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BACKGROUND Lumbar puncture (LP) is a frequently performed diagnostic and therapeutic procedure in oncology patients. Transfusing to a minimum preprocedural platelet threshold of 50 × 109 /L is widely upheld without good quality evidence. The objective was to compare the outcomes of LPs performed with platelets above and below this threshold. An increased risk of adverse events in patients with lower platelet counts was not expected. As a corollary, transfusion reaction rates incurred by transfusing to this recommended threshold are also reported. METHODS A total of 2259 LPs performed on 1137 oncology patients (adult, n = 871, and pediatric, n = 266) were retrospectively analyzed between February 2011 and December 2017. The incidence of LP-related complications for groups above and below the minimum platelet threshold was compared. Traumatic tap was defined as 500 or more red blood cells per high-power field in the cerebral spinal fluid. Groups were compared using the 2-Proportion Z-test and Fisher exact test. RESULTS At time of LP, the total number of events with platelets less than 50 × 109 /L and 50 × 109 /L or greater were 110 and 2149, respectively. There were no significant differences in LP-associated complications between patients with platelet counts above or below 50 × 109 /L (P = .29). Patients with a pre-LP platelet count of less than 50 × 109 /L had a higher proportion of traumatic taps (P

OBJECTIVE: To describe the clinical presentation, advanced imaging findings, and short‐ and long‐term outcomes in dogs with intracranial empyema. DESIGN: Retrospective case series. ANIMALS: Client‐owned dogs diagnosed with intracranial empyema. METHODS: Medical records from 2 referral hospitals were searched for dogs diagnosed with intracranial empyema. To be included in this study, dogs had to fulfill 1 or more of the following 3 inclusion criteria: a magnetic resonance imaging (MRI) scan with space occupying accumulation of extra‐axial material suggestive of empyema, a cerebrospinal fluid analysis suggestive of empyema, or direct visualization of purulent material during intracranial surgery. RESULTS: Nine dogs with intracranial empyema were included, with a median age of 3.5 years (range: 4 mo–12.5 y). All presented as emergencies with 7 of the 9 dogs showing neurological abnormalities and 2 of the 9 with retrobulbar swelling and exophthalmos. Six had surgical intervention, 1 was medically managed, and the remaining 2 dogs were euthanized. Typical MRI findings included extra‐axial, T1‐weighted hypo‐ to isointense, T2‐weighted hyperintense material compared to gray matter with varying degrees of contrast enhancement, with 6 of 8 showing evidence of contiguous infection from adjacent structures on MRI. For 7 dogs, ≥1 samples were sent for culture and sensitivity, with Enterococcus (surgical swab), Streptococcus pneumonia (from cerebral spinal fluid), and coagulase positive Staphylococcus (ear swab) being cultured. The median antimicrobial course length was 6 weeks (range: 2–28 wk). All dogs for which treatment was attempted survived to discharge, with a median hospitalization time of 7 days (range: 4–10 d). Four of the 7 are still alive at the time of writing (1 lost to follow‐up; 2 euthanized for other reasons) with all 4 considered neurologically normal with a successful long‐term outcome. CONCLUSION: Although intracranial empyema in dogs is a rare condition, excellent outcomes are possible in those cases treated appropriately.

BACKGROUND FLAIR (fluid attenuated inversion recovery) imaging via synthetic MRI methods leads to artifacts in the brain, which can cause diagnostic limitations. The main sources of the artifacts are attributed to the partial volume effect and flow, which are difficult to correct by analytical modeling. In this study, a deep learning (DL)-based synthetic FLAIR method was developed, which does not require analytical modeling of the signal. PURPOSE To correct artifacts in synthetic FLAIR using a DL method. STUDY TYPE Retrospective. SUBJECTS A total of 80 subjects with clinical indications (60.6 ± 16.7 years, 38 males, 42 females) were divided into three groups: a training set (56 subjects, 62.1 ± 14.8 years, 25 males, 31 females), a validation set (1 subject, 62 years, male), and the testing set (23 subjects, 57.3 ± 20.4 years, 13 males, 10 females). FIELD STRENGTH/SEQUENCE 3 T MRI using a multiple-dynamic multiple-echo acquisition (MDME) sequence for synthetic MRI and a conventional FLAIR sequence. ASSESSMENT Normalized root mean square (NRMSE) and structural similarity (SSIM) were computed for uncorrected synthetic FLAIR and DL-corrected FLAIR. In addition, three neuroradiologists scored the three FLAIR datasets blindly, evaluating image quality and artifacts for sulci/periventricular and intraventricular/cistern space regions. STATISTICAL TESTS Pairwise Student's t-tests and a Wilcoxon test were performed. RESULTS For quantitative assessment, NRMSE improved from 4.2% to 2.9% (P

Quantification of proton magnetic resonance spectroscopy (1 H-MRS) data is commonly performed by referencing the ratio of the signal from one metabolite, or metabolite group, to that of another, or to the water signal. Both approaches have drawbacks: ratios of two metabolites can be difficult to interpret because study effects may be driven by either metabolite, and water-referenced data must be corrected for partial volume and relaxation effects in the water signal. Here, we introduce combined reference (CRef) analysis, which compensates for both limitations. In this approach, metabolites are referenced to the combined signal of several reference metabolites or metabolite groups. The approach does not require the corrections necessary for water scaling and produces results that are less sensitive to the variation of any single reference signal, thereby aiding the interpretation of results. We demonstrate CRef analysis using 202 1 H-MRS acquisitions from the brains of 140 infants, scanned at approximately 1 and 3 months of age. We show that the combined signal of seven reference metabolites or metabolite groups is highly correlated with the water signal, corrected for partial volume and relaxation effects associated with cerebral spinal fluid. We also show that the combined reference signal is equally or more uniform across subjects than the reference signals from single metabolites or metabolite groups. We use CRef analysis to quantify metabolite concentration changes during the first several months of life in typically developing infants.

No abstract available Keywords: lysosomal storage disease; mononuclear cell cytoplasmic inclusions; mucopolysaccharidosis type I.

Leptomeningeal metastasis is an uncommon and typically late complication of cancer with a poor prognosis and limited treatment options. Diagnosis is often challenging, with nonspecific presenting symptoms ranging from headache and confusion to focal neurologic deficits, such as cranial nerve palsies. Standard diagnostic evaluation involves a neurologic examination, magnetic resonance imaging of the brain and spine with gadolinium, and cytologic evaluation of the cerebral spinal fluid. Therapy entails a multimodal approach focused on palliation with surgery, radiation, and/or chemotherapy, which may be administered systemically or directly into the cerebral spinal fluid. Limited trial data exist to guide treatment, and current regimens are based primarily on expert opinion. Although newer targeted and immunotherapeutic agents are under investigation and have shown promise, an improved understanding of the biology of leptomeningeal metastasis and treatment resistance as well as additional randomized controlled studies are needed to guide the optimal treatment of this devastating disease. Cancer 2018;124:21-35. © 2017 American Cancer Society.

CE and microchip CE (ME) are powerful tools for the analysis of a number of different analytes and have been applied to a variety of clinical fields and human samples. This review will present an overview of the most recent applications of these techniques to different areas of clinical medicine during the period of 2014 to mid-2017. CE and ME have been applied to clinical chemistry, drug detection and monitoring, hematology, infectious diseases, oncology, endocrinology, neonatology, nephrology, and genetic screening. Samples examined range from serum, plasma, and urine to lest utilized materials such as tears, cerebral spinal fluid, sweat, saliva, condensed breath, single cells, and biopsy tissue. Examples of clinical applications will be given along with the various detection systems employed.

In the history of medicine, one means to progress is when we make the decision that our assumptions and definitions of disease are no longer consistent with the scientific evidence, and no longer serve our health care needs. The arc of scientific progress is now requiring a change in how we diagnose Alzheimer's disease. Both the National Institute on Aging—Alzheimer's Association (NIA-AA) 2011 workgroup and the International Work Group (IWG) have proposed guidelines that use detectable measures of biological changes in the brain, commonly known as biological markers, or biomarkers, as part of the diagnosis. This Special Report examines how the development and validation of Alzheimer's disease biomarkers—including those detectable in the blood or cerebral spinal fluid, or through neuroimaging—is a top research priority. This has the potential to markedly change how we diagnose Alzheimer's disease and, as a result, how we count the number of people with this disease. As research advances a biomarker-based method for diagnosis and treatment at the earliest stages of Alzheimer's disease, we envision a future in which Alzheimer's disease is placed in the same category as other chronic diseases, such as cardiovascular disease or diabetes, which can be readily identified with biomarkers and treated before irrevocable disability occurs.

To date, cryptococcosis remains sporadic in Europe, and this is a case of canine cryptococcosis with ocular and CNS involvement in continental Europe with identification of the organism on cerebral spinal fluid (CSF) cytology and description of the clinical and MRI features, and outcome.

A lumbar puncture (LP) is performed to obtain cerebrospinal fluid. It is implemented in the clinic on a routine basis to aid the diagnosis of neurologic diseases. This paper accompanies an informative lumbar puncture video that shows the lumbar puncture procedure as routinely performed in the VUmc Alzheimer center based on the consensus guidelines by Engelborghs et al.

We report the case of an 11-month-old boy with Wilm's tumor, who underwent nephrectomy. Postoperative pain was managed with a lumbar epidural for 3 days, with the formation of a persistent cerebral spinal fluid cutaneous fistula.

Background Outcomes for acute lymphoblastic leukemia (ALL) in low-income countries lag far behind high-income countries (HIC). We explored the impact of central nervous system (CNS) involvement on outcome of pediatric patients with ALL in Tanzania. Procedure Comprehensive chart review was performed to characterize CNS involvement, treatment, and outcomes of pediatric patients with ALL at Muhimbili National Hospital in Dar es Salaam, Tanzania between January 1, 2011 and December 31, 2013. Results One hundred fifty-six patients with confirmed ALL had accessible data, and 128 initiated therapy. Sixteen percent of 156 patients had a documented cerebral spinal fluid analysis by cytospin. Seventy patients (45%) had a documented lumbar puncture with intrathecal (IT) therapy within 1 week of diagnosis. Thirteen patients presented with CNS involvement at diagnosis based on cytospin and/or unequivocal symptoms. Twenty-one patients (16%) experienced CNS relapse, three of whom had CNS disease at diagnosis. Median event-free survival (EFS) for all patients was 7.9 months and estimated EFS at 24 months was 31%. For the patients with CNS involvement at diagnosis, the estimated EFS at 24 months was 45%. Only three of 21 patients with CNS relapse were still alive with a median follow up of 3 months. Conclusions The rate of CNS disease in patients with ALL in Dar es Salaam at diagnosis and relapse was higher than that reported in HIC, and overall survival was lower. Improving outcomes will require further advances including consistent CNS prophylaxis and may include targeting high-risk patients with additional IT treatments.

Purpose To quantify the change in cerebral spinal fluid (CSF) production rate and maximum systolic velocity in astronauts before and after exposure to microgravity and identify any physiologic trend and/or risk factor related to intracranial hypertension. Materials and Methods Following Institutional Review Board (IRB) approval, with waiver of informed consent, a retrospective review of 27 astronauts imaged at 3T was done. Qualitative analysis was performed on T2-weighted axial images through the orbits for degree of flattening of the posterior globe according to the following grades: 0 = none, 1 = mild, 2 = moderate, and 3 = severe. One grade level change postflight was considered significant for exposure to intracranial hypertension. CSF production rate and maximum systolic velocity was calculated from cine phase-contrast magnetic resonance imaging and compared to seven healthy controls. Results Fourteen astronauts were studied. The preflight CSF production rate in astronauts was similar to controls (P = 0.83). Six astronauts with significant posterior globe flattening demonstrated a 70% increase in CSF production rate postflight compared to baseline (P = 0.01). There was a significant increase in CSF maximum systolic velocity in the subgroup without posterior globe flattening (P = 0.01). Conclusion The increased postflight CSF production rate in astronauts with positive flattening is compatible with the hypothesis of microgravity-induced intracranial hypertension inferring downregulation in CSF production in microgravity that is upregulated upon return to normal gravity. Increased postflight CSF maximum systolic velocity in astronauts with negative flattening suggests increased craniospinal compliance and a potential negative risk factor to microgravity-induced intracranial hypertension. J. Magn. Reson. Imaging 2015.

To determine the role of proteins, and in particular protein variants, in human health, it may often be necessary to quantitatively determine the concentration of a specific protein variant present in complex biological samples such as blood, cerebral spinal fluid (CSF), or tissue. Many protein variants are present only at trace levels and therefore a simple assay with very high sensitivity and reliability would greatly facilitate correlation of the presence of particular protein variants with the progression of specific diseases. We have developed a simple phage based capture ELISA system that enables femtomolar or better detection of individual protein variants directly from complex biological samples. The protocol utilizes a capture reagent that selectively recognizes a unique epitope of the protein variant and a phage based detection reagent that binds to a second epitope present in all forms of the target protein. The phage based detection reagent is essentially a self-assembling nanoparticle consisting of several thousand coat proteins that can each be labeled to amplify the detection signal by several orders of magnitude. Here we demonstrate that we can achieve subfemtomolar detection of individual protein variants that have been implicated in neurodegenerative disease directly from complex tissue homogenates and sera. The ELISA system should facilitate identification of disease specific protein variants or other compounds even when present at trace amounts in samples including blood, CSF, saliva and urine. © 2014 American Institute of Chemical Engineers Biotechnol. Prog., 31:289–298, 2015

The fabrication of a realistic head phantom to test microwave-based brain imaging is presented. Low-cost mixtures of materials are used to construct the main head tissues (hair, scalp, skull, cerebral spinal fluid, grey, and white matters). The properties of the fabricated tissues are stable over a long time and agree well with the measured data available in the literature across the band of interest (1-4 GHz). Because no data is available concerning the electrical properties of human hair, extensive measurements are done to find the properties of real and artificial wig hair across the band 0.2-20 GHz. A wig is found to emulate reasonably well the properties of real hair. It is thus used as part of the fabricated phantom. (c) 2014 Wiley Periodicals, Inc. Microwave Opt Technol Lett 56:979-982, 2014

A major concern in treating premature infants with birth-associated head trauma is the rapid determination of reliable biomarkers of neuroinflammation. To this end a chip-based immunoaffinity CE device has been applied to determine the concentrations of inflammation-associated chemokines in samples of cerebral spinal fluid collected from such subjects. The chip utilizes replaceable immunoaffinity disks, to which reactive antibody fragments (FAb) of 6 anti-chemokine-specific antibodies were immobilized. Following injection of a sample into the device, the analytes were captured by the immobilized FAbs, labelled in-situ with a red laser dye, chemically released and separated by CE. Each resolved peak was measured on-line by laser-induced fluorescence detection and the results compared to standard curves produced by running known chemokine standards through the immunoaffinity system. The complete processing of a sample took 10 min with separation of all 6 analytes being achieved in less than 2 min. The system compared well to commercial ELISA, analysis of the results by linear regression demonstrating r2 values in the range of 0.903 – 0.978 and intra- and inter-assay coefficients of variance (CV) of the migration times and the measured peak areas being less than 2.3% and 5%, respectively. Application of the system to analysis of cerebrospinal fluid from head traumatized babies clearly indicated the group with mild trauma versus those with severe injury. Additionally, CE analysis demonstrated that the severe trauma group could be divided into individuals with good and poor prognosis, which correlated with the clinical finding for each patient.

Objective To review experience with cochlear implant reimplantations, including effect of reinsertion on audiological performance. Study design and setting Retrospective review of cochlear implant reinsertions in patients seen in a private tertiary neurotologic practice. Forty-three patients (8 adults and 35 children) underwent revision cochlear implant surgery for device failure or upgrade. Findings at initial and repeat operations were noted, including number of electrodes inserted, and speech perception performance data were obtained when available. Results Five complications occurred in the reinsertion operations, 2 (6%) intraoperative cerebral spinal fluid leaks and 3 (7%) postoperative flap breakdowns with implant extrusion. Number of electrodes inserted was unchanged in 40/43 patients. Speech perception abilities remained stable or improved. Conclusion Cochlear reimplantation is technically feasible and allows for continued auditory stimulation. Significance Patients facing reimplantation must be aware of the possibility of differences in sound quality and speech recognition performance with their replacement device, but speech perception ability will typically remain the same or improve.

Methods: We reviewed the English and Japanese literature published from January 1995 to December 2013 using the keywords “CC,” “CI,” and “cochlear malformation.” We included cochlear implanted CC patients whose records on the occurrence of cerebral spinal fluid (CSF) gusher, facial nerve stimulation (FNS), the number of inserted and actively used electrodes, and/or hearing levels after CI were available.

Summary. Forty Cryptococcus neoformans strains isolated from cerebral spinal fluid specimens collected from 39 patients were included in the study. The MICs for fluconacole were determined by YNB macrodilution test, microdilution tests using both RPMI1640 and YNB medium and E-tests on solidified RPMI1640 medium, Casitone and YNB agar. In comparison with the reference macrodilution method NCCLS M27-P both the microdilution as well as the E-test techniques can be used for fluconacole susceptibility testing of Cr. neoformans. Zusammenfassung. In der Studie wurden 40 Cryptococcus neoformans-Isolate von 39 Patienten auf ihre Suszeptibilitat fur Fluconazol untersucht. Dabei wurden die technischen Bedingungen variiert: Es wurde der Bouillon-Makrodilutionstest mit dem Bouillon-Mikrodilutonstest und dem E-Test verglichen. Fernerhin wurde das YNB-Medium mit dem RPMI-Medium verglichen. Neben der Referenzmethode der Makrodilution erweisen sich sowohl die Mikrodilution wie auch der E-test fur die Bestimmung der Fluconazol-Suszeptibilitat bei Cr. neoformans als brauchbar.

A single-shot diffusion MRI technique on a standard clinical 1.5T scanner is presented. The method incorporates the following elements: (a) an inversion RF pulse followed by a delay of 1.3 s to null cerebral spinal fluid (CSF) signal, (b) a stimulated echo sequence (TE = 56 ms, TM = 100 ms) to obtain strong diffusion weighting, (c) a single-shot gradient- and spin-echo (GRASE) sequence for imaging with a modified k-space trajectory and Carr-Purcell Meiboom-Gill (CPMG)-phase cycle. The trace of the diffusion coefficient obtained with this approach is in good agreement with values reported for animal brain, and for recent human studies. It is demonstrated that single-shot diffusion imaging of human brain is feasible on an unmodified standard instrument without high-gradient slew rate or extreme field homogeneity.

Objective: Determine whether the endoscopic or sublabial transseptal transsphenoidal approach for pituitary surgery has superior outcomes or decreased complication rates.Method: A Medline search was conducted identifying all relevant literature in the English language from 1998 through 2010. Studies explicitly identifying pure sublabial or completely endoscopic approaches were included. Meta-analysis comparing the two techniques was performed for multiple outcome measures utilizing a random effects approach.Results: A total of 21 endoscopic studies (n = 2335) and 17 sublabial studies (n = 2565) met inclusion criteria. Analysis revealed significantly superior rates of gross tumor resection (79% vs 65%, P < .0001), as well as lower rates of cerebral spinal fluid leak (5% vs 7%, P < .01), septal perforation (0% vs 4%), and postoperative epistaxis (1% vs 4%, P < .0001) for the endoscopic approach compared to the sublabial approach. There was no difference between the 2 techniques in the incidence of meningiti...

As recently as the early 1990s, DNA purification was time-consuming, requiring the use of toxic, hazardous reagents. The advent of solid phase extraction techniques and the availability of commercial kits for quick and reliable DNA extraction has relegated those early techniques largely to the history books. High quality DNA can now be extracted from whole blood, serum, saliva, urine, stool, cerebral spinal fluid, tissues, and cells in less time without sacrificing recovery. Having achieved such a radical change in the methodology of DNA extraction, focus has shifted to adapting these methods to a miniaturized system, or “lab-on-a-chip” (A. Manz, N. Graber and H. M. Widmer, Sens. Actuators, B, 1990, 1, 244–248).1 Manz et al.'s concept of a “miniaturized total chemical analysis system” (µTAS) involved a silicon chip that incorporated sample pretreatment, separation and detection.1 This review will focus on the first of these steps, sample pretreatment in the form of DNA purification. The intention of this review is to provide an overview of the fundamentals of nucleic acid purification and solid phase extraction (SPE) and to discuss specific microchip DNA extraction successes and challenges. In order to fully appreciate the advances in DNA purification, a brief review of the history of DNA extraction is provided so that the reader has an understanding of the impact that the development of SPE techniques have had. This review will highlight the different methods of nucleic acid extraction (Table 1), including relevant citations, but without an exhaustive summary of the literature. A recent review by Wen et al. (J. Wen, L. A. Legendre, J. M. Bienvenue and J. P. Landers, Anal. Chem., 2008, 80, 6472–6479)2 covers solid phase extraction methods with a greater focus on their incorporation into integrated microfluidic systems.

Hydrocephalus is a severe disorder of the central nervous system characterized by absorption blockage of the cerebral spinal fluid (CSF). The archaeological record of the condition ranges in time from 10,000 B.C. to 1670 A.D. and consists of 30 possible cases worldwide. A review of this material reveals that diagnostic criteria which fully delineate the condition have not been established. Previously, no attempt has been made to differentiate the two major categories of hydrocephalus and their subgroupings, or to identify other conditions which might result in similar morphologies. A partial child's skeleton from the Middle Period (ca. 2500 B.C. to 500 A.D.) of Central California Prehistory is described in light of an extensive clinical literature. Examination of this individual reveals a unique craniofacial configuration and malformed postcrania. Bony criteria for a differential diagnosis of hydrocephalus are established and applied to this individual. Based on these criteria, the individual is diagnosed as having a chronic form of noncommunicating hydrocephalus. Blockage of the CSF pathway most likely occurred in the aqueduct of Sylvius with a partial occlusion of the foramen of Monro or a frontal cyst. In addition, femoral development is suggestive of partial paralysis.

Free-living amebas represented by Naegleria fowleri, Acanthamoeba and Balamutia have been known to cause fatal meningoencephalitis since Fowler and Carter (1965) reported the first four human cases. An autopsy case of a 25-year-old female with primary amebic meningoencephalitis (PAM) due to Naegleria fowleri is described. Headache, lethargy and coma developed in this patient, and her condition progressed to death 8 days after the onset of clinical symptoms. Cerebral spinal fluid examination confirmed clusters of amebas, which were grown in culture and identified as Naegleria fowleri. At autopsy, lesions were seen in the central nervous system (CNS) and the ethmoid sinus. The CNS had severe, suppurative meningoencephalitis with amebic trophozoites mingled with macrophages. This case is the first report of PAM due to Naegleria fowleri in Japan.

Problem: Hearing preservation during acoustic tumor removal is generally attempted using 1 of 2 approaches: the middle fossa or retrosigmoid. This study evaluates hearing and facial nerve preservation rates using the retrosigmoid approach and compares the postoperative results with those reported in the literature using the middle fossa technique. This comparison was conducted to determine which approach offers an opportunity for the best patient outcome. Methods: Hearing preservation was attempted in 46 patients with vestibular schwannomas. Tumor size ranged from 0.5 to 2.5 cm. A retrosigmoid approach and direct eighth nerve monitoring (DENM) was used for all patients. Outcome measures of hearing preservation, facial nerve function, and cerebral spinal fluid leak were evaluated and compared to those reported using the middle fossa approach. Results: Hearing was preserved in 71% of patients with tumors 1 cm or smaller and 32% of patients with tumors between 1 and 2.5 cm. Facial nerve preservation rates were 94% (HB 1–2) for tumors smaller than 2 cm. Conclusion: The retrosigmoid approach with DENM provides rates of hearing preservation comparable to those reported for the middle fossa approach for the resection of vestibular schwannomas. Facial nerve function, both short-term and long-term, appears to be better with the retrosigmoid approach. Significance: Resection of vestibular schwannomas via either the retrosigmoid approach, the use of DENM, or the middle fossa approach provides comparable results for hearing preservation. However, facial nerve function appears to be better preserved with the retrosigmoid approach. Support: None reported.

Tumor necrosis factor (TNF) a and b are multifunctional cytokines elaborated primarily by monocytes and macrophages (TNF-a) or T cells (TNF-b). Some cells that bind TNF-a or -b on their surface receptors lyse as a consequence of the binding reaction. This unit presents a protocol that employs TNF-sensitive, actinomycin D-treated murine L929 fibroblasts to quantify TNF activity in supernatants derived from cell cultures, serum samples, or cerebral spinal fluid. While the assay can measure picogram concentrations of human, rat, and murine TNF-ab, it cannot distinguish between the a and b forms of any species. A Support Protocol describes propagation and preparation of L929 fibroblasts.

Purpose: To determine whether a spin-echo-based sequence, which are inherently insensitive to magnetic field inhomogeneity, can be used for brain cortical thickness measurement studies. Materials and Methods: By using a double inversion recovery (DIR) spin-echo-based sequence, cortical thickness estimates were performed from data acquired from seven healthy volunteers. The cortical thickness was also calculated from data acquired using an MPRAGE sequence and the Bland-Altman analysis was performed for comparison of the two methods. The average signal and contrast to noise ratios (SNR, CNR) of the two methods were also calculated. Results: The bias over the entire brain between DIR and MPRAGE was 0.87 ± 0.08 mm. The bias calculated in the major regional lobes were temporal: 0.76 ± 0.09 mm, frontal: 0.89 ± 0.07 mm, parietal: 0.92 ± 0.10 mm, occipital: 0.75 ± 0.12 mm, and cingulate: 0.79 ± 0.10 mm. This thickness difference was due mainly to the boundary difference in the MPRAGE and DIR at the grey matter/cerebral spinal fluid (GM/CSF) regions. The mean SNR and CNR was CNRMPRAGE = 47.8 ± 8.4 and CNRDIR = 19.2 ± 2.9, SNRMPRAGE = 76.8 ± 10.5 and SNRDIR = 21.1 ± 2.8. Conclusion: The study suggests that cortical thickness measurements can be performed using a DIR spin-echo sequence, which is inherently immune to main field inhomogeneity. Larger thickness measurements were consistently observed in DIR compared with MPRAGE. J. Magn. Reson. Imaging 2011;33:1218–1223. © 2011 Wiley-Liss, Inc.

Neurotologic and skull base procedures that include dissection within the subarachnoid space carry with them the potential for meningitis. Postoperative aseptic leptomeningitis occurs more frequently than purulent bacterial meningitis. Differentiation between these two conditions early in the postoperative period is important to avoid delay in or unnecessary treatment. The definitive diagnosis is made with cerebral spinal fluid culture. Early differentiation between postoperative aseptic leptomeningitis and purulent bacterial meningitis on the basis of results of cerebral spinal fluid profile before cerebral spinal fluid culture would result in earlier appropriate therapy.

Standing myelography was conducted in six neurologically normal adult horses. Myelograms were performed without general anesthesia or tranquilization. Four horses were premedicated orally with 2.2 milligrams/kilogram (mg/kg) of phenobarbital 16 hours and 4 hours prior to myelography to raise their seizure threshold. One-hundred milliters (ml) of cerebral spinal fluid (CSF) was withdrawn from the lumbosacral space prior to injection. Approximately 100 ml of technical grade metrizamide* was injected into the subarachnoid space via a lumbosacral tap. After injection the horse's head was lowered for approximately 10 minutes to facilitate cranial movement of the metrizamide. Lateral cervical radiographs were taken in a standing position. Filling of the subarachnoid space in the cranial cervical region was good to excellent in five horses. In one horse there was poor definition of the cranial cervical region. There was good to excellent filling of the subaranoid space in the caudal cervical region in all six horses. Reactions to metrizamide injection varied. The most severe reaction was generalized seizure.

The classical form of adrenoleukodystrophy (ALD; McKusick 20237) has infantile onset. Adrenomyeloneurodystrophy (AMN), having genetic, biochemical and ultrastructural features closely correlated to those of ALD, has been described in adults (Griffin et al., 1977). AMN is clinically characterized by spastic paraparesis, adrenal insufficiency, peripheral neuropathy and variable degree of hypogonadism.