A-55 Neuropsychological Findings Associated with Progressive Lesion Development in Cerebral Cavernous Malformation Secondary to PDCD10 Mutation

Objective A rare mutation in the PDCD10 gene causes cerebral cavernous malformations, which can result in multiple brain hemorrhages and hundreds of lesions. Up to 50% of individuals with the PDCD10 mutation remain symptom-free throughout their lives; however, others can suffer from seizures or focal neurologic deficits. Participant: A 67-year-old Caucasian male presented for a neuropsychological re-evaluation (2020) following a progressive decline in his memory and attention dating back 20 years. A baseline neuropsychological evaluation was obtained 7 years ago. Relevant medical history included a 5 mm left falcine meningioma, epilepsy, obstructive sleep apnea, hypertension, and type II diabetes. Neuroimaging revealed over 250 scattered lesions that had advanced over the past 7 years, particularly in the paramedian pontine reticular formation, left inferior cerebellum, and right middle frontal gyrus. Results His neurocognitive profile was marked by mild impairments in immediate verbal memory. The remainder of his cognitive profile was average. Compared to his 2013 evaluation, he showed only a minimal decline in verbal memory, but he showed slight improvements in the domains of executive functioning, visuospatial abilities, and language. Conclusion Despite the marked progression of lesions documented on current neuroimaging, aside from immediate verbal memory problems the patient’s neurocognitive functioning was relatively well-preserved. He even exhibited minor improvements within several domains. Given the patient’s current neurocognitive status, this case illustrates the importance of comprehensive neuropsychological testing in cases that would appear more severe based on neuroimaging data alone. Relatedly, progression of neuropathological disease burden on neuroimaging is not necessarily accompanied by consistent progression of neuropsychological dysfunction.

Prevalence of traumatic brain hemorrhages in brain death patients

Background: Considering the significant burden of brain death and its leading cause in emergency clinical settings, head traumatic intracranial hemorrhage, the most prevalent type of hemorrhagic event in these scenarios, will help us predict the possibility of consequent development of a vegetative state. Methods: This study aimed to assess the prevalence of other intracranial hemorrhages in patients with brain death. 70 head traumatic brain dead patients referred to Masih Daneshvari hospital underwent CT scan assessment to determine the prevalence of major intracranial hemorrhage types and their complications. Results: Subarachnoid (SAH) and subdural (SDH) hemorrhages consisted of the most prevalent intracranial hemorrhage types among patients with brain dead; 45.7 % and 40%, respectively. Overall, hemorrhagic events led to a midline shift in 14.3% and Edema in 12.9% of cases. We noticed midline shift more in SAH subjects while Edema was of higher prevalence among subarachnoid hemorrhages SDH patients. Conclusion: This study found Subarachnoid (SAH) and subdural (SDH) hemorrhages as the most prevalent types of intracranial hemorrhage among head traumatic brain-dead patients.

MR relaxometry-based analysis of brain hemorrhages: an experimental study on a rabbit model

Magnetic Resonance Relaxometry is a quantitative MRI-based technique able to estimate tissue relaxation times T1 and T2. This approach allows increasing the MRI diagnostic accuracy mostly in case of brain neoplasia or neurodegenerative disorders in human medicine. However, few reports are available on the application of this technique in the clinical field of veterinary medicine. For this reason, in this work, we developed a relaxometry based approach on experimentally induced brain hemorrhages on rabbits. Specifically, the methodology is based on a hierarchical clustering procedure driven by the T1 relaxometry signals from a set of regions of interest selected on the T2 map. The approach is multivariate since it combines both T1 and T2 information and allows the diagnosis at the subject level by comparing “suspected” pathological regions with healthy homologous ones within the same brain.To validate the proposed technique, the scanned brains underwent histopathological analyses to estimate the performance of the proposed classifier in terms of Receiver Operator Curve analyses. The results showed that, in terms of identification of the lesion and its contours, the proposed approach resulted accurate and outperformed the standard techniques based on T1w and T2w images. Finally, since the proposed protocol in terms of the adopted scanner, sequences, and analysis tools, is suitable for the clinical practice, it can be potentially validated through large-scale multi-center clinical studies.

Pathology of an outbreak of highly pathogenic avian influenza A(H5N1) virus of clade 2.3.2.1a in turkeys in Bangladesh

A mixed-aged flock of 130 turkeys in Bangladesh reported the sudden death of 1 bird in September 2017. Highly pathogenic avian influenza A(H5N1) virus was detected in 3 turkeys, and phylogenetic analysis placed the viruses in the reassortant clade 2.3.2.1a. The birds had clinical signs of depression, diarrhea, weakness, closed eyes, and finally death. The mortality rate of the flock was 13% over the 6 d prior to the flock being euthanized. At autopsy, we observed congestion in lungs and brain, hemorrhages in the trachea, pancreas, breast muscle, coronary fat, intestine, bursa of Fabricius, and kidneys. Histopathology revealed hemorrhagic pneumonia, hemorrhages in the liver and kidneys, and hemorrhages and necrosis in the spleen and pancreas. Significant changes in the brain included gliosis, focal encephalomalacia and encephalitis, and neuronophagia.

Neuroimaging in Neuro-Ophthalmology (Systematic Review)

There are quite a number of neurological diseases, which initially present to the ophthalmologists. Based on the proper history and clinical findings ophthalmologist have to suggest the ancillary neuro-imaging to support their provisional diagnosis and reach the site of lesion. Unless the ophthalmologists are aware of the right imaging at right time and at right area to focus, there are many pitfalls. MRI and CT of the brain and orbit are important investigations in neuro-ophthalmology which if intelligently ordered can add to the diagnostic and management process. In general, MRI is the most commonly ordered investigation in neuro-ophthalmology with so many additional sequences as FLAIR, GRE, diffusion weighted imaging, spectroscopy, in addition to T1 and T2 weighted imaging. Having said that CT scan has its advantages in cases of bony pathologies and acute brain hemorrhages. This article reviews the indications and importance of different neuro-imaging techniques, based on the previous studies from 1997 to 2019.

Classification of Brain Hemorrhages in MRI Using Naïve Bayes- Probabilistic Kernel Approach

A brain hemorrhage is one type of stroke, which is caused due to artery burst in the brain, killing the brain cells due to bleeding. Therefore, to reduce the criticality among the patients, for treatment, the doctors depend on accurate reports on the location of hemorrhage. Magnetic resonance imaging (MRI) is one of the best imaging modality when functional and structural abnormalities need to be found. To aid the identification of presence of abnormality, a novel NB-PKC algorithm for effective recognition of brain hemorrhages in MRI is proposed. A series of preprocessing is done, then the image undergoes binary thresholding process for applying an image mask on the hemorrhage region. Then for segmentation a modified multi-level segmenting algorithm is applied, using minimal local binary pattern and GLCM, combined features are extracted and finally for classification a novel Naïve Bayes- Probabilistic Kernel Classification is applied. These techniques designed could accurately identify the position and classified whether the image had an abnormality or not and could reduce human errors.

Outcome Predictors in Patient with Traumatic Intracerebral Hemorrhage in Hasan Sadikin General Hospital Bandung

Predictions about patient outcomes can help doctors make decisions. Intracerebral hemorrhage acccompanied by brain injury can increase mortality but specific studies on outcomes of patients with traumatic intracerebral hemorrhage are still rare. The purpose of this study was to determine the factors that influence the outcome of traumatic intracerebral hemorrhage patients in the RSHS period from January to December 2017. This is an observational study with cross sectional method, categorical comparative analytic. The study involved 60 traumatic intracerebral hemorrhages aged ? 15 years who were hospitalized in RSHS. The data was analyzed univariately and bivariately using Chi Square statistical test, Eta correlation test and contingency coefficient. The results showed age (p = 0.003), GCS scores assessed at admission (p <0.001), and the presence or absence of other brain hemorrhages (p = 0.050) significantly affected the patient's outcome. Gender (p = 0.932), mechanism of injury (p = 0.739), and pupillary response (p = 0.056) did not affect the outcome significantly. In conclusion, the factors that influence the outcome of traumatic intracerebral hemorrhage patients are age, GCS score, and presence or absence of other brain hemorrhages. Keywords: intracerebral hemorrhage, trauma, predictors, outcome