Hyperostosis frontalis interna and frontal bone thickness among various age groups - differences between males and females.

Hyperostosis frontalis interna (HFI) represents an abnormality of the frontal cranial bone that is characterized by bilateral, nodular thickening of its inner lamina and may sometimes be associated with neuropsychiatric symptoms such as headaches and depression. The aim was to assess prevalence, sex and age differences of HFI and frontal bone thickness by means of MRI. This retrospective study included 908 subjects who were divided into male and female groups and further subdivided into three groups, youngest (≤45 years), middle-aged (46- 65 years) and the oldest group (65 years). The thickness of the frontal bone was measured on the T2-weighted axial images at the top level of the lateral ventricles as a mean from both sides. We considered 10mm or thicker frontal bone as HFI. The total prevalence of HFI was 8.1%, with a more frequent occurrence in women (p0.05). In males, there was no difference in the frontal bone thickness between different age groups (p0.05), while in females we found differences between the youngest and the oldest group, and also between the middle-aged and the oldest group (p0.05). The female respondents had a thicker frontal bone, which was statistically significant only in the oldest group (p0.001). Frontal bone thickness was age-dependent only in women (Spearman's Rho 0.11; p≤0.01). In women, unlike in men, there is an age-related progression of HFI with increasing prevalence, with 16.4% occurrence in the oldest group.

Proton Chemical Shift Imaging Study of the Combined Antiretroviral Therapy Impact on Neurometabolic Parameters in Chronic HIV Infection.

BACKGROUND AND PURPOSE: The introduction of combination antiretroviral therapy has failed to reduce the high prevalence of mild forms of HIV-associated neurocognitive disorders. The aim of this study was to test the effect of combined antiretroviral therapy on brain metabolite ratios in chronic HIV infection by using proton chemical shift imaging. MATERIALS AND METHODS: We performed 2D chemical shift imaging in 91 subjects (31 HIV+ patients with chronic infection on combination antiretroviral therapy, 19 combination antiretroviral therapy-naïve HIV+ subjects with chronic infection, and 41 healthy controls), covering frontal and parietal subcortical white and cingulate gyrus gray matter, analyzing ratios of NAA/Cr and Cho/Cr on long-TE and mIns/Cr on short-TE MR spectroscopy. We correlated neurometabolic parameters with immunologic, clinical, data and combined antiretroviral therapy efficacy scores. RESULTS: There was a significant decrease in NAA/Cr (P < .05) in HIV-positive patients on and without combined antiretroviral therapy, compared with healthy controls in all locations. There were significant differences in Cho/Cr (P < .05) and mIns/Cr (P < .05) ratios between HIV+ patients on and without therapy, compared with healthy controls, but these differed in distribution. There were no significant differences in brain metabolite ratios between the 2 groups of chronically HIV-infected patients. The CNS penetration efficacy score showed weak positive correlations only with Cho/Cr ratios in some locations. CONCLUSIONS: The impact of combined antiretroviral therapy on the process of neuronal loss and dysfunction in chronic HIV infection appears to be suboptimal in successful peripheral suppression of viral replication. Spectroscopic imaging might be a useful tool for monitoring the effects of different combined antiretroviral therapy regimens on brain metabolite ratios.

Evaluation of functional outcome measured by modified Rankin scale in rtPA treated patients with acute ischemic stroke.

Aim of our study was to assess functional outcome measured by modified Rankin scale (mRS) in patients that were treated with thrombolytic therapy-recombinant tissue plasminogen activator (rtPA) after acute ischemic stroke. The study included 100 participants that were treated after acute ischemic stroke. Analyzed parameters included: gender; age groups: age 54 and below (Groupup to-54), 55-64 (Group55-64), 65-74 (Group65-74), and 75 and above (Group75-up); cerebral blood flow (CBF) and cerebral blood volume (CBV). Considering time of rtPA administration, we analyzed 3 groups: between 1-2 hours from stroke onset (Time1-2h), 2-3 hours (Time2-3h) and 3-4.5 hours (Time3h-up). NIHSS scores were analyzed: NIHSS 1-at admission and NIHSS 2-at discharge from hospital; and mRS values: RANKIN 1-at admission and RANKIN 2-at discharge from hospital. There is significant reduction in NIHSS and mRS scores between two measurements for all groups of evaluated parameters. CBF, CBV and NIHSS values at admission significantly correlated with mRS scores at admission (p<0.01), as well as with mRS scores at discharge except for CBF where statistical significance was (p=0.019). Significantly lower values of NIHSS at admission (p<0.01), CBF values (p<0.01) and CBV values (p<0.01) are noticed in the group with mRS≤2. Early induction of rtPA treatment in patients with acute ischemic stroke within first 4.5 hours significantly increases positive treatment outcome in both genders and for all evaluated age groups. Favorable outcome (mRS≤2) at the time of discharge from hospital is significantly associated with lower NIHSS values at admission.

Cognitive impairment and functional ability in the acute phase of ischemic stroke.

OBJECTIVE: Acute ischemic stroke significantly affects cognitive efficiency and functional ability, primarily physical ability. Decreased cognitive efficiency is often in correlation with decreased functional ability following an ischemic stroke. The aim of the study was to determine whether there is cognitive impairment in patients with preserved physical ability in acute ischemic stroke, and if so, determine whether there is a significant correlation with the functional, i.e. physical status. PATIENTS AND METHODS: The study included a total of 80 subjects: 40 subjects (26 male and 14 female) in the acute phase of ischemic stroke and 40 healthy subjects (20 male and 20 female) with no history of neurological disease. Both groups were matched with regard to basic sociodemographic characteristics. The cognitive status was evaluated using a comprehensive neuropsychological battery, while physical status was assessed using the modified Rankin scale. Cognitive performance was presented using the following seven cognitive domains: executive function, immediate recall, delayed recall, speech, divergent thinking, attention and concentration, and visual-constructive performance. RESULTS: The two groups differed in all the studied cognitive domains, with acute ischemic stroke subjects achieving poorer results. There was no correlation between the cognitive status and the functional, i.e.physical ability in the acute ischemic stroke group. CONCLUSIONS: The results showed significant impairment in all cognitive domains in the acute phase of ischemic stroke, regardless of the preserved functional, i.e. physical ability of these patients.

Extensive myelitis after oral polio vaccination: MRI features.

A 7-year-old boy presented with fever and ataxia 20 days after oral polio vaccination. Magnetic resonance imaging showed extensive myelitis, involving both anterior and posterior horns of the gray matter. Complete posttreatment recovery was evident. Postvaccinal myelitis after oral polio vaccination, of either infectious or immune mediated etiology, is very rare entity that should be promptly recognized in order to initiate adequate treatment.

The role of MR spectroscopy in neurooncology.

Magnetic resonance spectroscopy (MRS) is a diagnostic tool that provides information related to brain's metabolic activity. Literature data suggest that elevation of the ratio between the choline and creatine (the Cho/Cr ratio), the reduction of the ratio between n-acetyl-aspartate acid and creatine (the NAA/Cr ratio), increase of the ratio between myo-inositol and creatine (the MI/Cr ratio), and the presence of lipids and lactate are useful diagnostic markers in grading tumors as well as in the prediction of tumor malignancy potential. Two additional important roles of MRS are differentiation between recurrent tumor and radiation necrosis and evaluation of peritumoral region.

Are irreversible morphological [corrected] signs of portal hypertension in neurological form of Wilson's disease associated with treatment delay? A pilot study.

Aim of this study was to evaluate the rate of morphological liver and spleen abnormalities in patients with neurological clinical presentation of Wilson's disease (WD). Fourteen patients with neurological presentation of WD divided into group A (5 patients who initiated chelating therapy <24 months from the first symptoms) and group B (9 patients whose therapy started ≥24 months after the initial symptoms) underwent abdominal MRI examination. Abnormal findings on abdominal MRI were present in 28% of patients with neurological form of WD. Significant hepatosplenomegaly was present in none of the patients from group A and in 4 (44%) patients from group B. In addition, macronodular liver cirrhosis and peritoneal effusion were evident in two and one patient from group B, respectively, and in none of the patients from group A. Our results suggest that severe portal hypertension and liver damage in patients with neurological presentation of WD might be reversible or do not even develop if chelating treatment is initiated <2 years after the onset of symptoms.

Progressive multifocal leukoencephalopathy associated with mycophenolate mofetil treatment in a woman with lupus and CD4+ T-lymphocyte deficiency.

There is an increase in the number of patients with systemic lupus erythematosus (SLE) reported as developing progressive multifocal leukoencephalopathy (PML) while on intensive immunosuppressive therapy. A 39-year-old HIV-negative woman with a 10-year history of SLE presented with progressive left-side weakness while on maintenance therapy with oral prednisone and mycophenolate mofetil (MMF). On several occasions low CD4+ T-lymphocyte counts were found (68/µL). Brain magnetic resonance imaging (MRI) revealed a large lesion in the right subcortical fronto-parietal region and a smaller one in the left frontal subcortex, corresponding to the PML. In cerebrospinal fluid, polymerase chain reaction (PCR) for JC virus (JCV) was negative, but anti-JCV antibodies were highly positive. Diagnosis of probable PML was made and MMF was withdrawn. The patient's condition improved with marked reduction of left-side weakness and an increase in CD4(+) T-lymphocyte count (141/µL). Follow-up MRI showed regression of lesions and over the next 6 months the patient remained stable. In spite of the grave prognosis associated with PML, SLE patients can have an excellent outcome if immunosuppressants are discontinued as soon as the correct diagnosis is made. SLE patients with associated low CD4(+) T-lymphocyte counts should be monitored for the development of PML during immunosuppressive therapy in particular.

Three-dimensional multivoxel spectroscopy of the healthy hippocampus-are the metabolic differences related to the location?

AIM: The aim of this study was to determine the bilateral distribution of proton metabolites along the long axis of the hippocampus. MATERIALS AND METHODS: Forty-one healthy volunteers were examined using a 1.5T magnetic resonance imaging system, using proton three-dimensional spectroscopic imaging (3D CSI) of the left and the right hippocampus separately. Three dominant signals were measured: choline (Cho), total creatine (tCr), and n-acetylaspartate (NAA) and expressed as ratios of Cho:tCr, NAA:tCr, NAA:Cho and NAA:(Cho+tCr). We compared the data from three hippocampal regions: head, body and tail. RESULTS: Lower NAA:tCr ratios were found in head compared with the body (p<0.05) and in the head compared with the tail (p<0.05) bilaterally. Lower NAA:Cho and NAA:(Cho+tCr) ratios were found in the head compared with the body (p<0.05), in the body compared with the tail (p<0.05), and in the head compared with the tail (p<0.05) bilaterally. There was no statistically significant difference between the left and the right hippocampus. CONCLUSION: Ratios of NAA:tCr, NAA:Cho, and NAA:(Cho+tCr) in hippocampal tissue were significantly higher posteriorly than anteriorly. As the differences are present in healthy volunteers, the appearance in patients related to approximate voxel positioning within hippocampi may result in false-positive results.

Overlooked early CT signs of cerebral venous thrombosis with lethal outcome.

The aim of this report is to emphasize the consequences of overlooked initial CT signs of cerebral venous thrombosis. Brain CT was ordered in an afebrile patient with neck pain and occipital headache. Since no abnormalities were noted on non-contrast CT study, the patient was discharged with recommendation for routine laboratory tests and plain X-ray of the cervical spine. Right hemiparesis developed the next day with persistent headache and the patient was sent back to the Neurology Clinic where he developed myoclonic seizures compatible with focal motor status epilepticus. Neuroimaging, performed two days later, revealed a huge hemorrhagic venous infarcts in the left posterior cerebral hemisphere associated with typical signs of dural sinus thrombosis. Subtle curvilinear hyperdensities were detected within the left parietal cortico-subcortical border zone on reevaluation of the initial brain CT. A posteriori these were thought to be compatible with a developing venous infarct, associated with subtle signs most consistent with combined cortical vein and sinus thrombosis. No improvement was noted after administration of anticoagulant treatment and the patient died 11 days after the initial CT scan. Detection of early CT signs of cerebral venous thrombosis is extremely important, since delaying adequate treatment may have catastrophic consequences.

[Magnetic resonance imaging and proton magnetic resonance spectroscopy in the diagnosis of prostate carcinoma ].

PURPOSE: To estimate the diagnostic possibilities of magnetic resonance imaging (MRI) techniques and three-dimensional multivoxel proton magnetic resonance spectroscopy (MRS) in patients with clinical suspicion of prostate carcinoma. MATERIALS AND METHODS: 36 patients suspected to have prostate carcinoma underwent MRI with dynamic contrast enhanced study and MRS at 1.5T MRI unit using a pelvic phased array coil. MRI and MRS results were correlated with pathohystological findings after radical prostatectomy and standard biopsy with 12 or 24 cores or guided biopsy. RESULTS: Out of 44 detected prostate carcinomas, 38 (86.36%) demonstrated low T2W signal intensity while pathognomonic contrast enhancement has been detected in 40 (91%) carcinomas. MRS showed (Cho+Cr)/Ci ratio mean value of 3.52 in carcinoma, and 0.14 in normal prostatic tissue (p < 0.01). CONCLUSION: MR techniques, both nonenhanced and contrast enhanced when combined with MRS can provide reliable diagnostic results in the evaluation of prostate carcinoma even by use of pelvic phased array coil at 1.5T unit.

Regression of nodular liver lesions in Wilson's disease.

Long-term follow-up abdominal imaging studies have not been reported previously in patients with the hepatic form of Wilson's disease (WD). This paper reports the case of a 35-year-old woman with symptoms dating back several months and with multiple, nodular liver lesions. The lesions were hyperdense on non-enhanced computed tomography and hypointense on T2-weighted magnetic resonance (MR) images. A diagnosis of WD was established several weeks after her admission to hospital, and chelating treatment was commenced promptly. No abnormalities were found on follow-up MR examinations of the abdomen and brain 4.5 years later. These imaging features suggest that so long as WD is diagnosed in the initial stages, liver nodules can regress with time and complete healing can be achieved with continuous decoppering treatment.

Malignant peripheral nerve sheath tumor of the oculomotor nerve.

We present the short-term follow-up magnetic resonance (MR) studies and 1H-MR spectroscopy in a child with malignant peripheral nerve sheath tumor of the oculomotor nerve associated with other less aggressive cranial nerve schwannomas. The tumor revealed perineural extension and diffuse nerve involvement besides rapid growth. 1H-MR spectroscopy was helpful in excluding an intra-axial neoplasm with exophytic growth, mainly due to the absence of creatine and N-acetyl aspartate peaks, and markedly elevated choline peak.

MR imaging of the brain in patients with hepatic form of Wilson's disease.

The aim of this study was to detect the sites and frequency of possible lesions by brain magnetic resonance imaging (MRI; 1,5T) in a group of 16 neurologically asymptomatic patients with hepatic form of Wilson's disease (WD; seven untreated and nine under treatment). Abnormal MR findings of the brain were found in 75% of patients. Lesions in brain parenchyma were detected in all untreated, drug-naive patients and in 44% of treated patients. Abnormal signal in globus pallidus, putamen, and caudate nucleus was revealed in 86, 71 and 71% of treated and in 33, 33 and 22% of untreated patients, respectively. In five of eight patients with putaminal pathology (62.5%) and in four of seven patients with caudate nuclei involvement (57%), only proton density 2-weighted sequence (PDW) exhibited sensitivity for lesion detection, with both T1W and long echo T2W sequences being insensitive. This superiority of PDW sequence was even more pronounced in the group of untreated patients in whom 80% of putaminal pathology was visible exclusively on this sequence. The lower frequency of lesions in the group of treated in comparison with untreated patients indicated that they might be reversible in the course of chronic chelating therapy.

Dystonia in Wilson's disease.

The frequency and type of dystonic movements, as well as brain abnormalities, as depicted with magnetic resonance imaging (MRI), which might correlate with dystonia, were studied in 27 consecutive patients with a neurologic form of Wilson's disease (WD) and optimized treatment. Dystonia was found in 10 patients (37%), being generalized in half of them, while two patients had segmental, two patients multifocal dystonia, and one patient bilateral foot dystonia. Dystonia was a presenting sign in four patients and developed later in the course of the disease in six patients, despite the administered therapy for WD. Putamen was the only structure significantly more frequently lesioned in dystonic (80%) in comparison to WD patients without dystonia (24%), suggesting a relation between abnormalities in this brain region and dystonic movements in WD.

A variant of the Kleine-Levin syndrome following head trauma.

A 19-year-old man developed the Kleine-Levin syndrome three weeks after the head trauma and subsequent neurosurgical evacuation of right-sided, fronto-temporal epidural hematoma. The expression of periodic episodes was observed for hypersomnolence and, to a lesser degree, for behavioral disturbances, while the hyperphagia was constantly present during a period of 1.5 years. These clinical features were associated with the focal, right-sided hypothalamic lesion and ipsilateral posttraumatic parenchymal temporal lobe damage on NMR imaging.