scholarly journals Acute disseminated encephalomyelitis following endonasal resection of a craniopharyngioma: illustrative case

2021 ◽  
Vol 2 (16) ◽  
Author(s):  
Konrad Gag ◽  
Jonas Müller ◽  
Marie Süße ◽  
Robert Fleischmann ◽  
Henry W. S. Schroeder
Keyword(s):  
White Matter ◽  
White Matter Lesions ◽  
Acute Disseminated Encephalomyelitis ◽  
Intravenous Immunoglobulins ◽  
Neurological Deficits ◽  
Illustrative Case ◽  
Sensorimotor Deficits ◽  
Fluid Analysis ◽  
Magnetic Resonance Imaging Mri

BACKGROUND Acute disseminated encephalomyelitis (ADEM) is a rare, acquired demyelination syndrome that causes cognitive impairment and focal neurological deficits and may be fatal. The potentially reversible disease mainly affects children, often after vaccination or viral infection, but may be seen rarely in adults. OBSERVATIONS A 50-year-old woman presented with loss of visual acuity of the left eye. Magnetic resonance imaging (MRI) revealed an intra- and suprasellar mass, which was removed successfully. On postoperative day 1, MRI showed gross total resection of the lesion and no surgery-related complications. On postoperative day 2, the patient presented with a progressive left-sided hemiparesis, hemineglect, and decline of cognitive performance. MRI showed white matter edema in both hemispheres. Cerebrospinal fluid analysis revealed mixed pleocytosis (355/µL) without further evidence of infection. In synopsis of the findings, ADEM was diagnosed and treated with intravenous immunoglobulins. Shortly thereafter, the patient recovered, and no sensorimotor deficits were detected in the follow-up examination. LESSONS Pituitary gland pathologies are commonly treated by transsphenoidal surgery, with only minor risks for complications. A case of ADEM after craniopharyngioma resection has not been published before and should be considered in case of progressive neurological deterioration with multiple white matter lesions.

scholarly journals White matter lesions in Fabry disease before and after enzyme replacement therapy: a 2-year follow-up

2006 ◽  
Vol 64 (3b) ◽  
pp. 711-717 ◽  
Author(s):  
Laura B. Jardim ◽  
Flávio Aesse ◽  
Leonardo M. Vedolin ◽  
Cláudio Pitta-Pinheiro ◽  
João Marconato ◽  
...  
Keyword(s):  
White Matter ◽  
Enzyme Replacement Therapy ◽  
Fabry Disease ◽  
Replacement Therapy ◽  
White Matter Lesions ◽  
Resonance Imaging ◽  
Enzyme Replacement ◽  
Before And After ◽  
Magnetic Resonance Imaging Mri

PURPOSE: To report the clinical and neuroimaging, central nervous system (CNS) findings of patients with Fabry disease (FD) during 24 months of enzyme replacement therapy (ERT) with agalsidase-alpha. METHOD: Eight patients were included. Six completed 24 months of ERT. Clinical and magnetic resonance imaging (MRI) data were obtained at 0, 12 and 24 months of ERT. White matter lesions (WML) were evaluated as well as their relation to age, symptoms and neurological examination (CNS score). RESULTS: MRI was stable in 3 patients. WML and CNS score worsened in one patient, fluctuated in another, and improved in the sixth patient. In the whole series, there were 15 WML at baseline, and 19 at the 24th month. In two years, 4 lesions disappeared, whereas 8 appeared. CONCLUSION: A widespread pattern of silent WML in FD was seen. In two years, some WML appeared, and some disappeared. If these phenomena were related to the natural history, remains to be demonstrated.

scholarly journals The utility of diffusion tractography for speech preservation in laser ablation of the dominant insula: illustrative case

2021 ◽  
Vol 1 (19) ◽  
Author(s):  
Timothy J. Kaufmann ◽  
Vance T. Lehman ◽  
Lily C. Wong-Kisiel ◽  
Panagiotis Kerezoudis ◽  
Kai J. Miller
Keyword(s):  
Laser Ablation ◽  
White Matter ◽  
Diffusion Tensor ◽  
Neurological Deficits ◽  
Illustrative Case ◽  
Dominant Hemisphere ◽  
White Matter Tracts ◽  
Dti Tractography ◽  
Magnetic Resonance Imaging Mri ◽  
Open Surgical Treatment

BACKGROUND Open surgical treatment of insular epilepsy holds particular risk of injury to middle cerebral artery branches, the operculum (through retraction), and adjacent language-related white matter tracts in the language-dominant hemisphere. Magnetic resonance imaging (MRI)-guided laser interstitial thermal therapy (LITT) is a surgical alternative that allows precise lesioning with potentially less operative risk. The authors presented the case of a 13-year-old girl with intractable, MRI-negative, left (dominant hemisphere) insular epilepsy that was treated with LITT. Diffusion tensor imaging (DTI) tractography was used to aid full posterior insular lesioning in the region of stereo electroencephalography–determined seizure onset while avoiding thermal injury to the language-related superior longitudinal fasciculus (SLF)/arcuate fasciculus (AF) and inferior fronto-occipital fasciculus (IFOF). OBSERVATIONS DTI tractography was used successfully in planning insular LITT and facilitated a robust insular ablation with sharp margins at the interfaces with the SLF/AF and IFOF. These tracts were spared, and no neurological deficits were induced through LITT. LESSONS Although it is technically demanding and has important limitations that must be understood, clinically available DTI tractography adds precision and confidence to insular laser ablation when used to protect important language-related white matter tracts.

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.

scholarly journals Limbic encephalitis with relapsing polychondritis: persistent white matter lesions and brain atrophy

2018 ◽  
Vol 46 (12) ◽  
pp. 5297-5302 ◽  
Author(s):  
Zilong Zhu ◽  
Decai Tian ◽  
Ning Ren ◽  
Zhihong Zhao ◽  
Xin Wang ◽  
...  
Keyword(s):  
White Matter ◽  
Limbic Encephalitis ◽  
Relapsing Polychondritis ◽  
White Matter Lesions ◽  
Autoimmune Disorder ◽  
Current Case ◽  
System Manifestation ◽  
Temporal Lobe Lesions ◽  
Chinese Male

Relapsing polychondritis (RP) is a rare autoimmune disorder affecting cartilage. Limbic encephalitis is a rare central nervous system manifestation of RP. This current case report describes a 66-year-old Chinese male patient who complained of developing myoclonus in the left leg, ataxia and speech difficulties 3 weeks prior to hospital admission. The patient presented with cognitive impairment, sleep disorder and extrapyramidal symptoms. The patient was diagnosed with RP that affected auricular cartilage, which also manifested as limbic encephalitis. Magnetic resonance imaging showed bilateral temporal lobe lesions involving the hippocampi and basal ganglia. Signal abnormalities in the white matter persisted during the 15-month follow-up period after treatment with corticosteroids and intravenous immunoglobulin. Over the same period, the bilateral hippocampi showed significant atrophy.

scholarly journals Multifocal Balo's Concentric Sclerosis in Children: Report of a Case and Review of Literature

2017 ◽  
Vol 08 (S 01) ◽  
pp. S136-S138
Author(s):  
Sanjeev Kumar Bhoi ◽  
Suprava Naik ◽  
Jayantee Kalita ◽  
U. K. Misra
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Sclerosis ◽  
Acute Disseminated Encephalomyelitis ◽  
Review Of Literature ◽  
Resonance Imaging ◽  
Concentric Pattern ◽  
Baló’S Concentric Sclerosis ◽  
Magnetic Resonance Imaging Mri ◽  
Post Infectious

ABSTRACTBalo's concentric sclerosis (BCS) is a rare demyelinating lesion considered to be a variant of multiple sclerosis (MS). On magnetic resonance imaging (MRI) Balo's concentric sclerosis shows the typical concentric pattern. We report a case of 10 year old child with BCS who presented as post infectious acute disseminated encephalomyelitis (ADEM). He is asymptomatic and had no relapse after 6 years of follow-up.

White Matter Changes and Cognitive Decline in a Ten-Year Follow-Up Period: A Pilot Study on a Single-Center Cohort from the Leukoaraiosis and Disability Study

2016 ◽  
Vol 41 (5-6) ◽  
pp. 303-313
Author(s):  
Sofia Madureira ◽  
Ana Verdelho ◽  
Carla Moleiro ◽  
Catarina Santos ◽  
Philip Scheltens ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
White Matter ◽  
Verbal Learning ◽  
White Matter Lesions ◽  
Disease Assessment ◽  
California Verbal Learning Test ◽  
Clinical Diagnoses ◽  
Neuropsychological Predictors ◽  
Learning Test

Aims: To describe the contribution of white matter lesions to the long-term neuropsychological profiles of different groups of clinical diagnoses, and to identify neuropsychological predictors of cognitive impairment in a 10-year follow-up. Methods: The Lisbon subcohort of the Leukoaraiosis and Disability (LADIS) study was re-evaluated performing a clinical, functional and cognitive evaluation [including Mini-Mental State Examination (MMSE), Alzheimer's Disease Assessment Scale - Cognition (ADAS-Cog) and ADAS-Cog with the extension for vascular impairment (VADAS-Cog), the 9-word version of the California Verbal Learning Test (CVLT-9), the Trail-Making test and the Stroop test] as well as an MRI scan. Using clinical diagnostic criteria, participants were identified as having no cognitive impairment (NI), cognitive impairment but no dementia (CIND) or dementia (DEM), and the effect of time on clinical diagnosis and neuropsychological profiles was analyzed. Results: From the initial group of 66 participants, 37 out of 41 survivors (90%) were re-evaluated (mean age 81.40 years, 57% women). Fifteen patients (41%) had DEM, 12 (32%) CIND and 10 (27%) NI. Over time, the three groups presented distinct profiles in the MMSE [F2, 62 = 15.85, p = 0.000], ADAS [F2, 62 = 15.85, p = 0.000] and VADAS [F2, 48 = 5.87, p = 0.008]. Logistic regression analysis identified higher scores on MMSE (β = 1.14, p = 0.03, OR = 3.13, 95% CI 1.09-8.97) as predictors of NI after 10 years of follow-up. Conclusion: Higher scores on baseline MMSE were the only neuropsychological predictors of NI after 10 years.

Lower urinary tract dysfunction in acute disseminated encephalomyelitis

2009 ◽  
Vol 15 (9) ◽  
pp. 1118-1122 ◽  
Author(s):  
JN Panicker ◽  
D Nagaraja ◽  
JME Kovoor ◽  
KPS Nair ◽  
DK Subbakrishna
Keyword(s):  
Urinary Tract ◽  
Functional Outcome ◽  
Lower Limb ◽  
Lower Urinary Tract ◽  
Voiding Dysfunction ◽  
Acute Disseminated Encephalomyelitis ◽  
Neurological Deficits ◽  
Lower Urinary Tract Dysfunction ◽  
Lower Urinary

Background Lower urinary tract dysfunction (LUTD) in multiple sclerosis has been well documented. However, its occurrence and outcome in acute disseminated encephalomyelitis (ADEM) has only been variably reported. Objective To evaluate LUTD in ADEM, correlation with other neurological deficits, and outcome. Methods Patients with ADEM having significant LUTD were evaluated. LUTD was evaluated by symptom analysis, ultrasonography, and urodynamics. Storage symptoms were managed using antimuscarinics and significant voiding dysfunction by catheterization. Results Of 61 patients, 20 (33%) had LUTD. Voiding dysfunction was more common and 16 patients were in urinary retention. Cystometry demonstrated detrusor overactivity in four patients and underactivity in four patients. Incontinence was reported more often in patients with frontoparietal white matter changes in MR imaging. LUTD was found to be associated with occurrence of paraparesis or tetraparesis, though did not predict functional outcome at discharge. At 3 months follow up, five patients continued to have LUTD and urgency and hesitancy were commonest symptoms. Conclusion LUTD is common in ADEM, especially in patients with lower limb pyramidal involvement and its causes multifactorial. Presence of LUTD does not influence the functional outcome of patients with ADEM. Recovery may be incomplete and symptoms may persist even after recovery of other neurological deficits.

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.

scholarly journals White matter volume changes in people who develop psychosis

2008 ◽  
Vol 193 (3) ◽  
pp. 210-215 ◽  
Author(s):  
Mark Walterfang ◽  
Philip K. McGuire ◽  
Alison R. Yung ◽  
Lisa J. Phillips ◽  
Dennis Velakoulis ◽  
...  
Keyword(s):  
White Matter ◽  
Grey Matter ◽  
White Matter Volume ◽  
Volume Changes ◽  
Matter Volume ◽  
Original Group ◽  
Magnetic Resonance Imaging Mri ◽  
Longitudinal Comparison ◽  
The Right

BackgroundGrey matter changes have been described in individuals who are pre- and peri-psychotic, but it is unclear if these changes are accompanied by changes in white matter structures.AimsTo determine whether changes in white matter occur prior to and with the transition to psychosis in individuals who are pre-psychotic who had previously demonstrated grey matter reductions in frontotemporal regions.MethodWe used magnetic resonance imaging (MRI) to examine regional white matter volume in 75 people with prodromal symptoms. A subset of the original group (n=21) were rescanned at 12–18 months to determine white matter volume changes. Participants were retrospectively categorised according to whether they had or had not developed psychosis at follow-up.ResultsComparison of the baseline MRI data from these two subgroups revealed that individuals who later developed psychosis had larger volumes of white matter in the frontal lobe, particularly in the left hemisphere. Longitudinal comparison of data in individuals who developed psychosis revealed a reduction in white matter volume in the region of the left fronto-occipital fasciculus. Participants who had not developed psychosis showed no reductions in white matter volume but increases in a region subjacent to the right inferior parietal lobule.DiscussionThe reduction in volume of white matter near the left fronto-occipital fasciculus may reflect a change in this tract in association with the onset of frank psychosis.

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