Brain Involvement in Myotonic Dystrophy Type 1: A Morphometric and Diffusion Tensor Imaging Study with Neuropsychological Correlation

Objective

Myotonic dystrophy type 1 (DM1), the most prevalent inherited neuromuscular disease in adults, is a genetic multisystem disorder with a well-established but not well-characterized cerebral involvement. The aim of this study was to evaluate the presence of white matter and gray matter abnormalities in DM1 patients and to investigate their relationship with neurocognitive dysfunction.

Methods

A total of 42 DM1 patients and 42 healthy controls were included in the study. Clinical, cognitive, and magnetic resonance imaging evaluations, including the use of structural and diffusion tensor imaging (DTI) techniques, were performed. White matter lesion (WML) load, volumetric analysis, and diffusivity changes were assessed and correlated with clinical and neuropsychological test findings.

Results

WMLs were significantly more frequent in DM1 patients (p < .001), and anterior temporal lobe lesions were only found in the patient group. Global and regional cortical volume loss and corpus callosum atrophy were found. Diffuse white matter DTI abnormalities, including fractional anisotropy, mean diffusivity, axial diffusivity, and radial diffusivity were observed with sparing of the internal capsule. Subcortical structures showed volume loss and increased median diffusivity. Neuropsychological evaluation showed significant impairment in several cognitive functions, but only visuospatial impairment was correlated with white matter abnormalities and cortical atrophy. Daytime sleepiness was associated with WML and ventral diencephalon and pallidum volume loss.

Conclusion

DM1 produces a widespread involvement of white matter and gray matter, including cortical and subcortical structures. These structural abnormalities are involved in the progressive neuropsychological functional impairment in these patients.

Parkinsonism and basal ganglia volumes in first-episode psychosis

Introduction

Parkinsonian motor signs are the most frequent of the genuine motor abnormalities present in drug-naïve patients with schizophrenia, and are also present in patients with a first-episode of psychosis (FEP).

Objective

To study whether there are differences in basal ganglia volumes depending on the presence of Parkinsonism in FEP.

Methods

Forty-six patients with a FEP were included in the study. Twenty-three controls were included to normalise patients’ brain volume data. Parkinsonism was assessed with the UKU scale. Brain volumes were obtained with MRI (1.5 Tesla Siemens Avanto). Reconstruction and volumetric segmentation was made with the Freesurfer© software (http://surfer.nmr.mgh.harvard.edu/). Patients were divided into two groups, considering the presence/absence of Parkinsonism (UKU total score cutoff point = 4). Patients have been treated with antipsychotics a mean of less than 2 months. There were not significant differences in the total exposure to antipsychotics between both groups. ANCOVAS were performed including gender as covariate.

Results

Patients with Parkinsonism showed a trend towards significance to exhibit reduced volumes in the left caudate and right putamen (Fig. 1).

Conclusions

FEP patients who exhibit Parkinsonian signs tend to show reduced left caudate and right putamen volumes in the early phases of psychotic illness, after correcting by gender.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

EPB41L3, TSP-1 and RASSF2 as new clinically relevant prognostic biomarkers in diffuse gliomas

Hypermethylation of tumor suppressor genes is one of the hallmarks in the progression of brain tumors. Our objectives were to analyze the presence of the hypermethylation of EPB41L3, RASSF2 and TSP-1 genes in 132 diffuse gliomas (astrocytic and oligodendroglial tumors) and in 10 cases of normal brain, and to establish their association with the patients’ clinicopathological characteristics. Gene hypermethylation was analyzed by methylation-specific-PCR and confirmed by pyrosequencing (for EPB41L3 and TSP-1) and bisulfite-sequencing (for RASSF2). EPB41L3, RASSF2 and TSP-1 genes were hypermethylated only in tumors (29%, 10.6%, and 50%, respectively), confirming their cancer-specific role. Treatment of cells with the DNA-demethylating-agent 5-aza-2′-deoxycytidine restores their transcription, as confirmed by quantitative-reverse-transcription-PCR and immunofluorescence. Immunohistochemistry for EPB41L3, RASSF2 and TSP-1 was performed to analyze protein expression; p53, ki-67, and CD31 expression and 1p/19q co-deletion were considered to better characterize the tumors. EPB41L3 and TSP-1 hypermethylation was associated with worse (p = 0.047) and better (p = 0.037) prognosis, respectively. This observation was confirmed after adjusting the results for age and tumor grade, the role of TSP-1 being most pronounced in oligodendrogliomas (p = 0.001). We conclude that EPB41L3, RASSF2 and TSP-1 genes are involved in the pathogenesis of diffuse gliomas, and that EPB41L3 and TSP-1 hypermethylation are of prognostic significance.

[Symptomatic xanthogranuloma of the lateral ventricle]

Xanthogranulomas of the choroid plexus is a benign tumour of uncertain etiology, usually asymptomatic. We report a case of symptomatic xanthogranuloma of the left lateral ventricle with edema in adjacent white matter, in a 62-year-old man with seizures.

[Cocaine-induced brain stem stroke associated to craneal midline destructive lesions]

INTRODUCTION

Abuse of cocaine and other sympathomimetic drugs has been reported as a significant risk factor for stroke. The physiopathologic mechanisms implicated are multifactorial. Chronic cocaine use leads to extensive destruction of osteocartilaginous structures of nose, sinuses and palate.

CASE REPORT

We report the case of a 56 years-old woman with hypertension and smoke abuse who was admitted with a pontine paramedian infarction. Cranial resonance findings of midline destructive lesions lead to the suspicion of chronic cocaine consumption. The initial outcome was good but she was re-admitted nine months later with an extent pontomesencephalic infarction.

CONCLUSIONS

Abuse of cocaine is a risk factor for stroke that should be considered not only in young patients. The pathogenic relationship between stroke and midline cocaine related destructive lesions is discussed.

Solitary thoracic intradural extramedullary plasmacytoma

The bodies of the vertebrae are common locations for plasma cell diseases such as multiple myeloma and solitary plasmacytoma. Secondary invasion of the epidural space is infrequent but can cause neurological symptoms. Spinal cord compression due to pure intradural plasma cell infiltration is very rare. The authors report a 25-year-old woman who developed a progressive difficulty in walking due to a solitary spinal dural plasmacytoma. This is the first reported example in the English language literature of a purely intradural spinal plasmacytoma in a patient without other myelomatous lesions. An entirely intradural solitary plasmacytoma has a relatively better prognosis.

Linfoma cerebral primario: revisión bibliográfica y experiencia en el Hospital de Navarra en los últimos 5 años (2000-2004)

Primary cerebral lymphoma (Primary CNS Lymphoma, PCNSL) is an aggressive non-Hodgkin lymphoma that originates in the central nervous system without evidence of lymphoma in any other localization at the time of diagnosis. Primary cerebral lymphomas are less well-known and are characterized than their homologues the systemic lymphomas, as they are an entity whose frequency was scarce until a few decades ago. However, the great rise in incidence that this pathology has undergone over the last three decades, and which is still unexplained, makes more studies necessary to better understand the etiopathology of this entity. Thanks to the new systems of treatment, the prognosis of this pathology has improved significantly in recent years. Nonetheless, treatment of primary cerebral lymphoma continues to give rise to numerous controversies at present due to its high neurotoxicity in patients over 60 years of age, a group of patients frequently affected by this pathology. To resolve these and other questions it is necessary to deep in the study of primary cerebral lymphoma and to carry out high quality clinical trials.

[Cystic pancreatic tumours and pseudo-tumoural lesions]

Cystic lesions of the pancreas are infrequent, estimated at only some 1% of all pancreatic tumours and at some 10% of all pancreatic cysts. The pre-operational diagnosis is important for a suitable treatment, with valuable radiological techniques available today such as ultrasound, computerised tomography and magnetic resonance. In spite of this we have to accept that we are facing a group of tumours whose diagnosis is difficult, due to the great variety of cellular types existing within them.

Carpal tunnel syndrome: usefulness of sonography

The aim of this study was to evaluate sonographic signs described for carpal tunnel syndrome (CTS). Sixty-four wrists from 40 patients with CTS confirmed by electromyography, and 42 wrists from 24 healthy individuals, were examined using sonography. Cross-sectional area, flattening ratio in proximal, middle and distal segments of the carpal median nerve and bowing of the flexor retinaculum were measured. The accuracies of the sonographic diagnostic criteria for CTS were assessed using receiver-operating-characteristic (ROC) analytical techniques. A significant swelling of the median nerve was observed at the proximal (p < 0.001), middle (p < 0.0001) and distal (p< 0.0001) segments and a significant bowing of the flexor retinaculum in CTS patients with respect to healthy subjects. No significant differences were found in the mean value of flattening ratio between the groups. The sensitivity, specificity, positive predictive value, and the negative predictive value were 73.4, 57.1, 72.3 and 58.5%, respectively, in the proximal and middle segments; 75, 57.1, 72.7 and 60% in the distal segment for areas greater than 11 mm2: and 81.3, 64.3, 77.6 and 69.2% for the bowing of the flexor retinaculum greater than 2.5 mm. All sonographic criteria were found in 34 CTS patients (53.1%) and none in 3 patients. Sonography may be useful in the diagnosis of CTS. The most reliable sign was increased bowing of the flexor retinaculum and cross-sectional area of median nerve with specificity close to 60%.

[Pulse rate of the venous wave in the eco-Doppler study of the lower extremities as a sign of elevated pressure in the right atrium]

AIM

The aim of this study is to determine the nature of venous flow in the lower extremities, as well as to correlate the velocity of the flow with average vein pressure in the right atrium.

MATERIAL AND METHODS

Over a period of one year 236 pulsated Doppler echographs were made of patients, bearers of a venous catheter located in the right atrium. The patients were in a supine lying position and breathing gently. The lines of the Doppler wave were used to analyse the frequency of the wave, the components of its velocity, the relationships of velocity and the existence of pulsatile flow. These parameters were compared with the pressure in the right atrium.

RESULTS

The study showed a cardiac and respiratory periodicity of the venous wave. A statistically significant correlation (p<0.0001) was found between average venous pressure in the right atrium and the following variables: the systolic atrium wave (a), the diastolic atrium wave (d), the relation of pulsatility (RP=Velocity min/Velocity max) and the index of pulsatility (IP=[Velocity max-Velocity min]/Velocity average).

CONCLUSION

There is an inverse and significant relationship between pulsatile flow and atrium pressure. Nonetheless, although a relation exists between the different components of the venous wave, an elevation in central vein pressure cannot be predicted.

Cysts of the tunica albuginea: sonographic appearance

OBJECTIVE

Testicular cysts of the tunica albuginea are an uncommon phenomenon, important because of their possible confusion with testicular tumors. Accurate diagnosis may avoid aggressive and irreversible treatment such as testicular ablation. The purpose of this study is to report our experience in such diagnosis through sonographic detection of albuginea cysts.

CONCLUSION

Sonography is the technique of choice in the diagnosis of any testicular tumor formation, allowing the differentiation of cysts from neoplasia and avoiding unnecessary intervention in patients with cysts of the tunica albuginea.

False aneurysm of the femoral artery as a late complication of an intertrochanteric fracture. A case report

False aneurysms of the femoral vessels are an important, but rare, complication after an intertrochanteric fracture of the femur. The diagnosis is usually delayed, because pain, a haematoma and unexplained anaemia are the nonspecific clinical signs. Early diagnosis by duplex and colour Doppler ultrasound is a good alternative to arteriography or magnetic resonance imaging.