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PubMed1985

Visualisation of stereotactic radiolesions by nuclear magnetic resonance.

The ability to visualise stereotactic brain lesions produced by irradiation from the stereotactic Gamma Unit at the Karolinska Hospital was investigated. A patient who had undergone bilateral stereotactic gamma capsulotomy in two stages was examined by the nuclear magnetic resonance imaging technique, which demonstrated that the stereotactic lesions in the internal capsule could be visualised in the immediate postoperative period. This gives stereotactic radiosurgery a reliable anatomical basis and facilitates the planning and follow-up studies in this type of cerebral surgery.

Adult↗
PubMed1986

Severe chorea after acute carbon monoxide poisoning.

Ten days after an acute exposure to carbon monoxide, a 33-year-old woman exhibited severe chorea. CT scan revealed bilateral lucencies of the pallidum and anterior arm of the internal capsule. Chorea was successfully treated by chlorpromazine and did not relapse after treatment withdrawal. The mechanism of chorea in acute carbon monoxide poisoning is discussed.

Adult↗
PubMed1986

Limb apraxia in patients with damage confined to the left basal ganglia and thalamus.

Limb apraxia was investigated with standardised tests in 14 patients whose CT scan provided evidence of a vascular lesion confined to the left basal ganglia, or the thalamus, or both, and not involving the cortex or adjacent white matter. Five patients were severely impaired in imitating movements and pantomiming object use. Four of them also performed poorly when tested with real objects. In two patients the lesion was primarily thalamic and in three the lesion was primarily in the lenticular nucleus and the posterior limb of the internal capsule. Patients without apraxia generally had smaller injuries, but there were exceptions. Apraxia is currently conceived of as due to damage of cortical areas and their cortico-cortical connections, but the present data suggest that the model should be enlarged to include the deep nuclei and the pathways running through them.

Aged↗
PubMed1988

Memory loss from a subcortical white matter infarct.

Clinical disorders of memory are believed to occur from the dysfunction of either the mesial temporal lobe, the mesial thalamus, or the basal forebrain. Fibre tract damage at the level of the fornix has only inconsistently produced amnesia. A patient is reported who suffered a cerebrovascular accident involving the posterior limb of the left internal capsule that resulted in a persistent and severe disorder of verbal memory. The inferior extent of the lesion effectively disconnected the mesial thalamus from the amygdala and the frontal cortex by disrupting the ventral amygdalofugal and thalamic-frontal pathways as they course through the diencephalon. This case demonstrates that an isolated lesion may cause memory loss without involvement of traditional structures associated with memory and may explain memory disturbances in other white matter disease such as multiple sclerosis and lacunar state.

Aged↗
PubMed1992

Crossed cerebellar diaschisis accompanied by hemiataxia: a PET study.

To study crossed cerebellar diaschisis (CCD), cerebellar blood flow and oxygen metabolism were measured with positron emission tomography (PET) in 12 patients who showed a minimal degree of hemiparesis due to single unilateral supratentorial lesion. Six patients presenting with mild to moderate cerebellar type hemiataxia showed CCD, that is, decreased blood flow and oxygen metabolism in the cerebellar hemisphere contralateral to the side of supratentorial lesion. Hemiataxia and reduced cerebellar blood flow and metabolism occurred in the ipsilateral side. Lesions were located in the thalamus in four patients and the parietal lobe and internal capsule in one each. The other six patients did not exhibit ataxia, and oxygen metabolism was not reduced in the contralateral cerebellar hemisphere. In two of these cases, however, reduced cerebellar perfusion was observed in the contralateral cerebellar hemisphere. These findings indicate that CCD occurs with hemiataxia and suggest that it results not only from disruption of the corticopontocerebellar pathway but also of the dentatorubrothalamic pathway. CCD associated with hemiataxia, demonstrated in patients with thalamic lesions, was presumed to result from retrograde deactivation of the cerebellar hemisphere via the dentatorubrothalamic pathway.

Adult↗
PubMed1995

Vascular ataxic hemiparesis: a re-evaluation.

Ataxic hemiparesis is commonly considered as one of the "typical" lacunar syndromes. Using the prospective stroke registries from Lausanne and Besançon, 100 patients were selected consecutively (73% men, 27% women; age 64.7 (SD 13.6) years) with a first stroke and ataxic hemiparesis (hemiparesis or pyramidal signs and ipsilateral incoordination without sensory loss). Brain CT or MRI was performed on all patients. A primary haemorrhage was present in 5%, an infarct in 72%, isolated leukoaraiosis in 9%, and no apparent abnormality in 14%. The locations of lesions were the internal capsule (39%), pons (19%), thalamus (13%), corona radiata (13%), lentiform nucleus (8%), cerebellum (superior cerebellar artery territory) (4%), and frontal cortex (anterior cerebral artery territory) (4%). The clinical features of ataxic hemiparesis with different locations were almost identical. Only minor associated signs allowed the localisation of the lesions (paraesthesiae with a lesion in the thalamus; nystagmus or dysarthria with a cerebellar or pontine location). Crural paresis with homolateral ataxia was seen only with cortical paramedian frontal lesions. Presumed hypertensive small artery disease was not always found, but was still the leading cause of stroke, being present in 59% of the patients and in 62% of those with small deep infarcts. A potential source of embolism (arterial or cardiac) was found in one fourth of the patients. Therefore no definite association can be made between ataxic hemiparesis and lacunar infarction. In particular, so called uncommon lesion locations may not be rare. After extensive investigations a diagnosis of lacunar infarct can be retained in only slightly more than half of the cases.

Adult↗
PubMed1996

Brain and spinal cord MRI in motor neuron disease.

Motor neuron disease causes widespread degeneration of motor neurons within both the brain and spinal cord. Brain and spinal cord MRI were performed in 11 patients with motor neuron disease, and in 17 controls. Symmetric areas of high signal within the corticospinal tracts were found in nine patients on T2 weighted spin echo (SE) or fast spin echo (FSE) images of the brain and in eight on T2 or T2* weighed images of the spinal cord. High signal within the posterior limbs of the internal capsules was also found in four controls; this finding in isolation is therefore not pathological. No controls had abnormalities within the spinal cord. Low signal within the motor cortex was found in 10 patients, but was also seen in six controls. Thus MRI often displays characteristic abnormalities within the corticospinal tracts in patients with motor neuron disease, and should be considered in the investigation of suspected cases.

Adult↗
PubMed1997

Left-right differences in motor thresholds after stimulation of the globus pallidus before pallidotomy.

Left-right upper limb motor threshold differences were found after electrical stimulation of the globus pallidus administered as a neuroprotective measure to avoid lesioning of the internal capsule during stereotactic pallidotomy for treatment of Parkinson's disease. Left sided stimulation resulted in lower thresholds in right handed patients compared with left handed patients. These differences were significant in women, but no significant differences were found in men. In patients undergoing bilateral pallidotomy, the stimulation produced more significant left-right motor threshold differences. In the absence of known sex-related anatomical left-right corticospinal tract differences, the variability was the result of spinal excitability modulations most likely related to handedness.

Electric Stimulation↗
PubMed1998

Decreased capacity for mental effort after single supratentorial lacunar infarct may affect performance in everyday life.

OBJECTIVES: The long term outcome after a single symptomatic lacunar infarct may be less favourable than is generally assumed. Patients often present with complaints such as fatigue or "being different from before the stroke", for which there are no obvious physical explanations. Although cognitive functioning is considered normal in most patients with lacunar infarction in the internal capsule or corona radiata, a study was carried out to determine if subclinical changes in mental or emotional function can explain these vague complaints characteristic for their disablement. METHODS: Sixteen patients, each with a single symptomatic supratentorial lacunar infarct, and 16 matched healthy controls were examined with an extensive neuropsychological screening battery and a standardised questionnaire aimed at emotional problems. The mean number of correct responses was calculated for each subject and averaged within each group. RESULTS: Although, on the whole, there were no differences in performance, patients' results on the following tasks in different modalities showed evidence for decreased performance under relatively more demanding conditions: line orientation task (mean difference (MD) 261 ms; 95% confidence interval (95%CI) 94 to 428), Rey-Osterrieth delayed recall (MD-3.8, 95% CI -7.5 to 0.0), visual elevator subtest of the everyday attention task (EAT) (MD -0.7, 95% CI -1.5 to 0.1), lottery subtest of the EAT (MD -0.6, 95% CI -1.3 to 0.1) and WAIS similarities (MD -3.2 95% CI -6.3 to 0.1). Patients also more often had emotional disturbances than controls. CONCLUSION: Both subtle cognitive impairments and emotional disturbances may play a part in the decreased competence in everyday life of patients with a supratentorial lacunar infarct.

Activities of Daily Living↗
PubMed1999

Isolated dysarthria due to extracerebellar lacunar stroke: a central monoparesis of the tongue.

OBJECTIVES: The pathophysiology of dysarthria can preferentially be studied in patients with the rare lacunar stroke syndrome of "isolated dysarthria". METHODS: A single study was carried out on seven consecutive patients with sudden onset of isolated dysarthria due to single ischaemic lesion. The localisation of the lesion was identified using MRI. The corticolingual, cortico-orofacial, and corticospinal tract functions were investigated using transcranial magnetic stimulation. Corticopontocerebellar tract function was assessed using 99mTc hexamethylpropylene amine oxime-single photon emission computerised tomography (HMPAO-SPECT) in six patients. Sensory functions were evaluated clinically and by somatosensory evoked potentials. RESULTS: Brain MRI showed the lesions to be located in the corona radiata (n=4) and the internal capsule (n=2). No morphological lesion was identified in one patient. Corticolingual tract function was impaired in all patients. In four patients with additional cortico-orofacial tract dysfunction, dysarthria did not differ from that in patients with isolated corticolingual tract dysfunction. Corticospinal tract functions were normal in all patients. HMPAO-SPECT showed no cerebellar diaschisis, suggesting unimpaired corticopontocerebellar tract function. Sensory functions were not affected. CONCLUSION: Interruption of the corticolingual pathways to the tongue is crucial in the pathogenesis of isolated dysarthria after extracerebellar lacunar stroke.

Cerebellum↗
PubMed1999

Extrapyramidal involvement in amyotrophic lateral sclerosis: backward falls and retropulsion.

Three patients with sporadic amyotrophic lateral sclerosis (ALS) presented with a history of backward falls. Impaired postural reflexes and retropulsion accompanied clinical features of ALS. Hypokinesia, decreased arm swing, and a positive glabellar tap were noted in two of these three patients. Cognitive impairment, tremor, axial rigidity, sphincter dysfunction, nuchal dystonia, dysautonomia, and oculomotor dysfunction were absent. Brain MRI disclosed bilateral T2 weighted hyperintensities in the internal capsule and globus pallidus in one patient. Necropsy studies performed late in the course of ALS have shown degeneration in extrapyramidal sites-for example, the globus pallidus, thalamus, and substantia nigra. Clinically, backward falls and retropulsion may occur early in ALS. This may reflect extrapyramidal involvement.

Aged↗
PubMed2000

Atypical form of non-Langerhans histiocytosis with disseminated brain and leptomeningeal lesions.

An 18 year old girl presented with acute visual loss. T2 weighted brain MRI showed areas of hyperintensities in the thalamic nuclei, internal capsule, lentiform nuclei, the subarachnoidal spaces, and a retrobulbar infiltration. Analysis of CSF showed numerous foamy histiocytes without malignant cells, raised protein, and depressed glucose concentration. Biopsy of the right thalamus demonstrated aggregates of histiocytes with immunohistological and ultrastructural characteristics of non-Langerhans cell histiocytosis. The patient improved with chemotherapy and corticosteroids. After 3 months of treatment, CSF analysis showed no more histiocytes. Cytological examination of CSF can be helpful for the management of patients with extensive histiocytic infiltration.

Adolescent↗
PubMed2001

Clinical study of 222 patients with pure motor stroke.

The objective was to assess the frequency of pure motor stroke caused by different stroke subtypes and to compare demographic, clinical, neuroimaging, and outcome data of pure motor stroke with those of patients with other lacunar stroke as well as with those of patients with non-lacunar stroke. Data from 2000 patients with acute stroke (n=1761) or transient ischaemic attack (n=239) admitted consecutively to the department of neurology of an acute care 350 bed teaching hospital were prospectively collected in the Sagrat Cor Hospital of Barcelona stroke registry over a 10 year period. For the purpose of the study 222 (12.7%) patients with pure motor stroke were selected. The other study groups included 218 (12.3%) patients with other lacunar strokes and 1321 (75%) patients with non-lacunar stroke. In relation to stroke subtype, lacunar infarcts were found in 189 (85%) patients, whereas ischaemic lacunar syndromes not due to lacunar infarcts occurred in 23 (10.4%) patients (atherothrombotic stroke in 12, cardioembolic stroke in seven, infarction of undetermined origin in three, and infarction of unusual aetiology in one) and haemorrhagic lacunar syndromes in 10 (4.5%). Patients with pure motor stroke showed a better outcome than patients with non-lacunar stroke with a significantly lower number of complications and in hospital mortality rate, shorter duration of hospital stay, and a higher number of symptom free patients at hospital discharge. After multivariate analysis, hypertension, diabetes, obesity, hyperlipidaemia, non-sudden stroke onset, internal capsule involvement, and pons topography seemed to be independent factors of pure motor stroke in patients with acute stroke. In conclusion, about one of every 10 patients with acute stroke had a pure motor stroke. Pure motor stroke was caused by a lacunar infarct in 85% of patients and by other stroke subtypes in 15%. Several clinical features are more frequent in patients with pure motor stroke than in patients with non-lacunar stroke.

Aged↗
PubMed2002

White matter damage in Alzheimer's disease assessed in vivo using diffusion tensor magnetic resonance imaging.

OBJECTIVE: To investigate the extent and the nature of white matter tissue damage of patients with Alzheimer's disease using diffusion tensor magnetic resonance imaging (DT-MRI). BACKGROUND: Although Alzheimer's disease pathology mainly affects cortical grey matter, previous pathological and MRI studies showed that also the brain white matter of patients is damaged. However, the nature of Alzheimer's disease associated white matter damage is still unclear. METHODS: Conventional and DT-MRI scans were obtained from 16 patients with Alzheimer's disease and 10 sex and age matched healthy volunteers. The mean diffusivity (D), fractional anisotropy (FA), and inter-voxel coherence (C) of several white matter regions were measured. RESULTS: D was higher and FA lower in the corpus callosum, as well as in the white matter of the frontal, temporal, and parietal lobes from patients with Alzheimer's disease than in the corresponding regions from healthy controls. D and FA of the white matter of the occipital lobe and internal capsule were not different between patients and controls. C values were also not different between patients and controls for any of the regions studied. Strong correlations were found between the mini mental state examination score and the average overall white matter D (r=0.92, p<0.001) and FA (r=0.78; p<0.001). CONCLUSIONS: White matter changes in patients with Alzheimer's disease are likely to be secondary to wallerian degeneration of fibre tracts due to neuronal loss in cortical associative areas.

Aged↗
PubMed2002

Minor head injury as cause and co-factor in the aetiology of stroke in childhood: a report of eight cases.

BACKGROUND: Traumatic stroke usually occurs after dissection of large extracranial or intracranial vessels, leading to disseminated cerebral embolism. Stretching and distorting forces in cerebral intraparenchymal end arteries can cause intimal lesions followed by an occluding thrombus. OBJECTIVE: To investigate the importance of traumatic endothelial lesions in intraparenchymal end arteries after minor head injuries. METHODS: The cases of eight children are reported. They were aged between two and seven years (mean 6.2 years), and they developed significant neurological deficits at 15 minutes to 72 hours (mean 16.3 hours) after minor head injuries. RESULTS: The the patients all had hemiparesis combined with other signs, including central facial paralysis, dysphasia, dysphagia, and extrapyramidal signs. Computed tomography or magnetic resonance imaging showed cerebral infarctions affecting branches of the middle cerebral artery (n = 3), anterior cerebral artery (n = 1), posterior cerebral artery (n = 1), and basilar artery (n = 3). These lesions affected the basal ganglia, the internal capsule, and the brain stem. Neither heart disease nor dissections of large vessels were present. Two children had prothrombotic risk factors (an increase in lipoprotein (a) and a factor V Leiden mutation). The follow up period was between three months and 13 years (mean 3.9 years). Outcome was classified according to the Glasgow outcome scale as moderate disability (n = 4), severe disability (n = 2), non-disabling sequelae (n = 1), and total recovery (n = 1). CONCLUSIONS: Minor head injuries can be cause and co-factor in the aetiology of stroke. The frequency of this may be underestimated, and detailed medical history of the days before stroke manifestation may identify more traumatic events, especially in the group of so called "idiopathic" strokes.

Accidents↗
PubMed1994

Pseudobulbar palsy associated with trismus.

A 60 year old patient presented with an acute pseudobulbar palsy associated with trismus. A computed tomography scan revealed low attenuation areas consistent with infarction affecting the genu of the internal capsules bilaterally. Trismus has not previously been described as the presenting feature of a pseudobulbar palsy.

Brain↗
PubMed2001

Normal brain maturation during childhood: developmental trends characterized with diffusion-tensor MR imaging.

PURPOSE: To characterize the maturational changes in water diffusion within central gray matter nuclei and central white matter pathways of the human brain by using diffusion-tensor magnetic resonance (MR) imaging. MATERIALS AND METHODS: Retrospective analysis of normal MR examination findings in 153 subjects (age range, 1 day to 11 years) referred for clinical neuroimaging was performed. All studies included diffusion tensor-encoded echo-planar MR imaging. Isotropic diffusion coefficient (D) and diffusion anisotropy (A(sigma)) were measured in the corpus callosum, internal capsule, caudate nucleus, lentiform nucleus, and thalamus. RESULTS: exhibited biexponential decay with age in gray and white matter regions, except for monoexponential decay in the genu of the corpus callosum. There was a steep nonlinear increase of A(sigma) in white matter tracts that paralleled the time course of the decline in D. In basal ganglia, only a small linear increase in A(sigma) was observed in patients. A(sigma) changes in the thalamus were intermediate between basal ganglia and white matter structures. CONCLUSION: Changes in magnitude and anisotropy of water diffusion follow stereotypical time courses during brain development that can be empirically described with multiexponential regression models, which suggests that quantitative scalar parameters derived from diffusion-tensor MR imaging may provide clinically useful developmental milestones for brain maturity.

Brain↗
PubMed2002

Correlation of white matter diffusivity and anisotropy with age during childhood and adolescence: a cross-sectional diffusion-tensor MR imaging study.

PURPOSE: To evaluate differences in white matter diffusion properties as a function of age in healthy children and adolescents. MATERIALS AND METHODS: Echo-planar diffusion-tensor magnetic resonance (MR) imaging was performed in 33 healthy subjects aged 5-18 years who were recruited from a functional imaging study of normal language development. Results of neurologic, psychologic, and structural MR imaging examinations were within the normal range for all subjects. The trace of the apparent diffusion coefficient and fractional anisotropy in white matter were correlated as a function of age by using Spearman rank correlation. RESULTS: Statistically significant negative correlation of the trace of the apparent diffusion coefficient with age was found throughout the white matter. Significant positive correlation of fractional anisotropy with age was found in the internal capsule, corticospinal tract, left arcuate fasciculus, and right inferior longitudinal fasciculus. CONCLUSION: Diffusion-tensor MR imaging results indicate that white matter maturation assessed at different ages involves increases in both white matter density and organization during childhood and adolescence. The trace of the apparent diffusion coefficient and fractional anisotropy may reflect different physiologic processes in healthy children and adolescents.

Adolescent↗