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PubMed1992

[An infantile case of cerebral infarction associated with thrombocytosis].

Cerebral infarction in children is often caused by intracranial vascular disorder, cardiac disease, head injury, or infection, and is rarely induced by blood disease. In this paper, we describe an infantile case of cerebral infarction associated with thrombocytosis. A female infant of eight months of age developed left hemiparesis after a slight head injury. Her CT and MRI demonstrated a cerebral infarction located from the right internal capsule to the right corona radiata. Laboratory findings revealed iron-deficiency anemia and thrombocytosis with a platelet count 107.5 x 10(4)/mm3. Although she had no disorder that had caused iron deficiency, serum Fe value of the patient was low with a count of 18 micrograms/dl. Her bone marrow was normal except for a slight increase in the number of megakaryocytes. One month later, her anemia was improved by means of oral iron replacement. However, her platelet count remained at more than 100 x 10(4)/mm3 as it had been before. Her condition of left-sided hemiparesis gradually improved by a program of rehabilitation, and did not recur after aspirin administration. Although the main cause of her thrombocytosis that led to a transient cerebrovascular accident is obscure, it is postulated that her iron deficiency anemia induced secondary thrombocytosis, or else the patient had essential thrombocytosis.

Anemia, Hypochromic↗
PubMedDate not supplied

[Stereotactic technique in the surgical treatment of deeply located cerebral masses].

The paper analyzes the use of a Leibinger Stryker stereotactic frame system (Germany) for surgical interventions for deeply located cerebral masses. Twenty three patients were operated on, by applying this system. Twenty five supratentorial masses were removed; of them 12 masses were paraventricularly located, including 5 masses being present close to the subcortical nuclei and internal capsule or immediately in them. In 9 patients, the foci were located subcortically in the projection of the sensorimotor region and motor zone of speech. Four masses were positioned in the substantia alba of the hemispheres. The patients having foci measuring not greater than 30-35 mm in diameter were selected for the study. Most cases were metastatic medullary lesions (11 single cases, 2 cases with multiple metastases, 3 cavernous angiomas, 2 arteriovenous malformations, 5 glial tumors). An algorithm for the stereotactic planning of approaches to masses of various localization and a procedure for there removal are presented in the paper. All the patients showed satisfactory postoperative results. Only did 4 patients with metastases being adjacent to the motor zone of the cortex and with a significant perifocal edema in the postoperative period display a recess of preoperative contralateral hemiparesis that regressed due to therapy. There were no other surgical complications. The method has proved to be effective against minor tumors (not more than 30 mm); whose access trajectory is over a length of more than 40-50 mm and against metastatic processes with a significant perifocal edema. This stereotactic system that considers the individual anatomic features of the patients' brain altered due to a pathological process provides convenience and precision when the deeply located brain masses are removed, by minimizing surgical trauma.

Brain Neoplasms↗
PubMed2005

Intraoperative monitoring of motor symptoms using surface electromyography during stereotactic surgery for movement disorders.

The authors present practical evidence for the usefulness of intraoperative monitoring with surface electromyograms (sEMGs) from the affected muscles to assist electrode implantation and lesioning in patients with movement disorders. In 22 consecutive patients with various movement disorders, sEMGs were monitored in selected muscles during stereotactic surgery that involved either lesioning or electrode implantation. The electromyograms related to major motor symptoms such as tremor, rigidity, myoclonus, dystonia, and chorea were monitored and characterized on-line by both amplitude and frequency. Major motor symptoms were revealed by sEMGs recorded from the affected muscles. Tremor manifested as highly rhythmic bursts with a narrow frequency band; dyskinesias and chorea appeared as irregularly repeated bursts within a broad frequency range of 1 to 5 Hz; and rigidity and dystonia appeared as sustained high-frequency activity and co-contraction between antagonist muscles. The results suggest that intraoperative monitoring of sEMGs could help to functionally refine and confirm target localization. Surface EMGs could be used (1) as reference signals of the motor symptoms so that other signals, such as the oscillatory local field potentials simultaneously recorded via the implanted electrodes, could be correlated with the sEMGs and used to fine-tune or confirm the target localization; (2) to quantify the effects of acute electrical stimulation on the motor symptoms; and (3) to sensitively detect unwanted capsular responses induced by direct stimulation of the internal capsule. The authors conclude that intraoperative monitoring of sEMGs of the affected muscles of patients with movement disorders during stereotactic surgery provides sensitive and quantitative information that can contribute to improved electrode or lesion placement.

Electric Stimulation↗
PubMed2005

[Pneumocephalus caused by failed ventricular tap: case report].

OBJECTIVE AND IMPORTANCE: Ventricular tap is one of the most basic and important techniques to neurosurgeon. Brain tap itself usually does not cause symptomatic complication. The authors report an extremely rare complication case of pneumocephalus caused by failed ventricular tap. CLINICAL PRESENTATION AND INTERVENTION: A 79-year-old woman suffered from normal pressure hydrocephalus after subarachnoid hemorrhage (SAH). Ventriculo-peritoneal shunt was performed two month after SAH. In the operation, ventricular taps were failed twice and third tap was successful for ventricular catheterization through the right posterior parietal burr hole. She presented left hemiparesis from three hours after the operation, and her symptom was gradually deteriorated to complete paralysis the next day. Computed tomography scan disclosed the movement of air along the tract of failed ventricular tap from subcortex to internal capsule. CONCLUSION: Failed ventricular tap could cause severe complications. We have to try to perform ventricular tap by only one attempt.

Aged↗
PubMed1992

[Serial changes of magnetic resonance imagings in acute disseminated encephalomyelitis].

We reported serial changes of MRIs in a case of acute disseminated encephalomyelitis (ADEM). On November 1, 1990, a previously healthy 73-year-old man had a grand mal seizure following myoclonic jerks of the right arm for six days. On admission, he was drowsy and presented with right facial palsy and incomplete tetraparesis. He became coma on the next day of admission. There was moderate leukocytosis. A spinal tap showed a normal opening pressure, 2 white blood cells/mm3, a total protein of 84 mg/dl, glucose of 89 mg/dl. CSF IgG (6.2 mg/dl) and myelin basic protein (6.7 ng/dl) were slightly increased. Serological examinations for virus titer were all negative. A CT scan on the 2nd day showed no abnormal findings, but MRI revealed small high intensity areas in the left thalamus, left prefrontal gyrus and right corona radiata, internal capsule on both the T2-weighted and proton density sequences. An MRI on the 14th day showed high intensity signals in the white matter of the bilateral frontal lobes, left operculum and right corona radiata. In contrast, the left thalamic lesion became smaller and less conspicuous than on the initial scans, but was enhanced with Gd on the T1-weighted sequences. Our findings indicate that MRIs are valuable in detecting pathophysiological changes of ADEM from the acute to chronic phases.

Aged↗
PubMed1992

[A case of portal-systemic encephalopathy presenting characteristic MR images in globus pallidus, hypothalamus, corpus callosum, pontine base, and middle cerebellar peduncle].

A 53-year-old woman developed symptoms of slow speech, mild dementia, increased deep tendon reflex, ataxic gait, flapping tremor, and dystonic posture during two years. She had liver cirrhosis and hyperammonemia, which suggested a diagnosis of portal-systemic encephalopathy. MR T1-weighted images showed increased signal intensity in globus pallidus, internal capsule, substantia innominata, and a part of hypothalamus. T2-weighted images revealed abnormal findings as follows: high intense area in middle cerebellar peduncle, and low signal intensity of corpus callosum and pontine base. This is the first report about MRI abnormalities in substantia innominata, corpus callosum, and pontine base in a patient with portal-systemic encephalopathy.

Brain↗
PubMed2005

Serial MR imaging findings of acute hemorrhagic leukoencephalitis: a case report.

We report a patient with acute hemorrhagic leukoencephalitis with a focus on serial MR imaging findings. Initial MR imaging of a 42-year-old woman revealed a 2.5-cm focal nonhemorrhagic lesion in the left thalamus and internal capsule. Twenty-four days later, fever and altered consciousness developed, and MR imaging showed huge masslike lesions in both frontal lobes, mainly involving the white matter and the genu of the corpus callosum, with massive edematous swelling that contained multifocal small hemorrhages. Most lesions showed high apparent diffusion coefficient value with peripheral small areas of low apparent diffusion coefficient. On follow-up MR imaging obtained 49 days after initial MR imaging, the lesions progressed with increase in extent and development of rim-enhancing necrosis, despite steroid therapy. Following stereotactic biopsy and subsequent high-dose steroid treatment, the patient recovered with some neurologic sequelae. MR imaging obtained at 72 and 126 days revealed residual necrosis and cerebromalacia in the both frontal lobes.

Adrenal Cortex Hormones↗
PubMed2005

Semilobar holoprosencephaly seen with diffusion tensor imaging and fiber tracking.

A neonate with semilobar holoprosencephaly was studied with diffusion tensor imaging and fiber tracking. Fiber tracking showed that the frontooccipital fasciculi were in continuity across the ventral midline, interposed between fused caudate and dysplastic fornices. Tractography of the posterior limbs of the internal capsules showed fibers arching ventrally toward the expected location of the motor cortex; some fibers also coursed dorsally, presumably to the sensory cortex. There was a posterior commissural white matter bundle representing a callosal splenium. Diffusion tensor imaging and fiber tracking revealed white matter structures not apparent on routine imaging sequences, which are in agreement with pathologic descriptions of the holoprosencephalic brain.

Brain↗
PubMedDate not supplied

Ischaemic stroke in Jordan: a 2-year hospital-based study of subtypes and risk factors.

A retrospective study was made of 200 consecutive patients with first-ever ischaemic stroke, admitted to Jordan University Hospital over a 2-year period. The mean age was 61.2 years (range 29-95). The most common stroke subtype was lacunar infarct (51.5%), but frequency of cardioembolic stroke was low (8.0%). Hypertension, diabetes mellitus and smoking were the most common risk factors for atherosclerotic non-cardioembolic stroke. Chronic atrial fibrillation was the most common risk factor for cardioembolic stroke. No patient had severe extracranial carotid or vertebral artery stenosis (> 50% narrowing). Lacunar strokes presented predominantly as pure motor stroke (67/103) and were mainly in the internal capsule (34/ 103). The favourable outcome (85% discharged home) may be due to the relatively young age and the predominance of lacunar infarcts.

Adult↗
PubMed2005

[A case of aphasia with preserved repetition due to anterior choroidal artery territory infarction].

A 55-year-old right-handed male patient with atrial fibrillation was admitted to our hospital because of a sudden disturbance of consciousness and right hemiparesis. Neurological examinations revealed left conjugate deviation of the eyes, aphasia, right hemianopsia without macula sparing using a Goldmann perimeter, right hemianesthesia, and right hemiparesis. Magnetic resonance imaging showed low intensity areas (left posterior limb of internal capsule, left cerebral peduncle of middle brain, a part of left substantia nigra, left amygdala, ventral posterior lateral nucleus and ventral anterior nucleus of left thalamus, left lateral geniculate body, and left occipital lobe) in T1 weighted image, due to the infarct in the left anterior choroidal artery territory. Aphasia in this case was accompanied with non-fluent speech, good repetition, naming deficits, and perseveration. We suggest that aphasia with anterior choroidal artery syndrome cannot be classified using the conventional system, and emphasize the importance of accurate descriptions of the symptoms characteristic of aphasia with anterior choroidal artery.

Aphasia↗
PubMed2006

Direct visualization of the human subthalamic nucleus with 3T MR imaging.

BACKGROUND AND PURPOSE: Electrical stimulation of the subthalamic nucleus (STN) is an accepted treatment for advanced Parkinson disease (PD). Although procedural details are well established, targeting STN remains problematic because of its variable location and relatively small size (20-30 mm(3)). A combination of anatomic imaging with a stereotactic frame, atlas coordinates, and intraoperative neurophysiology is currently considered the most reliable approach for STN targeting. CT imaging is dependent on atlas coordinates, because the STN is not visualized. The STN is also difficult to visualize directly by using MR imaging at 1.5 T. METHODS: We performed preoperative stereotactic MR imaging at 3T to visualize the STN in 13 patients undergoing deep-brain stimulation for PD. With the patient positioned within a standard Leksell type G stereotactic frame localizer, rapidly acquired scout images are used to prescribe volumes of contiguous high-resolution T2-weighted fast spin-echo images in the axial, sagittal, and coronal planes through the midbrain and basal ganglia. The STN is identified in all 3 planes by cross-referencing in a 3-plane viewer. These coordinates are used for surgical targeting. RESULTS: At 3T, the STN was visualized as a small, hypointense, almond-shaped structure in 3 planes located immediately lateral to the anterior edge of the red nucleus, medial to the internal capsule, about 5 mm inferior, 1-2 mm posterior, and 9-12 mm lateral to the midcommissural point. Intraoperative microelectrode recordings confirmed these coordinates in all cases from the first microelectrode pass, thereby eliminating prolonged intraoperative electrophysiological STN searching and tissue disruption that may occur from multiple passes. CONCLUSION: 3T MR imaging appears to be an excellent tool for reliable and accurate direct visualization of the human STN, necessary for precise surgical targeting.

Adult↗
PubMed2005

"Chasing the dragon"--imaging of heroin inhalation leukoencephalopathy.

"Chasing the dragon" refers to the inhalation of heroin pyrolysate vapors produced when the freebase form of heroin is heated. Inhalation of these vapors can result in a rare toxic spongiform leukoencephalopathy. The patients may progress through 3 defined clinical stages, with one-quarter reaching the terminal stage, which invariably leads to death. Imaging and, in particular, magnetic resonance imaging (MRI) demonstrates white matter findings that are felt to be specific for this entity and essential in its early diagnosis. We present the typical imaging findings in a pictorial essay format, using images taken from 9 patients who presented within an 18-month period at UBC-affiliated hospitals. These findings include low computed tomography (CT) attenuation and high T2 MRI signal most commonly in the posterior cerebral and cerebellar white matter, cerebellar peduncles, splenium of the corpus callosum, and posterior limb of the internal capsules. In addition, there is often selective, symmetric involvement of the corticospinal tract, the medial lemniscus, and the tractus solitarius. We also present the variable diffusion-weighted imaging and apparent diffusion coefficient findings from 4 of our patients, which to our knowledge, have not been described in the literature.

Administration, Inhalation↗
PubMed2005

Witzelsucht after right putaminal hemorrhage: a case report.

Witzelsucht is a tendency to tell inappropriate and poor jokes. It usually occurs after a focal lesion involving orbitofrontal cortical or paramedian thalamic regions, especially on the right side. Here we report a 56-year-old man developing witzelsucht and hypersexuality after a right putaminal hemorrhage. The hematoma extended to the sublenticular part of posterior internal capsule and mesencephalon. The hemorrhage might have disconnected the fibers in the ascending reticular systems, and the fibers between paramedian thalamus and orbitofrontal cortex, and thus could be responsible for the patient's rare clinical manifestations.

Cognition↗
PubMed2006

Quantitative MR imaging R2 relaxometry in elderly participants reporting memory loss.

BACKGROUND AND PURPOSE: In Alzheimer disease (AD), elevated brain iron concentrations in gray matter suggest a disruption in iron homeostasis, while demyelination processes in white matter increase the water content. Our aim was to assess whether the transverse proton relaxation rate, or R2, an MR imaging parameter affected by changes in brain iron concentration and water content, was different in elderly participants with mild to severe levels of cognitive impairment compared with healthy controls. METHODS: Twelve elderly participants reporting memory problems and 11 healthy volunteers underwent single-spin-echo MR imaging in a 1.5T scanner, with subsequent neuropsychological testing. R2 data were collected from 14 brain regions in cortical and subcortical gray and white matter. Those with memory complaints were separated into 2 further subgroups: MC1 (no objective cognitive impairment) and MC2 (mild to severe objective cognitive impairment). RESULTS: Mean brain R2 values from the 11 controls correlated strongly (r = 0.94, P < .0001) with reference brain iron concentrations for healthy adults. R2 values in the MC1 and MC2 subgroups were significantly higher in the right temporal cortex and significantly lower in the left internal capsule, compared with healthy controls. R2 values in the MC2 subgroup were significantly lower in the left temporal and frontal white matter, compared with healthy controls. CONCLUSIONS: R2 differences between both subgroups and the healthy controls suggest iron has increased in the temporal cortex, and myelin has been lost from several white matter regions in those with memory complaints, consistent with incipient AD pathogenesis and biochemical data.

Aged↗
PubMed2006

Recovery of a partially damaged corticospinal tract in a patient with intracerebral hemorrhage: a diffusion tensor image study.

PURPOSE: We hypothesized that diffusion tensor imaging (DTI) could be useful for exploring corticospinal tract (CST) regeneration if longitudinal changes of diffusion anisotropy can be detected. In this study, we explored the recovery of a CST partially damaged by intracerebral hematoma in a patient by DTI. METHODS: A 61-year-old female patient and six age-matched control subjects were evaluated. The patient presented with complete paralysis of the left extremities, which occurred at the onset of a spontaneous intracerebral hemorrhage (ICH) in the right corona radiata and internal capsule. Over the five-month period following onset, motor function of the affected extremities slowly recovered to the normal range. Two longitudinal DTIs were acquired from the patient (at 3 weeks and 5 months from onset) and one DTI from the control subjects. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were measured using a region of interest (ROI) method. RESULTS: On the 3-week DTI, FA values of ROIs in the ICH regions in the affected hemisphere were significantly lower, and ADC values of ROIs in the same areas were significantly higher than those of the control subjects (p<0.002). However, both mean FA and ADC values of the affected hemisphere in the 5-month DTI showed no significant differences versus those of the control.

Aged↗
PubMed1991

[Striatal involvement on MRI in adrenomyeloneuropathy].

Adrenomyeloneuropathy (AMN), a clinical variant of child adrenoleukodystrophy (ALD), is an adult-onset progressive disorder which presents spastic paraparesis with peripheral nerve involvement and affects mainly the pyramidal tracts from the brainstem to the spinal cord. We report a case of AMN in which serial MRI showed unusual development of areas of high signal in the right striatum. The patient was in good health until the age of 12, when he began to lose his hair. At age 25 he started to have progressive gait disturbance and erectile impotence. In his first admission to our hospital at age 33, he showed diffuse baldness. He was intelligent but childish. His cranial nerves were normal. Muscle strength was weak (3-4/5) in the lower extremities. Deep tendon reflexes were hyperactive in the lower extremities while normal in the upper extremities. Babinski signs were elicited bilaterally. Pinprick and vibratory sensation was impaired in the lower legs. Proprioceptive sensations were normal. Co-ordination was intact. There were urinary incontinence and impairment of erection with preserved libido and ejaculation. Routine laboratory data including hematological studies, serum chemistry and urinalysis were all normal except for mild hyperlipidemia. Serum cortisol response to ACTH was low and serum levels of very long chain fatty acids were increased. Nerve conduction studies were abnormal and consistent with peripheral polyneuropathy. A biopsy specimen of left sural nerve revealed a mild loss of myelinated fibers with thinning of the myelin. These findings and the clinical features confirmed the diagnosis of AMN. MRI in SE2000/40 scans at age 34 disclosed areas of high signal in the bilateral internal capsules.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenoleukodystrophy↗
PubMed2006

[Two cases of Duchenne muscular dystrophy complicated with dilated cardiomyopathy and cerebral infarction].

We report two cases of Duchenne muscular dystrophy (DMD) complicated with dilated cardiomyopathy (DCM), who were affected with cerebral infarction. Case 1 suddenly developed dysarthria and right facial weakness at age 21. Cranial CT study disclosed a low density area in the left basal ganglia and internal capsule. Case 2 had a history of transient ischemic attack (TIA) at age 21. Five months after the TIA, he developed right hemiplegia and dysarthria, and a low density area in the corona radiate in left cerebral hemisphere was observed in cranial CT. These two cases showed the radiographic cardiomegaly with cardio thoracic ratio (CTR) of 72.8% and 66.6%, the decreased echocardiographic left ventricular ejection fraction below 20%, and the elevated titer of thrombin-anti-thrombin III complex (TAT) and D-dimer. The autopsy of Case 2 at age 26 disclosed the remarkable degeneration and fibrosis of myocardium and old ischemic lesion in the left cerebral frontal cortex. Despite the negative finding of the emboli in the left heart, cardiogenic cerebral infarction secondary to DCM was strongly suspected in both cases.

Adult↗
PubMed2006

Diffusion-weighted MR imaging characteristics of an acute strokelike form of multiple sclerosis.

The characteristics of multiple sclerosis (MS) lesions on diffusion-weighted sequences and apparent diffusion coefficient (ADC) mapping at the very early phase of symptoms have not been clearly described. We report the case of a young woman who presented with a sudden pseudostroke form of MS resulting in hemiplegia and sudden aphasia. MR imaging showed a lesion of the left internal capsule with reduced ADC, which suggests an ischemic stroke. This case shows that very acute MS lesions may have reduced ADC on MR imaging, reflecting cytotoxic and not vasogenic edema.

Acute Disease↗