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1.
Isr Med Assoc J ; 22(1): 27-31, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31927802

RESUMO

BACKGROUND: Congenital heart defects (CHD) may be associated with neurodevelopmental abnormalities mainly due to brain hypoperfusion. This defect is attributed to the major cardiac operations these children underwent, but also to hemodynamic instability during fetal life. Advances in imaging techniques have identified changes in brain magnetic resonance imaging (MRI)in children with CHD. OBJECTIVES: To examine the correlation between CHD and brain injury using fetal brain MRI. METHODS: We evaluated 46 fetuses diagnosed with CHD who underwent brain MRI. CHD was classified according to in situs anomalies, 4 chamber view (4CV), outflow tracts, arches, and veins as well as cyanotic or complex CHD. We compared MRI results of different classes of CHD and CHD fetuses to a control group of 113 healthy brain MRI examinations. RESULTS: No significant differences were found in brain pathologies among different classifications of CHD. The anteroposterior percentile of the vermis was significantly smaller in fetuses with abnormal 4CV. A significantly higher biparietal diameter was found in fetuses with abnormal arches. A significantly smaller transcerebellar diameter was found in fetuses with abnormal veins. Compared to the control group, significant differences were found in overall brain pathology in cortex abnormalities and in extra axial findings in the study group. Significantly higher rates of overall brain pathologies, ventricle pathologies, cortex pathologies, and biometrical parameters were found in the cyanotic group compared to the complex group and to the control group. CONCLUSIONS: Fetuses with CHD demonstrate findings in brain MRI that suggest an in utero pathogenesis of the neurological and cognitive anomalies found during child development.


Assuntos
Lesões Encefálicas/embriologia , Feto/diagnóstico por imagem , Cardiopatias Congênitas/etiologia , Adulto , Encéfalo/diagnóstico por imagem , Encéfalo/embriologia , Encéfalo/patologia , Lesões Encefálicas/complicações , Lesões Encefálicas/diagnóstico por imagem , Lesões Encefálicas/patologia , Estudos de Casos e Controles , Ecocardiografia , Feminino , Cardiopatias Congênitas/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Neuroimagem , Gravidez , Diagnóstico Pré-Natal/métodos
2.
Adv Exp Med Biol ; 1232: 3-9, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31893387

RESUMO

Neonates with hypoxic-ischaemic (HI) brain injury were monitored using a broadband near-infrared spectroscopy (NIRS) system in the neonatal intensive care unit. The aim of this work is to use the NIRS cerebral oxygenation data (HbD = oxygenated-haemoglobin - deoxygenated-haemoglobin) combined with arterial saturation (SaO2) from pulse oximetry to calculate cerebral blood flow (CBF) based on the oxygen swing method, during spontaneous desaturation episodes. The method is based on Fick's principle and uses HbD as a tracer; when a sudden change in SaO2 occurs, the change in HbD represents a change in tracer concentration, and thus it is possible to estimate CBF. CBF was successfully calculated with broadband NIRS in 11 HIE infants (3 with severe injury) for 70 oxygenation events on the day of birth. The average CBF was 18.0 ± 12.7 ml 100 g-1 min-1 with a range of 4 ml 100 g-1 min-1 to 60 ml 100 g-1 min-1. For infants with severe HIE (as determined by magnetic resonance spectroscopy) CBF was significantly lower (p = 0.038, d = 1.35) than those with moderate HIE on the day of birth.


Assuntos
Lesões Encefálicas , Encéfalo , Circulação Cerebrovascular , Oximetria , Oxigênio , Espectroscopia de Luz Próxima ao Infravermelho , Encéfalo/irrigação sanguínea , Encéfalo/diagnóstico por imagem , Lesões Encefálicas/diagnóstico por imagem , Humanos , Recém-Nascido , Oximetria/instrumentação , Oximetria/métodos , Oxigênio/metabolismo
3.
Forensic Sci Int ; 307: 110118, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31869653

RESUMO

Brain and cervical injuries are often described after major facial impacts but rarely after low-intensity mandibular impacts. Force transmission to the brain and spinal cord from a mandibular impact such as a punch was evaluated by the creation and validation of a complete finite element model of the head and neck. Anteroposterior uppercut impacts on the jaw were associated with considerable extension and strong stresses at the junction of the brainstem and spinal cord. Hook punch impacts transmitted forces directly to the brainstem and the spinal cord without extension of the spinal cord. Deaths after this type of blow with no observed histological lesions may be related to excessive stressing of the brainstem, through which pass the sensory-motor pathways and the vagus nerve and which is the regulatory center of the major vegetative functions. Biological parameters are different in each individual, and by using digital modeling they can be modulated at will (jaw shape, dentition…) for a realistic approach to forensic applications.


Assuntos
Lesões Encefálicas/diagnóstico por imagem , Simulação por Computador , Traumatismos Mandibulares/diagnóstico por imagem , Traumatismos da Medula Espinal/diagnóstico por imagem , Adulto , Lesões Encefálicas/etiologia , Análise de Elementos Finitos , Medicina Legal/métodos , Humanos , Imagem Tridimensional , Masculino , Traumatismos Mandibulares/complicações , Abuso Físico , Traumatismos da Medula Espinal/etiologia , Tomografia Computadorizada por Raios X
4.
Acta Chir Orthop Traumatol Cech ; 86(5): 342-347, 2019.
Artigo em Tcheco | MEDLINE | ID: mdl-31748109

RESUMO

PURPOSE OF THE STUDY The aim of our study is to show the pitfalls of performing skull X-rays in patients with head injuries and the lack of accuracy of this examination nowadays, and to clarify the current trend in the MTBI investigation algorithm. MATERIAL AND METHODS A retrospective study of 3,950 patients treated for acute head injury at the Department of Trauma Surgery (University Hospital Brno) in the period from 2015 to 2016. Inclusion criteria were the following: mild brain injury (GCS = 15), primary skull X-ray design in head injury diagnosis. Patients with a positive skull X-ray finding underwent a head CT evaluation up to 24-hours from the injury except for the patients with an isolated nose bone fracture. A CT head scan was also performed in patients indicated by the neurologist at the initial examination based on the anamnestic data and an objective finding. RESULTS Inclusion criteria were met by 1,938 patients. In 1806 (93.2%) cases the X-ray was negative, in 132 (6.8%) patients the X-ray was positive, of which in 62% of patients a nasal fracture was detected. A skull fracture reported in 16 cases. Once the CT scan of the head was obtained, all of these cases were classified as false negative. After the CT scan of the head, intracranial bleeding was observed in 12 patients, in 4 cases accompanied by fractures of the skull, not visible on the X-ray images. After the statistical evaluation, the sensitivity and specificity of the X-ray examination compared to the CT scan of the head was determined to be 0.00 and 0.94, respectively. DISCUSSION The aim of MTBI diagnostics is primarily to detect serious intracranial lesions requiring neurosurgical intervention. A simple X-ray of the skull shows fractures only and does not allow to visualize both the brain and any traces of bleeding that would show an intracranial injury. Hofman, in his meta-analysis, points out that a simple X-ray image of the skull has only very little noticeable value when diagnosing MTBI. The prevalence of intracerebral hematoma (ICH) over MTBI is 0.083. The sensitivity of a radiographic finding of skull fracture in the diagnosis of ICH based on the CT verification is only 0.38 with a specificity of 0.95, which is consistent with our study where the sensitivity of the radiographic finding was 0.00 with a specificity of 0.94 relative to CT. Thus, the question is not whether to perform an X-ray of the skull in mild head injuries, but rather when to indicate a CT scan of the brain, when to admit the patient to the hospital for observation, and for how long or when the patient can be safely discharged into home care. The purpose of MTBI diagnostics, however, should not be a rashly decision to perform a brain CT scan, but to put into practice the CT indication criteria in MTBI applying and respecting the validated guidelines known worldwide. CONCLUSIONS Our study, in which no X-ray examination revealed possible intracranial bleeding, clearly shows that nowadays the plain radiograph of the skull does not bring any benefit in the diagnosis of minor traumatic brain injury. Key words:skull X-ray, CT of the head, head injury, minor traumatic brain injury.


Assuntos
Encéfalo/diagnóstico por imagem , Traumatismos Craniocerebrais/diagnóstico por imagem , Fraturas Cranianas/diagnóstico por imagem , Crânio/diagnóstico por imagem , Algoritmos , Lesões Encefálicas/diagnóstico por imagem , Traumatismos Craniocerebrais/complicações , Humanos , Estudos Retrospectivos , Fraturas Cranianas/etiologia , Tomografia Computadorizada por Raios X , Raios X
5.
Medicina (B Aires) ; 79 Suppl 3: 10-14, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31603836

RESUMO

Preterm birth is one of the main country health indicators. It is associated with high mortality and significant morbidity in preterm newborns with cerebral palsy and potential long-term neurodevelopmental disabilities like cognitive and learning problems. The main lesions could be: a) white matter injuries, generally associated with cortical and other regions of grey matter neuronal-axonal disturbances; b) intracranial hemorrhage that includes germinal matrix, intraventricular and parenchymal, c) cerebellum injuries. The white matter lesions include cystic and non-cystic (with microscopic focal necrosis) periventricular leukomalacia and non-necrotic diffuse white matter injury. Multiple etiologic factors are associated with these injuries. Anatomical and physiological characteristics of periventricular vascular structures predispose white matter to cerebral ischemia and, interacting with infection/inflammation factors, activate microglia, generating oxidative stress (mediated by free oxygen and nitrogen radicals), pro-inflammatory cytokine and glutamate toxicity, energetic failure and vascular integrity disturbances. All these factors lead to a particular vulnerability of pre-oligodendrocytes that will affect myelination. Hypoxia-ischemia also may produce selective neuronal necrosis in different cerebral regions. Germinal matrix is a highly vascularized zone beneath ependymal or periventricular region that constitutes a capillary bed with a particular structural fragility that predispose it to hemorrhage.


Assuntos
Lesões Encefálicas/etiologia , Isquemia Encefálica/etiologia , Paralisia Cerebral/etiologia , Hipóxia-Isquemia Encefálica/etiologia , Recém-Nascido Prematuro , Leucomalácia Periventricular/etiologia , Lesões Encefálicas/diagnóstico por imagem , Lesões Encefálicas/mortalidade , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/mortalidade , Paralisia Cerebral/mortalidade , Humanos , Hipóxia-Isquemia Encefálica/diagnóstico por imagem , Hipóxia-Isquemia Encefálica/mortalidade , Recém-Nascido , Leucomalácia Periventricular/diagnóstico por imagem , Leucomalácia Periventricular/mortalidade , Substância Branca/patologia
6.
Artigo em Russo | MEDLINE | ID: mdl-31577269

RESUMO

OBJECTIVE: The aim of this study was to estimate the prognostic value of magnetic resonance imaging (MRI) classification of traumatic brain lesion localization and levels in patients with a brain injury of various severity in a few days to three weeks after the injury. MATERIAL AND METHODS: The cohort of 278 patients with traumatic brain injury (TBI) of various severity aged 8-74 y.o. (average -31.4±13.8, median - 29 (21.3; 37.0) was included in the analysis. The severity of TBI at admission varied from 3 to 15 Glasgow coma scores (GCS) (average - 8±4, median - 7 (5; 12). The main indications and conditions for MRI were: inconsistency between computed tomography (CT) data and neurological status, the necessity to clarify the location and type of brain damage, the absence of metal implants, the stabilization of the patient's vital functions, etc. MRI was performed during the first three weeks after the injury using T1, T2, T2-FLAIR, DWI, T2*GRE, SWAN sequences. The damage to the brain was classified according to 8 grades depending on the lesion levels (cortical-subcortical level, corpus callosum, basal ganglia and/or thalamus, and/or internal, and/or external capsules, uni- or bilateral brain stem injury at a different level). Outcomes were assessed by the Glasgow outcome scale (GOS) 6 months after injury. RESULTS: The significant correlations were found for the entire cohort between MRI grading and TBI severity (by GCS) and outcome (by GOS) of the injury (R=-0.66; p<0.0001; R=-0.69; p<0.0001, respectively). A high accuracy (77%), sensitivity (77%) and specificity (76%) of the proposed MRI classification in predicting injury outcomes (AUC=0.85) were confirmed using the logistic regression and ROC analysis. The assessment of MRI-classification prognostic value in subgroups of patients examined during the first, second, and third weeks after injury showed significant correlations between the GCS and the GOS as well as between MRI-grading and GCS, and GOS in all three subgroups. In the subgroup of patients examined during the first 14 days after the injury, the correlation coefficients were higher compared with those obtained in a subgroup examined 15-21 days after the injury. The highest correlations between MRI grading, TBI severity, and the outcome were found in the subgroup of patients who underwent MRI in the first three days after the injury (n=58). CONCLUSION: The proposed MRI classification of traumatic brain lesion levels and localization based on the use of different MR sequences reliably correlated with the clinical estimate of TBI severity by GCS and the outcomes by GOS in patients examined during the first three weeks after injury. The strongest correlation was observed for patients examined during the first three days after the injury.


Assuntos
Lesões Encefálicas , Imagem por Ressonância Magnética , Neuroimagem , Adolescente , Adulto , Idoso , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Lesões Encefálicas/diagnóstico por imagem , Criança , Escala de Coma de Glasgow , Escala de Resultado de Glasgow , Humanos , Pessoa de Meia-Idade , Prognóstico , Adulto Jovem
7.
Medicine (Baltimore) ; 98(28): e16320, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305419

RESUMO

To investigate the use of neuroimaging in children and adolescents with minor brain injury in pediatric and non-pediatric departments.In this observational cohort study data were extracted from a large German statutory health insurance (AOK Plus Dresden ∼3.1 million clients) in a 7-year period (2010-2016). All patients with International Classification of Diseases (ICD) code S06.0 (concussion; minor brain injury; commotio cerebri) aged ≤ 18 years were included. Demographic and clinical data were analyzed by logistic regression analysis for associations with the use of CT and MRI (independent variables: gender, age, length of stay, pediatric vs non-pediatric department, university vs non-university hospital).A total of 14,805 children with minor brain injuries (mean age 6.0 ±â€Š5.6; 45.5% females) were included. Treatment was provided by different medical departments: Pediatrics (N = 8717; 59%), Pediatric Surgery (N = 3582, 24%), General Surgery (N = 2197, 15%), Orthopedic Trauma Surgery (N = 309, 2.1%). Patients admitted to pediatric departments (Pediatrics and Pediatric Surgery) underwent head CT-imaging significantly less frequently (3.8%) compared to patients treated in non-pediatric departments (18.5%; P < .001; General Surgery: 15.6%; Orthopedic Trauma Surgery: 39.2%). Logistic regression confirmed a significantly higher odds ratio (OR) for the use of cranial CT by the non-pediatric departments (OR: 3.2 [95-%-CI: 2.72-3.76]).CT was significantly less frequently used in pediatric departments. Educational efforts and quality improvement initiatives on physicians, especially in non-pediatric departments may be an effective approach to decreasing rates of CT after minor traumatic brain injuries.


Assuntos
Lesões Encefálicas/diagnóstico por imagem , Assistência à Saúde , Neuroimagem , Adolescente , Lesões Encefálicas/terapia , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Imagem por Ressonância Magnética , Masculino , Utilização de Procedimentos e Técnicas , Tomografia Computadorizada por Raios X
8.
BMJ Case Rep ; 12(7)2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31308190

RESUMO

A 54-year-old man was referred to the acute medical unit with a suspected stroke after presenting to his general practitioner with altered speech, left sided facial droop and confusion. The patient had a new right sided swelling on the lateral aspect of his head but did not report any history of trauma. Imaging revealed a 9.2 cm nail entering via the right parietal bone with associated acute haemorrhage. After further discussion with the patient, he disclosed a suicide attempt with a nail gun 5 days prior to presentation. The nail was successfully removed by the neurosurgical team and the patient received rehabilitation and psychiatric assessment on the brain injury unit before going home.


Assuntos
Lesões Encefálicas/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Corpos Estranhos/diagnóstico por imagem , Traumatismos Cranianos Penetrantes/diagnóstico por imagem , Tentativa de Suicídio , Lesões Encefálicas/psicologia , Diagnóstico Diferencial , Corpos Estranhos/psicologia , Traumatismos Cranianos Penetrantes/psicologia , Humanos , Achados Incidentais , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
9.
BMC Med Imaging ; 19(1): 53, 2019 07 05.
Artigo em Inglês | MEDLINE | ID: mdl-31277606

RESUMO

BACKGROUND: The invasive method for intracranial pressure measurement is 'gold standard' but not always feasible because the intraventricular catheter/ intraparenchymal micro transducer used in the measurement of intracranial pressure measurement may cause complications. Imaging modalities with clinical examination protocol have a lack of specificity and accuracy. The objective of the study was to compare the accuracy of diagnostic parameters of ultrasound measurements in patients with brain injury underwent invasive intracranial pressure measurement method. METHODS: Data of invasive intracranial pressure measurement method and ultrasound measurements of 185 patients with brain injury who required admission diagnosis were included in the analysis. Pearson correlation was tested for diagnostic parameters. Logistical regression analysis was performed for diagnostic parameters of death patients to evaluate independent parameter of mortality. RESULTS: Straight sinus flow velocities, middle cerebral artery flow velocities, and optic nerve sheath diameter were correlated with intracranial pressure (p < 0.0001 for all). Arterial blood pressure (p = 0.127) and middle cerebral artery pulsatility index (p = 0.06) were not correlated with intracranial pressure. A total of 47 patients died during the study period. Intracranial pressure (p = 0.015) and optic nerve sheath diameter (p = 0.035) were found to be independent predictor of mortality. CONCLUSIONS: Ultrasound measurement especially optic nerve sheath diameter can be successfully used instead of invasive intracranial pressure measurement method in patients with brain injury. LEVEL OF EVIDENCE: III.


Assuntos
Lesões Encefálicas/mortalidade , Lesões Encefálicas/fisiopatologia , Pressão Intracraniana , Monitorização Fisiológica/métodos , Velocidade do Fluxo Sanguíneo , Lesões Encefálicas/diagnóstico por imagem , Feminino , Humanos , Modelos Logísticos , Masculino , Estudos Retrospectivos , Sensibilidade e Especificidade , Ultrassonografia Doppler Transcraniana
10.
Eur J Paediatr Neurol ; 23(4): 604-608, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31147107

RESUMO

Pediatric abusive head trauma (AHT) or non accidental head trauma (NAHT) is a major cause of death from trauma in children under 2 years of age. Main etiological factor for non accidental head trauma is shaking a baby, causing brain injury by rotational head acceleration and deceleration. The consequent brain damage as shown by magnetic resonance imaging (MRI) is subdural haemorrhage and to a lesser extent parenchymal injuries of variable severity. Involvement of the cerebellum has very rarely been described. We report the clinical history and the development of cerebral magnetic resonance imaging findings in two children with serious brain injury following probable shaking who presented the typical "triad" with subdural haematoma, retinal haemorrhage and encephalopathy. We want to draw attention to cerebellar involvement characterized by cortico-subcortical signal alterations most prominent on T2w images following diffusion changes during the acute period. We discuss cerebellar involvement as a sign of higher severity of AHT which is probably underrecognized.


Assuntos
Lesões Encefálicas/patologia , Cerebelo/lesões , Cerebelo/patologia , Maus-Tratos Infantis , Traumatismos Craniocerebrais/patologia , Lesões Encefálicas/diagnóstico por imagem , Cerebelo/diagnóstico por imagem , Maus-Tratos Infantis/diagnóstico , Traumatismos Craniocerebrais/diagnóstico por imagem , Feminino , Humanos , Lactente , Imagem por Ressonância Magnética/métodos , Masculino
11.
J Neurol ; 266(8): 1859-1868, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31049729

RESUMO

OBJECTIVE: To determine the optimal observation period (OBP) in adults with a clinical diagnosis of brain death (BD) using electroencephalography (EEG) or computerized tomography angiography (CTA). METHODS: We conducted a retrospective observational analysis of adult patients with a diagnosis of BD from January 2000 to February 2017. The optimal OBP was defined as the minimum time interval from the first complete clinical neurological examination (CNE) that ensures that neither a second CNE nor any ancillary test (AT) performed after this period would fail to confirm BD. RESULTS: The study sample included 447 patients. In the supratentorial group, the first AT confirmed BD in 389 cases (98%), but in 8 (2%) cases the complementary test was incongruent. In this group, 8 of 245 patients in whom the first AT was carried out within the first 2 h after a complete CNE had a non-confirmatory test of BD versus none of 152 in whom the first AT was delayed more than 2 h (3.0% vs 0.0%; p = 0.026). In the infratentorial group, we found a higher probability of obtaining a first non-confirmatory AT of BD (34% vs 2%; p = 0.0001) and an OBP greater than 32.5 h was necessary to confirm a BD diagnosis. CONCLUSIONS: We found important differences in the confirmation of BD diagnosis between primary supratentorial and infratentorial lesion, and identified an optimal OBP of 2 h in patients with supratentorial lesions. By contrast, in primary posterior fossa/infratentorial lesions, the determination of an optimal OPB remains less accurate and hence more challenging.


Assuntos
Morte Encefálica/diagnóstico por imagem , Lesões Encefálicas/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Angiografia por Tomografia Computadorizada/métodos , Eletroencefalografia/métodos , Ultrassonografia Doppler Transcraniana/métodos , Adulto , Idoso , Encéfalo/fisiopatologia , Morte Encefálica/fisiopatologia , Lesões Encefálicas/fisiopatologia , Angiografia por Tomografia Computadorizada/normas , Eletroencefalografia/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Ultrassonografia Doppler Transcraniana/normas
12.
Eur J Pediatr ; 178(7): 1053-1061, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31065842

RESUMO

This study aimed to investigate the accuracy of different grades of brain injuries on serial and term equivalent age (TEA)-cranial ultrasound imaging (cUS) as compared to TEA magnetic resonance imaging (MRI) in extremely preterm infants < 28 weeks, and determine the predictive value of imaging abnormalities on neurodevelopmental outcome at 1 and 3 years. Seventy-five infants were included in the study. Severe TEA-cUS injury had high positive predictive value-PPV (100%) for predicting severe MRI injury compared to mild to moderate TEA-cUS injury or severe injury on worst cranial ultrasound scan. Absence of moderate to severe injury on TEA cUS or worst serial cUS was a good predictor of a normal MRI (negative predictive values > 93%). Severe grade 3 injuries on TEA-US had high predictive values in predicting abnormal neurodevelopment at both 1 and 3 years of age (PPV 100%). All grades of MRI and worst serial cUS injuries poorly predicted abnormal neurodevelopment at 1 and 3 years. Absence of an injury either on a cranial ultrasound or an MRI did not predict a normal outcome. Multiple logistic regression did not show a significant correlation between imaging injury and neurodevelopmental outcomes.Conclusion: This study demonstrates that TEA cUS can reliably identify severe brain abnormalities that would be seen on MRI imaging and positively predict abnormal neurodevelopment at both 1 and 3 years. Although MRI can pick up more subtle abnormalities that may be missed on cUS, their predictive value on neurodevelopmental impairment is poor. Normal cUS and MRI scan may not exclude abnormal neurodevelopment. Routine TEA-MRI scan provides limited benefit in predicting abnormal neurodevelopment in extremely preterm infants. What is Known: • Preterm neonates are at increased risk of white matter and other brain injuries, which may be associated with adverse neurodevelopmental outcome. • MRI is the most accurate method in detecting white matter injuries. What is New: • TEA-cUS can reliably detect severe brain injuries on MRI, but not mild/moderate lesions as well as abnormal neurodevelopment at 1 and 3 years. • TEA-MRI brain injury is poor in predicting abnormal neurodevelopment at 1 and 3 years and normal cUS or MRI brain injury may not guarantee normal neurodevelopment.


Assuntos
Lesões Encefálicas/diagnóstico por imagem , Doenças do Prematuro/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Transtornos do Neurodesenvolvimento/diagnóstico , Ultrassonografia/métodos , Lesões Encefálicas/classificação , Lesões Encefálicas/complicações , Pré-Escolar , Feminino , Humanos , Lactente , Lactente Extremamente Prematuro , Recém-Nascido , Escala de Gravidade do Ferimento , Masculino , Transtornos do Neurodesenvolvimento/etiologia , Valor Preditivo dos Testes , Estudos Retrospectivos
13.
J Nepal Health Res Counc ; 17(1): 56-60, 2019 Apr 28.
Artigo em Inglês | MEDLINE | ID: mdl-31110378

RESUMO

BACKGROUND: Head injury is a common problem encountered in emergency department. Among various neurological diseases, cranio-cerebral trauma ranks high in order of frequency and gravity. In acute setting, computed tomography is modality of choice because of its high accuracy in detecting intracranial lesions. The study was done to analyze computed tomography findings in cerebral trauma in regards to sociodemographic characteristics and find out associations of Computed tomography findings with mechanism of injury and clinical manifestations. METHODS: The study was carried in Department of Radiology, BPKIHS, over a period of one year from Aug. 2015 to Aug. 2016. 450 patients were included in our study and findings noted on structured pro forma. Analysis was done using SPSS version 20 applying simple descriptive statistical methods. RESULTS: Among 450 patients, 220 patients (48.9%) had various cranio-cerebral injuries. Most were in age group of 20-29 years (49.5%) and most common mode was road traffic accident (44.6%).Most patients presented with altered sensorium (39.2%) and Glasgow Coma Scale score of ?13 (70.9%). Scalp lesion was the most common finding (24%) followed by bone fractures (19.8 %). Patients with road traffic accident (59.7%) and fall from height (46.7%) had more positive computed tomography findings than from physical assault (28.2%). Glasgow Coma Scale showed significant statistical association with computed tomography findings (p<0.001). CONCLUSIONS: Road traffic accident is the most common mode of head injury in young adults patients presenting in our hospital. Glasgow Coma Scale can be considered as an important clinical marker for predicting positive computed tomography findings. Also computed tomography is an important initial investigation to evaluate the various craniocerebral injury in trauma patients.


Assuntos
Lesões Encefálicas/diagnóstico por imagem , Traumatismos Craniocerebrais/diagnóstico por imagem , Acidentes por Quedas/estatística & dados numéricos , Acidentes de Trânsito/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Lesões Encefálicas/epidemiologia , Lesões Encefálicas/patologia , Criança , Pré-Escolar , Traumatismos Craniocerebrais/epidemiologia , Traumatismos Craniocerebrais/patologia , Estudos Transversais , Feminino , Escala de Coma de Glasgow , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Nepal/epidemiologia , Neuroimagem , Fraturas Cranianas/diagnóstico por imagem , Fraturas Cranianas/patologia , Centros de Atenção Terciária/estatística & dados numéricos , Tomografia Computadorizada por Raios X , Adulto Jovem
14.
PLoS One ; 14(4): e0213528, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30969973

RESUMO

Locked-in syndrome (LIS) is a state of quadriplegia and anarthria with preserved consciousness, which is generally triggered by a disruption of specific white matter fiber tracts, following a lesion in the ventral part of the pons. However, the impact of focal lesions on the whole brain white matter microstructure and structural connectivity pathways remains unknown. We used diffusion tensor magnetic resonance imaging (DT-MRI) and tract-based statistics to characterise the whole white matter tracts in seven consecutive LIS patients, with ventral pontine injuries but no significant supratentorial lesions detected with morphological MRI. The imaging was performed in the acute phase of the disease (26 ± 13 days after the accident). DT-MRI-derived metrics were used to quantitatively assess global white matter alterations. All diffusion coefficient Z-scores were decreased for almost all fiber tracts in all LIS patients, with diffuse white matter alterations in both infratentorial and supratentorial areas. A mixture model of two multidimensional Gaussian distributions was fitted to cluster the white matter fiber tracts studied in two groups: the least (group 1) and most injured white matter fiber tracts (group 2). The greatest injuries were revealed along pathways crossing the lesion responsible for the LIS: left and right medial lemniscus (98.4% and 97.9% probability of belonging to group 2, respectively), left and right superior cerebellar peduncles (69.3% and 45.7% probability) and left and right corticospinal tract (20.6% and 46.5% probability). This approach demonstrated globally compromised white matter tracts in the acute phase of LIS, potentially underlying cognitive deficits.


Assuntos
Tronco Encefálico/diagnóstico por imagem , Imagem de Tensor de Difusão , Substância Branca/diagnóstico por imagem , Adulto , Idoso , Vias Auditivas/diagnóstico por imagem , Vias Auditivas/fisiopatologia , Lesões Encefálicas/diagnóstico , Lesões Encefálicas/diagnóstico por imagem , Lesões Encefálicas/fisiopatologia , Tronco Encefálico/fisiopatologia , Sistema Nervoso Central/diagnóstico por imagem , Sistema Nervoso Central/fisiopatologia , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/diagnóstico por imagem , Transtornos Cognitivos/fisiopatologia , Feminino , Humanos , /fisiopatologia , Masculino , Pessoa de Meia-Idade , Distribuição Normal , Tratos Piramidais/diagnóstico por imagem , Tratos Piramidais/fisiopatologia , Substância Branca/lesões , Substância Branca/fisiopatologia
15.
Perm J ; 232019.
Artigo em Inglês | MEDLINE | ID: mdl-30939275

RESUMO

INTRODUCTION: Preterm infants require intravenous (IV) access for administration of medications, IV fluids, and parenteral nutrition. The scalp is a common site for obtaining IV access, and in children with hydrocephalus or wide fontanelles and sutures, there is a high probability of penetrating the meninges and brain matter with the scalp IV needle. If this penetration occurs and remains unnoticed, the contents of the IV infusion can infiltrate into the brain and cause severe brain damage. CASE PRESENTATION: A 3-day-old female neonate, born with myelomeningocele, was receiving total parenteral nutrition through a scalp-vein IV. She experienced a sudden increase in head circumference, a bulging fontanelle, and respiratory distress. Magnetic resonance images demonstrated subdural fluid collection, and the patient underwent emergency surgery. The dura, when opened, exuded milky-white fluid consistent in color with parenteral nutrition. Postoperative imaging showed a parenchymal abnormality caused by the intracranial and intraparenchymal infusion of parenteral nutrition. Four years later, the child had a shunt and had mild cognitive impairment. DISCUSSION: In cases of accidental intracranial administration of parenteral nutrition, we recommend that aggressive therapy be pursued to minimize the risks of developing comorbidities such as meningitis and to allow for maximal functional recovery.


Assuntos
Lesões Encefálicas/etiologia , Cateteres/efeitos adversos , Meningomielocele/terapia , Nutrição Parenteral/efeitos adversos , Nutrição Parenteral/instrumentação , Couro Cabeludo , Encéfalo/diagnóstico por imagem , Encéfalo/cirurgia , Lesões Encefálicas/diagnóstico por imagem , Lesões Encefálicas/cirurgia , Disfunção Cognitiva/etiologia , Diagnóstico por Imagem , Feminino , Humanos , Hidrocefalia/diagnóstico por imagem , Hidrocefalia/etiologia , Hidrocefalia/cirurgia , Recém-Nascido , Infusões Intravenosas , Meninges/lesões , Meningomielocele/complicações , Nutrição Parenteral/métodos , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/cirurgia , Índice de Gravidade de Doença , Derivação Ventriculoperitoneal
16.
Cancer Imaging ; 19(1): 19, 2019 Mar 25.
Artigo em Inglês | MEDLINE | ID: mdl-30909974

RESUMO

BACKGROUND: The purpose/aim of this study was to 1) use magnetic resonance diffusion tensor imaging (DTI), fibre bundle/tract-based spatial statistics (TBSS) and machine learning methods to study changes in the white matter (WM) structure and whole brain WM network in different periods of the nasopharyngeal carcinoma (NPC) patients after radiotherapy (RT), 2) identify the most discriminating WM regions and WM connections as biomarkers of radiation brain injury (RBI), and 3) supplement the understanding of the pathogenesis of RBI, which is useful for early diagnosis in the clinic. METHODS: A DTI scan was performed in 77 patients and 67 normal controls. A fractional anisotropy map was generated by DTIFit. TBSS was used to find the region where the FA differed between the case and control groups. Each resulting FA value image is registered with each other to create an average FA value skeleton. Each resultant FA skeleton image was connected to feature vectors, and features with significant differences were extracted and classified using a support vector machine (SVM). Next, brain segmentation was performed on each subject's DTI image using automated anatomical labeling (AAL), and deterministic white matter fiber bundle tracking was performed to generate symmetrical brain matrix, select the upper triangular component as a classification feature. Two-sample t-test was used to extract the features with significant differences, then classified by SVM. Finally, we adopted a permutation test and ROC curves to evaluate the reliability of the classifier. RESULTS: For FA, the accuracy of classification between the 0-6, 6-12 and > 12 months post-RT groups and the control group was 84.5, 83.9 and 74.5%, respectively. In the case groups, the FA with discriminative ability was reduced, mainly in the bilateral cerebellum and bilateral temporal lobe, with prolonged time, the damage was aggravated. For WM connections, the SVM classifier classification recognition rates of the 0-6, 6-12 and > 12 months post-RT groups reached 82.5, 78.4 and 76.3%, respectively. The WM connections with discriminative ability were reduced. CONCLUSIONS: RBI is a disease involving whole brain WM network anomalies. These brain discriminating WM regions and WM connection modes can supplement the understanding of RBI and be used as biomarkers for the early clinical diagnosis of RBI.


Assuntos
Lesões Encefálicas/diagnóstico por imagem , Imagem de Tensor de Difusão/métodos , Aprendizado de Máquina , Carcinoma Nasofaríngeo/radioterapia , Lesões por Radiação/diagnóstico por imagem , Substância Branca/diagnóstico por imagem , Adulto , Anisotropia , Encéfalo/diagnóstico por imagem , Encéfalo/efeitos da radiação , Lesões Encefálicas/etiologia , Fracionamento da Dose de Radiação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROC , Lesões por Radiação/diagnóstico , Lesões por Radiação/etiologia , Radioterapia Conformacional/efeitos adversos , Radioterapia Conformacional/métodos , Reprodutibilidade dos Testes , Substância Branca/lesões , Substância Branca/fisiopatologia , Substância Branca/efeitos da radiação
17.
PLoS One ; 14(2): e0213200, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30818392

RESUMO

Population reduction or eradication of domestic or non-domestic species may be required to address their impacts on the environment, other species, or human interests. Firearms are often used to accomplish these practical management objectives, and there is increased concern that the methods used may compromise animal welfare. We document the accuracy and humaneness of gunshot placement to the brain and cervical vertebrae of Philippine deer (Rusa marianna) on Guam during depopulation activities as a model for meeting AVMA standards of euthanasia under field conditions (e.g., animal is not in hand). Deer were shot with a .223 caliber rifle from 10-125 m and approached immediately (<20 s) for assessment. A subset of adult deer was further evaluated for physiological responses including cessation of heart rate, respiration, ocular reflexes, and post-mortem spasms. All deer shot in the brain (n = 132) and upper cervical spine (C1-C3; n = 18) died immediately due to the destruction of the brain or spinal tissue. Shot placements were all within 1.9 cm of the point of aim (i.e., the center of the target region). The accuracy and immediate insensibility resulting from targeting of C1-C3 demonstrates that this is an alternative target site when animal positioning is not optimal for targeting the brain, or there is a need to preserve brain tissue (e.g., Chronic Wasting Disease testing). While targeting of C4 -C7 vertebrae (n = 6) was accurate and resulted in immediate incapacitation, the failure to produce immediate insensibility does not support the use of this shot placement when upper cervical or brain shot placement is an option. It is reasonable to achieve sufficient accuracy to target the brain or upper cervical vertebrae of deer under field conditions and meet standards of euthanasia while accomplishing management objectives.


Assuntos
Bem-Estar do Animal , Cervos , Eutanásia Animal/métodos , Animais , Lesões Encefálicas/diagnóstico por imagem , Lesões Encefálicas/veterinária , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/lesões , Ecossistema , Armas de Fogo , Guam , Humanos , Espécies Introduzidas , Ferimentos por Arma de Fogo
19.
Z Orthop Unfall ; 157(5): 558-561, 2019 Oct.
Artigo em Inglês, Alemão | MEDLINE | ID: mdl-30722074

RESUMO

In a comatose patient with acute subdural haematoma, the polytrauma spiral indicated pulmonary metastasising renal carcinoma, which limited therapeutic possibilities. Whole-body positron-emission tomography/computer tomography (PET/CT) was performed with fluorodesoxyglucose. Renal carcinoma with pulmonary, nodal and parotidal metastases was proved. A cerebral metastasis could not be excluded because of perifocal hypermetabolism. There were few therapeutic possibilities. PET/CT is possible and sensible in the unconscious patient to differentiate the results of polytrauma-CT.


Assuntos
Lesões Encefálicas/diagnóstico por imagem , Carcinoma de Células Renais/diagnóstico por imagem , Hematoma Subdural Agudo/diagnóstico por imagem , Neoplasias Renais/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Acidentes de Trânsito , Lesões Encefálicas/etiologia , Lesões Encefálicas/terapia , Carcinoma de Células Renais/secundário , Hematoma Subdural Agudo/etiologia , Hematoma Subdural Agudo/terapia , Humanos , Neoplasias Renais/patologia , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/secundário , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/secundário , Metástase Linfática/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Neoplasias Parotídeas/diagnóstico por imagem , Neoplasias Parotídeas/secundário , Prognóstico , Suspensão de Tratamento
20.
Neuroimage ; 190: 4-13, 2019 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-30686616

RESUMO

Neuroscience has a long history of inferring brain function by examining the relationship between brain injury and subsequent behavioral impairments. The primary advantage of this method over correlative methods is that it can tell us if a certain brain region is necessary for a given cognitive function. In addition, lesion-based analyses provide unique insights into clinical deficits. In the last decade, statistical voxel-based lesion behavior mapping (VLBM) emerged as a powerful method for understanding the architecture of the human brain. This review illustrates how VLBM improves our knowledge of functional brain architecture, as well as how it is inherently limited by its mass-univariate approach. A wide array of recently developed methods appear to supplement traditional VLBM. This paper provides an overview of these new methods, including the use of specialized imaging modalities, the combination of structural imaging with normative connectome data, as well as multivariate analyses of structural imaging data. We see these new methods as complementing rather than replacing traditional VLBM, providing synergistic tools to answer related questions. Finally, we discuss the potential for these methods to become established in cognitive neuroscience and in clinical applications.


Assuntos
Lesões Encefálicas , Mapeamento Encefálico/métodos , Imagem por Ressonância Magnética/métodos , Acidente Vascular Cerebral , Lesões Encefálicas/diagnóstico por imagem , Lesões Encefálicas/patologia , Lesões Encefálicas/fisiopatologia , Mapeamento Encefálico/normas , Humanos , Imagem por Ressonância Magnética/normas , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/patologia , Acidente Vascular Cerebral/fisiopatologia
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