scholarly journals Neuroimaging Insights Into Early Stages of HIV-Progressive Multifocal Leukoencephalopathy: A Case Report

2020 ◽  
Vol 12 ◽  
pp. 117957352093933
Author(s):  
Natalia Gonzalez Caldito ◽  
J Scott Loeb ◽  
Darin T Okuda
Keyword(s):  
Progressive Multifocal Leukoencephalopathy ◽  
Early Recognition ◽  
Brain Mri ◽  
Disease Evolution ◽  
Early Stages ◽  
Mri Features ◽  
Fluid Attenuated Inversion Recovery ◽  
Magnetic Resonance Imaging Mri ◽  
Punctate Pattern ◽  
The Right

This report aims to enhance the understanding of early longitudinal neuroimaging features of progressive multifocal leukoencephalopathy (PML) in human immunodeficiency virus (HIV). Neuroimaging has become crucial in the diagnosis and early recognition of PML. Recognition of magnetic resonance imaging (MRI) features in the early stages of PML is paramount to avoid misdiagnosis and facilitate the delivery of treatments aimed at reducing disease progression. A 49-year-old white man with HIV presented with 4-month progressive left-sided weakness. Neurological examination revealed mild cognitive impairment, left-sided hemiparesis, and somatosense impairment to all modalities. Brain MRI revealed a punctate pattern with innumerable T2-FLAIR (fluid attenuated inversion recovery) hyperintensities in the cortex, brainstem, cerebellum, subcortical, and periventricular areas. Susceptibility-weighted imaging (SWI) revealed hypointensities involving subcortical U-fibers and cortical architecture. A comprehensive diagnostic evaluation was inconclusive. John Cunningham virus (JCV) PCR in cerebrospinal fluid (CSF) was indeterminate. He was started on antiretroviral therapy. Repeat brain MRI performed 1.5 months later, in the setting of further neurological decline, demonstrated progression of the T2-hyperintensities into a large confluent white matter lesion in the right frontoparietal lobe. Despite an indeterminate JCV PCR, the appearance and characteristic progression of the lesions in successive imaging in the setting of severe immunosuppression, with extensive negative infectious workup, was indicative of PML. This clinical experience illustrates unique neuroimaging features of HIV-PML in early stages and its progression over time. It especially highlights the relevance of the SWI sequence in the diagnosis and features observed with disease evolution. Short-term imaging follow-up may assist with the recognition of MRI features consistent with the biology of the infection.

scholarly journals Punctate pattern and Milky Way appearance caused by PML in a patient with AIDS

2021 ◽  
Author(s):  
João Henrique Fregadolli Ferreira ◽  
André Franzoi ◽  
Bernardo Corrêa de Almeida Teixeira ◽  
Tamires Maier Silva Ferreira ◽  
Mariana de Moura Souza ◽  
...  
Keyword(s):  
Milky Way ◽  
Jc Virus ◽  
Brain Mri ◽  
Mass Effect ◽  
Final Diagnosis ◽  
Cd4 Cell Count ◽  
Magnetic Resonance Imaging Mri ◽  
Punctate Pattern ◽  
The Right ◽  
Cd4 Cell

Introduction: Progressive multifocal leukoencephalopathy (PML) is an opportunistic infection caused by reactivation of JC virus in the central nervous system and is an important differential diagnosis in patients with subacute focal neurologic deficits. Magnetic resonance imaging (MRI) is the most sensitive tool for detection of early manifestations of the disease1 . Case Report: A 42-year-old woman with a previous diagnosis of HIV infection, without treatment for the last two years, presented with progressive headache, left hemiparesis, hypoesthesia and homonymous hemianopia in the last two months. CD4 cell count was 16 cel/mm3 and viral load of 99.364 copies/mL. Brain MRI revealed multifocal, subcortical and confluent hyperintense T2/FLAIR lesions in the right parietooccipital lobe, crossing the midline by the corpus callosum, with hyperintense peripheral rim on DWI-image and a central hypointense core, without mass effect. On T2-weighted image, typical multiple punctiform hyperintensities formed the Punctate Pattern, which is known as the Milky Way appearance when nearby a larger PML lesion. The final diagnosis was confirmed by the detection of JC virus on cerebrospinal fluid by PCR. Discussion: The punctate pattern is characterized by at least three punctiform (<5mm) hyperintense lesions on T2/FLAIR images, with or without contrast enhancement. It has already been described in PML, neurosarcoidosis, hematologic diseases, CLIPPERS and CNS vasculitis. Recently it was described as a highly specific feature of PML related to natalizumab, even in pre-symptomatic stages. Further studies are required stablish its incidence in patients with PML from other causes2.

scholarly journals Juxtacortical susceptibility changes in progressive multifocal leukoencephalopathy at the gray–white matter junction correlates with iron-enriched macrophages

2021 ◽  
pp. 135245852199965
Author(s):  
Kedar R Mahajan ◽  
Moein Amin ◽  
Matthew Poturalski ◽  
Jonathan Lee ◽  
Danielle Herman ◽  
...  
Keyword(s):  
White Matter ◽  
Progressive Multifocal Leukoencephalopathy ◽  
Central Nervous System Lymphoma ◽  
Susceptibility Weighted Imaging ◽  
Resonance Imaging ◽  
Gradient Echo ◽  
Total N ◽  
Mri Brain ◽  
Fluid Attenuated Inversion Recovery ◽  
Magnetic Resonance Imaging Mri

Objective: Describe magnetic resonance imaging (MRI) susceptibility changes in progressive multifocal leukoencephalopathy (PML) and identify neuropathological correlates. Methods: PML cases and matched controls with primary central nervous system lymphoma (PCNSL) were retrospectively identified. MRI brain at 3 T and 7 T were reviewed. MRI-pathology correlations in fixed brain autopsy tissue were conducted in three subjects with confirmed PML. Results: With PML ( n = 26 total, n = 5 multiple sclerosis natalizumab-associated), juxtacortical changes on susceptibility-weighted imaging (SWI) or gradient echo (GRE) sequences were noted in 3/3 cases on 7 T MRI and 14/22 cases (63.6%) on 1.5 T or 8/22 (36.4%) 3 T MRI. Similar findings were only noted in 3/25 (12.0%) of PCNSL patients (odds ratio (OR) 12.83, 95% confidence interval (CI), 2.9–56.7, p < 0.001) on 1.5 or 3 T MRI. On susceptibility sequences available prior to diagnosis of PML, 7 (87.5%) had changes present on average 2.7 ± 1.8 months (mean ± SD) prior to diagnosis. Postmortem 7 T MRI showed SWI changes corresponded to areas of increased iron density along the gray–white matter (GM-WM) junction predominantly in macrophages. Conclusion: Susceptibility changes in PML along the GM-WM junction can precede noticeable fluid-attenuated inversion recovery (FLAIR) changes and correlates with iron accumulation in macrophages.

scholarly journals Two cases of possible neuro-Sweet disease with meningoencephalitis as the initial manifestation

2012 ◽  
Vol 4 (1) ◽  
pp. 5 ◽  
Author(s):  
Go Makimoto ◽  
Yasuhiro Manabe ◽  
Chizuru Yamakawa ◽  
Daiki Fujii ◽  
Yasuko Ikeda-Sakai ◽  
...  
Keyword(s):  
High Intensity ◽  
Skin Lesions ◽  
Pulse Therapy ◽  
Initial Manifestation ◽  
Diffusion Weighted Images ◽  
Fluid Analysis ◽  
Fluid Attenuated Inversion Recovery ◽  
Left Caudate ◽  
Magnetic Resonance Imaging Mri ◽  
The Right

We report 2 cases that were considered to be neuro-Sweet disease. They initially manifested with meningoencephalitis and no skin lesions, and rapidly improved with corticosteroid therapy. In both cases, patients complained of meningitic symptoms such as fever and headache, and HLA-B54 and -Cw1 turned out to be positive over the clinical course. Cerebrospinal fluid analysis showed increased levels of lymphocytes and protein. In case #1, fluid-attenuated inversion recovery (FLAIR), magnetic resonance imaging (MRI) and diffusion-weighted images (DWI) showed high-intensity signals in the right dorsal medulla oblongata, bilateral dorsal midbrain, and left thalamus. In case #2, FLAIR and DWI showed high-intensity signals in the bilateral cerebellar cortex and left caudate nucleus. Symptoms and MRI images were markedly improved in both cases after corticosteroid pulse therapy. According to published diagnostic criteria, these 2 cases were considered possible neuro-Sweet disease. These cases suggest that the combination of meningoencephalitis and HLA specificity is important to consider the possibility of neuro-Sweet disease, even without skin lesions.

scholarly journals Case Report: Anti-NMDAR Encephalitis With Anti-MOG CNS Demyelination After Recurrent CNS Demyelination

2021 ◽  
Vol 12 ◽  
Author(s):  
Bing-Yan Ren ◽  
Yi Guo ◽  
Jing Han ◽  
Qian Wang ◽  
Zai-Wang Li
Keyword(s):  
Case Report ◽  
Brain Mri ◽  
Clinical Manifestations ◽  
Epileptic Seizures ◽  
Autoimmune Disorder ◽  
Pulse Therapy ◽  
Nmdar Encephalitis ◽  
Cns Demyelination ◽  
Magnetic Resonance Imaging Mri ◽  
The Right

Introduction: Anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis, a serious neurological autoimmune disorder caused by autoantibodies with diverse clinical manifestations, may simultaneously onset with antimyelin oligodendrocyte glycoprotein (MOG) demyelination after recurrent central nervous system (CNS) demyelination.Case Report: We present a case of anti-NMDAR encephalitis combining with anti-MOG CNS demyelination following recurrent CNS demyelination. A 38-year-old man admitted to hospital developed epileptic seizures following recurrent episodes of cross-sensory disturbance and dizziness. Magnetic resonance imaging (MRI) showed a demyelinating lesion in the right brainstem initially. Despite a good response to methylprednisolone pulse therapy at the beginning, the patient still had relapses and progression after corticosteroid reduction or withdrawal. Then brain MRI discovered new serpentine lesions involving extensive cerebral cortex on his second relapse. Repeat autoantibodies test indicated cerebrospinal fluid (CSF) NMDAR antibodies coexisted with MOG-Abs simultaneously, suggesting the diagnosis of anti-NMDAR encephalitis with anti-MOG CNS demyelination.Results: After a definite diagnosis, the patient was treated with mycophenolate mofetil (MMF) and corticosteroid. He was discharged after his symptoms ameliorated. No neurological sequels remained, and there were no effects on his activities of daily living after 6 months of immunoregulatory therapy of MMF and corticosteroid.Conclusion: For individuals with recurrent CNS demyelination, especially combining with cortical encephalitis, repeated detection of autoantibodies against AE, and demyelination in CSF/serum can be helpful to enable a definite early diagnosis. For patients who suffer from anti-NMDAR encephalitis combining with anti-MOG CNS demyelination, second-line immunotherapy is recommended when first-line treatment such as steroids, intravenous immunoglobulin G (IVIG) and plasma exchange has been proven ineffective to prevent the relapse of disease.

scholarly journals Pharmacovigilance during treatment of multiple sclerosis: early recognition of CNS complications

2020 ◽  
pp. jnnp-2020-324534
Author(s):  
Martijn T Wijburg ◽  
Clemens Warnke ◽  
Christopher McGuigan ◽  
Igor J Koralnik ◽  
Frederik Barkhof ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Adverse Events ◽  
Early Recognition ◽  
Brain Mri ◽  
Infectious Complications ◽  
Interdisciplinary Management ◽  
Marketing Approval ◽  
Beneficial Effects ◽  
Mri Features ◽  
The Central Nervous System

An increasing number of highly effective disease-modifying therapies for people with multiple sclerosis (MS) have recently gained marketing approval. While the beneficial effects of these drugs in terms of clinical and imaging outcome measures is welcomed, these therapeutics are associated with substance-specific or group-specific adverse events that include severe and fatal complications. These adverse events comprise both infectious and non-infectious complications that can occur within, or outside of the central nervous system (CNS). Awareness and risk assessment strategies thus require interdisciplinary management, and robust clinical and paraclinical surveillance strategies. In this review, we discuss the current role of MRI in safety monitoring during pharmacovigilance of patients treated with (selective) immune suppressive therapies for MS. MRI, particularly brain MRI, has a pivotal role in the early diagnosis of CNS complications that potentially are severely debilitating and may even be lethal. Early recognition of such CNS complications may improve functional outcome and survival, and thus knowledge on MRI features of treatment-associated complications is of paramount importance to MS clinicians, but also of relevance to general neurologists and radiologists.

Segmentation of Brain MRI Using Wavelet Transform and Grammatical Bee Colony

2018 ◽  
Vol 27 (07) ◽  
pp. 1850108 ◽  
Author(s):  
Tapas Si ◽  
Arunava De ◽  
Anup Kumar Bhattacharjee
Keyword(s):  
Magnetic Resonance ◽  
Brain Mri ◽  
Mr Images ◽  
Bee Colony ◽  
Analysis Task ◽  
Trained Classifier ◽  
Skull Stripping ◽  
Segmented Images ◽  
Fluid Attenuated Inversion Recovery ◽  
Magnetic Resonance Imaging Mri

Multimodal Magnetic Resonance Imaging (MRI) is an imaging technique widely used in the diagnosis and treatment planning of patients. Lesion segmentation of brain MRI is one of the most important image analysis task in medical imaging. In this paper, a new method for the supervised segmentation of the lesion in brain MRI using Grammatical Bee Colony (GBC) is proposed. The segmentation process is adversely affected by the presence of noises and intensity inhomogeneities in the Magnetic Resonance (MR) images. Therefore, noises are removed from the images and intensity inhomogeneities are corrected in the pre-processing steps. A set of stationary wavelet features are extracted from the co-registered [Formula: see text]1-weighted ([Formula: see text]-[Formula: see text]), [Formula: see text]2-weighted ([Formula: see text]-[Formula: see text]) and Fluid–Attenuated Inversion Recovery (FLAIR) images after skull stripping. A classifier is evolved using the GBC to classify the tissues as healthy tissues or lesions. The GBC classifier is trained with extracted features. The trained classifier is used to segment the test Magnetic Resonance (MR) image into healthy tissues or lesion regions. Finally, the connected component labeling algorithm is used to extract the lesions from the segmented images in the post-processing step. Effectiveness of the proposed method is tested by identifying the brain lesions from a set of MR images.

scholarly journals Early signs of damage to the brain as a target organ in hypertension

2019 ◽  
Vol 11 (3S) ◽  
pp. 32-37 ◽  
Author(s):  
T. M. Ostroumova ◽  
O. D. Ostroumova ◽  
V. A. Parfenov
Keyword(s):  
Brain Damage ◽  
Diffusion Tensor ◽  
Brain Mri ◽  
Hypertensive Patients ◽  
Early Stages ◽  
Cerebrovascular Complications ◽  
Control Functions ◽  
Magnetic Resonance Imaging Mri ◽  
Function Testing ◽  
The Brain

The paper reviews the data available in the literature on and the results of the authors' own investigations of the signs of brain damage in hypertension in its early stages. The signs of early brain damage in hypertension can be considered as deteriorated control functions, white matter hyperintensities (WMH), as evidenced by the standard modes of magnetic resonance imaging (MRI), decreased fractional anisotropy in the frontal lobes, as shown by diffusion tensor MRI, and reduced cerebral perfusion. The latter two signs are detected even in hypertensive patients without WMH. Cognitive function testing and brain MRI using special regimens make it possible to identify a group of hypertensive patients at higher risk for cerebrovascular complications just in the early stages of the disease.

A comparative study of Japanese multiple sclerosis patients with and without oligoclonal IgG bands

2002 ◽  
Vol 8 (6) ◽  
pp. 459-462 ◽  
Author(s):  
I Nakashima ◽  
K Fujihara ◽  
T Misu ◽  
J Fujimori ◽  
S Sato ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Brain Mri ◽  
White Matter Lesions ◽  
Diffuse White Matter ◽  
Mri Features ◽  
Spinal Form ◽  
Magnetic Resonance Imaging Mri ◽  
Oligoclonal Igg ◽  
Multiple Sclerosis Patients ◽  
Oligoclonal Igg Bands

The cerebrospinal fluid oligoclonal IgG bands (OB) are less frequently observed in Japanese multiple sclerosis (MS) patients compared with Caucasian patients. We studied 40 consecutive Japanese MS patients to investigate the differences in the clinical and magnetic resonance imaging (MRI) features of MS between OB-positive patients and OB-negative ones. Among the 40 patients, 22 (55%) patients were OB-positive by either agarose gel electrophoresis (AGE) or isoelectric focusing (IEF), and 18 (45%) patients were OB-negative by both AGE and IEF. There were differences between the two groups only in the clinical forms of MS, but not in terms of gender, onset age, disease duration, or disease severity. In the OB-negative group, nine (50%) of the patients had the optic-spinal form of MS (OS-MS), but only one patient (4.5%) in the OB-positive group had OS-MS. Although most OB-positive patients showed brain MRI lesions typical of MS, 13 (72%) of the OB-negative patients showed no or few brain MRI lesions and the rest of the OB-negative patients showed atypical MS lesions, such as diffuse white matter lesions or large ring-enhanced lesions. Our results suggest that the majority of OB-negative Japanese MS patients show either no or few brain MRI lesions or atypical brain MRI lesions.

scholarly journals Thermal Index for early non-invasive assessment of brain injury in newborns treated with therapeutic hypothermia: preliminary report

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
W. Walas ◽  
A. Mączko ◽  
Z. Halaba ◽  
M. Bekiesińska-Figatowska ◽  
I. Miechowicz ◽  
...  
Keyword(s):  
Brain Injury ◽  
Therapeutic Hypothermia ◽  
Perinatal Asphyxia ◽  
Brain Mri ◽  
Inversion Recovery ◽  
University Hospital ◽  
Thermal Index ◽  
Fluid Attenuated Inversion Recovery ◽  
Magnetic Resonance Imaging Mri ◽  
Mri Score

AbstractPerinatal asphyxia (PA) is the 3rd most common cause of neonatal death and one of the most common causes of severe neurological impairments in children. Current tools and measurements mainly based on the analysis of clinical evaluation and laboratory and electrophysiological tests do not give consistent data allowing to predict the severity of hypoxic-ischemic encephalopathy (HIE) until a magnetic resonance imaging (MRI) score is performed. The aim of this work is to evaluate the usefulness of the new index, called Thermal Index (TI) in the assessment of the degree of brain damage in newborns in the course of therapeutic hypothermia (TH) due to PA. This was a prospective, observational, pilot study which did not require any changes in the applicable procedures. Analysis has been applied to six newborn babies treated with TH in Neonatal/Paediatric ICU in University Hospital in Opole in 2018 due to PA. They all met criteria for TH according to the current recommendations. Brain MRI was performed after the end of TH when the children were brought back to normal temperature, with the use of a 1.5 T scanner, using T1-, T2-weighted images, fluid-attenuated inversion recovery (FLAIR), inversion recovery (IR), susceptibility-weighted imaging (SWI), and diffusion-weighted imaging (DWI). The images were assessed using MRI score according to the scoring system proposed by Weeke et al. The Thermal Index assessing endogenous heat production was calculated according to the formula proposed in this paper. A high, statistically significant positive correlation was found between MRI scores and TI values (0.98; p = 0.0003) in the 1st hour of therapy. High correlation with MRI assessment, the non-invasiveness of measurements and the availability of results within the first few hours of treatment, allow authors to propose the Thermal Index as a tool for early evaluating of the brain injury in newborns treated with TH. Further research is required to confirm the usefulness of the proposed method.

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