Coexistence of Cerebral Microbleeds and Amyloid Pathology in Patients with Cognitive Complaints

Different Cortical Thinning Patterns Depending on Their Prognosis in Individuals with Subjective Cognitive Decline

BACKGROUND AND PURPOSE: Subjective cognitive decline (SCD) may be the first stage corresponding to subtle cognitive changes in patients with Alzheimer's disease (AD) spectrum disorders. We evaluated the differences in cortical thinning patterns among patients with SCD who progressed to mild cognitive impairment or dementia (pSCD), those who remained stable (sSCD), and healthy normal controls (NCs).METHODS: We retrospectively recruited SCD subjects (14 pSCD and 21 sSCD cases) and 29 NCs. Structural 3-dimensional-T1-weighted magnetic resonance imaging was performed using a single 1.5 Tesla scanner. Freesurfer software was used to map cortical thickness for group comparisons.RESULTS: Compared with NC group, the sSCD group showed diffuse cortical atrophy associated with bilateral fronto-parieto-temporal area. The pSCD group showed further characteristic cortical atrophy in AD-vulnerable regions including the inferior parieto-temporal and middle temporal areas. Cortical thinning in the bilateral medial frontal areas was observed in patients with sSCD and involved the right inferior temporal and left precentral areas in those with pSCD.CONCLUSIONS: Our study showed that SCD subjects exhibit different cortical thinning patterns depending on their prognosis.

Relationship between Neuropsychiatric Symptoms and Activities of Daily Living in Alzheimer's Disease

BACKGROUND: In Alzheimer's disease (AD), cognitive impairment is associated with functional impairment; and neuropsychiatric symptoms are common in AD patients. However, there have been few studies about the relationship between neuropsychiatric symptoms and functional state in AD. The objective of this study is to investigate the effects of neuropsychiatric symptoms on activities of daily living in AD. METHODS: We reviewed the medical records of 60 AD patients meeting the criteria of the Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA) for probable AD (mean age, 75.4+/-7.0 years; 13 men, 47 women). The relationships between the Neuropsychiatric Inventory (NPI) and two functional measures, instrumental activities of daily living (IADL) and the Barthel Index, were analysed. RESULTS: The total NPI score was significantly associated with both functional measures (IADL: r=0.543; Barthel Index: r=-0.515), as were the NPI subscale scores of delusion, hallucination, agitation, depression, anxiety, and irritability. Multivariate regression analyses showed that total NPI score and duration of dementia were significant predictive factors for both IADL and the Barthel Index. In addition, the total NPI score still significantly influenced the two functional measures after controlling for age, duration of dementia, and Mini-Mental State Examination. CONCLUSION: The total NPI score was a significant predictive factor for functional status beyond the contribution of cognitive impairment in AD. Neuropsychiatric symptoms are associated with increased functional impairments in AD. Screening and management of neuropsychiatric symptoms during the course of AD would be helpful in improving functional status.

Measurement of Precuneal and Hippocampal Volumes Using Magnetic Resonance Volumetry in Alzheimer's Disease

BACKGROUND AND PURPOSE: Alzheimer's disease (AD) is associated with structural alterations in the medial temporal lobe (MTL) and functional alterations in the posterior cortical region, especially in the early stages. However, it is unclear what mechanisms underlie these regional discrepancies or whether the posterior cortical hypometabolism reflects disconnection from the MTL lesion or is the result of local pathology. The precuneus, an area of the posteromedial cortex that is involved in the early stages of AD, has recently received a great deal of attention in functional neuroimaging studies. To assess the relationship between the precuneus and hippocampus in AD, we investigated the volumes of these two areas using a magnetic resonance volumetric method. METHODS: Twenty-three subjects with AD and 14 healthy age-matched controls underwent T1-weighted three-dimensional volumetric brain magnetic resonance imaging. Volumetric measurements were performed in the precuneus and hippocampus. RESULTS: Compared to controls, AD patients exhibited a significant reduction in total precuneal volume, which was more prominent on the right side, and significant bilateral reductions in hippocampal volume. No correlation was found between the total volumes of the precuneus and hippocampus in the AD group. CONCLUSIONS: These results suggest that volumetric measurements of both the precuneus and hippocampus are useful radiological indices for the diagnosis of AD. Furthermore, the lack of correlation is attributable to local pathology rather than being a secondary consequence of MTL pathology.

Measurement of Precuneal and Hippocampal Volumes Using Magnetic Resonance Volumetry in Alzheimer's Disease

BACKGROUND AND PURPOSE: Alzheimer's disease (AD) is associated with structural alterations in the medial temporal lobe (MTL) and functional alterations in the posterior cortical region, especially in the early stages. However, it is unclear what mechanisms underlie these regional discrepancies or whether the posterior cortical hypometabolism reflects disconnection from the MTL lesion or is the result of local pathology. The precuneus, an area of the posteromedial cortex that is involved in the early stages of AD, has recently received a great deal of attention in functional neuroimaging studies. To assess the relationship between the precuneus and hippocampus in AD, we investigated the volumes of these two areas using a magnetic resonance volumetric method. METHODS: Twenty-three subjects with AD and 14 healthy age-matched controls underwent T1-weighted three-dimensional volumetric brain magnetic resonance imaging. Volumetric measurements were performed in the precuneus and hippocampus. RESULTS: Compared to controls, AD patients exhibited a significant reduction in total precuneal volume, which was more prominent on the right side, and significant bilateral reductions in hippocampal volume. No correlation was found between the total volumes of the precuneus and hippocampus in the AD group. CONCLUSIONS: These results suggest that volumetric measurements of both the precuneus and hippocampus are useful radiological indices for the diagnosis of AD. Furthermore, the lack of correlation is attributable to local pathology rather than being a secondary consequence of MTL pathology.

A Case of Leptomeningeal Carcinomatosis Presenting as a Neurological Complication of Stomach Cancer

Leptomeningeal carcinomatosis, an important and serious neurological complication of malignant cancers, is asso- ciated with severe disability and high mortality. It is most commonly seen in patients with breast cancer, lung cancer and malignant melanoma. However, leptomeningeal carcinomatosis induced by gastric cancer has been rarely reported, although gastric cancer is one of the most common causes of cancer-related deaths in Korea. We report a case of a 76- year-old woman with leptomeningeal carcinomatosis presenting as a neurological complication of gastric cancer and con- firmed by cytology examination of the cerebrospinal fluid and brain magnetic resonance imaging with gadolinium enhan-cement.

Pure Limb Ataxia as Isolated Manifestation in Lateral Medullary Infarction

Pure limb ataxia without other common symptoms of Wallenberg syndrome has rarely been reported as manifestation of lateral medullary infarction. We describe a patient with lateral medullary infarction who presented with almost isolated right limb(mainly lower limb) ataxia without usual symptoms such as hemibody sensory changes, dysphagia, hoarseness, hiccup, and Horner sign. The brain magnetic resonance image showed small ischemic lesion involving the dorsolateral portion of the medulla oblongata.

Pisa Syndrome in Parkinson's Disease With a Good Response to Dopamine Therapy

No abstract available.

The Effect of Imaging Parameters of Diffusion Tensor Imaging on Fractional Anisotropy

PURPOSE: To evaluate the effect of changes of parameters of diffusion tensor imaging (DTI), including slice thickness/slice number, b-value and the direction number of a diffusion gradient on fractional anisotropy (FA). MATERIALS AND METHODS: Three groups of normal volunteers underwent brain diffusion tensor imaging with the use of three different imaging parameters as follows: a different slice thickness/slice number (6 mm/20 slices and 2.33 mm/54 slices), a different b-value (800 s/mm2/1000 s/mm2) and a different number of directions of the diffusion gradient (6 and 15 directions). The signal to noise ratio (SNR) and FA were measured by a ROI measurement at the anterior corona radiata, superior corona radiata, putamen and corpus callosum. We compared the mean SNR and FA in each group by the use of the paired T-test. RESULTS: The SNR decreased and the FA increased significantly according to the increase of the slice number (6 mm/20 slices vs. 2.33 mm/54 slices). The SNR of DTI with 15 diffusion gradient directions was significantly higher than DTI with six directions, without a difference of FA. There were no significant changes of the SNR and FA of DTI according to the b-value. CONCLUSION: It is essential and useful in the clinical application of DTI to understand the effect of imaging parameters on FA.

Pure Sensory Deficit at the T4 Sensory Level as an Isolated Manifestation of Lateral Medullary Infarction

In rare cases restricted sensory deficits along the somatotopic topography of the spinothalamic tract can develop from a lateral medullary infarction. To our knowledge, isolated dermatomal sensory deficit as a single manifestation of a lateral medullary infarction has not been reported previously. A 58-year-old man presenting with sudden left-sided paresthesia complained of sensory deficit of pain and temperature below the left T4 sensory level without other neurologic deficits. Diffuse- and T2-weighted magnetic resonance imaging (MRI) of the brain showed high signal intensities in the right lower medulla oblongata, whereas thoracic-spine MRI and somatosensory evoked potentials produced normal findings.

A Case of Gliomatosis Cerebri with Serial MRI Findings

No abstract available.

A Case of Gliomatosis Cerebri with Serial MRI Findings

No abstract available.

Alice in Wonderland Syndrome in a Case with Infarct in the Right Medial Temporal Lobe

We describe a patient who suffered an infarct of the right medial temporal lobe, and developed visual illusions for body images, referred to as Alice in wonderland syndrome (AIWS). Although, these phenomena are usually seen in settings of migraine with aura or epilepsy, an association with strokes has not previously been described. The occurrence of AIWS in our patient, following an infarct of the right medial temporal lobe, provides support for this symptom having a biological and anatomical substrate.

The Effect of 1, 25-Dihydroxyvitamin D3 on Dopaminergic Neurons and Microglial Activation in Parkinsonian Rat Model Induced by 6-Hydroxydopamine

BACKGROUND: Recent studies have shown increasing evidence for microglial activation in neuronal degeneration in Parkinson's disease (PD), although the cause of PD remains unclear. Recent studies have also shown that 1alpha, 25-dihydroxyvitamin D3 (vitamin D3) exert neuroprotective effects by inducing an increased expression of neurotrophic factors, suggesting the possibility of vitamin D3 for the treatment of PD and other neurodegenerative diseases. The purpose of this study was to investigate the effect of vitamin D3 on 6-hydroxydopamine (6-OHDA)-induced neurotoxicity and microglial activation in adult rats. METHODS: Adult male Sprague-Dawley rats were subcutaneously injected with vitamin D3 or 0.1% ethanol for seven consecutive days and then infused unilaterally with 6-OHDA in the medial forebrain bundle. After 7 days of injection with 6-OHDA, the substantia nigra was examined by immunohistochemistry. RESULTS: The number of tyrosine hydroxylase (TH)-positive neurons in the lesioned substantia nigra pars compacta of vitamin D3 and ethanol groups was 84.8 +/- 18.84 and 52.6 +/- 13.23, respectively, fewer than that of the contralateral side (122.35 +/- 9.79 and 123.81 +/- 12.11, respectively) (P<0.05). The vitamin D3 group showed significantly higher numbers of the TH-positive neurons than that of the ethanol group (P<0.05). CD11b-positive microglial immunoreactivity was stronger in the lesion side than that of the normal side, and it was much weaker in the vitamin D3 group than that of the ethanol group (P<0.05). CONCLUSIONS: These results indicate that vitamin D3 protects dopaminergic neurons from the neuronal injury induced by 6-OHDA, possibly by the mechanism involving microglial activation.

Two Cases of Invasive Aspergillosis of Sino-nasal Origin

Cerebral aspergillosis is a rare condition that affects primarily the immunocompromised host. Most of cerebral aspergillosis is developed by hematogenous dissemination from extracranial foci, but aspergillosis of sino-nasal origin rarely affects the CNS. In case 1, wel symptom of tumor recurrence was unilateral numbness of the chin. A 65-year-old male was admitted because of paresthesia around the left chin and left lower lip. Neurologic examination revealed hypesthesia on the left side of chin, lower lip and buccal mucous mem-brane. Bone scan (Tc-99m MDP) showed focal hot uptakes on the left mandible and left first rib. Brain CT with bone window setting showed a focal osteolytic lesion in the bone marrow of the left mandibular canal without destruction of bone cortex. Both coronal T1 weighted image and axial T2 weighted image showed focal low signal intensities on the left ramus. The pathophysiologic mechanism could be understood by identification of the pathologic focus.

Two Cases with Carbamazepine-induced Unusual Side Effects-Encephalopathy and Myoclonic Jerks

Central nervous system toxicity is the most commonly recognized problem during treatment with carbamazepine (CBZ). The most common side effects of CBZ are drowsiness, incoordination, and vertigo. However, unusual conditions such as movement disorders, seizure aggravation, and encephalopathy have also been attributed to CBZ therapy. In case 1, cognitive dysfunction and exacerbation of preexisting gait disturbance were observed in a 63-year-old female who had frontal lobe epilepsy, schizencephaly, and lissencephaly treated with CBZ. The neurological symptoms were resolved 24 hours after the withdrawal of CBZ and induced with the reintroduction of CBZ. In case 2, myoclonic jerks occurred in a 37-year-old female when CBZ was readministered after a 4-day-withdrawal period of CBZ. The myoclonic jerks disappeared 12 days after CBZ was discontinued. In both cases, plasma CBZ levels were within the therapeutic range. We report two cases with encephalopathy and myoclonic jerks as unusual side effects of CBZ, with the plasma levels of CBZ being within the therapeutic range.