Modified Visual Magnetic Resonance Rating Scale for Evaluation of Patients with Forgetfulness.

BACKGROUND: As cognitive impairment increases with age, sulcal atrophy (SA) and the enlargement of the ventricles also increase. Considering the measurements on the previously proposed visual scales, a new scale is proposed in this study that allows us to evaluate the atrophy, white matter hyperintensities (WMHs), basal ganglia infarct (BGI), and infratentorial infarct (ITI) together. Our aim of this study is to propose a practical and standardized MRI for the clinicians to be used in daily practice. METHODS: A total of 97 patients older than 60 years and diagnosed with depression or Alzheimer's disease (AD) are included. Cranial MRI, Mini Mental State Examination (MMSE), detailed neuropsychometric tests, and depression scales are applied to all patients. The SA, ventricular atrophy (VA), medial temporal lobe atrophy (MTA), periventricular WMH (PWMH), subcortical WMH (SCWMH), BGI, and ITI are scored according to the scale. The total score is also recorded. RESULTS: The average age of the patients was 74.53, and the mean MMSE score was 22.7 in the degenerative group and 27.8 in the non-degenerative group. Among the patients, 50 were diagnosed with AD. All parameters significantly increased with age. In the degenerative group, SA, VA, MTA, PWMH, SCWMH, and total scores were found to be significantly higher. Sensitivities of VA, PWMH, SCWMH, and total scores, as well as both sensitivity and specificities of MTA score, were observed to be high. When they were combined, sensitivities and specificities were found to be high. CONCLUSION: The scale is observed to be predictive in discriminating degenerative and non-degenerative processes. This discrimination is important, particularly in depressive patients complaining of forgetfulness.

CONTEXTE: Dans la mesure où les manifestations de déficience cognitive ont tendance à augmenter avec le vieillissement, on constate aussi une augmentation de l'atrophie des sillons du cortex cérébral et de l'élargissement des ventricules cérébraux. En tenant compte des mesures propres à des échelles visuelles utilisées antérieurement, cette étude entend proposer une nouvelle échelle nous permettant d'évaluer en même temps des cas d'atrophie ainsi que la présence d'hyperdensités de la substance blanche, d'anomalies des ganglions de la base et d'infarctus affectant l'étage sus-tentoriel (infratentorial infarcts). L'objectif de cette étude est donc de proposer un examen d'IRM pratique et standardisé pouvant être utilisé quotidiennement par les cliniciens. MÉTHODES: Nous avons inclus dans cette étude 97 patients âgés de plus de 60 ans qui étaient soit atteints de dépression, soit de la maladie d'Alzheimer. Tous les patients recrutés ont été soumis à des examens d'IRM crâniens, au test de Folstein (ou MMSE), à un ensemble de tests neuro-psychométriques approfondis et à des échelles diagnostiques permettant d'évaluer la dépression. L'incidence de l'atrophie des sillons du cortex cérébral, de la région ventriculaire, du lobe temporal médian, des régions péri-ventriculaire et sous-corticale et de la substance blanche qu'elles contiennent, d'anomalies affectant les ganglions de base et d'infarctus à l'étage sus-tentoriel a été ainsi mesurée selon notre échelle. Le score total obtenu a aussi été enregistré. RÉSULTATS: L'âge moyen des patients était de 74,53 ans. Leur score moyen au test de Folstein était de 22,7 dans le cas du groupe de patients atteints d'une maladie dégénérative et de 27,8 dans le cas du groupe de patients n'étant pas atteints par ce type de maladie. Fait à noter, cinquante patients avaient reçu un diagnostic de maladie d'Alzheimer. Tous les paramètres évalués ont augmenté de façon notable avec l'âge. Ainsi, tant les scores obtenus dans le cas de l'atrophie des sillons du cortex cérébral, de celle affectant le lobe temporal médian, la région ventriculaire, la région péri-ventriculaire, la région sous-corticale que les scores totaux se sont révélés nettement plus élevés au sein du groupe de patients atteints d'une maladie dégénérative. La sensibilité des scores totaux et des scores évaluant l'atrophie des régions vasculaire, péri-vasculaire et sous-corticale, de même que la sensibilité et la spécificité des scores évaluant l'atrophie du lobe temporal médian, se sont révélées élevées. Lorsque combinées, la sensibilité et la spécificité sont apparues élevées. CONCLUSIONS: Notre échelle possède un caractère prédictif en ce qu'elle permet d'établir une distinction entre les processus dégénératifs et les processus non-dégénératifs. Cette capacité est particulièrement importante dans le cas de patients dépressifs qui se plaignent de perte de mémoire.

A case of secondary SUNCT syndrome.

SUNCT syndrome, a rare form of primary headaches, may be secondary to pituitary tumours. The secondary forms usually related with prolactinomas. The response of dopamin agonists could be variable. In this study, we reported a case of SUNCT syndrome secondary to prolactinoma. Cranial magnetic resonance imaging was performed for this patient because of the increase in pain severity and frequency. A hemorrhage was detected into the prolactinoma ipsilateral to the pain. The headache attacks were taken undercontrol and remission was ensured with cabergoline in a short time.

Assessing atrophy measurement techniques in dementia: Results from the MIRIAD atrophy challenge.

Structural MRI is widely used for investigating brain atrophy in many neurodegenerative disorders, with several research groups developing and publishing techniques to provide quantitative assessments of this longitudinal change. Often techniques are compared through computation of required sample size estimates for future clinical trials. However interpretation of such comparisons is rendered complex because, despite using the same publicly available cohorts, the various techniques have been assessed with different data exclusions and different statistical analysis models. We created the MIRIAD atrophy challenge in order to test various capabilities of atrophy measurement techniques. The data consisted of 69 subjects (46 Alzheimer's disease, 23 control) who were scanned multiple (up to twelve) times at nine visits over a follow-up period of one to two years, resulting in 708 total image sets. Nine participating groups from 6 countries completed the challenge by providing volumetric measurements of key structures (whole brain, lateral ventricle, left and right hippocampi) for each dataset and atrophy measurements of these structures for each time point pair (both forward and backward) of a given subject. From these results, we formally compared techniques using exactly the same dataset. First, we assessed the repeatability of each technique using rates obtained from short intervals where no measurable atrophy is expected. For those measures that provided direct measures of atrophy between pairs of images, we also assessed symmetry and transitivity. Then, we performed a statistical analysis in a consistent manner using linear mixed effect models. The models, one for repeated measures of volume made at multiple time-points and a second for repeated "direct" measures of change in brain volume, appropriately allowed for the correlation between measures made on the same subject and were shown to fit the data well. From these models, we obtained estimates of the distribution of atrophy rates in the Alzheimer's disease (AD) and control groups and of required sample sizes to detect a 25% treatment effect, in relation to healthy ageing, with 95% significance and 80% power over follow-up periods of 6, 12, and 24months. Uncertainty in these estimates, and head-to-head comparisons between techniques, were carried out using the bootstrap. The lateral ventricles provided the most stable measurements, followed by the brain. The hippocampi had much more variability across participants, likely because of differences in segmentation protocol and less distinct boundaries. Most methods showed no indication of bias based on the short-term interval results, and direct measures provided good consistency in terms of symmetry and transitivity. The resulting annualized rates of change derived from the model ranged from, for whole brain: -1.4% to -2.2% (AD) and -0.35% to -0.67% (control), for ventricles: 4.6% to 10.2% (AD) and 1.2% to 3.4% (control), and for hippocampi: -1.5% to -7.0% (AD) and -0.4% to -1.4% (control). There were large and statistically significant differences in the sample size requirements between many of the techniques. The lowest sample sizes for each of these structures, for a trial with a 12month follow-up period, were 242 (95% CI: 154 to 422) for whole brain, 168 (95% CI: 112 to 282) for ventricles, 190 (95% CI: 146 to 268) for left hippocampi, and 158 (95% CI: 116 to 228) for right hippocampi. This analysis represents one of the most extensive statistical comparisons of a large number of different atrophy measurement techniques from around the globe. The challenge data will remain online and publicly available so that other groups can assess their methods.

Auditory startle response is normal in juvenile myoclonic epilepsy.

Juvenile myoclonic epilepsy (JME) is hypothesized to originate from the dysfunction of thalamo-cortical circuit. We aimed to analyze any changes in auditory startle response in JME patients to determine the role of brainstem in JME. The responses of 18 JME patients to auditory simulation were recorded over the unilateral orbicularis oculi, masseter, sternocleidomastoid, and extremity muscles. Results were compared with those of 18 age and gender matched healthy volunteers. Total auditory startle response frequencies were similar between the two groups (31.1 ± 11.1 % vs. 33.7 ± 8.7 %, p = 0.400). Other parameters over each muscle were also similar. There were no impacts of antiepileptic drug use or disease duration. We may conclude that our findings may provide sufficient evidence for the lack of functional changes of the auditory startle response circuit even in longstanding cases of JME.

Cognitive Outcome after Surgery in Patients with Mesial Temporal Lobe Epilepsy.

INTRODUCTION: The aim of the present study was to evaluate the neuropsychological outcomes of patients with medically intractable unilateral mesial temporal lobe epilepsy (MTLE) due to hippocampal sclerosis (HS) treated either by anterior temporal lobectomy (ATL) or selective amygdalohippocampectomy (SAH). METHODS: This was a retrospective study where 67 patients who had undergone surgery for MTLE were evaluated. Thirty-two patients underwent ATL and 35 underwent SAH. All patients underwent a detailed neuropsychological evaluation before and 1 year after surgery. RESULTS: The verbal memory outcome was unchanged after left-sided surgery, whereas learning capacity increased after right-sided surgery (p=0.038). The visual memory outcome improved after right-sided surgery. Improvement of executive functions, particularly in the resistance of interference pattern in the Stroop Test, shortened 5th card time (p=0.000), and decreased corrections (p=0.003), after right-sided surgery and increased attention (p=0.027) after left-sided surgery were observed. After both surgery types, although statistically insignificant, there was a marked decrease in incorrect answers in the Stroop Test, which also showed an improvement in the resistance of interference pattern. Moreover, there was a significant decrease in switching errors with word pairs in the Verbal Fluency Test (p=0.008) after right-sided surgery. When the two sides were compared, we observed that the recall phase of the verbal memory worsened (p=0.018); however, the recognition phase improved (p=0.015) after left-sided surgery. Additionally, the short-term visual memory was better for both sides (p=0.035). CONCLUSION: Our results showed that patients with left MTLE were not worsened in verbal memory, but despite improved recognition, they have some problems in recalling information and only a minor improvement in attention. Patients with right MTLE improved in their verbal learning capacity, visual memory, and resistance of interference pattern 1 year after surgery. It was thus shown that while epilepsy surgery is associated with some negative cognitive changes, it may also improve some cognitive functions.

Enhanced blink reflex recovery in juvenile myoclonic epilepsy.

Juvenile myoclonic epilepsy (JME), which has been attributed to the dysfunction of cortico-thalamic pathway, has been considered to be one of the system epilepsies. However, electrophysiological and functional neuroimaging techniques have revealed the functional involvement of various parts of the central nervous system, also. Here, we aimed to analyze the role of brainstem circuits in JME by using the blink reflex recovery cycle (BRrc). Electrophysiological recordings of 18 JME patients together with age and gender matched 18 healthy subjects were made during single and paired supraorbital stimulation. Constant current paired stimuli were delivered at interstimulus intervals (ISI) of 200 and 400ms. Amplitudes of R2 responses were measured on the non-dominant side, and percentages of the recovery cycles were calculated. All participants had normal and similar R1 and R2 components of blink reflex (BR). At ISI of 400ms, R2 recoveries were significantly higher in the JME group compared to healthy subjects (p=0.040). There was no correlation between R2-BRrc and ages of JME patients, disease duration and daily dosage of valproic acid. We suggest that in JME, the integrity of BR circuit is preserved while the excitability of the brainstem BR circuitry is enhanced.

Reversible Posterior Leukoencephalopathy Syndrome Due to Carboplatin and Paclitaxel Therapy.

BACKGROUND: Reversible posterior leukoencephalopathy syndrome (RPLS) is a clinicoradiologic syndrome characterized by headache, decreased alertness, seizures, visual abnormalities, and white matter changes indicative of cerebral edema. Although the pathogenesis remains poorly understood, several etiological causes have been described. RPLS is a common complication of chemotherapeutics because of its toxic effect on the central nervous system. This syndrome is frequently associated with seizures but rarely seen with status epilepticus and periodic lateralized epileptiform discharges (PLEDs). CASE REPORT: We present a case with metastatic lung cancer that developed RPLS after carboplatin and paclitaxel therapy. Our case was admitted to the hospital with status epilepticus and her electroencephalography showed PLEDs. CONCLUSION: It is important to closely monitor blood pressure and electrolyte levels in patients who take chemotherapeutic agents, especially when there is no previous history of hypertension. It should be kept in mind that RPLS is a causative factor of status epilepticus and PLEDs.