Regional Distribution of Brain Injury After Cardiac Arrest: Clinical and Electrographic Correlates

Background and Objectives:Disorders of consciousness, EEG background suppression and epileptic seizures are associated with poor outcome after cardiac arrest. Our objective was to identify the distribution of diffusion MRI-measured anoxic brain injury after cardiac arrest and to define the regional correlates of disorders of consciousness, EEG background suppression, and seizures.Methods:We analyzed patients from a single-center database of unresponsive patients who underwent diffusion MRI following cardiac arrest (n=204). We classified each patient based on recovery of consciousness (command-following) before discharge, the most continuous EEG background (burst suppression versus continuous), and the presence or absence of seizures. Anoxic brain injury was measured using the apparent diffusion coefficient (ADC) signal. We identified ADC abnormalities relative to control subjects without cardiac arrest (n=48) and used voxel lesion symptom mapping to identify regional associations with disorders of consciousness, EEG background suppression, and seizures. We then used a bootstrapped lasso regression procedure to identify robust, multivariate regional associations with each outcome variable. Finally, using area under receiver operating characteristic curves, we then compared the classification ability of the strongest regional associations to that of brain-wide summary measures.Results:Compared to controls, cardiac arrest patients demonstrated ADC signal reduction most significant in the occipital lobes. Disorders of consciousness were associated with reduced ADC most prominently in the occipital lobes, but also in deep structures. Regional injury more accurately classified patients with disorders of consciousness than whole-brain injury. Background suppression mapped to a similar set of brain regions, but regional injury could no better classify patients than whole-brain measures. Seizures were less common in patients with more severe anoxic injury, particularly in those with injury to the lateral temporal white matter.Discussion:Anoxic brain injury was most prevalent in posterior cerebral regions, and this regional pattern of injury was a better predictor of disorders of consciousness than whole-brain injury measures. EEG background suppression lacked a specific regional association, but patients with injury to the temporal lobe were less likely to have seizures. Regional patterns of anoxic brain injury are relevant to the clinical and electrographic sequelae of cardiac arrest and may hold importance for prognosis.Classification of Evidence:This study provides Class IV evidence that disorders of consciousness after cardiac arrest are associated with widely lower ADC values on diffusion MRI and are most strongly associated with reductions in occipital ADC.

Effects of an Agro-healing Program on Promoting Mental Health of the Middle-aged

Background and objective: This study was conducted with 10 men and women in their 50s-60s to investigate the effect of agro-healing activities on the improvement of mental health.Methods: The experimental group participated in total 8 sessions of agro-healing activities, once a week for 2 hours each, at a care farm in Wanju-gun. Physiological measurements were taken with an electroencephalogram (EEG), Salivettes samples, and blood pressure before and after the activities.Results: As a result of analyzing the changes in brainwaves of the experimental group before and after agro-healing activities, relative slow alpha (RSA), relative fast alpha (RFA), and ratio of alpha to high beta (RAHB), the indices of stability and relaxation, increased after the program with statistical significance. Also, the ratio of SMR to theta (RST) of the attention index increased on the right frontal lobes, temporal lobes, and left occipital lobes, and relative low beta (RLB) increasd on the frontal lobes, temporal lobes, and occipital lobes after the program with statistical significance. The sympathetic nervous system activity, which is a stress index, decreased after the program, whereas the parasympathetic nervous system activity, which is a relaxation index, increased, showing statistical significance (p < .05). As a result of analyzing the changes in blood pressure after the program, systolic blood pressure and diastolic blood pressure decreased from prehypertension to normal blood pressure, showing statistical significance. SThese results indicate that participating in agro-healing activities at a care farm for the 50-60s helps reduce stress and improve stability and relaxation as well as attention.Conclusion: Thus, developing and applying customized agro-healing programs for participants will have a positive effect on brain activity and psychophysiological improvement by relieving tension and stress. However, there are limitations in generalizing the results of this study since most of agro-healing farms have low accessibility that leads to a low level of participants.

Altered Processing of Visual Stimuli in Vestibular Migraine Patients Between Attacks: A Combined VEP and sLORETA Study

Objective: Vestibular migraine (VM) is one of the most common causes of recurrent vertigo, but the neural mechanisms that mediate such symptoms remain unknown. Since visual symptoms and photophobia are common clinical features of VM patients, we hypothesized that VM patients have abnormally sensitive low-level visual processing capabilities. This study aimed to investigate cortex abnormalities in VM patients using visual evoked potential (VEP) and standardized low-resolution brain electromagnetic tomography (sLORETA) analysis.Methods: We employed visual stimuli consisting of reversing displays of circular checkerboard patterns to examine “low-level” visual processes. Thirty-three females with VM and 20 healthy control (HC) females underwent VEP testing. VEP components and sLORETA were analyzed.Results: Patients with VM showed significantly lower amplitude and decreased latency of P1 activation compared with HC subjects. Further topographic mapping analysis revealed a group difference in the occipital area around P1 latency. sLORETA analysis was performed in the time frame of the P1 component and showed significantly less activity (deactivation) in VM patients in the frontal, parietal, temporal, limbic, and occipital lobes, as well as sub-lobar regions. The maximum current density difference was in the postcentral gyrus of the parietal lobe. P1 source density differences between HC subjects and VM patients overlapped with the vestibular cortical fields.Conclusion: The significantly abnormal response to visual stimuli indicates altered processing in VM patients. These findings suggest that abnormalities in vestibular cortical fields might be a pathophysiological mechanism of VM.

Physiological and Psychological Effects of Visual Stimulation with Green Plant Types

This study was designed to assess the physiological and psychological benefits of visually looking at foliage plants in adults. This study involved 30 adults in their 20s (11 males, 19 females), and using a crossover design, participants looked at four different types of visual stimuli, namely, real plants, artificial plants, a photograph of plants, and no plants for 5 min. Brain waves were measured while viewing each type of plant, and a subjective evaluation of emotions was performed after each visual stimulus. Semantic differential methods (SDM) and Profile of Mood States (POMS) were used for the subjective evaluation. During the real plant visual stimulation, relative theta (RT) power spectrum was increased in the bilateral occipital lobes, while relative high beta (RHB) power spectrum was reduced in the left occipital lobe, indicating a reduction in stress, anxiety, and tension. The subjective survey results revealed that when looking at real plants, the participants exhibited significantly higher “comfort,” “natural,” and “relaxed” scores as well as an increase in positive mood conditions. In conclusion, among the four types of plants, visual stimulation with real plants induces physiological relaxation in adults and has a positive psychological effect.

Deep medullary veins are associated with widespread brain structural abnormalities

Our aim is to investigate the association of cerebral deep medullary veins (DMVs) with white matter microstructural integrity and regional brain atrophy in MRI. In a community-based cohort of 979 participants (mean age 55.4 years), DMVs were identified on susceptibility-weighted imaging. Brain structural measurements including gray matter and hippocampus volumes, as well as diffusion tensor metrics, were evaluated. The mean (SD)number of DMVs was 19.0 (1.7). A fewer number of DMVs was related to lower fractional anisotropy and higher mean diffusivity in multiple voxels on the white matter skeleton (threshold-free cluster enhancement corrected p < 0.05, adjusted for age and sex). Also, fewer DMVs were significantly related to a lower gray matter fraction and a hippocampal fraction (0.10 and 0.11 per DMV, respectively; SE, 0.03 for both; p < 0.001 for both). A significant correlation between DMVs’ reduction and cortical atrophy was observed in the bilateral occipital lobes, temporal lobes, hippocampus, and frontal lobes (p < 0.001, adjusted for age, sex, and total intracranial volume). Our results provided evidence that cerebral small venules disease play a role in brain parenchymal lesions and neurodegenerative processes.

P.127 Ultra-high field 7-Tesla magnetic resonance imaging and electroencephalography findings in epilepsy

Background: Assessment of patients for temporal lobe epilepsy (TLE) surgery requires multimodality input, including EEG to ensure optimal surgical planning. Often EEG demonstrates abnormal foci not detected on clinical MRI. 7T MRI provides improved resolution and we investigated its utility to detect potential abnormalities associated with EEG. Methods: Images were acquired on 7T MRI scanner (N=13) in oatients with TLE. Evaluation of 7T imaging for focal abnormalities was performed. Correlation of 7T MRI findings with EEG of focal slowing or interictal epileptic spikes (IEDs) and seizures was performed. Results: Assessment of 7T MRI demonstrated concordance with TLE in 8/13 cases. Three cases exhibited abnormal 7T MRI abnormalities not detected by 1.5 T MRI. Eleven out of 13 cases had EEG findings without anatomic correlates on MRI, with IEDs localizing to contralateral temporal, frontal, and parieto-occipital lobes. 7T images did not reveal focal anatomical abnormalities to account for the EEG findings in these patients. Conclusions: To our knowledge, this is the first study to investigate the role of 7T MRI in relation to EEG abnormalities. 7T RI findings show concordance with clinical data. 7T MRI did not reveal anatomical findings to account for EEG abnormalities, suggesting that such changes may be functional rather than anatomical.

Brain tumors and indications for brain imaging in patients with psychiatric manifestations: a case report

Background Studies on the relationship between psychiatric symptoms and brain tumors are ambiguous, as it is not clear whether these symptoms are due to the direct effect of the tumor or a secondary psychological response to stress, resulting from the diagnosis and treatment of the disease; therefore, it is difficult to analyze and retrieve relevant information. Case presentation We present the case of a 43-year-old male patient, who was admitted to a psychiatric emergency room with psychiatric symptoms, such as restlessness and extreme talkativeness, but normal neurological examinations. He showed no response to outpatient treatment and had no history of psychiatric disorders. The onset of symptoms was 2 months before his visit. On neuroimaging, a brain tumor was observed in the right temporal and occipital lobes. Accordingly, the patient was transferred to the neurosurgery ward. Conclusion Factors, such as increased internal pressure on the brain due to a brain tumor or the effect of tumor area, contribute to the occurrence of symptoms, such as restlessness and talkativeness. However, further studies are needed to confirm these findings.

Prevalence of Cerebrovascular Accidents in Patients with Ulcerative Colitis in a Single Academic Health System

Background:In general, IBD increases arteriovenous thromboembolic events, though the association between UC and cerebrovascular complications remains inconclusive. Some studies suggest young women with UC have an increased risk of cerebrovascular accidents (CVA). The focus of this study was to characterize the rates, anatomic locations and risk factors for CVA in patients with UC. Methods:We developed a retrospective cohort of patients with UC at a single health care system from June 2010 to June 2015. Neuroimaging was used to document presence, location and type of stroke and traditional risk factors were considered. Results:The prevalence of CVAs increased in both sexes with a peak prevalence of 24.7% (95% CI 17.1 - 34.4) in women with UC over the age of 80. Older age, cancer and atrial fibrillation were risk factors for CVA in univariate analysis for both sexes. In multifactorial analysis, both age and atrial fibrillation were risk factors for CVA in the m-UC cohort, but only age was associated with CVA in f-UC. The most common type of CVA was ischemic stroke (77.7%). The most common locations for CVAs in UC patients were frontal and occipital lobes (19% and 18%, respectively). Conclusions:UC patients have an increased risk for CVA, with women over 80 demonstrating the highest risk. Providers should be aware of these risks in making treatment decisions for UC.

Clinical Implications of Amyloid-Beta Accumulation in Occipital Lobes in Alzheimer’s Continuum

A substantial amount of amyloid-beta (Aβ) accumulates in the occipital cortices; however, it draws less attention. We investigated the clinical implications of Aβ accumulation in the occipital lobes in the Alzheimer’s disease (AD) continuum. [18F]-Florbetaben amyloid PET scans were performed in a total of 121 AD or amnestic mild cognitive impairment (aMCI) patients. Of the 121 patients, 74 Aβ positive patients were divided into occipital Aβ positive (OCC+) and occipital Aβ negative (OCC−) groups based on Aβ accumulation in the bilateral occipital lobes. The OCC+ group (41/74, 55.4%) was younger and had a younger age at onset than the OCC− group. The OCC+ group also had an increased standard uptake value ratio in the occipital lobes and greater cortical thinning in relevant areas. The OCC+ group had a higher global deterioration scale, lower performance for the copy, immediate recall, delayed recall, and recognition in Rey–Osterrieth Complex Figure tests than the OCC- group, although both groups had similar disease durations. AD or aMCI patients in the OCC+ group exhibited features noted in early onset AD with relevant neuropsychological and image findings. Occipital Aβ positivity in amyloid PET scans need to be considered as an underestimated marker of early onset AD continuum.

Case Report: PRES-Like Syndrome With Reversible Cortical Blindness Associated With Essential Thrombocythemia

Background: There are few reported cases of posterior reversible encephalopathy syndrome (PRES) combined with essential thrombocythemia (ET). We report a case of PRES-like syndrome in ET.Case Report: A 60-year-old man with a history of hypertension and thrombocythemia presented with progressive visual loss after waking up; and neurological examination showed pupils were 3 mm and equally reactive to light, which suggested cortical blindness. Brain magnetic resonance imaging (MRI) revealed restricted diffusion in diffusion-weighted imaging (DWI) in the bilateral parietal and occipital lobes. Routine blood tests revealed a platelet count of 1,044 × 109/L. ET was diagnosed after exclusion of other causes. Electroencephalography (EEG) showed periodic triphasic waves in the occipital region. The lesions of the parietal and occipital lobes on MRI and periodic triphasic waves of EEG disappeared quickly, and patient's vision returned to normal after the treatment with hydroxyurea and sodium bicarbonate. The patient experienced hallucinatory palinopsia during the recovery of vision.Conclusion: ET may be a risk factor for PRES.