Loneliness in late-life depression: structural and functional connectivity during affective processing.

BACKGROUND: Late-life depression (LLD) in the elderly was reported to present with emotion dysregulation accompanied by high perceived loneliness. Previous research has suggested that LLD is a disorder of connectivity and is associated with aberrant network properties. On the other hand, perceived loneliness is found to adversely affect the brain, but little is known about its neurobiological basis in LLD. The current study investigated the relationships between the structural connectivity, functional connectivity during affective processing, and perceived loneliness in LLD. METHOD: The current study included 54 participants aged >60 years of whom 31 were diagnosed with LLD. Diffusion tensor imaging (DTI) data and task-based functional magnetic resonance imaging (fMRI) data of an affective processing task were collected. Network-based statistics and graph theory techniques were applied, and the participants' perceived loneliness and depression level were measured. The affective processing task included viewing affective stimuli. RESULTS: Structurally, a loneliness-related sub-network was identified across all subjects. Functionally, perceived loneliness was related to connectivity differently in LLD than that in controls when they were processing negative stimuli, with aberrant networking in subcortical area. CONCLUSIONS: Perceived loneliness was identified to have a unique role in relation to the negative affective processing in LLD at the functional brain connectional and network levels. The findings increas our understanding of LLD and provide initial evidence of the neurobiological mechanisms of loneliness in LLD. Loneliness might be a potential intervention target in depressive patients.

Tackers versus glue mesh fixation: an objective assessment of postoperative acute and chronic pain using inflammatory markers.

PURPOSE: Laparoscopic hernioplasty has become a popular choice for inguinal hernia repair since its advent in 1990s. Postoperative pain is an undesirable clinical outcome impairing daily activity of 22.5% of patients. The aim of this study is to evaluate postoperative acute and chronic pain via inflammatory markers as an objective assessment following tacks or glue mesh fixation in TEP repair. METHODS: Sixty-six (66) patients with unilateral uncomplicated inguinal hernia were randomized into 34 patients in the tacker and 32 patients in cyanoacrylate glue mesh fixation in TEP repair. The extent of surgical trauma was evaluated by measuring inflammatory markers of C-reactive protein, white blood cell count at 48 h, and ESR at 3 months postoperatively. Postoperative acute and chronic pain was assessed by recording the visual analogue scale scores and surgical complications were recorded over 3 months of the study period. RESULTS: The median CRP and WBC levels at postoperative 48 h in both groups raised significantly from the baseline values (p < 0.05), however, did not differ significantly between the two study groups at 48 h (p > 0.05). The median ESR level increased significantly at 3 months postoperatively from baseline in the glue mesh fixation group only (p < 0.05), however, did not differ significantly between the two study groups (p > 0.05). There was no significant difference for VAS scores at all timelines between the tacker and glue mesh fixation group (p > 0.05). CONCLUSION: Cyanoacrylate glue mesh fixation technique as an alternative method to mechanical fixation in TEP repair is comparable to tacker and can be considered to be safe and feasible.

Cortical dysplasia associating with abnormal vasculature complicated with subdural haemorrhage.

Cortical dysplasia is a neuronal migration disorder occasionally associated with anomalous draining veins. However, to our knowledge, no intracranial haemorrhage in conjunction with this association has been reported in the literature. We herein report a 7-month-old baby girl with cortical dysplasia associated with an ipsilateral cortical draining vein and complicated with subdural haemorrhage, with the diagnosis made by computed tomography and magnetic resonance imaging. This case demonstrated that patients with this condition could have an excellent prognosis even when the anomalous veins coexist with intracranial haemorrhage. We postulate that venous rupture may be the cause of this condition and further discuss the possible pathophysiology.

Common carotid artery occlusion: evaluation with duplex sonography.

PURPOSE: To demonstrate the efficacy of carotid duplex ultrasound to diagnose common carotid artery occlusion (CCAO) and to define the clinical features of CCAO. METHODS: We reviewed 5400 carotid duplex ultrasonograms obtained over a 7-year period for suspected carotid artery disease. In cases of CCAO, medical records were reviewed. RESULTS: Thirteen cases (0.24%) of CCAO were diagnosed by carotid duplex ultrasonography, including five cases of isolated CCAO. Seven cases were proved by cerebral angiography. Cerebral angiography failed to demonstrate patent internal carotid arteries in two cases of isolated CCAO. Mean age of onset was 67 +/- 9 years. The main clinical presentation was stroke in nine cases (69%). The most common vascular risk factors were hypertension (62%) and heart diseases (54%). Three patients had a history of radiation therapy to the neck. Two of five patients with isolated CCAO had major stroke, with good recovery in one, whereas five of eight patients with CCAO had major stroke; among them, only one had good recovery. CONCLUSION: Patients with isolated CCAO may have a better outcome than patients with CCAO. Duplex sonography, particularly with color-coded flow imaging, provides an accurate examination to define the patency of the arteries distal to the carotid bifurcation. The clinical features of CCAO are similar to those of internal carotid artery occlusion except for the low prevalence of CCAO.

Arachnoid cyst of the lateral ventricle manifesting positional psychosis.

A 30-year-old woman had an arachnoid cyst in the trigone of the right lateral ventricle 5 years before she developed episodic auditory and visual hallucinations as well as delusions of persecution. The psychotic episodes tended to occur after the patient had lain in bed for 1 to 2 hours. After craniotomy and wide excision of the cystic membrane, draining the cystic fluid to the lateral ventricle, the psychotic episodes subsided in a follow-up period of 6 months. We believe that when the patient was recumbent, the trigone cyst blocked the temporal horn further, caused local ischemia, and triggered the psychosis, which was a form of partial complex psychomotor seizure.

Intracerebral malignant fibrous histiocytoma: case report and review of the literature.

A 50-year-old woman developed an intracerebral malignant fibrous histiocytoma at the site of a previously clipped aneurysm in the right temporal lobe. This tumor rarely originates within the brain. Review of the literature suggests that postoperative and/or postirradiation effects may contribute to the growth of this particular tumor.

Spontaneous intracerebral hematoma from occult carotid-cavernous fistula during pregnancy and puerperium. Case report.

In most cases, intracerebral hemorrhage during pregnancy or puerperium results from cerebral aneurysms or arteriovenous malformations. The authors present a case of a 30-year-old woman whose symptoms from a traumatic carotid-cavernous fistula had completely resolved 1 1/2 years after the event, but recurred 4 years later, causing two hemorrhages during pregnancy (33rd and 35th week of gestation) and one during the postpartum period (10 days after Caesarean section). Partial thrombosis of the cavernous sinus with obliteration of most of the drainage from the fistula accounted for the resolution of clinical symptoms, but also promoted back-flow to the preserved drainage of superficial cortical veins. The hemodynamic changes and the hormonal effects due to the patient's subsequent pregnancy further aggravated the venous engorgement and finally caused rupture. All three hematomas occurred in the vicinity of the extremely dilated veins, suggesting that back-flow with venous hypertension was the probable cause for the intracerebral hematomas. Spontaneous healing of the carotid-cavernous fistula should be confirmed with cerebral angiography.

Isolated involvement of substantia nigra in acute transient parkinsonism: MRI and PET observations.

A woman, aged 27 years, developed acute headache and fever followed by tremor, rigidity, and bradykinesia. Masked face, drooling saliva, monotonous voice, and dysphagia were observed. She was totally bedridden during the worst period because of marked generalized rigidity and bradykinesia. There was no neurological disturbance other than parkinsonism. Several herpetic vesicles were noticed at the left angle of her mouth. The cerebrospinal fluid revealed a mononuclear pleocytosis with a normal concentration of sugar and protein. The antibody test for Type I herpes simplex virus was positive in the serum but negative in the cerebrospinal fluid. Brain CT and EEG were normal. However, MRI study showed markedly increased signals in the bilateral substantia nigra on T2-weighted, proton density, and in gradient recall acquisition imagings. Those abnormal findings had almost disappeared in a follow-up MRI study 2 months later. Her parkinsonian symptoms were substantially resolved by the time. However, PET scans, performed 8 months later, disclosed: (1) mild reduction of fluorodopa uptake; and (2) increased raclopride binding, predominantly in the putamen. These findings suggest a subclinical nigrostriatal dopaminergic deficit and a relative excess of the D2 receptors, with a pattern similar to that found in typical idiopathic parkinsonism.

CT angiography of intracranial aneurysms: advantages and pitfalls.

OBJECTIVE: To determine the clinical usefulness of computed tomography (CT) angiography in the evaluation of cerebral aneurysms. MATERIALS AND METHODS: From October 1994 through April 1996, 26 patients with 30 surgical proven intracranial aneurysms underwent both CT angiography and catheter cerebral angiography. The findings of the two methods were reviewed independently and then compared with each other. RESULTS: Comparing with catheter angiography, CT angiography was superior in demonstrating the aneurysmal neck in seven aneurysms but was inferior in one. The thrombosed part and calcification of aneurysms were clearly demonstrated on CT angiograms. CT angiography also aided in differentiating tight vascular loops from aneurysms. On CT angiograms, one posterior communicating arterial aneurysm was overlooked and another anterior choroidal artery aneurysm was misinterpreted as a posterior communicating artery aneurysm. Of note were two patients in whom the infundibulum of the orbitofrontal artery was misinterpreted as the anterior communicating artery aneurysm. CONCLUSION: CT angiography can compliment conventional catheter angiography for its better demonstration of the 3-dimensional anatomy. It can provide surgical information about the neck, calcification and thrombosed part of an aneurysm and its relation to adjacent structures. However, caution is advocated because CT angiography may fail to demonstrate small but important vessels such as posterior communicating, anterior choroidal and orbitofrontal arteries. Recognition of the limitations of CT angiography is important in minimizing interpretation errors.

Intramedullary spinal tuberculomas during treatment of tuberculous meningitis.

A case of multiple intramedullary spinal tuberculomas developing paradoxically during effective treatment of tuberculous meningitis is described. Serial MR imagings with Gd-DTPA enhancement studies showed initial homogeneous enhanced lesion representing myelitis or the early tuberculoma stage, which evolved to show ring enhancement with hypointense center later. Their appearance was similar to those described in brain tuberculoma. Gd-DTPA enhancement MR imaging is more sensitive than MR imaging without enhancement in demonstrating the lesions of tuberculoma and arachnoiditis. Antituberculous medication was effective with marked clinical improvement.

Spinal extradural cavernous hemangioma.

Three cases of isolated spinal extradural cavernous hemangiomas are reported, two in the thoracic and one in the lumbar region. One of them manifested as acute cord compression, the other two as chronic progressive myelopathy or radiculopathy. A total excision or subtotal excision with irradiation was performed. All of them had good functional recovery. The clinical picture, radiological diagnosis, and optimal method of treatment are discussed. The relevant literature is reviewed.

Isolated cortical venous thrombosis--discrepancy between clinical features and neuroradiologic findings. A case report.

Isolated cortical venous thrombosis (CVT) is rare, and the discrepancy between clinical features and neuroradiologic findings has not been adequately emphasized. A thirty-one-year-old woman presented with focal seizures and occasionally secondary generalization. There was no focal neurologic deficit except for Todd's paralysis. Electroencephalography showed intermittent theta waves at the left frontoparietal area. Brain computed tomography (CT) and magnetic resonance imaging (MRI) disclosed a large lesion in the left frontoparietal area. An extensive occlusion of the superior cerebral veins of the left hemisphere with a patency of the dural sinuses was noted in the cerebral angiography. Eight months later, the CT hypodense lesion disappeared. Her neurologic status was stationary, but the seizures, mostly focal, still occurred occasionally. In this report, the authors emphasize the dissociation between minor clinical features and larger CT and MRI lesions in isolated CVT.

MRI diagnosis of spinal cord infarction: report of a case.

A 62-year-old diabetic women developed acute quadriparesis. Her first symptom was clumsiness of the right limbs, which was followed shortly after by quadriparesis with severe left-sided symptoms. Sensory examination showed pinprick and thermal sensation deficits below the left T6 and right T8 dermatomes. An intramedullary infarction in the cervical cord at C5 to C6 levels was demonstrated by serial magnetic resonance imaging (MRI) studies with Gadolinium-DTPA (Gd-DTPA) enhancement. Based on the findings from this patient and 20 patients with spinal cord infarction reported in the literature, it was concluded that spinal cord infarct lesions are characterized by negative Gd-DTPA enhancement at the acute and chronic stages and positive enhancement at the subacute stage, 1 to 4 weeks after the onset of infarction.

Hypothalamic amenorrhea in a case of mitochondrial encephalomyopathy.

A 26-year-old female with myoclonus epilepsy associated with ragged-red fibers is reported. Clinically, she had myoclonus epilepsy, cerebellar ataxia, a bilateral neurosensory type hearing loss, retinitis pigmentosa and short stature. She also presented with primary amenorrhea and poor development of secondary sexual characteristics. Endocrinologic studies revealed that hypothalamic dysfunction was the most plausible cause of her primary amenorrhea. Magnetic resonance imaging showed marked dilatation of the third ventricle indicating thalamic and hypothalamic degeneration. We conclude that hypothalamic dysfunction may be one of the characteristic features of mitochondrial encephalomyopathies.

Significant temporal evolution of diffusion anisotropy for evaluating early response to radiosurgery in patients with vestibular schwannoma: findings from functional diffusion maps.

BACKGROUND AND PURPOSE: Outcome evaluation in clinical oncology is conventionally based on long-term volumetric changes in the tumor size. The purpose of this study was to prospectively investigate the usefulness of fDMs in incorporating anisotropic diffusion in the evaluation of early response after radiosurgery in patients with vestibular schwannoma. MATERIALS AND METHODS: The MD, FA, and IVDC were calculated by using simple averaging methods and fDMs. Six patients with vestibular schwannoma treated with stereotactic radiosurgery underwent longitudinal DTI studies on a 3T MR imaging scanner (maximum follow-up, 6 months). Posttreatment DTI data were spatially coregistered with pretreatment scans. RESULTS: Tumors did not change significantly in size until 6 months after treatment. Diffusion indices changed significantly during the study period. There was a transient decrease in averaged MD followed by a significant increase. IVDC showed an opposite behavior compared with MD. FA decreased continuously throughout the study period. Functional diffusion maps showed a heterogeneous response of tumors to treatment, thereby providing complementary information to simple averaged values. CONCLUSIONS: DTI allows early detection of therapeutic-induced changes in patients with vestibular schwannoma. Functional diffusion maps incorporating anisotropic diffusion may aid in assessing the heterogeneity of the therapeutic response in this patient group.

Lobar holoprosencephaly: prenatal MR diagnosis with postnatal MR correlation.

Holoprosencephaly is a congenital anomaly characterized by lack of cleavage of the prosencephalon. Although, relatively rare, it is the most common anomaly that involves both the brain and the face. Prenatal diagnosis of this anomaly using ultrasonography, particularly of the less severe forms, is difficult. Magnetic resonance imaging has recently become an important complement to US in prenatal diagnosis of CNS anomalies. We herein report a patient in whom, at 23 weeks of gestation, US suggested agenesis of the corpus callosum and in whom, at 24 weeks of gestation, MRI correctly diagnosed lobar holoprosencephaly, which was confirmed by a postnatal MRI at 3 weeks of age.

The association of arteriovenous malformation and aneurysm within the posterior cranial fossa--report of a case.

A relatively rare case of cerebellar arteriovenous malformation (AVM) associated with a saccular aneurysm fed by the left posterior inferior cerebellar artery (PICA) is described. The interpretation of angiograms and the appropriate surgical treatment for the coexistence of the intracranial AVM and aneurysm are discussed. It is a fact that the steal phenomenon existed in the flow of contrast medium during the angiography. The appropriate surgical treatment may be clipping of the aneurysmal neck first and then radical excision of the AVM.

MRI of intraosseous dural arteriovenous malformation: findings in two cases.

Intraosseous dural arteriovenous malformation (DAVM) is rare. The intraosseous component of this DAVM has usually been neglected on conventional angiography and found during operation after the bone drilling has been completed. Considerable bleeding usually occurs during operation because of the unexpected hypervascular bone marrow. We report the use of MRI to help in the diagnosis and therapeutic plan for this rare type of DAVM.