The Gibraltar Sign: An Anatomic Landmark for Predicting Transverse Sinus Dominance Laterality on Conventional MRI

BACKGROUND AND PURPOSE

Physiologic asymmetry of transverse sinus (TS) caliber is common and can lead to misinterpretation of magnetic resonance venography (MRV) studies of the brain. This retrospective study assesses the ability of multiple anatomic features on axial noncontrast T1‐weighted images (T1WIs) of the brain to predict congenital TS dominance.

METHODS

One hundred consecutively acquired combined MRI‐MRV studies of the brain were reviewed. On noncontrast axial T1WI, each reviewer measured (1) inclination of the groove for the superior sagittal sinus (SSS), (2) angulation of the posterior falx, (3) laterality of the SSS flow void, and (4) laterality of the inferior‐most occipital lobe. TS cross‐sectional area was measured on noncontrast sagittal 2‐dimensional time‐of‐flight MRV images and served as the reference standard.

RESULTS

The bony groove for the SSS sloped down to the right in 65 of 100 patients and correctly predicted right TS dominance in 63 of 65 cases (97% positive predictive value [PPV]). The groove sloped down to the left in 24 of 100 patients and correctly predicted left TS dominance in 22 of 24 cases (92% PPV). Laterality of the SSS flow void, laterality of the inferior‐most occipital lobe, and angulation of the posterior falx had 91% PPV, 82% PPV, and 74% PPV for predicting TS dominance, respectively.

CONCLUSIONS

Multiple anatomic features seen on conventional axial T1WI can be used to predict the laterality of congenital TS dominance and can help inform the interpretation of MRV studies of the brain.     

Adult-Onset Complex Partial Seizures as the Presenting Sign in Colpocephaly: MRI and PET Correlates

In a 30-year-old man, adult-onset complex partial seizures were associated with colpocephaly as evident from magnetic resonance images. The structurally normal lateral neocortex of the right temporal lobe showed a severe reduction in regional glucose consumption corresponding to the epileptic focus as judged from the surface electroencephalogram. In contrast to previously reported patients, this patient had no focal neurological signs, and neuropsychological testing revealed normal general intelligence. Thus, this patient adds a benign variant to the clinical spectrum of this cerebral developmental disorder.     

Diagnostic Performances of the Susceptibility Vessel Sign on MRI for the Prediction of Macroscopic Thrombi Features in Acute Ischemic Stroke

Background and PurposeThe “white” compared to “Red-Black” visual aspect of the thrombus at withdrawal with mechanical thrombectomy (MT) for acute ischemic stroke (AIS) was related to atypical etiologies like infective endocarditis. The susceptibility vessel sign (SVS) and the two-layered SVS (TL-SVS) could help predict outcome and cardio-embolic etiology of AIS. We aim to evaluate the diagnostic performance of the SVS and TLSVS to predict the visual aspect of the thrombus.Materials and MethodsWe included patients treated by MT and screened with MRI for the SVS and the TL-SVS for whom thrombus photograph was available. Photographs underwent a double-blind evaluation by neuroradiologists who classified the thrombus as “White” or “Red-Black”. Logistic regression assessed the association of Red-Black thrombus and age, sex, baseline National Institutes of Health Stroke Scale, occlusion site, the IVr-tPA administration, SVS and TL-SVS. We calculated the diagnostic performances of the SVS to predict a Red-Black type thrombus.ResultsBetween May 2017 and July 2018, 139 patients were included in the study. On multivariate analysis, only SVS was an independent predictor for Red-Black thrombus (Odd ratio 8.31, 95%CI2.30 to 32, p value<0.001). Concerning SVS diagnostic performances, the specificity was 0.58 (95%CI0.28 to 0.85), the sensitivity was 0.87 (95%CI0.80 to 0.93), the negative predictive value was 0.30 (95% 0.13 to 0.53), the positive predictive value was 0.96 (95%CI0.90 to 0.99) and accuracy was 0.85 (95%CI0.78 to 0.90).ConclusionThe SVS on MRI provides a good prediction accuracy to anticipate the macroscopic visual aspect of the thrombus after MT for AIS.     

Boomerang sign: Clinical significance of transient lesion in splenium of corpus callosum

Transient signal abnormality in the splenium of corpus callosum on magnetic resonance imaging (MRI) is occasionally encountered in clinical practice. It has been reported in various clinical conditions apart from patients with epilepsy. We describe 4 patients with different etiologies presenting with signal changes in the splenium of corpus callosum. They were diagnosed as having progressive myoclonic epilepsy (case 1), localization-related epilepsy (case 2), hemicrania continua (case 3), and postinfectious parkinsonism (case 4). While three patients had complete involvement of the splenium on diffusion-weighted image (“boomerang sign”), the patient having hemicrania continua showed semilunar involvement (“mini-boomerang”) on T2-weighted and FLAIR image. All the cases had noncontiguous involvement of the splenium. We herein, discuss these cases with transient splenial involvement and stress that such patients do not need aggressive diagnostic and therapeutic interventions. An attempt has been made to review the literature regarding the pathophysiology, etiology, and outcome of such lesions.     

Sign language and autism

Research findings and issues in teaching sign language to nonspeaking autistic children are reviewed. Data on over 100 children indicate that nearly all autistic children learn receptive and expressive signs, and many learn to combine signs. These children also exhibit marked improvement in adaptive behaviors. Speech skills are acquired by fewer children and may be developed through simultaneous speech and sign training. Possible explanations for these results are given, together with suggestions for future research and data collection. Recommended innovations include exposure to fluent signers and training in discourse and code-switching. Different sign language teaching methods need to be investigated more fully, including emphasis on training sign language within the children's total environment and with greater staff and parental participation.     

三种血管闭合器Starclose，Perclose和Boomerang在股动脉穿刺止血中的

背景：随着血管闭合器广泛应用于经股动脉途径介入手术,如何客观评价和合理应用这些闭合器值得关注。 目的：对比观察冠状动脉造影和经皮冠状动脉介入治疗后应用3种股动脉血管穿刺闭合器与人工压迫止血方法的安全性和有效性。 设计、时间及地点：随机分组设计,对比观察,病例来自2006-03/2008-07解放军空军总医院心内科。 对象和材料：选择解放军空军总医院心内科收治的行冠状动脉造影380例和经皮冠状动脉介入治疗538例的患者共918例,男562例,女356例,年龄24~83岁。Starclose血管闭合系统和Perclose缝合装置由美国Abott公司生产,Boomerang血管封堵器由美国Cardiva公司生产。 方法：918例患者按止血方法分为4组。人工压迫止血组(n=271)：采用压迫止血,冠状动脉造影后立即拔除鞘管,局部压迫止血;经皮冠状动脉介入治疗后活化凝血活酶时间降至65 s以下时拔管压迫止血10~20 min。Boomerang封堵器组(n=178)：封堵器送入动脉鞘管,展开止血伞后,调整封堵器方向后用固定夹固定,冠状动脉造影后20 min拔除,经皮冠状动脉介入治疗依肝素量不同决定拔除时间,而后人工加压至出血停止。Perclose缝合器组(n=183)：术后立即送入Perclose操纵杆,打结缝合穿刺点。Starclose闭合器组(n=286)：冠脉造影或介入术后直接利用一个环形可弯曲的小镍钛合金闭合夹从血管外对穿刺口周围进行闭合。 主要观察指标：记录每例的止血操作时间、制动总时间、血管并发症的发生和失败病例数量。 结果：918例患者均进入结果分析。①Starclose闭合器组和Perclose缝合器组在缩短止血操作时间和制动时间方面明显优于Boomerang封堵器组和人工压迫止血组(P < 0.01);其中Boomerang封堵器组亦较人工压迫止血组有明显缩短(P < 0.01)。②采用血管闭合装置与人工压迫法相比,经皮冠状动脉介入治疗后能明显减少并发症的发生(P < 0.05)。③人工压迫止血组行冠状动脉造影患者中有2例渗血,经皮冠状动脉介入治疗有12例止血失败;Boomerang封堵器组行冠状动脉造影患者中1例失败,经皮冠状动脉介入治疗有5例失败;Perclose缝合器组行冠状动脉造影患者中1例失败,经皮冠状动脉介入治疗10例失败;Starclose闭合器组行冠状动脉造影患者中1例渗血,经皮冠状动脉介入治疗5例失败。 结论：3种血管闭合器包括Starclose、Perclose和Boomerang的有效性和安全性明显优于人工压迫止血,且不存在特殊生物相容性问题。Starclose闭合器的优势更为突出。     

Sign comprehension in global aphasia

Ten global aphasics and eight brain-damaged non-aphasics were given a test of sign comprehension. The test contained natural, animal and human signs. Subjects were matched for etiology, age and residual intellectual functioning. The global aphasics scored significantly lower than the nonaphasics on the test of sign comprehension, indicating that global aphasia might be reconsidered as a disorder of sign comprehension.     

Sign language in Landau-Kleffner syndrome

This article reviews the history of sign language (SL) and the rationale for its use in children with profound auditory agnosia due to Landau-Kleffner syndrome (LKS), illustrated by studies of children and adults followed for many years and rare cases from the literature. The reasons that SL was successful and brought some children out of isolation while it could not be implemented in others are discussed. The nowadays earlier recognition and treatment of LKS and better awareness of the crucial need to maintain communication have certainly improved the outcome of affected children. Alternatives to oral language, even for less severe cases, are increasingly accepted. SL can be learned at different ages with a clear benefit, but the ambivalence of the patients and their families with the world and culture of the deaf may sometimes explain its refusal or limited acceptance. There are no data to support the fear that SL learning may delay or prevent oral language recovery in children with LKS. On the contrary, SL may even facilitate this recovery by stimulating functionally connected core language networks and by helping speech therapy and auditory training.     

Lhermitte's Sign: The Current Status

Lhermitte''s sign was described by Marie and Chatelin and named after Jean Lhermitte. This sign is mostly described as an electric shock like condition by some patients of multiple sclerosis. This sensation occurs when the neck is moved in a wrong way or rather flexed. It can also travel down to the spine, arms, and legs, and sometimes the trunk. Demyelination and hyperexcitability are the main pathophysiological reasons depicted for the Lhermitte''s sign. Other causes for Lhermitte''s sign include transverse myelitis, behçet''s disease, trauma, etc. This article reviews the Lhermitte''s sign, its history, and its etiopathophysiology. Very few studies are available on Lermitte''s sign and more research need to be done on the same to ensure its sensitivity and specificity.     

脑出血后血肿扩大预测：碘征还是点征？

<正>首都医科大学附属北京天坛医院神经病学博士刘大成与大家分享于2018年7月25日在线发表在Stroke杂志上的Iodine Sign as a Novel Predictor of Hematoma Expansion and Poor Outcomes in Primary Intracerebral Hemorrhage Patients一文。     

Sign language aphasia in a non-deaf-mute

A 19-year-old left-handed man, who was raised by deaf-mute parents and learned sign language concurrently with normal speech, sustained a traumatic cerebral contusion. He subsequently had no evidence of apraxic, visual-spatial, or sensorimotor deficits of the left limbs with which he was accustomed to use signs. Globally aphasic with a dense right hemiparesis, he initially recovered sign language to a greater degree than spoken language with a reversal on follow-up observations. Receptive skills improved to a greater degree than expressive skills with no marked difference between verbal and sign language, but with natural signs better preserved than finger spelling.     

Thumbs Up Sign in Brain Death

Introduction

Spinal reflexes can be seen in the setting of brain death. We present a new spinal reflex. We also review spinal movements in pediatric brain death and provide suggestions to distinguish them from movements generated by the brain.

Case Report

We report a five-year old girl admitted after an asystolic cardiac arrest and was soon declared brain death as a result of bilateral cerebellar hematoma. She had spinal movements including a ??Thumbs up sign??. These findings delayed organ procurement.

Conclusion

??Thumbs up sign?? should be added to the list of spinal reflexes seen with brain death. Spinal reflexes in brain death can be clinically recognized and should explained to all involved parties to avoid unnecessary testing, confusion for family members, and delay or refusal of organ donation.     

The Impact of Developmental Visuospatial Learning Difficulties on British Sign Language

There has been substantial research interest in recent years in the relationship between the development of language and cognition, especially where dissociations can be seen between them. Williams syndrome, a rare congenital disorder characterized by a fractionation of higher cortical functions, with relatively preserved language but marked difficulties with visuospatial constructive cognition, has been extensively studied. The case of Heather, who is remarkably similar to the characteristic phenotype of Williams syndrome in physical appearance and cognitive abilities, but who is also congenitally deaf and a user of British Sign Language, provides the first opportunity to explore the consequences of specific visuospatial learning difficulties on the linguistic system when the language used is visuospatial. Heather shows a pattern of impaired drawing ability and visual form discrimination, but preserved ability to discriminate faces. She has a large vocabulary in British Sign Language, and overall presents a picture of relative competence in British Sign Language grammar. However, she shows specific deficits in those areas of British Sign Language which directly rely on spatial representations for linguistic purposes. A number of theories as to the nature of her impairments and those found in Williams syndrome are discussed, using models of the relationship between language and visuospatial cognition based on data from this unique case.