A Review on Effects of Non-Invasive Brain Stimulation in the Treatment of Sleep Disorders / 수면정신생리

Sleep disorders, increasingly prevalent in the general population, induce impairment in daytime functioning and other clinical problems. As changes in cortical excitability have been reported as potential pathophysiological mechanisms underlying sleep disorders, multiple studies have explored clinical effects of modulating cortical excitability through non-invasive brain stimulation in treating sleep disorders. In this study, we critically reviewed clinical studies using non-invasive brain stimulation, particularly transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS), for treatment of sleep disorders. Previous studies have reported inconsistent therapeutic effects of TMS and tDCS for various kinds of sleep disorders. Specifically, low-frequency repetitive TMS (rTMS) and cathodal tDCS, both of which exert an inhibitory effect on cortical excitability, have shown inconsistent therapeutic effects for insomnia. On the other hand, high-frequency rTMS and anodal tDCS, both of which facilitate cortical excitability, have improved the symptoms of hypersomnia. In studies of restless legs syndrome, high-frequency rTMS and anodal tDCS induced inconsistent therapeutic effects. Single TMS and rTMS have shown differential therapeutic effects for obstructive sleep apnea. These inconsistent findings indicate that the distinctive characteristics of each non-invasive brain stimulation method and specific pathophysiological mechanisms underlying particular sleep disorders should be considered in an integrated manner for treatment of various sleep disorders. Future studies are needed to provide optimized TMS and tDCS protocols for each sleep disorder, considering distinctive effects of non-invasive brain stimulation and pathophysiology of each sleep disorder.

Monitoring Radiation Doses during Diagnostic and Therapeutic Neurointerventional Procedures: Multicenter Study for Establishment of Reference Levels / 신경중재치료의학

Purpose@#To assess patient radiation doses during diagnostic and therapeutic neurointerventional procedures from multiple centers and propose dose reference level (RL). @*Materials and Methods@#Consecutive neurointerventional procedures, performed in 22 hospitals from December 2020 to June 2021, were retrospectively studied. We collected data from a sample of 429 diagnostic and 731 therapeutic procedures. Parameters including dose-area product (DAP), cumulative air kerma (CAK), fluoroscopic time (FT), and total number of image frames (NI) were obtained. RL were calculated as the 3rd quartiles of the distribution. @*Results@#Analysis of 1160 procedures from 22 hospitals confirmed the large variability in patient dose for similar procedures. RLs in terms of DAP, CAK, FT, and NI were 101.6 Gy·cm2, 711.3 mGy, 13.3 minutes, and 637 frames for cerebral angiography, 199.9 Gy·cm2, 3,458.7 mGy, 57.3 minutes, and 1,000 frames for aneurysm coiling, 225.1 Gy·cm2, 1,590 mGy, 44.7 minutes, and 800 frames for stroke thrombolysis, 412.3 Gy·cm2, 4,447.8 mGy, 99.3 minutes, and 1,621.3 frames for arteriovenous malformation (AVM) embolization, respectively. For all procedures, the results were comparable to most of those already published. Statistical analysis showed male and presence of procedural complications were significant factors in aneurysmal coiling. Male, number of passages, and procedural combined technique were significant factors in stroke thrombolysis. In AVM embolization, a significantly higher radiation dose was found in the definitive endovascular cure group. @*Conclusion@#Various RLs introduced in this study promote the optimization of patient doses in diagnostic and therapeutic interventional neuroradiology procedures. Proposed 3rd quartile DAP (Gy·cm2) values were 101.6 for diagnostic cerebral angiography, 199.9 for aneurysm coiling, 225.1 for stroke thrombolysis, and 412.3 for AVM embolization. Continual evolution of practices and technologies requires regular updates of RLs.

Ischemic Stroke after Use of Cannabis: a Case Report and Review of Literature

Cannabis or marijuana is the most commonly used recreational drug after alcohol in the world, and usage is generally recognized as having few serious adverse effects. However, usage is restricted in South Korea. The report of ischemic stroke associated with cannabis is rare in literature. We present a case of a 47-year-old female patient with no underlying disease presenting with acute ischemic stroke after smoking cannabis in South Korea. The result for synthetic cannabinoid metabolites (delta-9 tetrahydrocannabinol) screening was positive. Absence of other vascular risk factors and drug screening results suggest a causal role of cannabis in this ischemic stroke case. The patient eventually progressed to brain death. The underlying mechanism, clinical manifestation, and imaging findings of cannabis-related stroke will be reviewed.

Complete Recovery of Perfusion Abnormalities in a Cardiac Arrest Patient Treated with Hypothermia: Results of Cerebral Perfusion MR Imaging

Therapeutic hypothermia in cardiac arrest patients is associated with favorable outcomes mediated via neuroprotective mechanisms. We report a rare case of a 32-year-old male who demonstrated complete recovery of signal changes on perfusion-weighted imaging after therapeutic hypothermia due to cardiac arrest. Brain MRI with perfusion-weighted imaging, performed three days after ending the hypothermia therapy, showed a marked decrease in relative cerebral blood flow (rCBF) and delay in mean transit time (MTT) in the bilateral basal ganglia, thalami, brain stem, cerebellum, occipitoparietal cortex, and frontotemporal cortex. However, no cerebral ischemia was not noted on diffusion-weighted imaging (DWI) or fluid-attenuated inversion recovery (FLAIR) sequences. A follow-up brain MRI after one week showed complete resolution of the perfusion deficit and the patient was discharged without any neurologic sequelae. The mechanism and interpretation of the perfusion changes in cardiac arrest patients treated with therapeutic hypothermia are discussed.

Imaging Findings of a Nonenhancing Intradural Paramedian Chordoma Mimicking an Epidermoid Cyst

Intracranial chordoma is a rare tumor, originating from embryonic remnants of the primitive notochord. It typically appears as an enhancing extradural midline tumor with bone involvement. We introduce a rare case of a 27-year-old male who had a nonenhancing intradural chordoma showing paramedian location, involving the left cavernous sinus, Meckel's cave, and prepontine cistern. The pathologic diagnosis was confirmed as an intradural chordoma. The imaging findings of this unusual case of a nonenhancing intradural paramedian chordoma will be presented with the differential diagnosis focused on the epidermoid cyst.

Animal Models of Demyelination and ¹H-Magnetic Resonance Spectroscopy

The proton magnetic resonance spectroscopy (¹H-MRS) is a tool used to detect concentrations of brain metabolites such as N-acetyl aspartate, choline, creatine, glutamate, and gamma-amino butyric acid (GABA). It has been widely used because it does not require additional devices other than the conventional magnetic resonance scanner and coils. Demyelination, or the neuronal damage due to loss of myelin sheath, is one of the common pathologic processes in many diseases including multiple sclerosis, leukodystrophy, encephalomyelitis, and other forms of autoimmune diseases. Rodent models mimicking human demyelinating diseases have been induced by using virus (e.g., Theiler's murine encephalomyelitis virus) or toxins (e.g., cuprizon or lysophosphatidyl choline). This review is an overview of the MRS findings on brain metabolites in demyelination with a specific focus on rodent models.

Patient Radiation Exposure During Diagnostic and Therapeutic Procedures for Intracranial Aneurysms: A Multicenter Study / 신경중재치료의학

PURPOSE: To assess patient radiation doses during cerebral angiography and embolization of intracranial aneurysms across multi-centers and propose a diagnostic reference level (DRL). MATERIALS AND METHODS: We studied a sample of 490 diagnostic and 371 therapeutic procedures for intracranial aneurysms, which were performed at 23 hospitals in Korea in 2015. Parameters including dose-area product (DAP), cumulative air kerma (CAK), fluoroscopic time and total angiographic image frames were obtained and analyzed. RESULTS: Total mean DAP, CAK, fluoroscopy time, and total angiographic image frames were 106.2 ± 66.4 Gy-cm2, 697.1 ± 473.7 mGy, 9.7 ± 6.5 minutes, 241.5 ± 116.6 frames for diagnostic procedures, 218.8 ± 164.3 Gy-cm², 3365.7 ± 2205.8 mGy, 51.5 ± 31.1 minutes, 443.5 ± 270.7 frames for therapeutic procedures, respectively. For diagnostic procedure, the third quartiles for DRLs were 144.2 Gy-cm² for DAP, 921.1 mGy for CAK, 12.2 minutes for fluoroscopy times and 286.5 for number of image frames, respectively. For therapeutic procedures, the third quartiles for DRLs were 271.0 Gy-cm² for DAP, 4471.3 mGy for CAK, 64.7 minutes for fluoroscopy times and 567.3 for number of image frames, respectively. On average, rotational angiography was used 1.5 ± 0.7 times/session (range, 0-4; n=490) for diagnostic procedures and 1.6 ± 1.2 times/session (range, 0-4; n=368) for therapeutic procedures, respectively. CONCLUSION: Radiation dose as measured by DAP, fluoroscopy time and image frames were lower in our patients compared to another study regarding cerebral angiography, and DAP was lower with fewer angiographic image frames for therapeutic procedures. Proposed DRLs can be used for quality assurance and patient safety in diagnostic and therapeutic procedures.

Progressive Pituitary Involvement in a Patient with Localized Granulomatosis with Polyangiitis / 이화의대지

Localized granulomatosis with polyangiitis (loc-GPA) is a milder disease state of GPA restricted to the respiratory tract. Transition from localized form to systemic/generalized disease is predicted to occur in approximately 10% of the patients. We report an unusual case of loc-GPA involving multiple cranial nerves, which in 3 years progressed into systemic disease involving pituitary gland. Initially antineutrophil cytoplasmic antibody (ANCA) was negative, but as symptoms of diabetes insipidus started, ANCA became positive. Clinical course of ANCA negative loc-GPA should be carefully monitored for development of systemic disease. ANCA may be a useful marker for detecting transition from localized to systemic disease.

Prefrontal Cortical Thickness Deficit in Detoxified Alcohol-dependent Patients

Alcohol dependence is a serious disorder that can be related with a number of potential health-related and social consequences. Cortical thickness measurements would provide important information on the cortical structural alterations in patients with alcohol dependence. Twenty-one patients with alcohol dependence and 22 healthy comparison subjects have been recruited and underwent high-resolution brain magnetic resonance (MR) imaging and clinical assessments. T1-weighted MR images were analyzed using the cortical thickness analysis program. Significantly thinner cortical thickness in patients with alcohol dependence than healthy comparison subjects was noted in the left superior frontal cortical region, correcting for multiple comparisons and adjusting with age and hemispheric average cortical thickness. There was a significant association between thickness in the cluster of the left superior frontal cortex and the duration of alcohol use. The prefrontal cortical region may particularly be vulnerable to chronic alcohol exposure. It is also possible that the pre-existing deficit in this region may have rendered individuals more susceptible to alcohol dependence.

Reduced Gray Matter Density in the Posterior Cerebellum of Patients with Panic Disorder: A Voxel-Based Morphometry Study

OBJECTIVES: It is increasingly thought that the human cerebellum plays an important role in emotion and cognition. Although recent evidence suggests that the cerebellum may also be implicated in fear learning, only a limited number of studies have investigated the cerebellar abnormalities in panic disorder. The aim of this study was to evaluate the cerebellar gray matter deficits and their clinical correlations among patients with panic disorder. METHODS: Using a voxel-based morphometry approach with a high-resolution spatially unbiased infratentorial template, regional cerebellar gray matter density was compared between 23 patients with panic disorder and 33 healthy individuals. RESULTS: The gray matter density in the right posterior-superior (lobule Crus I) and left posterior-inferior (lobules Crus II, VIIb, VIIIa) cerebellum was significantly reduced in the panic disorder group compared to healthy individuals (p < 0.05, false discovery rate corrected, extent threshold = 100 voxels). Additionally, the gray matter reduction in the left posterior-inferior cerebellum (lobule VIIIa) was significantly associated with greater panic symptom severity (r = -0.55, p = 0.007). CONCLUSIONS: Our findings suggest that the gray matter deficits in the posterior cerebellum may be involved in the pathogenesis of panic disorder. Further studies are needed to provide a comprehensive understanding of the cerebro-cerebellar network in panic disorder.

Effects of the Combination Herbal Extract on Working Memory and White Matter Integrity in Healthy Individuals with Subjective Memory Complaints : A Randomized, Double-Blind, Placebo-Controlled Clinical Trial

OBJECTIVES: The combination extract of four kinds of herbs, Gastrodia elata, Liriope platyphylla, Dimocarpus longan, and Salvia miltiorrhiza, has shown to have memory improving effects in mice. The aim of this study was to investigate the efficacy and safety of the herbal mixture for improving working memory as well as microstructural changes in white matter integrity in individuals with subjective memory complaints. METHODS: Seventy-five individuals with subjective memory complaints were assigned to receive either placebo (n = 15) or herbal mixture (low-dose group, n = 30 and high-dose group, n = 30) supplementation in an 8-week, randomized, double-blind, placebo-controlled clinical trial. Changes in working memory performance and fractional anisotropy (FA) values reflecting white matter integrity from baseline to 8-week endpoint were assessed. RESULTS: The herbal mixture group showed an increase in working memory performance compared to the placebo group (p for interaction = 0.001). In addition, the herbal mixture group showed an increase in FA values in the temporo-parietal regions (corrected p < 0.05), which are crucially involved in working memory function and are among the most affected regions in patients with cognitive impairments. CONCLUSIONS: Findings from this study indicate that the herbal mixture may be a promising therapeutic option for individuals with subjective memory complaints.

Effects of Korean Red Ginseng on White Matter Microstructure and Cognitive Functions: A Focus on Intrusion Errors

OBJECTIVES: Although ginseng has been reported to protect neuronal cells and improve various cognitive functions, relationship between ginseng supplementation and response inhibition, one of the important cognitive domains has not been explored. In addition, effects of ginseng on in vivo human brain have not been investigated using the diffusion tensor imaging (DTI). The purpose of the current study is to investigate changes in intrusion errors and white matter microstructure after Korean Red Ginseng supplementation using standardized neuropsychological tests and DTI. METHODS: Fifty-one healthy participants were randomly allocated to the Korean Red Ginseng (n = 26) or placebo (n = 25) groups for 8 weeks. The California Verbal Learning Test was used to assess the number of intrusion errors. Intelligence quotient (IQ) was measured with the Korean Wechsler Adult Intelligence Scale. Depressive and anxiety symptoms were evaluated using Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, and Hopkins Symptom Checklist-25. The fractional anisotropy (FA) was measured from the brain DTI data. RESULTS: After the 8-week intervention, Korean Red Ginseng supplementation significantly reduced intrusion errors after adjusting age, sex, IQ, and baseline score of the intrusion errors (p for interaction = 0.005). Change in FA values in the left anterior corona radiata was greater in the Korean Red Ginseng group compared to the placebo group (t = 4.29, p = 0.04). CONCLUSIONS: Korean Red Ginseng supplementation may be efficacious for improving response inhibition and white matter microstructure integrity in the prefrontal cortex.

Levator Palpebrae and Inferior Rectus Palsy From Thalamo-Mesencephalic Infarction

No abstract available.

Disturbance of the Glutamatergic System in Mood Disorders

The role of glutamatergic system in the neurobiology of mood disorders draws increasing attention, as disturbance of this system is consistently implicated in mood disorders including major depressive disorder and bipolar disorder. Thus, the glutamate hypothesis of mood disorders is expected to complement and improve the prevailing monoamine hypothesis, and may indicate novel therapeutic targets. Since the contribution of astrocytes is found to be crucial not only in the modulation of the glutamatergic system but also in the maintenance of brain energy metabolism, alterations in the astrocytic function and neuroenergetic environment are suggested as the potential neurobiological underpinnings of mood disorders. In the present review, the evidence of glutamatergic abnormalities in mood disorders based on postmortem and magnetic resonance spectroscopy (MRS) studies is presented, and disrupted energy metabolism involving astrocytic dysfunction is proposed as the underlying mechanism linking altered energy metabolism, perturbations in the glutamatergic system, and pathogenesis of mood disorders.

Reliability and Validity of the Fatigue Severity Scale among University Student in South Korea

OBJECTIVES: There are only a limited number of studies on instruments assessing fatigue in university students, although fatigue exerts negative influences on their health and academic performances and fatigue-related complaints are more frequently reported in young adults than middle-aged adults. The aim of this study was to validate the 9-item Fatigue Severity Scale (FSS) among university students including both undergraduate and graduate students in South Korea. METHODS: A total of 176 university students completed a battery of self-report questionnaires, including the FSS, the Brief Fatigue Inventory (BFI), the Beck Depression Inventory-II (BDI-II), the Beck Anxiety Inventory (BAI), the Medical Outcomes Study Short Form 36 version 2 (MOS-SF36v2), and the Inclusion of Community in the Self Scale (ICS). The data were collected from February of 2012 to June of 2012. The reliability, convergent validity, divergent validity, and exploratory factor analyses were conducted to assess psychometric properties of the FSS. RESULTS: The mean FSS score was 3.20 (standard deviation = 1.43). The FSS demonstrated an excellent internal consistency (Cronbach's alpha = 0.93) and item-total correlations ranged from 0.56 to 0.90. Correlations of the FSS with the BFI (r = 0.71, p < 0.01), BDI-II (r = 0.54, p < 0.01), BAI (r = 0.46, p < 0.01), MOS-SF36v2 physical component summary (r = -0.28, p < 0.01), MOS-SF36v2 mental component summary (r = -0.55, p < 0.01), and ICS (Spearman's rho = -0.07, p = 0.33) showed acceptable convergent and divergent validity. Exploratory factor analysis defined one underlying factor (eigenvalue = 5.67) that explained 93.50% of the total variance. CONCLUSIONS: To the best of our knowledge, this is the first study to investigate reliability and validity of the FSS in university students. The FSS exhibits good psychometric properties for evaluation of fatigue among university students in South Korea. Since the FSS is easy to administer, score, and interpret, it could be a useful tool in research and practice for assessing fatigue among university students.

Recanalization of Acute Intracranial Artery Occlusion Using Temporary Endovascular Bypass Technique / 신경중재치료의학

PURPOSE: The purpose of this study is to present our preliminary experience of the temporary endovascular bypass (TEB) technique using an Enterprise stent for recanalization of acute intracranial artery (IA) occlusion. MATERIALS AND METHODS: Patients treated by TEB were enrolled in this retrospective study from January 2009 to May 2010. All the procedures consist of temporary partial deployment and subsequent retrieval of Enterprise stent, supplemented by intra-arterial infusion of urokinase (UK) and/or tirofiban. According to the thrombolysis in cerebral infarction (TICI) classification, recanalization was evaluated with initial and postprocedural angiography. Safety was evaluated related to the procedure and clinical outcomes were assessed by National Institute of Health Stroke Scale (NIHSS) score at discharge and modified Rankin scale (mRS) score at 3 months. RESULTS: Eleven patients (median NIHSS 12.8, mean age 61.6 years, male: female = 8:3) with acute IA occlusion were treated with TEB. All the patients presented with TICI 0, and the occluded vessel was the middle cerebral artery (n=7), the basilar artery (n=1), and the distal ICA occlusion (n = 3). IV infusion of tissue plasminogen activator (tPA) was done in 4 patients and mechanical thrombolysis with intra-arterial UK was performed in 9. Recanalization was achieved in 73% (8 patients; TICI > or = 2). There were no procedure-related complications except for two asymptomatic intracranial hemorrhages. Improvement (> or = 4 points on the NIHSS) and good outcome (mRS < or =2) after 90 days was shown in six patients (55%). One patient died 6 days after procedure. CONCLUSION: TEB may be a valuable treatment option in acute thromboembolic IA occlusion without stent implantation.

Prevalence of Disc Degeneration in Asymptomatic Korean Subjects. Part 2 : Cervical Spine

OBJECTIVE: Similar to back pain, neck pain has recently shown to have increasing prevalence. Magnetic resonance imaging (MRI) is useful in identifying the causes of neck pain. However, MRI shows not only pathological lesions but also physiological changes at the same time, and there are few Korean data. The authors have attempted to analyze the prevalence of disc degeneration in highly selective asymptomatic Korean subjects using MRI. METHODS: We performed 3 T MRI sagittal scans from C2 to T1 on 102 asymptomatic subjects (50 men and 52 women) who visited our hospital between the ages of 14 and 82 years (mean age 46.3 years). All images were read independently by three observers (two neurosurgeons and one neuroradiologist) who were not given any information about the subjects. We classified grading for cervical disc herniation (HN), annular fissure (AF), and nucleus degeneration (ND), using disc degeneration classification. RESULTS: The prevalence of HN, AF, and ND were 81.0%, 85.9%, and 95.4%, respectively. High prevalence of HN, AF, and ND was shown compared to previous literature. CONCLUSION: In asymptomatic Korean subjects, the abnormal findings of 3 T MRI showed a high prevalence in HN, AF, and ND. Several factors might play important roles in these results, such as population-specific characters, MRI field strength, and disc degeneration grading system.

Prevalence of Disc Degeneration in Asymptomatic Korean Subjects. Part 1 : Lumbar Spine

OBJECTIVE: Asymptomatic patients show high degeneration prevalence at lumbar disc in previous literatures. Unfortunately, there are few Korean data, so the authors attempted to analyze the prevalence of disc degeneration in highly selective asymptomatic Korean subjects using MRI. METHODS: We performed 3 T MRI sagittal scans from T12 to S1 on 102 asymptomatic subjects (50 men and 52 women) who visited our hospital between the ages of 14 and 82 years (mean age 46.3 years). All images were read independently by three observers (two neurosurgeons and one neuroradiologist) who were not given any information about the subjects. We classified grading for lumbar disc herniation (HN), annular fissure (AF), and nucleus degeneration (ND), using disc degeneration classification. RESULTS: The prevalence of HN, AF, and ND were 81.4%, 76.1%, and 75.8% respectively. Almost all levels showed an age-related proportional tendency with some exceptions. CONCLUSION: In asymptomatic Korean subjects, the abnormal findings showed high prevalence of AF, ND, and extrusion. Especially in young ages, the authors found that bulging, protrusion, and AF showed high prevalence at L4/5 and L5/S1. And ND showed high prevalence at L5/S1. So, all lumbar disc degenerations are not pathologic, especially in children and adolescents.

The Results of Radiation Therapy as Definitive, Postoperative, and Salvage Therapy for Meningioma / 이화의대지

OBJECTIVES: Radiation therapy has multiple roles in the treatment of meningioma although surgery remains the primary treatment of choice. In this retrospective study, we report the results of radiation therapy for meningioma as definitive, postoperative or salvage therapies. METHODS: Seventeen patients diagnosed with meningioma were treated with radiation therapy in our institute from May 2000 to October 2009. Radiation therapies were performed as definitive therapies in 8 patients, as postoperative therapies in 5 and as salvage therapies in 4. Nine patients received stereotactic radiosurgery (SRS), 2 patients fractionated stereotactic radiotherapy (FSRT), and 5 patients 3-dimensional conformal radiotherapy (3DCRT). Radiation dose were 12 to 20 Gy for SRS, 36 Gy in 9 fractions for FSRT and 50.4 Gy in 28 fractions for 3DCRT. Follow-up imaging study of computed tomography or magnetic resonance imaging was performed at 6 to 12 months intervals and neurologic exam was performed with an interval less than 6 months. RESULTS: The median follow-up duration was 38 months (range, 12 to 85 months). Tumor progression after radiation therapy developed in one patient. The reduction of tumor volume measured on follow-up images were more than 20% in 4 patients and minimal change of tumor volume less than 20% were observed in 12 patients. Peritumoral edema developed in 4 patients and disappeared without any treatment. One patient had radiation necrosis. CONCLUSION: Our experience is consistent with the current understanding that radiotherapy is as an effective and safe treatment modality for meningiomas when the tumor cannot be resected completely or when recurred after surgery.

Sex Differences in Cerebellar Structure of Healthy Adults

OBJECTIVES: Although there have been studies that examine sex differences of the brain structures using magnetic resonance imaging, studies that specifically investigate cerebellar structural differences between men and women are scarce. The purpose of current study was to examine sex differences in structures of the cerebellum using cerebellar template and cerebellum analysis methods. METHODS: Sixteen men and twenty women were included in the study. A MATLAB based program (MathWorks, Natick, MA, USA), Statistical Parametric Mapping 5 (SPM5) using the spatially unbiased infra-tentorial atlas template (SUIT) as the cerebellum template, was used to analyze the brain imaging data. RESULTS: There was no significant difference in age between men (mean age = 28.1) and women (mean age = 27.2). Men showed higher gray matter density than women in two left cerebellar areas including the clusters in the lobules IV and V (a cluster located across the lobules IV and V), and the lobule VIIIb (lobules IV and V, t = 4.75, p < 0.001 ; lobule VIIIb, t = 3.08, p = 0.004). CONCLUSIONS: The current study found differences in cerebellar gray matter density between men and women. The current study holds its significance for applying the template specifically developed for the analysis of cerebellum.