Journal of neuroimaging : official journal of the American Society of Neuroimaging
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The authors investigate changes in brain metabolites among patients with amyotrophic lateral sclerosis (ALS). Twelve patients diagnosed with definite ALS (and 2 subgroups with either pronounced upper motoneuron signs or less obvious, probable upper motoneuron involvement) and 10 controls were examined. 1H studies were performed on a 1.5-T Siemens Magnetom Vision with single voxel (SV). A voxel (TR = 1500 ms, TE = 270 ms, 512 acquisitions, VOI = 8 cm3) was placed bilaterally in the precentral gyrus. In addition, chemical shift imaging (CSI) (VOI = 1 x 1 x 1.5 cm, TR = 1500 ms, TE = 135 ms) was performed. Ratios of peak integrals (N-acetyl-aspartate/choline, N-acetyl-aspartate/creatine, and creatine/choline) were determined. A Mann-Whitney U Test and a Wilcoxon Matched Pairs Test were applied. ⋯ The authors conclude that CSI is more effective at detecting lower N-acetyl-aspartate/choline levels among ALS patients than is SV.
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Patients with cerebellar infarction are threatened by infratentorial herniation and impaired circulation of cerebrospinal fluid if mass effect in posterior fossa develops. Clinical assessment is often impaired in patients with disturbances of consciousness. Therefore, computed tomography (CT) examination is essential in the diagnosis of complication and decision for operative treatment. ⋯ The proposed CT score is of high interrater and retest reliability, supplements the clinical assessment of the patient, and is able to monitor the efficacy of decompressive treatment.
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Case Reports
Intraosseous sacral myxopapillary ependymoma and the differential diagnosis of sacral tumors.
Although involvement of other regions of the spinal cord and brain stem is seen, myxopapillary ependymoma is most commonly found at the filum terminale or cauda equina. Less commonly, myxopapillary ependymoma may occur outside the central nervous system from direct metastatic extension of an intrathecal tumor, and rarely it may present as a primary tumor outside the thecal sac. ⋯ They then discuss the magnetic resonance imaging findings of this and other sacral tumors. Myxopapillary ependymoma should be considered in the differential diagnosis for a primary expansile sacral mass along with other lesions such as chordoma, aneurysmal bone cyst, and giant cell tumor.
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A 36-year-old homosexual man with 6 months of visual symptoms and headaches had right homonymous hemianopia, mild new learning impairment, and alexia with agraphia. The initial brain magnetic resonance imaging (MRI) scan was reported consistent with left occipital infarction. Subsequent MRI demonstrated abnormal demyelination in subcortical white matter and deep parieto-occipital white matter bilaterally, but primarily left. ⋯ After the antiretroviral regimen was intensified by the addition of a protease inhibitor, rapid clinical and radiographic improvement occurred with subsequent MRI studies revealing only residual left parieto-occipital encephalomalacia. PML in AIDS patients has been associated with a nearly uniformly poor prognosis until recent reports of improved outcomes after highly active antiretroviral therapy. This patient with PML and AIDS similarly showed a robust clinical and MRI response to intensive antiretroviral combination therapy, which has been maintained for more than 3 years.
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The effect of temporal lobe transection area, volume of postoperative gliosis, and surgical technique on patients' seizure-free outcome is unknown. The authors studied the effects of these variables on patients' seizure-free outcome. ⋯ The authors found no clear association between postoperative outcome and residual temporal lobe gliosis, the surgical technique, or the total area of temporal lobe transected by the scalpel.