Housing Instability, Structural Vulnerability, and Non-Fatal Opioid Overdoses Among People Who Use Heroin in Washington Heights, New York City.

Nationally, opioid overdose remains strikingly persistent among people experiencing homelessness and housing instability. Limited information is available about the characteristics of this phenomenon in economically disadvantaged communities of color. This study sought to evaluate the association between key contextual factors and experiencing a non-fatal opioid overdose among people who use heroin in Washington Heights, New York City. We conducted a cross-sectional survey (N = 101) among participants seeking harm reduction services who reported heroin use in the last three months. Binary logistic regression models examined the association between key social and structural factors and the likelihood of ever experiencing a non-fatal opioid overdose and recently experiencing a non-fatal opioid overdose. The majority of the sample reported housing instability and lived in poverty; almost 42% were homeless. After adjustment, participants who injected heroin were more likely to have ever experienced a non-fatal opioid overdose. Also, younger participants who reported hunger in the last six months were more likely to have experienced a non-fatal opioid overdose in the last three months. Findings suggest the role of structural vulnerability in shaping overdose risk among the participants. Overdose prevention strategies should consider factors of the social and economic environment to mitigate barriers to accessing health and social services within the context of the current opioid crisis.

Amygdalae and striatum calcification in lipoid proteinosis.

Lipoid proteinosis is a rare genodermatosis characterized by multisystem involvement due to intracellular deposition of an amorphous hyaline material. Lipoid proteinosis is caused by mutations in the ECM1 gene. In many patients, skin and mucosa abnormalities are the first manifestation. When the CNS is affected, a wide variety of neurologic abnormalities may be present. The hallmark findings are calcifications, mostly occurring in the amygdalae, hippocampus, parahippocampal gyrus, or even the striatum. Present in half of the patients, moniliform blepharosis is considered a pathognomonic finding. In the other half of patients imaging could assist in the diagnosis. The authors present a series of 3 cases of lipoid proteinosis with brief clinical data and imaging findings.

Exclusion of SIX6 hemizygosity in a child with anophthalmia, panhypopituitarism and renal failure.

We report a patient who presented with anophthalmia, panhypopituitarism, early onset of end stage renal failure, and craniofacial abnormalities. MRI at age 3 revealed that the pituitary was absent and renal biopsy demonstrated nephronophthisis as the cause of the renal failure. A similar syndrome has been associated with interstitial deletions of chromosome 14q22 and in one case hemizygosity for SIX6 was demonstrated. The patient reported here had a normal karyotype and Southern blot did not reveal loss of one copy of SIX6. We discuss other possible candidate genes that could be implicated in this syndrome.

Late postpartum eclampsia 16 days after delivery: case report with clinical, radiologic, and pathophysiologic correlations.

BACKGROUND: Postpartum eclampsia is a rare, frightening, and potentially tragic complication of hypertensive pregnancies, usually developing within 48 hours of delivery. Seizures occurring days to weeks after parturition are exceedingly uncommon and require rapid, precise clinical evaluation by multiple specialists. METHODS: A case presentation of delayed postpartum eclampsia illustrates unique features of the syndrome. Extensive review of the literature highlights pathogenesis, controversies, and dilemmas surrounding this enigmatic hypertensive disorder. RESULTS AND CONCLUSIONS: A 39-year-old hypertensive patient had an uneventful full-term delivery by her family physician only to develop headache, double vision, and recurrent tonic-clonic seizures 16 days later. Initial evaluation showed severe hypertension, diplopia, hyperreflexia, proteinuria, and hyperuricemia. She was given a magnesium sulfate infusion. Magnetic resonance imaging (MRI) documented asymmetric ischemic foci within gray matter in the distribution of the posterior cerebral arteries. All symptoms, signs, and abnormal laboratory values resolved within 4 days. A follow-up MRI showed complete resolution of all cytotoxic cortical lesions. Based on human autopsy data, radiologic investigations, and animal studies, eclampsia is believed to result from explosive vasospasm, endothelial dysfunction, and cytotoxic edema of cerebral cortex. This central nervous system vasculopathy is most prominent in the posterior cerebral vasculature and is often rapidly reversible. Difficulties in differential diagnosis, typical findings on neuroimaging, and urgent management strategies are discussed. The time limit for postpartum eclampsia probably should be lengthened to 4 weeks, as indicated by our case and other clinical series.

Embryology and anatomy of the neck.

As a prelude to understanding pathologic conditions of the pediatric neck, this article presents the embryologic development of the neck, fascial planes, and key anatomic structures. Detailed discussion includes the normal development of the neck and illustrates, using selected CT and MR images, the fascial spaces, larynx and trachea, thyroid, parathyroid, and vascular and lymphatic anatomy.

Functional MRI cerebral activation and deactivation during finger movement.

OBJECTIVE: To examine interhemispheric interactions of motor processes by using functional MRI (fMRI). BACKGROUND: Despite evidence of interhemispheric inhibition from animal, clinical, and transcranial magnetic stimulation (TMS) studies, fMRI has not been used to explore activation and deactivation during unilateral motor tasks. fMRI changes associated with motor activity have traditionally been described by comparing cerebral activation during motor tasks relative to a "resting state." In addition to this standard comparison, we examined fMRI changes in the resting state relative to a motor task. METHODS: Thirteen healthy volunteers performed self-paced sequential finger/thumb tapping for each hand. During fMRI data acquisition, four epochs were obtained; each comprised of 30 seconds of rest, 30 seconds of right hand activity, and 30 seconds of left hand activity. Resultant echoplanar images were spatially normalized and spatially and temporally smoothed. RESULTS: As expected, hand movements produced activation in the contralateral sensorimotor cortex and adjacent subcortical regions and, when present, the ipsilateral cerebellum. However, hand movement also produced a significant deactivation (i.e., decreased blood flow) in the ipsilateral sensorimotor cortex and subcortical regions, and when present, the contralateral cerebellum. Conjunction analysis demonstrated regions that are activated by one hand and deactivated by the contralateral hand. CONCLUSION: Unilateral hand movements are associated with contralateral cerebral activation and ipsilateral cerebral deactivation, which we hypothesize result from transcallosal inhibition.

Abnormalities of the central nervous system in very young children with sickle cell anemia.

OBJECTIVE: To determine whether abnormalities of the CNS are present in very young children with sickle cell anemia. STUDY DESIGN: Thirty-nine children with hemoglobin SS between the ages of 7 and 48 months were examined with magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA). No child had a history of clinical stroke, although 3 had a history of seizures (2 neonatal). Twenty-one patients underwent developmental testing with the Bayley or McCarthy Scales. RESULTS: The overall prevalence of CNS abnormalities in asymptomatic children was 4 of 36 (11%, confidence interval 3, 26%). One patient had a silent infarct observed on MRI and a stenotic lesion on MRA; 3 other patients had stenotic lesions on MRA. The 3 patients who had a history of seizures all had lesions consistent with infarcts on MRI. Of the asymptomatic patients who had psychometric testing, 1 of 18 was developmentally delayed. One of 3 with a history of seizures had mild developmental delay. CONCLUSIONS: Very young children with sickle cell anemia (and no history of clinical stroke) have infarction in the brain and/or stenosis of major cerebral arteries, similar to those reported in older children. These findings indicate a need for larger studies to define the incidence of CNS lesions in this age group and to determine the need for early therapeutic intervention to prevent CNS sequelae of sickle cell disease.

Allergic fungal sinusitis: CT findings.

PURPOSE: To determine the computed tomographic (CT) findings in patients with allergic fungal sinusitis. MATERIALS AND METHODS: The authors retrospectively reviewed CT scans and surgical and histopathologic reports in 45 patients (27 male, 18 female; age range, 8-68 years) with allergic fungal sinusitis from multiple institutions. The median age (25 years) and demographics of the patients were determined. Two head and neck radiologists together evaluated the CT scans for the presence of intrasinus high-attenuation areas, extent of sinus involvement, bone expansion and thinning, bone erosion, and extension of disease into the adjacent soft tissues. RESULTS: Allergic fungal sinusitis was more common in male patients and in patients aged 20-30 years. All patients had increased intrasinus attenuation at non-contrast material-enhanced CT. Multiple sinus involvement occurred in 43 patients. Bilateral involvement was more common than unilateral disease. Forty-four patients had complete opacification of at least one of the involved sinuses; 43 of these patients had expansion of an involved sinus, 42 had remodeling and thinning of the bony sinus walls, and 41 had erosion of the sinus wall. CONCLUSION: Allergic fungal sinusitis is a distinct clinical entity with nonspecific symptoms that may be initially suggested by the CT findings. These findings should alert the clinician to the possibility of allergic fungal sinusitis and prompt other diagnostic studies to establish the diagnosis and treatment plan.

Functional MR imaging in patients with epilepsy.

Recent advances in MR imaging have significantly enhanced the diagnosis and management of epilepsy. This article focuses on the expanding role of functional MR imaging in our imaging armamentarium. Diffusion, perfusion, and BOLD functional MR imaging techniques are discussed in detail with emphasis on epilepsy applications. Functional MR imaging seizure focus localization, eloquent cortex mapping, and the potential for functional MR imaging to replace Wada testing are explored. With anticipated future developments, functional MR imaging holds great promise for epilepsy patients.

An outbreak of hantavirus pulmonary syndrome in western Paraguay.

During an investigation of hantavirus pulmonary syndrome (HPS) in Paraguay in 1995, sera from persons with HPS-like illness, houshold contacts of confirmed HPS case-patients, and a sample of the area residents were analyzed by ELISA for antibodies to Sin Nombre virus (SNV). Rodent serosurveys and analysis of precipitation records were also conducted. Twenty-three of 24 available probable cases were SNV antibody-positive, 17 of whom were ill between July 1995 and January 1996. Four (14.8%) of 27 case-contacts and 44 (12.8%) of 345 community residents were also seropositive. Calomys laucha (vesper mouse) was the most common rodent species captured and the most frequently SNV-seropositive. Rainfall in May 1995 was 10-fold greater than that seen in May over the preceding 11 years. This 17 case-cluster represents the largest documented outbreak since HPS was first recognized in 1993. Calomys laucha is the likely primary rodent reservoir for a SNV-like hantavirus in western Paraguay. Fluctuations in monthly precipitation rates may have contributed to increased risk for HPS in this region.

Level of consciousness and memory during the intracarotid sodium amobarbital procedure.

Controversy exists regarding differential effects on consciousness of left/right cerebral inactivation via intracarotid amobarbital. Further, the effects of level of consciousness (LOC) on memory during the intracarotid sodium amobarbital procedure (IAP) are unclear. A modified version of the Glasgow Coma Scale altered to avoid the confounding effects of aphasia was employed to assess LOC in 97 patients during the IAP. A greater impairment in LOC occurred with left cerebral inactivation. Memory was more impaired following left hemisphere injections as well as from injections contralateral to seizure focus. Memory was correlated with LOC, and this effect was more prominent for right hemisphere injections and for injections ipsilateral to seizure focus. These findings support differential cerebral roles in consciousness and demonstrate that IAP memory performance may be affected by the patient's LOC.

Detection and localization of steel intraocular foreign bodies using computed tomography. A comparison of helical and conventional axial scanning.

PURPOSE: To compare the sensitivity and specificity of detection, and accuracy of localization, of small steel intraocular and episcleral foreign bodies, using conventional axial and helical computed tomographic scanning in an experimental model. METHODS: Small steel foreign bodies ranging in size from 0.048 to 0.179 mm3 were placed in intraocular and episcleral locations in eye bank eyes mounted in the orbits of a human skull and scanned using helical and conventional axial techniques. Helical scanning was performed using 1-mm and 3-mm thick sections. Conventional axial scanning was performed using 3-mm thick sections. Images were reviewed by masked observers to determine sensitivity, specificity, and accuracy of localization for each imaging method. RESULTS: Steel foreign bodies as small as 0.048 mm3 were detectable with each scanning protocol. Although the helical scans appeared to provide higher levels of sensitivity compared to conventional axial scanning, the difference in outcome between the scan types was not statistically significant. Sensitivity was dependent on the size of the foreign body and ranged from 45% to 65% for the smaller ones (< 0.06 mm3) to 100% for the larger ones (> 0.06 mm3). Multiplanar reformatting of images was helpful in achieving optimal accuracy. CONCLUSION: In an experimental model of steel intraocular foreign body, helical computed tomographic scanning provided images of high quality similar to that of conventional axial scanning.

Neuroradiologic MR applications with multiparametric color composite display.

The purpose of this article is to demonstrate the application of a PC-based multiparameter full color composite display technique of MR images of 14 selected patients with neuropathology while assessing the ability of this technique to display clinically important neuroanatomic and neuropathologic tissues. Using a PC with a 386 microprocessor and full color 24-bit graphics display capabilities, custom and commercially available image-processing softwares were applied to spatially aligned multiparameter proton density, T1-weighted (with and/or without gadolinium-DTPA) and T2-weighted MR image sets obtained from 14 patients with known neuropathology to generate intensity-based color composites. Quantitative color channel applications were used to assess the ability of this technique to differentiate anatomically and pathologically confirmed tissue types into unique color regions within the full color spectrum display in each patient case. Based on the results of pathologic correlation and quantitative color imaging analysis, the application of full color composite generation techniques to multiple MR images of selected neuropathology cases represents a viable technique for displaying diagnostically relevant tissue contrast information in one color image. With this technique, it is possible to generate composites that simultaneously display uniquely color-coded neuroanatomic and neuropathologic tissue information within the context of partially natural-appearing images.

Leukocyte trafficking in response to magnetic resonance imaging.

There were significant increases in total T cells and in T helper cells in blood samples collected immediately following magnetic resonance imaging (MRI) examinations of brains of male volunteers and patients. Percentages of total lymphocytes and suppressor/cytotoxic T cells decreased in these same samples. There were no significant changes in any leukocyte subpopulations in males undergoing lumbar MRI and females undergoing brain MRI. Thus, it is unlikely that stress from the procedure is the explanation for these changes. Our results show that MRI has specific effects on a brain system(s) that controls lymphocyte subpopulations.

Lumbosacral spinal intradural extramedullary paciniomyolipoma: magnetic resonance imaging, computed tomography, and pathology findings.

This report describes a paciniomyolipoma as an intradural tumor of the lumbar spinal cord composed of adipose tissue, striated skeletal muscle, and pacinian corpuscles. Simple lipomas, myolipomas, and other variant lipomas of the spinal cord have been described in the literature; to the authors' knowledge, however, this is the first report of this unusual and unique lipoma.

Seizure localization in temporal lobe epilepsy: a comparison of scalp-sphenoidal EEG and volumetric MRI.

We determined the accuracy of volumetric MRI (based on identification of unilateral hippocampal atrophy) and scalp-sphenoidal EEG (based on concordant interpretations of scalp-sphenoidal ictal EEG by three independent interpreters) for seizure focus localization in 20 patients with temporal lobe epilepsy. All patients became seizure-free or had rare seizures following temporal lobectomy. Among the 20 patients, nine (45%) met both MRI and EEG localization criteria, six (30%) met MRI localization criteria alone, three (15%) met EEG localization criteria alone, and two patients (10%) did not meet either localization criteria. In the 18 patients meeting MRI or EEG localization criteria, the predicted localization agreed with the side of temporal lobectomy. These results suggest that a noninvasive approach combining MRI and EEG will correctly localize the side of seizure onset in most patients with temporal lobe epilepsy.

MR artifacts after anterior cervical diskectomy and fusion: a cadaver study.

OBJECTIVE: To identify the source of metallic artifacts observed on cervical spine MR studies following anterior cervical diskectomy and fusion (ACD&F), preoperative and postoperative MR studies were done on cadavers using standard spin echo T1, T2, and GRASS imaging. MATERIALS AND METHODS: An ACD&F was performed on each cadaver at various levels using different combinations of drill burrs, curettes, and suction tips. RESULTS: Results showed that contact between the drill burr and suction tip produced the worst artifacts; however, artifacts still occurred in cases in which the suction tip was not introduced. CONCLUSION: This observation suggests that metal flakes from the curettes also produced artifacts. Image distortion was greater on GRASS imaging than on the spin echo imaging.

Posttraumatic pseudoaneurysm of the posterior meningeal artery associated with intraventricular hemorrhage.

A 22-year-old man sustained a severe head injury and had a torn posterior meningeal artery that caused massive intraventricular hemorrhage. Traumatic pseudoaneurysm of the posterior meningeal artery should be considered in cases where intraventricular hemorrhage occurs in the presence of occipital bone fracture and contiguous epidural hematoma; vertebral angiography is of value in this regard.

Understanding the radiology of intracranial primitive neuroectodermal tumors from a pathological perspective: a review.

The concept of primitive neuroectodermal tumors (PNETs) has been controversial since its introduction in 1973. Understanding these tumors is important for the neuroradiologist, because certain radiological features may suggest their diagnosis. A review of the PNET concept, as well as the different types of intracranial PNETs is made, using as a framework the cytogenesis of the brain. Emphasis is given to pathologic features, as they ultimately determine radiologic findings. Supratentorial PNETs are large, bulky, heterogeneous masses with "cystic" (necrotic) areas, calcification, and very little edema. Infratentorial PNETs are generally less heterogeneous, but the larger tumors tend to be more cystic, necrotic, and calcific, resembling supratentorial PNETs.

Unilateral cerebral inactivation produces differential left/right heart rate responses.

We studied heart rate following unilateral hemispheric inactivation by intracarotid amobarbital in 25 patients undergoing preoperative evaluation for epilepsy surgery. Heart rate increased after left hemisphere inactivation, but decreased following right hemisphere inactivation. The results are consistent with differential left/right cerebral hemispheric effects on autonomic function, and appear related to functional and anatomic asymmetries in both the central and peripheral nervous systems.