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1.
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
Imagem 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
3.
Neurology ; 95(14): e1918-e1931, 2020 10 06.
Artigo em Inglês | MEDLINE | ID: mdl-32887784

RESUMO

OBJECTIVE: To characterize lesion evolution and neurodegeneration in retinal vasculopathy with cerebral leukoencephalopathy and systemic manifestations (RVCL-S) using multimodal MRI. METHODS: We prospectively performed MRI and cognitive testing in RVCL-S and healthy control cohorts. Gray and white matter volume and disruption of white matter microstructure were quantified. Asymmetric spin echo acquisition permitted voxel-wise oxygen extraction fraction (OEF) calculation as an in vivo marker of microvascular ischemia. The RVCL-S cohort was included in a longitudinal analysis of lesion subtypes in which hyperintense lesions on fluid-attenuated inversion recovery (FLAIR), T1-postgadolinium, and diffusion-weighted imaging were delineated and quantified volumetrically. RESULTS: Twenty individuals with RVCL-S and 26 controls were enrolled. White matter volume and microstructure declined faster in those with RVCL-S compared to controls. White matter atrophy in RVCL-S was highly linear (ρ = -0.908, p < 0.0001). Normalized OEF was elevated in RVCL-S and increased with disease duration. Multiple cognitive domains, specifically those measuring working memory and processing speed, were impaired in RVCL-S. Lesion volumes, regardless of subtype, progressed/regressed with high variability as a function of age, while FLAIR lesion burden increased near time to death (p < 0.001). CONCLUSION: RVCL-S is a monogenic microvasculopathy affecting predominantly the white matter with regard to atrophy and cognitive impairment. White matter volumes in RVCL-S declined linearly, providing a potential metric against which to test the efficacy of future therapies. Progressive elevation of white matter OEF suggests that microvascular ischemia may underlie neurodegeneration in RVCL-S.


Assuntos
Disfunção Cognitiva/patologia , Doenças Desmielinizantes Hereditárias do Sistema Nervoso Central/patologia , Degeneração Neural/patologia , Doenças Retinianas/patologia , Doenças Vasculares/patologia , Substância Branca/patologia , Adulto , Disfunção Cognitiva/diagnóstico por imagem , Feminino , Doenças Desmielinizantes Hereditárias do Sistema Nervoso Central/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Degeneração Neural/diagnóstico por imagem , Neuroimagem/métodos , Doenças Retinianas/diagnóstico por imagem , Doenças Vasculares/diagnóstico por imagem , Substância Branca/diagnóstico por imagem
4.
PLoS One ; 15(9): e0239731, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32986760

RESUMO

BACKGROUND: Computed tomography (CT) imaging is an indispensable tool in the management of acute paediatric neurological illness providing rapid answers that facilitate timely decisions and interventions that may be lifesaving. While clear guidelines exist for use of CT in trauma to maximise individual benefits against the risk of radiation exposure and the cost to the healthcare system, the same is not the case for medical emergency. AIMS: The study primarily aimed to retrospectively describe indications for non-trauma head CT and the findings at a tertiary paediatric hospital. METHODS: Records of children presenting with acute illness to the medical emergency unit of Red Cross War Children's Hospital, Cape Town, over one year (2013) were retrospectively reviewed. Participants were included if they underwent head CT scan within 24 hours of presentation with a non-trauma event. Clinical data and reports of CT findings were extracted. RESULTS: Inclusion criteria were met by 311 patients; 188 (60.5%) were boys. The median age was 39.2 (IQR 12.6-84.0) months. Most common indications for head CT were seizures (n = 169; 54.3%), reduced level of consciousness (n = 140;45.0%), headache (n = 74;23.8%) and suspected ventriculoperitoneal shunt (VPS) malfunction (n = 61;19.7%). In 217 (69.8%) patients CT showed no abnormal findings. In the 94 (30.2%) with abnormal CT results the predominant findings were hydrocephalus (n = 54;57.4%) and cerebral oedema (n = 29;30.9%). Papilloedema was more common in patients with abnormal CT (3/56; 5.4%) compared with none in those with normal CT; P = 0.015; while long tract signs were found in 42/169 (24.9%) and 23/56 (41.1%) of patients with normal and abnormal CT findings, respectively; P = 0.020. Post-CT surgery was required by 47(15.1%) of which 40 (85.1%) needed a ventricular drainage. A larger proportion of patients with VPS (25/62; 40.3%) required surgery compared to patients without VPS (22/249; 8.8%; P<0.001). CONCLUSION: A majority of head CT scans in children with medical emergency with acute neurological illness were normal. Patients with VPS constituted the majority of patients with abnormal CT scans that required subsequent neurosurgical intervention. Evidence-based guidelines are required to guide the best use of head CT in the management of children without head trauma.


Assuntos
Cabeça/diagnóstico por imagem , Cefaleia/diagnóstico por imagem , Hidrocefalia/diagnóstico por imagem , Neuroimagem/métodos , Convulsões/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Inconsciência/diagnóstico por imagem , Doença Aguda , Adolescente , Criança , Pré-Escolar , Feminino , Cefaleia/epidemiologia , Hospitais Pediátricos , Humanos , Hidrocefalia/epidemiologia , Renda , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Convulsões/epidemiologia , África do Sul/epidemiologia , Inconsciência/epidemiologia
5.
Neuroradiol J ; 33(5): 353-367, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32894991

RESUMO

The ongoing COVID-19 pandemic has forced every radiology set-up to evolve and formulate guidelines for day-to-day functioning. The sub-speciality of neuroradiology, both diagnostic and neuro-intervention, forms a very important part of any radiology or 'neuro-care' set-up. The present document is a consensus statement of the Indian Society of Neuroradiology, prepared after reviewing the available data and working experience. It scientifically tries to answer many questions faced by neuroradiologists everyday in practice. It encompasses simple things such as which patients need to be imaged, what precautions are essential, the work-flows, cleaning of radiology equipment, how to carry out neuro-interventions in COVID-suspect patients, and what procedures/tests to avoid, or their alternatives, to minimise the spread of COVID infection both to the patients and health care personnel. As radiology set-ups can be large, every sub-speciality may have certain precautions which will not be covered in general guidelines, and this document tries to answer those for neuroradiologists. Carefully evolved Standards of Operating Procedure (SOPs) and guidelines are the need of the hour to guide in providing uninterrupted and adequate services to the needy without compromising the safety of the specialised work force and facilities involved.


Assuntos
Infecções por Coronavirus/prevenção & controle , Controle de Infecções/métodos , Neuroimagem/métodos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Radiologia Intervencionista/métodos , Pessoal Técnico de Saúde , Betacoronavirus , Desinfecção , Emergências , Fumigação , Humanos , Índia , Equipamento de Proteção Individual , Admissão e Escalonamento de Pessoal , Radiologia/métodos , Sociedades Médicas , Ventilação
6.
BMC Med Genet ; 21(1): 181, 2020 09 12.
Artigo em Inglês | MEDLINE | ID: mdl-32919460

RESUMO

BACKGROUND: The complement component (3b/4b) receptor 1 gene (CR1) gene has been proved to affect the susceptibility of Alzheimer's disease (AD) in different ethnic and districts groups. However, the effect of CR1 genetic variants on amyloid ß (Aß) metabolism of AD human is still unclear. Hence, the aim of this study was to investigate genetic influences of CR1 gene on Aß metabolism. METHODS: All data of AD patients and normal controls (NC) were obtained from alzheimer's disease neuroimaging initiative database (ADNI) database. In order to assess the effect of each single nucleotide polymorphism (SNP) of CR1 on Aß metabolism, the PLINK software was used to conduct the quality control procedures to enroll appropriate SNPs. Moreover, the correlation between CR1 genotypes and Aß metabolism in all participants were estimated with multiple linear regression models. RESULTS: After quality control procedures, a total of 329 samples and 83 SNPs were enrolled in our study. Moreover, our results identified five SNPs (rs10494884, rs11118322, rs1323721, rs17259045 and rs41308433), which were linked to Aß accumulation in brain. In further analyses, rs17259045 was found to decrease Aß accumulation among AD patients. Additionally, our study revealed the genetic variants in rs12567945 could increase CSF Aß42 in NC population. CONCLUSIONS: Our study had revealed several novel SNPs in CR1 genes which might be involved in the progression of AD via regulating Aß accumulation. These findings will provide a new basis for the diagnosis and treatment AD.


Assuntos
Doença de Alzheimer/genética , Peptídeos beta-Amiloides/líquido cefalorraquidiano , Biomarcadores/líquido cefalorraquidiano , Neuroimagem/métodos , Fragmentos de Peptídeos/líquido cefalorraquidiano , Polimorfismo de Nucleotídeo Único , Receptores de Complemento 3b/genética , Idoso , Idoso de 80 Anos ou mais , Alelos , Doença de Alzheimer/diagnóstico , Doença de Alzheimer/metabolismo , Peptídeos beta-Amiloides/metabolismo , Biomarcadores/metabolismo , Encéfalo/diagnóstico por imagem , Encéfalo/metabolismo , Feminino , Genótipo , Humanos , Masculino , Fragmentos de Peptídeos/metabolismo
7.
Neurology ; 95(14): 632-643, 2020 10 06.
Artigo em Inglês | MEDLINE | ID: mdl-32847959

RESUMO

OBJECTIVE: To provide precise estimates of the association between noncontrast CT (NCCT) markers, hematoma expansion (HE), and functional outcome in patients presenting with intracerebral hemorrhage (ICH) through a systematic review and meta-analysis. METHODS: We searched PubMed for English-written observational studies or randomized controlled trials reporting data on NCCT markers of HE and outcome in spontaneous ICH including at least 50 subjects. The outcomes of interest were HE (hematoma growth >33%, >33% and/or >6 mL, >33% and/or >12.5 mL), poor functional outcome (modified Rankin Scale 3-6 or 4-6) at discharge or at 90 days, and mortality. We pooled data in random-effects models and extracted cumulative odds ratio (OR) for each NCCT marker. RESULTS: We included 25 eligible studies (n = 10,650). The following markers were associated with increased risk of HE and poor outcome, respectively: black hole sign (OR = 3.70, 95% confidence interval [CI] = 1.42-9.64 and OR = 5.26, 95% CI = 1.75-15.76), swirl sign (OR = 3.33, 95% CI = 2.42-4.60 and OR = 3.70; 95% CI = 2.47-5.55), heterogeneous density (OR = 2.74; 95% CI = 1.71-4.39 and OR = 2.80; 95% CI = 1.78-4.39), blend sign (OR = 3.49; 95% CI = 2.20-5.55 and OR = 2.21; 95% CI 1.16-4.18), hypodensities (OR = 3.47; 95% CI = 2.18-5.50 and OR = 2.94; 95% CI = 2.28-3.78), irregular shape (OR = 2.01, 95% CI = 1.27-3.19 and OR = 3.43; 95% CI = 2.33-5.03), and island sign (OR = 7.87, 95% CI = 2.17-28.47 and OR = 6.05, 95% CI = 4.44-8.24). CONCLUSION: Our results suggest that multiple NCCT ICH shape and density features, with different effect size, are important markers for HE and clinical outcome and may provide useful information for future randomized controlled trials.


Assuntos
Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/patologia , Neuroimagem/métodos , Tomografia Computadorizada por Raios X/métodos , Humanos , Recuperação de Função Fisiológica
8.
Medicine (Baltimore) ; 99(31): e21499, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756184

RESUMO

BACKGROUND: Numerous studies using a variety of non-invasive neuroimaging techniques in vivo have demonstrated that chronic pain (CP) is associated with brain alterations. Cortical thickness (CTh) via surface-based morphometry (SBM) analysis of magnetic resonance imaging data is a valid and sensitive method to investigate the structure of brain gray matter. Many studies have employed SBM to measure CTh difference between patients with CP and pain-free controls and provided important insights into the brain basis of CP. However, the findings from these studies were inconsistent and have not been quantitatively reviewed. METHODS: Three major electronic medical databases: PubMed, Web of Science, and Embase were searched for eligible studies published in English on April 3, 2020. This protocol was prepared based on the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols. The Seed-based d Mapping with Permutation of Subject Images software package will be employed to conducted a coordinate-based meta-analysis (CBMA) to identify consistent CTh differences between patients with CP and pain-free controls. Several complementary analyses, including sensitivity analysis, heterogeneity analysis, publication bias, subgroup analysis, and meta-regression analysis, will be further conducted to test the robustness of the results. RESULTS: This CBMA will tell us whether CP with different subtypes shares common CTh alterations and what the pattern of its characterized alterations is. CONCLUSIONS: To the best of our knowledge, this will be the first CBMA of SBM studies that characterizes brain CTh alterations in CP. The CBMA will provide the quantitative evidence of common brain cortical morphometry of CP. The findings will help us to understand the neural basis underlying CP. TRIAL REGISTRATION NUMBER: INPLASY202050069.


Assuntos
Córtex Cerebral/diagnóstico por imagem , Dor Crônica/diagnóstico por imagem , Substância Cinzenta/diagnóstico por imagem , Imagem por Ressonância Magnética/estatística & dados numéricos , Neuroimagem/estatística & dados numéricos , Dor Crônica/patologia , Feminino , Substância Cinzenta/patologia , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Metanálise como Assunto , Neuroimagem/métodos , Projetos de Pesquisa , Revisões Sistemáticas como Assunto
9.
Lancet Neurol ; 19(9): 784-796, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32822636

RESUMO

Trigeminal neuralgia is a very painful neurological condition with severe, stimulus-evoked, short-lasting stabbing pain attacks in the face. The past decade has offered new insights into trigeminal neuralgia symptomatology, pathophysiology, and treatment, leading to a change in the classification of the condition. An accurate diagnosis is crucial because neuroimaging interpretation and clinical management differ among the various forms of facial pain. MRI using specific sequences should be a part of the diagnostic workup to detect a possible neurovascular contact and exclude secondary causes. Demonstration of a neurovascular contact should not be used to confirm a diagnosis but rather to facilitate surgical decision making. Carbamazepine and oxcarbazepine are drugs of first choice for long-term treatment, whereas microvascular decompression is the first-line surgery in medically refractory patients. Advances in neuroimaging techniques and animal models will provide further insight into the causes of trigeminal neuralgia and its pathophysiology. Development of more efficacious treatment options is highly warranted.


Assuntos
Gerenciamento Clínico , Neuralgia do Trigêmeo/diagnóstico por imagem , Neuralgia do Trigêmeo/fisiopatologia , Animais , Anticonvulsivantes/farmacologia , Anticonvulsivantes/uso terapêutico , Carbamazepina/farmacologia , Carbamazepina/uso terapêutico , Descompressão Cirúrgica/métodos , Humanos , Neuroimagem/métodos , Oxcarbazepina/farmacologia , Oxcarbazepina/uso terapêutico , Medição da Dor/efeitos dos fármacos , Medição da Dor/métodos , Neuralgia do Trigêmeo/classificação , Neuralgia do Trigêmeo/terapia
10.
PLoS One ; 15(8): e0237511, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32785278

RESUMO

Eating disorder is highly associated with obesity and it is related to brain dysfunction as well. Still, the functional substrates of the brain associated with behavioral traits of eating disorder are underexplored. Existing neuroimaging studies have explored the association between eating disorder and brain function without using all the information provided by the eating disorder related questionnaire but by adopting summary factors. Here, we aimed to investigate the multivariate association between brain function and eating disorder at fine-grained question-level information. Our study is a retrospective secondary analysis that re-analyzed resting-state functional magnetic resonance imaging of 284 participants from the enhanced Nathan Kline Institute-Rockland Sample database. Leveraging sparse canonical correlation analysis, we associated the functional connectivity of all brain regions and all questions in the eating disorder questionnaires. We found that executive- and inhibitory control-related frontoparietal networks showed positive associations with questions of restraint eating, while brain regions involved in the reward system showed negative associations. Notably, inhibitory control-related brain regions showed a positive association with the degree of obesity. Findings were well replicated in the independent validation dataset (n = 34). The results of this study might contribute to a better understanding of brain function with respect to eating disorder.


Assuntos
Mapeamento Encefálico/métodos , Encéfalo/fisiopatologia , Transtornos da Alimentação e da Ingestão de Alimentos/etiologia , Imagem por Ressonância Magnética/métodos , Neuroimagem/métodos , Adulto , Índice de Massa Corporal , Função Executiva , Comportamento Alimentar , Transtornos da Alimentação e da Ingestão de Alimentos/patologia , Feminino , Humanos , Masculino , Estudos Retrospectivos
11.
PLoS One ; 15(8): e0237537, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32785286

RESUMO

BACKGROUND: An accurate and precise surgical procedure is crucial for patient safety and treatment efficacy of deep brain stimulation (DBS). OBJECTIVES: To investigate the characteristics of intracranial lead bending phenomenon after DBS, and to suggest the methods to avoid bending-related complications. METHODS: A retrospective review of brain computed tomography scans after DBS was performed. Using 3-dimensional reconstruction, the maximal distance between the planned trajectory and actual lead location was measured. When the distance exceeded the lead body diameter, the lead was considered bent. The distance between the bending point and planned trajectory, and the relative direction between the bending point and lead securing site were analyzed. Changes over time in the range of lead bending and depth were analyzed when possible. RESULTS: A total of 190 implanted leads in 102 patients were analyzed; 104 leads (54.7%) were bent. The average deviation of bent leads was 2.3 mm (range, 1.3-7.1 mm). Thirty-five (18.4%) and seven leads (3.7%) had deviations exceeding twice and three times the lead body diameter, respectively. Angles between the deviation point and securing site at the skull ranged from 135-180° in 83 leads (53.2%), 45-135° in 58 (37.2%), and 0-45° in 15 (9.6%). Among 17 leads that were initially bent, 16 had less deviation compared to baseline. The lead depth increased in 35 (92.1%) of 38 leads by 1.2 mm (range, 0.1-4.7 mm). CONCLUSION: The extent of lead bending should be considered during the planning and procedural phases of intracranial lead implantation for DBS.


Assuntos
Estimulação Encefálica Profunda/instrumentação , Estimulação Encefálica Profunda/métodos , Eletrodos Implantados , Transtornos dos Movimentos/terapia , Neuroimagem/métodos , Tomografia Computadorizada por Raios X/métodos , Adolescente , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos dos Movimentos/diagnóstico por imagem , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
12.
Nat Commun ; 11(1): 4238, 2020 08 25.
Artigo em Inglês | MEDLINE | ID: mdl-32843633

RESUMO

Recently, deep learning has unlocked unprecedented success in various domains, especially using images, text, and speech. However, deep learning is only beneficial if the data have nonlinear relationships and if they are exploitable at available sample sizes. We systematically profiled the performance of deep, kernel, and linear models as a function of sample size on UKBiobank brain images against established machine learning references. On MNIST and Zalando Fashion, prediction accuracy consistently improves when escalating from linear models to shallow-nonlinear models, and further improves with deep-nonlinear models. In contrast, using structural or functional brain scans, simple linear models perform on par with more complex, highly parameterized models in age/sex prediction across increasing sample sizes. In sum, linear models keep improving as the sample size approaches ~10,000 subjects. Yet, nonlinearities for predicting common phenotypes from typical brain scans remain largely inaccessible to the examined kernel and deep learning methods.


Assuntos
Encéfalo/diagnóstico por imagem , Neuroimagem/métodos , Bancos de Espécimes Biológicos , Aprendizado Profundo , Humanos , Modelos Lineares , Aprendizado de Máquina , Fenótipo , Tamanho da Amostra , Reino Unido
13.
Proc Natl Acad Sci U S A ; 117(37): 23066-23072, 2020 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-32843342

RESUMO

Humans have an extraordinary ability to interact and cooperate with others. Despite the social and evolutionary significance of collaboration, research on finding its neural correlates has been limited partly due to restrictions on the simultaneous neuroimaging of more than one participant (also known as hyperscanning). Several studies have used dyadic fMRI hyperscanning to examine the interaction between two participants. However, to our knowledge, no study to date has aimed at revealing the neural correlates of social interactions using a three-person (or triadic) fMRI hyperscanning paradigm. Here, we simultaneously measured the blood-oxygenation level-dependent signal from 12 triads (n = 36 participants), while they engaged in a collaborative drawing task based on the social game of Pictionary General linear model analysis revealed increased activation in the brain regions previously linked with the theory of mind during the collaborative phase compared to the independent phase of the task. Furthermore, using intersubject correlation analysis, we revealed increased synchronization of the right temporo-parietal junction (R TPJ) during the collaborative phase. The increased synchrony in the R TPJ was observed to be positively associated with the overall team performance on the task. In sum, our paradigm revealed a vital role of the R TPJ among other theory-of-mind regions during a triadic collaborative drawing task.


Assuntos
Encéfalo/fisiologia , Neurônios/fisiologia , Adulto , Mapeamento Encefálico/métodos , Cognição/fisiologia , Feminino , Humanos , Relações Interpessoais , Colaboração Intersetorial , Imagem por Ressonância Magnética/métodos , Masculino , Neuroimagem/métodos , Comportamento Social , Teoria da Mente/fisiologia
14.
Am J Psychiatry ; 177(8): 671-685, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32741287

RESUMO

Major depressive disorder is a remarkably common and often severe psychiatric disorder associated with high levels of morbidity and mortality. Patients with major depression are prone to several comorbid psychiatric conditions, including posttraumatic stress disorder, anxiety disorders, obsessive-compulsive disorder, and substance use disorders, and medical conditions, including cardiovascular disease, diabetes, stroke, cancer, which, coupled with the risk of suicide, result in a shortened life expectancy. The goal of this review is to provide an overview of our current understanding of major depression, from pathophysiology to treatment. In spite of decades of research, relatively little is known about its pathogenesis, other than that risk is largely defined by a combination of ill-defined genetic and environmental factors. Although we know that female sex, a history of childhood maltreatment, and family history as well as more recent stressors are risk factors, precisely how these environmental influences interact with genetic vulnerability remains obscure. In recent years, considerable advances have been made in beginning to understand the genetic substrates that underlie disease vulnerability, and the interaction of genes, early-life adversity, and the epigenome in influencing gene expression is now being intensively studied. The role of inflammation and other immune system dysfunction in the pathogenesis of major depression is also being intensively investigated. Brain imaging studies have provided a firmer understanding of the circuitry involved in major depression, providing potential new therapeutic targets. Despite a broad armamentarium for major depression, including antidepressants, evidence-based psychotherapies, nonpharmacological somatic treatments, and a host of augmentation strategies, a sizable percentage of patients remain nonresponsive or poorly responsive to available treatments. Investigational agents with novel mechanisms of action are under active study. Personalized medicine in psychiatry provides the hope of escape from the current standard trial-and-error approach to treatment, moving to a more refined method that augurs a new era for patients and clinicians alike.


Assuntos
Transtorno Depressivo Maior , Gerenciamento Clínico , Comorbidade , Transtorno Depressivo Maior/etiologia , Transtorno Depressivo Maior/imunologia , Transtorno Depressivo Maior/fisiopatologia , Transtorno Depressivo Maior/terapia , Interação Gene-Ambiente , Humanos , Neuroimagem/métodos , Medicina de Precisão/tendências , Fatores de Risco
15.
Pediatrics ; 146(Suppl 1): S75-S80, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32737237

RESUMO

Death is defined biologically as the irreversible loss of the functioning of the organism as a whole, which typically occurs after the loss of cardiorespiratory function. In 1968, a Harvard committee proposed that death could also be defined neurologically as the irreversible loss of brain function. Brain death has been considered to be equivalent to cardiorespiratory arrest on the basis of the belief that the brain is required to maintain functioning of the organism as a whole and that without the brain, cardiorespiratory arrest and biological death are both rapid and certain. Over the past 20 years, however, this equivalence has been shown to be false on the basis of numerous cases of patients correctly diagnosed as brain-dead who nevertheless continued to survive for many years. The issue reached national attention with the case of Jahi McMath, a young woman diagnosed as brain-dead after a surgical accident, who survived for almost 5 years, mostly at home, supported with a ventilator and tube feedings. The fact that brain death is not biological death has many implications, notably including the concern that procurement of organs from brain-dead donors may not comply with the so-called dead donor rule, which requires that vital organs be procured from patients only after they are dead. In this article, I conclude with an analysis of options for moving forward and among them advocate for reframing brain death as a "social construct," with implicit societal acceptance that patients diagnosed as brain-dead may be treated legally and ethically the same as if they were biologically dead.


Assuntos
Morte Encefálica , Morte , Parada Cardíaca , Adolescente , Atitude Frente a Morte , Morte Encefálica/diagnóstico , Morte Encefálica/legislação & jurisprudência , Morte Encefálica/fisiopatologia , Feminino , Parada Cardíaca/diagnóstico , Parada Cardíaca/etiologia , Parada Cardíaca/fisiopatologia , História do Século XXI , Humanos , Neuroimagem/métodos , Neurologia/normas , Hemorragia Pós-Operatória/complicações , Guias de Prática Clínica como Assunto , Respiração Artificial , Sobrevivência , Fatores de Tempo , Inconsciência , Estados Unidos
17.
Stroke ; 51(8): 2563-2567, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32646324

RESUMO

BACKGROUND AND PURPOSE: Multiple societal guidelines recommend urgent brain and neurovascular imaging in patients with transient ischemic attack (TIA) to identify and treat risk factors that may lead to future stroke. The purpose of this study was to evaluate whether national imaging utilization for workup of TIA complies with society guidelines. METHODS: Analysis utilized the Nationwide Emergency Department Sample. Primary analysis was performed on a 2017 cohort, and secondary trend analysis was performed on cohorts from 2006 to2017. Patients diagnosed and discharged from emergency departments with TIA were identified using International Classification of Diseases, Ninth Revision and Tenth Revision codes. Brain and neurovascular imaging obtained during the encounter was identified using Current Procedural Terminology codes. Demographics, health insurance, patient income, and hospital-type covariates were analyzed using a hierarchical multivariable logistic regression analysis to identify predictors of obtaining neurovascular imaging during an emergency department encounter. RESULTS: In 2017, there were 167 999 patients evaluated and discharged from emergency departments with TIA. The percentage of patients receiving brain and neurovascular imaging was 78.5% and 43.2%, respectively. The most common imaging workup utilized was a solitary computed tomography-brain without any neurovascular imaging (30.9% of encounters). Decreased odds of obtaining neurovascular imaging was observed in Medicaid patients (odds ratio, 0.65 [95% CI, 0.58-0.74]), rural hospitals (odds ratio, 0.26 [95% CI, 0.17-0.41]), nontrauma centers (odds ratio, 0.40 [95% CI, 0.21-0.74]), and weekend encounters (odds ratio, 0.91 [95% CI, 0.85-0.96]). Trend analysis demonstrated a steady rise in brain and neurovascular imaging in 2006 from 34.9% and 6.8% of encounters, respectively, to 78.5% and 43.2% of encounters in 2017. CONCLUSIONS: Compliance with imaging guidelines is improving; however, the majority of TIA patients discharged from the emergency department do not receive recommended neurovascular imaging during their encounter. Follow-up studies are needed to determine whether delayed or incomplete vascular screening increases the risk of future stroke.


Assuntos
Serviço Hospitalar de Emergência/normas , Ataque Isquêmico Transitório/diagnóstico por imagem , Ataque Isquêmico Transitório/epidemiologia , Neuroimagem/normas , Guias de Prática Clínica como Assunto/normas , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Neuroimagem/métodos , Alta do Paciente/normas , Estados Unidos/epidemiologia
18.
Neurology ; 95(12): e1629-e1639, 2020 09 22.
Artigo em Inglês | MEDLINE | ID: mdl-32675077

RESUMO

OBJECTIVE: We implemented automated methods to analyze speech and evaluate the hypothesis that cognitive and motor factors impair prosody in partially distinct ways in patients with amyotrophic lateral sclerosis (ALS). METHODS: We recruited 213 participants, including 67 with ALS (44 with motor ALS, 23 with ALS and frontotemporal degeneration [FTD]), 33 healthy controls, and neurodegenerative reference groups with behavioral variant FTD (n = 90) and nonfluent/agrammatic primary progressive aphasia (n = 23). Digitized, semistructured speech samples obtained from picture descriptions were automatically segmented with a Speech Activity Detector; continuous speech segments were pitch-tracked; and duration measures for speech and silent pause segments were extracted. Acoustic measures were calculated, including fundamental frequency (f0) range, mean speech and pause segment durations, total speech duration, and pause rate (pause count per minute of speech). Group comparisons related performance on acoustic measures to clinical scales of cognitive and motor impairments and explored MRI cortical thinning in ALS and ALS-FTD. RESULTS: The f0 range was significantly impaired in ALS spectrum disorders and was related to bulbar motor disease, and regression analyses related this to cortical thickness in primary motor cortex and perisylvian regions. Impaired speech and pause duration measures were related to the degree of cognitive impairment in ALS spectrum disorders, and regressions related duration measures to bilateral frontal opercula and left anterior insula. CONCLUSION: Automated analyses of acoustic speech properties dissociate motor and cognitive components of speech deficits in ALS spectrum disorders.


Assuntos
Esclerose Amiotrófica Lateral/complicações , Encéfalo/diagnóstico por imagem , Distúrbios da Fala/diagnóstico por imagem , Medida da Produção da Fala/métodos , Idoso , Esclerose Amiotrófica Lateral/diagnóstico por imagem , Esclerose Amiotrófica Lateral/patologia , Encéfalo/patologia , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Neuroimagem/métodos , Distúrbios da Fala/etiologia , Distúrbios da Fala/patologia
19.
Neurology ; 95(12): e1694-e1705, 2020 09 22.
Artigo em Inglês | MEDLINE | ID: mdl-32675079

RESUMO

OBJECTIVE: Since the strongest risk factor for sudden unexpected death in epilepsy (SUDEP) is frequent bilateral tonic-clonic seizures (BTCS), our aim was to determine whether postictal hypoperfusion in brainstem respiratory centers (BRCs) is more common following tonic-clonic seizures. METHODS: We studied 21 patients with focal epilepsies who underwent perfusion imaging with arterial spin labeling MRI. Subtraction maps of cerebral blood flow were obtained from the postictal and baseline scans. We identified 6 regions of interest in the brainstem that contain key BRCs. Patients were considered to have postictal BRC hypoperfusion if any of the 6 regions of interest were significantly hypoperfused. RESULTS: All 6 patients who experienced BTCS during the study had significant clusters of postictal hypoperfusion in BRCs compared to 7 who had focal impaired awareness seizures (7/15). The association between seizure type studied and the presence of BRC hypoperfusion was significant. Duration of epilepsy and frequency of BTCS were not associated with postictal brainstem hypoperfusion despite also being associated with risk for SUDEP. CONCLUSION: Postictal hypoperfusion in brainstem respiratory centers occurs more often following BTCS than other seizure types, providing a possible explanation for the increased risk of SUDEP in patients who regularly experience BTCS.


Assuntos
Tronco Encefálico/irrigação sanguínea , Convulsões/complicações , Morte Súbita Inesperada na Epilepsia/etiologia , Adulto , Tronco Encefálico/diagnóstico por imagem , Circulação Cerebrovascular/fisiologia , Epilepsias Parciais/complicações , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Neuroimagem/métodos , Imagem de Perfusão/métodos , Fatores de Risco , Adulto Jovem
20.
Neurology ; 95(8): e943-e952, 2020 08 25.
Artigo em Inglês | MEDLINE | ID: mdl-32646955

RESUMO

OBJECTIVE: To evaluate progressive white matter (WM) degeneration in amyotrophic lateral sclerosis (ALS). METHODS: Sixty-six patients with ALS and 43 healthy controls were enrolled in a prospective, longitudinal, multicenter study in the Canadian ALS Neuroimaging Consortium (CALSNIC). Participants underwent a harmonized neuroimaging protocol across 4 centers that included diffusion tensor imaging (DTI) for assessment of WM integrity. Three visits were accompanied by clinical assessments of disability (ALS Functional Rating Scale-Revised [ALSFRS-R]) and upper motor neuron (UMN) function. Voxel-wise whole-brain and quantitative tract-wise DTI assessments were done at baseline and longitudinally. Correction for site variance incorporated data from healthy controls and from healthy volunteers who underwent the DTI protocol at each center. RESULTS: Patients with ALS had a mean progressive decline in fractional anisotropy (FA) of the corticospinal tract (CST) and frontal lobes. Tract-wise analysis revealed reduced FA in the CST, corticopontine/corticorubral tract, and corticostriatal tract. CST FA correlated with UMN function, and frontal lobe FA correlated with the ALSFRS-R score. A progressive decline in CST FA correlated with a decline in the ALSFRS-R score and worsening UMN signs. Patients with fast vs slow progression had a greater reduction in FA of the CST and upper frontal lobe. CONCLUSIONS: Progressive WM degeneration in ALS is most prominent in the CST and frontal lobes and, to a lesser degree, in the corticopontine/corticorubral tracts and corticostriatal pathways. With the use of a harmonized imaging protocol and incorporation of analytic methods to address site-related variances, this study is an important milestone toward developing DTI biomarkers for cerebral degeneration in ALS. CLINICALTRIALSGOV IDENTIFIER: NCT02405182.


Assuntos
Esclerose Amiotrófica Lateral/diagnóstico por imagem , Córtex Cerebral/diagnóstico por imagem , Tratos Piramidais/diagnóstico por imagem , Substância Branca/diagnóstico por imagem , Adulto , Idoso , Esclerose Amiotrófica Lateral/patologia , Córtex Cerebral/patologia , Imagem de Tensor de Difusão , Progressão da Doença , Feminino , Humanos , Interpretação de Imagem Assistida por Computador/métodos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Degeneração Neural/diagnóstico por imagem , Degeneração Neural/patologia , Neuroimagem/métodos , Estudos Prospectivos , Tratos Piramidais/patologia , Substância Branca/patologia
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