The impact of multiple sclerosis on the size and morphology of corpus callosum: an MRI-based retrospective study / Impacto de la esclerosis múltiple en el tamaño y la morfología del cuerpo calloso: un estudio retrospectivo basado en resonancia magnética

SUMMARY: The corpus callosum (CC) includes the majority of fibers linking the two brain hemispheres. Several cross sectional studies showed an association between callosal atrophy and malfunction and neurodegenerative diseases, which may play a role in their pathological manifestations. As a result, the accurate quantification of the corpus callosum is important to have normative values according to sex, age and ethnicity. The purpose of this study is to determine the size of CC in patients suffering from multiple sclerosis, and compare it to CC size in healthyindividuals. Midsagittal size of CC were recorded prospectively from 404 routine MR brain examinations in normal individuals. The internal skull surface was measured to calculate CC/ internal skull surface ratio. Two groups of patients were studied: 200 (100 male /100 female) healthy individuals and 204 (101 males/103 females) with multiple sclerosis (MS). Mean surface area of CC in controls was 6.58±1.04 cm2 and there was no significant difference between males and females (P< 0.627). CC/ internal skull surface ratio was 4.44±0.77 %. MS patients showed a significant decrease in CC size compared to normal controls. Using MR imaging, we measured the mean sizes of the various portions of the CC in normal individuals, in addition to MS patients; these values may provide a useful basis to determine changes occurring in CC structures.

El cuerpo calloso (CC) incluye la mayoría de las fibras que unen los dos hemisferios cerebrales. Varios estudios transversales mostraron una asociación entre la atrofia y el mal funcionamiento calloso y las enfermedades neurodegenerativas, lo que puede desempeñar un papel en sus manifestaciones patológicas. En consecuencia, la cuantificación precisa del cuerpo calloso es importante para tener valores normativos según sexo, edad y etnia. El propósito de este estudio fue determinar el tamaño de CC en pacientes que padecen esclerosis múltiple y compararlo con el tamaño de CC en individuos sanos. El tamaño sagital medio del CC se registró prospectivamente a partir de 404 exámenes cerebrales de RM de rutina en individuos normales. Se midió la superficie interna del cráneo para calcular la relación CC/superficie interna del cráneo. Se estudiaron dos grupos de pacientes: 200 (100 hombres/100 mujeres) sanos y 204 (101 hombres/103 mujeres) con esclerosis múltiple (EM). El área superficial media de CC en los controles fue de 6,58±1,04 cm2 y no hubo diferencia significativa entre hombres y mujeres (P< 0,627). La relación CC/superficie interna del cráneo fue de 4,44±0,77 %. Los pacientes con EM mostraron una disminución significativa en el tamaño de CC en comparación con los controles normales. Usando imágenes de RM, medimos los tamaños medios de las diversas porciones del CC en individuos normales, además de pacientes con EM; estos valores pueden proporcionar una base útil para determinar los cambios que ocurren en las estructuras CC.

Fetal akinesia deformation sequence with pontocerebellar hypoplasia, and migration and gyration defects

Fetal akinesia deformation sequence (FADS), or Pena-Shokeir phenotype is a constellation of deformational changes resulting from decreased or absent fetal movement, and include arthrogryposis, and craniofacial and central nervous system anomalies. We report an autopsy case of a 36-6/7week female neonate with a normal female karyotype and chromosome microarray demonstrating findings consistent with FADS. We provide a detailed examination of the severe and complex central nervous system abnormalities, including marked pontocerebellar hypoplasia and cortical and cerebellar migration and gyration defects. This case represents a rare detailed examination of the central nervous system of a patient with FADS.

Hereditary spastic paraplegia: a clinical and epidemiological study of a Brazilian pediatric population / Paraplegia espástica hereditária: estudo clínico e epidemiológico em uma população pediátrica brasileira

ABSTRACT Aims: To investigate hereditary spastic paraplegia (HSP) in a pediatric Brazilian sample. Methods: Epidemiological, clinical, radiological and laboratory data were analyzed in 35 patients. Results: Simple HSP (HSP-S) was detected in 12 patients, and complicated HSP (HSP-C) was detected in 23 patients. The mean age of onset of symptoms was 2.9 years in HSP-S and 1.6 years in HSP-C (p = 0.023). The disease was more severe in HSP-C. There were no differences in sex, ethnic background, or family history between groups. Intellectual disability was the most frequent finding associated with HSP-C. Peripheral axonal neuropathy was found in three patients. In the HSP-C group, MRI was abnormal in 13 patients. The MRI abnormalities included nonspecific white matter lesions, cerebellar atrophy, thinning of the corpus callosum and the "ear of the lynx sign". Conclusions: In children with spastic paraplegia, HSP must be considered whenever similar pathologies, mainly diplegic cerebral palsy, are ruled out.

RESUMO Objetivo: Investigar paraplegia espástica hereditária (PEH) em uma amostra brasileira de pacientes pediátricos. Métodos: Foram colhidos dados clínicos, epidemiológicos, radiológicos e laboratoriais de 35 pacientes. Resultados: Doze pacientes foram classificados como PEH simples (PEH-S), e 23 como PEH complicada (PEH-C). A média de idade de início dos sintomas foi de 2,9 anos na PEH-S e 1,6 anos na PEH-C (p = 0,023). A doença foi mais grave na PEH-C. Não houve diferença de sexo, etnia e histórico familial entre os dois grupos. Deficiência intelectual foi a associação clínica mais frequente na PEH-C. Neuropatia periférica axonal foi encontrada em três pacientes. A RM foi normal em 13 casos de PEH-C. Anormalidades de RM incluiram alterações inespecíficas da substância branca, atrofia de cerebelo, afilamento de corpo caloso e o "sinal da orelha de lince". Conclusões: PEH deve ser considerada em crianças com paraparesia espástica sempre que descartadas condições patológicas similares, principalmente paralisia cerebral.

White matter volume is decreased in bipolar disorder at early and late stages / O volume da substância branca está reduzido tanto nos estágios iniciais quanto nos estágios avançados do transtorno bipolar

Abstract Introduction: Bipolar disorder (BD) is a debilitating mood condition that affects approximately 1.3% of people worldwide, although some studies report up to 3.9% lifetime prevalence and 4-6% in adults when broad diagnostic criteria are applied. Objective: To compare differences in total white matter (WM), corpus callosum (CC) and total gray matter (GM) volumes in patients with type I BD at early and late stages compared with controls. Methods: Fifty-five subjects were enrolled in this study protocol. The double case-control design included 14 patients with BD at early stage; 15 patients at late stage; and their respective matched controls (14 and 12 subjects). Results: CC and total WM volumes were significantly smaller in patients with BD at early and late stages vs. controls. There was no difference for total GM volume in the early stage group, but in patients at late stage total GM volume was significantly smaller than in controls. The total GM volume reduction in patients at late stage is in agreement with the neuroprogression theory of BD. The reduction of WM volumes in total WM and in the CC at early and late stages supports the possibility that an early demyelination process could occur underlying the clinical manifestation of BD. Conclusion: Our findings may direct to the investigation of WM abnormalities in populations at high risk to develop BD, perhaps as early biomarkers before the overt syndrome.

Resumo Introdução: O transtorno do humor bipolar (THB) é uma condição debilitante que afeta aproximadamente 1,3% das pessoas em todo o mundo, embora alguns estudos relatem uma prevalência acumulada de até 3,9% e de 4-6% em adultos quando os critérios diagnósticos mais abrangentes são aplicados. Objetivo: Comparar as diferenças nos volumes totais de substância branca (SB), corpo caloso (CC) e volume total de substância cinzenta (SC) em pacientes com THB tipo I em estágios iniciais e tardios em comparação com controles. Métodos: Cinquenta e cinco sujeitos foram incluídos neste protocolo de estudo. O desenho de caso com duplo controle incluiu 14 pacientes com THB em estágio inicial; 15 pacientes com THB em fase tardia; e seus respectivos controles correspondentes (14 e 12 sujeitos). Resultados: Os volumes do CC e total de SB foram significativamente menores nos pacientes com THB nos estágios iniciais e tardios vs. controles. Não houve diferença para o volume total de SC no grupo em estágio inicial, mas em pacientes em fase tardia o volume total de SC foi significativamente menor do que nos controles. A redução do volume total de SC em pacientes em fase tardia está de acordo com a teoria da neuroprogressão do THB. A redução dos volumes de SB em SB total e no CC em fases precoces e tardias suporta a possibilidade de que um processo de desmielinização precoce poderia ocorrer subjacente à manifestação clínica de THB. Conclusão: Nossos achados podem direcionar a investigação de anormalidades da SB em populações de alto risco para o desenvolvimento de THB, talvez como biomarcadores precoces antes da síndrome aberta.

Corpus callosum and ventricle: MRI determination of dementia in Turkish population and healthy geriatric subjects / Cuerpo calloso y ventrículo: determinación de demencia con RM en una población turca y sujetos geriátricos saludables

SUMMARY: The aim of this study was to identify the values of corpus callosum sections and ventricles in Dementia and healthy geriatric subjects using magnetic resonance imaging (MRI) and to establish both gender differences and differences between groups. The MRI results of 163 geriatric subjects (81 healthy individuals; 82 Dementia subjects) aged 60-89 years were studied. The midsagittal and axial images were used for measurements of the corpus callosum and lateral ventricle, respectively on MRI. The mean values of the widths of genu, body, splenium, height of the corpus callosum, longitudinal dimension of the corpus callosum and brain were 8.74±1.53 mm, 5.37±0.75 mm, 9.37±1.33 mm, 25.42±2.89 mm, 70.99±3.86 mm, 148.87±6.67 mm and 8.51±1.93 mm, 5.37±0.84 mm, 9.74±1.17 mm and 25.67±2.88 mm, 72.41±4.99 mm, 153.66±8.00 mm in females and males of healthy geriatric age, respectively. The same measurements were found to be 6.90±1.66 mm, 4.33±0.76 mm, 7.94±1.38 mm, 24.42±3.11 mm, 69.01±4.52 mm, 149.18±7.13 mm and 7.55±1.98 mm, 4.56±1.02 mm, 8.60±1.58 mm, 23.96±3.51 mm, 73.42±3.81 mm, 155.38±8.39 mm in females and males with Dementia, respectively. Additionally, the means of the frontal horn width and Evans index measurements were lower in healthy geriatric subjects, whereas the transverse inner diameter of the skull were higher in healthy geriatric subjects than dementia subjects in both sexes. The observations presented in this report have defined anatomic parameters of healthy and dementia geriatric subjects that need to be taken into consideration for reference data to determine sex discrepancies, and be helpful for radiologists and clinicians.

RESUMEN: El objetivo del estudio fue identificar los valores de las secciones del cuerpo calloso y los ventrículos en una población turca de sujetos geriátricos sanos y con demencia, mediante resonancia magnética (RM) y establecer diferencias tanto de sexo como diferencias entre los grupos. Se estudiaron los resultados de 163 sujetos geriátricos (81 sujetos sanos, 82 sujetos con demencia) de 60-89 años. Las imágenes sagitales y axiales se utilizaron para las realizar las mediciones del cuerpo calloso y del ventrículo lateral en RM, respectivamente. Los valores medios de los anchos de rodilla, cuerpo, rodete, altura del cuerpo calloso, dimensión longitudinal del cuerpo calloso y del cerebro fueron de 8,74 ± 1,53 mm, 5,37 ± 0,75 mm, 9,37 ± 1,33 mm, 25,42 ± 2,89 mm, 70,99 ± 3,86 mm, 148,87 ± 6,67 mm y 8,51 ± 1,93 mm, 5,37 ± 0,84 mm, 9,74 ± 1,17 mm y 25,67 ± 2,88 mm, 72,41 ± 4,99 mm, 153,66 ± 8,00 mm en mujeres y hombres sanos, respectivamente. Las mismas medidas fueron de 6,90 ± 1,66 mm, 4,33 ± 0,76 mm, 7,94 ± 1,38 mm, 24,42 ± 3,11 mm, 69,01 ± 4,52 mm, 149,18 ± 7,13 mm y 7,55 ± 1,98 mm, 4,56 ± 1,02 mm, 8,60 ± 1,58 mm, 23,96 ± 3,51 mm, 73,42 ± 3,81 mm, 155,38 ± 8,39 mm en mujeres y hombres con demencia, respectivamente. Además, las medias de la anchura del asta frontal y las mediciones del índice de Evans fueron menores en sujetos geriátricos saludables, mientras que el diámetro interno transversal del cráneo fue mayor en sujetos geriátricos sanos que en los sujetos con demencia en ambos sexos. Las observaciones presentadas en este informe han definido los parámetros anatómicos de los sujetos sanos y con demencia que deben tenerse en cuenta para identificar los datos de referencia para determinar las discrepancias de sexo y que puedan ser útiles para los radiólogos y los médicos.

Diffusion tensor imaging of brain white matter in Huntington gene mutation individuals / Imagem por tensor de difusão em indivíduos com mutação do gene da doença de Huntington

ABSTRACT Objective To evaluate the role of the involvement of white matter tracts in huntingtin gene mutation patients as a potential biomarker of the progression of the disease. Methods We evaluated 34 participants (11 symptomatic huntingtin gene mutation, 12 presymptomatic huntingtin gene mutation, and 11 controls). We performed brain magnetic resonance imaging to assess white matter integrity using diffusion tensor imaging, with measurement of fractional anisotropy. Results We observed a significant decrease of fractional anisotropy in the cortical spinal tracts, corona radiate, corpus callosum, external capsule, thalamic radiations, superior and inferior longitudinal fasciculus, and inferior frontal-occipital fasciculus in the Huntington disease group compared to the control and presymptomatic groups. Reduction of fractional anisotropy is indicative of a degenerative process and axonal loss. There was no statistically significant difference between the presymptomatic and control groups. Conclusion White matter integrity is affected in huntingtin gene mutation symptomatic individuals, but other studies with larger samples are required to assess its usefulness in the progression of the neurodegenerative process.

RESUMO Objetivo Avaliar o envolvimento da substância branca (SB) cerebral em indivíduos com mutação do gene da huntingtina. Métodos Foram avaliados 34 indivíduos: 11 com mutação do gene da huntingtina sintomática, 12 assintomáticos com mutação do gene da huntingtina e 11 indivíduos controles. Realizamos ressonância magnética cerebral para avaliar a integridade da SB usando o tensor de difusão (DTI), com medição da anisotrofia fracionada (FA). Resultados Observamos uma diminuição da FA no trato corticoespinhal, coroa radiada, corpo caloso (joelho, corpo e esplênio), cápsula externa, radiações talâmicas, fascículo longitudinal superior e inferior, e fascículo frontal-occipital inferior no grupo dos indivíduos com mutação sintomática. A redução da FA é indicativa de processo degenerativo e perda axonal. Não houve diferença estatística entre os grupos controle e pré-sintomático. Conclusão Houve comprometimento da integridade da SB em indivíduos com mutação no gene da Huntingtina sintomática, mas outros estudos são necessários para avaliar a sua utilidade na progressão do processo neurodegenerativo.

Assessment transcallosal Diaschisis in a model of focal cerebral ischemia in rats / Evaluación de la diásquisis transcallosa en un modelo de isquemia cerebral focal en ratas

Objective: To evaluate transcallosal changes after a local ischemic injury in rats by using the monoclonal marker anti-NeuN (Mouse anti-neuronal nuclei). Methods: Twenty eight adult, male, Wistar rats were subjected to focal injury in the right hemisphere. The technique used was the experimental model of focal ischemic injury through intraluminal suture of the middle cerebral artery. Analyses were made for the five groups: and after the lesion (control), at 24 h, 96 h, 10 days and 20 days. Exofocal neuronal damage was inferred from neuronal immunoreactivity changes to NeuN. Results: In the cortex contralateral to the lesion, immunoreactivity was diminished. This was most notable in the supragranular layers 24 h post ischemia. After 96 h, there was a generalized diminishment of the inmmunoreactivity in supra and infragranular layers. At 10 and 20 days, the tissue recovered some NeuN immunoreactivity, but there were set changes in the VI layer. Conclusion: The immunoreactive changes to NeuN support the process of interhemispheric diaschisis. Changes in immunoreactivity could indicate metabolic stress secondary to the disruption in connectivity to the site of lesion.

Objetivo: Evaluar los cambios exofocales transcallosos después de lesión isquémica focal en ratas, mediante marcación inmunohistoquímica con el anticuerpo monoclonal anti-NeuN (Mouse Anti-Neuronal Nuclei). Métodos: Se intervinieron 28 ratas machos Wistar adultas. Mediante el modelo experimental de isquemia cerebral focal del territorio de la arteria cerebral media por filamento intraluminal, se les ocasionó una lesión focal en el hemisferio derecho. Posteriormente se evaluó el hemisferio contralateral, marcando la población neuronal con el anticuerpo monoclonal anti-NeuN. Se definieron cinco grupos de evaluación: uno de control, 24 h, 96 h, 10 días y 20 días. Se evaluaron los cambios neuronales exofocales después de la lesión con base en la observación de los cambios en la inmunoreactividad de las neuronas al NeuN. Resultados: Se redujo la inmunoreactividad en la corteza contralateral a la lesión. Este fenómeno fue más notable en las capas supragranulares después de 24 h post isquemia. Después de 96 h hubo una disminución generalizada de la inmmunoreactivity en las capas supra e infragranulares. A los 10 y 20 días, el tejido recobró alguna inmunoreactividad NeuN, estos cambios se dieron en la capa VI. Conclusiones: Los cambios inmunorreactivos a NeuN apoyan el proceso de diasquisis interhemisférica. Los cambios en la inmunorreactividad podrían indicar estrés metabólico secundario a la interrupción en la conectividad con el sitio de la lesión.

Efectividad del ejercicio físico en la fatiga de pacientes con cáncer durante el tratamiento activo: revisión sistemática y metaanálisis / Effectiveness of physical exercise on fatigue in cancer patients during active treatment: a systematic review and meta-analysis / Eficácia do exercício físico na fadiga dos pacientes com câncer durante o tratamento ativo: revisão sistemática e meta-análise

El objetivo del estudio fue determinar la efectividad del ejercicio físico en la fatiga de pacientes con cáncer durante el tratamiento activo. Las bases de datos de PubMed Central, EMBASE y OVID fueron consultadas hasta abril de 2014 para identificar ensayos clínicos aleatorizados, que evaluaran el efecto del ejercicio en la fatiga de pacientes con cáncer sometidos a tratamiento activo. Once estudios (n = 1.407) fueron incluidos. La quimioterapia fue el tratamiento más común (n = 1.028). Los estudios tuvieron bajo riesgo de sesgo y alta calidad metodológica. Las estimaciones de efecto mostraron que el ejercicio físico mejoró significativamente la fatiga (SMD = -3,0; IC95%: -5,21; -0,80), p < 0,0001. Se encontraron efectos similares para el entrenamiento de resistencia (SMD = -4,5; IC95%: -7,24; -1,82), p = 0,001. Se encontraron mejoras significativas en pacientes con cáncer de mama y de próstata (p < 0,05). El ejercicio es una intervención segura y eficaz en el control de la fatiga en pacientes sometidos a tratamiento activo.

This study aimed to determine the effectiveness of physical exercise in decreasing fatigue in cancer patients during active treatment. The PubMed Central, EMBASE, and OVID databases were consulted up to April 2014 to identify randomized clinical trials that evaluated the effect of exercise on fatigue in cancer patients undergoing active treatment. Eleven studies (n = 1,407) were included. Chemotherapy was the most common form of treatment (n = 1,028). The studies showed a low risk of bias and high methodological quality. Effect estimates showed that physical exercise significantly improved fatigue (SMD = -3.0; 95%CI: -5.21; -0.80), p < 0.0001. Similar effects were found for resistance training (SMD = -4.5; 95%CI: -7.24; -1.82), p = 0.001. Significant improvements were found in breast and prostate cancer patients (p < 0.05). Exercise is a safe and effective intervention in the management fatigue in cancer patients undergoing active treatment.

O objetivo foi determinar a efetividade do exercício físico sobre a fadiga em pacientes com câncer durante o tratamento ativo. As bases de dados PubMed Central, EMBASE e OVID foram consultadas até abril de 2014 para identificar ensaios clínicos randomizados que avaliaram o efeito do exercício sobre a fadiga em pacientes com câncer em tratamento ativo. Onze estudos (n = 1.407) foram incluídos. A quimioterapia foi o tratamento mais comum (n = 1.028). Os estudos tiveram baixo risco de viés e alta qualidade metodológica. As estimativas de efeito mostraram que o exercício melhorou significativamente a fadiga (DMP = -3,0; IC95%: -5,21; -0,80), p < 0,0001. Efeitos semelhantes sobre o treinamento de resistência (DMP = -4,5; IC95%: -7,24; -1,82), p = 0,001 foram encontrados. O exercício físico é uma intervenção segura e eficaz contra a fadiga em pacientes submetidos ao tratamento ativo.

Morfometría del cuerpo calloso y de los cuerpos mamilares en el alcoholismo por resonancia magnética / Morphometry of the corpus callosum and mammillary bodies in alcoholism using magnetic resonance

Las alteraciones morfológicas encefálicas en individuos que padecen alcoholismo crónico explican los severos trastornos neurocognitivos, principalmente amnésicos anterógrados, y neuropsiquiátricos debido al carácter neurotóxico y déficits nutricionales que genera. El objetivo fue describir la morfología del cuerpo calloso y los cuerpos mamilares en dependientes al alcohol y su relación volumétrica otras áreas cerebrales. Se estudiaron morfológica y morfométricamente con resonancia magnética los cerebros de 26 masculinos, edades 29 a 51 años, con diagnóstico de trastorno por consumo de alcohol tipo dependencia (DSM IV). Fueron criterios de exclusión: patologías hepáticas, autoinmunes, neurológicas centrales y antecedentes neurológicos no relacionados con el consumo, traumatismo craneoencefálico o neurocirugías previas. Se cuantificó la volumetría (método ROI) de: corteza prefrontal, hipocampo, cuerpo amigdalino, tálamo y cuerpos mamilares; y la morfometría bidimensional de las regiones del cuerpo calloso (métodos de Witelson y de Clarke). El procedimiento fue sometido a pruebas estadísticas y cumplió con los reparos ético-legales vigentes. Todos los volúmenes de pacientes dependientes fueron menores. Se registró según severidad reducción volumétrica significativa en corteza prefrontal, cuerpo mamilar, hipocampo y tálamo izquierdos, seguidos por el cuerpo amigdalino derecho. La superficie con mayor afectación del cuerpo calloso fue el 1/3 anterior. Se determinaron correlaciones entre la afectación de los cuerpos mamilares y el cuerpo calloso con estructuras subcorticales. El compromiso del cuerpo calloso y los cuerpos mamilares presentó correlación con la afectación del hipocampo, cuerpo amigdalino y tálamo, y una estrecha relación con el tiempo y cantidad de consumo. Estas alteraciones morfométricas son indicadores de severidad cognitiva y alteración comportamental.

Brain morphological abnormalities in individuals with severe chronic alcoholism explains the severe neurocognitive disorders, namely neuropsychiatric and anterograde amnesia, due to the neurotoxic nature and nutritional deficits generated. The objective of the present study was to describe in alcohol dependent subjects, the morphology of the corpus callosum and mammillary bodies and volume ratio in other brain areas. We used morphological and morphometric magnetic resonance imaging to study the brains of 26 men, ages 29-51 years diagnosed with alcohol dependence type disorder (DSM IV). Exclusion criteria were: liver diseases, autoimmune and central neurological disorders, as well as a neurological history not related to consumption, prior traumatic brain injury or brain surgery. Volumes were quantified by (ROI method) for the following: prefrontal cortex, hippocampus, amygdaloid body, thalamus and mammillary bodies, and the two-dimensional morphometry of corpus callosum regions (Witelson and Clarke methods). The procedure was subject to statistical tests and current legal ethical standards. Our results showed all patients dependent volumes were lower. In accordance with severity, significant volume reduction was recorded in prefrontal cortex, mammillary body, left hippocampus and thalamus, followed by the right amygdaloid body. The most affected area of the corpus callosum was the anterior third. Correlations were determined between the involvement of the mammillary bodies and the corpus callosum with subcortical structures. The relation of the corpus callosum and mammillary bodies correlated with the involvement of the hippocampus, amygdala and thalamus body, and are closely related to the amount of time and consumption of alcohol. These morphometric changes are indicative of severe cognitive and behavioral impairment.

Segmented corpus callosum diffusivity correlates with the Expanded Disability Status Scale score in the early stages of relapsing-remitting multiple sclerosis

OBJECTIVE: The aim of this study was to characterize the microscopic damage to the corpus callosum in relapsing-remitting multiple sclerosis (RRMS) with diffusion tensor imaging and to investigate the correlation of this damage with disability. The diffusion tensor imaging parameters of fractional anisotropy and mean diffusivity provide information about the integrity of cell membranes, offering two more specific indices, namely the axial and radial diffusivities, which are useful for discriminating axon loss from demyelination. METHOD: Brain magnetic resonance imaging exams of 30 relapsing-remitting multiple sclerosis patients and 30 age- and sex-matched healthy controls were acquired in a 3T scanner. The axial diffusivities, radial diffusivities, fractional anisotropy, and mean diffusivity of five segments of the corpus callosum, correlated to the Expanded Disability Status Scale score, were obtained. RESULTS: All corpus callosum segments showed increased radial diffusivities and mean diffusivity, as well as decreased fractional anisotropy, in the relapsing-remitting multiple sclerosis group. The axial diffusivity was increased in the posterior midbody and splenium. The Expanded Disability Status Scale scores correlated more strongly with axial diffusivities and mean diffusivity, with an isolated correlation with radial diffusivities in the posterior midbody of the corpus callosum. There was no significant correlation with lesion loads. CONCLUSION: Neurological dysfunction in relapsing-remitting multiple sclerosis can be influenced by commissural disconnection, and the diffusion indices of diffusion tensor imaging are potential biomarkers of disability that can be assessed during follow-up. .

Changes caused by hidrocephalus, induced by kaolin, in the corpus callosum of adult dogs / Alterações causadas pela hidrocefalia, induzida por caulim, no corpo caloso de cães adultos

PURPOSE: To analyze the ventricular enlargement and myelination of the corpus callosum in adult dogs after four and eight weeks of kaolin-induction of hydrocephalus. METHODS: 36 dogs were randomly divided into 3 groups: 1 - without hydrocephalus, 2 - kaolin-induction of hydrocephalus until the fourth week, and 3 - kaolin-induction of hydrocephalus until the eighth week. Ventricular ratios and volumes were calculated using magnetic resonance images, and myelination of the corpus callosum were histologically evaluated using solocromo-cianin stain. RESULTS: Radiological hydrocephalus was observed in 93.75 percent and overall mortality was 38.4 percent. Ventricular volumes and ratios were higher in groups 2 and 3 compared to group 1 and similar when measures in the fourth and eighth weeks were compared in the group 3. Indices of luminescence in the knee and in the splenium of the corpus callosum were higher in group 2 than in group 1 indicating that there was loss of myelin in group 2, and similar in groups 1 and 3, showing a tendency to remyelination after 8 weeks. CONCLUSION: The corpus callosum of dogs with kaolin-induced hydrocephalus responds with demyelination of the knee and splenium by the fourth week with a tendency to remyelination by the eighth week.

OBJETIVO: Analisar a dilatação ventricular e a mielinização do corpo caloso em cães adultos após quatro e oito semanas da indução de hidrocefalia por caulin. MÉTODOS: 36 cães foram aleatoriamente divididos em 3 grupos: 1- sem hidrocefalia, 2- quatro semanas de hidrocefalia induzida por caulin, 3- oito semanas de hidrocefalia induzida por caulin. As razões e volumes ventriculares foram calculados utilizando imagens de ressonância magnética, e, a mielinização do corpo caloso por estudo histológico (coloração com solocromo- cianina). RESULTADOS: Hidrocefalia foi observada radiologicamente em 93,75 por cento e a mortalidade global foi de 38,4 por cento. Os volumes e as razões ventriculares foram maiores nos grupos 2 e 3 em relação ao grupo 1 e semelhantes nas quarta e oitava semanas no grupo 3. Índices de luminescência no joelho e no esplênio do corpo caloso foram maiores no grupo 2 em relação ao grupo 1, indicando que houve perda de mielina no grupo 2, e semelhantes nos grupos 1 e 3, mostrando uma tendência à remielinização em torno de 8 semanas. CONCLUSÃO: O corpo caloso de cães com hidrocefalia induzida por caulin responde com desmielinização no joelho e esplênio em torno de quatro semanas com tendência à remielinização em torno da oitava semana.

Síndrome de Aicardi: descripción de cuatro casos venezolanos / Aicardi syndrome: a report of four venezuelan patients

El síndrome de Aicardi (SA) se caracteriza por agenesia del cuerpo calloso, espasmos infantiles y lesiones lacunares coriorretinianas. Su espectro evolutivo es variable, con pronóstico habitualmente muy grave en los primeros cinco años de vida. El objetivo de este trabajo es describir el espectro del fenotipo clínico y evolución de este trastorno en cuatro pacientes venezolanos. Todas las pacientes evaluadas cumplieron los criterios diagnósticos mayores, mostraron retraso psicomotor grave y convulsiones de inicio muy temprano. En dos pacientes se observó microftalmía. En tres (75 por ciento) de ellas se observó coloboma del nervio óptico, quistes interhemisféricos y heterotopías periventriculares. La primera paciente, con mayor tiempo de evolución, tiene actualmente 22 años. Todos los casos exhibieron un patrón asimétrico de hipsarritmia alternante en el electroencefalograma. Estos casos ilustran la expresión clínica y gravedad variables del síndrome de Aicardi. Su diagnóstico debe considerarse en niñas con retardo del desarrollo psicomotor y crisis convulsivas recurrentes iniciadas en la infancia temprana.

Aicardi syndrome is characterized by agenesis of the corpus callosum, infantile spasms and chorioretinal lacunae. The evolution of this disorder is variable, with a severe outcome over the first five years of age. The purpose of this report was to demonstrate the spectrum of the clinical phenotype and the course of this disorder in four Venezuelan patients. All patients met the major criteria, had severe psychomotor impairment and early onset seizures. There were microphtalmia in two of the patients. Three patients (75 percent) showed coloboma, interhemispheric cyst and periventricular heterotopias. The first patient, with longer follow-up, is currently aged 22. They all exhibited a typical asymmetric pattern on the electroencephalogram. These cases illustrate the variable clinical expression and severity of the Aicardi syndrome. A diagnosis of this disorder should be considered in girls with developmental delay, particularly, when there are accompanying recurrent seizures occurring in early childhood.

Reversible Splenium Lesion of the Corpus Callosum in Hemorrhagic Fever with Renal Failure Syndrome

This is the first case of virus-associated encephalitis/encephalopathy in which the pathogen was Hantaan virus. A 53-yr-old man presented fever, renal failure and a hemorrhagic tendency and he was diagnosed with hemorrhagic fever with renal failure syndrome (HFRS). In the course of his illness, mild neurologic symptoms such as dizziness and confusion developed and magnetic resonance images revealed a reversible lesion in the splenium of the corpus callosum. This case suggests that HFRS patients with neurologic symptoms like dizziness and mental slowing should be considered to have structural brain lesions and to require brain imaging studies.

Butterfly glioma of the corpus callosum.

The prognosis of glioblastoma multiforme (GBM) is poor even with aggressive first-line therapy, which includes surgery, radiation therapy, and adjuvant chemotherapy. Although the ideal course of treatment for elderly patients with newly diagnosed GBM is still undecided and requires further studies, the new chemotherapeutic agents administered with or without concomitant radiation therapy have shown promising results. However, in our setting, where resources are limited and newer treatment options are expensive, it is often difficult to deliver the best care to the patient.

Diffusion tensor MR imaging evaluation of the corpus callosum of patients with multiple sclerosis / Avaliação do corpo caloso em pacientes com esclerose múltipla através de imagens de RM por tensor de difusão

OBJECTIVE: To evaluate the fractional anisotropy (FA) values of the normal-appearing white matter of the corpus callosum (CC) in patients with relapsing-remitting multiple sclerosis (MS). METHOD: Fifty-seven patients with diagnosis of relapsing-remitting MS and 47 age- and gender-matched controls were studied. A conventional MR imaging protocol and a DTI sequence were performed. One neuroradiologist placed the regions of interest (ROIs) in the FA maps in five different portions of the normal-apearing CC (rostrum, genu, anterior and posterior portion of the body and splenium) in all cases. The statistical analysis was performed with the Mann-Whitney U test and p<0.05 was considered statistically significant. RESULTS: The FA values were lower in the MS patients compared with the controls (p<0.05) in the following CC regions: rostrum (0.720 vs 0.819), anterior body (0.698 vs 0.752), posterior body (0.711 vs 0.759) and splenium (0.720 vs 0.880). CONCLUSION: In this series, there was a robust decrease in the FA in all regions of the normal-appearing CC, being significant in the rostrum, body and splenium. This finding suggests that there is a subtle and diffuse abnormality in the CC, which could be probably related to myelin content loss, axonal damage and gliosis.

OBJETIVO: Avaliar os valores da anisotropia fracionada (FA) da substância branca aparentemente normal do corpo caloso (CC) em pacientes com esclerose múltipla (EM) remitente recorrente. MÉTODO: 57 pacientes com diagnóstico de EM remitente recorrente e 47 controles pareados por sexo e idade foram estudados. O protocolo convencional de RM e imagens de tensor de difusão foram adquiridas. Um neurorradiologista posicionou as regiões de interesse nos mapas de FA em seis porções do CC aparentemente normal (rostro, joelho, anterior e posterior porções do corpo e esplênio) em todos os casos. A análise estatística foi realizada com o teste Mann-Whitney U e p<0,05 foi considerado estatisticamente significativo. RESULTADOS: Os valores de FA foram menores nos pacientes com EM comparados com os controles (p<0,05) nas seguintes porções do CC: rostro (0,720 vs 0,819), corpo anterior (0,698 vs 0,752), corpo posterior (0,711 vs 0,759) e esplênio (0,720 vs 0,880). CONCLUSÃO: Na presente série houve redução robusta na FA em todas as regiões aparentemente normais do CC, sendo significativa no rostro, corpo e esplênio. Este achado sugere que há alteração difusa no corpo caloso de pacientes com EM, provavelmente relacionada a perda da mielina, lesão axonal e gliose.

Marchiafava-Bignami disease.

Marchiafava- Bignami disease is the symmetrical demyelination of the middle portion of the corpus callosum observed in people with chronic alcoholism. We report two male patients who had history of chronic alcoholism, different clinical presentation and MRI findings consistent with the diagnosis of Marchiafava-Bignami disease.

Tracking of Neural Stem Cells in Rats with Intracerebral Hemorrhage by the Use of 3T MRI

OBJECTIVE: To access the feasibility of clinically available 3T MRI to detect the migration of labeled neural stem cells (NSCs) in intracerebral hemorrhage (ICH) in a rat model. MATERIALS AND METHODS: The ethics committee of our institution approved this study. ICH was induced by the injection of collagenase type IV into the right striatum of ten Sprague-Dawley rats. Human NSCs conjugated with Feridex (super-paramagnetic iron oxide: SPIO) were transplanted into the left striatum one week after ICH induction. MRI was performed on a 3T scanner during the first, second, third, fourth, and sixth weeks post-transplantation. MRI was obtained using coronal T2- and T2*-weighted sequences. Two rats were sacrificed every week after in vivo MRI in order to analyze the histological findings. RESULTS: ICH in the right striatum was detected by MRI one and two weeks after transplantation without migration of the NSCs. There was no migration of the NSCs as seen on the histological findings one week after transplantation. The histological findings two weeks after transplantation showed a small number of NSCs along the corpus callosum. On MRI three weeks after transplantation, there was a hypointense line along the corpus callosum and decreased signal intensity in the right periventricular region. Histological findings three weeks after transplantation confirmed the presence of the hypointense line representing SPIO-labeled NSCs. MRI four and six weeks after transplantation showed a hypointense spot in the right periventricular region. The histological findings four and six weeks after transplantation showed the presence of prominent NSCs in the right periventricular region. CONCLUSION: 3T MRI can detect the migration of NSCs in rats with ICH along the corpus callosum. Therefore, 3T MRI could be feasible for detecting the migration of NSCs in the clinical setting of stem cell therapy.

Corpus Callosum Index: A practical method for long-term follow-up in multiple sclerosis

Rather than acute inflammation, long-standing multiple sclerosis (MS) course is hallmarked by relentless axonal loss and brain atrophy, both with subtle clinical expression and scarcely visible on conventional MRI studies. Brain atrophy imaging has sophisticated methodological requirements, not always practical and accessible to most centers. Corpus callosum (CC) is a major inter-hemispheric white matter bundle, grossly affected by long term MS and easily assessed by MRI. To determine whether a practical imaging method can reliably follow presumed axonal loss in patients with progressive MS, we designed a 5-year prospective open label study, enrolling 128 consecutive patients (75 relapsing-remitting (RR) and 53 secondary-progressive (SP)), on regular immunomodulatory therapy compared to control group, formed by 23 patients with MRI considered normal. On a conventional best mid-saggital T1W, CC index (CCI) was obtained by measuring anterior, medium and posterior segments of CC, normalized to its greatest anteroposterior diameter using an orthogonal semi-automated linear system. CCI was measured at baseline and at least once yearly. Results were plotted intra-individually; baseline values were used as reference. At baseline, CCI was able to distinguish SP patients from RR and controls, and on follow-up, despite some overlap, demonstrated a progressive reduction from baseline on both RR and SP groups compared to controls. From the third year on, difference between SP and RR patients reached statistical significance, which did not correlated with disability measured by EDSS. So, a corpus callosum index proved practical and feasible to longitudinally demonstrate morphometric callosal changes with potential to be used as a tool for long-term follow-up, mostly in SP patients.

Mais do que inflamação aguda, a perda celular e conseqüente atrofia cerebral são os fatos patofisiológicos mais marcantes na fase progressiva da esclerose múltipla (EM). No entanto, correlatos clínicos e de imagem por ressonância magnética (IRM) destes eventos, requerem sofisticada tecnologia, nem sempre prática e quase nunca acessível à maioria dos centros de tratamento. Deste modo, considerando a hipótese de que esta perda celular compromete fibras associativas que compõem o corpo caloso (CC), estrutura facilmente acessível à IRM convencional, nosso grupo elaborou um estudo prospectivo aberto, atualmente com 5 anos de duração, e envolvendo 128 pacientes consecutivos, todos em acompanhamento regular em nosso centro de tratamento para a EM. A aquisição do índice de CC se deu através de um "melhor" corte meio-sagital em estudo convencional de imagem ponderada por T1, utilizando um sistema linear ortogonal semi-automatizado. Este índice foi obtido no início do seguimento e sua evolução foi acompanhada anualmente. A partir do terceiro ano deste seguimento, sua diferença entre os pacientes com a forma surto-remissiva e aqueles com a forma secundariamente progressiva alcançou significância estatística. Esta diferença não mostrou correlação com o grau de incapacidade medido pelo EDSS. Assim, um índice de CC mostrou-se uma medida prática para o seguimento de alterações morfométricas do corpo caloso, provando assim potencial para ser utilizado no acompanhamento em longo prazo de pacientes com EM, em especial aqueles com a forma progressiva.