Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 5.279
Filtrar
1.
Artigo em Russo | MEDLINE | ID: mdl-33834716

RESUMO

OBJECTIVE: To develop and implement the tactics of the differentiated complex (medication in combination with surgery) treatment of the form of Parkinson's disease (PD) associated with dyskinesias, according to the severity of atrophic changes in the brain. MATERIAL AND METHODS: The study included 40 patients with PD associated with dyskinesias and motor fluctuations. Patients of the main group received medication and surgical treatment, patients of the comparison group received only medication. The patient's health was assessed every 3 months during 1.5 years. Three atrophy indices were proposed to describe atrophic changes in the brain. RESULTS: We have determined the values of the indices when the complex treatment was optimal for patients. CONCLUSION: The results of the study are supposed to be used in the practice of neurologists and neurosurgeons.


Assuntos
Discinesias , Doença de Parkinson , Antiparkinsonianos/uso terapêutico , Atrofia/patologia , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Humanos , Doença de Parkinson/tratamento farmacológico , Doença de Parkinson/patologia
2.
Int J Mol Sci ; 22(7)2021 Mar 29.
Artigo em Inglês | MEDLINE | ID: mdl-33805296

RESUMO

The aim of this study was to compare the patterns of cerebellar alterations associated with bipolar disease with those induced by the presence of cerebellar neurodegenerative pathologies to clarify the potential cerebellar contribution to bipolar affective disturbance. Twenty-nine patients affected by bipolar disorder, 32 subjects affected by cerebellar neurodegenerative pathologies, and 37 age-matched healthy subjects underwent a 3T MRI protocol. A voxel-based morphometry analysis was used to show similarities and differences in cerebellar grey matter (GM) loss between the groups. We found a pattern of GM cerebellar alterations in both bipolar and cerebellar groups that involved the anterior and posterior cerebellar regions (p = 0.05). The direct comparison between bipolar and cerebellar patients demonstrated a significant difference in GM loss in cerebellar neurodegenerative patients in the bilateral anterior and posterior motor cerebellar regions, such as lobules I-IV, V, VI, VIIIa, VIIIb, IX, VIIb and vermis VI, while a pattern of overlapping GM loss was evident in right lobule V, right crus I and bilateral crus II. Our findings showed, for the first time, common and different alteration patterns of specific cerebellar lobules in bipolar and neurodegenerative cerebellar patients, which allowed us to hypothesize a cerebellar role in the cognitive and mood dysregulation symptoms that characterize bipolar disorder.


Assuntos
Transtorno Bipolar/patologia , Doenças Cerebelares/patologia , Cerebelo/patologia , Substância Cinzenta/patologia , Adulto , Atrofia/diagnóstico por imagem , Atrofia/patologia , Transtorno Bipolar/diagnóstico por imagem , Doenças Cerebelares/diagnóstico por imagem , Cerebelo/diagnóstico por imagem , Feminino , Substância Cinzenta/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Doenças Neurodegenerativas/diagnóstico por imagem , Doenças Neurodegenerativas/patologia
3.
Neuron ; 109(8): 1243-1245, 2021 04 21.
Artigo em Inglês | MEDLINE | ID: mdl-33887187

RESUMO

TREM2 variants increase the risk for Alzheimer's disease. In this issue of Neuron, Lee et al. demonstrate that TREM2-dependent microglial functions prevent accumulation and spreading of tau, but only in the presence of amyloid pathology. This provides additional fuel for the amyloid cascade hypothesis and supports a protective function of microglia.


Assuntos
Doença de Alzheimer , Peptídeos beta-Amiloides , Doença de Alzheimer/genética , Doença de Alzheimer/patologia , Peptídeos beta-Amiloides/metabolismo , Atrofia/patologia , Encéfalo/metabolismo , Humanos , Glicoproteínas de Membrana , Microglia/metabolismo , Receptores Imunológicos/genética
4.
Menopause ; 28(4): 444-446, 2021 01 25.
Artigo em Inglês | MEDLINE | ID: mdl-33752218

RESUMO

ABSTRACT: Genitourinary syndrome of menopause (GSM) is a highly prevalent and progressive condition of postmenopausal women that has significant negative effects on vulvovaginal health, sexual health, and overall quality of life. Despite many available safe and effective therapies, GSM often goes undiagnosed and untreated. This Practice Pearl addresses the pathophysiology of GSM and reviews available treatment options.


Assuntos
Doenças Urogenitais Femininas , Qualidade de Vida , Atrofia/patologia , Feminino , Doenças Urogenitais Femininas/epidemiologia , Doenças Urogenitais Femininas/patologia , Humanos , Menopausa , Síndrome , Vagina/patologia
5.
Neuron ; 109(8): 1283-1301.e6, 2021 04 21.
Artigo em Inglês | MEDLINE | ID: mdl-33675684

RESUMO

Loss-of-function TREM2 mutations strongly increase Alzheimer's disease (AD) risk. Trem2 deletion has revealed protective Trem2 functions in preclinical models of ß-amyloidosis, a prominent feature of pre-diagnosis AD stages. How TREM2 influences later AD stages characterized by tau-mediated neurodegeneration is unclear. To understand Trem2 function in the context of both ß-amyloid and tau pathologies, we examined Trem2 deficiency in the pR5-183 mouse model expressing mutant tau alone or in TauPS2APP mice, in which ß-amyloid pathology exacerbates tau pathology and neurodegeneration. Single-cell RNA sequencing in these models revealed robust disease-associated microglia (DAM) activation in TauPS2APP mice that was amyloid-dependent and Trem2-dependent. In the presence of ß-amyloid pathology, Trem2 deletion further exacerbated tau accumulation and spreading and promoted brain atrophy. Without ß-amyloid pathology, Trem2 deletion did not affect these processes. Therefore, TREM2 may slow AD progression and reduce tau-driven neurodegeneration by restricting the degree to which ß-amyloid facilitates the spreading of pathogenic tau.


Assuntos
Doença de Alzheimer/metabolismo , Precursor de Proteína beta-Amiloide/metabolismo , Amiloide/metabolismo , Encéfalo/metabolismo , Glicoproteínas de Membrana/metabolismo , Receptores Imunológicos/metabolismo , Proteínas tau/metabolismo , Doença de Alzheimer/genética , Doença de Alzheimer/patologia , Peptídeos beta-Amiloides/metabolismo , Precursor de Proteína beta-Amiloide/genética , Animais , Atrofia/genética , Atrofia/metabolismo , Atrofia/patologia , Encéfalo/patologia , Modelos Animais de Doenças , Glicoproteínas de Membrana/genética , Camundongos , Camundongos Transgênicos , Receptores Imunológicos/genética , Proteínas tau/genética
6.
Artigo em Inglês | MEDLINE | ID: mdl-33528453

RESUMO

In everyday practice, surgeons have to deal with bone atrophy. These rehabilitations are even more complex in the posterior mandible, and it is still unclear in the literature which fixed rehabilitation option is best. The purpose of this article was to help oral surgeons to choose the proper and updated treatment for their atrophic patients. Posterior mandible bone atrophies were divided into four main groups depending on the bone height measured above the inferior alveolar nerve: (1) ≤ 4 mm; (2) > 4 mm ≤ 5 mm; (3) > 5 mm ≤ 6 mm; (4) > 6 mm < 7 mm. Different approaches were proposed for each group, considering patient expectations. If ≤ 4 mm of bone height was available, guided bone regeneration was used as the adequate approach. For bone heights > 4 mm and ≤ 6 mm, the "sandwich" technique and/or short implants were used, depending on esthetics. In cases with > 6 mm and < 7 mm above the mandibular canal, short implants might be the proper option. The authors' clinical experience and the literature were considered in order to suggest a possible correct treatment decision based on the residual bone height in the posterior mandible.


Assuntos
Aumento do Rebordo Alveolar , Implantes Dentários , Atrofia/patologia , Implantação Dentária Endo-Óssea , Prótese Dentária Fixada por Implante , Humanos , Mandíbula/diagnóstico por imagem , Mandíbula/patologia , Mandíbula/cirurgia , Resultado do Tratamento
9.
BMC Neurol ; 21(1): 51, 2021 Feb 03.
Artigo em Inglês | MEDLINE | ID: mdl-33535984

RESUMO

BACKGROUND: There is no established pathogenesis of hemiparkinsonism-hemiatrophy syndrome (HPHA), and the varied clinical presentations have been reported in several case studies. To the best of our knowledge, the present report describes the first case of HPHA with unusual brain imaging findings. CASE PRESENTATION: A 20-year-old man presented with a 6-month history of weakness and clumsiness in his right limbs. He showed right-sided parkinsonism with dystonic hand posture; however, body asymmetry was not noted. Brain imaging revealed hemiatrophy of the left hemisphere subcortical structures and brainstem, and iron deposition in the left globus pallidus and substantia nigra. In addition, dopamine transporter imaging demonstrated normal presynaptic dopaminergic function. The patient was treated with levodopa, which had little to no effect. CONCLUSIONS: This case demonstrates the unique imaging characteristics of HPHA associated with widespread brain hemiatrophy and iron deposition. Further studies are needed to elucidate the diagnostic criteria for this heterogeneous syndrome.


Assuntos
Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Transtornos Parkinsonianos/diagnóstico por imagem , Transtornos Parkinsonianos/patologia , Antiparkinsonianos/uso terapêutico , Atrofia/patologia , Lateralidade Funcional , Humanos , Ferro , Levodopa/uso terapêutico , Imagem por Ressonância Magnética , Masculino , Transtornos Parkinsonianos/tratamento farmacológico , Adulto Jovem
10.
Int J Oral Maxillofac Implants ; 36(1): 30-37, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33600520

RESUMO

PURPOSE: This study aimed to assess the survival rate, marginal bone levels, and prosthetic success of short implants when placed in posterior areas of severely reabsorbed mandibles. MATERIALS AND METHODS: A systematic review was performed of all randomized controlled trials with at least 10 patients with a control group where bone augmentations were performed that were published between January 2015 and February 2020. From 77 pertinent studies, 14 full-text publications were studied, and 6 studies fulfilled the inclusion criteria. RESULTS: The implant survival rates of short dental implants ranged from 92% to 96.9% with a follow-up from 1 to 5 years, and the prosthetic success rate ranged from 90% to 100% during the same follow-up. The mean marginal bone level values of involved short implants ranged from -0.51 to -2.30 mm. CONCLUSION: The obtained data showed that short dental implants are a valid therapeutic choice to rehabilitate severe mandibular atrophy in the medium to long term.


Assuntos
Aumento do Rebordo Alveolar , Implantes Dentários , Atrofia/patologia , Implantação Dentária Endo-Óssea , Planejamento de Prótese Dentária , Prótese Dentária Fixada por Implante , Falha de Restauração Dentária , Humanos , Mandíbula/patologia , Mandíbula/cirurgia , Resultado do Tratamento
11.
Lakartidningen ; 1182021 01 21.
Artigo em Sueco | MEDLINE | ID: mdl-33491762

RESUMO

Posterior cortical atrophy (PCA) is a neurodegenerative disease which was described originally in 1988 by dr Frank Benson. PCA is characterized by progressive deficits in higher visual functions while episodic memory and speech are relatively preserved. Studies have shown that the neuropathologic findings in most cases are consistent with Alzheimer's disease (AD). However, patients with PCA show greater occipitoparietal atrophy on neuroimaging compared with the more prominent mesiotemporal atrophy in patients with amnestic AD. Until recently, diagnostics were based mainly on clinical experience due to the lack of validated diagnostic criteria. In 2017, new consensus criteria for the diagnosis and classification of PCA were published. In this article we make a brief review of the disease and describe a 58 year old man with complex visual deficits and apraxia who was ultimately diagnosed with PCA.


Assuntos
Doença de Alzheimer , Doenças Neurodegenerativas , Doença de Alzheimer/diagnóstico , Doença de Alzheimer/diagnóstico por imagem , Atrofia/patologia , Córtex Cerebral/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Neurodegenerativas/diagnóstico , Doenças Neurodegenerativas/diagnóstico por imagem
12.
Intern Med ; 60(1): 39-46, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33390470

RESUMO

Objective Prospective memory (PM) is an important social cognitive function in everyday life. PM is one of the most affected cognitive domains in multiple sclerosis (MS) patients. Gray matter (GM) atrophy and plaques have been attracting attention for various cognitive impairments in MS patients. This study aimed to clarify the atrophic GM regions associated with PM deficits and investigate the relationship between the atrophic GM regions and GM plaques. Methods Twenty-one MS patients and 10 healthy controls (HCs) underwent neuropsychological tests and MRI. PM was assessed using subtests of the Rivermead Behavioural Memory Test. A lesion symptom analysis was performed using voxel-based morphometry (VBM). We then evaluated GM plaques in the corresponding areas using double inversion recovery (DIR). Results MS patients showed lower PM scores than HCs (p=0.0064). The GM volume of MS patients tended to be lower than those of HCs. VBM analyses revealed correlations of the PM score with the orbital part of the left inferior frontal gyrus, the left hippocampus, and the right parahippocampus. There was no GM plaque in the orbital part of the left inferior frontal gyrus and the right parahippocampus. Only one patient (4.8%) had GM plaque in the left hippocampus. Conclusion The left inferior frontal gyrus, the left hippocampus, and the right parahippocampus were associated with PM in MS, whereas these atrophic GM regions were not associated with GM plaque. Regardless of the location of plaques on DIR, both PM deficit and GM atrophy should be detected using neuropsychological tests and VBM in MS patients.


Assuntos
Memória Episódica , Esclerose Múltipla , Atrofia/patologia , Substância Cinzenta/diagnóstico por imagem , Substância Cinzenta/patologia , Humanos , Imagem por Ressonância Magnética , Esclerose Múltipla/complicações , Esclerose Múltipla/diagnóstico por imagem
13.
Neurology ; 96(11): e1561-e1573, 2021 03 16.
Artigo em Inglês | MEDLINE | ID: mdl-33441452

RESUMO

OBJECTIVES: Gay matter (GM) involvement is clinically relevant in multiple sclerosis (MS). Using source-based morphometry (SBM), we characterized GM atrophy and its 1-year evolution across different MS phenotypes. METHODS: Clinical and MRI data were obtained at 8 European sites from 170 healthy controls (HCs) and 398 patients with MS (34 with clinically isolated syndrome [CIS], 226 with relapsing-remitting MS [RRMS], 95 with secondary progressive MS [SPMS], and 43 with primary progressive MS [PPMS]). Fifty-seven HCs and 144 with MS underwent 1-year follow-up. Baseline GM loss, atrophy progression, and correlations with disability and 1-year clinical worsening were assessed. RESULTS: SBM identified 26 cerebellar, subcortical, sensory, motor, and cognitive GM components. GM atrophy was found in patients with MS vs HCs in almost all components (p range <0.001-0.04). Compared to HCs, patients with CIS showed circumscribed subcortical, cerebellar, temporal, and salience GM atrophy, while patients with RRMS exhibited widespread GM atrophy. Cerebellar, subcortical, sensorimotor, salience, and frontoparietal GM atrophy was found in patients with PPMS vs HCs and in patients with SPMS vs those with RRMS. At 1 year, 21 (15%) patients had clinically worsened. GM atrophy progressed in MS in subcortical, cerebellar, sensorimotor, and fronto-temporo-parietal components. Baseline higher disability was associated (R 2 = 0.65) with baseline lower normalized brain volume (ß = -0.13, p = 0.001), greater sensorimotor GM atrophy (ß = -0.12, p = 0.002), and longer disease duration (ß = 0.09, p = 0.04). Baseline normalized GM volume (odds ratio 0.98, p = 0.008) and cerebellar GM atrophy (odds ratio 0.40, p = 0.01) independently predicted clinical worsening (area under the curve 0.83). CONCLUSION: GM atrophy differed across disease phenotypes and progressed at 1 year in MS. In addition to global atrophy measures, sensorimotor and cerebellar GM atrophy explained baseline disability and clinical worsening.


Assuntos
Encéfalo/patologia , Substância Cinzenta/patologia , Esclerose Múltipla/patologia , Adulto , Atrofia/patologia , Progressão da Doença , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Fenótipo
14.
Biol Psychiatry ; 89(8): 807-816, 2021 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-33500176

RESUMO

BACKGROUND: Characterizing changing brain structure in neurodegeneration is fundamental to understanding long-term effects of pathology and ultimately providing therapeutic targets. It is well established that Huntington's disease (HD) gene carriers undergo progressive brain changes during the course of disease, yet the long-term trajectory of cortical atrophy is not well defined. Given that genetic therapies currently tested in HD are primarily expected to target the cortex, understanding atrophy across this region is essential. METHODS: Capitalizing on a unique longitudinal dataset with a minimum of 3 and maximum of 7 brain scans from 49 HD gene carriers and 49 age-matched control subjects, we implemented a novel dynamical systems approach to infer patterns of regional neurodegeneration over 10 years. We use Bayesian hierarchical modeling to map participant- and group-level trajectories of atrophy spatially and temporally, additionally relating atrophy to the genetic marker of HD (CAG-repeat length) and motor and cognitive symptoms. RESULTS: We show, for the first time, that neurodegenerative changes exhibit complex temporal dynamics with substantial regional variation around the point of clinical diagnosis. Although widespread group differences were seen across the cortex, the occipital and parietal regions undergo the greatest rate of cortical atrophy. We have established links between atrophy and genetic markers of HD while demonstrating that specific cortical changes predict decline in motor and cognitive performance. CONCLUSIONS: HD gene carriers display regional variability in the spatial pattern of cortical atrophy, which relates to genetic factors and motor and cognitive symptoms. Our findings indicate a complex pattern of neuronal loss, which enables greater characterization of HD progression.


Assuntos
Doença de Huntington , Atrofia/patologia , Teorema de Bayes , Encéfalo/patologia , Criança , Progressão da Doença , Humanos , Doença de Huntington/genética , Doença de Huntington/patologia , Imagem por Ressonância Magnética
15.
Clin Imaging ; 69: 238-242, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32977196

RESUMO

PURPOSE: The present study was carried out to investigate any possible linkage between cerebral grey matter volumetric, iron changes, white matter's lesions load and serum iron levels in a group of relapsing-remitting multiple sclerosis (RRMS) patients. MATERIALS AND METHODS: Sixty-five RRMS patients along with thirty-four age-matched healthy controls (HCs) were recruited. Serum samples were isolated from blood samples which were collected in vacutainer plain tubes individually from both groups. Both groups were scanned at 1.5 T magnetic resonance imaging (MRI) using the following 3D sequences; T1-weighted gradient echo (MPRAGE), T2*-weighted gradient echo and T2-weighted fluid-attenuated inversion recovery (FLAIR). RESULTS: Significant differences were observed between the RRMS patients and HCs for cortical and deep grey matter (dGM) volumes where cortical and dGM volumes in RRMS patient were significantly smaller than those in HCs. While iron deposition in the cortex, putamen (PT) and globus pallidus (GP) of RRMS patients were significantly higher than those of HCs, iron levels in thalamus (TH) and serum were significantly lower in RRMS compared to those in HCs. Except for T2 lesion load, none of volumetric measures showed any association with patients' disability status. Cerebral grey matter's iron changes did not show any association with those of serum. CONCLUSION: Smaller cortical and subcortical grey matter volumes in RRMS patients compared to HCs were detected. None of the volumetric measures showed any association with patients' disability status. RRMS patients showed increased iron levels in the PT, GP and cortex and decreased levels in the TH and serum.


Assuntos
Esclerose Múltipla Recidivante-Remitente , Esclerose Múltipla , Atrofia/patologia , Substância Cinzenta/diagnóstico por imagem , Substância Cinzenta/patologia , Humanos , Ferro , Imagem por Ressonância Magnética , Esclerose Múltipla/patologia , Esclerose Múltipla Recidivante-Remitente/diagnóstico por imagem
16.
Artigo em Inglês | MEDLINE | ID: mdl-33309266

RESUMO

OBJECTIVES: Localized juvenile spongiotic gingival hyperplasia (LJSGH) is a recently described entity with distinct manifestations. Herein we report a comprehensive histopathologic study of 21 lesions and a literature review. Additionally, we propose a new term that we consider more appropriate. STUDY DESIGN: LJSGH cases were retrieved and their clinicopathologic characteristics were assessed. A review of all pertinent literature was also conducted. RESULTS: Eighteen patients with LJSGH (21 biopsied lesions) were identified. Microscopically, surface morphology was classified into exophytic/papillary, flat, and micropapillary (8, 7, and 6 lesions, respectively). Cases with parakeratinization (n = 9), no prominent spongiosis (n = 5), or epithelial atrophy (n = 4) were recorded. Increased vascularity, mixed inflammation with exocytosis, and cytokeratin-19 positivity were uniformly observed. Less frequent findings included pseudoepitheliomatous hyperplasia (n = 8), bacterial colonies (n = 5), acantholysis (n = 3), and dystrophic calcifications (n = 2). The literature review disclosed 201 patients with a mean age of 14.8 years (range, 3-72; 13.6% affecting adults), similar sex distribution (103:98, female:male), and predominance of the anterior maxilla (≈ 80%). Eighteen cases were multifocal (≈ 10%). CONCLUSIONS: Our data suggest that the terminology could be modified, because LJSGH may be multifocal, affect older individuals, or exhibit epithelial atrophy, and the entity's odontogenic origin (as highlighted by the histopathologic and immunohistochemical findings) needs to be emphasized.


Assuntos
Hiperplasia Gengival , Adolescente , Adulto , Idoso , Atrofia/patologia , Criança , Pré-Escolar , Edema/patologia , Feminino , Humanos , Hiperplasia/patologia , Masculino , Maxila/patologia , Pessoa de Meia-Idade , Adulto Jovem
17.
Zhonghua Yi Xue Za Zhi ; 100(43): 3397-3401, 2020 Nov 24.
Artigo em Chinês | MEDLINE | ID: mdl-33238668

RESUMO

Objective: To investigate the association of age-related white matter hyperintensity (WMH) with brain atrophy and cognitive impairment in patients with Parkinson's disease (PD). Methods: Consecutive samples of a prospective PD cohort with complete 3-dimensional magnetic resonance imaging in the Department of Movement Disorders in Beijing Tiantan Hospital, Capital Medical University, from October 2018 to August 2019 was retrospectively analyzed. Cognition was evaluated by Mini-Mental State Scale (MMSE) and Montreal Cognitive Assessment (MoCA). The severity of WMH was semi-quantitatively measured by Fazekas scale (0-6 points), and the mean cortical thickness and thalamus volume were calculated by FreeSurfer software. The demographic and disease characteristics, the severity of WMH, the mean cortical thickness and thalamus volume were respectively compared between PD patients with and without dementia. Moreover, univariate and multivariate generalized linear models were used to analyze the correlation of the severity of WMH with brain atrophy and MoCA. Results: A total of 225 patients with PD were included in the study, with a median age of 66 years old. Comparisons between groups suggested that patients with dementia were with severer WMH, older, and had lower levels of serum cholesterol and low-density lipoprotein and more reduced mean cortical thickness than those without dementia (all P<0.05), but no significant difference in the thalamus volume was found between the two groups. The generalized linear model showed that the cognitive impairment of PD patients was significantly correlated with WMH (ß=-0.021, 95%CI:-0.040--0.002, P=0.032), but independent of age, cortical thickness, and levels of serum cholesterol and low-density lipoprotein. Conclusion: WMH may worsen PD cognitive impairment independent of brain atrophy. Clinical prevention and treatment of cerebral small vessel disease may have protective effects on cognitive function in patients with PD.


Assuntos
Disfunção Cognitiva , Doença de Parkinson , Substância Branca , Idoso , Atrofia/patologia , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/patologia , Humanos , Imagem por Ressonância Magnética , Testes Neuropsicológicos , Doença de Parkinson/complicações , Doença de Parkinson/patologia , Estudos Prospectivos , Estudos Retrospectivos , Substância Branca/patologia
18.
Neurol Neurochir Pol ; 54(5): 410-415, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33085075

RESUMO

Magnetic resonance imaging (MRI) is a widely used method for the diagnosis of multiple sclerosis that is essential for the detection and follow-up of the disease. OBJECTIVE: The Polish Medical Society of Radiology (PLTR) and the Polish Society of Neurology (PTN) present the second version of their recommendations for investigations routinely conducted in magnetic resonance imaging departments in patients with multiple sclerosis. This version includes new data and practical comments for electroradiology technologists and radiologists. The recommended protocol aims to improve the MRI procedure and, most importantly, to standardise the method of conducting scans in all MRI departments. This is crucial for the initial diagnostics necessary for establishing a diagnosis, as well as for MS patient monitoring, which directly translates into significant clinical decisions. INTRODUCTION: Multiple sclerosis (MS) is a chronic immune mediated inflammatory demyelinating disease of the central nervous system (CNS), the aetiology of which is still unknown. The nature of the disease lies in a CNS destruction process disseminated in time (DIT) and space (DIS). MRI detects focal lesions in the white and grey matter with high sensitivity (although with significantly lower specificity in the latter). It is also the best tool to assess brain atrophy in patients with MS in terms of grey matter volume (GMV) and white matter volume (WMV) as well as local atrophy (by measuring the volume of thalamus, corpus callosum, subcortical nuclei, and hippocampus) as parameters that correlate with disability progression and cognitive dysfunctions. Progress in MR techniques, as well as advances in postprocessing the obtained data, has driven the dynamic development of computer programs that allow for a more repeatable assessment of brain atrophy in both cross-sectional and longitudinal studies. MR imaging is unquestionably the best diagnostic tool available to follow up the course of the disease and support clinicians in choosing the most appropriate treatment strategy for their MS patient. However, to diagnose and follow up MS patients on the basis of MRI in accordance with the latest standards, the MRI study must adhere to certain quality criteria. Such criteria are the subject of this paper.


Assuntos
Esclerose Múltipla , Neurologia , Atrofia/patologia , Encéfalo/patologia , Estudos Transversais , Humanos , Imagem por Ressonância Magnética , Esclerose Múltipla/diagnóstico por imagem , Esclerose Múltipla/patologia , Polônia , Sociedades Médicas
19.
Brain Nerve ; 72(9): 923-930, 2020 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-32934181

RESUMO

Marie et al. (1922) first proposed a disease entity "late cortical cerebellar atrophy (LCCA)", which is characterized neuropathologically by pure cerebello-olivary degeneration. LCCA was originally described as sporadic, late-onset, pure cerebellar ataxia of unknown etiology; however, it has occasionally been used to denote familial or secondary ataxias, particularly alcoholic cerebellar degeneration. Sporadic ataxia is classified mainly into LCCA or CCA and olivo-ponto-cerebellar atrophy (OPCA) in Japan. OPCA, now multiple system atrophy with predominant cerebellar ataxia, has characteristic brain imaging features and is clearly diagnosed based on the consensus criteria. On the other hand, there is no specific biomarker for LCCA/CCA, and neuropathological examination is required for a definitive diagnosis. Therefore, the clinical diagnosis of LCCA/CCA depends on the exclusion of other diseases manifesting as cerebellar ataxia. However the differential diagnosis for LCCA/CCA is not necessarily made carefully. As a result, the LCCA/CCA category in Japan is a "waste basket," including OPCA, hereditary ataxias, and secondary ataxias, which are unidentified yet. To refine the LCCA/CCA category, we proposed the clinically-defined term "idiopathic cerebellar ataxia (IDCA)" and established its diagnostic criteria. By nationwide screening, we have identified 51 patients with probable IDCA according to the criteria so far. Here we review the clinical characteristics of IDCA patients.


Assuntos
Ataxia Cerebelar , Degenerações Espinocerebelares , Atrofia/patologia , Ataxia Cerebelar/diagnóstico , Cerebelo , Humanos , Japão , Degenerações Espinocerebelares/diagnóstico , Degenerações Espinocerebelares/patologia
20.
Brain Nerve ; 72(9): 931-937, 2020 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-32934182

RESUMO

Cerebellar ataxia-predominant multiple system atrophy (MSA-C) and cortical cerebellar atrophy are representative diseases of adult-onset sporadic degenerative ataxia. Both diseases are distinctly different because of α-synuclein pathology. However, it takes approximately 2 years for cerebellar ataxia to progress to concomitant severe autonomic dysfunction in patients with MSA-C. The period of only cerebellar ataxia (mono system atrophy) may extend to more than 10 years. Understanding mono system atrophy is vital for the early diagnosis and drug development for MSA. In this review, we discuss mono system atrophy focusing on the concept and natural history and the possibility of the of early diagnosis and disease-modifying therapy for MSA.


Assuntos
Ataxia Cerebelar , Atrofia de Múltiplos Sistemas , Adulto , Ataxia , Atrofia/patologia , Ataxia Cerebelar/diagnóstico , Ataxia Cerebelar/tratamento farmacológico , Cerebelo , Humanos , Atrofia de Múltiplos Sistemas/diagnóstico , Atrofia de Múltiplos Sistemas/tratamento farmacológico , Atrofia de Múltiplos Sistemas/patologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...