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Jahanshahi A, Salarinejad S, Oraee-Yazdani S, Chehresonboll Y, Morsali S, Jafarizadeh A, Falahatian M, Rahimi F, Jaberinezhad M. Gliomatosis cerebri with blindness: A case report with literature review. Radiol Case Rep 2023; 18:2884-2894. [PMID: 37388536 PMCID: PMC10300258 DOI: 10.1016/j.radcr.2023.05.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/10/2023] [Accepted: 05/12/2023] [Indexed: 07/01/2023] Open
Abstract
Cerebral gliomatosis (GC) is a rare diffuse infiltrative growth pattern of glioma with nonspecific clinical manifestations like visual impairment that may involve bilateral temporal lobes. Herpes simplex encephalitis (HSE) and limbic encephalitis (LE) can also lead to temporal lobe involvement. Differentiating these entities is necessary for patients with misleading presentations and imaging findings. To the best of our knowledge, this is the third case of GC presenting with blindness. The patient was a 35 years-old male in a drug rehabilitation center for heroin addiction. He presented with a headache, a single episode of seizure, and a 2-month history of bilateral decrease in visual acuity, which had acutely worsened. Magnetic resonance imaging (MRI) and computed tomography (CT) showed bilateral temporal lobe involvement. Ophthalmological studies showed bilateral papilledema, absence of visual evoked potential, and thickening of the retinal nerve fiber layer. Due to this clinical presentation, normal laboratory data, and suspicious MRI findings, further investigation with magnetic resonance spectroscopy (MRS) was performed. Results showed a greatly increased ratio of choline to creatinine(Cr) or N-acetyl aspartate (NAA), suggesting a neoplastic nature of the disease. Subsequently, the patient was referred for a brain tissue biopsy with a suspicion of malignancy. The pathology results revealed adult-type diffuse glioma with isocitrate dehydrogenase (IDH) mutation. Bilateral blindness, as well as bilateral temporal lobe involvement, each has many different causes. However, as demonstrated in this study, adult-type diffuse glioma must be considered a rare cause of concomitant bilateral temporal lobe involvement and blindness.
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Affiliation(s)
- Amirreza Jahanshahi
- Department of Radiology, Emam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
- Medical Radiation Sciences Research Group, Imam Reza Hosptial, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sareh Salarinejad
- Department of Pathology, Faculty of Medicine, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Saeed Oraee-Yazdani
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yasaman Chehresonboll
- Department of Surgical and Clinical Pathology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soroush Morsali
- Neuroscience Research Center (NSRC), Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Jafarizadeh
- Nikookari Eye Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Masih Falahatian
- Medical Radiation Sciences Research Group, Imam Reza Hosptial, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Faezeh Rahimi
- Department of Radiology, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Mehran Jaberinezhad
- Clinical Research Development Unit of Tabriz Valiasr Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
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Gao JH, Ding DY, Qi YY, Huang YM, Zhang JL, Zhang W. Neuropsychological Features in Patients with General Paresis of the Insane at an Early Stage. Med Sci Monit 2022; 28:e938316. [PMID: 36482803 PMCID: PMC9749326 DOI: 10.12659/msm.938316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND This study aimed to explore the features of cognitive impairment in patients with neurosyphilis at the early stage of mild cognitive impairment (MCI). MATERIAL AND METHODS A total of 18 patients with asymptomatic neurosyphilis (ANS), 19 patients with neurosyphilis at the MCI stage (neurosyphilis-MCI), and 15 patients with neurosyphilis at the dementia stage (neurosyphilis-dementia) were enrolled. Cognitive function was evaluated using comprehensive rating scales. Tests of syphilis in blood and cerebrospinal fluid (CSF) were conducted, and white blood cell (WBC) counts and protein levels in CSF were measured. RESULTS Overall cognitive function and individual cognitive domains, including memory, language, visuospatial skill, and attention/executive function, were all significantly impaired in the neurosyphilis-MCI group compared with the ANS group, and were further impaired in the neurosyphilis-dementia group. Although there was no difference in serum rapid plasma regain (RPR) titer among the 3 groups, the number of patients with serum RPR titer ≥1: 32 in the neurosyphilis-MCI group was much higher than that in the ANS group. CSF RPR positive rate in the neurosyphilis-MCI group was significantly higher than that in the ANS group. The WBC count, protein level, and the rate of elevated protein level or increased WBC count in CSF did not differ among the 3 groups. CONCLUSIONS The feature of cognitive impairment of neurosyphilis-MCI patients displayed multiple-domain amnestic MCI. Perhaps there were extensive brain areas involved at the early stage, and a continuous neuroinflammatory process was through the different stages of neurosyphilis. Early diagnosis and treatment are very important for preventing the progression of general paresis of the insane.
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Affiliation(s)
- Jun-Hua Gao
- Center for Cognitive Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China,Center of Parkinson’s Disease, Beijing Institute for Brain Disorders, Beijing, PR China,Beijing Key Laboratory on Parkinson Disease, Beijing, PR China,Department of Neurology, Beijing Ditan Hospital, Capital Medical University, Beijing, PR China
| | - Du-Yu Ding
- Department of Neurology, Beijing Ditan Hospital, Capital Medical University, Beijing, PR China
| | - Yan-Yun Qi
- Department of Neurology, Beijing Ditan Hospital, Capital Medical University, Beijing, PR China
| | - Yu-Ming Huang
- Department of Neurology, Beijing Ditan Hospital, Capital Medical University, Beijing, PR China
| | - Jing-Lin Zhang
- Department of Neurology, Beijing Ditan Hospital, Capital Medical University, Beijing, PR China
| | - Wei Zhang
- Center for Cognitive Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China,Center of Parkinson’s Disease, Beijing Institute for Brain Disorders, Beijing, PR China,Beijing Key Laboratory on Parkinson Disease, Beijing, PR China
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Biswas S, Ghosh R, Roy D, Ray A, De K, Biswas S, Naga D, Benito-León J. Scrub Typhus Masquerading as Limbic Encephalitis. Neurohospitalist 2022; 12:105-110. [PMID: 34950396 PMCID: PMC8689554 DOI: 10.1177/19418744211016107] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Scrub typhus, an acute febrile infectious disease prevalent in the 'tsutsugamushi triangle', is a mite-born rickettsial zoonosis, caused by Orientia tsutsugamushi. The clinical presentation is protean and involves multiple organ systems of the body, including central and peripheral nervous systems. We report a 22-year-old previously healthy Indian woman who presented with clinical (confusion, excessive sleepiness, cognitive dysfunction and focal seizures) and neuroimaging features of limbic encephalitis. After exclusion of common infectious, autoimmune and paraneoplastic causes, she was diagnosed with scrub typhus associated encephalitis, which responded to doxycycline and azithromycin therapy.
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Affiliation(s)
- Subhrajyoti Biswas
- Department of General Medicine, Burdwan Medical College, Burdwan, West Bengal, India
| | - Ritwik Ghosh
- Department of General Medicine, Burdwan Medical College, Burdwan, West Bengal, India
| | - Dipayan Roy
- Department of Biochemistry, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India,Indian Institute of Technology (IIT), Madras, Tamil Nadu, India
| | - Adrija Ray
- Department of General Medicine, RG Kar Medical College & Hospital, Kolkata, West Bengal, India
| | - Kaustav De
- Department of General Medicine, Burdwan Medical College, Burdwan, West Bengal, India
| | - Subrata Biswas
- Department of General Medicine, Burdwan Medical College, Burdwan, West Bengal, India
| | - Dinabandhu Naga
- Department of General Medicine, Burdwan Medical College, Burdwan, West Bengal, India
| | - Julián Benito-León
- Department of Neurology, University Hospital “12 de Octubre”, Madrid, Spain,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain,Department of Medicine, Complutense University, Madrid, Spain,Julián Benito-León. Department of Neurology, University Hospital “12 de Octubre”, 28041 Madrid, Spain.
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Bisinotto HS, Jarry VM, Reis F. Clinical and radiological aspects of bilateral temporal abnormalities: pictorial essay. Radiol Bras 2021; 54:115-122. [PMID: 33854266 PMCID: PMC8029941 DOI: 10.1590/0100-3984.2019.0134] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The temporal lobes are vulnerable to several diseases, including infectious, immune-mediated, degenerative, vascular, metabolic, and neoplastic processes. Therefore, lesions in the temporal lobes can pose a diagnostic challenge for the radiologist. The temporal lobes are connected by structures such as the anterior commissure, corpus callosum, and hippocampal commissure. That interconnectedness favors bilateral involvement in various clinical contexts. This pictorial essay is based on a retrospective analysis of case files from a tertiary university hospital and aims to illustrate some of the conditions that simultaneously affect the temporal lobes, as well as to define some neuroimaging elements that may be useful for the differential diagnosis of these diseases. Using computed tomography and magnetic resonance imaging scans, we illustrate the neuroradiological findings in confirmed cases of human herpesvirus 1, central nervous system tuberculosis, autoimmune encephalitis, Alzheimer's disease, frontotemporal dementia, mesial temporal sclerosis, stroke, kernicterus, megalencephalic leukoencephalopathy with subcortical cysts, low-grade glioma, and secondary lymphoma, the objective being to emphasize the importance of these imaging methods for making the differential diagnosis.
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Affiliation(s)
| | | | - Fabiano Reis
- Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brazil
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Chaudhry FB, Raza S, Ahmad U. Anton's syndrome: a rare and unusual form of blindness. BMJ Case Rep 2019; 12:12/12/e228103. [PMID: 31801772 DOI: 10.1136/bcr-2018-228103] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Anton syndrome is characterised by visual anosognosia. It results from damage to both occipital lobes, while the anterior visual pathways remain intact. We describe four cases of Anton's syndrome. First case is that of a 73-year-old woman, who presented with two separate events of intraparenchymal brain haemorrhage, 4 years apart. Her first stroke affected the left and second affected the right occipital lobe. Bilateral occipital lobe damage resulted in cortical blindness. Second case is an 88-year-old man, who suffered from two ischaemic strokes, 2 days apart. Each stroke involved one posterior cerebral artery. This resulted in bilateral occipital and temporal lobe infarcts. Third case is a 64-year-old woman with chronic renal failure, who suffered bilateral occipital lobe infarction after haemodialysis, due to posterior reversible encephalopathy syndrome. Last case is that of an 80-year-old woman who suffered a basilar artery stroke, resulting in bilateral thalamic, temporal and occipital lobe infarction.
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Affiliation(s)
| | - Samavia Raza
- Radiology Department, John Radcliffe Hospital, Oxford, UK
| | - Usman Ahmad
- Gastroenterology, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
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Li R, Shi PA, Liu TF, Li Y, Wang Y, Wu K, Chen XJ, Xiao HF, Wang YL, Ma L, Lou X. Role of 3D Pseudocontinuous Arterial Spin-Labeling Perfusion in the Diagnosis and Follow-Up in Patients with Herpes Simplex Encephalitis. AJNR Am J Neuroradiol 2019; 40:1901-1907. [PMID: 31649156 DOI: 10.3174/ajnr.a6279] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 08/26/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND AND PURPOSE Early diagnosis and treatment of herpes simplex encephalitis are crucial to reduce morbidity and mortality. Our aim was to investigate the role of 3D pseudocontinuous arterial spin-labeling in herpes simplex encephalitis. MATERIALS AND METHODS From 2014 to 2019, seventeen consecutive patients with herpes simplex encephalitis and 15 healthy volunteers were recruited in the study. Conventional MR imaging and 3D pseudocontinuous arterial spin-labeling were performed in all subjects. According to the disease duration, the lesions were classified into 3 groups, including acute, subacute, and chronic stages, respectively. Clinical, neuroradiologic, and follow-up features were studied. The normalized lesion/normal tissue CBF values of lesions at different stages were measured and compared with those in the control group, respectively. RESULTS Compared with the control group, herpes simplex encephalitis demonstrated hyperperfusion in 11 acute cases and 6 subacute cases and hypoperfusion in 6 chronic cases. The mean normalized lesion/normal tissue CBF values of the lesions were 2.68 ± 0.54 in the acute stage, 2.42 ± 0.52 in the subacute stage, and 0.87 ± 0.30 in the chronic stage, respectively. The mean normalized lesion/normal tissue CBF values of acute and subacute lesions were significantly higher than those of the control group (1.33 ± 0.08; P < .001, respectively), while the mean normalized lesion/normal tissue CBF values of chronic lesions were lower than those of the control group (P < .05). Gradual perfusion reduction on serial 3D pseudocontinuous arterial spin-labeling was observed in herpes simplex encephalitis after effective therapy. CONCLUSIONS Conventional MR imaging remains most helpful in the diagnosis of herpes simplex encephalitis, while 3D pseudocontinuous arterial spin-labeling could be an adjunctive technique by providing dynamic CBF features at different stages in herpes simplex encephalitis.
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Affiliation(s)
- R Li
- From the School of Medicine (R.L., L.M.), Nankai University, Tianjin, China
- Department of Radiology (R.L., T.-F.L., Y.L., Y.W., K.W., X.-J.C., H.-F.X., Y.-L.W., L.M., X.L.), Chinese People's Liberation Army General Hospital, Beijing, China
| | - P-A Shi
- Department of Endocrinology (P.-A.S.), Cangzhou Central Hospital, Cangzhou, Hebei, China
| | - T-F Liu
- Department of Radiology (R.L., T.-F.L., Y.L., Y.W., K.W., X.-J.C., H.-F.X., Y.-L.W., L.M., X.L.), Chinese People's Liberation Army General Hospital, Beijing, China
| | - Y Li
- Department of Radiology (R.L., T.-F.L., Y.L., Y.W., K.W., X.-J.C., H.-F.X., Y.-L.W., L.M., X.L.), Chinese People's Liberation Army General Hospital, Beijing, China
| | - Y Wang
- Department of Radiology (R.L., T.-F.L., Y.L., Y.W., K.W., X.-J.C., H.-F.X., Y.-L.W., L.M., X.L.), Chinese People's Liberation Army General Hospital, Beijing, China
| | - K Wu
- Department of Radiology (R.L., T.-F.L., Y.L., Y.W., K.W., X.-J.C., H.-F.X., Y.-L.W., L.M., X.L.), Chinese People's Liberation Army General Hospital, Beijing, China
| | - X-J Chen
- Department of Radiology (R.L., T.-F.L., Y.L., Y.W., K.W., X.-J.C., H.-F.X., Y.-L.W., L.M., X.L.), Chinese People's Liberation Army General Hospital, Beijing, China
| | - H-F Xiao
- Department of Radiology (R.L., T.-F.L., Y.L., Y.W., K.W., X.-J.C., H.-F.X., Y.-L.W., L.M., X.L.), Chinese People's Liberation Army General Hospital, Beijing, China
| | - Y-L Wang
- Department of Radiology (R.L., T.-F.L., Y.L., Y.W., K.W., X.-J.C., H.-F.X., Y.-L.W., L.M., X.L.), Chinese People's Liberation Army General Hospital, Beijing, China
| | - L Ma
- From the School of Medicine (R.L., L.M.), Nankai University, Tianjin, China
- Department of Radiology (R.L., T.-F.L., Y.L., Y.W., K.W., X.-J.C., H.-F.X., Y.-L.W., L.M., X.L.), Chinese People's Liberation Army General Hospital, Beijing, China
| | - X Lou
- Department of Radiology (R.L., T.-F.L., Y.L., Y.W., K.W., X.-J.C., H.-F.X., Y.-L.W., L.M., X.L.), Chinese People's Liberation Army General Hospital, Beijing, China
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Late-onset Mitochondrial Encephalopathy, Lactic Acidosis, and Stroke-like Episodes Presenting With Auditory Agnosia. Neurologist 2019; 24:90-92. [PMID: 31045719 DOI: 10.1097/nrl.0000000000000229] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) is a multisystemic mitochondrial disorder that usually presents in childhood. Patients can have a wide array of neurological symptoms when presenting with stroke-like episodes, and imaging characteristics during the episodes can overlap with different neurological disorders. CASE REPORT A 61-year-old woman presented with communication difficulties consistent with auditory agnosia and was found to have bitemporal abnormalities on imaging that first raised the concern for herpes simplex virus encephalitis. Further work-up, in conjunction with the patient's past medical and family history, suggested a mitochondrial disorder. Mitochondrial full genome analysis revealed m.3243A>G variant in the MT-TL1 gene, with 6% heteroplasmy in blood leading to a diagnosis of MELAS. CONCLUSIONS MELAS is a disorder with clinical variability. Neuroimaging studies during stroke-like episodes in MELAS can provide significant clues to the underlying disorder. Although patients typically present in childhood, the first stroke-like episode can occur later in life in some patients, potentially related to a lower heteroplasmy level.
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Pandya M, Palpagama TH, Turner C, Waldvogel HJ, Faull RL, Kwakowsky A. Sex- and age-related changes in GABA signaling components in the human cortex. Biol Sex Differ 2019; 10:5. [PMID: 30642393 PMCID: PMC6332906 DOI: 10.1186/s13293-018-0214-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 12/09/2018] [Indexed: 12/13/2022] Open
Abstract
Gamma-aminobutyric acid (GABA) is the primary inhibitory neurotransmitter in the nervous system. Previous studies have shown fluctuations in expression levels of GABA signaling components-glutamic acid decarboxylase (GAD), GABA receptor (GABAR) subunit, and GABA transporter (GAT)-with increasing age and between sexes; however, this limited knowledge is highly based on animal models that produce inconsistent findings. This study is the first analysis of the age- and sex-specific changes of the GAD, GABAA/BR subunits, and GAT expression in the human primary sensory and motor cortices; superior (STG), middle (MTG), and inferior temporal gyrus (ITG); and cerebellum. Utilizing Western blotting, we found that the GABAergic system is relatively robust against sex and age-related differences in all brain regions examined. However, we observed several sex-dependent differences in GABAAR subunit expression in STG along with age-dependent GABAAR subunit and GAD level alteration. No significant age-related differences were found in α1, α2, α5, β3, and γ2 subunit expression in the STG. However, we found significantly higher GABAAR α3 subunit expression in the STG in young males compared to old males. We observed a significant sex-dependent difference in α1 subunit expression: males presenting significantly higher levels compared to women across all stages of life in STG. Older females showed significantly lower α2, α5, and β3 subunit expression compared to old males in the STG. These changes found in the STG might significantly influence GABAergic neurotransmission and lead to sex- and age-specific disease susceptibility and progression.
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Affiliation(s)
- Madhavi Pandya
- Centre for Brain Research, Department of Anatomy and Medical Imaging, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Thulani H. Palpagama
- Centre for Brain Research, Department of Anatomy and Medical Imaging, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Clinton Turner
- Centre for Brain Research, Department of Anatomy and Medical Imaging, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Anatomical Pathology, LabPlus, Auckland City Hospital, Auckland, New Zealand
| | - Henry J. Waldvogel
- Centre for Brain Research, Department of Anatomy and Medical Imaging, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Richard L. Faull
- Centre for Brain Research, Department of Anatomy and Medical Imaging, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Andrea Kwakowsky
- Centre for Brain Research, Department of Anatomy and Medical Imaging, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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9
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Weinstein GM, Small JE. Herpes Simplex Encephalitis. Neuroradiology 2019. [DOI: 10.1016/b978-0-323-44549-8.00007-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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10
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Bido-Medina R, Wirsich J, Rodríguez M, Oviedo J, Miches I, Bido P, Tusen L, Stoeter P, Sadaghiani S. Impact of Zika Virus on adult human brain structure and functional organization. Ann Clin Transl Neurol 2018; 5:752-762. [PMID: 29928658 PMCID: PMC5989769 DOI: 10.1002/acn3.575] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 04/12/2018] [Accepted: 04/13/2018] [Indexed: 01/11/2023] Open
Abstract
Objective To determine the impact of Zika virus (ZIKV) infection on brain structure and functional organization of severely affected adult patients with neurological complications that extend beyond Guillain–Barré Syndrome (GBS)‐like manifestations and include symptoms of the central nervous system (CNS). Methods In this first case–control neuroimaging study, we obtained structural and functional magnetic resonance images in nine rare adult patients in the subacute phase, and healthy age‐ and sex‐matched controls. ZIKV patients showed atypical descending and rapidly progressing peripheral nervous system (PNS) manifestations, and importantly, additional CNS presentations such as perceptual deficits. Voxel‐based morphometry was utilized to evaluate gray matter volume, and resting state functional connectivity and Network Based Statistics were applied to assess the functional organization of the brain. Results Gray matter volume was decreased bilaterally in motor areas (supplementary motor cortex, specifically Frontal Eye Fields) and beyond (left inferior frontal sulcus). Additionally, gray matter volume increased in right middle frontal gyrus. Functional connectivity increased in a widespread network within and across temporal lobes. Interpretation We provide preliminary evidence for a link between ZIKV neurological complications and changes in adult human brain structure and functional organization, comprising both motor‐related regions potentially secondary to prolonged PNS weakness, and nonsomatomotor regions indicative of PNS‐independent alternations. The latter included the temporal lobes, particularly vulnerable in a range of neurological conditions. While future studies into the ZIKV‐related neuroinflammatory mechanisms in adults are urgently needed, this study indicates that ZIKV infection can lead to an impact on the brain.
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Affiliation(s)
- Richard Bido-Medina
- Beckman Institute for Advanced Science and Technology University of Illinois at Urbana-Champaign Urbana Illinois 61801.,Neuroscience Program University of Illinois at Urbana-Champaign Urbana Illinois 61801
| | - Jonathan Wirsich
- Beckman Institute for Advanced Science and Technology University of Illinois at Urbana-Champaign Urbana Illinois 61801
| | | | - Jairo Oviedo
- Centro Diagnostico de Medicina Avanzada y Telemedicina (CEDIMAT) Santo Domingo Dominican Republic
| | - Isidro Miches
- Neuroscience Program University of Illinois at Urbana-Champaign Urbana Illinois 61801
| | - Pamela Bido
- Hospital Salvador B. Gautier Santo Domingo Dominican Republic
| | - Luis Tusen
- Hospital Salvador B. Gautier Santo Domingo Dominican Republic
| | - Peter Stoeter
- Centro Diagnostico de Medicina Avanzada y Telemedicina (CEDIMAT) Santo Domingo Dominican Republic
| | - Sepideh Sadaghiani
- Beckman Institute for Advanced Science and Technology University of Illinois at Urbana-Champaign Urbana Illinois 61801.,Psychology Department University of Illinois at Urbana-Champaign Urbana Illinois 61801
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Shoaib M, Kraus JJ, Khan MT. Herpes Simplex Virus Encephalitis: Atypical Presentation as a Right Middle Cerebral Artery Stroke. Cureus 2018; 10:e2067. [PMID: 29564192 PMCID: PMC5858849 DOI: 10.7759/cureus.2067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Herpes simplex virus encephalitis (HSVE) is a medical emergency associated with high mortality and morbidity. Definitive diagnosis is established by history, clinical examination, neuroimaging studies, supportive electroencephalogram (EEG) findings, and cerebrospinal fluid (CSF) analysis. We report a case of HSVE presenting as a stroke mimic in a 76-year-old female with a history of atrial fibrillation on warfarin. She was admitted to our medical intensive care unit with intermittent fever, lethargy, and new onset left-sided hemiparesis. A computed tomography (CT) of the head showed a right middle cerebral artery (MCA) acute ischemic stroke with midline shift and a dense right MCA sign. Brain magnetic resonance imaging (MRI) showed evidence of acute stroke with consideration of herpes encephalitis. CSF analysis was positive for herpes simplex virus (HSV) type one. She recovered with high-dose intravenous acyclovir therapy. Our patient was a diagnostic dilemma, initially being diagnosed with an acute ischemic stroke and yet found to have HSVE, which mimicked an acute ischemic stroke. Delay in treatment may result in devastating clinical outcomes that may include severe cognitive, focal neurological deficits, persistent seizures, and even death. This case highlights the importance of a multidisciplinary approach and the need for increased awareness of an atypical presentation of HSVE among emergency physicians, neurologist, intensivists, and radiologists.
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Affiliation(s)
- Maria Shoaib
- Department of Medicine, Dow Medical College Pakistan
| | - Jacqueline J Kraus
- Attending Physician, Charleston Area Medical Center / West Virginia University
| | - Muhammad T Khan
- Attending Physician, Charleston Area Medical Center / West Virginia University
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12
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Yedavalli V, Nyberg EM, Chow DS, Thaker AA. Beyond the embolus: "do not miss" diffusion abnormalities of ischaemic and non-ischaemic neurological disease. Insights Imaging 2017; 8:573-580. [PMID: 28986862 PMCID: PMC5707221 DOI: 10.1007/s13244-017-0574-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 08/21/2017] [Accepted: 09/04/2017] [Indexed: 11/23/2022] Open
Abstract
Abstract Given the rapid evolution and technological advances in the diagnosis and treatment of acute ischaemic stroke (AIS), including the proliferation of comprehensive stroke centres and increasing emphasis on interventional stroke therapies, the need for prompt recognition of stroke due to acute large vessel occlusion has received significant attention in the recent literature. Diffusion-weighted imaging (DWI) is the gold standard for the diagnosis of acute ischaemic stroke, as images appear positive within minutes of ischaemic injury, and a high signal-to-noise ratio enables even punctate infarcts to be readily detected. DWI lesions resulting from a single arterial embolic occlusion or steno-occlusive lesion classically lateralise and conform to a specific arterial territory. When there is a central embolic source (e.g. left atrial thrombus), embolic infarcts are often found in multiple vascular territories. However, ischaemic disease arising from aetiologies other than arterial occlusion will often not conform to an arterial territory. Furthermore, there are several important entities unrelated to ischaemic disease that can present with abnormal DWI and which should not be confused with infarct. This pictorial review explores the scope and typical DWI findings of select neurologic conditions beyond acute arterial occlusion, which should not be missed or misinterpreted. Teaching points • DWI abnormalities due to acute arterial occlusion must be promptly identified. • DWI abnormalities not due to arterial occlusion will often not conform to an arterial territory. • Several important non-ischaemic entities can present on DWI and should not be confused with infarct.
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Affiliation(s)
- Vivek Yedavalli
- Department of Diagnostic Radiology, Advocate Illinois Masonic Medical Center, Chicago, IL, 60657, USA
| | - Eric M Nyberg
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Daniel S Chow
- Department of Radiological Sciences, UC Irvine Health School of Medicine, Orange, CA, 92868, USA
| | - Ashesh A Thaker
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, 80045, USA.
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Dekeyzer S, De Kock I, Nikoubashman O, Vanden Bossche S, Van Eetvelde R, De Groote J, Acou M, Wiesmann M, Deblaere K, Achten E. "Unforgettable" - a pictorial essay on anatomy and pathology of the hippocampus. Insights Imaging 2017; 8:199-212. [PMID: 28108955 PMCID: PMC5359145 DOI: 10.1007/s13244-016-0541-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 12/18/2016] [Accepted: 12/20/2016] [Indexed: 11/24/2022] Open
Abstract
Abstract The hippocampus is a small but complex anatomical structure that plays an important role in spatial and episodic memory. The hippocampus can be affected by a wide range of congenital variants and degenerative, inflammatory, vascular, tumoral and toxic-metabolic pathologies. Magnetic resonance imaging is the preferred imaging technique for evaluating the hippocampus. The main indications requiring tailored imaging sequences of the hippocampus are medically refractory epilepsy and dementia. The purpose of this pictorial review is threefold: (1) to review the normal anatomy of the hippocampus on MRI; (2) to discuss the optimal imaging strategy for the evaluation of the hippocampus; and (3) to present a pictorial overview of the most common anatomic variants and pathologic conditions affecting the hippocampus. Teaching points • Knowledge of normal hippocampal anatomy helps recognize anatomic variants and hippocampal pathology. • Refractory epilepsy and dementia are the main indications requiring dedicated hippocampal imaging. • Pathologic conditions centered in and around the hippocampus often have similar imaging features. • Clinical information is often necessary to come to a correct diagnosis or an apt differential.
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Affiliation(s)
- Sven Dekeyzer
- Department of Diagnostic and Interventional Neuroradiology, University Hospital, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany. .,Department of Radiology, University Hospital (UZ) Ghent, De Pintelaan 185, 9000, Ghent, Belgium. .,Department of Medical Imaging, Onze-Lieve-Vrouw Hospital (OLV) Aalst, Moorselbaan 164, 9300, Aalst, Belgium.
| | - Isabelle De Kock
- Department of Radiology, University Hospital (UZ) Ghent, De Pintelaan 185, 9000, Ghent, Belgium
| | - Omid Nikoubashman
- Department of Diagnostic and Interventional Neuroradiology, University Hospital, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
| | | | - Ruth Van Eetvelde
- Department of Radiology, University Hospital (UZ) Ghent, De Pintelaan 185, 9000, Ghent, Belgium.,Department of Medical Imaging, Onze-Lieve-Vrouw Hospital (OLV) Aalst, Moorselbaan 164, 9300, Aalst, Belgium
| | - Jeroen De Groote
- Department of Radiology, University Hospital (UZ) Ghent, De Pintelaan 185, 9000, Ghent, Belgium
| | - Marjan Acou
- Department of Radiology, University Hospital (UZ) Ghent, De Pintelaan 185, 9000, Ghent, Belgium
| | - Martin Wiesmann
- Department of Diagnostic and Interventional Neuroradiology, University Hospital, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Karel Deblaere
- Department of Radiology, University Hospital (UZ) Ghent, De Pintelaan 185, 9000, Ghent, Belgium
| | - Eric Achten
- Department of Radiology, University Hospital (UZ) Ghent, De Pintelaan 185, 9000, Ghent, Belgium
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