Trigeminal neuralgia: Assessment with T2 VISTA and FLAIR VISTA fusion imaging

Objective  

To evaluate the neurovascular compression (NVC) in patients with trigeminal neuralgia (TN) using T2 VISTA and FLAIR VISTA fusion imaging.     

Dermatomyositis associated with generalized subcutaneous edema and Evans syndrome

Although periorbital edema is a common manifestation of dermatomyositis (DM), generalized subcutaneous edema associated with DM is extremely rare. Evans syndrome is an autoimmune disease in which an individual's antibodies attack one's own red blood cells and platelets. Evans syndrome is rarely a presenting feature of DM. DM has been rarely reported to be associated with either generalized edema or Evans syndrome. We report the case of a 52-year-old Korean woman who presented with generalized subcutaneous edema, an erythematous rash, dysphagia, and proximal muscle weakness, and subsequently developed features of Evans syndrome. Treatment with high-dose glucocorticoids and an immunosuppressive agent controlled the DM, the generalized subcutaneous edema, and the Evans syndrome.     

Morphological and functional MRI, MRS, perfusion and diffusion changes after radiosurgery of brain metastasis

Radiosurgery is a noninvasive procedure where spatially accurate and highly conformal doses of radiation are targeted at brain lesions with an ablative intent. Recently, radiosurgery has been established as an effective technique for local treatment of brain metastasis. After radiosurgery, magnetic resonance (MR) imaging plays an important role in the assessment of the therapeutic response and of any complications. The therapeutic approach depends on the imaging findings obtained after radiosurgery, which have a role in the decision making to perform additional invasive modalities (repeat resection, biopsy) to obtain a definite diagnosis and to improve the survival of patients. Conventional MR imaging findings are mainly based on morphological alterations of tumors. However, there are variable imaging findings of radiation-induced changes including radiation necrosis in the brain. Radiologists are sometimes confused by radiation-induced injuries, including radiation necrosis, that are seen on conventional MR imaging. The pattern of abnormal enhancement on follow-up conventional MR imaging closely mimics that of a recurrent brain metastasis. So, classifying newly developed abnormal enhancing lesions in follow-up of treated brain metastasis with correct diagnosis is one of the key goals in neuro-oncologic imaging. To overcome limitations of the use of morphology-based conventional MR imaging, several physiological-based functional MR imaging methods have been used, namely diffusion-weighted imaging, perfusion MR imaging, and proton MR spectroscopy, for the detection of hemodynamic, metabolic, and cellular alterations. These imaging modalities provide additional information to allow clinicians to make proper decisions regarding patient treatment.     

Adenovirus-mediated expression of dominant negative c-myb induces apoptosis in head and neck cancer cells and inhibits tumor growth in animal model

The recent demonstration of aberrant expression of the c-myb proto-oncogene in various cancers suggests that c-myb plays an important role in the development of cancer. On this basis, it has been proposed that ablation of c-myb function might be an effective approach for therapy of c-myb dependent malignancies. We previously used a dominant negative c-myb (DN-myb) construct to induce apoptosis in K562 cells. In this study, DN-myb was expressed in an adenovirus-mediated gene delivery system and introduced into head and neck squamous cell carcinoma cells (HNSCC) in vitro and in vivo to examine its tumor suppressive function and its potential in HNSCC gene therapy. Over expression of DN-myb in HNSCC cells inhibited in vitro cell proliferation, expression of growth factors such as IGF-I, -II, IGF-1R, and VEGF, inhibited Akt/PKB pathway activation, and enhanced induction of apoptosis. Similarly, in vivo administration of DN-myb retarded tumor-growth. Our results support a role for DN-myb in inducing apoptosis and tumor suppression, and, furthermore, suggest that DN-myb gene therapy might provide a powerful tool for treatment of c-myb dependent malignancies such as HNSCC.     

Evaluation of cardiac sympathetic neuronal integrity in diabetic patients using iodine-123 metaiodobenzylguanidine

Autonomic dysfunction is associated with increased mortality in diabetic patients. To evaluate the cardiac autonomic dysfunction in these patients, a prospective study was undertaken using iodine-123 metaiodobenzylguanidine (MIBG) single-photon emission tomography (SPET). The study groups consisted of ten diabetic patients with cardiac autonomic neuropathy (group 1) and six without autonomic neuropathy (group II). Autonomic nervous function tests, thallium scan, radionuclide ventriculographic data including ejection fraction and wall motion study, and 24-h urine catecholamine levels were evaluated.¹²³I-MIBG SPET was performed at 30 min and 4 h following injection of 3 mCi of¹²³I-MIBG in groups I and II and in normal subjects (n=4). On planar images, the heart to mediastinum (H/M) ratio was measured. Defect pattern and severity of MIBG uptake were qualitatively analysed on SPET. Compared with control subjects, diabetic patients had a reduced H/M ratio regardless of the presence of clinical autonomic neuropathy. There was no difference in H/M ratio between groups I and II. On SPET images, focal or diffuse defects were demonstrated in all patients in group I, and in five of the six patients in group II. The extent of defects tended to be more pronounced in group I than in group II. In conclusion, SU1-MIBG scan was found to be a more sensitive method than clinical autonomic nervous function tests for the detection of autonomic neuropathy in diabetes.     

Stent-assisted angioplasty of symptomatic intracranial vertebrobasilar artery stenosis: feasibility and follow-up results

BACKGROUND AND PURPOSE: The natural history of symptomatic, untreated posterior circulation stenosis is dismal, with many patients experiencing significant morbidity or mortality. The purpose of this study was to evaluate the feasibility and results of stent-assisted angioplasty of symptomatic intracranial vertebrobasilar artery stenosis.METHODS: We reviewed the imaging findings and medical records of 17 consecutive patients who were treated with stent-assisted angioplasty for medically refractory vertebrobasilar artery stenosis. The location of the lesion, degree of stenosis, procedure-related complications, and clinical and short- and long-term angiographic results were assessed.RESULTS: The population included 17 cases (10 men, seven women; age range, 51–74 years; mean, 64 years). The locations of the lesions were intracranial vertebral artery (n = 13) and basilar artery (n = 6). The mean degree of stenosis decreased from 76.1 ± 14.6% before stent-assisted angioplasty to 1.3 ± 2.8% (P < .05) after the procedure. Acute in-stent thrombosis developed in one case (6%, Mori type B lesion), which was successfully treated with intraarterial abciximab infusion and angioplasty. Another patient (6%, Mori type C lesion) developed immediate postprocedural transient diplopia and ataxia, which gradually resolved. No other patient showed symptoms related to the vertebrobasilar artery lesion at follow-up. No significant restenosis was observed at short-term (five patients; follow-up range, 0.5–6 months; mean, 4.3 months) or long-term (six patients; follow-up range, 12–41 months; mean, 21 months) angiographic follow-up.CONCLUSION: Stent-assisted angioplasty is a feasible treatment method for vertebrobasilar artery stenosis. The patency of the stent-assisted angioplasty seems to be preserved in the long-term, with good clinical outcome.

The natural history of untreated posterior circulation stenosis is dismal, with many patients experiencing significant morbidity or mortality (1–3). Retrospective data suggest that the annual stroke rates for patients with symptomatic intracranial vertebral or basilar artery stenosis are 7.8% and 10.7%, respectively, despite anticoagulation or antiplatelet therapy (3).Recently, percutaneous transluminal angioplasty was proposed as a promising alternative treatment for patients with intracranial atherosclerotic stenosis symptoms despite medical therapy. However, percutaneous transluminal angioplasty has had the problems of dissection, elastic recoil, and thrombosis (4, 5). In a series of 42 cases of angioplasty for intracranial stenosis by Mori et al (4), the 1-year angiographic restenosis rate in type A (short, ≤5 mm in length, concentric or moderately eccentric lesions not totally occlusive), type B (tubular, 5–10 mm in length, extremely eccentric or totally occluded lesions, <3 months old), and type C (diffuse, >10 mm in length, extremely angulated [>90°] lesions with excessive tortuosity of the proximal segment, or totally occluded lesions, and ≥3 months old) lesions were 0%, 33%, and 100%, respectively, with cumulative risk of fatal or nonfatal ipsilateral ischemic stroke in 8%, 12%, 56%, respectively, at 1 and 2 years.Stent-assisted angioplasty has been limited mainly by the apprehension concerning the technical feasibility, periprocedural complications, and short- and long-term outcomes (6). Major problems still exist; nonetheless, recent technical advances in instruments used for angioplasty and stent placement have allowed easier trackability through the small and tortuous intracranial vessels. Also, experience from the earlier works of intracranial angioplasty and stent placement has allowed a relatively safe procedure with fewer periprocedural complications (7–14).We reviewed our experience with stent-assisted angioplasty for medically refractory intracranial vertebral and basilar artery stenoses, including the intra- and periprocedural complications and long-term angiographic and clinical outcomes.     

Fulminant type 1 diabetes mellitus in Korean adolescents

Fulminant type 1 diabetes has recently been identified as a new subtype of idiopathic diabetes that is mostly found in Japanese adults. The aim of this study was to investigate the frequency as well as the clinical and laboratory characteristics of fulminant type 1 diabetes among Korean children with childhood-onset type 1 diabetes. One-hundred and fifty patients that had been newly diagnosed with type 1 diabetes over the past 10 years were included. These patients came from three hospitals. Out of the 150 patients, two female patients fulfilled the criteria for fulminant type 1 diabetes. They were negative for islet autoantibodies. The patients with fulminant type 1 diabetes had an older age of onset and a lower HbA1c than the patients with autoimmune or idiopathic type 1 diabetes. In addition, the patients with fulminant type 1 diabetes had increased serum aspartate aminotransferase, alanine aminotransferase and amylase levels, and decreased fasting serum C-peptide levels. The frequency of fulminant type 1 diabetes was 1.33% among all patients newly diagnosed with type 1 diabetes under the age of 16. Although this type of diabetes is more commonly an adult-onset disease, it is possible that fulminant type 1 diabetes has not yet been fully recognized in children and adolescence, and may be more common than initially thought.