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Willems R, You SJ, Vollmer F, Hattingen E, Weidauer S. Toxic Leukoencephalopathy due to Suspected Levamisole-adulterated Cocaine. Clin Neuroradiol 2024; 34:503-506. [PMID: 37962601 DOI: 10.1007/s00062-023-01358-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/06/2023] [Indexed: 11/15/2023]
Affiliation(s)
- Rafael Willems
- Institute of Neuroradiology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany.
| | - Se-Jong You
- Institute of Neuroradiology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Friederike Vollmer
- Clinic of Neurology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Elke Hattingen
- Institute of Neuroradiology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Stefan Weidauer
- Institute of Neuroradiology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
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2
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Middleton B, Albany Z, Kamer A, Kara A. Hemichorea-hemiballismus due to diabetic striatopathy a serious complication of uncontrolled diabetes. BMJ Case Rep 2024; 17:e259046. [PMID: 38782432 PMCID: PMC11116358 DOI: 10.1136/bcr-2023-259046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2024] [Indexed: 05/25/2024] Open
Abstract
We report the case of a man in his mid-80s with diabetes mellitus who presented to the emergency department with a 1-day history of right-sided choreiform movements and falls. Laboratory tests revealed blood glucose of 597 mg/dL. Non-contrast CT imaging of his head demonstrated a faint hyperdensity involving the left lentiform nucleus and brain MRI showed a hyperintensity in the left basal ganglia on T1-weighted images. These lesions are typical of diabetic striatopathy. Symptoms of hemichorea/hemiballismus did not resolve with glycaemic control and several pharmacological agents were tried with eventual improvement with risperidone. He was discharged to a rehabilitation facility and had mild persistent arm chorea at 6-month follow-up.
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Affiliation(s)
- Brian Middleton
- Internal Medicine, Indiana University School of Medicine, Carmel, Indiana, USA
| | - Zhanna Albany
- Internal Medicine, Indiana University School of Medicine, Carmel, Indiana, USA
| | - Aaron Kamer
- Clinical Radiology & Imaging Sciences, Indiana University Health Inc, Indianapolis, Indiana, USA
| | - Areeba Kara
- Internal Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
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3
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Agarwal A, Rees JH, Sabat S. Toxic and Drug-Related White Matter Diseases of the Brain and Spine. Magn Reson Imaging Clin N Am 2024; 32:253-275. [PMID: 38555140 DOI: 10.1016/j.mric.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Toxic leukoencephalopathy and myelopathy are common neurologic complications of a wide range of chemotherapeutic and substance abuse agents. During the last decade, there has been a significant change in the profile of white matter toxins, primarily driven by the development and usage of new chemotherapeutic and immunotherapeutic agents and by the continuous increase in illicit drug abuse with contaminants. Neuroimaging in the form of MR imaging forms the cornerstone in the diagnosis of these entities, many of which are reversible and amenable to rapid correction. Chronic white matter changes are also seen with these toxins with gradually progressive clinicoradiological findings.
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Affiliation(s)
- Amit Agarwal
- Department of Radiology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - John H Rees
- Department of Radiology, University of Florida at Gainesville, 1600 Southwest Archer Road, Gainesville, FL 32608, USA
| | - Shyamsunder Sabat
- Department of Radiology, University of Florida at Gainesville, 1600 Southwest Archer Road, Gainesville, FL 32608, USA.
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4
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Ho C, Crawford JR. Neuroimaging features of psilocybin-induced toxic-metabolic encephalopathy in an adolescent. BMJ Case Rep 2024; 17:e259721. [PMID: 38442973 PMCID: PMC10916098 DOI: 10.1136/bcr-2024-259721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024] Open
Affiliation(s)
- Clarice Ho
- School of Medicine, University of Nevada Reno School of Medicine, Reno, Nevada, USA
| | - John Ross Crawford
- Pediatrics, University of California Irvine, Irvine, California, USA
- Pediatrics, Children's Hospital Orange County, Orange, USA
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Lim CG, Lee HJ. Pattern Clustering of Symmetric Regional Cerebral Edema on Brain MRI in Patients with Hepatic Encephalopathy. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2024; 85:381-393. [PMID: 38617858 PMCID: PMC11009126 DOI: 10.3348/jksr.2023.0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 05/16/2023] [Accepted: 06/11/2023] [Indexed: 04/16/2024]
Abstract
Purpose Metabolic abnormalities in hepatic encephalopathy (HE) cause brain edema or demyelinating disease, resulting in symmetric regional cerebral edema (SRCE) on MRI. This study aimed to investigate the usefulness of the clustering analysis of SRCE in predicting the development of brain failure. Materials and Methods MR findings and clinical data of 98 consecutive patients with HE were retrospectively analyzed. The correlation between the 12 regions of SRCE was calculated using the phi (Φ) coefficient, and the pattern was classified using hierarchical clustering using the φ2 distance measure and Ward's method. The classified patterns of SRCE were correlated with clinical parameters such as the model for end-stage liver disease (MELD) score and HE grade. Results Significant associations were found between 22 pairs of regions of interest, including the red nucleus and corpus callosum (Φ = 0.81, p < 0.001), crus cerebri and red nucleus (Φ = 0.72, p < 0.001), and red nucleus and dentate nucleus (Φ = 0.66, p < 0.001). After hierarchical clustering, 24 cases were classified into Group I, 35 into Group II, and 39 into Group III. Group III had a higher MELD score (p = 0.04) and HE grade (p = 0.002) than Group I. Conclusion Our study demonstrates that the SRCE patterns can be useful in predicting hepatic preservation and the occurrence of cerebral failure in HE.
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de Morais GL, Alves GM, Alves FHM, da Silva NO, Cetlin RS, Dach F. Bilateral Dentate Nuclei Hyperintensity: An Important Diagnostic Clue in a Woman with Encephalopathy. Ann Indian Acad Neurol 2024; 27:199-200. [PMID: 38751915 PMCID: PMC11093177 DOI: 10.4103/aian.aian_998_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 02/28/2024] [Accepted: 03/20/2024] [Indexed: 05/18/2024] Open
Affiliation(s)
- Gabriela Lopes de Morais
- Department of Neurology and Neurosciences – Ribeirão Preto, Hospital das Clínicas of Ribeirão Preto (HCFMRP-USP) – University of São Paulo, School of Medicine, São Paulo, Brazil
| | - Gustavo Maximiano Alves
- Department of Neurology and Neurosciences – Ribeirão Preto, Hospital das Clínicas of Ribeirão Preto (HCFMRP-USP) – University of São Paulo, School of Medicine, São Paulo, Brazil
| | | | - Natalia Oliveira da Silva
- Department of Neurology and Neurosciences – Ribeirão Preto, Hospital das Clínicas of Ribeirão Preto (HCFMRP-USP) – University of São Paulo, School of Medicine, São Paulo, Brazil
| | - Roberto Satler Cetlin
- Department of Neurology and Neurosciences – Ribeirão Preto, Hospital das Clínicas of Ribeirão Preto (HCFMRP-USP) – University of São Paulo, School of Medicine, São Paulo, Brazil
| | - Fabíola Dach
- Department of Neurology and Neurosciences – Ribeirão Preto, Hospital das Clínicas of Ribeirão Preto (HCFMRP-USP) – University of São Paulo, School of Medicine, São Paulo, Brazil
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Hoang TN, Bich VLT, Thien TC, The HT, Tri DP, Van PL. Characteristics of brain magnetic resonance imaging in acute methanol intoxication: Report of 3 cases. Radiol Case Rep 2023; 18:4414-4418. [PMID: 37840895 PMCID: PMC10570555 DOI: 10.1016/j.radcr.2023.09.019] [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: 06/09/2023] [Revised: 08/30/2023] [Accepted: 09/05/2023] [Indexed: 10/17/2023] Open
Abstract
Acute methanol intoxication is uncommon. Methanol is mildly toxic, but its metabolites are formic acid and formaldehyde, causing total metabolism, visual disturbances, and central nervous system disturbances, leading to coma and death. Magnetic resonance imaging (MRI) is very important for the diagnosis and prognosis of methanol intoxication. Putaminal necrosis with or without hemorrhage is the most frequently reported finding. Other affected areas that are reported in the literature are subcortical white matter, hippocampus, optic nerve, and cerebellum. We report 3 cases of methanol intoxication and discuss their brain lesions on MRI.
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Affiliation(s)
| | - Van Le Thi Bich
- Department of Radiology, Cho Ray Hospital, Ho Chi Minh, Vietnam
| | - Tuong Cao Thien
- Department of Radiology, Cho Ray Hospital, Ho Chi Minh, Vietnam
| | - Hiep Truong The
- Emergency Department, Cho Ray Hospital, Ho Chi Minh, Vietnam
| | - Dung Pham Tri
- Emergency Department, Cho Ray Hospital, Ho Chi Minh, Vietnam
| | - Phuoc Le Van
- Department of Radiology, Cho Ray Hospital, Ho Chi Minh, Vietnam
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8
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Dekeyzer S, Vanden Bossche S, De Cocker L. Anything but Little: a Pictorial Review on Anatomy and Pathology of the Cerebellum. Clin Neuroradiol 2023; 33:907-929. [PMID: 37410171 DOI: 10.1007/s00062-023-01326-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 06/09/2023] [Indexed: 07/07/2023]
Abstract
Despite its small size the cerebellum is an anatomically complex and functionally important part of the brain. Traditionally the cerebellum is viewed as a motor control structure entirely devoted to motor control and learning, but recent functional magnetic resonance imaging (fMRI) studies demonstrated significant involvement of the cerebellum in higher order cognitive functions. The anatomical complexity of the cerebellum is reflected by the several nomenclature systems that exist for the description of cerebellar anatomy. The cerebellum can be affected by a variety of pathological processes, including congenital, infectious and inflammatory, neoplastic, vascular, degenerative and toxic metabolic diseases. The purpose of this pictorial review is to (1) provide a general overview of cerebellar anatomy and function, (2) demonstrate normal cerebellar anatomy on imaging studies, and (3) illustrate both common as well as rare pathological conditions affecting the cerebellum.
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Affiliation(s)
- Sven Dekeyzer
- Department of Radiology and Medical Imaging, Ghent University Hospital (UZG), Corneel Heymanslaan 10, 9000, Gent, Belgium.
- Department of Radiology, Antwerp University Hospital (UZA), Drie Eikenstraat 655, 2650, Edegem, Belgium.
| | - Stephanie Vanden Bossche
- Department of Radiology, Antwerp University Hospital (UZA), Drie Eikenstraat 655, 2650, Edegem, Belgium
- Department of Radiology, AZ Sint Jan Bruges, Ruddershove 10, 8000, Bruges, Belgium
| | - Laurens De Cocker
- Department of Radiology, AZ Maria Middelares Gent, Buitenring-Sint-Denijs 30, 9000, Gent, Belgium
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Farrukh S, Habib S, Rafaqat A, Sarfraz A, Sarfraz Z, Tariq H. Association of exercise, brain-derived neurotrophic factor, and cognition among older women: A systematic review and meta-analysis. Arch Gerontol Geriatr 2023; 114:105068. [PMID: 37257214 DOI: 10.1016/j.archger.2023.105068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 05/15/2023] [Accepted: 05/21/2023] [Indexed: 06/02/2023]
Abstract
This systematic review and meta-analysis explored the effects of structured exercise regimens on brain-derived neurotrophic factor (BDNF) levels, a proxy for cognitive function, in older women. In this study, we collated evidence from the available clinical trials that reported BDNF levels and other outcomes following structured exercise regimens. Adhering to PRISMA Statement 2020 guidelines. PubMed/MEDLINE, Scopus, CINAHL Plus, and Cochrane were systematically searched using a combination of the following keywords: brain-derived neurotrophic factor, women, exercise, older, cognition, and/or cognitive. A random-effects model was applied; the statistical analysis was conducted in RevMan 5.4 (Cochrane). The risk of bias in the included trials was assessed using the Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) tool. Across 12 trials, 994 older women were included that were enrolled in different exercise regimens globally. Exercise regimens were categorized as aerobic, resistance/power training, aquatic, taekwondo, and multimodal and ranging from 30 to 60 min, 1-5 times per week across 5-24 weeks. Moderate improvement (Cohen's d: 0.44, 95% CI: 0.04-0.84, p = 0.03) was found in BDNF levels across all trials. There was a small yet insignificant improvement in mini-mental state examination (MMSE) scores (Cohen's d: 0.17, 95% CI: -0.79-1.13, p = 0.73). Aerobic exercise, aquatic exercise, and multimodal regimens showed significant association with improved BDNF levels but the sample size for individual exercise regimens was small A main limitation was the inclusion of 114 (10.3%) males in the data, introducing gender bias. This study provides novel insight into the association between various exercise regimens and BDNF levels among older women.
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Affiliation(s)
| | - Shagufta Habib
- University Medical and Dental College Faisalabad, Pakistan
| | - Amna Rafaqat
- Fatima Jinnah Medical University, Lahore, Pakistan
| | | | | | - Hira Tariq
- Shalamar Medical and Dental College, Lahore, Pakistan
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Nakanishi T, Tamaru S, Harada T, Shukuya K, Yamasato K, Kataoka J, Makita K, Nakai M. Osmotic Demyelination Syndrome in a Patient with Diabetic Ketoacidosis Despite No Rapid Sodium Correction. Intern Med 2023:2451-23. [PMID: 37866918 DOI: 10.2169/internalmedicine.2451-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2023] Open
Abstract
Osmotic demyelination syndrome (ODS) occurs in patients with diabetes and hyponatremia. We herein report a case of ODS with chorea detected on serial magnetic resonance imaging (MRI), despite no prompt hyponatremia correction. A 74-year-old man with cirrhosis and uncontrolled type 2 diabetes developed an altered mental status and chorea during treatment for diabetic ketoacidosis (DKA). Despite no rapid sodium correction and normal initial brain MRI findings, serial MRI revealed ODS-related abnormalities. Clinicians should consider ODS in patients with DKA and a hyperosmolar hyperglycemic state displaying unconsciousness and neurological manifestations, including chorea, even without substantial changes in serum sodium levels. An MRI re-examination can help capture missing ODS complications.
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Affiliation(s)
| | - Satoko Tamaru
- Department of General Medicine, Nerima Hikarigaoka hospital, Japan
| | - Taku Harada
- Department of General Medicine, Nerima Hikarigaoka hospital, Japan
| | - Kenta Shukuya
- Department of General Medicine, Nerima Hikarigaoka hospital, Japan
| | - Kazushi Yamasato
- Department of General Medicine, Nerima Hikarigaoka hospital, Japan
| | - Jun Kataoka
- Department of Critical Care Medicine, Nerima Hikarigaoka hospital, Japan
| | - Kohzoh Makita
- Department of Radiology, Nerima Hikarigaoka hospital, Japan
| | - Mori Nakai
- Department of General Medicine, Nerima Hikarigaoka hospital, Japan
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11
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Zhang Z, Xu Q, Li J, Zhang C, Bai Z, Chai X, Xu K, Xiao C, Chen F, Liu T, Gu H, Xing W, Lu G, Zhang Z. MRI features of neuronal intranuclear inclusion disease, combining visual and quantitative imaging investigations. J Neuroradiol 2023:S0150-9861(23)00245-6. [PMID: 37758172 DOI: 10.1016/j.neurad.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/08/2023] [Accepted: 09/24/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE To observe the radiological characteristics of Neuronal Intranuclear Inclusion Disease (NIID) on lesion locations and diffusion property using quantitative imaging analysis. METHODS Visual inspection and quantitative analyses were performed on MRI data from 31 retrospectively included patients with NIID. Frequency heatmaps of lesion locations on T2WI and DWI were generated using voxel-wise analysis. Gray matter volume (GMV), white matter volume (WMV) and diffusion property of apparent diffusion coefficient (ADC) values of patients were voxel-wisely compared with healthy controls. Moreover, the ADC values within the DWI-detected lesion were compared with those within the adjacent cortical gray matter and white matter. Voxel-based lesion symptom mapping (VLSM) techniques, were used to determine the relationship between DWI lesion location and disease durations. RESULTS By visual inspection on the imaging findings, we proposed an "cockscomb flower sign" for describing the radiological feature of DWI hyperintensity within the corticomedullary junction. A "T2WI-DWI mismatch of spatial distribution" pattern was also revealed with visual inspection and frequency heatmaps, for describing the feature of a wider lesion distribution covering white matter shown on T2WI than that on DWI. Voxel-based morphometry comparison revealed that wildly reduced GMV and WMV, both the lesion areas detected by DWI and T2WI demonstrated ADC increase in patients. Furthermore, the ADC values within the DWI-detected lesion were intermediate between the adjacent cortex and the deep white matter with highest ADC. VLSM analysis revealed that frontal lobe, parietal lobe and internal capsule damage were associated with higher NIID durations. CONCLUSION NIID features with "cockscomb flower-like" DWI hyperintensity in area of corticomedullary junction, based on a "T2WI-DWI mismatch of spatial distribution" of lesion locations. The pathological substrate of corticomedullary junction hyperintensity on DWI, can not be explained as diffusion restriction. These typical radiological features of brain MRI would be helpful for diagnosis of NIID.
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Affiliation(s)
- Zixuan Zhang
- Department of Diagnostic Radiology, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China; School of Medical Imaging, Xuzhou Medical University, Xuzhou 221004, China
| | - Qiang Xu
- Department of Diagnostic Radiology, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Jianrui Li
- Department of Diagnostic Radiology, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Chao Zhang
- School of Medical Imaging, Xuzhou Medical University, Xuzhou 221004, China; Department of Medical Imaging, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221004, China
| | - Zhuojie Bai
- Department of Medical Imaging, Nanjing Jiangbei Hospital, Nanjing 210000, China
| | - Xue Chai
- Department of Medical Imaging, Nanjing Brain Hospital, Nanjing 210029, China
| | - Kai Xu
- School of Medical Imaging, Xuzhou Medical University, Xuzhou 221004, China; Department of Medical Imaging, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221004, China
| | - Chaoyong Xiao
- Department of Medical Imaging, Nanjing Brain Hospital, Nanjing 210029, China
| | - Feng Chen
- Department of Medical Imaging, Hainan General Hospital, Hainan 570311, China
| | - Tao Liu
- Department of Neurology, Hainan General Hospital, Haikou 570311, China
| | - Hongmei Gu
- Department of Medical Imaging, Affiliated Hospital of Nantong University, Nantong 226001, China
| | - Wei Xing
- Department of Medical Imaging, The first people's hospital of Changzhou. Changzhou 213200, China
| | - Guangming Lu
- Department of Diagnostic Radiology, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China; School of Medical Imaging, Xuzhou Medical University, Xuzhou 221004, China
| | - Zhiqiang Zhang
- Department of Diagnostic Radiology, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China; School of Medical Imaging, Xuzhou Medical University, Xuzhou 221004, China.
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Feige J, Klausner F, Pfaff JAR, Trinka E, Pikija S, Safdarian M. Stroke-like presentation of acute toxic leukoencephalopathy due to capecitabine treatment with extensive intramyelinic edema. Chronic Dis Transl Med 2023; 9:258-262. [PMID: 37711866 PMCID: PMC10497845 DOI: 10.1002/cdt3.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 04/27/2023] [Accepted: 05/11/2023] [Indexed: 09/16/2023] Open
Affiliation(s)
- Julia Feige
- Department of Neurology, Neurocritical Care and Neurorehabilitation, Centre of Cognitive Neuroscience, Christian Doppler University HospitalParacelsus Medical University, Salzburg, Member of EpiCARESalzburgAustria
| | - Fritz Klausner
- Department of Neuroradiology, Christian Doppler University HospitalParacelsus Medical UniversitySalzburgAustria
| | - Johannes A. R. Pfaff
- Department of Neuroradiology, Christian Doppler University HospitalParacelsus Medical UniversitySalzburgAustria
| | - Eugen Trinka
- Department of Neurology, Neurocritical Care and Neurorehabilitation, Centre of Cognitive Neuroscience, Christian Doppler University HospitalParacelsus Medical University, Salzburg, Member of EpiCARESalzburgAustria
- Neuroscience Institute, Christian‐Doppler University HospitalParacelsus Medical University, Centre for Cognitive NeuroscienceSalzburgAustria
- Institute of Public Health, Medical Decision‐Making and HTAUMIT ‐ Private University for Health Sciences, Medical Informatics and TechnologyHall in TyrolAustria
| | - Slaven Pikija
- Department of Neurology, Neurocritical Care and Neurorehabilitation, Centre of Cognitive Neuroscience, Christian Doppler University HospitalParacelsus Medical University, Salzburg, Member of EpiCARESalzburgAustria
| | - Mahdi Safdarian
- Department of Neurology, Neurocritical Care and Neurorehabilitation, Centre of Cognitive Neuroscience, Christian Doppler University HospitalParacelsus Medical University, Salzburg, Member of EpiCARESalzburgAustria
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Pi S, Li Q, Li J, Long H, Xiao B. Clinical Reasoning: A 14-Year-Old Girl With Reversible Peripheral Neuropathy and Encephalopathy. Neurology 2023; 101:e665-e671. [PMID: 37076303 PMCID: PMC10424836 DOI: 10.1212/wnl.0000000000207270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 02/22/2023] [Indexed: 04/21/2023] Open
Abstract
A 14-year-old girl presented with acute ascending, symmetric numbness, and flaccid paralysis 3 weeks after a suspected gastrointestinal infection. She had experienced anorexia since this gastrointestinal episode. EMG showed a sensorimotor axonal polyneuropathy. Routine CSF analysis and serum-specific antibodies (antiganglioside and node of Ranvier-associated antibodies) were all negative. Laboratory investigations for possible etiologies revealed only mild metabolic perturbations. During her hospitalization, she developed mild cognitive deficits. Brain MRI showed bilateral symmetric basal ganglia lesions with hyperintensity on T2 fluid-attenuated inversion recovery, diffusion-weighted imaging hyperintensity, and corresponding apparent diffusion coefficient hypointensity, but without contrast enhancement. A more thorough and detailed history indicated exercise intolerance, and specific examinations subsequently revealed an underlying etiology. This case presentation discusses specific etiology of an acute-onset diffuse and symmetric neuropathy after an acquired injury in a teenager, emphasizing the need of a broad differential diagnosis in this condition.
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Affiliation(s)
- Shanyu Pi
- From the Department of Neurology (S.P., Q.L., J.L., H.L., B.X.), and National Clinical Research Center for Geriatric Disorders (S.P., Q.L., J.L., H.L., B.X.), Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qiuxiang Li
- From the Department of Neurology (S.P., Q.L., J.L., H.L., B.X.), and National Clinical Research Center for Geriatric Disorders (S.P., Q.L., J.L., H.L., B.X.), Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jing Li
- From the Department of Neurology (S.P., Q.L., J.L., H.L., B.X.), and National Clinical Research Center for Geriatric Disorders (S.P., Q.L., J.L., H.L., B.X.), Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Hongyu Long
- From the Department of Neurology (S.P., Q.L., J.L., H.L., B.X.), and National Clinical Research Center for Geriatric Disorders (S.P., Q.L., J.L., H.L., B.X.), Xiangya Hospital, Central South University, Changsha, Hunan, China.
| | - Bo Xiao
- From the Department of Neurology (S.P., Q.L., J.L., H.L., B.X.), and National Clinical Research Center for Geriatric Disorders (S.P., Q.L., J.L., H.L., B.X.), Xiangya Hospital, Central South University, Changsha, Hunan, China.
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14
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Mankad JP, Paulsen K, Shah M. Partial Recovery in Toxic Leukoencephalopathy: Is It Really a Slow Improvement or a Warning Sign? Cureus 2023; 15:e42966. [PMID: 37667711 PMCID: PMC10475324 DOI: 10.7759/cureus.42966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2023] [Indexed: 09/06/2023] Open
Abstract
A 55-year-old African American man who was found down by a friend nine hours after being last seen at the same place was brought to the emergency department (ED) with encephalopathy, lactic acidosis, rhabdomyolysis, elevated troponin, acute kidney injury (AKI), and transaminitis. His urine drug screen (UDS) was positive for cocaine. Intravenous (IV) Narcan was given with minimal improvement in mental status. A computed tomography (CT) scan of the head and a CT scan of the cervical spine in the ED showed no acute findings. Due to hypoxia, the patient was eventually intubated. The patient also required a fasciotomy and eventually hyperbaric oxygen (HBO) therapy due to the left lower extremity wound. He was transferred to our facility for further care. Due to incomplete cognitive recovery, as the patient was oriented to self only, further neurological workup, including magnetic resonance imaging (MRI) of the brain, was obtained, which showed bilateral symmetric T2 FLAIR (Fluid attenuated inversion recovery) hyperintensity in the globus pallidus. The patient had slow and gradual deterioration with worsening encephalopathy, akinetic mutism, parkinsonian features, and seizures, which prompted further evaluation from neurology. The patient eventually underwent extensive workup, including a continuous video electroencephalogram (cvEEG), repeat MRI brain with and without contrast, lumbar puncture for cerebrospinal fluid (CSF) analysis, MRI brain with diffusion tensor imaging (DTI), and magnetic resonance spectroscopy (MRS). The patient was treated with multivitamin therapy and coenzyme Q10, but there was no significant benefit. We report a case of cocaine-induced leukoencephalopathy with findings like 'chasing the dragon encephalopathy' with a possible component of delayed post-hypoxic injury with underlying neuroinflammation.
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Affiliation(s)
- Jigar P Mankad
- Neurology, Aurora St. Luke's Medical Center, Milwaukee, USA
| | - Kyle Paulsen
- Neuro Critical Care, Aurora St. Luke's Medical Center, Milwaukee, USA
| | - Mihir Shah
- Neuro Critical Care, Aurora St. Luke's Medical Center, Milwaukee, USA
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Muthusamy K, Sivadasan A, Dixon L, Sudhakar S, Thomas M, Danda S, Wszolek ZK, Wierenga K, Dhamija R, Gavrilova R. Adult-onset leukodystrophies: a practical guide, recent treatment updates, and future directions. Front Neurol 2023; 14:1219324. [PMID: 37564735 PMCID: PMC10410460 DOI: 10.3389/fneur.2023.1219324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 06/19/2023] [Indexed: 08/12/2023] Open
Abstract
Adult-onset leukodystrophies though individually rare are not uncommon. This group includes several disorders with isolated adult presentations, as well as several childhood leukodystrophies with attenuated phenotypes that present at a later age. Misdiagnoses often occur due to the clinical and radiological overlap with common acquired disorders such as infectious, immune, inflammatory, vascular, metabolic, and toxic etiologies. Increased prevalence of non-specific white matter changes in adult population poses challenges during diagnostic considerations. Clinico-radiological spectrum and molecular landscape of adult-onset leukodystrophies have not been completely elucidated at this time. Diagnostic approach is less well-standardized when compared to the childhood counterpart. Absence of family history and reduced penetrance in certain disorders frequently create a dilemma. Comprehensive evaluation and molecular confirmation when available helps in prognostication, early initiation of treatment in certain disorders, enrollment in clinical trials, and provides valuable information for the family for reproductive counseling. In this review article, we aimed to formulate an approach to adult-onset leukodystrophies that will be useful in routine practice, discuss common adult-onset leukodystrophies with usual and unusual presentations, neuroimaging findings, recent advances in treatment, acquired mimics, and provide an algorithm for comprehensive clinical, radiological, and genetic evaluation that will facilitate early diagnosis and consider active treatment options when available. A high index of suspicion, awareness of the clinico-radiological presentations, and comprehensive genetic evaluation are paramount because treatment options are available for several disorders when diagnosed early in the disease course.
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Affiliation(s)
- Karthik Muthusamy
- Department of Clinical Genomics, Mayo Clinic, Jacksonville, FL, United States
| | - Ajith Sivadasan
- Department of Neurological Sciences, Christian Medical College, Tamil Nadu, Vellore, India
| | - Luke Dixon
- Department of Radiology, Imperial College, NHS Trust, London, United Kingdom
| | - Sniya Sudhakar
- Department of Radiology, Great Ormond Street Hospital, London, United Kingdom
| | - Maya Thomas
- Department of Neurological Sciences, Christian Medical College, Tamil Nadu, Vellore, India
| | - Sumita Danda
- Department of Medical Genetics, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Klaas Wierenga
- Department of Clinical Genomics, Mayo Clinic, Jacksonville, FL, United States
| | - Radhika Dhamija
- Department of Clinical Genomics and Neurology, Mayo Clinic, Phoenix, AZ, United States
| | - Ralitza Gavrilova
- Department of Clinical Genomics and Neurology, Mayo Clinic, Rochester, MN, United States
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16
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Farrell A, O'Brien B, Janeczko P, Cassimatis N, Monoky D. Heroin Inhalation Leukoencephalopathy: An Overlooked Entity in the Opioid Epidemic. Cureus 2023; 15:e40535. [PMID: 37461780 PMCID: PMC10350332 DOI: 10.7759/cureus.40535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2023] [Indexed: 07/20/2023] Open
Abstract
Heroin inhalation leukoencephalopathy (HIL) is a rare complication of vaporized heroin inhalation leading to white matter degeneration resulting in a range of neurologic disturbances including softened speech, cerebellar ataxia, behavioral changes, cerebellar gait abnormalities, and even respiratory failure resulting in death in the most severe cases. Magnetic resonance imaging (MRI) most commonly demonstrates bilateral hyperintensities affecting the basal ganglia, periventricular white matter, and cerebellum. In this case report, we present a relatively mild case of HIL in a young female patient to describe the characteristic challenges associated with the condition's presentation, diagnosis, and treatment. While healthcare workers everywhere are addressing a complex and ever-changing opioid epidemic, we strive to raise awareness about HIL as only one of a variety of complications resulting from opioid use disorder.
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Affiliation(s)
- Aidan Farrell
- Radiology, Hackensack Meridian School of Medicine, Nutley, USA
| | | | | | | | - David Monoky
- Radiology, Hackensack University Medical Center, Hackensack, USA
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17
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Costa O, Pinto J, Santos AF. Reversible Bilateral Basal Ganglia Lesions Due to Multifactorial Toxic-Metabolic Disorders. Cureus 2023; 15:e38733. [PMID: 37292566 PMCID: PMC10247155 DOI: 10.7759/cureus.38733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2023] [Indexed: 06/10/2023] Open
Abstract
Bilateral basal ganglia lesions can include a wide variety of etiologies, including metabolic, toxic, degenerative, vascular, inflammatory, infectious, and neoplastic etiology. We present a case of a 78-year-old man who was hospitalized with acute behavioral changes and psychomotor slowing. His medical history included diabetes mellitus, arterial hypertension, and prostate adenocarcinoma. In his spare time, he was a pigeon fancier and regularly burned waste (including diapers) outside his home. In the initial evaluation, he was hypertensive, drowsy, disoriented in time and space, dysarthric, and with global bradykinesia. From the research carried out, we stand out the following: brain magnetic resonance imaging showing bilateral hyperintensity of the basal ganglia on T2/fluid-attenuated inversion recovery, with foci of hypersignal on T1 without diffusion restriction or contrast enhancement; CSF presenting 15 cells/uL, without other alterations; analytical results presenting hypernatremia (171 mEq/L), creatinine at 3.5 mg/dL, hyperglycemia (always <300 mg/dL), and slightly elevated C-reactive protein and anticardiolipin antibodies in addition to thrombocytopenia (107,000). After correcting the metabolic disturbances and evading the identified toxic substances, magnetic resonance imaging showed regression of the lesions, and the patient returned to a normal state. The functions of the basal ganglia are complex, requiring increased use of glucose and oxygen, therefore presenting a high metabolic activity, which makes them vulnerable to various metabolic changes. We report a rare case affected by symmetrical lesions in the basal ganglia and presenting an acute onset of altered mental status with behavioral alterations, related to hyperglycemia, acute kidney injury, hypertension, and exposure to toxic substances (smoke from bonfires and/or toxic chemical components). Complete clinical recovery, remaining negative investigation, and regression of the lesions support our diagnosis.
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18
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Faria BCD, Figueiredo GRF, de Souza LC. Reversible lesion in the splenium of the corpus callosum after intense use of cannabis. Neurol Sci 2023:10.1007/s10072-023-06772-2. [PMID: 37009947 DOI: 10.1007/s10072-023-06772-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 03/20/2023] [Indexed: 04/04/2023]
Affiliation(s)
- Bárbara Caroline Dias Faria
- Grupo de Pesquisa em Neurologia Cognitiva e do Comportamento, Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | | | - Leonardo Cruz de Souza
- Grupo de Pesquisa em Neurologia Cognitiva e do Comportamento, Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.
- Programa de Pós-Graduação em Neurociências, UFMG, Belo Horizonte, MG, Brazil.
- Departamento de Clínica Médica, Faculdade de Medicina, UFMG, Av. Prof. Alfredo Balena, 190, sl 243. Santa Efigênia, Belo Horizonte, MG, 30130-100, Brazil.
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
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19
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Neuroimaging findings of inborn errors of metabolism: urea cycle disorders, aminoacidopathies, and organic acidopathies. Jpn J Radiol 2023:10.1007/s11604-023-01396-0. [PMID: 36729192 PMCID: PMC9893193 DOI: 10.1007/s11604-023-01396-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/23/2023] [Indexed: 02/03/2023]
Abstract
Although there are many types of inborn errors of metabolism (IEMs) affecting the central nervous system, also referred to as neurometabolic disorders, individual cases are rare, and their diagnosis is often challenging. However, early diagnosis is mandatory to initiate therapy and prevent permanent long-term neurological impairment or death. The clinical course of IEMs is very diverse, with some diseases progressing to acute encephalopathy following infection or fasting while others lead to subacute or slowly progressive encephalopathy. The diagnosis of IEMs relies on biochemical and genetic tests, but neuroimaging studies also provide important clues to the correct diagnosis and enable the conditions to be distinguished from other, more common causes of encephalopathy, such as hypoxia-ischemia. Proton magnetic resonance spectroscopy (1H-MRS) is a powerful, non-invasive method of assessing neurological abnormalities at the microscopic level and can measure in vivo brain metabolites. The present review discusses neuroimaging findings, including those of 1H-MRS, of IEMs focusing on intoxication disorders such as urea cycle disorders, aminoacidopathies, and organic acidopathies, which can result in acute life-threatening metabolic decompensation or crisis.
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20
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Imaging of metabolic and overload disorders in tissues and organs. Jpn J Radiol 2023; 41:571-595. [PMID: 36680702 DOI: 10.1007/s11604-022-01379-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 12/24/2022] [Indexed: 01/22/2023]
Abstract
Metabolic and overload disorders are a heterogeneous group of relatively uncommon but important diseases. While imaging plays a key role in the early detection and accurate diagnosis in specific organs with a pivotal role in several metabolic pathways, most of these diseases affect different tissues as part of a systemic syndromes. Moreover, since the symptoms are often vague and phenotypes similar, imaging alterations can present as incidental findings, which must be recognized and interpreted in the light of further biochemical and histological investigations. Among imaging modalities, MRI allows, thanks to its multiparametric properties, to obtain numerous information on tissue composition, but many metabolic and accumulation alterations require a multimodal evaluation, possibly using advanced imaging techniques and sequences, not only for the detection but also for accurate characterization and quantification. The purpose of this review is to describe the different alterations resulting from metabolic and overload pathologies in organs and tissues throughout the body, with particular reference to imaging findings.
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21
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Pehlivan UA, Gürkan E, Açar İH, Bıçakcı YK. Central nervous system neurotoxicity associated with nelarabine in T-cell acute lymphoblastic leukemia. J Oncol Pharm Pract 2023; 29:246-251. [PMID: 35593112 DOI: 10.1177/10781552221102591] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Nelarabine, a prodrug of arabinosylguanine has lineage-specific toxicity for T lymphoblasts and is used to treat refractory or relapsed T-cell acute lymphoblastic leukemia and T-cell lymphoblastic lymphoma patients. The most commonly observed adverse effects associated with nelarabine are mainly hematological, i.e. neutropenia, anemia, and thrombocytopenia. Additionally, neurological, and gastrointestinal toxicities have been reported. Central nervous system neurotoxicity associated with nelarabine is very rare. CASE DESCRIPTION A 37-year-old man patient diagnosed with T-cell acute lymphoblastic leukemia had experienced generalized tonic-clonic seizure which lasted for a few seconds and upper extremity weakness after three weeks of the nelarabine infusion. Computed tomography and magnetic resonance imaging have shown periventricular and nucleus caudatus abnormalities. Radiological findings suggested toxic leukoencephalopathy and acute infarct of right nucleus caudatus. MANAGEMENT AND OUTCOME After high-dose steroids, intravenous immunoglobulin, and support treatment, his neurologic symptoms disappeared except for mild peroral numbness. However, radiological sequelae persisted despite clinical improvement. CONCLUSION Physicians involved in the care of these patients who use nelarabine should be aware of the fact that cerebral toxicity of the nelarabine may occur especially in the presence of predisposing factors. It is crucial to monitor closely those patients receiving nelarabine and also those who have additional predisposing factors for neurotoxicity.
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Affiliation(s)
- Umur A Pehlivan
- Department of Radiology, Van Baskale State Hospital, Van, Turkey
| | - Emel Gürkan
- Department of Hematology, 63988Cukurova University School of Medicine, Adana, Turkey
| | - İbrahim H Açar
- Department of Hematology, 63988Cukurova University School of Medicine, Adana, Turkey
| | - Yunus K Bıçakcı
- Department of Radiology, 63988Cukurova University School of Medicine, Adana, Turkey
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22
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Zolyan A, Crawford JR. Unusual radiographic presentation of methotrexate-induced leukoencephalopathy involving the internal capsule. BMJ Case Rep 2022; 15:e253342. [PMID: 36428027 PMCID: PMC9703313 DOI: 10.1136/bcr-2022-253342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Anna Zolyan
- Neurology, University of California, Irvine, California, USA
| | - John Ross Crawford
- Pediatrics, University of California, Irvine, California, USA
- Pediatrics, Children's Hospital Orange County, Orange, California, USA
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23
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Methotrexate-Induced Stroke-Like Encephalopathy: Beware the Stroke Mimic. J Belg Soc Radiol 2022; 106:98. [DOI: 10.5334/jbsr.2935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 10/19/2022] [Indexed: 11/05/2022] Open
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24
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Sakurai K, Ikenouchi H, Yamamoto N, Furuta K, Ogawa R, Endo K. Uremic Encephalopathy Presenting with Unilateral Destructive Leukoencephalopathy Successfully Treated with Hemodialysis. Intern Med 2022; 62:1351-1353. [PMID: 36198609 DOI: 10.2169/internalmedicine.9494-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
An 81-year-old woman was hospitalized with progressive consciousness disturbance. Blood tests showed acidemia with severe renal dysfunction, and a cerebral spinal fluid (CSF) test showed pleocytosis with myelin basic protein (MBP) elevation. Brain magnetic resonance imaging showed unilaterally dominant subcortical white matter lesions with lentiform fork sign on T2-weighted imaging. After initiating hemodialysis, her consciousness disturbance and white matter lesions improved, suggesting uremic encephalopathy (UE). Unilaterally dominant leukoencephalopathy and high pleocytosis with MBP elevation in CSF are less common than previously identified characteristics of UE. When unilateral leukoencephalopathy occurs in patients with renal failure, UE should be considered.
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Affiliation(s)
| | | | | | - Kyohei Furuta
- Division of Internal Medicine, Sendai City Hospital, Japan
| | - Ryo Ogawa
- Division of Neurology, Sendai City Hospital, Japan
| | - Kaoru Endo
- Division of Neurology, Sendai City Hospital, Japan
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25
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Yang CWR, Mason M, Parizel PM, Warne R. Magnetic resonance imaging patterns of paediatric brain infections: a pictorial review based on the Western Australian experience. Insights Imaging 2022; 13:160. [PMID: 36194350 PMCID: PMC9532482 DOI: 10.1186/s13244-022-01298-1] [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: 05/30/2022] [Accepted: 09/10/2022] [Indexed: 12/01/2022] Open
Abstract
Paediatric brain infections are relatively uncommon, but it is important for radiologists to recognise the disease and provide accurate differential diagnoses. Magnetic resonance imaging (MRI) plays an important role in determining the most likely causative pathogen—either in the setting of an unwell child with acute infectious encephalitis, or in the evaluation of a child for sequela of prior infection. Image analysis can, however, be difficult since a particular pathogen can cause variable MRI findings across different geographic environments, and conversely, a particular appearance on MRI may be caused by a variety of pathogens. This educational review aims to identify some of the key MRI patterns seen in paediatric brain infections and present example cases encountered in Western Australia. Based on (i) the predominant type of signal abnormality (restricted diffusion versus T2 hyperintensity) and (ii) the distribution of signal abnormality throughout the brain, this review presents a framework of six key MRI patterns seen in paediatric brain infections, with an emphasis on acute infectious encephalitis. There is general utility to these MRI patterns—each suggestive of a group of likely diagnostic possibilities which can be calibrated according to institution and local environment. The pattern-based framework of this review can be easily transitioned into daily radiological practice, and we hope it facilitates the formation of accurate differential diagnoses in paediatric brain infections.
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Affiliation(s)
- Chi-Wei Robin Yang
- Department of Medical Imaging, Perth Children's Hospital (PCH), 15 Hospital Avenue, Nedlands, WA, 6009, Australia.
| | - Michael Mason
- Department of Medical Imaging, Perth Children's Hospital (PCH), 15 Hospital Avenue, Nedlands, WA, 6009, Australia
| | - Paul M Parizel
- Department of Radiology, University of Western Australia (UWA), Royal Perth Hospital (RPH), Perth, WA, Australia
| | - Richard Warne
- Department of Medical Imaging, Perth Children's Hospital (PCH), 15 Hospital Avenue, Nedlands, WA, 6009, Australia
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26
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MRI Evolution of a Patient with Viral Tick-Borne Encephalitis and Polymorphic Seizures. Diagnostics (Basel) 2022; 12:diagnostics12081888. [PMID: 36010239 PMCID: PMC9406907 DOI: 10.3390/diagnostics12081888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 07/28/2022] [Indexed: 11/16/2022] Open
Abstract
Some neurotropic viruses induce specific lesions in the deep structures, such as basal ganglia and thalamus. These anatomical structures play an important role in initiating and maintaining different types of epileptic seizures. We present the case of a 25-year-old male, transferred to our clinic one week after the onset of the symptomatology, with a recent history of traveling to Turkey and Egypt. At the moment of his hospital admission, his symptoms included altered consciousness, agitation, and seizures. Shortly after, his state worsened, requiring intubation. Viral tick-borne encephalitis diagnoses were favored by the CSF (cerebrospinal fluid) analysis, EEG (Electroencephalography), MRI (magnetic resonance imaging) images presenting symmetric hyper signal in the basal ganglia, and IgM antibodies for anti-tick-borne encephalitis. These lesions persisted for several weeks, and the patient’s seizures were polymorphic, originally generalized onset motor, generalized onset non-motor, and focal myoclonic. The patient achieved his independence, seizures decreasing both in intensity and frequency; the MRI images became almost normal. The reduction in antiepileptic doses was not followed by seizure recurrence.
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27
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Rakocevic N, Alaslani OH, Torres CH. Case 303: Delayed Posthypoxic Leukoencephalopathy. Radiology 2022; 304:241-244. [PMID: 35727714 DOI: 10.1148/radiol.203756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
HISTORY A 54-year-old man was found by paramedics in his home face-down at his computer desk with a substantially reduced level of consciousness. He had not contacted his family for more than 50 hours. The patient lived alone and was a heavy smoker with a history of alcohol abuse. His medical history was otherwise unremarkable, and there was no history of cancer, psoriasis, or rheumatoid arthritis, nor was there a history of methotrexate administration. At presentation to the emergency department, he was mildly hypotensive and was experiencing hypercapnic respiratory failure and acute renal failure with rhabdomyolysis. His toxicology screen was mildly positive for opiates. He received naloxone (Narcan; Emergent) with minimal effect. An unenhanced CT scan of the head was obtained. Of note, this patient's presentation predated the COVID-19 pandemic. He was admitted to the intensive care unit for decreased level of consciousness and respiratory failure. The decreased level of consciousness was thought to be secondary to seizure, as he developed seizurelike movements prior to intubation, probably in the context of intoxication or alcohol withdrawal. Electroencephalography revealed moderate bilateral cerebral dysfunction and encephalopathy, with no evidence of nonconvulsive seizures. He had a short course of intermittent hemodialysis and was discharged home 8 days later with an appointment for neurology follow-up. At discharge, he was at his cognitive and functional baseline. Approximately 3 weeks later, the patient was brought back to the emergency department for progressive confusion and decrease in balance. He became apathetic with reduced psychomotor activity and was no longer able to perform basic daily activities, such as cooking or bathing. He displayed bizarre behavior, such as staring at a wall for hours, and was somnolent, irritable, and inattentive. He eventually became incontinent of urine and stool. Results of a neurologic examination of the cranial nerves, motor function, sensation, and reflexes were normal. The results of blood work-up were grossly normal, and the results of an extensive toxicology work-up were negative. Repeat head CT was performed. MRI was ordered to further investigate the patient's encephalopathic presentation.
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Affiliation(s)
- Natalie Rakocevic
- From the Department of Radiology, University of Ottawa, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6 (N.R., O.H.A., C.H.T.), and Department of Medical Imaging, The Ottawa Hospital, Ottawa, Canada (O.H.A., C.H.T.)
| | - Ohoud H Alaslani
- From the Department of Radiology, University of Ottawa, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6 (N.R., O.H.A., C.H.T.), and Department of Medical Imaging, The Ottawa Hospital, Ottawa, Canada (O.H.A., C.H.T.)
| | - Carlos H Torres
- From the Department of Radiology, University of Ottawa, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6 (N.R., O.H.A., C.H.T.), and Department of Medical Imaging, The Ottawa Hospital, Ottawa, Canada (O.H.A., C.H.T.)
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28
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Alves IS, Coutinho AMN, Vieira APF, Rocha BP, Passos UL, Gonçalves VT, Silva PDS, Zhan MX, Pinho PC, Delgado DS, Docema MFL, Lee HW, Policeni BA, Leite CC, Martin MGM, Amancio CT. Imaging Aspects of the Hippocampus. Radiographics 2022; 42:822-840. [PMID: 35213261 DOI: 10.1148/rg.210153] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The hippocampus is one of the most sophisticated structures in the brain, owing to its complex anatomy, intriguing functions, relationship with other structures, and relevant associated symptoms. Despite being a structure analyzed for centuries, its anatomy and physiology in the human body are still being extensively studied, as well as associated pathologic conditions and potential biomarkers. It can be affected by a broad group of diseases that can be classified as congenital, degenerative, infectious or inflammatory, neoplastic, vascular, or toxic-metabolic disease. The authors present the anatomy and close structures, function, and development of the hippocampus, as well as an original algorithm for imaging diagnosis. The algorithm includes pathologic conditions that typically affect the hippocampus and groups them into nodular (space occupying) and nonnodular pathologic conditions, serving as a guide to narrow the differential diagnosis. MRI is the imaging modality of choice for evaluation of the hippocampus, and CT and nuclear medicine also improve the analysis. The MRI differential diagnosis depends on anatomic recognition and careful characterization of associated imaging findings such as volumetric changes, diffusion restriction, cystic appearance, hyperintensity at T1-weighted imaging, enhancement, or calcification, which play a central role in diagnosis along with clinical findings. Some pathologic conditions arising from surrounding structures such as the amygdala are also important to recognize. Pathologic conditions of the hippocampus can be a challenge to diagnose because they usually manifest as similar clinical syndromes, so the imaging findings play a potential role in guiding the final diagnosis. Online supplemental material is available for this article. ©RSNA, 2022.
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Affiliation(s)
- Isabela S Alves
- From the Neuroradiology Section, Department of Radiology, Hospital Sírio-Libanês, Adma Jafet 91, Bela Vista, São Paulo SP 01308-050, Brazil (I.S.A., A.M.N.C., A.P.F.V., B.P.R., U.L.P., V.T.G., P.C.P., D.S.D., M.F.L.D., H.W.L., M.G.M.M., C.T.A.); Neuroradiology Section, Department of Radiology, University of São Paulo, Brazil (A.M.N.C., P.C.P., C.C.L., M.G.M.M.); Department of Neurology, Prevent Senior, São Paulo, Brazil (P.D.S.S.); and Neuroradiology Section, Department of Radiology, University of Iowa, Iowa City, Iowa (M.X.Z., B.A.P.)
| | - Artur M N Coutinho
- From the Neuroradiology Section, Department of Radiology, Hospital Sírio-Libanês, Adma Jafet 91, Bela Vista, São Paulo SP 01308-050, Brazil (I.S.A., A.M.N.C., A.P.F.V., B.P.R., U.L.P., V.T.G., P.C.P., D.S.D., M.F.L.D., H.W.L., M.G.M.M., C.T.A.); Neuroradiology Section, Department of Radiology, University of São Paulo, Brazil (A.M.N.C., P.C.P., C.C.L., M.G.M.M.); Department of Neurology, Prevent Senior, São Paulo, Brazil (P.D.S.S.); and Neuroradiology Section, Department of Radiology, University of Iowa, Iowa City, Iowa (M.X.Z., B.A.P.)
| | - Ana P F Vieira
- From the Neuroradiology Section, Department of Radiology, Hospital Sírio-Libanês, Adma Jafet 91, Bela Vista, São Paulo SP 01308-050, Brazil (I.S.A., A.M.N.C., A.P.F.V., B.P.R., U.L.P., V.T.G., P.C.P., D.S.D., M.F.L.D., H.W.L., M.G.M.M., C.T.A.); Neuroradiology Section, Department of Radiology, University of São Paulo, Brazil (A.M.N.C., P.C.P., C.C.L., M.G.M.M.); Department of Neurology, Prevent Senior, São Paulo, Brazil (P.D.S.S.); and Neuroradiology Section, Department of Radiology, University of Iowa, Iowa City, Iowa (M.X.Z., B.A.P.)
| | - Bruno P Rocha
- From the Neuroradiology Section, Department of Radiology, Hospital Sírio-Libanês, Adma Jafet 91, Bela Vista, São Paulo SP 01308-050, Brazil (I.S.A., A.M.N.C., A.P.F.V., B.P.R., U.L.P., V.T.G., P.C.P., D.S.D., M.F.L.D., H.W.L., M.G.M.M., C.T.A.); Neuroradiology Section, Department of Radiology, University of São Paulo, Brazil (A.M.N.C., P.C.P., C.C.L., M.G.M.M.); Department of Neurology, Prevent Senior, São Paulo, Brazil (P.D.S.S.); and Neuroradiology Section, Department of Radiology, University of Iowa, Iowa City, Iowa (M.X.Z., B.A.P.)
| | - Ula L Passos
- From the Neuroradiology Section, Department of Radiology, Hospital Sírio-Libanês, Adma Jafet 91, Bela Vista, São Paulo SP 01308-050, Brazil (I.S.A., A.M.N.C., A.P.F.V., B.P.R., U.L.P., V.T.G., P.C.P., D.S.D., M.F.L.D., H.W.L., M.G.M.M., C.T.A.); Neuroradiology Section, Department of Radiology, University of São Paulo, Brazil (A.M.N.C., P.C.P., C.C.L., M.G.M.M.); Department of Neurology, Prevent Senior, São Paulo, Brazil (P.D.S.S.); and Neuroradiology Section, Department of Radiology, University of Iowa, Iowa City, Iowa (M.X.Z., B.A.P.)
| | - Vinicius T Gonçalves
- From the Neuroradiology Section, Department of Radiology, Hospital Sírio-Libanês, Adma Jafet 91, Bela Vista, São Paulo SP 01308-050, Brazil (I.S.A., A.M.N.C., A.P.F.V., B.P.R., U.L.P., V.T.G., P.C.P., D.S.D., M.F.L.D., H.W.L., M.G.M.M., C.T.A.); Neuroradiology Section, Department of Radiology, University of São Paulo, Brazil (A.M.N.C., P.C.P., C.C.L., M.G.M.M.); Department of Neurology, Prevent Senior, São Paulo, Brazil (P.D.S.S.); and Neuroradiology Section, Department of Radiology, University of Iowa, Iowa City, Iowa (M.X.Z., B.A.P.)
| | - Paulo D S Silva
- From the Neuroradiology Section, Department of Radiology, Hospital Sírio-Libanês, Adma Jafet 91, Bela Vista, São Paulo SP 01308-050, Brazil (I.S.A., A.M.N.C., A.P.F.V., B.P.R., U.L.P., V.T.G., P.C.P., D.S.D., M.F.L.D., H.W.L., M.G.M.M., C.T.A.); Neuroradiology Section, Department of Radiology, University of São Paulo, Brazil (A.M.N.C., P.C.P., C.C.L., M.G.M.M.); Department of Neurology, Prevent Senior, São Paulo, Brazil (P.D.S.S.); and Neuroradiology Section, Department of Radiology, University of Iowa, Iowa City, Iowa (M.X.Z., B.A.P.)
| | - Malia X Zhan
- From the Neuroradiology Section, Department of Radiology, Hospital Sírio-Libanês, Adma Jafet 91, Bela Vista, São Paulo SP 01308-050, Brazil (I.S.A., A.M.N.C., A.P.F.V., B.P.R., U.L.P., V.T.G., P.C.P., D.S.D., M.F.L.D., H.W.L., M.G.M.M., C.T.A.); Neuroradiology Section, Department of Radiology, University of São Paulo, Brazil (A.M.N.C., P.C.P., C.C.L., M.G.M.M.); Department of Neurology, Prevent Senior, São Paulo, Brazil (P.D.S.S.); and Neuroradiology Section, Department of Radiology, University of Iowa, Iowa City, Iowa (M.X.Z., B.A.P.)
| | - Paula C Pinho
- From the Neuroradiology Section, Department of Radiology, Hospital Sírio-Libanês, Adma Jafet 91, Bela Vista, São Paulo SP 01308-050, Brazil (I.S.A., A.M.N.C., A.P.F.V., B.P.R., U.L.P., V.T.G., P.C.P., D.S.D., M.F.L.D., H.W.L., M.G.M.M., C.T.A.); Neuroradiology Section, Department of Radiology, University of São Paulo, Brazil (A.M.N.C., P.C.P., C.C.L., M.G.M.M.); Department of Neurology, Prevent Senior, São Paulo, Brazil (P.D.S.S.); and Neuroradiology Section, Department of Radiology, University of Iowa, Iowa City, Iowa (M.X.Z., B.A.P.)
| | - Daniel S Delgado
- From the Neuroradiology Section, Department of Radiology, Hospital Sírio-Libanês, Adma Jafet 91, Bela Vista, São Paulo SP 01308-050, Brazil (I.S.A., A.M.N.C., A.P.F.V., B.P.R., U.L.P., V.T.G., P.C.P., D.S.D., M.F.L.D., H.W.L., M.G.M.M., C.T.A.); Neuroradiology Section, Department of Radiology, University of São Paulo, Brazil (A.M.N.C., P.C.P., C.C.L., M.G.M.M.); Department of Neurology, Prevent Senior, São Paulo, Brazil (P.D.S.S.); and Neuroradiology Section, Department of Radiology, University of Iowa, Iowa City, Iowa (M.X.Z., B.A.P.)
| | - Marcos F L Docema
- From the Neuroradiology Section, Department of Radiology, Hospital Sírio-Libanês, Adma Jafet 91, Bela Vista, São Paulo SP 01308-050, Brazil (I.S.A., A.M.N.C., A.P.F.V., B.P.R., U.L.P., V.T.G., P.C.P., D.S.D., M.F.L.D., H.W.L., M.G.M.M., C.T.A.); Neuroradiology Section, Department of Radiology, University of São Paulo, Brazil (A.M.N.C., P.C.P., C.C.L., M.G.M.M.); Department of Neurology, Prevent Senior, São Paulo, Brazil (P.D.S.S.); and Neuroradiology Section, Department of Radiology, University of Iowa, Iowa City, Iowa (M.X.Z., B.A.P.)
| | - Hae W Lee
- From the Neuroradiology Section, Department of Radiology, Hospital Sírio-Libanês, Adma Jafet 91, Bela Vista, São Paulo SP 01308-050, Brazil (I.S.A., A.M.N.C., A.P.F.V., B.P.R., U.L.P., V.T.G., P.C.P., D.S.D., M.F.L.D., H.W.L., M.G.M.M., C.T.A.); Neuroradiology Section, Department of Radiology, University of São Paulo, Brazil (A.M.N.C., P.C.P., C.C.L., M.G.M.M.); Department of Neurology, Prevent Senior, São Paulo, Brazil (P.D.S.S.); and Neuroradiology Section, Department of Radiology, University of Iowa, Iowa City, Iowa (M.X.Z., B.A.P.)
| | - Bruno A Policeni
- From the Neuroradiology Section, Department of Radiology, Hospital Sírio-Libanês, Adma Jafet 91, Bela Vista, São Paulo SP 01308-050, Brazil (I.S.A., A.M.N.C., A.P.F.V., B.P.R., U.L.P., V.T.G., P.C.P., D.S.D., M.F.L.D., H.W.L., M.G.M.M., C.T.A.); Neuroradiology Section, Department of Radiology, University of São Paulo, Brazil (A.M.N.C., P.C.P., C.C.L., M.G.M.M.); Department of Neurology, Prevent Senior, São Paulo, Brazil (P.D.S.S.); and Neuroradiology Section, Department of Radiology, University of Iowa, Iowa City, Iowa (M.X.Z., B.A.P.)
| | - Claudia C Leite
- From the Neuroradiology Section, Department of Radiology, Hospital Sírio-Libanês, Adma Jafet 91, Bela Vista, São Paulo SP 01308-050, Brazil (I.S.A., A.M.N.C., A.P.F.V., B.P.R., U.L.P., V.T.G., P.C.P., D.S.D., M.F.L.D., H.W.L., M.G.M.M., C.T.A.); Neuroradiology Section, Department of Radiology, University of São Paulo, Brazil (A.M.N.C., P.C.P., C.C.L., M.G.M.M.); Department of Neurology, Prevent Senior, São Paulo, Brazil (P.D.S.S.); and Neuroradiology Section, Department of Radiology, University of Iowa, Iowa City, Iowa (M.X.Z., B.A.P.)
| | - Maria G M Martin
- From the Neuroradiology Section, Department of Radiology, Hospital Sírio-Libanês, Adma Jafet 91, Bela Vista, São Paulo SP 01308-050, Brazil (I.S.A., A.M.N.C., A.P.F.V., B.P.R., U.L.P., V.T.G., P.C.P., D.S.D., M.F.L.D., H.W.L., M.G.M.M., C.T.A.); Neuroradiology Section, Department of Radiology, University of São Paulo, Brazil (A.M.N.C., P.C.P., C.C.L., M.G.M.M.); Department of Neurology, Prevent Senior, São Paulo, Brazil (P.D.S.S.); and Neuroradiology Section, Department of Radiology, University of Iowa, Iowa City, Iowa (M.X.Z., B.A.P.)
| | - Camila T Amancio
- From the Neuroradiology Section, Department of Radiology, Hospital Sírio-Libanês, Adma Jafet 91, Bela Vista, São Paulo SP 01308-050, Brazil (I.S.A., A.M.N.C., A.P.F.V., B.P.R., U.L.P., V.T.G., P.C.P., D.S.D., M.F.L.D., H.W.L., M.G.M.M., C.T.A.); Neuroradiology Section, Department of Radiology, University of São Paulo, Brazil (A.M.N.C., P.C.P., C.C.L., M.G.M.M.); Department of Neurology, Prevent Senior, São Paulo, Brazil (P.D.S.S.); and Neuroradiology Section, Department of Radiology, University of Iowa, Iowa City, Iowa (M.X.Z., B.A.P.)
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29
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Murthy VD, McLarty E, Woolard KD, Parker RL, Kortz G, King JN, Poppenga RH, Knipe MF, Dickinson PJ. Case Report: MRI, Clinical, and Pathological Correlates of Bromethalin Toxicosis in Three Dogs. Front Vet Sci 2022; 9:879007. [PMID: 35558887 PMCID: PMC9087846 DOI: 10.3389/fvets.2022.879007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 03/16/2022] [Indexed: 11/13/2022] Open
Abstract
Bromethalin toxicosis is an increasingly common clinical presentation in dogs that may be fatal depending on the extent of intoxication. Antemortem diagnosis of bromethalin toxicosis was achieved in three dogs by demonstration of the active metabolite desmethylbromethalin in fat or serum. Magnetic resonance imaging (MRI) findings were consistent with a diffuse leukoencephalopathy with restricted diffusion and prominent involvement of the corticospinal motor tracts on T2-weighted and diffusion-weighted sequences. Imaging findings were confirmed in one non-surviving dog at necropsy. Resolution of MRI abnormalities was demonstrated in one surviving dog that was consistent with the associated resolution of clinical signs. Initial findings in these dogs support further investigation of specific MRI patterns in cases of leukoencephalopathy to aid differential diagnosis. While antemortem detection of bromethalin and its metabolites confirms exposure, quantitation may be informative as a prognostic biomarker.
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Affiliation(s)
- Vishal D. Murthy
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, WA, United States
- *Correspondence: Vishal D. Murthy
| | - Ehren McLarty
- Department of Surgical and Radiological Sciences, University of California, Davis, Davis, CA, United States
| | - Kevin D. Woolard
- Department of Pathology, Microbiology and Immunology, University of California, Davis, Davis, CA, United States
| | - Rell L. Parker
- Department of Small Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States
| | - Gregg Kortz
- Department of Neurology, VCA Sacramento Veterinary Referral Center, Sacramento, CA, United States
| | - Jamie N. King
- Department of Neurology, VCA Sacramento Veterinary Referral Center, Sacramento, CA, United States
| | - Robert H. Poppenga
- California Animal Health and Food Safety Laboratory System, University of California, Davis, Davis, CA, United States
| | - Marguerite F. Knipe
- Department of Surgical and Radiological Sciences, University of California, Davis, Davis, CA, United States
| | - Peter J. Dickinson
- Department of Surgical and Radiological Sciences, University of California, Davis, Davis, CA, United States
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30
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Ball C, Fisicaro R, Morris L, White A, Pacicco T, Raj K, Agarwal A, Lee WC, Yu FF. Brain on fire: an imaging-based review of autoimmune encephalitis. Clin Imaging 2022; 84:1-30. [DOI: 10.1016/j.clinimag.2021.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 11/28/2021] [Accepted: 12/16/2021] [Indexed: 12/28/2022]
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31
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Lai LM, Gropman AL, Whitehead MT. MR Neuroimaging in Pediatric Inborn Errors of Metabolism. Diagnostics (Basel) 2022; 12:diagnostics12040861. [PMID: 35453911 PMCID: PMC9027484 DOI: 10.3390/diagnostics12040861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/24/2022] [Accepted: 03/25/2022] [Indexed: 02/04/2023] Open
Abstract
Inborn errors of metabolism (IEM) are a group of disorders due to functional defects in one or more metabolic pathways that can cause considerable morbidity and death if not diagnosed early. While individually rare, the estimated global prevalence of IEMs comprises a substantial number of neonatal and infantile disorders affecting the central nervous system. Clinical manifestations of IEMs may be nonspecific. Newborn metabolic screens do not capture all IEMs, and likewise, genetic testing may not always detect pathogenic variants. Neuroimaging is a critical component of the work-up, given that imaging sometimes occurs before prenatal screen results are available, which may allow for recognition of imaging patterns that lead to early diagnosis and treatment of IEMs. This review will demonstrate the role of magnetic resonance imaging (MRI) and proton magnetic resonance spectroscopy (1H MRS) in the evaluation of IEMs. The focus will be on scenarios where MRI and 1H MRS are suggestive of or diagnostic for IEMs, or alternatively, refute the diagnosis.
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Affiliation(s)
- Lillian M. Lai
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA;
- Department of Radiology, Children’s Hospital Los Angeles, Los Angeles, CA 90027, USA
| | - Andrea L. Gropman
- Department of Neurology, Children’s National, Washington, DC 20010, USA;
| | - Matthew T. Whitehead
- Department of Radiology, Children’s National, Washington, DC 20010, USA
- Correspondence: ; Tel.: +1-202-476-5000
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32
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Khan F, Sharma N, Ud Din M, Akabalu IG. Clinically Isolated Brainstem Progressive Multifocal Leukoencephalopathy: Diagnostic Challenges. AMERICAN JOURNAL OF CASE REPORTS 2022; 23:e935019. [PMID: 35001072 PMCID: PMC8762610 DOI: 10.12659/ajcr.935019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patient: Female, 47-year-old
Final Diagnosis: Brainstem progressive multifocal leukoencephalopathy
Symptoms: Dizziness • intermittent slurred speech • right-sided facial droop and numbness
Medication: —
Clinical Procedure: Lumbar puncture
Specialty: Neurology
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Affiliation(s)
- Faisal Khan
- Department of Neurology, Sam Houston State University College of Osteopathic Medicine, Huntsville, TX, USA.,Research Fellow, Houston Medical Clerkship, Sugar Land, TX, USA
| | - Neha Sharma
- Research Fellow, Houston Medical Clerkship, Sugar Land, TX, USA
| | - Moin Ud Din
- Research Fellow, Houston Medical Clerkship, Sugar Land, TX, USA
| | - Ijeoma Gloria Akabalu
- Medical Student 4, Caribbean Medical University School of Medicine, Willemstad, Curacao, Netherlands Antilles
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33
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Abstract
This article discusses new diffusion-weighted imaging (DWI) sequences, diffusion tensor imaging (DTI), and fiber tractography (FT), as well as more advanced diffusion imaging in pediatric brain and spine. Underlying disorder and pathophysiology causing diffusion abnormalities are discussed. Multishot echo planar imaging (EPI) DWI and non-EPI DWI provide higher spatial resolution with less susceptibility artifact and distortion, which are replacing conventional single-shot EPI DWI. DTI and FT have established clinical significance in pediatric brain and spine. This article discusses advanced diffusion imaging, including diffusion kurtosis imaging, neurite orientation dispersion and density imaging, diffusion spectrum imaging, intravoxel incoherent motion, and oscillating-gradient spin-echo.
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Affiliation(s)
- Toshio Moritani
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 East Medical Center Drive, UH B2 A209K, Ann Arbor, MI 48109, USA.
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34
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Brain Injury Patterns in Neonates With Hypernatremic Dehydration: Single Center Experience. Indian Pediatr 2021. [DOI: 10.1007/s13312-021-2328-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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35
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Berhoumi AE, Laoudiyi D, Doumiri M, Lhajoui H, Labied M, Chbani K, Salam S, Ouzidane L. [Gayet-Wernicke encephalopathy with normal thiamine level: a case report]. Pan Afr Med J 2021; 38:16. [PMID: 34567343 PMCID: PMC8444120 DOI: 10.11604/pamj.2021.38.16.25888] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 12/22/2020] [Indexed: 01/19/2023] Open
Abstract
Gayet-Wernicke encephalopathy is a neuropsychiatric emergency due to thiamine deficiency (vitamin B1), secondary to several factors. We here report a case of Gayet-Wernicke encephalopathy in a 43-year-old woman who didn't consume alcoholic beverages, presenting with disorders of consciousness and diplopia with normal thiamine level. Classic triad of symptoms and Magnetic resonance imaging (MRI) played an important role, in particular, in the diagnosis of Gayet-Wernicke encephalopathy with normal thiamine levels in the absence of alcohol abuse.
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Affiliation(s)
- Assia El Berhoumi
- Service de Radiologie Pédiatrique, Hôpital d´Enfants Abderrahim Harouchi, Centre Hospitalier Universitaire Ibn Rochd, Casablanca, Maroc
| | - Dalale Laoudiyi
- Service de Radiologie Pédiatrique, Hôpital d´Enfants Abderrahim Harouchi, Centre Hospitalier Universitaire Ibn Rochd, Casablanca, Maroc
| | - Meriem Doumiri
- Service de Radiologie Pédiatrique, Hôpital d´Enfants Abderrahim Harouchi, Centre Hospitalier Universitaire Ibn Rochd, Casablanca, Maroc
| | - Hayat Lhajoui
- Service de Radiologie Pédiatrique, Hôpital d´Enfants Abderrahim Harouchi, Centre Hospitalier Universitaire Ibn Rochd, Casablanca, Maroc
| | - Mohamed Labied
- Service de Radiologie Pédiatrique, Hôpital d´Enfants Abderrahim Harouchi, Centre Hospitalier Universitaire Ibn Rochd, Casablanca, Maroc
| | - Kamilia Chbani
- Service de Radiologie Pédiatrique, Hôpital d´Enfants Abderrahim Harouchi, Centre Hospitalier Universitaire Ibn Rochd, Casablanca, Maroc
| | - Siham Salam
- Service de Radiologie Pédiatrique, Hôpital d´Enfants Abderrahim Harouchi, Centre Hospitalier Universitaire Ibn Rochd, Casablanca, Maroc
| | - Lahcen Ouzidane
- Service de Radiologie Pédiatrique, Hôpital d´Enfants Abderrahim Harouchi, Centre Hospitalier Universitaire Ibn Rochd, Casablanca, Maroc
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36
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Júnior SFA, Ventura N, Marchiori E. Osmotic demyelination syndrome diagnosed radiologically during Wilson's disease investigation. Eur J Neurol 2021; 28:726-728. [PMID: 33022802 DOI: 10.1111/ene.14573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 09/30/2020] [Indexed: 11/28/2022]
Abstract
Wilson's disease (WD), also known as hepatolenticular degeneration, is a rare autosomal recessive disorder that results from abnormal ceruloplasmin metabolism, with copper deposition affecting multiple systems. Osmotic demyelination syndrome (ODS) refers to acute demyelination seen in the setting of osmotic changes, typically with the rapid correction of electrolyte disturbance. We present a 29-year-old male patient diagnosed with WD 1 year after the onset of extrapyramidal symptoms. Magnetic resonance imaging performed during hospitalization showed two patterns of pons involvement, which allowed the diagnosis of ODS in addition to WD. Classic imaging findings were observed and illustrate perfectly these two conditions.
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Affiliation(s)
- S F A Júnior
- Radiology Department, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil
| | - N Ventura
- Radiology Department, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil
| | - E Marchiori
- Radiology Department, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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37
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Meyers SP. Intracranial Abnormalities with Diffusion Restriction. Magn Reson Imaging Clin N Am 2021; 29:137-161. [PMID: 33902900 DOI: 10.1016/j.mric.2021.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Multiple pathologic conditions can cause changes in the random movement of water, which can be detected with diffusion-weighted imaging (DWI). DWI plays a powerful clinical role in detecting restricted diffusion associated with acute brain infarction. Other disorders can also result in restricted diffusion. This article focuses on showing examples of common and uncommon disorders that have restricted diffusion secondary to cytotoxic and/or intramyelinic edema. These disorders include ischemia, infection, noninfectious demyelinating diseases, genetic mutations affecting metabolism, acquired metabolic disorders, toxic or drug exposures, neoplasms and tumorlike lesions, radiation treatment, trauma, and denervation.
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Affiliation(s)
- Steven P Meyers
- Department of Radiology/Imaging Sciences, University of Rochester Medical Center, University Medical Imaging, 4901 Lac de Ville Boulevard, Building D - Suite 140, Rochester, NY 14618, USA.
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38
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Pediatric inflammatory demyelinating disorders and mimickers: How to differentiate with MRI? Autoimmun Rev 2021; 20:102801. [PMID: 33727154 DOI: 10.1016/j.autrev.2021.102801] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 01/25/2021] [Indexed: 11/21/2022]
Abstract
Multiple sclerosis (MS) is a chronic, immune-mediated, neurodegenerative disorder of the central nervous system (CNS).While the clinical symptoms of MS most commonly manifest between 20 and 40 years of age, approximately 3 to 10% of all MS patients report that their first inaugural events can occur earlier in life, even in childhood, and thus include the pediatric population. The prevalence of MS onset in childhood/adolescence varies between 2.0% and 4.0% of all MS cases according to several extensive studies. The main imaging patterns of pediatric inflammatory demyelinating disorders and mimicking entities, including multiple sclerosis, neuromyelitis optica spectrum disorders, acute disseminated encephalomyelitis, MOG (myelin oligodendrocyte glycoprotein) antibody-related disorders and differential diagnoses will be addressed in this article, highlighting key points to the differential diagnosis.
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39
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Repple J, Haessner S, Johnen A, Landmeyer NC, Schulte-Mecklenbeck A, Pawlitzki M, Wiendl H, Meyer Zu Hörste G. Intravenous methadone causes acute toxic and delayed inflammatory encephalopathy with persistent neurocognitive impairments. BMC Neurol 2021; 21:85. [PMID: 33618681 PMCID: PMC7898738 DOI: 10.1186/s12883-021-02108-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 02/10/2021] [Indexed: 11/22/2022] Open
Abstract
Background The mu-opioid agonist methadone is administered orally and used in opioid detoxification and in the treatment of moderate-to-severe pain. Acute oral methadone–use and –abuse have been associated with inflammatory and toxic central nervous system (CNS) damage in some cases and cognitive deficits can develop in long-term methadone users. In contrast, reports of intravenous methadone adverse effects are rare. Case presentation Here, we report a patient who developed acute bilateral hearing loss, ataxia and paraparesis subsequently to intravenous methadone-abuse. While the patient gradually recovered from these deficits, widespread magnetic resonance imaging changes progressed and delayed-onset encephalopathy with signs of cortical dysfunction persisted. This was associated with changes in the composition of monocyte and natural killer cell subsets in the cerebrospinal fluid. Conclusion This case suggests a potential bi-phasic primary toxic and secondary inflammatory CNS damage induced by intravenous methadone. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-021-02108-9.
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Affiliation(s)
- Jonathan Repple
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, A1, 48149, Münster, Germany.,Department of Psychiatry, University of Münster, Münster, Germany
| | - Svea Haessner
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, A1, 48149, Münster, Germany.
| | - Andreas Johnen
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, A1, 48149, Münster, Germany
| | - Nils C Landmeyer
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, A1, 48149, Münster, Germany
| | - Andreas Schulte-Mecklenbeck
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, A1, 48149, Münster, Germany
| | - Marc Pawlitzki
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, A1, 48149, Münster, Germany
| | - Heinz Wiendl
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, A1, 48149, Münster, Germany
| | - Gerd Meyer Zu Hörste
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, A1, 48149, Münster, Germany
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40
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Gut Microbiota at the Intersection of Alcohol, Brain, and the Liver. J Clin Med 2021; 10:jcm10030541. [PMID: 33540624 PMCID: PMC7867253 DOI: 10.3390/jcm10030541] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/20/2021] [Accepted: 01/26/2021] [Indexed: 12/12/2022] Open
Abstract
Over the last decade, increased research into the cognizance of the gut-liver-brain axis in medicine has yielded powerful evidence suggesting a strong association between alcoholic liver diseases (ALD) and the brain, including hepatic encephalopathy or other similar brain disorders. In the gut-brain axis, chronic, alcohol-drinking-induced, low-grade systemic inflammation is suggested to be the main pathophysiology of cognitive dysfunctions in patients with ALD. However, the role of gut microbiota and its metabolites have remained unclear. Eubiosis of the gut microbiome is crucial as dysbiosis between autochthonous bacteria and pathobionts leads to intestinal insult, liver injury, and neuroinflammation. Restoring dysbiosis using modulating factors such as alcohol abstinence, promoting commensal bacterial abundance, maintaining short-chain fatty acids in the gut, or vagus nerve stimulation could be beneficial in alleviating disease progression. In this review, we summarize the pathogenic mechanisms linked with the gut-liver-brain axis in the development and progression of brain disorders associated with ALD in both experimental models and humans. Further, we discuss the therapeutic potential and future research directions as they relate to the gut-liver-brain axis.
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Luo C, Fu Y. A case of organotin toxic encephalopathy with atypical imaging characteristic. Neurol Sci 2021; 42:2579-2581. [PMID: 33471260 DOI: 10.1007/s10072-020-04977-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Cong Luo
- Clinical Medicine Eight-year Program, Xiangya Medical School, Central South University, Changsha, 410000, Hunan, China.,Department of Neurology, Xiangya Hospital, Central South University, Changsha, 410000, Hunan, China
| | - Yujiao Fu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, 410000, Hunan, China.
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Rapalino O, Pourvaziri A, Maher M, Jaramillo-Cardoso A, Edlow BL, Conklin J, Huang S, Westover B, Romero JM, Halpern E, Gupta R, Pomerantz S, Schaefer P, Gonzalez RG, Mukerji SS, Lev MH. Clinical, Imaging, and Lab Correlates of Severe COVID-19 Leukoencephalopathy. AJNR Am J Neuroradiol 2021; 42:632-638. [PMID: 33414226 DOI: 10.3174/ajnr.a6966] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 10/28/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND PURPOSE Patients infected with the Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) can develop a spectrum of neurological disorders, including a leukoencephalopathy of variable severity. Our aim was to characterize imaging, lab, and clinical correlates of severe coronavirus disease 2019 (COVID-19) leukoencephalopathy, which may provide insight into the SARS-CoV-2 pathophysiology. MATERIALS AND METHODS Twenty-seven consecutive patients positive for SARS-CoV-2 who had brain MR imaging following intensive care unit admission were included. Seven (7/27, 26%) developed an unusual pattern of "leukoencephalopathy with reduced diffusivity" on diffusion-weighted MR imaging. The remaining patients did not exhibit this pattern. Clinical and laboratory indices, as well as neuroimaging findings, were compared between groups. RESULTS The reduced-diffusivity group had a significantly higher body mass index (36 versus 28 kg/m2, P < .01). Patients with reduced diffusivity trended toward more frequent acute renal failure (7/7, 100% versus 9/20, 45%; P = .06) and lower estimated glomerular filtration rate values (49 versus 85 mL/min; P = .06) at the time of MRI. Patients with reduced diffusivity also showed lesser mean values of the lowest hemoglobin levels (8.1 versus 10.2 g/dL, P < .05) and higher serum sodium levels (147 versus 139 mmol/L, P = .04) within 24 hours before MR imaging. The reduced-diffusivity group showed a striking and highly reproducible distribution of confluent, predominantly symmetric, supratentorial, and middle cerebellar peduncular white matter lesions (P < .001). CONCLUSIONS Our findings highlight notable correlations between severe COVID-19 leukoencephalopathy with reduced diffusivity and obesity, acute renal failure, mild hypernatremia, anemia, and an unusual brain MR imaging white matter lesion distribution pattern. Together, these observations may shed light on possible SARS-CoV-2 pathophysiologic mechanisms associated with leukoencephalopathy, including borderzone ischemic changes, electrolyte transport disturbances, and silent hypoxia in the setting of the known cytokine storm syndrome that accompanies severe COVID-19.
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Affiliation(s)
- O Rapalino
- From the Department of Radiology (O.R., A.P., M.M., A.J.-C., J.C., S.H., J.M.R., R.G., S.P., P.S., R.G.G., M.H.L.)
| | - A Pourvaziri
- From the Department of Radiology (O.R., A.P., M.M., A.J.-C., J.C., S.H., J.M.R., R.G., S.P., P.S., R.G.G., M.H.L.)
| | - M Maher
- From the Department of Radiology (O.R., A.P., M.M., A.J.-C., J.C., S.H., J.M.R., R.G., S.P., P.S., R.G.G., M.H.L.)
| | - A Jaramillo-Cardoso
- From the Department of Radiology (O.R., A.P., M.M., A.J.-C., J.C., S.H., J.M.R., R.G., S.P., P.S., R.G.G., M.H.L.)
| | | | - J Conklin
- From the Department of Radiology (O.R., A.P., M.M., A.J.-C., J.C., S.H., J.M.R., R.G., S.P., P.S., R.G.G., M.H.L.)
| | - S Huang
- From the Department of Radiology (O.R., A.P., M.M., A.J.-C., J.C., S.H., J.M.R., R.G., S.P., P.S., R.G.G., M.H.L.)
| | | | - J M Romero
- From the Department of Radiology (O.R., A.P., M.M., A.J.-C., J.C., S.H., J.M.R., R.G., S.P., P.S., R.G.G., M.H.L.)
| | - E Halpern
- Institute for Technology Assessment (E.H.), Massachusetts General Hospital, Boston, Massachusetts
| | - R Gupta
- From the Department of Radiology (O.R., A.P., M.M., A.J.-C., J.C., S.H., J.M.R., R.G., S.P., P.S., R.G.G., M.H.L.)
| | - S Pomerantz
- From the Department of Radiology (O.R., A.P., M.M., A.J.-C., J.C., S.H., J.M.R., R.G., S.P., P.S., R.G.G., M.H.L.)
| | - P Schaefer
- From the Department of Radiology (O.R., A.P., M.M., A.J.-C., J.C., S.H., J.M.R., R.G., S.P., P.S., R.G.G., M.H.L.)
| | - R G Gonzalez
- From the Department of Radiology (O.R., A.P., M.M., A.J.-C., J.C., S.H., J.M.R., R.G., S.P., P.S., R.G.G., M.H.L.)
| | | | - M H Lev
- From the Department of Radiology (O.R., A.P., M.M., A.J.-C., J.C., S.H., J.M.R., R.G., S.P., P.S., R.G.G., M.H.L.)
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Khan IR, Pai V, Mundada P, Sitoh YY, Purohit B. Detecting the Uncommon Imaging Manifestations of Posterior Reversible Encephalopathy Syndrome (PRES) in Adults: a Comprehensive Illustrated Guide for the Trainee Radiologist. Curr Probl Diagn Radiol 2020; 51:98-111. [PMID: 33257096 DOI: 10.1067/j.cpradiol.2020.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/28/2020] [Accepted: 11/09/2020] [Indexed: 12/11/2022]
Abstract
Posterior reversible encephalopathy syndrome (PRES) has traditionally been described as a reversible leukoencephalopathy with a distinct pattern of posteriorly distributed vasogenic oedema involving the subcortical regions of parietal and occipital lobes. PRES commonly occurs in the setting of hypertensive emergencies, pre-eclampsia/eclampsia, impaired renal function, and immunosuppressive therapy. The various clinical presentations of PRES include encephalopathy, seizures, headache, visual, and focal neurological deficits. As knowledge of this entity grows, the range of clinical, and radiological features is seen to be much broader than originally described. The brain oedema may not always be posteriorly distributed and the syndrome may not be uniformly reversible. Of special note are some uncommon imaging features (unilateral cerebral involvement, and isolated posterior fossa involvement) and also some uncommon complications (haemorrhage, cytotoxic oedema, and vasoconstriction). These red herrings may lead to potential diagnostic challenges and pitfalls especially for trainee radiologists, who often read these scans in an emergency setting. Early and accurate diagnosis is crucial for prompt optimum management, thereby avoiding residual morbidity. This review article focusses on the atypical radiological features of PRES in adults with extensive case-based imaging examples. A brief description of the pathophysiology, clinical, and classic radiological features of PRES has also been included. A tabulated summary of potential mimics with diagnostic pearls is provided to highlight pertinent take home points and to serve as an easy guide for day-to-day clinical practice.
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Affiliation(s)
- Iram R Khan
- Department of Neuroradiology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore
| | - Vivek Pai
- Department of Neuroradiology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore
| | - Pravin Mundada
- Department of Diagnostic and Interventional Radiology, Raffles Hospital, 585 North Bridge Rd, Singapore
| | - Yih Yian Sitoh
- Department of Neuroradiology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore
| | - Bela Purohit
- Department of Neuroradiology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore.
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Pernicone E, Watal P, Dhar D, Hayes LL, Chandra T. Neuroimaging of Propofol Infusion Syndrome: A Case Report and Review of Literature. Cureus 2020; 12:e10583. [PMID: 33110719 PMCID: PMC7580968 DOI: 10.7759/cureus.10583] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 09/22/2020] [Indexed: 12/11/2022] Open
Abstract
A school-age boy with a complex medical history underwent a minor elective surgical procedure. Propofol was used for sedation during the procedure. The patient could not be awakened post-operatively. Laboratory findings demonstrated metabolic lactic acidosis, leukocytosis with bandemia, and transaminitis. Neuroimaging demonstrated findings that were consistent with hypoxic-ischemic or toxic-metabolic brain injury involving the bilateral basal ganglia, hippocampi, and cerebellum. The patient's condition progressively worsened over the course of the following few weeks, and brain death was confirmed by scintigraphy seven weeks later. Prompt neuroimaging in unresponsive patients with suspected propofol infusion syndrome (PRIS) is of critical importance in detecting neurologic injuries, excluding alternative diagnoses, and determining prognostication.
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Affiliation(s)
| | - Pankaj Watal
- Pediatric Radiology, Nemours Children's Hospital, Orlando, USA
| | - Deeksha Dhar
- Medicine, Government Medical College and Affiliated Hospitals, Jammu, IND
| | - Laura L Hayes
- Pediatric Radiology, Nemours Children's Clinic, Pensacola, USA
| | - Tushar Chandra
- Pediatric Radiology, Nemours Children's Hospital, Orlando, USA
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Agarwal N, Martini R, Pedrotti G, Della Sala SW. Unusual lesion in the splenium of the corpus callosum and coronavirus infectious disease-19. BJR Case Rep 2020; 6:20200068. [PMID: 32922853 PMCID: PMC7465731 DOI: 10.1259/bjrcr.20200068] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/04/2020] [Accepted: 06/30/2020] [Indexed: 12/13/2022] Open
Abstract
Coronavirus infectious diseases (COVID-19) is an emerging infectious disease that has taken a strong grip on the entire global community. The diagnosis per se is straightforward; however, the disease seems to affect multiple organs. Cytokine-storm, increased thromboembolic state, deranged overall homeostasis and aggressive medical treatment can cause a variety of lesions in the central nervous system. Interpretation of brain imaging findings will require a thorough understanding of the clinical status of the patient and treatment being offered, keeping in mind the several ways in which the viral pathogen, severe acute respiratory syndrome coronavirus-2 may interact with brain tissue. We present differential diagnosis of a MRI identified solitary lesion in the splenium of the corpus callosum, in a COVID-19 positive patient with altered mental status.
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Affiliation(s)
| | - Rosella Martini
- Section of Anesthesia, Santa Maria del Carmine Hospital, Rovereto (TN), Italy
| | - Giovanni Pedrotti
- Section of Anesthesia, Santa Maria del Carmine Hospital, Rovereto (TN), Italy
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Mojica CV, Pasol EA, Dizon ML, Kiat WA, Lim TRU, Dominguez JC, Valencia VV, Tuaño BJP. Chronic methanol toxicity through topical and inhalational routes presenting as vision loss and restricted diffusion of the optic nerves on MRI: A case report and literature review. eNeurologicalSci 2020; 20:100258. [PMID: 32775706 PMCID: PMC7394764 DOI: 10.1016/j.ensci.2020.100258] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 07/17/2020] [Indexed: 02/07/2023] Open
Abstract
Methanol intoxication can cause irreversible neurologic sequelae if unrecognized and untreated. Ingestion is the most common form of toxicity; however, dermal and inhalational exposures likewise occur but are documented rarely. While acute intoxication is commonly encountered, chronic exposure to methanol should also be highlighted. We report a case of a 57-year old female presenting in the emergency room with progressive dyspnea, metabolic acidosis with high anion gap, and metabolic encephalopathy. After emergency hemodialysis, the patient complained of vision loss on both eyes. Initial non-contrast cranial magnetic resonance imaging (MRI) revealed restricted diffusion of the intraorbital segment of both optic nerves. A thorough history revealed that she was applying a clear colorless liquid bought online all over her body for alleged pruritus for more than a year. The syndrome of metabolic acidosis with high anion gap, metabolic encephalopathy, vision loss, and laboratory findings led us to suspect a diagnosis of chronic methanol poisoning with an acute component. The liquid in question was sent for chemical analysis and result showed that it consisted of 95.5% Methanol. This case highlights the need for high index of clinical suspicion for methanol toxicity in the absence of oral consumption, the complications of chronic form of methanol intoxication, and the uncommon radiologic finding seen in diffusion-weighted imaging (DWI).
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Affiliation(s)
- Christianne V. Mojica
- St. Luke's Medical Center, Institute for Neurosciences, 279 E Rodriguez Sr. Avenue, Quezon City, Philippines
| | - Esteban A. Pasol
- St. Luke's Medical Center, Institute for Neurosciences, 279 E Rodriguez Sr. Avenue, Quezon City, Philippines
| | - Mercedes L. Dizon
- St. Luke's Medical Center, Institute of Radiology, 279 E Rodriguez Sr. Avenue, Quezon City, Philippines
| | - Wenceslao A. Kiat
- St. Luke's Medical Center, Department of Internal Medicine, Clinical Toxicology, 279 E Rodriguez Sr. Avenue, Quezon City, Philippines
| | - Timothy Reynold U. Lim
- St. Luke's Medical Center, Institute of Radiology, 279 E Rodriguez Sr. Avenue, Quezon City, Philippines
| | - Jacqueline C. Dominguez
- St. Luke's Medical Center, Institute for Neurosciences, 279 E Rodriguez Sr. Avenue, Quezon City, Philippines
| | - Vincent V. Valencia
- St. Luke's Medical Center, Heart Institute, 279 E Rodriguez Sr. Avenue, Quezon City, Philippines
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Koksel Y, McKinney A. Potentially Reversible and Recognizable Acute Encephalopathic Syndromes: Disease Categorization and MRI Appearances. AJNR Am J Neuroradiol 2020; 41:1328-1338. [PMID: 32616580 PMCID: PMC7658879 DOI: 10.3174/ajnr.a6634] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 04/26/2020] [Indexed: 01/21/2023]
Abstract
"Encephalopathy" is a vague term that encompasses varying definitions, often with a nonspecific clinical presentation and numerous possible pathophysiologic causes. Hence, MR imaging plays a crucial role in the early diagnosis and treatment by identifying imaging patterns when there is limited clinical history in such patients with acute encephalopathy. The aim of this review was to aid in remembrance of etiologies of potentially reversible acute encephalopathic syndromes on MR imaging. The differential includes vascular (reversible cerebral vasoconstriction syndrome, transient global amnesia, disseminated intravascular coagulation, and thrombotic microangiopathy), infection (meningitis, encephalitis), toxic (posterior reversible encephalopathy syndrome, acute toxic leukoencephalopathy; carbon monoxide, alcohol-related, medication- and illicit drug-related toxic encephalopathies), autoimmune, metabolic (osmotic demyelination syndrome, uremic, acute hepatic encephalopathy), idiopathic/inflammatory (stroke-like migraine attacks after radiation therapy syndrome), neoplasm-related encephalopathy, and seizure-related encephalopathy.
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Affiliation(s)
- Y. Koksel
- From the Department of Radiology (Y.K.), Division of Neuroradiology, University of Minnesota Medical Center, Minneapolis, Minnesota
| | - A.M. McKinney
- Department of Radiology (A.M.M.), University of Miami School of Medicine, Miami, Florida
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