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1.
CNS Neurosci Ther ; 30(7): e14828, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38946709

RESUMO

OBJECTIVE: Wallerian degeneration (WD) of the middle cerebellar peduncles (MCPs) following pontine infarction is a rare secondary degenerative neurological condition. Due to its infrequency, there is limited research on its characteristics. METHODS: This study aims to present three cases of WD of MCPs following pontine infarction and to analyze the prognosis, clinical manifestations, and neuroimaging features by amalgamating our cases with previously reported ones. RESULTS: The cohort consisted of 25 cases, comprising 18 men and 7 women aged 29 to 77 years (mean age: 66.2 years). The majority of patients (94%) exhibit risk factors for cerebrovascular disease, with hypertension being the primary risk factor. Magnetic resonance imaging (MRI) can detect WD of MCPs within a range of 21 days to 12 months following pontine infarction. This degeneration is characterized by bilateral symmetric hyperintensities on T2/FLAIR-weighted images (WI) lesions in the MCPs. Moreover, restricted diffusion, with hyperintensity on diffusion-weighted imaging (DWI) and low apparent diffusion coefficient (ADC) signal intensity may be observed as early as 21 days after the infarction. Upon detection of WD, it was observed that 20 patients (80%) remained asymptomatic during subsequent clinic visits, while four (16%) experienced a worsening of pre-existing symptoms. CONCLUSIONS: These findings underscore the importance of neurologists enhancing their understanding of this condition by gaining fresh insights into the neuroimaging characteristics, clinical manifestations, and prognosis of individuals with WD of bilateral MCPs.


Assuntos
Infartos do Tronco Encefálico , Pedúnculo Cerebelar Médio , Ponte , Degeneração Walleriana , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Adulto , Degeneração Walleriana/diagnóstico por imagem , Degeneração Walleriana/patologia , Ponte/diagnóstico por imagem , Ponte/patologia , Infartos do Tronco Encefálico/diagnóstico por imagem , Pedúnculo Cerebelar Médio/diagnóstico por imagem , Pedúnculo Cerebelar Médio/patologia , Imageamento por Ressonância Magnética , Neuroimagem/métodos
3.
Parkinsonism Relat Disord ; 90: 114-119, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34481140

RESUMO

INTRODUCTION: This study aimed to evaluate whether novel individual voxel-based morphometry adjusting covariates (iVAC), such as age, sex, and total intracranial volume, could increase the accuracy of a diagnosis of multiple system atrophy (MSA) and enable the differentiation of MSA from Parkinson's disease (PD). METHODS: We included 53 MSA patients (MSA-C: 33, MSA-P: 20), 53 PD patients, and 189 healthy controls in this study. All participants underwent high-resolution T1-weighted imaging (WI) and T2-WI with a 3.0-T MRI scanner. We evaluated the occurrence of significant atrophic findings in the pons/middle cerebellar peduncle (MCP) and putamen on iVAC and compared these findings with characteristic changes on T2-WI. RESULTS: On iVAC, abnormal findings were observed in the pons/MCP of 96.2% of MSA patients and in the putamen of 80% of MSA patients; however, on T2-WI, they were both observed at a frequency of 60.4% in MSA patients. On iVAC, all but one MSA-P patient (98.1%) showed significant atrophic changes in the pons/MCP or putamen. By contrast, 69.8% of patients with MSA showed abnormal signal changes in the pons/MCP or putamen on T2-WI. iVAC yielded 95.0% sensitivity and 96.2% specificity for differentiating MSA-P from PD. CONCLUSION: iVAC enabled us to recognize the morphological characteristics of MSA visually and with high accuracy compared to T2-WI, indicating that iVAC is a potential diagnostic screening tool for MSA.


Assuntos
Imageamento por Ressonância Magnética/métodos , Atrofia de Múltiplos Sistemas/diagnóstico , Doença de Parkinson/diagnóstico , Adulto , Idoso , Estudos de Casos e Controles , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pedúnculo Cerebelar Médio/diagnóstico por imagem , Ponte/diagnóstico por imagem , Putamen/diagnóstico por imagem , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
4.
Parkinsonism Relat Disord ; 85: 30-36, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33713904

RESUMO

INTRODUCTION: Microstructural integrity of the middle cerebellar peduncle (MCP) and the putamen captured by diffusion-tensor imaging (DTI) is differentially affected in the parkinsonian and cerebellar variants of multiple system atrophy (MSA-P, MSA-C) compared to Parkinson's disease (PD). The current study applied DTI and tractography in order to 1) characterize the distribution of DTI metrics along the tracts of the MCP and from the putamen in MSA variants, and 2) evaluate the usefulness of combining these measures for the differential diagnosis of MSA-P against PD in the clinical setting. METHODS: Twenty-nine MSA patients (MSA-C, n = 10; MSA-P, n = 19), with a mean disease duration of 2.8 ± 1.7 years, 19 PD patients, and 27 healthy controls (HC) were included in the study. Automatized tractography with a masking procedure was employed to isolate the MCP tracts. DTI measures along the tracts of the MCP and within the putamen were acquired and jointly used to classify MSA vs. PD, and MSA-P vs. PD. Putamen volume was additionally tested as classification feature in post hoc analyses. RESULTS: DTI measures within the MCP and putamen showed significant alterations in MSA variants compared to HC and PD. Classification accuracy for MSA vs. PD and MSA-P vs PD using diffusion measures was 91.7% and 89.5%, respectively. When replacing the putaminal DTI measure by a normalized measure of putamen volume classification accuracy improved to 95.8% and 94.7%, respectively. CONCLUSION: Multimodal information from MCP tractography and putamen volume yields excellent diagnostic accuracy to discriminate between early-to-moderately advanced patients with MSA and PD.


Assuntos
Imagem de Tensor de Difusão/normas , Pedúnculo Cerebelar Médio/diagnóstico por imagem , Atrofia de Múltiplos Sistemas/diagnóstico por imagem , Doença de Parkinson/diagnóstico por imagem , Putamen/diagnóstico por imagem , Idoso , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pedúnculo Cerebelar Médio/patologia , Atrofia de Múltiplos Sistemas/patologia , Doença de Parkinson/patologia , Putamen/patologia , Sensibilidade e Especificidade
6.
Acta Radiol ; 62(3): 368-376, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32529894

RESUMO

BACKGROUND: The switch from the linear gadolinium-based contrast agent (GBCA) gadopentate dimeglumine (Gd_DTPA) to the macrocyclic GBCA gadobutrol is associated with a decrease of the T1 signal intensity (SI) in brain gray matter nuclei. The effects of the switch to other macrocyclic GBCAs are not yet established. PURPOSE: To explore the effects of switching from Gd-DTPA to the macrocyclic GBCA gadoterate meglumine (Gd-DOTA) in pediatric patients. MATERIAL AND METHODS: We measured the pallidus/middle cerebellar peduncle (MCP) SI ratio and the dentate/MCP SI ratio in pre-contrast sagittal T1-weighted spin-echo images in nine patients who had received ≥6 administrations of Gd-DTPA and then of Gd-DOTA, in 18 patients who had received ≥6 administrations of Gd-DOTA alone, and in nine age-matched controls without prior GBCA administrations. Serial assessment was performed in patients who switched from Gd-DTPA to Gd-DOTA. Finally, the rate of change of pallidal/MCP and dentate/MCP SI ratios between the first and last Gd-DOTA administrations was compared. RESULTS: The pallidal/MCP and dentate/MCP SI ratios were (P < 0.05) higher in patients with prior Gd-DTPA and Gd-DOTA administrations compared to the controls. After the switch, the pallidal/MCP SI ratio increased in nine patients and the dentate/MCP ratio in seven patients. The rate of change of pallidal/MCP SI ratio after Gd-DOTA was higher (P < 0.01) in patients who had previously received Gd-DTPA (mean 2.89 ± 2.6%) than in patients who had received Gd-DOTA alone (mean 0.53 ± 0.89%). CONCLUSION: T1 SI in gray matter nuclei does not decrease after switching from Gd-DTPA to Gd-DOTA. The switch effects from Gd-DTPA to each macrocyclic GBCA should be individually evaluated.


Assuntos
Meios de Contraste , Giro Denteado/diagnóstico por imagem , Gadolínio DTPA , Globo Pálido/diagnóstico por imagem , Compostos Heterocíclicos , Imageamento por Ressonância Magnética , Compostos Organometálicos , Adolescente , Neoplasias Encefálicas/diagnóstico por imagem , Criança , Feminino , Humanos , Masculino , Pedúnculo Cerebelar Médio/diagnóstico por imagem , Estudos Retrospectivos
7.
Eur Radiol ; 31(6): 4277-4284, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33241514

RESUMO

OBJECTIVE: We aimed to investigate the use of a myelin-sensitive MRI contrast, the standardized T1-weighted/T2-weighted (sT1w/T2w) ratio, for detecting early changes in the middle cerebellar peduncle (MCP) in cerebellar subtype multiple system atrophy (MSA-C) patients. METHODS: We included 28 MSA-C patients, including a subset of 17 MSA-C patients within 2 years of disease onset (early MSA-C), and 28 matched healthy controls. T1w and T2w scans were acquired using a 3-T MR system. The sT1w/T2w ratio in MCP was analyzed using SPM12 by utilizing a region-of-interest approach in normalized space. The diagnostic performance of the MCP sT1w/T2w ratio in discriminating MSA-C and the subgroup of early MSA-C from the matched controls was assessed. Correlation analyses were performed to evaluate the relationship between the MCP sT1w/T2w ratio and other clinical parameters including the International Cooperative Ataxia Scale (ICARS) score for quantifying cerebellar ataxia. RESULTS: Compared to controls, the sT1w/T2w ratio in the MCP was markedly lower in all (p < 0.001) MSA-C patients and 17 early (p < 0.001) MSA-C patients. The MCP sT1w/T2w ratio had high sensitivity (96%) and specificity (100%) to distinguish MSA-C from controls (area under the curve = 0.99), even for the early MSA-C group (area under the curve = 0.99; sensitivity = 94%, specificity = 100%). The MCP sT1w/T2w ratio correlated with the ICARS score in early MSA-C. CONCLUSIONS: The sT1w/T2w ratio can detect MSA-C-related changes in the MCP, even in the early stages of the disorder, and could be a sensitive biomarker for MSA-C. KEY POINTS: • The sT1w/T2w ratio can detect MSA-C-related changes in the middle cerebellar peduncle, even in the early stages of the disorder. • The middle cerebellar peduncle sT1w/T2w ratio correlated with a cerebellar ataxia score in early MSA-C patients.


Assuntos
Pedúnculo Cerebelar Médio , Atrofia de Múltiplos Sistemas , Biomarcadores , Humanos , Imageamento por Ressonância Magnética , Espectroscopia de Ressonância Magnética , Pedúnculo Cerebelar Médio/diagnóstico por imagem , Atrofia de Múltiplos Sistemas/diagnóstico por imagem
8.
Hum Brain Mapp ; 42(3): 753-765, 2021 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-33098363

RESUMO

This study aimed to explore brain structural and white matter microstructural reorganization in the early stage of tinnitus and identify brain alterations that contribute to its relief after 6 months of sound therapy. We studied 64 patients with idiopathic tinnitus, including 29 patients who were categorized into an effective group (EG) and 35 who were categorized into an ineffective group (IG) according to the 6-month follow-up improvement of the Tinnitus Handicap Inventory score, along with 63 healthy controls (HCs). All participants underwent structural and diffusion tensor imaging scanning on a 3-T magnetic resonance system. Differences in brain gray/white matter volume and white matter microstructure were evaluated using voxel-based morphometry analysis and tract-based spatial statistics among the three groups. Associations between brain reorganization and the improvement of tinnitus symptoms were also investigated. Compared with EG patients, IG patients experienced a significant gray matter volume decrease in the right middle frontal gyrus (MFG)/right precentral gyrus (PreCG). Meanwhile, both EG and IG patients showed significant changes (decrease or increase) in brain white matter integrity in the auditory-related or nonauditory-related white matter fiber tracts compared with HCs, while EG patients showed decreased axial diffusivity in the bilateral middle cerebellar peduncle (MCP) compared with IG patients. We combined the gray matter change of the MFG/PreCG and the white matter integrity of the bilateral MCP as an imaging indicator to evaluate the patient's prognosis and screen patients before treatment; this approach reached a sensitivity of 77.1% and a specificity of 82.8%. Our study suggests that there was a close relationship between brain reorganization and tinnitus improvement. The right MFG/PreCG and bilateral MCP may be indicators that can be used to predict prognoses in patients with idiopathic tinnitus and may be used to screen patients before sound therapy. These findings may provide new useful information that can lead to a better understanding of the tinnitus mechanism.


Assuntos
Córtex Cerebral/patologia , Substância Cinzenta/patologia , Pedúnculo Cerebelar Médio/patologia , Neuroimagem/normas , Avaliação de Resultados em Cuidados de Saúde , Zumbido/patologia , Zumbido/terapia , Substância Branca/patologia , Estimulação Acústica , Adulto , Córtex Cerebral/diagnóstico por imagem , Imagem de Tensor de Difusão , Feminino , Seguimentos , Substância Cinzenta/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Pedúnculo Cerebelar Médio/diagnóstico por imagem , Sensibilidade e Especificidade , Zumbido/diagnóstico por imagem , Substância Branca/diagnóstico por imagem
9.
Afr Health Sci ; 20(2): 932-935, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33163061

RESUMO

BACKGROUND: Pica is a poorly understood psychiatric disorder that presents with the ingestion of non-nutritious substances for unclear reasons. A high index of suspicion for unusual toxin exposure aids in the diagnosis of pica patients presenting with unexplained neurodegenerative features. METHODS: We present a 47-year-old female with worsening gait over the past year. Prior to this, she was fully independent with activities of daily living, but is now mostly housebound due to frequent falls. Past medical history is significant for menorrhagia, iron deficiency anemia and pica. CBC and iron studies revealed iron deficiency with microcytic hypochromic anemia. MRI brain demonstrated symmetrical T2 hyperintensities within the middle cerebellar peduncles. RESULTS: Differential diagnoses for her clinical deficits and imaging, including Spinocerebellar Ataxia, Multiple System Atrophy and Fragile X Tremor-Ataxia Syndrome, were excluded based on neurological assessment, family history and genetic PCR testing. Collateral history revealed a regular habit of mothball ingestion and serum paradichlorobenzene levels were elevated to 15mcg/mL. The patient was treated with iron replacement therapy and her symptoms gradually improved over several months. CONCLUSION: Iron deficiency anemia is commonly associated with pica, which can lead to toxin ingestion. A high index of suspicion for toxin ingestion in pica patients can immensely aid in the diagnosis. Mothball abuse secondary to pica may affect the CNS and can present with nonspecific neurodegenerative changes. To our knowledge, there have been no reported cases in the literature with paradichlorobenzene neurotoxicity predominantly affecting the middle cerebellar peduncles.


Assuntos
Clorobenzenos/toxicidade , Repelentes de Insetos/intoxicação , Síndromes Neurotóxicas/diagnóstico , Pica/complicações , Anemia Ferropriva/etiologia , Clorobenzenos/sangue , Clorobenzenos/intoxicação , Feminino , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Pedúnculo Cerebelar Médio/diagnóstico por imagem
10.
Parkinsonism Relat Disord ; 80: 152-157, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33010532

RESUMO

INTRODUCTION: In recent years, cerebellar abnormalities have gained increasing attention as possible physiopathological substratum of idiopathic cervical dystonia (ICD), but a consistent pattern of cerebellar structural modifications has not yet been established. We systematically investigated the presence of volumetric alterations of cerebellar gray (GM) and white matter (WM) in ICD patients, as well as their clinical relevance. METHODS: In this two-centers prospective cross-sectional study, from May 2013 to December 2017, 27 patients with ICD and 27 age- and sex-comparable healthy controls underwent brain MRI including 3D T1-weighted sequences for volumetric analyses. Between-group differences in terms of gray matter and cerebellar peduncles volumes were investigated using both region of interest (ROI)-based and voxel-based approaches using the SUIT tool (SPM12), and significant volumetric changes were correlated with clinical impairment (as measured with the Tsui score) and presence of tremor. RESULTS: ICD patients showed significant volumetric reduction of cerebellar GM in the anterior lobe and lobule VI, resulting from both ROI-based (p ≤ 0.009) and voxel-based (p ≤ 0.04) analyses, while small clusters of reduced WM volume were found in the right cerebellum and left midbrain (p = 0.04), along with reduced volume of the bilateral superior (p = 0.04) and middle (p = 0.03) cerebellar peduncles. Furthermore, higher middle cerebellar peduncles volume was associated with the presence of tremor (p = 0.04). CONCLUSION: Our data show evidence of a specific pattern of cerebellar structural abnormalities in ICD patients, with volume loss mainly involving cortical GM regions related to the somatotopic representation of the affected body parts and, to a lesser extent, cerebellar peduncles.


Assuntos
Cerebelo/patologia , Distúrbios Distônicos/patologia , Substância Cinzenta/patologia , Pedúnculo Cerebelar Médio/patologia , Torcicolo/patologia , Tremor/patologia , Adulto , Idoso , Atrofia/patologia , Cerebelo/diagnóstico por imagem , Estudos Transversais , Distúrbios Distônicos/complicações , Distúrbios Distônicos/diagnóstico por imagem , Feminino , Substância Cinzenta/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Pedúnculo Cerebelar Médio/diagnóstico por imagem , Estudos Prospectivos , Torcicolo/diagnóstico por imagem , Tremor/diagnóstico por imagem , Tremor/etiologia
11.
Brain Behav ; 10(10): e01778, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32755074

RESUMO

OBJECTIVES: Lesions limited to the bilateral middle cerebellar peduncles (MCPs) are uncommon. This retrospective study investigated diseases with a proclivity for the bilateral MCPs and explored the associations between their neuroimaging features and clinical findings for the differential diagnosis of such lesions. METHODS: We enrolled 26 patients who were admitted to our department between January 2016 and March 2019 with bilateral MCP abnormalities on magnetic resonance imaging (MRI). The demographic, clinical, and neuroimaging characteristics, and the biomarkers and diagnoses were evaluated. RESULTS: Although all patients exhibited symmetrical bilateral MCP hypointensities on T1-weighted imaging and hyperintensities on T2-weighted and fluid-attenuated inversion recovery imaging, they were diagnosed with different conditions. Diagnoses included acute cerebral infarction (ACI) (n = 9, 34.62%), Wallerian degeneration (WD) (n = 8, 30.77%), multiple system atrophy (MSA) (n = 6, 23.08%), neuromyelitis optica (NMO) (n = 1, 3.85%), heroin-induced leukoencephalopathy (n = 1, 3.85%), and primary central nervous system lymphoma (PCNSL) (n = 1, 3.85%). Patients with ACI exhibited bilateral MCP-restricted diffusion hyperintensities on diffusion-weighted imaging and corresponding stenosis or occlusion of the vertebrobasilar system. The initial MRI of patients with WD depicted pontine infarctions, while symmetrical MCP lesions were observed on follow-up MRI. Symmetrical MCP lesions, cruciform hyperintensity, and marked atrophy in the posterior fossa were characteristic manifestations of MSA. Longitudinally extensive myelitis affecting more than three vertebral segments on cervical MRI and positive serum AQP4-IgG may be indicative of NMO. Heroin-induced leukoencephalopathy was characterized by extra-symmetrical lesions in the posterior limbs of the internal capsules, while the anterior limbs were spared. PCNSL was indicated by a significant and characteristic "fist" sign on contrast-enhanced MRI. CONCLUSIONS: Bilateral MCP lesions were most frequently observed in cerebrovascular diseases, followed by neurodegenerative diseases, inflammatory diseases, toxic encephalopathies, and lymphomas. Our findings demonstrate that bilateral MCP signal abnormalities are more common in patients with ACI and WD, with fewer degenerative processes than previously believed. The high frequency of WD may be attributed to the specific awareness of this pathology. WD can also present with stage-related restricted diffusion and should not be mistaken for a new infarction. The symmetrical bilateral MCP hypointensities on T1-weighted imaging and hyperintensities on T2-weighted imaging often raise concern regarding a demyelinating process. Our findings emphasize that neurologists should consider the aforementioned conditions and correlate the specific neuroimaging characteristics and medical history before arriving at the final diagnosis.


Assuntos
Infartos do Tronco Encefálico , Pedúnculo Cerebelar Médio , Diagnóstico Diferencial , Humanos , Imageamento por Ressonância Magnética , Pedúnculo Cerebelar Médio/diagnóstico por imagem , Neuroimagem , Estudos Retrospectivos
12.
Cerebellum ; 19(6): 771-777, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32642932

RESUMO

Reading in children has been associated with microstructural properties of the cerebellar peduncles, the white matter pathways connecting the cerebellum to the cerebrum. In this study, we used two independent neuroimaging modalities to assess which features of the cerebellar peduncles would be associated with reading. Twenty-three 8-year-old children were evaluated on word reading efficiency and imaged using diffusion MRI (dMRI) and quantitative T1 relaxometry (qT1). We segmented the superior (SCP), middle, and inferior cerebellar peduncles and extracted two metrics: fractional anisotropy (FA) from dMRI and R1 from qT1. Tract-FA was significantly correlated with tract-R1 in left and right SCPs (left: rP(21) = .63, right: rP(21) = .76, p ≤ .001) suggesting that FA of these peduncles, at least in part, indexed myelin content. Tract-FA and tract R1 were not correlated in the other cerebellar peduncles. Reading efficiency negatively correlated with tract-FA of the left (rP(21) = - .43, p = .040) and right SCP (rP(21) = - .37, p = .079). Reading efficiency did not correlate with tract-R1 in the SCPs. The negative association of reading efficiency with tract-FA and the lack of association of reading efficiency with tract-R1 implicate properties other than myelin content as relevant to the information flow between the cerebellum and the cerebrum for individual differences in reading skills in children.


Assuntos
Cerebelo/diagnóstico por imagem , Cerebelo/fisiologia , Leitura , Substância Branca/diagnóstico por imagem , Substância Branca/fisiologia , Anisotropia , Criança , Feminino , Humanos , Estudos Longitudinais , Imageamento por Ressonância Magnética/métodos , Masculino , Pedúnculo Cerebelar Médio/diagnóstico por imagem , Pedúnculo Cerebelar Médio/fisiologia
13.
Int J Pediatr Otorhinolaryngol ; 134: 110048, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32353617

RESUMO

Acute vestibular syndrome is most often caused by vestibular neuritis or stroke, although demyelinating diseases may be responsible for 4% of all AVS episodes. The authors present the case of a previously healthy 17-year-old female patient complaining of spontaneous vertigo and right-sided hearing loss. Otoneurological examination suggested a peripheral vestibular cause and video head impulse test revealed a reduced vestibulo-ocular reflex gain. The presence of sensorineural hearing loss raised the suspicion of a central cause and prompted imaging evaluation. A brain MRI evidenced demyelinating lesions in the right middle cerebellar peduncle and the patient was ultimately diagnosed with Multiple Sclerosis.


Assuntos
Cerebelo/diagnóstico por imagem , Perda Auditiva Neurossensorial/diagnóstico , Labirintite/diagnóstico , Pedúnculo Cerebelar Médio/diagnóstico por imagem , Esclerose Múltipla Recidivante-Remitente/diagnóstico , Neuronite Vestibular/diagnóstico , Doença Aguda , Adolescente , Audiometria de Tons Puros , Audiometria da Fala , Diagnóstico Diferencial , Feminino , Teste do Impulso da Cabeça , Perda Auditiva Neurossensorial/etiologia , Humanos , Imageamento por Ressonância Magnética , Esclerose Múltipla Recidivante-Remitente/complicações , Náusea/etiologia , Nistagmo Patológico/diagnóstico , Nistagmo Patológico/etiologia , Reflexo Vestíbulo-Ocular , Vertigem/etiologia , Neuronite Vestibular/etiologia , Vômito/etiologia
14.
J Clin Neurosci ; 76: 238-240, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32307300

RESUMO

The hot cross bun (HCB) sign describes cruciform-shaped T2-weighted hyperintensities of pontocerebellar fibers within the pons and is a typical, but not specific imaging hallmark of the cerebellar variant of multiple system atrophy (MSA-C). We report a case of a 51-year-old woman who was first diagnosed with MSA-C based on progressive cerebellar ataxia, the HCB sign and T2-weighted hyperintensities in middle cerebellar peduncles on MRI. However, further diagnostic work-up revealed positive anti-amphiphysin antibodies in blood and cerebrospinal fluid and subsequently breast cancer. This report of a paraneoplastic rhombencephalitis which initially mimicked MSA-C imaging features stresses the importance of considering immune-mediated rhombencephalitis as differential diagnosis in cases of progressive cerebellar ataxia and the HCB sign on T2-weighted MRI, especially in the absence of pontocerebellar atrophy.


Assuntos
Atrofia de Múltiplos Sistemas/diagnóstico , Neoplasias da Mama , Ataxia Cerebelar/diagnóstico , Ataxia Cerebelar/diagnóstico por imagem , Doenças Cerebelares/diagnóstico por imagem , Cerebelo/diagnóstico por imagem , Diagnóstico Diferencial , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Pedúnculo Cerebelar Médio/diagnóstico por imagem , Atrofia de Múltiplos Sistemas/diagnóstico por imagem , Degenerações Espinocerebelares/diagnóstico por imagem
15.
J Clin Neurosci ; 76: 205-207, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32291239

RESUMO

Venous malformation (VM) in the posterior cranial fossa occasionally cause trigeminal neuralgia (TN), which were treated with microvascular decompression of its drainer, whereas it was effective only in the limited cases, and its pathological mechanism causing TN is controversial. A 72-year-old man had a 20-year history of typical but severe TN in his left face. Without radiographic evidence of vascular compression on the root entry zone (REZ) of the trigeminal nerve, he underwent stereotactic radiosurgery in previous hospital, resulting in only temporary improvement. On T1-wighted magnetic resonance image with enhancement, the left trigeminal nerve was focally enhanced, which was typical finding after high dose irradiation for TN. Simultaneously, it disclosed small "caput medusa" within the pontine tegmentum, indicated existence of VM in brachium pontis. A 3-dimensional computer graphics model created by fusion of magnetic resonance angiography, diffusion tensor tractography, and fast imaging employing steady-state acquisition elucidated VM was located in the trigeminal nucleus of brachium pontis, which will be very useful for understanding the anatomic correlation of VM and pontine trigeminal nucleus. Since there was no vascular compression at the REZ of the trigeminal nerve, microvascular decompression was not indicated. With minimum dose of gabapentine and carbamazepin, his facial pain completely disappeared and controlled for more than 5 years.


Assuntos
Imageamento Tridimensional , Pedúnculo Cerebelar Médio/diagnóstico por imagem , Nervo Trigêmeo/diagnóstico por imagem , Neuralgia do Trigêmeo/diagnóstico por imagem , Núcleos do Trigêmeo/diagnóstico por imagem , Idoso , Gráficos por Computador , Imagem de Tensor de Difusão , Humanos , Angiografia por Ressonância Magnética , Masculino , Cirurgia de Descompressão Microvascular/efeitos adversos , Pedúnculo Cerebelar Médio/patologia , Radiocirurgia , Nervo Trigêmeo/patologia , Neuralgia do Trigêmeo/patologia , Núcleos do Trigêmeo/patologia
17.
World Neurosurg ; 137: 286-290, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32084623

RESUMO

BACKGROUND: Hypertrophic olivary degeneration (HOD) is very rare type of degeneration that causes hypertrophy rather than atrophy. The classical presentation of HOD is palatal myoclonus. However, HOD may rarely present with Holmes tremor (HT). HT is unusual symptomatic tremor characterized by combination of rest and intention tremor. It has been reported in small case series, so far. CASE DESCRIPTION: In this study, a man aged 62 years with HOD and HT spreading to the upper and lower extremities after pontine-midbrain hemorrhage due to cavernoma was presented. CONCLUSIONS: Although pontine-midbrain hemorrhage may cause HT in the late period, HOD can be revealed on magnetic resonance imaging. Tract anatomy, especially the Guillain-Mollaret triangle, should be considered to explain the relationship between HT and HOD.


Assuntos
Neoplasias do Tronco Encefálico/complicações , Hemangioma Cavernoso do Sistema Nervoso Central/complicações , Hemorragias Intracranianas/etiologia , Núcleo Olivar/diagnóstico por imagem , Degeneração Retrógrada/etiologia , Tremor/etiologia , Neoplasias do Tronco Encefálico/diagnóstico por imagem , Hemangioma Cavernoso do Sistema Nervoso Central/diagnóstico por imagem , Humanos , Hipertrofia , Hemorragias Intracranianas/diagnóstico por imagem , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Pedúnculo Cerebelar Médio/diagnóstico por imagem , Núcleo Olivar/patologia , Ponte/diagnóstico por imagem , Núcleo Rubro/diagnóstico por imagem , Degeneração Retrógrada/diagnóstico por imagem , Degeneração Retrógrada/patologia , Tomografia Computadorizada por Raios X , Tremor/diagnóstico por imagem
18.
J Neurol ; 267(5): 1269-1277, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31938861

RESUMO

AIM: The second consensus statement for the diagnosis of multiple system atrophy type cerebellar (MSA-C) includes pons and middle cerebellar peduncle (MCP) atrophy as MRI features. However, other MRI abnormalities such as MCP hyperintensity, hot cross bun sign (HCB), putaminal hypointensity and hyperintense putaminal rim have been described. OBJECTIVES: To evaluate, in patients with sporadic late-onset cerebellar ataxia (SLOCA), the discriminative value of several MRI features for the diagnosis of MSA-C, to follow their evolution during the course of MSA-C, and to search for correlations between these MRI features and clinical signs. METHODS: Consecutive patients referred for SLOCA underwent comprehensive clinical evaluation and laboratory investigations, brain MRI, DaTscan and a 1-year follow-up. RESULTS: Among 80 patients, 26 had MSA-C, 22 another diagnosis, and 32 no diagnosis at the end of the follow-up. At baseline, MCP hyperintensity and HCB were more frequent in patients finally diagnosed with MSA-C than in other patients with SLOCA (p < 0.0001), and had the highest specificity (98.5%) and positive predictive value (91.7%) for the diagnosis of MSA-C, compared to all other MRI signs. The most relevant MRI sequence regarding HCB sign was the T2-proton density (DP) weighted. All MRI features were more frequent with disease duration. No correlation was found between any MRI feature and neither clinical data, nor dopaminergic neuronal loss (p = 0.5008), except between vermis atrophy and UPDRSIII score. CONCLUSION: MCP hyperintensity and HCB sign should be added into the list of additional features of possible MSA-C. MRI signal abnormalities suggestive of MSA-C should be searched for in suitable sequence.


Assuntos
Ataxia Cerebelar/diagnóstico , Atrofia de Múltiplos Sistemas/diagnóstico , Atrofia de Múltiplos Sistemas/patologia , Adulto , Idoso , Ataxia Cerebelar/diagnóstico por imagem , Ataxia Cerebelar/patologia , Feminino , Seguimentos , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Pedúnculo Cerebelar Médio/diagnóstico por imagem , Pedúnculo Cerebelar Médio/patologia , Atrofia de Múltiplos Sistemas/diagnóstico por imagem , Ponte/diagnóstico por imagem , Ponte/patologia , Estudos Prospectivos , Tomografia Computadorizada de Emissão de Fóton Único
19.
Med Sci Monit ; 26: e919565, 2020 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-31904008

RESUMO

BACKGROUND Controversies exist in imaging modalities for predicting adenoma consistency. In this study, we proposed a method of predicting consistency by magnetic resonance T2-sequence imaging based on adenoma to cerebellar peduncle signal (TCTI) ratio. MATERIAL AND METHODS Between January 2013 and May 2017, 191 consecutive patients with pituitary adenoma diagnosed at our institution were retrospectively studied. The consistency grade for each lesion was assigned. And the TCTI ratio based on preoperative and postoperative T2-weighted imaging was calculated. RESULTS The median TCTI ratio was 1.55, 1.28, and 1.25 for soft, fibrous, and hard adenomas, respectively. The differences were significant for all groups (p<0.001). A cutoff value of 1.38 for soft adenomas was found to be 80.2% sensitive and 88.7% specific. The median ratio of the outermost layer of residual tumor was 1.25 (SD±0.408, 95% CI 1.27-1.42). It was less than that ratio of the upper, lower quarter, and middle region of adenoma, respectively, and the inter-group differences were all statistically significant with p≤0.001. The extent of resection for the soft group was significantly greater than that of the hard group (85.3% vs. 70.6%, p=0.011). Analysis of Variance (ANOVA) revealed that the consistency grade was the influencing factor of degree of resection. p=0.003. CONCLUSIONS The TCTI ratio showed a good correlation with pituitary adenoma consistency. We also determined the optimal ratio of the residual adenoma.


Assuntos
Imageamento por Ressonância Magnética/métodos , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/patologia , Adenoma/diagnóstico por imagem , Adenoma/patologia , Adulto , Idoso , Neoplasias Cerebelares/diagnóstico por imagem , Neoplasias Cerebelares/patologia , Cerebelo/diagnóstico por imagem , Cerebelo/patologia , China , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pedúnculo Cerebelar Médio/diagnóstico por imagem , Pedúnculo Cerebelar Médio/metabolismo , Neoplasias Hipofisárias/metabolismo , Período Pós-Operatório , Período Pré-Operatório , Prognóstico , Estudos Retrospectivos , Sensibilidade e Especificidade , Substância Branca/diagnóstico por imagem , Substância Branca/patologia
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