomas W. , Knorr John R. , Weyreuther Martin , Lau Kam Ying
Published: February 2016

The computed tomographic and magnetic resonance appearance of a calvarial aneurysmal bone cyst is described. Both forms of imaging demonstrate an epidural mass in the right occiput. The fluid‐fluid levels in the mass on the T2‐weighted Images are characteristic of, though not specific for, aneurysmal bone cyst.
Brain Metastases from Primary Lung Malignant Fibrous Histiocytoma: A Case Report
Authors: Kamath Sanjay V , Tenreiro‐Picon Oscar R , Ragland Ronald l , Smith Thomas W , Weaver John P , Knorr John R
Published: February 2016

Primary malignant fibrous histiocytomas are rare. The authors report on a 56‐year‐old man who presented with neurological symptoms due to cerebral metastasis of a pnmary malignant fibrous histiocytoma of the lung.
Doppler Monitoring of Middle Cerebral Artery Emboli from Carotid Stenoses
Authors: Müller Hans R. , lyrer Philippe , Boccalini Pia
Published: February 2016

The aim of this study was to prove the existence of clinically silent embolization arising from carot1d stenoses. Simultaneous bilateral transcranial Doppler sonography of the middle cerebral artery was earned out during 10 mmutes in 30 patients having ultrasonically demonstrated unilateral (n = 12) or bilateral internal carotid stenoses (n = 18) Twenty‐four of the stenoses were clinically cons1dered to be symptomatic and 24 were asymptomatic. Emboli s1gnals were detected in 5 of the 30 patients. All occurred unilaterally on the side of a high‐grade carotid stenosis. Four of the 5 lesions were symptomatic, and 1 was asymptomatic.
Noninvasive Assessment of Intracranial Perfusion in Acute Cerebral Ischemia
Authors: Alexandrov Andrei V. , Bladin Christopher F. , Ehrlich Lisa E. , Norris John W.
Published: February 2016

Single‐photon emission computed tomography (SPECT) and transcranial Doppler sonography (TCD) may help to determine a target group of patients w1th maximum therapeutiC response for tissue rescue after acute stroke. As previously described, the cerebral perfusion mdex represents a combination of these techniques, and is calculated by multiplying assigned values for TCD and SPECT perfusion patterns. The three grades of cerebral perfusion index (1–5, 6–12, 15–20) may predict short‐term outcome if the index is based on SPECT and TCD performed w1thin the first 6 hours after stroke. A total of 30 consecutive patients were studied (18 with middle cerebral artery stroke and 12 with transient ischemic attack or minor stroke) Neurological deficit was scored using the Canadian Neurological Scale. SPECT and TCD were performed 4 ± 2 hours after the onset. Forty‐five minutes were required to perform both tests, evaluate the results, and calculate the cerebral perfusion index. The mean score ( ± standard deviation) of the neurological deficit on admission was 84 ± 20 in patients with transient ischemic attack/minor stroke and 54 ± 33 in patients with stroke (p < 0 009) The volume of 1schemic lesion was measured on computed tomography scans performed more than 3 days after the ictus. Patients with transient ischemic attack/minor stroke had lesion volumes of 8 ± 7 cm3 compared to 72 ± 26 cm3 for those with stroke (p < 0.0001). The mean cerebral perfusion index in the transient ischemic attack group was 18 ± 4, while in the stroke group it was 4 ± 1 (p < 0.0001 ). Clinical examination on admission correctly predicted a reversible neurological deficit in 9 of 12 patients in the transient ischemic attack group and the irreversibility of brain damage in 14 of 18 patients in the stroke group. With the three‐grades scale, cerebral perfusion index correctly identified 10 transient ischemic attacks and 17 strokes. Noninvasive diagnosis of intracranial perfusion abnormalities using SPECT and TCD correlates with the clinical outcome and the volume of brain damage, and therefore may improve the accuracy of prognosis in the hyperacute phase of cerebral ischemia. Cerebral perfusion index is a fast and qualitative scoring system that may be used for early differentiation of transient ischemic attacks, minor strokes, and strokes durmg the first 6 hours of cerebral ischemia.
Increased Middle Cerebral Artery Flow Velocity During the Initial Phase of Cardiopulmonary Bypass May Cause Neurological Dysfunction
Authors: Brillman Jon , Davis Donalee , Clark Richard E. , Price Trevor R. P. , Lovell Mark R. , Benckart Daniel A.
Published: February 2016

One hundred twenty‐seven patients undergoing coronary artery bypass graft surgery were monitored by transcranial Doppler ultrasonography. Five patients had more than 50% increases in middle cerebral artery mean flow velocity during the initial phase (10–120 sec) of cardiopulmonary bypass. Four of these 5 developed neurological complications including stroke and encephalopathy. These results indicate that overperfusion of the basal cerebral arteries during cardiopulmonary bypass procedures may contribute to neurological dysfunction after the surgery
lnterictal Single‐Photon Emission Computed Tomography in Partial Epilepsy
Authors: Tatum William O. , Sperling Michael R. , Connor Michael J. O , Jacobstein Jerome G.
Published: February 2016

The role of interictal brain single‐photon emission computed tomography (SPECT) was examined using (99mTc)‐labeled hexamethylpropyleneamine oxime (HMPAO) in refractory partial epilepsy. The accuracy with which SPECT localized an epileptic focus and whether it predicted long‐term postoperative seizure relief were assessed. Twenty patients were evaluated, 14 of whom ultimately had anterior temporal lobectomy with followup rangmg from 41 to 56 months. A single‐headed gamma camera was used. The interictal SPECT showed ipsilateral temporal hypoperfusion in 8 (47%) of 17 patients with temporal lobe epilepsy and showed either multilobar hypoperfusion or no perfusion defects in the rest. The sensitivity and specificity were similar in patients with a more complex clinical picture who required intracranial electrodes and those who did not. Presence or absence of temporal lobe hypoperfusion did not correlate with postoperative seizure relief. It is concluded that interictal SPECT with 99mTcHMPAO with a single‐headed gamma camera does not add useful information in preoperative localization or predicting postoperative seizure relief.
HMPAO Single‐Photon Emission Computed Tomography in Posterior Circulation Infarcts
Authors: Laloux Patrice , Richelle Fabienne , De Coster Patrick , Jamart Jacques
Published: February 2016

The sensitivity of single‐photon emission computed tomography (SPECT) in evaluating posterior mculation infarcts compared with that of computed tomography (CT) or magnetic resonance imaging (MRI) remains unknown. In a hospital‐based population, the authors studied SPECT, CT, and MRI in 35 consecutive patients presentmg with acute infarction clinically localized in the thalamus (7), posterior cerebral artery (PCA) territory (15), bramtem (19), and cerebellum (3) Multiple infarcts were noted m 8 patients. Overall, the SPECT sensitivity was lower than that of MRI (21% vs 93%, p ~ 0 004) and CT (42% vs 65%, p = 0 046) The SPECT and CT sensitivities were not Significantly different (67% vs 73%) for PCA Infarcts. Performed within 24 hours, SPECT showed a relevant hypoperfusion in all PCA mfarcts. For brainstem infarcts, CT (33%, p = 0 074) and MRI (91 %, p = 0.004) were more sensitive than SPECT, which showed no hemispheric hypoperfusion. The sensitivity of the three imaging techniques was 100% for large cerebellar infarcts. For the small group of thalamic infarcts, the SPECT, CT, and MRI sensitivities were 14, 71, and 100%, respectively. Thus, SPECT compared to CT and MRI is not helpful in the subacute phase to localize PCA and cerebellar infarcts and is of limited value for thalamic infarcts. In the first hours, the absence of cerebral hypoperfusion in brainstem mfarcts may help to differentiate them from hemispheric infarcts usually associated with profound hypoperfusion.
Embolic Pontine Infarction in a Nonhypertensive Patient Following Coronary Angioplasty
Authors: Asconapé Jorge , Asconapé Jorge
Published: February 2016

A 63‐year‐old woman was found to have decreased vibration, light touch, and proprioception sensations in the right hemibody, following cardiac angioplasty. The patient was not hypertensive although she had a h1story of hypercholesterolemia and was a smoker. Magnetic resonance images of the brain demonstrated abnormal signal intensity in the left paramedian basis pons anterior to the fourth ventricle. The lesion was believed to be consistent with a lacunar infarction. Unlike this woman, the majority of patients who have a small‐vessel stroke are usually diabetic or hypertensive. The interesting features here were that the stroke was a complication of coronary angioplasty, was cardioembolic to the pons, and was falsely localized to the thalamus. In addition, rarely does an embolic stroke involve a single brainstem tract
Carotid Steal Syndrome: A Case Study
Authors: Schwend Raymond B. , Hambsch Kevin , Baker Leslie , Kwan Kwok , Torruella Ann , Otis Shirley M.
Published: February 2016

The progression of subclavian arterial stenosis and the subsequent formation of collateral pathways serve to alter the pressure gradients in subclavian steal syndrome, altering ipsilateral vertebral artery flow from its normal state to “latent,” “transient,” and “continuous” steals. A similar altered flow in the carotid arteries can be observed with stenosis of the proximal common or innominate artery. A 59‐year‐old man was seen in the vascular laboratory for evaluation of symptomatic peripheral arterial disease. An incidental asymptomatic stenosis of the right innominate and left proximal subclavian artery was found . Further cerebral vascular evaluation displayed a continuous right subclavian steal and a latent steal in the right internal carotid artery. Transcranial Doppler examination displayed “transient” steal in the terminal right internal carotid artery. Combining duplex and transcranial Doppler evaluation s allows sequential evaluation of the progression of arterial disease and its effect on the flow patterns in the cerebral vasculature.
False Evidence of Carotid Stenosis on Magnetic Resonance Angiography Caused by Surgical Clips
Authors: Bertorini Tulio E. , Laster Robert
Published: February 2016

Patients with transient ischemic attacks are increasingly studied with magnetic resonance angiography, allowing noninvasive evaluation of both the intracranial and the extracranial vessels. Described here are 3 patients who after endarterectomies presented with transient ischemic attacks and in whom magnetic resonance ang1ography with a two‐dimensional time‐of‐flight pulse sequence showed a false‐positive artenal stenosis, as documented by transfemoral carotid angiography. The pseudostenosis was believed to be artifactually caused by operative clips. Results of magnetic resonance angiography should be interpreted with caution in patients with previous neck surgery.
Acute Wernicke's Encephalopathy Associated with Hyperemesis Gravidarum: Magnetic Resonance Imaging Findings
Authors: Omer S. M. , Al Kawi M. Z. , Watban J. AI , Bohleg S. , Mclean D. R. , Miller G.
Published: February 2016

A 25‐year‐old woman with hyperemesis gravidarum developed acute Wernicke 's encephalopathy during prolonged mt ravenous fluid therapy without vitamin supplements. Delay in diagnosis led to a persistent severe neurological deficit, including coma. Gadolinium‐diethylenetriaminepentaacetic acid‐enhanced magnetic resonance imaging revealed symmetrical lesions around the aqueduct and fourth ventpathy Which resolved after treatment with thiamine. She did not regain consciousness. This report demonstrates the diagnostic value of enhanced magnetic resonance Imaging in acute Wernicke's encephalopathy.
The Clinical Role of SPECT in Patients with Brain Tumors
Authors: Leonard B. , Dayem Hussein Abdei
Published: February 2016

The introduction of computed tomography (CT) in the early 1970s effectively replaced radionuclide brain imaging as the main modality to evaluate the structure and morphology of brain tumors. There are, nevertheless, a number of management problems in patients with suspected brain tumors that can be addressed only by functional imaging. There is the need to determine whether a focal mass detected on CT or magnetic resonance imaging (MRI) is benign or malignant. Since the prognosis of the patient is related to the tumor grade, and because stereotactic biopsy recovers only a small fragment of the tumor, there is the need for an imaging technique that reflects the behavior and the malignancy of the tumor. After treatment, it is important to continue to determine the cause of clinical deterioration in patients with glioma who have received high doses of radiation. Progressive radiation necrosis may require surgical debulking. Detection and localization of solid tumor recurrence, on the other hand, may aid in designing treatment. Positron emission tomography (PET) using 1xF‐fluorodeoxyglucose (18FDG) has been the standard functional imaging modality in these patients. With the introduction of single‐photon emitting brain perfusion tracers in the last decade, brain single‐photon emission computed tomography (SPECT) has reemerged as a useful measure of brain function. Other tracers such as thallium‐201 (201TI) chloride have emerged as tumor markers and have also found a role in brain SPECT. This review evaluates the clinical value and potential of201TI and perfusion brain SPECT in patients with brain tumors
Scientific Session III: Impact of Neurosonology on Therapeutic Decisions
Authors: N Bornstein , EG Shifrin , A Kantarosky , B Morag
Published: February 2016

Background and Purpose: A study of carotid endarterectomies performed without angiography was conducted in order to evaluate the safety of this approach in a selected group of patients.
Scientific Session IV: Impact of Neurosonology on Therapeutic Decisions
Authors: Becker V.U. , Hansen H.C. , Brewitt U. , Thie A.
Published: February 2016

To assess the impact of brain activation and subarachnoid haemorrhage (SAH) on flow velocity changes after visual stimulation, we examined 27 healthy controls ( 13 subjects examined with closed and opened eyes), 12 patients with SAH while eyes were kept open, 9 patients under general anesthesia without brain disease and 5 patients with vegetative state after brain injury. All subjects were examined with bilateral TCD monitoring of one PCA and contralateral MCA during rest (30s) and stimulation with 10 Hz flashlight (30s). Ten cycles of stimulation were averaged for estimation of the specific flow response (SFR), which was computed as percent increase of PCNMCA ratio. In controls, SFR was significantly higher with opened eyes (mean, 15.8%) than closed eyes (mean, 11.8%, p < 0.01, Wilcoxon test). SFR was significantly decreased in early stage of SAH (mean, 4,83%, p < 0.01) and normalized during course of disease. Four of 5 patients with abolished SFR suffered delayed ischemia due to vasospasm. Of 7 patients with preserved SFR, 5 had vasospasm by ultrasonic or angiographic criteria, but none had delayed ischemia. No SFR was observed in general anesthesia and apallic state. We conclude that vasoneuronal coupling depends on stimulus directed attention. Furthermore, abolished SFR in SAH might indicate a high risk of delayed ischemia due to vasospasm.
Scientific Session VI: Technical Progress and Future Aspects of Neurosonology
Authors: Valikovics A , Ries S , Kühnen J , Nell W , Daffertshofer M , Hennenci M
Published: February 2016

Background and Purpose: Transcranial Doppler ultrasound (TCD) is a well‐established Technique to ascertain intracranial obstructive artery disease. and has been shown to he highly sensitive for the diagnosis of MCA stenoses A new Multi‐Gate TCD application offers a simultaneous examination at different depths We compared this new application to conventional TCD and MRA in 10 patients known to httve MCA‐stenoses
Usefulness of Follow‐up Regional Cerebral Blood Flow Measurements by Single‐Photon Emission Computed Tomography in the Differential Diagnosis of Dementia
Authors: Golan Haim , Kremer Janus , Freedman Morris , lchise Masanori
Published: February 2016

The aim of this study was to evaluate whether follow‐up measurements of regional cerebral blood flow (rCBF) by single‐photon emission computed tomography (SPECT) provide additional information in the differential diagnosis of dementia. Thirty‐six patients (70 ± 14 yr) with suspected dementia who had two technetium 99m‐hexamethylpropyleneamineoxime SPECT scans over 18 ± 7 months were included in this retrospective study. The patients comprised three groups based on the final clinical diagnosis: (1) neurodegenerative disorder (NDD) including Alzheimer's disease (AD) (n = 13), frontotemporal lobe dementia (n = 2), progressive supranuclear palsy (n = 1 ), and mixed dementia (AD plus multi infarct dementia [MID]) (n = 3); (2) MID (n = 8); and (3) psychiatric disorders (depression [n = 7]. psychosis [n = 1]. and anxiety [n = 1 ]). Blinded to the clinical diagnosis and using visual analysis, the nuclear medicine physicians compared the second scan with the first scan for each patient to characterize temporal changes in rCBF. SPECT findings were categorized into three patterns of rCBF change: worsened, improved, and unchanged. Of the worsened rCBF group, 17 (85%) belonged to the NDD group whereas 2 (1 0%) and 1 (5%) belonged to the MID and psychiatric disorders groups, respectively. All 5 (1 00%) of the improved rCBF patients belonged to the psychiatric disorders group. Thus, worsening of rCBF favors the diagnosis of NDD whereas improvement in rCBF may mitigate against the diagnosis of NDD or MID. Follow‐up rCBF measurements by SPECT thus provided additional information on the possible cause of dementia. A prospective study to further evaluate the usefulness of follow‐up rCBF measurements by SPECT appears warranted.
Time Course of Acetazolamide Effect in Normal Persons
Authors: Hamann Gerhard F. , Stoll Martin , Jost Volker , Bompotti Urania Argyropulu‐Raka , Fitridge Robert , Schimrigk Klaus
Published: February 2016

The intravenous injection of the carbonic anhydrase inhibitor acetazolamide causes a sustained increase of blood flow velocity in the middle cerebral artery. This effect is used in the acetazolamide test of the so‐called cerebrovascular reserve capacity. The acetazolamide test is performed routinely as a two‐point measurement of the blood flow velocity by transcranial Doppler before and 15 to 20 minutes after drug injection. Based on the assumption that evaluation of the time course will more sensitively detect an impaired cerebrovascular reserve capacity, suitable parameters for description of the time course were developed and normal values were established from 18 healthy persons (31 hemispheres). The mean value for the maximal increase of the mean flow velocity (MFV) was 29.7 ± 8.3 em/sec (as percentage of increase, 62.0 ± 17 .3%) and the time of the maximal increase was 15.35 ± 8.46 seconds. Also calculated were the velocity of the MFV rise to the maximal value (3.0 ± 3.2 em/sec/min), the mean of the changes of the continuously measured MFV to the baseline value (21.0 ± 7.4 em/sec), and the integral of MFV represented by the plane under the MFV curve (967.8 ± 350.0 em). The best parameter for the description of the time dependency of the acetazolamide effect is the integral of MFV.
Power Doppler Ultrasound Examination of the Intracerebral and Extracerebral Vasculature
Authors: Griewing B. , Doherty C. , Kessler Ch.
Published: February 2016

Power Doppler is a new ultrasound technique based on the visualization of the Doppler power spectrum. In 22 patients with different lesions of brain–supplying vessels the results of power Doppler ultrasound were compared with those of digital subtraction angiography and conventional color Doppler ultrasound. In patients with intracranial high–degree stenoses, power Doppler was largely free of those artifacts that occur with conventional color Doppler (e.g., echoshadowing and aliasing). The vessel lumen was seen in all patients with more than 80% stenoses. Power Doppler was superior to conventional color Doppler in visualizing both middle cerebral artery stenosis and intracerebral aneurysms. Power Doppler visualization of intracranial pathology was similar to visualization by digital subtraction angiography. Power Doppler appears to be a valuable tool in the noninvasive imaging of intracranial and extracranial pathological vascular conditions.
Giant Paraganglioma of the Cauda Equina in Adolescence: Magnetic Resonance Imaging Demonstration
Authors: Wolansky Leo J. , Stewart Vidor A. , Pramanik Bidyut K. , Heary Robert F. , Cho Eun‐Sook , Schulder Michael , Pak Jayoung
Published: February 2016

A case of giant paraganglioma of the cauda equina is presented. This is only the second reported case in a minor and the first with magnetic resonance imaging. At 13 em long, this is the largest paraganglioma of the cauda equina ever recorded.
Extracranial Plasma Cell Granuloma Presenting as a Diffuse Meningeal and lntraparenchymal Mass
Authors: Dardas Gregory , Walz Elizabeth T. , Newton Herbert B. , Slivka Andrew P.
Published: February 2016

Plasma cell granuloma (PCG) is uncommon, characterized by polyclonal proliferation of mature plasma cells, usually within systemic organs. Only four previous cases have involved the central nervous system (CNS). This is the first reported case of an extracranial PCG and secondary involvement of the brain and meninges. Magnetic resonance imaging (MRI) disclosed a diffuse, enhancing meningeal process infiltrating the underlying brain, causing severe swelling and edema, consistent with an inflammatory, infectious, or neoplastic etiology. Examination of temporal dural biopsy specimen demonstrated PCG, consistent with the patient's original tumor. Following dexamethasone and radiation therapy, MRI and neurological findings normalized.
Sarcoid Myelopathy
Authors: Pascuzzi Robert M. , Shapiro Scott A. , Rau Aruna N. , Schultz Charles E. , Bowman Robin M. , Caldemeyer Karen S. , Wilkes David S. , Wilkes David S.
Published: February 2016

A 45‐year‐old woman with history of iritis, uveitis, and sarcoidosis of the skin presented with a subacute cervical myelopathy. Magnetic resonance imaging (MRI) ;howed patchy, multifocal, gadoliniumenhancing intramedullary lesions of the spinal cord, and extramedullary lesions of the basal cisterns and fourth ventricle. Symptoms and MRI abnormalities were improved within 1 month of corticosteroid therapy.
Evaluating Brain Death with Positron Emission Tomography: Case Report on Dynamic Imaging of 18F‐Fluorodeoxyglucose Activity after Intravenous Bolus Injection
Authors: Meyer Michael A.
Published: February 2016

A dynamic positron emission tomography (PET) study of the head was performed over 1 hour after the intravenous bolus administration of 18F‐fluorodeoxyglucose (18F‐FDG) to a 18‐year‐old patient with the clinical diagnosis of brain death. This dynamic PET study was performed on the seventh day after a severe posttraumatic closed‐head injury. No intracerebral uptake or retention of tracer was noted, consistent with a diffuse absence of brain metabolism. A small amount of tracer was noted to slowly rise over time within the sagittal sinus, indicating that visualization of sagittal sinuses on technetium 99m‐diethylenetriaminepentaacetic acid planar images could provide a falsely negative scintigraphic evaluation for the presence of brain death. It is concluded that PET FDG imaging may be a useful technique in evaluating patients for brain death.
Middle Cerebral Artery Velocity Correlates with Nitroglycerin‐induced Headache Onset
Authors: Tegeler C. H. , Davidai G. , Gengo F. M. , Knappertz V. A. , Troost B. T. , Gabriel H. , Davis R. L.
Published: February 2016

Headache often accompanies treatment with nitroglycerin, but the cerebral hemodynamic effects and the exact mechanism of the headache are incompletely understood. Transcranial Doppler monitoring allows evaluation and monitoring of changes in blood flow velocity in the large intracranial arteries. The objective of this study was to assess middle cerebral artery (MCA) blood flow velocities with transcranial Doppler monitoring in subjects receiving continuous low‐dose nitroglycerin intravenously or by patch, and correlate these with clinical headache. Twenty‐eight normal adult men received nitroglycerin (0.12 μg/kg/min intravenously \n = 14] or 0.6 mg/min by transdermal patch \n = 14\), for up to 120 minutes, with monitoring of cl inical headache status (standard 4‐point scale), blood pressure, heart rate, endexpiratory PC02 (C02), and right MCA velocity. All subjects developed headache (mean time to onset, 34 min), reaching moderate or severe levels in 20. There were no differences in age, weight, mean blood pressure, mean heart rate, or resting end‐tidal C02 between those whose headache reached a moderate to severe level and those whose headache remained mild. MCA velocity decreased from baseline values at all levels of clinical headache (onset, ‒17%; moderate, ‒18%; severe, ‒16%; nitroglycerin stopped, ‒19%) (p < 0.0001 by ttest for each stage of headache). MCA velocity remained decreased at the time of headache resolution (‒14%; p < 0.001). Blood pressure, heart rate, and C02 did not change significantly. There were no differences related to route of nitroglycerin dosing. These data show that continuous low doses of nitroglycerin by patch or intravenously produce headache in normal male subjects. MCA velocities were significantly decreased at headache onset and at all levels of headache severity. Changes in MCA velocity persisted beyond the clinical headache. These results suggest a direct MCA vasodilatory effect of nitroglycerin. This method may also be used to evaluate the int racranial hemodynamic effects of other vasoactive drugs, even in clinical settings.
Balo‐s Concentric Sclerosis Report of Two Patients with Magnetic Resonance Imaging Follow‐up
Authors: Bolay Hayrunnisa , Karabudak Rana , Tacal Tuğra , Önol Behsan , Selekler Kaynak , Saribaş Okay
Published: February 2016

Balo's concentric sclerosis was diagnosed antemortem in 2 patients, by magnetic resonance (MR) imaging showing striking concentric alternating rings in 1 patient and by characteristic histopathological features in the other. The course of the lesions and the concentric pattern were followed by MR imaging for 3 years and 18 months, respectively. One patient demonstrated spontaneous remission that has not been reported in Balo's disease . Balo's disease may not have a fulminant course as described in the past and the MR appearance of the chronic lesion may resemble that of a chronic multiple sclerosis plaque.
Time Course of the Acetazolamide Effect in Patients with Extracranial Carotid Artery Disease
Authors: Stoll Martin , Hamann Gerhard F. , Jost Volker , Bompotti Urania Argyropulu-Raka , Fitridge Robert , Schimrigk Klaus
Published: February 2016

The acetazolamide test of cerebrovascular reserve is performed as a two‐point transcranial Doppler (TCD) measurement of the flow velocity in the middle cerebral artery (MCA) before and 15 to 20 minutes after injection of the carbonic anhydrase inhibitor. The time course was evaluated by bilateral TCD monitoring over 45 minutes in 51 patients with extracranial carotid artery disease. Twenty‐nine patients in Group 1 showed a unilateral and 22 patients in Group 2, a bilateral stenosis of the internal carotid artery (ICA). Thirty‐one normal hemispheres in 18 normal subjects provided baseline control values. The most useful parameter for the description of the time course was the integral of the mean flow velocity. In both groups integral of the mean flow velocity was significantly reduced compared to that in normal persons (Group 1:587.2 ± 538.3 cm, p < 0.01; Group 2: 728.9 ± 397.1 cm, p < 0.01; normal persons: 967.8 ± 350.0 cm). The maximal increase of mean flow velocity in a two‐point measurement also was significantly lower in the patient groups, but did not reach the same level of significance in Group 2 (Group 1: 19.6 ± 12.3 cm/sec, p < 0.01; Group 2: 24.2 ± 10.4 cm/sec, p < 0.05). Thirty‐four of 73 hemispheres had reduced integral of the mean flow velocity, but only 29 had a reduced maximal increase. These data indicate that continuous monitoring and evaluation of the time course of the acetazolamide effect provide additional information on cerebrovascular reserve and help to detect an increased number of patients with impaired cerebrovascular reserve.
Neuroimaging Characteristics in Carbon Monoxide Toxicity
Authors: Tom T. , Abedon S. , Clark R. I. , Wong W.
Published: February 2016

Neuroimaging studies for 18 patients carrying carbon monoxide toxicity as a discharge diagnosis were reviewed. The most common positive findings were low‐density lesions in the globus pallidus (7/18, 39%) and deep white matter changes (5/18, 28%). Six computed tomography head scans showed no acute changes. Advanced age, method of exposure (intentional vs accidental), and severity of carboxyhemoglobin level did not predict neuroradiological or clinical outcomes. Early neuroimaging could not be used to predict clinical courses (death or coma vs discharge to either an institution or a home) in the patient population studied.