The corpus callosum in communicating and noncommunicating hydrocephalus

To investigate morphological changes in the corpus callosum in hydrocephalus and to correlate them with clinical findings we studied sagittal T2^*-weighted cine MR images of 163 patients with hydrocephalus. The height, length and cross-sectional area of the corpus callosum were measured and related to the type of cerebrospinal fluid flow anomaly and to clinical features, especially dementia. With expansion of the lateral ventricles the corpus callosum showed mainly elevation of its body and, to a lesser degree, increase in length. Upward bowing was more pronounced in noncommunicating than in communicating hydrocephalus. Dorsal impingement on the corpus callosum by the free edge of the falx correlated with the height of the corpus callosum. Cross-sectional area did not correlate with either height, length or impingement; it was, however, the strongest anatomical discriminator between demented and nondemented patients. The area of the corpus callosum was significantly smaller in patients with white matter disease. Our findings suggest that, due to its plasticity, the corpus callosum can to some degree resist distortion in hydrocephalus. Dementia, although statistically related to atrophy of the corpus callosum, is possibly more directly related to white matter disease.Dedicated to Prof. M. Nadjmi on the occasion of his sixty-fifth birthday     

高血压脑病发病机制及相关MRI表现

高血压脑病（hypertensive encephalopathy ,HE）是内科较为常见的急症,常发生在重症高血压患者,其发病机制目前较为公认的主要有血管痉挛学说和脑血管自动调节功能崩溃学说。M RI在高血压脑病诊断、鉴别诊断、疗效观察及预后评定中有重要帮助,以下主要通过 M RI不同成像技术方法,包括常规平扫、弥散加权成像、磁共振血管成像（MRA）、磁共振波谱成像（MRS）、磁共振增强扫描、磁共振灌注成像（PWI）及磁敏感成像（SWI）,综合起来阐述该病各有何种表现,就其相关临床发病机制予以综述。     

Brain stem hypertensive encephalopathy evaluated by line scan diffusion-weighted imaging

Hypertensive encephalopathy rarely presents with predominant involvement of the brain stem and relative sparing of the supratentorial regions. We describe the MR imaging features in a patient with reversible brain stem hypertensive encephalopathy. Extensive hyperintensity was predominantly seen in brain stem regions on fluid-attenuated inversion-recovery and T2-weighted images. These lesions showed an increased apparent diffusion coefficient with the use of line scan diffusion-weighted imaging. The clinical findings and MR imaging abnormalities resolved with control of hypertension.     

Brainstem tegmental lesions in neonates with hypoxic-ischemic encephalopathy: Magnetic resonance diagnosis and clinical outcome

Lesions of the brainstem have been reported in the clinical scenarios of hypoxic-ischemic encephalopathy (HIE), although the prevalence of these lesions is probably underestimated. Neuropathologic studies have demonstrated brainstem involvement in severely asphyxiated infants as an indicator of poor outcome. Among survivors to HIE, the most frequent clinical complaints that may be predicted by brainstem lesions include feeding problems, speech, language and communication problems and visual impairments. Clinical series, including vascular and metabolic etiologies, have found selective involvement of the brainstem with the demonstration of symmetric bilateral columnar lesions of the tegmentum. The role of brainstem lesions in HIE is currently a matter of debate, especially when tegmental lesions are present in the absence of supra-tentorial lesions. Differential diagnosis of tegmental lesions in neonates and infants include congenital metabolic syndromes and drug-related processes. Brainstem injury with the presence of supratentorial lesions is a predictor of poor outcome and high rates of mortality and morbidity. Further investigation will be conducted to identify specific sites of the brainstem that are vulnerable to hypoxic-ischemic and toxic-metabolic insults.     

多奈哌齐治疗放射性脑病认知功能障碍的疗效研究

目的 评估多奈哌齐治疗放射性脑病导致的认知功能障碍的疗效及安全性。方法 回顾性研究既往55例确诊为放射性脑病出现认知功能障碍的患者,按是否服用多奈哌齐治疗分为治疗组（多奈哌齐+神经营养药物）和对照组（神经营养药物）。治疗组除了正常治疗额外口服多奈哌齐5~10 mg/d,疗程16周。采用蒙特利尔认知功能检查量表（MoCA）和简易精神状态量表（MMSE）于治疗前和治疗16周时进行认知功能的评定。结果 治疗组在治疗后其认知功能在MoCA和MMSE量表评分上分别提高（3.2±2.7）和（3.5±3.2）分,与对照组对比,差异有统计学意义（t=5.40、3.88,P<0.01）,而且在视空间与执行功能、命名、注意力、抽象思维、延迟回忆均有改善提高,差异有统计学意义（t=-3.55、-3.08、-3.21、-2.58、-3.65,P<0.05）,对照组则对应项目的评分基本不变。结论 多奈哌齐联合常规神经营养药物治疗放射性脑病引起认知功能的损害有较好的疗效,并能有效地改善、维持患者的生活质量,在治疗过程中未发现与药物相关的明显不良反应。     

Pulse-wave encephalopathy: a comparative study of the hydrodynamics of leukoaraiosis and normal-pressure hydrocephalus

There is a strong association between the occurrence of leukoaraiosis and normal-pressure hydrocephalus (NPH). Venous compression secondary to alterations in craniospinal compliance is implicated in the pathogenesis of NPH, and venous pathology has also been implicated in leukoaraiosis. The purpose of this paper is to compare and contrast the blood-flow and fluid-pulsatility characteristics of these conditions. I initially studied 18 subjects without pathology, with MRI flow-quantification studies of the cerebral arteries and veins, to define the range of normality. The main study involved 10 patients with idiopathic dementia but no leukoaraiosis who served as controls, 50 with idiopathic dementia with varying degrees of leukoaraiosis and 18 with NPH. I compared blood-flow volumes, vascular pulse-wave amplitudes and velocities. There was no significant difference in blood flow across the dementia patients. In patients with moderate leukoaraiosis, arterial pulsatility was 69%, cerebrospinal fluid (CSF) pulsation 104%, sagittal sinus pulsatility 48% and cortical vein pulsatility 34% higher than in demented patients without leukoaraiosis. Patients with NPH showed similar results with arterial pulsatility increased by 56% and sagittal sinus pulsatility by 70%. By contrast, the NPH patients' CSF pulse was 42% and the pulse wave delay at the sagittal sinus 50% less than in moderate leukoaraiosis. Thus, leukoaraiosis and NPH share increased arterial and sinus pulsatility. In leukoaraiosis cortical vein compliance is initially increased but in severe leukoaraiosis and NPH it is reduced.     

高压氧综合治离颅脑损伤性脑积水10例

脑积水是颅脑外伤的常见并发症,传统治疗方法多采用药物或手术引流,治疗效果大多不佳.     

Serial investigation of perfusion disturbances and vasogenic oedema in hypertensive encephalopathy by diffusion and perfusion weighted imaging

Serial MRI including diffusion and perfusion imaging was performed in a patient with hypertensive encephalopathy. At admission, the patient was disorientated and presented with seizures and cortical blindness. Perfusion imaging showed a marked reduction in blood volume and flow, with corresponding vasogenic oedema in the occipital, posterior temporal, and, to a lesser extent, frontal lobes. The clinical symptoms disappeared rapidly following treatment, whereas the disturbed circulation pattern and vasogenic oedema resolved more slowly. A complete normalisation was seen after 1 year.     

放射性脑病认知功能障碍的康复性治疗研究

目的 评估认知康复治疗对放射性脑病导致的认知功能障碍的治疗作用及存在问题。方法 回顾性研究既往63 例确诊为放射性脑病出现认知功能障碍的患者,按是否接受认知康复治疗分为治疗组（认知康复治疗＋神经营养药物34例）和对照组（神经营养药物29例）。治疗组除神经营养药物治疗外,每天认知康复治疗2次,每次30 min,共治疗12周。每组于治疗前和治疗后采用蒙特利尔认知功能检查量表（MoCA）和简易精神状态量表（MMSE）进行认知功能的评定。结果 治疗前2组患者MoCA评分、MMSE评分差异均无统计学意义（P>0.05）。治疗12周后,治疗组比对照组患者MoCA总分和MMSE总分增加,差异均有统计学意义（t=5.20、3.18,P<0.01）。而且在视空间、命名、注意、抽象思维、延迟回忆、定向各方面均有提高,差异均有统计学意义（t=-3.51、-3.09、-3.18、-2.57、-3.52、-3.39,P<0.05）。结论 在常规用药基础上辅以认知康复治疗,能进一步提高放射性脑病患者的认知能力。     

Ventricular differences between hydrostatic hydrocephalus and hydrocephalus ex vacuo by computed tomography

Summary Transaxial CT scans of 100 patients with hydrostatic hydrocephalus and 50 patients with hydrocephalus ex vacuo have been reviewed with respect to measurements of: frontal horn ratio, width of the temporal horns, width of the third ventricle, width of cerebral fissures and sulci. The diagnosis of hydrostatic hydrocephalus is probale when (a) both temporal tips are visualized and measure 2 mm or greater in width and the sylvian and interhemispheric fissures and cerebral sulci are not visible, or (b) there is visualization of temporal horn tips measuring 2 mm or greater in width and the lateral ventricles are symmetrically enlarged with the frontal horn ratio 0.50 or more.     

Gadolinium enhancement of the leptomeninges caused by hydrocephalus: a potential mimic of leptomeningeal metastasis.

A patient had severe hydrocephalus and diffuse leptomeningeal enhancement on MR which mimicked leptomeningeal spread of a primary brain tumor. The leptomeningeal enhancement resolved completely after decompression of the hydrocephalus. Data suggest that the leptomeningeal enhancement is caused by vascular stasis induced by the hydrocephalus.     

婴儿维生素B1缺乏性脑病的CT诊断(附25例分析)

目的 :探讨婴儿维生素B1缺乏性脑病的CT表现特点 ,提高临床诊断水平。方法 :回顾性分析 2 5例经临床证实的婴儿维生素B1缺乏性脑病患者的临床和CT资料。结果 :2 5例脑CT扫描均显示为双基底节 (壳核、苍白球、尾状核 )对称性低密度影 ,呈圆形或斑片状 ,可伴有脑白质低密度病变、脑萎缩、脑软化。结论 :CT对婴儿维生素B1缺乏性脑病的诊断具有重要价值。     

Clinical manifestations of hydrocephalus caused by impingement of the corpus callosum on the falx: an MR study in 40 patients

The clinical features of patients with hydrocephalus include generalized reductions in coordinated motor and cognitive functions. Although some group similarities have been noted, the outward manifestations of this dysfunction vary in degree and character, with some subjects revealing no overt signs of the underlying hydrocephalus. A retrospective review of subjects with MR criteria of hydrocephalus was undertaken to reevaluate the specific imaging correlates of the signs and symptoms associated with this pathologic process. Forty adults with hydrocephalus on MR evaluation were carefully scrutinized in an effort to elucidate specific clinicoradiologic patterns of abnormality. Spin-echo MR techniques were used with T1 and/or T2 weighting in three orthogonal planes. MR criteria of hydrocephalus encompassed dilated lateral ventricles to include the temporal horns, a pronounced upward elevation of the corpus callosum, and an outward expansion of the cerebral hemispheres at the expense of the subarachnoid space overlying the convexities. The significant related morphologic change on MR that has not been previously described in hydrocephalus was a localized dorsal flattening and thinning of the posterior body of the corpus callosum. Importantly, all but three of the 24 patients with this phenomenon manifested varying combinations of imbalance, gait disturbance, incontinence, short-term memory deficits, and global dementia. In the presence of hydrocephalus, but in the absence of this specific callosal configuration, only one of the remaining 16 subjects revealed symptoms that might suggest the presence of hydrocephalus (i.e., profound dementia). The structure responsible for this focal callosal flattening and thinning in hydrocephalus is the rigid free surface of the falx cerebri as it impinges on the caudal extent of the upwardly expanding corpus callosum and supracallosal hippocampal formation. This mechanical insult hypothetically causes variable axonal dysfunction, ranging from decreased to increased neurophysiologic activity. In summary, it is postulated that callosal impingement represents a dynamic partial hemispheric disconnection and accounts, in part, for the complex clinical state associated with hydrocephalus.     

Wernicke encephalopathy: follow-up study by CT and MR

A follow-up study by CT and MR of a case of Wernicke encephalopathy is reported. In the early stages, CT and MR revealed a characteristic topographical distribution of lesions in the midbrain, pons, and thalami. In the later stages, MR showed atrophy of the mamillary bodies and midbrain tegmentum and dilatation of the third ventricle. Both CT and MR are useful tools for the diagnosis of Wernicke encephalopathy in the early stages.     

最大长序列和常规方式诱发的听性脑干反应成分的相关性研究

目的研究最大长度序列诱发听性脑干反应(maximum length sequence evoked auditory brainstem response,MLS-ABR)线性成分及非线性成分与常规方式下ABR(conventional ABR,c ABR)之间Ⅴ/5波峰潜伏期的相关性,了解MLS-ABR成分波的主要特性及应用于听力检测的依据。方法记录10名正常听力青年右耳的MLS-ABR及c ABR,然后对MLS-ABR中线性成分、非线性成分以及c ABR三者Ⅴ/5波峰潜伏期进行相关性分析。结果 c ABR与MLS-ABR中线性成分、非线性成分的Ⅴ/5波峰潜伏期相关系数分别为0.87、0.71;MLS-ABR中线性成分及非线性成分5波峰峰值潜伏期的相关系数为0.86。结论MLS-ABR可以获得清晰的线性和非线性成分,非线性成分的幅度明显减小;其中非线性成分的5波与c ABR的Ⅴ波的峰潜伏期相比明显延长但存在显著相关,提示两者之间存在同源关系以及MLS-ABR临床应用价值。