MR Imaging in Eclampsia

Background : The aim of this study is to determine the distribution and nature of Cranial MRI findings in eclamptic patients, and to correlate them with clinical and laboratory data. Materials and Methods : This study was conducted in the Department of Obstetrics and Gynecology in Sri Ramachandra Institute of Higher Education and Research. A total number of 35 Eclamptic patients were included in this study and they were analyzed retrospectively. Laboratory parameters, Blood Pressure and Cranial MRI was performed for all and the same were analyzed statistically. Results : Out of 35 Eclamptic patients, MR Imaging was normal in 6 patients. Among the 29 patients with abnormal MRI, Cortical-subcortical Lesion, appeared iso/hypo-intense in T-1 weighted images and hyper intense in T-2 weighted images. In most of the patients, occipital lobe was involved followed by involvement of other lobes such as Parietal, Frontal, Temporal, Basal Ganglia and Cerebellum. When patients with and without positive MRI findings were compared regarding clinical features such as Headache, Blurred Vision, Nausea and Vomiting, Epigastric Pain, Loss of Consciousness, Reduced Urine Output there was no statistically significant difference between the two groups. Similarly, there was no statistical difference in mean arterial pressures between MRI positive and MRI negative patients (p=0.218) however, it was found that those with MR imaging positive features had a higher Blood Pressure than those with MRI negative findings. Among the laboratory parameters, in the patients with abnormal MRI findings Fibrinogen was found to be significantly low than those with normal MRI findings (p=0.0002).

Experimental study on acute hypertensive cerebral edema at 7.0T MR / 实用放射学杂志

Objective To verify the feasibility of a rat model of acute hypertension, and to observe the imaging findings at 7.0T MR scanner of the model.Methods In experimental group, the rats were scanned at 7.0T Bruker MR scanner when phenylephrine was injected continuously to evoke an acute hypertension state.The real time blood pressure was monitored through a femoral arterial catheter connected to a pressure transducer.The control group was infused with saline.T2WI, DWI and T1 mapping were performed in the two rat groups.ADC maps and T1 maps were acquired after image post-processing, and a voxel wise analysis and a ROI analysis were applied.The brain morphology change was evaluated by HE staining.The blood-brain barrier permeability was evaluated by Evans blue staining.Results The T2 images and DWI images of the experiment group showed no abnormal signal intensity changes observed by naked eyes.But ROI analysis of the ADC maps showed that the brain ADC values of the experiment group was higher than the control group (t=3.291,P0.05).The blue dye region was only performed in the experimental group,the results of HE staining corresponded with vasogenic brain edema.Conclusion Continuous infusing of phenylephrine hydrochloride can induce a rat model of acute hypertension.Vasogenic edema and blood-brain barrier permeability change can be observed in the rat model, and the imaging distribution of vasogenic edema can be detected by MRI.

Expression of aquaporin 4 in 1,2-dichloroethane-induced toxic brain edema in rats / 中国职业医学

OBJECTIVE: To explore the effects of aquaporin 4( APQ4) in rat toxic brain edema induced by subacute 1,2-dichloroethane( 1,2-DCE) exposure. METHODS: Thirty-two specific pathogen free healthy adult female SD rats were randomly divided into control( 8 rats),low-dose( 12 rats) and high-dose( 12 rats) groups. The treatment groups were exposed to 1,2-DCE( low-dose: 600 mg / m3; high-dose: 1 800 mg/m3,nose-only) and the control group was exposed to fresh air by dynamic inhalation for 8 hours per day for consecutive 7 days. After exposure,histopathologic changes were examined in the cerebral cortex. Real-time polymerase chain reaction was used to detect the mRNA relative expression of matrix metalloproteinase 2( MMP2),Na-K-Cl cotransporter-1( NKCC1) and AQP4. The Western blotting was used to detect the expression of AQP4 protein in the cerebral cortex. RESULTS: The pathological results showed that the cerebral cortex tissues were loose around the peripheral vessels and the vessels tissue space appeared widen in low-dose exposure group. The pathological change was more serious in high-dose group than low-dose group,with obvious loosen vessels and vacuole. Compared with those of the control group and the low-dose group,the relative expression level of MMP2 mRNA in the high-dose group increased significantly[( 1. 07 ± 0. 41) vs( 1. 56 ± 0. 55),( 1. 21 ± 0. 59) vs( 1. 56 ± 0. 55),P <0. 05],while the the relative expression level of AQP4 mRNA in the high-dose group significantly decreased [( 1. 03 ±0. 25) vs( 0. 81 ± 0. 12),( 1. 00 ± 0. 20) vs( 0. 81 ± 0. 12),P < 0. 05]. The relative expression levels of NKCC1 mRNA in all groups showed no statistical difference [( 1. 03 ± 0. 31) vs( 1. 14 ± 0. 43) vs( 1. 36 ± 0. 50),P > 0. 05]. The relative expression level of AQP4 protein in the high-dose group was lower than that of the control group [( 0. 80 ± 0. 25) vs( 1. 19 ± 0. 42),P < 0. 05]. CONCLUSION: The brain edema induced by subacute inhalation of 1,2-DCE is of mixed types with vasogenic edema as its main symptom. Its pathogenesis is related to the changes of AQP4 expression.

Clinical, imagiological and etiological spectrum of posterior reversible encephalopathy syndrome / Espectro clínico, imagiológico e etiológico da síndrome de encefalopatia posterior reversível

Objective Analyze the cases of posterior reversible encephalopathy syndrome (PRES) admitted in a Neurology Department during an 8-year period. Method Retrospective observational study in a central hospital in the north of Portugal. Results 14 patients were identified, mean age 52.3 years. Precipitating factors included: eclampsia, isolated arterial hypertension, spinal trauma and autonomic dysreflexia, Guillain-Barré syndrome, sepsis, sarcoidosis and pulmonary cryptococcosis and drugs. Most patients presented posterior-predominant vasogenic edema lesions, however 64.2% presented frontal lesions and in 42.8% cerebellum was involved. Four patients also had acute ischemic lesions and 1 had hemorrhagic lesions. During follow-up 10 patients recovered fully, 2 recovered partially, 1 suffered a recurrence and 2 died in hospital. Conclusion PRES has many etiological factors. The terms posterior and reversible should be revised because PRES frequently involves other brain regions and it is not always reversible. PRES patients may develop life-threatening complications and mortality is not negligible. .

Objetivo Análise dos casos de síndrome de encefalopatia posterior reversível (PRES) internados em um Serviço de Neurologia durante oito anos. Método Estudo restrospectivo observacional num hospital central do norte de Portugal. Resultados Identificaram-se 14 casos, idade média de 52,3 anos. Os factores precipitantes foram: eclâmpsia, hipertensão arterial isolada, traumatismos vertebro-medulares com disfunção autonómica, síndrome de Guillain-Barré, sépsis, sarcoidose e criptococose pulmonar e fármacos. A maioria dos doentes apresentou lesões edematosas de predomínio posterior, contudo 64,2% apresentaram lesões frontais e 42,8% apresentaram também lesões cerebelosas. Quatro doentes tinham lesões isquémicas agudas e um apresentou lesões hemorrágicas. Durante o seguimento, 10 doentes recuperaram totalmente, 2 recuperaram com sequelas, 1 teve recidiva e 2 faleceram durante o internamento. Conclusão A PRES apresenta muitos factores precipitantes. As designações posterior e reversível deverão ser reequacionadas dado que a PRES afecta outras zonas do cérebro e nem sempre é reversível, apresentado complicações e mortalidade não ...

Hashimoto's Encephalopathy Presented with Nonspecific Vasogenic Edema in Brain Magnetic Resonance Imaging

Hashimoto's encephalopathy (HE) is a rare autoimmune disorder characterized by a nonspecific encephalopathy with high titers of serum anti-thyroid antibody in the absence of other defined causes. A 54-year-old woman was admitted due to recurrent seizures and confusion. Her serum anti-thyroid antibody level was elevated, and brain MRI showed multiple instances of vasogenic edema. Her symptoms disappeared after treatment with high-dose steroids and antiepileptic drugs. We propose that HE should be considered in the differential diagnosis of multiple vasogenic edema on brain imaging.

Hashimoto's Encephalopathy Presented with Nonspecific Vasogenic Edema in Brain Magnetic Resonance Imaging

Hashimoto's encephalopathy (HE) is a rare autoimmune disorder characterized by a nonspecific encephalopathy with high titers of serum anti-thyroid antibody in the absence of other defined causes. A 54-year-old woman was admitted due to recurrent seizures and confusion. Her serum anti-thyroid antibody level was elevated, and brain MRI showed multiple instances of vasogenic edema. Her symptoms disappeared after treatment with high-dose steroids and antiepileptic drugs. We propose that HE should be considered in the differential diagnosis of multiple vasogenic edema on brain imaging.

Posterior Reversible Encephalopathy Syndrome Following Bee Venom Acupuncture

A 64-year-old woman presented with headache and visual disturbance which occurred 10 minutes after bee venom acupuncture. She was normotensive. Her pupils were isocoric and normally reflexive but she could precept only lights just in front of her eyes. The brain MRI showed vasogenic edema in the cerebellum and occipitotemporoparietal areas. She fully recovered 2 days later. The brain MRI taken after 7 days revealed remarkable improvement. This case suggests that bee venom might cause posterior reversible encephalopathy syndrome.

Interrelationship between Cerebral Vasospasm and Vasogenic Edema in Eclampsia Complicated by Posterior Reversible Encephalopathy Syndrome (PRES): a Case Report / 대한주산의학회잡지

Posterior reversible encephalopathy syndrome (PRES) is a transient clinical neuroradiological disease entity characterized by clinical signs and symptoms including hypertension, generalized seizure, mental status change, headache, and vision change. It is most commonly reported in the literature in association with obstetrical patients suffering from preeclampsia and eclampsia. Two theories of vasospasm and vasogenic edema have been suggested to explain cerebral abnormalities associated with eclampsia. But, the pathophysiology of PRES remains unclear. Here we present one patient who suffered from eclampsia complicated by PRES and we could assume the pathophysiological mechanism in the development of PRES through this case.

Blood-Brain Barrier Experiments with Clinical Magnetic Resonance Imaging and an Immunohistochemical Study

OBJECTIVE: The purpose of study was to evaluate the feasibility of brain magnetic resonance (MR) images of the rat obtained using a 1.5T MR machine in several blood-brain barrier (BBB) experiments. METHODS: Male Sprague-Dawley rats were used. MR images were obtained using a clinical 1.5T MR machine. A microcatheter was introduced via the femoral artery to the carotid artery. Normal saline (group 1, n = 4), clotted autologous blood (group 2, n = 4), triolein emulsion (group 3, n = 4), and oleic acid emulsion (group 4, n = 4) were infused into the carotid artery through a microcatheter. Conventional and diffusion-weighted images, the apparent coefficient map, perfusion-weighted images, and contrast-enhanced MR images were obtained. Brain tissue was obtained and triphenyltetrazolium chloride (TTC) staining was performed in group 2. Fluorescein isothiocyanate (FITC)-labeled dextran images and endothelial barrier antigen (EBA) studies were performed in group 4. RESULTS: The MR images in group 1 were of good quality. The MR images in group 2 revealed typical findings of acute cerebral infarction. Perfusion defects were noted on the perfusion-weighted images. The MR images in group 3 showed vasogenic edema and contrast enhancement, representing vascular damage. The rats in group 4 had vasogenic edema on the MR images and leakage of dextran on the FITC-labeled dextran image, representing increased vascular permeability. The immune reaction was decreased on the EBA study. CONCLUSION: Clinical 1.5T MR images using a rat depicted many informative results in the present study. These results can be used in further researches of the BBB using combined clinical MR machines and immunohistochemical examinations.

Bilateral Internuclear Ophthalmoplegia Following Spontaneous Subarachnoid Hemorrhage

A 44-year-old woman presented with horizontal diplopia 2 days after spontaneous subarachnoid hemorrhage. Neurological examination disclosed bilateral internuclear ophthalmoplegia and neck stiffness. Neurovascular imagings documented subarachnoid and intraventriclar hemorrhage with an aneurysm arising from the left superior cerebellar artery, and vasogenic edema in the bilateral pontomesencephalic junction. Parenchymal vasogenic edema due to microvascular damage may give rise to bilateral internuclear ophthalmoplegia during the acute stage of spontaneous subarachnoid hemorrhage.

The Feature of CT and MRI in the Patients with Eclamptic Encephalopathy / 医学研究杂志

Objective To incestigate the fetures of cranial CT and MRI in the patients with eclamptic encephalopathy.Methods The CT and MRI findings of eight cases of eclamptic encephalopathy with the charge of CT,MRI appearance of FLAIR(fluid attenvated inversion-recovery),DWI(difussion weighted imaging),ADC(apparent diffusion coefficient)were analyzed retrospectively.Results Of eight patients,5 cases had abnormal finding in the cranial CT with showed symmetric plaque-like low-attenuated lesions in cortex and subcortical white matter of parietal and occipital lobes in six cases;eight cases had abnormal findings in the cranial MRI,the lesions were demonstrated as slightly hypointensity on T1WI and slightly hyperintensity on T2WI and remarkably hyperintensity on FLAIR,and iso or slightly hyperintensity on DWI,and remarkably hyperintensity on ADC.The lilateral parietal occipital lobes and cerebellar hemisphere and Brain Stem were the more common sites.Conclusions The only characteristric findings of eclamptic encephalopathy in MRI and CT imaging studies is vasogenic edema and reversible,especially in the subcortical white matter of the parietal and occipital lobes bilaterally,and cereballar hemisphere et al;especially cranial CT showed symmetric plaque like low-attenuated lesions of posterior brain;FLAIR,DWI and ADC of MRI can be helpful for early diagnosis and diffenential diagnosis,prognosis and curative effect of hypertensive encephalopathy.

The feature of CT and MRI in the Patients with Hypertensive Encephalopathy / 医学研究杂志

Objective To incestigate the fetures of cranial CT and MRI in the patients with hypertensive encephalopathy. Methods The CT and MRI findings of ten cases of hypertensive encephalopathy with the charge of CT,MRI appearance of FLAIR (fluid attenvated inversion-recovery), DWI(difussion weighted imaging),ADC(apparent diffusion coefficient) were analyzed retrospectively. Results Of ten patients,3 cases had abnormal finding in the cranial CT;10 cases had abnormal finding in the cranial MRI,the lesions were demonstrated as slightly hypointensity on T1WI and slightly hyperintensity on T2WI and remarkably hyperintensity on FLAIR,and iso or slightly hyperintensity on DWI,and remarkably hyperintensity on ADC.The lilateral parietal occipital lobes and cerebellar hemisphere and Brain Stem were the more common sites. Conclusions The only characteristric finding of hypertensive encephalopathy in MRI and CT imaging studies is vasogenic edema,especially in the subcortical white matter of the parietal and occipital lobes bilaterally,and cereballar hemisphere et al;especially FLAIR,DWI and ADC of MRI can be helpful for diagnosis and diffenential diagnosis,prognosis and curative effect of hypertensive encephalopathy.

Vasogenic Edema in a Patient with Partial Status Epilepticus / 대한간질학회지

We report a patient who showed vasogenic edema on MRI in association with partial status epilepticus. The patient, for a month, experienced clonic movements of the right arm and leg. As the amplitude and frequency of the clonic movements increased, resulting in epilepsia partialis continua, MRI showed characteristic vasogenic edema features;normal or decreased signal on diffusion-weighted imaging, and increased apparent diffusion coefficient value in the left parasagittal frontal region with strong leptomeningeal enhancement. This region was corresponded to the leg motor area, which was correlated with the degree of hypemetabolism of ictal FDG-PET findings. Considering limited progression of the seizure activity and focal slow waves on EEG, time-locked by clonic jerks, which might result from synaptic inhibition, this case suggests that vasogenic edema may be associated with a lower intensity of the seizure activity compared with cytotoxic edema noted in most of the reported patients.

Therapeutic role on monoclonal antibody of alkaline phosphatase to vasogenic cerebral edema in rats / 临床神经病学杂志

Objective To observe the therapeutic role on monoclonal antibody of alkaline phosphatase(AAP) to vasogenic cerebral edema in rats(VCE).Methods 60 Wistar rats were randomly divided into 3 groups:normal group,VCE group and AAP group.VCE animal model was made by injecting AAP.Brain water content of gray and white matter were measured by Moistrue Analyzer respectively.The permeability of the blood brain barrier (BBB) was determined by Evan's blue(EB) extravasation.Results The brain water content of gray and white matter in AAP group was reduced markedly,so the permeability of BBB was reduced(P0.05). Conclusion AAP can treat VCE well. Morbidity mechanism of VCE is related to the activity of alkaline phosphatase.

Brain Edema Formation after Cryogenic Brain Injury in Rats / 대한마취과학회지

The method of cryogenic brain edema has been used popularly for the study of experimental brain edema which is similar to vasogenic brain edema due to traumatic brain damage. After experimental cryogenic cerebral injury, severe focal brain contusion will be developed due to BBB breakdown and vasogenic cerebral edema formation. This study has been conducted to find out the index of other studies of brain edema by watching the time courses of cryogenic brain edema in rats. Forty five rats of either sex weighing 277+/-5 g(mean+/-SD) were freely drunken and fed till just before operation. Anesthesia was induced in a plastic box with 5% halothane in oxygen and then 1mg/kg of 0.5% urethane was injected into the peritonial cavity. The skull was exposed by a midline incision after infiltration of 2% lidocaine(total dose, <10 mg) and skull was reflected bilaterally. A funnel, an attached side of which was 5 mm in diameter, was attached on the left temporo-parietal area with epoxy glue. All rats were randomly selected into one of the two groups; Edema Group(40 rats) for the evaluation of brain edema and Barrier Group(5 rats) for the evaluation of integrity of BBB. Edema group was subdivided into 8 subgroup(5 rats in each group) according to the decapitation time in control, 15, 30, 45, 60, 90, 120, and 180 min. In edema group, cryogenic brain injury was made by pouring liquid nitrogen into the funnel for 60 seconds and then the brain was quickly removed at 0, 15, 30, 45, 90, 120, and 180 minutes after liquid nitrogen exposure. The cerebellum and brain stem caudal to the colliculi were discarded, and the cerebral hemisphere was separated. According to dry-weight method, the water contents of each hemisphere were measured. Data were analyzed by a one-way ANOVA test. In barrier group, the method of cryogenic brain injury was same as edema group and 0.5 ml of 3% Evans Blue was injected via right femoral vein just before exposure of liquid nitrogen. At 60 minutes after the cryogenic brain injury, the perfusion fixation was done and the brain was quickly removed and stored in the 10% formalin solution. The water contents of each hemisphere were proved to be similar with those of previous studies even through the conditions of dry-weight method were different. In this study, the amount of brain edema was increased till 90 minute after cryogenic brain injury and then decreased as time went by. From these results, the method of experimental brain edema after cryogenic brain injury is a good guidance of BBB breakdown and vasogenic brain edema study.