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1.
BMJ Case Rep ; 13(11)2020 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-33148560

RESUMO

A 60-year-old man recently admitted for bipedal oedema, endocarditis and a persistently positive COVID-19 swab with a history of anticoagulation on rivaroxaban for atrial fibrillation, transitional cell carcinoma, cerebral amyloid angiopathy, diabetes and hypertension presented with sudden onset diplopia and vertical gaze palsy. Vestibulo-ocular reflex was preserved. Simultaneously, he developed a scotoma and sudden visual loss, and was found to have a right branch retinal artery occlusion. MRI head demonstrated a unilateral midbrain infarct. This case demonstrates a rare unilateral cause of bilateral supranuclear palsy which spares the posterior commisure. The case also raises a question about the contribution of COVID-19 to the procoagulant status of the patient which already includes atrial fibrillation and endocarditis, and presents a complex treatment dilemma regarding anticoagulation.


Assuntos
Aspirina/administração & dosagem , Fibrilação Atrial , Cegueira , Infartos do Tronco Encefálico , Infecções por Coronavirus , Diplopia , Endocardite Bacteriana , Oftalmoplegia , Pandemias , Pneumonia Viral , Pirazóis/administração & dosagem , Piridonas/administração & dosagem , Oclusão da Artéria Retiniana , Fibrilação Atrial/complicações , Fibrilação Atrial/tratamento farmacológico , Betacoronavirus/isolamento & purificação , Cegueira/diagnóstico , Cegueira/etiologia , Infartos do Tronco Encefálico/diagnóstico por imagem , Infartos do Tronco Encefálico/tratamento farmacológico , Infartos do Tronco Encefálico/fisiopatologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/fisiopatologia , Diplopia/diagnóstico , Diplopia/etiologia , Endocardite Bacteriana/complicações , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/fisiopatologia , Inibidores do Fator Xa/administração & dosagem , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Oftalmoplegia/diagnóstico , Oftalmoplegia/etiologia , Inibidores da Agregação Plaquetária/administração & dosagem , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/fisiopatologia , Oclusão da Artéria Retiniana/diagnóstico por imagem , Oclusão da Artéria Retiniana/tratamento farmacológico , Oclusão da Artéria Retiniana/etiologia , Oclusão da Artéria Retiniana/fisiopatologia , Tomografia de Coerência Óptica/métodos , Resultado do Tratamento
2.
BMC Neurol ; 20(1): 388, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33096988

RESUMO

BACKGROUND: Cerebral Palsy (CP) is a group of disorders that affect the development of movement and posture. CP results from injuries to the immature brain during the prenatal, perinatal, or postnatal stage of development. Neuroimaging research in CP has focused on the structural changes of the brain during early development, but little is known about brain's structural and functional changes during late adolescence and early adulthood, a period in time when individuals experience major changes as they transition into adulthood. The work reported here served as a feasibility study within a larger program of research (MyStory Study). We aimed to determine whether it would be feasible to scan and obtain good quality data without the use of sedation during a resting state condition for functional connectivity (FC) analyses in young adults with CP. Second, we aimed to identify the FC pattern(s) that are associated with depressive mood ratings, indices of pain and fatigue, and quality of life in this group. METHODS: Resting state functional images were collected from 9 young people with CP (18-29 years). We applied a stringent head motion correction and quality control methods following preprocessing. RESULTS: We were able to scan and obtain good quality data without the use of sedation from this group of young individuals with CP who demonstrated a range of gross motor ability. The functional connectivity networks of interest were identified in the data using standard seed regions. Our analyses further revealed that higher well-being scores were associated with higher levels of FC between the Medial Pre-Frontal Cortex and the right Lateral Parietal regions, which are implicated in prosocial and emotion regulations skills. The implications of this association are discussed. CONCLUSION: The findings of the present study demonstrate that it is feasible to conduct resting state functional connectivity in young adults with CP with different gross motor abilities without the use of sedation. Our results also highlight a neural circuitry that is associated with the self-report of quality of life and emotion regulation. These findings identify these regions/circuitries as important seeds for further investigations into mental health and wellbeing in CP.


Assuntos
Encéfalo/diagnóstico por imagem , Paralisia Cerebral/diagnóstico por imagem , Rede Nervosa/diagnóstico por imagem , Neuroimagem/métodos , Adolescente , Adulto , Encéfalo/fisiopatologia , Paralisia Cerebral/fisiopatologia , Estudos de Viabilidade , Feminino , Humanos , Interpretação de Imagem Assistida por Computador/métodos , Imageamento por Ressonância Magnética/métodos , Masculino , Rede Nervosa/fisiopatologia , Qualidade de Vida , Adulto Jovem
3.
BMC Med Genet ; 21(1): 191, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33004005

RESUMO

BACKGROUND: Central nervous system (CNS) hemangioblastomas are the most frequent cause of mortality in patients with Von Hippel-Lindau (VHL) disease, an autosomal dominant genetic disease resulting from germline mutations in the VHL tumor suppressor gene, with most mutations occurring in the exons. To date, there have been no reports of CNS hemangioblastoma cases related to pathogenic variants in intron 2 of VHL, which encodes a tumor suppressor protein (i.e., pVHL) that regulates hypoxia-inducible factor proteins. CASE PRESENTATION: We report the presence of a base substitution of c.464-1G > C and c.464-2A > G in the intron 2 of VHL causing CNS hemangioblastomas in six patients with VHL from two Chinese families. The clinical information about the two pathogentic variants has been submitted to ClinVar database. The ClinVar accession for NM_000551.3(VHL):c.464-1G > C was SCV001371687. This finding may provide a new approach for diagnosing and researching VHL-associated hemangioblastomas. CONCLUSIONS: This is the first report of a pathogenic variant at intron 2 in VHL-associated hemangioblastomas. Gene sequencing showed that not only exonic but also intronic mutations can lead to the development of CNS hemangioblastomas.


Assuntos
Neoplasias do Sistema Nervoso Central/genética , Hemangioblastoma/genética , Mutação , Proteína Supressora de Tumor Von Hippel-Lindau/genética , Doença de von Hippel-Lindau/genética , Adulto , Grupo com Ancestrais do Continente Asiático/genética , Sequência de Bases , Neoplasias do Sistema Nervoso Central/diagnóstico por imagem , Neoplasias do Sistema Nervoso Central/etnologia , China , Saúde da Família , Feminino , Hemangioblastoma/diagnóstico por imagem , Hemangioblastoma/etnologia , Humanos , Íntrons/genética , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Linhagem , Análise de Sequência de DNA , Doença de von Hippel-Lindau/diagnóstico por imagem , Doença de von Hippel-Lindau/etnologia
4.
Nat Protoc ; 15(11): 3595-3614, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33005039

RESUMO

Transcranial magnetic stimulation (TMS) is a noninvasive method to stimulate the cerebral cortex that has applications in psychiatry, such as in the treatment of depression and anxiety. Although many TMS targeting methods that use figure-8 coils exist, many do not account for individual differences in anatomy or are not generalizable across target sites. This protocol combines functional magnetic resonance imaging (fMRI) and iterative electric-field (E-field) modeling in a generalized approach to subject-specific TMS targeting that is capable of optimizing the stimulation site and TMS coil orientation. To apply this protocol, the user should (i) operationally define a region of interest (ROI), (ii) generate the head model from the structural MRI data, (iii) preprocess the functional MRI data, (iv) identify the single-subject stimulation site within the ROI, and (iv) conduct E-field modeling to identify the optimal coil orientation. In comparison with standard targeting methods, this approach demonstrates (i) reduced variability in the stimulation site across subjects, (ii) reduced scalp-to-cortical-target distance, and (iii) reduced variability in optimal coil orientation. Execution of this protocol requires intermediate-level skills in structural and functional MRI processing. This protocol takes ~24 h to complete and demonstrates how constrained fMRI targeting combined with iterative E-field modeling can be used as a general method to optimize both the TMS coil site and its orientation.


Assuntos
Mapeamento Encefálico/métodos , Encéfalo/fisiologia , Imageamento por Ressonância Magnética/métodos , Estimulação Magnética Transcraniana/métodos , Encéfalo/diagnóstico por imagem , Humanos , Fluxo de Trabalho
5.
Intern Med ; 59(22): 2927-2930, 2020 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-32999229

RESUMO

Tocilizumab (TCZ; Actemra/RoActemra) is an anti-interleukin (IL)-6 receptor antibody for the treatment of rheumatoid arthritis (RA) and other autoimmune diseases and cytokine storms. The present case is a 63-year-old female well-controlled RA patient, who presented with a progressive cognitive impairment after 34 months of TCZ administration. Brain magnetic resonance imaging (MRI) showed leukencephalopathy with a lactic acid peak in magnetic resonance spectroscopy (MRS), a decreased blood flow in single photon emission computed tomography (SPECT), and a decreased accumulation in fluorodeoxyglucose positron emission tomography (FDG-PET). The discontinuation of TCZ improved her cognitive function and brain MRI findings at 3 months after drug cessation. The present case suggests that TCZ may sometimes cause leukoencephalopathy after long-term administration, and thus the early discontinuation of TCZ is recommended to achieve a good prognosis.


Assuntos
Anticorpos Monoclonais Humanizados/efeitos adversos , Artrite Reumatoide/tratamento farmacológico , Leucoencefalopatias/induzido quimicamente , Anticorpos Monoclonais Humanizados/uso terapêutico , Artrite Reumatoide/sangue , Artrite Reumatoide/diagnóstico , Citocinas/sangue , Feminino , Humanos , Leucoencefalopatias/diagnóstico , Imageamento por Ressonância Magnética/métodos , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons/métodos
6.
Ideggyogy Sz ; 73(9-10): 303-308, 2020 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-33035419

RESUMO

Evidence suggests that pathogen-associated pattern recognition receptors (Toll-like receptors, TLRs) are implicated in the pathophysiology of schizophrenia. TLRs are important in both peripheral immune responses and neuronal plasticity. However, the relationship between peripheral TLR expression and regional brain volumes is unknown in schizophrenia. We therefore assessed 30 drug-naïve, first-episode patients with schizophrenia. TLR4+/TLR1+ monocytes were measured using flow-cytometry. High resolution magnetic resonance images (T1 MRI) were obtained and analyzed with FreeSurfer. Results revealed significant negative correlations between the percentage of TLR4+ monocytes, mean fluorescent intensities, and brain volumes in frontal and anterior cingulate regions. The measures of TLR1+ monocytes did not show significant relationships with regional brain volumes. These results raise the possibility that abnormal TLR-activation is associated with decreased brain volumes in schizophrenia.


Assuntos
Lobo Frontal/metabolismo , Imageamento por Ressonância Magnética/métodos , Esquizofrenia/genética , Esquizofrenia/metabolismo , Receptor 4 Toll-Like/metabolismo , Antipsicóticos/uso terapêutico , Lobo Frontal/diagnóstico por imagem , Giro do Cíngulo/diagnóstico por imagem , Giro do Cíngulo/metabolismo , Humanos , Polimorfismo de Nucleotídeo Único , Esquizofrenia/tratamento farmacológico
8.
Radiol Clin North Am ; 58(6): 1019-1031, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33040845

RESUMO

Radiologists very frequently encounter incidental findings related to the thyroid gland. Given increases in imaging use over the past several decades, thyroid incidentalomas are increasingly encountered in clinical practice, and it is important for radiologists to be aware of recent developments with respect to workup and diagnosis of incidental thyroid abnormalities. Recent reporting and management guidelines, such as those from the American College of Radiology and American Thyroid Association, are reviewed along with applicable evidence in the literature. Trending topics, such as artificial intelligence approaches to guide thyroid incidentaloma workup, are also discussed.


Assuntos
Inteligência Artificial/estatística & dados numéricos , Tomada de Decisão Clínica , Diagnóstico por Imagem/métodos , Achados Incidentais , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Nódulo da Glândula Tireoide/diagnóstico por imagem , Biópsia por Agulha , Feminino , Humanos , Imuno-Histoquímica , Incidência , Imageamento por Ressonância Magnética/métodos , Masculino , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Guias de Prática Clínica como Assunto , Radiologistas/estatística & dados numéricos , Neoplasias da Glândula Tireoide/epidemiologia , Neoplasias da Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/epidemiologia , Nódulo da Glândula Tireoide/patologia , Ultrassonografia Doppler/métodos , Estados Unidos/epidemiologia
9.
Radiol Clin North Am ; 58(6): 1059-1070, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33040848

RESUMO

Over the past several years, there has been an increase in the discovery of thyroid cancers, likely because of the marked increased utilization of computed tomography (CT) and MR imaging. Despite the increase in number of thyroid cancers, the overall mortality remains unchanged because most of these cancers are the differentiated type and have a more indolent behavior. CT and MR imaging are important in the preoperative evaluation of thyroid goiters and thyroid cancer. This article discusses the imaging characteristics of benign and malignant thyroid diseases, and the important information that needs to be relayed to the surgeon.


Assuntos
Imageamento por Ressonância Magnética/métodos , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Nódulo da Glândula Tireoide/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Biópsia por Agulha , Diagnóstico Diferencial , Feminino , Humanos , Imuno-Histoquímica , Incidência , Masculino , Medição de Risco , Doenças da Glândula Tireoide/diagnóstico por imagem , Doenças da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/epidemiologia , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgia , Nódulo da Glândula Tireoide/epidemiologia , Nódulo da Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/cirurgia , Tireoidectomia/métodos , Resultado do Tratamento
10.
Radiol Clin North Am ; 58(6): 1115-1133, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33040852

RESUMO

The pituitary gland is a small endocrine organ located within the sella turcica. Various pathologic conditions affect the pituitary gland and produce endocrinologic and neurologic abnormalities. The most common lesion of the pituitary gland is the adenoma, a benign neoplasm. Dedicated MR imaging of the pituitary is radiologic study of choice for evaluating pituitary gland and central skull region. Computed tomography is complimentary and allows for identification of calcification and adjacent abnormalities of the osseous skull base. This review emphasizes basic anatomy, current imaging techniques, and highlights the spectrum of pathologic conditions that affect the pituitary gland and sellar region.


Assuntos
Imageamento por Ressonância Magnética/métodos , Neuroimagem/métodos , Hipófise/anatomia & histologia , Hipófise/diagnóstico por imagem , Sela Túrcica/diagnóstico por imagem , Feminino , Humanos , Masculino , Doenças da Hipófise/diagnóstico por imagem , Doenças da Hipófise/patologia , Hipófise/patologia , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/patologia , Sela Túrcica/patologia , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X/métodos
11.
Radiol Clin North Am ; 58(6): 1147-1159, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33040854

RESUMO

Neuroendocrine tumors are rare solid tumors with an estimated 12,000 people in the United States diagnosed each year. Neuroendocrine tumors can occur in any part of the body. There is a wide spectrum of disease, ranging from slow-growing and indolent tumors found incidentally to highly aggressive malignancies with a poor prognosis. Knowledge of neuroendocrine tumor pathology is essential in the diagnostic workup of these patients. This article focuses on the evaluation, detection, and staging of common neuroendocrine tumors with multiple imaging modalities; the information gained with a multimodality approach is often complementary and leads to image-guided treatment decision making.


Assuntos
Tomada de Decisão Clínica/métodos , Imagem Multimodal/métodos , Tumores Neuroendócrinos/diagnóstico por imagem , Tumores Neuroendócrinos/cirurgia , Cirurgia Assistida por Computador/métodos , Intervalo Livre de Doença , Feminino , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Tumores Neuroendócrinos/mortalidade , Tumores Neuroendócrinos/patologia , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Análise de Sobrevida , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Estados Unidos
12.
Radiol Med ; 125(11): 1124-1134, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33025305

RESUMO

Myocarditis is an inflammatory disease of the heart muscle, diagnosed by histological, immunological, and immunohistochemical criteria. Endomyocardial biopsy represents the diagnostic gold standard for its diagnosis but is infrequently used. Due to its noninvasive ability to detect the presence of myocardial edema, hyperemia and necrosis/fibrosis, Cardiac MR imaging is routinely used in the clinical practice for the diagnosis of acute myocarditis. Recently pixel-wise mapping of T1 and T2 relaxation time have been introduced into the clinical Cardiac MR protocol increasing its accuracy. Our paper will review the role of MR imaging in the diagnosis of acute myocarditis.


Assuntos
Técnicas de Imagem Cardíaca/métodos , Endocárdio/patologia , Imageamento por Ressonância Magnética/métodos , Miocardite/diagnóstico por imagem , Doença Aguda , Adulto , Doenças Assintomáticas , Betacoronavirus , Bioprospecção , Doença Crônica , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Imagem Cinética por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Miocardite/etiologia , Miocardite/patologia , Pandemias , Pericardite/diagnóstico por imagem , Pericardite/etiologia , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Prognóstico
13.
Lancet Child Adolesc Health ; 4(11): 828-836, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33068549

RESUMO

BACKGROUND: Acute flaccid myelitis (AFM) is characterised by rapid onset of limb weakness with spinal cord grey-matter abnormalities on MRI scan. We aimed to assess whether detection of enterovirus in respiratory or other specimens can help predict prognosis in children with AFM. METHODS: In this nationwide, longitudinal study, we evaluated the significance of detection of enterovirus in any sample in predicting outcomes in a cohort of Canadian children younger than 18 years presenting with AFM to tertiary paediatric hospitals in Canada in 2014 and 2018. All patients fulfilled the 2015 US Centers for Disease Control and Prevention case definition for definite AFM or probable AFM. Clinical data, laboratory findings, treatment, and neuroimaging results were collected (follow up period up to 5 years). We assessed neurological function and motor outcomes using Kurtzke's Expanded Disability Status Scale (EDSS) and a Weakest Limb Score. FINDINGS: 58 children with AFM (median age 5·1 years, IQR 3·8-8·3) were identified across five of Canada's ten provinces and three territories. 25 (43%) children had enterovirus detected in at least one specimen: 16 (64%) with EV-D68, two (8%) with EV-A71, two (8%) with coxsackievirus, 10 (40%) with untyped enterovirus. Children who were enterovirus positive were more likely than those that were negative to have had quadriparesis (12 [48%] of 25 vs four [13%] of 30; p=0·028), bulbar weakness (11 [44%] of 25 vs two [7%] of 30; p=0·028), bowel or bladder dysfunction (14 [56%] of 25 vs seven [23%] of 30; p=0·040), cardiovascular instability (nine [36%] of 25 vs one [3%] of 30; p=0·028), and were more likely to require intensive care unit admission (13 [52%] of 25 vs 5 [17%] of 30; p=0·028). On MRI, most children who were enterovirus positive showed brainstem pontine lesions (14 [61%] of 23), while other MRI parameters did not correlate with enterovirus status. Median EDSS of enterovirus positive (EV+) and enterovirus negative (EV-) groups was significantly different at all timepoints: baseline (EDSS 8·5, IQR 4·1-9·5 vs EDSS 4·0, IQR 3·0-6·0; p=0·0067), 3 months (EDSS 4·0, IQR 3·0-7·4 vs EDSS 3·0, IQR 1·5-4·3; p=0·0067), 6 months (EDSS 3·5, IQR 3·0-7·0 vs EDSS 3·0, IQR 1·0-4·0; p=0·029), and 12 months (EDSS 3·0, IQR 3·0-6·9 vs EDSS 2·5 IQR 0·3-3·0; p=0·0067). Kaplan-Meier survival analysis of a subgroup of patients showed significantly poorer motor recovery among children who tested positive for enterovirus than for those who tested negative (p=0·037). INTERPRETATION: Detection of enterovirus in specimens from non-sterile sites at presentation correlated with more severe acute motor weakness, worse overall outcomes and poorer trajectory for motor recovery. These results have implications for rehabilitation planning as well as counselling of families of children with these disorders. The findings of this study support the need for early testing for enterovirus in non-CNS sites in all cases of AFM. FUNDING: None.


Assuntos
Viroses do Sistema Nervoso Central , Enterovirus/isolamento & purificação , Debilidade Muscular , Mielite , Doenças Neuromusculares , Medula Espinal/diagnóstico por imagem , Canadá/epidemiologia , Viroses do Sistema Nervoso Central/diagnóstico , Viroses do Sistema Nervoso Central/epidemiologia , Viroses do Sistema Nervoso Central/microbiologia , Viroses do Sistema Nervoso Central/terapia , Pré-Escolar , Enterovirus/classificação , Feminino , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Estudos Longitudinais , Imageamento por Ressonância Magnética/métodos , Imageamento por Ressonância Magnética/estatística & dados numéricos , Masculino , Destreza Motora , Debilidade Muscular/diagnóstico , Debilidade Muscular/etiologia , Debilidade Muscular/reabilitação , Mielite/diagnóstico , Mielite/epidemiologia , Mielite/microbiologia , Mielite/terapia , Doenças Neuromusculares/diagnóstico , Doenças Neuromusculares/epidemiologia , Doenças Neuromusculares/microbiologia , Doenças Neuromusculares/terapia , Avaliação de Resultados em Cuidados de Saúde , Prognóstico , Recuperação de Função Fisiológica
14.
PLoS One ; 15(10): e0238994, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33052938

RESUMO

Brain networks offers a new insight about connections between function and anatomical regions of human brain. We present results from brain networks built from functional magnetic resonance images during finger tapping paradigm. Pearson voxel-voxel correlation in time and frequency domains were performed for all subjects. Besides this standard framework we have implemented a new approach consisting in filtering the data with respect to the fMRI paradigm (finger tapping) in order to obtain a better understanding of the network involved in the execution of the task. The main topological graph measures have been compared in both cases: voxel-voxel correlation and voxel-paradigm filtering plus voxel-voxel correlation. With the standard voxel-voxel correlation a clearly free-scale network was obtained. On the other hand, when we prefiltered the paradigm we obtained two different kind of networks: 1) free-scale; 2) random-like. To our best knowledge, this behaviour is reported here for first time for brain networks. We suggest that paradigm signal prefiltering can provide more infomation about the brain networks.


Assuntos
Mapeamento Encefálico/métodos , Encéfalo/diagnóstico por imagem , Encéfalo/fisiologia , Imageamento por Ressonância Magnética/métodos , Adulto , Mapeamento Encefálico/estatística & dados numéricos , Conectoma/métodos , Conectoma/estatística & dados numéricos , Feminino , Humanos , Imageamento por Ressonância Magnética/estatística & dados numéricos , Masculino , Rede Nervosa/diagnóstico por imagem , Rede Nervosa/fisiologia , Oxigênio/sangue , Desempenho Psicomotor/fisiologia
15.
Nat Commun ; 11(1): 5046, 2020 10 07.
Artigo em Inglês | MEDLINE | ID: mdl-33028816

RESUMO

Signal loss in blood oxygen level-dependent (BOLD) functional neuroimaging is common and can lead to misinterpretation of findings. Here, we reconstructed compromised fMRI signal using deep machine learning. We trained a model to learn principles governing BOLD activity in one dataset and reconstruct artificially compromised regions in an independent dataset, frame by frame. Intriguingly, BOLD time series extracted from reconstructed frames are correlated with the original time series, even though the frames do not independently carry any temporal information. Moreover, reconstructed functional connectivity maps exhibit good correspondence with the original connectivity maps, indicating that the model recovers functional relationships among brain regions. We replicated this result in two healthy datasets and in patients whose scans suffered signal loss due to intracortical electrodes. Critically, the reconstructions capture individual-specific information. Deep machine learning thus presents a unique opportunity to reconstruct compromised BOLD signal while capturing features of an individual's own functional brain organization.


Assuntos
Mapeamento Encefálico/métodos , Córtex Cerebral/diagnóstico por imagem , Aprendizado Profundo , Processamento de Imagem Assistida por Computador/métodos , Imageamento por Ressonância Magnética/métodos , Adolescente , Adulto , Córtex Cerebral/irrigação sanguínea , Córtex Cerebral/fisiologia , Conjuntos de Dados como Assunto , Estimulação Encefálica Profunda , Feminino , Voluntários Saudáveis , Humanos , Masculino , Modelos Neurológicos , Oxigênio/sangue , Doença de Parkinson/diagnóstico , Doença de Parkinson/fisiopatologia , Doença de Parkinson/terapia , Adulto Jovem
16.
PLoS One ; 15(10): e0239773, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33031428

RESUMO

Oral health conditions and cerebral small vessel disease, such as white matter lesions or cerebral microbleeds (CMBs), are associated with the incidence of stroke. The purpose of this study was to examine the associations between oral health conditions (serum IgG titers of periodontal pathogens) with the presence or severity of CMBs in acute stroke patients. From January 2013 to April 2016, acute stroke patients were registered in two hospitals. Serum samples were evaluated for antibody titers against 9 periodontal pathogens using the ELISA method. The cut-off points for reactivity (the positive decision point) to each antigen were defined as more than a mean ELISA unit + 1 standard deviation (after logarithmic transformation) in all subjects. CMBs were evaluated on T2*-weighted MRI. In all, 639 patients were evaluated (ischemic, n = 533 and hemorrhagic, n = 106; 73.1 ± 12.9 years old). Among these patients, 627 were available for CMB evaluation. Among the 9 evaluated periodontal pathogens, only Campylobacter rectus (C. rectus) was associated with the presence of CMBs. the prevalence of positive serum antibody titers against C. rectus was higher among patients with CMBs than among those without CMBs (14.6% vs. 8.7%, P = 0.025). In addition, positive serum antibody titers against C. rectus remained one of the factors associated with the presence of CMBs in multivariate logistic analysis (odds ratio 2.03, 95% confidence interval 1.19-3.47, P = 0.010). A positive serum antibody titer against C. rectus was associated with the presence of CMBs in acute stroke patients.


Assuntos
Infecções por Campylobacter/complicações , Campylobacter rectus/patogenicidade , Hemorragia Cerebral/complicações , Hemorragia Cerebral/etiologia , Doenças Periodontais/etiologia , Doenças Periodontais/microbiologia , Acidente Vascular Cerebral/complicações , Idoso , Isquemia Encefálica/etiologia , Doenças de Pequenos Vasos Cerebrais/complicações , Doenças de Pequenos Vasos Cerebrais/etiologia , Feminino , Humanos , Incidência , Imageamento por Ressonância Magnética/métodos , Masculino , Razão de Chances , Prevalência , Fatores de Risco , Acidente Vascular Cerebral/microbiologia
17.
Medicine (Baltimore) ; 99(40): e22619, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019483

RESUMO

RATIONALE: Xanthogranuloma of the sellar region is exceedingly rare, and described in only a handful of case reports. Herein, we present a case of xanthogranuloma of the sellar region to improve our knowledge for the diagnosis and management of this unusual disease. PATIENT CONCERNS: A 50-year-old female presented with the symptoms of intermittent vomiting, occasional head discomfort, and diabetes insipidus of 1 month duration. DIAGNOSES: Magnetic resonance imaging showed a large well-defined, vase-like, heterogeneous mass in the sellar region. The lesion showed mixed signal with hierarchical signal presentation. Fluid-fluid level sign can be found within the lesion. The upper part of the lesion was hyperintense, and the lower part was hypointense on both T1-weighted images and T2-weighted images. The lesion showed no enhancement following the intravenous administration of gadolinium. The normal pituitary tissue was not clearly visible. Optic chiasm was compressed and displaced by the lesion. Initial diagnosis of pituitary macroadenoma with hemorrhage in the sellar region was made before surgery. Final diagnosis of sellar xanthogranuloma was confirmed by histopathological examination after surgical resection. INTERVENTIONS: Gross total resection of the lesion was achieved using the microscope through endonasal transsphenoidal approach. OUTCOMES: The patient recovered well with improved binocular vision and no symptom of diabetes insipidus, and was discharged 5 days after operation. LESSONS: Sellar xanthogranuloma should receive diagnostic consideration for the lesion that is a heterogeneously mixed mass with a degree of T1-weighted images hyperintense in the sellar region.


Assuntos
Diabetes Insípido/etiologia , Granuloma/cirurgia , Sela Túrcica/patologia , Xantomatose/patologia , Xantomatose/cirurgia , Diagnóstico Diferencial , Feminino , Gadolínio/administração & dosagem , Granuloma/patologia , Cefaleia/etiologia , Humanos , Imageamento por Ressonância Magnética/métodos , Pessoa de Meia-Idade , Neoplasias Hipofisárias/diagnóstico , Sela Túrcica/diagnóstico por imagem , Resultado do Tratamento , Vômito/etiologia
18.
Medicine (Baltimore) ; 99(40): e22639, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019487

RESUMO

INTRODUCTION: Tuberculous meningitis (TBM) is the most fatal type of tuberculosis in which corticosteroids are added with antitubercular therapy to prevent permanent brain damage. However, this treatment may produce paradoxical reactions. In such cases, thalidomide use might reduce central nervous system inflammation and improve the outcome. We present the case of a human immunodeficiency virus-negative patient with TBM who developed paradoxical reactions manifesting as multiple intracranial tuberculomas that were resistant to standard care (antitubercular drugs and corticosteroids) but responded well to thalidomide. PATIENT'S MAIN CONCERN AND CLINICAL FINDINGS: The patient was a 40-year-old Chinese female, who was admitted with a 10-day history of headaches, night sweats, and cough. She was healthy before contracting the infection and had no history of contact with tuberculosis patients. DIAGNOSES, INTERVENTION, AND OUTCOME: We diagnosed the patient with TBM complicated by the occurrence of pulmonary tuberculosis. Positive results were obtained from Gram and Ziehl-Neelsen staining of the sputum and acid-fast bacilli sputum culture. Standard treatment was initiated with antitubercular drugs (daily isoniazid, rifampicin, ethionamide, and pyrazinamide) and corticosteroids (dexamethasone). However, 3 months later the magnetic resonance imaging of the head revealed some new tuberculoma lesion. Thus, a specific therapy of antitubercular drugs and thalidomide was introduced. On completion of a 12-month course of antitubercular drugs with 2 months of thalidomide, the patient showed favorable outcomes without neurologic sequelae. Moreover, thalidomide appeared safe and well tolerated in the patient. CONCLUSION: In addition to the specific anti-tubercular and adjuvant corticosteroid therapies for TBM, thalidomide can be used as a "salvage" antitubercular drug in cases that are unresponsive to corticosteroids.


Assuntos
HIV/imunologia , Imunossupressores/uso terapêutico , Talidomida/uso terapêutico , Tuberculose Meníngea/tratamento farmacológico , Tuberculose Pulmonar/complicações , Corticosteroides/uso terapêutico , Adulto , Antituberculosos/uso terapêutico , Grupo com Ancestrais do Continente Asiático/etnologia , Encéfalo/patologia , Quimioterapia Combinada , Feminino , Hospitalização , Humanos , Imageamento por Ressonância Magnética/métodos , Terapia de Salvação , Resultado do Tratamento , Tuberculoma/diagnóstico por imagem , Tuberculose Meníngea/diagnóstico , Tuberculose Pulmonar/tratamento farmacológico
19.
Int J Nanomedicine ; 15: 7433-7450, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33116480

RESUMO

Purpose: Salicyl (Sal) - among other oxygen functionalities - multi-walled carbon nanotubes (MWCNTs) and their nanohybrids are investigated as promising contrast agents (CA) in magnetic resonance imaging (MRI) or drug delivery platforms, due to their unique properties. The preliminary results and the literature reports were the motivation to endow high r2 relaxivities, excellent dispersibility in water, and biocompatibility to superparamagnetic MWCNTs nanohybrids. It was hypothesized that these goals could be achieved by, not described in the literature yet, two-stage oxygen functionalization of MWCNTs. Results: Two structurally different MWCNT materials differing in diameters (44 and 12 nm) and the iron content (4.7% and 0.5%) are studied toward the functionalization effect on the T2 relaxometric properties. MWCNT oxidation is typically the first step of functionalization resulting in "first generation" oxygen functional groups (OFGs) on the surface. Until now, the impact of OFGs on the relaxivity of MWCNT was not truly recognized, but this study sheds light on this issue. By follow-up functionalization of oxidized MWCNT with 4-azidosalicylic acid through [2+1] cycloaddition of the corresponding nitrene, "second generation" of oxygen functional groups is grafted onto the nanohybrid, ie, Sal functionality. Conclusion: The introduced OFGs are responsible for an almost 30% increase in the relaxivity, which leads to remarkable r2 relaxivity of 951 mM-1s-1 (419 (mg/mL)-1s-1), the unprecedented value reported to date for this class of CAs. Also, the resulting nanohybrids express low cytotoxicity and superb diffusion after subcutaneous injection to a mouse.


Assuntos
Meios de Contraste/química , Meios de Contraste/farmacologia , Imageamento por Ressonância Magnética/métodos , Nanotubos de Carbono/química , Oxigênio/química , Animais , Azidas/química , Reação de Cicloadição , Camundongos Endogâmicos C57BL , Oxirredução , Prótons , Salicilatos/química , Água/química
20.
Medicine (Baltimore) ; 99(44): e22822, 2020 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-33126321

RESUMO

INTRODUCTION: Vertebral artery dissection (VAD) is a common cause of stroke in young and mid-aged adults without predisposing risk factors for vascular disease. It can be induced by a particular head or neck posture; its early signs often include headache and neck pain. Improved imaging techniques can be used to detect VAD, whose current treatment options are limited. PATIENT CONCERNS: The patient presented with neck and shoulder pain for a week after sleeping against the wall with cervical proneness for 1 night. He had sudden headache, slurred speech, and left side weakness for 1.5 hours on admission. DIAGNOSIS: The patient had VAD complicated by posterior circulation stroke. INTERVENTIONS: Acute stroke was treated with intravenous thrombolytic therapy. Then, the patient was administered follow-up anticoagulants. OUTCOMES: The patient's condition improved after thrombolytic therapy. He recovered well, with no recurrence during a 4-year follow-up. CONCLUSION: VAD should be taken into consideration in differential diagnosis of posterior circulation stroke or transient ischemic attack in young patients. Intravenous thrombolytic therapy may be safe and effective for stroke-complicated cases. This case report demonstrates that expanded diagnostic protocol for acute ischemic stroke assures rapid and correct diagnosis.


Assuntos
Acidente Vascular Cerebral/etiologia , Dissecação da Artéria Vertebral/diagnóstico , Adulto , Fibrinolíticos/uso terapêutico , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Cervicalgia/etiologia , Dor de Ombro/etiologia , Terapia Trombolítica/métodos , Dissecação da Artéria Vertebral/complicações
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