Brain Magnetic Resonance Imaging in Elderly Depressed Patients Receiving Electroconvulsive Therapy

The authors review their experience with brain magnetic resonance (MR) imaging in elderly patients with depression referred for electroconvulsive therapy (ECT). A variety of brain changes were identified on the pre-ECT MR scans of these patients, including cortical atrophy, subcortical encephalomalacia, lateral ventricular enlargement, and lesions of the pons. The authors examine the effects of these preexisting brain changes on the therapeutic outcome and side effects from ECT. Pilot data suggest that these brain findings do not change during a course of ECT. The potential relationship of these brain changes to the development of affective disorder in the elderly is discussed and areas for future research are suggested.     

Electroconvulsive Therapy in Multiple Sclerosis: A Magnetic Resonance Imaging Study of the Brain

A depressed woman with multiple sclerosis was successfully treated with electroconvulsive therapy without any adverse effects to her neurologic status. Magnetic resonance imaging of the brain was performed before and after the course of therapy and revealed no change in the white matter lesions visualized on spin-echo images.     

Electroconvulsive Therapy in a Depressed Heart Transplant Patient

Medication-resistant major depression was diagnosed in a 67-year-old man 1 1/2 years after heart transplantation. Electroconvulsive therapy was administered, resulting in remarkable improvement in depressive symptoms without complications related to the cardiac condition.     

Electroconvulsive Therapy in a Depressed Patient with a Functioning Ventriculoatrial Shunt

We report a depressed man, with a ventriculoatrial shunt for normal pressure hydrocephalus, who was successfully treated with electroconvulsive therapy (ECT). The management of patients who have brain shunts and who are referred for ECT is discussed.     

Multiple Giant Intracranial Aneurysms Associated with Lymphomatoid Granulomatosis: A Magnetic Resonance Imaging and Angiographic Study

Lymphomatoid granulomatosis is an uncommon lymphoproliferative disorder that frequently has central nervous system manifestations. Lymphomatoid granulomatosis has clinical features similar to both vasculitis and lymphoma. The pathological hallmarks of this disease include necrotic angiecentric and angiodestructive infiltrations of premalignant or malignant lymphoid cells. There are, to the authors' knowledge, only a few magnetic resonance imaging reports and no magnetic resonance angiographic reports of this disorder. Presented here is a case of lymphomatoid granulomatosis producing multiple giant fusiform and saccular aneurysms throughout the major intracerebral arteries, along with patterns of vascular beading typically seen with vasculitis demonstrated by magnetic resonance angiography.     

蛛网膜囊肿伴癫痫的外科治疗

目的 探讨颅内网膜囊肿（arachnoid cyst,AC)与癫痫的关系以及外科治疗方法。方法 手术治疗23例颅内大脑凸面蛛网膜囊肿（AC）伴癫痫病人,采用AC和致痫灶切除21例,AC－腹腔分流术1例,胼胝体切开术1例。结果 23例病人中,完全不发作有5例,显改善有11例,无变化7例。结论 颅内AC可引起癫痫,采用AC和致痫灶切除效果较为理想。     

Proton Magnetic Resonance Spectroscopy and Magnetic Resonance Imaging Findings in a Patient with Central Nervous System Paracoccidioidomycosis

The authors describe a patient with brain paracoccidioidomycosis whose magnetic resonance image (MRI) showed multiple hypointense lesions on T2-weighted images with peripheral enhancement after gadolinium injection. Single-voxel proton magnetic resonance spectroscopy (1H-MRS) of one of the lesions showed 2 peaks at 0.9 and 1.32 ppm, corresponding to lipid signals, indicating intense necrosis. The other characteristic peaks of 1H-MRS were undifferentiated from baseline. These findings, although not specific, may help to differentiate fungal abscess from tumoral lesions and other types of abscess.     

Extensive Reversible Brain Magnetic Resonance Lesions in a Patient with HELLP Syndrome

A severe form of toxemia of pregnancy with microangiopathic hemolytic anemia, elevated /iver enzymes, and /ow platelets has been called the HELLP syndrome. A patient with the HELLP syndrome developed a severe, reversible encephalopathy. Brain computed tomography and magnetic resonance imaging showed abnormalities consistent with edema limited to the posterior circulation territory. The location of the lesions and their occurrence in the HELLP syndrome support suggestions that the vulnerability of posterior structures in eclamptic encephalopathy is due to a vascular susceptibility of the posterior circulation and that endothelial cell dysfunction plays an important role in the pathogenesis of eclamptic encephalopathy.     

颅内动脉粥样硬化斑块高分辨率磁共振成像研究进展

颅内动脉粥样硬化斑块被认为是中国人群中导致缺血性卒中的主要因素之一,随着影像 学的技术进展,高分辨率磁共振成像为无创性评价颅内动脉粥样硬化斑块的成分构成和特点、与 动脉狭窄的关系等方面提供了更精准的成像技术,其研究逐渐成为热点。动脉粥样硬化斑块在磁 共振成像中3维时间飞跃序列（3D time of flight,3D-TOF）及T1序列（T1-wei ghted i magi ng,T1WI ）、T2序 列（T2-weighted imaging,T2WI）、质子序列（proton density weighted imaging,PDWI）、磁化准备快速梯 度回波序列（magnetization prepared rapid gradient echo,MP-RAGE）、强化序列（T1 contrast enhanced weighted imaging,T1+C）上有不同的信号特点,这些序列也是研究颅内动脉粥样硬化斑块影像学特点 及其与临床预后关系的主要方向。     

Novel Neuroimaging Findings in a Patient with Cerebral Whipple''s Disease: A Magnetic Resonance Imaging and Positron Emission Tomography Study

The authors report a 43-year-old patient with histopathologically proven cerebral Whipple's disease. Magnetic resonance imaging (MRI) revealed a multilayered left frontal lesion without mass effect, no perifocal brain edema, no contrast enhancement, and a thin shell of fluid signal that presented as an incomplete, open ring. An [11C]methionine positron emission tomography (PET) study showed low uptake below the threshold that is characteristic for brain tumors. In precise co-registration to the MR images, the PET data showed that increased uptake was mainly located in the direct adjacent part of the MRI lesion. The fluid signal on MRI corresponded to the extensive outflow of fluid from the lesion, which was observed during neurosurgical resection, and also to the neuropathological findings. The authors conclude that this cerebral manifestation of Whipple's disease made a unique and hitherto undescribed appearance on MRI; uptake pattern of PET amino acid tracer may help in the preoperative distinction of inflammatory from neoplastic lesions.     

Magnetic Resonance Imaging in a Patient with Wernicke's Encephalopathy Due to Hyperemesis Gravidarum

Magnetic resonance imaging (MRI) demonstrated acute bilateral hyperintense lesions involving the thalami, hypothalami, quadrigeminal plate, and periaqueductal white matter in a patient with Wernicke's encephalopathy due to hyperemesis gravidarum. This prompted diagnosis despite an initially oligosymptomatic clinical presentation. The reversibility of these changes following treatment was docu.mented.     

Clinical and Magnetic Resonance Imaging Regression of Progressive Multifocal Leukoencephalopathy in an AIDS Patient After Intensive Antiretroviral Therapy

A 36-year-old homosexual man with 6 months of visual symptoms and headaches had right homonymous hemianopia, mild new learning impairment, and alexia with agraphia. The initial brain magnetic resonance imaging (MRI) scan was reported consistent with left occipital infarction. Subsequent MRI demonstrated abnormal demyelination in subcortical white matter and deep parieto-occipital white matter bilaterally, but primarily left. Human immunodeficiency virus testing and cerebrospinal fluid polymerase chain reaction for JC virus DNA were both positive, consistent with progressive multifocal leukoencephalopathy (PML) with AIDS. His clinical status steadily deteriorated, and MRI white matter abnormalities worsened despite high-dose antiretroviral therapy. After the antiretroviral regimen was intensified by the addition of a protease inhibitor, rapid clinical and radiographic improvement occurred with subsequent MRI studies revealing only residual left parieto-occipital encephalomalacia. PML in AIDS patients has been associated with a nearly uniformly poor prognosis until recent reports of improved outcomes after highly active antiretroviral therapy. This patient with PML and AIDS similarly showed a robust clinical and MRI response to intensive antiretroviral combination therapy, which has been maintained for more than 3 years.     

Electroconvulsive Therapy with Fetal Monitoring in a Bipolar Pregnant Patient

The management of depression in a pregnant patient is a therapeutic challenge because of the potential teratogenicity of psychotropic medications. The present case report details the safe and effective use of electroconvulsive therapy in a pregnant patient with bipolar affective disorder. Values for maternal blood gases, fetal heart rate monitoring with Doppler ultrasound, and the use of real-time ultrasonography indicate that the treatment has no adverse effect on the fetus. This is believed to be the second case report in the literature in which continuous fetal monitoring and maternal blood gases have been used during electroconvulsive therapy.     

Effects of Electroconvulsive Therapy on Brain Glucose Metabolism: A Preliminary Study

We measured (15)O water uptake and [(18)F]fluorodeoxyglucose (FDG) uptake in four depressed individuals before electroconvulsive therapy (ECT) and 24 h after completion of a series of six to 11 bilateral ECT treatments. Studies of radioactive uptake were done using positron emission tomography, with FDG as a measure for glucose metabolism and with oxygen-15-labeled water as a measure for cerebral blood flow. The four patients showed decreased uptake of FDG in the frontal cortex after ECT treatment. Two of the three patients in whom (15)O water was measured showed decreased uptake in the frontal cortex after ECT.