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Alves CAPF, Sidpra J, Manteghinejad A, Sudhakar S, Massey FV, Aldinger KA, Haldipur P, Lucato LT, Ferraciolli SF, Teixeira SR, Öztekin Ö, Bhattacharya D, Taranath A, Prabhu SP, Mirsky DM, Andronikou S, Millen KJ, Barkovich AJ, Boltshauser E, Dobyns WB, Barkovich MJ, Whitehead MT, Mankad K. Dandy-Walker Phenotype with Brainstem Involvement: 2 Distinct Subgroups with Different Prognosis. AJNR Am J Neuroradiol 2023; 44:1201-1207. [PMID: 37591769 PMCID: PMC10549954 DOI: 10.3174/ajnr.a7967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/18/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND AND PURPOSE Although cardinal imaging features for the diagnostic criteria of the Dandy-Walker phenotype have been recently defined, there is a large range of unreported malformations among these patients. The brainstem, in particular, deserves careful attention because malformations in this region have potentially important implications for clinical outcomes. In this article, we offer detailed information on the association of brainstem dysgenesis in a large, multicentric cohort of patients with the Dandy-Walker phenotype, defining different subtypes of involvement and their potential clinical impact. MATERIALS AND METHODS In this established multicenter cohort of 329 patients with the Dandy-Walker phenotype, we include and retrospectively review the MR imaging studies and clinical records of 73 subjects with additional brainstem malformations. Detailed evaluation of the different patterns of brainstem involvement and their potential clinical implications, along with comparisons between posterior fossa measurements for the diagnosis of the Dandy-Walker phenotype, was performed among the different subgroups of patients with brainstem involvement. RESULTS There were 2 major forms of brainstem involvement in patients with Dandy-Walker phenotype including the following: 1) the mild form with anteroposterior disproportions of the brainstem structures "only" (57/73; 78%), most frequently with pontine hypoplasia (44/57; 77%), and 2) the severe form with patients with tegmental dysplasia with folding, bumps, and/or clefts (16/73; 22%). Patients with severe forms of brainstem malformation had significantly increased rates of massive ventriculomegaly, additional malformations involving the corpus callosum and gray matter, and interhemispheric cysts. Clinically, patients with the severe form had significantly increased rates of bulbar dysfunction, seizures, and mortality. CONCLUSIONS Additional brainstem malformations in patients with the Dandy-Walker phenotype can be divided into 2 major subgroups: mild and severe. The severe form, though less prevalent, has characteristic imaging features, including tegmental folding, bumps, and clefts, and is directly associated with a more severe clinical presentation and increased mortality.
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Affiliation(s)
- C A P F Alves
- From the Division of Neuroradiology (C.A.P.F.A., A.M., S.R.T., S.A., M.T.W.), Department of Radiology, Children's Hospital of Philadelphia, Philadephia, Pennsylvania
| | - J Sidpra
- Unit of Neuroradiology (J.S., S.S., K.M.), Great Ormond Street Hospital for Children, National Health Service Foundation Trust, London, United Kingdom
- Developmental Biology & Cancer Section (J.S., K.M.), University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - A Manteghinejad
- From the Division of Neuroradiology (C.A.P.F.A., A.M., S.R.T., S.A., M.T.W.), Department of Radiology, Children's Hospital of Philadelphia, Philadephia, Pennsylvania
| | - S Sudhakar
- Unit of Neuroradiology (J.S., S.S., K.M.), Great Ormond Street Hospital for Children, National Health Service Foundation Trust, London, United Kingdom
| | - F V Massey
- Unit of Functional Neurosurgery (F.V.M.), National Hospital for Neurology & Neurosurgery, London, United Kingdom
| | - K A Aldinger
- Center for Integrative Brain Research (K.A.A., P.H., K.J.M.), Seattle Children's Research Institute, Seattle, Washington
- Departments of Pediatrics and Neurology (K.A.A., P.H., K.J.M.), University of Washington, Seattle, Washington
| | - P Haldipur
- Center for Integrative Brain Research (K.A.A., P.H., K.J.M.), Seattle Children's Research Institute, Seattle, Washington
- Departments of Pediatrics and Neurology (K.A.A., P.H., K.J.M.), University of Washington, Seattle, Washington
| | - L T Lucato
- Department of Radiology, Division of Neuroradiology (L.T.L., S.F.F.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - S F Ferraciolli
- Department of Radiology, Division of Neuroradiology (L.T.L., S.F.F.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - S R Teixeira
- From the Division of Neuroradiology (C.A.P.F.A., A.M., S.R.T., S.A., M.T.W.), Department of Radiology, Children's Hospital of Philadelphia, Philadephia, Pennsylvania
| | - Ö Öztekin
- Department of Neuroradiology (Ö.Ö.), Bakırçay University, Çiğli Education and Research Hospital, İzmir, Turkey
| | - D Bhattacharya
- Department of Neuroradiology (D.B.), Royal Victoria Hospital, Belfast, UK
| | - A Taranath
- Department of Medical Imaging (A.T.), Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - S P Prabhu
- Department of Radiology, Neuroradiology Division (S.P.P.), Boston Children's Hospital, Boston, Massachusetts
| | - D M Mirsky
- Department of Radiology, Neuroradiology Division (D.M.M.), Children's Hospital Colorado, Aurora, Colorado
| | - S Andronikou
- From the Division of Neuroradiology (C.A.P.F.A., A.M., S.R.T., S.A., M.T.W.), Department of Radiology, Children's Hospital of Philadelphia, Philadephia, Pennsylvania
| | - K J Millen
- Center for Integrative Brain Research (K.A.A., P.H., K.J.M.), Seattle Children's Research Institute, Seattle, Washington
- Departments of Pediatrics and Neurology (K.A.A., P.H., K.J.M.), University of Washington, Seattle, Washington
| | - A J Barkovich
- Department of Neuroradiology (A.J.B., M.J.B.), University of California, San Francisco, San Francisco, California
| | - E Boltshauser
- Department of Pediatric Neurology (E.B.), University Children's Hospital, Zürich, Switzerland
| | - W B Dobyns
- Department of Genetics and Metabolism (W.B.D.), University of Minnesota, Minneaplis, Minnesota
| | - M J Barkovich
- Department of Neuroradiology (A.J.B., M.J.B.), University of California, San Francisco, San Francisco, California
| | - M T Whitehead
- From the Division of Neuroradiology (C.A.P.F.A., A.M., S.R.T., S.A., M.T.W.), Department of Radiology, Children's Hospital of Philadelphia, Philadephia, Pennsylvania
| | - K Mankad
- Unit of Neuroradiology (J.S., S.S., K.M.), Great Ormond Street Hospital for Children, National Health Service Foundation Trust, London, United Kingdom
- Developmental Biology & Cancer Section (J.S., K.M.), University College London Great Ormond Street Institute of Child Health, London, United Kingdom
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Whitehead MT, Barkovich MJ, Sidpra J, Alves CA, Mirsky DM, Öztekin Ö, Bhattacharya D, Lucato LT, Sudhakar S, Taranath A, Andronikou S, Prabhu SP, Aldinger KA, Haldipur P, Millen KJ, Barkovich AJ, Boltshauser E, Dobyns WB, Mankad K. Refining the Neuroimaging Definition of the Dandy-Walker Phenotype. AJNR Am J Neuroradiol 2022; 43:1488-1493. [PMID: 36137655 PMCID: PMC9575531 DOI: 10.3174/ajnr.a7659] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/28/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE The traditionally described Dandy-Walker malformation comprises a range of cerebellar and posterior fossa abnormalities with variable clinical severity. We aimed to establish updated imaging criteria for Dandy-Walker malformation on the basis of cerebellar development. MATERIALS AND METHODS In this multicenter study, retrospective MR imaging examinations from fetuses and children previously diagnosed with Dandy-Walker malformation or vermian hypoplasia were re-evaluated, using the choroid plexus/tela choroidea location and the fastigial recess shape to differentiate Dandy-Walker malformation from vermian hypoplasia. Multiple additional measures of the posterior fossa and cerebellum were also obtained and compared between Dandy-Walker malformation and other diagnoses. RESULTS Four hundred forty-six examinations were analyzed (174 fetal and 272 postnatal). The most common diagnoses were Dandy-Walker malformation (78%), vermian hypoplasia (14%), vermian hypoplasia with Blake pouch cyst (9%), and Blake pouch cyst (4%). Most measures were significant differentiators of Dandy-Walker malformation from non-Dandy-Walker malformation both pre- and postnatally (P < .01); the tegmentovermian and fastigial recess angles were the most significant quantitative measures. Posterior fossa perimeter and vascular injury evidence were not significant differentiators pre- or postnatally (P > .3). The superior posterior fossa angle, torcular location, and vermian height differentiated groups postnatally (P < .01), but not prenatally (P > .07). CONCLUSIONS As confirmed by objective measures, the modern Dandy-Walker malformation phenotype is best defined by inferior predominant vermian hypoplasia, an enlarged tegmentovermian angle, inferolateral displacement of the tela choroidea/choroid plexus, an obtuse fastigial recess, and an unpaired caudal lobule. Posterior fossa size and torcular location should be eliminated from the diagnostic criteria. This refined phenotype may help guide future study of the numerous etiologies and varied clinical outcomes.
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Affiliation(s)
- M T Whitehead
- From the Department of Radiology (M.T.W.)
- Prenatal Pediatrics Institute (M.T.W.), Children's National Hospital, Washington DC
- The George Washington University School of Medicine and Health Sciences (M.T.W.), Washington DC
- Division of Neuroradiology (M.T.W., C.A.A., S.A.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Radiology, Perelman School of Medicine (M.T.W., S.A), University of Pennsylvania, Philadelphia, Pennsylvania
| | - M J Barkovich
- Department of Radiology and Biomedical Imaging (M.J.B., A.J.B.) University of California, San Francisco, San Francisco, California
- Neuroradiology Section (M.J.B., A.J.B.), University of California, San Francisco-Benioff Children's Hospital, San Francisco, California
| | - J Sidpra
- Developmental Biology and Cancer Section (J.S., K.M.), University College London Great Ormond Street Institute of Child Health, London, UK
- Department of Neuroradiology (J.S., S.S., K.M.), Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, UK
| | - C A Alves
- Division of Neuroradiology (M.T.W., C.A.A., S.A.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - D M Mirsky
- Department of Radiology (D.M.M.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Ö Öztekin
- Department of Neuroradiology (Ö.Ö.), Bakırçay University, Çiğli Education and Research Hospital, İzmir, Turkey
| | - D Bhattacharya
- Department of Neuroradiology (D.B.), Royal Victoria Hospital, Belfast, UK
| | - L T Lucato
- Division of Diagnostic Neuroradiology (L.T.L.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - S Sudhakar
- Department of Neuroradiology (J.S., S.S., K.M.), Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, UK
| | - A Taranath
- Department of Medical Imaging (A.T.), Women's and Children's Hospital, North Adelaide, South Australia, Australia
- Faculty of Medicine (A.T.), University of Adelaide, Adelaide, South Australia, Australia
| | - S Andronikou
- Division of Neuroradiology (M.T.W., C.A.A., S.A.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Radiology, Perelman School of Medicine (M.T.W., S.A), University of Pennsylvania, Philadelphia, Pennsylvania
| | - S P Prabhu
- Department of Neuroradiology (S.P.P.), Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - K A Aldinger
- Center for Integrative Brain Research (K.A.A., P.H., K.J.M.), Seattle Children's Research Institute, Seattle, Washington
| | - P Haldipur
- Center for Integrative Brain Research (K.A.A., P.H., K.J.M.), Seattle Children's Research Institute, Seattle, Washington
| | - K J Millen
- Center for Integrative Brain Research (K.A.A., P.H., K.J.M.), Seattle Children's Research Institute, Seattle, Washington
- University of Washington School of Medicine (K.J.M.), Seattle, Washington
| | - A J Barkovich
- Department of Radiology and Biomedical Imaging (M.J.B., A.J.B.) University of California, San Francisco, San Francisco, California
- Neuroradiology Section (M.J.B., A.J.B.), University of California, San Francisco-Benioff Children's Hospital, San Francisco, California
| | - E Boltshauser
- Department of Pediatric Neurology (E.B.), University Children's Hospital, Zürich, Switzerland
| | - W B Dobyns
- Department of Genetics and Metabolism (W.B.D.), Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - K Mankad
- Developmental Biology and Cancer Section (J.S., K.M.), University College London Great Ormond Street Institute of Child Health, London, UK
- Department of Neuroradiology (J.S., S.S., K.M.), Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, UK
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Figueiredo T, Melo US, Pessoa ALS, Nobrega PR, Kitajima JP, Rusch H, Vaz F, Lucato LT, Zatz M, Kok F, Santos S. A homozygous loss-of-function mutation in inositol monophosphatase 1 (IMPA1) causes severe intellectual disability. Mol Psychiatry 2016; 21:1125-9. [PMID: 26416544 DOI: 10.1038/mp.2015.150] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 08/17/2015] [Accepted: 08/19/2015] [Indexed: 11/09/2022]
Abstract
The genetic basis of intellectual disability (ID) is extremely heterogeneous and relatively little is known about the role of autosomal recessive traits. In a field study performed in a highly inbred area of Northeastern Brazil, we identified and investigated a large consanguineous family with nine adult members affected by severe ID associated with disruptive behavior. The Genome-Wide Human SNP Array 6.0 microarray was used to determine regions of homozygosity by descent from three affected and one normal family member. Whole-exome sequencing (WES) was performed in one affected patient using the Nextera Rapid-Capture Exome kit and Illumina HiSeq2500 system to identify the causative mutation. Potentially deleterious variants detected in regions of homozygosity by descent and not present in either 59 723 unrelated individuals from the Exome Aggregation Consortium (Browser) or 1484 Brazilians were subject to further scrutiny and segregation analysis by Sanger sequencing. Homozygosity-by-descent analysis disclosed a 20.7-Mb candidate region at 8q12.3-q21.2 (lod score: 3.11). WES identified a homozygous deleterious variant in inositol monophosphatase 1 (IMPA1) (NM_005536), consisting of a 5-bp duplication (c.489_493dupGGGCT; chr8: 82,583,247; GRCh37/hg19) leading to a frameshift and a premature stop codon (p.Ser165Trpfs*10) that cosegregated with the disease in 26 genotyped family members. The IMPA1 gene product is responsible for the final step of biotransformation of inositol triphosphate and diacylglycerol, two second messengers. Despite its many physiological functions, no clinical phenotype has been assigned to this gene dysfunction to date. Additionally, IMPA1 is the main target of lithium, a drug that is at the forefront of treatment for bipolar disorder.
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Affiliation(s)
- T Figueiredo
- Northeast Biotechnology Network (RENORBIO), Federal University of Paraiba (UFPB), Joao Pessoa, Brazil.,Department of Biology, Paraiba State University (UEPB), Campina Grande, Brazil.,Department of Genetics and Evolutionary Biology, Human Genome and Stem Cell Research Center, Biosciences Institute, University of Sao Paulo (USP), Sao Paulo, Brazil
| | - U S Melo
- Department of Genetics and Evolutionary Biology, Human Genome and Stem Cell Research Center, Biosciences Institute, University of Sao Paulo (USP), Sao Paulo, Brazil
| | - A L S Pessoa
- Department of Neurology, School of Medicine, University of Sao Paulo (USP), Sao Paulo, Brazil.,School of Medicine, Fortaleza University (UNIFOR), Fortaleza, Brazil
| | - P R Nobrega
- Department of Neurology, School of Medicine, University of Sao Paulo (USP), Sao Paulo, Brazil
| | | | - H Rusch
- Laboratory of Genetic Metabolic Diseases, Department of Clinical Chemistry, University of Amsterdam, Academic Medical Center (AMC), Amsterdam, The Netherlands
| | - F Vaz
- Laboratory of Genetic Metabolic Diseases, Department of Clinical Chemistry, University of Amsterdam, Academic Medical Center (AMC), Amsterdam, The Netherlands
| | - L T Lucato
- Institute of Radiology, School of Medicine, University of Sao Paulo (USP), Sao Paulo, Brazil
| | - M Zatz
- Department of Genetics and Evolutionary Biology, Human Genome and Stem Cell Research Center, Biosciences Institute, University of Sao Paulo (USP), Sao Paulo, Brazil
| | - F Kok
- Department of Genetics and Evolutionary Biology, Human Genome and Stem Cell Research Center, Biosciences Institute, University of Sao Paulo (USP), Sao Paulo, Brazil.,Department of Neurology, School of Medicine, University of Sao Paulo (USP), Sao Paulo, Brazil.,Mendelics Genomic Analysis, Sao Paulo, Brazil
| | - S Santos
- Northeast Biotechnology Network (RENORBIO), Federal University of Paraiba (UFPB), Joao Pessoa, Brazil.,Department of Biology, Paraiba State University (UEPB), Campina Grande, Brazil
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Santos GT, Leite CC, Machado LR, McKinney AM, Lucato LT. Reduced diffusion in neurocysticercosis: circumstances of appearance and possible natural history implications. AJNR Am J Neuroradiol 2012; 34:310-6. [PMID: 22821919 DOI: 10.3174/ajnr.a3198] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Few studies discuss DWI findings in patients with NCC, and their conclusions are variable and contradictory. The aim of our study was to describe DWI findings of a cohort of patients with NCC, emphasizing the frequency of reduced diffusion. MATERIALS AND METHODS This retrospective study included 48 patients with NCC. Two neuroradiologists analyzed MR images regarding location, number, and stage of NCC lesions. On the basis of visual analysis, they defined, by consensus, the presence of high signal within NCC lesions on DWI and measured their ADC values when feasible. RESULTS The total number of lesions was 342: parenchymal (263), subarachnoid (65), and intraventricular (14); 83 were DWI hyperintense. The first pattern was a small eccentric hyperintense dot/curvilinear structure on DWI (representing the scolex) noted in intraparenchymal lesions in vesicular (41 lesions, 29%) and colloidal vesicular (18 lesions, 19%) stages, in 14 (22%) subarachnoid lesions, and 2 (14%) intraventricular lesions; rADC calculations were hampered by the intrinsic small dimensions of this finding. The second pattern was the presence of total/subtotal DWI hyperintensity in intraparenchymal lesions, 5 in the colloidal vesicular stage (5%) and 1 in the granular nodular phase (3%). Two subarachnoid lesions also showed the same presentation; in this second pattern, reduced diffusion was present in different degrees, measured by rADC calculations. CONCLUSIONS DWI may identify the scolex, increasing diagnostic confidence for NCC. Total/subtotal DWI hyperintensity, related to the stage of the lesion, though uncommon, allows including NCC as a consideration in the differential diagnosis of lesions with reduced diffusion and ring enhancement.
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Affiliation(s)
- G T Santos
- Departments of Radiology, Clinics Hospital of the University of Sao Paulo, School of Medicine, Sao Paulo, Brazil
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Rodrigues CL, de Andrade DC, Livramento JA, Machado LR, Abraham R, Massaroppe L, Lucato LT, Caramelli P. Spectrum of cognitive impairment in neurocysticercosis: differences according to disease phase. Neurology 2012; 78:861-6. [PMID: 22402863 DOI: 10.1212/wnl.0b013e31824c46d1] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Cognitive decline related to neurocysticercosis (NC) remains poorly characterized and underdiagnosed. In a cross-sectional study with a prospective phase, we evaluated cognitive decline in patients with strictly calcified form (C-NC), the epidemiologically largest subgroup of NC, and investigated whether there is a spectrum of cognitive abnormalities in the disease. METHODS Forty treatment-naive patients with C-NC aged 37.6 ± 11.3 years and fulfilling criteria for definitive C-NC were submitted to a comprehensive cognitive and functional evaluation and were compared with 40 patients with active NC (A-NC) and 40 healthy controls (HC) matched for age and education. Patients with dementia were reassessed after 24 months. RESULTS Patients with C-NC presented 9.4 ± 3.1 altered test scores out of the 30 from the cognitive battery when compared to HC. No patient with C-NC had dementia and 10 patients (25%) presented cognitive impairment-no dementia (CIND). The A-NC group had 5 patients (12.5%) with dementia and 11 patients (27.5%) with CIND. On follow-up, 3 out of 5 patients with A-NC with dementia previously still presented cystic lesions with scolex on MRI and still had dementia. One patient died and the remaining patient no longer fulfilled criteria for either dementia or CIND, presenting exclusively calcified lesions on neuroimaging. CONCLUSIONS Independently of its phase, NC leads to a spectrum of cognitive abnormalities, ranging from impairment in a single domain, to CIND and, occasionally, to dementia. These findings are more conspicuous during active vesicular phase and less prominent in calcified stages.
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Affiliation(s)
- C L Rodrigues
- Departamento de Neurologia, Universidade de São Paulo, Brazil
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da Silva-Júnior FP, Machado AAC, Lucato LT, Cançado ELR, Barbosa ER. Copper deficiency myeloneuropathy in a patient with Wilson disease. Neurology 2011; 76:1673-4. [PMID: 21555737 DOI: 10.1212/wnl.0b013e318219fac8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Gonzalez-Toledo E, Santos Andrade C, Da Costa Leite C, Del Carpio-O'Donovan R, Fayed N, Morales H, Peterson R, Palacios E, Previgliano CH, Rocha AJ, Romero JM, Rugilo C, Staut CCV, Tamer I, Tavares Lucato L, Nader M. An Atlas of Infectious and Parasitic Diseases of the Central Nervous System. A Cooperative Study of SILAN (Sociedad Iberolatinoamericana de Neurorradiologia). Neuroradiol J 2010; 23:554-73. [PMID: 24148677 DOI: 10.1177/197140091002300505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Accepted: 09/04/2010] [Indexed: 11/17/2022] Open
Abstract
Infectious diseases of the central nervous system vary in frequency in different locations in America and Europe. What is common in Brazil can be a sporadic presentation in Europe. Cooperative work gathering experiences from neuroradiologists working in various places can be achieved and will help to identify uncommon cases that can present in our daily practice.
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Affiliation(s)
- E Gonzalez-Toledo
- Department of Radiology, Louisiana State University Health Sciences Center; Shreveport; USA -
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Embiruçu EK, Otaduy MCG, Taneja AK, Leite CC, Kok F, Lucato LT. MR spectroscopy detects lipid peaks in cerebrotendinous xanthomatosis. AJNR Am J Neuroradiol 2010; 31:1347-9. [PMID: 20150306 DOI: 10.3174/ajnr.a1885] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
CTX is a rare lipid-storage disease. Novel MRS findings from 3 patients, using a short TE, were the presence of lipid peaks at 0.9 and 1.3 ppm in the depth of the cerebellar hemisphere; this might represent an additional marker of disease that is CNS-specific and noninvasive. A decrease in NAA concentration was also detected and attributed to neuroaxonal damage. One patient presented an increase in mIns concentration, pointing to gliosis and astrocytic proliferation.
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Affiliation(s)
- E K Embiruçu
- Department of Neurology, Clinics Hospital of the University of Sao Paulo, School of Medicine, Sao Paulo, Brazil
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Lucato LT, Passos RBD, Campos CR, Conforto AB, McKinney AM. Multidetector-row computed tomography in the diagnosis of Collet-Sicard syndrome. BMJ Case Rep 2009; 2009:bcr2007120972. [PMID: 21687282 DOI: 10.1136/bcr.2007.120972] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- L T Lucato
- Department of Radiology, The Clinics Hospital of the University of Sao Paulo, School of Medicine, Sao Paulo, Brazil
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Andrade CS, Lucato LT, da Costa Leite C. Neurological picture. Massive fatal cerebral air embolism as a negative contrast angiogram. J Neurol Neurosurg Psychiatry 2008; 79:1357-8. [PMID: 19010946 DOI: 10.1136/jnnp.2008.145938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Lucato LT, Passos RBD, Campos CR, Conforto AB, McKinney AM. Neurological picture. Multidetector-row computed tomography in the diagnosis of Collet-Sicard syndrome. J Neurol Neurosurg Psychiatry 2008; 79:521. [PMID: 18408088 DOI: 10.1136/jnnp.2007.120972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- L T Lucato
- Department of Radiology, The Clinics Hospital of the University of Sao Paulo, School of Medicine, Sao Paulo, Brazil.
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Nagae LM, Hoon AH, Stashinko E, Lin D, Zhang W, Levey E, Wakana S, Jiang H, Leite CC, Lucato LT, van Zijl PCM, Johnston MV, Mori S. Diffusion tensor imaging in children with periventricular leukomalacia: variability of injuries to white matter tracts. AJNR Am J Neuroradiol 2007; 28:1213-22. [PMID: 17698519 PMCID: PMC7977654 DOI: 10.3174/ajnr.a0534] [Citation(s) in RCA: 122] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Conventional MR imaging shows evidence of brain injury and/or maldevelopment in 70%-90% of children with cerebral palsy (CP), though its capability to identify specific white matter tract injury is limited. The great variability of white matter lesions in CP already demonstrated by postmortem studies is thought to be one of the reasons why response to treatment is so variable. Our hypothesis is that diffusion tensor imaging (DTI) is a suitable technique to provide in vivo characterization of specific white matter tract lesions in children with CP associated with periventricular leukomalacia (PVL). MATERIALS AND METHODS In this study, 24 children with CP associated with PVL and 35 healthy controls were evaluated with DTI. Criteria for identification of 26 white matter tracts on the basis of 2D DTI color-coded maps were established, and a qualitative scoring system, based on visual inspection of the tracts in comparison with age-matched controls, was used to grade the severity of abnormalities. An ordinal grading system (0=normal, 1=abnormal, 2=severely abnormal or absent) was used to score each white matter tract. RESULTS There was marked variability in white matter injury pattern in patients with PVL, with the most frequent injury to the retrolenticular part of the internal capsule, posterior thalamic radiation, superior corona radiata, and commissural fibers. CONCLUSION DTI is a suitable technique for in vivo assessment of specific white matter lesions in patients with PVL and, thus, a potentially valuable diagnostic tool. The tract-specific evaluation revealed a family of tracts that are highly susceptible in PVL, important information that can potentially be used to tailor treatment options in the future.
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Affiliation(s)
- L M Nagae
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USAand Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil.
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Lucato LT, Guedes MS, Sato JR, Bacheschi LA, Machado LR, Leite CC. The role of conventional MR imaging sequences in the evaluation of neurocysticercosis: impact on characterization of the scolex and lesion burden. AJNR Am J Neuroradiol 2007; 28:1501-4. [PMID: 17846200 PMCID: PMC8134382 DOI: 10.3174/ajnr.a0623] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE There are few studies comparing the capacity of lesion detection of conventional MR imaging in neurocysticercosis (NCC). This study was designed to clarify its role in the evaluation of this disease, focusing on the total number of lesions identified and the characterization of the scolex. MATERIALS AND METHODS MR images from 115 patients were prospectively collected during a 3-year interval, including axial spin-echo (SE) T1-weighted; axial fast SE T2-weighted; axial fluid-attenuated inversion recovery (FLAIR); and gadolinium-enhanced axial, coronal, and sagittal SE T1-weighted sequences. They were compared regarding the potential for detection of NCC lesions and specifically of the scolex. RESULTS Comparing all sequences, we found that FLAIR images were more sensitive to the detection of the scolex (P < .003), whereas the last gadolinium-enhanced T1-weighted series (coronal or sagittal) identified the highest number of lesions (P < .001). CONCLUSION When dealing with NCC, optimal MR imaging protocols should include FLAIR images to obtain maximal rates of scolex detection. Special attention should be paid to the last gadolinium-enhanced sequence, which maximizes the quantification of lesion load.
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Affiliation(s)
- L T Lucato
- Department of Radiology, Clinics Hospital of the University of São Paulo, School of Medicine, São Paulo, Brazil.
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de Andrade DC, Nogueira RC, Lucato LT, Marchiori PE, Machado LR, Teixeira MJ, Scaff M. Isolated CNS Whipple disease with a variant of oculofacial skeletal myorhythmia (OFSM). Neurology 2007; 69:E12. [PMID: 17846404 DOI: 10.1212/01.wnl.0000277047.22403.8d] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Gonçalves MRR, Capelli LP, Nitrini R, Barbosa ER, Porto CS, Lucato LT, Vianna-Morgante AM. Atypical clinical course of FXTAS: rapidly progressive dementia as the major symptom. Neurology 2007; 68:1864-6. [PMID: 17515552 DOI: 10.1212/01.wnl.0000262058.68100.ea] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- M R R Gonçalves
- Department of Neurology, School of Medicine, University of São Paulo, Brazil
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Leite CC, Lucato LT, Sato JR, Valente KD, Otaduy MCG. Multivoxel proton MR spectroscopy in malformations of cortical development. AJNR Am J Neuroradiol 2007; 28:1071-5; discussion 1076-7. [PMID: 17569960 PMCID: PMC8134160 DOI: 10.3174/ajnr.a0511] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2006] [Accepted: 11/02/2006] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Malformations of cortical development (MCD) are traditionally considered as a cause of epilepsy. Our aim was to study patients with focal MCD, by using multivoxel proton MR spectroscopy; we focused not only on the lesion but also on the normal-appearing contralateral side (NACS). Our hypothesis was that the metabolic abnormality extends to the NACS; therefore, it would be inadequate to consider NACS as an internal control. MATERIALS AND METHODS We studied 16 patients with focal MCD. MR spectroscopy was performed by using a point-resolved spectroscopy sequence technique, including the MCD area and the NACS. In each volume of interest, a smaller volume of interest of 2.25 cm(3) centered on the MCD was selected to study the N-acetylaspartate/creatine (NAA/Cr) ratio. In NACS, this ratio was studied by placing a symmetric voxel in comparison with the smaller MCD volume of interest. A control group (n=30) was also studied to evaluate both white and gray matter by using the same MR spectroscopy protocol. RESULTS From 16 analyzed volumes of interest with MCD, 9 were composed of gray matter heterotopia and 7 of cortical dysplasia. MR spectroscopy of both MCD lesions and NACS (n=10) showed decreased NAA/Cr compared with that of the control group. NACS in these patients did not present significant differences regarding NAA/Cr in comparison with the affected side. CONCLUSIONS MR spectroscopy demonstrated abnormal NAA/Cr in both MCD lesions and NACS in patients harboring focal MCD, giving support to the hypothesis that in MCD metabolic abnormalities extend far away from the limits of the lesion, reaching the contralateral side.
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Affiliation(s)
- C C Leite
- Department of Radiology, University of São Paulo School of Medicine, São Paulo, Brazil.
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Abstract
A 35-year-old woman presented with neurotoxicity correlated to an i.v. regimen of 5-fluorouracil as episodes of acute confusional state and abnormalities of symmetrically restricted diffusion in the periventricular white matter and corpus callosum. On discontinuing the medication, the areas of severely restricted diffusion had entirely resolved, with minimal residual T2 signal abnormality. In this case, immediate discontinuation of the chemotherapeutic agent apparently reversed the patient's symptoms and findings on MRI. The scant information available in the published literature regarding this phenomenon is reviewed with regard to 5-fluorouracil.
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Affiliation(s)
- L T Lucato
- Department of Radiology, University of Minnesota Medical School and Hennepin County Medical Center, Minneapolis, MN 55415, USA
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