An 87-year-old right-handed man with untreated hypertension and hypercholesterolaemia presented w... more An 87-year-old right-handed man with untreated hypertension and hypercholesterolaemia presented with acute flinging and throwing movements of the left upper and lower limb. Clinical examination confirmed involuntary, irregular, wide amplitude movements of the left limbs consistent with left hemiballism in the absence of other neurological deficit. Blood count, CRP, glucose level, calcium, renal and liver function tests, ANF, lupus anticoagulant, anticardiolipin antibodies, thyroid function, serology of HIV, and arterial blood gas analysis were all normal. Brain MRI showed an acute infarction in the left (i.e. ipsilateral to the hemiballistic movements) subthalamic nucleus (STN) zone (Fig. 1), together with signs of chronic ischaemic microangiopathy in the brainstem and the periventricular areas (Fig. 2). [F] FDG PET performed 1 week after symptom onset revealed hypometabolism in the left hemispheric cortex (preserving only the anteromedial part of the frontal lobe) and the left caudate nucleus and the putamen (Fig. 1), probably due to deafferentation via connections between the STN and the ipsilateral basal ganglia system and the cortex, respectively. Carotid duplex sonography showed bilateral nonstenotic carotid atheroma. Electrocardiography and transthoracic echocardiography were normal. Recent infarction was probably due to occlusion of a small artery related to untreated cardiovascular risk factors. Secondary prevention treatment for ischaemic stroke was started. Neuropsychological testing 1 week after symptom onset showed a mild to moderate amnestic syndrome with preserved executive functions. Hemiballism disappeared progressively over the following months. [F] FDG PET 5 months after hemiballism onset showed near complete recovery of hypometabolism (Fig. 1), and neuropsychological testing normalized. Historically, acute hemiballism was thought to be related almost exclusively to contralateral (ischaemic or haemorrhagic) STN lesions. However, recently the era of modern neuroimaging has allowed identification of lesions often outside the STN (e.g. thalamus, globus pallidum, putamen, caudate nucleus, white matter, and cortex) [1]. The vast majority of lesions are contralateral to the hemiballism. Only a few cases with ipsilateral STN lesions have been described [2, 3]. The pathophysiology of ipsilateral hemiballism is poorly understood. The possibility that the STN exerts a bilateral control of motor function may explain this. This is supported by the observation that unilateral stereotaxic neurosurgery in Parkinson’s disease frequently results in bilateral improvement of abnormal movements. Anatomic pathways related to this bilateral control are unknown. [F] FDG PET in our patient nicely showed the connections between the STN and the other ipsilateral brain structures. DimitriRenard (&) A. Le Floch G. Castelnovo P. Labauge Department of Neurology, CHU Nimes, Hopital Caremeau, Place du Pr Debre, 30029 Nimes Cedex 4, France e-mail: [email protected]
A 77-year-old woman with a history of left corticosubcortical hemorrhagic posterior middle cerebr... more A 77-year-old woman with a history of left corticosubcortical hemorrhagic posterior middle cerebral artery infarction presented with acute aphasia and confusion. Acute magnetic resonance imaging (MRI; performed during ongoing aphasia and confusion) showed restricted diffusion in the cortex (Fig A, B, diffusionweighted imaging [DWI], arrows) adjacent to the chronic lesion and in the ipsilateral pulvinar (Fig A, DWI, arrowhead), associated with hyperperfusion in these regions (Fig C, D, perfusion-weighted imaging [PWI] quantitative map of cerebral blood flow). Just after MRI performance, the patient presented a generalized tonic–clonic seizure treated by intravenous clonazepam 1 mg, and antiepileptic treatment with levetiracetam 500 mg bid was started. The patient recovered progressively and both DWI (Fig E, F) and PWI (Fig G, H) abnormalities completely disappeared (arrowheads and arrows showing normalized signal in regions earlier involved) on MRI 1 month later. Initial MRI abnormalities were probably related to prolonged left posterior cortical ictal activity spreading to the thalamic area.
Introduction 3,4-Dihydroxy-6-[ 18 F]-fluoro-l-phenylalanine (FDOPA) positron emission tomography ... more Introduction 3,4-Dihydroxy-6-[ 18 F]-fluoro-l-phenylalanine (FDOPA) positron emission tomography (PET) is sensitive for identifying primary brain tumors. However, increased FDOPA uptake has been reported in pseudotumoral brain lesions. Our aim was to analyse FDOPA-PET in patients with pseudotumoral brain lesions and to compare them with patients with brain tumors. Methods We retrospectively analysed consecutively recruited patients with suspected primary brain tumor (based on clinical and magnetic resonance imaging findings) referred for FDOPA-PET in our centre between November 2013 and June 2019 (n = 74). FDOPA-PET parameters (maximum and mean lesion standardised uptake values [SUV] and ratios comparing lesion with different background uptake SUV) and thresholds were evaluated to determine which offered optimal discrimination between pseudotumoral and tumoral lesions. Results Overlapping PET values were observed between pseudotumoral (n = 26) and tumoral (n = 48) lesion, particularly for low-grade tumors. Based on receiver operating characteristic (ROC) analyses, the optimal PET parameters to discriminate pseudotumoral from tumoral lesions were SUV max lesion/basal ganglia, SUV max lesion/grey matter, SUV mean lesion/grey matter, and SUV max lesion/mirror area in contralateral hemisphere (all ratios showing area under the curve [AUC] 0.85, 95% CI). The narrowest 95% sensitivity-95% specificity window was observed for SUV max lesion/basal ganglia ratio, with ratio values of 0.79 and 1.35 corresponding to 95% sensitivity and 95% specificity, respectively. Conclusion FDOPA-PET uptake should be interpreted with caution in patients with suspected primary brain tumor, especially in patients showing low or intermediate SUV values and ratios. Clinical Trial Registration-URL caltr ials.gov. Unique identifier: NCT04306484
2068 Background: Intramedullary spinal cord tumors (IMST) are among the rarest types of tumors, a... more 2068 Background: Intramedullary spinal cord tumors (IMST) are among the rarest types of tumors, account for 2 to 4% of all central nervous system tumors. This study was conducted to describe clinical features, radiological imaging, anatomopathological characteristics, management and outcome of neuroepithelial IMST. Methods: in this retrospective review, a total of 319 patients were included from 7 French neurosurgical University Hospital Centers, between 1984 and 2011. The patient’s pre and postoperative neurological state were classified according to the Mac Cormick scale. Only patients with a preoperative MRI and confirmed histological were included. Results: Mean age at diagnostic was 42.4 for ependymomas, 39.6 for astrocytomas, (included 20 patients older than 65 years old). The male/female ratio was 1.6 for ependymomas, and 1.1 for astrocytomas. Ependymomas were associated with neurofibromatosis in four patients. Pain was the most common presenting symptom (74%), followed by mo...
Refractory chronic migraine is a disabling disorder impacting quality of life. BOTOX ® (Onabotuli... more Refractory chronic migraine is a disabling disorder impacting quality of life. BOTOX ® (Onabotulinumtoxin A) is approved as a prophylactic treatment of chronic migraine in patients unresponsive to at least three prior preventive treatments. The objective of this study was to determine the prophylactic effect of 145 U XEOMIN ® (Incobotulinumtoxin A) injected at 31 specific sites in adult patients with refractory chronic migraine. Sixty-one patients (8 men and 53 women, mean age 50) with migraine were recruited, including 20 patients with isolated chronic migraine, 18 patients with chronic migraine associating tension-type headache, 12 patients with migraine associating medication overuse headache, and 11 patients with episodic disabling migraine. The mean number of injections and duration of treatment per patient was 3.5 (range 2-13) and 21 (6-68) months, respectively. From baseline to first injection, 44 patients (73%) had >50% reduction in frequency of migraine episodes, 29 patients (48%) showed >50% reduction in number of headache days, and 28 patients (46%) had a >50% reduction in drug intake. Stable response for all three parameters was observed after the last injection. XEOMIN ® thus seems to represent an effective and sustained prophylactic treatment of chronic migraine.
hemin ont présenté en moyenne 3,5 crises/personne/an. Les dosages moyens d'ALA et de PBG à la sél... more hemin ont présenté en moyenne 3,5 crises/personne/an. Les dosages moyens d'ALA et de PBG à la sélection étaient 9 et 23 fois supérieurs à la limite supérieure de la normale, respectivement. Discussion EXPLORE, la première étude internationale de l'histoire naturelle des porphyries hépatiques avec crises récurrentes démontre que les patients présentent des crises et des symptômes chroniques. Conclusion Il demeure un besoin non satisfait de nouveaux traitements pour prévenir les crises et traiter les symptômes chroniques. Histoire Naturelle ; Porphyrie Hépatiques Aigues ; Douleurs Neuroviscérales Déclaration de liens d'intérêts Les auteurs n'ont pas précisé leurs éventuels liens d'intérêts.
Single or multiple space-occupying lesions on brain MRI, with or without contrast enhancement and... more Single or multiple space-occupying lesions on brain MRI, with or without contrast enhancement and/or perilesional oedema, evoke a neoplastic origin. However, a multitude of non-neoplastic disorders can simulate cerebral neoplasia. In this review, we will discuss the MRI characteristics of non-neoplastic disorders that can mimic cerebral neoplasia. Distinguishing MRI characteristics are discussed for each of these non-neoplastic disorders.
white matter) and SWI microbleeds ( fig. 1 ) [2] . The vicinity of FLAIR hyperintensities (unior ... more white matter) and SWI microbleeds ( fig. 1 ) [2] . The vicinity of FLAIR hyperintensities (unior multifocal, corticosubcortical or deep, asymmetric, and extending to the immediately subcortical white matter) and microbleeds (often cortical, juxtacortical, or subcortical in distribution) on SWI is in favour of the hypothesis that inflammation (seen as FLAIR hyperintensities) and hemorrhages have a We present MRIs of 6 patients with cerebral amyloid angiopathy-related inflammation (CAA-I), fulfilling diagnostic criteria for probable CAA-I according to Chung et al. [1] and the recently modified CAA-I criteria in 5 patients and for definite CAA-I in 1 patient, showing vicinity of FLAIR hyperintensities (especially were white matter hyperintensities extend to the immediately subcortical Received: February 16, 2016 Accepted: April 7, 2016 Published online: April 27, 2016
Cerebral cortical lesions develop in many disorders including vascular diseases, metabolic disord... more Cerebral cortical lesions develop in many disorders including vascular diseases, metabolic disorders, inflammatory diseases, tumours, infections and genetic disorders. In some diseases, the cortical involvement is typical and sometimes isolated, while in others the cortical lesions occur only occasionally (often alongside other typical extra-cortical lesions). In this review, we discuss mainly the MRI characteristics of cortical lesions encountered in different disorders. From a radiological perspective, identifying the origin of a cortical lesion depends on the exact localisation of signal changes, the presence of extra-cortical lesions, the signal changes on different MRI sequences and the evolution of the radiological abnormalities over time. These must be interpreted in light of the history and clinical state of the patient, and other radiological and non-radiological examinations.
huit mois avant de progresser et de de ´clencher un e ´tat de mal e ´pileptique partiel (EMEp) ph... more huit mois avant de progresser et de de ´clencher un e ´tat de mal e ´pileptique partiel (EMEp) pharmacore ´sistant mortel. Homme de 18 ans diagnostique ´devant une ataxie, une dystonie et des hypersignaux (HS) des thalami et du cortex frontal a `l'IRM. Cinq mois apre `s l'instauration de dP le patient pre ´senta un EMEp pharmacore ´sistant associe ´a `une large extension des HS corticaux. La dP fut change ´e par de la trientine. L'e ´volution clinique fut alors satisfaisante associe ´e a `la re ´gression des HS IRM. Adolescent de 15 ans diagnostique ´devant un syndrome parkinsonien et une dystonie ge ´ne ´ralise ´e. L'IRM montrait des HS Flair des GB. Apre `s trois mois de dP, il pre ´senta une crise d'e ´pilepsie ge ´ne ´ralise ´e avec de nouvelles le ´sions corticales frontotemporales. Le changement de la dP par la trientine s'accompagna d'une ame ´lioration transitoire puis d'un EMEp pharmacore ´sistant avec extension des le ´sions corticales. Quatre ans apre `s, le patient ne fait plus de crise et l'IRM ne s'est pas modifie ´e. Discussion Ces trois observations soulignent que l'atteinte IRM corticale dans la MW peut apparaı ˆtre pre ´cocement et devenir symptomatique a `l'instauration ou au changement de che ´lateur. Son e ´volution est variable, de l'extension a `la re ´gression partielle. L'atteinte e ´pileptique associe ´e apparaı ˆt se ´ve `re sous forme d'EMEp pharmacore ´sistant qui peut e ˆtre fatal vue la fragilite ´des patients ou se stabiliser sous traitement antie ´pileptique. Conclusion Un contro ˆle IRM re ´gulier dans la MW est important vu le risque d'EME en lien avec de nouvelles le ´sions corticales sous traitement che ´lateur. La question d'un traitement pre ´ventif anticomitial pourrait se poser dans ces cas la `. Informations comple´mentaires Aucun financement. Mots cle´s Maladie de Wilson ; E ´pilepsie ; IRM De´claration d'inte´reˆts Les auteurs n'ont pas transmis de de ´claration de conflits d'inte ´re ˆts.
Background. Thalamic lesions are seen in a multitude of disorders including vascular diseases, me... more Background. Thalamic lesions are seen in a multitude of disorders including vascular diseases, metabolic disorders, inflammatory diseases, trauma, tumours, and infections. In some diseases, thalamic involvement is typical and sometimes isolated, while in other diseases thalamic lesions are observed only occasionally (often in the presence of other typical extrathalamic lesions).Summary. In this review, we will mainly discuss the MRI characteristics of thalamic lesions. Identification of the origin of the thalamic lesion depends on the exact localisation inside the thalamus, the presence of extrathalamic lesions, the signal changes on different MRI sequences, the evolution of the radiological abnormalities over time, the history and clinical state of the patient, and other radiological and nonradiological examinations.
Focal task-specific dystonia (FTSD) occurs exclusively during a specific activity that usually in... more Focal task-specific dystonia (FTSD) occurs exclusively during a specific activity that usually involves a highly skilled movement. Classical FTSD dystonias include writer's cramp and musician's dystonia. Few cases of sport-related dystonia have been reported. We describe the first four cases of FTSD related to table tennis (TT), two involving professional international competitors. We also systematically analyzed the literature for reports of sport-related dystonia including detailed clinical descriptions. We collected a total of 13 cases of sport-related dystonia, including our four TT players. Before onset, all the patients had trained for many years, for a large number of hours per week. Practice time had frequently increased significantly in the year preceding onset. As TT is characterized by highly skilled hand/forearm movements acquired through repetitive exercises, it may carry a higher risk of FTSD than other sports. Intensive training may result in maladaptive responses and overwhelm homeostatic mechanisms that regulate cortical plasticity in vulnerable individuals. Our findings support the importance of environmental risk factors in sport-related FTSD, as also suggested in classical FTSD, and have important implications for clinical practice.
Journal of Neurology, Neurosurgery & Psychiatry, 2014
Lesions of the corpus callosum (CC) are seen in a multitude of disorders including vascular disea... more Lesions of the corpus callosum (CC) are seen in a multitude of disorders including vascular diseases, metabolic disorders, tumours, demyelinating diseases, trauma and infections. In some diseases, CC involvement is typical and sometimes isolated, while in other diseases CC lesions are seen only occasionally in the presence of other typical extra-callosal abnormalities. In this review, we will mainly discuss the MRI characteristics of acquired lesions involving the CC. Identification of the origin of the CC lesion depends on the exact localisation of the lesion(s) inside the CC, presence of other lesions seen outside the CC, signal changes on different MRI sequences, evolution over time of the radiological abnormalities, history and clinical state of the patient, and other radiological and non-radiological examinations.
An 87-year-old right-handed man with untreated hypertension and hypercholesterolaemia presented w... more An 87-year-old right-handed man with untreated hypertension and hypercholesterolaemia presented with acute flinging and throwing movements of the left upper and lower limb. Clinical examination confirmed involuntary, irregular, wide amplitude movements of the left limbs consistent with left hemiballism in the absence of other neurological deficit. Blood count, CRP, glucose level, calcium, renal and liver function tests, ANF, lupus anticoagulant, anticardiolipin antibodies, thyroid function, serology of HIV, and arterial blood gas analysis were all normal. Brain MRI showed an acute infarction in the left (i.e. ipsilateral to the hemiballistic movements) subthalamic nucleus (STN) zone (Fig. 1), together with signs of chronic ischaemic microangiopathy in the brainstem and the periventricular areas (Fig. 2). [F] FDG PET performed 1 week after symptom onset revealed hypometabolism in the left hemispheric cortex (preserving only the anteromedial part of the frontal lobe) and the left caudate nucleus and the putamen (Fig. 1), probably due to deafferentation via connections between the STN and the ipsilateral basal ganglia system and the cortex, respectively. Carotid duplex sonography showed bilateral nonstenotic carotid atheroma. Electrocardiography and transthoracic echocardiography were normal. Recent infarction was probably due to occlusion of a small artery related to untreated cardiovascular risk factors. Secondary prevention treatment for ischaemic stroke was started. Neuropsychological testing 1 week after symptom onset showed a mild to moderate amnestic syndrome with preserved executive functions. Hemiballism disappeared progressively over the following months. [F] FDG PET 5 months after hemiballism onset showed near complete recovery of hypometabolism (Fig. 1), and neuropsychological testing normalized. Historically, acute hemiballism was thought to be related almost exclusively to contralateral (ischaemic or haemorrhagic) STN lesions. However, recently the era of modern neuroimaging has allowed identification of lesions often outside the STN (e.g. thalamus, globus pallidum, putamen, caudate nucleus, white matter, and cortex) [1]. The vast majority of lesions are contralateral to the hemiballism. Only a few cases with ipsilateral STN lesions have been described [2, 3]. The pathophysiology of ipsilateral hemiballism is poorly understood. The possibility that the STN exerts a bilateral control of motor function may explain this. This is supported by the observation that unilateral stereotaxic neurosurgery in Parkinson’s disease frequently results in bilateral improvement of abnormal movements. Anatomic pathways related to this bilateral control are unknown. [F] FDG PET in our patient nicely showed the connections between the STN and the other ipsilateral brain structures. DimitriRenard (&) A. Le Floch G. Castelnovo P. Labauge Department of Neurology, CHU Nimes, Hopital Caremeau, Place du Pr Debre, 30029 Nimes Cedex 4, France e-mail: [email protected]
A 77-year-old woman with a history of left corticosubcortical hemorrhagic posterior middle cerebr... more A 77-year-old woman with a history of left corticosubcortical hemorrhagic posterior middle cerebral artery infarction presented with acute aphasia and confusion. Acute magnetic resonance imaging (MRI; performed during ongoing aphasia and confusion) showed restricted diffusion in the cortex (Fig A, B, diffusionweighted imaging [DWI], arrows) adjacent to the chronic lesion and in the ipsilateral pulvinar (Fig A, DWI, arrowhead), associated with hyperperfusion in these regions (Fig C, D, perfusion-weighted imaging [PWI] quantitative map of cerebral blood flow). Just after MRI performance, the patient presented a generalized tonic–clonic seizure treated by intravenous clonazepam 1 mg, and antiepileptic treatment with levetiracetam 500 mg bid was started. The patient recovered progressively and both DWI (Fig E, F) and PWI (Fig G, H) abnormalities completely disappeared (arrowheads and arrows showing normalized signal in regions earlier involved) on MRI 1 month later. Initial MRI abnormalities were probably related to prolonged left posterior cortical ictal activity spreading to the thalamic area.
Introduction 3,4-Dihydroxy-6-[ 18 F]-fluoro-l-phenylalanine (FDOPA) positron emission tomography ... more Introduction 3,4-Dihydroxy-6-[ 18 F]-fluoro-l-phenylalanine (FDOPA) positron emission tomography (PET) is sensitive for identifying primary brain tumors. However, increased FDOPA uptake has been reported in pseudotumoral brain lesions. Our aim was to analyse FDOPA-PET in patients with pseudotumoral brain lesions and to compare them with patients with brain tumors. Methods We retrospectively analysed consecutively recruited patients with suspected primary brain tumor (based on clinical and magnetic resonance imaging findings) referred for FDOPA-PET in our centre between November 2013 and June 2019 (n = 74). FDOPA-PET parameters (maximum and mean lesion standardised uptake values [SUV] and ratios comparing lesion with different background uptake SUV) and thresholds were evaluated to determine which offered optimal discrimination between pseudotumoral and tumoral lesions. Results Overlapping PET values were observed between pseudotumoral (n = 26) and tumoral (n = 48) lesion, particularly for low-grade tumors. Based on receiver operating characteristic (ROC) analyses, the optimal PET parameters to discriminate pseudotumoral from tumoral lesions were SUV max lesion/basal ganglia, SUV max lesion/grey matter, SUV mean lesion/grey matter, and SUV max lesion/mirror area in contralateral hemisphere (all ratios showing area under the curve [AUC] 0.85, 95% CI). The narrowest 95% sensitivity-95% specificity window was observed for SUV max lesion/basal ganglia ratio, with ratio values of 0.79 and 1.35 corresponding to 95% sensitivity and 95% specificity, respectively. Conclusion FDOPA-PET uptake should be interpreted with caution in patients with suspected primary brain tumor, especially in patients showing low or intermediate SUV values and ratios. Clinical Trial Registration-URL caltr ials.gov. Unique identifier: NCT04306484
2068 Background: Intramedullary spinal cord tumors (IMST) are among the rarest types of tumors, a... more 2068 Background: Intramedullary spinal cord tumors (IMST) are among the rarest types of tumors, account for 2 to 4% of all central nervous system tumors. This study was conducted to describe clinical features, radiological imaging, anatomopathological characteristics, management and outcome of neuroepithelial IMST. Methods: in this retrospective review, a total of 319 patients were included from 7 French neurosurgical University Hospital Centers, between 1984 and 2011. The patient’s pre and postoperative neurological state were classified according to the Mac Cormick scale. Only patients with a preoperative MRI and confirmed histological were included. Results: Mean age at diagnostic was 42.4 for ependymomas, 39.6 for astrocytomas, (included 20 patients older than 65 years old). The male/female ratio was 1.6 for ependymomas, and 1.1 for astrocytomas. Ependymomas were associated with neurofibromatosis in four patients. Pain was the most common presenting symptom (74%), followed by mo...
Refractory chronic migraine is a disabling disorder impacting quality of life. BOTOX ® (Onabotuli... more Refractory chronic migraine is a disabling disorder impacting quality of life. BOTOX ® (Onabotulinumtoxin A) is approved as a prophylactic treatment of chronic migraine in patients unresponsive to at least three prior preventive treatments. The objective of this study was to determine the prophylactic effect of 145 U XEOMIN ® (Incobotulinumtoxin A) injected at 31 specific sites in adult patients with refractory chronic migraine. Sixty-one patients (8 men and 53 women, mean age 50) with migraine were recruited, including 20 patients with isolated chronic migraine, 18 patients with chronic migraine associating tension-type headache, 12 patients with migraine associating medication overuse headache, and 11 patients with episodic disabling migraine. The mean number of injections and duration of treatment per patient was 3.5 (range 2-13) and 21 (6-68) months, respectively. From baseline to first injection, 44 patients (73%) had >50% reduction in frequency of migraine episodes, 29 patients (48%) showed >50% reduction in number of headache days, and 28 patients (46%) had a >50% reduction in drug intake. Stable response for all three parameters was observed after the last injection. XEOMIN ® thus seems to represent an effective and sustained prophylactic treatment of chronic migraine.
hemin ont présenté en moyenne 3,5 crises/personne/an. Les dosages moyens d'ALA et de PBG à la sél... more hemin ont présenté en moyenne 3,5 crises/personne/an. Les dosages moyens d'ALA et de PBG à la sélection étaient 9 et 23 fois supérieurs à la limite supérieure de la normale, respectivement. Discussion EXPLORE, la première étude internationale de l'histoire naturelle des porphyries hépatiques avec crises récurrentes démontre que les patients présentent des crises et des symptômes chroniques. Conclusion Il demeure un besoin non satisfait de nouveaux traitements pour prévenir les crises et traiter les symptômes chroniques. Histoire Naturelle ; Porphyrie Hépatiques Aigues ; Douleurs Neuroviscérales Déclaration de liens d'intérêts Les auteurs n'ont pas précisé leurs éventuels liens d'intérêts.
Single or multiple space-occupying lesions on brain MRI, with or without contrast enhancement and... more Single or multiple space-occupying lesions on brain MRI, with or without contrast enhancement and/or perilesional oedema, evoke a neoplastic origin. However, a multitude of non-neoplastic disorders can simulate cerebral neoplasia. In this review, we will discuss the MRI characteristics of non-neoplastic disorders that can mimic cerebral neoplasia. Distinguishing MRI characteristics are discussed for each of these non-neoplastic disorders.
white matter) and SWI microbleeds ( fig. 1 ) [2] . The vicinity of FLAIR hyperintensities (unior ... more white matter) and SWI microbleeds ( fig. 1 ) [2] . The vicinity of FLAIR hyperintensities (unior multifocal, corticosubcortical or deep, asymmetric, and extending to the immediately subcortical white matter) and microbleeds (often cortical, juxtacortical, or subcortical in distribution) on SWI is in favour of the hypothesis that inflammation (seen as FLAIR hyperintensities) and hemorrhages have a We present MRIs of 6 patients with cerebral amyloid angiopathy-related inflammation (CAA-I), fulfilling diagnostic criteria for probable CAA-I according to Chung et al. [1] and the recently modified CAA-I criteria in 5 patients and for definite CAA-I in 1 patient, showing vicinity of FLAIR hyperintensities (especially were white matter hyperintensities extend to the immediately subcortical Received: February 16, 2016 Accepted: April 7, 2016 Published online: April 27, 2016
Cerebral cortical lesions develop in many disorders including vascular diseases, metabolic disord... more Cerebral cortical lesions develop in many disorders including vascular diseases, metabolic disorders, inflammatory diseases, tumours, infections and genetic disorders. In some diseases, the cortical involvement is typical and sometimes isolated, while in others the cortical lesions occur only occasionally (often alongside other typical extra-cortical lesions). In this review, we discuss mainly the MRI characteristics of cortical lesions encountered in different disorders. From a radiological perspective, identifying the origin of a cortical lesion depends on the exact localisation of signal changes, the presence of extra-cortical lesions, the signal changes on different MRI sequences and the evolution of the radiological abnormalities over time. These must be interpreted in light of the history and clinical state of the patient, and other radiological and non-radiological examinations.
huit mois avant de progresser et de de ´clencher un e ´tat de mal e ´pileptique partiel (EMEp) ph... more huit mois avant de progresser et de de ´clencher un e ´tat de mal e ´pileptique partiel (EMEp) pharmacore ´sistant mortel. Homme de 18 ans diagnostique ´devant une ataxie, une dystonie et des hypersignaux (HS) des thalami et du cortex frontal a `l'IRM. Cinq mois apre `s l'instauration de dP le patient pre ´senta un EMEp pharmacore ´sistant associe ´a `une large extension des HS corticaux. La dP fut change ´e par de la trientine. L'e ´volution clinique fut alors satisfaisante associe ´e a `la re ´gression des HS IRM. Adolescent de 15 ans diagnostique ´devant un syndrome parkinsonien et une dystonie ge ´ne ´ralise ´e. L'IRM montrait des HS Flair des GB. Apre `s trois mois de dP, il pre ´senta une crise d'e ´pilepsie ge ´ne ´ralise ´e avec de nouvelles le ´sions corticales frontotemporales. Le changement de la dP par la trientine s'accompagna d'une ame ´lioration transitoire puis d'un EMEp pharmacore ´sistant avec extension des le ´sions corticales. Quatre ans apre `s, le patient ne fait plus de crise et l'IRM ne s'est pas modifie ´e. Discussion Ces trois observations soulignent que l'atteinte IRM corticale dans la MW peut apparaı ˆtre pre ´cocement et devenir symptomatique a `l'instauration ou au changement de che ´lateur. Son e ´volution est variable, de l'extension a `la re ´gression partielle. L'atteinte e ´pileptique associe ´e apparaı ˆt se ´ve `re sous forme d'EMEp pharmacore ´sistant qui peut e ˆtre fatal vue la fragilite ´des patients ou se stabiliser sous traitement antie ´pileptique. Conclusion Un contro ˆle IRM re ´gulier dans la MW est important vu le risque d'EME en lien avec de nouvelles le ´sions corticales sous traitement che ´lateur. La question d'un traitement pre ´ventif anticomitial pourrait se poser dans ces cas la `. Informations comple´mentaires Aucun financement. Mots cle´s Maladie de Wilson ; E ´pilepsie ; IRM De´claration d'inte´reˆts Les auteurs n'ont pas transmis de de ´claration de conflits d'inte ´re ˆts.
Background. Thalamic lesions are seen in a multitude of disorders including vascular diseases, me... more Background. Thalamic lesions are seen in a multitude of disorders including vascular diseases, metabolic disorders, inflammatory diseases, trauma, tumours, and infections. In some diseases, thalamic involvement is typical and sometimes isolated, while in other diseases thalamic lesions are observed only occasionally (often in the presence of other typical extrathalamic lesions).Summary. In this review, we will mainly discuss the MRI characteristics of thalamic lesions. Identification of the origin of the thalamic lesion depends on the exact localisation inside the thalamus, the presence of extrathalamic lesions, the signal changes on different MRI sequences, the evolution of the radiological abnormalities over time, the history and clinical state of the patient, and other radiological and nonradiological examinations.
Focal task-specific dystonia (FTSD) occurs exclusively during a specific activity that usually in... more Focal task-specific dystonia (FTSD) occurs exclusively during a specific activity that usually involves a highly skilled movement. Classical FTSD dystonias include writer's cramp and musician's dystonia. Few cases of sport-related dystonia have been reported. We describe the first four cases of FTSD related to table tennis (TT), two involving professional international competitors. We also systematically analyzed the literature for reports of sport-related dystonia including detailed clinical descriptions. We collected a total of 13 cases of sport-related dystonia, including our four TT players. Before onset, all the patients had trained for many years, for a large number of hours per week. Practice time had frequently increased significantly in the year preceding onset. As TT is characterized by highly skilled hand/forearm movements acquired through repetitive exercises, it may carry a higher risk of FTSD than other sports. Intensive training may result in maladaptive responses and overwhelm homeostatic mechanisms that regulate cortical plasticity in vulnerable individuals. Our findings support the importance of environmental risk factors in sport-related FTSD, as also suggested in classical FTSD, and have important implications for clinical practice.
Journal of Neurology, Neurosurgery & Psychiatry, 2014
Lesions of the corpus callosum (CC) are seen in a multitude of disorders including vascular disea... more Lesions of the corpus callosum (CC) are seen in a multitude of disorders including vascular diseases, metabolic disorders, tumours, demyelinating diseases, trauma and infections. In some diseases, CC involvement is typical and sometimes isolated, while in other diseases CC lesions are seen only occasionally in the presence of other typical extra-callosal abnormalities. In this review, we will mainly discuss the MRI characteristics of acquired lesions involving the CC. Identification of the origin of the CC lesion depends on the exact localisation of the lesion(s) inside the CC, presence of other lesions seen outside the CC, signal changes on different MRI sequences, evolution over time of the radiological abnormalities, history and clinical state of the patient, and other radiological and non-radiological examinations.
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