Triphasic waves and brain atrophy in patients with acute encephalopathy / Ondas trifásicas y atrofia cerebral en pacientes con encefalopatía aguda

Abstract Introduction: Triphasic waves (TW) constitute an electroencephalographic pattern associated with certain kinds of encephalopathy. Brain atrophy may be a predisposing factor linked with TW. Objective: To compare the degree of brain atrophy and white matter disease between patients with acute encephalopathy with and without TW. Methods: A retrospective observational study including adult patients with encephalopathy, with and without TW, hospitalized between 2016 and 2017. The degree of brain atrophy and white matter lesion were defined using the Global Cortical Atrophy and Age Related White Matter Changes (ARWMC) scales, respectively. Scores were compared between groups. Mortality rates were registered. Results: Sixteen patients with TW were identified matched by age and sex with 30 patients without TW. The mean age was 80 years in the TW group. Women represented 87.5%. Multifactorial encephalopathy was the most frequent diagnosis followed by metabolic encephalopathy. Patients with TW had more brain atrophy (10.43 vs 6.9, p= 0.03). Mean ARWMC was 9.43±6.5 and 8.5 ±7.89 in patients with and without TW respectively (p= 0.5). Mortality rate was higher in the TW group (31.25 vs 6.66% p= 0.02). Conclusions: Patients with acute encephalopathy and TW had higher degree of cerebral atrophy. It is possible that this structural alteration predisposes to the appearance of TW. There was no significant difference in white matter lesion degree. The mortality of the TW group was high, so future studies are necessary to determine their prognostic value.

Resumen Introducción: Las ondas trifásicas (OT) constituyen un patrón electroencefalográfico asociado con diversas encefalopatías. La atrofia cerebral podría predisponer a su aparición. Objetivo: Comparar el grado de atrofia cerebral y de lesión de sustancia blanca en pacientes con encefalopatía aguda con y sin OT. Métodos: Estudio observacional retrospectivo, incluyó pacientes adultos con encefalopatía aguda con y sin OT internados entre 2016 y 2019. El grado de atrofia cerebral y de lesión de sustancia blanca se definieron según las escalas Global Cortical Atrophy y Age Related White Matter Changes (ARWMC), respectivamente. Se compararon los puntajes entre grupos. Se registró la mortalidad. Resultados: Se identificaron 16 pacientes con OT y 30 sin OT pareados según edad y sexo. La edad promedio del grupo con OT fue 80 años. El 87.5% fueron mujeres. La encefalopatía multifactorial fue el diagnóstico más frecuente seguido de la encefalopatía metabólica. El grado de atrofia fue mayor en pacientes con OT (10.43 vs 6.9, p= 0.03). El puntaje ARWMC fue 9.43 ±6.5 y 8.5 ±7.89 en pacientes con y sin OT respectivamente (p= 0.5). La mortalidad fue mayor en el grupo con OT (31.25 vs 6.66% p= 0.02). Conclusiones: Pacientes con encefalopatía aguda y OT tuvieron mayor grado de atrofia cerebral. Dicha alteración estructural podría relacionarse con la aparición de OT. No hubo diferencias significativas en el grado de lesión de sustancia blanca. La mortalidad del grupo con OT fue elevada. Son necesarios estudios para determinar su valor pronóstico.

Research Development in Patients with Multiple Sclerosis by Focus on MRI / 罕见病研究

Multiple sclerosis (MS) is an autoimmune inflammatory demyelinating disease of the central nervous system whose clinical manifestations and diagnostic criteria are non-specific and absence of golden criteria when diagnosing. Magnetic resonance imaging (MRI) can not only observe the focal lesions of demyelination, but also evaluate microstructural damages and iron deposition in the white/gray matter in MS patients by applying various developing sequences. MRIs play an irreplaceable role in revealing pathological evolution, prognosis and monitoring after treatment of MS patients. This paper reviewed the clinical value and application of MRIs for the MS patients in recent years.

Valor pronóstico del glutamato en el líquido cefalorraquídeo en esclerosis múltiple / Prognostic value of cerebrospinal fluid glutamate in multiple sclerosis

Resumen El objetivo del trabajo fue evaluar la asociación entre el nivel de glutamato en el líquido cefalorraquídeo (LCR) al inicio de la enfermedad y la progresión de la enfermedad durante el seguimiento en una cohorte de pacientes con esclerosis múltiple (EM). Se determinaron niveles de glutamato (Glu) en LCR al inicio de la enfermedad. Se realizó una resonancia basal y durante el seguimiento cada 12 meses con el objeto de determinar el porcentaje de cambio de volumen cerebral (PCVC), grosor cortical (GC) y volumen le sional cerebral en secuencia T2 (VLT2). Los predictores primarios de interés fueron los niveles basales de Glu en LCR, PCVC Y GC, así como la progresión clínica de la enfermedad [medida por Expanded Disability Status Scale (EDSS) y tasa anual de recaídas]. Un total de 26 pacientes fueron incluidos. La concentración media de Glu fue de 5.3 ± 0.4 μM/l. Se encontró una asociación significativa entre concentraciones basales elevadas de Glu y la progresión del EDSS (b = 1.06, IC 95% 0.47-1.66, p = 0.003), así como también el PCVC (b = -0.71, IC 95% -0.56-1.38, p = 0.002) y CG (b = -0.15, IC 95% -0.06-0.33, p = 0.01). No se encontró asociación entre los niveles de Glu y la tasa anual de recaídas como tampoco el VLT2 (b = 0.08, IC 95% -0.11-0.43, p = 0.11 y b = 195, IC -39-330, p = 0.22, respectivamente). Los niveles aumentados de Glu se asociaron con un mayor cambio en el PCVC y progresión del EDSS durante el seguimiento.

Abstract. The objective of this study was to evaluate the association between glutamate (Glu) levels in cerebrospinal fluid (CSF) at disease onset and disease progression during follow up in a cohort of multiple sclerosis (MS) patients. Glu level was measured at disease onset (first relapse). MRI was obtained at baseline and follow-up (every 12 months) to determine the percent of brain volume change (PBVC), cortical thickness (CT), and T2 lesion volume (T2LV). The primary predictors of interest were baseline CSF Glu levels, PBVC and CT, as well as clinical disease progression [measured by Expanded Disability Status Scale (EDSS) and annualized relapse rate] during follow-up. A total of 26 MS patients were included. Mean concentration of Glu in CSF at diagnosis was 5.3 ± 0.4 μM/l. A significant association was observed between higher baseline levels of Glu and an increase in EDSS during follow up (b = 1.06, 95%CI 0.47-1.66, p = 0.003) as well as PBVC (b = -0.71 95%CI -0.56-1.38, p = 0.002) and CT (b = -0.15, 95%CI -0.06-0.33, p = 0.01). We did not observe an association between baseline Glu levels and relapse rate or T2LV during follow-up (b = 0.08, 95%CI -0.11-0.43, p = 0.11 and b = 195, 95%CI -39-330, p = 0.22, respectively). Higher Glu concentrations at disease onset were associated with an increase in PBVC and EDSS progression during follow-up in MS patients.

Regional brain atrophy is related to social cognition impairment in multiple sclerosis / La atrofia cerebral regional se relaciona con el deterioro de la cognición social en sclerosis múltiple

ABSTRACT Background: Multiple sclerosis exhibits specific neuropathological phenomena driving to both global and regional brain atrophy. At the clinical level, the disease is related to functional decline in cognitive domains as the working memory, processing speed, and verbal fluency. However, the compromise of social-cognitive abilities has concentrated some interest in recent years despite the available evidence suggesting the risk of disorganization in social life. Recent studies have used the MiniSEA test to assess the compromise of social cognition and have found relevant relationships with memory and executive functions, as well as with the level of global and regional brain atrophy. Objective: The present article aimed to identify structural changes related to socio-cognitive performance in a sample of patients with relapsing-remitting multiple sclerosis. Methods: 68 relapsing-remitting multiple sclerosis Chilean patients and 50 healthy control subjects underwent MRI scans and neuropsychological evaluation including social-cognition tasks. Total brain, white matter, and gray matter volumes were estimated. Also, voxel-based morphometry was applied to evaluate regional structural changes. Results: Patients exhibited lower scores in all neuropsychological tests. Social cognition exhibited a significant decrease in this group mostly related to the declining social perception. Normalized brain volume and white matter volume were significantly decreased when compared to healthy subjects. The regional brain atrophy analysis showed that changes in the insular cortex and medial frontal cortices are significantly related to the variability of social-cognitive performance among patients. Conclusions: In the present study, social cognition was only correlated with the deterioration of verbal fluency, despite the fact that previous studies have reported its link with memory and executive functions. The identification of specific structural correlates supports the comprehension of this phenomenon as an independent source of cognitive disability in these patients.

RESUMEN Antecedentes: La esclerosis múltiple presenta fenómenos neuropatológicos específicos que conducen a la atrofia cerebral global y regional. A nivel clínico, la enfermedad está relacionada con el deterioro funcional de los dominios cognitivos como la memoria de trabajo, la velocidad de procesamiento y la fluidez verbal. Sin embargo, el compromiso de las habilidades socio-cognitivas ha concentrado cierto interés en los últimos años debido a la evidencia disponible que sugiere el riesgo de desorganización en la vida social. Estudios recientes han utilizado la prueba MiniSEA para evaluar el compromiso de la cognición social y han encontrado relaciones relevantes con la memoria y funciones ejecutiva, así como con el nivel de atrofia cerebral global y regional. Objetivo: El presente artículo tiene como objetivo identificar cambios estructurales relacionados con el rendimiento sociocognitivo en una muestra de pacientes con esclerosis múltiple recurrente-remitente. Métodos: 68 pacientes Chilenos con esclerosis múltiple recurrente-remitente y 50 sujetos de control sanos se sometieron a resonancias magnéticas y evaluación neuropsicológica, incluidas las tareas de cognición social. Se estimaron los volúmenes cerebrales totales, de materia blanca y materia gris. Además, se aplicó la morfometría basada en vóxel para evaluar los cambios estructurales regionales. Resultados: Los pacientes muestran puntuaciones más bajas en todas las pruebas neuropsicológicas. La cognición social exhibe una disminución significativa en este grupo principalmente relacionada con la disminución de la percepción social. El volumen normalizado del cerebro y el volumen de la materia blanca disminuyeron significativamente en comparación con los sujetos sanos. El análisis regional de atrofia cerebral mostró que los cambios en la corteza insular y la corteza frontal medial están significativamente relacionados con la variabilidad del rendimiento sociocognitivo entre los pacientes. Conclusiones: En el presente estudio, la cognición social sólo se correlacionó con el deterioro de la fluencia verbal, a pesar de que estudios previos han reportado su vinculación con la memoria y funciones ejecutivas. La identificación de correlatos estructurales específicos apoya la comprensión de este fenómeno como una fuente independiente de discapacidad cognitiva en estos pacientes.

Complicaciones neurológicas en un niño con neumonía por influenza: reporte de caso clínico / Neurological complications in a child with influenza pneumonia: clinical case report

RESUMEN La influenza es una enfermedad endémica transmisible, en Ecuador los subtipos de virus que circulan son A(H1N1), A (H3N2) y tipo B. Existen dos picos de circulación del virus que fueron registrados en Ecuador en los años 2016 y 2018, siendo éste último el de mayor incidencia. Las complicaciones neurológicas asociadas a la influenza han sido descritas de manera poco frecuente, representando el 10% de los niños afectados y los reportes que existen la mayoría son de niños y adultos jóvenes. En el presente artículo se reporta un caso ocurrido en el 2018 de un lactante mayor con cuadro de neumonía por Influenza A/H3, Influenza A/pan1, Influenza A/pan2, virus Parainfluenza 1, complicada con derrame pleural izquierdo y atrofia cerebral y microhemorragias cerebrales.Palabras claves: Influenza; neumonía; neurología; derrame pleural; atrofia cerebral; hemorragia cerebral; informes de caso

BSTRACT Influenza is a transmissible endemic disease, in Ecuador the virus subtypes that circulate are A (H1N1), A (H3N2) and type B. There are two peaks of virus circulation that were registered in Ecuador in 2016 and 2018, the latter being the one with the highest incidence. The neurological complications associated with influenza have been described infrequently, representing 10% of the affected children and the reports that there are the majority are of children and young adults. This article presents a case in 2018 of an older infant with Influenza A / H3 pneumonia, Influenza A / pan1, Influenza A / pan2, Parainfluenza virus 1, complicated with left pleural effusion and cerebral atrophy and cerebral microhemorrhages.Keywords: Influenza; pneumonia; neurology; pleural effusion; Brain atrophy; cerebral haemorrhage; case reports.Correspondencia: Paúl MoscosoTeléfonos: (593) 987 038 828e-mail: paulmoscoso@hotmail.comIDs OrcidPaúl Moscoso: https://orcid.org/0000-0001-9018-7611Dayana Navarro: https://orcid.org/0000-0001-8601-9965Nicolás Espinosa:https://orcid.org/0000-0001-9825-0136

Xantomatosis cerebrotendinosa: Reporte de un caso en el Perú: Evaluación clínica integral y estudios de neuroimágenes / Cerebrotendinous Xanthomatosis: Report of a case in Peru: Comprehensive clinical evaluation and neuroimaging studies

Se presenta el caso de una paciente de 73 años de edad que, a los 30 años aproximadamente, comenzó a quejarse de dolor al caminar, localizando la molestia a nivel de las regiones aquilianas, con subsecuente aumento de volumen; al paso del tiempo, estas molestias la obligaron a efectuar consulta médica. Los análisis de laboratorio mostraron severa dislipidemia mixta. Al lado de información de significativa declinación cognitiva, provista por familiares (vgr., (i.e., olvidos frecuentes, desorientación, atención disminuida, concentración pobre), hubo evidencia de ánimo fluctuante, labilidad emocional, crisis ansiosas evolucionando hacia ataques de pánico. El test minicognitivo de Folstein, mostró severo estado demencial y en el examen neurológico se constataron ataxia cerebelosa y signos de piramidalismo parcial. El examen oftalmológico puso en evidencia xantelasmas, cataratas y un denso arco senil. El estudio del cerebro con resonancia magnética (RM) mostró el daño encefálico y signos sugestivos de depósitos del colastenol en el SNC. La presencia de xantomas , los hallazgos oftalmológicos, la demencia definidamente progresiva y la ataxia cerebelosa fueron hallazgos clínicos que permitieron establecer el diagnóstico de xantomatosis cerebrotendinosa.

The case of a 73 years-old woman that, since approximately the age of 30 years started to complain of pain when walking, is presented. The symptom was mainly located in the acchillean regions which, as time advanced, showed gradual volume increase and, finally, forced her to seek medical evaluation. Accompanying relatives reported a several years’ history of gradually increasing cognitive difficulties (i.e., forgetfulness, disorientation, poor attention and concentration), fluctuating mood (from periods of good humor switching to sudden episodes of sadness and crying spells), emotional lability and anxiety crises evolving into brief panic attacks. The Mini-cognitive Fenton Test confirmed severe dementia and the neurological evaluation showed cerebellar ataxia and partial pyramidalism. The ophthalmological examination revealed xanthelasmas, cataracts and dense arcus senilis. Xanthomas were detected in the Achillean tendons of both lower extremities. Auxiliary laboratory and densitometric tests demonstrated mixed dyslipidemia and dorsal-lumbar osteoporosis, respectively, and magnetic resonance imaging of the brain (RMC) confirmed SNC damage and suggested deposits of cholestenol, thus confirming the diagnosis of Cerebroitendinous Xanthomatosis.

Magnetic resonance imaging revealed the relationship between brain atrophy and white matter lesions / 中国中西医结合急救杂志

Objective To analyze the correlation between cerebral atrophy and white matter lesions (WML) in magnetic resonance imaging (MRI) by quantitative and qualitative methods. Methods Two hundred and seventy-two patients with WML admitted to the Department of Neurology of Taizhou Central Hospital from January 2015 to December 2017 were enrolled, by adopting MCMxxxVI 9.0 TM image processing tool and Analyze 9.0TM image editing tool, the volume within the skull, whole brain tissue, cerebrospinal fluid, subarachnoid volume on the surface of the brain, gray matter, normal brain white matter and diseased white matter were quantitatively determined in the MRI, Fazekas visual score was used to qualitatively evaluate the WML of MRI, and the correlation between brain atrophy and WML was analyzed. Results General linear model analysis showed that the WML volume had a negative correlation with total brain atrophy or decreased whole brain volume (β = -0.432, P = 0.004), especially with deep brain atrophy, namely WML volume had a significant positive correlation with the increase of ventricular volume (β = 0.098, P = 0.031), and it had no correlation with superficial brain atrophy or the increase of subarachnoid volume on the surface of the brain (β = 0.088, P = 0.547). Fazekas rating scale used for the correlation analysis of WML and brain atrophy also showed similar results. After adjusting for the gender and skull content volume, it was shown that the WML volume was well fitted with brain volume model, and so was the WML with the following volumes: cerebral white matter volume without any pathological changes, the whole brain tissue volume, gray matter volume models (brain volume R2 = 0.25, cerebral white matter volume with no pathological changes R2 = 0.35, whole brain tissue volume R2 = 0.77, gray matter volume R2 = 0.25, all P < 0.05). Conclusion MRI analysis showed WML was associated with brain atrophy, primarily with deep brain atrophy.

Paraparesis, leucodystrophy and brain atrophy are neurological manifestations of congenital immunodeficiency disease? / 中华实用儿科临床杂志

A 4-year-old boy complained of weakness of the lower limbs for one and a half month.The child had been diagnosed as X-linked agammaglobulinemia (XLA) at 1-year old.In recent one and a half month,he gradually suffered from activity intolerance and fatigue,inability to jump and run,staggering gait and slow speech.All the symptoms above indicated deteriorating motor function.The brain magnetic resonance imaging revealed abnormal signals in white matter and brain atrophy.The cerebrospinal fluid analysis detected the presence of oligoclonal immunoglobulin G band.In short term after intravenous immunoglobulin and methylprednisolone treatment,the boy's lower extremity function and speech speed were slightly improved.However,at 1-year follow-up,the boy's condition became even worse.The child could not sit without support and had difficulty in swallowing.The child could not speak or follow any commands.Neurological examination revealed spastic quadriplegia and pseudobulbar palsy.Progressive neurodegeneration is not a common syndrome in patients with XLA.Brain biopsy is an important approach clinically to find out etiology.

Age-related cerebral ventricular volume changes in healthy elderly humans / Alterações volumétricas dos ventrículos cerebrais relacionadas a idade em idosos saudáveis

Introduction: Normal aging is associated with morphological alte-rations in brain. Ventricular system is located deep inside brain and reflect the overall process of parenchymal atrophy. Once neurode-generative disorders course with more prominent dilatation of brain ventricles, to establish normative volumetric parameters from Brazi-lian healthy old individuals is necessary, and it may be an additional tool on differentiation from the normal to pathological. Objective: To investigate brain ventricular volume changes in Brazilian healthy el-derly people. Methods: Transversal study using magnetic resonance imaging (1.5T) of the brain from 21 elderly healthy volunteers (67±6 years old). Data were assessed with manual segmentation techni-que. Regions of interest were the brain ventricles and intracranial volumes. Old (60-69 years old, 15 women) and Older (>69 years old) groups were created for analysis. Results: Volume of all ventricular compartments significantly increased (p<.001) with age, with excep-tion of the fourth ventricle. The third and lateral ventricles increased between groups 2.1- and 2.8-fold, respectively. Mean total ventricular volume was 1.2±.4% of intracranial volume in Old and 3.2±1.8% in Ol-der group (p<.001), which represents 15±6ml and 40±24ml (p=.001), respectively. We observed a moderate to strong positive correlation between ventricular volume and age, with the best correlation in the third ventricle (r=.710). Total intracranial volume diminished with age, but without statistical significance. Conclusions: Brain ventricles vo-lume increased significantly with age in healthy old individuals, with exception of the fourth ventricle. (AU)

Introdução: O envelhecimento normal está associado a alterações morfológicas do cérebro. O sistema ventricular está localizado pro-fundamente no encéfalo e reflete o processo global de atrofia do pa-rênquima. Uma vez que doenças neurodegenerativas cursam com dilatação mais proeminente dos ventrículos cerebrais, estabelecer parâmetros volumétricos de normalidade em nossa população idosa saudável se faz necessário, podendo ser uma ferramenta a mais para diferenciar o normal do patológico. Objetivo: Investigar alterações volumétricas dos ventrículos cerebrais em brasileiros idosos sau-dáveis. Métodos: Estudo transversal com imagens de ressonância magnética (1,5T) do encéfalo de 21 idosos saudáveis (68±6 anos, 15 mulheres). Os dados foram examinados por técnicas de segmenta-ção manual. As regiões de interesse foram os ventrículos cerebrais e o volume intracraniano. Criamos os subgrupos Idosos (60-69 anos) e Mais idosos (>69 anos) para a análise. Resultados: O volume de todos os ventrículos aumentou com a idade (p<0,001), com exceção do quarto ventrículo. O terceiro e os ventrículos laterais aumentaram 2,1 e 2,8 vezes, respectivamente, entre os grupos. O volume ventri-cular médio foi de 1,2±0,4% do volume intracraniano nos Idosos e de 3,2±1,8% nos mais idosos, o que representa 15±6ml e 40±24ml, respectivamente. Observamos correlação positiva de moderada a forte entre volume ventricular e idade, com a melhor correlação no terceiro ventrículo (r=0,710). O volume intracraniano diminui com a idade, sem significância estatística. Conclusão: os ventrículos cere-brais aumentam significativamente com o envelhecimento em idosos saudáveis, exceto o quarto ventrículo. (AU)

Neurosyphilis (Ocular Syphilis) with Bilateral Temporal Lobe Atrophy in an HIV patient: A case report

Introduction@#Before the advent of antibiotics, syphilis was known to be one of the most common infections affecting approximately 10% of the adult population worldwide. One of its devastating complications is neurosyphilis, which has a broad set of manifestations. Some patients may present with blurring of vision in the setting of an ongoing syphilis infection known as ocular syphilis. In the advent of increasing incidence of human immunodeficiency virus (HIV) infection, co-infection with it may further obscure its manifestations or may even cause synergistic effects.@*Case Presentation@#Presenting a case of a 26-year-old male patient who complained of bilateral fronto-occipital headache with progressive blurring of vision and scaly reddish to brown maculopapular lesions affecting the limbs prominently the soles and palms. CT scan showed cerebral atrophy prominently on the temporal lobe bilaterally. Mental status exam was normal. Neurosyphilis was confirmed by CSF studies and patient tested positive for HIV infection. Patient was then started on aqueous crystalline benzathine penicillin G four million units every four hours for ten days and was discharged with improved condition and no neurocognitive deficits. . He was advised to have CD4 count and other work up for his HIV infection as outpatient.@*Conclusion@#The reported incidence of neurosyphilis is increasing in the advent of HIV infection. The deficiency of a clear epidemiology, pathophysiology and complications of cerebral atrophy in neurosyphilis patients co-infected with HIV necessitates further studies to elucidate the proper approach to this preventable and treatable disease.

Correlation between Brain Atrophy and Cognitive Impairment in Patients with Alzheimer / 现代医院

Objective To analyze the correlation between brain atrophy and cognitive impairment in patients with Alzheimer.Methods 45 cases of Alzheimer in recent years in our hospital were selected as the observation group, and 45 patients without Alzheimer in the same period in our hospital as control group.The relationship between brain atrophy and cognitive impairment in patients with Alzheimer was analyzed.Results The width of temporal and anterior horn of lateral ventricle, three ventricle, quadrigeminal and the average width of lateral fissure, the body and occipital lateral cerebral ventricle and sulci in the observation group were significantly bigger than that in the control group.The memory, orientation, problem solving ability, social function, family life, the degree of self-care ability impairment of the observation group were significantly higher than that of the control group (P<0.05).Conclusion Brain atrophy is a specific marker of Alzheimer, which may lead to cognitive impairment.

Relapsing Polychondritis Presented with Encephalitis Followed by Brain Atrophy

Relapsing polychondritis (RP) is a rare autoimmune disease that is characterized by inflammatory reaction of unknown etiology and destruction of cartilaginous structures. Characteristic symptoms of this disease include cartilage inflammation of the ear, nose, larynx, trachea, bronchi, joints, eyes, heart and skin. Concomitance with neurologic symptom is very rare in RP, and the detailed underlying mechanism of neurological involvement associated with RP is not fully understood. We herein described an unusual recurrent case of inflammatory brain lesions associated with RP, with attention to clinical manifestations, autoimmune disease involvement, and therapeutic effects.

Brain atrophy in multiple sclerosis: therapeutic, cognitive and clinical impact / Atrofia cerebral en esclerosis múltiple: impacto clínico, cognitivo y terapéutico

ABSTRACT Multiple sclerosis (MS) was always considered as a white matter inflammatory disease. Today, there is an important body of evidence that supports the hypothesis that gray matter involvement and the neurodegenerative mechanism are at least partially independent from inflammation. Gray matter atrophy develops faster than white matter atrophy, and predominates in the initial stages of the disease. The neurodegenerative mechanism creates permanent damage and correlates with physical and cognitive disability. In this review we describe the current available evidence regarding brain atrophy and its consequence in MS patients.

RESUMEN La esclerosis múltiple (EM) fue considerada históricamente como una enfermedad inflamatoria de la sustancia blanca. Hoy en día hay mucha evidencia que apoya, además, el compromiso de la sustancia gris y los mecanismos neurodegenerativos, que son al menos parcialmente independientes de la inflamación. La atrofia de la sustancia gris se desarrolla más rápido que la atrofia de la sustancia blanca y predomina en las etapas iniciales de la enfermedad. El mecanismo neurodegenerativo, crea un daño permanente y se correlacionaría con la discapacidad física y cognitiva del paciente. En esta revisión, se describe la evidencia disponible actual con respecto a la atrofia cerebral y su consecuencia en los pacientes con EM.

Risk factors for different brain region atrophy among stroke and transient ischemic attack patients / 中国神经精神疾病杂志

Objectives Brain atrophy plays a key role in post-stroke dementia. The current study aims to explore risk factors for brain atrophy in different regions in order to find the ultimate therapeutic strategy. Methods Consecutive stroke and/or transient ischemic attack (TIA) patients were recruited from July 2012 to June . The clinical features, neuro?imaging findings and risk factors were collected during hospitalization. Logistic regression analysis showed that, except for age, female gender (Odds ratio, OR=2.447, P=0.007) and the number of silent lacuna infarcts (OR=1.414, P=0.027) were independent risk factors for frontal lobe atrophy. Ischemic stroke history (OR=2.224, P=0.024) was the independent risk factor for parietal lobe atrophy. All of extra-/intracranial larger artery diseases (OR=2.584, P=0.015) and white mat?ter severity score (OR=1.112, P=0.007) as well as the number of silent lacuna infarcts (OR=1.158,P=0.042) were inde?pendent risk factors for medial temporal lobe atrophy. Moreover, diabetes (OR=2.109, P=0.001),atrial fibrillation (OR=1.934, P=0.015) and white matter severity score (OR=1.098, P=0.002) were independent risk factors for global brain atro? phy. Conclusion Risk factors for brain atrophy included diabetes,atrial fibrillation, silent lacuna infarcts and white mat?ter changes. We should pay more attention to those patients with above risk factors in order to slow down the progression of brain atrophy and also prevent them from dementia by early interventions.

Late life depression and cognition：interaction with cerebrovascular factors / 中华神经科杂志

Objective To investigate the relationship among the late-life depression ( LLD ) , cognitive function and white matter lesions ( WML) , after excluding vascular risk factors and brain atrophy.Methods The depression and cognition status of 277 patients were assessed using a variety of neurological scales, and the actually enrolled patients were divided into LLD group ( 77 cases ) and the non-depressed group (103 cases).The independent samples t test and multivariate Logistic regression were used to analyze independent risk factors for depressive symptoms with the model Ⅰ of controlling age , sex, years of education and the model Ⅱof controlling age, sex, years of education, high blood pressure, diabetes and coronary heart disease.Under the premise of controlling mode Ⅱand brain atrophy , partial correlation was used to analyze the correlations of depressive symptoms and cognitive function and WML , and the correlation between depressive symptoms and cognitive items.Results The results showed that the proportion of high blood pressure (90.9%vs 74.7%, χ2 =6.342,P=0.046), cognitive scores (19.23 ±7.05 vs 22.99 ± 6.71, t=3.343,P=0.001), WML level 2 proportion (65.1% vs 34.9%, χ2 =7.373,P=0.025) and temporal lobe atrophy of hippocampal sulcus ratio (0.24 ±0.03 vs 0.22 ±0.03, t=-2.041,P=0.044) had statistically significant difference between the two groups.Multivariate Logistic regression showed that cognitive function was an independent risk factor for depression ( OR=1.63,95% CI 1.01 -2.80, P=0.030).Controlling for all risk factors , partial correlation analysis showed that depressive symptoms were correlated with cognitive function ( r=-0.239,P=0.004) and WML ( r=0.222,P=0.008) and the atrophy of temporal lobe and hippocampus ( r=0.173, P=0.040 ).Under the model Ⅱ, depressive symptoms correlated with attention (r=-0.175, P=0.040), memories (r=-0.140, P=0.050) and drawing clock test ( r=-0.186, P=0.029 ).Conclusions Excluding vascular risk factorts , brain atrophy and WML , cognitive impairment has significant correlation with depressive symptoms.Vascular risk factors are involved in the occurrence of depression , and WML may be the severity of cognitive impairment reserve marker.LLD patients showed hippocampal atrophy similar with early AD , manifesting the cognitive feature of memory and executive dysfunction and attention disorder .

Prediction of brain atrophy using three drug scores in neuroasymptomatic HIV-infected patients with controlled viremia

ABSTRACTBACKGROUND: Despite potent antiretroviral therapy, HIV still causes brain damage. Better penetration into the CNS and efficient elimination of monocyte/macrophages reservoirs are two main characteristics of an antiretroviral drug that could prevent brain damage. The aim of our study was to assess efficacy of three antiretroviral drug scores to predict brain atrophy in HIV-infected patients.METHODS:A cross sectional study consisting of 56 HIV-infected patients with controlled viremia, who had no clinically evident neurocognitive impairment. All patients had MRI of the head. A typical T2 transversal slice was analyzed and ventricles-brain ratio (VBr) as an overall brain atrophy index was calculated. Three antiretroviral drug scores were used and correlated with VBr: 2008 and 2010 CNS penetration effectiveness scores (SCPE2008 and SCPE2010) and the recently established monocyte efficacy (SME) score. A p-value <0.05 was considered significant.RESULTS:SCPE2010 was significantly associated with VBr in both univariate (r = -0.285, p = 0.033) and multivariate (ß = -0.299, p = 0.016) regression models, while SCPE2008 was not (r = -0.141, p = 0.300 and ß = -0.156,p = 0.214). SME was associated with VBr in multivariate model only (r = -0.297, p = 0.111 andß = -0.406, p = 0.029). Age and reported duration of HIV infection were also significant predictors of overall brain atrophy in multivariate regression models.CONCLUSIONS:Although based on similar type of research, SCPE2010 is a superior drug score compared to SCPE2008. SME is an efficient drug score in determining brain damage. Both SCPE2010 and SME scores should be taken into account in preventive strategies of brain atrophy and neurocognitive impairment in HIV-infected patients.

Study of correlation between the elder brain atrophy and calcification score at siphon segment of internal carotid artery / 临床神经病学杂志

Objective To explore the correlation between the elder brain atrophy and calcification score at siphon segment of internal carotid artery.Methods The brain CT examination was detected in 327 elders.The brain atrophy occurrence were observed, and the calcification score at siphon segment of internal carotid artery were determined and calculated.Accroding to the calcification score, all the cases were divided into calcification 0 score group, calcification 1-199 score group, calcification 200-399 score group, calcification 400-599 score group and calcification ≥600 score group.The situation of brain atrophy were compared among these groups.And the correlation between the brain atrophy and calcification score were analyzed.Results Accroding to the calcification score, there were 63 cases in calcification 0 score group, 133 cases in calcification 1-199 score group, 72 cases in calcification 200-399 score group, 28 cases in calcification 400-599 score group and 31 cases in calcification ≥600 score group.There were 13 cases ( 20.63%) of brain atrophy in calcification 0 score group, 64 cases (48.12%) in calcification 1 -199 score group, 51 cases (70.83%) in calcification 200 -399 score group, 23 cases (82.14%) in calcification 400-599 score group and 28 cases (90.32%) in calcification≥600 score group;the differences of the brain atrophy rate among these groups were statistical significant ( all P<0.05 ) .The brain atrophy was mainly mild-moderate in calcification 0 score group and calcification 1 -199 score group;which was mainly severe in calcification 200 -399 score group;and mainly moderate-severe in calcification 400 -599 score group and calcification≥600 score group (all P<0.05).Spearman rank correlation analysis showed that the degree of brain atrophy were positive correlated with calcification score at siphon segment of internal carotid artery ( r=0.717, P<0.05) .Conclusions The elder brain atrophy is significantly correlated with calcification score at siphon segment of internal carotid artery.The calcification score higher, the brain atrophy rate higher and the degree more severe.Calcification score can be used as an important indicator of the elder brain atrophy.

Is There Relationship between Brain Atrophy and Higher Incidence of Hip Fracture in Old Age?: A Preliminary Study

PURPOSE: The studies on the correlation between incidence of fall and brain atrophy have been going on to find out the cause of fall and its prevention. The purpose of this study was to explore the relationship between incidence of hip fracture and brain volume, measured by magnetic resonance image. MATERIALS AND METHODS: A total of 14 subjects with similar conditions (age, height, weight, and past history) were selected for this study. Fracture group (FG) was consisted of 5 subjects with intertrochanteric fracture. Control group (CG) had 9 subjects without intertrochanteric fracture. MRI-based brain volumetry was done in FG and CG with imaging software (V-works, CyberMed Co., Korea). Total brain (tBV), absolute cerebellar volumes (aCV) and relative cerebellar volumes (rCV) were compared between two groups. Student t-test was used to statistically analyze the results. RESULTS: In FG, average tBV, aCV and rCV were 1034.676+/-38.80, 108.648+/-76.80 and 10.50+/-0.72 cm3, respectively. In CG, average tBV, aCV and rCV were found to be 1106.459+/-89.15, 114.899+/-98.06 and 10.39+/-0.53 cm3, respectively, having no statistically significant difference (p>0.05). CONCLUSION: There was no significant difference between the fracture and control groups. Patients with neurologic disease such as cerebellar ataxia definitely have high incidence of fall that causes fractures and have brain changes as well. However, FG without neurologic disease did not have brain volume change. We consider that high risk of fall with hip fracture might decrease brain function which is not obvious to pickup on MRI.

Association between Characteristics of Brain Magnetic Resonance Imaging and Atypical Antipsychotics Use in Dementia Patients

OBJECTIVES: We aimed to identify the neuroimaging marker for prediction of the use of atypical antipsychotics (AAP) in dementia patients. METHODS: From April 2010 to March 2013, 31 patients who were diagnosed as dementia at the psychiatric department of Soonchunhyang University Hospital, completed the brain magnetic resonance imaging scan and cognitive test for dementia. Ten patients were treated with AAP for the improvement of behavioral and psychological symptoms of dementia (BPSD) and the other 21patients were not. Using T1 weighted and Fluid Attenuated Inversion Recovery (FLAIR) images of brain, areas of white matter (WM), gray matter (GM), cerebrospinal fluid (CSF) and white matter hyperintensities (WMH) have been segmented and measured. Multivariate logistic regression models were applied for assessment of association between AAP use and the GM/WM ratio, the WMH/whole brain (GM + WM + CSF) ratio. RESULTS: There was a significant association between AAP use and the GM/WM ratio (odds ratio, OR = 1.18, 95% confidence interval, CI 1.01-1.38, p = 0.037), while there was no association between AAP use and the WMH/whole brain ratio (OR = 0.82, 95% CI 0.27-2.48, p = 0.73). CONCLUSIONS: The GM/WM ratio could be a biological marker for the prediction of AAP use and BPSD in patients with dementia. It was more likely to increase as dementia progress since atrophy of WM was more prominent than that of GM over aging.

Brain atrophy at onset and physical disability in multiple sclerosis / Atrofia cerebral al inicio de la enfermedad y discapacidad fisica en esclerosis multiple

The aim of this study was to investigate if brain atrophy in multiple sclerosis (MS) patients during the disease onset predicts long term disability. METHODS: MS patients with follow-up time of at least 7 years from disease onset and with baseline and second magnetic resonance 12 months later were included to measure brain atrophy. Expanded Disability Status Scale (EDSS) was categorized in three groups, EDSS=0, EDSS=1 and 2.5 and EDSS>2.5, and used as disability measure. RESULTS: Twenty-six patients were included. Mean atrophy during the first year in patients that reached an EDSS≥3 was -0.76±0.45 %, in patients with an EDSS between 1 and 2.5 was -0.59±0.56, while in patients with an EDSS of 0 it was -0.38±0.42 (p=0.003). DISCUSSION: Brain atrophy rates during the first year of disease were predictive of disease progression in our population.

El objetivo fue evaluar en pacientes con esclerosis múltiple (EM) si la atrofia durante el primer año de iniciada la enfermedad predecía la discapacidad física a largo plazo. MÉTODOS: Pacientes con EM seguidos al menos durante 7 años del inicio de la enfermedad y con una resonancia magnetica al inicio y una segunda a los 12 meses de la inicial fueron incluidos para evaluar la atrofia cerebral. El Expanded Disability Status Scale (EDSS) fue categorizado en tres grupos, EDSS=0, EDSS=1 y 2.5 y EDSS>2.5, y usado como medida de la discapacidad. RESULTADOS: Veintiséis pacientes fueran incluidos. El porcentaje de atrofia durante el primer año de iniciada la enfermedad en los pacientes que alcanzaron un EDSS≥3 fue de -0.76±0.45%, de -0.59 ±0.56 en pacientes con EDSS entre 1 y 2.5; de -0.38±0.42 en pacientes con EDSS de 0 (p=0,003). DISCUSIÓN: La tasa de atrofia cerebral durante el primer año de la esclerosis múltiple fue predictora de progresión de la discapacidad.