RESUMO
AIMS: To examine how fasting glucose and glucose tolerance are related to magnetic resonance imaging-assessed indicators of subclinical cerebrovascular disease and brain atrophy and their variation according to age, sex and education. METHODS: Participants in the present study were 172 healthy, community-dwelling older adults. An oral glucose tolerance test was administered and magnetic resonance imaging performed. Fasting, 2-h, and 2-h area-under-the-curve glucose levels, their associations with subclinical cerebrovascular disease and brain atrophy, and their respective interactions with age, sex and education were examined. RESULTS: A positive association between fasting glucose and subclinical cerebrovascular disease (but not brain atrophy) emerged; this association was more pronounced for participants with < 12 years of education; however, glucose tolerance was not related to subclinical cerebrovascular disease or brain atrophy. CONCLUSIONS: Findings revealed a potential link between fasting glucose levels and the presence of subclinical cerebrovascular disease indicators - white matter hyperintensities and silent brain infarction - in older adults without diabetes and with an education level below high school. Additional research is needed to confirm these associations and to determine the need for interventions aimed at closely monitoring and preventing elevated glucose levels in this population to reduce the prevalence of subclinical cerebrovascular disease.
Assuntos
Glicemia/metabolismo , Encéfalo/patologia , Transtornos Cerebrovasculares/patologia , Diabetes Mellitus Tipo 2/patologia , Angiopatias Diabéticas/patologia , Nefropatias Diabéticas/patologia , Idoso , Idoso de 80 Anos ou mais , Atrofia/sangue , Atrofia/patologia , Transtornos Cerebrovasculares/sangue , Estudos Transversais , Diabetes Mellitus Tipo 2/sangue , Angiopatias Diabéticas/sangue , Nefropatias Diabéticas/sangue , Jejum/sangue , Feminino , Teste de Tolerância a Glucose , Voluntários Saudáveis , Humanos , Angiografia por Ressonância Magnética , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-IdadeRESUMO
We describe a 68-year-old man with invasive transitional cell carcinoma of the bladder metastatic to the dura who presented with complex partial status epilepticus (CPSE). To our knowledge, the association of CPSE and dural metastases has not been previously reported.
Assuntos
Carcinoma de Células de Transição/secundário , Dura-Máter/patologia , Epilepsia Parcial Complexa/etiologia , Neoplasias Meníngeas/secundário , Estado Epiléptico/etiologia , Idoso , Encéfalo/fisiopatologia , Carcinoma de Células de Transição/complicações , Eletroencefalografia , Epilepsia Parcial Complexa/fisiopatologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Neoplasias Meníngeas/complicações , Estado Epiléptico/fisiopatologia , Neoplasias da Bexiga Urinária/patologiaRESUMO
This is the first report of cranial positron emission tomography findings of an infant in a persistent vegetative state. Serial positron emission tomography/2-deoxy-2[18F]fluoro-D-glucose studies demonstrated persistent global reduction of cerebral glucose metabolism, results similar to those found in adults in persistent vegetative states. Positron emission tomography may be useful in confirming this clinical diagnosis in infants.
Assuntos
Glicemia/metabolismo , Dano Encefálico Crônico/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Coma/diagnóstico por imagem , Hipóxia Encefálica/diagnóstico por imagem , Afogamento Iminente/diagnóstico por imagem , Tomografia Computadorizada de Emissão , Desoxiglucose/análogos & derivados , Desoxiglucose/metabolismo , Fluordesoxiglucose F18 , Humanos , Lactente , Masculino , Exame Neurológico , RessuscitaçãoRESUMO
We report a kindred with cerebral arteriovenous malformations in three generations, suggesting autosomal dominant inheritance in this family. Screening asymptomatic persons with a family history for cerebral arteriovenous malformations is discussed.
Assuntos
Malformações Arteriovenosas Intracranianas/genética , Adulto , Angiografia Cerebral , Criança , Aberrações Cromossômicas/genética , Transtornos Cromossômicos , Feminino , Lobo Frontal/irrigação sanguínea , Genes Dominantes/genética , Testes Genéticos , Humanos , Malformações Arteriovenosas Intracranianas/diagnóstico , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Linhagem , GravidezRESUMO
A vacuum facet phenomenon, seen on computed tomography as a lens-shaped lucency within a lumbar facet joint, was observed as a consequence of degenerative spondylolisthesis. The significance of this finding is discussed.
Assuntos
Espondilolistese/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Feminino , Humanos , Pessoa de Meia-Idade , Espondilolistese/patologiaRESUMO
The extremely poor prognosis of high-grade brain tumors (glioblastoma multiforme and anaplastic astrocytomas) has been well documented in the literature. Almost 90% of patients die within 18 months after therapy, most commonly because of local persistence of the tumor, which may be controlled if a sufficient amount of irradiation can be delivered. Currently, postoperative radiation therapy offers the best median survival rate. However, the response to external-beam radiation therapy has reached a plateau because of the intolerance of healthy brain tissue to excessive irradiation. To treat these tumors, brachytherapy (interstitial implantation of radioactive sources) can be used with debulking surgery. This therapy is becoming an effective alternative to conventional external-beam radiation therapy, since it allows a higher dose to be delivered to the tumor bed without damaging the surrounding healthy brain tissue. With continual refinements of the technique, brachytherapy, performed by a skilled brachytherapy team, offers an opportunity to improve patient survival.
Assuntos
Astrocitoma/radioterapia , Braquiterapia/métodos , Neoplasias Encefálicas/radioterapia , Glioblastoma/radioterapia , Astrocitoma/mortalidade , Neoplasias Encefálicas/mortalidade , Glioblastoma/mortalidade , Humanos , Dosagem Radioterapêutica , Técnicas Estereotáxicas/instrumentaçãoRESUMO
Blunt trauma involving the innominate and carotid arteries is a rare occurrence that can be lethal or have serious neurologic sequelae. To our knowledge this is the first reported case in the international literature describing the association of posttraumatic innominate artery aneurysm with total occlusion and thrombosis of the common carotid artery at its origin by an intimal flap. The diagnostic problems created by this unusual injury are discussed. In this case the patency of the distal portion of the common and internal carotid arteries was demonstrated by magnetic resonance angiography (MRA), whereas color duplex and digital arteriographic studies were unsuccessful. This demonstration was crucial to patient management. Since no studies are available comparing color duplex imaging, conventional arteriography, and MRA in the evaluation of blunt carotid trauma, this case study is presented to demonstrate the utility of MRA in emergency situations. In addition, we analyze the possible pathogenesis and discuss the surgical treatment.
Assuntos
Aneurisma/etiologia , Arteriopatias Oclusivas/etiologia , Tronco Braquiocefálico/lesões , Doenças das Artérias Carótidas/etiologia , Lesões das Artérias Carótidas , Trombose das Artérias Carótidas/etiologia , Traumatismos Torácicos/complicações , Ferimentos não Penetrantes/complicações , Adolescente , Aneurisma/patologia , Tronco Braquiocefálico/patologia , Artéria Carótida Primitiva/patologia , Artéria Carótida Interna/patologia , Circulação Colateral , Humanos , Imageamento por Ressonância Magnética , Masculino , Túnica Íntima/lesões , Túnica Íntima/patologiaRESUMO
We examined the effect of the neuroprotective and neuroreparative agent citicoline on the growth of cerebral ischemic lesions in a double-blind placebo-controlled study involving patients with acute ischemic stroke using diffusion-weighted magnetic resonance imaging (DWI). Patients with acute ischemic stroke symptom onset 24 hours or less before the start of treatment, National Institutes of Health Stroke Scale (NIHSS) scores of 5 or higher, and lesions of 1 to 120 cc in cerebral gray matter by DWI were enrolled. DWI, T2-weighted magnetic resonance imaging (MRI), perfusion-weighted MRI, and magnetic resonance angiography were obtained at baseline, week 1, and week 12. Citicoline (500 mg/day) was administered orally for 6 weeks, and patients were followed for 12 weeks. The primary assessment was progression of ischemic lesion volume from baseline to 12 weeks as measured by MRI. A total of 100 patients entered the study. The primary MRI analysis included 40 placebo-treated patients and 41 citicoline-treated patients with both baseline and week 12 MRI data and failed to demonstrate a significant difference in lesion volume change from baseline to week 12. From baseline to week 12, ischemic lesion volume [all values mean (SE)] expanded by 180% (107) among placebo-treated patients compared with 34% (19) among citicoline-treated patients. In a secondary analysis, lesion volume decreased from week 1 to week 12 by 6.9 cc (2.8) on placebo versus 17.2 cc (2.6) on citicoline. Baseline variables that were predictors of change in lesion size over 12 weeks were the volume of hypoperfusion (strongest association), baseline NIHSS score, lesion volume on DWI, arterial lesion by magnetic resonance angiography, and categorized elapsed time (< or =12 or >12 hours) from stroke onset to first dose. A marked association between lesion volume reduction and improvement of NIHSS score by seven or more points was observed. Significant correlations between lesion volumes and clinical measures were found, replicating values reported in the literature for smaller case series. We observed a reduction in lesion volume growth from baseline to week 12 with citicoline treatment, with a significantly greater reduction in volume from week 1 to week 12 with citicoline. We found a significant inverse relationship between lesion volume change over 12 weeks as measured by MRI and clinical outcome for ischemic stroke. This relationship supports the role of DWI as a surrogate marker of clinically meaningful lesion progression in stroke clinical trials. The hypothesis that citicoline reduces lesion growth and improves clinical outcome will be tested further.
Assuntos
Isquemia Encefálica/tratamento farmacológico , Isquemia Encefálica/patologia , Encéfalo/efeitos dos fármacos , Encéfalo/patologia , Citidina Difosfato Colina/uso terapêutico , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/patologia , Idoso , Isquemia Encefálica/fisiopatologia , Método Duplo-Cego , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Prognóstico , Acidente Vascular Cerebral/fisiopatologiaRESUMO
The Doppler RI, measured in a blinded fashion, was correlated with RBF, RVR, and GFR calculated by simultaneous clearance measurements. Nine hypertensive patients were studied weekly while receiving increasing doses of the vasodilator minoxidil. In 36 studies, RI was significantly correlated with RBF (r = -0.42) but not with RVR or GFR. When RI values were adjusted for ERV, correlations strikingly improved and were further improved by adjustment for pulse pressure. The ARI allowed semiquantitative predictions of RBF and RVR more accurately than blood urea nitrogen or serum creatinine levels. Correlation with GFR was weak.
Assuntos
Hipertensão/fisiopatologia , Circulação Renal/fisiologia , Resistência Vascular/fisiologia , Adulto , Idoso , Velocidade do Fluxo Sanguíneo , Pressão Sanguínea , Humanos , Hipertensão/tratamento farmacológico , Rim/diagnóstico por imagem , Rim/fisiopatologia , Pessoa de Meia-Idade , Minoxidil/uso terapêutico , Ultrassonografia/métodos , UrodinâmicaRESUMO
OBJECTIVE: This retrospective study describes the phenotype associated with the single most common cause of genetic hearing loss. The frequency of childhood deafness is estimated at 1/500. Half of this hearing loss is genetic and approximately 80% of genetic hearing loss is nonsyndromic and inherited in an autosomal recessive manner. Approximately 50% of childhood nonsyndromic recessive hearing loss is caused by mutations in the connexin 26 (Cx26) gene (GJB2/DFNB1), making it the most common form of autosomal recessive nonsyndromic hearing loss with a carrier rate estimated to be as high as 2.8%. One mutation, 35delG, accounts for approximately 75% to 80% of mutations at this gene. METHODS: Hearing loss was examined in 46 individuals from 24 families who were either homozygous or compound heterozygous for Cx26 mutations. A subset of these individuals were examined for vestibular function, otoacoustic emissions, auditory brainstem response, temporal bone computed tomography, electrocardiography, urinalyses, dysmorphology, and thyroid function. RESULTS: Although all persons had hearing impairment, no consistent audiologic phenotype was observed. Hearing loss varied from mild-moderate to profound, even within the group of families homozygous for the common mutation 35delG, suggesting that other factors modify the phenotypic effects of mutations in Cx26. Furthermore, the hearing loss was observed to be progressive in a number of cases. No associations with inner ear abnormality, thyroid dysfunction, heart conduction defect, urinalyses, dysmorphic features, or retinal abnormality were noted. CONCLUSION: Newborns with confirmed hearing loss should have Cx26 testing. Cx26 testing will help define a group in which approximately 60% will have profound or severe-profound hearing loss and require aggressive language intervention (many of these patients will be candidates for cochlear implants).