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Introduction: We describe the first case of acute flaccid myelitis (AFM) related to enterovirus D68 (EV-D68) infection in Belgium. The clinical and radiological presentation of AFM associated with EV-D68 although well described currently remains a challenging diagnosis. Through this interesting clinical case, we aimed to review the differential diagnosis of acute flaccid palsy in a child and discuss the specific point of interest related to AFM. Case Presentation: We present the case of a 4-year-old girl with a torticollis associated with an acute palsy of the right upper limb. The magnetic resonance imaging revealed an increased T2 signal intensity of the entire central gray matter of the cervical cord with involvement of the posterior brainstem. A polymerase chain reaction (PCR) conducted on a nasopharyngeal swab was found positive for EV-D68. The definition of AFM proposed by the Center for Disease Control and Prevention (CDC) is an acute-onset flaccid weakness of one or more limbs in the absence of a clear alternative diagnosis and the radiological evidence of gray matter involvement on an MRI picture, and our case fits these two criteria. A prompt and detailed workup is required to distinguish this emergent disease from other forms of acute flaccid palsy. The functional prognosis of AFM is poor, and there are no evidence-based treatment guidelines so far. Conclusion: AFM is an emerging pathology that requires the attention of pediatricians to quickly rule out differential diagnoses and adequately manage the patient. Further research is needed to optimize treatments, improve outcomes, and provide scientifically based guidelines. [ABSTRACT FROM AUTHOR]

Purpose: Human ageing is associated with a regional reduction in cerebral neuronal activity as assessed by numerous studies on brain glucose metabolism and perfusion, grey matter (GM) density and white matter (WM) integrity. As glucose metabolism may impact energetics to maintain myelin integrity, but changes in functional connectivity may also alter regional metabolism, we conducted a cross-sectional simultaneous FDG PET/MR study in a large cohort of healthy volunteers with a wide age range, to directly assess the underlying associations between reduced glucose metabolism, GM atrophy and decreased WM integrity in a single ageing cohort. Methods: In 94 healthy subjects between 19.9 and 82.5 years (mean 50.1 ± 17.1; 47 M/47F, MMSE ≥ 28), simultaneous FDG-PET, structural MR and diffusion tensor imaging (DTI) were performed. Voxel-wise associations between age and grey matter (GM) density, RBV partial-volume corrected (PVC) glucose metabolism, white matter (WM) fractional anisotropy (FA) and mean diffusivity (MD), and age were assessed. Clusters representing changes in glucose metabolism correlating significantly with ageing were used as seed regions for tractography. Both linear and quadratic ageing models were investigated. Results: An expected age-related reduction in GM density was observed bilaterally in the frontal, lateral and medial temporal cortex, striatum and cerebellum. After PVC, relative FDG uptake was negatively correlated with age in the inferior and midfrontal, cingulate and parietal cortex and subcortical regions, bilaterally. FA decreased with age throughout the entire brain WM. Four white matter tracts were identified connecting brain regions with declining glucose metabolism with age. Within these, relative FDG uptake in both origin and target clusters correlated positively with FA (0.32 ≤ r ≤ 0.71) and negatively with MD (− 0.75 ≤ r ≤ − 0.41). Conclusion: After appropriate PVC, we demonstrated that regional cerebral glucose metabolic declines with age and that these changes are related to microstructural changes in the interconnecting WM tracts. The temporal course and potential causality between ageing effects on glucose metabolism and WM integrity should be further investigated in longitudinal cohort PET/MR studies. [ABSTRACT FROM AUTHOR]

Background: The evidence on the mechanisms of action of electroconvulsive therapy (ECT) has grown over the past decades. Recent studies show an ECT-related increase in hippocampal, amygdala and subgenual cortex volume. We examined grey matter volume changes following ECT using voxel-based morphometry (VBM) whole brain analysis in patients with severe late life depression (LLD). Methods: Elderly patients with unipolar depression were treated twice weekly with right unilateral ECT until remission on the Montgomery-Åsberg Depression Rating Scale (MADRS) was achieved. Cognition (Mini Mental State Examination) and psychomotor changes (CORE Assessment) were monitored at baseline and 1 week after the last session of ECT. We performed 3 T structural MRI at both time points. We used the VBM8 toolbox in SPM8 to study grey matter volume changes. Paired t tests were used to compare pre-and post-ECT grey matter volume (voxel-level family-wise error threshold p < 0.05) and to assess clinical response. Results: Twenty-eight patients (mean age 71.9 ± 7.8 yr, 8 men) participated in our study. Patients received a mean of 11.2 ± 4 sessions of ECT. The remission rate was 78.6%. Cognition, psychomotor agitation and psychomotor retardation improved significantly (p < 0.001). Right-hemispheric grey matter volume was increased in the caudate nucleus, medial temporal lobe (including hippocampus and amygdala), insula and posterior superior temporal regions but did not correlate with MADRS score. Grey matter volume increase in the caudate nucleus region correlated significantly with total CORE Assessment score (r = 0.63; p < 0.001). Limitations: Not all participants were medication-free. Conclusion: Electroconvulsive therapy in patients with LLD is associated with significant grey matter volume increase, which is most pronounced ipsilateral to the stimulation side. [ABSTRACT FROM AUTHOR]

Recent studies show lower gray matter volumes and altered white matter networks in boys with Duchenne Muscular Dystrophy (DMD) compared with healthy controls, suggesting a lack of dystrophin impacts brain structures. However, the majority of boys with DMD are chronically treated with corticosteroids (CS), which are known to cross the blood-brain barrier and cause brain atrophy. Unraveling the impact of CS treatment on the brain of boys with DMD is key to understand brain involvement in this disease. This study compared two groups of DMD boys treated with a different CS regimen with 2 healthy control groups. 3D T1-weighted images were obtained on a 3T Philips system at two different sites. Scans from 20 DMD patients (13.0±3.1y) on a 10 days on/10 days off prednisolone schedule and 20 age-matched controls (13.2±1.8y) were obtained at the LUMC Leiden, the Netherlands. Additionally scans of 20 age-matched DMD patients (12.8±3.0y) on a daily deflazacort regime and 20 age-matched controls (13.1±3.2y) were acquired at the UZ Leuven, Belgium. All 80 scans were processed using FSL software to calculate intracranial (ICV), total brain (TBV), grey matter (GMV), white matter (WMV) and CSF volumes. In addition, volumes of the hippocampus, amygdala, thalamus, nucleus accumbens, caudate nucleus, globus pallidus and putamen were calculated. To control for intracranial volume differences, relative volumes were compared between controls and DMD per center using univariate analyses of variances in SPSS and considered significant at p<0.05. Both DMD groups showed a significant lower relative GMV, and higher relative CSF volume compared to their control groups. Interestingly, a significantly lower relative WMV (33.81% vs 35.45%, p=.002) and relative volume of the globus pallidus (0.25% vs 0.22%, p<.001) was found in the deflazacort group compared with their control group, but not in the prednisolone group. This study suggest that different CS regimes lead to different regional brain volume reductions in patients with DMD. [ABSTRACT FROM AUTHOR]