Spatial distribution of white matter degenerative lesions and cognitive dysfunction in relapsing-remitting multiple sclerosis patients

AIM

The aim of this study was to assess degenerative lesion localisation in the course of relapsing-remitting multiple sclerosis (RRMS) and to identify the association between localisation and the frequency of T1-hypointense lesions (black holes) with cognitive dysfunction. We also searched for neuroradiological predictors of cognitive dysfunction in patients. The clinical rationale for the study was previous research, and our own findings suggest that lesion localisation plays an important role in cognitive performance and neurological disability of MS patients.

MATERIAL AND METHODS

Forty-two patients were included in the study. All subjects underwent neuropsychological examination using Raven's Coloured Progressive Matrices, a naming task from the Brief Repeatable Battery of Neuropsychological Tests, and attention to detail tests. Magnetic resonance imaging (MRI) was acquired on 1.5 Tesla scanner and black holes were manually segmented on T1-weighted volumetric images using the FMRIB Software Library. Linear regression was applied to establish a relationship between black hole volume per lobe and cognitive parameters. Bonferroni correction of voxelwise analysis was used to correct for multiple comparisons.

RESULTS

The following associations between black hole volume and cognition were identified: frontal lobes black hole volume was associated with phonemic verbal fluency (t = -4.013, p < 0.001), parietal black hole volume was associated with attention (t = -3.776, p < 0.001), and parietal and temporal black hole volumes were associated with nonverbal intelligence (p < 0.001). The volume of parietal black holes was the best predictor of cognitive dysfunction.

CONCLUSIONS

Our approach, including measurement of focal axonal loss based on T1-volumetric MRI sequence and brief neuropsychological assessment, might improve personalised diagnostic and therapeutic decisions in clinical practice.

Distinct regional brain atrophy pattern in multiple sclerosis and neuropsychiatric systemic lupus erythematosus patients

Differentiation of systemic lupus erythematosus (SLE) from multiple sclerosis (MS) can be challenging, especially when neuropsychiatric (NP) symptoms are accompanied by white matter lesions in the brain. Given the lack of discriminative power of currently applied tools for their differentiation, there is an unmet need for other measures that can aid in distinguishing between the two autoimmune disorders. In this study we aimed at exploring whether brain atrophy measures could serve as markers differentiating MS and SLE. Thirty-seven relapsing-remitting MS and 38 SLE patients with nervous system manifestations, matched according to age and disease duration, underwent 1.5 Tesla magnetic resonance imaging (MRI), including volumetric sequences, and clinical assessment. Voxelwise analysis was performed using ANTS-SyN elastic registration protocol, FSL Randomise and Gamma methods. Cortical and subcortical segmentation was performed with Freesurfer 5.3 pipeline using T1-weighted MPRAGE sequence data. Using MRI volumetric markers of general and subcortical gray matter atrophy and clinical variables, we built a stepwise multivariable logistic diagnostic model to identify MRI parameters that best differentiate MS and SLE patients. We found that the best volumetric predictors to distinguish them were: fourth ventricle volume (sensitivity 0.86, specificity 0.57, area under the curve, AUC 0.77), posterior corpus callosum (sensitivity 0.81, specificity 0.57, AUC 0.68), and third ventricle to thalamus ratio (sensitivity 0.42, specificity 0.84, AUC 0.65). The same classifiers were identified in a subgroup analysis that included patients with a short disease duration. In MS brain atrophy and lesion load correlated with clinical disability, while in SLE age was the main determinant of brain volume. This study proposes new imaging parameters for differential diagnosis of MS and SLE with central nervous system involvement. We show there is a different pattern of atrophy in MS and SLE, and the key structural volumes that are differentially affected include fourth ventricle and posterior section of corpus callosum, followed by third ventricle to thalamus ratio. Different correlation patterns between volumetric and clinical data may suggest that while in MS atrophy is driven mainly by disease activity, in SLE it is mostly associated with age. However, these results need further replication in a larger cohort.

Subcortical gray matter atrophy is associated with cognitive deficit in multiple sclerosis but not in systemic lupus erythematosus patients

Cognitive impairment is a significant clinical problem both in multiple sclerosis (MS) and systemic lupus erythematosus (SLE) patients. In MS cognitive dysfunction has been associated with brain atrophy and total demyelinating lesion volume. In SLE cognitive impairment is much less understood, and its link to structural brain damage remains to be established. The aim of this study was to identify the relationship between subcortical gray matter volume and cognitive impairment in MS and SLE. We recruited 37 MS and 38 SLE patients matched by age, disease duration and educational level. Patients underwent magnetic resonance imaging (MRI) and a battery of psychometric tests. Severity of cognitive impairment was similar in both cohorts despite larger white matter lesion load in MS patients. Psychometric scores were associated with global and subcortical gray matter atrophy measures and lesion load in MS, but not in SLE. In SLE, the lack of a relationship between cognitive impairment and structural damage, defined either as atrophy or white matter lesions, indicates a different causal mechanism of cognitive deficit.

Immune Cell Neurotrophin Production Is Associated with Subcortical Brain Atrophy in Neuropsychiatric Systemic Lupus Erythematosus Patients

OBJECTIVE

Central nervous system (CNS) involvement in systemic lupus erythematosus (SLE) remains poorly understood. Damage within the CNS is driven by the autoimmune response; however, immunopathophysiology of neuropsychiatric (NP) SLE is multifactorial. Immune cell neurotrophin production could be neuroprotective against autoimmunity-driven CNS damage, as has been shown in multiple sclerosis. The aim of this study was to establish whether immune cell neurotrophin production is associated with damage severity in NPSLE.

METHODS

Selected neurotrophins (BDNF, NGF, NT-3, and NT-4/5) were measured with ELISA within peripheral blood mononuclear cells (PBMCs) isolated from 38 NPSLE patients matched with 39 healthy controls. Subcortical and cortical structure volumes were segmented with the Freesurfer 5.3 pipeline on T1-weighted isotropic images acquired on a 1.5-T MRI scanner.

RESULTS

BDNF and NGF levels in PBMCs were reduced in NPSLE compared to the healthy population. The PBMC BDNF level was associated with reduced thalamus, caudate, and putamen volumes. The NGF level correlated with lateral ventricles enlargement and thalamic volume loss.

CONCLUSIONS

In NPSLE, immune cell BDNF and NGF levels are linked with subcortical atrophy. Higher BDNF levels are associated with higher midsagittal atrophy, which may reflect compensatory mechanisms, upregulating BDNF when neuroprotection is needed. These data require further confirmation.

Accuracy of the anthropometric measurements of skeletonized skulls with corresponding measurements of their 3D reconstructions obtained by CT scanning

BACKGROUND

The anthropometric measurements of the skeletonized skull are crucial in the investigation of human remains, mostly for personal identification. The images of the skull are used if the superimposition or approximation of the facial appearance is to be performed. The aim of the study was to compare the accuracy of the anthropometric measurements of skeletonized skulls with corresponding measurements of their 3D reconstructions obtained by CT scanning.

METHODS

Ten skeletonized skulls and their 3D digital reconstructions were measured according to standard anthropometric procedures. The results were compared and statistical analysis was performed.

RESULTS

The statistical analysis revealed that the 3D reconstruction is absolutely reliable for any measurements within the skull. The results of the measurements obtained from the CT image were accurate and comparable to the results of the anthropometric analysis of the skeletonized skull. The correlation between the anthropometry of the skeletonized skulls and the CT reconstructions was strong.

CONCLUSIONS

It is relevant that 3D reconstructions of the skull can be used in forensic anthropology for personal identification.

Body mass estimation in modern population using anthropometric measurements from computed tomography

Forensic anthropologists are able to estimate the stature of a skeleton, its sex and biological age at death, with a relatively high degree of accuracy. Body mass estimation from the stature and bi-iliac (maximum pelvic) breadth and femoral head breadth can be useful in forensic investigations involving unidentified skeletal remains. Predicting the body mass of skeletal remains always involves significant inaccuracy, however when body mass extremes are disregarded average figures provide the best estimation. The aim of the study was to investigate whether the methods usually used in body mass estimation are accurate in different BMI ranges. The usefulness of these methods in forensic anthropology was discussed. The study was performed using CT images of widely differing body types of modern central European populations. Maximum pelvic breadth and anteroposterior femoral head breadth were measured directly from the appropriate CT scan slices for each individual. Body mass index was established for each individual. Four different methods of body mass estimation were applied. The statistical analysis showed that body mass prediction methods based on the bi-iliac breadth with known stature and the femoral head breadth show strong correspondence. The results of body mass estimation using different methods were in high correlation with normal BMI. The accuracy of body mass prediction of underweight and obesity cases (BMI extremes) showed significant inaccuracy. Body mass estimation methods can provide important information for forensic anthropological investigation and personal identification. However, one should be aware of the discrepancies and should apply the equations carefully as they can carry significant errors.

Immune cell NT-3 expression is associated with brain atrophy in multiple sclerosis patients

While neurotrophins mediate cell survival and proliferation in the nervous system, they are also expressed within peripheral blood mononuclear cells (PBMCs) of the immunological system. In multiple sclerosis (MS) neurotrophins released from PBMCs might play a neuroprotective role, delaying neurodegeneration within central nervous system. We aimed for identifying the link between neurotrophins' PBMCs expression and brain atrophy markers in relapsing-remitting MS (RRMS) patients. We have found that neurotrophin-3 PBMCs concentration is strongly correlated with brain-parenchymal fraction and corpus callosum cross-sectional area, which are well-established brain atrophy measures. Thus, PBMC-derived neurotrophin-3 might exert a direct or indirect neuroprotective effect in MS.

[Impact of L-thyroxine replacement therapy on pituitary changes secondary to congenital primary hypothyroidism--three cases report]

The aim of the study was an evaluation of the impact of L-thyroxine substitution therapy on the size and structure of the pituitary gland using MRI in three patients with pituitary hyperplasia or tumor secondary to primary congenital hypothyroidism. Along with imaging studies (MRI, skull X-rays) all patients had performed hormonal tests. All hormones (except adrenocorticotropic hormone) of anterior pituitary lobe were measured in basal condition, and some of them (GH, PRL) after stimulation tests, which showed hyperprolactinemia in one case and pituitary somatotropin insufficiency in the other. Only in one out of three patients the regression of the pituitary enlargement was complete, whereas in second case the regression was partial and in third patient evaluation revealed no changes on the MRI. Correct L-thyroxine therapy prevents enlargement of pituitary gland and may regress these changes, but is not the only outcome of pituitary enlargement. Those results shows, that other coexisting disturbances like TSH-secreting adenoma or thyroid hormone resistance must be considered when the treatment is not successful.

[Magnetic resonance imaging and hormonal profile of the pituitary gland in patients with primary congenital hypothyroidism]

The aim of our study was an estimation of the size and structure of the pituitary gland using MRI and the estimation of hormonal profile of the pituitary anterior lobe (except for ACTH) in 21 adult patients with congenital primary hypothyroidism.

MATERIAL AND METHODS

The studied group was divided into 2 subgroups: A--with normal level of serum TSH and B--with its elevated. The MRI showed pituitary hyperplasia or tumor in 28.5% of patients, partially empty sella in 14.3% and hypoplasia in 9.5%. In subgroup B there were mostly hyperplasia or tumor (35.7%), while in subgroup A there were no domination of any abnormalities.

RESULTS

Serum mean TSH level was 49.8+/-86.2 mU/l with an increase in 67%. The mean prolactin was 11.2+/-7.5 mg/ml with an increase in 19%. Serum LH and FSH concentrations were normal in the whole group. The mean alpha subunit level was elevated in 52%. In 42.8% somatotropic hypopituitarism was recognised due to GH stimulation tests.

CONCLUSIONS

The TRH hyperstimulation in patients with congenital primary hypothyroidism may lead to pituitary hyperplasia or tumor visible on MRI and to pituitary hormonal abnormalities.

Pituitary abscess: a case report

OBJECTIVES

Pituitary abscess is rare disease and the correct diagnosis is difficult because there are non-specific symptoms and it is often radiologically indistinguishable from other pituitary lesions.

CASE PRESENTATION

We present one case of pituitary abscess that constitute 0.15% of all pituitary adenomas operated in our department in the 20 years. A 49-year-old woman presented with a history of 10 months bifrontal headache. The MRI showed cystic intra and suprasellar mass with ring enhancement after contrast injection. During transsphenoidal surgery, copious yellowish pus was found. Antibiotic therapy was performed. Histological study of the cyst wall confirmed the diagnosis of pituitary abscess.

CONCLUSION

Pituitary abscess should be considered in the differential diagnosis of all other cyst mass in patients with diabetes insipidus.

Application of internal stabilisation in the surgical treatment of spinal metastases

BACKGROUND AND PURPOSE

Neoplastic disease damages the spine more often than trauma. Metastatic tumour causes vertebral column instability and neurological deficit. Surgical intervention indications depend on the patient's general and neurological status. The aim of neuro-orthopaedic treatment is to achieve pain relief and neurological improvement. Spine stability is secured by various implant systems. The aim of the paper is to present indications, operative techniques and stabilisation methods in patients with metastatic spine disease.

MATERIAL AND METHODS

There were 73 patients included in this study: 50 males and 23 females, aged 17-74 years. The dominant tumour location was the thoracic spine (41 cases), followed by the lumbar spine (19). Symptoms of spinal cord lesion were observed in 71 patients. Qualification for surgery and approach planning were based on different scales (ASA, DeWald, Frankel, Karnofsky, Denis, Tomita). Internal stabilisation implantation followed tumour resection.

RESULTS

Anterior approach was used in 15 cases, posterolateral in 39, posterior in 13, and combined in 6 cases. Histological findings generally allowed the primary tumour location to be disclosed, which in most cases involved the kidney, prostate, lung and the haematopoietic system. Neurological improvement was observed in 82% of cases. Perioperative death occurred in 3% of all patients.

CONCLUSIONS

Employed operative techniques are adequate for tumour removal, neural and vascular structures decompression and for implant placement.

[Can a cutaneous-muscular biopsy be helpful in the diagnosis of vasculitis in the stroke?]

Vasculitis includes a heterogeneous group of multisystemic disorders characterized pathologically by inflammation of blood vessels. The diagnosis of vasculitis is difficult and more often than not, it is made indirectly after eliminating other causes of the stroke. Vasculitis is an infrequent disorder and a rare cause of the stroke. This is a case report of a 41-year-old man who had the first-ever stroke with vasculitis diagnosed histologically in a cutaneous-muscular biopsy from the place not changed by the disease. After corticosteroid therapy the hemiparesis disappeared. The patient has continued the treatment with immunosuppressive drugs.

Effects of magnetic resonance imaging on polymorphonuclear neutrophil adhesion

BACKGROUND

Limited research has been performed concerning the effects of MR imaging on the immune system. In this study the influence of MR imaging exposure on polymorphonuclear neutrophil (PMN) adhesion was evaluated.

MATERIAL AND METHODS

In vivo and in vitro studies were performed in 10 patients undergoing an MR imaging procedure, PMN adhesion to a plastic surface, as well as the expression of adhesion molecules beta 2-integrins CD11b, CD18, and L-selectin on the surface of PMN were estimated.

RESULTS

Exposure to MR imaging significantly increased adhesion of isolated PMNs to plastic surfaces. PMNs from blood samples obtained from patients undergoing MR imaging as well as from blood samples placed beside patients during MR imaging did not differ from controls in adhesion to plastic surfaces. Similarly, plasma from three tested samples did not change control PMN adhesion to plastic surface. Expression of beta 2-integrins (CD11, CD18) was significantly increased in samples left beside patients during MR imaging, while significantly decreased in samples obtained from patients after MR imaging exposure when compared to control samples. Expression of the surface adhesion molecule L-selectin on the surface of PMN decreased significantly in blood samples left beside patients during MR imaging.

CONCLUSION

The results indicate that the PMN adhesion properties increase under the influence of MR imaging exposure. This phenomenon may be the result of direct stimulation of polymorphonuclear neutrophils by the exposure to MR imaging.

[Transient patency loss of the internal carotid artery in a young patient]

Ischaemic stroke has been observed more rarely among young people in comparison to old adults. The causes of ischaemic stroke among young adults are numerous. One of them is occlusion of internal carotid artery (ICA). The aetiology of the occlusion is different from arteriosclerotic disorders. Within the last few years the authors have paid much attention to the fact that spontaneous dissection is not such a rare cause of ICA occlusion. In many cases (60-70%) of dissection recanalization and benign outcome occur. Angiography has been considered as a gold standard in establishing the diagnosis. We described a young, 16-year-old patient with ischaemic stroke. The cause occlusion of ICA, probably was dissection. The diagnosis was made by angiography MR. In our patient follow-up angiography MR demonstrated recanalisation. The outcome of the stroke was benign and hemiplegia reversed.

[Developmental anomalies of thoracic and lumbosacral vertebral column with diastematomyelia: case report]

Patient, 37-years old, female, admitted to Department of Neurology, with intensive lower back pain and weakness of right lower extremity. Radiological evaluation showed developmental anomalies of spinal cord and vertebral column, with double spinal cord Th10-S1. The mechanism of described clinical symptoms is due to affixed spinal cord syndrome. According to current literature we presented the mechanism of anomaly development. The above case was classified as the second type of split cord malformations.

A Polish pedigree with Alzheimer's disease determined by a novel mutation in exon 12 of the presenilin 1 gene: clinical and molecular characterization

The presenilin 1 (PS-1) gene, recently identified on chromosome 14q24.3, is a major gene involved into the autosomal dominant forms of early onset Alzheimer's disease (EOAD). Mutations of the PS-1 gene are responsible for the majority of familial EOAD. We found a novel mutation in a Polish family with EOAD from the Poznań region. The mutation at codon 424 in exon 12 of the PS-1 gene leads to an amino acid substitution Leu-Arg in a transmembrane domain VIII of the presenilin 1 molecule. The change is predicted to have a drastic effect on the protein function because it is associated with a very early age of onset (a range of 30-35 years) and a quick progression (about a 4-5 years duration) of the disease.

[Warthin's tumors with atypical location]

This article addresses etiology, pathogenesis and histology of papillary cystadenoma lymphomatosum (Warthin's tumor). Described are two cases of tumors with this histopathological characteristics with unusual locations. The first patient presented with a discrete lesion located in the nasopharynx, and the second with multiple post-infectious nodules located in the parotid glands bilaterally. The approach to the diagnosis and treatment of these cases is discussed.

[Diagnostic studies of optic neuritis in children and adolescents]

PURPOSE

To evaluate the sensitivity of various diagnostic methods in the optic neuritis.

MATERIAL AND METHODS

15 patients, 10 boys and 5 girls, aged 6-18 years, with optic neuritis have been examined. Multiple sclerosis was diagnosed in 12 cases, the etiology of 3 was unknown. The full ophthalmological examination, including static perimetry and visual evoked potentials (VEP) as well as brain computed tomography (CT) and magnetic resonance imaging (MRI) were performed.

RESULTS

MRI revealed plaques of demyelination in 11 patients; no pathological changes were observed in cases of idiopathic neuritis. In CT plaques of demyelination were found in 2 patients only. In most cases VEPs were abnormal, mainly there was prolonged latency of deflection, decreased amplitude and more rarely changes of the shape of the record. Static perimetry, with white and blue target, revealed multiple scattered absolute and relative scotoma in the 30 degrees central area.

CONCLUSIONS

MRI and static perimetry were the most sensitive methods for detection of the changes in optic neuritis and these methods are also useful in cases with asymptomatic involvement of visual pathway, especially in multiple sclerosis.

[Central neurocytoma of the right parietal and occipital lobe. Case report]

Central neurocytoma is a rare tumour of the CNS. It typically occurs in intraventricular location in young adults. The authors describe central neurocytoma in a 17-year-old woman, which was situated unusually for this type of tumour in the brain parenchyma. In this paper radiological and histopathological picture is presented.

[Familial metachromatic leukodystrophy as a cause of psychotic manifestations in young adults]

Cases of metachromatic leucodystrophy in brother and sister are presented. The clinical pattern in the female was characterised by the progressing dementia, whereas in the male the first symptom was the manic syndrome. The neurological status was normal. The cases were diagnosed by the demyelination visible in MRI pattern and in the decreased activity of arylsulphatase A in blood leukocytes.

[Surgical approach to cranial base and craniofacial tumors]

Skull base tumour is rare and until recently was considered unresectable. The authors present a patient with skull base tumour of extra and intracranial compartment penetrating into parapharyngeal space and maxillary bone. Radiologic findings on CT, MRI, arteriography were studied. A surgical technique to expose the cranial base and intraoperative findings are described. Significant improvement occurred after incomplete tumour resection.

Effects of magnetic resonance imaging on polymorphonuclear neutrophil functions

RATIONALE AND OBJECTIVES

Limited research has been performed on the effects of magnetic resonance (MR) imaging on the immune system. To our knowledge, there are no reported studies of MR imaging effects on the polymorphonuclear neutrophil (PMN) system. Therefore, we evaluated the influence of MR imaging exposure on PMNs.

METHODS

In vivo and in vitro studies were performed on 36 patients undergoing MR imaging. The following were estimated in blood samples: leukocyte and PMN count, PMN phagocytosis and bactericidal capacity, percentage of cells with expression of surface receptor for the Fc fragment of immunoglobulin G (IgG), PMN superoxide, hydrogen peroxide production, and plasma lysozyme activity. Another sample of patients was used to eliminate temperature as an influence on changes in PMN functions.

RESULTS

Both in vitro and in vivo MR imaging led to a decrease in PMNs and an increase in PMN phagocytosis, bactericidal capacity, hydrogen peroxide production, and percentage of cells with expression of surface receptor for Fc IgG. Superoxide anion production did not change significantly. Elevated temperature, stress, and anxiety were excluded as influences on our results.

CONCLUSION

The PMN system is affected seriously by MR imaging.

[A case of arachnoid cyst in vertebral canal]

A rare case of intradural subarachnoid cyst in the vertebral canal was observed in a female aged 52 years. Operation was followed by marked improvement of the neurological condition. The large defect of the dura required grafting of lyophilized dura. The role of MRI in the diagnosis of this case is stressed.

[A case of diffuse form of multiple sclerosis with extensive periventricular demyelination]

A case of transitional type of multiple sclerosis with large periventricular cuffs of demyelination is presented. The case suggests that in the mechanism of myelin decay a significant role might be played by the diffusion of the demyelinating factors contained in the cerebro-spinal fluid.