1
|
Yeom JS, Cho JY, Woo HO. Understanding the importance of cerebrovascular involvement in Kawasaki disease. KOREAN JOURNAL OF PEDIATRICS 2019; 62:334-339. [PMID: 31096739 PMCID: PMC6753317 DOI: 10.3345/kjp.2019.00143] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 05/15/2019] [Indexed: 12/19/2022]
Abstract
Kawasaki disease (KD) is a systemic vasculitis in infants and young children. However, its natural history has not been fully elucidated because the first case was reported in the late 1960s and patients who have recovered are just now entering middle age. Nevertheless, much evidence has raised concerns regarding the subclinical vascular changes that occur in post-KD patients. KD research has focused on coronary artery aneurysms because they are directly associated with fatality. However, aneurysms have been reported in other extracardiac muscular arteries and their fate seems to resemble that of coronary artery aneurysms. Arterial strokes in KD cases are rarely reported. Asymptomatic ischemic lesions were observed in a prospective study of brain vascular lesions in KD patients with coronary artery aneurysms. The findings of a study of single-photon emission computed tomography suggested that asymptomatic cerebral vasculitis is more common than we believed. Some authors assumed that the need to consider the possibility of brain vascular lesions in severe cases of KD regardless of presence or absence of neurological symptoms. These findings suggest that KD is related with cerebrovascular lesions in children and young adults. Considering the fatal consequences of cerebral vascular involvement in KD patients, increased attention is required. Here we review our understanding of brain vascular involvement in KD.
Collapse
Affiliation(s)
- Jung Sook Yeom
- Department of Pediatrics, Gyeongsang National University Hospital, Gyeongsang Institute of Health Science, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Jae Young Cho
- Department of Pediatrics, Gyeongsang National University Hospital, Gyeongsang Institute of Health Science, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Hyang-Ok Woo
- Department of Pediatrics, Gyeongsang National University Hospital, Gyeongsang Institute of Health Science, Gyeongsang National University College of Medicine, Jinju, Korea
| |
Collapse
|
2
|
Abstract
"Neuroimaging plays a vital role in the diagnosis of primary and secondary vasculitic disorders. There multiple neuroimaging options available to accurately describe the underlying clinical deficits of involved cases. Noninvasive neuroimaging modalities provide less risk and when interdigitated, form the basis for a more conclusive understanding of the disease process. There are instances in which invasive cerebral angiography may be needed to image the intricate and at times, small involved vessels. Neuroradiologists should be included in the multidisciplinary team of physicians caring for patients with vasculitides and in research to provide more sensitive and safe modalities for accurate diagnosis."
Collapse
|
3
|
Mauro L, Manuela M, Valentina M, Sara C, Chondrogiannis S, Maria DF, Christos A, Liana C, Ada F, Maffione AM, Marzola MC, Rubello D. Role of Brain Perfusion SPECT with 99mTc HMPAO in the Assessment of Response to Drug Therapy in Patients with Autoimmune Vasculitis: A Prospective Study. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2015; 7:135-42. [PMID: 25973400 PMCID: PMC4426516 DOI: 10.4103/1947-2714.156008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The diagnosis of vasculitis in the brain remains a quite difficult achievement. To the best of our knowledge, there is no imaging method reported in literature which is capable of reaching to a diagnosis of vasculitis with very high sensitivity. AIM The aim of this study was to determine whether perfusion brain single photon emission computed tomography (SPECT) can be usefully employed in monitoring the treatment of vasculitis, allowing treating only potentially responder patients and avoiding the side effects on patients who do not respond. MATERIALS AND METHODS Twenty patients (two males and 18 females) suffering from systemic lupus erythematosus (SLE; n = 5), Behcet's disease (BD; n = 5), undifferentiated vasculitis (UV; n = 5), and Sjogren's syndrome (SS; n = 5) were included in the study. All patients underwent a wide neurological anamnestic investigation, a complete objective neurological examination and SPECT of the brain with 99mTc-hexamethyl-propylene-aminoxime (HMPAO). The brain SPECT was then repeated after appropriate medical treatment. The neurological and neuropsychiatric follow-up was performed at 6 months after the start of the treatment. RESULTS Overall, the differences between the scintigraphic results obtained after and before the medical treatment indicated a statistically significant increase of the cerebral perfusion (CP). In 19 out of 200 regions of interest (ROI) studied, the difference between pre- and post treatment percentages had negative sign, indicating a worsening of CP. This latter event has occurred six times (five in the same patients) in the UV, 10 times (eight in the same patients) in the SLE, never in BD, and three times (two in the same patient) in the SS. CONCLUSION The reported results seem to indicate the possibility of identifying, by the means of a brain SPECT, responder and nonresponder (unchanged or worsened CP) patients, affected by autoimmune vasculitis, to the therapy.
Collapse
Affiliation(s)
- Liberatore Mauro
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, University of Rome “Sapienza”, Rome, Italy
| | - Morreale Manuela
- Department of Medical and Surgical Sciences and Biotechnologies, Section of Neurology, Neuropsychology Outpatients Service, University of Rome “Sapienza”, Rome, Italy
| | - Megna Valentina
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, University of Rome “Sapienza”, Rome, Italy
| | - Collorone Sara
- Department of Neurology and Psychiatry, University of Rome “Sapienza”, Rome, Italy
| | | | - Drudi Francesco Maria
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, University of Rome “Sapienza”, Rome, Italy
| | - Anagnostou Christos
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, University of Rome “Sapienza”, Rome, Italy
| | - Civitelli Liana
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, University of Rome “Sapienza”, Rome, Italy
| | - Francia Ada
- Department of Neurology and Psychiatry, University of Rome “Sapienza”, Rome, Italy
| | | | | | - Domenico Rubello
- Department of Nuclear Medicine, Santa Maria della Misericordia Hospital, Rovigo, Italy
| |
Collapse
|
4
|
Sneddon's Syndrome presenting with topographic disorientation. J Clin Neurosci 2011; 18:980-1. [PMID: 21565509 DOI: 10.1016/j.jocn.2010.11.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Revised: 08/16/2010] [Accepted: 11/09/2010] [Indexed: 11/22/2022]
Abstract
A 32-year-old woman was admitted to our department for a progressive difficulty in topographic orientation, confirmed by an extensive battery of neuropsychological tests. All biochemical and immunological examinations of blood and cerebrospinal fluid and a cerebral MRI were normal, but a technetium-99m-ethyl cysteinate dimer-single photon emission CT (Tc-99m ECD-SPECT) scan showed bilateral parietal hypoperfusion. The patient refused to undergo other examinations, but 14 months later she returned to hospital for diffuse cutaneous livedo reticularis over her trunk and legs. This time the MRI showed small frontoparietal cortical-subcortical abnormalities suggestive of arterial ischemic infarctions. We made a diagnosis of Sneddon's Syndrome (SNS). SNS is characterized by the association of livedo reticularis and cerebrovascular disease; non-dermatological onset is extremely uncommon. To our knowledge, this is the first description of a patient presenting with cognitive impairment only and observed at such an early stage of the disease that a cerebral MRI was normal.
Collapse
|
5
|
Manger B. New developments in imaging for diagnosis and therapy monitoring in rheumatic diseases. Best Pract Res Clin Rheumatol 2005; 18:773-81. [PMID: 15501182 DOI: 10.1016/j.berh.2004.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The availability of therapeutic modalities that are able to stop inflammatory joint damage has also markedly influenced recent developments in muskuloskeletal imaging. One focus of interest is the detection of joint pathology as early as possible in order to prevent erosive bony changes. Ultrasonography and magnetic resonance imaging are the most valuable technologies in this respect. Another focus is on the exact assessment and documentation of joint damage using scoring systems not only in therapeutic trials, but also in clinical practice. In addition to these recent advances in peripheral and axial joint imaging, this chapter also discusses advances in vascular imaging and scintigraphy in rheumatoid diseases as well as interventional procedures guided by imaging technologies.
Collapse
Affiliation(s)
- Bernhard Manger
- Department of Medicine III, Institute for Clinical Immunology and Rheumatology, Friedrich-Alexander-University Erlangen-Nürnberg, Krankenhausstrasse 12, D-91054 Erlangen, Germany.
| |
Collapse
|
6
|
Razumovsky AY, Wityk RJ, Geocadin RG, Bhardwaj A, Ulatowski JA. Cerebral vasculitis: diagnosis and follow-up with transcranial Doppler ultrasonography. J Neuroimaging 2001; 11:333-5. [PMID: 11462307 DOI: 10.1111/j.1552-6569.2001.tb00059.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The authors report a patient with postpartum intracerebral hemorrhage associated with cerebral vasculitis. Cerebral circulation was assessed with transcranial Doppler (TCD) ultrasonography, magnetic resonance angiography, and conventional cerebral angiography. Initial TCD studies demonstrated bilateral patchy increased cerebral blood flow velocity (CBFV) in the anterior circulation with complete normalization during remission. This case report provides evidence that cerebral vasculitis leads to relevant CBFV changes and that the TCD technique may assist in diagnosis and follow-up of these patients.
Collapse
Affiliation(s)
- A Y Razumovsky
- Department of Neurology, Neurosciences Critical Care Division, Johns Hopkins Medical Institutions, Meyer 8-140, 600 North Wolfe Street, Baltimore, MD 21287-7840, USA.
| | | | | | | | | |
Collapse
|
7
|
Abstract
Vasculitis is a process that results from the inflammation of blood vessels and can occur de novo or secondary to a variety of diseases or drugs. Clinical presentation depends on the size and distribution of vessels involved. Anti-neutrophil cytoplasmic antibodies (ANCA) have been shown to have variable sensitivity in making the diagnosis of specific vasculitic syndromes, therefore histological confirmation may be necessary. Angiography is a useful tool in evaluating disease of large and medium-sized vessels that are inaccessible or potentially dangerous to biopsy. New imaging modalities are becoming more useful in diagnosing vessel wall changes, particularly in large-vessel vasculitides. In clinical practice it is not always possible to classify or apply a specific label to a patient with vasculitis, but for appropriate patient management it is important to define the extent and severity of disease and to exclude underlying secondary causes.
Collapse
Affiliation(s)
- N Mohan
- Division of Rheumatology, Allergy and Immunology, Georgetown University Medical Center, 3800 Reservoir Road NW, Washington, DC 20007, USA
| | | |
Collapse
|
8
|
Nishikawa M, Matsubara T, Yoshitomi T, Ichiyama T, Hayashi T, Furukawa S. Abnormalities of brain perfusion in echovirus type 30 meningitis. J Neurol Sci 2000; 179:122-6. [PMID: 11054495 DOI: 10.1016/s0022-510x(00)00398-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
From May to August 1998 an epidemic of aseptic meningitis (AM) due to echovirus type 30 (E30) occurred in Yamaguchi prefecture, Japan. We performed single-photon emission-computed tomography (SPECT) to evaluate cerebral perfusion during the acute stage in 27 patients with AM due to E30. Moreover, we measured the cerebrospinal fluid (CSF) concentrations of soluble tumor necrosis factor receptor (sTNF-R) and interleukin-1 beta (IL-1beta) in all 27 patients, and the serum concentration of soluble E-selectin (sE-selectin) in 19 of the 27 patients, which is responsible for vasculitis, by means of a sandwich enzyme-linked immunosorbent assay. In 20 of the 27 (74.1%) children, SPECT imaging revealed localized cerebral hypoperfusion without abnormal focal neurological findings or symptoms. Follow-up SPECT after about 1 month revealed no abnormalities. The CSF concentrations of sTNF-R and IL-1beta, and the serum concentration of sE-selectin in the group with abnormal findings on SPECT were significantly higher than those in the group without abnormal findings on SPECT and the control subjects. Our results indicate that transient reduced regional blood flow is a frequent finding in children with AM due to E30 infection and that this abnormal finding may be induced by cerebral vasculitis.
Collapse
Affiliation(s)
- M Nishikawa
- Department of Pediatrics, Yamaguchi University School of Medicine, 1-1-1 Minamikogushi, Ube, 755-8505, Yamaguchi, Japan
| | | | | | | | | | | |
Collapse
|
9
|
Sumi Y, Ozaki Y, Itoh S, Katayama H, Tanaka S. Cerebral blood flow-SPECT in a patient with Sneddon's syndrome. Ann Nucl Med 1999; 13:109-12. [PMID: 10355955 DOI: 10.1007/bf03164886] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We report a 50-year-old woman diagnosed with Sneddon's syndrome and examined by CBF scintigraphy several times for follow-up of the disease. There were no significant changes in her CBF scintigraphic findings or neurological status during the 6-year follow-up period. Sneddon's syndrome is a slowly progressive disorder in which livedo reticularis precedes cerebrovascular accidents. Because small cortical arteries are predominantly affected in Sneddon's syndrome, MR and conventional angiography often fail to show any abnormal findings, and MR imaging may not visualize decreased CBF in the early stage. Therefore, CBF scintigraphy should be performed in patients who have or are suspected of having Sneddon's syndrome.
Collapse
Affiliation(s)
- Y Sumi
- Department of Radiology, Juntendo University Urayasu Hospital, Chiba, Japan.
| | | | | | | | | |
Collapse
|
10
|
Heuser G, Mena I. Neurospect in neurotoxic chemical exposure demonstration of long-term functional abnormalities. Toxicol Ind Health 1998; 14:813-27. [PMID: 9891913 DOI: 10.1177/074823379801400604] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Patients who had experienced well-documented neurotoxic exposure months or years earlier were evaluated. Seventy-two right-handed adults who claimed continuing abnormalities of cognitive and memory function were examined after Xenon-133 inhalation and i.v. HMPAO. Single photon emission computed tomography (SPECT) results were statistically compared with age-matched controls. Bilateral, often asymmetrical, impairment of perfusion was found, mostly in the frontal, temporal, and parietal lobes. This hypoperfusion was predominantly left-sided in young patients and predominantly right-sided in the elderly. Abnormalities were found months and years after neurotoxic exposure had ceased. Our findings suggest that NeuroSPECT can provide evidence of impaired cerebral function and may therefore help to further define neurotoxic exposure and its chronic effects.
Collapse
Affiliation(s)
- G Heuser
- Department of Radiology, UCLA-Harbor Medical Center, Torrance, USA.
| | | |
Collapse
|
11
|
Abstract
Alice in Wonderland syndrome (AIWS) is characterized by visual hallucinations and bizarre perceptual distortions. Technetium-99m hexamethylpropyleneamine tomography (SPECT) brain scans were performed in four patients during the acute stage of AIWS. Two patients were demonstrated to have Epstein-Barr virus infections. One had abnormal (EEG) findings. The visual-evoked potential, cranial CT, and MRI findings were negative. The decreased cerebral perfusion areas in all patients were near the visual tract and visual cortex. All involved some regions of the temporal lobe. In most patients with AIWS, the EEG, CT, and MRI are unable to determine the precise pathologic areas. However, a SPECT brain scan may demonstrate abnormal perfusion areas and explain the clinical presentations.
Collapse
Affiliation(s)
- Y T Kuo
- Department of Pediatrics, Taipei Municipal Wan-Fang Hospital, Taiwan
| | | | | | | | | |
Collapse
|
12
|
Ichiyama T, Nishikawa M, Hayashi T, Koga M, Tashiro N, Furukawa S. Cerebral hypoperfusion during acute Kawasaki disease. Stroke 1998; 29:1320-1. [PMID: 9660380 DOI: 10.1161/01.str.29.7.1320] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Kawasaki disease is a febrile disease of children notable for systemic vasculitis. There have been many previous reports of various complications, including disorders of the central nervous system. We evaluated cerebral perfusion during the acute stage in patients with Kawasaki disease. METHODS Single-photon emission-computed tomography (SPECT) with 99mTc-hexamethylpropyleneamine oxime was performed in 21 children with acute stage Kawasaki disease. Follow-up SPECT and MRI were performed about 1 month after the first SPECT in patients who exhibited abnormal SPECT findings during the acute stage. RESULTS In 6 of 21 children SPECT imaging demonstrated localized cerebral hypoperfusion without abnormal neurological findings or clinical symptoms, and the follow-up SPECT and MRI approximately 1 month after the first SPECT revealed no abnormalities. CONCLUSIONS Some patients with Kawasaki disease have transient localized cerebral hypoperfusion at the acute stage.
Collapse
Affiliation(s)
- T Ichiyama
- Department of Pediatrics, Yamaguchi University School of Medicine, Ube, Japan
| | | | | | | | | | | |
Collapse
|
13
|
Wynne PJ, Younger DS, Khandji A, Silver AJ. Radiographic features of central nervous system vasculitis. Neurol Clin 1997; 15:779-804. [PMID: 9367964 DOI: 10.1016/s0733-8619(05)70347-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Central nervous system (CNS) vasculitis refers to primary and secondary disorders of the CNS vasculature. Most authorities agree that CNS vasculitis is a potentially serious disorder; therefore, prompt diagnosis and initiation of therapy are high priorities in treatment. Remarkable progress has been made in the diagnosis, evaluation, and treatment of this disorder. This article examines many aspects of the radiographic evaluation of CNS vasculitis.
Collapse
Affiliation(s)
- P J Wynne
- Department of Radiology, Division of Neuroradiology, Columbia-Presbyterian Medical Center, New York, New York 10032, USA
| | | | | | | |
Collapse
|