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2.
No Shinkei Geka ; 49(2): 294-300, 2021 Mar.
Artigo em Japonês | MEDLINE | ID: mdl-33762450

RESUMO

High-resolution magnetic resonance imaging has made it possible to examine the normal anatomy, variations, and diseases of the lateral ventricles more precisely. Better understanding of the anatomic variations and lesions of the ventricular system helps to prevent erroneous interpretation of normal variants or lesions without clinical significance. We review the anatomy and tumors of the lateral ventricles in this article.


Assuntos
Ventrículos Laterais , Imagem por Ressonância Magnética , Ventrículos Cerebrais/diagnóstico por imagem , Humanos , Ventrículos Laterais/diagnóstico por imagem
3.
No Shinkei Geka ; 49(2): 317-327, 2021 Mar.
Artigo em Japonês | MEDLINE | ID: mdl-33762452

RESUMO

Hydrocephalus is caused by excessive accumulation of cerebrospinal fluid(CSF)in the ventricles or the skull. Unlike acute hydrocephalus presenting with elevated intracranial pressure, chronic hydrocephalus is called normal-pressure hydrocephalus(NPH). Because the CSF volume increases slowly, the brain compressively deforms without increasing intracranial pressure. NPH should be diagnosed and treated according to the following three categories: idiopathic NPH(iNPH), secondary NPH(sNPH), and congenital NPH(cNPH). The intracranial CSF distribution in iNPH differed from that in sNPH or cNPH. In iNPH, the Sylvian fissure and basal cistern were conspicuously enlarged, whereas the convexity subarachnoid space was severely decreased. CSF distribution in the subarachnoid space specific to iNPH is known as "disproportionately enlarged subarachnoid space hydrocephalus(DESH)," which might be due to direct CSF communication between the lateral ventricles and the basal cistern at the inferior choroidal point of the choroidal fissure. After shunt surgery in a patient with NPH, the lateral ventricles and Sylvian fissure shrank from top to bottom, while the convexity subarachnoid space expanded. In NPH, except for obstructive hydrocephalus, the flow void sign on spin-echo T2-weighted images is usually observed around the aqueduct, which reflects the increased CSF movement.


Assuntos
Hidrocefalia de Pressão Normal , Hidrocefalia , Ventrículos Cerebrais/diagnóstico por imagem , Ventrículos Cerebrais/cirurgia , Derivações do Líquido Cefalorraquidiano , Humanos , Hidrocefalia/diagnóstico por imagem , Hidrocefalia/cirurgia , Hidrocefalia de Pressão Normal/diagnóstico por imagem , Hidrocefalia de Pressão Normal/cirurgia , Imagem por Ressonância Magnética , Proteínas de Membrana , Proteínas do Tecido Nervoso , Espaço Subaracnóideo/cirurgia
4.
Neurosciences (Riyadh) ; 26(1): 31-35, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33530041

RESUMO

OBJECTIVES: To determine the prevalence of shunt malfunction without change in ventricle size in imaging modalities, and its clinical presentation. METHODS: A cross-sectional study conducted at King Abdulaziz Medical City, Riyadh, from June 2015 to May 2019. Patient's demographics, clinical presentation and changes in ventricle size were collected. Statistical analysis was done using SPSS version 23. RESULTS: The study included 42 patients who underwent shunt revision. Imaging showed no change in size in 10 (24%) patients, mild enlargement in 8 (19%), and obvious enlargement in 24 (57%). The mean age of diagnosis was 22±16.7. 55% of the patients were males, 45% females. The cause of the malfunction was ventricular catheter occlusion in 14 (34%) patients, 10 (24%) patients had valve-related malfunction, and peritoneal catheter occlusion was present in 6 (14%) patients, and 12 (28%) patients had a combination of the previously mentioned causes. Analysis of the association between ventricular size and headache, vomiting, seizure, confusion, and loss of consciousness in patients with unchanged ventricular size and those with increased ventricular size has shown no statistical significance. CONCLUSION: Shunt malfunction without ventricular size change was observed in 24% of all shunt malfunction patients. In addition, there was no relationship between ventricular size and patient symptoms.


Assuntos
Ventrículos Cerebrais/cirurgia , Falha de Equipamento/estatística & dados numéricos , Hidrocefalia/cirurgia , Derivação Ventriculoperitoneal/efeitos adversos , Adolescente , Ventrículos Cerebrais/diagnóstico por imagem , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Hidrocefalia/diagnóstico por imagem , Lactente , Masculino , Estudos Retrospectivos , Arábia Saudita , Tomografia Computadorizada por Raios X , Adulto Jovem
5.
Neurosurgery ; 88(3): 698-706, 2021 02 16.
Artigo em Inglês | MEDLINE | ID: mdl-33313901

RESUMO

BACKGROUND: Posthemorrhagic hydrocephalus (PHH) is associated with neurological morbidity and complex neurosurgical care. Improved tools are needed to optimize treatments and to investigate the developmental sequelae of PHH. OBJECTIVE: To examine the relationship between diffusion magnetic resonance imaging (dMRI) and cerebrospinal fluid (CSF) biomarkers of PHH. METHODS: A total of 14 preterm (PT) infants with PHH and 46 controls were included. PT CSF was collected at temporizing surgery in PHH infants (PHH PT CSF) or lumbar puncture in controls. Term-equivalent age (TEA) CSF was acquired via implanted device or at permanent CSF diversion surgery in PHH (PHH-TEA-CSF) or lumbar puncture in controls. TEA dMRI scans were used to measure fractional anisotropy (FA) and mean diffusivity (MD) in the genu of corpus callosum (gCC), posterior limb of internal capsule (PLIC), and optic radiations (OPRA). Associations between dMRI measures and CSF amyloid precursor protein (APP), neural cell adhesion-1 (NCAM-1), and L1 cell adhesion molecule (L1CAM) were assessed using Pearson correlations. RESULTS: APP, NCAM-1, and L1CAM were elevated over controls in PHH-PT-CSF and PHH-TEA-CSF. dMRI FA and MD differed between control and PHH infants across all tracts. PHH-PT-CSF APP levels correlated with gCC and OPRA FA and PLIC MD, while L1CAM correlated with gCC and OPRA FA. In PHH-TEA-CSF, only L1CAM correlated with OPRA MD. CONCLUSION: Tract-specific associations were observed between dMRI and CSF biomarkers at the initiation of PHH treatment. dMRI and CSF biomarker analyses provide innovative complementary methods for examining PHH-related white matter injury and associated developmental sequelae.


Assuntos
Hemorragia Cerebral/líquido cefalorraquidiano , Hemorragia Cerebral/diagnóstico por imagem , Hidrocefalia/líquido cefalorraquidiano , Hidrocefalia/diagnóstico por imagem , Doenças do Prematuro/líquido cefalorraquidiano , Doenças do Prematuro/diagnóstico por imagem , Substância Branca/diagnóstico por imagem , Precursor de Proteína beta-Amiloide/líquido cefalorraquidiano , Biomarcadores/líquido cefalorraquidiano , Hemorragia Cerebral/complicações , Ventrículos Cerebrais/diagnóstico por imagem , Ventrículos Cerebrais/cirurgia , Derivações do Líquido Cefalorraquidiano , Imagem de Difusão por Ressonância Magnética/métodos , Feminino , Humanos , Hidrocefalia/etiologia , Hidrocefalia/cirurgia , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Molécula L1 de Adesão de Célula Nervosa/líquido cefalorraquidiano , Punção Espinal/métodos , Substância Branca/cirurgia
6.
J Stroke Cerebrovasc Dis ; 30(2): 105527, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33310072

RESUMO

We report herein a case of intraventricular silicone oil migration, a rare complication of intraocular silicone oil tamponade, mimicking a hemorrhage during antithrombotic therapy for ischemic stroke. A 62-year-old male patient with a history of diabetic retinopathy was admitted for right hemiparesis and dysarthria. Brain magnetic resonance imaging on admission showed an acute left-sided ventral medullary infarction, and antithrombotic therapy was started. Head computed tomography done on the next day after admission showed an area of high-density resembling a hematoma in the lateral ventricle. Additional magnetic resonance imaging in the supine and lateral recumbent positions confirmed migration of the lesion within the ventricles by position, indicating intraventricular silicone oil migration. Several facilities in Japan perform magnetic resonance imaging instead of computed tomography as the first step in assessing stroke in the emergency clinical setting. While the silicone oil used in internal tamponade appears high-density on computed tomography, it does not register as an abnormality on diffusion-weighted imaging, thus creating a pitfall to diagnosis based on this modality.


Assuntos
Hemorragia Cerebral/diagnóstico por imagem , Ventrículos Cerebrais/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética , Fibrinolíticos/administração & dosagem , Migração de Corpo Estranho/diagnóstico por imagem , Óleos de Silicone/efeitos adversos , Tomografia Computadorizada por Raios X , Hemorragia Cerebral/induzido quimicamente , Erros de Diagnóstico , Fibrinolíticos/efeitos adversos , Migração de Corpo Estranho/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Óleos de Silicone/administração & dosagem , Resultado do Tratamento
7.
Medicine (Baltimore) ; 99(38): e22305, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957391

RESUMO

RATIONALE: A developmental venous anomaly (DVA) is the most common intracranial congenital anomaly and is mostly asymptomatic. Thrombosis rarely develops in a DVA due to hypercoagulation. We report a case of ischemic stroke in the area of a DVA after minor head trauma in a patient with DVA and without a predisposition thrombosis. PATIENT CONCERNS: A healthy 17-year-old male was admitted to the emergency room due to left hemiparesis, which was caused by a ball hitting the right side of his head during a soccer game. DIAGNOSIS: Brain magnetic resonance (MR) susceptibility-weighted image showed several small veins draining to the central vein in the area from the right posterior putamen to the periventricular white matter. INTERVENTIONS: We diagnosed the patient with an ischemic stroke associated with a DVA and administered antiplatelet agents. The patient's autoantibodies (including antiphospholipid antibody) and factors of blood coagulation were normal. OUTCOMES: The left hemiparesis of the patient worsened by the second day of admission. Moreover, high signal intensity was observed in the DVA region of the diffusion weighted image of brain MR. The patient's symptoms gradually improved afterward, and left hemiparesis recovered fully 3 weeks after the onset. LESSONS: DVAs may predispose to ischemic stroke due to thrombosis and hypercoagulation, although it is rare. It is necessary to consider the possibility of ischemic stroke due to minor head trauma, even without factors causing hypercoagulation.


Assuntos
Concussão Encefálica/complicações , Acidente Vascular Cerebral/etiologia , Adolescente , Concussão Encefálica/diagnóstico por imagem , Ventrículos Cerebrais/diagnóstico por imagem , Ventrículos Cerebrais/patologia , Imagem de Difusão por Ressonância Magnética , Humanos , Angiografia por Ressonância Magnética , Masculino , Inibidores da Agregação de Plaquetas/uso terapêutico , Futebol/lesões , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/tratamento farmacológico
8.
Neurology ; 95(17): e2418-e2426, 2020 10 27.
Artigo em Inglês | MEDLINE | ID: mdl-32817185

RESUMO

OBJECTIVE: To test the hypothesis that in periventricular nodular heterotopia (PVNH) structure and function of cortical areas overlying the heterotopic gray matter are preferentially affected. METHODS: We studied a group of 40 patients with PVNH and normal-appearing cortex and compared their quantitative MRI markers of brain development, structure, and function to those of 43 age- and sex-matched healthy controls. Inspired by models of neocortical development suggesting that neuronal migration follows a curvilinear path to preserve topologic correspondence between the outer ventricular zone and the cortical surface, we computationally defined the overlying cortex using the Laplace equation and generated synthetic streamlines that link the ventricles, where nodules are located, and the neocortex. RESULTS: We found multilobar cortical thickening encompassing prefrontal, latero-basal temporal, and temporoparietal cortices largely corresponding with the PVNH group-averaged map of the overlying cortex, the latter colocalized with areas of abnormal function, as defined by resting-state fMRI. Patients also presented hippocampal functional hyperconnectivity and malrotation, the latter positively correlating with neocortical maldevelopment indexed by increased folding complexity of the parahippocampus. In clusters of thickness and curvature findings, there were no significant differences between unilateral and bilateral PVNH; contrasting brain-wide metrics between cohorts was also unrevealing. There was no relationship between imaging markers and disease duration except for positive correlation with functional anomalies. CONCLUSION: Our quantitative image analysis demonstrates widespread structural and functional alterations in PVNH with differential interaction with the overlying cortex and the hippocampus. Right hemispheric predominance may be explained by an early insult, likely genetically determined, on brain morphogenesis.


Assuntos
Encéfalo/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Heterotopia Nodular Periventricular/diagnóstico por imagem , Adulto , Mapeamento Encefálico , Córtex Cerebral/diagnóstico por imagem , Ventrículos Cerebrais/diagnóstico por imagem , Epilepsia Resistente a Medicamentos/complicações , Epilepsia Resistente a Medicamentos/diagnóstico por imagem , Eletroencefalografia , Lateralidade Funcional , Substância Cinzenta/diagnóstico por imagem , Hipocampo/diagnóstico por imagem , Humanos , Masculino , Modelos Neurológicos , Imagem Multimodal , Neocórtex/crescimento & desenvolvimento , Giro Para-Hipocampal/diagnóstico por imagem , Fenótipo , Adulto Jovem
9.
Rinsho Shinkeigaku ; 60(8): 543-548, 2020 Aug 07.
Artigo em Japonês | MEDLINE | ID: mdl-32641631

RESUMO

We describe an additional patient with spastic paraplegia 48 (SPG48). A 52-year-old woman with gradually increasing gait disturbance was admitted to our hospital. When she was 47 years old, acquaintances noted a shuffling gait. Gait worsening was evident at 48 years. Spastic gait was apparent at 50, and she required a walking stick at 54. Her elder brother had similar gait disturbance. No consanguinity was known. Neurologic examination at 52 disclosed spasticity and moderate weakness in the lower limbs. Spasticity and brisk reflexes in all limbs. Laboratory studies including HTLV-1 titer detected no abnormalities. MRI demonstrated mild corpus callosum narrowing and prominent anterior periventricular hyperintensities in fluid attenuation inversion recovery images. In limb muscles, electromyography (EMG) showed a chronic neurogenic pattern including reduced interference. Gene analysis identified compound homozygosity in exon 7 of adaptor-related protein complex 5 subunit zeta 1 (AP5Z1), including a novel frameshift mutation, c.1662_1672del;p.Glu554Hfs*15 in the patient, and a heterozygous missense mutation in asymptomatic family members, including her mother, two siblings, and a daughter. The frameshift mutation is considered a pathogenic variant according to American College of Medical Genetics and Genomics standards and guidelines. Based on clinical features, imaging findings and genetic abnormalities, we diagnosed this patient with SPG48. Mutations in AP5Z1, which encodes the ζ subunit of AP-5, underlie SPG48. The AP-5 adaptor protein complex, which is mutated in SPG48, binds to both spastizin and spatacsin. While hereditary spastic paraplegias generally are clinically and genetically heterogenous, SPG48, SPG11, and SPG15 are clinically similar.


Assuntos
Proteínas Adaptadoras de Transporte Vesicular/genética , Mutação da Fase de Leitura , Paraparesia Espástica/genética , Ventrículos Cerebrais/diagnóstico por imagem , Ventrículos Cerebrais/patologia , Corpo Caloso/diagnóstico por imagem , Corpo Caloso/patologia , Feminino , Transtornos Neurológicos da Marcha/etiologia , Genes Recessivos , Homozigoto , Humanos , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Paraparesia Espástica/complicações
10.
AJNR Am J Neuroradiol ; 41(7): 1187-1192, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32527841

RESUMO

BACKGROUND AND PURPOSE: Ventricular enlargement in idiopathic normal pressure hydrocephalus is often estimated using the Evans index. However, the sensitivity of the Evans index to estimate changes in ventricular size postoperatively has been questioned. Here, we evaluated the postoperative change in ventricle size in relation to shunt response in patients with idiopathic normal pressure hydrocephalus, by comparing ventricular volume and the Evans index. MATERIALS AND METHODS: Fifty-seven patients with idiopathic normal pressure hydrocephalus underwent high-resolution MR imaging preoperatively and 6 months after shunt insertion. Clinical symptoms of gait, balance, cognition, and continence were assessed according to the idiopathic normal pressure hydrocephalus scale. The ventricular volume of the lateral and third ventricles and the Evans index were measured using ITK-SNAP software. Semiautomatic volumetric analysis was performed, and postoperative changes in ventricular volume and the Evans index and their relationships to postoperative clinical improvement were compared. RESULTS: The median postoperative ventricular volume decrease was 25 mL (P < .001). The proportional decrease in ventricular volume was greater than that in the Evans index (P < .001). The postoperative decrease in ventricular volume was associated with a postoperative increase in the idiopathic normal pressure hydrocephalus scale score (P = .004). Shunt responders (75%) demonstrated a greater ventricular volume decrease than nonresponders (P = .002). CONCLUSIONS: Clinical improvement after shunt surgery in idiopathic normal pressure hydrocephalus is associated with a reduction of ventricular size. Ventricular volume is a more sensitive estimate than the Evans index and, therefore, constitutes a more precise method to evaluate change in ventricle size after shunt treatment in idiopathic normal pressure hydrocephalus.


Assuntos
Ventrículos Cerebrais/diagnóstico por imagem , Hidrocefalia de Pressão Normal/cirurgia , Neuroimagem/métodos , Resultado do Tratamento , Idoso , Idoso de 80 Anos ou mais , Derivações do Líquido Cefalorraquidiano , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
11.
Pediatrics ; 145(6)2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32381625

RESUMO

BACKGROUND: Intraventricular hemorrhage (IVH) disproportionately affects black neonates. Other conditions that are more common in black neonates, including low birth weight and preterm delivery, have been linked with residential racial segregation (RRS). In this study, we investigated the association between RRS and IVH. METHODS: A retrospective cohort of neonates born between 24 and 32 weeks' gestation was constructed by using birth certificates linked to medical records from California, Missouri, and Pennsylvania between 1995 and 2009. Dissimilarity, a measure of RRS indicating the proportion of minorities in the census tract of the mother in comparison to the larger metropolitan area, was linked to patient data, yielding a cohort of 70 775 infants. Propensity score analysis matched infants born to mothers living in high segregation to those living in less segregated areas on the basis of race, sociodemographic factors, and medical comorbidities to compare the risk of developing IVH. RESULTS: Infants born to mothers in the most segregated quartile had a greater risk of developing IVH compared with those in the lowest quartile (12.9% vs 10.4%; P < .001). In 17 918 pairs matched on propensity scores, the risk of developing IVH was greater in the group exposed to a segregated environment (risk ratio = 1.08, 95% confidence interval: 1.01-1.15). This effect was stronger for black infants alone (risk ratio = 1.16; 95% confidence interval: 1.03-1.30). CONCLUSIONS: RRS is associated with an increased risk of IVH in preterm neonates, but the effect size varies by race. This association persists after balancing for community factors and birth weight, representing a novel risk factor for IVH.


Assuntos
Grupo com Ancestrais do Continente Africano , Hemorragia Cerebral/epidemiologia , Doenças do Prematuro/epidemiologia , Recém-Nascido Prematuro/fisiologia , Segregação Social/tendências , Adulto , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/economia , Ventrículos Cerebrais/diagnóstico por imagem , Estudos de Coortes , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Doenças do Prematuro/diagnóstico por imagem , Doenças do Prematuro/economia , Masculino , Pontuação de Propensão , Estudos Retrospectivos , Estados Unidos/epidemiologia , Adulto Jovem
13.
J Clin Neurosci ; 76: 240-243, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32295747

RESUMO

Developmental venous anomaly (DVA) is the most common type of intracranial vascular malformation. These lesions are benign and are considered to be non-pathological variants of normal deep parenchymal veins. Although most of them are asymptomatic, a small subset of them located in aqueductal region have been reported to cause obstructive hydrocephalus. The authors present an interesting case of biventricular hydrocephalus secondary to a DVA located on the proximal aqueduct in an adolescent patient. This case is discussed with in corroboration with current literature and management recommendations.


Assuntos
Angioma Venoso do Sistema Nervoso Central/complicações , Ventrículos Cerebrais/patologia , Hidrocefalia/etiologia , Hidrocefalia/patologia , Adolescente , Aqueduto do Mesencéfalo/diagnóstico por imagem , Aqueduto do Mesencéfalo/patologia , Veias Cerebrais/diagnóstico por imagem , Veias Cerebrais/patologia , Ventrículos Cerebrais/diagnóstico por imagem , Feminino , Humanos , Hidrocefalia/diagnóstico por imagem
14.
Rev Neurol (Paris) ; 176(5): 393-396, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32169327

RESUMO

The mold of the human cerebral ventricles produced in 1918 by Walter E. Dandy had an experimental precedent, a wax cast of ox ventricles made four hundred years earlier (1508-9) by Leonardo da Vinci (1452-1519). This paper is an homage to the epitome of Renaissance and polymath Leonard da Vinci, as well as to Walter Edward Dandy (1886-1946) who developed the ventriculography (1918) and pneumoencephalography (1919) techniques. Pneumoencephalography was applied broadly up to the late 1970s, when it was replaced by less invasive and more accurate neuroimaging techniques.


Assuntos
Moldes Cirúrgicos , Ventrículos Cerebrais/anatomia & histologia , Ventrículos Cerebrais/diagnóstico por imagem , Neuroimagem/história , Ceras/química , Moldes Cirúrgicos/história , Pessoas Famosas , História do Século XVI , História do Século XX , Humanos , Medicina nas Artes/história , Ceras/história
15.
Int J Geriatr Psychiatry ; 35(7): 702-711, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32100326

RESUMO

OBJECTIVES: Geriatric depression is a special condition associated with a chronic course, treatment resistance and vascular processes. However, its neurobiology has not been fully elucidated. There is no study in geriatric depression evaluating deep brain structures with transcranial sonography (TCS) which is a low-cost, non-invasive and practical tool. The present study aimed to evaluate the changes in the echogenicity of brainstem raphe (BR), substantia nigra (SN) and ventricular diameters by TCS in association with cognitive dysfunctions in patients with geriatric depression. METHODS: Echogenicity of BR and SN were assessed and transverse diameters of the third ventricle and frontal horns of the lateral ventricles were measured by TCS in 34 patients with DSM-5 major depression and 31 healthy volunteers aged 60 and older. Cognitive functions were evaluated by using Mini Mental State Examination, Montreal Cognitive Assessment Tool, Clock Drawing Test and Subjective Memory Complaints Questionnaire. RESULTS: Although depressed patients had more subjective memory complaints than controls, they had similar cognitive performances. Reduced echogenicity (interrupted/invisible echogenic line) of BR was found to be significantly higher and the ventricular diameters were larger in the depressed group. There was no difference between the groups in terms of SN echogenicity. There was no correlation between ventricular diameters and depression severity or cognitive functions. CONCLUSIONS: Results of the present study are important in terms of pointing out neurobiological changes related to geriatric depression which are in parallel with the results of the studies in younger patients with depression. However, long-term follow-up studies are required for accurate differentiation of neurocognitive disorders.


Assuntos
Depressão , Ultrassonografia Doppler Transcraniana , Idoso , Tronco Encefálico , Ventrículos Cerebrais/diagnóstico por imagem , Humanos , Pessoa de Meia-Idade , Substância Negra/diagnóstico por imagem , Ultrassonografia
16.
Stroke ; 51(4): 1120-1127, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32078498

RESUMO

Background and Purpose- Definitions of significant hematoma expansion traditionally focus on changes in intraparenchymal volume. The presence of intraventricular hemorrhage (IVH) is a predictor of poor outcome, but current definitions of hematoma expansion do not include IVH expansion. We evaluated whether including IVH expansion to current definitions of hematoma expansion improves the ability to predict 90-day outcome. Methods- Using data from the PREDICT-ICH study (Predicting Hematoma Growth and Outcome in Intracerebral Hemorrhage Using Contrast Bolus CT), we compared a standard definition of hematoma expansion (≥6 mL or ≥33%) to revised definitions that includes new IVH development or expansion (≥6 mL or ≥33% or any IVH; ≥6 mL or ≥33% or IVH expansion ≥1 mL). The primary outcome was poor clinical outcome (modified Rankin Scale score, 4-6) at 90 days. Diagnostic accuracy measures were calculated for each definition, and C statistics for each definition were compared using nonparametric methods. Results- Of the 256 patients eligible for primary analysis, 127 (49.6%) had a modified Rankin Scale score of 4 to 6. Sensitivity and specificity for the standard definition (n=80) were 45.7% (95% CI, 36.8-54.7) and 82.9% (95% CI, 75.3-88.9), respectively. The revised definition, ≥6 mL or ≥33% or any IVH (n=113), possessed a sensitivity of 63.8% (95% CI, 54.8-72.1) and specificity of 75.2% (95% CI, 66.8-82.4). Overall accuracy was significantly improved with the revised definition (P=0.013) and after adjusting for relevant covariates, was associated with a 2.55-fold increased odds (95% CI, 1.31-4.94) of poor outcome at 90 days. A second revised definition, ≥6 mL or ≥33% or IVH expansion ≥1 mL, performed similarly (sensitivity, 56.7% [95% CI, 47.6-65.5]; specificity, 78.3% [95% CI, 40.2-85.1]; aOR, 2.40 [95% CI, 1.23-4.69]). Conclusions- In patients with mild-to-moderate ICH, including IVH expansion to the definition of hematoma expansion improves sensitivity with only minimal decreases to specificity and improves overall prediction of 90-day outcome.


Assuntos
Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/epidemiologia , Ventrículos Cerebrais/diagnóstico por imagem , Hematoma/diagnóstico por imagem , Hematoma/epidemiologia , Tomografia Computadorizada por Raios X/tendências , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos
18.
AJNR Am J Neuroradiol ; 41(1): 57-63, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31924603

RESUMO

BACKGROUND AND PURPOSE: Imaging evaluation of ventriculostomy tubes, despite the frequency of malfunction, has remained inadequate due to the absence of a systematic way of assessing the catheter itself. In this retrospective review, we assessed the utility of high-resolution 3D MR imaging techniques, including CISS and volumetric interpolated breath-hold examination sequences, in the evaluation of ventriculostomy catheters. MATERIALS AND METHODS: We performed a retrospective review of 23 clinical MR imaging cases of shunted hydrocephalus spanning a 3-year period, all depicting ventriculostomy catheters. The MR imaging examinations included isotropic CISS and volumetric interpolated breath-hold examination sequences performed with and without contrast. These were independently evaluated by 2 neuroradiologists with respect to the catheter course, side hole position, relationship of the side holes to the ventricles, patency, and the presence or absence of intraluminal debris. RESULTS: The catheter tip was best seen on isotropic CISS sequences reformatted in an oblique plane, and side holes were visualized as CSF signal defects along the catheter wall in 10/23 (43%) cases. The relationship of the catheter side holes to the ventricles was seen in 47% of cases and was best visualized on the coronal CISS sequences. Catheter patency was confirmed in 12/23 (52%) cases, while the other 48% were notable for T2 hypointense filling defects compatible with luminal obstruction. Enhancement of some of these filling defects on imaging is suggestive of choroid plexus ingrowth rather than debris. CONCLUSIONS: High-resolution 3D MR imaging using isotropic CISS sequences allows systematic evaluation of catheter positioning, patency, and potential etiologic differentiation of filling defects when shunt dysfunction is suspected.


Assuntos
Ventrículos Cerebrais/diagnóstico por imagem , Imageamento Tridimensional/métodos , Neuroimagem/métodos , Ventriculostomia/métodos , Adulto , Idoso , Cateteres/efeitos adversos , Falha de Equipamento , Feminino , Humanos , Hidrocefalia/diagnóstico por imagem , Hidrocefalia/cirurgia , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Ventriculostomia/efeitos adversos
19.
Clin Anat ; 33(3): 446-457, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31944414

RESUMO

Anatomic connections between the cerebral lateral and third ventricles have been mischaracterized since Monro's original erroneous description of his eponymous foramina (FoMs) as being only one T-shaped passage. Accurate knowledge of the in vivo three-dimensional (3D) configuration of FoM has important clinical neuroendoscopic, neurosurgical, and neuroimaging implications. We retrospectively analyzed volumetric high-resolution brain magnetic resonance imaging of 100 normal individuals to characterize the normal spatial anatomy and morphometry for each FoM. We measured the true anatomical 3D angulations of FoMs relative to standard neuroimaging orthogonal planes, and their minimum width, depth, and distance between the medial borders of bilateral FoMs. The right and left FoMs were separate, distinct, and in a V-shaped configuration. Each FoM was a round, oval, or crescent-shaped canal-like passage with well-defined borders formed by the semicircular concavity of the ipsilateral forniceal column. The plane of FoM was angled on average 56.8° ± 9.1° superiorly from the axial plane, 22.5° ± 10.7° laterally, and 37.0° ± 6.9° anteriorly from the midsagittal plane; all these angles changing significantly with increasing age. The mean narrowest diameter of FoM was 2.8 ± 1.2 mm, and its depth was 2.5 ± 0.2 mm. Thus, the true size and orientation of FoM differs from that depicted on standard neuroimaging. Notably, in young subjects, FoM has a diameter smaller than its depth, a configuration akin to a short, small canal. We propose that the eponym "Monro" no longer be associated with this structure, and the term "foramen" be abandoned. Instead, FoM should be more appropriately renamed as the "interventricular canaliculus," or IVC, for short.


Assuntos
Ventrículos Cerebrais/anatomia & histologia , Ventrículos Cerebrais/diagnóstico por imagem , Imagem por Ressonância Magnética , Terminologia como Assunto , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
20.
Neurology ; 94(5): e549-e556, 2020 02 04.
Artigo em Inglês | MEDLINE | ID: mdl-31748251

RESUMO

OBJECTIVE: To compare the clinical utility of volume-based ratios with the standard linear ratio of Evans index (EI) by examining their associations with gait, cognition, and other patient and imaging variables. METHODS: From MRI scans of 1,774 participants in the Mayo Clinic Study of Aging, we calculated 3 ventricle size measures: Evan index (frontal horn width divided by widest width of skull inner table), total ventricular volume, and frontal horn volume as ratios of total intracranial volume. Gait was measured by a timed 25-foot walk and cognition by a composite of psychometric tests. We also evaluated variables associated with the measures of ventricular size. Further, we evaluated gait and cognition associations with MRI of extraventricular findings seen in normal-pressure hydrocephalus: disproportionate enlargement of subarachnoid space (DESH) and focal sulcal dilations (FSD). RESULTS: Ventricular volume measures had stronger association with gait and cognition measures than EI. In decreasing order of strength of association with ventricle size were DESH, FSD, white matter hyperintensity volume ratio, age, male sex, cortical thickness, and education. Modest evidence was observed that FSD was associated with future decline in gait and cognition. CONCLUSION: Ventricular volume measures are clinically more useful than EI in indicating current and future gait and cognition. Multiple factors are associated with ventricle volume size, including FSD and DESH, suggesting that changes in CSF dynamics may go beyond simple ventriculomegaly.


Assuntos
Ventrículos Cerebrais/diagnóstico por imagem , Cognição/fisiologia , Marcha/fisiologia , Idoso , Idoso de 80 Anos ou mais , Apolipoproteína E4 , Córtex Cerebral/diagnóstico por imagem , Córtex Cerebral/patologia , Ventrículos Cerebrais/patologia , Escolaridade , Feminino , Humanos , Hidrocefalia de Pressão Normal/diagnóstico por imagem , Hidrocefalia de Pressão Normal/fisiopatologia , Imagem por Ressonância Magnética , Masculino , Tamanho do Órgão , Substância Branca/diagnóstico por imagem , Substância Branca/patologia
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