Quantitative MRI study of progressive cerebral atrophy in multiple system atrophy]

We investigated cerebral atrophy in multiple system atrophy (MSA) by quantitative analysis of MRI. The subjects were 28 patients with MSA (14 striato-nigral degeneration; SND, 14 olivo-ponto-cerebellar atrophy; OPCA. 106 MRI examinations were performed totally) and 85 normal persons for control. The ratios of the ventral pons to the infratentorial space in the sagittal section, the putamen, cerebrum, frontal lobe and parietal & occipital lobes to the intracranial space in the horizontal section, and the temporal lobe to the intracranial space in the coronal section were measured. In the early stage of the disease, OPCA showed significant atrophy of the ventral pons compared with SND, and conversely, SND demonstrated significantly smaller putamen than that in OPCA. According to the progression of the disease, the atrophy of these neural tissues progressed, which resulted in no significant differences between SND and OPCA. The cerebral atrophy was observed in 17 MSA patients. The atrophy of the frontal lobe was much frequent and prominent to that in the temporal lobe and parietal & occipital lobes. SND showed higher incidence of the cerebral atrophy than OPCA in the early stage of the disease. In long period follow-up cases, one case showed cerebral atrophy in earlier stage, and another case in late stage. We indicated the involvement of the cerebral hemispheres in MSA, especially the frontal lobe.     

Pontocerebellar hypoplasia type 3 with tetralogy of Fallot

We report a male infant with pontocerebellar hypoplasia type 3 and tetralogy of Fallot. He showed optic nerve atrophy, progressive microcephaly, severe psychomotor developmental delay, and vesicoureteral reflux. Magnetic resonance imaging revealed severe hypoplasia of the cerebellar vermis and hemisphere, and of the brainstem including the pons, and simplified gyral patterns in bilateral frontal lobes. An unknown etiology differing from other cases of PCH type 3 might have caused not only optic nerve atrophy and hypoplasia of the cerebellum and brainstem, but also cerebral and visceral malformations. To the best of our knowledge, this represents the first report of pontocerebellar hypoplasia with congenital cardiac malformation.     

Hypertensive brain stem encephalopathy: clinically silent massive edema of the pons

Hypertensive encephalophathy is a medical emergency whose clinical manifestations are associated with bilateral parieto-occipital lesions. We describe a case of hypertensive brainstem encephalopathy in which high blood pressure was accompanied only by nuchal headaches of violent onset. T2-weighted magnetic resonance images showed hyperintensity and edema of the pons without any parieto-occipital lesions, but with hyperintense lesions at the level of the basal nuclei, insula and temporal lobes. The lesions rapidly regressed once the hypertension had been controlled. Received: 4 April 2001 / Accepted in revised form: 5 July 2001     

Venous infarction associated with carotid-cavernous fistula]

We report an 88-year-old woman who developed a hemorrhagic venous infarction in the left cerebral hemisphere and brainstem, in association with left carotid-cavernous fistula (CCF). Without aura the patient noticed diplopia due to left abducens palsy, and exophthal mos and congestion of the left eye. Brain CT revealed extrusion of the left eye, and dilatation of left superior orbital vein and cerebral cortical veins. She received diagnosis of CCF. Brain CT also revealed a small mass in the left ethmoidal sinus, which was not attached to the CCF. Biopsy of the mass was done under local anesthesia. On the following she had high fever. Her consciousness level deteriorated and she developed right hemiparesis FLAIR images of MRI showed, extensive high signal lesions in the left frontal and temporal cortices, basal ganglia, thalamus, midbrain and pons. These findings were consisted with venous infarction, possibly associated with peri-operative infection and hypovolemia. Intracranial hemorrhage occur in 3% of cases with CCF, but venous infarction was much rarer. The patients with CCF, who show dilatation of cortical veins in CT or MRI, have a higher risk of cerebral hemorrhage or infarction, and should be carefully observed.     

Brain perfusion disturbances in patients with vertigo -- a study with SPECT

BACKGROUND AND PURPOSE: The aim of our study was to evaluate brain perfusion in patients with vertigo using the SPECT technique. METHODS: The study involved a group of 32 patients and was performed in the Neurological Department of the Medical University in Bialystok. Patients with vertigo of peripheral origin like middle ear pathology were excluded from the study. Tomographic pictures were taken with Nucline X-Ring camera after administration of Tc99m-ECD. Perfusion maps were estimated by qualitative and semi-quantitative methods. RESULTS: In 8 patients (25%) perfusion maps were normal in the hemispheres, cerebellum and subcortical structures. In 10 patients (31.2%) there was a substantial decrease in perfusion in the left temporal region, in 8 patients (25%) -- hypoperfusion was seen in the right temporal region. In 4 patients (12.5%) there was a substantial decrease in perfusion in the cerebellum, in two persons -- in the frontal lobes. CONCLUSIONS: The results obtained so far confirm the major role of ischemia in etiology of the central origin vertigo and balance disturbances. It involves not only the brainstem and cerebellar structures, but the temporal lobes as well. The test has also proved that the qualitative and semi-quantitative methods of assessing brain perfusion with a SPECT are satisfactory in diagnostics of vertigo.     

卒中类型、卒中部位与卒中后癫痫的多因素关系

目的探讨卒中类型、卒中部位与卒中后癫痫的多因素关系,为卒中后癫痫的防治提供参考。方法以1804例卒中患者为研究对象,收集其性别、年龄、卒中类型、卒中部位、卒中后癫痫发生的时间等资料,根据卒中后是否发生癫痫,将患者分为卒中后无癫痫组(n=1487)和卒中后癫痫组(n=317),分析卒中后癫痫发作的危险因素。结果共317例卒中后癫痫发作患者,其中早发性癫痫141例(44.48%),迟发性癫痫176例(55.52%)。不同卒中部位及卒中类型的癫痫发病率为17.57%。多因素logistic回归分析显示,卒中部位中的顶叶合并蛛网膜下腔、额叶合并颞叶、额叶合并颞叶和枕叶、单一颞叶是卒中后发生癫痫的危险因素(P<0.01),其中单一颞叶是卒中后早发性癫痫的危险因素(P<0.01)。脑梗死患者常见早发性癫痫(23.66%),脑出血患者常见迟发性癫痫(47.95%)。结论卒中类型中的脑梗死、脑出血、蛛网膜下腔出血与卒中后癫痫有关;卒中部位中顶叶合并蛛网膜下腔、额叶合并颞叶、额叶合并颞叶和枕叶、单一颞叶与卒中后癫痫有关。     

Single-photon emission computed tomography of the brain in autism: effect of the developmental level

Brain single-photon emission computed tomography was performed in 22 autistic and 10 nonautistic disabled patients. The regional cerebral blood flow in both laterotemporal and dorso-medio-lateral frontal areas decreased significantly in the autistic group compared with in nonautistic group. In the autistic group, the regional cerebral blood flow was significantly higher in the right temporal and right parietal lobes than that in the left ones. Inversely, the regional cerebral blood flow in the frontal and occipital lobes was significantly higher on the left side than on the right side. In the nonautistic group, except for in the dorso-medio-lateral frontal lobes (left > right), there was no difference in the regional cerebral blood flow in either cerebrum or cerebellum. A positive correlationship between regional cerebral flow and development quotient (intelligence quotient) was observed in the left laterotemporal and both dorso-medio-lateral frontal areas, and a negative one was observed in the cerebellar vermis area. These results suggest that the regional cerebral blood flow decrease in the temporal and frontal areas relates to not only the brain mechanism of autism reported previously but also intelligence levels.     

Amnesia following herpes simplex encephalitis]

We describe three patients presenting themselves with amnesia following herpes simplex encephalitis. All three patients showed anterograde amnesia. Moreover, one patient showed retrograde amnesia extending about fifty years prior to the onset of the illness. Two patients revealed semantic memory disorder, disinhibitory behaviors and confabulations, which suggested the existence of frontal lobe dysfunction. MRI of all three patients disclosed uni- or bilateral temporal lesions. SPECT images showed decreased uptake not only in the temporal lobes but also in the frontal lobes. Amnesia following herpes simplex encephalitis has been thought to be caused by the temporal lobe disorder. However, we postulate that the frontal lobe dysfunction might contribute to the appearance of amnesia.     

Secondary obsessive-compulsive disorder related to diaschisis after pontine infarction, successfully treated with paroxetine

This report describes a case of secondary obsessive-compulsive disorder related to diaschisis after pontine infarction. A 71-year-old male developed obsessive images, after a pontine infarction. A brain magnetic resonance imaging scan showed a low intensity area in the right pons on T1-weighted image, while brain single photon emission computed tomography showed low cerebral blood flow in the temporal lobe as well as the pons. In this case, infarction in the pons appeared to cause dysfunction in the temporal lobe via the neural projection network, an example of so-called 'diaschisis'. This case suggests that brainstem infarction and decreased temporal lobe perfusion can lead to secondary obsessive-compulsive disorder.     

Diffuse cortical lesions with hemorrhage in cerebral Whipple's disease

A 30-year-old Chinese male with a history of diarrhea and arthralgia presented for evaluation of progressive dementia, epilepsy, and increased intracranial pressure. Imaging of the brain showed progressive cortical and subcortical lesions with hemorrhage involving the bilateral temporal and occipital lobes, the posterior parietal lobes, and the left frontal lobe. "Foamy" periodic acid-Schiff (PAS)-positive macrophages were demonstrated on brain biopsy. The patient showed clinical improvement following treatment with chloromycetin and sulfadiazine for 2 months. This constitutes the first reported case of cerebral Whipple's disease with diffuse cortical lesions with hemorrhage reported in a Chinese individual. Further, this case points out the significance of early recognition and treatment of cerebral Whipple's disease, especially in those cases with unusual manifestations.     

Progressive cerebral atrophy in multiple system atrophy

Nine patients with multiple system atrophy (MSA) were studied based on MRI findings of cerebral hemispheric involvement. The age at onset was 56.4+/-8.6 (mean+/-S.D.) years, duration of illness at the first MRI study 2.1+/-1.1 years, duration of illness at the last study 9.7+/-2.6 years, and the follow-up duration 7.6+/-2.3 years. Controls were 85 neurologically intact persons (60.2+/-11.1 years age). In the MRI study, measurements of the ratio of each area to the intracranial area were performed for the cerebral hemisphere, frontal, temporal and parietal-occipital lobes. A significant progression of atrophy to under the normal limit was observed in the cerebrum, frontal and temporal lobes. Besides the typical pathological lesions in MSA, five autopsied patients revealed frontal lobe atrophy with mild gliosis, mild demyelination and glial cytoplasmic inclusions (GCIs). One of these patients showed remarkable frontal lobe atrophy with degenerative changes in the cerebral cortex. We observed the involvement of the cerebral hemisphere, especially the frontal lobe.     

Outcome of intracerebral hemorrhage: clinical and CT findings in 326 patients

Clinical symptoms and findings in cranial computed tomography (CT) were evaluated in 326 patients with intracerebral hemorrhage (ICH). Localizations of ICH were the lobes (n = 254), the basal ganglia (n = 46), the pons and brain stem (n = 13) and the cerebellum (n = 8). Multiple hematomas were present in nine patients. An initial coma (n = 225) was most frequent in ICH of the pons (n = 7), cerebellum (n = 6), and the frontal (n = 71) and temporal (n = 66) lobes. Epileptic seizures (n = 70) were most common in hematomas of the frontal (n = 24), temporal (n = 19) and parietal (n = 12) lobes and the basal ganglia (n = 6). A history of hypertension was given in 140 patients; 119 of these had an ICH with a size of ≥3 cm. Mortality (n = 162) was high with ICH in the pons and brain stem (10 out of 13), in the frontal (54 out of 98) and parietal (32 out of 58) lobes and the basal ganglia (n = 23). A size of the ICH of 3 cm or more in cranial CT and an associated ventricular hemorrhage were associated with a bad outcome. An initial disturbance of consciousness was the only reliable clinical predictor of outcome (chi-square, p < 0.001). Katamnestic evaluation of 66 of the 164 survivors after 5.2 years revealed seizures in 20 patients and mild neurological deficits in 41. Another 14 patients were partially, and nine totally dependent Nineteen patients had died in between; there was only one death attributable to another ICH.     

Slowly progressive dysarthria and impaired language function--a case report]

A 68-year-old right-handed woman was admitted to Tokyo Metropolitan Geriatric Hospital because of slowly progressive dysarthria and writing disability over 2-year period. On admission, severe dysarthria was observed, but no dysphagia. The dysarthria mostly resembled a type of pseudobulbar palsy, although it was associated with effortful speech production. An oro-facial apraxia was also found. She could name objects, and could understand spoken words correctly. Examination using the Western Aphasia Battery showed diminution of word fluency, impaired repetition and perseveration and writing errors. On the Wechsler Adult Intelligence Scale-R verbal IQ was 100 and performance IQ was 87. These scores did not suggest any significant degree of general intellectual deterioration. Wisconsin card sorting test disclosed mild frontal dysfunction. Magnetic resonance imaging showed cortical atrophy in the bilateral frontal and temporal lobes. Measurements of regional cerebral metabolic rate by 18F-FDG-PET demonstrated decreased uptake in the latero-dorso-inferior area of the bilateral frontal lobes, especially on the left side. The present case showed slowly progressive dysarthria and progressive aphasia without generalized dementia, and without typical aphasia. These symptoms are speculated to be related to the atrophy in the bilateral frontal and temporal lobes shown by MRI and the decreased metabolic rate in the left dominant bilateral frontal lobes on PET study. The pathologic process responsible for these lesions remains obscure.     

Surgical experience with cerebral amyloid angiopathy

Cerebral amyloid angiopathy can present as lobar intracerebral hemorrhage in an elderly person, presumably due to increased fragility of the vessels affected by amyloid deposition. For this reason, patients presenting with intracerebral hemorrhage and suspected of having cerebral amyloid angiopathy have often been treated nonsurgically. Since 1983 we have evaluated 11 patients with cerebral amyloid angiopathy (nine women and two men, mean age 73 years) who have undergone either intracerebral hematoma evacuation or brain biopsy. Nine of the 11 patients presented with intracerebral hemorrhage, which was unilobar in three patients and multilobar in six and involved the parietal lobes seven times, the frontal lobes four times, the temporal lobes four times, and the occipital lobes twice. These nine patients underwent hematoma removal, with no cases of abnormal intraoperative bleeding or recurrent hemorrhage. Six patients improved neurologically, and two were unchanged after hematoma evacuation; the remaining patient had a fatal cardiopulmonary arrest during the immediate postoperative period. During follow-up in seven patients (median 11 months, range 1 week to 74 months) none experienced a recurrent intracerebral hemorrhage and four continued to improve. Two of the 11 patients had cerebral amyloid angiopathy diagnosed by brain biopsy as part of an evaluation for dementia, also without surgical complications. This series suggests that patients with cerebral amyloid angiopathy may safely undergo operative procedures, and patients presenting with intracerebral hemorrhage may show neurologic improvement following evacuation of the hematoma.     

CT灌注成像对烟雾病行脑血管重建术的疗效评价

目的 探讨CT灌注成像技术(CTP)在出血型烟雾病中的应用价值和评价颞浅-大脑中动脉搭桥术(STA-MCA)手术疗效.方法 20例出血型烟雾病患者在实施STA-MCA手术前、术后1周和术后3个月分别行CTP检查.对患者手术前腩血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT)进行定量和定性分析,并对手术前后及随访的CBF、CBV、MTT进行对比分析.结果 10例患者术前手术侧与对侧比较,额、颞叶CBF降低,CBV增加,MTT延长;术后1周复查,术侧额、颞叶与术前比较发现,rMTT降低,rCBV不变,rCBF增加;术后3个月复查,与术后1周比较,额、颞叶rMTT、rCBV降低;差异有统计学意义(P<0.05).结论 CTP能检测脑缺血的部位,有助于出血型烟雾病术前治疗方法的选择和术后疗效观察;出血型烟雾病仍存在脑灌注严重不足,以额、颞叶明显,STA-MCA搭桥术能增加额、颞叶脑血供,预防缺血或出血性卒中发生.     

CT灌注成像对烟雾病行脑血管重建术的疗效评价

目的 探讨CT灌注成像技术(CTP)在出血型烟雾病中的应用价值和评价颞浅-大脑中动脉搭桥术(STA-MCA)手术疗效.方法 20例出血型烟雾病患者在实施STA-MCA手术前、术后1周和术后3个月分别行CTP检查.对患者手术前腩血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT)进行定量和定性分析,并对手术前后及随访的CBF、CBV、MTT进行对比分析.结果 10例患者术前手术侧与对侧比较,额、颞叶CBF降低,CBV增加,MTT延长;术后1周复查,术侧额、颞叶与术前比较发现,rMTT降低,rCBV不变,rCBF增加;术后3个月复查,与术后1周比较,额、颞叶rMTT、rCBV降低;差异有统计学意义(P<0.05).结论 CTP能检测脑缺血的部位,有助于出血型烟雾病术前治疗方法的选择和术后疗效观察;出血型烟雾病仍存在脑灌注严重不足,以额、颞叶明显,STA-MCA搭桥术能增加额、颞叶脑血供,预防缺血或出血性卒中发生.     

CT灌注成像对烟雾病行脑血管重建术的疗效评价

目的 探讨CT灌注成像技术(CTP)在出血型烟雾病中的应用价值和评价颞浅-大脑中动脉搭桥术(STA-MCA)手术疗效.方法 20例出血型烟雾病患者在实施STA-MCA手术前、术后1周和术后3个月分别行CTP检查.对患者手术前腩血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT)进行定量和定性分析,并对手术前后及随访的CBF、CBV、MTT进行对比分析.结果 10例患者术前手术侧与对侧比较,额、颞叶CBF降低,CBV增加,MTT延长;术后1周复查,术侧额、颞叶与术前比较发现,rMTT降低,rCBV不变,rCBF增加;术后3个月复查,与术后1周比较,额、颞叶rMTT、rCBV降低;差异有统计学意义(P<0.05).结论 CTP能检测脑缺血的部位,有助于出血型烟雾病术前治疗方法的选择和术后疗效观察;出血型烟雾病仍存在脑灌注严重不足,以额、颞叶明显,STA-MCA搭桥术能增加额、颞叶脑血供,预防缺血或出血性卒中发生.     

CT灌注成像对烟雾病行脑血管重建术的疗效评价

目的 探讨CT灌注成像技术(CTP)在出血型烟雾病中的应用价值和评价颞浅-大脑中动脉搭桥术(STA-MCA)手术疗效.方法 20例出血型烟雾病患者在实施STA-MCA手术前、术后1周和术后3个月分别行CTP检查.对患者手术前腩血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT)进行定量和定性分析,并对手术前后及随访的CBF、CBV、MTT进行对比分析.结果 10例患者术前手术侧与对侧比较,额、颞叶CBF降低,CBV增加,MTT延长;术后1周复查,术侧额、颞叶与术前比较发现,rMTT降低,rCBV不变,rCBF增加;术后3个月复查,与术后1周比较,额、颞叶rMTT、rCBV降低;差异有统计学意义(P<0.05).结论 CTP能检测脑缺血的部位,有助于出血型烟雾病术前治疗方法的选择和术后疗效观察;出血型烟雾病仍存在脑灌注严重不足,以额、颞叶明显,STA-MCA搭桥术能增加额、颞叶脑血供,预防缺血或出血性卒中发生.     

CT灌注成像对烟雾病行脑血管重建术的疗效评价

目的 探讨CT灌注成像技术(CTP)在出血型烟雾病中的应用价值和评价颞浅-大脑中动脉搭桥术(STA-MCA)手术疗效.方法 20例出血型烟雾病患者在实施STA-MCA手术前、术后1周和术后3个月分别行CTP检查.对患者手术前腩血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT)进行定量和定性分析,并对手术前后及随访的CBF、CBV、MTT进行对比分析.结果 10例患者术前手术侧与对侧比较,额、颞叶CBF降低,CBV增加,MTT延长;术后1周复查,术侧额、颞叶与术前比较发现,rMTT降低,rCBV不变,rCBF增加;术后3个月复查,与术后1周比较,额、颞叶rMTT、rCBV降低;差异有统计学意义(P<0.05).结论 CTP能检测脑缺血的部位,有助于出血型烟雾病术前治疗方法的选择和术后疗效观察;出血型烟雾病仍存在脑灌注严重不足,以额、颞叶明显,STA-MCA搭桥术能增加额、颞叶脑血供,预防缺血或出血性卒中发生.     

CT灌注成像对烟雾病行脑血管重建术的疗效评价

目的 探讨CT灌注成像技术(CTP)在出血型烟雾病中的应用价值和评价颞浅-大脑中动脉搭桥术(STA-MCA)手术疗效.方法 20例出血型烟雾病患者在实施STA-MCA手术前、术后1周和术后3个月分别行CTP检查.对患者手术前腩血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT)进行定量和定性分析,并对手术前后及随访的CBF、CBV、MTT进行对比分析.结果 10例患者术前手术侧与对侧比较,额、颞叶CBF降低,CBV增加,MTT延长;术后1周复查,术侧额、颞叶与术前比较发现,rMTT降低,rCBV不变,rCBF增加;术后3个月复查,与术后1周比较,额、颞叶rMTT、rCBV降低;差异有统计学意义(P<0.05).结论 CTP能检测脑缺血的部位,有助于出血型烟雾病术前治疗方法的选择和术后疗效观察;出血型烟雾病仍存在脑灌注严重不足,以额、颞叶明显,STA-MCA搭桥术能增加额、颞叶脑血供,预防缺血或出血性卒中发生.