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Joseph‐Mathurin N, Feldman RL, Lu R, Shirzadi Z, Toomer C, Saint Clair JR, Ma Y, McKay NS, Strain JF, Kilgore C, Friedrichsen KA, Chen CD, Gordon BA, Chen G, Hornbeck RC, Massoumzadeh P, McCullough AA, Wang Q, Li Y, Wang G, Keefe SJ, Schultz SA, Cruchaga C, Preboske GM, Jack CR, Llibre‐Guerra JJ, Allegri RF, Ances BM, Berman SB, Brooks WS, Cash DM, Day GS, Fox NC, Fulham M, Ghetti B, Johnson KA, Jucker M, Klunk WE, la Fougère C, Levin J, Niimi Y, Oh H, Perrin RJ, Reischl G, Ringman JM, Saykin AJ, Schofield PR, Su Y, Supnet‐Bell C, Vöglein J, Yakushev I, Brickman AM, Morris JC, McDade E, Xiong C, Bateman RJ, Chhatwal JP, Benzinger TLS. Presenilin-1 mutation position influences amyloidosis, small vessel disease, and dementia with disease stage. Alzheimers Dement 2024; 20:2680-2697. [PMID: 38380882 PMCID: PMC11032566 DOI: 10.1002/alz.13729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 02/22/2024]
Abstract
INTRODUCTION Amyloidosis, including cerebral amyloid angiopathy, and markers of small vessel disease (SVD) vary across dominantly inherited Alzheimer's disease (DIAD) presenilin-1 (PSEN1) mutation carriers. We investigated how mutation position relative to codon 200 (pre-/postcodon 200) influences these pathologic features and dementia at different stages. METHODS Individuals from families with known PSEN1 mutations (n = 393) underwent neuroimaging and clinical assessments. We cross-sectionally evaluated regional Pittsburgh compound B-positron emission tomography uptake, magnetic resonance imaging markers of SVD (diffusion tensor imaging-based white matter injury, white matter hyperintensity volumes, and microhemorrhages), and cognition. RESULTS Postcodon 200 carriers had lower amyloid burden in all regions but worse markers of SVD and worse Clinical Dementia Rating® scores compared to precodon 200 carriers as a function of estimated years to symptom onset. Markers of SVD partially mediated the mutation position effects on clinical measures. DISCUSSION We demonstrated the genotypic variability behind spatiotemporal amyloidosis, SVD, and clinical presentation in DIAD, which may inform patient prognosis and clinical trials. HIGHLIGHTS Mutation position influences Aβ burden, SVD, and dementia. PSEN1 pre-200 group had stronger associations between Aβ burden and disease stage. PSEN1 post-200 group had stronger associations between SVD markers and disease stage. PSEN1 post-200 group had worse dementia score than pre-200 in late disease stage. Diffusion tensor imaging-based SVD markers mediated mutation position effects on dementia in the late stage.
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Mena L, Mengual JJ, García-Sánchez SM, Avellaneda-Gómez C, Font MÀ, Montull C, Castrillo L, Blanch P, Castellanos P, Lleixa M, Martín-Baranera M, Armario P, Gómez-Choco M. Relationship of arterial stiffness and baseline vascular burden with new lacunes and microbleeds: A longitudinal cohort study. Eur Stroke J 2024; 9:251-258. [PMID: 37873938 PMCID: PMC10916807 DOI: 10.1177/23969873231207764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/28/2023] [Indexed: 10/25/2023] Open
Abstract
INTRODUCTION Arterial stiffness may have a significant impact on the development of cerebral small vessel disease (cSVD). PATIENTS AND METHODS We obtained pulse wave velocity (24-h PWV) by means of ambulatory blood pressure monitoring (ABPM) in patients with a recent small subcortical infarct (RSSI). Patients with known cardiac or arterial embolic sources were excluded. Lacunes, microbleeds, white matter hyperintensities and enlarged perivascular spaces at baseline were assessed in a brain MRI and included in a cSVD score. A follow-up MRI was obtained 2 years later and assessed for the appearance of new lacunes or microbleeds. We constructed both unadjusted and adjusted models, and subsequently selected the optimal models based on the area under the curve (AUC) of the predicted probabilities. RESULTS Ninety-two patients (mean age 67.04 years, 69.6% men) were evaluated and 25 had new lacunes or microbleeds during follow-up. There was a strong correlation between 24-h PWV and age (r = 0.942, p < 0.001). cSVD was associated with new lacunes or microbleeds when adjusted by age, 24-h PWV, NT-proBNP and hypercholesterolemia (OR 2.453, CI95% 1.381-4.358). The models exhibiting the highest discrimination, as indicated by their area under the curve (AUC) values, were as follows: 1 (AUC 0.854) - Age, cSVD score, 24-h PWV, Hypercholesterolemia; 2 (AUC 0.852) - cSVD score, 24-h PWV, Hypercholesterolemia; and 3 (AUC 0.843) - Age, cSVD score, Hypercholesterolemia. CONCLUSIONS cSVD score is a stronger predictor for cSVD progression than age or hemodynamic parameters in patients with a RSSI.
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Affiliation(s)
- Luis Mena
- Neurology Department, Complex Hospitalari Universitari Moisès Broggi, Sant Joan Despí, Spain
| | - Juan José Mengual
- Neurology Department, Complex Hospitalari Universitari Moisès Broggi, Sant Joan Despí, Spain
| | - Sonia María García-Sánchez
- Neurology Department, Complex Hospitalari Universitari Moisès Broggi, Sant Joan Despí, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Spain
| | - Carla Avellaneda-Gómez
- Neurology Department, Complex Hospitalari Universitari Moisès Broggi, Sant Joan Despí, Spain
| | - Maria Àngels Font
- Neurology Department, Complex Hospitalari Universitari Moisès Broggi, Sant Joan Despí, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Spain
| | - Caterina Montull
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Spain
- Radiology Department, Complex Hospitalari Universitari Moisès Broggi, Sant Joan Despí, Spain
| | - Laura Castrillo
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Spain
- Radiology Department, Complex Hospitalari Universitari Moisès Broggi, Sant Joan Despí, Spain
| | - Pedro Blanch
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Spain
- Cardiology Department, Complex Hospitalari Universitari Moisès Broggi, Sant Joan Despí, Spain
| | - Pere Castellanos
- Internal Medicine Department, Complex Hospitalari Universitari Moisès Broggi, Sant Joan Despí, Spain
| | - Mercè Lleixa
- Neurology Department, Complex Hospitalari Universitari Moisès Broggi, Sant Joan Despí, Spain
| | - Montserrat Martín-Baranera
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Spain
- Epidemiology Department, Complex Hospitalari Universitari Moisès Broggi, Sant Joan Despí, Spain
- Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Pedro Armario
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Spain
- Internal Medicine Department, Complex Hospitalari Universitari Moisès Broggi, Sant Joan Despí, Spain
- Universitat de Barcelona, Barcelona, Spain
| | - Manuel Gómez-Choco
- Neurology Department, Complex Hospitalari Universitari Moisès Broggi, Sant Joan Despí, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Spain
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Wheeler KV, Irimia A, Braskie MN. Using Neuroimaging to Study Cerebral Amyloid Angiopathy and Its Relationship to Alzheimer's Disease. J Alzheimers Dis 2024; 97:1479-1502. [PMID: 38306032 DOI: 10.3233/jad-230553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Cerebral amyloid angiopathy (CAA) is characterized by amyloid-β aggregation in the media and adventitia of the leptomeningeal and cortical blood vessels. CAA is one of the strongest vascular contributors to Alzheimer's disease (AD). It frequently co-occurs in AD patients, but the relationship between CAA and AD is incompletely understood. CAA may drive AD risk through damage to the neurovascular unit and accelerate parenchymal amyloid and tau deposition. Conversely, early AD may also drive CAA through cerebrovascular remodeling that impairs blood vessels from clearing amyloid-β. Sole reliance on autopsy examination to study CAA limits researchers' ability to investigate CAA's natural disease course and the effect of CAA on cognitive decline. Neuroimaging allows for in vivo assessment of brain function and structure and can be leveraged to investigate CAA staging and explore its associations with AD. In this review, we will discuss neuroimaging modalities that can be used to investigate markers associated with CAA that may impact AD vulnerability including hemorrhages and microbleeds, blood-brain barrier permeability disruption, reduced cerebral blood flow, amyloid and tau accumulation, white matter tract disruption, reduced cerebrovascular reactivity, and lowered brain glucose metabolism. We present possible areas for research inquiry to advance biomarker discovery and improve diagnostics.
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Affiliation(s)
- Koral V Wheeler
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina Del Rey, CA, USA
| | - Andrei Irimia
- Ethel Percy Andrus Gerontology Center, USC Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
- Department of Biomedical Engineering, Corwin D. Denney Research Center, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA
| | - Meredith N Braskie
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina Del Rey, CA, USA
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Yektay Farahmand M, Wasselius J, Englund E, Braverman I, Puschmann A, Ilinca A. Small vessel disease in primary familial brain calcification with novel truncating PDGFB variants. Neurol Neurochir Pol 2023; 58:94-105. [PMID: 38156729 DOI: 10.5603/pjnns.97716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/06/2023] [Accepted: 12/08/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION Primary familial brain calcification (PFBC) is a neurodegenerative disease characterised by bilateral calcification in the brain, especially in the basal ganglia, leading to neurological and neuropsychiatric manifestations. White matter hyperintensities (WMH) have been described in patients with PFBC and pathogenic variants in the gene for platelet-derived growth factor beta polypeptide (PDGFB), suggesting a manifest cerebrovascular process. We present below the cases of two PFBC families with PDGFB variants and stroke or transient ischaemic attack (TIA) episodes. We examine the possible correlation between PFBC and vascular events as stroke/TIA, and evaluate whether signs for vascular disease in this condition are systemic or limited to the cerebral vessels. MATERIAL AND METHODS Two Swedish families with novel truncating PDGFB variants, p.Gln140* and p.Arg191*, are described clinically and radiologically. Subcutaneous capillary vessels in affected and unaffected family members were examined by light and electron microscopy. RESULTS All mutation carriers showed WMH and bilateral brain calcifications. The clinical presentations differed, with movement disorder symptoms dominating in family A, and psychiatric symptoms in family B. However, affected members of both families had stroke, TIA, and/or asymptomatic intracerebral ischaemic lesions. Only one of the patients had classical vascular risk factors. Skin microvasculature was normal. CONCLUSIONS Patients with these PDGFB variants develop microvascular changes in the brain, but not the skin. PDGFB-related small vessel disease can manifest radiologically as cerebral haemorrhage or ischaemia, and may explain TIA or stroke in patients without other vascular risk factors.
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Affiliation(s)
- Maha Yektay Farahmand
- Division of Neurology, Department for Clinical Sciences, Lund University, Lund, Sweden
- Department of Neurology, Skåne University Hospital, Malmö, Sweden
| | - Johan Wasselius
- Section of Neuroradiology, Skåne University Hospital, Lund, Sweden
| | - Elisabet Englund
- Division of Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Irwin Braverman
- Department of Dermatology, Yale University Medical School, New Haven, Connecticut, USA
| | - Andreas Puschmann
- Division of Neurology, Department for Clinical Sciences, Lund University, Lund, Sweden
- Department of Neurology, Skåne University Hospital, Malmö, Sweden
- SciLifeLab National Research Infrastructure, Sweden
| | - Andreea Ilinca
- Division of Neurology, Department for Clinical Sciences, Lund University, Lund, Sweden.
- Department of Neurology, Skåne University Hospital, Malmö, Sweden.
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Lim J, Lee K, Kim BJ, Ryu W, Chung J, Gwak D, Lee JS, Kim S, Ko E, Lee J, Han M, Smith EE, Kim D, Bae H. Nonhypertensive White Matter Hyperintensities in Stroke: Risk Factors, Neuroimaging Characteristics, and Prognosis. J Am Heart Assoc 2023; 12:e030515. [PMID: 38014679 PMCID: PMC10727348 DOI: 10.1161/jaha.123.030515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 11/03/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND This study explored the risk factors, neuroimaging features, and prognostic implications of nonhypertensive white matter hyperintensity (WMH) in patients with acute ischemic stroke and transient ischemic attack. METHODS AND RESULTS We included 2283 patients with hypertension and 1003 without from a pool of 10 602. Associations of moderate-to-severe WMH with known risk factors, functional outcome, and a composite of recurrent stroke, myocardial infarction, and all-cause mortality were evaluated. A subset of 351 patients without hypertension and age- and sex-matched pairs with hypertension and moderate-to-severe WMH was created for a detailed topographic examination of WMH, lacunes, and microbleeds. Approximately 35% of patients without hypertension and 65% of patients with hypertensive stroke exhibited moderate-to-severe WMH. WMH was associated with age, female sex, and previous stroke, irrespective of hypertension. In patients without hypertension, WMH was associated with initial systolic blood pressure and was more common in the anterior temporal region. In patients with hypertension, WMH was associated with small vessel occlusion as a stroke mechanism and was more frequent in the periventricular region near the posterior horn of the lateral ventricle. The higher prevalence of occipital microbleeds in patients without hypertension and deep subcortical lacunes in patients with hypertension were also observed. Associations of moderate-to-severe WMH with 3-month functional outcome and 1-year cumulative incidence of the composite outcome were significant (both P<0.01), although the latter lost significance after adjustments. The associations between WMH and outcomes were consistent across hypertensive status. CONCLUSIONS One-third of patients without hypertension with stroke have moderate-to-severe WMH. The pathogenesis of WMH may differ between patients without and with hypertension, but its impact on outcome appears similar.
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Affiliation(s)
- Jae‐Sung Lim
- Department of Neurology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea
| | - Keon‐Joo Lee
- Department of NeurologyKorea University Guro Hospital, Korea University College of MedicineSeoulRepublic of Korea
| | - Beom Joon Kim
- Department of NeurologySeoul National University Bundang Hospital, Seoul National University College of MedicineSeongnamRepublic of Korea
| | | | - Jinyong Chung
- Medical Science Research CenterDongguk University Medical CenterGoyangRepublic of Korea
| | - Dong‐Seok Gwak
- Department of NeurologyDongguk University Ilsan Hospital, Dongguk University College of MedicineGoyangRepublic of Korea
| | - Ji Sung Lee
- Clinical Research CenterAsan Institute for Life Sciences, Asan Medical CenterSeoulRepublic of Korea
| | - Seong‐Eun Kim
- Department of NeurologySeoul National University Bundang Hospital, Seoul National University College of MedicineSeongnamRepublic of Korea
| | - Eunvin Ko
- Department of BiostatisticsKorea UniversitySeoulRepublic of Korea
| | - Juneyoung Lee
- Department of BiostatisticsKorea UniversitySeoulRepublic of Korea
| | - Moon‐Ku Han
- Department of NeurologySeoul National University Bundang Hospital, Seoul National University College of MedicineSeongnamRepublic of Korea
| | - Eric E. Smith
- Department of Clinical Neuroscience and Hotchkiss Brain Institute, Cumming School of MedicineUniversity of CalgaryCalgaryCanada
| | - Dong‐Eog Kim
- Department of NeurologyDongguk University Ilsan Hospital, Dongguk University College of MedicineGoyangRepublic of Korea
| | - Hee‐Joon Bae
- Department of NeurologySeoul National University Bundang Hospital, Seoul National University College of MedicineSeongnamRepublic of Korea
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Ikeda S, Saito S, Hosoki S, Tonomura S, Yamamoto Y, Ikenouchi H, Ishiyama H, Tanaka T, Hattori Y, Friedland RP, Carare RO, Kuriyama N, Yakushiji Y, Hara H, Koga M, Toyoda K, Nomura R, Takegami M, Nakano K, Ihara M. Harboring Cnm-expressing Streptococcus mutans in the oral cavity relates to both deep and lobar cerebral microbleeds. Eur J Neurol 2023; 30:3487-3496. [PMID: 36708081 DOI: 10.1111/ene.15720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 10/03/2022] [Accepted: 01/26/2023] [Indexed: 01/29/2023]
Abstract
BACKGROUND Cerebral microbleeds (CMBs) influence long-term prognoses of stroke patients. Streptococcus mutans expressing the collagen-binding protein Cnm induces cerebrovascular inflammation, impairing blood brain barrier integrity and causing cerebral bleeding. Here, we examine the association of Cnm-positive S. mutans with CMBs. METHODS Acute stroke patients were selected from a single-center registry database. Oral carriage of Cnm-positive or Cnm-negative S. mutans was determined using polymerase chain reaction assays. The associations of Cnm-positive S. mutans with CMB number and specifically the presence of >10 CMBs were examined using quasi-Poisson and logistic regression models, respectively. RESULTS This study included 3154 stroke patients, of which 428 patients (median [interquartile range] age, 73.0 [63.0-81.0] years; 269 men [62.9%]) underwent oral bacterial examinations. In total, 326 patients harbored S. mutans. After excluding four patients without imaging data, we compared patients with Cnm-positive (n = 72) and Cnm-negative (n = 250) S. mutans. Harboring Cnm-positive S. mutans was independently associated with the presence of >10 CMBs (adjusted odds ratio 2.20 [1.18-4.10]) and higher numbers of deep and lobar CMBs (adjusted risk ratio 1.61 [1.14-2.27] for deep; 5.14 [2.78-9.51] for lobar), but not infratentorial CMBs, after adjusting for age, sex, hypertension, stroke type, National Institutes of Health Stroke Scale score, and cerebral amyloid angiopathy. CONCLUSIONS Harboring Cnm-positive S. mutans was independently associated with a higher number of CMBs in deep and lobar locations. Reducing Cnm-positive S. mutans in the oral cavity may serve as a novel therapeutic approach for stroke.
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Affiliation(s)
- Shuhei Ikeda
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
- Division of Neurology, Department of Internal Medicine, Saga University Faculty of Medicine, Saga, Japan
| | - Satoshi Saito
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
- Department of Pediatric Dentistry, Osaka University Graduate School of Dentistry, Suita, Japan
- Clinical and Experimental Sciences, University of Southampton, Southampton, UK
| | - Satoshi Hosoki
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Shuichi Tonomura
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
- Department of Neurology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yumi Yamamoto
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hajime Ikenouchi
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hiroyuki Ishiyama
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Tomotaka Tanaka
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yorito Hattori
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Robert P Friedland
- Department of Neurology, University of Louisville, Louisville, Kentucky, USA
| | - Roxana O Carare
- Clinical and Experimental Sciences, University of Southampton, Southampton, UK
| | - Nagato Kuriyama
- Shizuoka Graduate University of Public Health, Shizuoka, Japan
- Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yusuke Yakushiji
- Division of Neurology, Department of Internal Medicine, Saga University Faculty of Medicine, Saga, Japan
- Department of Neurology, Kansai Medical University Medical Center, Hirakata, Japan
| | - Hideo Hara
- Division of Neurology, Department of Internal Medicine, Saga University Faculty of Medicine, Saga, Japan
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Ryota Nomura
- Department of Pediatric Dentistry, Osaka University Graduate School of Dentistry, Suita, Japan
- Department of Pediatric Dentistry, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Misa Takegami
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kazuhiko Nakano
- Department of Pediatric Dentistry, Osaka University Graduate School of Dentistry, Suita, Japan
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
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Zedde M, Grisendi I, Assenza F, Vandelli G, Napoli M, Moratti C, Lochner P, Seiffge DJ, Piazza F, Valzania F, Pascarella R. The Venular Side of Cerebral Amyloid Angiopathy: Proof of Concept of a Neglected Issue. Biomedicines 2023; 11:2663. [PMID: 37893037 PMCID: PMC10604278 DOI: 10.3390/biomedicines11102663] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/23/2023] [Accepted: 09/25/2023] [Indexed: 10/29/2023] Open
Abstract
Small vessel diseases (SVD) is an umbrella term including several entities affecting small arteries, arterioles, capillaries, and venules in the brain. One of the most relevant and prevalent SVDs is cerebral amyloid angiopathy (CAA), whose pathological hallmark is the deposition of amyloid fragments in the walls of small cortical and leptomeningeal vessels. CAA frequently coexists with Alzheimer's Disease (AD), and both are associated with cerebrovascular events, cognitive impairment, and dementia. CAA and AD share pathophysiological, histopathological and neuroimaging issues. The venular involvement in both diseases has been neglected, although both animal models and human histopathological studies found a deposition of amyloid beta in cortical venules. This review aimed to summarize the available information about venular involvement in CAA, starting from the biological level with the putative pathomechanisms of cerebral damage, passing through the definition of the peculiar angioarchitecture of the human cortex with the functional organization and consequences of cortical arteriolar and venular occlusion, and ending to the hypothesized links between cortical venular involvement and the main neuroimaging markers of the disease.
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Affiliation(s)
- Marialuisa Zedde
- Neurology Unit, Stroke Unit, AUSL-IRCCS di Reggio Emilia, Via Amendola 2, 42122 Reggio Emilia, Italy
| | - Ilaria Grisendi
- Neurology Unit, Stroke Unit, AUSL-IRCCS di Reggio Emilia, Via Amendola 2, 42122 Reggio Emilia, Italy
| | - Federica Assenza
- Neurology Unit, Stroke Unit, AUSL-IRCCS di Reggio Emilia, Via Amendola 2, 42122 Reggio Emilia, Italy
| | - Gabriele Vandelli
- Neurology Unit, Stroke Unit, AUSL-IRCCS di Reggio Emilia, Via Amendola 2, 42122 Reggio Emilia, Italy
| | - Manuela Napoli
- Neuroradiology Unit, AUSL-IRCCS di Reggio Emilia, Via Amendola 2, 42122 Reggio Emilia, Italy
| | - Claudio Moratti
- Neuroradiology Unit, AUSL-IRCCS di Reggio Emilia, Via Amendola 2, 42122 Reggio Emilia, Italy
| | - Piergiorgio Lochner
- Department of Neurology, Saarland University Medical Center, 66421 Homburg, Germany;
| | - David J. Seiffge
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Fabrizio Piazza
- CAA and AD Translational Research and Biomarkers Laboratory, School of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, Italy;
| | - Franco Valzania
- Neurology Unit, Stroke Unit, AUSL-IRCCS di Reggio Emilia, Via Amendola 2, 42122 Reggio Emilia, Italy
| | - Rosario Pascarella
- Neuroradiology Unit, AUSL-IRCCS di Reggio Emilia, Via Amendola 2, 42122 Reggio Emilia, Italy
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Theodorou A, Palaiodimou L, Papagiannopoulou G, Kargiotis O, Psychogios K, Safouris A, Bakola E, Chondrogianni M, Kotsali-Peteinelli V, Melanis K, Tsibonakis A, Andreadou E, Vasilopoulou S, Lachanis S, Velonakis G, Tzavellas E, Tzartos JS, Voumvourakis K, Paraskevas GP, Tsivgoulis G. Clinical Characteristics, Neuroimaging Markers, and Outcomes in Patients with Cerebral Amyloid Angiopathy: A Prospective Cohort Study. J Clin Med 2023; 12:5591. [PMID: 37685658 PMCID: PMC10488273 DOI: 10.3390/jcm12175591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/23/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
Background and purpose: Sporadic cerebral amyloid angiopathy (CAA) is a small vessel disease, resulting from progressive amyloid-β deposition in the media/adventitia of cortical and leptomeningeal arterioles. We sought to assess the prevalence of baseline characteristics, clinical and radiological findings, as well as outcomes among patients with CAA, in the largest study to date conducted in Greece. Methods: Sixty-eight patients fulfilling the Boston Criteria v1.5 for probable/possible CAA were enrolled and followed for at least twelve months. Magnetic Resonance Imaging was used to assess specific neuroimaging markers. Data regarding cerebrospinal fluid biomarker profile and Apolipoprotein-E genotype were collected. Multiple logistic regression analyses were performed to identify predictors of clinical phenotypes. Cox-proportional hazard regression models were used to calculate associations with the risk of recurrent intracerebral hemorrhage (ICH). Results: Focal neurological deficits (75%), cognitive decline (57%), and transient focal neurological episodes (TFNEs; 21%) were the most common clinical manifestations. Hemorrhagic lesions, including lobar cerebral microbleeds (CMBs; 93%), cortical superficial siderosis (cSS; 48%), and lobar ICH (43%) were the most prevalent neuroimaging findings. cSS was independently associated with the likelihood of TFNEs at presentation (OR: 4.504, 95%CI:1.258-19.088), while multiple (>10) lobar CMBs were independently associated with cognitive decline at presentation (OR:5.418, 95%CI:1.316-28.497). cSS emerged as the only risk factor of recurrent ICH (HR:4.238, 95%CI:1.509-11.900) during a median follow-up of 20 months. Conclusions: cSS was independently associated with TFNEs at presentation and ICH recurrence at follow-up, while a higher burden of lobar CMBs with cognitive decline at baseline. These findings highlight the prognostic value of neuroimaging markers, which may influence clinical decision-making.
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Affiliation(s)
- Aikaterini Theodorou
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.T.); (L.P.); (G.P.); (E.B.); (M.C.); (V.K.-P.); (K.M.); (A.T.); (J.S.T.); (K.V.); (G.P.P.)
| | - Lina Palaiodimou
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.T.); (L.P.); (G.P.); (E.B.); (M.C.); (V.K.-P.); (K.M.); (A.T.); (J.S.T.); (K.V.); (G.P.P.)
| | - Georgia Papagiannopoulou
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.T.); (L.P.); (G.P.); (E.B.); (M.C.); (V.K.-P.); (K.M.); (A.T.); (J.S.T.); (K.V.); (G.P.P.)
| | - Odysseas Kargiotis
- Stroke Unit, Metropolitan Hospital, 18547 Piraeus, Greece; (O.K.); (K.P.); (A.S.)
| | - Klearchos Psychogios
- Stroke Unit, Metropolitan Hospital, 18547 Piraeus, Greece; (O.K.); (K.P.); (A.S.)
| | - Apostolos Safouris
- Stroke Unit, Metropolitan Hospital, 18547 Piraeus, Greece; (O.K.); (K.P.); (A.S.)
| | - Eleni Bakola
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.T.); (L.P.); (G.P.); (E.B.); (M.C.); (V.K.-P.); (K.M.); (A.T.); (J.S.T.); (K.V.); (G.P.P.)
| | - Maria Chondrogianni
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.T.); (L.P.); (G.P.); (E.B.); (M.C.); (V.K.-P.); (K.M.); (A.T.); (J.S.T.); (K.V.); (G.P.P.)
| | - Vasiliki Kotsali-Peteinelli
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.T.); (L.P.); (G.P.); (E.B.); (M.C.); (V.K.-P.); (K.M.); (A.T.); (J.S.T.); (K.V.); (G.P.P.)
| | - Konstantinos Melanis
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.T.); (L.P.); (G.P.); (E.B.); (M.C.); (V.K.-P.); (K.M.); (A.T.); (J.S.T.); (K.V.); (G.P.P.)
| | - Athanasios Tsibonakis
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.T.); (L.P.); (G.P.); (E.B.); (M.C.); (V.K.-P.); (K.M.); (A.T.); (J.S.T.); (K.V.); (G.P.P.)
| | - Elissavet Andreadou
- First Department of Neurology, “Eginition” Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (E.A.); (S.V.)
| | - Sofia Vasilopoulou
- First Department of Neurology, “Eginition” Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (E.A.); (S.V.)
| | - Stefanos Lachanis
- Iatropolis Magnetic Resonance Diagnostic Centre, 15231 Athens, Greece;
| | - Georgios Velonakis
- Second Department of Radiology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece;
| | - Elias Tzavellas
- First Department of Psychiatry, “Aiginition” Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece;
| | - John S. Tzartos
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.T.); (L.P.); (G.P.); (E.B.); (M.C.); (V.K.-P.); (K.M.); (A.T.); (J.S.T.); (K.V.); (G.P.P.)
| | - Konstantinos Voumvourakis
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.T.); (L.P.); (G.P.); (E.B.); (M.C.); (V.K.-P.); (K.M.); (A.T.); (J.S.T.); (K.V.); (G.P.P.)
| | - Georgios P. Paraskevas
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.T.); (L.P.); (G.P.); (E.B.); (M.C.); (V.K.-P.); (K.M.); (A.T.); (J.S.T.); (K.V.); (G.P.P.)
| | - Georgios Tsivgoulis
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.T.); (L.P.); (G.P.); (E.B.); (M.C.); (V.K.-P.); (K.M.); (A.T.); (J.S.T.); (K.V.); (G.P.P.)
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN 38163, USA
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9
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Jaime Garcia D, Chagnot A, Wardlaw JM, Montagne A. A Scoping Review on Biomarkers of Endothelial Dysfunction in Small Vessel Disease: Molecular Insights from Human Studies. Int J Mol Sci 2023; 24:13114. [PMID: 37685924 PMCID: PMC10488088 DOI: 10.3390/ijms241713114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 08/19/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023] Open
Abstract
Small vessel disease (SVD) is a highly prevalent disorder of the brain's microvessels and a common cause of dementia as well as ischaemic and haemorrhagic strokes. Though much about the underlying pathophysiology of SVD remains poorly understood, a wealth of recently published evidence strongly suggests a key role of microvessel endothelial dysfunction and a compromised blood-brain barrier (BBB) in the development and progression of the disease. Understanding the causes and downstream consequences associated with endothelial dysfunction in this pathological context could aid in the development of effective diagnostic and prognostic tools and provide promising avenues for potential therapeutic interventions. In this scoping review, we aim to summarise the findings from clinical studies examining the role of the molecular mechanisms underlying endothelial dysfunction in SVD, focussing on biochemical markers of endothelial dysfunction detectable in biofluids, including cell adhesion molecules, BBB transporters, cytokines/chemokines, inflammatory markers, coagulation factors, growth factors, and markers involved in the nitric oxide cascade.
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Affiliation(s)
- Daniela Jaime Garcia
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4SB, UK; (D.J.G.); (J.M.W.)
- UK Dementia Research Institute, University of Edinburgh, Edinburgh EH16 4SB, UK;
| | - Audrey Chagnot
- UK Dementia Research Institute, University of Edinburgh, Edinburgh EH16 4SB, UK;
| | - Joanna M. Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4SB, UK; (D.J.G.); (J.M.W.)
- UK Dementia Research Institute, University of Edinburgh, Edinburgh EH16 4SB, UK;
| | - Axel Montagne
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4SB, UK; (D.J.G.); (J.M.W.)
- UK Dementia Research Institute, University of Edinburgh, Edinburgh EH16 4SB, UK;
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10
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Chen SY, Chen HC, Chen TB. Rapid Progressive Fatal Acute Hemorrhagic Encephalomyelitis. Diagnostics (Basel) 2023; 13:2481. [PMID: 37568845 PMCID: PMC10417807 DOI: 10.3390/diagnostics13152481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 08/13/2023] Open
Abstract
Acute hemorrhagic encephalomyelitis (AHEM) is the most severe form of acute disseminated encephalomyelitis (ADEM). Patients with AHEM usually have unfavorable outcomes with high mortality rate. We reported a middle-aged male, who was diagnosed with AHEM and died 35 days after admission even under intensive immune therapy. Clinical courses were recorded and serial MR images were demonstrated to illustrate the rapidly changes in brain parenchyma. By highlighting these aspects, we hope to provide valuable insights for future studies and potential advancements in the management of AHEM.
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Affiliation(s)
- Ssu-Yu Chen
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan;
| | - Hung-Chieh Chen
- Division of Neuroradiology, Department of Radiology, Taichung Veterans General Hospital, Taichung 407219, Taiwan
- School of Medicine, National Yang-Ming Chiao Tung University, Taipei 112304, Taiwan;
| | - Ting-Bin Chen
- School of Medicine, National Yang-Ming Chiao Tung University, Taipei 112304, Taiwan;
- Department of Neurology, Neurological Institute, Taichung Veterans General Hospital, Taichung 407219, Taiwan
- Dementia and Parkinson’s Disease Integrated Center, Taichung Veterans General Hospital, Taichung 407219, Taiwan
- Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung 407219, Taiwan
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11
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Puy L, Rauch A, Deramecourt V, Cordonnier C, Bérézowski V. Acute Microbleeds and Microinfarcts Within the Perihematomal Area After Intracerebral Hemorrhage. Stroke 2023; 54:e58-e62. [PMID: 36779341 DOI: 10.1161/strokeaha.122.040908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
BACKGROUND To further our understanding of the pathophysiology of spontaneous intracerebral hemorrhage (ICH) and related injury, we provided a postmortem neuropathological examination of acute microvascular lesions (microbleeds and microinfarcts) within the perihematomal area. METHODS We included all consecutive cases (2005-2019) from the Lille University Hospital brain bank of ICH patients who died within the first month. Paraffin-embedded tissue sections from the perihematomal area were processed for several stainings and immunolabelings to investigate the presence of acute microbleeds and microinfarcts in the perihematomal area and to characterize surrounding neuronal and systemic inflammatory reaction (macrophages and neutrophils). RESULTS We included 14 ICH cases (median age, 78 years; 10 females). Acute microbleeds were observed in the perihematomal area in 12/14 patients (86%, ranging from 1 through >10) and microinfarcts in 5/14 (36%, ranging from 1 through 4). Microbleeds were observed whatever the delay from ICH onset to death was, while most cases with acute microinfarcts were observed between day 3 and day 7 (n=3/5). Both lesions were characterized by an abundant accumulation of systemic inflammatory cells and necrotic areas. CONCLUSIONS Acute microbleeds and microinfarcts might contribute to the propagation of secondary brain tissue damages after ICH. Our examinations also question the potential role of massive systemic inflammatory cells recruitment in the genesis of these microvascular injuries.
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Affiliation(s)
- Laurent Puy
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000 Lille, France (L.P., A.R., V.D., C.C., V.B.)
| | - Antoine Rauch
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000 Lille, France (L.P., A.R., V.D., C.C., V.B.).,Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011- EGID, Lille, France (A.R.)
| | - Vincent Deramecourt
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000 Lille, France (L.P., A.R., V.D., C.C., V.B.).,Institute of Pathology, Centre de Biologie Pathologie, Lille University Hospital, Lille, France (V.D.)
| | - Charlotte Cordonnier
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000 Lille, France (L.P., A.R., V.D., C.C., V.B.)
| | - Vincent Bérézowski
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000 Lille, France (L.P., A.R., V.D., C.C., V.B.).,UArtois, Lens, France (V.B.)
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12
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Ambi A, Stanisavljevic A, Victor TW, Lowery AW, Davis J, Van Nostrand WE, Miller LM. Evaluation of Copper Chelation Therapy in a Transgenic Rat Model of Cerebral Amyloid Angiopathy. ACS Chem Neurosci 2023; 14:378-388. [PMID: 36651175 DOI: 10.1021/acschemneuro.2c00483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Cerebral amyloid angiopathy (CAA) is characterized by the accumulation of the amyloid β (Aβ) protein in blood vessels and leads to hemorrhages, strokes, and dementia in elderly individuals. Recent reports have shown elevated copper levels colocalized with vascular amyloid in human CAA and Alzheimer's disease patients, which have been suggested to contribute to cytotoxicity through the formation of reactive oxygen species. Here, we treated a transgenic rat model of CAA (rTg-DI) with the copper-specific chelator, tetrathiomolybdate (TTM), via intraperitoneal (IP) administration for 6 months to determine if it could lower copper content in vascular amyloid deposits and modify CAA pathology. Results showed that TTM treatment led to elevated Aβ load in the hippocampus of the rTg-DI rats and increased microbleeds in the wild type (WT) animals. X-ray fluorescence microscopy was performed to image the distribution of copper and revealed a surprising increase in copper colocalized with Aβ aggregates in TTM-treated rTg-DI rats. Unexpectedly, we also found an increase in the copper content in unaffected vessels of both rTg-DI and WT animals. These results show that IP administration of TTM was ineffective in removing copper from vascular Aβ aggregates in vivo and increased the development of disease pathology in CAA.
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Affiliation(s)
- Ashwin Ambi
- Department of Chemistry, Stony Brook University, Stony Brook, New York 11794, United States.,National Synchrotron Light Source II, Brookhaven National Laboratory, Upton, New York 11973, United States
| | - Aleksandra Stanisavljevic
- George & Anne Ryan Institute for Neuroscience, University of Rhode Island, Kingston, Rhode Island 02881, United States.,Department of Biomedical & Pharmaceutical Sciences, University of Rhode Island, Kingston, Rhode Island 02881, United States
| | - Tiffany W Victor
- National Synchrotron Light Source II, Brookhaven National Laboratory, Upton, New York 11973, United States
| | - Adam W Lowery
- National Synchrotron Light Source II, Brookhaven National Laboratory, Upton, New York 11973, United States.,Department of Mechanical Engineering, Virginia Tech, Blacksburg, Virginia 24060, United States
| | - Judianne Davis
- George & Anne Ryan Institute for Neuroscience, University of Rhode Island, Kingston, Rhode Island 02881, United States.,Department of Biomedical & Pharmaceutical Sciences, University of Rhode Island, Kingston, Rhode Island 02881, United States
| | - William E Van Nostrand
- George & Anne Ryan Institute for Neuroscience, University of Rhode Island, Kingston, Rhode Island 02881, United States.,Department of Biomedical & Pharmaceutical Sciences, University of Rhode Island, Kingston, Rhode Island 02881, United States
| | - Lisa M Miller
- Department of Chemistry, Stony Brook University, Stony Brook, New York 11794, United States.,National Synchrotron Light Source II, Brookhaven National Laboratory, Upton, New York 11973, United States
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13
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Shinohara M, Matsuda K, Ii Y, Tabei KI, Nakamura N, Hirata Y, Ishikawa H, Matsuyama H, Matsuura K, Maeda M, Tomimoto H, Shindo A. Association between behavioral and psychological symptoms and cerebral small vessel disease MRI findings in memory clinic patients. Front Aging Neurosci 2023; 15:1143834. [PMID: 37032819 PMCID: PMC10079999 DOI: 10.3389/fnagi.2023.1143834] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 03/08/2023] [Indexed: 04/11/2023] Open
Abstract
Objectives Cerebral small vessel disease (SVD) is commonly observed among elderly individuals with cognitive impairment and has been recognized as a vascular contributor to dementia and behavioral and psychological symptoms (BPS), however, the relationship between BPS and SVD burden remains unclear. Methods We prospectively recruited 42 patients with mild cognitive impairment (MCI) or mild dementia from the memory clinic in our hospital, who were assigned to either a clinical dementia rating (CDR) of 0.5 or 1.0, respectively. The presence of BPS was determined through interviews with caregivers. The patients underwent brain MRI and three types of SVD scores, total, cerebral amyloid angiopathy (CAA), and modified CAA, were assigned. Patients were also evaluated through various neuropsychological assessments. Results The CDR was significantly higher in patients with BPS (p = 0.001). The use of antihypertensive agents was significantly higher in patients without BPS (p = 0.038). The time taken to complete trail making test set-A was also significantly longer in patients with BPS (p = 0.037). There was no significant difference in total SVD and CAA-SVD score (p = 0.745, and 0.096) and the modified CAA-SVD score was significantly higher in patients with BPS (p = 0.046). In addition, the number of total CMBs and lobar CMBs was significantly higher in patients with BPS (p = 0.001 and 0.001). Receiver operating characteristic curves for BPS showed that for modified CAA-SVD, a cutoff score of 3.5 showed 46.7% sensitivity and 81.5% specificity. Meanwhile, for the total number of cerebral microbleeds (CMBs), a cut-off score of 2.5 showed 80.0% sensitivity and 77.8% specificity and for the number of lobar CMBs, a cut-off score of 2.5 showed 73.3% sensitivity and 77.8% specificity. Conclusion Overall, patients with BPS showed worse CDRs, reduced psychomotor speed, higher modified CAA-SVD scores, larger numbers of total and lobar CMBs. We propose that severe modified CAA scores and higher numbers of total and lobar CMBs are potential risk factors for BPS in patients with mild dementia or MCI. Therefore, by preventing these MRI lesions, the risk of BPS may be mitigated.
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Affiliation(s)
- Masaki Shinohara
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Kana Matsuda
- Department of Dementia Prevention and Therapeutics, Mie University Graduate School of Medicine, Tsu, Japan
| | - Yuichiro Ii
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Ken-ichi Tabei
- School of Industrial Technology, Advanced Institute of Industrial Technology, Tokyo Metropolitan Public University Corporation, Tokyo, Japan
| | - Naoko Nakamura
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Yoshinori Hirata
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Hidehiro Ishikawa
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Hirofumi Matsuyama
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Keita Matsuura
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Masayuki Maeda
- Department of Neuroradiology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Hidekazu Tomimoto
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Akihiro Shindo
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Japan
- Department of Dementia Prevention and Therapeutics, Mie University Graduate School of Medicine, Tsu, Japan
- *Correspondence: Akihiro Shindo,
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14
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Abstract
Cerebral small vessel disease (CSVD) encompasses a broad clinical spectrum united by pathology of the small vessels of the brain. CSVD is commonly identified using brain magnetic resonance imaging with well characterized markers including covert infarcts, white matter hyperintensities, enlarged perivascular spaces, and cerebral microbleeds. The pathophysiology of CSVD is complex involving genetic determinants, environmental factors, and their interactions. While the role of vascular risk factors in CSVD is well known and its management is pivotal in mitigating the clinical effects, recent research has identified novel genetic factors involved in CSVD. Delineating genetic determinants can promote the understanding of the disease and suggest effective treatments and preventive measures of CSVD at the individual level. Here we review CSVD focusing on recent advances in the genetics of CSVD. The knowledge gained has advanced understanding of the pathophysiology of CSVD, offered promising early results that may improve subtype identification of small vessel strokes, has led to additional identification of mendelian forms of small vessel strokes, and is getting closer to influencing clinical care through pharmacogenetic studies.
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Affiliation(s)
- Riwaj Bhagat
- Department of Neurology, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States
| | - Sandro Marini
- Department of Neurology, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States
| | - José R. Romero
- Department of Neurology, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States
- NHLBI’s Framingham Heart Study, Framingham, MA, United States
- *Correspondence: José R. Romero,
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15
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Yoon CW, Rha JH, Park HK, Park SH, Kwon S, Kim BC, Youn YC, Jeong JH, Han HJ, Choi SH. Sex differences in the progression of cerebral microbleeds in patients with concomitant cerebral small vessel disease. Front Neurol 2022; 13:1054624. [PMID: 36619919 PMCID: PMC9810543 DOI: 10.3389/fneur.2022.1054624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022] Open
Abstract
Background and purpose Sex differences in cerebral microbleeds (CMBs) are not well-known. We aimed to assess the impact of sex on the progression of CMBs. Methods The CHALLENGE (Comparison Study of Cilostazol and Aspirin on Changes in Volume of Cerebral Small Vessel Disease White Matter Changes) database was analyzed. Out of 256 subjects, 189 participants with a follow-up brain scan were included in the analysis. The linear mixed-effect model was used to compare the 2-year changes in the number of CMBs between men and women. Results A total of 65 men and 124 women were analyzed. There were no significant differences in the prevalence (70.8 vs. 71.8%; P = 1.000) and the median [interquartile range (IQR)] number of total CMBs [1 (0-7) vs. 2 (0-7); P = 0.810] at baseline between men and women. The median (IQR) increase over 2 years in the number of CMBs was statistically higher in women than in men [1 (0-2) vs. 0 (0-1), P = 0.026]. The multivariate linear mixed-effects model showed that women had a significantly greater increase in the number of total, deep, and lobar CMBs compared to men after adjusting for age and the baseline number of CMBs [estimated log-transformed mean of difference between women and men: 0.040 (P = 0.028) for total CMBs, 0.037 (P = 0.047) for deep CMBs, and 0.047 (P = 0.009) for lobar CMBs]. Conclusion The progression of CMB over 2 years was significantly greater in women than in men.
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Affiliation(s)
- Cindy W. Yoon
- Department of Neurology, Inha University School of Medicine, Incheon, Republic of Korea
| | - Joung-Ho Rha
- Department of Neurology, Inha University School of Medicine, Incheon, Republic of Korea
| | - Hee-Kwon Park
- Department of Neurology, Inha University School of Medicine, Incheon, Republic of Korea
| | - Soo-Hyun Park
- Department of Neurology, Inha University School of Medicine, Incheon, Republic of Korea
| | - Soonwook Kwon
- Department of Neurology, Inha University School of Medicine, Incheon, Republic of Korea
| | - Byeong C. Kim
- Department of Neurology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Young Chul Youn
- Department of Neurology, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Jee Hyang Jeong
- Department of Neurology, Ewha Womans University School of Medicine, Seoul, Republic of Korea
| | - Hyun Jeong Han
- Department of Neurology, Myongji Hospital, Hanyang University College of Medicine, Goyang, Republic of Korea
| | - Seong Hye Choi
- Department of Neurology, Inha University School of Medicine, Incheon, Republic of Korea,*Correspondence: Seong Hye Choi
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16
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Xie Z, Zhuang Y, Zhang Z, Liu J. Presence of cerebral microbleeds is associated with cognitive decline in acromegaly. Front Oncol 2022; 12:948971. [PMID: 36505847 PMCID: PMC9731478 DOI: 10.3389/fonc.2022.948971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 11/03/2022] [Indexed: 11/25/2022] Open
Abstract
Background Cognitive decline in acromegaly has gained increasing attention. Cerebral microbleeds (CMBs) as radiographic markers for microvascular injury have been linked to various types of cognitive decline. However, the association between CMB formation and acromegaly has not yet been quantified. This study is designed to investigate the prevalence and the radiographic patterns of CMBs and the association between cognitive function and acromegaly-related CMBs in growth hormone (GH)-secreting pituitary adenoma, which is characterized by acromegaly. Methods In a cohort of 55 patients with GH-secreting pituitary adenoma (acromegaly) and 70 healthy control (HC) patients, we determined the presence of CMBs using a 3.0-T MRI scanner. The numbers, locations, and grades of CMBs were determined via susceptibility-weighted imaging (SWI) and the Microbleed Anatomical Rating Scale. Obstructive sleep apnea (OSA) was assessed using the criteria of the American Academy of Sleep Medicine (AASM) Scoring Manual Version 2.2. The Montreal Cognitive Assessment (MoCA) was used to assess cognitive performance within 3 days of admission. The association between CMBs and cognitive function as well as clinical characteristics was explored. Results The incidence of CMBs was 29.1%, whereas that of OSA was 65.5% in acromegaly. There was a statistically significant difference in the prevalence of CMBs between subjects with and without acromegaly (29.1% and 5.3%, respectively) (p < 0.01). The age of acromegaly patients with CMBs was much younger compared with HCs with CMBs. Compared with HCs, a significant cognitive decline and the occurrence of OSA were demonstrated in patients with acromegaly (p < 0.01). Binary logistic regression analysis adjusted for age, education, and body mass index (BMI) revealed that CMB was an independent risk factor for cognitive impairment in patients with acromegaly (OR = 3.19, 95% CI 1.51-6.76, p = 0.002). Furthermore, in the logistic regression models adjusted for age, BMI, diabetes, and hypertension, OSA was independently associated with the occurrence of CMBs in patients with acromegaly (OR = 13.34, 95% CI 3.09-57.51, p = 0.001). Conclusions A significant increase of CMBs was demonstrated in patients with acromegaly, which may be a result of OSA in acromegaly. The present study indicated that increasing CMBs are responsible for cognitive decline in patients with acromegaly.
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Affiliation(s)
- Zhengxing Xie
- Department of Neurosurgery, The Affiliated Hospital of Jiangsu University, Zhenjiang, China,Neuro-Endoscope and Mini-Invasive Treatment Center, The Affiliated Hospital of Jiangsu University, Zhenjiang, China,Department of Neurosurgery, Wuxi No. 2 People’s Hospital, Wuxi, China,*Correspondence: Zhengxing Xie,
| | - Yan Zhuang
- Department of Neurosurgery, The Affiliated Hospital of Jiangsu University, Zhenjiang, China,Neuro-Endoscope and Mini-Invasive Treatment Center, The Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Zongqiang Zhang
- Department of Neurosurgery, Bingtuan Sishi Hospital, Yining, China
| | - Jieping Liu
- Department of Neurosurgery, The Affiliated Hospital of Jiangsu University, Zhenjiang, China,Neuro-Endoscope and Mini-Invasive Treatment Center, The Affiliated Hospital of Jiangsu University, Zhenjiang, China
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17
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Theodorou A, Palaiodimou L, Safouris A, Kargiotis O, Psychogios K, Kotsali-Peteinelli V, Foska A, Zouvelou V, Tzavellas E, Tzanetakos D, Zompola C, Tzartos JS, Voumvourakis K, Paraskevas GP, Tsivgoulis G. Cerebral Amyloid Angiopathy-Related Inflammation: A Single-Center Experience and a Literature Review. J Clin Med 2022; 11. [PMID: 36431207 DOI: 10.3390/jcm11226731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 11/04/2022] [Accepted: 11/08/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Limited data exist regarding the prevalence of clinical, neuroimaging, and genetic markers among patients diagnosed with Cerebral Amyloid Angiopathy−related inflammation (CAA-ri). We sought to determine these characteristics in patients diagnosed in our center and to summarize available literature published either as single-case reports or small case series (<5 patients). Methods: We reported our single-center experience of patients diagnosed with CAA-ri according to international criteria during a seven-year period (2015−2022), and we abstracted data from 90 previously published cases. Results: Seven patients (43% women, mean age 70 ± 13 years) were diagnosed with CAA-ri in our center. The most common symptom at presentation was focal neurological dysfunction (71%), and the most prevalent radiological finding was the presence of T2/FLAIR white matter hyperintensities (100%). All patients were treated with corticosteroids and had a favorable functional outcome. Among 90 previously published CAA-ri cases (51% women, mean age 70 ± 9 years), focal neurological dysfunction was the most common symptom (76%), followed by a cognitive decline (46%) and headache (34%). The most prevalent neuroimaging findings were cerebral microbleeds (85%), asymmetric T2/FLAIR white matter hyperintensities (81%), and gadolinium-enhancing T1-lesions (37%). Genetic testing for the Apolipoprotein-E gene was available in 27 cases; 59% carried the APOE ε4/ε4 genotype. The majority of the published CAA-ri cases (78%) received corticosteroid monotherapy, while 17 patients (19%) were treated with additional immunosuppressive treatment. Favorable functional outcome following treatment was documented in 70% of patients. Conclusion: Improving the vigilance of clinicians regarding the early recognition and accurate diagnosis of CAA-ri is crucial for swift therapy initiation, which may result in improved functional outcomes.
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Soyama S, Mano T, Yamada N, Iguchi N, Iwasa N, Sugie K. [A case of the palatal tremor that disappeared during swallowing, thought to be caused by microbleeds of bilateral dentate nucleus]. Rinsho Shinkeigaku 2022; 62:744-747. [PMID: 36031373 DOI: 10.5692/clinicalneurol.cn-001678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
A 72-year-old female presented with slowly progressive dysphonia, which was a syllable-separated utterance, for three years. She had the rhythmic continues contraction of palatal and uvula muscles during speech with a frequency of about 2 Hz. The videoendoscopy showed that the rhythmic contraction, which synchronized in the nasopharynx and the larynx, did not disappear during vocalization. The swallowing videofluorography showed that the rhythmic contraction disappeared transiently during the swallowing reflex, and there was no aspiration. The MRI revealed olivary pseudohypertrophy and multiple microbleedings including the bilateral dentate nucleus. The degeneration of olivary nucleus secondary to the bilateral asymptomatic dentate nucleus microbleedings within the dentato-rubro-olivary pathway was thought to be a cause of palatal tremor. This is a first report that a dynamic relation between vocalization and swallowing in palatal tremor.
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Affiliation(s)
- Shigeto Soyama
- Department of Medical Technology Center, Nara Medical University Hospital
| | - Tomoo Mano
- Department of Neurology, Nara Medical University
- Department of Rehabilitation Medicine, Nara Medical University
| | | | | | - Naoki Iwasa
- Department of Neurology, Nara Medical University
| | - Kazuma Sugie
- Department of Neurology, Nara Medical University
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19
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Dadar M, Zhernovaia M, Mahmoud S, Camicioli R, Maranzano J, Duchesne S. Using transfer learning for automated microbleed segmentation. Front Neuroimaging 2022; 1:940849. [PMID: 37555147 PMCID: PMC10406212 DOI: 10.3389/fnimg.2022.940849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/18/2022] [Indexed: 08/10/2023]
Abstract
INTRODUCTION Cerebral microbleeds are small perivascular hemorrhages that can occur in both gray and white matter brain regions. Microbleeds are a marker of cerebrovascular pathology and are associated with an increased risk of cognitive decline and dementia. Microbleeds can be identified and manually segmented by expert radiologists and neurologists, usually from susceptibility-contrast MRI. The latter is hard to harmonize across scanners, while manual segmentation is laborious, time-consuming, and subject to interrater and intrarater variability. Automated techniques so far have shown high accuracy at a neighborhood ("patch") level at the expense of a high number of false positive voxel-wise lesions. We aimed to develop an automated, more precise microbleed segmentation tool that can use standardizable MRI contrasts. METHODS We first trained a ResNet50 network on another MRI segmentation task (cerebrospinal fluid vs. background segmentation) using T1-weighted, T2-weighted, and T2* MRIs. We then used transfer learning to train the network for the detection of microbleeds with the same contrasts. As a final step, we employed a combination of morphological operators and rules at the local lesion level to remove false positives. Manual segmentation of microbleeds from 78 participants was used to train and validate the system. We assessed the impact of patch size, freezing weights of the initial layers, mini-batch size, learning rate, and data augmentation on the performance of the Microbleed ResNet50 network. RESULTS The proposed method achieved high performance, with a patch-level sensitivity, specificity, and accuracy of 99.57, 99.16, and 99.93%, respectively. At a per lesion level, sensitivity, precision, and Dice similarity index values were 89.1, 20.1, and 0.28% for cortical GM; 100, 100, and 1.0% for deep GM; and 91.1, 44.3, and 0.58% for WM, respectively. DISCUSSION The proposed microbleed segmentation method is more suitable for the automated detection of microbleeds with high sensitivity.
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Affiliation(s)
- Mahsa Dadar
- Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Maryna Zhernovaia
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Sawsan Mahmoud
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Richard Camicioli
- Department of Medicine, Division of Neurology, University of Alberta, Edmonton, AB, Canada
| | - Josefina Maranzano
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Simon Duchesne
- CERVO Brain Research Center, Quebec City, QC, Canada
- Department of Radiology and Nuclear Medicine, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
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20
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Taniguchi A, Shindo A, Tabei KI, Onodera O, Ando Y, Urabe T, Kimura K, Kitagawa K, Miyamoto Y, Takegami M, Ihara M, Mizuta I, Mizuno T, Tomimoto H. Imaging Characteristics for Predicting Cognitive Impairment in Patients With Cerebral Autosomal Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy. Front Aging Neurosci 2022; 14:876437. [PMID: 35754959 PMCID: PMC9226637 DOI: 10.3389/fnagi.2022.876437] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/06/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives Patients with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) show various clinical symptoms, including migraine, recurrent stroke, and cognitive impairment. We investigated the associations between magnetic resonance imaging (MRI) markers of small vessel disease and neuropsychological tests and identified the MRI characteristics for predicting cognitive impairment in patients with CADASIL. Methods Subjects included 60 CADASIL patients diagnosed with genetic tests and registered in the Japanese CADASIL REDCap database between June 2016 and December 2020. Patient information including clinical data, modified Rankin Scale (mRS); MRI findings of small vessel disease including periventricular and deep white matter lesions (WML), lacunar infarcts, and cerebral microbleeds (CMBs); and neuropsychological tests, including the Japanese version of the Mini-Mental State Examination (MMSE), the Japanese version of the Montreal Cognitive Assessment (MoCA-J), and the Frontal Assessment Battery (FAB), were evaluated. Results Data from 44 CADASIL patients were eligible for this study, compared between patients with and without dementia. Regarding the neuroimaging findings, the Fazekas score of periventricular and deep WML was higher in patients with dementia (periventricular, p = 0.003; deep, p = 0.009). The number of lacunar infarcts was higher in patients with dementia (p = 0.001). The standardized partial regression coefficient (SPRC) in MoCA-J was 0.826 (95% CI, 0.723-0.942; p = 0.005) for the number of CMBs. The SPRC in MMSE was 0.826 (95% CI, 0.719-0.949; p = 0.007) for the number of CMBs. The SPRC for FAB decreased significantly to 0.728 (95% CI, 0.551-0.960; p = 0.024) for the number of lacunar infarcts. Receiver operating characteristic (ROC) curves for dementia showed that in the number of lacunar infarcts, a cut-off score of 5.5 showed 90.9% sensitivity and 61.1% specificity. For the number of CMBs, a cut-off score of 18.5 showed 45.5% sensitivity and 100% specificity. Conclusion The characteristic MRI findings were that CADASIL patients with dementia had severe WML, both periventricular and deep, and a larger number of lacunar infarcts than those without dementia. The risk of dementia may be associated with ≥ 6 lacunar infarcts, ≥19 CMBs, or a Fazekas scale score of 3 in periventricular and deep WML.
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Affiliation(s)
- Akira Taniguchi
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Akihiro Shindo
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Ken-ichi Tabei
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Japan
- School of Industrial Technology, Advanced Institute of Industrial Technology, Tokyo Metropolitan Public University Corporation, Tokyo, Japan
| | - Osamu Onodera
- Department of Neurology, Clinical Neuroscience Branch, Brain Research Institute, Niigata University, Niigata, Japan
| | - Yukio Ando
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
- Department of Amyloidosis Research, Nagasaki International University, Nagasaki, Japan
| | - Takao Urabe
- Department of Neurology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Kazumi Kimura
- Department of Neurology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Kazuo Kitagawa
- Department of Neurology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Yoshihiro Miyamoto
- Open Innovation Center, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Misa Takegami
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Ikuko Mizuta
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Toshiki Mizuno
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hidekazu Tomimoto
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Japan
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21
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Ramusino MC, Vitali P, Anzalone N, Melazzini L, Lombardo FP, Farina LM, Bernini S, Costa A. Vascular Lesions and Brain Atrophy in Alzheimer's, Vascular and Mixed Dementia: An Optimized 3T MRI Protocol Reveals Distinctive Radiological Profiles. Curr Alzheimer Res 2022; 19:449-457. [PMID: 35726416 DOI: 10.2174/1567205019666220620112831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 05/10/2022] [Accepted: 05/17/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Vascular lesions may be a common finding also in Alzheimer's dementia, but their role on cognitive status is uncertain. OBJECTIVE The study aims to investigate their distribution in patients with Alzheimer's, vascular or mixed dementia and detect any distinctive neuroradiological profiles. METHODS Seventy-six subjects received a diagnosis of Alzheimer's (AD=32), vascular (VD=26) and mixed (MD=18) dementia. Three independent raters assessed the brain images acquired with an optimized 3T MRI protocol (including (3D FLAIR, T1, SWI, and 2D coronal T2 sequences) using semiquantitative scales for vascular lesions (periventricular lesions (PVL), deep white matter lesions (DWML), deep grey matter lesions (DGML), enlarged perivascular spaces (PVS), and microbleeds (MB)) and brain atrophy (medial temporal atrophy (MTA), posterior atrophy (PA), global cortical atrophy- frontal (GCA-F) and Evans' index). RESULTS Raters reached a good-to-excellent agreement for all scales (ICC ranging from 0.78-0.96). A greater number of PVL (p<0.001), DWML (p<0.001), DGML (p=0.010), and PVS (p=0.001) was observed in VD compared to AD, while MD showed a significant greater number of PVL (p=0.001), DWML (p=0.002), DGML (p=0.018), and deep and juxtacortical MB (p=0.006 and p<0.001, respectively). Comparing VD and MD, VD showed a higher number of PVS in basal ganglia and centrum semiovale (p=0.040), while MD showed more deep and juxtacortical MB (p=0.042 and p=0.022, respectively). No significant difference was observed in scores of cortical atrophy scales and Evans' index among the three groups. CONCLUSION The proposed MRI protocol represents a useful advancement in the diagnostic assessment of patients with cognitive impairment by more accurately detecting vascular lesions, mainly microbleeds, without a significant increase in time and resource expenditure. Our findings confirm that white and grey matter lesions predominate in vascular and mixed dementia, whereas deep and juxtacortical microbleeds predominate in mixed dementia, suggesting that cerebral amyloid angiopathy could be the main underlying pathology.
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Affiliation(s)
- Matteo Cotta Ramusino
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Unit of Behavioral Neurology, IRCCS Mondino Foundation, Pavia, Italy
| | - Paolo Vitali
- Department of Biomedical Sciences for Health, University of Milan, and Unit of Radiology, IRCCS Policlinico San Donato, Milan, Italy
| | | | - Luca Melazzini
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Francesca Paola Lombardo
- Advanced Imaging and Radiomics Center, Neuroradiology Department, IRCCS Mondino Foundation, Pavia, Italy
| | - Lisa Maria Farina
- Advanced Imaging and Radiomics Center, Neuroradiology Department, IRCCS Mondino Foundation, Pavia, Italy
| | - Sara Bernini
- Laboratory of Neuropsychology, IRCCS Mondino Foundation, Pavia, Italy
| | - Alfredo Costa
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Unit of Behavioral Neurology, IRCCS Mondino Foundation, Pavia, Italy
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22
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Yoneoka Y, Seki Y, Akiyama K. "Vascular" Korsakoff Syndrome With Bilaterally Damaged Mammillothalamic Tracts: Insights Into the Pathogenesis of "Acute" Korsakoff Syndrome As Acute-Onset Irreversible Anterograde Amnesia. Cureus 2021; 13:e19472. [PMID: 34912613 PMCID: PMC8664363 DOI: 10.7759/cureus.19472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2021] [Indexed: 11/24/2022] Open
Abstract
The structural pathogenesis of Wernicke-Korsakoff syndrome remains debatable. Wernicke encephalopathy is acute and often reversible whereas Korsakoff syndrome (KS) is chronic and may be irreversible. The cognitive deficits observed in KS are considered to be primarily due to damage to the anterior nucleus of the thalamus, mammillary bodies, and corpus callosum. We present an extremely rare case of non-alcoholic “vascular” KS (vKS) as acute-onset amnesia. A 97-year-old man living alone was brought to our hospital, complaining of sudden-onset behavioral changes with amnesia. Diffusion-weighted images (DWIs) showed fresh cerebral infarction in the right thalamus involving the right mammillothalamic tract (MTT). T2*-weighted images (T2*WIs), in addition, revealed a microbleed scar over the left MTT. This case supports the hypothesis that bilateral MTT dysfunction can lead to KS. Furthermore, in collaboration with a prior report about non-alcoholic “acute” KS due to cerebral infarction, this case supports the existence of vascular KS as an acute-onset amnestic syndrome, as well as insight into the pathogenesis of KS as an irreversible amnestic syndrome.
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Affiliation(s)
- Yuichiro Yoneoka
- Department of Neurosurgery, Uonuma Kikan Hospital, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minami-Uonuma, JPN
| | - Yasuhiro Seki
- Department of Neurosurgery, Uonuma Kikan Hospital, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minami-Uonuma, JPN
| | - Katsuhiko Akiyama
- Department of Neurosurgery, Uonuma Kikan Hospital, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minami-Uonuma, JPN
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23
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Környei BS, Szabó V, Perlaki G, Balogh B, Szabó Steigerwald DK, Nagy SA, Tóth L, Büki A, Dóczi T, Bogner P, Schwarcz A, Tóth A. Cerebral Microbleeds May Be Less Detectable by Susceptibility Weighted Imaging MRI From 24 to 72 Hours After Traumatic Brain Injury. Front Neurosci 2021; 15:711074. [PMID: 34658762 PMCID: PMC8514822 DOI: 10.3389/fnins.2021.711074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 08/12/2021] [Indexed: 01/26/2023] Open
Abstract
Purpose: A former rodent study showed that cerebral traumatic microbleeds (TMBs) may temporarily become invisible shortly after injury when detected by susceptibility weighted imaging (SWI). The present study aims to validate this phenomenon in human SWI. Methods: In this retrospective study, 46 traumatic brain injury (TBI) patients in various forms of severity were included and willingly complied with our strict selection criteria. Clinical parameters potentially affecting TMB count, Rotterdam and Marshall CT score, Mayo Clinic Classification, contusion number, and total volume were registered. The precise time between trauma and MRI [5 h 19 min to 141 h 54 min, including SWI and fluid-attenuated inversion recovery (FLAIR)] was individually recorded; TMB and FLAIR lesion counts were assessed. Four groups were created based on elapsed time between the trauma and MRI: 0–24, 24–48, 48–72, and >72 h. Kruskal–Wallis, ANOVA, Chi-square, and Fisher’s exact tests were used to reveal differences among the groups within clinical and imaging parameters; statistical power was calculated retrospectively for each comparison. Results: The Kruskal–Wallis ANOVA with Conover post hoc analysis showed significant (p = 0.01; 1−β > 0.9) median TMB number differences in the subacute period: 0–24 h = 4.00 (n = 11); 24–48 h = 1 (n = 14); 48–72 h = 1 (n = 11); and 72 h ≤ 7.5 (n = 10). Neither clinical parameters nor FLAIR lesions depicted significant differences among the groups. Conclusion: Our results demonstrate that TMBs on SWI MRI may temporarily become less detectable at 24–72 h following TBI.
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Affiliation(s)
- Bálint S Környei
- Department of Medical Imaging, Medical School, University of Pécs, Pécs, Hungary
| | - Viktor Szabó
- Department of Neurosurgery, Medical School, University of Pécs, Pécs, Hungary
| | - Gábor Perlaki
- Department of Neurosurgery, Medical School, University of Pécs, Pécs, Hungary.,MTA-PTE Clinical Neuroscience MR Research Group, Pécs Diagnostic Center, Pécs, Hungary
| | - Bendegúz Balogh
- Department of Medical Imaging, Medical School, University of Pécs, Pécs, Hungary
| | | | - Szilvia A Nagy
- MTA-PTE Clinical Neuroscience MR Research Group, Pécs Diagnostic Center, Pécs, Hungary.,Neurobiology of Stress Research Group, Szentágothai Research Centre, University of Pécs, Pécs, Hungary.,Department of Laboratory Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Luca Tóth
- Department of Neurosurgery, Medical School, University of Pécs, Pécs, Hungary
| | - András Büki
- Department of Neurosurgery, Medical School, University of Pécs, Pécs, Hungary
| | - Tamás Dóczi
- Department of Neurosurgery, Medical School, University of Pécs, Pécs, Hungary
| | - Péter Bogner
- Department of Medical Imaging, Medical School, University of Pécs, Pécs, Hungary
| | - Attila Schwarcz
- Department of Neurosurgery, Medical School, University of Pécs, Pécs, Hungary
| | - Arnold Tóth
- Department of Medical Imaging, Medical School, University of Pécs, Pécs, Hungary.,MTA-PTE Clinical Neuroscience MR Research Group, Pécs, Hungary
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24
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Fiford CM, Sudre CH, Young AL, Macdougall A, Nicholas J, Manning EN, Malone IB, Walsh P, Goodkin O, Pemberton HG, Barkhof F, Alexander DC, Cardoso MJ, Biessels GJ, Barnes J. Presumed small vessel disease, imaging and cognition markers in the Alzheimer's Disease Neuroimaging Initiative. Brain Commun 2021; 3:fcab226. [PMID: 34661106 PMCID: PMC8514859 DOI: 10.1093/braincomms/fcab226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 06/22/2021] [Accepted: 06/25/2021] [Indexed: 01/18/2023] Open
Abstract
MRI-derived features of presumed cerebral small vessel disease are frequently found in Alzheimer's disease. Influences of such markers on disease-progression measures are poorly understood. We measured markers of presumed small vessel disease (white matter hyperintensity volumes; cerebral microbleeds) on baseline images of newly enrolled individuals in the Alzheimer's Disease Neuroimaging Initiative cohort (GO and 2) and used linear mixed models to relate these to subsequent atrophy and neuropsychological score change. We also assessed heterogeneity in white matter hyperintensity positioning within biomarker abnormality sequences, driven by the data, using the Subtype and Stage Inference algorithm. This study recruited both sexes and included: controls: [n = 159, mean(SD) age = 74(6) years]; early and late mild cognitive impairment [ns = 265 and 139, respectively, mean(SD) ages =71(7) and 72(8) years, respectively]; Alzheimer's disease [n = 103, mean(SD) age = 75(8)] and significant memory concern [n = 72, mean(SD) age = 72(6) years]. Baseline demographic and vascular risk-factor data, and longitudinal cognitive scores (Mini-Mental State Examination; logical memory; and Trails A and B) were collected. Whole-brain and hippocampal volume change metrics were calculated. White matter hyperintensity volumes were associated with greater whole-brain and hippocampal volume changes independently of cerebral microbleeds (a doubling of baseline white matter hyperintensity was associated with an increase in atrophy rate of 0.3 ml/year for brain and 0.013 ml/year for hippocampus). Cerebral microbleeds were found in 15% of individuals and the presence of a microbleed, as opposed to none, was associated with increases in atrophy rate of 1.4 ml/year for whole brain and 0.021 ml/year for hippocampus. White matter hyperintensities were predictive of greater decline in all neuropsychological scores, while cerebral microbleeds were predictive of decline in logical memory (immediate recall) and Mini-Mental State Examination scores. We identified distinct groups with specific sequences of biomarker abnormality using continuous baseline measures and brain volume change. Four clusters were found; Group 1 showed early Alzheimer's pathology; Group 2 showed early neurodegeneration; Group 3 had early mixed Alzheimer's and cerebrovascular pathology; Group 4 had early neuropsychological score abnormalities. White matter hyperintensity volumes becoming abnormal was a late event for Groups 1 and 4 and an early event for 2 and 3. In summary, white matter hyperintensities and microbleeds were independently associated with progressive neurodegeneration (brain atrophy rates) and cognitive decline (change in neuropsychological scores). Mechanisms involving white matter hyperintensities and progression and microbleeds and progression may be partially separate. Distinct sequences of biomarker progression were found. White matter hyperintensity development was an early event in two sequences.
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Affiliation(s)
- Cassidy M Fiford
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, Queen Square, London WC1N 3BG, UK
| | - Carole H Sudre
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, Queen Square, London WC1N 3BG, UK
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
- Centre for Medical Image Computing, University College London, London WC1V 6LJ, UK
- MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Health Sciences, University College London, London WC1E 3HB, UK
| | - Alexandra L Young
- Centre for Medical Image Computing, University College London, London WC1V 6LJ, UK
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 3AF, UK
| | - Amy Macdougall
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, Queen Square, London WC1N 3BG, UK
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Jennifer Nicholas
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, Queen Square, London WC1N 3BG, UK
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Emily N Manning
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, Queen Square, London WC1N 3BG, UK
| | - Ian B Malone
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, Queen Square, London WC1N 3BG, UK
| | - Phoebe Walsh
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, Queen Square, London WC1N 3BG, UK
| | - Olivia Goodkin
- Centre for Medical Image Computing, University College London, London WC1V 6LJ, UK
| | - Hugh G Pemberton
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, Queen Square, London WC1N 3BG, UK
- Centre for Medical Image Computing, University College London, London WC1V 6LJ, UK
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam Neuroscience, 1081 HV Amsterdam, The Netherlands
- UCL Queen Square Institute of Neurology, London WC1N 3BG, UK
- UCL Institute of Healthcare Engineering, London WC1E 6DH, UK
| | - Daniel C Alexander
- Centre for Medical Image Computing, University College London, London WC1V 6LJ, UK
| | - M Jorge Cardoso
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - Geert Jan Biessels
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, 3584 CG Utrecht, The Netherlands
| | - Josephine Barnes
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, Queen Square, London WC1N 3BG, UK
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Herrmann FR, Montandon ML, Garibotto V, Rodriguez C, Haller S, Giannakopoulos P. Determinants of Cognitive Trajectories in Normal Aging: A Longitudinal PET-MRI Study in a Community-based Cohort. Curr Alzheimer Res 2021; 18:482-491. [PMID: 34602046 DOI: 10.2174/1567205018666210930111806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 04/01/2021] [Accepted: 05/18/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND The determinants of the progressive decrement of cognition in normal aging are still a matter of debate. Alzheimer disease (AD)-signature markers and vascular lesions, but also psychological variables such as personality factors, are thought to have an impact on the longitudinal trajectories of neuropsychological performances in healthy elderly individuals. OBJECTIVE The current research aimed to identify the main determinants associated with cognitive trajectories in normal aging. METHODS We performed a 4.5-year longitudinal study in 90 older community-dwellers coupling two neuropsychological assessments, medial temporal atrophy (MTA), number of cerebral microbleeds (CMB), and white matter hyperintensities (WMH) at inclusion, visual rating of amyloid and FDG PET at follow-up, and APOE genotyping. Personality factors were assessed at baseline using the NEO-PIR. Univariate and backward stepwise regression models were built to explore the association between the continuous cognitive score (CCS) and both imaging and personality variables. RESULTS The number of strictly lobar CMB at baseline (4 or more) was related to a significant increase in the risk of cognitive decrement. In multivariable models, amyloid positivity was associated with a 1.73 unit decrease of the CCS at follow-up. MTA, WMH and abnormal FDG PET were not related to the cognitive outcome. Among personality factors, only higher agreeableness was related to better preservation of neuropsychological performances. CONCLUSION CMB and amyloid positivity are the only imaging determinants of cognitive trajectories in this highly selected series of healthy controls. Among personality factors, higher agreeableness confers a modest but significant protection against the decline of cognitive performances.
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Affiliation(s)
- François R Herrmann
- Department of Rehabilitation and Geriatrics, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Marie-Louise Montandon
- Department of Rehabilitation and Geriatrics, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Valentina Garibotto
- Division of Nuclear Medicine and Molecular Imaging, Diagnostic Department, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | | | - Sven Haller
- CIMC - Centre d'Imagerie Médicale de Cornavin, Geneva, Switzerland
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26
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Liu J, Zhang Q, Wang Q, Luan S, Dong X, Cao H, Tao D, Dong H, Ji X. A case of CADASIL caused by NOTCH3 c.512_605delinsA heterozygous mutation. J Clin Lab Anal 2021; 35:e24027. [PMID: 34558736 PMCID: PMC8605158 DOI: 10.1002/jcla.24027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a cerebrovascular disease closely related to the NOTCH3 gene. More than 200 mutations in this gene have been reported to be associated with this disease. METHODS The NOTCH3 gene from CADASIL patient was screened for mutations by whole-exome sequencing (WES). PCR amplification and direct Sanger sequencing were used to verify the suspicious gene mutation sites detected by WES. RESULTS We performed second-generation sequencing on a sample of the patient's genome and found a heterozygous deletion-insertion mutation c.512_605delinsA in exon 4 of NOTCH3, which resulted in amino acid changes p.G171_A202delinsE. This variation was confirmed by the direct Sanger sequencing. It may be rated as a CADASIL clinical variation. CONCLUSION Discovery of this mutation site provides an important theoretical basis for specific gene-based diagnosis and treatment of CADASIL.
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Affiliation(s)
- Jiahui Liu
- Department of Neurology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Qiaoyu Zhang
- Department of Neurology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Qi Wang
- Department of Neurology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Siyu Luan
- Department of Neurology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xiang Dong
- Department of Neurology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Hua Cao
- Department of Neurology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Dingbo Tao
- Department of Neurology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Huijie Dong
- Department of Cardiology, Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xiaofei Ji
- Department of Neurology, First Affiliated Hospital of Dalian Medical University, Dalian, China
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27
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Montandon ML, Herrmann FR, Garibotto V, Rodriguez C, Haller S, Giannakopoulos P. Microbleeds and Medial Temporal Atrophy Determine Cognitive Trajectories in Normal Aging: A Longitudinal PET-MRI Study. J Alzheimers Dis 2021; 77:1431-1442. [PMID: 32925053 DOI: 10.3233/jad-200559] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND The cognitive trajectories in normal aging may be affected by medial temporal atrophy (MTA) and amyloid burden, as well as vascular pathologies such as cortical microbleeds (CMB) and white matter hyperintensities (WMH). OBJECTIVE We addressed here the role of imaging markers in their prediction in a real-world situation. METHODS We performed a 4.5-year longitudinal study in 90 older community-dwellers coupling two neuropsychological assessments, MTA estimated with the Schelten's scale, number of CMB, and WMH evaluated with the Fazekas score at inclusion and follow-up, visual rating of amyloid PET and glucose hypometabolism at follow-up, and APOE genotyping. Regression models were built to explore the association between the continuous cognitive score (CCS) and imaging parameters. RESULTS The number of strictly lobar CMB at baseline (4 or more) was related to a 5.5-fold increase of the risk of cognitive decrement. This association persisted in multivariable models explaining 10.6% of the CCS decrease variance. MTA, and Fazekas score at baseline and amyloid positivity or abnormal FDG PET, were not related to the cognitive outcome. The increase of right MTA at follow-up was the only correlate of CCS decrease both in univariate and multivariable models explaining 9.2% of its variance. CONCLUSION The present data show that the accumulation of more than four CMB is associated with significant cognitive decrement over time in highly educated elderly persons. They also reveal that the progressive deterioration of cognitive performance within the age-adjusted norms is also related to the increase of visually assessed MTA.
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Affiliation(s)
- Marie-Louise Montandon
- Department of Rehabilitation and Geriatrics, Geneva University Hospitals and University of Geneva, Switzerland.,Department of Psychiatry, University of Geneva, Switzerland
| | - François R Herrmann
- Department of Rehabilitation and Geriatrics, Geneva University Hospitals and University of Geneva, Switzerland
| | - Valentina Garibotto
- Division of Nuclear Medicine and Molecular Imaging, Diagnostic Department, Geneva University Hospitals and University of Geneva, Switzerland
| | - Cristelle Rodriguez
- Department of Psychiatry, University of Geneva, Switzerland.,Medical Direction, University of Geneva Hospitals, Geneva, Switzerland
| | - Sven Haller
- CIRD - Centre d'Imagerie Rive Droite in Geneva, Switzerland.,Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden.,Department of Neuroradiology, Faculty of Medicine of the University of Geneva, Geneva, Switzerland
| | - Panteleimon Giannakopoulos
- Department of Psychiatry, University of Geneva, Switzerland.,Medical Direction, University of Geneva Hospitals, Geneva, Switzerland
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28
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Voigt S, de Kruijff PC, Koemans EA, Rasing I, van Etten ES, Terwindt GM, van Osch M, van Buchem MA, van Walderveen M, Wermer M. Cerebellar hemorrhages in patients with Dutch-type hereditary cerebral amyloid angiopathy. Int J Stroke 2021; 17:637-644. [PMID: 34427476 PMCID: PMC9260473 DOI: 10.1177/17474930211043663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Recent studies suggest that superficially located cerebellar intracerebral
hemorrhage (ICH) and microbleeds might point towards sporadic cerebral
amyloid angiopathy (CAA). Aims We investigated the proportion of cerebellar ICH and asymptomatic macro- and
microbleeds in Dutch-type hereditary CAA (D-CAA), a severe and essentially
pure form of CAA. Methods Symptomatic patients with D-CAA (defined as ≥1 symptomatic ICH) and
presymptomatic D-CAA mutation-carriers were included. We assessed magnetic
resonance imaging scans for symptomatic (cerebellar) ICH and asymptomatic
cerebellar macro- and microbleeds according to the STRIVE-criteria. Location
was assessed as superficial-cerebellar (cortex, vermis or juxta-cortical) or
deep-cerebellar (white matter, pedunculi cerebelli and gray nuclei). Results We included 63 participants (mean age 58 years, 60% women, 42 symptomatic).
In total, the 42 symptomatic patients with D-CAA had 107 symptomatic ICH
(range 1–7). None of these ICH were located in the cerebellum. Six of 42
(14%, 95%CI 4–25%) symptomatic patients and none of the 21 (0%, 95%CI 0–0%)
presymptomatic carriers had ≥ 1 asymptomatic cerebellar macrobleed(s). All
macrobleeds were superficially located. Cerebellar microbleeds were found in
40 of 63 (64%, 95%CI 52–76) participants (median 1.0, range 0–159), 81% in
symptomatic patients and 29% in presymptomatic carriers. All microbleeds
were strictly or predominantly superficially (ratio superficial versus deep
15:1) located. Conclusions Superficially located asymptomatic cerebellar macrobleeds and microbleeds are
common in D-CAA. Cerebellar microbleeds are already present in the
presymptomatic stage. Despite the high frequency of cerebellar micro and
macrobleeds, CAA pathology did not result in symptomatic cerebellar ICH in
patients with D-CAA.
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Affiliation(s)
- S Voigt
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - P C de Kruijff
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - E A Koemans
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - I Rasing
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - E S van Etten
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - G M Terwindt
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Mjp van Osch
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - M A van Buchem
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Maa van Walderveen
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Mjh Wermer
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
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29
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Virani S, Barton A, Goodyear BG, Yeates KO, Brooks BL. Susceptibility-Weighted Magnetic Resonance Imaging (MRI) of Microbleeds in Pediatric Concussion. J Child Neurol 2021; 36:867-874. [PMID: 33966537 PMCID: PMC8438780 DOI: 10.1177/08830738211002946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The long-term consequences of pediatric concussion on brain structure are poorly understood. This study aimed to evaluate the presence and clinical significance of cerebral microbleeds several years after pediatric concussion. METHODS Children and adolescents 8-19 years of age with either a history of concussion (n = 35), or orthopedic injury (n = 20) participated. Mean time since injury for the sample was 30.4 months (SD = 19.6). Participants underwent susceptibility-weighted imaging, rated their depression and postconcussion symptoms, and completed cognitive testing. Parents of participants also completed symptom ratings for their child. Hypointensities in susceptibility-weighted images indicative of cerebral microbleeds were calculated as a measure of hypointensity burden. RESULTS Hypointensity burden did not differ significantly between participants with a history of concussion and those with a history of orthopedic injury. Depression ratings (self and parent report), postconcussion symptom ratings (self and parent report), and cognitive performance did not significantly correlate with hypointensity burden in the concussion group. CONCLUSIONS These findings suggest that at approximately 2.5 years postinjury, children and adolescents with prior concussion do not have a greater amount of cerebral microbleeds compared to those with orthopedic injury. Future research should use longitudinal study designs and investigate children with persistent postconcussive symptoms to gain better insight into the long-term effects of concussion on cerebral microbleeds.
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Affiliation(s)
- Shane Virani
- Department of Pediatrics, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada,Department of Pediatrics, Neurosciences Program, Alberta Children’s Hospital, Calgary, Alberta, Canada
| | - Alexander Barton
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - Bradley G. Goodyear
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada,Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada,Hotchkiss Brain Institute, Calgary, Alberta, Canada,Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Keith Owen Yeates
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada,Hotchkiss Brain Institute, Calgary, Alberta, Canada,Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada,Department of Psychology, University of Calgary, Calgary, Alberta, Canada,Alberta Children’s Hospital Research Institute, Calgary, Alberta, Canada
| | - Brian L. Brooks
- Department of Pediatrics, Neurosciences Program, Alberta Children’s Hospital, Calgary, Alberta, Canada,Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada,Hotchkiss Brain Institute, Calgary, Alberta, Canada,Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada,Department of Psychology, University of Calgary, Calgary, Alberta, Canada,Alberta Children’s Hospital Research Institute, Calgary, Alberta, Canada,Brian L. Brooks, PhD, Alberta Children’s Hospital, 28 Oki Drive NW, Calgary, Alberta, Canada T3B 6A8.
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30
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Castaño-Leon AM, Cicuendez M, Navarro-Main B, Paredes I, Munarriz PM, Hilario A, Ramos A, Gomez PA, Lagares A. Traumatic axonal injury: is the prognostic information produced by conventional MRI and DTI complementary or supplementary? J Neurosurg 2021; 136:242-256. [PMID: 34214979 DOI: 10.3171/2020.11.jns203124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 11/09/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE A traumatic axonal injury (TAI) diagnosis has traditionally been based on conventional MRI, especially on those sequences with a higher sensitivity to edema and blood degradation products. A more recent technique, diffusion tensor imaging (DTI), can infer the microstructure of white matter (WM) due to the restricted diffusion of water in organized tissues. However, there is little information regarding the correlation of the findings obtained by both methods and their use for outcome prognosis. The main objectives of this study were threefold: 1) study the correlation between DTI metrics and conventional MRI findings; 2) evaluate whether the prognostic information provided by the two techniques is supplementary or complementary; and 3) determine the incremental value of the addition of these variables compared to a traditional prognostic model. METHODS The authors studied 185 patients with moderate to severe traumatic brain injury (TBI) who underwent MRI with DTI study during the subacute stage. The number and volume of lesions in hemispheric subcortical WM, corpus callosum (CC), basal ganglia, thalamus, and brainstem in at least four conventional MRI sequences (T1-weighted, T2-weighted, FLAIR, T2* gradient recalled echo, susceptibility-weighted imaging, and diffusion-weighted imaging) were determined. Fractional anisotropy (FA) was measured in 28 WM bundles using the region of interest method. Nonparametric tests were used to evaluate the colocalization of macroscopic lesions and FA. A multivariate logistic regression analysis was performed to assess the independent prognostic value of each neuroimaging modality after adjustment for relevant clinical covariates, and the internal validation of the model was evaluated in a contemporary cohort of 92 patients. RESULTS Differences in the lesion load between patients according to their severity and outcome were found. Colocalization of macroscopic nonhemorrhagic TAI lesions (not microbleeds) and lower FA was limited to the internal and external capsule, corona radiata, inferior frontooccipital fasciculus, CC, and brainstem. However, a significant association between the FA value and the identification of macroscopic lesions in distant brain regions was also detected. Specifically, lower values of FA of some hemispheric WM bundles and the splenium of the CC were related to a higher number and volume of hyperintensities in the brainstem. The regression analysis revealed that age, motor score, hypoxia, FA of the genu of the CC, characterization of TAI lesions in the CC, and the presence of thalamic/basal ganglia lesions were independent prognostic factors. The performance of the proposed model was higher than that of the IMPACT (International Mission on Prognosis and Analysis of Clinical Trials in TBI) model in the validation cohort. CONCLUSIONS Very limited colocalization of hyperintensities (none for microbleeds) with FA values was discovered. DTI and conventional MRI provide complementary prognostic information, and their combination can improve the performance of traditional prognostic models.
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Affiliation(s)
| | - Marta Cicuendez
- 2Department of Neurosurgery, Hospital Universitario Vall d'Hebron, Universidad de Barcelona, Passeig de la Vall d'Hebron, Barcelona, Spain
| | | | - Igor Paredes
- 1Department of Neurosurgery and Research Institute i+12-CIBERESP, and
| | - Pablo M Munarriz
- 1Department of Neurosurgery and Research Institute i+12-CIBERESP, and
| | - Amaya Hilario
- 3Department of Radiology, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Avda de Cordoba SN, Madrid; and
| | - Ana Ramos
- 3Department of Radiology, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Avda de Cordoba SN, Madrid; and
| | - Pedro A Gomez
- 1Department of Neurosurgery and Research Institute i+12-CIBERESP, and
| | - Alfonso Lagares
- 1Department of Neurosurgery and Research Institute i+12-CIBERESP, and
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31
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Xiang L, Zhang T, Zhang B, Zhang C, Hou S, Yue W. The associations of increased cerebral small vessel disease with cognitive impairment in neurosyphilis presenting with ischemic stroke. Brain Behav 2021; 11:e02187. [PMID: 33998172 PMCID: PMC8213652 DOI: 10.1002/brb3.2187] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND AND PURPOSE Ischemic stroke is a common clinical feature of neurosyphilis, but its accompanying cognitive decline is often overlooked. The mechanisms of cognitive impairment in neurosyphilis presenting with ischemic stroke are not fully understood. Cerebral small vessel disease (CSVD) was recently shown to predict post-stroke cognitive decline. Therefore, this study aims to validate the correlation between CSVD and cognitive impairment in neurosyphilis presenting with ischemic stroke. METHODS We enrolled 179 neurosyphilis patients diagnosed as acute ischemic stroke and performed a 12-month cognitive assessment follow-up. CSVD burden was evaluated by neuroimaging markers, including white matter hyperintensities (WMHs), lacunes, cerebral microbleeds (CMBs), and perivascular spaces (PVS). We performed multivariate logistic regression analysis to determine the association between cognitive decline and total CSVD burden score in neurosyphilis patients. RESULTS The neurosyphilis participants had a significantly higher total CSVD score and lower cognitive function score compared with the syphilis-uninfected patients. Acute cognitive impairment was associated with total CSVD score, extensive microbleeds, and Grade 3 WMHs. After 12-month follow-up, the poor prognosis of post-stroke cognitive impairment was associated with a higher burden of CSVD and extensive microbleeds. CONCLUSIONS Cerebral small vessel disease loads in neurosyphilis patients presenting with ischemic stroke are independently associated with acute cognitive impairment and have a prospective value for post-stroke cognitive outcomes.
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Affiliation(s)
- Lei Xiang
- Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Tao Zhang
- Department of Intensive Care Unit, Tianjin Huanhu Hospital, Tianjin, China
| | - Biao Zhang
- Department of Clinical Laboratory, Tianjin Huanhu Hospital, Tianjin, China
| | - Chao Zhang
- Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Shuping Hou
- Department of Dermatovenereology, Tianjin Medical University General Hospital, Tianjin, China
| | - Wei Yue
- Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
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32
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Jäkel L, De Kort AM, Klijn CJM, Schreuder FHBM, Verbeek MM. Prevalence of cerebral amyloid angiopathy: A systematic review and meta-analysis. Alzheimers Dement 2021; 18:10-28. [PMID: 34057813 PMCID: PMC9290643 DOI: 10.1002/alz.12366] [Citation(s) in RCA: 80] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 04/05/2021] [Accepted: 04/12/2021] [Indexed: 01/05/2023]
Abstract
Reported prevalence estimates of sporadic cerebral amyloid angiopathy (CAA) vary widely. CAA is associated with cognitive dysfunction and intracerebral hemorrhage, and linked to immunotherapy‐related side‐effects in Alzheimer's disease (AD). Given ongoing efforts to develop AD immunotherapy, accurate estimates of CAA prevalence are important. CAA can be diagnosed neuropathologically or during life using MRI markers including strictly lobar microbleeds. In this meta‐analysis of 170 studies including over 73,000 subjects, we show that in patients with AD, CAA prevalence based on pathology (48%) is twice that based on presence of strictly lobar cerebral microbleeds (22%); in the general population this difference is three‐fold (23% vs 7%). Both methods yield similar estimated prevalences of CAA in cognitively normal elderly (5% to 7%), in patients with intracerebral hemorrhage (19% to 24%), and in patients with lobar intracerebral hemorrhage (50% to 57%). However, we observed large heterogeneity among neuropathology and MRI protocols, which calls for standardized assessment and reporting of CAA.
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Affiliation(s)
- Lieke Jäkel
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud Alzheimer Centre, Radboud University Medical Cente, Nijmegen, The Netherlands
| | - Anna M De Kort
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud Alzheimer Centre, Radboud University Medical Cente, Nijmegen, The Netherlands
| | - Catharina J M Klijn
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud Alzheimer Centre, Radboud University Medical Cente, Nijmegen, The Netherlands
| | - Floris H B M Schreuder
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud Alzheimer Centre, Radboud University Medical Cente, Nijmegen, The Netherlands
| | - Marcel M Verbeek
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud Alzheimer Centre, Radboud University Medical Cente, Nijmegen, The Netherlands.,Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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33
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Urushida Y, Kikuchi Y, Shimizu C, Amari M, Kawarabayashi T, Nakamura T, Ikeda Y, Takatama M, Shoji M. Improved Neuroimaging Findings and Cognitive Function in a Case of High-altitude Cerebral Edema. Intern Med 2021; 60:1299-1302. [PMID: 33229804 PMCID: PMC8112975 DOI: 10.2169/internalmedicine.5747-20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
High-altitude cerebral edema (HACE) is a rare condition of acute mountain sickness that manifests as consciousness disturbance and truncal ataxia. Neuroimaging shows vasogenic edema with microbleeds in the white matter and the corpus callosum. We herein report a case of HACE in which the patient showed widespread hyperintense signals with extensive microbleeds in the white matter and corpus callosum on MRI, as well as cognitive dysfunction. Rehabilitation to improve the higher brain function facilitated the recovery of the patient's cognitive impairment and was accompanied by improved MRI findings.
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Affiliation(s)
- Yuki Urushida
- Department of Neurology, Geriatrics Research Institute and Hospital, Japan
| | - Yutaro Kikuchi
- Department of Neurology, Geriatrics Research Institute and Hospital, Japan
| | - Chisato Shimizu
- Department of Neurology, Geriatrics Research Institute and Hospital, Japan
| | - Masakuni Amari
- Department of Neurology, Geriatrics Research Institute and Hospital, Japan
| | - Takeshi Kawarabayashi
- Department of Neurology, Geriatrics Research Institute and Hospital, Japan
- Department of Neurology, Gunma University Graduate School of Medicine, Japan
| | - Takumi Nakamura
- Department of Neurology, Gunma University Graduate School of Medicine, Japan
| | - Yoshio Ikeda
- Department of Neurology, Gunma University Graduate School of Medicine, Japan
| | - Masamitsu Takatama
- Department of Neurology, Geriatrics Research Institute and Hospital, Japan
| | - Mikio Shoji
- Department of Neurology, Geriatrics Research Institute and Hospital, Japan
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34
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Vemuri P, Graff-Radford J, Lesnick TG, Przybelski SA, Reid RI, Reddy AL, Lowe VJ, Mielke MM, Machulda MM, Petersen RC, Knopman DS, Jack CR. White matter abnormalities are key components of cerebrovascular disease impacting cognitive decline. Brain Commun 2021; 3:fcab076. [PMID: 33937772 PMCID: PMC8072521 DOI: 10.1093/braincomms/fcab076] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2021] [Indexed: 11/14/2022] Open
Abstract
While cerebrovascular disease can be observed in vivo using MRI, the multiplicity and heterogeneity in the mechanisms of cerebrovascular damage impede accounting for these measures in ageing and dementia studies. Our primary goal was to investigate the key sources of variability across MRI markers of cerebrovascular disease and evaluate their impact in comparison to amyloidosis on cognitive decline in a population-based sample. Our secondary goal was to evaluate the prognostic utility of a cerebrovascular summary measure from all markers. We included both visible lesions seen on MRI (white matter hyperintensities, cortical and subcortical infarctions, lobar and deep microbleeds) and early white matter damage due to systemic vascular health using diffusion changes in the genu of the corpus callosum. We identified 1089 individuals aged ≥60 years with concurrent amyloid-PET and MRI scans from the population-based Mayo Clinic Study of Aging. We divided these into discovery and validation datasets. Using the discovery dataset, we conducted principal component analyses and ascertained the main sources of variability in cerebrovascular disease markers. Using linear regression and mixed effect models, we evaluated the utility of these principal components and combinations of these components for the prediction of cognitive performance along with amyloidosis. Our main findings were (i) there were three primary sources of variability among the CVD measures-white matter changes are driven by white matter hyperintensities and diffusion changes; number of microbleeds (lobar and deep); and number of infarctions (cortical and subcortical); (ii) Components of white matter changes and microbleeds but not infarctions significantly predicted cognition trajectories in all domains with greater contributions from white matter; and (iii) The summary vascular score explained 3-5% of variability in baseline global cognition in comparison to 3-6% variability explained by amyloidosis. Across all cognitive domains, the vascular summary score had the least impact on memory performance (∼1%). Though there is mechanistic heterogeneity in the cerebrovascular disease markers measured on MRI, these changes can be grouped into three components and together explain variability in cognitive performance equivalent to the impact of amyloidosis on cognition. White matter changes represent dynamic ongoing damage, predicts future cognitive decline across all domains and diffusion measurements help capture white matter damage due to systemic vascular changes. Therefore, measuring and accounting for white matter changes using diffusion MRI and white matter hyperintensities along with microbleeds will allow us to capture vascular contributions to cognitive impairment and dementia.
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Affiliation(s)
| | | | - Timothy G Lesnick
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, USA
| | - Scott A Przybelski
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, USA
| | - Robert I Reid
- Department of Information Technology, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Val J Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
| | - Michelle M Mielke
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA.,Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, USA
| | - Mary M Machulda
- Department of Psychiatry/Psychology, Mayo Clinic, Rochester, MN 55905, USA
| | | | - David S Knopman
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Clifford R Jack
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
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Abstract
Cerebral small vessel disease (CSVD) is the most common, chronic and progressive vascular disease. The changes affect arterioles, capillaries and small veins supplying the white matter and deep structures of the brain. It is the most common incidental finding on brain scans, especially in people over 80 years of age. Magnetic resonance imaging (MRI) plays a key role in the diagnosis of CSVD. The nomenclature and radiological phenotypes of CSVD were published in 2013 based on the unified position of the so-called Centres of Excellence in Neurodegeneration. The disease is characterized by a diverse clinical and radiological picture. It is primarily responsible for stroke incidents, gait disturbances, depression, cognitive impairment, and dementia in the elderly. The CSVD contributes to about 20% of strokes, including 25% of ischemic strokes and 45% of dementias. Common causes of CSVD include arteriosclerosis, cerebral amyloid angiopathy (CAA), genetic small vessel angiopathy, inflammation and immune-mediated small vessel diseases, and venous collagenosis. There is no causal treatment and management is mainly based on combating known risk factors for cardiovascular disease (CVD).
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Affiliation(s)
| | | | - Anna Zimny
- Department of General Radiology, Interventional Radiology and Neuroradiology, Wroclaw Medical University, Poland
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36
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Charidimou A, Perosa V, Frosch MP, Scherlek AA, Greenberg SM, van Veluw SJ. Neuropathological correlates of cortical superficial siderosis in cerebral amyloid angiopathy. Brain 2021; 143:3343-3351. [PMID: 32935842 DOI: 10.1093/brain/awaa266] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 05/25/2020] [Accepted: 06/29/2020] [Indexed: 11/14/2022] Open
Abstract
Cortical superficial siderosis is an established haemorrhagic neuroimaging marker of cerebral amyloid angiopathy. In fact, cortical superficial siderosis is emerging as a strong independent risk factor for future lobar intracerebral haemorrhage. However, the underlying neuropathological correlates and pathophysiological mechanisms of cortical superficial siderosis remain elusive. Here we use an in vivo MRI, ex vivo MRI, histopathology approach to assess the neuropathological correlates and vascular pathology underlying cortical superficial siderosis. Fourteen autopsy cases with cerebral amyloid angiopathy (mean age at death 73 years, nine males) and three controls (mean age at death 91 years, one male) were included in the study. Intact formalin-fixed cerebral hemispheres were scanned on a 3 T MRI scanner. Cortical superficial siderosis was assessed on ex vivo gradient echo and turbo spin echo MRI sequences and compared to findings on available in vivo MRI. Subsequently, 11 representative areas in four cases with available in vivo MRI scans were sampled for histopathological verification of MRI-defined cortical superficial siderosis. In addition, samples were taken from predefined standard areas of the brain, blinded to MRI findings. Serial sections were stained for haematoxylin and eosin and Perls' Prussian blue, and immunohistochemistry was performed against amyloid-β and GFAP. Cortical superficial siderosis was present on ex vivo MRI in 8/14 cases (57%) and 0/3 controls (P = 0.072). Histopathologically, cortical superficial siderosis corresponded to iron-positive haemosiderin deposits in the subarachnoid space and superficial cortical layers, indicative of chronic bleeding events originating from the leptomeningeal vessels. Increased severity of cortical superficial siderosis was associated with upregulation of reactive astrocytes. Next, cortical superficial siderosis was assessed on a total of 65 Perls'-stained sections from MRI-targeted and untargeted sampling combined in cerebral amyloid angiopathy cases. Moderate-to-severe cortical superficial siderosis was associated with concentric splitting of the vessel wall (an advanced form of cerebral amyloid angiopathy-related vascular damage) in leptomeningeal vessels (P < 0.0001), but reduced cerebral amyloid angiopathy severity in cortical vessels (P = 0.048). In terms of secondary tissue injury, moderate-to-severe cortical superficial siderosis was associated with the presence of microinfarcts (P = 0.025), though not microbleeds (P = 0.973). Collectively, these data suggest that cortical superficial siderosis on MRI corresponds to iron-positive deposits in the superficial cortical layers, representing the chronic manifestation of bleeding episodes from leptomeningeal vessels. Cortical superficial siderosis appears to be the result of predominantly advanced cerebral amyloid angiopathy of the leptomeningeal vessels and may trigger secondary ischaemic injury in affected areas.
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Affiliation(s)
- Andreas Charidimou
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Boston Medical Center, Boston University, Boston, MA, USA
| | - Valentina Perosa
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Matthew P Frosch
- Neuropathology Service, C.S. Kubik Laboratory for Neuropathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ashley A Scherlek
- MassGeneral Institute for Neurodegenerative Disease, Massachusetts General Hospital, Charlestown, MA, USA
| | - Steven M Greenberg
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Susanne J van Veluw
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- MassGeneral Institute for Neurodegenerative Disease, Massachusetts General Hospital, Charlestown, MA, USA
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Bergeret S, Queneau M, Rodallec M, Landeau B, Chetelat G, Hong YT, Dumurgier J, Hugon J, Paquet C, Farid K, Baron JC. Brain Glucose Metabolism in Cerebral Amyloid Angiopathy: An FDG-PET Study. Stroke 2021; 52:1478-1482. [PMID: 33611942 DOI: 10.1161/strokeaha.120.032905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The in vivo diagnosis of cerebral amyloid angiopathy (CAA) is currently based on the Boston criteria, which largely rely on hemorrhagic features on brain magnetic resonance imaging. Adding to these criteria 18F-fluoro-deoxy-D-glucose (FDG) positron emission tomography, a widely available imaging modality, might improve their accuracy. Here we tested the hypothesis that FDG uptake is reduced in posterior cortical areas, particularly the primary occipital cortex, which pathologically bear the brunt of vascular Aβ deposition. METHODS From a large memory clinic database, we retrospectively included all patients in whom both brain magnetic resonance imaging and FDG positron emission tomography had been obtained as part of routine clinical care and who fulfilled the Boston criteria for probable CAA. None had a history of symptomatic intracerebral hemorrhage. FDG data processing involved (1) spatial normalization to the Montreal Neurology Institute/International Consortium for Brain Mapping 152 space and (2) generation of standardized FDG uptake (relative standardized uptake value; relative to the pons). The relative standardized uptake value data obtained in 13 regions of interest sampling key cortical areas and the cerebellum were compared between the CAA and age-matched control groups using 2 separate healthy subject databases and image-processing pipelines. The presence of significant hypometabolism (2-tailed P<0.05) was assessed for the bilaterally averaged regions-of-interest relative standardized uptake values. RESULTS Fourteen patients fulfilling the Boston criteria for probable CAA (≥2 exclusively lobar microbleeds) were identified. Significant hypometabolism (P range, 0.047 to <0.0001) consistently affected the posterior cortical areas, including the superior and inferior parietal, primary visual, lateral occipital, lateral temporal, precuneus, and posterior cingulate regions of interest. The anterior cortical areas were marginally or not significantly hypometabolic, and the cerebellum was spared. CONCLUSIONS Supporting our hypothesis, significant glucose hypometabolism predominantly affected posterior cortical regions, including the visual cortex. These findings from a small sample may have diagnostic implications but require replication in larger prospective studies. In addition, whether they generalize to CAA-related symptomatic intracerebral hemorrhage warrants specific studies.
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Affiliation(s)
- Sébastien Bergeret
- Department of Nuclear Medicine, CHU de Martinique, Université des Antilles, Fort-de-France (S.B., K.F.)
| | - Mathieu Queneau
- Department of Nuclear Medicine (M.Q.), Centre Cardiologique du Nord, Saint-Denis, France
| | - Mathieu Rodallec
- Department of Radiology (M.R.), Centre Cardiologique du Nord, Saint-Denis, France
| | - Brigitte Landeau
- INSERM U1237, Université Caen Normandie, France (G.C., B.L.).,CYCERON Biomedical Imaging Platform, Caen, France (G.C., B.L.)
| | - Gaël Chetelat
- INSERM U1237, Université Caen Normandie, France (G.C., B.L.).,CYCERON Biomedical Imaging Platform, Caen, France (G.C., B.L.)
| | - Young T Hong
- Department of Clinical Neurosciences, Wolfson Brain Imaging Centre, University of Cambridge, United Kingdom (Y.T.H.)
| | - Julien Dumurgier
- INSERM U1144 (J.D., J.H., C.P., K.F.), Université de Paris, France
| | - Jacques Hugon
- INSERM U1144 (J.D., J.H., C.P., K.F.), Université de Paris, France.,Assistance Publique-Hopitaux de Paris, Cognitive Neurology Center, Saint-Louis-Lariboisière-Fernand-Widal Hospital Group, Paris, France (J.H., C.P.)
| | - Claire Paquet
- INSERM U1144 (J.D., J.H., C.P., K.F.), Université de Paris, France.,Assistance Publique-Hopitaux de Paris, Cognitive Neurology Center, Saint-Louis-Lariboisière-Fernand-Widal Hospital Group, Paris, France (J.H., C.P.)
| | - Karim Farid
- Department of Nuclear Medicine, CHU de Martinique, Université des Antilles, Fort-de-France (S.B., K.F.).,INSERM U1144 (J.D., J.H., C.P., K.F.), Université de Paris, France
| | - Jean-Claude Baron
- Department of Neurology, Sainte-Anne Hospital (J.-C.B.), Université de Paris, France.,INSERM U1266 (J.-C.B.), Université de Paris, France
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Chary K, Nissi MJ, Nykänen O, Manninen E, Rey RI, Shmueli K, Sierra A, Gröhn O. Quantitative susceptibility mapping of the rat brain after traumatic brain injury. NMR Biomed 2021; 34:e4438. [PMID: 33219598 DOI: 10.1002/nbm.4438] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 10/13/2020] [Accepted: 10/14/2020] [Indexed: 06/11/2023]
Abstract
The primary lesion arising from the initial insult after traumatic brain injury (TBI) triggers a cascade of secondary tissue damage, which may also progress to connected brain areas in the chronic phase. The aim of this study was, therefore, to investigate variations in the susceptibility distribution related to these secondary tissue changes in a rat model after severe lateral fluid percussion injury. We compared quantitative susceptibility mapping (QSM) and R2 * measurements with histological analyses in white and grey matter areas outside the primary lesion but connected to the lesion site. We demonstrate that susceptibility variations in white and grey matter areas could be attributed to reduction in myelin, accumulation of iron and calcium, and gliosis. QSM showed quantitative changes attributed to secondary damage in areas located rostral to the lesion site that appeared normal in R2 * maps. However, combination of QSM and R2 * was informative in disentangling the underlying tissue changes such as iron accumulation, demyelination, or calcifications. Therefore, combining QSM with R2 * measurement can provide a more detailed assessment of tissue changes and may pave the way for improved diagnosis of TBI, and several other complex neurodegenerative diseases.
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Affiliation(s)
- Karthik Chary
- A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Mikko J Nissi
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland
| | - Olli Nykänen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Eppu Manninen
- A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Ramón I Rey
- Clinical Neurosciences Research Laboratory, Department of Neurology, Health Research Institute of Santiago de Compostela, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Karin Shmueli
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Alejandra Sierra
- A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Olli Gröhn
- A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
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39
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van Veluw SJ, Frosch MP, Scherlek AA, Lee D, Greenberg SM, Bacskai BJ. In vivo characterization of spontaneous microhemorrhage formation in mice with cerebral amyloid angiopathy. J Cereb Blood Flow Metab 2021; 41:82-91. [PMID: 31987010 PMCID: PMC7747164 DOI: 10.1177/0271678x19899377] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The pathophysiology of microhemorrhages in the context of cerebral amyloid angiopathy (CAA) remains poorly understood. Here we used in vivo two-photon microscopy in aged APP/PS1 mice with mild-to-moderate CAA to assess the formation of microhemorrhages and their spatial relationship with vascular Aβ depositions in the surrounding microvascular network. Mice with chronic cranial windows were intravenously injected with fluorescent dextran to visualize the vessels and a fluorescently labeled anti-fibrin antibody to visualize microhemorrhages. Focal vessel irradiations resulted in extravascular fibrin-positive clots at individual rupture sites that remained visible for weeks. Spontaneous extravascular fibrin-positive clots were more often observed in 19-month-old transgenic APP/PS1 mice compared to their wild-type littermate controls (p = 0.039), after heparin administration. In the transgenic mice, these spontaneous leakage sites frequently occurred at arteriolar segments without CAA at bifurcations or vessel bends. These findings suggest that the presence of vascular Aβ per se does not directly predispose vessels to leak, but that complex flow dynamics within CAA-affected vascular networks likely play a role. Our in vivo approach for the detection of individual spontaneous leakage sites may be used in longitudinal studies aimed to assess structural and functional alterations at the single-vessel level leading up to microhemorrhage formation.
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Affiliation(s)
- Susanne J van Veluw
- MassGeneral Institute for Neurodegenerative Disease, Massachusetts General Hospital and Harvard Medical School, Charlestown Navy Yard, MA, USA.,J. Philip Kistler Stroke Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Matthew P Frosch
- Neuropathology Service, C.S. Kubik Laboratory for Neuropathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Ashley A Scherlek
- MassGeneral Institute for Neurodegenerative Disease, Massachusetts General Hospital and Harvard Medical School, Charlestown Navy Yard, MA, USA
| | - Daniel Lee
- MassGeneral Institute for Neurodegenerative Disease, Massachusetts General Hospital and Harvard Medical School, Charlestown Navy Yard, MA, USA
| | - Steven M Greenberg
- J. Philip Kistler Stroke Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Brian J Bacskai
- MassGeneral Institute for Neurodegenerative Disease, Massachusetts General Hospital and Harvard Medical School, Charlestown Navy Yard, MA, USA
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40
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Abstract
Cerebral amyloid angiopathy is a common small vessel disease in the elderly involving vascular amyloid-β deposition. Cerebral amyloid angiopathy is one of the leading causes of intracerebral hemorrhage and a significant contributor to age-related cognitive decline. The awareness of a diagnosis of cerebral amyloid angiopathy is important in clinical practice as it impacts decisions to use lifelong anticoagulation or nonpharmacological alternatives to anticoagulation such as left atrial appendage closure in patients who have concurrent atrial fibrillation, another common condition in older adults. This review summarizes the latest literature regarding the management of patients with sporadic cerebral amyloid angiopathy, including diagnostic criteria, imaging biomarkers for cerebral amyloid angiopathy severity, and management strategies to decrease intracerebral hemorrhage risk. In a minority of patients, the presence of cerebral amyloid angiopathy triggers an autoimmune inflammatory reaction, referred to as cerebral amyloid angiopathy-related inflammation, which is often responsive to immunosuppressive treatment in the acute phase. Diagnosis and management of cerebral amyloid angiopathy-related inflammation will be presented separately. While there are currently no effective therapeutics available to cure or halt the progression of cerebral amyloid angiopathy, we discuss emerging avenues for potential future interventions.
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Affiliation(s)
- Mariel G Kozberg
- MassGeneral Institute for Neurodegenerative Disease, 2348Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA.,Department of Neurology, 2348Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Hemorrhagic Stroke Research Program, J. Philip Kistler Stroke Research Center, Department of Neurology, 2348Massachusetts General Hospital, Harvard Medical School, Boston, MA,USA
| | - Valentina Perosa
- MassGeneral Institute for Neurodegenerative Disease, 2348Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA.,Department of Neurology, 2348Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Hemorrhagic Stroke Research Program, J. Philip Kistler Stroke Research Center, Department of Neurology, 2348Massachusetts General Hospital, Harvard Medical School, Boston, MA,USA.,Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - M Edip Gurol
- Department of Neurology, 2348Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Hemorrhagic Stroke Research Program, J. Philip Kistler Stroke Research Center, Department of Neurology, 2348Massachusetts General Hospital, Harvard Medical School, Boston, MA,USA
| | - Susanne J van Veluw
- MassGeneral Institute for Neurodegenerative Disease, 2348Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA.,Department of Neurology, 2348Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Hemorrhagic Stroke Research Program, J. Philip Kistler Stroke Research Center, Department of Neurology, 2348Massachusetts General Hospital, Harvard Medical School, Boston, MA,USA
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41
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Buciuc M, Duffy JR, Machulda MM, Spychalla AJ, Gunter JL, Jack CR, Giannini C, Raghunathan A, Dickson DW, Josephs KA, Whitwell JL. Association of amyloid angiopathy with microbleeds in logopenic progressive aphasia: an imaging-pathology study. Eur J Neurol 2020; 28:670-675. [PMID: 33068458 DOI: 10.1111/ene.14594] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 10/09/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND PURPOSE Cerebral microbleeds (MB) and superficial siderosis (SS) are frequent neuroimaging findings in patients with logopenic progressive aphasia (LPA), often with frontal lobe predilection. Cerebral amyloid angiopathy (CAA) is hypothesized to be the major pathologic determinant of MB/SS in these patients; however, neuroimaging-pathologic data are limited. METHODS All patients who had been prospectively recruited by the Neurodegenerative Research Group at the Mayo Clinic (Rochester, MN) between 2010 and 2015 and met the following inclusion criteria were included: (i) received an antemortem LPA diagnosis, (ii) had a gradient-recalled echo T2*-weighted magnetic resonance imaging (MRI) performed, (iii) died and completed a brain autopsy. Demographic, genetic, neuroimaging, and clinical and pathologic characteristics were compared between patients with/without MB/SS. Two-tailed Fisher exact and Wilcoxon rank sum tests were used for comparison of categorical and continuous variables, respectively. RESULTS Thirteen patients met inclusion criteria, six (46%) had MB/SS on MRI. Moderate/severe CAA was associated with the presence of MB/SS (p = 0.029). As expected, MB/SS most frequently involved the frontal lobes, followed by the parietal lobes. No clear associations were found between regional MB/SS distribution and regional distribution of CAA or hypometabolism on [18 F]-fluorodeoxyglucose-positron emission tomography. There was some evidence for a regional association between MB/SS and uptake on Pittsburgh compound B, although not in all patients. No formal statistical analyses to assess topographic relationships were performed due to the small sample size. CONCLUSIONS The presence of MB/SS is a strong indicator of underlying moderate/severe CAA in LPA, although the biological mechanisms underlying the topographic distribution of MB/SS remain unclear.
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Affiliation(s)
- M Buciuc
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - J R Duffy
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - M M Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - A J Spychalla
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - J L Gunter
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - C R Jack
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - C Giannini
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - A Raghunathan
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - D W Dickson
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida, USA
| | - K A Josephs
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - J L Whitwell
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
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42
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Yoo JS, Ryu CH, Kim YS, Kim HJ, Bushnell CD, Kim HY. Homocysteinemia is Associated with the Presence of Microbleeds in Cognitively Impaired Patients. J Stroke Cerebrovasc Dis 2020; 29:105302. [PMID: 32992197 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105302] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/01/2020] [Accepted: 09/02/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND & OBJECTIVE Homocysteine is possibly associated with cerebral small vessel diseases such as leukoaraiosis, silent brain infarction and cerebral microbleeds, which are in turn associated with cognitive dysfunction. We aimed to examine the relationships between cerebral microbleeds (CMBs) and plasma total homocysteine (tHcy) level, methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism and cognitive function. METHODS A total of 819 patients with memory disturbance who visited a dementia clinic consecutively were included in this study. We retrospectively collected demographic, clinical and laboratory data including tHcy level, MTHFR C677T polymorphism and Mini-Mental State Examination (MMSE). All patients underwent brain MRI including fluid attenuated inversion recovery (FLAIR) image and T2*-weighed gradient-echo (GRE) image. Logistic regression analysis was performed to test the association between risk factors and the presence of microbleeds. RESULTS One hundred and sixty-one (19.7%) patients had CMBs, of whom 88 (54.7%) had CMBs in the lobar region. CMBs were more common in older hypertensive male patients with hyperhomocysteinemia. In multivariable analysis, plasma tHcy remained an independent predictor of the presence of CMBs after adjusting other confounders (OR: 1.035, 95% CI: 1.009-1.062, p = 0.009). Higher plasma tHcy level was also associated with number of CMBs, TT MTHFR genotype, and lower MMSE scores. CONCLUSIONS Elevated plasma tHcy level is related to high prevalence of CMBs and cognitive dysfunction. Lowering plasma tHcy could be helpful in cognitively impaired patients who have CMBs or the MTHFR TT genotype.
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Affiliation(s)
- Jun Sang Yoo
- Department of Neurology, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Chang-Hwan Ryu
- Department of Neurology, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Young Seo Kim
- Department of Neurology, College of Medicine, Hanyang University, Seoul, Republic of Korea.
| | - Hee-Jin Kim
- Department of Neurology, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Cheryl D Bushnell
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Hyun Young Kim
- Department of Neurology, College of Medicine, Hanyang University, Seoul, Republic of Korea
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Exalto LG, Boomsma JMF, Babapour Mofrad R, Barkhof F, Groeneveld ON, Heinen R, Kuijf HJ, Leeuwis AE, Prins ND, Biessels GJ, vd Flier WM. Sex differences in memory clinic patients with possible vascular cognitive impairment. Alzheimers Dement (Amst) 2020; 12:e12090. [PMID: 32875057 PMCID: PMC7447910 DOI: 10.1002/dad2.12090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/13/2020] [Accepted: 07/22/2020] [Indexed: 12/26/2022]
Abstract
INTRODUCTION We aimed to establish sex differences in vascular brain damage of memory clinic patients with possible vascular cognitive impairment (VCI). METHODS A total of 860 memory clinic patients (aged 67.7 ± 8.5; 46% female) with cognitive complaints and vascular brain damage (ie, possible VCI) from the prospective TRACE-VCI (Utrecht-Amsterdam Clinical Features and Prognosis in Vascular Cognitive Impairment) cohort study with 2-year follow-up were included. Age-adjusted female-to-male differences were calculated with general linear models, for demographic variables, vascular risk factors, clinical diagnosis, cognitive performance, and brain magnetic resonance imaging markers. RESULTS We found no difference in age nor distribution of clinical diagnoses between females and males. Females performed worse on the MMSE (Mini-Mental State Examination) and CAMCOG (Cognitive and Self-Contained Part of the Cambridge Examination for Mental Disorders of the Elderly). Females had a larger white matter hyperintensity volume, while males more often showed (lacunar) infarcts. There was no difference in microbleed prevalence. Males had smaller normalized total brain and gray matter volumes. During follow-up, occurrence of cognitive decline and institutionalization was comparable, but mortality was higher in males. DISCUSSION Our results suggest that susceptibility and underlying etiology of VCI might differ by sex. Males seem to have more large vessel brain damage compared to females that have more small vessel brain damage.
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Affiliation(s)
- Lieza G. Exalto
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center UtrechtUtrecht UniversiteitUtrechtthe Netherlands
| | - Jooske M. F. Boomsma
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center UtrechtUtrecht UniversiteitUtrechtthe Netherlands
| | - Rosha Babapour Mofrad
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam NeuroscienceVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
- Neurochemistry Laboratory and BiobankDepartment of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam UMCVU University Medical CenterAmsterdamthe Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear MedicineVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
- Institute of NeurologyUCLLondonUK
- Institute of Healthcare EngineeringUCLLondonUK
| | - Onno N. Groeneveld
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center UtrechtUtrecht UniversiteitUtrechtthe Netherlands
| | - Rutger Heinen
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center UtrechtUtrecht UniversiteitUtrechtthe Netherlands
| | - Hugo J. Kuijf
- Image Sciences InstituteUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - Anna E. Leeuwis
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam NeuroscienceVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
| | - Niels D. Prins
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam NeuroscienceVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
- Brain Research CenterAmsterdamthe Netherlands
| | - Geert Jan Biessels
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center UtrechtUtrecht UniversiteitUtrechtthe Netherlands
| | - Wiesje M. vd Flier
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam NeuroscienceVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
- Department of EpidemiologyVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
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44
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Verhaar BJ, de Leeuw FA, Doorduijn AS, Fieldhouse JL, van de Rest O, Teunissen CE, van Berckel BN, Barkhof F, Visser M, de van der Schueren MA, Scheltens P, Kester MI, Muller M, van der Flier WM. Nutritional status and structural brain changes in Alzheimer's disease: The NUDAD project. Alzheimers Dement (Amst) 2020; 12:e12063. [PMID: 32793798 PMCID: PMC7418890 DOI: 10.1002/dad2.12063] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 06/02/2020] [Accepted: 06/04/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Weight loss is associated with higher mortality and progression of cognitive decline, but its associations with magnetic resonance imaging (MRI) changes related to Alzheimer's disease (AD) are unknown. METHODS We included 412 patients from the NUDAD project, comprising 129 with AD dementia, 107 with mild cognitive impairment (MCI), and 176 controls. Associations between nutritional status and MRI measures were analyzed using linear regression, adjusted for age, sex, education, cognitive functioning, and cardiovascular risk factors. RESULTS Lower body mass index (BMI), fat mass (FM), and fat free mass index were associated with higher medial temporal atrophy (MTA) scores. Lower BMI, FM, and waist circumference were associated with more microbleeds. Stratification by diagnosis showed that the observed associations with microbleeds were only significant in MCI. DISCUSSION Lower indicators of nutritional status were associated with more MTA and microbleeds, with largest effect sizes in MCI.
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Affiliation(s)
- Barbara J.H. Verhaar
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam NeuroscienceVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
- Department of Internal Medicine, Amsterdam Cardiovascular SciencesVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
| | - Francisca A. de Leeuw
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam NeuroscienceVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
- Department of Clinical Chemistry, Amsterdam NeuroscienceVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
| | - Astrid S. Doorduijn
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam NeuroscienceVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
- Department of Nutrition and Dietetics, Amsterdam Public Health Research InstituteVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
| | - Jay L.P. Fieldhouse
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam NeuroscienceVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
| | - Ondine van de Rest
- Division of Human Nutrition and HealthWageningen University & ResearchWageningenthe Netherlands
| | - Charlotte E. Teunissen
- Department of Clinical Chemistry, Amsterdam NeuroscienceVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
| | - Bart N.M. van Berckel
- Department of Radiology and Nuclear MedicineVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
| | - Frederik Barkhof
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam NeuroscienceVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
- Department of Radiology and Nuclear MedicineVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
- UCL Institutes of Neurology and Healthcare EngineeringLondonUnited Kingdom
| | - Marjolein Visser
- Department of Health Sciences, Faculty of ScienceVrije Universiteit AmsterdamAmsterdamthe Netherlands
| | - Marian A.E. de van der Schueren
- Department of Nutrition and Dietetics, Amsterdam Public Health Research InstituteVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
- Department of Nutrition and HealthHAN University of Applied SciencesNijmegenthe Netherlands
| | - Philip Scheltens
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam NeuroscienceVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
| | - Maartje I. Kester
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam NeuroscienceVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
| | - Majon Muller
- Department of Internal Medicine, Amsterdam Cardiovascular SciencesVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
| | - Wiesje M. van der Flier
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam NeuroscienceVrije Universiteit Amsterdam, Amsterdam UMCAmsterdamthe Netherlands
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Abstract
Supplemental Digital Content is available in the text. Background and Purpose: We conducted this study to investigate the prevalence and distribution of cerebral microbleeds and leukoencephalopathy in hospitalized patients with coronavirus disease 2019 (COVID-19) and correlate with clinical, laboratory, and functional outcomes. Methods: We performed a retrospective chart review of 4131 COVID-19 positive adult patients who were admitted to 3 tertiary care hospitals of an academic medical center at the epicenter of the COVID-19 pandemic in New York City from March 1, 2020, to May 10, 2020, to identify patients who had magnetic resonance imaging (MRI) of the brain. We evaluated the MRIs in detail, and identified a subset of patients with leukoencephalopathy and/or cerebral microbleeds. We compared clinical, laboratory, and functional outcomes for these patients to patients who had a brain MRI that did not show these findings. Results: Of 115 patients who had an MRI of the brain performed, 35 (30.4%) patients had leukoencephalopathy and/or cerebral microbleeds. Patients with leukoencephalopathy and/or cerebral microbleeds had neuroimaging performed later during the hospitalization course (27 versus 10.6 days; P<0.001), were clinically sicker at the time of brain MRI (median GCS 6 versus 14; P<0.001), and had higher peak D-dimer levels (8018±6677 versus 3183±3482; P<0.001), lower nadir platelet count (116.9±62.2 versus 158.3±76.2; P=0.03), higher peak international normalized ratio (2.2 versus 1.57; P<0.001) values when compared with patients who had a brain MRI that did not show these findings. They required longer ventilator support (34.6 versus 9.1 days; P<0.001) and were more likely to have moderate and severe acute respiratory distress syndrome score (88.6% versus 23.8%, P<0.001). These patients had longer hospitalizations (42.1 versus 20.9 days; P<0.001), overall worse functional status on discharge (mRS 5 versus 4; P=0.001), and higher mortality (20% versus 9%; P=0.144). Conclusions: The presence of leukoencephalopathy and/or cerebral microbleeds is associated with a critical illness, increased mortality, and worse functional outcome in patients with COVID-19.
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Affiliation(s)
- Shashank Agarwal
- Department of Neurology (S.A., A.L., K.M., S.G.), NYU Langone Health, New York, NY
| | - Rajan Jain
- Department of Radiology (R.J., S.D., P.K., V.N.), NYU Langone Health, New York, NY.,Department of Neurosurgery (R.J., A.L., K.M.), NYU Langone Health, New York, NY
| | - Siddhant Dogra
- Department of Radiology (R.J., S.D., P.K., V.N.), NYU Langone Health, New York, NY
| | - Penina Krieger
- Department of Radiology (R.J., S.D., P.K., V.N.), NYU Langone Health, New York, NY
| | - Ariane Lewis
- Department of Neurology (S.A., A.L., K.M., S.G.), NYU Langone Health, New York, NY.,Department of Neurosurgery (R.J., A.L., K.M.), NYU Langone Health, New York, NY
| | - Vinh Nguyen
- Department of Radiology (R.J., S.D., P.K., V.N.), NYU Langone Health, New York, NY
| | - Kara Melmed
- Department of Neurology (S.A., A.L., K.M., S.G.), NYU Langone Health, New York, NY.,Department of Neurosurgery (R.J., A.L., K.M.), NYU Langone Health, New York, NY
| | - Steven Galetta
- Department of Neurology (S.A., A.L., K.M., S.G.), NYU Langone Health, New York, NY
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Warrier AR, Bhatia R, Garg A, Padma Srivastava MV, Dash D, Tripathi M, Singh MB, Singh V, Vishnubhatla S, Prasad K. Do Imaging Markers of Cerebral Small Vessel Disease Predict Hematoma Volume and Outcome in Acute Intracerebral Hemorrhage? Ann Indian Acad Neurol 2020; 24:204-210. [PMID: 34220064 PMCID: PMC8232507 DOI: 10.4103/aian.aian_183_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/09/2020] [Accepted: 05/08/2020] [Indexed: 11/04/2022] Open
Abstract
Background and Purpose Cerebral small vessel disease (CSVD) markers have not been widely studied in relation to hematoma volume and growth in hypertensive intracerebral hemorrhage (ICH). The objectives to assess the relationship of white matter hyperintense lesions (WMHL), microbleeds (MBs), and cortical siderosis (CSS) with hematoma volume, hematoma expansion (HE), and 3 months outcome in patients with hypertensive ICH. Methods All consecutive acute hypertensive supratentorial ICH presenting to the emergency were prospectively recruited. Baseline and 24 hours computed tomography (CT) to assess hematoma volume and magnetic resonance imaging (MRI) for CSVD markers were performed in all subjects. WMHL (graded using Fazekas's scale), MBs, and CSS were assessed and compared with baseline variables and outcomes. All the images were assessed by an experienced stroke neurologist/neuroradiologist. Results One hundred and fifty-seven patients were screened and 60 were included. Mean age was 54.08 ± 11.57 years and 47 (78%) were males. Of 60, 19 (28.1%) had HE, 31 (51.6%) had major bleed (>30 ml), and 28 (47.46%) had poor 3 month outcome (mRS 4-6). On univariate analysis, high grade WMHL was associated with greater HE [odds ratio (OR): 2.65, confidence interval (CI) 1.48-4.72, P = 0.001), greater proportion with volume >30 ml (OR: 7.16, CI: 1.09-47.13, P = 0.001) and poor outcome (OR: 2.1, CI: 0.05-3.27, P = 0.001). MBs were associated with poor outcome (P = 0.029) but not with HE/volume. CSS was related to HE (P = 0.031), a large volume bleed (P = 0.023), and poor outcome (P = 0.021). On multivariate model, only WMHL independently predicted HE (P = 0.034), greater proportion with bleed volume >30 ml (P = 0.041), and poor outcome (P = 0.042). Conclusions WMHL in MRI serves as a predictor of hematoma expansion, a large volume bleed, and poor outcome in hypertensive ICH and may be incorporated into existing prediction models.
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Affiliation(s)
- Anand R Warrier
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Rohit Bhatia
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Garg
- Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - M V Padma Srivastava
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Deepa Dash
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Mamta Bhushan Singh
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Vishwajeet Singh
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | | | - Kameshwar Prasad
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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Shindo A, Tabei KI, Taniguchi A, Nozaki H, Onodera O, Ueda A, Ando Y, Urabe T, Kimura K, Kitagawa K, Hanyu H, Hirano T, Wakita H, Fukuyama H, Kagimura T, Miyamoto Y, Takegami M, Saito S, Watanabe-Hosomi A, Mizuta I, Ihara M, Mizuno T, Tomimoto H. A Nationwide Survey and Multicenter Registry-Based Database of Cerebral Autosomal Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy in Japan. Front Aging Neurosci 2020; 12:216. [PMID: 32765252 PMCID: PMC7381163 DOI: 10.3389/fnagi.2020.00216] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 06/19/2020] [Indexed: 01/16/2023] Open
Abstract
Objectives Clinical characteristics of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) include migraine, recurrent stroke, white matter lesions, and vascular dementia. CADASIL is one of the most common hereditary cerebral small vessel diseases. Clinical presentation of CADASIL varies and a racial gap may exist between the Asian and Caucasian populations. This is the first nationwide epidemiological survey which aimed to elucidate the clinical features of CADASIL in Japan. Moreover, the registration database of CADASIL was constructed. Methods Subjects included CADASIL patients who visited the hospitals (totally 1,448 hospitals) certified by the Japanese Society of Neurology and/or Japan Stroke Society in 2016. This study consisted of a two-step survey; patients with CADASIL were identified genetically by the first questionnaire, and their clinical features were assessed by the second questionnaire. Selected 6 hospitals registered the data of all CADASIL patients using a Research Electronic Data Capture (REDCap) system for the second questionnaire. Results Based on the criteria, 88 patients (50 male and 38 female) with CADASIL were enrolled. The mean age of symptom onset was 49.5 years. Sixteen (18.2%) patients had an elderly onset (>60 years). Thirteen patients (13.6%) had history of migraine with aura and 33 patients (37.5%) had vascular risk factor(s). From among the 86 patients who were examined using magnetic resonance imaging, abnormal deep white matter lesions were detected in 85 patients (98.8%), WMLs extending to anterior temporal pole in 73 patients (84.9%), and cerebral microbleeds in 41 patients (47.7%). Anti-platelet therapy was received by 65 patients (73.9%). Thirty-eight patients (43.2%) underwent treatment with lomerizine hydrochloride. Thirty-four different mutations of NOTCH3 were found in exons 2, 3, 4, 5, 6, 8, 11, 14, and 19. Most of the mutations existed in exon 4 (n = 44, 60.3%). The prevalence rate of CADASIL was 1.20 to 3.58 per 100,000 adults in Japan. Conclusion This questionnaire-based study revealed clinical features and treatment status in Japanese CADASIL patient, although it may not be an exhaustive search. We have constructed the REDCap database for these CADASIL patients.
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Affiliation(s)
- Akihiro Shindo
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Ken-Ichi Tabei
- Department of Dementia Prevention and Therapeutics, Mie University Graduate School of Medicine, Tsu, Japan
| | - Akira Taniguchi
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Hiroaki Nozaki
- Department of Neurology, Clinical Neuroscience Branch, Brain Research Institute, Niigata University, Niigata, Japan
| | - Osamu Onodera
- Department of Neurology, Clinical Neuroscience Branch, Brain Research Institute, Niigata University, Niigata, Japan
| | - Akihiko Ueda
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yukio Ando
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.,Department of Amyloidosis Research, Nagasaki International University, Nagasaki, Japan
| | - Takao Urabe
- Department of Neurology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Kazumi Kimura
- Department of Neurology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Kazuo Kitagawa
- Department of Neurology, Tokyo Women's Medical University, Tokyo, Japan
| | - Haruo Hanyu
- Department of Geriatric Medicine, Tokyo Medical University, Tokyo, Japan
| | - Teruyuki Hirano
- Department of Stroke and Cerebrovascular Medicine, Kyorin University, Tokyo, Japan
| | - Hideaki Wakita
- Department of Internal Medicine, Nanakuri Memorial Hospital, Fujita Health University, Tsu, Japan
| | - Hidenao Fukuyama
- Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, Kyoto, Japan
| | - Tatsuo Kagimura
- Translational Research Center for Medical Innovation, Foundation for Biomedical Research and Innovation at Kobe, Kobe, Japan
| | - Yoshihiro Miyamoto
- Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Misa Takegami
- Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Satoshi Saito
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Akiko Watanabe-Hosomi
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ikuko Mizuta
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Toshiki Mizuno
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hidekazu Tomimoto
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Japan
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Fitsiori A, Pugin D, Thieffry C, Lalive P, Vargas MI. COVID-19 is Associated with an Unusual Pattern of Brain Microbleeds in Critically Ill Patients. J Neuroimaging 2020; 30:593-597. [PMID: 32639679 PMCID: PMC7361874 DOI: 10.1111/jon.12755] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND AND PURPOSE Covid-19, initially described as a respiratory system's infection, is currently more and more recognized as a multiorganic disease, including neurological manifestations. There is growing evidence about a potential neuroinvasive role of SARS-CoV-2. The purpose of this study is to describe new findings, in the form of cerebral microbleeds affecting different brain structures, observed in MRIs of critically ill patients. METHODS For this purpose, the MR images of 9 patients with a common pattern of abnormal findings (2 women/7 men; 55-79 years of age; mean age: 67.7 years) were depicted. All patients were tested positive for SARS-CoV-2 and presented with delayed recovery of consciousness or important agitation, requiring brain MRI. RESULTS All patients had suffered from severe (5/9) or moderate (4/9) acute respiratory distress syndrome, requiring prolonged stay in the intensive care unit. Their common MRI finding was the presence of microbleeds in unusual distribution with a specific predilection for the corpus callosum. Other uncommon locations of microbleeds were the internal capsule (5/9), as well as middle cerebellar peduncles (5/9). Subcortical regions were also affected in the majority of patients. CONCLUSIONS Brain MRI raised evidence that Covid-19 or its related treatment may involve the brain with an unusual pattern of microbleeds, predominantly affecting the corpus callosum. The mechanism of this finding is still unclear but the differential diagnosis should include thrombotic microangiopathy related to direct or indirect-through the cytokine cascade-damage by the SARS-CoV-2 on the endothelium of brain's vessels, as well as mechanisms similar to the hypoxemia brain-blood-barrier injury.
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Affiliation(s)
- Aikaterini Fitsiori
- Division of Neuroradiology, Diagnostic Department, University Hospitals of Geneva and Faculty of Medicine of Geneva, Geneva, Switzerland
| | - Deborah Pugin
- Division of Intensive Care, Acute Medical Department, University Hospitals of Geneva and Faculty of Medicine of Geneva, Geneva, Switzerland
| | - Camille Thieffry
- Division of Intensive Care, Acute Medical Department, University Hospitals of Geneva and Faculty of Medicine of Geneva, Geneva, Switzerland
| | - Patrice Lalive
- Division of Neurology, Department of Clinical Neurosciences, University Hospitals of Geneva and Faculty of Medicine of Geneva, Geneva, Switzerland
| | - Maria Isabel Vargas
- Division of Neuroradiology, Diagnostic Department, University Hospitals of Geneva and Faculty of Medicine of Geneva, Geneva, Switzerland
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Bouvy WH, van Veluw SJ, Kuijf HJ, Zwanenburg JJ, Kappelle JL, Luijten PR, Koek HL, Geerlings MI, Biessels GJ. Microbleeds colocalize with enlarged juxtacortical perivascular spaces in amnestic mild cognitive impairment and early Alzheimer's disease: A 7 Tesla MRI study. J Cereb Blood Flow Metab 2020; 40:739-746. [PMID: 30890076 PMCID: PMC7074594 DOI: 10.1177/0271678x19838087] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
MRI-visible perivascular spaces (PVS) in the semioval centre are associated with cerebral amyloid angiopathy (CAA), but it is unknown if PVS co-localize with MRI markers of CAA. To examine this, we assessed the topographical association between cortical cerebral microbleeds (CMBs) - as an indirect marker of CAA - and dilatation of juxtacortical perivascular spaces (jPVS) in 46 patients with amnestic mild cognitive impairment (aMCI) or early Alzheimer's disease (eAD). The degree of dilatation of jPVS <1 cm around each cortical CMBs was compared with a similar reference site (no CMB) in the contralateral hemisphere, using a 4-point scale. Also, jPVS dilatation was compared between patients with and without cortical CMBs. Eleven patients (24%) had cortical CMBs [total=35, median=1, range=1-14] of whom five had >1 cortical CMBs. The degree of jPVS dilatation was higher around CMBs than at the reference sites [Wilcoxon signed rank test, Z = 2.2, p = 0.03]. Patients with >1 cortical CMBs had a higher degree of jPVS dilation [median=2.2, IQR = 1.8-2.3] than patients without cortical CMBs [median=1.4, IQR = 1.0-1.8], p = 0.02. We found a topographical association between a high degree of jPVS dilatation and cortical CMBs, supporting a common underlying pathophysiology - most likely CAA.
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Affiliation(s)
- Willem H Bouvy
- Brain Center Rudolf Magnus, Department of Neurology, University Medical Center Utrecht, the Netherlands
| | - Susanne J van Veluw
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Hugo J Kuijf
- Image Sciences Institute, University Medical Center Utrecht, the Netherlands
| | - Jaco Jm Zwanenburg
- Department of Radiology, University Medical Center Utrecht, the Netherlands
| | - Jaap L Kappelle
- Brain Center Rudolf Magnus, Department of Neurology, University Medical Center Utrecht, the Netherlands
| | - Peter R Luijten
- Department of Radiology, University Medical Center Utrecht, the Netherlands
| | - Huiberdina L Koek
- Department of Geriatrics, University Medical Center Utrecht, the Netherlands
| | - Mirjam I Geerlings
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands
| | - Geert J Biessels
- Brain Center Rudolf Magnus, Department of Neurology, University Medical Center Utrecht, the Netherlands
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Andreasen SH, Andersen KW, Conde V, Dyrby TB, Puonti O, Kammersgaard LP, Madsen CG, Madsen KH, Poulsen I, Siebner HR. Limited Colocalization of Microbleeds and Microstructural Changes after Severe Traumatic Brain Injury. J Neurotrauma 2019; 37:581-592. [PMID: 31588844 DOI: 10.1089/neu.2019.6608] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Severe traumatic brain injury (TBI) produces shearing forces on long-range axons and brain vessels, causing axonal and vascular injury. To examine whether microbleeds and axonal injury colocalize after TBI, we performed whole-brain susceptibility-weighted imaging (SWI) and diffusion tensor imaging (DTI) in 14 patients during the subacute phase after severe TBI. SWI was used to determine the number and volumes of microbleeds in five brain regions: the frontotemporal lobe; parieto-occipital lobe; midsagittal region (cingular cortex, parasagittal white matter, and corpus callosum); deep nuclei (basal ganglia and thalamus); and brainstem. Averaged fractional anisotropy (FA) and mean diffusivity (MD) were measured to assess microstructural changes in the normal appearing white matter attributed to axonal injury in the same five regions. Regional expressions of microbleeds and microstructure were used in a partial least-squares model to predict the impairment of consciousness in the subacute stage after TBI as measured with the Coma Recovery Scale-Revised (CRS-R). Only in the midsagittal region, the expression of microbleeds was correlated with regional changes in microstructure as revealed by DTI. Microbleeds and microstructural DTI-based metrics of deep, but not superficial, brain regions were able to predict individual CRS-R. Our results suggest that microbleeds are not strictly related to axonal pathology in other than the midsagittal region. While each measure alone was predictive, the combination of both metrics scaled best with individual CRS-R. Structural alterations in deep brain structures are relevant in terms of determining the severity of impaired consciousness in the acute stage after TBI.
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Affiliation(s)
- Sara H Andreasen
- Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.,Research Unit on Brain Injury Rehabilitation Copenhagen (RUBRIC), Department of Neurorehabilitation, Traumatic Brain Injury, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kasper W Andersen
- Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Virginia Conde
- Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.,Clinical Neuroscience Laboratory, Institute of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Tim B Dyrby
- Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.,Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Oula Puonti
- Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.,Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Lars Peter Kammersgaard
- Research Unit on Brain Injury Rehabilitation Copenhagen (RUBRIC), Department of Neurorehabilitation, Traumatic Brain Injury, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Department of Neurology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Camilla G Madsen
- Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.,Department of Radiology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Kristoffer H Madsen
- Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.,Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Ingrid Poulsen
- Research Unit on Brain Injury Rehabilitation Copenhagen (RUBRIC), Department of Neurorehabilitation, Traumatic Brain Injury, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Department of Nursing Science, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Hartwig R Siebner
- Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department for Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
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