scholarly journals Disseminated Necrotizing Leukoencephalopathy Complicating Septic Shock in an Immunocompetent Patient

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Pedro Gaspar-da-Costa ◽  
Sofia Reimão ◽  
Sandra Braz ◽  
João Meneses Santos ◽  
Rui M. M. Victorino
Keyword(s):  
Septic Shock ◽  
White Matter ◽  
White Matter Lesions ◽  
Neurological Impairment ◽  
Immunocompetent Patient ◽  
Resonance Imaging ◽  
Mri Findings ◽  
Full Neurological Recovery ◽  
Magnetic Resonance Imaging Mri ◽  
Immunocompetent Patients

Disseminated necrotizing leukoencephalopathy (DNL) is characterized by multiple microscopic foci of white matter necrosis. DNL was initially thought to be exclusively associated with immunosuppression conditions but it has been recently described in immunocompetent patients in septic shock. A 90-year-old immunocompetent woman with no previous neurological impairment presented with septic shock and drowsiness that responded well to therapy with clinical improvement and a full neurological recovery. Unexpectedly deterioration with progression to coma occurred. Investigation excluded other causes and Magnetic Resonance Imaging (MRI) was consistent with the diagnosis of DNL showing bilateral multifocal white matter lesions with a nonvascular pattern with restricted diffusion. Neurological impairment persisted with progression to death. DNL is an unexpected diagnosis in an immunocompetent patient. We compared the present case to those found in the literature of DNL complicating septic shock and discuss the antemortem diagnosis based on MRI findings.

Brain magnetic resonance imaging does not contribute to the diagnosis of chronic neuroborreliosis

2007 ◽  
Vol 48 (7) ◽  
pp. 755-762 ◽  
Author(s):  
A. Aalto ◽  
J. Sjöwall ◽  
L. Davidsson ◽  
P. Forsberg ◽  
Ö. Smedby
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Disease Duration ◽  
Brain Magnetic Resonance Imaging ◽  
White Matter Lesions ◽  
Resonance Imaging ◽  
Mri Findings ◽  
Significant Difference ◽  
Fluid Attenuated Inversion Recovery ◽  
Magnetic Resonance Imaging Mri

Background: Borrelia infections, especially chronic neuroborreliosis (NB), may cause considerable diagnostic problems. This diagnosis is based on symptoms and findings in the cerebrospinal fluid but is not always conclusive. Purpose: To evaluate brain magnetic resonance imaging (MRI) in chronic NB, to compare the findings with healthy controls, and to correlate MRI findings with disease duration. Material and Methods: Sixteen well-characterized patients with chronic NB and 16 matched controls were examined in a 1.5T scanner with a standard head coil. T1- (with and without gadolinium), T2-, and diffusion-weighted imaging plus fluid-attenuated inversion recovery (FLAIR) imaging were used. Results: White matter lesions and lesions in the basal ganglia were seen in 12 patients and 10 controls (no significant difference). Subependymal lesions were detected in patients down to the age of 25 and in the controls down to the age of 43. The number of lesions was correlated to age both in patients (ρ = 0.83, P<0.01) and in controls (ρ = 0.61, P<0.05), but not to the duration of disease. Most lesions were detected with FLAIR, but many also with T2-weighted imaging. Conclusion: A number of MRI findings were detected in patients with chronic NB, although the findings were unspecific when compared with matched controls and did not correlate with disease duration. However, subependymal lesions may constitute a potential finding in chronic NB.

Myelin in SIDS: Assessment of Development and Damage using MRI

PEDIATRICS ◽  
1995 ◽  
Vol 95 (3) ◽  
pp. 409-413
Author(s):  
Phillipa Lamont ◽  
Toos Sachinwalla ◽  
Roger Pamphlett
Keyword(s):  
White Matter ◽  
White Matter Lesions ◽  
Sudden Infant Death ◽  
Sudden Infant ◽  
Proton Density ◽  
Resonance Imaging ◽  
Focal Lesions ◽  
White Matter Development ◽  
Magnetic Resonance Imaging Mri ◽  
And Inversion

Objective. Abnormalities of myelin that have been reported in Sudden Infant Death Syndrome (SIDS) include a delay in development and focal lesions presumed to be secondary to hypoxia. Magnetic resonance imaging (MRI) gives excellent images of white matter and can be used to map the progress of myelination and to demonstrate focal lesions. It was the aim of this study to determine whether any MRI abnormality of myelin could be detected in the brains of SIDS compared to control infants. Methods. The brains of 28 SIDS and 14 control infants were fixed in formalin and scanned with MRI. The proton density, T2-weighted, and inversion recovery scans were assessed for the presence of focal white matter lesions. The amount of myelin in 26 sites was measured in the proton density scans, using a densitometer. The amount of myelin present could be assessed in 21 of 26 sites. Results. In 15 of 21 sites the amount of myelin for age was the same in SIDS and controls. In three sites the rate of myelination was greater in SIDS than control and in another three sites the amount of myelin for age was greater in SIDS than control infants, but these differences were not seen in infants aged less than 8 months. No focal abnormalities of white matter were seen in either SIDS or control infants. Conclusions. The development of white matter in brains of SIDS infants less than 8 months old is the same as in controls, and in older SIDS infants white matter development may be slightly advanced compared to controls. No hypoxic changes can be seen in SIDS white matter on MRI.

Brain Magnetic Resonance Imaging (MRI) White Matter Hyperintensities in Cyclic Vomiting Syndrome With or Without Migraine

2021 ◽  
pp. 088307382110279
Author(s):  
Salman Rashid ◽  
Samantha Weaver ◽  
Khaled Al-Robaidi ◽  
Leon Dure ◽  
Sumit Singh
Keyword(s):  
Magnetic Resonance Imaging ◽  
White Matter ◽  
Magnetic Resonance ◽  
White Matter Hyperintensities ◽  
Brain Magnetic Resonance Imaging ◽  
Cyclic Vomiting Syndrome ◽  
Resonance Imaging ◽  
Mri Findings ◽  
Magnetic Resonance Imaging Mri ◽  
Cyclic Vomiting

Background: Cyclic vomiting syndrome is classified as a possible subset of migraine. Brain magnetic resonance imaging (MRI) findings of white matter hyperintensities are well documented in migraineurs, but not in patients with cyclic vomiting syndrome. This study focuses on white matter hyperintensities in children with cyclic vomiting syndrome. Methods: We investigated our database of outpatient medical records for the diagnosis codes associated with cyclic vomiting syndrome from January 2008 to October 2018. Results: Brain MRIs were obtained in 31 of 185 patients (∼17%) with a diagnosis code related to cyclic vomiting syndrome. We excluded 13 of 31 patients because of the inaccessibility of images or a confounding diagnosis. Remaining patients were divided into 2 groups: 13 of 18 cyclic vomiting syndrome with migraine (CVS+M), and 5 of 18 cyclic vomiting syndrome without migraine (CVS-M). We found that 3 of the 13 patients in the CVS +M group had migraine-like white matter hyperintensities compared to 0 of the 5 in the CVS-M group. Conclusion: This small study suggests a possible relationship between white matter hyperintensities and CVS+M. A larger study is required to validate these findings.

scholarly journals Multi-scale MRI spectrum detects differences in myelin integrity between MS lesion types

2016 ◽  
Vol 22 (12) ◽  
pp. 1569-1577 ◽  
Author(s):  
Yunyan Zhang ◽  
Laura Jonkman ◽  
Antoine Klauser ◽  
Frederik Barkhof ◽  
V Wee Yong ◽  
...  
Keyword(s):  
White Matter ◽  
Brain Slices ◽  
Low Frequency ◽  
White Matter Lesions ◽  
Image Texture ◽  
Local Spectrum ◽  
Resonance Imaging ◽  
Multi Scale ◽  
Normal Appearing White Matter ◽  
Magnetic Resonance Imaging Mri

Background: Lesions with different extents of myelin pathology are found at autopsy in multiple sclerosis (MS), but the differences are not discernible in magnetic resonance imaging (MRI). Objective: To determine whether analysis of the local spectrum in MRI is sensitive to lesion differences in myelin integrity. Methods: We imaged fresh brain slices from 21 MS patients using 1.5T scanners. White matter lesions were identified in T2-weighted MRI, matched to corresponding specimens, and then classified into five categories in histology: pre-active (intact myelin); active, chronic active, chronic inactive (complete demyelination); and remyelinated lesions. Voxel-based frequency spectrum was calculated using T2-weighted MRI to characterize lesion structure (image texture). Results: MRI texture heterogeneity resulting from all spectral scales was greater in completely demyelinated lesions than in myelin-preserved lesions ( p = 0.02) and normal-appearing white matter ( p < 0.01). Moreover, the spectral distribution pattern over low-frequency scales differentiated demyelinated lesions from remyelinated and pre-active lesions ( p < 0.01), where different lesion types also showed distinct texture scales. Conclusion: Using multi-scale spectral analysis, it may be possible for standard MRI to evaluate myelin integrity in MS lesions. This can be critical for monitoring disease activity and assessing remyelination therapies for MS patients.

scholarly journals White matter lesions in Fabry disease before and after enzyme replacement therapy: a 2-year follow-up

2006 ◽  
Vol 64 (3b) ◽  
pp. 711-717 ◽  
Author(s):  
Laura B. Jardim ◽  
Flávio Aesse ◽  
Leonardo M. Vedolin ◽  
Cláudio Pitta-Pinheiro ◽  
João Marconato ◽  
...  
Keyword(s):  
White Matter ◽  
Enzyme Replacement Therapy ◽  
Fabry Disease ◽  
Replacement Therapy ◽  
White Matter Lesions ◽  
Resonance Imaging ◽  
Enzyme Replacement ◽  
Before And After ◽  
Magnetic Resonance Imaging Mri

PURPOSE: To report the clinical and neuroimaging, central nervous system (CNS) findings of patients with Fabry disease (FD) during 24 months of enzyme replacement therapy (ERT) with agalsidase-alpha. METHOD: Eight patients were included. Six completed 24 months of ERT. Clinical and magnetic resonance imaging (MRI) data were obtained at 0, 12 and 24 months of ERT. White matter lesions (WML) were evaluated as well as their relation to age, symptoms and neurological examination (CNS score). RESULTS: MRI was stable in 3 patients. WML and CNS score worsened in one patient, fluctuated in another, and improved in the sixth patient. In the whole series, there were 15 WML at baseline, and 19 at the 24th month. In two years, 4 lesions disappeared, whereas 8 appeared. CONCLUSION: A widespread pattern of silent WML in FD was seen. In two years, some WML appeared, and some disappeared. If these phenomena were related to the natural history, remains to be demonstrated.

Late presentation of NMOSD as rapidly progressive leukoencephalopathy with atypical clinical and radiological findings

2017 ◽  
Vol 24 (5) ◽  
pp. 685-688 ◽  
Author(s):  
Elia Sechi ◽  
Alberto Addis ◽  
Lucia Batzu ◽  
Sara Mariotto ◽  
Sergio Ferrari ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
White Matter ◽  
Magnetic Resonance ◽  
The Elderly ◽  
Late Presentation ◽  
Neuromyelitis Optica Spectrum Disorder ◽  
Resonance Imaging ◽  
Radiological Findings ◽  
Mri Findings ◽  
Magnetic Resonance Imaging Mri

Brain abnormalities in neuromyelitis optica spectrum disorder (NMOSD) are highly heterogeneous and often non-specific. Extensive white matter involvement has been described and frequently manifests with encephalopathy requiring prompt intervention. Rarely, this may represent the only manifestation at onset without concurrent suggestive features of the disease, thus making diagnosis challenging. NMOSD may potentially occur at any age, but it seems that this disorder has distinctive clinical features in the elderly. We describe a case of NMOSD presenting as rapidly progressive leukoencephalopathy with atypical clinical and magnetic resonance imaging (MRI) findings in a 69-year-old woman.

scholarly journals Spinal Cord Infarction in the Course of a Septic Shock: About One Case and Review of the Literature

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
P. Henin ◽  
A. Molderez ◽  
V. Huberlant ◽  
H. Trine
Keyword(s):  
Septic Shock ◽  
Bile Ducts ◽  
Spinal Cord Infarction ◽  
Review Of The Literature ◽  
Resonance Imaging ◽  
Pathogenic Role ◽  
Mri Findings ◽  
Endoscopic Extraction ◽  
Magnetic Resonance Imaging Mri

We report the case of a patient admitted to our intensive care unit in the course of a septic shock, secondary to cholangitis. After rapid hemodynamic stabilization, antibiotherapy, and endoscopic extraction of bile ducts stones, she appeared to have developed flaccid paraplegia. The suspected diagnosis of medullar ischemia was confirmed by typical MRI findings. This case stresses the potential pathogenic role of hypotension in medullar ischemia and the place of magnetic resonance imaging (MRI) as a reliable diagnostic tool.

EEG in Sarcoidosis Patients Without Neurological Findings

2016 ◽  
Vol 48 (1) ◽  
pp. 54-59
Author(s):  
Özgür Bilgin Topçuoğlu ◽  
Murat Kavas ◽  
Selahattin Öztaş ◽  
Sibel Arınç ◽  
Gülgün Afşar ◽  
...  
Keyword(s):  
White Matter ◽  
Brain Activity ◽  
White Matter Lesions ◽  
Neurological Dysfunction ◽  
Neurological Involvement ◽  
Mri Findings ◽  
Neurological Findings ◽  
Theta Waves ◽  
Magnetic Resonance Imaging Mri ◽  
Mri Changes

Sarcoidosis is a multisystem granulomatous disease affecting nervous system in 5% to 10% of patients. Magnetic resonance imaging (MRI) is accepted as the most sensitive method for detecting neurosarcoidosis. However, the most common findings in MRI are the nonspecific white matter lesions, which may be unrelated to sarcoidosis and can occur because of hypertension, diabetes mellitus, smoking, and other inflammatory or infectious disorders, as well. Autopsy studies report more frequent neurological involvement than the ante mortem studies. The aim of this study is to assess electroencephalography (EEG) in sarcoidosis patients without neurological findings in order to display asymptomatic neurological dysfunction. We performed EEG on 30 sarcoidosis patients without diagnosis of neurosarcoidosis or prior neurological comorbidities. Fourteen patients (46.7%) showed intermittant focal and/or generalized slowings while awake and not mentally activated. Seven (50%) of these 14 patients with EEG slowings had nonspecific white matter changes while the other half showed EEG slowings in the absence of MRI changes. We conclude that EEG slowings, when normal variants (psychomotor variant, temporal theta of elderly, frontal theta waves) are eliminated, may be an indicator of dysfunction in brain activity even in the absence of MRI findings. Hence, EEG may contribute toward detecting asymptomatic neurological dysfunction or probable future neurological involvement in sarcoidosis patients.

Magnetic Resonance Image Abnormality in Migraine with Aura

Cephalalgia ◽  
1991 ◽  
Vol 11 (3) ◽  
pp. 147-150 ◽  
Author(s):  
Dewey K Ziegler ◽  
Solomon Batnitzky ◽  
Ruth Barter ◽  
John H McMillan
Keyword(s):  
Magnetic Resonance ◽  
Cerebral Atrophy ◽  
White Matter Lesions ◽  
Subcortical White Matter ◽  
Resonance Imaging ◽  
Mri Findings ◽  
Cerebral Magnetic Resonance Imaging ◽  
Small Areas ◽  
Magnetic Resonance Imaging Mri ◽  
Age Range

Cerebral magnetic resonance imaging (MRI) was performed on 18 patients with migraine characterized by aura consisting of both visual symptoms and paresthesias. Fifteen headache-free individuals of the same age range were used as controls. Records were randomized and read in blind fashion by two neuroradiologists. Small subcortical white matter lesions were seen in three migraine cases and two controls. In one migraine case cortical infarctions were seen. In two controls, small areas of increased density similar to those in migraine were seen. No consistent correlation of migraine or its duration with cerebral atrophy was found. It is concluded that identification of both these MRI findings (small subcortical white lesions and cerebral atrophy) as significantly associated with migraine is doubtful.

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