Subject(s)
Coronavirus Infections , Corpus Callosum , Pandemics , Pneumonia, Viral , Betacoronavirus , COVID-19 , Corpus Callosum/diagnostic imaging , Humans , Infarction , SARS-CoV-2ABSTRACT
BACKGROUND AND PURPOSE: Ischemic infarction of the corpus callosum is rare and infarction isolated to the corpus callosum alone rarer still, accounting for much <1% of ischemic stroke in most stroke registries. About half of callosal infarctions affect the splenium. METHODS: During a 2-week period, at the height of the coronavirus disease 2019 (COVID-19) pandemic in New York City, 4 patients at Montefiore Medical Center in the Bronx were found to have ischemic lesions of the splenium of the corpus callosum, 2 with infarction isolated to the corpus callosum. RESULTS: All patients tested positive for COVID-19 and 3 had prolonged periods of intubation. All had cardiovascular risk factors. Clinically, all presented with encephalopathy and had evidence of coagulopathy and raised inflammatory markers. CONCLUSIONS: Infarction of the splenium of the corpus callosum is exceedingly rare and a cluster of such cases suggests COVID-19 as an inciting agent, with the mechanisms to be elucidated.
Subject(s)
Cerebral Infarction/complications , Cerebral Infarction/pathology , Coronavirus Infections/complications , Corpus Callosum/pathology , Pneumonia, Viral/complications , Aged , Aged, 80 and over , Brain Ischemia/complications , Brain Ischemia/pathology , COVID-19 , Diabetes Complications/complications , Fatal Outcome , Female , Humans , Hypertension/complications , Hypothyroidism/complications , Inflammation/blood , Intubation, Intratracheal , Middle Aged , Pandemics , Risk Factors , Stroke/etiology , Stroke/pathology , Stroke RehabilitationABSTRACT
A case of Whipple's disease with development of antibiotic resistance is reported. The patient's symptomatology correlated with evolution of diffusion abnormality rather than with lesion enhancement. The lesion demonstrated no hyperperfusion, moderately elevated choline, and decreased N-acetylaspartate. Conventional magnetic resonance (MR) imaging findings of central nervous system Whipple's disease are nonspecific and may mimic neoplasm. MR perfusion and spectroscopy findings are reported, which may assist in diagnosis. Change in diffusion restriction appears to be a potential imaging indicator of clinical progression and response to therapy.
Subject(s)
Brain/pathology , Diffusion Magnetic Resonance Imaging/methods , Encephalitis/diagnosis , Whipple Disease/diagnosis , Female , Humans , Middle Aged , RecurrenceABSTRACT
We report five patients with mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) who had demyelinating peripheral neuropathy. The MNGIE neuropathy had clinical and electrodiagnostic features typical of acquired, rather than inherited, etiologies. In fact, three patients were actually treated for chronic inflammatory demyelinating polyneuropathy (CIDP). We discuss findings that may help distinguish patients with MNGIE from those with CIDP.
Subject(s)
Diagnostic Errors/prevention & control , Mitochondrial Encephalomyopathies/diagnosis , Polyradiculoneuropathy, Chronic Inflammatory Demyelinating/diagnosis , Adjuvants, Immunologic/therapeutic use , Adolescent , Adrenal Cortex Hormones/therapeutic use , Adult , Axons/metabolism , Axons/pathology , Diagnosis, Differential , Electrodiagnosis , Female , Humans , Immunoglobulins, Intravenous/therapeutic use , Male , Mitochondrial Encephalomyopathies/genetics , Mitochondrial Encephalomyopathies/physiopathology , Nerve Fibers, Myelinated/metabolism , Nerve Fibers, Myelinated/pathology , Neural Conduction/genetics , Peripheral Nerves/metabolism , Peripheral Nerves/pathology , Peripheral Nerves/physiopathology , Polyradiculoneuropathy, Chronic Inflammatory Demyelinating/physiopathology , Thymidine Phosphorylase/deficiency , Thymidine Phosphorylase/geneticsABSTRACT
Amusia and musicogenic epilepsy are clinical disorders that provide a window into the localization of music in the brain. Classic clinical studies of patients with these disorders, coupled with more recent studies employing modern neuroimaging and sophisticated neuropsychologic paradigms, have converged in helping to elucidate the complex neural systems that are utilized in decoding music. The notion of cerebral dominance for music has been replaced by a concept of modular but interconnected networks that have wide bilateral localization in the brain and that are molded both by genetics and experience. These disorders also provide insight into the important interface between music and emotion.
