Journal of neuroimaging : official journal of the American Society of Neuroimaging
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A 41-year-old male presented with an acute onset of headache, confusion, seizures, and unilateral focal neurological deficit 25 years after receiving whole-brain radiation therapy to treat a cerebellar medulloblastoma. Brain magnetic resonance imaging (MRI) demonstrated a thick unilateral parieto-occipital cortical contrast enhancement. ⋯ Here, we describe the brain MR spectroscopy findings of SMART, showing a decrease in N-acetyl-aspartate and increased levels of creatine and choline, corresponding with neuronal destruction or transient neuronal impairment with mild nonspecific gliosis. The absence of a lactate peak suggests that mitochondrial dysfunction, vasospasm or ischemic mechanisms were not involved.
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Obstructive sleep apnea (OSA) subjects show brain injury in sites that control autonomic, cognitive, and mood functions that are deficient in the condition. The processes contributing to injury may include altered blood-brain barrier (BBB) actions. Our aim was to examine BBB function, based on diffusion-weighted pseudo-continuous arterial spin labeling (DW-pCASL) procedures, in OSA compared to controls. ⋯ OSA subjects show compromised BBB function, but intact large artery integrity. The BBB alterations may introduce neural damage contributing to abnormal functions in OSA, and suggest a need to repair BBB function with strategies commonly used in other fields.
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Brainstem intracranial dural arteriovenous fistulas are extremely rare and can mimic a glioma at the time of presentation. ⋯ A careful radiological study looking for dilated vessels around the brainstem is necessary in the workup of an infiltrating brainstem lesion, in order to rule out intracranial dural arteriovenous fistula.
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With conventional magnetic resonance imaging (MRI), 20-30% of patients with temporal lobe epilepsy (TLE) have negative pathological MRI findings. Further investigations of the role of magnetic resonance spectroscopy (MRS) in the pre-surgical evaluation of patients with MRI-negative TLE are important to avoid intracranial EEG recording and to better understand the mechanism of the epileptogenic process. This study aimed to compare the measurements of N-acetylaspartate (NAA), creatine (Cr), and choline (Cho) in the hippocampi of MRI-negative TLE patients and normal subjects. ⋯ In MRI-negative TLE, significant reductions in the NAA/Cr and NAA/(Cr+Cho) ratios ipsilateral to the seizure side may help lateralize and localize the epileptogenic zone.