vasogenic edema
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2022 ◽  
Vol 12 (1) ◽  
pp. 109
Author(s):  
Lucian Mărginean ◽  
Paul Andrei Ștefan ◽  
Andrei Lebovici ◽  
Iulian Opincariu ◽  
Csaba Csutak ◽  
...  

Due to their similar imaging features, high-grade gliomas (HGGs) and solitary brain metastases (BMs) can be easily misclassified. The peritumoral zone (PZ) of HGGs develops neoplastic cell infiltration, while in BMs the PZ contains pure vasogenic edema. As the two PZs cannot be differentiated macroscopically, this study investigated whether computed tomography (CT)-based texture analysis (TA) of the PZ can reflect the histological difference between the two entities. Thirty-six patients with solitary brain tumors (HGGs, n = 17; BMs, n = 19) that underwent CT examinations were retrospectively included in this pilot study. TA of the PZ was analyzed using dedicated software (MaZda version 5). Univariate, multivariate, and receiver operating characteristics analyses were used to identify the best-suited parameters for distinguishing between the two groups. Seven texture parameters were able to differentiate between HGGs and BMs with variable sensitivity (56.67–96.67%) and specificity (69.23–100%) rates. Their combined ability successfully identified HGGs with 77.9–99.2% sensitivity and 75.3–100% specificity. In conclusion, the CT-based TA can be a useful tool for differentiating between primary and secondary malignancies. The TA features indicate a more heterogenous content of the HGGs’ PZ, possibly due to the local infiltration of neoplastic cells.


2022 ◽  
Author(s):  
SANTOSH SINGH ◽  
Arghya Mukherjee ◽  
Deepika Jeswani

Abstract Acute liver failure (ALF) is a complication of severe liver dysfunction resulting from a wide range of factors including alcoholism, drug-abuse, improper medication, viral hepatitis etc., and present with high mortality rate among the human population. ALF led hyperammonemia (HA) induced cerebral dysfunction is considered to be the main cause of death in patients, however, the precise molecular mechanism is not completely understood. The aim of this study was to investigate the status of brain edema and modulation of N-methyl D-aspartate receptors (NMDAR)- Nitric oxide synthase (NOS)- Nitric oxide (NO)- cyclic guanosine monophosphate (cGMP) axis in the cerebral cortex and cerebellum of ALF rats. ALF was induced by intraperitoneal (IP) injection of thioacetamide (TAA). We observed significantly increased brain water content in ALF rats but absence of astrocytes swelling suggested induction of vasogenic edema. Except constant NR2B, down regulation of NR2A, 2C and 2D subunits containing NMDAR genes in cerebral cortex, however, constant NR2A-C but up-regulation of NR2D subunit in cerebellum suggested brain regions specific differential regulation of NMDAR in ALF rats. Significantly increased nNOS gene and protein level were found to be accompanied by the significantly increased level of NO and cGMP in both brain tissues; however, increased eNOS expression in cortex but increased iNOS expression and activity in cerebellum were observed in ALF rats. Together these findings suggested that ALF in rats may trigger differential regulation of NR2A-D subunits containing NMDAR, induction of NOS-NO-cGMP axis and vasogenic edema in cerebral cortex and cerebellum.


2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Lu Lu ◽  
Weixi Xiong ◽  
Yingying Zhang ◽  
Yingfeng Xiao ◽  
Dong Zhou

AbstractPosterior reversible encephalopathy syndrome (PRES) is a rare clinical disease that refers to the subcortical vasogenic edema involving bilateral parieto-occipital regions, with a usually reversible syndrome when causes are eliminated or controlled. Hypertension or blood pressure fluctuations are most common causes of PRES, but other contributors like chemotherapy and autoimmune disorders have also been reported. PRES has rapid onset of symptoms. Therefore, it is of major importance to determine whether blood pressure management plays an important role in prognosis. We presented two PRES patients who developed non-convulsive seizure but had normal baseline blood pressure at the time of presence of cause. The diagnosis of PRES was made by neurologists. The patients had no history of seizure or hypertension, but during the disease course they presented with temporal elevation of blood pressure with different durations. The second patients without instant blood pressure control developed residual symptoms of seizure at 90- and 120-day follow-up. Although the exact pathophysiology of PRES remains to be fully understood, primary and secondary prolonged blood pressure fluctuations may be associated with the prognosis of this syndrome. Early blood pressure management would be critical to favorable outcome.


2021 ◽  
Vol 3 (Supplement_6) ◽  
pp. vi18-vi18
Author(s):  
Yoshiko Okita ◽  
Koji Takano ◽  
Soichiro Tateishi ◽  
Motohisa Hayashi ◽  
Mio Sakai ◽  
...  

Abstract Background: Glioblastoma is a highly infiltrative tumor. In the non-enhancing T2-weighted hyperintense area, differentiating between non-enhancing tumors (NETs) and vasogenic edema is challenging. Neurite orientation dispersion and density imaging (NODDI) is a new diffusion MRI technique that reveals the inhomogeneity of the brain microstructure. The aim of this study is to differentiate between NETs and edema in glioblastomas using NODDI. Methods: Data were collected from 20 patients with glioblastoma as well as three patients with metastasis and two with meningioma (control), who underwent MRI as part of pre-surgical examination. The MRI data included T2- and T1-weighted contrast-enhanced images and NODDI images. Three neurosurgeons manually placed the volume of interest (VOI) on the NETs and edema based on the previous reports. ICVF, ODI, ISOVF, FA, and ADC were calculated for each VOI. Results: Fifteen and 13 VOIs were placed on NETs and edema, respectively. Each parameter was measured and the unpaired t-test revealed a significant difference between NETs and edema (p <0.0001). The ROC curve analysis revealed a large difference in the ADC, FA, and ISOVF between NETs and edema compared to ICVF and ODI. Principal component analysis of the five parameters showed that ADC, ISOVF, and FA contributed to the differentiation between NETs and edema. Multiple logistic regression analysis was performed with the three aforementioned parameters. A predictive formula could be created to discriminate between NETs and edema, following the use of which, the ROC curve revealed an AUC value of 0.8891. Furthermore, this formula was applied to the edematous regions of the images of the negative control group, and the prediction degree of the tumor was well below 0.5, thus enabling differentiation as edema.Conclusions: NODDI may prove to be a useful tool to discriminate between NETs and edema in the non-contrast T2 hyperintensity region of glioblastoma.


Author(s):  
Erik J Uhlmann ◽  
Rosalia Rabinovsky ◽  
Hemant Varma ◽  
Rachid El Fatimy ◽  
Ekkehard M Kasper ◽  
...  

Abstract Meningioma is the most common primary central nervous system tumor. Although mostly nonmalignant, meningioma can cause serious complications by mass effect and vasogenic edema. While surgery and radiation improve outcomes, not all cases can be treated due to eloquent location. Presently no medical treatment is available to slow meningioma growth owing to incomplete understanding of the underlying pathology, which in turn is due to the lack of high-fidelity tissue culture and animal models. We propose a simple and rapid method for the establishment of meningioma tumor-derived primary cultures. These cells can be maintained in culture for a limited time in serum-free media as spheres and form adherent cultures in the presence of 4% fetal calf serum. Many of the tissue samples show expression of the lineage marker PDG2S, which is typically retained in matched cultured cells, suggesting the presence of cells of arachnoid origin. Furthermore, nonarachnoid cells including vascular endothelial cells are also present in the cultures in addition to arachnoid cells, potentially providing a more accurate tumor cell microenvironment, and thus making the model more relevant for meningioma research and high-throughput drug screening.


Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000013080
Author(s):  
Albert M Isaacs ◽  
Jeffrey J Neil ◽  
James P McAllister ◽  
Sonika Dahiya ◽  
Leandro Castaneyra-Ruiz ◽  
...  

Background and Objectives:The neurological deficits of neonatal post-hemorrhagic hydrocephalus (PHH) have been linked to periventricular white matter injury. To improve understanding of PHH-related injury, diffusion basis spectrum imaging (DBSI) was applied in neonates, modeling axonal and myelin integrity, fiber density, and extra-fiber pathologies. Objectives included characterizing DBSI measures in periventricular tracts, associating measures with ventricular size, and examining MRI findings in the context of post-mortem white matter histology from similar cases.Methods:A prospective cohort of infants born very preterm underwent term equivalent MRI, including infants with PHH, high-grade intraventricular hemorrhage without hydrocephalus (IVH), and controls (VPT). DBSI metrics extracted from the corpus callosum, corticospinal tracts, and optic radiations included fiber axial diffusivity, fiber radial diffusivity, fiber fractional anisotropy, fiber fraction (fiber density), restricted fractions (cellular infiltration), and non-restricted fractions (vasogenic edema). Measures were compared across groups and correlated with ventricular size. Corpus callosum postmortem immunohistochemistry in infants with and without PHH assessed intra- and extra-fiber pathologies.Results:Ninety-five infants born very preterm were assessed (68 VPT, 15 IVH, 12 PHH). Infants with PHH had the most severe white matter abnormalities and there were no consistent differences in measures between IVH and VPT groups. Key tract-specific white matter injury patterns in PHH included reduced fiber fraction in the setting of axonal and/or myelin injury, increased cellular infiltration, vasogenic edema, and inflammation. Specifically, measures of axonal injury were highest in the corpus callosum; both axonal and myelin injury were observed in the corticospinal tracts; and axonal and myelin integrity were preserved in the setting of increased extra-fiber cellular infiltration and edema in the optic radiations. Increasing ventricular size correlated with worse DBSI metrics across groups. On histology, infants with PHH had high cellularity, variable cytoplasmic vacuolation, and low synaptophysin marker intensity.Discussion:PHH was associated with diffuse white matter injury, including tract-specific patterns of axonal and myelin injury, fiber loss, cellular infiltration, and inflammation. Larger ventricular size was associated with greater disruption. Postmortem immunohistochemistry confirmed MRI findings. These results demonstrate DBSI provides an innovative approach extending beyond conventional diffusion MRI for investigating neuropathological effects of PHH on neonatal brain development.


2021 ◽  
Author(s):  
Katarina Cvitkovic ◽  
Anita Pusic Sesar ◽  
Antonio Sesar ◽  
Ivan Cavar

Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiological entity presented with different symptoms such as visual disturbances, headaches, seizures, severe hypertension and altered mental status. It has been recognized in a different pathological conditions, although preeclampsia/eclampsia is the most common cause of PRES. The pathogenesis of PRES is still not fully understood, but it seems that failure of cerebrovascular autoregulation causing vasogenic edema, cerebral vasoconstriction, and disruption of the blood brain barrier plays an important role. Cortical blindness, hypertensive retinopathy, serous retinal detachment (SRD), central retinal artery and vein occlusions, retinal or vitreous hemorrhages, anterior ischemic optic neuropathy (AION) and Purtscher’s retinopathy are ophthalmic disorders that may occur in PRES associated with preeclampsia. Among these, cortical blindness is the best documented complication of preeclampsia. Magnet resonance imaging (MRI) is a gold standard to establish the diagnosis of PRES because clinical findings are not sufficiently specific. Typically, there are bilateral cortical occipital lesions with hyperdensity on T2-weighted MRI. Blindness due to occipital lesions is reversible and the vision loss is usually regained within 4 h to 8 days.


BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nicholas Dietz ◽  
Zarmina Mufti ◽  
Muhammed Yousaf ◽  
Randal Brown ◽  
Christopher Counts ◽  
...  

Abstract Background Posterior reversible encephalopathy syndrome (PRES) represents a transient change in mental status with associated vasogenic edema of cortical and subcortical brain structures. It is often attributed to multifactorial etiology including hypertension and altered hemodynamics and disruption of vessel integrity. Patients with autoimmune disease and certain immune modulator therapies are at greater risk. Case presentation A 54-year-old female with past medical history of well-controlled multiple sclerosis on interferon-beta since 2013, presented with witnessed tonic colonic seizure. She also was noted to demonstrate left gaze deviation and left-sided hemiparesis. MRI fluid-attenuated inversion recovery sequence showed hyperintensity of the subcortical U fibers, concentrated in the occipital, parietal lobes and frontal lobes. Systolic blood pressure was 160 mmHg on arrival. The patient was started on seizure prophylxis and Interferon beta was discontinued. The patient’s mentation, seizures and hemiapresis significantly improved in next 72 h with tight blood pressure control, and had notble improvement on MRI imaging and inflammatory markers. Lumbar puncture CSF results were devoid of infectious and autoimmune pathology. Conclusions A middle-aged female with multiple sclerosis who was on chronic IFN-beta presented to the emergency room with a witnessed tonic-clonic seizure, with MRI T2 FLAIR imaging consistent with PRES. She had notable clinical improvement with decreased edema on imaging and improved inflammatory markers 72 h after cessation of IFN-beta therapy.


2021 ◽  
Author(s):  
◽  
Alexandra King

<p><b>Stroke is a leading cause of death worldwide [1], and is the third leading cause of death and the leading cause of serious adult disability in New Zealand[2]. The aim of this project was to quantify perfusion changes in the brains of 20 sheep that underwent a novel surgical model of transient ischemic stroke. The sheep, with its large, gyrencephalic brain, presents a promising, potential animal model for stroke that could help to bridge the historical gap in translational research in stroke therapies [3]. However, we require that an animal model can replicate human patterns of disease in order for it to be a meaningful model for research into potential stroke therapies for humans. It was this replication of human patterns of disease, in terms of perfusion, thatwas under investigation in this project. Dynamic Contrast Enhanced (DCE) MRI images were obtained from each animal before stroke, and at 24 hours, 3 days, 6 days, and 28 days post-stroke. It was found that perfusion from the DCE-MRI series was quantifiable using the extended Tofts model in the form of the parameters Ktrans, ve and vp. The parameter values calculated from this project replicate known human patternsof disease in terms of global Ktrans changes in the affected hemisphere [4], which were found to increase by more than 60% in the stroke hemisphere,replicating the increased permeability following blood brain barrier breakdown.</b></p> <p>In manually selected regions of cytotoxic and vasogenic edema, it was found that the estimated parameters in these regions replicated known perfusionchanges in these types of edema in humans [5]. Finally, the peak post-stroke permeability time point, as determined by Ktrans, was found to align exactlywith when we would expect vasogenic edema, a type of cerebral swelling that causes increased barrier permeability, to dominate in humans [5].</p> <p>This thesis is the first time these DCE-MRI datasets have been analysed, and there remains a wealth of physiological and MRI data available forthis animal cohort. Avenues for future research include investigation into perfusion-diffusion mismatch in this animal model, further consideration ofindividual animal characteristics in analysis, and use of these results as a point of comparison for future research into pharmaceutical agents for treatment ofstroke, and in new non-contrast perfusion measurement techniques.</p>


2021 ◽  
Author(s):  
◽  
Alexandra King

<p><b>Stroke is a leading cause of death worldwide [1], and is the third leading cause of death and the leading cause of serious adult disability in New Zealand[2]. The aim of this project was to quantify perfusion changes in the brains of 20 sheep that underwent a novel surgical model of transient ischemic stroke. The sheep, with its large, gyrencephalic brain, presents a promising, potential animal model for stroke that could help to bridge the historical gap in translational research in stroke therapies [3]. However, we require that an animal model can replicate human patterns of disease in order for it to be a meaningful model for research into potential stroke therapies for humans. It was this replication of human patterns of disease, in terms of perfusion, thatwas under investigation in this project. Dynamic Contrast Enhanced (DCE) MRI images were obtained from each animal before stroke, and at 24 hours, 3 days, 6 days, and 28 days post-stroke. It was found that perfusion from the DCE-MRI series was quantifiable using the extended Tofts model in the form of the parameters Ktrans, ve and vp. The parameter values calculated from this project replicate known human patternsof disease in terms of global Ktrans changes in the affected hemisphere [4], which were found to increase by more than 60% in the stroke hemisphere,replicating the increased permeability following blood brain barrier breakdown.</b></p> <p>In manually selected regions of cytotoxic and vasogenic edema, it was found that the estimated parameters in these regions replicated known perfusionchanges in these types of edema in humans [5]. Finally, the peak post-stroke permeability time point, as determined by Ktrans, was found to align exactlywith when we would expect vasogenic edema, a type of cerebral swelling that causes increased barrier permeability, to dominate in humans [5].</p> <p>This thesis is the first time these DCE-MRI datasets have been analysed, and there remains a wealth of physiological and MRI data available forthis animal cohort. Avenues for future research include investigation into perfusion-diffusion mismatch in this animal model, further consideration ofindividual animal characteristics in analysis, and use of these results as a point of comparison for future research into pharmaceutical agents for treatment ofstroke, and in new non-contrast perfusion measurement techniques.</p>


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