Cerebral tubercular thrombophlebitis presenting as venous infarct: Magnetic resonance imaging and pathologic correlation.

Central nervous system involvement by tuberculosis to produce basal meningitis, hydrocephalus, arteritis and infarcts is well-known, the brunt of the pathology being borne by the arterial vasculature to produce neurological sequelae. However, tuberculous thrombophlebitis causing venous infarction is exceedingly rare. We present imaging and pathological features of two autopsy proven cases of tuberculous thrombophlebitis with venous infarcts involving superficial venous system in one and deep venous system in the other. This is the first study presenting radiopathologic correlation of this rare complication. Tuberculous thrombophlebitis should be suspected if basal exudates and multiple white matter T2 hyperintensities are seen on neuroimaging and the imaging protocol should include both magnetic resonance arteriogram and venogram.

High energy phosphate abnormalities normalize after antipsychotic treatment in schizophrenia: a longitudinal 31P MRS study of basal ganglia.

We reported increased high-energy phosphate metabolism in the basal ganglia of antipsychotic-naïve schizophrenia patients using (31)P Magnetic Resonance Spectroscopy (MRS). These patients were followed up for 1 year and and reassessed using (31)P MRS. Fourteen (8 males) patients with DSM-IV schizophrenia and 14 (11 males) healthy controls underwent (31)P MRS of sub-cortical structures (predominantly basal ganglia) twice (mean+/-S.D. interscan interval 1.15+/-0.17year) on a 1.5T scanner. Total scores on the Positive and Negative Syndrome Scale (PANSS) decreased significantly after treatment in schizophrenia patients. Patients had significantly lower mean PCr/ATP ratios than healthy controls at baseline but not during the follow-up. In patients, there was a significant positive correlation between the magnitude of improvement in PANSS total scores and the extent of change in the PCr/ATP ratio. Findings support the hypothesis that reduction of energy demand or induction of decreased energy-demanding processes might underlie the mechanism of action of antipsychotics in schizophrenia.

Functional correlates of incoordination in patients with spinocerebellar ataxia 1: a preliminary fMRI study.

The neural (blood oxygenation level dependent) correlates of motor coordination of both hands were studied in adult right-handed volunteers and patients with spinocerebellar ataxia 1 (SCA1), using functional magnetic resonance imaging (fMRI) of the entire brain. Each experimental condition consisted of five sets of alternate pronation and supination tasks for either hand in a prescribed sequence as the active phase followed by a period of rest. An intricate network consisting of sensorimotor cortex, supplementary motor area (SMA), cingulate motor area (CMA), putamina and cerebellum, was identified when the task was performed in healthy volunteers. However, cerebellar activity was largely absent with additional activity in contralateral cortices and in thalami in patients with SCA1. This apparent decoupling of sensorimotor cortical and cerebellar areas during coordinated movement in patients with SCA1, suggests that cortico-cerebellar loops may be malfunctioning in SCA1.

Relaxation and susceptibility MRI characteristics in Hallervorden-Spatz syndrome.

PURPOSE: To evaluate the imaging characteristics of the brain with respect to relaxation and susceptibility in Hallervorden-Spatz syndrome (HSS), a rare inherited neurodegenerative disorder (also referred to as neurodegeneration with brain iron accumulation). MATERIALS AND METHODS: We reviewed 13 affected individuals who satisfied the inclusion criteria for HSS. Clinically, the patients were divided into two groups: early-childhood onset (age of onset before 10 years) and late-childhood onset (age of onset after 10 years). MRI was performed on 1.5T MR equipment. The imaging protocol included spin-echo (SE) T1-weighted (T1W), turbo spin-echo (TSE) T2W, and fluid attenuated inversion recovery (FLAIR) sequences in all patients. Susceptibility-weighted imaging (SWI) included a fast low-angle shot (FLASH) sequence in 10 patients and a blood oxygen level-dependent (BOLD) sequence in two patients. RESULTS: All of the patients showed hyperintensity on T1WI and hypointensity on T2WI in the globus pallidi (GPs) bilaterally. Central or anteromedial hyperintensity was found in all but one patient. FLASH showed augmented hypointensity in 10 patients, and BOLD showed bilateral striatonigral abnormal pigmentation in two patients. MR spectroscopy (MRS) showed normal spectra in four patients, and a reduced NAA/Cho ratio in two. CONCLUSION: MRI showed prominent signal abnormalities in the GP bilaterally in HSS. T1WI showed hyperintensity in all cases of HSS in addition to the "eye-of-the-tiger" sign on T2WI. SWI, FLASH, and BOLD demonstrated mineral deposition in the GP better than conventional imaging. Involvement of the striatonigral pathways was demonstrated for the first time on BOLD SWI.

Clinical heterogeneity in Hallervorden-Spatz syndrome: a clinicoradiological study in 13 patients from South India.

Hallervorden-Spatz syndrome (HSS) is a rare autosomal recessive neurodegenerative disorder of childhood. Thirteen patients with this syndrome seen over a period of 7 years were reviewed. Two distinct groups were identified. The early onset childhood group had uniform presentation with developmental delay, recurrent falls, gait abnormalities, cognitive deterioration and dystonia. This group was also characterised by familial incidence, retinal involvement and absence of behavioural problems. Late onset group, included patients with different presentations such as behavioural changes, optic atrophy and dystonia. Consanguinity was prominent in this study, being present in 61.5% patients. MRI (n=11) showed pallidal hyperintensity on T1-weighted images and hypointensity or 'eye of the tiger' sign on T2-weighted images. Two patients had acanthocytes in peripheral blood smear. This study emphasizes the phenotypic heterogeneity in HSS and as well brings out the common features shared by patients with early onset disease.