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.

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.

scholarly journals Prevalence of Cerebral Microbleeds in Thai Patients with Ischemic Stroke

2017 ◽  
Vol 08 (02) ◽  
pp. 216-220 ◽  
Author(s):  
Artit Potigumjon ◽  
Arvemas Watcharakorn ◽  
Pornpatr A. Dharmasaroja
Keyword(s):  
Ischemic Stroke ◽  
White Matter ◽  
Magnetic Resonance ◽  
White Matter Lesions ◽  
Cerebral Microbleeds ◽  
National Institutes Of Health ◽  
Asian Origin ◽  
Chinese Study ◽  
Japanese Studies ◽  
Magnetic Resonance Imaging Mri

ABSTRACT Background: With the widespread use of magnetic resonance imaging (MRI), cerebral microbleeds (CMBs) are commonly detected. Ethnicity seems to play a role in the prevalence of CMB, with higher prevalence in participants from Asian origin. The purpose of the study is to look for the prevalence of CMBs and associated factors in Thai patients with ischemic stroke. Methods: Patients with acute ischemic stroke who had MRI and magnetic resonance angiography during January–August 2014 were included in the study. T2*-weighted gradient-recalled echo was used to define CMBs. Baseline characteristics, stroke subtypes, and severity of white matter lesions were compared between patients with and without CMBs. Results: Two hundred patients were included in the study. Mean age of the patients was 61-year-old. Mean National Institutes of Health Stroke Scale was 8. The prevalence of CMBs was 20% (39/200 patients). Hypertension (odds ratio [OR] 3.05, 95% confidence interval [CI] 1.07–8.68, P = 0.037), and moderate-to-severe white matter lesions (Fazekas 2–3, OR 7.61, 95% CI 3.06–18.95, P < 0.001) were related to the presence of CMBs. Conclusions: CMBs were found in 20% of patients with ischemic stroke, which was lower than those reported from Japanese studies but comparable to a Chinese study. CMBs were associated with hypertension and severity of the white matter lesions.

Posterior Reversible Encephalopathy (PRES) in a Child with Severe Dengue

2019 ◽  
Vol 66 (3) ◽  
pp. 322-326
Author(s):  
Yogini Sawant ◽  
Suresh Birajdar ◽  
Hiren Doshi ◽  
Pooja Soni ◽  
Deepak Patkar ◽  
...  
Keyword(s):  
Pediatric Population ◽  
White Blood Cells ◽  
Neurological Complications ◽  
Severe Dengue ◽  
Mri Findings ◽  
Posterior Reversible Encephalopathy ◽  
Magnetic Resonance Imaging Mri ◽  
Mri Changes ◽  
Reversible Encephalopathy ◽  
Csf Examination

Abstract Among neurological complications associated with dengue, posterior reversible encephalopathy syndrome (PRES) has not been reported in pediatric population. We report a 10-year-old girl with severe dengue who developed PRES. The patient presented with hemorrhagic shock that required fluid resuscitation and inotropic support. She developed seizures with encephalopathy 2 days after recovering from the shock. Cerebrospinal fluid (CSF) examination was negative for dengue (no white blood cells in CSF with negative polymerase chain reaction for dengue). Her clinical features and magnetic resonance imaging (MRI) findings showed typical changes associated with posterior encephalopathy that reverted after resolution of hypertension. Repeat MRI after a month was normal. PRES should be considered as a possible differential diagnoses of dengue associated encephalopathy, especially in cases with normal CSF examination and characteristic MRI changes.

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

2019 ◽  
Vol 47 (8) ◽  
pp. 3681-3689 ◽  
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.

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

2019 ◽  
Vol 7 ◽  
pp. 232470961986826 ◽  
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.

Ischemic White Matter Lesions Associated With Medullary Arteries: Classification of MRI Findings Based on the Anatomic Arterial Distributions

2017 ◽  
Vol 209 (3) ◽  
pp. W160-W168 ◽  
Author(s):  
Toshiaki Akashi ◽  
Shoki Takahashi ◽  
Shunji Mugikura ◽  
Shiho Sato ◽  
Takaki Murata ◽  
...  
Keyword(s):  
White Matter ◽  
White Matter Lesions ◽  
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.

scholarly journals In vivo detection of connectivity between cortical and white matter lesions in early MS

2016 ◽  
Vol 23 (7) ◽  
pp. 973-981 ◽  
Author(s):  
Jan-Mendelt Tillema ◽  
Stephen D Weigand ◽  
Jay Mandrekar ◽  
Yunhong Shu ◽  
Claudia F Lucchinetti ◽  
...  
Keyword(s):  
White Matter ◽  
Diffusion Tensor ◽  
White Matter Lesions ◽  
Cortical Lesion ◽  
In Vivo Detection ◽  
Relapsing Remitting ◽  
Mri Scans ◽  
Healthy Control ◽  
Magnetic Resonance Imaging Mri

Background: The relationship between cortical lesions (CLs) and white matter lesions (WMLs) in multiple sclerosis (MS) is poorly understood. Pathological studies support a topographical association between CLs and underlying subcortical WMLs and suggest CLs may play a role in both disease initiation and progression. We hypothesized that cortical MS lesions are physically connected to white matter MS lesions via axonal connections. Objective: To assess the presence of CL-WML connectivity utilizing novel magnetic resonance imaging (MRI) methodology. Methods: In all, 28 relapsing-remitting MS patients and 25 controls received 3 T MRI scans, including double inversion recovery (DIR) for CL detection coupled with diffusion tensor imaging (DTI). CL and WML maps were created, and DTI was used to calculate inter-lesional connectivity and volumetric connectivity indices. Results: All patients showed inter-lesional WML connectivity (median 76% of WMLs connected to another WML; interquartile range (IQR), 58%–88%). On average, 52% of detected CLs per patient were connected to at least one WML (IQR, 42%–71%). Volumetric connectivity analysis showed significantly elevated cortical lesion ratios in MS patients (median, 2.3; IQR, 1.6–3.3) compared to null MS and healthy control datasets ( p < 0.001). Conclusion: These findings provide strong evidence of inter-lesional connectivity between CLs and WMLs, supporting our hypothesis of intrinsic CL-WML connectivity.

MRI white matter lesions in pediatric migraine

Cephalalgia ◽  
2013 ◽  
Vol 33 (11) ◽  
pp. 906-913 ◽  
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.

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

2014 ◽  
Vol 6 (4) ◽  
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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