Abstract T P362: Prevalence and Clinicoradiological Profile of Japanese Patients with Alzheimer Disease Coexisting Multiple Microbleeds

Background: Pathological findings of cerebral amyloid angiopathy (CAA) and Alzheimer’s disease (AD) coexist frequently. Both diseases are associated with β-amyloid deposition and dementia. We aimed to evaluate frequency and clinicoradiological profile of AD patients with multiple microbleeds (MBs) Methods: We reviewed clinical charts and magnetic resonance imaging (MRI) findings in patients with probable AD from 2009 to 2012, according to the DSM-IV. Brain MRI was performed at 1.5 T using protocols, including T2*-weighted gradient-echo or susceptibility-weighted imaging. MBs were defined as rounded, hypointense foci ≤ 10 mm in size in the brain parenchyma. MBs topography was divided into the lobar (L) and the deep/infratentorial (D/I) region. Multiple MBs were defined as the number ≥ 8 in the L or the D/I territory. White matter hyperintensities (WMH) were assessed using the age-related white matter changes scale. Clinicoradiological findings were examined for ≥ 1 year. Prevalence and clinicoradiological profiles were studied in patients with multiple L MBs or multiple D/I MBs. Results: Five hundred fifty patients (238 men and 312 women) were participated in the present study. Mean age (SD) was 78.4 (7.7) years, 78.3 (8.1) in men and 78.6 (7.5) in woman. A total of 132 patients (55 men and 78 women) had at least MB. Prevalence of total MBs was 24.0%, 23.1 in men and 25.0 in women. Multiple L MBs existed in 49 patients (8.9%), 15 men (6.3) and 34 women (10.9). Multiple D/I MBs were found in 44 patients (8.0%), 23 men (9.7) and 21 women (6.7). Clinical profiles of multiple L MBs revealed sudden deterioration, rapid progression, non-hypertension, higher rates of symptomatic subcortical hemorrhage and onset of CAA-associated leukoencephalopathy. Radiological hallmarks exhibited increased number and size of MBs, high score of WMH and asymptomatic subcortical hemorrhage. Clinicoradiological features of multiple D/I MBs exhibited higher rates of hypertension and variable degrees of WMH. Conclusions: The present study indicated that prevalence of multiple MBs was 16.9% in Japanese patients with AD. The clinicoradiological profile suggested severe degree of CAA in patients with multiple L MBs (8.9%) and hypertensive changes in patients with multiple D/I MBs (8.0%).

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Abstract 36: The Boston Criteria V2.0 for Cerebral Amyloid Angiopathy: Updated Criteria and Multicenter MRI-Neuropathology Validation

Stroke ◽

10.1161/str.52.suppl_1.36 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Andreas Charidimou ◽

Gregoire Boulouis ◽

Matthew Frosch ◽

Jean-Claude Baron ◽

Marco Pasi ◽

...

Keyword(s):

White Matter ◽

Intracerebral Hemorrhage ◽

Diagnostic Accuracy ◽

Cerebral Amyloid Angiopathy ◽

Brain Mri ◽

Amyloid Angiopathy ◽

Perivascular Spaces ◽

Validation Sample ◽

Temporal Validation ◽

Cerebral Amyloid

Introduction: The Boston criteria are used worldwide for in vivo diagnosis of cerebral amyloid angiopathy (CAA). Given substantial advances in CAA research, we aimed to update the Boston criteria and externally validate their diagnostic accuracy across the spectrum of CAA-related presentations and across international sites. Methods: As part of an International CAA Association multicenter study, we identified patients age 50 or older with potential CAA-related clinical presentations (spontaneous intracerebral hemorrhage, cognitive impairment, or transient focal neurological episodes), available brain MRI, and histopathologic assessment for the diagnosis of CAA. We derived Boston criteria v2.0 by selecting MRI features to optimize diagnostic specificity and sensitivity in a pre-specified derivation sample (Boston cases 1994 to 2012, n=159), then externally validated in pre-specified temporal (Boston cases 2012-2018, n=59) and geographical (non-Boston cases 2004-2018; n=123) validation samples and compared their diagnostic accuracy to the currently used modified Boston criteria. Results: Based on exploratory analyses in the derivation sample, we derived provisional criteria for probable CAA requiring presence of at least 2 strictly lobar hemorrhagic lesions (intracerebral hemorrhage, cerebral microbleed, or cortical superficial siderosis focus) or at least 1 strictly lobar hemorrhagic lesion and 1 white matter characteristic (severe degree of visible perivascular spaces in centrum semiovale or white matter hyperintensities multispot pattern). Sensitivity/specificity of the criteria were 74.8/84.6% in the derivation sample, 92.5/89.5% in the temporal validation sample, 80.2/81.5% in the geographic validation sample, and 74.5/95.0% in cases across all samples with autopsy as the diagnostic gold standard. The v2.0 criteria for probable CAA had superior accuracy to the currently modified Boston criteria (p<0.005) in the autopsied cases. Conclusion: The Boston criteria v.2.0 incorporate emerging MRI markers of CAA to enhance sensitivity without compromising their high specificity. Validation of the criteria across independent patient settings firmly supports their adoption into clinical practice and research.

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Volume of white matter hyperintensities increases with blood pressure in patients with hypertension

Journal of International Medical Research ◽

10.1177/0300060519858023 ◽

2019 ◽

Vol 47 (8) ◽

pp. 3681-3689 ◽

Cited By ~ 2

Author(s):

Yu Zhao ◽

Zunyu Ke ◽

Wenbo He ◽

Zhiyou Cai

Keyword(s):

Blood Pressure ◽

White Matter ◽

White Matter Hyperintensities ◽

Clinical Analysis ◽

Primary Diagnosis ◽

Mri Findings ◽

Scale Scores ◽

History Of ◽

Magnetic Resonance Imaging Mri ◽

Fazekas Scale

Objective Hypertension is a risk factor for development of white matter hyperintensities (WMHs). However, the relationship between hypertension and WMHs remains obscure. We sought to clarify this relationship using clinical data from different regions of China. Methods We analyzed the data of 333 patients with WMHs in this study. All included patients underwent conventional magnetic resonance imaging (MRI) examination. A primary diagnosis of WMHs was made according to MRI findings. The volume burden of WMHs was investigated using the Fazekas scale, which is widely used to rate the degree of WMHs. We conducted retrospective clinical analysis of the data in this study. Results Our findings showed that WMHs in patients with hypertension were associated with diabetes, cardiovascular diseases, history of cerebral infarct, and plasma glucose and triglyceride levels. Fazekas scale scores for WMHs increased with increased blood pressure values in patients with hypertension. Conclusion This analysis indicates that hypertension is an independent contributor to the prevalence and severity of WMHs.

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Full Recovery From Cocaine-Induced Toxic Leukoencephalopathy: Emphasizing the Role of Neuroinflammation and Brain Edema

Journal of Investigative Medicine High Impact Case Reports ◽

10.1177/2324709619868266 ◽

2019 ◽

Vol 7 ◽

pp. 232470961986826 ◽

Cited By ~ 1

Author(s):

Edward C. Mader ◽

Alexander B. Ramos ◽

Roberto A. Cruz ◽

Lionel A. Branch

Keyword(s):

White Matter ◽

Time Course ◽

Brain Mri ◽

White Matter Lesions ◽

Psychomotor Retardation ◽

Full Recovery ◽

White Matter Disease ◽

Mri Findings ◽

Prognostic Information ◽

Toxic Leukoencephalopathy

Toxic leukoencephalopathy (TL) is characterized by white matter disease on magnetic resonance imaging (MRI) and evidence of exposure to a neurotoxic agent. We describe a case of cocaine-induced TL in which extensive white matter disease did not preclude full recovery. A 57-year-old man with substance abuse disorder presented with a 5-day history of strange behavior. On admission, he was alert but had difficulty concentrating, psychomotor retardation, and diffuse hyperreflexia. Brain MRI revealed confluent subcortical white matter hyperintensities with restricted diffusion in some but not in other areas. Electroencephalography (EEG) showed mild diffuse slowing. Blood tests were normal except for mild hyperammonemia. Urine screen was positive for cocaine and benzodiazepine but quantitative analysis was significant only for cocaine. Prednisone 60-mg qd was initiated on day 4, tapered over a 5-day period, and discontinued on day 9. He was discharged after 3 weeks. Cognitive function returned to normal 2 weeks after discharge. Five months later, neurologic exam and EEG were normal and MRI showed near-100% resolution of white matter lesions. TL has been attributed to white matter ischemia/hypoxia resulting in demyelination/axonal injury. The clinical, EEG, and MRI findings and time course of recovery of our patient suggest that cocaine-induced inflammation/edema resulted in TL but not in ischemic/hypoxic injury. While inflammation/edema may have regressed when cocaine was discontinued, we cannot exclude a role for prednisone in protecting the patient from the ischemic/hypoxic sequelae of inflammation/edema. MRI is indispensable for diagnosing TL but EEG may provide additional useful diagnostic and prognostic information.

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Bilateral Medial Medullary Stroke: A Challenge in Early Diagnosis

Case Reports in Neurological Medicine ◽

10.1155/2013/274373 ◽

2013 ◽

Vol 2013 ◽

pp. 1-3

Author(s):

Amir M. Torabi

Keyword(s):

Cervical Spine ◽

Early Diagnosis ◽

Brain Mri ◽

Brain Magnetic Resonance Imaging ◽

Mri Findings ◽

Rare Type ◽

Abnormal Signal ◽

Acute Vestibular Syndrome ◽

Spine Mr ◽

Magnetic Resonance Imaging Mri

Bilateral medial medullary stroke is a very rare type of stroke, with catastrophic consequences. Early diagnosis is crucial. Here, I present a young patient with acute vertigo, progressive generalized weakness, dysarthria, and respiratory failure, who initially was misdiagnosed with acute vestibular syndrome. Initial brain magnetic resonance imaging (MRI) that was done in the acute phase was read as normal. Other possibilities were excluded by lumbar puncture and MRI of cervical spine. MR of C-spine showed lesion at medial medulla; therefore a second MRI of brain was requested, showed characteristic “heart appearance” shape at diffusion weighted (DWI), and confirmed bilateral medial medullary stroke. Retrospectively, a vague-defined hyperintense linear DWI signal at midline was noted in the first brain MRI. Because of the symmetric and midline pattern of this abnormal signal and similarity to an artifact, some radiologists or neurologists may miss this type of stroke. Radiologists and neurologists must recognize clinical and MRI findings of this rare type of stroke, which early treatment could make a difference in patient outcome. The abnormal DWI signal in early stages of this type of stroke may not be a typical “heart appearance” shape, and other variants such as small dot or linear DWI signal at midline must be recognized as early signs of stroke. Also, MRI of cervical spine may be helpful if there is attention to brainstem as well.

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MRI white matter lesions in pediatric migraine

Cephalalgia ◽

10.1177/0333102413480955 ◽

2013 ◽

Vol 33 (11) ◽

pp. 906-913 ◽

Cited By ~ 13

Author(s):

Tal Eidlitz-Markus ◽

Avraham Zeharia ◽

Yishay Haimi-Cohen ◽

Osnat Konen

Keyword(s):

White Matter ◽

Pediatric Patients ◽

Medical Center ◽

Brain Mri ◽

Brain Magnetic Resonance Imaging ◽

White Matter Lesions ◽

Pediatric Migraine ◽

Laboratory Examinations ◽

Magnetic Resonance Imaging Mri ◽

Headache Clinic

Objectives: Studies have reported an association between migraine and white matter hyperintensities on T2-weighted brain magnetic resonance imaging (MRI) in adults. The aim of the present study was to evaluate white matter MRI brain findings in pediatric patients with migraine. Methods: The medical files and imaging scans of all 194 patients who underwent brain MRI at the headache clinic of a tertiary medical center in 2008–2011 were reviewed. Results: Mean age was 10.9 ± 3.5 years. Migraine was diagnosed in 131 patients and other disorders in 63. In the migraine group, findings on physical and laboratory examinations were within normal range. White matter lesions were identified on MRI scan in 14 children with migraine (10.6%) and none of the children with other disorders ( p = 0.006). In 13/14 patients, the lesions were focal with a variable distribution; in the remaining patient, confluent periventricular hyperintensities were documented. Conclusions: In a headache clinic of a tertiary pediatric medical center, white matter lesions are found in about 10% of pediatric patients with migraine.

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A case of chronic progressive Lyme encephalitis as a manifestation of late Lyme neuroborreliosis

Infectious Disease Reports ◽

10.4081/idr.2014.5496 ◽

2014 ◽

Vol 6 (4) ◽

Cited By ~ 2

Author(s):

Vivek Verma ◽

Matthew Roman ◽

Disha Shah ◽

Marina Zaretskaya ◽

Mohamed H. Yassin

Keyword(s):

White Matter ◽

Short Term Memory ◽

Treatment Options ◽

Chronic Fatigue ◽

Short Term ◽

Mri Findings ◽

White Matter Changes ◽

Neurological Improvement ◽

Magnetic Resonance Imaging Mri

A 54-year-old female living in Europe presented with gait ataxia, dizziness, and bilateral hearing loss. Magnetic resonance imaging (MRI) revealed non-specific white matter changes. The patient’s condition gradually deteriorated over two years without diagnosis. The patient continued to decline cognitively and neurologically with worsening ataxia and upper motor neuron signs. Repeat MRI showed worsening white matter changes. Lumbar puncture, not previously done, showed positive Lyme testing. Treatment with intravenous ceftriaxone resulted in marked neurological improvement. Four years after symptom, the patient has short-term memory deficits and chronic fatigue, but is otherwise neurologically, cognitively, and functionally intact. Follow up MRI findings remain largely unchanged. Because cases of intraparenchymal or encephalopathic neuroborreliosis in America are lacking, so are treatment options. We present a rare case and discuss our experience with antibiotic treatment. This case lends evidence to define optimal treatment of this disease, imperative for hastening neurological recovery.

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Psychological distress in patients suffering from femoral head osteonecrosis, with and without white matter lesions: clinical characteristics and personality traits

European Psychiatry ◽

10.1016/s0924-9338(11)72582-2 ◽

2011 ◽

Vol 26 (S2) ◽

pp. 877-877

Author(s):

O. Mouzas ◽

M.N. Papaliaga ◽

A. Zibis ◽

G. Hadjigeorgiou ◽

N. Angelopoulos ◽

...

Keyword(s):

Psychological Distress ◽

White Matter ◽

Femoral Head ◽

Brain Mri ◽

General Health Questionnaire ◽

White Matter Lesions ◽

Self Report ◽

Cerebral White Matter ◽

Mri Findings ◽

Femoral Head Osteonecrosis

BackgroundThe aim of the present study was to investigate clinical parameters in relation to personality characteristics and psychopathology, in patients with non traumatic osteonecrosis of the femoral head (ONFH), with and without cerebral white matter lesions (WML).MethodsSixty seven patients participated in the study, 48 males and 19 females. The mean age was 37.6 years (SD 10.92, range: 15–61). Seventy five healthy individuals age and sex matched, served as controls. Socio-demographic information, clinical data and brain MRI findings were collected. The following self-report instruments were used: General Health Questionnaire (GHQ-28) and Defense Style Questionnaire (DSQ).ResultsThe odds of being assessed with a psychiatric diagnosis upon interview were three times greater among patients with ONFH compared to healthy controls (p < .006). The presence of cerebral WML and secondary nature of ONFH were associated with intense symptoms of psychological distress and especially with somatic symptoms of depression and social dysfunction (p < .003). A specific personality structure was identified in patients with ONFH.ConclusionsPatients suffering from osteonecrosis of femoral head, especially when white matter lesions are present, often present psychological distress and problematic personality organization. Therefore psychological support and/or psychiatric intervention can be beneficial to these individuals.

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Unusual neurological manifestations of bilateral medial medullary infarction: A case report

Open Medicine ◽

10.1515/med-2021-0382 ◽

2022 ◽

Vol 17 (1) ◽

pp. 119-123

Author(s):

Ruizhi Zheng ◽

Ting Zhang ◽

Xianzhu Zeng ◽

Miao Yu ◽

Zhao Jin ◽

...

Keyword(s):

Early Stage ◽

Brain Mri ◽

Resonance Imaging ◽

Mri Findings ◽

Rare Type ◽

Acute Ischemic Stroke Patient ◽

Medial Medullary Infarction ◽

Functional Consequences ◽

Magnetic Resonance Imaging Mri ◽

Medullary Infarction

Abstract Bilateral medial medullary infarction (BMMI) is an extremely rare type of cerebrovascular accident often resulting in poor functional consequences. “Heart appearance” on diffusion-weighted imaging (DWI) of magnetic resonance imaging (MRI) is the unique presentation of BMMI. In this article, we present an acute ischemic stroke patient whose brain MRI showed the atypical “heart appearance” sign, manifested unusual bilateral central facial paralysis concurrently. For an early diagnosis of BMMI, it is essential to recognize the characteristic clinical and MRI findings of this rare type of stroke. Abnormal small dot or linear DWI signal at the midline of the brainstem should not be ignored at the early stage of stroke.

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Intracranial meningioma in a pet rat: MRI findings

Veterinární Medicína ◽

10.17221/191/2020-vetmed ◽

2021 ◽

Author(s):

C Cococcetta ◽

F Del Signore ◽

I Cerasoli ◽

G Di Guardo ◽

M Baffoni ◽

...

Keyword(s):

Brain Mri ◽

Granular Cell ◽

Intracranial Meningioma ◽

Granular Cell Tumour ◽

Resonance Imaging ◽

Mri Findings ◽

Axial Mass ◽

Brain Compression ◽

Magnetic Resonance Imaging Mri ◽

Well Differentiated

We herein report the magnetic resonance imaging (MRI) findings in a brain meningioma in a pet rat (Rattus norvegicus domestica). A 1.5-year-old pet rat was referred for depression, ataxia, tremors and bilateral nystagmus; a brain MRI was elected suspecting an intracranial neoplasia. The study was performed with a 0.25 T scanner. The MRI revealed a well-defined oval mass with a heterogeneous appearance, hyperintense in T1 and T2, and with extra-axial localisation and severe brain compression, the mass appeared strongly and diffusely contrast-enhancing. Euthanasia was elected, with the necropsy confirming the presence of a voluminous extra-axial mass. Histologically, a well-differentiated, benign meningotheliomatous meningioma was diagnosed, with the histochemical stains allowing one to exclude a granular cell tumour. To the best of our knowledge, this is the first report of MRI investigations on a pet rat intracranial meningioma.

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Pelizaeus-Merzbacher Disease: A Case Report

Case Reports in Clinical Practice ◽

10.18502/crcp.v5i2.3841 ◽

2020 ◽

Author(s):

Ghazaleh Jamalipour Soufi ◽

Siavash Iravan

Keyword(s):

Case Report ◽

White Matter ◽

Brain Mri ◽

Brain Magnetic Resonance Imaging ◽

Proteolipid Protein ◽

Radiology Department ◽

Magnetic Resonance Imaging Mri ◽

Normal White Matter ◽

Pelizaeus Merzbacher Disease ◽

The Brain

Pelizaeus-Merzbacher Disease (PMD), as a rare genetically x-linked leukodystrophy, is a disorder of proteolipid protein expression in myelin formation. This disorder is clinically presented by neurodevelopmental delay and abnormal pendular eye movements. The responsible gene for this disorder is the proteolipid protein gene (PLP1). Our case was a oneyear-old boy referred to the radiology department for evaluating the Central Nervous System (CNS) development by brain Magnetic Resonance Imaging (MRI). Clinically, he demonstrated neuro-developmental delay symptoms. The brain MRI results indicated a diffuse lack of normal white matter myelination. This case report should be considered about the possibilityof PMD in the brain MRI of patients who present a diffuse arrest of normal white matter myelination.

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