Left egocentric neglect in early subacute right-stroke patients is related to damage of the superior longitudinal fasciculus.

A typical consequence of stroke in the right hemisphere is unilateral spatial neglect. Distinct forms of neglect have been described, such as space-based (egocentric) and object-based (allocentric) neglect. However, the relationship between these two forms of neglect is still far from being understood, as well as their neural substrates. Here, we further explore this issue by using voxel lesion symptoms mapping (VLSM) analyses on a large sample of early subacute right-stroke patients assessed with the Apples Cancellation Test. This is a sensitive test that simultaneously measures both egocentric and allocentric neglect. Behaviourally, we found no correlation between egocentric and allocentric performance, indicating independent mechanisms supporting the two forms of neglect. This was confirmed by the VLSM analysis that pointed out a link between a damage in the superior longitudinal fasciculus and left egocentric neglect. By contrast, no association was found between brain damage and left allocentric neglect. These results indicate a higher probability to observe egocentric neglect as a consequence of white matter damages in the superior longitudinal fasciculus, while allocentric neglect appears more "globally" related to the whole lesion map. Overall, these findings on early subacute right-stroke patients highlight the role played by white matter integrity in sustaining attention-related operations within an egocentric frame of reference.

Women Stroke Association Statement on Stroke.

We describe the current and future objectives of the Women Stroke Association, a nonprofit multidisciplinary organization promoting research awareness on medical, psychological, and social issues concerning women affected by cerebrocardiovascular disease. In this paper, we deal with only cerebrovascular disease, whereas cardiovascular disorders will be addressed in a future paper. Gender differences in the clinical presentation of cerebrovascular diseases have been repeatedly suggested, and some treatment options may not be as effective and safe in men and women. For many years, women have either been underrepresented or excluded from randomized clinical trials, and the majority of therapeutic research has been carried on predominantly male populations. Furthermore, gender differences have been shown to contribute to different responses to cerebrovascular drugs in women when compared with men, regarding pharmacokinetics, pharmacodynamics, and physiology. In this statement, we discuss main research fields relevant to Women Stroke Association's mission and commitment, highlighting opportunities and critical from the women's health perspective. Future directions and goals of the Women Stroke Association arise from these considerations and represent the association's commitment to combating stroke.

Cerebral transverse sinus morphology as detected by MR venography in patients with chronic migraine.

OBJECTIVE: To clarify the frequency and characteristics of altered transverse sinus morphology in a series of consecutive patients with chronic migraine. BACKGROUND: As terminology, neuroradiological techniques and patient selection differ widely across various studies, reliable, reproducible information is lacking on the frequency of cerebral transverse sinus asymmetry as measured by cerebral magnetic resonance venography in patients with chronic migraine. METHODS: We assessed the frequency and characteristics of transverse sinus asymmetries and their correlation with the chronic migraine phenotype in a blind, cross-sectional magnetic resonance venographic study in a series of 83 consecutive patients with chronic migraine. RESULTS: After excluding mild (≤ 10%) physiological differences in transverse sinus diameter, we found magnetic resonance venographic evidence of altered transverse sinus morphology in 50.6% of the patients: 16.9% had moderate transverse sinus asymmetry (≤ 50%), 24.1% severe asymmetry (>50%), and 9.6% aplasia. Among the tested risk factors for migraine chronification, analgesic consumption, anxiety, and high systolic blood pressure were more frequent in patients with transverse sinus aplasia than in those without. CONCLUSIONS: Advanced magnetic resonance venographic techniques used in strictly selected subjects disclose transverse sinus asymmetries in as many as 50.6% of patients with chronic migraine, even when mild differences in physiological caliber are excluded. The unexpected correlation between transverse sinus aplasia and some risk factors for migraine chronification requires confirmation in larger studies.

Anterior choroidal artery territory infarction.

The anterior choroidal artery (AChA) originates from the posterior wall of the internal carotid distal to the posterior communicating artery and proximal to the intracerebral carotid bifurcation. This thin artery is rarely the cause of aneurysm and only accounts for 2-5% of all aneurysms. Even though the AChA territory shows large variations among individuals, it supplies crucial motor and sensory structures, such as the internal capsule, optic tract, the posterior limb of the internal capsule, the cerebral peduncle, and the choroid plexus.

Contrast echocardiography and migraine in divers with patent foramen ovale.

BACKGROUND: It has been proposed that the patent foramen ovale (PFO) may be associated with migraine, in particular migraine with aura. However, it is not clear whether paradoxical embolism triggers crises of headache. Cerebral embolization is provoked in subjects with PFO through contrast echocardiography, a safe method to diagnose the presence of foramen ovale pervium. METHODS: Twenty-four men practicing diving, an activity characterized by increased prevalence of PFO and migraine, underwent trans-thoracic echocardiography with contrast solution, composed of saline and air mixture and checked for the occurrence of migraine in the following 24 hours. RESULTS: A PFO (five of minimal size, i.e. visible only during Valsalva, one of small and two of medium size) was detected in 8/24 divers (33%). No one reported headache over the 24 hours after the procedure. DISCUSSION: Our preliminary data suggest that cerebral micro-embolism, provoked by contrast echocardiography, does not systematically trigger migraine crises when a minimal-to-medium sized patent foramen ovale is present.

DWI and MR-spectroscopy in the differential diagnosis of focal brain lesions.

The case of a patient with a previous history of cerebral infarction, shown to be positive for a brain neoformation on control CT, is presented. Subsequent MRI for an in-depth diagnostic study was completed with DWI and MR spectroscopy to define the nature of the lesion. The differential diagnosis of the lesion is discussed. In conclusion, the major diagnostic role of combined standard MRI with DWI sequences and MR-spectroscopy in the radiologic study of focal brain lesions, is stressed.

Multiple watershed cerebral infarcts.

The case of a 63-year-old female patient affected by arterial hypertension under home therapy, with disordered consciousness and confusion, is discussed. At the emergency department of another hospital she underwent cranial CT which showed mild swelling of right cerebral hemisphere. Based on the clinical suspicion of herpes simplex encephalitis compatible with a first MRI examination of the brain, the patient was admitted to the department of infectious disease of the polyclinic to confirm the diagnosis and plan the therapeutic approach. MRI was repeated and completed with EPI-DWI sequences and PRESS spectroscopy. It did not rule out categorically the infectious/inflammatory pattern but, based on a careful evaluation of the anatomic distribution of acute lesions, the most likely diagnostic hypothesis was the presence of multiple watershed cerebral infarcts on the right side.

Unusual lesion of the thalamic pineal region: role of conventional MRI and DWI in the differential diagnosis.

The case of a 53-year-old female patient admitted to the Emergency department with symptoms from right third cranial nerve of acute onset, is presented. Cranial CT, performed in emergency, documented an intra-axial mass which required an in-depth diagnostic study with cranial MRI after contrast administration. Conventional MRI and DWI helped in correct lesion characterization and in the differential diagnosis with other brain disorders.

Primary central nervous system lymphoma: role of DWI in the differential diagnosis.

The case of a female patient admitted to the hospital for a syncopal episode characterized by mental confusion, retrograde amnesia, agnosia, lack of sphincter control and behavior disorders, is presented. Cranial CT showed a frontal bihemispheric lesion. MRI completed with DWI was then performed to better define the nature of the lesion and for an in-depth diagnostic study. The diagnostic role of conventional MRI combined with DWI and the importance of the latter in the differential diagnosis between primary central nervous system lymphoma (confirmed at histology) and glioblastoma multiforme is discussed.

A case of primary breast lymphoma.

The case of a patient with a lesion in the right breast, is discussed. Retrospective evaluation of mammography and US previously performed elsewhere were not fully helpful in the differential diagnosis between benign and malignant and MRI was necessary. Morphological and dynamic characteristics could be indicative of an expansive/infiltrating lesion of the breast and support the staging. The histological examination established the diagnosis of primary breast lymphoma.

Combined diagnostic and therapeutic imaging in the diagnosis of venous sinus thrombosis in postpartum patients.

The case of a woman on day four post partum with sensorimotor deficit of the right side and CT evidence of a left temporofrontal hemorrhagic lesion, is presented. Attending physicians requested cerebral angiography. To better evaluate the clinical justification of requested imaging procedure the patient medical history and performed CT examination were carefully revised. According to this analysis and based on a clinicoradiological methodology, the request of a cerebral angiography was considered appropriate. The examination showed several radiological signs but a definitive diagnosis could not be established. Second choice imaging procedures were analyzed and MRI completed with MR-angiography was performed. It allowed to document transverse and sigmoid sinus thrombosis. Therefore, in the diagnosis of venous sinus thrombosis, MRI combined with MR-angiography was shown to be a method of first choice while angiography plays a major role in therapy for intravascular thrombolysis.

Conventional MRI, DWI and MR-spectroscopy in the study of focal brain lesions.

A case of a patient with neurologic symptoms is reported. Baseline MRI findings were inconclusive to establish a definitive diagnosis. The worsened neurologic and neuroradiologic pattern directed towards a diagnosis of tumor. A second MRI examination and MR-spectroscopy confirmed the hypothesis based on both the diagnosis of nature of the lesion and the histological characterization of the surgical specimen. The technique of MR-spectroscopy is briefly described.