scholarly journals Acute and Chronic Effects of Multiple Concussions on Midline Brain Structures

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012580
Author(s):  
Nathan W Churchill ◽  
Michael G Hutchison ◽  
Simon J Graham ◽  
Tom A Schweizer
Keyword(s):  
Assessment Tool ◽  
Mean Diffusivity ◽  
Brain Structures ◽  
Return To Play ◽  
Post Injury ◽  
Chronic Effects ◽  
History Of ◽  
Magnetic Resonance Imaging Mri ◽  
One Year ◽  
Mri Study

Objective:To test the hypothesis that a history of concussion (HOC) causes greater disturbances in cerebral blood flow (CBF) and white matter microstructure of midline brain structures after subsequent concussions, during the acute and chronic phases of recovery.Methods:In this longitudinal magnetic resonance imaging (MRI) study, 61 athletes with uncomplicated concussion (36 with HOC) were imaged at the acute phase of injury (1 to 7 days post-injury), the subacute phase (8 to 14 days), medical clearance to return to play (RTP), one month post-RTP and one year post-RTP. A normative group of 167 controls (73 with HOC) were also imaged. Each session assessed CBF of the cingulate cortex, along with fractional anisotropy (FA) and mean diffusivity (MD) of the corpus callosum. Linear mixed models tested for interactions of HOC with time post-injury. The sport concussion assessment tool (SCAT) was also used to evaluate effects of HOC on symptoms, cognition and balance.Results:Athletes with HOC had greater declines in midcingulate CBF subacutely (z=-3.29, p=0.002) and greater declines in posterior cingulate CBF at one year post-RTP (z=-2.42, p=0.007). No significant effects of HOC were seen for FA, whereas athletes with HOC had higher MD of the splenium at RTP (z=2.54, p=0.008). These effects were seen in the absence of differences in SCAT domains (|z|<1.14, p>0.256) or time to RTP (z=0.23, p=0.818).Conclusions:Results indicate subacute and chronic effects of HOC on cingulate CBF and callosal microstructure, in the absence of differences in clinical indices. These findings provide new insights into physiological brain recovery after concussion, with cumulative effects of repeated injury detected among young, healthy athletes.

scholarly journals Cutaneous Metastasis in a Previously Known Case of Ovarian Dysgerminoma: A Case Report

2021 ◽  
Vol 14 (10) ◽  
Author(s):  
Farokh Seilanian Toosi ◽  
Malihe Hasanzadeh ◽  
Mona Maftouh ◽  
Ahmadreza Tavassoli
Keyword(s):  
Local Recurrence ◽  
Cutaneous Metastasis ◽  
Mri Findings ◽  
Surgical Incision ◽  
Case Presentation ◽  
Pathologic Evaluation ◽  
History Of ◽  
Ovarian Dysgerminoma ◽  
Magnetic Resonance Imaging Mri ◽  
One Year

Introduction: Cutaneous metastasis is an uncommon manifestation that mostly occurs in patients with previous gastrointestinal or gynecological malignancies. Local recurrence usually can be seen in surgical incisions. Dysgerminomas are rare ovarian tumors that usually have local invasions, but metastases are infrequent. Here, we described a case of dysgerminoma and cutaneous metastasis in the surgical incision. Case Presentation: The patient was a 39-year-old woman previously known as ovarian dysgerminoma, who had undergone surgery one year ago. Ultrasound examination a year after surgery showed a 35 × 33 millimeters hypoechoic solid tumor in the left ovary and another 3 masses with similar echo pattern and vascularity were found in the surgical incision. Magnetic resonance imaging (MRI) findings were compatible with cutaneous metastasis of pervious dysgerminoma. Pathologic evaluation and Immunohistochemistry (IHC) confirmed dysgerminoma's skin metastasis. She received chemotherapy due to the recurrence of malignancy. Conclusions: Local recurrence and metastases (even in the skin) should be kept in mind and the clinician must examine the surgical site skin in patients with a history of malignancy.

scholarly journals Wernicke's encephalopathy with chorea: Neuroimaging findings

2016 ◽  
Vol 10 (4) ◽  
pp. 370-372 ◽  
Author(s):  
Jivago S. Sabatini ◽  
Gustavo Leopold Schutz-Pereira ◽  
Fabrício Feltrin ◽  
Hélio Afonso Ghizone Teive ◽  
Carlos Henrique Ferreira Camargo
Keyword(s):  
Spastic Paraparesis ◽  
Brain Magnetic Resonance Imaging ◽  
Cognitive Disorders ◽  
Disease Evolution ◽  
Course Of Disease ◽  
The Family ◽  
History Of ◽  
Magnetic Resonance Imaging Mri ◽  
One Year ◽  
Sleep Alterations

ABSTRACT We present a case report of motor and cognitive disorders in a 36-year-old woman with a history of twelve years of heavy alcohol abuse. The patient presented depressive symptoms over the course of one year after a loss in the family, evolving with ataxia, bradykinesia and choreiform movements. Progressive cognitive decline, sleep alterations and myalgia were also reported during the course of disease evolution. Physical examination revealed spastic paraparesis with fixed flexion of the hips and knees with important pain upon extension of these joints. Initial investigation suggested the diagnosis of thiamine deficiency by brain magnetic resonance imaging (MRI).

scholarly journals Hirayama disease

2010 ◽  
Vol 01 (01) ◽  
pp. 46-48 ◽  
Author(s):  
Atul T Tayade ◽  
Sushilkumar K Kale ◽  
Arvind Pandey ◽  
Shriprakash Kalantri
Keyword(s):  
Pyramidal Tract ◽  
Posterior Wall ◽  
Cord Compression ◽  
Hirayama Disease ◽  
Dural Sac ◽  
History Of ◽  
Cervical Magnetic Resonance Imaging ◽  
Magnetic Resonance Imaging Mri ◽  
One Year ◽  
Spine Radiographs

ABSTRACTA 17-year-old male, who gave up his favorite sport cricket and started playing football, presented with one-year history of slowly progressive atrophic weakness of forearms and hands. Neurological examination showed weak and wasted arms, forearms and hand but no evidence of pyramidal tract, spinothalmic tract and posterior column lesions. Plain cervical spine radiographs showed no abnormal fi ndings. Cervical magnetic resonance imaging (MRI) showed asymmetric cord atrophy; images obtained with neck fl exed showed the anterior shifting of the posterior wall of the lower cervical dural sac resulting in cord compression. These fi ndings suggest Hirayama disease, a kind of cervical myelopathy related to the fl exion movements of the neck.

scholarly journals Recovery Profiles Following Concussion Among Male Athletes with a Family History of Neurodegenerative Disease: Data from the NCAA-DOD CARE Consortium

Neurology ◽  
2019 ◽  
Vol 93 (14 Supplement 1) ◽  
pp. S13.2-S14
Author(s):  
Adam Harrison ◽  
Steven Broglio ◽  
R. Davis Moore ◽  
Andrew Lapointe ◽  
Michael McCrea
Keyword(s):  
Family History ◽  
Neurodegenerative Disease ◽  
Repeated Measures ◽  
Visual Memory ◽  
Memory Performance ◽  
Return To Play ◽  
Post Injury ◽  
Male Athletes ◽  
Time Interaction ◽  
History Of

ObjectiveLongitudinally assess recovery following concussion in male athletes with fhNDD.BackgroundResearch suggests that a family history of neurodegenerative disease (fhNDD) may predispose an athlete to abnormal recovery following brain injury. However, no one has longitudinally assessed recovery following concussion in male athletes with fhNDD.Design/MethodsData from the NCAA-DOD Grand Alliance: Concussion Assessment, Research, and Education (CARE) Consortium were used to compared male athletes with (n = 51) and without (n = 102) a family history of neurodegenerative disease (Parkinson’s, Alzheimer’s, Non-Alzheimer’s Dementia, and Mild Cognitive Impairment). All athletes completed baseline ImPACT assessments prior to the beginning of their sporting season. Athletes that sustained a concussion were then re-evaluated 24-48 hours post-injury, prior to un-restricted return to play (RTP), and again 6 months post-injury. Athletes without fhNDD were double matched based on age, body mass index, sport category, and concussion history.ResultsRepeated measures ANCOVA models were used to evaluate performance at each post-injury timepoint, while controlling for baseline performance. A group × time interaction was observed for visual memory performance. Post-hoc univariate analyses revealed that male athletes with fhNDD demonstrated significantly poorer visual memory performance 24–48 hours post-injury compared to controls (p ≤ 0.005). Additionally, we found a main effect of group for impulse control, indicating that male athletes with fhNDD demonstrated an increase number of impulse errors at all three post-injury evaluations (p ≤ 0.004). We did not to observe any other group differences (p’s > 0.05).ConclusionsOur results suggest that male athletes with a family history of neurodegenerative disease may exhibit greater post-injury cognitive deficits compared to controls. Additionally, some deficits may persist for at least 6 months post-injury. Further research is warranted to investigate the interaction between family history of neurodegenerative disease and concussion.

scholarly journals Concussion assessment potentially aided by use of an objective multimodal concussion index

2021 ◽  
Vol 5 ◽  
pp. 205970022110043
Author(s):  
Arnaud E Jacquin ◽  
Jeffrey J Bazarian ◽  
Douglas J Casa ◽  
Robert J Elbin ◽  
Gillian Hotz ◽  
...  
Keyword(s):  
Assessment Tool ◽  
Point Of Care ◽  
Objective Assessment ◽  
Normal Activity ◽  
Brain Regions ◽  
Return To Play ◽  
Neurocognitive Performance ◽  
Post Injury ◽  
Care Assessment ◽  
Over Time

Objective Prompt, accurate, objective assessment of concussion is crucial as delays can lead to increased short and long-term consequences. The purpose of this study was to derive an objective multimodal concussion index (CI) using EEG at its core, to identify concussion, and to assess change over time throughout recovery. Methods Male and female concussed ( N = 232) and control ( N = 206) subjects 13–25 years were enrolled at 12 US colleges and high schools. Evaluations occurred within 72 h of injury, 5 days post-injury, at return-to-play (RTP), 45 days after RTP (RTP + 45); and included EEG, neurocognitive performance, and standard concussion assessments. Concussed subjects had a witnessed head impact, were removed from play for ≥ 5 days using site guidelines, and were divided into those with RTP < 14 or ≥14 days. Part 1 describes the derivation and efficacy of the machine learning derived classifier as a marker of concussion. Part 2 describes significance of differences in CI between groups at each time point and within each group across time points. Results Sensitivity = 84.9%, specificity = 76.0%, and AUC = 0.89 were obtained on a test Hold-Out group representing 20% of the total dataset. EEG features reflecting connectivity between brain regions contributed most to the CI. CI was stable over time in controls. Significant differences in CI between controls and concussed subjects were found at time of injury, with no significant differences at RTP and RTP + 45. Within the concussed, differences in rate of recovery were seen. Conclusions The CI was shown to have high accuracy as a marker of likelihood of concussion. Stability of CI in controls supports reliable interpretation of CI change in concussed subjects. Objective identification of the presence of concussion and assessment of readiness to return to normal activity can be aided by use of the CI, a rapidly obtained, point of care assessment tool.

scholarly journals Misdiagnosed Frontal_Transethmoidal Meningoencephalocele : Case Report

2017 ◽  
Vol 1 (1) ◽  
Author(s):  
Enas Hamed Al-Fattani, Tariq Abdulfattah Al-Jammal, Tariq Ah
Keyword(s):  
Folic Acid ◽  
Nasal Obstruction ◽  
Healthcare Providers ◽  
Middle Turbinate ◽  
Complete Healing ◽  
Folic Acid Deficiency ◽  
Nasal Tissue ◽  
History Of ◽  
Magnetic Resonance Imaging Mri ◽  
Mri Study

To enhance awareness of healthcare providers for any baby comes with persistence unilateral nasal obstruction, and take care for him. Methods: A report of rare case for a child presented with an internal nasal mass with maternal history of folic acid deficiency Results:  The diagnosis of transethmoidal encephalocele was confirmed by a computed tomography (CT) and magnetic resonance imaging(MRI). Craniotomy excision and duroplasty, assisted with endonasal endoscopic excision and repair of skull base defect by middle turbinate graft were done. Nasal tissue was taken for Histological examination which confirmed the diagnosis of an encephalocele within the nasal cavity. The patient had recovered with complete healing of grafts with no recurrence and follow up CT after 6 months was normal. Conclusion:   The general physicians and pediatricians must put in consideration any baby with unilateral persistence nasal obstruction which can be frontal-transethmoidal meningocele +/- encephalocele . Taking folic acid or food rich of folate during pregnancy can help in reduction of neural tube defects prevalence.  Radiological imaging (CT +/- MRI) study should be done for every Pediatric case presenting with an intranasal mass before any surgical intervention or an invasive intranasal procedure.

scholarly journals Flying may not affect symptom recovery after concussion in Athletes

Neurology ◽  
2019 ◽  
Vol 93 (14 Supplement 1) ◽  
pp. S23.1-S23
Author(s):  
Tara Sharma ◽  
Julia Kerrigan ◽  
David McArthur ◽  
Thomas McAllister ◽  
Michael McCrea ◽  
...  
Keyword(s):  
College Athletes ◽  
Assessment Tool ◽  
Symptom Burden ◽  
Collegiate Athletes ◽  
Group Differences ◽  
Post Injury ◽  
Significant Group ◽  
Time Zones ◽  
History Of ◽  
Chi Square Analysis

ObjectiveTo determine if there is a relationship between concussion recovery and airplane travel soon after injury in collegiate athletes and military cadets.BackgroundConcussions are a common occurrence in young athletes. Very few studies have examined how flying may influence the clinical progression of a concussive injury.Design/MethodsThis is a prospective cohort study comprised of 3480 college athletes and cadets with concussion obtained from the Concussion Assessment, Research and Education (CARE) Consortium and divided in two groups: those who flew and those who did not fly after concussion. Those with unknown flight status were excluded. Demographics between groups were compared using Chi Square analysis. Symptom burden was calculated by subtracting baseline Sports Concussion Assessment Tool (SCAT3) symptom scores from the post-injury score after flying. Significance between outcome measures and flight status were evaluated using a paired t-test. Analysis of Variance (ANOVA) was used to determine if number of time zones crossed during flight influenced outcomes.Results165 athletes flew 31.8 ± 52.3 [SD] hours after injury, 2235 athletes did not fly, and 1080 had unknown flight status. There were no significant study group differences for age, sex, sport, history of prior concussion, and history of headache. No significant group differences were found in days to return to unrestricted play (p = 0.11), days after injury to start graded exertion (p = 0.50), duration of concussion symptoms (p = 0.23), days until return to normal academic performance (p = 0.75), and symptom burden (p = 0.47). Number of time zones crossed did not affect any outcomes.ConclusionsAirplane travel early after concussion did not significantly affect recovery or severity of concussion symptoms in college athletes and cadets. Further studies need to investigate the possible effects of flying more acutely after injury. These data may help guide future recommendations on flight travel after concussion in athletes.

scholarly journals Motor Speech Apraxia in a 70-Year-Old Man with Left Dorsolateral Frontal Arachnoid Cyst: A [18F]FDG PET-CT Study

2016 ◽  
Vol 2016 ◽  
pp. 1-3
Author(s):  
Nicolaas I. Bohnen ◽  
Jacob Haugen ◽  
Karen Kluin ◽  
Vikas Kotagal
Keyword(s):  
Arachnoid Cyst ◽  
Brain Structures ◽  
Motor Speech ◽  
Left Frontal Lobe ◽  
Neurodegenerative Process ◽  
Positron Emission ◽  
Pet Ct ◽  
History Of ◽  
Magnetic Resonance Imaging Mri ◽  
Fdg Pet Ct

Motor speech apraxia is a speech disorder of impaired syllable sequencing which, when seen with advancing age, is suggestive of a neurodegenerative process affecting cortical structures in the left frontal lobe. Arachnoid cysts can be associated with neurologic symptoms due to compression of underlying brain structures though indications for surgical intervention are unclear. We present the case of a 70-year-old man who presented with a two-year history of speech changes along with decreased initiation and talkativeness, shorter utterances, and dysnomia. [18F]Fluorodeoxyglucose (FDG) Positron Emission and Computed Tomography (PET-CT) and magnetic resonance imaging (MRI) showed very focal left frontal cortical hypometabolism immediately adjacent to an arachnoid cyst but no specific evidence of a neurodegenerative process.

Multiple sclerosis risk in radiologically uncovered asymptomatic possible inflammatory-demyelinating disease

2009 ◽  
Vol 15 (8) ◽  
pp. 918-927 ◽  
Author(s):  
A Siva ◽  
S Saip ◽  
A Altintas ◽  
A Jacob ◽  
BM Keegan ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Demyelinating Disease ◽  
Clinical Symptoms ◽  
Tertiary Care ◽  
Similar Rate ◽  
Randomized Controlled Studies ◽  
History Of ◽  
Magnetic Resonance Imaging Mri ◽  
Mri Study

Background Natural history of patients with incidentally discovered lesions that fulfill magnetic resonance imaging (MRI) criteria for multiple sclerosis (MS) in the absence of objective clinical symptoms suggestive of central nervous system (CNS) inflammatory-demyelinating disease is not well defined. Objective We evaluated the risk of developing symptomatic MS in patients with radiologically uncovered asymptomatic possible inflammatory-demyelinating disease (RAPIDD). Methods We identified and longitudinally followed a cohort of 22 patients from two tertiary care MS centers: Istanbul University, Cerrahpasa School of Medicine, Istanbul, Turkey, and Mayo Clinic, Rochester, Minnesota, after an initial MRI study fulfilling the Barkhof–Tintore MRI criteria completed for other reasons unrelated to MS. Results Eight of 22 patients developed an objective clinical symptom consistent with a CNS inflammatory-demyelinating syndrome and fulfilled dissemination in space and time criteria for definite MS. Median age at the time of diagnosis of MS was 44.8 years (range 28.3–71.4 years). Time taken for the development of definite MS was studied by survival analysis. Cumulative event rates were; 12 months: 9%, 24 months: 15%, 36 months: 30.4%, and 60 months: 44.6%. Six of 22 patients were followed beyond 60 months. Two of these six patients developed MS later (at 66 and 112 months, respectively). Three patients remained asymptomatic despite follow-up of 10 years. Conclusions Patients with RAPIDD develop MS at a similar rate to treated patients (and less frequently than placebo groups) with clinically isolated syndromes from prior randomized controlled studies. Some patients with RAPIDD continue to have radiological evolution of subclinical disease without MS symptoms despite long follow-up periods.

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