Search

Marchiafava-Bignami disease is a rare affliction characterized by primary degeneration of the corpus callosum associated with chronic consumption of ethanol. The disease may occasionally occur in patients who are not alcoholics but are chronically malnourished. A complex deficiency of group B vitamins is the main etiopathogenic hypothesis, and many patients improve after the administration of these compounds. However, a good response is not always observed. The definitive diagnosis of Marchiafava-Bignami disease can be problematic and is based on features of neuroimaging studies, especially magnetic resonance imaging. Its treatment is still controversial and shows variable results. Because nutritional factors are implicated, as in Wernicke's encephalopathy, some authors claim that replacement of B vitamins is beneficial. The present article is a case report of a severe acute form of Marchiafava-Bignami disease in an alcohol-dependent male patient who improved after the administration of parenteral B vitamins. As a consequence of his neurological and immunologic conditions, he developed multiple pulmonary infections and had a protracted course in the intensive care unit. He eventually died of sepsis associated with an uncommon fungus, Rhodotorula mucilaginosa. The present article reports the clinical and neuroimaging data from this patient and contains a review of Marchiafava- Bignami disease and Rhodotorula infections in the intensive care unit. [ABSTRACT FROM AUTHOR]

The purpose of this case report was to report a rare case of pyogenic spondylodiscitis caused by Campylobacter fetus . A 37-year-old male presented with fever and low back pain. By lumbar magnetic resonance imaging (MRI), no abnormal finding was observed at the first presentation. However, low back pain was aggravated, and fever did not improve. Thus, lumbar MRI was repeated on the 26 day after the onset of symptoms, showing abnormal signals at vertebrae and disc spaces, and pyogenic spondylitis was diagnosed. The possibility of pyogenic spondylodiscitis should be taken into account if a patient presents with low back pain and fever, and areas of low signal intensity on a T1-weighted MRI should be carefully examined. When initial MRI does not reveal abnormal findings, repeated MRI after one or two weeks or, more favorably, immediate gadolinium enhancement MRI, are important for patients who have persistent low back pain and fever. [ABSTRACT FROM AUTHOR]

Isolated right ventricular hypoplasia, unassociated with severe pulmonary or tricuspid valvular malformation, is a rare congenital heart disease. Herein the authors report a case of a 6-year-old girl having isolated right ventricular hypoplasia treated with one and a half ventricular repair, and describe the cardiac magnetic resonance (CMR) imaging findings. CMR imaging revealed diffuse subendocardial or transmural late gadolinium enhancement of the right ventricle with a thin, smooth wall due to the absence of trabeculations. Noncompaction of the left ventricle was also demonstrated, although the relevance to isolated right ventricular hypoplasia is not obviously explicable. [ABSTRACT FROM AUTHOR]

The article presents a study which assesses acute pulmonary hemodynamics during glossopharyngeal insufflation (GI) using phase-contrast magnetic resonance imaging (MRI). It notes that the hemodynamic parameters were measured in nine healthy male breath hold divers, ages between 20-43 years old by velocity-encoding cine (VEC)-MRI of the main pulmonary artery (PA) before, during, and after GI. It says the GI-lung volume was also simultaneously measured by MR-compatible spirometry, used to assess baseline spirometry in the suspine position. It ends that while acute voluntary lung hyperinflation imitates changes seen in pulmonary arterial hypertension, the changes are fully reversible right after cessation of voluntary lung hyperinflation.

Abstract: We correlated serial brain MRIs with neuropathological findings in a 16-year-old female whose autopsy was consistent with Wernicke''s encephalopathy (WE). Diffusion-weighted imaging, diffusion coefficients mapping and neuropathology findings were suggested vasogenic edema in the periaqueductal and peri-the-fourth ventricular areas. This is the first documented case report to make this direct comparison. The characteristic WE changes in the mammillary body was also correlated with the findings of MRI with contrast enhancement. Bilateral cortical lesions revealed by MRI were atypical and rare in WE and were not evidenced by pathological changes. [Copyright &y& Elsevier]

Abundant data now link composition of the vascular wall, rather than the degree of luminal narrowing, with the risk for acute ischemic syndromes in the coronary, central nervous system, and peripheral arterial beds. Over the past few years, magnetic resonance angiography has evolved as a well-established method to determine the location and severity of advanced, lumen-encroaching atherosclerotic lesions. In addition, more recent studies have shown that high spatial resolution, multisequence MRI is also a promising tool for noninvasive, serial imaging of the aortic and carotid vessel wall, which potentially can be applied in the clinical setting. Because of the limited spatial resolution of current MRI techniques, characterization of coronary vessel wall atherosclerosis, however, is not yet possible and remains the holy grail of plaque imaging. Recent technical developments in MRI technology such as dedicated surface coils, the introduction of 3.0-T high-field systems and parallel imaging, as well as developments in the field of molecular imaging such as contrast agents targeted to specific plaque constituents, are likely to lead to the necessary improvements in signal to noise ratio, imaging speed, and specificity. These improvements will ultimately lead to more widespread application of this technology in clinical practice. In the present review, the current status and future role of MRI for plaque detection and characterization are summarized. [ABSTRACT FROM AUTHOR]

Considerable evidence has emerged that adverse blood flow patterns are a major factor in the onset of atherosclerotic disease and may play a role in disease progression. This chapter reviews a technique, referred to as vascular computational fluid dynamics (CFD), for characterizing blood flow patterns in large arteries from magnetic resonance angiography (MRA) and velocity‐encoded phase‐contrast magnetic resonance (PC MR) imaging. In vascular CFD, hemodynamic conditions are modeled by the finite‐element method with flow is governed by the incompressible Navier‐Stokes equations. Construction of the vascular CFD models is a multi‐step process. Critical aspects of the methodology are described in detail including surface reconstruction, construction of the volumetric mesh, imposition of boundary conditions and solution of the finite element model. In vitro and in vivo experimentation is discussed that demonstrates, in a preliminary manner, the validity of the methodology. Flow models are presented for carotid arteries with a wide range of atherosclerotic disease. Considerable evidence has emerged that disturbed blood flow patterns are a major factor in the onset of atherosclerotic disease and may play a role in disease progression. The proposed chapter will review a technique for characterizing blood flow patterns in large arteries from magnetic resonance angiography (MRA) and velocity‐encoded phase‐contrast magnetic resonance imaging. This technique, known as vascular computational fluid dynamics (CFD), has been applied extensively to the bifurcation region of the carotid artery, a common site of plaque formation. Common hemodynamic features in this region will be presented based on imaging of a series of normal subjects. Hemodynamic features in the vicinity of the carotid bifurcation will also be presented for a series of subjects with advanced atherosclerotic disease. [ABSTRACT FROM AUTHOR]

Magnetic resonance imaging (MRI) has been useful in revealing subtle structural differences in the brains of schizophrenic patients compared with healthy controls. MR structural analyses have revealed a number of brain abnormalities including ventricular enlargement, total brain volume reduction, and regional reductions in brain volume in frontal, parietal and temporal regions. However, it is still unknown whether the brain abnormalities observed with MRI in schizophrenia arc confounded by chronicity or whether there is a continual degenerative process. Evaluation of the brain structure during the first episode of psychosis (FEP) is a powerful strategy for investigating these fundamental questions. The first-episode design avoids the confusion of chronicity of illness, longstanding substance abuse, and the effects of treatment. Structural MRI studies of patients experiencing a first-episode psychosis have revealed a similar pattern of brain abnormalities as in samples of chronic patients, although deficits may be less extensive. The temporal lobe, a brain structure traditionally implicated in the pathophysiology of schizophrenia, has been examined often in first-episode studies. Many studies have reported significant abnormalities in the medial areas and superior temporal gyro. However, most studies examining the whole temporal lobe have been unable to show such significant abnormalities. In the light of the increasing amount of ambiguous findings regarding structural temporal lobe abnormalities in patients with schizophrenia experiencing their first-episode of psychosis, a quantitative review of the existing literature was needed to better characterize the temporal lobe deficits observed with MRI in those patients. [ABSTRACT FROM AUTHOR]

Cognitive dysfunction can occur in some patients with amyotrophic lateral sclerosis (ALS) who are not suffering from dementia. The most striking and consistent cognitive deficit has been found using tests of verbal fluency. ALS patients with verbal fluency deficits have shown functional imaging abnormalities predominantly in frontotemporal regions using positron emission tomography (PET). This study used automated volumetric voxel-based analysis of grey and white matter densities of structural magnetic resonance imaging (MRI) scans to explore the underlying pattern of structural cerebral change in nondemented ALS patients with verbal fluency deficits. Two groups of ALS patients, defined by the presence or absence of cognitive impairment on the basis of the Written Verbal Fluency Test (ALSi, cognitively impaired, n = 11; ALSu, cognitively unimpaired n = 12) were compared with healthy age matched controls (n = 12). A comparison of the ALSi group with controls revealed significantly (p<0.002) reduced white matter volume in extensive motor and non-motor regions, including regions corresponding to frontotemporal association fibres. These patients demonstrated a corresponding cognitive profile of executive and memory dysfunction. Less extensive white matter reductions were revealed in the comparison of the ALSu and control groups in regions corresponding to frontal association fibres. White matter volumes were also found to correlate with performance on memory tests. There were no significant reductions in grey matter volume in the comparison of either patient group with controls. The structural white matter abnormalities in frontal and temporal regions revealed here may underlie the cognitive and functional imaging abnormalities previously reported in non-demented ALS patients. The results also suggest that extra-motor structural abnormalities may be present in ALS patients with no evidence of cognitive change. The findings support the hypothesis of a continuum of extra-motor cerebral and cognitive change in this disorder. [ABSTRACT FROM AUTHOR]

Magnetic resonance (MR)-guided liver biopsy was performed in three patients with hepatocellular carcinoma. The tumor was considered (n = 2) or proven (n = 1) inaccessible with ultrasound or computed tomographic guidance. Because all lesions were poorly delineated on nonenhanced MR imaging, contrast agents (Gd-BOPTA, n = 1; ferucarbotran, n = 2) were applied to facilitate biopsy in an open low-field scanner. Postcoatrast tumor conspicuity was fair in the patient receiving Gd-BOPTA and excellent in both patients receiving ferucarbotran, and biopsy was successful in all eases. [ABSTRACT FROM AUTHOR]

Background: Recent advances in the treatment of primary pulmonary hypertension (PPH), and in surgery to correct tetralogy of Fallot (TOF), have rekindled interest in evaluating right ventricular (RV) volume and ejection fraction (EF). The purpose of this investigation was to determine the accuracy of RV functional parameters assessed by single photon emission computed tomography (SPECT) equilibrium radionuclide angiography (ERNA).Methods and Results: Twenty-eight patients with PPH (n = 15) or TOF (n = 13) (aged 28 +/- 14 years; 57% male) were analyzed by means of SPECT ERNA algorithms that automatically identified mid-RV tomographic planes, generated regions isolating the right ventricle from other structures, and presented RV-segmented regions as a cinematic display. RV EF and volumes were computed and compared with values obtained by magnetic resonance imaging (MRI). Mean values were not different between SPECT ERNA and MRI for RV EF, end-diastolic volume, and end-systolic volume (42% +/- 11% vs 41% +/- 10%, 135 +/- 67 mL vs 139 +/- 91 mL, and 87 +/- 54 mL vs 85 +/- 61 mL, respectively; P = not significant for all comparisons). Significant linear correlation (P <.0001) was found between SPECT ERNA and MRI for RV EF, end-diastolic volume, and end-systolic volume (r = 0.85, r = 0.94, and r = 0.93, respectively). No statistically significant trends or biases for RV EF were found. Intraobserver and interobserver comparisons demonstrated good reproducibility. As expected, RV volume was significantly higher and RV EF was significantly lower for patients with PPH and TOF than were values for individuals at low likelihood for coronary artery disease or other cardiac disease.Conclusions: SPECT ERNA provides accurate, reproducible assessment of RV volumes and EF and should prove useful in evaluating the magnitude of RV dysfunction in patients and in providing an objective means with which to assess the results of therapeutic interventions. [ABSTRACT FROM AUTHOR]

Patients with non-Hodgkin’s lymphoma occasionally develop widespread invasion of peripheral nerves by tumor cells or neurolymphomatosis (NL). Clinically this usually results in asymmetrical, progressive, and painful polyneuropathy. Diagnosis rests on the identification of tumor cells in peripheral nerves. To avoid false-negative biopsy findings in patients with malignant lymphomatous infiltration of peripheral nerves it has been recommended to biopsy clinically involved nerves. We present two patients with histologically confirmed NL in whom sural the nerve biopsy finding was negative despite clinical and neurophysiological evidence of involvement of the sural nerve a. The clinical features of NL are reviewed. Some patients with neurolyphomatosis have only focal or proximal involvement of nerves, requiring the biopsy of an affected part of these nerves. Magnetic resonance imaging may be useful in identifying affected nerves. [ABSTRACT FROM AUTHOR]

Magnetic resonance imaging (MRI) is frequently used to monitor new treatments in multiple sclerosis (MS), but its role is limited by the uncertain relationship between MRI parameters and clinical disability. A brain MRI study using nine MRI parameters was undertaken in 15 MS patients with a wide spectrum of disability to evaluate the relationship between each parameter and disability. A strong correlation was found between disability (measured using Kurtzke’s EDSS) and total lesion load on both proton density (PD; r = 0.79) and T1 ( r = 0.71) weighted sequences. There was also a strong correlation of disability with average lesion magnetisation transfer ratio (MTR; r = –0.74) and calculated T1 ( r = 0.71) but not with calculated T2 or the average signal intensity of lesions on the conventional T1-weighted, PD-weighted and heavily T2-weighted images. Thus, four parameters which measured either the extent of lesions (PD lesion load) or their pathological severity (MTR, calculated T1, hypointense T1-lesion load) were correlated significantly with disability. While this suggests that such parameters will be useful in treatment trial monitoring, further multi-parameter MRI studies, of larger cohorts and using a wider range of techniques, are indicated. [ABSTRACT FROM AUTHOR]

We describe the findings of functional magnetic resonance imaging (fMRI) in a patient with Broca’s aphasia. The patient was a 45-year-old, right-handed woman who developed Broca’s aphasia after infarction in the left frontal lobe. The first fMRI showed no signals in the left frontal lobe during verbal tasks, 2 weeks after the onset of infarction. Four weeks later, when the patient’s symptom had improved, the second fMRI showed some increase in the fMRI signals in the left frontal lobe. Seven months later, she had completely recovered the ability to speak. The last fMRI then showed that the increment in signal activity in the left frontal lobe during verbal tasks had recovered to the level seen in normal subjects. There was a good correlation between the increase in task-related signals in Broca’s area and the recovery of language function. Our findings show that fMRI has can be important in assessing cognitive functions in patients with Broca’s aphasia. [ABSTRACT FROM AUTHOR]

We report two adult Japanese sisters with l-2-hydroxyglutaric aciduria (acidemia), both of whom were much older (aged 57, 47 years old) than previously reported patients (from neonate to 44 years old), and who presented with differing severity. Magnetic resonance imaging revealed typical subcortical white matter lesions in both cases and showed brainstem atrophy and thickness of the calvarium in the elder sister. l-2-Hydroxyglutaric acid levels were increased in urine, plasma, and cerebrospinal fluid. These cases suggest that organic acid analysis is necessary even in elderly patients who seem to have neurodegenerative disorders. [ABSTRACT FROM AUTHOR]

The pattern of anatomical features of the brain revealed by magnetic resonance imaging (MRI) is described in six patients incidentally identified as having acallosal brains. The complex of morphological features associated with complete agenesis of the corpus callosum included lateral displacement of slit-like anterior horns of the lateral ventricles (bullhorn-like shape), dilatation of the posterior horns of the lateral ventricles, absence of the septum pellucidum, lateral displacement of the cingulate gyri, complete separation of fornices and the presence of the anterior commissure and longitudinal callosal bundles (Probst’s bundles). No compensatory enlargement of the anterior commissure was seen in the patients. The planimetrically measured cross-sectional areas of the anterior commissures were between 2.0 and 4.2 mm2 (mean 3.1) (in ten normal subjects they were 4.5, SD 0.4; range 3.8–5.2 mm2) and were reduced in four and normal in two patients. Inconstant morphological features were an absence of the posterior commissure and a radial pattern of the sulci and gyri on the medial aspect of the hemispheres. Conventional clinical testing revealed no abnormalities except a slight impairment of walking heel-to-toe in two patients. None of the patients had subjective restrictions of activities of daily life, which shows the efficacy of unknown compensatory processes. [ABSTRACT FROM AUTHOR]

Recent reports have suggested that fluid attenuated inversion recovery (FLAIR) is a technique superior to conventional (CSE) or fast spin echo (FSE) T2-weighted sequences in detecting intrinsic lesions both in the brain and spinal cord. We report our experience of an inversion recovery prepared FSE, which we refer to as fast FLAIR, in a comparative study of ten patients with clinically definite multiple sclerosis (MS) who underwent cervical cord and brain imaging with both FSE and fast FLAIR. The results showed that in the cerebral hemispheres fast FLAIR detected more lesions than FSE ( P < 0.001). However, FSE detected more lesions than fast FLAIR in the posterior fossa ( P = 0.02) and in the cord fast FLAIR was much inferior detecting only 2 of 33 lesions seen on FSE. Estimating the T2 relaxation times of lesions in each of three areas (periventricular, posterior fossa, cervical cord) showed that the T2 value of posterior fossa and cervical cord lesions was significantly lower than that of periventricular lesions, suggesting that the lesion composition is different and consequently their imaging appearances are different. In conclusion, although fast FLAIR improves the detection of MS lesions in the cerebral hemispheres, its substantially lower sensitivity in the posterior fossa and spinal cord is a potentially important limitation to its use as a tool for the diagnosis of MS and for monitoring therapies. Further studies are needed to elucidate the mechanisms underlying the loss of sensitivity. [ABSTRACT FROM AUTHOR]

Central nervous system (CNS) involvement in systemic lupus erythematosus (SLE) remains difficult to diagnose, particularly since structural abnormalities may not be revealed by magnetic resonance imaging (MRI). Glucose utilisation was measured by positron emission tomography (PET) in 35 SLE patients to detect signs of CNS involvement. The patients were examined by a standardised neurological examination, a battery of tests to evaluate neuropsychological performance and MRI. Antineuronal antibodies were determined to investigate their putative role in CNS involvement in SLE. Twenty patients had distinct neurological (17) and/or psychiatric (3) symptoms. Ten patients had pronounced cognitive impairment. Neurological and cognitive deficits were thus found to be unrelated disorders in SLE. Global glucose utilisation of SLE patients did not differ significantly from that of normal controls, nor were differences found between SLE patients with or without neurological or cognitive abnormalities. On MRI of the brain, the number and size of white matter lesions correlated with the presence of neurological deficits but were unrelated to the severity of cognitive impairment. Within the normal range, lower global glucose utilisation tended towards lower values with increasing number and size of white matter lesions. Patients with lesions larger than 8 mm also showed distinctly increased IgG anticardiolipin antibody titres, whereas measuring antineuronal antibodies did not reveal any relation to the variables investigated. We conclude that the demonstration of CNS lesions by MRI can contribute confirmatory evidence for CNS involvement in SLE, but PET or the presence of antineuronal antibodies adds little if any information beyond that obtained by clinical examination, neuropsychological testing, and MRI. [ABSTRACT FROM AUTHOR]

Bone scintigraphy is the primary method for the diagnosis of skeletal métastases. This investigation is sensitive, but the interpretation must be performed in the knowledge that it is also nonspecific. Despite this, a correct diagnosis can usually be achieved. The first-hand supplementary investigation, after a doubtful scintigraphic finding, is radiography. In most cases this is sufficient for a diagnosis. When a scintigraphic abnormality cannot be adequately explained, usually because of a negative radiographic examination, a more sensitive modality must be used. Computerized tomography offers increased sensitivity and specificity, and is primarily used for this purpose. In this way contrast resolution is increased and problems caused by obscuring tissue and complicated anatomy are reduced. Since bone metastases migrate via the active bone marrow an alternative supplementary investigation is bone marrow scintigraphy. Its usefulness is restricted by disturbing activity, from the liver and the spleen, which obscures a significant part of the active marrow, and by the fact that a lesion must be of a certain size to become apparent. Magnetic resonance imaging yields excellent images of the extension of a tumor in soft tissue. Owing to high costs and restricted availability it is still mainly used for preoperative location of metastases. [ABSTRACT FROM AUTHOR]

Saad S Hammadi*, Salman K Ajlan@, Asal B. Shindi# & Abdul-Sattar J Yousof% *MB,ChB, FICMS, Professor, Department of Medicine. @MB,ChB, MSc, Assist Professor, Department of Biochemistry. #MB,ChB, MSc, Assist Professor, Department of Surgery College of Medicine, University of Basrah, Basrah, IRAQ. %FICMS, Department of Medicine, Al-Faiha General Hospital, Basrah, IRAQ. Address of Correspondence: Dr Saad S. Hammadi. Department of Medicine, College of Medicine, University of Basrah, Basrah, IRAQ. Abstract This study aimed to evaluate the degree of oxidative stress associated with magnetic resonance imaging (MRI) examination. Serum malondialdehyde (MDA) levels were estimated in 70 patients, 44 males and 26 females, 16-70 years of age underwent MRI examination for various reasons. There was an overall increase in serum MDA level following MRI examination with overall mean difference between pre- and post- MRI examination MDA level of 0.066 ±0.110 Mmole /l (P=65 were 0.05). It is concluded that MRI examination is associated with significant free radical activity reflected by marked elevation of serum MDA levels. This implies that MRI examination may impose an oxidative assault which in turn, may be of clinical significance in elderly patients in particular.

Resting-state functional magnetic resonance imaging (fMRI), a promising imaging technique to investigate brain functional reorganization, has been widely used in Parkinson's disease (PD) that has improved the current knowledge about the mechanisms underlying motor and non-motor symptoms [[2]]. For the first time, using the anisotropic effect size version of signed differential mapping (AES-SDM), Wolters et al. performed a voxel-based meta-analysis of 17 resting-state fMRI studies that investigated the resting-state functional connectivity alterations in patients with PD-CI compared with cognitively unimpaired patients with PD (PD-CU) or healthy controls [[1]]. [Extracted from the article]

Stress cardiomyopathy (SC) is an increasingly recognized form of acute heart failure, which has been linked to a wide variety of emotional and physical triggers. The pathophysiological mechanisms of the disease remain incompletely understood, however, inflammation has been recently shown to play a pivotal role. This review summarizes the most notable findings of myocardial inflammation, demonstrated from biopsies and cardiac magnetic resonance imaging in humans. In the acute stage macrophage infiltration appears to represent the substrate for myocardial edema, together defining the local myocardial inflammation. This appears to evolve into a low grade systemic chronic inflammation which could explain the protracted clinical course of these patients and raises hope for finding a specific SC cardiac biomarker as well as a therapeutic breakthrough. As a parallel to the human findings the review covers some of the emerging mechanistic insights from experimental models, which, albeit not proven in the human condition, highlight the possible importance in pursuing distinct paths of investigation such as the beta-receptor signaling, aberrations of nitric oxide generation and signaling and the contribution of the vascular endothelium/permeability to edema and inflammation during the acute stage., (Copyright © 2020. Published by Elsevier Inc.)

We report a rare case of sarcoidosis of the hypothalamic and suprasellar region, with clinical course and the magnetic resonance imaging follow-up. [ABSTRACT FROM AUTHOR]