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1.
Medicine (Baltimore) ; 98(39): e17334, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574870

RESUMO

RATIONALE: Subacute combined degeneration (SCD) is a disease caused by decreased vitamin B12 intake or metabolic disorders. It is more common in the elderly and rarely seen in children. Here, we report 2 pediatric cases of SCD in late-onset cobalamin C (CblC) deficiency. PATIENT CONCERNS: The patients complained of unsteady gait. Their physical examination showed sensory ataxia. Magnetic resonance imaging showed classic manifestations of SCD. The serum vitamin B12 level was normal, but urine methylmalonic acid and serum homocysteine levels were high. DIAGNOSIS: The pathogenic gene was confirmed as MMACHC. The 2 patients each had 2 pathogenic mutations C.482 G>A and C.271dupA and C.365A>T and C.609G>A in this gene. They were diagnosed with combined methylmalonic acidemia and homocysteinemia-CblC subtype. INTERVENTIONS: The patients were treated with methylcobalamin 500 µg intravenous injection daily after being admitted. After the diagnosis, levocarnitine, betaine, and vitamin B12 were added to the treatment. OUTCOMES: Twelve days after treatment, the boy could walk normally, and his tendon reflex and sense of position returned to normal. The abnormal gait seemed to have become permanent in the girl and she walked with her legs raised higher than normal. LESSONS: To the best of our knowledge, this is the first report of 2 cases of isolated SCD in children with late-onset CblC disorder. Doctors should consider that SCD could be an isolated symptom of CblC disorder. The earlier the treatment, the lower the likelihood of sequelae.


Assuntos
Proteínas de Transporte/genética , Homocistinúria , Degeneração Combinada Subaguda , Deficiência de Vitamina B 12/congênito , Vitamina B 12/análogos & derivados , Adolescente , Ataxia/diagnóstico , Ataxia/etiologia , Ataxia/terapia , Encéfalo/diagnóstico por imagem , Criança , Feminino , Homocisteína/sangue , Homocistinúria/diagnóstico , Homocistinúria/genética , Humanos , Injeções Intravenosas , Transtornos de Início Tardio , Imagem por Ressonância Magnética/métodos , Masculino , Ácido Metilmalônico/urina , Mutação , Degeneração Combinada Subaguda/diagnóstico , Degeneração Combinada Subaguda/etiologia , Degeneração Combinada Subaguda/fisiopatologia , Degeneração Combinada Subaguda/terapia , Resultado do Tratamento , Vitamina B 12/administração & dosagem , Vitamina B 12/sangue , Deficiência de Vitamina B 12/diagnóstico , Deficiência de Vitamina B 12/genética , Complexo Vitamínico B/administração & dosagem
2.
Medicine (Baltimore) ; 98(36): e16887, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31490372

RESUMO

RATIONALE: Multiple syphilitic gummas involving both the brain and spinal cord are quite rare. Central nervous system (CNS) syphilitic gummas are commonly misdiagnosed as CNS tumors, and clinical suspicion and diagnosis of a syphilitic gumma by physicians are vital to avoiding unnecessary surgeries. Our case emphasizes the importance of routine serologic syphilis tests and standard therapy with penicillin in patients with a CNS mass. PATIENT CONCERNS: A 22-year-old previously healthy man presented with a 9-day history of progressive right lower limb weakness. DIAGNOSIS: The diagnosis of gummatous neurosyphilis was based on positive serological, cerebrospinal fluid tests for syphilis and magnetic resonance imaging (MRI) findings, which revealed the presence of multiple dural-based enhancing masses with marked edema. INTERVENTIONS: Therapy consisting of intravenous penicillin G at 24 million units daily divided into 6 doses were given for a total of 21 days, along with 3 weekly intramuscular injections of benzathine penicillin G (2.4 million units) to ensure that the syphilitic lesions in the CNS were adequately treated. OUTCOMES: Complete resolution of the lesions was observed on MRI over a 3-month period. LESSONS: The importance of routine serologic syphilis tests and standard therapy with penicillin in patients with central CNS mass lesions is noted to avoiding unnecessary surgeries.


Assuntos
Neurossífilis/diagnóstico , Antibacterianos/uso terapêutico , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Diagnóstico Diferencial , Soronegatividade para HIV , Humanos , Imagem por Ressonância Magnética , Masculino , Neurossífilis/diagnóstico por imagem , Neurossífilis/tratamento farmacológico , Penicilina G/uso terapêutico , Medula Espinal/diagnóstico por imagem , Medula Espinal/patologia , Adulto Jovem
3.
Pan Afr Med J ; 33: 154, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31558951

RESUMO

Posterior reversible encephalopathy syndrome (PRES) is a radioclinical entity associating a reversible central nervous system involvement with a common brain imaging feature. There is a great variability in the clinical presentation of this syndrome and in the features of its sometimes atypical imaging appearance. PRES is an unusual neurological complication occurring during pregnancy or in the post-partum period, other than any pre-existing pathology occurred during pregnancy. Vasogenic edema due to the rupture of the blood-brain barrier seems to be its main cause. We here report the case of a primiparous patient with generalized tonic-clonic seizures associated with hypertensive peak occurred during the third trimester of pregnancy. Magnetic resonance imaging (MRI) of the brain showed posterior reversible encephalopathy. PRES should be suspected in patients with any sign of neurological disorder. It has a favorable outcome without sequelae under early and fast treatment.


Assuntos
Síndrome da Leucoencefalopatia Posterior/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Convulsões/etiologia , Adulto , Encéfalo/diagnóstico por imagem , Encéfalo/fisiopatologia , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Síndrome da Leucoencefalopatia Posterior/fisiopatologia , Complicações Pós-Operatórias/fisiopatologia , Gravidez , Terceiro Trimestre da Gravidez
4.
Brain Nerve ; 71(9): 1003-1012, 2019 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-31506402

RESUMO

We present a case of a 73-year-old female who developed subacute memory disturbance, reduced consciousness and quadriparesis following pernicious anemia. Brain magnetic resonance imagings (MRI) in diffusion weighted, T2 weighted and fluid attenuated inversion recovery (FLAIR) images revealed hyperintensities in bilateral frontal, parietal, temporal and occipital cortices, left thalamus, bilateral splenium of corpus callosum, and bilateral subcortical white matters. Brain gadolinium enhanced T1 weighted MRI revealed very slight post-contrast enhancement lesions in the right posterior temporal region and bilateral parietal regions. Serum was negative for anti- aquaporin (AQP) 4 antibody, anti-glutamic acid decarboxylase (GAD) antibody and anti-voltage-gated potassium channel (VGKC) antibody, and cerebrospinal fluid (CSF) was negative for anti- N-methyl-D-aspartate (NMDA) receptor antibody. CSF analysis showed slight protein elevation with normal cellular content. No evidence of neoplasm was observed using whole-body 18 F -fluorodeoxyglucose- positron emission tomography/computed tomography. Pathological findings of the left frontal lesion revealed perivascular and scattered parechymal T-lymphocytic infiltration, and astrogliosis without vascular hyalinization. Patient achieved partial recovery during two intraveneous pulse methylprednisolone treatments, and exacerbation afterwards. After the third intraveneous pulse methylprednisolone treatment, remission is sustained for six years. This case can be regarded as autoantibody-negative but probable autoimmune encephalitis with the features of nonparaneoplastic panencephalitis and treatable dementia. Nonparaneoplastic autoimmune panencephalitis with widespread multifocal brain lesions on brain MRI is extremely rare, with exception of anti- NMDA receptor antibody encephalitis.


Assuntos
Anemia Perniciosa/complicações , Doenças Autoimunes/etiologia , Demência/etiologia , Encefalite/etiologia , Idoso , Doenças Autoimunes/tratamento farmacológico , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Demência/tratamento farmacológico , Encefalite/tratamento farmacológico , Feminino , Seguimentos , Humanos , Imagem por Ressonância Magnética
5.
Zhonghua Yi Xue Za Zhi ; 99(35): 2773-2776, 2019 Sep 17.
Artigo em Chinês | MEDLINE | ID: mdl-31550801

RESUMO

Objective: To investigate the brain activities of exercise addiction (EA) group people with the task-functional magnetic resonance image (task-fMRI). Methods: A total of 29 exercise addicts (addiction group, average age 46±4 years) and 26 non-exercise addicts (control group, average age 46±6 years) matched by sex, age, average education level and sports dependence degree were selected by using exercise addiction index (EAI) through questionnaires to members of Jiangsu Local Fitness and Long-distance Running Association between January 2018 and June 2018. The participants were scanned with fMRI while watching sports pictures or non-sports pictures. The brain responses of the two groups under two stimulation tasks were analyzed and compared. Results: Compared with the control group, while watching sports pictures, the right fusiform gyrus (MNI:x=30, y=-87, z=0), left posterior central gyrus (MNI:x=-51, y=-21, z=54), left medial superior frontal gyrus (MNI:x=-9, y=54, z=30), and right middle occipital gyrus (MNI:x=42, y=-72, z=36) were significantly inhibited in the addiction group (t-test, all P<0.05). When watching non-sports pictures, the addictive group showed the left superior frontal gyrus (MNI:x=-12, y=54, z=30), left middle frontal gyrus (MNI:x=-30, y=18, z=45), right inferior frontal gyrus (MNI:x=42, y=33, z=-12), right occipital gyrus (MNI:x=42, y=-72, z=36), and they were more significantly inhibited than the control group (t-test, all P<0.05). Conclusion: Compared to the control group, the EA group shows significant brain inhibition with visual stimulation, particularly with non-sports pictures.


Assuntos
Comportamento Aditivo/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Exercício , Imagem por Ressonância Magnética , Adulto , Mapeamento Encefálico , Lobo Frontal , Humanos , Pessoa de Meia-Idade , Lobo Temporal
6.
Ideggyogy Sz ; 72(7-8): 251-256, 2019 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-31517457

RESUMO

Background and purpose: In this study, we aimed to examine the risk factors, topographic features and stroke mechanisms of acute ischemic unilateral infarcts of thalamus. Methods: Patient with isolated thalamic infarct and those with posterior cerebral artery (PCA) infarction who were admitted to our hospital between January 2014 and January 2017 with acute unilateral thalamic infarction (TI) were included in this study (isolated thalamic infarction/ isolated TI; thalamic and posterior cerebral artery infarction/PCA+TI). Demographic characteristics and vascular risk factors of the patients were determined. Thalamic infarct areas were recorded topographically as anterior, posteromedial, ventrolateral, posterolateral, more than one area, and variant areas. Stroke mechanism was determined according to the criteria of "Trial of Org 10172 in Acute Stroke Treatment" (TOAST). Patients with isolated TI and PCA TI were compared according to risk factors, stroke mechanism and infarct topography. Results: Forty-three patients with a mean age of 63.3 ± 14.5 years were included in the study. Twenty-eight patients (60.1%) were found to have isolated TI and the remaining 15 patients (34.9%) had PCA+TI. 32.1% of patients with isolated TI had sensory symptoms on presentation, and 60% of patients with PCA-TI had sensorimotor symptoms. The mean age, the mean score on National Institutes of Health Stroke Scale (NIHSS) and the mean frequency of atrial fibrillation were higher in PCA+TI patients than in isolated-TI patients (p: 0.04, p: 0.004, p: 0.02 respectively). 32.6% of the patients had ventrolateral, 30.2% had posteromedial involvement. Ventrolateral topography was seen in 46.7% of the PCA+TI patients, while posteromedial topography was seen in 39.3% of the isolated-TI patients. 53.6% of the isolated-TI had small vessel disease etiology, while 40% of the PCA+TI had cardioembolic etiology, and the other 40% had large artery atherosclerosis. Conclusion: Our study showed that the most ommon stroke mechanism in patients with thalamic infarction is the small vessel disease. Isolated TI and PCA+TI patients differ in terms of etiologic mechanism and infarct topography. Variant territorial involvement and multiple area involvements can be quite common in thalamic infarcts.


Assuntos
Infarto da Artéria Cerebral Posterior/patologia , Artéria Cerebral Posterior , Acidente Vascular Cerebral/fisiopatologia , Doenças Talâmicas/diagnóstico , Tálamo/irrigação sanguínea , Idoso , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Humanos , Infarto da Artéria Cerebral Posterior/diagnóstico por imagem , Pessoa de Meia-Idade , Artéria Cerebral Posterior/diagnóstico por imagem , Artéria Cerebral Posterior/patologia , Fatores de Risco , Doenças Talâmicas/etiologia , Tálamo/fisiopatologia
7.
Ideggyogy Sz ; 72(7-8): 285-288, 2019 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-31517463

RESUMO

Morvan syndrome is a rare disease characterized by peripheral nerve hyperexcitability, encephalopathy, dys-autonomia and significant insomnia. The patient, who was included in the present study, was followed-up at our clinics for confusion, myokymia, hyperhidrosis, epileptic seizures, tachycardia, agitation, hypokalemia, and hyponatremia. The cranial MRI of the patient demonstrated hyperintensities at the T2 and FLAIR sections of the medial temporal lobe and insular lobes. Electromyography and neurotransmission examination results were concordant with peripheral nerve hyperreactivity. Contactin-associated protein-like 2 antibodies and leucine-rich glioma inactivated protein 1 antibodies were detected as positive. The patient was diagnosed with Morvan syndrome; intravenous immunoglobulin and corticosteroid treatment was started. Almost full remission was achieved. This very rare syndrome implies challenges in diagnosis and treatment; however, remission can be achieved during the follow-up. In addition, caution is needed in the long-term follow-up of these patients regarding the development of malignancies.


Assuntos
Encefalopatias , Encéfalo/diagnóstico por imagem , Transtornos dos Movimentos/fisiopatologia , Doenças Musculares/fisiopatologia , Doenças do Sistema Nervoso Periférico/diagnóstico , Corticosteroides/uso terapêutico , Autoanticorpos/sangue , Eletromiografia , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Fatores Imunológicos/uso terapêutico , Encefalite Límbica , Transtornos dos Movimentos/tratamento farmacológico , Doenças Musculares/tratamento farmacológico , Doenças do Sistema Nervoso Periférico/tratamento farmacológico , Convulsões/etiologia , Resultado do Tratamento
9.
JAMA ; 322(6): 524-534, 2019 08 13.
Artigo em Inglês | MEDLINE | ID: mdl-31408137

RESUMO

Importance: The effect of intensive blood pressure lowering on brain health remains uncertain. Objective: To evaluate the association of intensive blood pressure treatment with cerebral white matter lesion and brain volumes. Design, Setting, and Participants: A substudy of a multicenter randomized clinical trial of hypertensive adults 50 years or older without a history of diabetes or stroke at 27 sites in the United States. Randomization began on November 8, 2010. The overall trial was stopped early because of benefit for its primary outcome (a composite of cardiovascular events) and all-cause mortality on August 20, 2015. Brain magnetic resonance imaging (MRI) was performed on a subset of participants at baseline (n = 670) and at 4 years of follow-up (n = 449); final follow-up date was July 1, 2016. Interventions: Participants were randomized to a systolic blood pressure (SBP) goal of either less than 120 mm Hg (intensive treatment, n = 355) or less than 140 mm Hg (standard treatment, n = 315). Main Outcomes and Measures: The primary outcome was change in total white matter lesion volume from baseline. Change in total brain volume was a secondary outcome. Results: Among 670 recruited patients who had baseline MRI (mean age, 67.3 [SD, 8.2] years; 40.4% women), 449 (67.0%) completed the follow-up MRI at a median of 3.97 years after randomization, after a median intervention period of 3.40 years. In the intensive treatment group, based on a robust linear mixed model, mean white matter lesion volume increased from 4.57 to 5.49 cm3 (difference, 0.92 cm3 [95% CI, 0.69 to 1.14]) vs an increase from 4.40 to 5.85 cm3 (difference, 1.45 cm3 [95% CI, 1.21 to 1.70]) in the standard treatment group (between-group difference in change, -0.54 cm3 [95% CI, -0.87 to -0.20]). Mean total brain volume decreased from 1134.5 to 1104.0 cm3 (difference, -30.6 cm3 [95% CI, -32.3 to -28.8]) in the intensive treatment group vs a decrease from 1134.0 to 1107.1 cm3 (difference, -26.9 cm3 [95% CI, 24.8 to 28.8]) in the standard treatment group (between-group difference in change, -3.7 cm3 [95% CI, -6.3 to -1.1]). Conclusions and Relevance: Among hypertensive adults, targeting an SBP of less than 120 mm Hg, compared with less than 140 mm Hg, was significantly associated with a smaller increase in cerebral white matter lesion volume and a greater decrease in total brain volume, although the differences were small. Trial Registration: ClinicalTrials.gov Identifier: NCT01206062.


Assuntos
Anti-Hipertensivos/uso terapêutico , Encéfalo/fisiologia , Hipertensão/tratamento farmacológico , Substância Branca/patologia , Idoso , Pressão Sanguínea , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Feminino , Humanos , Hipertensão/complicações , Hipertensão/patologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Fatores de Risco
11.
Phys Rev Lett ; 123(3): 038301, 2019 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-31386449

RESUMO

The brain requires diverse segregated and integrated processing to perform normal functions in terms of anatomical structure and self-organized dynamics with critical features, but the fundamental relationships between the complex structural connectome, critical state, and functional diversity remain unknown. Herein, we extend the eigenmode analysis to investigate the joint contribution of hierarchical modular structural organization and critical state to brain functional diversity. We show that the structural modes inherent to the hierarchical modular structural connectome allow a nested functional segregation and integration across multiple spatiotemporal scales. The real brain hierarchical modular organization provides large structural capacity for diverse functional interactions, which are generated by sequentially activating and recruiting the hierarchical connectome modes, and the critical state can best explore the capacity to maximize the functional diversity. Our results reveal structural and dynamical mechanisms that jointly support a balanced segregated and integrated brain processing with diverse functional interactions, and they also shed light on dysfunctional segregation and integration in neurodegenerative diseases and neuropsychiatric disorders.


Assuntos
Encéfalo/fisiologia , Conectoma/métodos , Modelos Neurológicos , Encéfalo/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética
12.
Br J Radiol ; 92(1101): 20190165, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31364398

RESUMO

The recreational consumption of cannabis has increased significantly across the world with an estimated 180 million people currently using. In the United States, 4.1 million are currently diagnosed with cannabis use disorder. Cannabis dependence and abuse was combined into a single entity as a behavioral disorder with a problematic pattern of cannabis use and termed cannabis use disorder by the Diagnostic and Statistical Manual of Mental Disorders. Chronic use of cannabis has been linked with region-specific effects across the brain mediating reward processing, cognitive control and decision-making that are central to understanding addictive behaviors. This review presents a snapshot of the current literature assessing the effects of chronic cannabis use on human brain function via functional MRI. Studies employing various paradigms and contrasting cognitive activation amongst cannabis users and non-users were incorporated. The effects of trans-del-ta-9-tetrahydrocannabinol (Δ9-THC) in marijuana and other preparations of cannabis are mediated by the endocannabinoid system, which is also briefly introduced.Much variation exists in the current literature regarding the functional changes associated with chronic cannabis use. One possible explanation for this variation is the heterogeneity in study designs, with little implementation of standardized diagnostic criteria when selecting chronic users, distinct time points of participant assessment, differing cognitive paradigms and imaging protocols. As such, there is an urgent requirement for future investigations that further characterize functional changes associated with chronic cannabis use.


Assuntos
Encéfalo/diagnóstico por imagem , Encéfalo/fisiopatologia , Tomada de Decisões/fisiologia , Imagem por Ressonância Magnética/métodos , Abuso de Maconha/fisiopatologia , Recompensa , Adolescente , Adulto , Feminino , Humanos , Masculino , Abuso de Maconha/psicologia , Adulto Jovem
13.
Br J Radiol ; 92(1101): 20190365, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31368776

RESUMO

There are numerous challenges to identifying, developing and implementing quantitative techniques for use in clinical radiology, suggesting the need for a common translational pathway. We developed the quantitative neuroradiology initiative (QNI), as a model framework for the technical and clinical validation necessary to embed automated segmentation and other image quantification software into the clinical neuroradiology workflow. We hypothesize that quantification will support reporters with clinically relevant measures contextualized with normative data, increase the precision of longitudinal comparisons, and generate more consistent reporting across levels of radiologists' experience. The QNI framework comprises the following steps: (1) establishing an area of clinical need and identifying the appropriate proven imaging biomarker(s) for the disease in question; (2) developing a method for automated analysis of these biomarkers, by designing an algorithm and compiling reference data; (3) communicating the results via an intuitive and accessible quantitative report; (4) technically and clinically validating the proposed tool pre-use; (5) integrating the developed analysis pipeline into the clinical reporting workflow; and (6) performing in-use evaluation. We will use current radiology practice in dementia as an example, where radiologists have established visual rating scales to describe the degree and pattern of atrophy they detect. These can be helpful, but are somewhat subjective and coarse classifiers, suffering from floor and ceiling limitations. Meanwhile, several imaging biomarkers relevant to dementia diagnosis and management have been proposed in the literature; some clinically approved radiology software tools exist but in general, these have not undergone rigorous clinical validation in high volume or in tertiary dementia centres. The QNI framework aims to address this need. Quantitative image analysis is developing apace within the research domain. Translating quantitative techniques into the clinical setting presents significant challenges, which must be addressed to meet the increasing demand for accurate, timely and impactful clinical imaging services.


Assuntos
Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Demência/diagnóstico , Demência/patologia , Imagem por Ressonância Magnética/métodos , Neuroimagem/métodos , Estudos de Avaliação como Assunto , Humanos
15.
Medicine (Baltimore) ; 98(35): e16593, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31464894

RESUMO

RATIONALE: Limbic encephalitis is one of the most common paraneoplastic neurological disorders (PND). The role of brain Fluorine-18-fluorodeoxyglucose position emission tomography/computed tomography (CT) in paraneoplastic limbic encephalitis (PLE) and of the whole body 18F-FDG PET/CT in this setting, remains still not well defined. PATIENT CONCERNS: We report a case of a patient with chronic inflammatory rheumatism, psoriasis and Hashimoto thyroiditis and subsequent appearance of static and dynamic ataxia and episodic memory deficit who was diagnosed as PLE combined with small cell lung cancer (SCLC). DIAGNOSES: The diagnosis of SCLC was made with EBUS-TBNA of a mediastinal lymph node. INTERVENTIONS: Whole-body 18F-FDG PET/CT was performed for the initial staging of SCLC, in the planning of radiotherapy treatment, to evaluate therapeutic response and in the follow-up. A dedicated brain scan was included to the same PET session. Whole-body contrast enhanced computed tomography (CT) and contrast enhanced whole-brain MRI were also performed. OUTCOMES: She was administered neoadjuvant chemioterapy with Cisplatin and Etoposide with concomitant radiotherapy treatment. Whole body 18F-FDG PET/CT showed a complete metabolic response already after 3 cycles of chemioterapy. Brain functional study showed a metabolic pattern characterized by the migration of hypermetabolism in the bilateral hippocampal areas during the therapeutic treatment, which correlated with the persistence of clinical symptoms. LESSONS: In the era of personalized medicine and targeted therapy, this case highlights the importance of the 18F-FDG PET/CT study as an accurate tool to identify PLE and to guide the diagnostic work-up of the underlying tumor. Considering that most of these are 18F-FDG avid tumors and that the 18F-FDG PET/CT scan is often added to the diagnostic work-up when screening patients for malignancy, this functional imaging can play a decisive role.


Assuntos
Fluordesoxiglucose F18/administração & dosagem , Encefalite Límbica/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico por imagem , Carcinoma de Pequenas Células do Pulmão/diagnóstico por imagem , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Encéfalo/diagnóstico por imagem , Cisplatino/uso terapêutico , Etoposídeo/uso terapêutico , Feminino , Humanos , Encefalite Límbica/tratamento farmacológico , Encefalite Límbica/patologia , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/patologia , Terapia Neoadjuvante , Estadiamento de Neoplasias , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Carcinoma de Pequenas Células do Pulmão/tratamento farmacológico , Carcinoma de Pequenas Células do Pulmão/patologia , Resultado do Tratamento , Imagem Corporal Total
17.
JAMA ; 322(4): 336-347, 2019 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-31334794

RESUMO

Importance: United States government personnel experienced potential exposures to uncharacterized directional phenomena while serving in Havana, Cuba, from late 2016 through May 2018. The underlying neuroanatomical findings have not been described. Objective: To examine potential differences in brain tissue volume, microstructure, and functional connectivity in government personnel compared with individuals not exposed to directional phenomena. Design, Setting, and Participants: Forty government personnel (patients) who were potentially exposed and experienced neurological symptoms underwent evaluation at a US academic medical center from August 21, 2017, to June 8, 2018, including advanced structural and functional magnetic resonance imaging analytics. Findings were compared with imaging findings of 48 demographically similar healthy controls. Exposures: Potential exposure to uncharacterized directional phenomena of unknown etiology, manifesting as pressure, vibration, or sound. Main Outcomes and Measures: Potential imaging-based differences between patients and controls with regard to (1) white matter and gray matter total and regional brain volumes, (2) cerebellar tissue microstructure metrics (eg, mean diffusivity), and (3) functional connectivity in the visuospatial, auditory, and executive control subnetworks. Results: Imaging studies were completed for 40 patients (mean age, 40.4 years; 23 [57.5%] men; imaging performed a median of 188 [range, 4-403] days after initial exposure) and 48 controls (mean age, 37.6 years; 33 [68.8%] men). Mean whole brain white matter volume was significantly smaller in patients compared with controls (patients: 542.22 cm3; controls: 569.61 cm3; difference, -27.39 [95% CI, -37.93 to -16.84] cm3; P < .001), with no significant difference in the whole brain gray matter volume (patients: 698.55 cm3; controls: 691.83 cm3; difference, 6.72 [95% CI, -4.83 to 18.27] cm3; P = .25). Among patients compared with controls, there were significantly greater ventral diencephalon and cerebellar gray matter volumes and significantly smaller frontal, occipital, and parietal lobe white matter volumes; significantly lower mean diffusivity in the inferior vermis of the cerebellum (patients: 7.71 × 10-4 mm2/s; controls: 8.98 × 10-4 mm2/s; difference, -1.27 × 10-4 [95% CI, -1.93 × 10-4 to -6.17 × 10-5] mm2/s; P < .001); and significantly lower mean functional connectivity in the auditory subnetwork (patients: 0.45; controls: 0.61; difference, -0.16 [95% CI, -0.26 to -0.05]; P = .003) and visuospatial subnetwork (patients: 0.30; controls: 0.40; difference, -0.10 [95% CI, -0.16 to -0.04]; P = .002) but not in the executive control subnetwork (patients: 0.24; controls: 0.25; difference: -0.016 [95% CI, -0.04 to 0.01]; P = .23). Conclusions and Relevance: Among US government personnel in Havana, Cuba, with potential exposure to directional phenomena, compared with healthy controls, advanced brain magnetic resonance imaging revealed significant differences in whole brain white matter volume, regional gray and white matter volumes, cerebellar tissue microstructural integrity, and functional connectivity in the auditory and visuospatial subnetworks but not in the executive control subnetwork. The clinical importance of these differences is uncertain and may require further study.


Assuntos
Encéfalo/patologia , Empregados do Governo , Doenças do Sistema Nervoso/diagnóstico por imagem , Adulto , Encéfalo/anatomia & histologia , Encéfalo/diagnóstico por imagem , Estudos de Casos e Controles , Cuba , Imagem de Difusão por Ressonância Magnética , Feminino , Substância Cinzenta/anatomia & histologia , Substância Cinzenta/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Doenças do Sistema Nervoso/etiologia , Ruído/efeitos adversos , Tamanho do Órgão , Valores de Referência , Estados Unidos , Substância Branca/anatomia & histologia , Substância Branca/diagnóstico por imagem
18.
Brain Nerve ; 71(7): 733-748, 2019 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-31289247

RESUMO

Artificial intelligence (AI) shows promises in terms of diagnostic support on neuroimaging. We developed a software that predicts Alzheimer's disease (AD) using support vector machines (SVM) through three-dimensional brain MR images. Here, we will explain the general idea of voxel-based morphometry and SVM. We used the Alzheimer's Disease Neuroimaging Initiative (ADNI) database for SVM training and tested it on the Australian Imaging Biomarkers and Lifestyle Study of Ageing (AIBL) and the Japanese ADNI database. AI shows higher accuracy for predicting AD than a method of conventional statistical analysis, indicating potential clinical use for diagnostic support.


Assuntos
Doença de Alzheimer/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Neuroimagem , Máquina de Vetores de Suporte , Humanos
19.
Brain Nerve ; 71(7): 751-758, 2019 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-31289248

RESUMO

Using AI for dementia diagnosis is still in research stage, however some of the work points to the development of new medical devices. One is a voxel-based morphometry analysis of brain atrophy, and a brain network analysis using a resting state functional MRI and diffusion tensor imaging. The other is an application to detect dementia in daily life using "IoT" technology. As it has been determined that elderly people's dementia is closely related to lifestyle, the use of AI in the diagnosis is to predict the possibility of dementia in the preclinical stage and to link it to prevention, rather than to provide a definitive diagnosis.


Assuntos
Inteligência Artificial , Encéfalo/diagnóstico por imagem , Demência/diagnóstico , Idoso , Atrofia , Encéfalo/patologia , Demência/prevenção & controle , Imagem de Tensor de Difusão , Humanos , Imagem por Ressonância Magnética
20.
Zhonghua Nei Ke Za Zhi ; 58(7): 501-507, 2019 Jul 01.
Artigo em Chinês | MEDLINE | ID: mdl-31269566

RESUMO

Objective: To evaluate the clinical manifestations, metal metabolism, imaging characteristics and treatment response in patients with delayed Wilson disease (WD). Methods: Patients with untreated WD (40 with delayed onset and 40 with non-delayed onset) were enrolled. Twenty healthy people were included as normal controls. All patients were evaluated with modified Young scale neural symptom scores, grade of Child liver function and mental symptoms rating scale, magnetic resonance imaging (MRI) scan, magnetic sensitive imaging (susceptibility weighted imaging, SWI), metal metabolism. Corrected phase (CP) was measured at SWI. After 2 week treatment, neurologic symptoms, liver function, and metal metabolism were reviewed. Results: The total score of neurological symptoms in WD patients with delayed onset was lower than that of non-delayed onset (13.00±6.87 vs. 21.13±5.53, P=0.033). The scores of SCL-90 and HAMA depression scales in patients with delayed onset were lower than those of non-delayed onset. On T(2) weighted imaging, areas including substantia nigra and thalamus, the caudate nucleus, globus pallidus, putamen presented high signal rate in patients with delated onset than those with non-delayed (P=0.022, 0.037, 0.022, 0.037, 0.029 respectively). The SWI CP values of cangbai sphere and shell nucleus in patients with delayed onset were lower than those with non-delayed onset. Patients with delayed onset had higher urinary copper than those with non-delayed onset before and after treatment (P=0.040, 0.036). After treatment, the score of abnormal tremor and gait in patients with delayed onset was decreased (P=0.037, 0.044), while as the occurrence of neurological symptoms was increased by 10%, and the liver function level in patients with delayed WD was decreased in 3 cases. Conclusions: The brain of WD patients with delayed onset is mainly composed of metal deposits, however the cell damage is not apparent. Clinical symptoms are characterized by significant liver injury, but relatively mild neurological and psychiatric symptoms. Patients with delayed WD have higher urinary copper excretion than those with non-delayed WD. Chelating agents improves the neurological symptoms in patients with delayed onset.


Assuntos
Encéfalo/diagnóstico por imagem , Cobre/metabolismo , Degeneração Hepatolenticular/patologia , Encéfalo/metabolismo , Estudos de Casos e Controles , Criança , Cobre/urina , Degeneração Hepatolenticular/metabolismo , Humanos , Imagem por Ressonância Magnética , Tálamo
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