Brain involvement by leprosy presenting as a frontal cystic lesion

2014 ◽  
Vol 121 (1) ◽  
pp. 184-188 ◽  
Author(s):  
Kyung-Hwa Lee ◽  
Kyung-Sub Moon ◽  
Sook Jung Yun ◽  
Young Ho Won ◽  
Jae-Hyuk Lee ◽  
...  
Keyword(s):  
Cystic Lesion ◽  
Polymerase Chain Reaction Amplification ◽  
Brain Mri ◽  
Lepromatous Leprosy ◽  
Molecular Evidence ◽  
Low Grade ◽  
Perivascular Spaces ◽  
Cns Involvement ◽  
Nested Polymerase Chain Reaction ◽  
Presumptive Diagnosis

Leprosy has a predilection for peripheral nerves and is not considered to involve the CNS. The idea that the CNS is exempt from Mycobacterium leprae bacilli has been suspected from a clinical perspective or CSF study in leprosy patients. However, there has been no direct evidence for CNS involvement by leprosy in a living patient. To the best of the authors' knowledge, the present case is the first report providing histopathological and molecular evidence for CNS involvement by leprosy in a living patient. Brain MRI revealed a 2-cm cystic lesion in the right frontal lobe of the patient. The medical history revealed that the patient had been receiving multidrug therapy for borderline lepromatous leprosy. Neuronavigation-guided craniotomy and lesion removal were performed due to a presumptive diagnosis of low-grade glioma. The brain specimen demonstrated variably thickened blood vessels and densely scattered foamy macrophages in the perivascular spaces and parenchymal stroma. Fite acid-fast stain displayed red granular inclusions that were suggestive for fragmented M. leprae. M. leprae-specific nested polymerase chain reaction amplification showed positive bands, and DNA sequencing also demonstrated homology with the M. leprae genome. This case supports the notion that M. leprae can involve the cerebral cortex regardless of cranial nerve engagement.

scholarly journals LGG-18. EVEROLIMUS TREATMENT IN PEDIATRIC PATIENTS AFFECTED BY LOW-GRADE GLIOMAS (pLGG) NON-TSC, BRAF v600-WT

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii369-iii369
Author(s):  
Antonella Cacchione ◽  
Evelina Miele ◽  
Maria Chiara Lodi ◽  
Andrea Carai ◽  
Giovanna Stefania Colafati ◽  
...  
Keyword(s):  
Adverse Event ◽  
Disease Progression ◽  
Mapk Pathway ◽  
Brain Mri ◽  
Mammalian Target Of Rapamycin ◽  
Low Grade ◽  
Duration Of Treatment ◽  
Tumor Biopsy ◽  
Low Grade Gliomas ◽  
Personalized Approach

Abstract BACKGROUND MAPK pathway is the hallmark of pediatric low grade gliomas (pLGGs); hyperactivation of mTOR (mammalian target of rapamycin) might be a suitable biomarker for therapeutic response. We investigated the feasibility of Everolimus, mTOR inhibitor, in patients affected by pLGGs. METHODS Patients 1 to 18 years old, diagnosed with pLGG, with a positive tumor biopsy for mTOR/phospho-mTOR and radiological and / or clinical disease progression, treated at Bambino Gesù Children’s Hospital in Rome were evaluated. Tumor DNA methylation analysis was performed in 10 cases. Exclusion criteria included: Tuberous Sclerosis patients, Sub Ependymal Giant Astrocytoma. Everolimus was administered orally at a dose of 2.5 mg or 5 mg daily based on body weight. Patients were evaluated with brain MRI every 4, 8 and 12 months after treatment start and every six months thereafter. RESULTS 16 patients were enrolled from September 2014 and 2019. The median age was 7.5 years old. All patients had at least one adverse event. Events rated as severe (grade 3/4) were reported in 6 patients. Stomatitis was the most frequent adverse event. One patient discontinued treatment due to grade 4 toxicity (ulcerative stomatitis and fatigue). The median duration of treatment was 21 months (4–57 months). Brain MRI evaluations have showed disease stability in 11 patients, partial response in 2 patients and disease progression in 3 patients. CONCLUSIONS Everolimus has proven to be well tolerated and effective treatment in terms of disease stability in patients with pLGGs. It’s also an excellent example of chemo-free personalized approach.

scholarly journals LINC-06. OBSERVATION ONLY IN A PATIENT WITH SUSPECTED LOW GRADE GLIOMA. SHOULD NEUROSURGERY ALWAYS BE THE FIRST STEP IN LOW AND MIDDLE INCOME COUNTRIES?

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii379-iii379
Author(s):  
Carlos Leal - Cavazos ◽  
Jose Arenas-Ruiz ◽  
Oscar Vidal-Gutierrez
Keyword(s):  
Brain Mri ◽  
Internal Capsule ◽  
Pediatric Brain Tumor ◽  
Clinical History ◽  
Low Grade ◽  
Large Tumor ◽  
Middle Income ◽  
Dismal Prognosis ◽  
Close Observation ◽  
The Right

Abstract BACKGROUND Low grade gliomas (LGGs) are the most frequent pediatric brain tumor and they comprise a variety of histologies. Complete surgery is curative but sometimes its location makes it difficult. Recent publications highlight the excellent long-term outcomes of patients with LGGs with complete and incomplete resected tumors. Current strategies are focused on reducing risks of treatment related sequelae. METHOD We describe a patient with a suspected LGG managed by close observation. We describe the case of a 6 year old female with 5 months history of focal onset seizures. During this time a brain MRI was requested and tumor was evidenced. After “tumor diagnosis” was made family visited a handful of private neurosurgeons with a uniformly dismal prognosis and high risk morbidity from procedures offered. When first seen at our Hospital, the clinical history seemed compatible with a LGG and seizures well controlled with antiepileptic drugs. Neurological examination was completely normal. MRI showed a large tumor (7x5x5 cm) hypointense on T1, hyperintense on T2, without contrast enhancement, involving the right temporal lobe white matter, insula, internal capsule, hipoccampus, thalamus and mesencephalus with middle cerebral artery encasement. Interval imaging was proposed and after 4.5 years since diagnosis the tumor has been stable and patient clinically excellent. CONCLUSION Overall survival in pediatric LGGs is excellent and risk of sequelae should always be part of multidisciplinary team considerations. In centers with significant neurosurgical morbidity, biopsy of large tumors that are compatible with LGG may not be required in selected cases.

Fish Intake and MRI Burden of Cerebrovascular Disease in Older Adults

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012916
Author(s):  
Aline Thomas ◽  
Fabrice Crivello ◽  
Bernard Mazoyer ◽  
Stephanie Debette ◽  
Christophe Tzourio ◽  
...  
Keyword(s):  
Factor Analysis ◽  
Cerebrovascular Disease ◽  
Brain Mri ◽  
Large Population ◽  
Population Based ◽  
Fish Intake ◽  
Mixed Data ◽  
Perivascular Spaces ◽  
Intracranial Volume ◽  
Cross Sectional

Background and Objective:Fish intake may prevent cerebrovascular disease (CVD), yet the mechanisms are unclear, especially regarding its impact on subclinical damage. Assuming that fish may have pleiotropic effect on cerebrovascular health, we investigated the association of fish intake with global CVD burden based on brain MRI markers.Methods:This cross-sectional analysis included participants from the Three-City Dijon population-based cohort (aged ≥65 years) without dementia, stroke, or history of hospitalized cardiovascular disease, who underwent brain MRI with automated assessment of white matter hyperintensities, visual detection of covert infarcts, and grading of dilated perivascular spaces. Fish intake was assessed through a frequency questionnaire and the primary outcome measure was defined as the first component of a factor analysis of mixed data applied to MRI markers. The association of fish intake with the CVD burden indicator was studied using linear regressions.Results:In total, 1,623 participants (mean age, 72.3 years; 63% women) were included. The first component of factor analysis (32.4% of explained variance) was associated with higher levels of all three MRI markers. Higher fish intake was associated with lower CVD burden. In a model adjusted for total intracranial volume, compared to participants consuming fish <1 per week, those consuming fish 2-3 and ≥4 times per week had a β = -0.19 (95% CI, -0.37; -0.01) and β = -0.30 (-0.57; -0.03) lower indicator of CVD burden, respectively (P trend <0.001). We found evidence of effect modification by age, so that the association of fish to CVD was stronger in younger participants (65-69 years) and not significant in participants aged ≥75 years. For comparison, in the younger age group, consuming fish 2-3 times a week was roughly equivalent (in opposite direction) to the effect of hypertension.Discussion:In this large population-based study, higher frequency of fish intake was associated with lower CVD burden, especially among participants younger than 75 years, suggesting a beneficial effect on brain vascular health before manifestation of overt brain disease.Classification of Evidence:This study provides Class II evidence that in individuals without stroke or dementia, higher fish intake is associated with lower subclinical CVD at MRI.

scholarly journals Low and high grade glioma segmentation in multispectral brain MRI data

2018 ◽  
Vol 10 (1) ◽  
pp. 110-132 ◽  
Author(s):  
László Szilágyi ◽  
David Iclănzan ◽  
Zoltán Kapás ◽  
Zsófia Szabó ◽  
Ágnes Győrfi ◽  
...  
Keyword(s):  
Early Stage ◽  
Brain Mri ◽  
High Grade Glioma ◽  
Detection Algorithm ◽  
Gabor Wavelet ◽  
Low Grade ◽  
Data Sets ◽  
Morphological Operations ◽  
High Grade ◽  
Mass Screening System

Abstract Several hundreds of thousand humans are diagnosed with brain cancer every year, and the majority dies within the next two years. The chances of survival could be easiest improved by early diagnosis. This is why there is a strong need for reliable algorithms that can detect the presence of gliomas in their early stage. While an automatic tumor detection algorithm can support a mass screening system, the precise segmentation of the tumor can assist medical staff at therapy planning and patient monitoring. This paper presents a random forest based procedure trained to segment gliomas in multispectral volumetric MRI records. Beside the four observed features, the proposed solution uses 100 further features extracted via morphological operations and Gabor wavelet filtering. A neighborhood-based post-processing was designed to regularize and improve the output of the classifier. The proposed algorithm was trained and tested separately with the 54 low-grade and 220 high-grade tumor volumes of the MICCAI BRATS 2016 training database. For both data sets, the achieved accuracy is characterized by an overall mean Dice score > 83%, sensitivity > 85%, and specificity > 98%. The proposed method is likely to detect all gliomas larger than 10 mL.

scholarly journals Neuroimaging abnormalities in patients with Cowden syndrome

2018 ◽  
Vol 8 (3) ◽  
pp. 207-213 ◽  
Author(s):  
Radhika Dhamija ◽  
Steven M. Weindling ◽  
Alyx B. Porter ◽  
Leland S. Hu ◽  
Christopher P. Wood ◽  
...  
Keyword(s):  
White Matter ◽  
Brain Mri ◽  
Cowden Syndrome ◽  
Perivascular Spaces ◽  
Developmental Venous Anomaly ◽  
Cortical Malformation ◽  
Cavernous Malformations ◽  
Clinical Criteria ◽  
Signal Abnormality ◽  
Criteria For Diagnosis

BackgroundWe retrospectively reviewed the neuroimaging findings of patients with Cowden syndrome and determined their frequency in a single cohort.MethodsElectronic medical records were queried from January 1999 to January 2017 to identify patients who fit the clinical criteria for diagnosis of Cowden syndrome with or without a documentedPTENmutation. Patients with brain MRI examinations were then identified.ResultsWe retrospectively identified 44 patients with Cowden syndrome, 22 of whom had neuroimaging for review. Eleven (50%) had Lhermitte-Duclos disease, 4 (18.1%) had meningiomas, 13 (59.1%) had at least one developmental venous anomaly, 3 had cavernous malformations, 2 had evidence of dural arteriovenous fistula, 7 had increased white matter signal abnormalities relative to age (31.8%), 4 had prominent perivascular spaces, cerebellar tonsillar ectopia was present in 7 of 21 (33.3%), and 1 had cortical malformation.ConclusionsIt is important to recognize that in addition to Lhermitte-Duclos disease, other intracranial findings such as multiple venous anomalies, meningiomas, greater than expected white matter signal abnormality, prominent perivascular spaces, and cortical malformations may warrant a thorough evaluation for Cowden syndrome in the appropriate clinical setting. We further recommend that this broader spectrum of intracranial abnormalities be considered for addition to the Cowden syndrome diagnostic criteria at the time of next revision.

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

Stroke ◽  
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.

Abstract TP176: Carotid Arterial Diameters as an Effect Modifier of Pulsatile Hemodynamics and Brain Perivascular Spaces

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Jose Gutierrez ◽  
Chuanhui Dong ◽  
Mitchell Elkind ◽  
Noam Alperin ◽  
Ahmet Bagci ◽  
...  
Keyword(s):  
Arterial Stiffness ◽  
Linear Models ◽  
Brain Mri ◽  
Mechanical Effect ◽  
Brain Parenchyma ◽  
Brain Diseases ◽  
Imaging Biomarkers ◽  
Perivascular Spaces ◽  
The Right ◽  
Arterial Diameters

Introduction: Brain perivascular spaces (PVS) are associated with higher pulse pressures and may be imaging biomarkers of systemic arterial stiffness. We hypothesized that larger proximal arterial diameters act as effect modifiers between downstream PVS and surrogate measures of arterial stiffness. Methods: Stroke-free Northern Manhattan Study participants with brain MRI and carotid ultrasound were analyzed. Perivascular spaces were rated semi-quantitatively as ≤ 3 mm voids on axial T1 images without associated FLAIR hyperintensities. Intracranial brain arterial diameters were measured on MRA. The right common carotid artery (CCA) was assessed by high resolution B-mode ultrasound to obtain systolic and diastolic diameters. CCA stiffness was calculated as a ratio between log n transformed systolic-diastolic blood pressure and (systolic - diastolic diameter)/diastolic diameter. We created generalized linear models using and pulse pressure (PP) and CCA stiffness as predictors as independent variables and right anterior PVS score as the outcome, adjusting for demographics, risk factors, head size. Results: Among 941 participants (N=941, mean age 71 ± 9 year, 60% women, 66% Hispanic), PP was associated with PVS score (B=0.003, P=0.04) in an adjusted model. There was a statistical interaction between PP, right CCA diastolic diameter, and right intracranial arterial diameters as predictors of right anterior PVS score (P=0.03), but this interaction was not significant for posterior fossa PVS score (B=0.015, P=0.191), or when substituting right intracranial arterial diameters with the basilar artery diameter (B=-0.004, P=0.191). The association between PP (P=0.003) or carotid stiffness (P=0.002) with right anterior PVS score was greater among participants with larger right intracranial arterial and larger CCA diameters. Conclusions: Arterial stiffness is related to downstream PVS in those with larger proximal arterial diameters. These results suggest a mechanical effect of pulsatility on brain parenchyma and further studies are needed to enhance our understanding of the link between systemic hemodynamics and brain diseases such as dementia and stroke.

scholarly journals Molecular identification of Toxoplasma gondii in roadkill wild animals in Yucatan, Mexico

2019 ◽  
Vol 6 (1) ◽  
Author(s):  
Marco Antonio Torres-Castro ◽  
Rodrigo Adán Medina-Pinto ◽  
Henry René Noh-Pech ◽  
Fernando I. Puerto ◽  
Roger Iván Rodríguez-Vivas
Keyword(s):  
Toxoplasma Gondii ◽  
Animal Health ◽  
Negative Control ◽  
Molecular Evidence ◽  
Wild Animals ◽  
Intermediate Hosts ◽  
Nested Polymerase Chain Reaction ◽  
Muscle Sample ◽  
Wild Mammals ◽  
Lung Sample

Toxoplasma gondii is an obligate intracellular protozoan parasite, recognized as the etiologic agent of toxoplasmosis, a zoonotic endemic disease in several countries, including Mexico. In the Yucatan State of Mexico, Toxoplasma infection has a high impact in both human and domestic animal health. Wild animals can also host zoonotic pathogens such as Toxoplasma gondii. The presence of Toxoplasma gondii DNA in roadkill wild animals in Yucatan was detected using a nested Polymerase Chain Reaction. Toxoplasma gondii DNA was identified in several organs retrieved from a Yucatan squirrel (Sciurus yucatanensis), a coatimundi (Nasua narica), and a greater grison (Galictis vittata). The amplified fragments of Toxoplasma gondii DNA were purified, sequenced, and certified by BLAST analysis. Our results confirm that Toxoplasma gondii can infect wild mammals from Yucatan, which could act as intermediate hosts and contribute to the transmission of the disease to humans and domestic animals, as well as other wild animal species. We present the first molecular evidence of Toxoplasma gondii in a squirrel and a coatimundi from Yucatan, and quite possibly in a greater grison at a global level.Figure 1. Agarose gel presenting PCR amplicons (560 bp) positive to Toxoplasma gondii. 1) C+: positive control; A: Yucatan squirrel liver sample; B: great grison femoral muscle sample; C: coatimundi kidney sample; C-: negative control. 2) A: Yucatan squirrel brain sample; B: great grison lung sample; C-: negative control.

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