Neuroimaging correlation with EEG in status epilepticus.

PURPOSE: This study was to correlate EEG patterns with peri­ictal perfusion CT abnormality (PCA) or peri­ictal MR abnormality (PMA) in patients with status epilepticus (SE). METHODS: This is a retrospective study done with SE patients from January 2016 to December 2021. We defined the PCA as single or multi-territorial cortical and/or thalamic hyper-perfusion. The PMA was defined as increased signal intensity in multiple brain regions including the cortex and subcortical regions. EEG patterns were categorized into electrographic seizure (ESz)/electroclinical seizure (ECSz), ictal-interictal continuum (IIC), and lateralized periodic discharges (LPDs) per the American Clinical Neurophysiology Society's guideline. We analyzed the association between the patterns of EEG and the presence of PCA or PMA. RESULTS: Among 73 patients, 26 % (19/73) showed PCA and 25 % (18/73) demonstrated PMA. The patterns of EEG were as follows; ESz/ECSz in 25 % (18/73), IIC in 34 % (25/73), and LPD in 12 % (9/73). There was a significant correlation between the patterns of EEG and the presence of PMA, but not PCA. 48 % (12/25) had both PMA and PCA whereas 52 % (13/25) showed either PMA (6/25) or PCA (7/25). CONCLUSION: Although PCA did not reveal an electro-radiographical correlation, PMA was strongly linked to ESz, ECSz, IIC, and LPD.

Measurement of thalamus and cortical damages in hypoxic ischemic encephalopathy.

Background: The thalamic gray-white matter ratios (GWRs) on CT and quantitative suppression ratios (SRs) of background activities on EEG may reflect damages in the thalamus and cerebral hemispheres in patients with hypoxic-ischemic encephalopathy (HIE). Methods: The inclusion criteria were (1) cardiac arrest patients over the age of 20 years from March 2010 to March 2020, and (2) patients who had both EEG and brain CT within 7 days after cardiac arrest. The thalamic GWRs were semi-quantitatively measured by using the region of interest (ROI). SRs of background were analyzed with the installed software (Persyst® v13) in EEG machine. Results: 175 patients were included among 686 patients with HIE and the thalamic GWRs of 168 patients were successfully measured. 155 patients (89 %) showed poor outcomes. The poor outcome group revealed not only higher SRs, but also lower thalamic GWRs. The thalamic GWRs showed a negative correlation to the SRs (ρ (rho) = -0.36, p < 0.0001 for right side, ρ (rho) = -0.31, p < 0.0001 for left side). The good outcome group showed neither beyond the cut-off values of thalamic GWRs nor SRs [40 % (59/148) VS 0 % (0/20) in right side, p = 0.0005 %, and 28 % (42/148) VS 0 % (0/20) in left side, p = 0.0061]. Conclusion: The thalamic GWRs and SRs may reflect the damage in the thalamus and cerebral hemispheres in patients with HIE. Insults in the thalamocortical circuit (TCC) or the thalamus might be responsible for the poor outcome.

Semi-quantitative analysis of periventricular gray-white matter ratio on CT in patients with idiopathic normal pressure hydrocephalus.

To investigate alterations in the periventricular gray-white matter ratio (GWR) on computed tomography (CT) in patients with idiopathic normal pressure hydrocephalus (INPH), a total of 140 patients with INPH and 52 age-and sex-matched controls were included by using Japanese guidelines published in 2021: possible, probable, and definite INPH for a retrospective case-control study. The non-enhanced brain CT was reviewed, and the Hounsfield unit (HU) was semi-quantitatively measured using the region of interest (ROI). The size (40 mm2) and location of the ROI were standardized within the periventricular white matter (WM) and thalamus. Bilateral anterior (ant) and posterior (post) periventricular WMs were measured using the ROI. The GWR was calculated using the HU on ROI at the thalamus and ant or post-periventricular WMs: GWR = HU at thalamus/HU at periventricular WM. There was a significant difference in the GWRs between patients with INPH and controls at the group level. A significant difference in the GWRs was found only in the ant part of the periventricular area; the bilateral GWRs ant were significantly higher in patients with INPH than in controls (p < 0.0001 with multiple corrections). The ROC analysis clearly showed a cut-off value of GWRs (>1.17) for diagnosing INPH. The diagnostic accuracy was satisfactory: >90% with specificity and>93% with a positive predictive value. The sensitivity and negative predictive value (NPV) were acceptable: >57% with sensitivity and>50% NPV. The GWR ant on CT could be a useful and reliable diagnostic tool in patients with INPH.

Disease-Modifying Therapies During the COVID-19 Outbreak: A Narrative Review of International and National Recommendations.

BACKGROUND: Managing multiple sclerosis (MS) during the novel coronavirus disease 2019 (COVID-19) pandemic is a challenge due to the lack of evidence from clinical studies. Disease-modifying therapies (DMTs) may affect the immune response and subsequently alter the risk of COVID-19 infections. METHODS: A literature search was conducted on the MEDLINE, Embase, and Cochrane databases. A focused Google search was also performed. Recommendations regarding the use of DMTs during the COVID-19 outbreak from national and international MS/neurology societies were identified and reviewed. RESULTS: The review included 16 recommendations from international and national MS organizations. All recommendations are based on expert opinions. The recommendations regarding DMT initiation and management during this outbreak are summarized. Moreover, the experts' views about the risk of COVID-19 infection with each DMT are discussed. CONCLUSIONS: There is significant agreement among most experts' recommendations from a variety of sources based on collective clinical experience. However, the recommendations will likely evolve because sufficient clinical data are limited. Several ongoing registries will help provide information for future recommendations.

Rapidly progressive dementia-associated N-type voltage-gated calcium channel antibody encephalopathy.

Autoimmune encephalopathy is one of the treatable causes of rapidly progressive dementia; however, it is often underdiagnosed. Autoantibodies against voltage-gated calcium channel (VGCC) have been linked to several neurological disorders, including Lambert-Eaton syndrome, but VGCC antibody-associated encephalopathy is uncommon. Herein, we present a case of a 74-year-old woman with prominent neuropsychiatric symptoms followed by rapid cognitive decline. Extensive initial studies were nondiagnostic. Subsequently, serum N-type VGCC antibody was positive. After treatment with intravenous immunoglobulin, the patient's cognition and neuropsychiatric symptoms significantly improved.

Acute motor-sensory axonal neuropathy associated with systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) is an autoimmune disease that involves multiple organs and is generally treated by immunosuppressive agents. Acute motor-sensory axonal neuropathy (AMSAN) is a variant of Guillain-Barré syndrome. The standard therapies are intravenous immunoglobulin or plasmapheresis. An association between AMSAN and SLE is rarely reported. Herein, we describe a case of a 72-year-old man who presented with rapidly progressive paraparesis, dysesthesia, and joint pain with morning stiffness. Initially, he was diagnosed with AMSAN. Intravenous immunoglobulin was given without significant improvement. Subsequent studies indicated the diagnosis of SLE. Therefore, the patient was treated with intravenous methylprednisolone, cyclophosphamide, and then plasmapheresis. At 3 months, he improved from bedridden to wheelchair-bound. Our case demonstrates AMSAN as a rare initial manifestation that can lead to significant disability.