Aortic valve endocarditis by Actinomyces odontolyticus and Gemella morbillorum oral pathogens.

A 56-year-old female with a history of poor dental hygiene and aortic insufficiency status post aortic valve replacement in 2015 presented with chest pain and fevers. She was found to have portal vein thrombosis, colitis, and infective endocarditis with aortic valve thickening. Blood cultures were positive for Actinomyces odontolyticus and Gemella morbillorum. Transesophageal echocardiogram was positive for aortic root thickening. Patient was treated with ceftriaxone and apixaban with full recovery.

Feasibility of Magnetoencephalography after Endovascular Treatment of Ruptured Intracranial Aneurysms.

OBJECTIVE: Among good outcome survivors of aneurysmal subarachnoid hemorrhage (aSAH), only 23% have normal neurocognitive performance, despite imaging that is often normal. The aim of this work is to explore the use of magnetoencephalography (MEG) after endovascular treatment of ruptured aneurysms. METHODS: Good outcome aSAH patients treated with coiling and matched controls were recruited. Clinical assessments and resting-state MEG and anatomical MRI images were obtained. Brain space was normalized to standard Montreal Neurological Institute (MNI) brain. Areas of interest were identified with Automated Anatomical Labeling (AAL) and "electrodes" reconstructed using vector beamformer. Spectral power density estimates for each location was averaged across the brain to derive mean signal power. Virtual-sensor data closest to the coil was assessed for signal quality. RESULTS: Thirteen aSAH patients and 13 matched controls were recruited. Mean age was 54.5 years (SD = 9.9) for controls and 56.8 years (SD = 11.8) for aSAH. The majority of aneurysms (62%) were in the midline. Mean time from aSAH to MEG was 18.8 months (2.4-67.5; SD = 19). Data quality was comparable in both groups, including the virtual-sensors close to the coil mass. Mean signal power showed no significant spectral alterations in the aSAH group. CONCLUSION: MEG is feasible in aSAH patients after endovascular treatment. Our results suggest that the signal quality and strength is good, and the presence of coils does not interfere with testing. Considering the common neurocognitive complaints of aSAH survivors MEG could be developed to diagnose, quantify, and monitor neurocognitive problems after aSAH.

Development of Network Synchronization Predicts Language Abilities.

Synchronization of oscillations among brain areas is understood to mediate network communication supporting cognition, perception, and language. How task-dependent synchronization during word production develops throughout childhood and adolescence, as well as how such network coherence is related to the development of language abilities, remains poorly understood. To address this, we recorded magnetoencephalography while 73 participants aged 4-18 years performed a verb generation task. Atlas-guided source reconstruction was performed, and phase synchronization among regions was calculated. Task-dependent increases in synchronization were observed in the theta, alpha, and beta frequency ranges, and network synchronization differences were observed between age groups. Task-dependent synchronization was strongest in the theta band, as were differences between age groups. Network topologies were calculated for brain regions associated with verb generation and were significantly associated with both age and language abilities. These findings establish the maturational trajectory of network synchronization underlying expressive language abilities throughout childhood and adolescence and provide the first evidence for an association between large-scale neurophysiological network synchronization and individual differences in the development of language abilities.

Abnormal Brain Dynamics Underlie Speech Production in Children with Autism Spectrum Disorder.

A large proportion of children with autism spectrum disorder (ASD) have speech and/or language difficulties. While a number of structural and functional neuroimaging methods have been used to explore the brain differences in ASD with regards to speech and language comprehension and production, the neurobiology of basic speech function in ASD has not been examined. Magnetoencephalography (MEG) is a neuroimaging modality with high spatial and temporal resolution that can be applied to the examination of brain dynamics underlying speech as it can capture the fast responses fundamental to this function. We acquired MEG from 21 children with high-functioning autism (mean age: 11.43 years) and 21 age- and sex-matched controls as they performed a simple oromotor task, a phoneme production task and a phonemic sequencing task. Results showed significant differences in activation magnitude and peak latencies in primary motor cortex (Brodmann Area 4), motor planning areas (BA 6), temporal sequencing and sensorimotor integration areas (BA 22/13) and executive control areas (BA 9). Our findings of significant functional brain differences between these two groups on these simple oromotor and phonemic tasks suggest that these deficits may be foundational and could underlie the language deficits seen in ASD.

Soldiers With Posttraumatic Stress Disorder See a World Full of Threat: Magnetoencephalography Reveals Enhanced Tuning to Combat-Related Cues.

BACKGROUND: Posttraumatic stress disorder (PTSD) is linked to elevated arousal and alterations in cognitive processes. Yet, whether a traumatic experience is linked to neural and behavioral differences in selective attentional tuning to traumatic stimuli is not known. The present study examined selective awareness of threat stimuli and underlying temporal-spatial patterns of brain activation associated with PTSD. METHODS: Participants were 44 soldiers from the Canadian Armed Forces, 22 with PTSD and 22 without. All completed neuropsychological tests and clinical assessments. Magnetoencephalography data were collected while participants identified two targets in a rapidly presented stream of words. The first target was a number and the second target was either a combat-related or neutral word. The difference in accuracy for combat-related versus neutral words was used as a measure of attentional bias. RESULTS: All soldiers showed a bias for combat-related words. This bias was enhanced in the PTSD group, and behavioral differences were associated with distinct patterns of brain activity. At early latencies, non-PTSD soldiers showed activation of midline frontal regions associated with fear regulation (90-340 ms after the second target presentation), whereas those with PTSD showed greater visual cortex activation linked to enhanced visual processing of trauma stimuli (200-300 ms). CONCLUSIONS: These findings suggest that attentional biases in PTSD are linked to deficits in very rapid regulatory activation observed in healthy control subjects. Thus, sufferers with PTSD may literally see a world more populated by traumatic cues, contributing to a positive feedback loop that perpetuates the effects of trauma.

Delayed and disorganised brain activation detected with magnetoencephalography after mild traumatic brain injury.

BACKGROUND: Awareness to neurocognitive issues after mild traumatic brain injury (mTBI) is increasing, but currently no imaging markers are available for mTBI. Advanced structural imaging recently showed microstructural tissue changes and axonal injury, mild but likely sufficient to lead to functional deficits. Magnetoencephalography (MEG) has high temporal and spatial resolution, combining structural and electrophysiological information, and can be used to examine brain activation patterns of regions involved with specific tasks. METHODS: 16 adults with mTBI and 16 matched controls were submitted to neuropsychological testing (Wechsler Abbreviated Scale of Intelligence (WASI); Conners; Alcohol Use Disorders Identification Test (AUDIT); Generalised Anxiety Disorder Seven-item Scale (GAD-7); Patient Health Questionnaire (PHQ-9); Symptom Checklist and Symptom Severity Score (SCAT2)) and MEG while tested for mental flexibility (Intra-Extra Dimensional set-shifting tasks). Three-dimensional maps were generated using synthetic aperture magnetometry beamforming analyses to identify differences in regional activation and activation times. Reaction times and accuracy between groups were compared using 2×2 mixed analysis of variance. FINDINGS: While accuracy was similar, patients with mTBI reaction time was delayed and sequence of activation of brain regions disorganised, with involvement of extra regions such as the occipital lobes, not used by controls. Examination of activation time showed significant delays in the right insula and left posterior parietal cortex in patients with mTBI. CONCLUSIONS: Patients with mTBI showed significant delays in the activation of important areas involved in executive function. Also, more regions of the brain are involved in an apparent compensatory effort. Our study suggests that MEG can detect subtle neural changes associated with cognitive dysfunction and thus, may eventually be useful for capturing and tracking the onset and course of cognitive symptoms associated with mTBI.

Age-related sex differences in language lateralization: A magnetoencephalography study in children.

It is well supported by behavioral and neuroimaging studies that typical language function is lateralized to the left hemisphere in the adult brain and this laterality is less well defined in children. The behavioral literature suggests there maybe be sex differences in language development, but this has not been examined systematically with neuroimaging. In this study, magnetoencephalography was used to investigate the spatiotemporal patterns of language lateralization as a function of age and sex. Eighty typically developing children (46 female, 34 male; 4-18 years) participated in an overt visual verb generation task. An analysis method called differential beamforming was used to analyze language-related changes in oscillatory activity referred to as low-gamma event-related desynchrony (ERD). The proportion of ERD over language areas relative to total ERD was calculated. We found different patterns of laterality between boys and girls. Boys showed left-hemisphere lateralization in the frontal and temporal language-related areas across age groups, whereas girls showed a more bilateral pattern, particularly in frontal language-related areas. Differences in patterns of ERD were most striking between boys and girls in the younger age groups, and these patterns became more similar with increasing age, specifically in the preteen years. Our findings show sex differences in language lateralization during childhood; however, these differences do not seem to persist into adulthood. We present possible explanations for these differences. We also discuss the implications of these findings for presurgical language mapping in children and highlight the importance of examining the question of sex-related language differences across development.

Aneurysmal subarachnoid haemorrhage from a neuroimaging perspective.

Neuroimaging is a key element in the management of patients suffering from subarachnoid haemorrhage (SAH). In this article, we review the current literature to provide a summary of the existing neuroimaging methods available in clinical practice. Noncontrast computed tomography is highly sensitive in detecting subarachnoid blood, especially within 6 hours of haemorrhage. However, lumbar puncture should follow a negative noncontrast computed tomography scan in patients with symptoms suspicious of SAH. Computed tomography angiography is slowly replacing digital subtraction angiography as the first-line technique for the diagnosis and treatment planning of cerebral aneurysms, but digital subtraction angiography is still required in patients with diffuse SAH and negative initial computed tomography angiography. Delayed cerebral ischaemia is a common and serious complication after SAH. The modern concept of delayed cerebral ischaemia monitoring is shifting from modalities that measure vessel diameter to techniques focusing on brain perfusion. Lastly, evolving modalities applied to assess cerebral physiological, functional and cognitive sequelae after SAH, such as functional magnetic resonance imaging or positron emission tomography, are discussed. These new techniques may have the advantage over structural modalities due to their ability to assess brain physiology and function in real time. However, their use remains mainly experimental and the literature supporting their practice is still scarce.

Cortical activity during speech and non-speech oromotor tasks: a magnetoencephalography (MEG) study.

We used whole-head magnetoencephalography to investigate cortical activity during two oromotor activities foundational to speech production. 13 adults performed mouth opening and phoneme (/pa/) production tasks to a visual cue. Jaw movements were tracked with an ultrasound-emitting device. Trials were time-locked to both stimulus onset and peak of jaw displacement. An event-related beamformer source reconstruction algorithm was used to detect areas of cortical activity for each condition. Beamformer output was submitted to iterative K-means clustering analyses. The time course of neural activity at each cluster centroid was computed for each individual and condition. Peaks were identified and latencies submitted for statistical analysis to reveal the relative timing of activity in each brain region. Stimulus locked activations for the mouth open task included a progression from left cuneus to left frontal and then right pre-central gyrus. Phoneme generation revealed the same sequence but with bilateral frontal activation. When time locked to jaw displacement, the mouth open condition showed left frontal followed by right frontal-temporal areas. Phoneme generation showed a complicated sequence of bilateral temporal and frontal areas. This study used three unique approaches (beamforming, clustering and jaw tracking) to demonstrate the temporal progression of neural activations that underlie the motor control of two simple oromotor tasks. These findings have implications for understanding clinical conditions with deficits in articulatory control or motor speech planning.

An MEG study of the spatiotemporal dynamics of bilingual verb generation.

Studies of first (L1) and second (L2) language representation in the brain have not identified the timing and locations of neural regions involved in L1 and L2 processing. Magnetoencephalography offers high spatial and temporal resolution and can be employed to disentangle subtle timing and neural control differences between L1 and L2 use. We tested bilingual adults in the MEG as they completed a picture verb generation task in L1 and L2. We found the expected progression of activation from occipital to temporal to inferior frontal areas. We also observed the following differences. A sustained insula and early cingulate event-related desynchrony was observed only with L2; the fMRI literature suggests that the former reflects an activation, and the latter an inhibition, sub-process for language selection. L2 processes exhibited a lag and were bilateral compared to L1 processes. Finally, L1 and L2 activated adjacent language control in dorsolateral pre-frontal cortex.

Desipramine reduces stress-activated dynorphin expression and CREB phosphorylation in NAc tissue.

The nucleus accumbens (NAc) is a critical brain area for reward and motivated behavior. Accumulating evidence suggests that altered function of the transcription factor cAMP response element binding protein (CREB) within the NAc is involved in depressive behavior. In rats, stress activates CREB within the NAc, and elevation of CREB expression in this region produces depressive-like behaviors that are accompanied by activation of CREB-regulated target genes. The depressive-like behaviors seem to be due, at least in part, to CREB-mediated increases in dynorphin function, because they are mimicked by kappa-opioid receptor (KOR) agonists and attenuated by KOR antagonists. We hypothesized that if CREB-mediated dynorphin expression in the NAc contributes to depressive behavior, then antidepressants might reduce dynorphin function in this region. Here, we demonstrate that desipramine (DMI), a norepinephrine reuptake inhibitor that has been used for decades to treat clinical depression, blocks swim stress-induced activation of prodynorphin (encodes dynorphin) in the NAc. In primary cultures of NAc and striatum, DMI decreases basal and stimulated CREB phosphorylation by causing reductions in intracellular calcium (Ca(2+)) availability that are independent of norepinephrine or other monoaminergic inputs, identifying a potential mechanism for alterations in CREB-mediated gene expression. Fluoxetine (FLX), a selective serotonin reuptake inhibitor, has similar effects in culture, suggesting a common intracellular effect of these antidepressants. These findings raise the possibility that a therapeutically relevant mechanism of action of DMI occurs through attenuation of CREB-mediated gene transcription, which is mediated via previously uncharacterized mechanisms that occur directly within the NAc.