Elevated Aortic Pulse Wave Velocity Relates to Longitudinal Gray and White Matter Changes

2021 ◽  
Author(s):  
Corey W. Bown ◽  
Omair A. Khan ◽  
Elizabeth E. Moore ◽  
Dandan Liu ◽  
Kimberly R. Pechman ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
White Matter ◽  
Magnetic Resonance ◽  
Gray Matter ◽  
Gray Matter Volume ◽  
Brain Magnetic Resonance Imaging ◽  
Aortic Pulse Wave Velocity ◽  
Resonance Imaging ◽  
Gray Matter Volumes ◽  
Over Time

Objective: To determine whether baseline aortic stiffness, measured by aortic pulse wave velocity (PWV), relates to longitudinal cerebral gray or white matter changes among older adults. Baseline cardiac magnetic resonance imaging will be used to assess aortic PWV while brain magnetic resonance imaging will be used to assess gray matter and white matter hyperintensity (WMH) volumes at baseline, 18 months, 3 years, 5 years, and 7 years. Approach and Results: Aortic PWV (m/s) was quantified from cardiac magnetic resonance. Multimodal 3T brain magnetic resonance imaging included T 1 -weighted imaging for quantifying gray matter volumes and T 2 -weighted fluid-attenuated inversion recovery imaging for quantifying WMHs. Mixed-effects regression models related baseline aortic PWV to longitudinal gray matter volumes (total, frontal, parietal, temporal, occipital, hippocampal, and inferior lateral ventricle) and WMH volumes (total, frontal, parietal, temporal, and occipital) adjusting for age, sex, race/ethnicity, education, cognitive diagnosis, Framingham stroke risk profile, APOE (apolipoprotein E)-ε4 carrier status, and intracranial volume. Two hundred seventy-eight participants (73±7 years, 58% male, 87% self-identified as non-Hispanic White, 159 with normal cognition, and 119 with mild cognitive impairment) from the Vanderbilt Memory & Aging Project (n=335) were followed on average for 4.9±1.6 years with PWV measurements occurring from September 2012 to November 2014 and longitudinal brain magnetic resonance imaging measurements occurring from September 2012 to June 2021. Higher baseline aortic PWV was related to greater decrease in hippocampal (β=−3.6 [mm 3 /y]/[m/s]; [95% CI, −7.2 to −0.02] P =0.049) and occipital lobe (β=−34.2 [mm 3 /y]/[m/s]; [95% CI, −67.8 to −0.55] P =0.046) gray matter volume over time. Higher baseline aortic PWV was related to greater increase in WMH volume over time in the temporal lobe (β=17.0 [mm 3 /y]/[m/s]; [95% CI, 7.2–26.9] P <0.001). All associations may be driven by outliers. Conclusions: In older adults, higher baseline aortic PWV related to greater decrease in gray matter volume and greater increase in WMHs over time. Because of unmet cerebral metabolic demands and microvascular remodeling, arterial stiffening may preferentially affect certain highly active brain regions like the temporal lobes. These same regions are affected early in the course of Alzheimer disease.

scholarly journals Multimodal Magnetic Resonance Imaging reveals alterations of sensorimotor circuits in restless legs syndrome

SLEEP ◽  
2019 ◽  
Vol 42 (12) ◽  
Author(s):  
Ambra Stefani ◽  
Thomas Mitterling ◽  
Anna Heidbreder ◽  
Ruth Steiger ◽  
Christian Kremser ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
White Matter ◽  
Magnetic Resonance ◽  
Gray Matter ◽  
Disease Duration ◽  
Gray Matter Volume ◽  
Resonance Imaging ◽  
Iron Storage ◽  
Matter Volume ◽  
The Right

Abstract Study Objectives Integrated information on brain microstructural integrity and iron storage and its impact on the morphometric profile is not available in restless legs syndrome (RLS). We applied multimodal magnetic resonance imaging (MRI) including diffusion tensor imaging, the transverse relaxation rate (R2*), a marker for iron storage, as well as gray and white matter volume measures to characterize RLS-related MRI signal distribution patterns and to analyze their associations with clinical parameters. Methods Eighty-seven patients with RLS (mean age 51, range 20–72 years; disease duration, mean 13 years, range 1–46 years, of those untreated n = 30) and 87 healthy control subjects, individually matched for age and gender, were investigated with multimodal 3T MRI. Results Volume of the white matter compartment adjacent to the post- and precentral cortex and fractional anisotropy (FA) of the frontopontine tract were both significantly reduced in RLS compared to healthy controls, and these alterations were associated with disease duration (r = 0.25, p = 0.025 and r = 0.23, p = 0.037, respectively). Corresponding gray matter volume increases of the right primary motor cortex in RLS (p &lt; 0.001) were negatively correlated with the right FA signal of the frontopontine tract (r = −0.22; p &lt; 0.05). Iron content evaluated with R2* was reduced in the putamen as well as in temporal and occipital compartments of the RLS cohort compared to the control group (p &lt; 0.01). Conclusions Multimodal MRI identified progressing white matter decline of key somatosensory circuits that may underlie the perception of sensory leg discomfort. Increases of gray matter volume of the premotor cortex are likely to be a consequence of functional neuronal reorganization.

Precentral and cerebellar atrophic changes in moyamoya disease using 7-T magnetic resonance imaging

2019 ◽  
Vol 61 (4) ◽  
pp. 487-495
Author(s):  
Hyeong Cheol Moon ◽  
Byeong Ho Oh ◽  
Chaejoon Cheong ◽  
Won Seop Kim ◽  
Kyung Soo Min ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
White Matter ◽  
Magnetic Resonance ◽  
Moyamoya Disease ◽  
Gray Matter ◽  
Gray Matter Volume ◽  
Healthy Controls ◽  
Resonance Imaging ◽  
Matter Volume ◽  
Age Range

Background Chronic repeated transient ischemic changes are one of the common symptoms of moyamoya disease that could affect cortical and subcortical atrophy. Purpose We aimed to assess the cortical gray matter volume and thickness, white matter subcortical volume, and clinical characteristics using 7-T magnetic resonance imaging (MRI) and MR angiography (MRA). Material and Methods In this case-control study, whole-brain parcellation of gray matter and subcortical volumes were manually assessed in nine patients with moyamoya disease (18 hemispheres; median age = 34 years; age range = 10–60 years) and nine healthy controls (18 hemispheres; median age = 29 years; age range = 20–62 years) matched for age and sex, who underwent both 7-T MRI and MRA. The volumes were measured using high-resolution image (<1 mm) processing based on the Desikan-Killiany-Tourville (DKT) atlas, via an automated segmentation method (FreeSurfer version 6.0). Results The gray matter volume of the left precentral cortex and the white matter volume of the subcortical cerebellum were lower in both hemispheres in the patients with moyamoya disease compared to the healthy controls. Conclusion Gray matter atrophy in the precentral cortex and cerebellar white matter were detected in this 7-T MRI volumetric analysis study of patients with moyamoya disease who experienced repeated transient ischemic changes. Cortical atrophy in precentral cortex and cerebellum could explain the transient motor weakness in patients with moyamoya disease, as one of the early findings was that patients with moyamoya disease do not have detectable infarction changes on conventional MRI images.

scholarly journals ASPREE-NEURO study protocol: A randomized controlled trial to determine the effect of low-dose aspirin on cerebral microbleeds, white matter hyperintensities, cognition, and stroke in the healthy elderly

2016 ◽  
Vol 12 (1) ◽  
pp. 108-113 ◽  
Author(s):  
Stephanie A Ward ◽  
Parnesh Raniga ◽  
Nicholas J Ferris ◽  
Robyn L Woods ◽  
Elsdon Storey ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
White Matter ◽  
Primary Prevention ◽  
Magnetic Resonance ◽  
Controlled Trial ◽  
Brain Magnetic Resonance Imaging ◽  
Cerebral Microbleeds ◽  
Resonance Imaging ◽  
Healthy Elderly ◽  
Cerebral Microbleed

Rationale Cerebral microbleeds seen on brain magnetic resonance imaging are markers of small vessel disease, linked to cognitive dysfunction and increased ischemic and hemorrhagic stroke risk. Observational studies suggest that aspirin use may induce cerebral microbleeds, and associated overt intracranial hemorrhage, but this has not been definitively resolved. Aims ASPREE-NEURO will determine the effect of aspirin on cerebral microbleed development over three years in healthy adults aged 70 years and over, participating in the larger ‘ASPirin in Reducing Events in the Elderly (ASPREE)’ primary prevention study of aspirin. Sample size Five hundred and fifty-nine participants provide 75% power (two-sided p value of 0.05) to determine an average difference of 0.5 cerebral microbleed per person after three years. Methods and design A multi-center, randomized placebo-controlled trial of 100 mg daily aspirin in participants who have brain magnetic resonance imaging at study entry, one and three years after randomization and who undergo cognitive testing at the same time points. Study outcomes The primary outcome is the number of new cerebral microbleeds on magnetic resonance imaging after three years. Secondary outcomes are the number of new cerebral microbleeds after one year, change in volume of white matter hyperintensity, cognitive function, and stroke. Discussion ASPREE-NEURO will resolve whether aspirin affects the presence and number of cerebral microbleeds, their relationship with cognitive performance, and indicate whether consideration of cerebral microbleeds alters the risk-benefit profile of aspirin in primary prevention for older people. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12613001313729.

Seizures and Enhancing Brain Lesions

2021 ◽  
pp. 219-221
Author(s):  
Josephe Archie Honorat ◽  
Andrew McKeon
Keyword(s):  
Magnetic Resonance Imaging ◽  
Mycophenolate Mofetil ◽  
White Matter ◽  
Magnetic Resonance ◽  
Brain Magnetic Resonance Imaging ◽  
Brain Biopsy ◽  
Resonance Imaging ◽  
History Of ◽  
High Doses ◽  
T2 Hyperintensity

A 51-year-old man sought care for a 4-month history of generalized seizures. The description of his seizures was consistent with generalized tonic-clonic seizures with focal onset. The patient had no history of head trauma or central nervous system infection and no family history of seizures. The patient reported having visual disturbances for 2 years before the seizures. His medical and surgical history was unremarkable. Brain magnetic resonance imaging showed left temporo-occipital, white matter, T2-signal intensity with gadolinium-enhancing lesions. Brain magnetic resonance imaging showed patchy gadolinium enhancement with T2 hyperintensity in the left parietotemporal and occipital lobes. Brain biopsy of the left temporal lobe showed white matter lesions with necrosis and chronic infiltration with macrophages and CD3-positive T lymphocytes and a predominant perivascular distribution. Focal, secondary vasculitis was present. There was no evidence of lymphoma. A repeated brain biopsy of the parietal lobe after another inflammatory relapse showed pathologic findings identical to the first biopsy. The patient was diagnosed with inflammatory encephalitis without additional defining features on biopsy. The patient received levetiracetam for seizure control, but the seizures remained refractory. He then was treated with high doses of intravenous methylprednisolone and then oral prednisone. Simultaneously, mycophenolate mofetil was initiated. The patient was monitored every 3 months with complete blood cell counts and liver function tests. Three months later, the prednisone dose was slowly tapered. During that process, the patient had no new seizures, and brain magnetic resonance imaging showed no active inflammation. After discontinuation of corticosteroids, the patient had a relapse with a generalized seizure, and brain magnetic resonance imaging showed new gadolinium-enhancing lesions. Prednisone was resumed, with near-remission. He then reinitiated mycophenolate mofetil and continued levetiracetam. With this regimen he remained clinically and radiologically stable, with only occasional visual phenomena that were possibly epileptic, although follow-up electroencephalography when he was symptomatic was normal. Encephalitis of unknown origin represents approximately one-third of cases. This proportion is decreasing over time with the development of novel diagnostic technologies, such as sequencing techniques to identify causative infectious agents and advances in neural autoantibody diagnostics.

Breakthrough Disease While on Multiple Sclerosis Immunomodulatory Therapy

2021 ◽  
pp. 55-56
Author(s):  
Jonathan L. Carter
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Sclerosis ◽  
Spinal Cord ◽  
White Matter ◽  
Magnetic Resonance ◽  
Disease Activity ◽  
Brain Magnetic Resonance Imaging ◽  
White Matter Lesions ◽  
Dimethyl Fumarate ◽  
Resonance Imaging

A 36-year-old woman with a history of relapsing-remitting multiple sclerosis was evaluated for new multiple sclerosis symptoms accompanied by new, enhancing, white matter lesions on brain magnetic resonance imaging. Her multiple sclerosis presented with L’hermitte sign when she was 24 years old. She had onset of bilateral lower extremity and left upper extremity tingling at age 26 years. Magnetic resonance imaging and cerebrospinal fluid examination at the time were supportive of the diagnosis of multiple sclerosis, and disease-modifying therapy was recommended by her neurologist. She initiated therapy with dimethyl fumarate at age 30 years after several further relapses. Surveillance magnetic resonance imaging showed new gadolinium-enhancing lesions on brain magnetic resonance imaging on each of 3 consecutive yearly scans. Urine culture and sensitivity tests were performed to rule out occult urinary tract infection; results of this testing were negative. magnetic resonance imaging of the brain concurrently showed new enhancing white matter lesions. The patient was diagnosed with clinical and radiographic breakthrough disease activity while receiving therapy for multiple sclerosis. The patient was treated with 5 days of intravenous methylprednisolone for her relapse. After discussion with the patient, it was decided to transition therapy from dimethyl fumarate to ocrelizumab infusions for her breakthrough disease activity. This decision was further supported by the patient’s concerns that she might be entering an early progressive phase of the disease. In patients with spinal-predominant multiple sclerosis, or with symptoms potentially indicating new spinal cord involvement, it may be necessary to include spinal cord imaging to assess for new disease activity.

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