Distribution by Scientific Domains
Distribution within Medical Sciences

Kinds of Neuroimaging

  • functional neuroimaging

  • Terms modified by Neuroimaging

  • neuroimaging data
  • neuroimaging evidence
  • neuroimaging feature
  • neuroimaging finding
  • neuroimaging investigation
  • neuroimaging research
  • neuroimaging studies
  • neuroimaging techniques

  • Selected Abstracts


    Article first published online: 14 AUG 200
    No abstract is available for this article. [source]


    BIOETHICS, Issue 6 2009
    ABSTRACT Purpose: Whereas ethical considerations on imaging techniques and interpretations of neuroimaging results flourish, there is not much work on their preconditions. In this paper, therefore, we discuss epistemological considerations on neuroimaging and their implications for neuroethics. Results: Neuroimaging uses indirect methods to generate data about surrogate parameters for mental processes, and there are many determinants influencing the results, including current hypotheses and the state of knowledge. This leads to an interdependence between hypotheses and data. Additionally, different levels of description are involved, especially when experiments are designed to answer questions pertaining to broad concepts like the self, empathy or moral intentions. Interdisciplinary theoretical frameworks are needed to integrate findings from the life sciences and the humanities and to translate between them. While these epistemological issues are not specific for neuroimaging, there are some reasons why they are of special importance in this context: Due to their inferential proximity, ,neuro-images' seem to be self-evident, suggesting directness of observation and objectivity. This has to be critically discussed to prevent overinterpretation. Additionally, there is a high level of attention to neuroimaging, leading to a high frequency of presentation of neuroimaging data and making the critical examination of their epistemological properties even more pressing. Conclusions: Epistemological considerations are an important prerequisite for neuroethics. The presentation and communication of the results of neuroimaging studies, the potential generation of new phenomena and new ,dysfunctions' through neuroimaging, and the influence on central concepts at the foundations of ethics will be important future topics for this discipline. [source]

    Cerebral palsy in siblings caused by compound heterozygous mutations in the gene encoding protein C

    We report two sisters with extensive bilateral periventricular haemorrhagic infarction (PVHI) causing cerebral palsy (CP). The older sister presented at 20 months with cortical visual blindness, spastic diplegia, and purpura fulminans. The younger sister presented aged 3 days old with apnoeas and multifocal seizures. She subsequently had global developmental delay, cortical visual blindness, spastic quadriplegia, epilepsy, and purpura fulminans at age 2 years. Neuroimaging of both siblings showed bilateral PVHI consistent with bilateral cerebral intramedullary venous thrombosis occurring at under 28 weeks' gestation for the older sister and around time of birth for the younger sister. At latest follow-up, the older sister (13y) has spastic diplegia at Gross Motor Function Classification System (GMFCS) level II, and the younger sister (10y) has spastic quadriplegia at GMFCS level IV. Both sisters showed partial quantitative reduction in plasma protein C antigen and severe qualitative reduction in plasma protein C anticoagulant activity. They were heterozygous for two independent mutations in the protein C gene (PROC). There was no other risk factor for CP. To our knowledge, this is the first family reported with compound heterozygous PROC mutations as the likely genetic cause of familial CP. This report adds to the list of known monogenic causes of CP. [source]

    Autism spectrum disorder and underlying brain mechanism in the oculoauriculovertebral spectrum

    Maria Johansson MD
    As part of a multidisciplinary study, the rate of autism spectrum disorder (ASD), learning disability (LD), and brain abnormalities was examined in 20 participants (12 males, 8 females; age range 8mo-17y, mean age 8y 1mo) diagnosed as falling within the oculoauriculovertebral spectrum (OAV). A neuropsychiatric examination was performed, including standardized autism diagnostic interviews. Two individuals met diagnostic criteria for autism, one for autistic-like condition, and five for autistic traits. Four patients had mild LD, three severe LD, two profound LD, and two borderline intellectual functioning. Neuroimaging indicated cerebral abnormalities in more than half of the patients. Abnormalities of white/grey matter were found in more than half of examined individuals; enlargement of ventricles in more than a third. Results indicate that at least a subgroup of ASD may be associated with errors in early embryonic brain development. Awareness of the coexistence of OAV/ASD is important in habilitation care of individuals with OAV. [source]

    Ataxia, autism, and the cerebellum: a clinical study of 32 individuals with congenital ataxia

    Ingegerd Åhsgren MD
    The suggested link between autism and cerebellar dysfunction formed the background for a Swedish clinical study in 2001. Thirty-two children (17 females, 15 males; mean age 12y, SD 3y 10mo; range 6 to 21y) with a clinical suspicion of non-progressive congenital ataxia were examined, and parents were interviewed about the presence of neuropsychiatric problems in the child. Twelve children had simple ataxia, eight had ataxic diplegia, and 12 had,borderline'ataxia. All but one of the 32 children had a mild to moderate gross motor disability according to Gross Motor Function Classification System (15 were categorized as level I,16 as level II, and one child as level IV). Neuroimaging and neuropsychological testing were achieved in most cases. There was a strong association between learning disability* and autism spectrum disorder (often combined with hyperactivity disorder) on the one hand, and both simple and borderline,ataxia'on the other, but a weaker link between ataxic diplegia and neuropsychiatric disorders. A correlation between cerebellar macropathology on neuroimaging and neuropsychiatric disorders was not supported. Congenital ataxia might not be a clear-cut syndrome of cerebellar disease, but one of many signs of prenatal events or syndromes, leading to a complex neurodevelopmental disorder including autism and learning disability. [source]

    National Study on Emergency Department Visits for Transient Ischemic Attack, 1992,2001

    Jonathan A. Edlow MD
    Abstract Objectives: To describe the epidemiology of U.S. emergency department (ED) visits for transient ischemic attack (TIA) and to measure rates of antiplatelet medication use, neuroimaging, and hospitalization during a ten-year time period. Methods: The authors obtained data from the 1992,2001 National Hospital Ambulatory Medical Care Survey. TIA cases were identified by having ICD-9 code 435. Results: From 1992 to 2001, there were 769 cases, representing 2,969,000 ED visits for TIA. The population rate of 1.1 ED visits per 1,000 U.S. population (95% CI = 0.92 to 1.30) was stable over time. TIA was diagnosed in 0.3% of all ED visits. Physicians administered aspirin and other antiplatelet agents to a small percentage of patients, and 42% of TIA patients (95% CI = 29% to 55%) received no medications at all in the ED. Too few data points existed to measure a statistically valid trend over time. Physicians performed computed tomography scanning in 56% (95% CI = 45% to 66%) of cases and performed magnetic resonance imaging (MRI) in < 5% of cases, and there was a trend toward increased imaging over time. Admission rates did not increase during the ten-year period, with 54% (95% CI = 42% to 67%) admitted. Regional differences were noted, however, with the highest admission rate found in the Northeast (68%). Conclusions: Between 1992 and 2001, the population rate of ED visits for TIA was stable, as were admission rates (54%). Antiplatelet medications appear to be underutilized and to be discordant with published guidelines. Neuroimaging increased significantly. These findings may reflect the limited evidence base for the guidelines, educational deficits, or other barriers to guideline implementation. [source]

    Febrile infection,related epilepsy syndrome (FIRES): A nonencephalitic encephalopathy in childhood

    EPILEPSIA, Issue 7 2010
    Andreas Van Baalen
    Summary Encephalitis is generally presumed, even when seizures follow banal febrile infection, and pathogen detection in cerebrospinal fluid fails. This retrospective multicenter case series reports on 22 previously healthy children aged 3,15 years (median 6.5 years) with prolonged or recurrent seizures occurring 2,14 days (median 5 days) after fever onset (19 children with respiratory or nonspecific infections). Cerebrospinal fluid studies revealed 2,42 cells/,l (median 5 cells/,l) and no pathogens. Electroencephalography showed diffuse slowing or multifocal discharges. Neuroimaging demonstrated normal findings in 10 children. Brain biopsies were performed in seven children showing gliosis but no inflammation. Anesthetic barbiturates were used in 14 children with refractory status epilepticus, and immunotherapy in 9. Two children died, eight remained in a state of impaired consciousness, eight developed therapy-refractory epilepsies, two had behavioral disturbances, and two recovered. The lack of evidence for encephalitis suggests another infection-related pathogenesis of this disastrous epileptic encephalopathy. Therefore, we propose the term "febrile infection,related epilepsy syndrome" (FIRES). [source]

    Neuroimaging and Neurophysiology of Periodic Lateralized Epileptiform Discharges: Observations and Hypotheses

    EPILEPSIA, Issue 7 2007
    Giridhar P. Kalamangalam
    Summary:,Purpose: We assessed neuroimaging lesion type and distribution in patients with periodic lateralized epileptiform discharges (PLEDs), with a view to identifying electrographic differences between PLEDs associated with differing lesion locations. Our observations led us to consider a conceptual synthesis between PLEDs and periodic complexes (PCs). Methods: Retrospective review of acute neuroimaging results (CT/MRI) on patients identified to have EEG PLEDs, for the period 1999,2003 (n = 106). Blinded classification of original EEG recordings. Results: Neuroimaging abnormalities were classified as acute or chronic cortical, or acute or chronic subcortical. Seven out of 106 scans were classified nonlesional. Overall ,70% of scans had cortical abnormalities, whether acute or chronic; ,23% had subcortical abnormalities. "Cortical" PLEDs were significantly longer in duration (p < 0.05) and more variable in morphology (p < 0.01) than "subcortical" PLEDs. Conclusions: Structural brain disease commonly, but not invariably, underlies PLEDs; lesion type is spatiotemporally variable. Cortical and subcortical PLEDs have distinct EEG signatures. There is evidence that these may relate to mechanisms for other pathological large-scale oscillatory brain synchronies (e.g., PCs). [source]

    Viral meningoencephalitis: a review of diagnostic methods and guidelines for management

    I. Steiner
    Background:, Viral encephalitis is a medical emergency. The prognosis depends mainly on the pathogen and host immunologic state. Correct immediate diagnosis and introduction of symptomatic and specific therapy has a dramatic influence upon survival and reduces the extent of permanent brain injury. Methods:, We searched the literature from 1966 to 2009. Recommendations were reached by consensus. Where there was lack of evidence but consensus was clear, we have stated our opinion as good practice points. Recommendations:, Diagnosis should be based on medical history and examination followed by CSF analysis for protein and glucose levels, cellular analysis, and identification of the pathogen by polymerase chain reaction amplification (recommendation level A) and serology (level B). Neuroimaging, preferably by MRI, is essential (level B). Lumbar puncture can follow neuroimaging when immediately available, but if this cannot be performed immediately, LP should be delayed only under unusual circumstances. Brain biopsy should be reserved only for unusual and diagnostically difficult cases. Patients must be hospitalized with easy access to intensive care units. Specific, evidence-based, antiviral therapy, acyclovir, is available for herpes encephalitis (level A) and may also be effective for varicella-zoster virus encephalitis. Ganciclovir and foscarnet can be given to treat cytomegalovirus encephalitis, and pleconaril for enterovirus encephalitis (IV class evidence). Corticosteroids as an adjunct treatment for acute viral encephalitis are not generally considered to be effective, and their use is controversial, but this important issue is currently being evaluated in a large clinical trial. Surgical decompression is indicated for impending uncal herniation or increased intracranial pressure refractory to medical management. [source]

    Viral encephalitis: a review of diagnostic methods and guidelines for management

    I. Steiner
    Viral encephalitis is a medical emergency. The spectrum of brain involvement and the prognosis are dependent mainly on the specific pathogen and the immunological state of the host. Although specific therapy is limited to only several viral agents, correct immediate diagnosis and introduction of symptomatic and specific therapy has a dramatic influence upon survival and reduces the extent of permanent brain injury in survivors. We searched MEDLINE (National Library of Medicine) for relevant literature from 1966 to May 2004. Review articles and book chapters were also included. Recommendations are based on this literature based on our judgment of the relevance of the references to the subject. Recommendations were reached by consensus. Where there was lack of evidence but consensus was clear we have stated our opinion as good practice points. Diagnosis should be based on medical history, examination followed by analysis of cerebrospinal fluid for protein and glucose contents, cellular analysis and identification of the pathogen by polymerase chain reaction (PCR) amplification (recommendation level A) and serology (recommendation level B). Neuroimaging, preferably by magnetic resonance imaging, is an essential aspect of evaluation (recommendation level B). Lumbar puncture can follow neuroimaging when immediately available, but if this cannot be obtained at the shortest span of time it should be delayed only in the presence of strict contraindications. Brain biopsy should be reserved only for unusual and diagnostically difficult cases. All encephalitis cases must be hospitalized with an access to intensive care units. Supportive therapy is an important basis of management. Specific, evidence-based, anti-viral therapy, acyclovir, is available for herpes encephalitis (recommendation level A). Acyclovir might also be effective for varicella-zoster virus encephalitis, gancyclovir and foscarnet for cytomegalovirus encephalitis and pleconaril for enterovirus encephalitis (IV class of evidence). Corticosteroids as an adjunct treatment for acute viral encephalitis are not generally considered to be effective and their use is controversial. Surgical decompression is indicated for impending uncal herniation or increased intracranial pressure refractory to medical management. [source]

    Laryngeal schwannoma in an 8-year-old boy with inspiratory dyspnea

    Elisa Rognone MD
    Abstract Background Schwannomas of the larynx are rare lesions in the pediatric age group. Methods In this article, we report on the neuroimaging features of a schwannoma arising from the left aryepiglottic fold in an 8-year-old boy with a 6-month history of inspiratory dyspnea. Results Neuroimaging showed a well-defined, avoid mass originating from the left aryepiglottic fold. The lesion was removed endoscopically. Conclusion Complete removal of laryngeal schwannomas is curative, and adjuvant treatment is not required. © 2007 Wiley Periodicals, Inc. Head Neck, 2007 [source]

    Cluster headache: aetiology, diagnosis and management.

    HEADACHE, Issue 3 2003
    K Ekbom
    Drugs. 2002;62(1):61-69 Cluster headache is characterised by repeated attacks of strictly unilateral pain in the orbital region associated with local autonomic symptoms or signs. The attacks are brief but of a very severe, almost excruciating intensity. For unknown reasons males are affected more often than females. Recent studies suggest that an autosomal dominant gene has a role in some families with cluster headache. Hormonal studies indicate a dysfunction in the central nervous system. Neuroimaging has revealed primary defects in the hypothalamic grey matter. Local homolateral dilatation in the intracranial segment of the internal carotid and ophthalmic arteries during attacks is the result of a generic neurovascular activation, probably mediated by trigeminal parasympathetic reflexes. Sumatriptan 6mg subcutaneously is the drug of choice in the treatment of acute attacks. Inhalation of 100% oxygen can also be recommended. In the prophylactic treatment, verapamil is the first option. Other drugs that can be considered are corticosteroids, which may induce a remission of frequent, severe attacks, and lithium. Oral ergotamine tartrate may be sufficient for patients with night attacks and/or short, rather mild to moderately severe cluster headache periods. Third line drugs are serotonin inhibitors (methysergide and pizotifen) and valproic acid. Patients should be encouraged to keep headache diaries and be carefully instructed about the nature and treatment of the headaches. Alcohol can bring on extra attacks and should not be consumed during active periods of cluster headache. Comment: A useful review of clinical options. Given the effectiveness of injectable sumatriptan and the prophylactic use of ergotamine mentioned, one might speculate that the new intranasal formulations of triptans (eg, zolmitriptan) and triptans with a longer half-life (eg, frovatriptan) may prove to be effective in the treatment of cluster headache. DSM [source]

    Neuroimaging of the developing brain: Taking "developing" seriously

    HUMAN BRAIN MAPPING, Issue 6 2010
    Annette Karmiloff-Smith
    Abstract With a few notable exceptions, many studies, be they behavioral, neuroimaging, or genetic, are snapshots that compare one child group to one adult group, which capture only two points in time and tell the scientist nothing about the mechanisms underlying neural trajectories over developmental time. Thus, a distinction needs to be drawn between child neuroimaging and developmental neuroimaging, the latter approach being relevant not just to children, but to adults and the ageing brain. Hum Brain Mapp, 2010. © 2010 Wiley-Liss, Inc. [source]

    Prediction rules for computed tomography in the dementia assessment: do they predict clinical utility of CT?

    Kelly A. Condefer
    Abstract Neuroimaging is widely employed in the dementia assessment in refining clinical decision-making. However, with rising interest in cost-effective medical practice, efforts have been made in the literature to define clinical prediction rules that select for a subgroup of patients who would most likely benefit from neuroimaging. This short study examined the ability of a group of published clinical predictors to identify patients whose diagnoses or management would be influenced by CT scan results. The study finds that none of the published predictors bears a significant relationship to actual influence of CT scans in a group of memory clinic patients, highlighting the need for the development of clinical predictors for neuroimaging that will impact patient care. Copyright © 2003 John Wiley & Sons, Ltd. [source]

    Neuroimaging of cortical development and brain connectivity in human newborns and animal models

    JOURNAL OF ANATOMY, Issue 4 2010
    Gregory A. Lodygensky
    Abstract Significant human brain growth occurs during the third trimester, with a doubling of whole brain volume and a fourfold increase of cortical gray matter volume. This is also the time period during which cortical folding and gyrification take place. Conditions such as intrauterine growth restriction, prematurity and cerebral white matter injury have been shown to affect brain growth including specific structures such as the hippocampus, with subsequent potentially permanent functional consequences. The use of 3D magnetic resonance imaging (MRI) and dedicated postprocessing tools to measure brain tissue volumes (cerebral cortical gray matter, white matter), surface and sulcation index can elucidate phenotypes associated with early behavior development. The use of diffusion tensor imaging can further help in assessing microstructural changes within the cerebral white matter and the establishment of brain connectivity. Finally, the use of functional MRI and resting-state functional MRI connectivity allows exploration of the impact of adverse conditions on functional brain connectivity in vivo. Results from studies using these methods have for the first time illustrated the structural impact of antenatal conditions and neonatal intensive care on the functional brain deficits observed after premature birth. In order to study the pathophysiology of these adverse conditions, MRI has also been used in conjunction with histology in animal models of injury in the immature brain. Understanding the histological substrate of brain injury seen on MRI provides new insights into the immature brain, mechanisms of injury and their imaging phenotype. [source]

    Rheumatoid Leptomeningitis: Magnetic Resonance Imaging and Pathologic Findings,A Case Report

    Alessandro Cianfoni MD
    ABSTRACT BACKGROUND AND PURPOSE Rheumatoid arthritis (RA) is a chronic inflammatory multisystem disease with articular and extra-articular manifestations. Intracranial manifestations of RA are rare. Purpose of this article is to report on a rarely described leptomeningeal involvement in RA, and on its neuroimaging features, including diffusion-weighted imaging (DWI). METHODS The authors describe the case of a 74-year-old woman with a 5-year history of RA presenting with progressive left-side weakness and hypoesthesia. The patient underwent laboratory investigation and brain contrast-enhanced MRI, also with DWI, before undergoing brain biopsy. RESULTS Neuroimaging revealed abnormal high T2-signal in right frontal and parietal lobes, restricted diffusion in the subarachnoid space, and diffuse thick linear leptomeningeal contrast-enhancement. These findings were interpreted as rheumatoid leptomeningitis, and brain biopsy confirmed this diagnosis. CONCLUSIONS In summary, rheumatoid meningitis is a rare neurological complication of RA, but it should be considered in the proper clinical setting when patient presentation and laboratory results fail to support the other differential diagnostic possibilities proposed by the MR imaging findings. [source]

    MRI Assessment Followed by Successful Mechanical Recanalization of a Complete Tandem (Internal Carotid/Middle Cerebral Artery) Occlusion and Reversal of a 10-Hour Fixed Deficit

    Catalina C. Ionita MD
    ABSTRACT BACKGROUND Mechanical clot extraction up to 8 hours after stroke onset is an alternative strategy for opening large vessels, especially for patients ineligible for intravenous thrombolysis. Safety beyond this therapeutic window is untested. METHODS An 81-year-old woman presented 8 hours after she developed left-sided weakness and dysarthria with a National Institutes of Health Stroke Scale (NIHSS) score fluctuating between 6 and 13. Neuroimaging revealed a large perfusion deficit with no diffusion abnormalities. An emergent cerebral angiogram revealed a complete internal carotid artery terminus occlusion. RESULTS Successful mechanical thrombectomy was performed without complication and resulted in almost complete reversal of the patient's deficit to an NIHSS score of 1, 10 hours after stroke onset. CONCLUSION Patients with large hypoperfused areas and minimal diffusion abnormalities on the MRI may benefit from mechanical thrombectomy beyond an 8-hour window. [source]

    Neuroimaging and Neurologic Complications after Organ Transplantation

    ABSTRACT Neurologic complications are common after transplantation and affect 30-60% of transplant recipients. The etiology of most of the posttransplant neurologic disorders is related to the opportunistic infections, both systemic and involving central nervous system (CNS), toxicity of immunosuppressive medications, and the metabolic insult created by the underlying primary disease and the transplant procedure. Neuroimaging studies are one of the key tools in the evaluation and enable early diagnosis of neurologic complications in transplant patients, especially posterior reversible leukoencephalopathy syndrome, central pontine myelinolysis, intracerebral hemorrhage, and fungal and bacterial abscesses. Magnetic resonance imaging (MRI) is the preferred technique, but each of the available neuroimaging techniques offers a unique insight into the pathophysiologic mechanisms underlying neurologic complications of transplantation. The role of neuroimaging in this population includes early detection of calcineurin inhibitor neurotoxicity, opportunistic infections, neoplasia, metabolic disorders, or cerebrovascular diseases. In addition, we can monitor longitudinal progression of disease and treatment response. [source]

    Neuroimaging of Tuberculous Myelitis: Analysis of Ten Cases and Review of Literature

    Mohammad Wasay MD
    ABSTRACT We retrospectively reviewed the clinical and neuroimaging features of 10 patients with tuberculous myelitis. The most common presenting symptoms were fever (70%) and paraplegia (60%). Bladder and bowel symptoms were present in 90% patients. On MRI, the involvement of the cervical/thoracic segment of the spinal cord was most commonly seen (90%). The most consistent finding was hyperintense signals on T2-weighted MRI. T1-weighted images showed isointense (n= 5) and hypointense (n= 4) signals in the spinal cord lesions. Post-contrast enhancement was present in 6 patients, epidural enhancement in 4 patients, and cord swelling in 2 patients. We reviewed more than 250 published cases with the diagnosis of tuberculous myelitis and radiculomyelitis with special attention to MRI findings. It is predominantly a disease of the thoracic spinal cord. Most spinal cord lesions appear as hyperintense on T2 and iso- or hypointense on T1-weighted images. MRI findings in patients with spinal cord tuberculosis have both diagnostic and prognostic significance. Cord atrophy or cavitation and the presence of syrinx on MRI may be associated with poor outcome. [source]

    An Unusual Presentation of Rheumatoid Meningitis

    Vaidehi Chowdhry MD
    ABSTRACT Background. Central nervous system involvement in rheumatoid arthritis can rarely occur in the absence of systemic disease. Rheumatoid meningitis has not been reported to present as spells of neurologic dys-function. Patient and Methods. The authors describe a woman with a history of well-controlled rheumatoid arthritis who presented with headaches and spells of focal neurological dysfunction. Brain magnetic resonance imaging, brain biopsy, and temporal artery biopsy were required to make the diagnosis of rheumatoid meningitis with arteritis. Results. Neuroimaging revealed abnormal leptomeningeal enhancement. Necrotizing granulomatous inflammation was seen on meningeal and brain biopsy. A temporal artery biopsy showed evidence of arteritis without giant cells. Conclusions. The possibility of central nervous system involvement by rheumatoid arthritis should be considered in patients with a history of rheumatoid arthritis even in the absence of systemic symptoms. Making the diagnosis may require meningeal and brain biopsy. The condition may be steroid responsive. [source]

    Neuroimaging Curriculum for Neurology Trainees: Report from the Neuroimaging Section of the AAN

    Rohit Bakshi MD
    ABSTRACT Neuroimaging plays a major role in the evaluation of patients with neurological disorders. Surveys of neurologists have revealed that most rely on their own readings of images for patient management, and a majority believe that neurologists should be allowed to officially interpret and bill for scan reviews. The importance of neuroimaging training for neurology residents has been stressed by the Association of University Professors of Neurology. Although there is a desire to promote the neuroimaging education of neurologists, no curricula have existed previously. The Neuroimaging Section of the American Academy of Neurology (AAN) developed a task force of practicing neuroimagers to provide a neuroimaging curriculum for neurological trainees and training directors. The resulting curriculum is available on the Web sites of the AAN ( and the American Society of Neuroimaging ( and will be updated as the need arises through evolving technology or breadth of applications. This curriculum should help in the design of neurology residency and fellowship programs and subspecialty path-ways in which adequate neuroimaging education and training are desired for various reasons, including certification and the demonstration of competency and proficiency. [source]

    Evaluation of first unprovoked seizures in children by general paediatricians in New Zealand

    Rachel E Johnson
    Aim: To determine current practice of general paediatricians in New Zealand in the investigation and management of a first unprovoked seizure in childhood. Methods: A self-administered questionnaire was emailed to 109 general paediatricians in New Zealand. The questionnaire presented the participant with three hypothetical case scenarios representing a generalised tonic clonic seizure, a complex partial seizure and an episode of non-specific collapse. The participant was asked to indicate what investigations and course of management was required. Results: Forty-seven questionnaires were returned. Primary investigations included an electroencephalogram (EEG) in 47% of cases after a first generalised tonic clonic seizure increasing to 89% after a second. Ninety-one per cent of paediatricians were likely to request an EEG after a complex partial seizure. No paediatrician would request neuroimaging following a first generalised tonic clonic seizure. Neuroimaging was requested by 10% of paediatricians following a second generalised tonic clonic seizure and by 47% following a complex partial seizure. No paediatrician elected to initiate antiepileptic drugs after a first generalised tonic clonic seizure, but 49% would initiate treatment after a second generalised tonic clonic seizure. Eleven per cent of paediatricians would start treatment after a single complex partial seizure. Conclusion: Less than 50% of general paediatricians would request an EEG after a first unprovoked seizure. This is an unexpectedly low rate that may reflect accessibility. New Zealand paediatricians had an appropriately low rate of requesting neuroimaging. As currently recommended no general paediatricians began antiepileptic drugs in the scenario of a single uncomplicated seizure in the absence of other risk factors. [source]

    Neuroimaging of Language: Why Hasn't a Clearer Picture Emerged?

    Evelina Fedorenko
    Two broad questions have driven dozens of studies on the neural basis of language published in the last several decades: (i) Are distinct cortical regions engaged in different aspects of language? (ii) Are regions engaged in language processing specific to the domain of language? Neuroimaging has not yet provided clear answers to either question. In this paper, we discuss one factor that is a likely contributor to the unclear state of affairs in the neurocognition of language, and that, in our opinion, has not received sufficient attention in the recent literature. In particular, fMRI studies of language have relied, almost exclusively, on group analyses, in which data from multiple individuals are co-registered to and analyzed in a common space. We argue that this approach can obscure functional specificity because of the anatomical variability across individual brains, and we advocate the use of an alternative approach , the functional localization approach , that circumvents this problem. [source]

    Severe generalized dystonia due to primary putaminal degeneration: Case report and review of the literature,

    MOVEMENT DISORDERS, Issue 3 2002
    Ruth H. Walker MB
    Abstract Putaminal lesions of a variety of etiologies may cause secondary dystonia. We report on a case of primary putaminal degeneration as a cause of severe childhood-onset generalized dystonia and review the literature of the pathology of dystonia. A 44-year-old patient with severe generalized childhood-onset dystonia and macrocephaly underwent neurological evaluation and neuropathological examination. Neurological examination was normal apart from dystonia and signs referable to prior cryothalamotomy. Workup for metabolic and genetic causes of dystonia was negative. Neuroimaging showed severe bilateral putaminal degeneration, which subsequently correlated with the neuropathological findings of gliosis, spongiform degeneration, and cavitation. The substantia nigra pars compacta contained a normal number of neurons but decreased tyrosine hydroxylase immunoreactivity. There were no histopathological markers of other metabolic or degenerative diseases. © 2002 Movement Disorder Society. [source]

    McLeod neuroacanthocytosis: Genotype and phenotype,

    ANNALS OF NEUROLOGY, Issue 6 2001
    Adrian Danek MD
    McLeod syndrome is caused by mutations of XK, an X-chromosomal gene of unknown function. Originally defined as a peculiar Kell blood group variant, the disease affects multiple organs, including the nervous system, but is certainly underdiagnosed. We analyzed the mutations and clinical findings of 22 affected men, aged 27 to 72 years. Fifteen different XK mutations were found, nine of which were novel, including the one of the eponymous case McLeod. Their common result is predicted absence or truncation of the XK protein. All patients showed elevated levels of muscle creatine phosphokinase, but clinical myopathy was less common. A peripheral neuropathy with areflexia was found in all but 2 patients. The central nervous system was affected in 15 patients, as obvious from the occurrence of seizures, cognitive impairment, psychopathology, and choreatic movements. Neuroimaging emphasized the particular involvement of the basal ganglia, which was also detected in 1 asymptomatic young patient. Most features develop with age, mainly after the fourth decade. The resemblance of McLeod syndrome with Huntington's disease and with autosomal recessive chorea-acanthocytosis suggests that the corresponding proteins,XK, huntingtin, and chorein,might belong to a common pathway, the dysfunction of which causes degeneration of the basal ganglia. [source]

    Neuroimaging and Cognition in Parkinson's Disease Dementia

    BRAIN PATHOLOGY, Issue 3 2010
    Lisa C. Silbert MD
    Abstract The prevalence of cognitive impairment and dementia in Parkinson's disease (PD) is high and can potentially occur as the result of multiple differing pathologies. Neuroimaging has provided evidence of decreased cortical volume, increased white matter diffusion changes, and decreased resting metabolic activity that appears to begin prior to the onset of dementia in PD patients. Cognitive impairment has been found to be associated with multiple neurotransmitter transmission deficiencies, including dopamine and acetylcholine, indicating a widespread neurotransmitter dysfunction in PD-related dementia. Findings of increased Pittsburgh Compound B (PiB) binding in subjects with Lewy Body Disease (LBD) compared with Parkinson's disease and dementia (PDD) may explain phenotype differences in the spectrum of Dementia with Lewy Bodies (DLB), and show promise in guiding future therapeutic trials aimed at this disease. Advances in neuroimaging now allow for the detection of volumetric, pharmacologic, and pathological changes that may assist in the diagnosis and prediction of cognitive impairment in Parkinson's patients so that better evaluation of disease progression and treatment can be obtained. [source]

    The changing panorama of cerebral palsy in Sweden.

    ACTA PAEDIATRICA, Issue 9 2010

    Abstract Aim:, The aim of the study was to describe the prevalence and origin of cerebral palsy (CP), which is the tenth report from the western Swedish study. Methods:, A population-based study covering 85 737 live births in the area in 1999,2002. Birth characteristics and neuroimaging findings were recorded, prevalence of CP was calculated and aetiology was analysed. Results:, CP was found in 186 children. The crude prevalence was 2.18 per 1000 live births. The gestational age-specific prevalence for <28 gestational weeks was 55.6 per 1000 live births, whereas it was 43.7 for 28,31 weeks, 6.1 for 32,36 weeks and 1.43 per 1000 for >36 weeks. There was a female majority among children born at term and a male predominance in children born preterm. Hemiplegia accounted for 38%, diplegia for 32%, tetraplegia for 7%, whereas 17% had dyskinetic CP and 5% ataxia. Neuroimaging showed white-matter lesions in 31% and cortical/subcortical lesions in 29%. The aetiology was considered to be prenatal in 36%, peri/neonatal in 42%, whereas it remained unclassified in 21%. Conclusion:, The decrease in CP prevalence observed since the 1980s had ceased. An increase in children born at term and in dyskinetic CP was found. In children born before 28 weeks of gestation, the prevalence decreased significantly. White-matter and cortical/subcortical lesions dominated on neuroimaging. [source]

    Structural and functional neuroimaging in Klinefelter (47,XXY) syndrome: A review of the literature and preliminary results from a functional magnetic resonance imaging study of language

    Kyle Steinman
    Abstract Klinefelter (47,XXY) syndrome (KS), the most common form of sex-chromosomal aneuploidy, is characterized by physical, endocrinologic, and reproductive abnormalities. Individuals with KS also exhibit a cognitive/behavioral phenotype characterized by language and language-based learning disabilities and executive and attentional dysfunction in the setting of normal general intelligence. The underlying neurobiologic mechanisms are just now beginning to be elucidated through structural and functional neuroimaging. Here, we review the literature of structural and functional neural findings in KS identified by neuroimaging and present preliminary results from a functional magnetic resonance imaging study examining brain activity during a verb generation task in KS. © 2009 Wiley-Liss, Inc. Dev Disabil Res Rev 2009;15:295,308. [source]

    The neurobiological profile of girls with ADHD

    E. Mark Mahone
    Abstract Since boys are more commonly diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) than girls, the majority of theories and published research studies of ADHD have been based on samples comprised primarily (or exclusively) of boys. While psychosocial impairment in girls with ADHD is well established, the neuropsychological and neurobiological basis of these deficits is less consistently observed. There is growing evidence that boys' and girls' brains develop and mature at different rates, suggesting that the trajectory of early anomalous brain development in ADHD may also be sex-specific. It remains unclear, however, whether earlier brain maturation observed in girls with ADHD is protective. In this review, we outline the current theory and research findings that seek to establish a unique neurobiological profile of girls with ADHD, highlighting sex differences in typical brain development and among children with ADHD. The review highlights findings from neurological, neurocognitive, and behavioral studies. Future research directions are suggested, including the need for longitudinal neuroimaging and neurobehavioral investigation beginning as early as the preschool years, and continuing through adolescence and adulthood, with consideration of identified sex differences in the development of ADHD. © 2008 Wiley-Liss, Inc. Dev Disabil Res Rev 2008;14:276,284. [source]

    Neuropsychological profile of children with subcortical band heterotopia

    Aim, Subcortical band heterotopia (SBH) or ,double cortex' is a malformation of cortical development resulting from impaired neuronal migration. So far, research has focused on the neurological, neuroimaging, and genetic correlates of SBH. More recently, clinical reports and small sample studies have documented neuropsychological dysfunction in patients with this malformation. This study aimed to characterize further the phenotype of patients with SBH by describing the neuropsychological profiles of children. Method, Seven children (six females) aged 4 to 15 years were assessed for cognitive functioning (intellectual ability, processing speed, attention, working memory) and academic achievement (reading, spelling, arithmetic). Parents completed questionnaires examining their child's social skills and problem behaviours. Magnetic resonance images (MRI) conducted for routine clinical follow-up were coded by a paediatric neurologist. Genetic and seizure history were obtained from medical records. Results, There was variation in the neurological, neuroimaging, and genetic presentation of children in the sample. Impairments were observed in all areas of neuropsychological functioning examined. Intellectual ability was generally within the ,extremely low' range (full-scale IQ 44,74; performance IQ 45,72; verbal IQ 57,80). Generalized impairments in cognitive skills were typical, with severe impairments (scores greater than 2SD below the test mean) reported in processing speed, working memory, and arithmetic. Impairments in academic, social, and behavioural functioning were less generalized. No clear relationship between neuroimaging and neuropsychological impairments was found. Interpretation, Children with SBH demonstrate cognitive, academic, social, and behavioural problems, with the greatest difficulties in processing speed and complex cognitive skills. [source]