bluuebunny/crossref_metadata_2025 huggingface dataset:
Magnetic Resonance Angiography in Patients with Brain Infarction
Authors: Qureshi Adnan I. , lsa Arnaldo , Cinnamon Jay , Fountain Jack , Ottenlips Jeffrey R. , Braimah Janet , Frankel Michael R.
Published: February 2016

This study evaluated the role of magnetic resonance angiography (MRA) in detecting extra‐ or intracranial vascular disease in 118 patients with brain infarction and the accuracy of MRA diagnosis when compared with conventional angiography in patients who had both investigations. Magnet ic resonance angiography ruled out extra‐ and intracranial large vessel disease in 36% of the patients. MRA also demonstrated extra‐ or intracranial disease in 56% (probably symptomatic in 31, possibly symptomatic in 18, and asymptomatic in 17 patients), and provided no information in 8% of the 118 patients. Among the 176 major vessels visualized by both MRA and conventional angiography, conventional angiography confirmed the presence of 9/10 extracranial and 32/40 intracranial large vessel abnormalit ies detected on MRA. There were two false‐negative findings on MRA: occlusion of a distal branch of middle cerebral artery, and an asymptomatic posterior cerebral artery stenosis. Magnetic resonance angiography is a clinically useful method for screening extra‐ and intracranial disease in patients with brain infarction and selecting high‐yield patients for conventional angiography.
Three‐Dimensional Reconstruction of the Power Flow Doppler Imaging of Intracranial Vascular Structures in the Neonate
Authors: Hayashi Takashi , Ichiyama Takashi , Nishikawa Miki , Kaneko Junko , Nakashima Kanae , Furukawa Susumu
Published: February 2016

Three‐dimensional (3D) ultrasonography reconstructing from power flow Doppler imaging (PF) is able to image the 3D structures of the vascular systems. We tried to display the 3D images of intracranial vascular structures in 5 neonates with a portable data processor. Data acquisition was performed using PF through the anterior fontanel. We succeeded in reconstructing vivid 3D images of the anterior cerebral arteries (ACA), basilar artery (BA), internal carotid arteries (ICA), middle cerebral arteries (MCA), lenticulostriate arteries (LSA), internal cerebral vein (ICV), the vein of Galen (GV) and straight sinus (SS) in all subjects. The MCA could be displayed in only a proximal portion. The images of the LSAs were fainter than the other vessels. These problems are based on the character of PF; the flow signal, sampling from the small sized vessels and the perpendicular vessels to ultrasonic beam, is weak. The images of these vessels are fainter than other vessels. These limitations of PF performance directly influence the quality of the 3D images. The benefits and limitations of 3D ultrasonography system are discussed.
Activation of the Cerebellum by Sensory Finger Stimulation and by Finger Opposition Movements; A Functional Magnetic Resonance Imaging Study
Authors: Nitschke Matthias F. , Hahn Christoph , Melchert Uwe H. , Handels Heinz , Wessel Karl
Published: February 2016

Activation of the ipsilateral anterior lobe of the cerebellum by means of hand movements by humans is a well‐known phenomenon, but the cerebellar encoding of sensory information has not been well established. The authors delineated the representation of sensory stimulation of fingers in the anterior lobe of the cerebellum using functional magnetic resonance imaging sensitized to changes in blood oxygenation and compared these areas to the regions activated by means of finger opposition movements. Activation was determined by means of pixel‐bypixel correlation of the signal intensity time course with a reference waveform equivalent to the stimulus protocol. All subjects showed significant activation of the anterior lobe of the cerebellum, mainly located in the ipsilateral Larsell lobules IV‐V and less consistent in the vermis in relation to sensory finger stimulation. Among some subjects the authors also found activation in the anterior lobe on the contralateral side. The finger movements activated regions that overlapped with the areas activated by sensory finger stimulation but showing a larger and more intense activation pattern.
A Comparison Between the Sensitivities of 3‐mm and 5‐mm Thick Serial Brain MRI for Detecting Lesion Volume Changes in Patients with Multiple Sclerosis
Authors: Rovaris Marco , Rocca Maria Assunta , Capra Ruggero , Prandini Francesca , Martinelli Vittorio , Comi Giancarlo , Filippi Massimo
Published: February 2016

In this longitudinal study the authors evaluated the sensitivity of 3‐mm and 5‐mm magnetic resonance imaging (MRI) of the brain in the detection of lesion load changes over time in multiple sclerosis (MS). The authors also correlated the changes detected with these two techniques with the changes in disability. Eighteen patients with MS underwent two MRI examinations of the brain‐one at entrance into the study and one follow‐up examination. At both sessions, images with 24 contiguous slices 5 mm thick and another with 40 contiguous axial slices 3 mm thick were consecutively acquired. On the same occasions, the patients' Expanded Disability Status Scale (EDSS) scores were rated. MR images with slices 3 mm thick showed higher lesion loads than those with slices 5 mm thick at both entrance and follow‐up examinations (median, 13.4 vs 12.8 ml and 17.5 vs 17.0 ml, respectively; p < 0.0001). The correlation between MRI and EDSS changes was significant for both MRI acquisition schemes (3 mm, r = 0.64; 5 mm, r = 0.59). The data suggest that acquisition of thinner slices does not significantly increase the sensitivity of MRI of the brain in the detection of lesion load changes in MS.
Absence of the Adhesio Interthalamica as a Marker of Early Developmental Neuropathology in Schizophrenia: An MRI and Postmortem Histologic Study
Authors: Snyder Peter J. , Bogerts Bernhard , Wu Houwei , Bilder Robert M. , Deoras Kiran S. , Lieberman Jeffrey A.
Published: February 2016

Several recent studies have reported an association between midline cerebral malformations (e.g., corpus callosum, cavum septum pellucidum) and schizophrenia. The authors investigated whether absence of the adhesio interthalamica (AI), a midline structure that develops in concert with prominent features of the ventricular system soon after the bridge from the late embryonic stages to early fetal life, might constitute a marker of early developmental neuropathologic changes in schizophrenia. Eighty‐two patients (54 men, 28 women) with a diagnosis of first‐episode schizophrenia (FES) were recruited from consecutive admissions to a psychiatric inpatient service. Fifty‐two healthy control subjects (30 men, 22 women) were recruited and matched to the patient sample on distributions of sex and age. Magnetic resonance imaging studies were performed, and the presence versus absence of the AI was determined for each subject. The length and volume of the third ventricle were measured for each subject. The AI was found to be absent more often among patients with FES compared with control subjects, and patients without an observable AI also had larger third‐ventricle volumes. These differences in presence or absence of the AI observed in vivo (but not in a comparable postmortem sample of histologically fixed and prepared brain slices), which are likely related to third‐ventricle enlargement, may represent yet another early developmental marker of cerebral malformation among patients with FES.
Cobalamin Deficiency: MRI Detection of Posterior Columns Involvement and Posttreatment Resolution
Authors: Karacostas Dimitris , Artemis Nikos , Bairactaris Chris , Tsitourides Ioannis , Milonas Ioannis
Published: February 2016

Cobalamin‐deficient myelopathy is a neurologic disorder manifesting progressive symptoms of paresthesiae and spastic paralysis. The pathologic changes initially involve the posterior columns of the cervical and upper thoracic cord. The authors present the case of a patient with cobalamin deficiency with preferential posterior columns involvement as evidenced by spinal magnetic resonance imaging findings. Marked clinical and radiographic resolution occurred after administration of vitamin B12. Early recognition of this specific magnetic resonance pattern is essential, because complete recovery can be achieved with prompt treatment at this reversible stage of the disease. Key words: cobalamin, MRI, myelopathy, vitamin B12.
Transcranial 30 B‐Mode Imaging in a Case of Cerebral Hemorrhage
Authors: Delcker Andreas , Knappertz Volker A. , Wilson John , Branch Charles , Bell Tony , Tegeler Charles
Published: February 2016

The case of a patient with temporal lobe hemorrhage is presented. This is the first report of use of a new three‐dimensional data acquisition system that entails freehand scanning with three‐dimensional transcranial duplex sonography. Threedimensional image reconstruction reduced the spatial asymmetry inherent in oblique two‐dimensional ultrasonography, making evaluation of the precise location, size, and anatomic relations of intracranial hemorrhage easier.
Early Diagnosis by Diffusion‐Weighted MRI of Pure Motor Stroke Limited to Finger Weakness
Authors: Hochman M. Seth , DePrima Steven J. , Leon Bill J.
Published: February 2016

Pure motor neurologic deficits occur among 3%–14% of all patients with ischemic stroke. Pure motor monoparesis occurs among 2%–22% of patients with pure motor stroke. The authors report the case of a 73‐year‐old woman with isolated finger weakness as the sole manifestation of a small cortical‐subcortical pure motor stroke diagnosed within 4 hours of onset by means of diffusion‐weighted echoplanar magnetic resonance imaging. To the authors' knowledge, the case of a patient with pure motor stroke with finger weakness as the only manifestation has not been previously reported. Increased awareness of this rare clinical presentation of pure motor stroke coupled with the promise of prompt diagnosis by means of diffusion‐weighted MRI should lead to earlier stroke intervention.
PET and CBF Studies of Chronic Hydrocephalus: A Contribution to Surgical Indication and Prognosis
Authors: Klinge Petra , Fischer Jens , Brinker Thomas , Heissler Hans E. , Burchert Wolfgang , Berding Georg , Knapp Wolfram H. , Samii Madjid
Published: February 2016

The authors investigate whether measurement of cerebral blood flow (CBF) in chronic hydrocephalus is a reliable indicator in selecting patients to undergo ventriculoperitoneal shunting. Global and regional CBF is quantified (Kety‐Schmidt one‐compartment model) by positron emission tomography in 21 patients. CBF is determined following inJection of 15 0‐H2O at three time points 1 week before, 7 days after, and 7 months after shunting. The neurological status of these patients is classified, and cerebrospinal fluid (CSF) dynamics (continuous intracranial pressure [ICP] monitoring and CSF infusion tests) were assessed prior to surgery. Preoperative global CBF values correlate well with clinical outcome. Patients with a significantly lower global CBF value show clinical improvement after 7 months, whereas patients with higher CBF values do not (mean, 33 vs. 45 ml/1 00 ml per minute; p < 0 05). In contrast to conventional methods, including long‐term ICP measurement and CSF infusion tests, preoperative global CBF values are discriminating in terms of clinical outcome. Thus, measurement of CBF may be helpful in evaluating the ultimate utility of shunt therapy in chronic hydrocephalus.
Cerebral Venous Infarctions Presenting as Enhancing Space‐Occupying Lesions: MRI Findings
Authors: Bakshi Rohit , Lindsay Bret D. , Bates Vernice E. , Kinkel Peter R. , Mechtler Laszlo L. , Kinkel William R.
Published: February 2016

Cerebral venous thrombosis is an unusual form of cerebrovascular disease that may cause cerebral venous infarction (CVI). Magnetic resonance imaging (MRI) of the brain may improve the often elusive diagnosis of CVI. However, the sensitivity, specificity, and full spectrum of such MRI findings are poorly understood. The authors present the cases of three patients with CVI whose MRI scans showed abnormally enhancing tumor‐like brain lesions. Two of the CVIs were hemorrhagic and exerted mass effect. One patient showed increasingly nodular and heterogeneous ring‐like enhancement progressing from the single‐dose to the triple‐dose gadolinium contrast images. The CVI of a second patient also showed ring‐like enhancement. Biopsy was performed on one of these patients and was strongly considered for the other two patients to exclude neoplastic disease. Careful examination of the MRI appearance of venous structures and the use of specialized MRI techniques improved the recognition of CVI for two patients and prevented biopsy. This represents the first description of abnormal tripledose MRI contrast enhancement in CVI. Consideration of CVI in the care of patients with enhancing tumor‐like masses may lead to earlier diagnosis and treatment, preventing unnecessary invasive diagnostic procedures. CVI should be added to the differential diagnosis of supratentorial ring‐enhancing masses.
High‐Resolution Fluorodeoxyglucose Positron Emission Tomography Shows Both Global and Regional Cerebral Hypometabolism in Multiple Sclerosis
Authors: Bakshi Rohit , Miletich Robert S. , Kinkel Peter R. , Emmet Marja L. , Kinkel William R.
Published: February 2016

The authors study brain regional glucose metabolism prospectively in multiple sclerosis (MS) using high‐resolution 2‐[18‐F]fluoro‐2‐deoxy‐D‐glucose positron emission tomography (FDG PET) in 25 MS patients of the Dent Neurologic Institute compared with 6 healthy subjects. Glucose metabolism is measured in 20 regions of interest using a line‐profile technique. Compared with control subjects, a 9% reduction in total brain glucose metabolism is noted in MS patients (p < 0.05). Hypometabolism is widespread, including the cerebral cortex, subcortical nuclei, supratentorial white matter, and infratentorial structures. This reduction represents absolute regional decreases ranging from 3% to 18%. The most dramatic absolute reductions occur in the superior mesial frontal cortex, superior dorsolateral frontal cortex, mesial occipital cortex, lateral occipital cortex, deep inferior parietal white matter, and pons. The regional hypometabolism in the superior mesial frontal cortex and superior dorsolateral frontal cortex is statistically significant (p < 0.05), whereas the changes in the mesial occipital cortex (p = 0.07) and the lateral occipital cortex (p = 0.09) approach significance. The authors' findings suggest that widespread cerebral dysfunction occurs in MS, and that diaschisis or neuronal system disconnection resulting from white matter disease plays a major role. Cortical gray matter hypometabolism may also reflect direct MS involvement. The quantitative cerebral abnormalities detected by FDG PET may serve as a marker of disease activity in understanding the pathophysiological expression and therapeutic response of MS.
Transient Blindness Associated with Reversible Occipital White Matter Abnormalities: Two Patients Studied by MR, CT, and 18F‐FDG PET Imaging
Authors: Meyer Michael A. , Galloway Gloria , Khan Shahzad
Published: February 2016

Reversible, multifocal hyperintense T2 signal abnormalities were noted within the occipital and posterior parietal subcortical white matter in a previously healthy 59‐year‐old right‐handed woman with acute onset of cortical blindness and seizures.
Engorged Anterior Epidural Venous Plexus Mimics an Anterior Epidural Mass
Authors: Shinaver C. Nazenin , Caldemeyer Karen S.
Published: February 2016

A 48‐year‐old woman presented with severe neck pain on flexion 1 week after a reportedly uncomplicated lumbar puncture, and with a slightly elevated white blood cell count. Magnetic resonance imaging showed an anterior epidural mass that was thought to represent an epidural abscess. At surgery, the epidural "mass" was due to an engorged anterior epidural venous plexus.
Internal Carotid Artery Dissection Causes Hypoglossal Nerve Palsy: CT, MRI, and Angiographic Findings
Authors: Boukobza M. , Ast G. , Reizine D. , Merland J. J.
Published: February 2016

A case of unilateral XIIth nerve palsy due to the dissection of the internal carotid artery is reported. The clinical and radiological features are described. In this patient, cranial nerve palsy is probably the result of compression by an enlarging carotid artery due to mural hematoma. Diagnosis is discussed with emphasis on magnetic resonance imaging findings. Magnetic resonance imaging is also useful for follow‐up of arterial lesions.
Bilateral Representation of Language Function
Authors: Komaba Yuichi , Senda Michio , Mori Takahiro , Ishii Kenji , Mishina Masahiro , Kitamura Shin , Terashi Akiro
Published: February 2016

A 33‐year‐old right‐handed man with intermittent headache was found to have agenesis of the corpus callosum. He underwent magnetic resonance imaging, positron emission tomography (PET), and detailed neuropsychologic tests, including a Wada test There was bilateral representation of language, and a PET activation study with word repetition revealed bilateral areas of activation that were not completely symmetric. These findings and the literature concerning agenesis of the corpus cal losum are discussed as is the possible compensatory mechanism for absence of the corpus callosum, which is important for cross‐communication.
Visual Form of Alzheimer's Disease and Its Response to Anticholinesterase Therapy
Authors: Warren Stacey , Hier Daniel B. , Pavel Dan
Published: February 2016

In a 60‐year‐old woman with the visual variant of Alzheimer's disease, single photon emission computed tomography abnormalities were most marked in the parieto‐occipital regions of the brain. After treatment with donepezil, improvement is noted on neuropsychological testing and on brain SPECT, including increased perfusion (metabolism) in the occipital lobes.
Orthostatic‐Mediated Hypoperfusion in Limb‐Shaking Transient Ischemic Attack
Authors: Khan Atiq , Beletsky Vadim , Kelley Roger , Ehsan Tajammul
Published: February 2016

In patients with severe carotid stenosis or total occlusion, episodic contralateral motor dysfunction is more likely related to cerebral hypoperfusion than epileptogenic activity. A man with orthostatic‐mediated right‐sided limb shaking was found to have total left internal carotid artery occlusion. There was prominent reduction of cerebrovascular reserve seen on single photon emission computed tomography (SPECT) performed with and without acetazolamide. During assumption of an upright position transcranial Doppler (TCD) revealed a marked attenuation of the left middle cerebral artery flow pattern not associated with changes during electroencephalographic monitoring, even after administration of acetazolamide. In this man, limb shaking episodes were attributed to hypoperfusion of the contralateral cerebral hemisphere, and not to epileptogenic activity.
Orthostasis as a Test for Cerebral Autoregulation in Normal Persons and Patients With Carotid Artery Disease
Authors: Stoll Martin , Seidel Antje , Schimrigk Klaus , Hamann Gerhard F.
Published: February 2016

Orthostasis reduces mean flow velocity (FVmean) in cerebral arteries. This might be used as an alternative provocation test for cerebral hemodynamics in patients with carotid artery disease (CAD). In 21 unilateral CAD patients and 21 controls, FVmean in both middle cerebral arteries (MCA) was measured by transcranial Doppler, together with blood pressure (BP) and heart rate (HR) during a tilt table test. Cerebrovascular reserve (CVR) was measured by an acetazolamide test. In all cases, FVmean dropped to a lower level (controls: 81.9 ± 9.4% of baseline; patients: 84.3 ± 7.9% symptomatic side, 85.6 ± 9.0% contralateral). Impaired CVR patients showed a smaller (p<0.01) decrease (90.6 ± 3.3%) compared to contralateral (84.9 ± 6.0%), to normal CVR patients (81.1 ± 7.8%) and to controls. Heart rate increased in both groups (controls: ‒ 16.6 ± 9.9%, patients+ 10.3 ± 9.9%; p‒0.01 ); BP showed no change. Orthostasis induces a decrease of MCA Fvmean as already previously described. This decrease is significantly smaller in patients with impaired CVR. Since BP does not change, some authors explain the lower MCA Fvmean during orthostasis as caused by sympathetic induced vasoconstriction of cerebral resistance vessels. The authors speculate that in impaired CVR‐patients autoregulative protection against ischemia might limit vasoconstriction. In combination with standard tests for measurement of CVR, this test might be useful for evaluation of cerebral autoregulation.
Diaschisis in Chronic Viral Encephalitis With Koshevnikov Syndrome
Authors: Thajeb Peterus , Huang Kou‐Mou , Shih Chi‐Ching
Published: February 2016

The authors report a 61‐year‐old man with chronic viral encephalitis and Koshevnikov syndrome occurring 42 months after initial symptom of right hemiparesis. Serial computed tomography of the brain showed changes in the attenuation of the left temporal lobe lesion over time. Magnetic resonance images of the brain showed enlargement of left temporoparietooccipital lobes with cortical gyral enhancement on T1‐weighted images following intravenous administration of gadolinium‐DTPA. 99mTc‐HMPAO single‐photon emission computerized tomography showed increased radioactivity and hyperperfusion in the left temporoparietal region with paradoxically decreased local tissue perfusion at the contralateral right hemisphere. Follow‐up madnetic resonance images of the brain 4 years later showed atrophy of bilateral cerebral hemispheres. We postulate that a “transcallosal diaschisis” with subsequent degeneration is a possible mechanism. A brain biopsy from the left temporal lobe lesion showed pictures compatible with viral encephalitis probably herpes simplex encephalitis.
Cranial Magnetic Resonance Imaging Findings in Bacterial Endocarditis: The Neuroimaging Spectrum of Septic Brain Embolization Demonstrated in Twelve Patients
Authors: Bakshi Rohit , Wright Peter D. , Kinkel Peter R. , Bates Vernice E. , Mechtler Laszlo L. , Kamran Sadaat , Pullicino Patrick M. , Sirotkin Igor , Kinkel William R.
Published: February 2016

Infective endocarditis (IE) is an elusive systemic disorder that is often associated with neurologic complications. The contribution of brain magnetic resonance imaging (MRI) to the diagnosis of IE and the spectrum of such findings has been only sparsely described previously. The authors report cranial MRI findings in 12 patients with IE. Each of the patients had MRI evidence of cerebral embolization, with multiple brain lesions noted in most patients (n = 1 0). Cortical branch infarction was the most common lesion (n = 8), which usually involved the distal middle cerebral artery tree. The next most common finding (n = 7) was numerous small embolic lesions which typically lodged in the supratentorial gray‐white junction, some of which were clinically silent and many of which enhanced (probable microabscesses). Brain hemorrhages were noted in four patients, most commonly subarachnoid hemorrhage (n = 3). Two patients developed multiple frank parenchymal macroabscesses/cerebritis lesions. A previously unreported finding in septic embolization, a stroke that became infected with abscess formation (“septic infarction”), was noted in two patients. MRI showed orbital cellulitis in two patients. Most patients studied with gadolinium showed enhancement of lesions (n = 5/8). The authors conclude that cranial MRI may be a valuable tool in the evaluation of patients with IE. The presence of characteristic cranial MRI lesions, especially of multiple types, may prompt early diagnosis and treatment. Key words: MRI, brain, endocarditis, septic emboli, abscess, stroke, orbital infection.
Feature Extraction for MRI Segmentation
Authors: Velthuizen Robert P. , Hall Lawrence O. , Clarke Laurence P.
Published: February 2016

Magnetic resonance images (MRis) of the brain are segmented to measure the efficacy of treatment strategies for brain tumors. To date, no reproducible technique for measuring tumor size is available to the clinician, which hampers progress of the search for good treatment protocols. Many segmentation techniques have been proposed, but the representation (features) of the MRI data has received little attention. A genetic algorithm (GA) search was used to discover a feature set from multi‐spectral MRI data. Segmentations were performed using the fuzzy c‐means (FCM) clustering technique. Seventeen MRI data sets from five patients were evaluated. The GA feature set produces a more accurate segmentation. The GA fitness function that achieves the best results is the Wilks's lambda statistic when applied to FCM clusters. Compared to linear discriminant analysis, which requires class labels, the same or better accuracy is obtained by the features constructed from a GA search without class labels, allowing fully operator independent segmentation. The GA approach therefore provides a better starting point for the measurement of the response of a brain tumor to treatment.
Lesion Localization in Acute Stroke
Authors: Daniels Stephanie K. , Foundas Anne L.
Published: February 2016

The objective of this prospective study was to determine whether specific neuroanatomical sites were associated with increased risk of aspiration in acute stroke patients. Videofluoroscopic swallow studies (VSS) and computed tomography or magnetic resonance imaging scans were completed on consecutive male stroke patients (n = 54). Videofluoroscopic swallow studies were scored on a scale from 0 (normal swallowing) to 4 (severe dysphagia). Patients with scores of 0–1 were grouped together as having no risk of aspiration, and patients with scores of 2–4 were grouped together as having a risk of aspiration. Lesion analyses revealed that location appeared to be more critical than hemisphere or lesion size in predicting patients at risk of aspiration. Anterior locations and subcortical periventricular white matter sites were commonly lesioned in patients with risk of aspiration, whereas patients without risk of aspiration were more likely to have posterior lesions and lesions to subcortical gray matter structures. These data demonstrate that swallowing appears to be mediated by a distributed neural network that involves both cerebral hemispheres with descending input to the medulla; however, specific lesion locations may put patients at a greater risk of aspiration.
MRI Findings in 32 Consecutive Lipomas Using Conventional and Advanced Sequences
Authors: Bakshi Rohit , Shaikh Zubair A. , Kamran Saadat , Kinkel Peter R.
Published: February 2016

Intracranial lipomas are histologically benign and usually incidental magnetic resonance imaging findings that must be differentiated from ominous lesions. The authors describe 32 lipomas in 30 patients using conventional spin‐echo (CSE) T1‐weighted images (T1WI); CSE proton density (PDWI); CSE T2‐weighted images (T2WI); fast spin‐echo (FSE) T2WI; and FSE fluid‐attenuated inversion recovery (FLAIR). Lipomas occurred most commonly in the trigonal choroid plexus; cerebral convexity; pericallosal; and quadrigeminal cistern regions. Lipomas were hyperintense on CSE T1WI and of variable appearance on CSE PDWI and CSE T2WI. Lipomas were isointense to hyperintense on FSE T2WI and hyperintense on FLAIR. Chemical shift artifact (CSA) usually was present on either CSE PDWI or CSE T2WI but was not seen on FSE images. One patient had intracranial hypotension associated with a large convexity lipoma. The authors conclude that lipomas appear different on CSE T2WI than on FSE T2WI. CSE PDWI and CSE T2WI are complementary in detecting CSA. The lack of CSA being detected in lipomas on FSE images most likely relates to inherent bandwidth differences compared with those of CSE. The hyperintense appearance of lipomas on FSE FLAIR and FSE T2WI may be confused with subacute hematomas. The authors recommend that if CSE technique by itself is used to exclude lipomas (in centers that are not using FSE); then T1 WI; PDWI; and T2WI usually are sufficient. For centers using FSE routinely; fat saturation or CSE sequences also may be needed to exclude lipomas. Finally; the authors' series suggests that intracranial lipomas may occur in lateral locations more frequently than reported previously.
Chemotherapy for Pancreatic Cancer: A Neuroimaging Clinicopathologic Correlation
Authors: Rojiani Amyn M. , Williams Lorna S. , Valenstein Edward J.
Published: February 2016

This 52‐year‐old male without a significant medical history was receiving chemotherapy with diethylnorspermine (DENSPM), a polyamine analogue, for a partially resected pancreatic adenocarcinoma. Ten months after his initial diagnosis, he was admitted to an outside hospital for evaluation of altered mental status. Over the course of the next few days the patient developed progressive neurologic signs and symptoms including lethargy, tonic deviation of his eyes to the left asymmetic pupils, and right‐sided decerebrate posturing elicited by painful stimuli. Neuroimaging studies revealed multiple lesions scattered in the periventricular white matter, thalamus, midbrain pons, and cerebellar peduncles. The clinical and neuroimaging differential diagnoses are discussed, and postmortem neuropathologic correlation is presented.
Brain CT and MRI Findings After Carbon Monoxide Toxicity
Authors: Prockop Leon D. , Naidu Kamatham A.
Published: February 2016

The neuropathologic sequelae of carbon monoxide (CO) toxicity have been well described in postmortem examinations. Globus pallidus damage as well as diffuse white matter lesions and encephalopathic changes occur. Brain CT has provided imaging correlates to the premortem changes. MRI is more sensitive and provides more specificity. Cerebral edema changes may occur early with subsequent demonstration of globus pallidus lesions and white matter changes. Globus pallidus lesions in many cases do not correlate directly to clinical status and outcome; however, the presence of diffuse white matter disease is a more reliable index of both. These changes are seen in patients in both accidental exposures to CO and in suicide attempts.
Lumbar Agenesis with Sacral Sparing: a Case Report
Authors: Goldberg Barry S. , Shah Biren A. , Wysoki Michael G. , Simmons Mike , Koenigsberg Robert A. , Squires Fredric , Faro Scott , Tsai Fong Y.
Published: February 2016

Caudal agenesis or caudal regression syndrome refers to a spectrum of malformations involving the lower spine, which can result in significant progressive or permanent neurologic defects. Caudal agenesis is frequently associated with other congenital anomalies of the axillary skeleton, hindgut, and genitourinary systems. Described in
Blood Flow Velocities in the Vertebral Veins of Healthy Subjects: A Duplex Sonographic Study
Authors: Hoffmann Olaf , Weih Markus , von Münster Thomas , Schreiber Stephan , Einhäupl Karl Max , Valdueza José Manuel
Published: February 2016

Along with the jugular veins, the vertebral veins serve as an important pathway for venous blood returning from the brain. In this study, the authors report duplex sonographic findings in 138 healthy subjects without central nervous disease. Successful insonation was possible in 70.7% of all examined vessels. Bilateral insonation was achieved in 86 subjects (62.3%). Only 1 vertebral vein was detected in 23 persons (16. 7%), whereas no vein was found in 29 persons (21 %). The authors observed a marked variation of peak flow velocities ranged (5–81 cm/s, mean ± standard deviation, 23.9 ± 12.3 cm/s). No significant gender‐related or side‐to‐side differences or age influences on flow velocities were detected. The authors' findings may be of relevance when discussing flow velocities in the vertebral veins in cases of cerebrovenous disorders (e.g., dural sinus thrombosis) or in patients after neck dissection.
Does an Increase in Sulcal or Ventricular Fluid Predict Where Brain Tissue Is Lost?
Authors: Symonds Laura L , Archibald Sarah L , Grant Igor , Zisook Sidney , Jernigan Terry L
Published: February 2016

Quantitative volumes of cerebrospinal fluid (CSF) and brain tissue were measured on magnetic resonance images (MRIs) of 287 individuals from 5 diagnostic groups: Alzheimer's disease (AD), chronic alcoholics (ALC), individuals positive for human immunodeficiency virus (HIV), schizophrenia subjects (SZ), and normal comparison subjects (NC) older than 50 years of age. Within each group, mean volumes were calculated for ventricular CSF, cortical (sulcal) CSF, cortical gray matter, total white matter, basal ganglia gray matter, and thalamic gray matter. Correlations of CSF measures with brain tissue measures were determined, and multiple regression analyses were performed to try and predict volume of gray matter or white matter region from volume of CSF compartment. Results indicated the following:

Enlarged cortical fluid volume significantly predicts cortical gray matter deficits for subjects with AD and those who are ALC and SZ but not for subjects with HIV or NC.

Enlarged cortical fluid volume also significantly predicts white matter deficits in all five groups.

Enlarged ventricular fluid volume significantly predicts basal ganglia deficits in AD, HIV, and NC but not in SZ or ALC.

Enlarged ventricular volume has no predictive value for thalamic volume for any of the groups. This study supports the clinical practice of predicting brain tissue volume loss from CSF enlargement but not for all brain regions in all diagnoses.
Hyperacute Cerebral Enhancement: The Earliest Predictor of Hemorrhage by MR Imaging?
Authors: Koenigsberg Robert A. , Gul Naveed , Faro Scott , Elfont Robert , Baker Kim , Tsai Fong
Published: February 2016

A test to detect very early hemorrhage in acute cerebral infarct could offer a substantial increase in the safety and success of advanced stroke therapies, particularly when the use of thrombolytic therapies is contemplated. Currently, computed tomography is the standard test for the detection of cerebral hemorrhage but is not a valid predictor of potential areas of hemorrhagic transformation. A technique to evaluate the risk of hemorrhagic transformation in infarcted cerebral tissue has been conducted with contrast‐enhanced magnetic resonance imaging in various animal stroke models. Knight demonstrated Gadolinium‐DTPA enhancement in the territory of occluded vessels immediately in rats after reperfusion. Gadolinium enhancement was thought to predict areas of hemorrhagic transformation. Yenari and associates demonstrated in rabbit models that contrast‐enhanced T1‐weighted scans can reveal regions of blood‐brain barrier disruption, characterized as hemorrhagic transformation in ischemic tissue. The authors report a clinical example in which hyperacute contrast‐enhanced magnetic resonance imaging was the first indication of hemorrhagic transformation within 24 hours of onset of an acute cerebral infarct.
Transcranial Sonography in a Patient With a Persistent Trigeminal Artery
Authors: Strasser Sheryl , Forteza Alejandro M. , Romano Jose G.
Published: February 2016

Transcranial ultrasonography was performed in a patient with a persistent trigeminal artery, a remnant of fetal cerebral circulation that bridges the carotid and basilar territories. The study revealed low flow and reversal of flow in the vertebral and basilar arteries, respectively. The interpretation and significance of these findings are discussed.
Accuracy and Criteria for Localizing Arterial Occlusion With Transcranial Doppler
Authors: Demchuk Andrew M. , Christou Ioannis , Wein Theodore H. , Felberg Robert A. , Malkoff Marc , Grotta James C. , Alexandrov Andrei V.
Published: February 2016

The authors determined transcranial Doppler (TCD) accuracy for the proximal internal carotid artery (ICA), distal ICA, proximal middle cerebral artery (MCA), distal MCA, anterior cerebral artery (ACA), posterior cerebral artery (PCA), terminal vertebral artery (tVA), and basilar artery (BA) occlusion in cerebral ischemia patients. Detailed diagnostic criteria were prospectively applied for TCD interpretation independent of angiographic findings. Of 320 consecutive patients referred to the neurosonology service with symptoms of cerebral ischemia, 190 (59%) patients also underwent angiography (MRA or DSA). 48 of those 190 patients had angiographic occlusion and 12 of those 48 patients had involvement of multiple vessels. Median time from TCD until angiography was performed was 1 hour (41 patients had angiography before TCD). TCD showed 40 true positive, 8 false negative, 8 false positive, and 134 true negative studies with sensitivity 83.0%, specificity 94.4%, positive predictive value 83.0%, negative predictive value 94.4%, and accuracy 91.6% to determine all sites of occlusion. Sensitivity for each individual occlusion site was: proximal ICA 94%, distaiiCA 81%, MCA 93%, tVA 56%, BA 60%. Specificity ranged from 96% to 98%. TCD is sensitive and specific in determining the site of the arterial occlusion using detailed diagnostic criteria, including proximal ICA and distal MCA lesions. TCD has the highest accuracy for ICA and MCA occlusions. If the results of TCD are normal, there is at least a 94% chance that angiographic studies will be negative.

Key words: ultrasound, transcranial Doppler sonography, stroke, occlusion, angiography.
Periventricular White Matter Hyperintensities on MRI: Correlation With Neuropathologic Findings
Authors: Smith Charles D. , Snowdon David , Markesbery William R.
Published: February 2016

Periventricular white matter hyperintensities on postmortem magnetic resonance imaging (MRI) and myelin‐stained frontal and parietal histologic sections were evaluated independently in 12 cases. There was a strong relationship between the extent of white matter hyperintensities on MRI and the extent of gross and microscopic changes seen in the white matter of myelinstained sections, particularly in the frontal lobe. In this material, the extent of myelin rarefaction correlated with a 0‐ to 8‐point white matter hyperintensity scale rating on MRI in the same brains.
Hyperkinetic Movement Disorders Caused by Corpus Striatum Infarcts: Brain MRI/CT Findings in Three Cases
Authors: Kelley Roger E. , Jain Pawan K.
Published: February 2016

Three patients with hemichorea/hemiballismus/hemidystonia caused by discrete contralateral infarction of the corpus striatum are presented. The infarcts were all small on CT or MRI brain scan and were lacunar in type. Small discrete infarction of basal ganglionic structures allows such adventitious movements to be manifested. Involvement of contiguous areas, seen with larger infarcts, can suppress such movements. The infrequency of such hyperkinetic movement disorders, and the subtle infarct appearance on brain scan, can lead to a delay in the diagnosis.
Registration of Neuroimaging Data: Implementation and Clinical Applications
Authors: Thurfjell Lennart , Pagani Marco , Andersson Jesper L.R. , Jonsson Cathrine , Lundqvist Roger , Wagner Anna
Published: February 2016

Image registration brings images into a form in which each voxel corresponds to a predetermined anatomic entity and is necessary for comparisons of data across scans. lntrasubject registration is a matter of translating and rotating one image volume into correspondence with another. lntersubject registration is more difficult because it requires the removal of individual anatomy dependence from the data. This article describes, with the help of clinical examples, automated methods for intrasubject registration of scans within and between modalities, and intersubject registration used for registering a three‐dimensional brain atlas with a patient's brain scan.
Basilar Artery Endoprosthesis Placement: Rescue Therapy for Recurrent Thrombosis
Authors: Callahan Alfred S. , Berger Brian L.
Published: February 2016

Hyperacute thrombosis of the basilar artery accompanied urgent treatment of basilar thrombosis with local thrombolytics and arterial reconstruction by balloon angioplasty. Successful placement of an endoprosthesis into the basilar artery permitted sustained restoration of blood flow. To the authors' knowledge, this is the first successful report of intracranial endoprosthesis deployment.
Transcranial Doppler Ultrasonography: Year 2000 Update
Authors: Babikian Viken L. , Feldmann Edward , Wechsler Lawrence R. , Newell David W. , Gomez Camilo R. , Bogdahn Ulrich , Caplan Louis R. , Spencer Merrill P. , Tegeler Charles , Ringelstein E. Bernd , Alexandrov Andrei V.
Published: February 2016

In this update, the main clinical applications of transcranial Doppler ultrasonography are reassessed. A specific format for technology assessment, personal experience, and an extensive review of the literature form the basis of the evaluation. The document is approved by the American Society of Neuroimaging and the Neurosonology Research Group of the World Federation of Neurology.
Intravascular Lymphomatosis: Contribution of Cerebral MRI Findings to Diagnosis
Authors: Liow Kore , Asmar Paul , Liow Michelle , Spanaki Marianna , Townsend Jeannette J. , Buys Saundra , Baringer J. Richard , Osborn Anne
Published: February 2016

Intravascular lymphomatosis (IL) is a rare variant of non‐Hodgkin's lymphoma with an unusual predilection for the central nervous system (CNS). Most cases are not diagnosed until postmortem because of variable clinical presentation and nonspecific laboratory findings. Neuroimaging findings vary widely and range from diffuse involvement of the deep white matter to infarct‐like lesions. Cerebral magnetic resonance imaging (MRI) may show parenchymal and meningeal gadolinium enhancement. The authors describe brain MRI findings of linear, punctate, and patchy enhancement suggestive of CNS IL in two patients confirmed by brain biopsy/histologic studies. High index of clinical suspicion and careful interpretation of MRI (including gadolinium contrast studies) may contribute to premortem diagnosis and early intervention of this often‐missed disease.
Diffusion‐Weighted MRI Diagnosis of Pure Motor Stroke Limited to Primarily Distal Leg Weakness
Authors: Hochman M. Seth , DePrima Steven J. , Leon Bill J.
Published: February 2016

Pure motor stroke (PMS) manifesting as distal weakness of a single extremity has rarely been described. The authors report a 59‐year‐old man with PMS who had primarily distal weakness of a single lower extremity, which to the authors' knowledge has not been previously described. Four days after onset, positive diffusion‐weighted imaging confirmed that the small subcortical T2‐ weighted hyperenhancing and nonenhancing T1‐weighted hypointensity noted on magnetic resonance imaging (MRI) represented an acute PMS that was the cause of the patient's weakness. Increased awareness of this rare clinical presentation of PMS coupled with the promise of imaging the PMS with diffusion weighted MRI should lead to earlier stroke intervention in these patients.
Temporal Lobe Epilepsy Presenting as Panic Attacks: Detection of lnterictal Hypometabolism With Positron Emission Tomography
Authors: Meyer Michael A , Zimmerman Andrew W , Miller Christopher A
Published: February 2016

Cerebral glucose metabolism was studied using positron emission tomography (PET) in a 13‐year‐old girl with a history of panic attacks that were thought to be of psychiatric origin. Positron emission tomography imaging revealed marked right temporal lobe hypometabolism and magnetic resonance imaging (MRI) detected T2 changes consistent with right mesial temporal sclerosis. Electroencephalogram (EEG) studies 3 years later confirmed a primary diagnosis of right temporal lobe epilepsy. As shown by this case and one other, PET and MRI imaging of patients with panic disorder who are thought to have epilepsy may be helpful in leading to definitive electrographic studies that confirm temporal lobe epilepsy as the primary diagnosis.
A New Pocket‐Sized Transcranial Ultrasound Device (NeuroDop): Comparison With Standard TCD
Authors: Kidwell Chelsea S. , Martin Neil A. , Saver Jeffrey L.
Published: February 2016

The NeuroDop is a new bedside assessment tool consisting of a continuous wave ultrasound probe attached to a stethoscope earpiece. This study was designed to compare middle cerebral artery (MCA) velocity assessment obtained with the NeuroDop versus standard transcranial Doppler (TCD). TCD technologists performed continuous wave NeuroDop studies followed by standard TCD studies on 60 subjects. Technologists recorded presence of MCA signal and estimated velocity based on NeuroDop auditory characteristics. Signal was obtained in 108 MCA vessels with the portable unit and in 112 vessels using standard TCD. For detection of patency, sensitivity was 96%, specificity 88%, positive predictive value 99%, and negative predictive value 58%. Auditorially estimated velocities from the NeuroDop strongly correlated with TCD velocity measures (r = 0.71). Categorical estimates of velocity as decreased (<37 em/sec), normal (37–81 em/sec), or increased (>81 em/sec) demonstrated an accuracy rate of 85%. This novel stethoscope‐continuous wave unit has excellent sensitivity in detecting presence of MCA patency. Moreover, MCA velocities can be characterized to a reasonable degree of accuracy based on NeuroDop auditory characteristics. The NeuroDop shows promise as a tool to rapidly assess and serially monitor presence and amplitude of MCA velocity and may help guide thrombolytic and other emergency management decisions in stroke patients.
Feasibility of Brain Volumetric Analysis and Reconstruction of Images by Transfontanel Three‐Dimensional Ultrasound
Authors: Abdui‐Khaliq Hashim , Vogel Michael , Lange Peter E.
Published: February 2016

Based on the authors' experience with reconstruction of the heart using three‐dimensional echocardiography, the authors assessed the feasibility of three‐dimensional reconstruction of brain images using transfontanelle ultrasound in selected cases of infants with abnormal intracranial findings. A conventional 5‐MHz ultrasound transducer inside a transducer holder was rotated 180° around its vertical axis using a computer‐controlled stepper motor to acquire multiple sequential cross‐sections of the brain. The raw digital data of this three‐dimensionally recorded dataset were transferred to a PC‐based workstation for further analyis. The reconstruction of the three‐dimensional brain images and volumetric analysis were undertaken using a new dedicated software capable of three‐dimensional reconstruction and volumetric analysis (Echo‐PAC‐30, version 1.2 Beta, GE Vingmed, Horton, Norway). The reconstruction of sequential slices from the stored three‐dimensional data allowed the visualization of the epicortical extension and volumetric meas.urements of the focal ischemic infarction in the superior tempoparietal lobe in a 2‐week‐old newborn with a focal ischemic brain lesion. In other 2‐week‐old newborns, the extension and volume of a periventricular hemorrhage was visualized by three‐dimensional reconstruction of coronal cross‐sectional images from the acquired three‐dimensional dataset. The threedimensional reconstruction of the lateral ventricles allowed the three‐dimensional visualization and estimation of ventricular dilatation in milliliters in an 8‐week‐old infant with hydrocephalus. Three‐dimensional reconstruction of brain images and volume estimation of brain lesions and cavities by ultrasound may provide new insights into the morphology and extension of ultrasonographically visible brain lesions.