Risk Factors for Silent Cerebral Infarcts in Subcortical White Matter and Basal Ganglia

Cerebral MR imaging (MR) and proton-MR spectroscopy (H-MRS) data are lacking in neurologically asymptomatic patients with Behçet's disease (BD). Aim of the following work was to assess MR and H-MRS characteristics of brain involvement over time in patients with BD without clinical neurological involvement. Forty cerebral MR and 12 H-MRS examinations obtained over a one to nine year follow-up in 17 patients with (group A n=9) or without (group B n=8) neurological involvement were retrospectively reviewed. Four group-B patients had a normal first MR examination whereas all group-A and four group-B patients showed single (n?3) or multiple (n=10) subcortical white matter foci of signal change. Large midbrain, basal ganglia or subcortical white matter lesions were depicted in six group-A patients. Comparison between initial and last MR examinations revealed 28 new small-to-medium size lesions. Over the course of the study, lesion enhancement was seen in five patients all belonging to group A. NAA/Cr and Cho/Cr ratios of supraventricular white matter did not show significant differences between patients and healthy controls or between group-A and group-B patients. Clinically silent cerebral involvement in the form of small-to-medium size subcortical lesions may be present at MR examination in BD patients. Large brainstem and basal ganglia lesions associated with overt neurological symptoms are characteristic of the disease. H-MRS of cerebral normal-appearing white matter does not show any significant metabolic change in BD.

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Jaw Dystonia and Reversible Basal Ganglia Changes as an Initial Presentation of Systemic Lupus Erythematosus

The Neurohospitalist ◽

10.1177/1941874417698323 ◽

2017 ◽

Vol 8 (1) ◽

pp. 31-34 ◽

Cited By ~ 2

Author(s):

Meghan Romba ◽

Yujie Wang ◽

Shu-Ching Hu ◽

Sandeep Khot

Keyword(s):

Systemic Lupus Erythematosus ◽

White Matter ◽

Basal Ganglia ◽

Brain Imaging ◽

Lupus Erythematosus ◽

Subcortical White Matter ◽

High Dose ◽

Neuropsychiatric Lupus ◽

Systemic Lupus ◽

Traditional Treatment

Dystonia as a manifestation of neuropsychiatric lupus erythematosus (NPSLE) is uncommon. We report a 25-year-old woman who experienced progressive confusion, reduced speech, and difficulty opening her mouth approximately 2 weeks after development of a facial rash. Brain imaging showed bilateral, symmetric signal abnormalities within the basal ganglia and subcortical white matter. Despite treatment with high-dose steroids, she continued to have difficulty speaking with evidence of jaw dystonia on examination. Jaw dystonia rapidly improved with the initiation of levodopa. Repeat evaluation 3 months later exhibited the absence of jaw dystonia and near resolution of the imaging abnormalities. Our patient demonstrated a unique presentation with jaw dystonia refractory to traditional treatment for NPSLE. Such a presentation likely represents a severe variant of NPSLE requiring both immunosuppressive and symptomatic therapies.

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Hemiballism-hemichorea Induced by Subcortical Ischemia

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100048253 ◽

1993 ◽

Vol 20 (4) ◽

pp. 324-328 ◽

Cited By ~ 9

Author(s):

Fukhi Toshiya ◽

Hasegawa YuKihiro ◽

Seriyama Shinya ◽

Takeuchi Toru ◽

Sugita Koujiro ◽

...

Keyword(s):

White Matter ◽

Cerebral Ischemia ◽

Basal Ganglia ◽

Subthalamic Nucleus ◽

Clinical Manifestation ◽

Cerebral Hemisphere ◽

Subcortical White Matter ◽

Pathological Changes ◽

Limb Weakness ◽

Involuntary Movements

ABSTRACT:Four patients presented with hemiballism-hemichorea as a clinical manifestation of white matter ischemia. These patients illustrate “positive” motor phenomena rather than limb weakness as a consequence of cerebral ischemia. In each patient, the involuntary movements disappeared following worsening of paresis. Subcortical white matter infarction in three patients and hemodynamic hypo-perfusion in the cerebral hemisphere contralateral to dyskinetic movements were possible causes. Neuroradiologically, none had pathological changes in the vicinity of the subthalamic nucleus. We presume from these observations that ischemia of the subcortical white matter, without involvement of the basal ganglia or the subthalamic nucleus, may cause hemiballism-hemichorea

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Recurrent Seizure: An Uncommon Presentation of Post Thyroidectomy Hypoparathyroidism

Journal of Medicine ◽

10.3329/jom.v16i1.22406 ◽

2015 ◽

Vol 16 (1) ◽

pp. 56-58

Author(s):

Abdul Wadud Chowdhury ◽

Sabbiha Nadia Majumder ◽

Md Gaffar Amin ◽

Kazi Nazrul Islam ◽

Mohammed Abaye Deen Saleh ◽

...

Keyword(s):

White Matter ◽

Basal Ganglia ◽

Total Thyroidectomy ◽

Subcortical White Matter ◽

Recurrent Seizure ◽

Lentiform Nucleus ◽

Basal Ganglia Calcification ◽

Uncommon Presentation ◽

Chronic Hypoparathyroidism ◽

Matter Detection

Basal ganglia calcification is associated with chronic hypoparathyroidism. We report a case of 37 year old lady with long standing iatrogenic hypoparathyroidism following total thyroidectomy. The clinical evaluation revealed neurological symptoms but without any neurological deficit. The CT scan of head showed calcification in caudate nucleus and part of lentiform nucleus of basal ganglia and in the cortical and subcortical white matter. Detection of brain calcinosis in patients who had total thyroidectomy can guide clinicians to further investigation for possible hypoparathyroidism.DOI: http://dx.doi.org/10.3329/jom.v16i1.22406 J MEDICINE 2015; 16 : 56-58

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Association of enlarged perivascular spaces and anticoagulant-related intracranial hemorrhage

Neurology ◽

10.1212/wnl.0000000000010788 ◽

2020 ◽

Vol 95 (16) ◽

pp. e2192-e2199 ◽

Cited By ~ 1

Author(s):

Jonathan G. Best ◽

Carmen Barbato ◽

Gareth Ambler ◽

Houwei Du ◽

Gargi Banerjee ◽

...

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

White Matter ◽

Basal Ganglia ◽

Intracranial Hemorrhage ◽

Cox Regression ◽

Significant Risk ◽

Cerebral White Matter ◽

Perivascular Spaces ◽

Univariable Analysis

ObjectiveTo investigate whether enlarged perivascular spaces (PVS) within the basal ganglia or deep cerebral white matter are risk factors for intracranial hemorrhage in patients taking oral anticoagulants (OACs), independent of established clinical and radiologic risk factors, we conducted a post hoc analysis of Clinical Relevance of Microbleeds in Stroke (CROMIS-2) (atrial fibrillation [AF]), a prospective inception cohort study.MethodsPatients with atrial fibrillation and recent TIA or ischemic stroke underwent standardized MRI prior to starting OAC. We rated basal ganglia PVS (BGPVS) and centrum semiovale PVS (CSOPVS), cerebral microbleeds (CMBs), white matter hyperintensities, and lacunes. We dichotomized the PVS rating using a threshold of >10 PVS in the relevant region of either cerebral hemisphere. The primary outcome was symptomatic intracranial hemorrhage (sICH). We identified risk factors for sICH using Cox regression.ResultsA total of 1,386 participants with available clinical and imaging variables were followed up for a mean of 2.34 years; 14 sICH occurred (11 intracerebral). In univariable analysis, diabetes, CMB presence, lacune presence, and >10 BGPVS, but not CSOPVS, were associated with sICH. In a multivariable model incorporating all variables with significant associations in univariable analysis, >10 BGPVS (hazard ratio [HR] 8.96, 95% [CI] 2.41–33.4, p = 0.001) and diabetes (HR 3.91, 95% CI 1.34–11.4) remained significant risk factors for sICH.ConclusionEnlarged BGPVS might be a novel risk factor for OAC-related ICH. The strength of this association and potential use in predicting ICH in clinical practice should be investigated in larger cohorts.

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Anatomical aspects of the insula, opercula and peri-insular white matter for a transcortical approach to insular glioma resection

Neurosurgical Review ◽

10.1007/s10143-021-01602-5 ◽

2021 ◽

Author(s):

Tomasz Andrzej Dziedzic ◽

Aleksandra Bala ◽

Andrzej Marchel

Keyword(s):

White Matter ◽

Basal Ganglia ◽

Brain Mapping ◽

Subcortical White Matter ◽

Detailed Knowledge ◽

Zone Ii ◽

Basal Ganglia Structures ◽

Glioma Resection ◽

The Brain ◽

Transcortical Approach

AbstractThe insula is a lobe located deep in each hemisphere of the brain and is surrounded by eloquent cortical, white matter, and basal ganglia structures. The aim of this study was to provide an anatomical description of the insula and white matter tracts related to surgical treatment of gliomas through a transcortical approach. The study also discusses surgical implications in terms of intraoperative brain mapping. Five adult brains were prepared according to the Klingler technique. Cortical anatomy was evaluated with the naked eye, whereas white matter dissection was performed with the use of a microscope. The widest exposure of the insular surface was noted through the temporal operculum, mainly in zones III and IV according to the Berger-Sanai classification. By going through the pars triangularis in all cases, the anterior insular point and most of zone I were exposed. The narrowest and deepest operating field was observed by going through the parietal operculum. This method provided a suitable approach to zone II, where the corticospinal tract is not covered by the basal ganglia and is exposed just under the superior limiting sulcus. At the subcortical level, the identification of the inferior frontoocipital fasciculus at the level of the limen insulae is critical in terms of preserving the lenticulostriate arteries. Detailed knowledge of the anatomy of the insula and subcortical white matter that is exposed through each operculum is essential in preoperative planning as well as in the intraoperative decision-making process in terms of intraoperative brain mapping.

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Diffuse subcortical white matter injury and bilateral basal ganglia neuronal loss after acute opioid overdose

The Neuroradiology Journal ◽

10.1177/1971400920927878 ◽

2020 ◽

Vol 33 (3) ◽

pp. 267-270 ◽

Cited By ~ 1

Author(s):

Andreea I Dinicu ◽

Amit Chaudhari ◽

Simon Kayyal

Keyword(s):

White Matter ◽

Basal Ganglia ◽

Neuronal Loss ◽

Subcortical White Matter ◽

White Matter Injury ◽

Adolescent Male ◽

Opioid Overdose ◽

Diffuse White Matter ◽

Neurological Exam ◽

Life Threatening

Opiate intoxication has been associated with life-threatening effects of sympathetic suppression and respiratory depression, but current literature is limited in describing its neurotoxic effects on the central nervous system. Here, we present the case of an otherwise high-functioning adolescent male who was found unresponsive after ingestion of approximately 3–4 fake oxycodone 10–325 mg pills laced with fentanyl. Magnetic resonance imaging showed evidence of diffuse T2 hyperintensities in the corpus callosum and bilateral frontal, parietal, and cerebellum indicative of diffuse white matter injury. In addition, there were distinct areas of restricted diffusion in the bilateral basal ganglia concerning for oxidative stress-mediated neuronal loss. His neurological exam improved with supportive treatment over the course of his hospitalization. Although limited literature has shown leukoencephalopathy to be associated with opioid overdose, we present a case of additional involvement of subcortical gray matter.

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An accidental finding of FAHR’s syndrome during computed tomography of skull – A case report

Biomedicine ◽

10.51248/.v40i4.344 ◽

2021 ◽

Vol 40 (4) ◽

pp. 557-559

Author(s):

Archana Rajasundaram ◽

Nitya Waghray ◽

W.M.S. Johnson

Keyword(s):

Computed Tomography ◽

Case Report ◽

White Matter ◽

Basal Ganglia ◽

Dentate Nucleus ◽

Subcortical White Matter ◽

Radiology Department ◽

Medical College ◽

Fahr’S Syndrome ◽

Middle Aged Adults

Calcification of basal ganglia is known as FAHR’s syndrome or FAHR’s disease. It’s a rare phenomenon which generally affects the young to middle aged adults. A 39-year-old female was sent to the radiology department of Sree Balaji Medical College, Chennai for computed tomography (CT) as she had a fall and injured her forehead. An axial plain CT scan without contrast was advised and performed. The CT study revealed mild frontal peri cranial swelling and calcification of dentate nucleus, basal ganglia, central semiovale and frontoparietal subcortical white matter was observed. On examination, however patient did not present with any other movement disorders.

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Anatomical aspects of the insula, opercula and peri-insular white matter for a transcortical approach to insular glioma resection

10.21203/rs.3.rs-337829/v1 ◽

2021 ◽

Author(s):

Tomasz Andrzej Dziedzic ◽

Aleksandra Bala ◽

Andrzej Marchel

Keyword(s):

White Matter ◽

Basal Ganglia ◽

Brain Mapping ◽

Subcortical White Matter ◽

Detailed Knowledge ◽

Zone Ii ◽

Basal Ganglia Structures ◽

Glioma Resection ◽

The Brain ◽

Transcortical Approach

Abstract Introduction: The insula is a lobe located deep in each hemisphere of the brain and is surrounded by eloquent cortical, white matter and basal ganglia structures. The aim of this study was to provide an anatomical description of the insula and white matter tracts related to surgical treatment of gliomas through a transcortical approach. The study also discusses surgical implications in terms of intraoperative brain mapping. Methods Five adult brains were prepared according to the Klingler technique. Cortical anatomy was evaluated with the naked eye, whereas white matter dissection was performed with the use of a microscope. Results The widest exposure of the insular surface was noted through the temporal operculum, mainly in Zones III and IV according to the Berger-Sanai classification. By going through the pars triangularis in all cases, the anterior insular point and most of Zone I were exposed. The narrowest and deepest operating field was observed by going through the parietal operculum. This method provided a suitable approach to Zone II, where the corticospinal tract is not covered by the basal ganglia and is exposed just under the superior limiting sulcus. At the subcortical level, the identification of the inferior frontoocipital fasciculus at the level of the limen insulae is critical in terms of preserving the lenticulostriate arteries. Conclusion Detailed knowledge of the anatomy of the insula and subcortical white matter that is exposed through each operculum is essential in preoperative planning as well as in the intraoperative decision-making process in terms of intraoperative brain mapping.

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Subacute Sclerosing Panencephalitis (SSPE) Associated with Basal Ganglia Involvement - Two Case Reports

Bangladesh Journal of Child Health ◽

10.3329/bjch.v36i3.14289 ◽

2013 ◽

Vol 36 (3) ◽

pp. 153-155

Author(s):

GK Kundu ◽

MM Mahmud ◽

MM Rahman

Keyword(s):

Spinal Cord ◽

White Matter ◽

Basal Ganglia ◽

Child Health ◽

Case Reports ◽

Subacute Sclerosing Panencephalitis ◽

Subcortical White Matter ◽

Resonance Imaging ◽

Basal Ganglia Involvement

Magneting resonance imaging in subacute sclerosing panencephalitis (SSPE) usually demonstrates changes in periventicular and subcortical white matter. Basal ganglia, Cerebellum, Spinal cord are less commonly involved. In this article, we report two cases of SSPE associated with basal ganglia involvement. The 1st case a 11 years old boy had the severe symptoms of SSPE with bilateral basal ganglia involvement. The 2nd case a 8 years old girl had right sided hemiplegia. DOI: http://dx.doi.org/10.3329/bjch.v36i3.14289 BANGLADESH J CHILD HEALTH 2012; VOL 36 (3) : 153-155

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