Vascular risk factors, apolipoprotein E, and hippocampal decline on magnetic resonance imaging over a 10-year follow-up

2012 ◽  
Vol 8 (5) ◽  
pp. 417-425 ◽  
Author(s):  
Tom den Heijer ◽  
Fedde van der Lijn ◽  
Arfan Ikram ◽  
Peter J. Koudstaal ◽  
Aad van der Lugt ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Risk Factors ◽  
Magnetic Resonance ◽  
Apolipoprotein E ◽  
Vascular Risk Factors ◽  
Vascular Risk ◽  
Resonance Imaging

Acute Quadriparesis in a Smoker

2021 ◽  
pp. 238-241
Author(s):  
Nicholas L. Zalewski
Keyword(s):  
Magnetic Resonance Imaging ◽  
Risk Factors ◽  
Spinal Cord ◽  
Magnetic Resonance ◽  
Vascular Risk Factors ◽  
Spinal Cord Infarction ◽  
Imaging Findings ◽  
Vascular Risk ◽  
Resonance Imaging ◽  
High Doses

A 51-year-old woman was seen for evaluation of transverse myelitis. Pertinent medical history included hypertension, hyperlipidemia, and 50 pack-years of cigarette smoking. Two months earlier, she was shopping and suddenly had excruciating pain in her upper back. Two hours later, severe weakness of both hands developed abruptly. Over the next 8 hours, severe paraparesis and urinary retention developed, with inability to lift legs against gravity, and she reported a T1 sensory level. Review of the outside magnetic resonance imaging noted key imaging findings, including initially normal magnetic resonance imaging within the first 12 hours of symptom presentation, and subsequent magnetic resonance imaging on day 3 showing anterior pencil-like hyperintensity on sagittal view and anterior U- or V-shaped pattern on axial view (termed U/V pattern), without associated gadolinium enhancement. Diffusion-weighted imaging was not obtained. Given the rapid, severe deficits with pain, spinal cord infarction was considered most likely, and the magnetic resonance imaging findings were typical. Magnetic resonance angiography of the neck with T1-fat-saturated views was obtained and did not show dissection. Laboratory evaluation showed a low-density lipoprotein value of 124 mg/dL and hemoglobin A1c of 6.2%. The patient was diagnosed with probable spontaneous spinal cord infarction on the basis of diagnostic criteria. The patient was counselled on smoking cessation, started on an aspirin and statin regimen, and followed up by a primary care provider for management of vascular risk factors. Residual neuropathic pain was treated with high doses of gabapentin. Importantly, unnecessary additional immunotherapy was avoided by establishing the correct diagnosis. Spontaneous spinal cord infarctions are an underrecognized cause of acute myelopathy. Spinal cord infarctions generally occur in older persons, with most cases associated with typical vascular risk factors, arterial dissection, and fibrocartilaginous embolism; historically, cases were often secondary to syphilis.

scholarly journals Clinical Relevance of Cortical Cerebral Microinfarcts on 1.5T Magnetic Resonance Imaging in the Late-Adult Population

Stroke ◽  
2021 ◽  
Author(s):  
Saima Hilal ◽  
Arwin Doolabi ◽  
Henri Vrooman ◽  
M. Kamran Ikram ◽  
M. Arfan Ikram ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Risk Factors ◽  
Magnetic Resonance ◽  
Cognitive Decline ◽  
Clinical Relevance ◽  
Color Naming ◽  
Population Based ◽  
Resonance Imaging ◽  
Increased Risk

Background and Purpose: Cortical cerebral microinfarcts (CMIs) have been linked with dementia and impaired cognition in cross-sectional studies. However, the clinical relevance of CMIs in a large population-based setting is lacking. We examine the association of cortical CMIs detected on 1.5T magnetic resonance imaging with cardiovascular risk factors, cerebrovascular disease, and brain tissue volumes. We further explore the association between cortical CMIs with cognitive decline and risk of stroke, dementia, and mortality in the general population. Methods: Two thousand one hundred fifty-six participants (age: 75.7±5.9 years, women: 55.6%) with clinical history and baseline magnetic resonance imaging (January 2009–December 2013) were included from the Rotterdam Study. Cortical CMIs were graded based on a previously validated method. Markers of cerebrovascular disease and brain tissue volumes were assessed on magnetic resonance imaging. Cognition was assessed using a detailed neuropsychological test at baseline and at 5 years of follow-up. Data on incident stroke, dementia, and mortality were included until January 2016. Results: Two hundred twenty-seven individuals (10.5%) had ≥1 cortical CMIs. The major risk factors of cortical CMIs were male sex, current smoking, history of heart disease, and stroke. Furthermore, presence of cortical CMIs was associated with infarcts and smaller brain volume. Persons with cortical CMIs showed cognitive decline in Stroop tests (color-naming and interference subtasks; β for color-naming, 0.18 [95% CI, 0.04–0.33], P interaction ≤0.001 and β for interference subtask, 1.74, [95% CI, 0.66–2.82], P interaction ≤0.001). During a mean follow-up of 5.2 years, 73 (4.3%) individuals developed incident stroke, 95 (5.1%) incident dementia, and 399 (19.2%) died. People with cortical CMIs were at an increased risk of stroke (hazard ratio, 1.18 [95% CI, 1.09–1.28]) and mortality (hazard ratio, 1.09 [95% CI, 1.00–1.19]). Conclusions: Cortical CMIs are highly prevalent in a population-based setting and are associated with cardiovascular disease, cognitive decline, and increased risk of stroke and mortality. Future investigations will have to show whether cortical CMIs are a useful biomarker to intervene upon to reduce the burden of stroke.

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