SARS-CoV-2's brain impact: revealing cortical and cerebellar differences via cluster analysis in COVID-19 recovered patients.

BACKGROUND: COVID-19 is a disease known for its neurological involvement. SARS-CoV-2 infection triggers neuroinflammation, which could significantly contribute to the development of long-term neurological symptoms and structural alterations in the gray matter. However, the existence of a consistent pattern of cerebral atrophy remains uncertain. OBJECTIVE: Our study aimed to identify patterns of brain involvement in recovered COVID-19 patients and explore potential relationships with clinical variables during hospitalization. METHODOLOGY: In this study, we included 39 recovered patients and 39 controls from a pre-pandemic database to ensure their non-exposure to the virus. We obtained clinical data of the patients during hospitalization, and 3 months later; in addition we obtained T1-weighted magnetic resonance images and performed standard screening cognitive tests. RESULTS: We identified two groups of recovered patients based on a cluster analysis of the significant cortical thickness differences between patients and controls. Group 1 displayed significant cortical thickness differences in specific cerebral regions, while Group 2 exhibited significant differences in the cerebellum, though neither group showed cognitive deterioration at the group level. Notably, Group 1 showed a tendency of higher D-dimer values during hospitalization compared to Group 2, prior to p-value correction. CONCLUSION: This data-driven division into two groups based on the brain structural differences, and the possible link to D-dimer values may provide insights into the underlying mechanisms of SARS-COV-2 neurological disruption and its impact on the brain during and after recovery from the disease.

Mapping the Cerebellar Cognitive Affective Syndrome in Patients with Chronic Cerebellar Strokes.

The cerebellar cognitive affective syndrome (CCAS) has been consistently described in patients with acute/subacute cerebellar injuries. However, studies with chronic patients have had controversial findings that have not been explored with new cerebellar-target tests, such as the CCAS scale (CCAS-S). The objective of this research is to prove and contrast the usefulness of the CCAS-S and the Montreal Cognitive Assessment (MoCA) test to evaluate cognitive/affective impairments in patients with chronic acquired cerebellar lesions, and to map the cerebellar areas whose lesions correlated with dysfunctions in these tests. CCAS-S and MoCA were administrated to 22 patients with isolated chronic cerebellar strokes and a matched comparison group. The neural bases underpinning both tests were explored with multivariate lesion-symptom mapping (LSM) methods. MoCA and CCAS-S had an adequate test performance with efficient discrimination between patients and healthy volunteers. However, only impairments determined by the CCAS-S resulted in significant regional localization within the cerebellum. Specifically, patients with chronic cerebellar lesions in right-lateralized posterolateral regions manifested cognitive impairments inherent to CCAS. These findings concurred with the anterior-sensorimotor/posterior-cognitive dichotomy in the human cerebellum and revealed clinically intra- and cross-lobular significant regions (portions of right lobule VI, VII, Crus I-II) for verbal tasks that overlap with the "language" functional boundaries in the cerebellum. Our findings prove the usefulness of MoCA and CCAS-S to reveal cognitive impairments in patients with chronic acquired cerebellar lesions. This study extends the understanding of long-term CCAS and introduces multivariate LSM methods to identify clinically intra- and cross-lobular significant regions underpinning chronic CCAS.

White Matter Abnormalities in Late Onset First Episode Mania: A Diffusion Tensor Imaging Study.

INTRODUCTION: A first manic episode after 50 years of age is uncommon. Late Onset Mania might be indicative of abnormalities in white matter, probably related to vascular, degenerative, or inflammatory processes. OBJECTIVE: To determine if patients with late onset mania have reduced white matter integrity according to Magnetic Resonance Diffusion Tensor Imaging (DTI) and structural MRI. METHODS: Twenty-two patients with late onset mania (>50 years old) and 22 age-paired healthy subjects were included in the study. Fractional anisotropy (FA) was used as a quantitative measure of white matter integrity. Fazekas scale was assessed also to measure white matter abnormalities in the FLAIR sequence. The Frontal Assessment Battery, COGNISTAT and Trail making test A and B were used as cognitive measurements. RESULTS: According to DTI, commissural connections (left corpus callosum), and limbic connections (right and left uncinate fasciculus) were different between the patients and the comparison group. Fractional anisotropy values in the left corpus callosum showed significant correlations with neuropsychological measures, and with the Fazekas scale score. According to Fazekas scale, a pathological score in the FLAIR sequence was significantly more frequent in the patients as compared to the comparison group. CONCLUSIONS: Patients with first episode mania in late life have relevant white matter abnormalities not explained by age, affecting interhemispheric and fronto-limbic networks probably related to executive functioning and emotional processing, at the level of the corpus callosum and the uncinate fasciculus. The etiology of this white matter loss of integrity in patients with late-onset mania is yet to be explored.

Is the Hypointensity in Motor Cortex the Hallmark of Amyotrophic Lateral Sclerosis?

BACKGROUND: Amyotrophic lateral sclerosis (ALS) is a devastating disease that targets motor neurons. Upper motor neurons degeneration is pathologically characterized by brain iron accumulation. Signal attenuation in the shape of a ribbon at the posterior border of the precentral gyrus can be observed on conventional magnetic resonance imaging (MRI) sequences including T2-weighted sequence. METHODS: With the aim to know the qualities of this potential marker of ALS, we conducted a prospective study. Patients with definite ALS in the age range of 40-70 years and healthy controls underwent 3T brain MRI using a standardized sequence. A second MRI was performed 18 months later under the same conditions in the patients with ALS. RESULTS: Most of the patients with ALS (91.66%) exhibited a "black ribbon" (BR) with an average area of 79.98 mm3. Signal attenuation discriminated ALS with a mean value of 63.97 arbitrary units (AU) on the left BR (95% CI: 60.67-67.27), a mean value of 59.15 AU (95% CI: 54.78-63.53) on the right BR, and a significant difference with control subjects presenting a mean value of 107.85 AU (p < 0.001). The optimal cut-off point for differentiating patients with ALS from controls (sensitivity, 0.92; specificity, 0.93) was 83 AU. Forced vital capacity and muscle strength in the contralateral upper extremity were significantly correlated with the ribbon intensity in ALS. Patients who underwent a second study exhibited significant changes in the BR related to the rapid evolution of the disease. CONCLUSIONS: This marker represents a valuable tool for the selection of candidates and their follow-up in clinical trials.

Fractal anatomy of the hippocampal formation.

PURPOSE: We believed that the hippocampal complex is a fractal, and we try to demonstrate it. METHODS: We selected 12 magnetic resonance (MR) studies from healthy brains. Five women and 7 men without neurological or psychiatric disease were analyzed. The age range was 50-71 years old, with a mean 57.1 ± 7.6 years. Image series of MR were obtained through 3D SPGR in scanner GE Singa 3.0 T (general Electric, USA), matrix acquisition 512 Å-512 Å-120, field size 240 mm, voxel size 0.47 mm Å-0.47 mm Å-1.2 mm, repetition time of 13 ms and eco time of 5.6 ms. The MRI were imported in DICOM format in the OsiriXsoftware where they were contoured. Post processing was done with ImageJ software; Box Counting method for fractal analysis and we also used the Box Counting method of the BoneJ plugin. RESULTS: All of the hippocampus analyzed were a fractal. The fractal dimension analysis distribution of the measurements had a central tendency. The mean of hippocampal fractal dimension was 1.32635, the range was from 1.3373 to 1.5344. We found a short interval of variability in the hippocampal fractal number. CONCLUSIONS: The hippocampal complex is a fractal. The fractal analysis must be an objective measurement that can help us as a descriptive tool in hippocampal anatomy and maybe in a close future in the diagnosis of anatomical alterations.

The painter from Sinaloa: artistic analysis of a case of spatial agnosia and neglect of visual shapes.

Paintings produced spontaneously by patients with neurological lesions represent a fascinating opportunity to analyze some aspects of the underlying disease and involved brain mechanisms. Many cases of artists who have suffered spatial neglect following a neurological disease have been reported in the literature. However, only a few studies evaluating the different subtypes of graphic neglect and aspects related to the construction of perspective (three dimensionality) in works of art have been published. In the present article, we present the case of an artist who, after resection of a central neurocytoma that affected the right thalamo-parietal connections, suffered an impairment of the ability to create perspective in his paintings and involuntary omission of only shapes in the left side of his paintings, although colors and contours were preserved.

[White matter hyperintensities and cognitive function in patients with late onset mania]. / Lesiones hiperintensas de la sustancia blanca y función cognoscitiva en pacientes con manía de inicio tardío.

Bipolar disorder is characterized by affective episodes in the mania-depression spectrum. Ninety per cent of the cases have an onset before age 50. In the patients with late onset mania, white matter hyperintensities (WMH) may be seen in the MRI FLAIR sequence, although these are of uncertain significance. A case-control study was done, including patients with late onset mania attended at the National Institute of Neurology and Neurosurgery, as well as healthy controls which were paired by age, sex, and academic level. Sagital FLAIR CUBE volumetric images were obtained, and later on assessed by an expert neuroradiologist, blinded to the diagnostic category. Neuropsychological measures were obtained. The patients with late onset mania showed statistically significant deficiencies (p < 0.05) in motor programming tasks, and inhibitory control tasks, according to the Frontal Assessment Battery, as well as a significant increase in the number of WMH in the right third frontal gyrus, the left first temporal gyrus, and the left second temporal gyrus. The total number of WMH and the Frontal Assessment Battery total score showed a significant inverse correlation.

In vivo study of cerebral white matter in the dog using diffusion tensor tractography.

Conventional magnetic resonance imaging (MRI) allows investigators and clinicians to observe the anatomy and injuries of the cerebral white matter (CWM) in dogs. However, dynamic images based on the diffusion tensor (DT) technique are required to assess fiber tract integrity of the CWM. Diffusion tensor tractography (DTT) produces a three-dimensional representation in which data are displayed on a colored map obtained from the anisotropy of water molecules in the CWM tracts. Fractional anisotropy (FA) is a value that measures changes in water diffusion, which can occur if the CWM tracts are displaced, disrupted, or infiltrated. The goal of this study was to determine the feasibility of DTT for in vivo examination of the normal appearance of CWM in dogs through visual and quantitative analysis of the most representative CWM tracts. Nine tractographies were performed on healthy dogs using a 3T MRI scanner. T1- and T2-weighted images and DTI were acquired at different planes. Using DTT, three-dimensional reconstructions were obtained. Fractional ansisotropy and apparent diffusion coefficient (ADC) values of the right and left corticospinal tracts, corpus callosum, cingulum, and right and left fronto-occipital fasciculus were determined. Tract reconstructions were similar in 8/9 healthy dogs. Values for FA and ADC were similar in all the dogs. In one dog, tract reconstructions were inhomogeneous; these were displaced because it had larger lateral ventricles. Findings indicated that DTT is a feasible technique for in vivo study of CWM in dogs and that it complements information from conventional MRI.

Assessment of visuospatial functions in post-Covid 19 patients: Beyond the traditional paradigm.

Several studies indicate that some cognitive changes occur after COVID-19. Visuospatial alterations have been reported in 24-40 %. These alterations may be useful as early biomarkers of neurodegenerative disease. Thus, we can emphasize the importance of visuospatial processes in cognition through quantitative and qualitative analysis of performance on the Clock Test (CDT) and the Rey-Osterrieth Complex Figure (FCRO). Our objective was to describe the performance of post COVID 19 patients in visuospatial tests, with different degrees of respiratory impairment and to perform a qualitative analysis of the performance to check its relationship with alterations in attention and executive functions. This will allow highlighting the executive component of the performance of the CDT and ROCF and differentiate patients with possible cognitive impairment. 77 patients with SARS-CoV-2 infection were evaluated (3 months post-infection) with a complete neuropsychological battery and MRI. Overall, there is a significant difference between FCRO and CDT, with FCRO having only 9 % change and CDT having 51.9 % change. Regarding the correlations observed between groups (VM Inv, VM non I and non hospitalized) the highest correlations were observed between Boston with FCRO copy (r=0.497; p=0.001) and with FCRO memory (r=0.429; p=0.001). Comparing the performance between groups by severity, significant differences were observed only in the TMT A (13.706 p=0.001) and B (9.583 p=0.008) tests and in the phonological fluency letter A (13.445 p=0.001), we observed that the group of non-hospitalized patients had a better performance. Neuropsychological deficits often have a direct impact on daily life by affecting the ability to learn and adapt. Thus, a useful strategy for the neuropsychological characterization of post-COVID-19 patients is the qualitative analysis of visuospatial abilities in conjunction with executive functions that cannot be analyzed in isolation.

Brain MRI volumetric changes in the follow-up of patients with anti-NMDAr encephalitis.

INTRODUCTION: Autoimmune anti-NMDAr encephalitis is an antibody-mediated disorder characterized by psychiatric symptoms followed by decreased consciousness, dysautonomia and seizures. The pathophysiology of the disease is related to the internalization of NR1 subtype NMDA receptors and the dysfunction of structures where they are abundant (frontotemporal and insular regions). Some reports suggest the existence of cerebral atrophy in the follow-up of these patients, with conflicting evidence regarding its presence and usefulness as a marker of prognosis. METHODS: In a longitudinal, observational study, all patients with the diagnosis of definite anti-NMDAr autoimmune encephalitis with initial and control MRI studies were included. Conventional MR Brain acquisition was performed using a 3-Tesla Skyra MRI System. Automated brain segmental analysis was performed using the Volbrain volumetry system. The differences between baseline MRI volumetric characteristics and volumetric measures at follow-up was assessed. RESULTS: 25 patients were included (mean age 26.6, SD 9.6). 44% were females. The mean time between the studies was 24 (SD 21.4, 3-24) months. Significant volume loss was identified in the total brain volume (- 0.02%, p = 0.029), cerebellar volume (- 0.27%, p = 0.048) and brainstem volume (- 0.16%, p = 0.021). CONCLUSIONS: This study supports previous observations regarding volume loss in several brain regions of patients with antiNMDAr encephalitis. Further analyses are required to understand the role of treatment and severe clinical forms, as well as the relationship between volume loss and functional outcome.

Anosognosia in Amnestic Mild Cognitive Impairment Is Related to Diminished Hippocampal Volume Comparable to Alzheimer's Disease Dementia: Preliminary MRI Findings.

Although the presence of anosognosia in amnestic mild cognitive impairment (aMCI) may be predictive of conversion to Alzheimer's disease (AD), little is known about its neural correlates in AD and aMCI. Four different groups were compared using volumetric and diffusion magnetic resonance imaging metrics in regions of interest (hippocampus and cingulum cortex gray matter, cingulum bundle white matter): aMCI subjects with anosognosia (n = 6), aMCI subjects without anosognosia (n = 12), AD subjects with anosognosia (n = 6), and AD subjects without anosognosia (n = 9). aMCI subjects with anosognosia displayed a significantly lower gray matter density (GMD) in the bilateral hippocampus than aMCI subjects without anosognosia, which was accounted for by bilateral hippocampal differences. Furthermore, we identified that the mean hippocampal gray matter density of aMCI subjects with anosognosia was not statistically different than that of AD subjects. The groups of aMCI and AD subjects with anosognosia also displayed a lower GMD in the bilateral cingulum cortex compared to subjects without anosognosia, but these differences were not statistically significant. No statistically significant differences were found in the fractional anisotropy or mean diffusivity of the hippocampus or cingulum between subjects with and without anosognosia in aMCI or AD groups. While these findings are derived from a small population of subjects and are in need of replication, they suggest that anosognosia in aMCI might be a useful clinical marker to suspect brain changes associated with AD neuropathology.

Prediction of Mechanical Properties and Subjective Consistency of Meningiomas Using T1-T2 Assessment Versus Fractional Anisotropy.

OBJECTIVE: This study aims to evaluate quantitatively the mechanical properties of meningiomas and their correlation with the qualitative surgeon's assessment of consistency, as well as comparing the capability to predict tumor consistency of fractional anisotropy values calculated from the diffusion tensor imaging and T1/T2 signal intensities. METHODS: Sixteen patients with the diagnosis of intracranial meningioma were included. Fractional anisotropy values were calculated and T1/T2 assessment was performed. The qualitative assessment of the tumor consistency intraoperatively was determined by a neurosurgeon and quantitative assessment was obtained with the Warner-Bratzler mechanical test. RESULTS: Surgeon's qualitative assessment was concordant with the cutting force obtained from the mechanical tests (P = 0.046). There was a high correlation between tumor consistency reported by the surgeon and T1/T2 assessment (0.622/P = 0.01) and a moderate correlation with cutting force (0.532/P = 0.034) and elasticity (0.49/P = 0.05). Fractional anisotropy values for hard tumors were not significantly higher than for soft tumors (P = 0.115). There was no significant correlation between the fractional anisotropy and mechanical measurements (0.192/P = 0.3). Predictions of hard consistency in meningiomas were obtained with a sensitivity of 25% and a specificity of 100% when using the T1/T2 assessment and a sensitivity of 87.5% and a specificity of 50% when using the fractional anisotropy value. CONCLUSIONS: Qualitative surgeon's assessment was in accordance with measured mechanical properties. Fractional anisotropy value was not an independent predictor for tumor consistency and was not correlated with the mechanical tests results. T1/T2 assessment was correlated with mechanical properties and it can be used to discriminate very hard or soft tumors.