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PubMed1990

High-intensity basal ganglia lesions on T1-weighted MR images in neurofibromatosis.

Basal ganglia lesions, characterized on MR by increased signal intensity on T1-weighted images, were observed in seven patients with documented neurofibromatosis. These lesions most often involved the globus pallidus and internal capsules in a bilateral and symmetric fashion, and extended across the anterior commissure resulting in a "dumbbell" configuration. Smaller and less prominent foci of increased signal also were present on corresponding T2-weighted images. These lesions did not exhibit mass effect, edema, or enhancement with gadolinium-DTPA. They were not visible on CT (performed in two patients) and demonstrated no progression during a 2-year interval in three patients. Their signal characteristics and morphology suggest that they represent heterotopias containing Schwann cells and/or melanin deposits. Migrational abnormalities of these neural crest derivatives are known to occur in neurofibromatosis, and the presence of such heterotopias has been documented pathologically in patients with this disorder. While recent reports discuss foci of increased signal intensity on T2-weighted MR images in patients with neurofibromatosis, signal abnormalities on T1-weighted images have not yet been described. When lesions characterized by similar signal as well as morphologic characteristics are encountered on MR, the diagnosis of neurofibromatosis should be considered.

Adolescent↗
PubMed1992

Evolution of white matter lesions in neurofibromatosis type 1: MR findings.

To characterize further the evolution of white matter lesions in neurofibromatosis type 1, we reviewed 68 MR images in 43 patients (age, 1-31 years), including 25 follow-up studies (mean interval, 27 months). Lesion number, location, morphology, signal characteristics, and contrast enhancement were assessed. Lesion characteristics and changes thereof were correlated with the patients' ages. Thirty-four patients (79%) had white matter lesions. These lesions were hyperintense on T2-weighted images, were isointense on T1-weighted images, and showed no mass effect or contrast enhancement in 31 patients; in three patients, T1-prolongation was observed (one with significant mass effect). None of the lesions evolved into a glioma. The most common locations were the cerebellum (49%), brainstem (22%), and internal capsule (19%). Nineteen patients had white matter lesions and follow-up studies. Lesions decreased in size or number in seven patients (average age, 13 years), showed no change in three (average age, 12 years), increased in size or number in four (average age, 5 years), and showed a mixed pattern (increased/decreased size/number) in four (average age, 7 years). White matter lesions in neurofibromatosis type 1 frequently increase in size or number early in childhood; this did not indicate neoplasia in our study. The lesions tend to resolve with increasing age. Lesion progression in a child more than 10 years old warrants close follow-up to rule out a neoplasm.

Adolescent↗
PubMed1993

Mesenrhombencephalitis: MR findings in nine patients.

OBJECTIVE: Mesenrhombencephalitis is a serious form of brainstem inflammation predominantly involving the deep and vital portions of the brain, that is, the mesencephalon (midbrain) and rhombencephalon (pons, medulla). Mesenrhombencephalitis is difficult to diagnose on the basis of clinical and laboratory findings alone, and access to this portion of the brain for surgical biopsy carries high morbidity. We describe the MR appearance of mesenrhombencephalitis and correlate the imaging findings with clinical information. MATERIALS AND METHODS: Unenhanced and contrast-enhanced MR images of nine patients with mesenrhombencephalitis were reviewed retrospectively and correlated with clinical, laboratory, and pathologic data. The patients were categorized according to the cause of the disease: three had herpes simplex, one had Listeria monocytogenes, and five had mesenrhombencephalitis of undetermined cause. The three patients with clinical and MR evidence of herpes simplex mesenrhombencephalitis (one confirmed by brain biopsy) were comatose at presentation, with cranial nerve abnormalities in two and seizures in one. One patient with L. monocytogenes (established by blood culture) had cranial nerve palsies, fever, and pain in the ear. Five additional patients had headache (three), fever (three), nausea and vomiting (four), cranial nerve palsies (three), coma (two), and hyporeflexia (one) or hyperreflexia (four). Brain biopsy performed in two patients revealed chronic inflammation of unspecified cause; in one, it was compatible with viral encephalitis. RESULTS: MR images in three patients with herpes simplex mesenrhombencephalitis showed T2 signal hyperintensity in the midbrain (two), pons (one), medulla (one), and temporal lobes (three). Parenchymal foci of hemorrhage (methemoglobin, one patient) and leptomeningeal enhancement (one patient) were identified in the temporal lobes. T2-weighted MR images in one patient with L. monocytogenes showed signal hyperintensity in the brainstem, vermis, midbrain, and internal capsules. On T1-weighted images, low signal was present in these areas, which enhanced with paramagnetic contrast agents. In the remaining five patients, T2-weighted MR images showed patchy signal hyperintensity in the pons, medulla, and thalamus in three each and in the midbrain and temporal lobes in one each. T1-weighted MR images showed normal findings (two) or signal hypointensity in the thalamus and pons in one patient each. Areas of leptomeningeal and parenchymal enhancement were identified in one patient each. Brainstem swelling was seen in three patients, one of whom had petechial hemorrhage in the pons and hydrocephalus. CONCLUSION: Mesenrhombencephalitis is a serious illness that is diagnosed by a combination of imaging, clinical, laboratory, and pathologic studies. MR imaging may be crucial to the early diagnosis of this illness, and radiologists must be familiar with this uncommon entity and its MR findings in order to make timely diagnoses and facilitate treatment.

Adult↗
PubMed2002

Evaluation of normal age-related changes in anisotropy during infancy and childhood as shown by diffusion tensor imaging.

OBJECTIVE: The first purpose of this study was to compare the degree of anisotropy in compact white matter and noncompact white matter in each of three pediatric age groups using diffusion tensor imaging. We hypothesized that anisotropy would be higher in compact white matter than in noncompact white matter in each age group. The second purpose of our study was to compare the increase in anisotropy over time in compact versus noncompact white matter during early childhood. We hypothesized that increases in anisotropy would be higher in noncompact white matter. MATERIALS AND METHODS: We retrospectively analyzed anisotropy maps derived from diffusion tensor imaging studies performed in 66 pediatric patients (age range, 4 days-71 months; mean age, 18.6 months) who underwent clinical MR imaging and were found to have no abnormalities on conventional MR images. Anisotropy was measured in three compact white matter structures (corpus callosum, internal capsule, cerebral peduncle) and two regions of noncompact white matter (corona radiata and peripheral white matter). Patients were assigned to one of the three following groups on the basis of age: group 1, younger than 12 months (n = 40); group 2, 12-35 months (n = 11); and group 3, 36-71 months (n = 15). First, we compared anisotropy values of noncompact white matter with those of compact white matter for each age group. Second, we compared the increase over time in anisotropy of noncompact white matter regions with that seen in compact white matter structures. RESULTS: Among all three age groups, anisotropy measurements in compact white matter structures were higher than those in noncompact white matter (p < 0.01). The mean anisotropy values in noncompact white matter for groups 1, 2, and 3, respectively, were 0.349, 0.480, and 0.531. The mean anisotropy values in compact white matter for groups 1, 2, and 3, respectively, were 0.494, 0.646, and 0.697. When age groups were compared, a statistically significant increase in anisotropy was seen in both compact white matter and noncompact white matter (p < 0.01). However, the increase in anisotropy was significantly greater in non-compact white matter regions than in compact white matter structures when comparing group 1 with group 3 (p < 0.01) as well as group 1 with group 2 (p < 0.01). CONCLUSION: Although anisotropy measurements were higher in compact than non-compact white matter in all three age groups, the increase in anisotropy was greater in non-compact white matter across each of the three groups. These data suggest that although myelination is initially greater in compact white matter, the change in myelination may be greater in noncompact white matter during the first few years after infancy.

Anisotropy↗
PubMed2003

Neuroimaging features of heroin inhalation toxicity: "chasing the dragon".

OBJECTIVE: Our objective was to illustrate the dramatic neuroimaging findings of toxic leukoencephalopathy caused by heroin vapor inhalation. CONCLUSION: Symmetric abnormality involving the cerebellar white matter and posterior limb of the internal capsule is characteristic of heroin vapor inhalation toxicity, although involvement may be more extensive, depending on the severity of the condition. MR imaging and CT appear to be essential for making this diagnosis because clinical history is often unreliable and findings at physical examination are nonspecific.

Administration, Inhalation↗
PubMed2004

The optimal trackability threshold of fractional anisotropy for diffusion tensor tractography of the corticospinal tract.

PURPOSE: In order to ensure that three-dimensional diffusion tensor tractography (3D-DTT) of the corticospinal tract (CST), is performed accurately and efficiently, we set out to find the optimal lower threshold of fractional anisotropy (FA) below which tract elongation is terminated (trackability threshold). METHODS: Thirteen patients with acute or early subacute ischemic stroke causing motor deficits were enrolled in this study. We performed 3D-DTT of the CST with diffusion tensor MR (magnetic resonance) imaging. We segmented the CST and established a cross-section of the CST in a transaxial plane as a region of interest. Thus, we selectively measured the FA values of the right and left corticospinal tracts at the level of the cerebral peduncle, the posterior limb of the internal capsule, and the centrum semiovale. The FA values of the CST were also measured on the affected side at the level where the clinically relevant infarction was present in isotropic diffusion-weighted imaging. RESULTS: 3D-DTT allowed us to selectively measure the FA values of the CST. Among the 267 regions of interest we measured, the minimum FA value was 0.22. The FA values of the CST were smaller and more variable in the centrum semiovale than in the other regions. The mean minus twice the standard deviation of the FA values of the CST in the centrum semiovale was calculated at 0.22 on the normal unaffected side and 0.16 on the affected side. CONCLUSION: An FA value of about 0.20 was found to be the optimal trackability threshold.

Aged↗
PubMed1994

Intracerebral methionine-enkephalin, serum cortisol, and serum beta-endorphin during acute exposure of sheep to physical or isolation stress.

In vivo microdialysis was used to estimate extracellular concentrations of methionine-enkephalin in 19 brain sites for 5 h on each of three consecutive days (trials) in six conscious ewes. Following control procedures on d 1, ewes were completely isolated from other sheep for 60 min on d 2 (psychological stress). Physical stress was imposed on d 3 and consisted of continuous pinching of the skin for 60 min during the middle of the 5-h experimental period. Imposition of both physical and psychological stress rapidly increased serum concentrations of cortisol, and the induced increase persisted for at least 30 min after termination of the stress. Psychological stress of isolation initially increased cortisol to a greater extent than the physical stress of skin pinch, but this difference disappeared after 30 min of stress exposure. Psychological stress also transiently increased serum concentrations of beta-endorphin/beta-lipotropin, whereas physical stress did not. Average concentrations of methionine-enkephalin in dialysate ranged between 1.52 and 1.85 ng/mL when the intracerebral probes were placed into the caudate nucleus, the preoptic area of the hypothalamus, or the thalamus. The concentration of methionine-enkephalin was consistently less than 1.0 ng/mL when probes were placed into major fiber tracts of the brain (corpus callosum, internal capsule). Potassium-induced depolarization around the probe tip located in the caudate nucleus increased dialysate concentrations of methionine-enkephalin by 2.7-fold. Imposition of physical or psychological stress did not consistently increase or decrease dialysate concentrations of methionine-enkephalin in any of the brain sites studied.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1991

Postnatal development of the pontine projections from the visual cortex of the mouse.

We studied the postnatal development of the corticopontine tract in mice by the injection of the axon tracer DiI into the visual cortex. In the postnatal day (P) 0.5 mouse, labeled pyramidal tract fibers pass through the internal capsule and cerebral peduncle, grow over the basilar pontine gray, and enter into the medullary pyramid (in this study, P0 refers to the first 24 hours after birth). Small collateral branches arise from these pyramidal tract fibers on P0.5-1.0, and elongate quickly into the basilar pontine gray around P2-4. These collateral branches give off many secondary branches on P4 and form the bright terminal zone in the rostral portion of the lateral basilar pontine gray on P9. In the P16 mouse, this terminal zone is more restricted, suggesting, on the basis of the anterograde DiI labeling technique, that the visual corticopontine projection matures by P16. DiI-labeled pyramidal tract fibers distal to the branching point of the pontine collaterals are found during the postnatal two weeks, but disappear by the later stages. We conclude that the visual corticopontine tract develops as collateral branches of the transient pyramidal tract fibers arising from the visual cortex of the mouse, as just described in the rat (O'Leary and Terashima, Neuron 1:901-910, 1988).

Animals↗
PubMed1982

Tolerance to electroacupuncture analgesia was reversed by microinjection of 5-hydroxytryptophan into nuclei accumbens in the rabbit.

Electroacupuncture (EA) of the hind limb points of the rabbit for 10 min elicited a significant increase of the latency of aversive responses (ARL) induced by radiant heat stimulation of the snout. This effect of analgesia was found to be gradually diminished when EA was applied repeatedly for 6 hr, implying the development of tolerance. A reversal of EA tolerance was achieved by microinjection of 5-hydroxytryptophan (5-HTP) (the direct precursor of 5-hydroxytryptamine (5-HT)), either intracerebroventricularly (200 micrograms) or into bilateral nuclei accumbens (10 micrograms). Injection of the same amount of 5-HTP into brain structures adjacent to nucleus accumbens, e.g., globus pallidus, corpus callosum, internal capsule, etc., was ineffective. It is concluded that a functional insufficiency of 5-HT in the brain, especially in nucleus accumbens, may constitute one of the mechanisms for the development of EA tolerance.

5-Hydroxytryptophan↗
PubMed1995

Defensive behavior induced by stimulation of the ventral striatum in the cat.

The behavioral responses induced by electrical stimulation of the ventral striatum were studied in 15 freely moving cats, chronically implanted with multiwire electrodes. Two types of defensive responses could be evoked from the ventral striatum, an arrest response and an escape or flight reaction. Stimulation of the dorsal striatum and the internal capsule induced contralateral head turning and movements of the face or limbs. The number of ventral striatal sites eliciting escape responses increased along the sessions, while their threshold decreased. Lesioning the ventral pallidal region with kainic acid increased significantly the threshold for defensive responses, whereas head turning responses showed no change. The results of this study indicate that the ventral striatum could be part of the neural substrate for defensive behavior, and that the ventral pallidal region plays a role in its mediation.

Animals↗
PubMed1986

The cerebral ocular pursuit pathways. A clinicoradiological study of small-field optokinetic nystagmus.

Optokinetic nystagmus was tested in patients with intracerebral tumors restricted to one hemisphere, by using a simple, hand-held drum and visual evaluation of symmetry of horizontal response. Computed tomographic mapping revealed that lesions associated with asymmetric optokinetic nystagmus involved the posterior hemisphere. The critical region appeared to extend from the posterior splenium and the anteromedial occipital lobe to the posterior internal capsule. It seemed to course below the posterior horn of the ventricular system, then turn anteriorly, and finally medially, above the temporal horn. It is argued that the posterior extremity of this C-shaped region contains the ipsilateral and contralateral visual inputs to a parietal cortex control over ipsilateral smooth eye movements, and that the anterior extremity contains the efferent motor command pathways destined to the brain stem.

Adolescent↗
PubMed1995

Evaluation of pain perception after anterior capsulotomy: a case report.

The medial prefrontal cortex has been implicated in pain perception by recent anatomical, physiological, and functional imaging data demonstrating that frontal and anterior cingulate cortices receive inputs related to nociception; neurosurgical case reports suggest that lesions involving these areas may specifically reduce the affective or emotional component of chronic intractable pain. We examined this hypothesis more closely by assessing psychophysical ratings of (1) warmth, pain intensity, and unpleasantness evoked by phasic thermal stimuli, (2) tolerance to tonic cold stimuli, and (3) perceived intensity of visual stimuli, both before and after neurosurgical lesions of the fiber tracts connecting the frontal lobes to subcortical structures. A 22-year-old male, with no history of chronic pain, underwent psychophysical testing 3 days before, 5 days after, and 6 months after receiving bilateral lesions of the anterior internal capsule (aIC), performed as treatment for obsessive-compulsive disorder. In each session, the patient rated the intensity and unpleasantness of 5-sec cutaneous heat stimuli (39-47 degrees C); pain tolerance was measured by means of a cold-pressor test (hand immersion in 1 degrees C water). The patient was able to differentially rate the intensities of heat stimuli during both pre- and postsurgical testing sessions (p < 0.001). However, he rated heat stimuli as less intense 5 days after surgery than during presurgical testing (p < 0.001), with significant decreases in both pain intensity (p < 0.005) and unpleasantness (p < 0.05). Likewise, the patient described the cold-water immersion as less painful following surgery, although his tolerance times were substantially shorter than those of the presurgical evaluation. Ratings of visual stimulus intensity did not differ across the pre- and postsurgical testing periods, suggesting that changes in pain perception were not related to attentional or cognitive deficits. Magnetic resonance imaging 5 days following surgery revealed bilateral lesions and edema centered in the aIC, with some edema in the left frontal lobe. Those 6 months later showed substantially smaller lesions involving less than half of the aIC and no edema; pain ratings and cold-water tolerance measured at that time indicated a substantial return toward the patient's presurgical values. These data suggest that blocking subcortical input to the anterior cingulate and frontal cortices reduces both the perceived intensity and the unpleasantness of noxious stimuli; reduced cold tolerance times--in the face of decreased pain perception--may reflect a disinhibition of cortical control on spinal reflexes.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1986

Brain oedema and blood-brain barrier permeability in pulsatile and nonpulsatile cardiopulmonary bypass.

In pigs subjected to pulsatile or nonpulsatile cardiopulmonary bypass (CPB) at normothermia for 3 hours, evaluation was made of water content in brain tissue (specific gravity measurements), blood-brain permeability to serum proteins (immunocytochemical demonstration of extravasated proteins, using peroxidase-antiperoxidase technique) and histopathology (paraffin sections). The specific gravity in parietal cortex was higher after pulsatile than after nonpulsatile CPB or in control pigs, the change corresponding to a 6.3% water increase. The tissue water content was unchanged in the internal capsule, basal ganglia and nucleus accumbens after CPB. The vascular permeability to serum proteins was unchanged after nonpulsatile CPB, but after pulsatile CPB minute foci of extravasated serum proteins appeared. All the animals showed dark neurons in cortical and subcortical regions, but these could have been artefacts in immersion-fixed tissue. There were no other signs of ischaemic tissue damage. The study indicated that cortical oedema may follow pulsatile CPB, the cause being altered permeability of the blood-brain barrier to serum proteins.

Animals↗
PubMed1991

[Crossed cerebellar atrophy following cerebrovascular lesions].

A neuroradiological study of crossed cerebellar atrophy (CCA) was performed using X-ray CT in 103 patients suffering from unilateral supratentorial cerebrovascular diseases. CCA was demonstrated in 9 (8.7%) of 103 patients. No difference between the occurrence of CCA in cerebral hemorrhage and that in cerebral infarction was found. CCA was seen in the chronic stage of cerebrovascular disease more than 3 years since stroke occurrence, and was found to be present more frequently and to a greater extent 7 years later. No correlation between the site of bleeding and the occurrence of CCA was found. Trans-synaptic degeneration of the corticopontocerebellar tract was considered in CCA following putaminal and combined hemorrhage involving an internal capsule lesion. However, in thalamic hemorrhage, retrograde degeneration within the cerebellorubrothalamic tract was presumed. CCA following cerebral infarction was seen in patients with massive lesions in the territory of the middle cerebral artery. Multivariate analysis showed that lesions of the parietal and frontal lobes appeared to greatly contribute to the development of CCA. As the degeneration and atrophy in the thalamus on the side of the lesion appeared early and frequently, it was suggested that retrograde degeneration of the cerebellorubrothalamic tract participated, in addition to anterograde corticopontocerebellar tract degeneration, in CCA following middle cerebral artery infarction. It is likely that CCA is caused by both transsynaptic degeneration of the corticopontocerebellar tract and the cerebellorubrothalamic tract.

Aged↗
PubMed1978

Microsurgical anatomy of the distal anterior cerebral artery.

The microsurgical anatomy of the distal anterior cerebral artery (ACA) has been defined in 50 cerebral hemispheres. The distal ACA, the portion beginning at the anterior communicating artery (ACoA), was divided into four segments (A2 through A5) according to Fischer. The distal ACA gave origin to central and cerebral branches. The central branches passed to the optic chiasm, suprachiasmatic area, and anterior forebrain below the corpus callosum. The cerebral branches were divided into cortical, subcortical, and callosal branches. The most frequent site of origin of the cortical branches was as follows: orbitofrontal and frontopolar arteries, A2; the anterior and middle internal frontal and callosomarginal arteries, A3; the paracentral artery, A4; and the superior and inferior parietal arteries, A5. The posterior internal frontal artery arose with approximately equal frequency from A3 and A4 and callosomarginal artery. All the cortical branches arose more frequently from the pericallosal than the callosomarginal artery. Of the major cortical branches, the internal frontal and paracentral arteries arose most frequently from the callosomarginal artery. The distal ACA of one hemisphere sent branches to the contralateral hemisphere in 64% of brains. The anterior portions of the hemisphere between the 5-cm and 15-cm points on the circumferential line showed the most promise of revealing a recipient artery of sufficient size for an extracranial-intracranial artery anastomosis. The distal ACA was the principal artery supplying the corpus callosum. The recurrent artery, which arose from the A2 segment in 78% of hemispheres, sent branches into the subcortical area around the anterior limb of the internal capsule.

Cerebral Arteries↗
PubMed1982

Arteriovenous malformations of the medial temporal lobe. Surgical approach and neuroradiological characterization.

Arteriovenous malformations (AVM's) of the medial temporal lobe frequently involve the basal ganglia and the thalamus and, for this reason, are commonly judged to be inoperable. However, when the medial involvement is limited to the posterolateral part of the thalamus and to the inferior portion of the basal ganglia lateral to the internal capsule, the lesions may be excised safely. Three patients who underwent successful excision of AVM's of this region are presented. A transcortical surgical approach through the inferior portion of the temporal lobe was used to minimize retraction of the temporal lobe and damage to the optic radiation, and to avoid postoperative dysphasia. The following neuroradiological criteria indicate that the bulk of the lesion is in the temporal lobe that only noncritical portions of the basal ganglia and thalamus are involved, and that therefore, surgical resection is relatively safe: 1) primary supply by the anterior choroidal artery and by laterally oriented branches of the posterior cerebral artery; 2) primary venous drainage into the basal vein of Rosenthal and medial Sylvian veins; 3) projection below the plane of the middle cerebral artery in the lateral carotid arteriogram; 4) projection lateral to the sweep of the posterior cerebral artery in the anteroposterior or Towne's view of te vertebral angiogram; and 5) demonstration of an intratemporal clot or intraventricular blood by computerized tomography.

Adult↗
PubMed1983

Regional cerebral blood flow in the acute stage of experimentally induced subarachnoid hemorrhage.

Subarachnoid hemorrhage (SAH) was induced in 13 adult mongrel cats by a slow injection of fresh autogenous blood into the cisterna magna. Serial determinations of regional cerebral blood flow (rCBF) in the cortex and deep-seated areas (internal capsule, thalamus, and caudate nucleus) were made during the following 2 hours, while intracranial pressure (ICP) was maintained at normal values. A decrease in rCBF was observed in all the areas examined. This reduction followed a characteristic triphasic pattern with an initial steep decline immediately after the SAH. The clinical implications of these findings are discussed.

Animals↗
PubMed1985

Electrical stimulation of the brain in treatment of chronic pain. Experience over 5 years.

Forty-eight patients underwent electrical stimulation of the brain for treatment of chronic pain between 1978 and 1983. Average pain duration prior to treatment was 4.5 years. Before selection for this procedure patients underwent pain treatment in a multidisciplinary pain center, intensive psychological and psychiatric evaluation, and assessment of pain responsiveness to intravenous administration of placebo, morphine, and naloxone. A total of 71 electrodes were placed in the 48 patients at a variety of stimulating targets, including the periaqueductal gray matter, periventricular gray matter, thalamus, and internal capsule. Seventy-two percent of patients experienced complete or partial pain relief. In addition, 59% of patients were able to discontinue narcotic usage. Twenty-five percent of patients returned to normal physical activities and another 33% showed marked improvement in functional capacity. Follow-up periods ranged from 2 to 60 months; with a mean follow-up period of 20 months. A variety of relatively minor complications occurred, but no mortality or permanent sequelae were experienced. No patient's pain was made worse as a result of electrical stimulation. Electrical stimulation of the brain offers a safe and relatively effective method for the treatment of chronic pain in appropriately selected patients, who are unresponsive to other forms of therapy.

Adult↗